specialty focus
specialty focus
Rethinking primary health
Photo: Eva Blue
Do Cuba, Alaska and the Netherlands hold the key to fixing Australia’ s primary healthcare woes?
Petra Bywood interviewed by Dallas Bastian
Primary Health Networks( PHNs) will likely benefit by adopting less traditional approaches to persistent problems, experts in the field have said.
Dr Petra Bywood and Dr Katrina Erny-Albrecht, both from Flinders University, recently penned an article on the topic in This Week in PHC, an online newsletter produced by the Flindersbased Primary Health Care Research and Information Service.
The researchers highlighted examples of innovative and successful international models for primary care. For instance, Cuba’ s model provides services through polyclinics, annual home visits for everyone, and additional visits for those with higher needs, while the Alaskan Nuka system of care has demonstrated very high levels of satisfaction among‘ customer-owners’ and employees.
Nursing Review sits down with Bywood to discuss these models, as well as those of the UK and the Netherlands, and to find out what insights PHNs can gather by looking abroad.
NR: Why is it important that PHNs continue to pay attention to healthcare models in different parts of the world? PB: Many health systems, including in Australia, are struggling with exactly the same kind of pressures and challenges. This includes things like ageing populations, increased patient expectations, limited resources, both financial and workforce resources, and also increased prevalence of obesity and chronic diseases and multi-morbidities, so in addressing these kind of common challenges they can learn from each other and avoid some of the costly trial and error approach and also reduce duplication of effort so that resources could be allocated more efficiently.
Each of the Primary Health Networks covers quite a different geographical area and population, and one single model is unlikely to meet all of their needs, but also those needs aren’ t necessarily unique. For example, the remote communities that exist in Canada and United States and Eastern Europe may also have the same kinds of problems as our Indigenous community, as the remote communities in Australia, and same with the indigenous communities that are in Canada or New Zealand and Alaska. There are some common problems. So before investing in major programs and strategies here in Australia, it might be useful to look at the evidence that’ s gained both locally and in other areas to provide confidence and also guidance in moving forward.
Without evaluation or evidence, it’ s impossible to know whether some of the programs have any impact and also whether they’ re making the best use of the limited resources. In other countries like Canada and the United Kingdom, evaluation is a key requirement of the funded programs, and there hasn’ t been a very strong focus on that in Australia at this point.
You recently highlighted the UK’ s Greater Manchester Devolution program( GM) which focuses on the place and the people who live in it rather than the needs of specific organisations and professional groups. How does the model do this and what impact does that focus have on the people it serves and the healthcare system more broadly? Greater Manchester, at this stage, is in a fairly early stage of implementation and so the evidence of impact is lacking, but there has been quite extensive consultation in publication of primary healthcare guidelines for Greater Manchester, so it’ s proposed that they focus on the place and the people and support this by working closely with patients, with service users, local communities, and the frontline staff, so this is not just in healthcare, but across sectors, like public health, housing, education, welfare, etc, and the aim is to achieve properly integrated public services.
This is also supported through a neighbourhood model which they call Locality Care Organisations, and they use multidisciplinary teams that serve natural populations of about 30,000 to 50,000 people, and it expands on the traditional concept of primary healthcare, fostering a much wider system that includes things like physiotherapy, midwifery, podiatry and social care, and also voluntary organisations, so it really taps into some of the community assets and the strengths of the local community.
The other thing that is really important I think in this system is that they take a very strong focus on preventive care, and that is something that I think in Australia has seemed to have dropped off the radar a little bit.
They also look at using the workforce differently so that to accommodate workforce shortages they expand the roles of other professionals like pharmacists and optometrists.
I guess for the general public the aim is to improve the access to primary healthcare and give them a greater say in what sort of services are provided, and also it requires rethinking about who is going to provide the care, so changing those professional boundaries means changing public and professional acceptance. Also, I think it’ s having that much broader focus that covers the other sectors that is one of the key strengths of the GM approach.
10 | nursingreview. com. au