How should the primary care system respond to people with chronic

disease and complex conditions?

Leanne Wells CEO, Consumers Health Forum of Australia

Chronic Disease & Mental Health Symposium

The Australian College of Mental Health Nurses in partnership

with the Australian Primary Health Care Nurses Association and Australian Diabetes Educators Association

Overview

• Why primary health care matters?

• What is the patient experience?

• Current issues in primary health care?

• A better system?

Why primary health care matters?

• Growing chronic condition burden

• The setting where we prevent/treat most

• It’s efficient and accessible

• We can get good outcomes

• It’s the backbone of a strong health systems

Major chronic conditions of Australians 2014-15

3.5 million

1.6 million

203,400

2.6 million

1.2 million

1.2 million

370,100 2.5 million

National Health Survey 2014-15

4 million Australians

(17.5%) reported having

a mental or behavioural

condition

3.6 million Australians

(15.8%) reported co-existing long-term mental and behavioural and physical health

conditions.

What is the impact?

Improving the way we respond to co-morbid physical and mental

health problems would have a high impact in

terms of patient experience and clinical

outcomes

WHY?

Because both of these are

substantially poorer relative to those for people

with a single condition

2015 Commonwealth Fund survey

Primary care doctors from 10 countries: is practice well prepared to manage patients with

complex needs?

COUNTRY Patients with…

Patients needing…

Multiple

chronic

condit-

ions

Dem-

entia

Severe

mental

health

issues

Substance

use-related

issues

Long-

term

home

care

services

Social

services

Palliat-

ive care

AUS (n=747) 85% 46% 34% 19% 47% 41% 48%

CAN (n=2,284) 70 42 24 15 40 28 42

GER (n=559) 88 67 32 14 68 71 58

NET (n=618) 88 65 44 16 80 25 92

NZ (n=503) 81 41 24 20 54 48 62

NOR (n=864) 86 69 56 36 78 41 54

SWE (n=2,905) 66 57 14 6 51 45 25

SWIZ (n=1,065) 80 49 26 25 64 55 48

UK (n=1,001) 79 64 43 41 60 44 81

US (n=1,001) 76 47 16 16 46 32 41 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians

Primary care doctors from 10 countries: practice capacity to provide enhanced access and care

management

C

o

u

n

t

r

y

Practice uses nurses/case

managers to monitor/ manage

care for chronic patients

Practice

staff…

Patients can….

Within

practice

Outside

practice

Make

frequent

home visits

Access

after

hours care

Email re

medical

concerns

View

records

online

AUS 75% 6% 25% 78% 30% 11%

CAN 43 23 19 48 15 7

GER 20 7 57 85 50 8

NET 78 14 88 94 57 13

NZ 83 7 20 92 53 24

NOR 32 37 20 80 32 3

SWE 75 13 24 75 61 20

SWIZ 8 52 43 69 80 11

UK 87 8 84 89 38 28

US 43 24 6 39 57 60 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians

21% reported

WAITING LONGER THAN ACCEPTABLE

23% from RURAL and REMOTE areas

28% of patients felt their

GP DID NOT SPEND ENOUGH TIME with them

1 in 8 reported issues caused by

LACK OF COMMUNICATION

between professionals

28% of patients felt their

GP DID NOT LISTEN

carefully to them

WOMEN reported longer

wait times than men

23% v 18%

ABS Patient Experiences : General Practice 2014-15

Survey

Chronic disease costs

1 in 3 have at least 1 chronic condition

Medicare spending

INCREASING

Potentially

preventable

Primary Health Care Advisory Group Discussion Paper

Primary Health Care Advisory Group consultations

• A fragmented system and providers working in isolation not as a team

• Uncoordinated care • Difficulty finding services • Service duplication, absent or delayed services • Low uptake of eHealth and other health

technology • Access problems due to cost, transport, language,

mobility and remoteness • Feelings of disempowerment

Experience of the system

“I don’t have a huge support structure outside of hospital. I’ve got my regular GP, because I have to have the same form filled every two to three months saying I can’t return to work. There’s a lot in the community if you can source it, but it’s hard because most people don’t know what’s available ….. I think what I’d tell people with a chronic condition is ….ask questions and be proactive. They aren’t going to cure you, but you they can help you get the most out of life”

“Michael”, type 2 diabetes

14

Impact of low health literacy

“As a patient with a lot of insight into my condition, the nurses will listen to me”

“Katy”, dysautonomia, chronic fatigue,

asthma, chronic pain

“I can understand that living in the country that I’m not going to have everything in one place. I’m not expecting the world. But I think at least having visiting specialists would help – or being told when they do have one – or central registries that doctors could access. That would be helpful. There is so much information out there, but nobody can get it”

“Eleanor”, intracranial hypertension

15

Multiple reviews and new ‘meso’ structures

• Make life easier, more

convenient for ME

• Let ME take ownership

• Empower ME

• Include and respect ME

in the relationship

• Keep ME informed

• Enable transparent

access to MY information

• Give ME the best care you can

• Reduce MY costs

Accessible and Affordable

Care

Timely access to care based

on need

Well organised, without

organisational or systemic

barriers

Affordable for consumers

Equitable access

Coordinated and

Comprehensive Care

Linked care with good referral

and feedback

Integrated with supported

transitions across the system

Availability of a range of services

to multidisciplinary care

Complete personally controlled

health record

Appropriate Care

Meet the needs and preferences of

individuals

Evidence based with consumers

engaged in research

Treatment options, risks and

benefits identified

Safe and technically proficient with

risks minimised

Practitioner engages with

consumers, families and carers

to ensure understanding

Whole of person care

Take account of consumers

lives and personal values

Emotional

Physical

Cultural, spiritual and social

factors

Consider carers and support

Address risk factors and all

health problems

Principles of

Consumer –

Centred

Health care

Trust and Respect

Provider asks about and

understands concerns

Transparent

Accountable

Timely and effective

complaint resolution process

Shared responsibility and

decision making

Informed Decision Making

Access to right information at

right time

Information is clear and

understandable

Costs are clear

Personal choice and right to

refuse respected

Informed and timely consent

Consider carers and supporters Planning and Governance

Partnership with consumers to

ensure sustainability

Consumers involved at all

levels of planning, system

design and service

development

Consumers involved in key

governance structures

Putting people in control of their own health and care

• Engaging people in keeping healthy

• Shared decision making

• Supported self management

• Having a personal health or social care budget

• Involving families and carers

• Choosing a provider

• Taking part in research as part of your care and treatment

• Evaluating services through feedback

Building a Better Primary Care System

Changing role of consumers

Makers and Shapers

NOT Users and Choosers

(Cornwall and Gaventa 2000)