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Hunter & New England HealthPathways (H&NE HealthPathways) is an initiative to improve the management and referral of patients by General Practitioners (GP) and Hunter New England Local Health District (HNE) clinical specialists, and to facilitate the redesign of clinical processes to achieve such an improvement. It seeks to achieve these outcomes through the collaborative development of web-based clinical pathways by primary and specialist care clinicians. An evaluation of H&NE HealthPathways was undertaken to describe: 1) changes over time in patient referral and access to specialist care; 2) the implementation of associated clinical redesign initiatives, and 3) change over time in, and the pattern of, H&NE HealthPathways website usage.
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Chronic mental health problems (depressive disorder, anxiety and schizophrenia) account for 9% of all chronic problems managed by General Practitioners (GPs). However, the prevalence of patients at risk of suicide is hard to quantify as GPs often document suicide ideation or suicide attempt as “depression”. A study conducted in the local Lake Macquarie area showed that GPs did not reliably predict patients with suicide ideation. In order to support GPs to manage patients at risk of suicide, the Hunter New England Local Health District (HNE LHD) Mental Health services and the Hunter Medicare Local (HML) Psychology Service agreed to be involved in developing a Suicide Risk HealthPathway.
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One in five people will experience persistent pain in their lifetime. People who experience persistent pain access healthcare services more frequently and this places a great burden on the Australian economy, costing $34 billion a year. Persistent pain is 4% of all chronic problems managed by General Practitioners (GPs) which equates to around 74,000 persistent pain patient problems managed by GPs in 2013 in the Hunter Medicare Local (HML) region. The Hunter Integrated Pain Service (HIPS) offers specialist pain management support in the Hunter New England Local Health District (HNE LHD). HIPS was one of the first specialist teams that requested to be a part of the Hunter & New England (H&NE) HealthPathways process.
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The John Hunter Hospital (JHH) is a tertiary referral public hospital located in Newcastle, New South Wales and is a facility of the Hunter New England Local Health District (HNE LHD). The Antenatal Clinics in JHH receive around 3,500 referrals each year for women at all levels of risk related to their pregnancy. The JHH Maternity service was one of the first specialist services to participate in the HealthPathways process. In collaboration with General Practice, the JHH Maternity service developed a suite of 17 HealthPathways including the Routine Antenatal Care HealthPathway.
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Objective This paper describes the 4-year journey of Hunter and New England HealthPathways - a password-protected web-based portal designed to provide localised evidence-informed clinical and referral information to support general practice at the point of care. Methods A process evaluation was conducted in 2013, with a case study comparison performed in 2014 to assess impact of HealthPathways on patient referral and access to specialist care, followed by a review in 2016 of utilisation of the online portal to assess whether healthcare providers continued to access HealthPathways. Results Increased utilisation was correlated with an increase in the number of pathways published online. Clinical leadership and the process of developing pathways built relationships between primary care and specialist teams. Case studies indicated that a comprehensive approach to pathway implementation accompanied by service redesign resulted in higher pathway use and improved access to specialist care. Senior management support and a formal partnership between major health care providers led to strong governance of HealthPathways and the delivery of other integrated care initiatives. There was significant growth in utilisation over the 4 years, increasing to an average of 6679 sessions per month in 2016 and more general practices reported use of HealthPathways. Conclusions HealthPathways is a vehicle for building strong foundations to support system change and integrated care. The critical elements for acceptability, growth and sustainability are the strong relationships between primary care and specialist clinicians, as well as formal partnerships that are built from the processes used to develop HealthPathways. What is known about the topic? HealthPathways and similar web-based evidence-informed guidelines aimed at improving system integration are increasing in Australia. There are few published papers that describe approaches to inform the ongoing implementation of such programs. What does this paper add? This paper describes iterative methodology for evaluating complex programs, such as HealthPathways, that identifies the critical factors required to build sustainable models of integrated care. What are the implications for practitioners? The 4-year experience of Hunter and New England HealthPathways provides an approach to improve the implementation, sustainability and spread of similar programs and associated integrated care initiatives.
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- Country - Australia (5)
- Impact - NA (4)
- Impact - Yes (1)
- Platform - Community HealthPathways (1)
- Programme evaluation (2)
- Quintuple Aim - Care team wellbeing (1)
- Referral quality / triage (5)
- Setting - Outpatient / Community (1)
- Type - Case study (4)
- User experience (1)
- Waiting times / Patient flow (2)
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- English (5)