9 December 2019
Vasvi Kapadia from the Royal Women’s Hospital has seen great improvement in referrals since the hospital started using HealthPathways as a triage tool. Photo: Leigh Henningham.
Primary health and specialist care are both integral to our overall health system. Separately, they each do great work. But working well together can sometimes be another matter.
Specialist wait lists for some conditions in public hospitals may stretch for years – and then when a person does get an appointment, they may find they haven’t had the necessary tests or investigations required to receive further care.
From the hospital’s point of view, general practitioners may not be adhering to the required referral criteria before referring patients. However, from a GP’s perspective, referral criteria can be unclear and inconsistently applied between different hospitals.
North Western Melbourne Primary Health Network (NWMPHN) is working to break down the barriers between the primary and hospital-based systems, by empowering GPs to extend their treatment of a range of conditions and provide clear and consistent information on referral requirements.
A key way we are doing this is through HealthPathways Melbourne, a collaborative efforts with Eastern Melbourne Primary Health Network (EMPHN) which provides clinicians with a single website to access clinical and referral pathways, and resources. The website is designed to enhance clinical knowledge and promote best practice care, aiming to reduce the number of patients referred to specialist care who could be managed in a primary care setting.
It also assists clinicians to align their referrals with local hospital requirements, potentially resulting in less referral rejections and higher patient satisfaction.
Vasvi Kapadia, Primary Care Liaison Officer at the Royal Women’s Hospital (RWH), focuses entirely on improving coordination and communication between primary health and hospitals.
Three years ago, the RWH started triaging all gynaecological referrals against the criteria outlined on HealthPathways Melbourne in order to preserve their capacity to accommodate women with complex or high-risk health needs requiring specialist care.
Women who require care for general gynaecology problems are now being referred to their local hospital or women’s service.
Over the three years, Ms Kapadia has noticed a substantial increase in general practitioners using HealthPathways Melbourne to check the correct referral processes and criteria, instead of sending in incomplete referrals that then need to be rejected.
“The GPs get less rejection letters now that they are constantly referring to HealthPathways, which has made the referral process easier and more time effective for them and helps patients get appointments quickly and easily.” Ms Kapadia said.
Ms Kapadia said that more services should be triaged against HealthPathways as it can become very confusing for GPs when hospitals are all using different referral criteria.
Dr Andrew Bahardeen, a general practitioner at Niddrie Medical Centre, said he has been benefiting greatly from the HealthPathways program, which has enabled him to know exactly where he can find up to date information on most Victorian referral criteria.
“Any time that I come up against a condition that I want to make sure I’m using the correct pathway for, HealthPathways is very useful for this,” Dr Bahardeen said.
Each pathway provides clear and concise guidance for assessing and managing a patient with a particular symptom or condition.
“The ‘when to refer’ section on the website is particularly helpful,” Dr Bahardeen said. “It is great in that it tells you the red flags of the condition in which you would need to consider referring.”
Dr Bahardeen has been using the HealthPathways referral criteria to refer to the Royal Women’s Hospital for some time, primarily for antenatal care and gynaecological conditions such as endometriosis.
He recommends all general practitioners use HealthPathways and ensures that all new registrars that come through his clinic become familiar with the site.
The Hospitals Admission and Risk (HARP) program is another initiative helping to improve collaboration between hospitals and primary health organisations.
HARP is a short-term service that supports people with chronic conditions to better manage their condition in the community and reduce avoidable hospital admissions.
The program provides specialist treatment including cardiac services, respiratory services, diabetes services and a diabetes foot unit, along with medication management services.
Jade Mitchell, HARP and Community Services Manager at the Royal Melbourne Hospital, said the HARP program aims to help patients overcome the barriers that can prevent them getting the care they need, where they need it.
“Consequences of barriers between primary and tertiary health can lead to reduced independence and the self-management capacity of our older and more vulnerable adults in the community, whether it be due to chronic health issues, mental health conditions or cognition concerns,” Ms Mitchell said.
“This in turn can lead to disengagement with support services or clients not knowing where to go when they need support with medications or treatment, which can lead to unplanned or avoidable presentations to the emergency department.”
The HARP program aims to provide coordinated, holistic and integrated support to clients at risk of presenting to the hospital when they are unaware of community services that can meet their needs. This short term, intensive assistance is designed to link the client with support and empower them to understand their health conditions and how best to manage them on a daily basis.
The HARP program runs both in the hospital setting and in the community, allowing staff to access information and improve communication channels to ensure an efficient and effective service is being delivered.
“We have a HARP liaison service based in the hospital setting which screens and triage’s all patients who present to the emergency department or are admitted to the ward from the previous day.” Ms Mitchell said. “We then undertake bedside reviews, speak with staff on the wards and undertake file audits to understand who is eligible for the program and may benefit from HARP involvement.”
Ms Mitchell said the program is integral to ensuring hospital admission and discharge issues are dealt with in an effective and timely manner, freeing up much needed specialist time.
Working together to break down the barriers between primary and tertiary health is integral to health care reform. Ensuring health care organisations are communicating openly and effectively can break down siloed thinking and care delivery, creating a better health system for our community.