ItemCorporatisation of general practice — Impact and implications(Primary Health Care Research & Information Service, 2016-08) Erny-Albrecht, Katrina; Bywood, Petra TeresiaIn Australia, general practice is largely private, ranging from small sole traders through to large partnerships comprising six or more practitioners. Over time, a number of corporate practices, which are registered under the Corporations Act 2001, have emerged on the Australian health care landscape. The corporate model also varies in size, depending on location (urban, rural) and types of services provided by the company. This review examines the impact and implications of corporatisation of general practice in Australia in terms of market competition, quality of care, patient outcomes, costs of care, and the health care workforce. ItemRegionalisation of health services: Benefits and impact(Primary Health Care Research & Information Service, 2016-06) Bywood, Petra Teresia; Erny-Albrecht, KatrinaProviding a well-integrated, cost-effective, quality health care system that meets the needs of the population is challenging for governments worldwide. In Australia, this challenge is complicated by a geographically and culturally diverse population; and complex funding and responsibilities across different levels of government. Regionalisation in health care is about enabling appropriate allocation and integration of resources according to the local population health needs, and community engagement and quality improvement to optimise delivery. From a governance perspective, control and accountability for allocation of resources and delivery of services may be centralised, decentralised, or a mixture of both. This review examines the different approaches that have been used in Australia; and assesses what is known of their effectiveness in terms of: patient health outcomes and experience, cost containment, economies of scale, accountability, citizen participation in decision-making, integration of services, and quality and equity of care. An overview of the current global trends in regionalisation is also presented. ItemThe role of primary health care in primary and secondary prevention of diabetes(Primary Health Care Research & Information Service, 2015) Erny-Albrecht, Katrina; Bywood, Petra Teresia; Oliver-Baxter, JodieIn Australia, diabetes represents a major burden in both human and financial terms, drawing heavily on limited health care resources including trained staff and carers. In contrast to many other health conditions, evidence suggests that many aspects of the burden imposed by diabetes could be avoided through preventive measures. Type 1 diabetes mellitus (T1DM) is a genetically linked autoimmune disease and there is currently no known prevention. However, the risk for complications associated with T1DM can be reduced by optimal management of blood glucose levels. Type 2 diabetes mellitus (T2DM) accounts for over 85 per cent of all diabetes in Australia. Obesity is a major contributor to the development of T2DM and weight loss has been shown to reduce the incidence of T2DM in people with impaired glucose tolerance (IGT). Therefore, primary prevention of T2DM has generally focused on weight loss and lifestyle interventions, while secondary prevention to reduce the risk of diabetes-related complications centres on use of pharmacotherapy in addition to diet and lifestyle interventions to manage surrogate markers of complication risk (e.g. blood glucose levels, blood pressure, and lipid levels). The aim of this research is to examine diabetes programmes reporting outcome data and used in general practice settings to identify and proactively manage individuals at high risk for developing diabetes; or where diabetes is diagnosed, at risk for development of, or deterioration in, diabetes-related complications. Comparison of programme structure with published evidence is used together with outcome data to assess programmes. ItemTelehealth in primary health care settings within Australia and internationally(Primary Health Care Research Information Service, 2013) Bywood, Petra Teresia; Raven, Melissa; Butler, CarynAccess to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously. ItemQuality improvement financial incentives for general practitioners(Primary Health Care Research & Information Service, 2014) Oliver-Baxter, Jodie; Brown, Lynsey; Raven, Melissa; Bywood, Petra TeresiaThis report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine tQuality improvement includes aspects of self-reflection and benchmarking, with continued evaluation to identify where additional improvements to practice can be made. Measures of the quality of care are typically structure (e.g. related to an organisation’s operations), process (e.g. clinical guidelines or care pathways) or outcomes-based (e.g. physiological indicators). Improvements can be measured in relative or absolute terms. The likelihood of engaging with incentives and the behavioural responses of health professionals are affected by the different characteristics of financial incentives, which may be directed at networks of practices, individual practices, or specific health care professionals. Payments may be offered as a bonus or addition to usual earnings, or may be withheld if practices do not achieve desired outcomes. Payments may be prospective or retrospective and may be linked to fixed thresholds or individual patients.ends in PAHs and ED presentations among people with chronic disease. ItemPrimary health care-based programmes targeting potentially avoidable hospitalisations in vulnerable groups with chronic disease(Primary Health Care Research & Information Service, 2016) Erny-Albrecht, Katrina; Oliver-Baxter, Jodie; Bywood, Petra TeresiaThis report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine trends in PAHs and ED presentations among people with chronic disease. ItemPredictive risk models to identify people with chronic conditions at risk of hospitalisation(Primary Health Care Research & Information Service, 2015) Oliver-Baxter, Jodie; Bywood, Petra Teresia; Erny-Albrecht, KatrinaA disproportionately large percentage of health care costs and utilisation is spent on a small fraction of the population with complex and chronic conditions (Panattoni et al., 2011). It is widely agreed that effective and accessible primary health care (PHC) is central to reducing potentially avoidable hospitalisations (PAHs) associated with chronic disease. Predictive risk modelling is one method that is used to identify individuals who may be at risk of a hospitalisation event. The Predictive Risk Model (PRM) is a tool for identifying at-risk patients, so that appropriate preventive care can be provided, to avoid both exacerbation and complications of existing conditions, and acute events that may lead to hospitalisation. This Policy Issue Review identifies a selection of currently available PRMs, focusing on those applied in a PHC setting; and examines evidence of reliability in targeting patients with complex and chronic conditions. ItemMedicare Locals: A model for primary health care integration?(Primary Health Care Research and Information Service, 2013) Brown, Lynsey; Katterl, Rachel; Bywood, Petra Teresia; Oliver-Baxter, Jodie; Cheffins, TraceyThe first tranche of Medicare Locals (MLs) was established in July 2011 as part of the Australian Government’s health care reform agenda. Nineteen proposals were accepted from Divisions of General Practice (DGP) to establish MLs, with an additional 18 established from January 2012, and a further 24 from July 2012. MLs are charged with improving the health care system’s responsiveness to the primary health care (PHC) needs of the population in their area. In order to achieve this, MLs will work in partnership with the Local Hospital Networks (LHNs) being established in each region by State and Territory Governments. One of the five objectives of MLs is improving the patient journey through developing integrated and coordinated services. ItemIntegrated care: What strategies and other arrangements support and influence integration at the meso/organisational level?(Primary Health Care Research and Information Service, 2013) Oliver-Baxter, Jodie; Brown, Lynsey; Bywood, Petra TeresiaHistorically, general practice has been the principal access point for health care delivery in the Australian community. Alongside the growing trend in specialised care, there has been increased fragmentation of health care services, particularly for patients with multiple and/or complex conditions. In Australia and elsewhere, governments recognise that there are multiple health, social and economic implications of fragmented health care; and an integrated health care system is an integral element of health reform. Increasingly, evidence suggests that integrated primary health care (PHC) is an effective way to optimise the efficient delivery of services and improve patients’ outcomes and experiences (Ham and Curry, 2011). ItemIntegrated care: What policies support and influence integration in health care in Australia?(Primary Health Care Research and Information Service, 2013) Oliver-Baxter, Jodie; Brown, Lynsey; Bywood, Petra TeresiaWithout integration, all aspects of care can suffer. Patients can get lost in the system, needed services fail to be delivered or are delayed or duplicated, the quality of the care experience declines, and the potential for cost-effectiveness diminishes (Kodner and Spreeuwenberg, 2002). Integrated health care has been a focus of national health reform in Australia and internationally. In Australia, this has culminated in the National Health Reform Agreement (NHR Agreement; August 2011) to deliver reforms to the organisation, funding and delivery of health and aged care. Over successive health reform agreements since the National Healthcare Agreement of 2008, there has been a concerted effort to promote integration at the macro level between governments. The NHR Agreement sets out the shared intention of Commonwealth, State and Territory governments to work in partnership to improve health outcomes for Australians and ensure the sustainability of the Australian health system. More recently, the Commonwealth has worked closely with states and territories and primary health care (PHC) stakeholders to develop a National Primary Health Care Strategic Framework (Standing Council on Health, 2013). ItemIntegrated care: What policies support and influence integration in health care across New Zealand, England, Canada and the United States?(Primary Health Care Research & Information Service, 2013) Oliver-Baxter, Jodie; Bywood, Petra Teresia; Brown, LynseyOne of the key challenges for health systems worldwide is the substantial cost of fragmented care, not only financially, but also in terms of patient and population health. In light of this, integrated health care has been a key element of health reforms internationally. Despite substantial diversity in health systems across developed countries, there is consensus that current health care expenditure is unsustainable, particularly in the context of ageing populations with increasing prevalence of chronic disease and multi-morbidities. The universal challenge is to improve the quality and safety of health care and, concomitantly, to curb the rising costs of health care delivery. Evidence indicates that health systems with strong integrated primary health care (PHC) at their core are both effective and efficient at delivering appropriate services where they are needed most. Although Australia is comparable to New Zealand (NZ), England, Canada, and the United States (US) in terms of expenditure and coverage of PHC, recent evidence suggests that there is room for improvement in Australia on indicators of integration including access, cost, coordination, information sharing and chronic disease management, which may reflect the fact that, for the most part, these countries have been working at ways to achieve integrated health services for longer than Australia. ItemIntegrated care: What can be done at the micro level to influence integration in primary health care?(Primary Health Care Research and Information Service, 2013) Oliver-Baxter, Jodie; Brown, Lynsey; O'Connor, John; Lunnay, Belinda Kate; Bywood, Petra TeresiaConsumers require health services that meet their needs, are connected and well-integrated. They want to experience ‘one health system’ regardless of service structure, funding or governance. The provider-patient interface is the critical environment in which the needs and expectations of both providers and patients are considered. ItemImproving the integration of mental health services in primary health care at the macro level(Primary Health Care Research & Information Service, 2015) Bywood, Petra Teresia; Brown, Lynsey; Raven, MelissaMental disorders are highly prevalent in Australia. The most frequently diagnosed conditions are anxiety, affective and substance use disorders. Comorbidities are common, both in terms of concurrent mental health conditions and concurrent physical and mental health conditions. Many individuals with lived experience of mental illness also face a range of non-medical issues (e.g. housing, employment and education needs). Typically, individuals requiring mental health care for most moderate/mild cases are supported in primary health care (PHC), though specialist care in secondary and tertiary settings is required for more severe conditions. Given the multifaceted nature of mental health conditions, support for individuals experiencing such diagnoses also needs to be multidisciplinary and collaborative. PHC mental health services encompass a range of services, including counselling, pharmacological treatments, referrals and follow-up care, provided by health professionals in PHC settings (e.g. general practice) to treat or prevent mental health problems. ItemFly-in Fly-out/Drive-in Drive-out practices and health service delivery in rural areas of Australia(Primary Health Care Research & Information Service (PHCRIS), 2014) Erny-Albrecht, Katrina; Brown, Lynsey; Raven, Melissa; Bywood, Petra TeresiaMany Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and informatioIt is recognised that rural and remote health services in Australia are in many cases challenged by a combination of inadequate facilities and insufficient staff. According to anecdotal accounts, this is further exacerbated by the demands placed on these health services by fly-in fly-out, drive-in drive-out, and bus-in bus-out workers and visitors (from here on referred to collectively as FIFO/DIDO). The focus of the current investigation was FIFO/DIDO in rural Australia involving mine workers, seasonal agricultural workers, and grey nomads. technology to supplement face-to-face delivery of healthcare services. ItemAllied health video consultation services(Primary Health Care Research & Information Service, 2013) Melissa; Bywood, Petra TeresiaMany Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and information technology to supplement face-to-face delivery of healthcare services. ItemAllied health integration: Collaborative care for arthritis and other musculoskeletal conditions(Primary Health Care Research & Information Service, 2014) Raven, Melissa; Brown, Lynsey; Bywood, Petra TeresiaMusculoskeletal conditions, including rheumatoid arthritis, osteoarthritis and osteoporosis, are prevalent in the Australian population, and they impose a substantial burden on the health care system and the community, reflected by their status as a national health priority area. They are the main cause of impaired physical functioning globally. These conditions have high chronicity rates and often have a long term impact, leading to reduced mobility and dexterity, chronic pain, reduced capacity for employment, and negative impact on family and social life. Much of the care for these conditions is provided in primary health care (PHC) settings. ItemPotentially avoidable hospitalisations in Australia: causes for hospitalisations and primary health care interventions(Primary Health Care Research & Information Service, 2012-07) Katterl, Rachel; Anikeeva, Olga; Butler, Caryn; Brown, Lynsey; Smith, Bradley; Bywood, Petra TeresiaThe Australian Institute of Health and Welfare (AIHW) described potentially avoidable hospitalisations (PAHs) as “admissions to hospital that could have potentially been prevented through the provision of appropriate non-hospital health services”. The AIHW classify PAHs into three main types: vaccine-preventable, chronic, and acute conditions. In 2009-10, PAHs related to chronic conditions were the most common, due mainly to the high rates of hospitalisations for diabetes complications (24% of all PAHs). Moderately high rates of PAHs were also reported for chronic obstructive pulmonary disease (COPD), dehydration and gastroenteritis, and dental conditions (9-10% of all PAHs). ItemRegionally-based needs assessment in Australian primary health care.(Primary Health Care Research & Information Service, 2011-12) Katterl, Rachel; Jackson-Bowers, Eleanor; Hagger, Christina; Bywood, Petra TeresiaNeeds assessments in primary health care provide information to plan and change services, with the ultimate goal of improving the health of a population. It is the first step in health care services planning, and involves identifying and analysing a region’s health problems and potential target group. For the purposes of this report, need was defined as “the population’s ability to benefit” as this lends itself most usefully to health services planning. This report also reflects on International and Australian models that may inform approaches to needs assessments in Australia. ItemDisparities in primary health care utilisation: Who are the disadvantaged groups? How are they disadvantaged? What interventions work?(Primary Health Care Research & Information Service, 2011-06) Bywood, Petra Teresia; Katterl, Rachel; Lunnay, Belinda KateThis Policy Issue Review draws on recent evidence to provide a picture of who in Australia experiences poor access to primary health care services, including particular areas of need, and how such needs may be remedied through intervention approaches that focus on equitable distribution of quality health care and outcomes. ItemInitiatives to integrate primary and acute health care, including ambulatory care services(Primary Health Care Research & Information Service, 2011-03) Bywood, Petra Teresia; Jackson-Bowers, Eleanor; Muecke, SandyMost people, at some time in their lives, will require health care services from multiple health care providers, whether it is for short-term unexpected ill health, long-term chronic conditions or co-morbidities that cross disciplines (eg. substance-related conditions and mental health). Integration of health services is particularly important for patients with chronic and complex conditions as they must frequently negotiate a path through different health care sectors, including primary, acute and ambulatory care services, as well as the public and private health jurisdictions. Standardised pathways for the more common chronic conditions may be needed to enable seamless transitions and avoid negative outcomes that may result from delays, duplications and errors in a system that operates as multiple independent organisations.