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Revolution needed to sustain robust health system

Aug 20, 2013

Fundamental changes in primary care are a necessity if New Zealand’s DHBs and the wider health system are to continue delivering the best services possible.

DHBs are facing significant cost pressures related to tight fiscal constraints. This is closely linked to wage inflation, the demand on services from a growing and aging population and new technologies.

Cranleigh, working in conjunction Counties Manukau DHB has come up with a strategy to alleviate these major issues.

Cranleigh director David Clarke says it means completely new roles, processes and funding in primary health care. “To keep health services delivery at the optimum we have to reduce hospital demand proactively by treating people early in the disease cycle.

“This includes better preventative medicine and making sure only patients who need expensive hospital treatments get them. There is evidence this new system can reduce the length of a hospital stay from six days to three days for patients over 65.”

He says by sticking with the current processes they will only deliver the current results. “The growing demand and funding constraints will not allow the continuation of current processes.

Clarke says many issues in clinical care arise when patients transfer from one provider to another. Under the new model primary care will have more accountability. “Co-ordinators of “at risk” patients will sit within primary care and have the right to see patients in their home, rest homes or other facilities and be part of a care team that has no boundaries.

“The new model has to include an increased role for allied professionals, such as pharmacists. Medication compliance and reconciliation is a significant component of patient care, especially as patients’ age.

The strategy will pivot on a new IT systems allowing access clinical information independent of institutions. “Access to the right information, even on mobile platforms, is essential if we are serious about fundamentally changing how we care for at risk patients in the community,” says Clarke.

He says, however, the strategy will only work if it is accompanied by the right funding, processes and systems. “There has to be a base set of standard operating procedures using widely accessible clinical information and the right economic incentives.”

Cranleigh analyst Patrick Mahoney, who worked on the strategy, says there key steps to improving proactive care for “at risk” patients:

  • Identification and stratification of “at risk” patients. This ensures proactive care. If it is delivered early the can avoid the patient’s disease becoming worse and admissions to expensive hospitals are reduced.
  • Complete a patient assessment using a standardised process and assessment. Develop a patient-centric care plan that will be shared between all team members with the right security in place. The care plan will be on evidence-based care with a high degree of patient involvement.
  1. The plan is to include red flags for possible significant events that might need oversight and intervention in the care of the patient.
  2. The use of a single shared care plan with all care team members assessing appropriate levels of information and providing input into the care plan.
  • The inclusion of a clinical care manager based with primary care, who will have overall oversight of patient care, co-ordinate care and care team members, work closely with clinicians and allied professionals to ensure the patient-centric care plan is followed.
  • Co-ordination of care has no boundaries so the clinical care manager provides a seamless link between primary and secondary care.

Clarke says the good news is that primary health care providers are backing the new system and want to change. “The difficult bit is the speed of change and putting in place the right incentives clinically and fiscally to make it work.”


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