The GP and Hospital Primary Care Liaison Unit at Austin Health has provided information for general practice about its new clinical programs.
Better@Home
The Better@Home Subacute Program aims to deliver more healthcare within the patients’ home through the use of home-delivered and virtual care.
The Austin Health Better@Home Subacute program will support the patient to continue his recovery in the comfort of his own home. Daily visits will be provided by an expert team of doctors, nurses and allied health, with individual goal directed care aiming to maximize independence. Whilst patients are enrolled in the program, they will remain an inpatient of Austin Health.
There is no cost to the patient for the services provided as part of Better@Home Subacute Program.
The patient’s GP will be notified of their patient’s admission to this service and a discharge summary will be provided upon discharge from the program.
Please be aware that whilst a patient is enrolled in this program, as the patient is still an inpatient of Austin Health, Medicare Rebates will not be available if a GP consults a patient whilst he/she is in the program. The program will provide the medical care for the patients.
For further information, please contact Austin Health Better@Home Subacute by phone on 0460 43 14 14 or email: betterathome@austin.org.au
PRIMA
Austin Health has launched a new program called ‘PRIMA’, to support people at risk of multiple hospital admissions and who have multiple chronic and complex conditions to stay well and home, and to reduce their usage of acute health services.
The program is being trialled for an initial period of nine months and is part of the State Government’s Better@Home initiative being conducted across hospitals within the North East Health Service Partnership.
In brief, the project’s foundational elements are:
- Use machine-learning data analytics to proactively identify people who are at high risk of multiple hospital admissions.
- Implement a dedicated model of care for PRIMA patients which will deliver a range of benefits for patient experience and the Austin Health organisation.
Delivery of these care components will be managed in close partnership with GP and community-based services. It is expected that the frequency and intensity with which patients would access care components will fluctuate over time, in response to the unique needs of each patient. PRIMA services will not be time limited.
A key feature is that once enrolled, each PRIMA patient’s care will be coordinated by a Care Manager and one unit called the Austin Health Home Unit (AHMU). The first AHMU has been established in the Geriatrics Team within Continuing Care. They will be responsible for developing, implementing and reviewing detailed patient care plans, in partnership with relevant clinical specialties, the GP and the Care Manager. This should include, where relevant, discussions around Goals of Care and Advance Care Planning.
At this stage, enrolment of the initial cohort of PRIMA patients will commence in December 2021, and it is planned to contact each patient’s GPs to discuss and establish the relevant mechanisms for ongoing communication and coordination for their participation in the planning and delivery of services for their patient.
For more information on the PRIMA program, please contact the project lead, Juliette Chapman at Austin Health by email: juliette.chapman@austin.org.au
Disclaimer: This article was provided by Austin Health. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
