Wednesday, July 31, 2013

Minister Plibersek Requests Comments On The Concept Of The Medical Home - Smart Move I Reckon.

The following appeared a little while ago.

Govt seeks GP advice on ‘medical homes’

19 July, 2013 Paul Smith
The Federal Health Minister wants “expert input” on patients registering with individual GP practices as part of a drive to tie patients closer to a “medical home”.
Marking the conclusion of last week’s Family Doctor Week, Tanya Plibersek lavished praise on GPs, describing them as the “backbone of Australia’s world-class universal health system”.
“It is their genuine, enduring, and intimate relationship with patients that helps make their clinical impact so powerful. That relationship allows family doctors to truly understand their patients, plan their care carefully, and even pre-empt their health needs.”
She said the government was seeking expert input on the “medical home” concept where patients receive much of their ongoing care through a single GP practice.
“That clinic then becomes responsible for the patient, providing access to a greater range of services aimed at keeping them healthy and out of hospital,” she said.
The minister said she wanted expert feedback — including from GPs — on whether the plan would improve patient care.
There have been various models proposed with the aim of strengthening cradle-to-grave care. The RACGP this year unveiled a blueprint in its budget submission calling for cash payments of $165 to practices for every patient who voluntarily enrols.  
More here:
There are discussions of this area on the blog going back to 2007.
Here are some recent links.
and here:
(This is an especially useful link). The article cited is found here:
and here:
and here:
These links all seem to suggest the Patient Centred Medical Home (PCMH) approach - especially if enabled by quality Health IT to assist with care co-ordination and a patient portal to assist with patient access can be a pretty good way to go.
It is a way better idea for investment than the PCEHR, which, if you think about it is not really the tool to make a PCMH work optimally as the practitioner does not have guaranteed access to all relevant information.
The point that it is important to make is that the PCMH concept is not just about patient registration but also about all the other infrastructure that is needed to make it work well.
As a last point if the Minister wants to know more this looks like a great place to start:
with all of 70 references!
David.

11 comments:

Tom Bowden said...

OK I am about to bang on about the NZ health system again so feel free to switch off now.

We have patients enrolled with a single general practice which in effect is their medical home. We have been doing this for 20 years, by doing so we have one of the most cost-effective health systems in the OECD. This efficiency enables choice,i.e. the ability to allocate unused resources as desired, which has to be good in a health system under pressure.

On the IT front, there is no question of the enrolled patient/PCMH's merits - in my view.

We have the second best connected health system in the world (after Denmark) with an average general practice communicating electronically with 66 other parties.

I say go for it Minister Plibersek, it is the logical choice.

Tom Bowden

Bernard Robertson-Dunn said...

Tom

Question:
What problems would there likely be if the NZ solution (NZ population 4.405 million) were to scale to Australia (22.32 million), the UK (62.74 million) or the USA (311.6 million), each with their own patient mobility characteristics? (All populations are for 2011)

You have to be very careful assuming that someone else's solution will solve your problem.

That the PCeHR is based upon (if not almost identical) to the Singapore solution raises all sorts of questions that, at least to me, have not been answered.

Terry Hannan said...

I have been interested in this topic for a long time and have links with the Californian Health Care Foundation (non profit) so the following may provide good reading to those interested.
1. http://www.chcf.org/publications?stopic=Patient%20Self%20Management&sdate=last24
2. http://www.chcf.org/publications?stopic=Patient+Self+Management&sdate=all&page=2
3. Health Care without the Doctor: http://www.chcf.org/publications/2009/05/health-care-without-the-doctor-how-new-devices-and-technologies-aid-clinicians-and-consumers

Anonymous said...

Well Minister........I moved a short time ago from an area where I had the luxury of a single GP who had been my family doctor for 20 years plus and who knew my complex medical history inside out. In my new location I had no option but to register at a Medical Clinic where I am seen by whomever is available whenever I can get an appointment.

Despite me paying to transfer all my copious medical information to this clinic no-one has read it. They all just ask me what they want to know. And every different doctor I see gives me different opinions and instructions on how to manage my various chronic conditions. If this is how the "medical home" is supposed to work you can keep it. I might add that none of them are interested in the PCEHR (funny that) but then neither am I! All I care about is quality health care and outdated nonsense in a record that is really only a prompt for health practitioners to use as a follow up. DoHA and NeHTA have always said that the PCEHR is only a point-in-time record and is never to be relied on as being up to date. So flippin useless if you ask me......

Tom Bowden said...

Bernard,
Good question.

Answer is, chop into chunks and deal with it at a regional level, using national policies to ensure consistency and quality.

The NZ system was based on a successful NHS approach developed over decades.

Its all about keeping local healthcare delivery local.

Cheers

Tom

Anonymous said...

Well I would have thought that patients would love a cosy medical home and they are free to do this now and the referral system in Australia almost mandates it.

They also currently have the freedom to move their home if they don't like it and any changes would just make that harder so why would consumers like this!

Over the years DOHA have worked hard to kill small practices where you see the same person all the time because some idiot in the department thinks a big corporate medical practice must be better.

So DOHA have patients comfortable medical home into something resembling a soup kitchen or a budget hostel. I would resist this at all costs.

In the US the lack of a referral system makes it more desirable, in Australia we had it, but its been shelled by DOHA for 20 years and it looking a bit worse for wear now. I am sure Mr Rudd has another revolutionary grand plan to "fix" what has been broken on purpose, but you would have to be a little worried....

Bernard Robertson-Dunn said...

Tom,

The question was: Would the NZ solution scale to address Australia's problem.

It seems that the answer is no. Partly because DoHA has defined the problem to include immediate national access to a patient's health record.

However, changing a problem so that a particular solution becomes acceptable is a valid approach.

Unfortunately, significantly changing a solution that has already been implemented becomes rather costly - and politically difficult.

Bernard Robertson-Dunn said...

Anonymous said:

"DoHA and NeHTA have always said that the PCEHR is only a point-in-time record and is never to be relied on as being up to date."

So, what might actually be useful are data that are stationary or slowly changing characteristics about a patient and which could be relied upon by health professionals.

Characteristics such as:

* Chronic conditions
* Implants
* Allergies
* Adverse reactions to medication

Information of high value and confidence.

Oh look, we're back at information and value. Funny that.

The PCeHR can contain all this data but its usefulness is diluted by all the other low value and potentially misleading data that a health professional would have to wade through and disregard.

We live in an information age where one of the problems is too much irrelevant information.

Anonymous said...

"Unfortunately, significantly changing a solution that has already been implemented becomes rather costly - and politically difficult."

I don't think it can be fixed, the only humane thing is to put it down and a smart health minister would do that now. We do know that caring for the terminally ill can be a very expensive exersize and if you are not careful you just prolong suffering without any useful life gained. PCEHR RIP

Freddy said...

"Well I would have thought that patients would love a cosy medical home and they are free to do this now"

Unfortunately there is nothing "free" about it.

My wife's GP moved to a medical centre and brought her 40 odd years of medical history with her. The GP has now moved to a different medical centre, however the first medical centre has claimed the records for themselves and are requesting what I would consider a large amount of money to have these records transferred.

I don't believe in personally controlled records, however personally owned (i.e. choosing who you allow to access) would be an improvement.

Tom Bowden said...

Bernard,
Closer examination of the real need shows that the "when I fall ill in Birmingham and my records are in Bradford" - Tony Blair - build an expensive National system and they will come approach is: not only a waste of time but also a huge opportunity wasted.

What does seem to work is creating systems that help local care delivery and that can be done at scale as long as designed and run appropriately - preferably to a national gameplan but with local admin and management.

The UK was successful with its enrolled patient strategy, linking patients to practices (Medical Homes) but lost the plot and went national with the NPfIT.

There is a lesson to be learned from that.- In my view

Tom