Presentation by Leanne Wells, CEO, CHF, at the Chronic and Mental Health Symposium, Sydney, 26 February 2016.

1. How should the primary care system
respond to people with chronic
disease and complex conditions?
Leanne Wells
CEO, Consumers Health Forum of Australia
Chronic Disease & Mental Health Symposium
The Australian College of Mental Health Nurses in partnership
with the Australian Primary Health Care Nurses Association
and Australian Diabetes Educators Association

2. Overview
• Why primary health care matters?
• What is the patient experience?
• Current issues in primary health care?
• A better system?

3. Why primary health care matters?
• Growing chronic condition burden
• The setting where we prevent/treat most
• It’s efficient and accessible
• We can get good outcomes
• It’s the backbone of a strong health systems

4. Major chronic conditions of Australians 2014-15
3.5 million
1.6 million
203,400
2.6 million
1.2 million
1.2 million
370,1002.5 million

5. National Health Survey 2014-15
4 million
Australians
(17.5%)
reported having
a mental or
behavioural
condition
3.6 million
Australians
(15.8%) reported
co-existing long-
term mental and
behavioural and
physical health
conditions.

6. What is the impact?
Improving the way we
respond to co-morbid
physical and mental
health problems would
have a high impact in
terms of patient
experience and clinical
outcomes
WHY?
Because both of
these are
substantially
poorer relative to
those for people
with a single
condition

7. 2015 Commonwealth Fund survey

8. 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

9. 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

10. 21% reported
WAITING LONGER THAN
ACCEPTABLE
23% from RURAL and
REMOTE areas
28% of patients felt their
GP DID NOT SPEND ENOUGH
TIME with them
1 in 8 reported issues
caused by
LACK OF COMMUNICATION
between professionals
28% of patients felt their
GP DID NOT LISTEN
carefully to them
WOMEN reported longer
wait times than men
23% v 18%
ABS Patient Experiences :
General Practice 2014-15
Survey

11. Chronic disease costs
1 in 3 have at least 1 chronic
condition
Medicare spending
INCREASING
Potentially
preventable

12. Primary Health Care Advisory Group
Discussion Paper

13. 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

14. 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
14

15. 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
15

17. Multiple reviews and new ‘meso’
structures

18. • 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
information
• Give ME the best care
you can
• Reduce MY costs

19. 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

20. Putting people in control of their own
health and care
• 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

21. Building a Better Primary Care System

22. Changing role of consumers
Makers and Shapers
NOT
Users and Choosers
(Cornwall and Gaventa 2000)