Report highlights failure in primary health care

The Grattan Institute, a public policy ‘think tank’, has just published a report entitled ‘Chronic failure in primary care’ (see here). It is disappointing there is little reference to nurses in the report but that aside, it does give a good insight into the problems (and some possible solutions) in Australian primary health care.

Some highlights of the report are as follows:

  • Ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million a year in avoidable hospital admissions.
  • Only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.
  • Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented. Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.
  • Three quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death. Social, economic and environmental changes are the best way to prevent these diseases, but there are much better outcomes where good quality primary care services are in place.
  • The focus must move away from GP fee-for-service payments for one-off visits; a broader payment for integrated treatment would help to focus care on patients and long-term outcomes.
  • PHNs should be given more responsibility for local primary care services. The evidence shows that a consistent, coordinated approach to specific diseases helps primary care more effectively prevent and manage chronic conditions. In regional areas, clear targets and well-designed incentives for disease prevention are vital.
  • There needs to be a focus on more flexible services, which might include greater use of nurses and allied health staff for assessment, planning, coordination, review and support of people with chronic disease.
  • Practice and incentive payments are not working.

Do you agree there are fundamental problems with our primary health care system? Are there any easy, or even achievable, solutions? We would love to know what you think.

New Atlas plots variation in healthcare across Australia

On 26 November the Australian Commission on Safety and Quality in Health Care (ACSQHC) launched the first Australian Atlas of Healthcare Variation (see here). The Atlas highlights the variation in healthcare provision across Australia, and importantly highlights the potential overuse of procedures, medication and interventions.

Key highlights of the Atlas are as follows:

  1. Antimicrobial dispensing – significant variation across the country, with the highest rate of total antimicrobial dispensing (Campbelltown, NSW) being almost 12 times more than the area with the lowest rate (Tiwi Islands/ West Arnhem). WA stands out as being more successful than other parts of the country in keeping rates of antimicrobial dispensing relatively low. Internationally, Australia has a very high rate of antimicrobial dispensing (more than twice the rates of the Netherlands for instance)
  2. Diagnostic interventions – wide variation of particular interventions across the country (an example being colonoscopies where the highest rate was 30 times that of the lowest).
  3. Surgical interventions – wide variation across the country (for example women living in regional areas of Australia were over five times more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas)
  4. Interventions for mental health and psychotropic medicines – the greatest variation was seen in in dispensing of prescriptions for psychotropic medicines for those aged 17 years and under (for example the number of prescriptions for attention deficit hyperactivity disorder (ADHD) medicines in the area with the highest rate was 75 times more than in the area with the lowest rate)
  5. Opioid medicines – a wide variety of rates of prescriptions for opioids across the country (the number of prescriptions dispensed was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate)
  6. Interventions for chronic diseases – reflective of the generally poorer health status of indigenous Australians, hospital admission rates for asthma, COPD, heart failure and diabetes-related amputations were markedly higher in remote areas of Australia.

What variations in healthcare provision have you seen or experienced? We would love to know.