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ACUTE VS PRIMARY HEALTHCARE

Payal Barde, Benefits Manager Queensland Public Sector

There has been a significant investment made within the acute healthcare sector in Australia. However, it is known that large communities which reside within regional and rural areas do not have easy access to hospitals. Primary healthcare is often the first point of call for these patients. There has been a recent change in direction by both the state and federal governments. A greater investment has been made in a national healthcare record that can be contributed to by general practitioners and community healthcare providers. However, a greater impetus is required for increased communication between the acute care and primary care sectors and easier methods of information exchange are necessary.

Often patients must travel a long distance to access healthcare services that may not be available close to their place of residence. To add to this, there is the complexity of an ageing population profile which makes travel a less attractive proposition for this group.

1In Queensland, the Patient Travel Subsidy Scheme (PTSS) provides financial assistance for patients who are referred to specialist medical services not available at their local public hospital or health facility. Patients approved for PTSS will receive a subsidy to attend the closest public hospital or health facility where the specialist medical treatment is available. There are similar subsidies provided to one or more patient groups in other states and territories of Australia.

The above scenario makes a compelling case for investment of government funding in primary and community healthcare services. If healthcare was brought to the patients instead of the patients having to travel long distances to access it, then it would result in better outcomes for the community.

Tertiary care hospitals are most likely concentrated in larger, metro cities that are more densely populated than their regional counterparts. However, if funds were injected into primary healthcare settings such that specialised care was not concentrated to metro areas and made available in rural and remote regions, seriously ill patients could remain within the comfort of their own homes and where they are supported by their families and loved ones.

2The PTSS provides travel and accommodation subsidies for patients who need to travel more than 50 km from their nearest hospital to attend specialist medical appointments. The overall amount of assistance is significant. In 2015-16, more than 72,000 patients received assistance, totalling over AUD $80 million. Many regional, rural and remote Queensland residents rely on the subsidy provided through the PTSS to access specialist healthcare that is not available locally.

If the money spent towards PTSS was redirected towards creating lucrative employment opportunities and incentives for medical professionals and services to be made available in regional settings, then the outcomes are expected to be positive on multiple fronts.

Firstly, there would be lesser pressure on the acute healthcare services that are already exploding at the seams to accommodate more patients. This is augmented by the fact that there exists a large proportion of the ageing population. 3The current Australian health landscape reflects an ageing population, an increasing prevalence and burden of chronic disease, and decreasing mortality rates amongst more common diseases. The combination of these three factors have meant that there is a rapidly growing need for the long-term management of many health conditions, which is resulting in increasing pressure and financial burden for the Australian health system.

Secondly, the affected families would have the necessary reassurance by not having to move away from the comfort of their homes. This applies to both patients and their carers who are often subject to this uncomfortable situation. This becomes particularly difficult for the senior population group who might not be able to undertake frequent travel. And most importantly, the money spent on subsidising travel and accommodation (a one-off return) could be reinvested to yield recurring returns if the funds were redirected at a more permanent solution of catering to the needs of the patient population in their local areas.

An increased emphasis on the health of the Indigenous people

4While there have been some improvements in mortality rates for Indigenous people over recent decades, a notable gap between Indigenous and non-Indigenous people remains. This difference results in lower estimated life expectancies for Indigenous Australians. The largest gaps between Indigenous and non-Indigenous people in age-standardised death rates in 2008– 2012 were due to:

• cardiovascular disease (24 per cent of the mortality gap between Indigenous and non-Indigenous people)
• endocrine, metabolic and nutritional disorders (21 per cent of the mortality gap, with diabetes alone explaining 19 per cent of the gap)
• respiratory diseases (12 per cent of the gap)
• cancer (11 per cent of the gap)
• Based on the findings above, it is evident that Indigenous people have a higher disease profile than non-indigenous people and there exists a greater gap in health outcomes between the two groups.

5At 30 June 2016, over one-third of all Aboriginal and Torres Strait Islander people lived in Major Cities of Australia (298,400 people), compared with around three-quarters of the Non-Indigenous population (17,013,400). A further 189,400 Aboriginal and Torres Strait Islander people (24 per cent) and 4,153,900 Non-Indigenous people (18 per cent) lived in Inner Regional Australia. There were 161,800 Aboriginal and Torres Strait Islander people (20 per cent) who lived in Outer Regional Australia compared with 1,879,100 Non-Indigenous people (8.0 per cent). The 53,500 remaining Aboriginal and Torres Strait Islander people (7 per cent) lived in Remote Australia and Very Remote Australia (95,200 or 12.0 per cent), while 239,900 Non-Indigenous people (1.0 per cent) lived in Remote Australia and 106,300 or 0.5 per cent in very remote Australia.

Given this geographical distribution of the Indigenous people and the gap to be bridged in health outcomes for them, there is a pressing need to funnel funding in health services and resources for indigenous populations in rural, regional and remote areas.

6There are two key targets specific to health performance in Indigenous people that are not on track for the ‘Closing the Gap’ agenda that is in place for the Australian Government. These are:

• To halve the gap in child mortality rates by 2018
• To close the gap in life expectancy by 203

Most of the bigger hospitals offering tertiary levels of care are concentrated in the metro cities of Queensland. In the regional and rural areas of the state, health services are provided in the form of primary healthcare centres and community outreach clinics. These facilities are not equipped with medical specialists and do not offer the services that are provided by advanced care hospital sites. The injection of funds into primary healthcare services to improve their service capability and provision of consultants is expected to make a positive impact to this critical government objective.

The importance of a National Health Record

8Every visit to a healthcare professional, or a hospital or other medical facility, may result in important information about their health being created and stored at that specific location. Digital health allows this information to be much more easily shared between the healthcare providers involved in their care. My Health Record is an online summary of a person’s key health information.

9Research indicates that as many as 13 per cent of primary care visits have missing clinical information. A patient’s health information is potentially distributed across a wide range of locations including their GP, hospitals, imaging centres, specialists and allied health practices.

This means that the National Health Record is an enabler to better caring for patients in the community as it allows greater information to be made available, about what happened to them in the hospital and any known conditions, medical history, allergies and other problems. However, there is still a further requirement for specialists to be located in these regions and better equipment, facilities and healthcare technology to be made available so that specialist care can be provided at the point of patient contact rather than having to move the patient to another location.


The relationship with telehealth

7Queensland’s telehealth programme enables patients to receive quality care closer to home via telecommunication technology, improving access to specialist healthcare for people in regional communities and reducing the need to travel for specialist advice.

However, not all healthcare conditions can be managed remotely and telehealth while helpful to reduce the strain on face to face consultations cannot be applied universally to all patients, based on their individual circumstances. Also, based on region and location, telehealth may or may not be available everywhere. This is where the gap to complement this service with in person consultations needs to be filled. In these scenarios, the need for specialist services in regional settings remains, as well as for suitable technology and infrastructure to be provided to support this provision.

Conclusion

In summary, the geographical dispersion of Indigenous communities coupled together with a less equivalent distribution of advanced care hospital services in regional and remote areas means that patients do not always have ease of access to the greater level of healthcare required. This in turn has an impact on the monies that might be spent on patient transport to healthcare facilities and result in inconvenience to the patient and their carer in living away from home. On the other hand, travel may not always be an optimal solution for a large proportion of the ageing patient population.

There has been a significant investment in healthcare services over a longitudinal period. This has included services like telehealth, the availability of a national healthcare record that can be contributed to by multiple healthcare providers, and investments in ICT to improve the information exchange between hospitals and primary healthcare settings.

However, there remains a case for both medical specialists and specialist healthcare to be stationed in primary healthcare settings so that existing gaps in serving patients with critical health needs are filled in at the first point of a patient’s visit. Ongoing investment of funds has been made in the Acute Care sector within hospital settings. There remains a significant requirement for an increased allocation of funds into primary healthcare services. Offering medical specialists’ better incentives and competitive monetary returns for relocating to non-metropolitan locations should serve as a move in the right direction. Furthermore, procuring necessary modern medical equipment and standing it with the necessary infrastructure will aid to assist with healthcare services being provided in these regions. The funds invested in regional areas are expected to boost the local economy in those regions.

Refernces:

1 https://www.qld.gov.au/health/services/travel/subsidies/about.
2 https://www.ombudsman.qld.gov.au/ArticleDocuments/495/PTSS%20report%20final.pdf.aspx
3 https://www1.health.gov.au/internet/main/publishing.nsf/Content/F520A0D5EDEA0172CA257BF0001D7B4D/$File/DAA%20PMP%20Report.pdf
4 hhttps://www.aihw.gov.au/getmedia/cb719825-4e63-468a-bc91-5ba220d98254/18175-chapter6.pdf.aspx
5 https://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001
6 https://ctgreport.niaa.gov.au/sites/default/files/ctgreport-20193872.pdf?a=1
7 https://www.health.qld.gov.au/telehealth
8 https://www.digitalhealth.gov.au/get-started-withdigital-health/benefits
9 Smith, PC, Araya-Guerra, R et al 2005, Missing Clinical Information During Primary Care Visits, JAMA, 293(5):565-571

--Issue 47--

Author Bio

Payal Barde

Payal has been closely involved with identifying benefits of ICT Health projects for over seven years and has worked for Queensland Government agencies for an impressive period of eleven years. It would be fair to say that she has a sound understanding and appreciation of the opportunities within this sector.