Monday, May 16, 2016

Seniors Health Roundtable - 11 May 2016, Canberra

The ACT Government has an Active Ageing Framework that sets out the Government’s priorities for active ageing over the next three years. The framework articulates the Government's vision for all senior Canberrans to lead active, healthy and rewarding lives as valued members of our community. One of the guiding principles is the health care is affordable and accessible This means that health services are community based in addition to hospitals.
HCCA had been advocating for a focussed discussion with community members on ways to improve access to health services for older people. We were pleased when the Active Ageing Framework was released and they included an action to convene a round table on health of older people. We participated in the Steering Committee for this round table and our members turned out in force at the event on 11 May 2016.
The round table was opened by Chris Bourke MLAMinister for Seniors and Veterans.
HCCA President, Dr Sue Andrews, spoke at the round table about the challenges in transitions in care. Her speaking notes are included here.

Theme: Transitions in Care – continuity of care across services

I would also like to acknowledge the traditional owners and custodians of the land on which we meet. I respect their continuing culture and the contribution they make to the life of this city and this region. I pay my respects to their elder past and present.

I am very pleased to be here today. The health of older people is one of the health policy priority areas for HCCA. We also have a very active group of members and consumer representatives who are involved in a consumer reference group who identify and advocate for the health of older people in the ACT and surrounding region.  Much of what I say in these introductory comments is informed by their work.

As health care consumers in many different settings, older people are particularly conscious of the frequency and quality of the transitions in care that they experience as they traverse the health system. As well as a general practitioner or family doctor, they are likely to have several other health care practitioners, often specialising in one organ system, disease or condition. They may receive this care in settings such as GP rooms and other private practitioners’ clinics, in a hospital (private or public), in a rehabilitation facility and in a long term facility such as in aged care.

Healthcare delivery is increasingly complex and multidisciplinary, and where the health care system is complex and often fragmented, good continuity of care across services is not always easy to achieve. When it is not working well people may not adequately understand their health problems and may not know which practitioner to talk to when they do have problems and questions. It is vital that older people are supported to access health literacy programs so they can be well informed and participate as much as possible in managing their own health care.

For consumers the challenges for achieving optimal transitions of care across health services relate to having many practitioners, many settings and many rules (eg about where different clinicians can practice, who has responsibility for different pieces of patient information).

Lack of access to health care can also contribute to disruption of continuity of care. Some older people may miss follow up appointments because they don’t have transport to their GP’s office, or need GP care after hours (sometimes resulting in a call to the ambulance to go to the Emergency Dept). They may not see their specialist because they can’t afford it. And they may not know what actions they need to follow if they have not received information that respects their cultural background or is in a language they cannot understand.

The Australian Safety and Quality Framework for Healthcare, under the principle of consumer centred care, identifies improvements in continuity of care as a key area for action. “Continuity of care for patients must apply within the healthcare team as well as between any team and other health professionals”. (p4)

One of the most important things for consumers is that each health practitioner they see is aware of their medical history, their social circumstances and their treatment plan. Lack of this information can cause considerable anxiety and frustration for patients (and the health practitioner) and can cause delays in appropriate treatment, duplication of investigations and even the provision of inappropriate care. (AQSH Framework p5)

Transitions in care for consumers always need to involve efficient and timely clinical handover. “Clinical handover is the transfer of professional responsibility and accountability for some or all aspects of care for the patient…to another person or professional group…Clinical handovers occur at shift change (in hospital), when patients are transferred between health services or wards, as well as during admission, referral or discharge.” (p5) Millions of clinical handovers occur annually in Australia and this is therefore a high risk area for patient safety with consequences that can be serious.

At all points in the process of transitions in care, communication between practitioners and with consumers and their families and carers is very important. Use of both paper based and electronic medical records are critical for handover and transfer documentation, as is working with patients to make sure they have sufficient information and understanding of their treatment to be able to effectively participate in maintaining the continuity of their own care.

Some of the issues that have been identified for discussion at this afternoon’s roundtable about transitions in care include:
·         High quality transitions in care through careful integration of services;
·         Avoiding gaps in care during critical transitions;
·         Effective communication with the consumer, their family, and other healthcare providers;
·         Complete transfer of information – a patient safety issue;
·         On- going access to health literacy for older people and their families and other care givers;
·         Access to essential services and a single point person to ensure effective coordination and continuity of care;
·         Health assessment processes that ensure consumers are supported to achieve the best health outcomes depending on their situation and condition;
·         Unnecessary or inappropriate transfer of residents of aged care facilities to hospital Emergency Departments; and
·         Availability of community nursing and community health services to enable people to return to their homes with appropriate support after discharge from hospital.

For most of us in this room today these are not new issues. So I look forward to our discussions this afternoon which will I hope focus on some innovative solutions for the healthcare system and improved outcomes for older health care consumers in our community.

Sue Andrews, 
President, Health Care Consumers Association ACT.

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