Transcript Older patients’ attitudes to multidisciplinary care for

Integrated care
What do we have to gain?
Prof Andrew Bonney
MBBS (Hons) MFM (Clin) PhD DRANZCOG FRACGP MAICD
Roberta Williams Chair of General Practice
Graduate School of Medicine
Principles of primary care
• General practice is the core provider of primary care
in Australia and thus is the foundation upon which
our health system is based
• Approximately 85% of Australians consult a general
practitioner (GP) each year (AIHW 2008)
White KL, Williams TF, Greenberg BG. The ecology of medical care.
N Engl J Med. Nov 2 1961;265:885-892.
Principles of primary care
• Primary care is defined by a number of key principles
that describe its function and also determine its
effectiveness (Starfield, Shi et al. 2005)
Principles of primary care
These principles are:
• First contact access for each new need
• Long-term person- (not disease-) focused care
• Comprehensive care for most health needs
• Co-ordinated care when it must be sought elsewhere
Principles of primary care
• Consistent and robust
international data
demonstrate that jurisdictions
with strong primary care
systems (as measured by the
strengths of each of the core
principles) have better health
outcomes and reduced
health related costs
compared with jurisdictions
with weaker primary care
systems (Starfield 1998;
Starfield and Shi 2002)
The role of primary care in the
health care of communities
• 126.8 million items of service claimed by GPs
through Medicare 2012-2013 (Britt et al, 2013)
• An average of 4.93 services per person for
2006-2007 (AIHW 2008)
Mathers CD, Vos ET, Stevenson CE, Begg SJ. The Australian Burden
of Disease Study: measuring the loss of health from diseases,
injuries and risk factors. Med J Aust. Jun 19 2000;172(12):592-596.
The role of primary care in
chronic disease management
• In those aged 60 years or more, 69% of
patients presenting to a general practice
report having at least one chronic or complex
medical condition (Bonney et al 2010, 2012)
• Overall, 42% of GP consultations address at
least one chronic problem (Britt et al 2013)
The role of primary care in
chronic disease management
• Patients aged 65 years and over represent
13.2% of the population, but 29.7% of time
spent in GP clinical care (Britt and Miller 2009)
• By 2020 a 45% increase in GPs will be
required due to population ageing (Harrison
and Britt 2011)
• The proportion of the population aged 65
years and over is expected to double by 2051
(AIHW 2000)
The role of primary care in
chronic disease management
• Older patients have a higher preference for
interpersonal continuity with a single doctor
(Kearley & Freeman, 2001; Nutting et al, 2003)
• In patients aged 60 years or more, nearly all
(89.8%) express a requirement for a regular
doctor who knows them and their medical
problems well (Bonney et al 2012)
• Chronic illness significantly increases the
likelihood of requiring interpersonal continuity
of care (Bonney et al 2014)
The role of primary care in
chronic disease management
Reduced continuity is associated with poorer
outcomes in older patients:
• Associated with increased Emergency
Department presentations (Ionescu-Ittu et al,
2007)
• Associated with increased hospitalisation rates
and mortality in diabetic patients (Worrall &
Knight, 2011)
Towards integrated care
Structured disease
management is associated
with:
• Improved care for coronary
artery disease, cardiac
failure, diabetes and asthma
(Fireman et.al.)
A medical home that coordinates care is associated
with:
• More responsive, efficient
care and fewer medical
errors (Schoen et. al. 2007)
Sustainable primary care?
• Ageing population
• Increasing chronic disease
rates
• Increasing requirement for
continuity of care
• Demands on medical
workforce outstripping supply
What do we need in future models
of chronic disease management?
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Efficient use of human resources
Maintenance of continuity of care
Maintenance of comprehensiveness of care
A ‘whole of system’ approach that balances
practice activity across the determinants of
effective primary care
Integrated care – what do we
stand to gain?
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If we get the model right, we should gain:
Optimal use of appropriate multidisciplinary
care (Harris et al 2007, NHHRC 2009)
Appropriate task distribution (Laurant et al
2004, Scott 2009)
Reduced reliance on GP consultations
Improved efficiency/productivity (Scott 2009)
Sustainability of the positive population
health impact of primary care
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References
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http://www.aihw.gov.au/cdarf/data_pages/incidence_prevalence/index.cfm [Accessed 26th May 2010.
AIHW. 2000. Disability and ageing Australian population patterns and implications [Online]. Canberra: Australian Government. Available:
http://www.aihw.gov.au/publication-detail/?id=6442467211
[Accessed 26th May 2010.
BONNEY, A., MAGEE, C. & PEARSON, R. 2012. Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in
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