One-of-a-kind palliative care

one-of-a-kind

PALLIATIVE CARE

Improving equity in access to quality palliative care is an Australia wide challenge and one Murrumbidgee general practice is the first in Australia to implement an innovative program to better support palliative care patients.

The Hay Medical Centre, under the leadership of Dr Muhummad Arshed, is leading in evidence based primary care management of palliative care through involvement with MPHNs At Home Palliative Care project and the Palliative Care Outcomes Collaboration (PCOC). The project focuses on enhancing local palliative care service provision and improving access to safe palliative care services in primary and community care. With support from MPHN, Dr Muhummad Arshed has implemented PCOC into his practice processes, and said every palliative patient in his care receives a standardised palliative care assessment to ensure they receive best practice care. “We know most expected deaths in Australia are due to chronic conditions and I realised there was a large cohort of patients who were not receiving the benefits of early identification of palliative care needs and routine palliative care assessment,” Dr Arshed explains. “We found only certain patients with malignant conditions were having their palliative needs regularly assessed and addressed, and in response we created a new practice process to identify which of our patients with chronic conditions might have palliative care needs and therefore were likely to benefit from the PCOC program.” For the practice to be able to easily identify at-risk patients, MPHN palliative care staff worked closely with health analytics software provider, Pen CS, and the Hay Medical Centre, to develop a filter recipe allowing the practice to produce a list of patients with a chronic condition and a likely shorter prognosis of one to two years. This list is then reviewed using the prognostic question ‘would you be surprised if this patient died in the next year?’ If the answer was no, then that patient is entered into the PCOC program. “We are currently the only general practice in Australia who has implemented this program. Now our patients are assessed regardless of diagnosis or setting of care, which ensures their palliative care needs are identified early and addressed.” The benefits for both community and general practice have been impressive and according to Dr Arshed, are leading to sustainable practices in quality palliative care and less complications for family and carers. “This new process strengthens the patient and carer voice, which ensures patient centred care. The regularity of the process works to eliminate crisis, especially in out of hours periods, which is also helping to prevent emergency room presentations and hospitalisations.” “We are also seeing some fantastic benefits within the practice as well with better use of GP time, and a focus on best use of clinical skills of our practice nurse.” The remarkable work and results achieved by Hay Medical Centre and others across the region in response to the palliative care challenge is gratifying to MPHN’s Healthy Ageing and Palliative Care Manager Stacey Heer and her team, but Stacey knows there is more work to be done. “We need to continue to promote having conversations about death so people are more willing to engage in this often difficult but important discussion. Community capacity around death literacy and encouraging people to engage in meaningful end of life planning, will lead to people with chronic disease being more open to having real conversations about their goals for end-of-life care.” MPHN is supporting the roll out of the overall At Home Palliative Care Project in several general practices across the region and Stacey is passionate about its implementation. “We must get this right. Access to palliative care should be based on need, and often this is not the case in Australia. You’re far more likely to be referred to a palliative care team if you have a cancer diagnosis and live in a metropolitan area. There are many population groups who are disadvantaged – First Nations, people who are incarcerated, LGBTIQ+ community members, and we also know accessing palliative care in aged care facilities remains a challenge,” Stacey says. “We have worked with some remarkable local health professionals who have a tremendous attitude towards getting this right and improving palliative care processes and outcomes for their patients, and I am looking forward to continuing support our region’s practices to implement palliative care initiatives.” Opportunities for general practices in the Murrumbidgee region to participate in the PCOC program and other At Home Palliative Care Project activities will be available throughout the rest of 2022 and 2023.