Academic journal article Australian Health Review

On the Right Path? Exploring the Experiences and Opinions of Clinicians Involved in Developing and Implementing HealthPathways Barwon

Academic journal article Australian Health Review

On the Right Path? Exploring the Experiences and Opinions of Clinicians Involved in Developing and Implementing HealthPathways Barwon

Article excerpt

Introduction

The primary care reform agenda in Australia prioritises improving coordination of services, greater timeliness of referrals, minimising duplication and improving efficiency of organisational arrangements.1 It has been argued that the current healthcare system in Australia often delivers fragmented care for patients and that greater collaboration between primary and secondary care sectors is needed.2,3

A needs analyses performed by the Barwon Medicare Local identifiedseveral issues regarding the primaryandsecondary care interface within the Barwon region in south-west Victoria (comprising the City of Greater Geelong, Surf Coast Shire, Golden Plains Shire (South East), Colac Otway Shire and the Borough of Queenscliff). These include inefficient referrals from primary to secondary care, long waiting lists for outpatient services, difficulty navigating local services and unnecessary follow-up visits with specialists.

HealthPathways is a low-cost web-based intervention developedin Canterbury,NewZealand.4,5It hasbeenpurchased bythe Barwon Medicare Local (as well as by health services in other Australian regions6,7) and adapted to address Barwon region needs.8 HealthPathways Barwon involves collaboration between BarwonMedicareLocal(theprimary fundersofthe program)and Barwon Health (the region's hospital and health service), local general practitioners (GPs), specialists, allied health professionals and nurses. Small groups of these stakeholders, known as 'HealthPathways workgroups', develop locally agreed-upon evidence-based clinical pathways that assist with assessment, management and region-specific referral for various clinical conditions. The clinical pathways are available to local clinicians via a password-protected web-based portal. Steps indevelopment and implementation of HealthPathways, including the role of clinical workgroups, are summarised in Box 1. Proposed benefits include GP empowerment, easier navigation of the local health system for health professionals, better quality referrals, more efficient use of local resources, reduced waiting times, greater collaboration between clinicians and improved patient care.2,6-8

Research and evaluation based on the clinical quality audit cycle is integral to the development and implementation of HealthPathways Barwon (see Fig. 1).9 HealthPathways Barwon went 'live' on 1 August 2013 with localised pathways in orthopaedics and paediatrics; localised pathways in other areas are continually being added (Appendix 1).

Case study

Thiscasestudyoutlinesfindingsofaprocessevaluation assessing the experiences and opinions of clinicians who have been involvedinthe HealthPathwaysBarwon orthopaedic andpaediatric workgroups. The implications of the findings for further development of the HealthPathways program and future evaluations are presented, as well as lessons for those involved with regional health service programs more broadly.

Methods

Setting

The Barwon region, located in south-west Victoria, Australia, has a population of over 271 000. It is serviced by 358 GPs, 229 specialists, Barwon Health and Barwon Medicare Local.10

Participants

Two focus groups were conducted, comprising the members of the first two clinical workgroups for HealthPathways Barwon: orthopaedics and paediatrics. The orthopaedics workgroup was made up of two orthopaedic surgeons, six GPs and two Health-Pathways administrative staff. Eight of these participated in the focus group session (two GPs were unable to attend). The paediatric workgroup had two paediatricians, a coordinator of local paediatric services, six GPs and a HealthPathways administrator. Seven participated in the focus group session (one paediatrician and two GPs were unable to attend).

Research team

The research team comprised a GP registrar (the primary investigator, SM) and an academic GP (GG) who were potential endusers of HealthPathways. In addition, there were two members of the HealthPathways Research and Evaluation Committee (FQ, KvT)(both academicsandpsychologists)whowere notend-users of the program. …

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