Making allies in health

continued from Page 11 saving GPs a physical visit in a lot of cases as well,” Professor Reid said.

“Especially by embracing technology such as the use of video consults and remote monitoring in aged care facilities, keeping track and touching base with the practice because somebody is sick or showing concerning symptoms.

“Nurses and paramedics know how to take the patient's vital signs, they know the patient's baseline, and they can electronically transmit it to the GP surgery or the care coordinator. There is the i-STAT machine where you can do basic bloods in the home, send it through and have a video consult.”

Professor Reid said it might be that the patient did not actually need clinical intervention, but it was important to look at their diet or get them to see a dentist.

It could be that this was their third fall in a week and the team knew that they needed a specialist to come in and look at what was needed to reduce the risk of falls.

“That is where the idea of allied health hubs and wraparound service can play a big part. Paying for a 15-minute consult is still a lot cheaper and a lot less resource intensive than paying $1250 for an ambulance trip to hospital as well as the cost of an ED presentation,” he said.

Enabling different clinicians to have efficient access to a patient’s medical records could also make a dramatic difference in terms of treatment options and outcomes.

“If you have a good wraparound service, there's clear sharing of information and you have got up to date, accurate feedback on the patient,” Professor Reid said.

“You can look at what has been happening with the patient and go, ‘Okay, they've been doing X, Y and Z as the clinician, I need to do A, B and C.’

GPs still the linchpins

“The ability in an integrated system to share records means the dietician can see what has been happening with the patient's blood pressure, they can see what the physio's been doing, or what the OTs been doing, and equally, the GP can see what has been going on as well – this is a crucial feature of preventative healthcare.

“For example, if an individual suddenly has a spike in visits to his allied health practitioners, or they have suddenly seen the GP four times in the last two weeks, whereas in the last year they had seen the GP only once. That begs the question, is there something here that we need to put some extra support around for a few weeks or months?”

Professor Reid explained that he lived in the UK for eight years, where patients must be registered with a primary GP or practice.

GP as lead

“It meant that there was one source of truth, there was the longevity to build a solid history about that patient and that continuity of care, with the GP as the care lead for clinical staff, was crucial for patients over time, especially given the impact of chronic disease,” he said.

“Your GP has a long, established history of what has been happening in your life, and not just the clinical aspects but the social factors as well.

“There is a real challenge here as well in terms of the electronic medical records maintained within GP clinics. You may have your preferred GP within a clinic, but if they're busy, or it's something that you can see any doctor at the clinic for, then any GP should be able to access those records and continue treatment.

“Otherwise, you have got to try and draw it out of the patient and work out exactly what has happened.” Similarly, many patients going into hospital were frustrated when they had to tell their story to the triage nurse, then tell the first doctor who saw them, then the second doctor and the nurse who came to look after them.

“There are stories about patients turning to clinicians and going, ‘This is the sixth time I have told this story. Don't you talk to each other? Don't you read the notes that the last person made?’

“There's a level of relief when you have that primary care person coordinating your treatment, you don't have to repeat yourself over and over again and that provides for better care.”

Professor Reid said the other consideration when co-locating allied with health professionals was that health care in general has become increasingly specialised, providing more focused opportunities for businesses to pursue.

“Even within a GP practice you will find that a doctor may have a special interest in paediatrics, for example, mental health or dermatology, and you need to decide what the business model is going to be,” he said.

“Will it focus on a particular area, such as sporting injuries or diabetes, or will it remain a generalist service? Is it a group of people working together as employees, or will they all be independent practitioners?

“The other issue is timing. For example, do you want your paediatric services running during the day in school hours, or are you better off running them in the evening after school? Could that be an opportunity to have evening sessional rooms, for instance.”

He said the success or failure of the initiative could come down to the efficient, flexible use of space.

“Space in capital cities is expensive and you need to maximise its use, which is a skill that practice managers and GPs will evolve over time,” Professor Reid said.

“It will also come down to professional relationships and breaking down professional barriers, with all clinicians being prepared to let go of something they potentially think is only theirs.

“At the end of the day, if you're providing good care for your patients, it's going to be of benefit to other healthcare professionals as well.”