Current issues, priorities

1
Current issues, priorities future directions

• Primary Community Health Services in NSW

Centre for Health Equity Training, Research
Evaluation
2
Why a conceptual framework?

• Shows how PaCH fits into the larger health system
• Shows how the different elements of PaCH fit
  together
• Shows PaCH as a system, not just a set of
  discrete services

3
Background

• 2001
• Strengthening Health Care in the Community
  Strategy
• 2002
• Consultations on SHCIC
• 2003-2005
• Evidence-based conceptual framework
• Information dissemination
• Models of service delivery

4
Where does PaCH sit within the Health System?
5
PaCH conceptual framework
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Primary Community Health

• Generalist PHC More specialised CBHS
• 1st contact Restricted access
• Comprehensive Specific conditions
• Continuity of care Episodic care
• Locally based/accessible Larger geographic
  area
• Filters access to specialised Refers to PHC for
  
• tier ongoing care
• Provides access to local Provides consultation,
  
• area for specialised services support to PHC

7
Generalist tier

• Expertise
• Across the four functions
• Community networking
• Local health welfare agencies
• Strengthens capacity resilience
• Consulting/referring on
• Working across disciplines

8
Assessment, referral, episodic care for common
conditions

• Promptness
• Locally available accessible
• Focus on care of individuals/families

9
Evidence

• Countries with strong PC systems
• Improved health status
• Less health inequalities
• Lower costs (Starfield, Macinko, Bunker, Shi)
• Solo/small group general medical practices
• Responsive to presenting needs of individuals
• Accessible (easy prompt) (CHSRF, 2003)

10
Primary prevention early intervention

• Focus on health wellbeing
• Integrated into client encounters
• Community development/engagement
• Enhances health literacy/resilience
• Takes account of social determinants
• Works through partnerships

11
Evidence

• Contribution of PaCH
• Early years of life (MacLeod Nelson Ciliska et
  al)
• EI for common risk factors, eg SNAP (Ammerman et
  al Lawrence et al Allen Scott)
• Community-wide interventions (Weinehall, Sowden
  Arblaster Lee et al)
• PaCH roles
• Home visiting
• Screening
• Pro-active preventive care
• Brief counselling/motivational interviewing
• Health education, inc health literacy
• Building capacity of individuals/communities
• Engaging local communities

12
Ongoing care for chronic conditions

• Coordinates care over the long term
• Uses multidisciplinary approaches
• Incorporates self management
• Enhances health literacy/resilience
• Engages communities
• Collaborates with other services/sectors

13
Evidence

• Multifaceted organisational educational
  interventions
• Improved access to care
• Improved quality of care
• Improved outcomes (satisfaction, QoL, symptoms,
  functional impairments)
• (Renders et al, Gilbody et al, Gruen et al
  Unutzer et al)
• Contribution of PaCH
• MD assessment facilitating access to GPs for
  ongoing care (Samet et al Meadows)
• Short focused interventions filtering access to
  specialised services (Worrall-Davies et al)
• Case mgt, enhanced nurse/allied health role
  (Renders Gilbody, Ununtzer)
• Patient education (Samet)
• Identifying responding to unmet health needs
  (Meadows, Worrall-Davies)

14
Acute/post acute care

• Short term acute treatment support
• Available for extended hours
• Facilitates access to specialist advice/services
  social supports
• Uses collaborative multidisciplinary approaches

15
Evidence

• Emerging evidence-base
• Reduced LOS
• Averted admissions
• Reduced re-admissions
• Cost savings
• Greater patient satisfaction
• Timely preventive care
• (Cochrane Brooten Brown Caplan Caplan et al
  Kotagul et al Regalado Halfon Lim et al,
  VDHS NSW Health)
• Critical success factors
• Links with GPs
• MD teamwork
• Clinical leadership governance
• Focus on self management
• Access to rehabilitation programs
• Family/carer support

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PaCH conceptual frameworkbenefits

• Clarifies the scope of PaCH
• Highlights the importance of both generalist and
  specialist
• Shows the relationship
• between the tiers,
• with other parts of the health system
• Identifies key points for building partnerships
• Provides a foundation for strengthening PaCH