Rachel Seeley from Health Consumers’ Council looks at how frequent users of health services can be better supported.
Each year in WA, more than 500,000 people go to emergency departments for care, and while most only go once or twice, there are a small number who attend more frequently.
In 2016, about 5% of patients who went to an ED averaged about nine visits, with some people going more than 100 times. These patients are classified as ‘high risk’ and are more likely to have complex needs.
This data comes from the Sustainable Health Review, which was was published in April 2019. The broad-reaching consultation that informed the SHR resulted in eight enduring strategies and 30 recommendations which seek to drive a cultural and behavioural shift across the health system.
Recommendation 13 – Implement models of care in the community for groups of people with complex conditions who are frequent presenters to hospital – seeks to prioritise a systemwide approach to identifying and supporting people who are frequent users of health services, including emergency and outpatient services, to improve pathways of care and reduce hospital presentations.
In consultation with the recommendation 13 working group and key stakeholders, it was decided that the project would initially focus on strategies and models to support care for frequent hospital attenders diagnosed with chronic obstructive pulmonary disease and chronic heart failure.
A key principle of the SHR is the importance of having the consumer, carer and community voice at the health and human services decision-making table. Engagement work around recommendation 13 will explore the lived experiences and healthcare journeys of COPD and CHF patients and their carers, including barriers, enablers and contextual factors to receiving patient-centred care close to home.
A survey of 215 clinicians collected input from hospital-based, primary care and community clinicians working inside or outside of the WA health system to understand their experience.
When asked to identify the most common reasons a person with COPD or CHF may frequently present to hospital, clinicians cited poor health literacy or disease knowledge regarding COPD or CHF and management strategies as the most common reason (130 responses).
Interestingly, anxiety resulting from COPD or CHF was identified as the second most common reason (110 responses), and lack of personal or social supports (such as family or social services) was identified as the third most common reason (104 responses).
In a separate survey, consumers were asked questions around hospital and healthcare use, healthcare preferences (such as home visits or telehealth), healthcare knowledge and skills, healthcare experiences, and personal and social factors, with 42% of participants responding that they often or always experience stress or anxiety from their COPD or CHF.
As one responding clinician said, “We need to remember that it is frightening having a feeling that you are drowning/can’t breathe. As with any other chronic condition, the patients and their support network need ongoing education and refreshers, as it will take several attempts for most before all is understood and accepted.”
Another clinical survey participant stated, “Patients get scared and then have very little support networks to stay out of hospital.”
An upcoming focus group for people with COPD or CFH, as well as those who care for someone with COPD or CHF, will seek further consumer insight around experiences of receiving and accessing care across the health system.
In a separate study funded by the WA Health Translation Network and led by the Curtin research team in partnership with the WA Primary Health Alliance, consumers diagnosed with COPD, diabetes or CHF were invited to take part in a forum to explore the possibilities of integrating primary and secondary care using linked data across the continuum of care and the impact it would have on reducing preventable hospital admissions.
This is in light of the data currently collected in general practice and available through other areas of the health system. It sparked thoughtful consideration and discussion with a second consumer forum being planned, which, collectively, will inform a national study on consumer perceptions and willingness to share data in a de-identified manner.
ED: More information about both projects can be obtained by emailing info@hconc.org.au