Consumers’ role in co-creation

Leanne Wells , CEO

Patient centred care

Working together to find solutions

Integration

http://www.kingsfund.org.uk/audio-video/joined-care-sams-story

Overview

• Why primary health care matters?

• What is the patient experience?

• Current issues in primary health care?

• A better system?

Health system: three tiers

Micro

Meso

Macro

KPMG maturity matrix 5 4 3 2 1 0

Work to create a new culture centred on patient culture

Absolute focus

Some focus

Key principles enacted

Strong narrative in place

Recognition for need to

act

No focus

Patient input into service design

Systems to support shared decision making

Models support self-care and help the professionals adapt

Are patients assets mobilised

Can patients get and use information

Are patients involved in teaching and research

Are the assets that communities can contribute mobilised

Are there measurements systems to support this

Why primary health care

matters

• Growing chronic condition burden

• The setting where we prevent and

treat most

• It is efficient and accessible

• We can get good outcomes

• It is the backbone of a strong health

system

Major chronic conditions of Australians 2014-15

3.5 million

1.6 million

203,400

2.6 million

1.2 million

1.2 million

370,100 2.5 million

National Health Survey 2014-15

What is the impact?

2015 Commonwealth Fund survey

Primary care doctors from 10 countries: is practice well

prepared to manage patients with complex needs?

COUNTRY Patients with…

Patients needing…

Multiple

chronic

condit-

ions

Dem-

entia

Severe

mental

health

issues

Substance

use-related

issues

Long-

term

home

care

services

Social

services

Palliat-

ive care

AUS (n=747) 85% 46% 34% 19% 47% 41% 48%

CAN (n=2,284) 70 42 24 15 40 28 42

GER (n=559) 88 67 32 14 68 71 58

NET (n=618) 88 65 44 16 80 25 92

NZ (n=503) 81 41 24 20 54 48 62

NOR (n=864) 86 69 56 36 78 41 54

SWE (n=2,905) 66 57 14 6 51 45 25

SWIZ (n=1,065) 80 49 26 25 64 55 48

UK (n=1,001) 79 64 43 41 60 44 81

US (n=1,001) 76 47 16 16 46 32 41 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians

Primary care doctors from 10 countries: practice capacity

to provide enhanced access and care management

C

o

u

n

t

r

y

Practice uses nurses/case

managers to monitor/ manage

care for chronic patients

Practice

staff…

Patients can….

Within

practice

Outside

practice

Make

frequent

home visits

Access

after

hours care

Email re

medical

concerns

View

records

online

AUS 75% 6% 25% 78% 30% 11%

CAN 43 23 19 48 15 7

GER 20 7 57 85 50 8

NET 78 14 88 94 57 13

NZ 83 7 20 92 53 24

NOR 32 37 20 80 32 3

SWE 75 13 24 75 61 20

SWIZ 8 52 43 69 80 11

UK 87 8 84 89 38 28

US 43 24 6 39 57 60 Source: 2015 Commonwealth Fund international Health Policy Survey of primary Care Physicians

ABS patient experiences: general

practice survey 2014-15

• Longer than acceptable wait time (21%)

• Higher in rural and remote areas (23%)

• Women reported longer wait times (23% v 18%)

• GP did not spend enough time (28%)

• Lack of communication between professionals

(reported by 1 in 8)

• GP did not listen carefully (28%)

Chronic disease costs

1 in 3 have at least 1 chronic condition

Medicare spending

INCREASING

Potentially

preventable

Primary Health Care Advisory

Group Discussion paper

Primary Health Care Advisory

Group consultations • A fragmented system and providers working in

isolation not as a team

• Uncoordinated care

• Difficulty finding services

• Service duplication, absent or delayed services

• Low uptake of eHealth and other health technology

• Access problems due to cost, transport,

language, mobility and remoteness

• Feelings of disempowerment

Experience of the system

“I don’t have a huge support structure outside of

hospital. I’ve got my regular GP, because I have to

have the same form filled every two to three months

saying I can’t return to work. There’s a lot in the

community if you can source it, but it’s hard because

most people don’t know what’s available ….. I think

what I’d tell people with a chronic condition is ….ask

questions and be proactive. They aren’t going to

cure you, but you they can help you get the most out

of life”

“Michael”, type 2 diabetes

Impact of low health literacy

“As a patient with a lot of insight into my condition, the

nurses will listen to me” “Katy”, dysautonomia, chronic fatigue, asthma, chronic pain

“I can understand that living in the country that I’m not

going to have everything in one place. I’m not

expecting the world. But I think at least having visiting

specialists would help – or being told when they do

have one – or central registries that doctors could

access. That would be helpful. There is so much

information out there, but nobody can get it” “Eleanor”, intracranial hypertension

Multiple reviews and new ‘meso’ structures

• Make life easier, more

convenient for ME

• Let ME take ownership

• Empower ME

• Include and respect ME

in the relationship

• Keep ME informed

• Enable transparent

access to MY info

• Give ME the best care you can

• Reduce MY costs

ACCESSIBLE AND

AFFORDABLE CARE Timely access to care based

on need

Well organised, without

organisational or systemic

barriers

Affordable for consumers

Equitable access

COORDINATED AND

COMPREHENSIVE CARE Linked care with good referral and

feedback

Integrated with supported

transitions across the system

Availability of a range of services to

multidisciplinary care

Complete personally controlled health

record

APPROPRIATE CARE Meet the needs and preferences of

individuals

Evidence based with consumers

engaged in research

Treatment options, risks and

benefits identified

Safe and technically proficient with

risks minimised

Practitioner engages with

consumers, families and carers

to ensure understanding

WHOLE OF PERSON

CARE Take account of consumers lives

and personal values

Emotional

Physical

Cultural, spiritual and social

factors

Consider carers and support

Address risk factors and all

health problems

PRINCIPLES OF

CONSUMER –

CENTRED

HEALTH CARE

TRUST AND

RESPECT Provider asks about and

understands concerns

Transparent

Accountable

Timely and effective

complaint resolution process

Shared responsibility and

decision making

INFORMED DECISION

MAKING Access to right information at right

time

Information is clear and

understandable

Costs are clear

Personal choice and right to refuse

respected

Informed and timely consent

Consider carers and supporters PLANNING AND

GOVERNANCE Partnership with consumers to

ensure sustainability

Consumers involved at all levels

of planning, system design and

service development

Consumers involved in key

governance structures

Putting people in control of their

own health

• A fragmented system and providers working in

isolation not as a team

• Engaging people in keeping healthy

• Shared decision making

• Supported self management

• Having a personal health or social care budget

• Involving families and carers

• Choosing a provider

• Taking part in research as part of your care and

treatment

• Evaluating services through feedback

Building a better primary care system

Changing role of consumers

Makers and Shapers

NOT Users and Choosers

(Cornwall and Gaventa 2000)