Presentation by Leanne Wells, CEO, CHF, at the Criterion Conference, Sydney, March 9-10 2016.

1. Patient experience: where can
we improve?
Leanne Wells , CEO

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
• Most patients don’t want to be in a
hospital
• Place based care
• Patient centred health care homes
• Hospitals partnering with settings
outside of the hospital to integrate
care ideal for tailored patient
experiences

4. 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

5. 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

6. National Health Survey 2014-15

7. What is the impact?

8. 2015 Commonwealth Fund survey

9. 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

10. 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

11. 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%)

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

13. Primary Health Care Advisory
Group Discussion paper

14. 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

15. 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

16. Experience of the system
“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

18. Multiple reviews and new ‘meso’ structures

19. • 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

20. 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

21. 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

22. Building a better primary care system

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