What pithy questions do you have about the directions of primary health care research, policy and programs?
This afternoon Professor Philip Davies, Professor of Health Systems and Policy at the University of Queensland, will run a Tony Jones-style Q and A session at the Primary Health Care Research conference in Brisbane.
The panel members are:
- RACGP President Claire Jackson
- Megan Morris, First Assistant Secretary, Primary and Ambulatory Care Division, DOHA
- Stephen McKernan, former Director General Health NZ, now head of Health Partners Consulting Group Ltd, NZ
- Faye McMillan, President Indigenous Allied Health Australia
- Emil Djakic, chair AGPN.
Apologies for the short notice but if you’d like to send any questions, please do so by 2.30pm (either email me direct or post as comment on this post). I will assume you are happy to be identified as the questioner unless you state otherwise.
Update: These are some of the questions that have landed from Croakey readers and contributors
Dr Kim Webber
CEO Rural Health Workforce Australia
How could the myriad research and evaluations and consultancy reports be released to inform policy? How do we move from a researcher driven research agenda to a community needs research agenda (ie. commissioning research that we need to go rather than funding researchers to research whatever they want)?
Professor Chris Del Mar, Bond Uni
How can we ensure that primary care gets funded to research clinical questions as well as health services research?
Dr John Dowden, Australian Prescriber
How do you give GPs the time to do research?
(I’m sure that you get the same feedback from GPs as I do, that they are sinking under masses of paperwork. Unless they have an academic appointment finding the time to participate in research can be very difficult. I suspect that in areas of need, where research might help lead to improved care of patients, the primary care teams who work there are fully occupied providing services.)
PHAA member Jessica Stewart
One of the major limitations for evaluating primary health care is the lack of routinely collected data on service delivery and patient outcomes (other than MBS items which primary function are for financial reimbursement). We are currently unable to track patient journey from primary health care and the quality of services they receive, through to the impact this has on hospitalisation rates and death – we are missing a large part of the ‘prevention’ story on how to keep people healthy! This has particular importance for Aboriginal and Torres Strait Islander people who experience such significant health disparity.
What does the panel see as the 3 major research infrastructure/capacity investments that could result in being able to better understand the impact of variation in primary health care services on morbidity and mortality at a population level?
Where is the community health dimensions of PHC in the overall research agenda? The NHHRC final report identified “a healthy start to life” as the critical prevention strategy for the future, how is this prioritized or placed?
Hudson Birden, Senior Lecturer University Centre for Rural Health, North Coast, Sydney Institute for Emerging Infectious Diseases & Biosecurity, Sydney School of Public Health
How can we expect to see research performed in primary care when there is no mandate or funding stream to support it? Research activity takes time, effort, and resources away from the primary mission- care provision.
CHRIS RISSEL, Professor, Prevention Research Collaboration | Sydney School of Public Health
What systems do you have in place/or want to put into place to meaningfully translate new research findings into the varied areas of primary care practice? What framework do you use to build evidence for programs being implemented?
Marilyn Wise, University of NSW
For me one of the primary questions is about the extent to which research, policy and programs are being developed with a view to increasing health equity.
Is access to primary health care equitable? What are the barriers to ensuring equitable access to primary health care in communities? What are the barriers within primary health care organisations?
What might be done (research, policy, and/or practice) to increase and measure the outcomes of primary health care with a particular focus on equity?
Amanda Wilson, Newcastle University
More of a theme than specific question about the issues around funding of research in primary health care – which rarely satisfies demands of NHMRC for funding. There are also issues about engagement with primary health care to conduct research.
Dr Fiona Blyth, Sax Institute
What is the one thing that would be most effective in increasing influential primary care research outputs in the next five years?
Margo Saunders, public health policy consultant
(1) The ‘disconnect’ between academic research (including publicly-funded research) and the needs of public sector policy has recently been highlighted by Terry Moran and Peter Shergold.
Does the panel believe that more needs to be done to ensure that Australian university researchers conduct policy-relevant research and that the implications of that research are translated into information that actually helps policy-makers?
If so, what sorts of measures could be implemented to facilitate this?
(2) Health literacy (the ability to obtain, process and understand information to make appropriate health decisions) is mentioned in just about every policy framework document, including the NHHRC reform documents and national strategies for primary care, chronic disease, preventive health and men’s & women’s health.
However, despite evidence of low levels of health literacy throughout the population, Australia has no national health literacy strategy or action plan. Now that the United States has a National Health Literacy Action Plan, and initiatives are well advanced in other countries including Canada and Britain, what is preventing a more co-ordinated, high-profile, national approach to health literacy in Australia?
(3) For Megan Morris: Now that we have a National Male Health Policy, and an expert reference group to oversee its implementation, what measures will be undertaken to implement the National Male Health Policy in relation to primary health care?
(4) Three years ago, health economist Jeff Richardson proposed that Australian health system suffers from the absence of satisfactory navigation equipment – independent research, reporting and evaluation capacity.
In his view, reforms need to be de-politicised or at least reduced in terms of their political costs. The problem, he suggests, is that much of the information and analysis have been poor and have focused on managing political costs and balancing vested interests. There also been, he says, a failure to invest in health services research based on a serious strategy or plan — resulting in research largely conducted on an ad hoc basis, with confidential reports and a dearth of creative ideas flowing through to the level of creative planning.
Richardson proposed the establishment of one or more independent research institutes. Given the prominent roles of expert organisations such as the Institute of Medicine in the United States, which is part of the National Academy of Sciences, what is the panel’s view about enhancing Australia’s capacity for independent research and analysis on health care policy and practice?
RURAL AND REMOTE ISSUES
A rural doctor in Qld (known to Croakey readers as: Duggy the DC3)
General practice and primary care is under significant strain in rural and remote areas. Lack of new graduates, lack of supervisors and training posts, an aging workforce and reduced funding for primary care make access to General Practice very difficult for rural patients. How do Primary Care Researchers see future rural primary care surviving and thriving?
Professor David Atkinson, UWA
My main area of concern is the difficulty of getting appropriate resources for Rural and Regional research. My question is:
The current process for funding for research remains very heavily focused on ‘track record’ in the traditional academic sense of published papers, previous grants etc and, despite a recent apparent focus on ‘translation’, really only pays lip service to changes in policy and implementation of research outcomes. These processes are controlled and priorities are set by urban institutions with variable and usually limited levels of input from rural and regional areas.
How do you propose to change the system so it genuinely represents remote, rural and Aboriginal health interests and funds what is needed not what just what interests high profile researchers?
FUNDING ISSUES/POLICY/SERVICE DELIVERY ISSUES
Reporters at Medical Observer
The first tranche of Medicare Locals have been supposedly ‘set up’, and there has been much talk about what they will do for providing primary health care services. But the process has not been without in-fighting between merging divisions, and we’ve also learned that one Medicare Local has since sent its contract back to the government for rewriting because the doctors were unhappy with its terms. How ‘on board’ are GPs with the Medicare Locals really?
Professor Gavin Frost, Notre Dame University
I’d ask can we get anywhere if we still have major turf issues based on current funding models?
Jon Wardle NHMRC Research Scholar, School of Population Health
University of Queensland
Most health experts agree that for future healthcare delivery challenges we need to develop and implement more health professions – many of them new – not rely on existing professions and certainly not rationalise. Yet at every stage there are setbacks: in legislative policy development (for example, the Practitioner Regulation Subcommittee of AHPRA has said that they will not even discuss the possibility of inclusion of new professions until 2014); education (witness the University of Queensland dropping its physician assistant program) and implementation (too numerous to mention, I guess midwives, PAs and Nurse Practitioners the ‘big ones’ here – though if Medicare Locals continue to be dominated by medical professionals these problems are likely to continue and become almost institutionalised).
If developing more health professions that respond better to the public’s health needs is considered an intrinsic part of healthcare reform, how can we get over these existing barriers that almost seem to assure this will never happen?
Dr Bronwyn Hemsley UQ (via Twitter)
How will primary health researchers/policy makers/providers utilise social media to engage with public to improve health? eg services un/blocking facebook/twitter etc, policies on disseminating (eg nhmrc use twitter well) what’s their strategy?
Dr David Briggs, Coordinator, Health Management and Gerontology Programs. School of Health, Faculty of the Professions, University of New England
PHC in the context of MLs will require new organisational relationships and different management skills to manage diverse organisational relationships. Do you think the PHC sector is ready to respond to these challenges?
What level of commitment is being made to research and training to ensure system capacity to respond to these changes?
Professor Mark Harris, Executive Director Centre for Primary Health Care and Equity
What is the role of Medicare Locals in developing or delivering multi-disciplinary care for disadvantaged patients who are less access to multi-disciplinary services and providers. How will they perform this role?
Merrilyn Walton, Professor of Medical Education (Patient Safety)
Sydney School of Public Health |Faculty of Medicine University of Sydney
Today patient safety is at the forefront of most hospital attempts to reduce adverse events associated with medication errors, transmission of infection, identity problems and inappropriate treatments and poor teamwork. What steps are being taken in the primary care sector to reduce patient harm?
Elizabeth Harris, Senior Lecturer, Centre for Health Equity Training and Evaluation, Part of the UNSW Centre for Primary Health Care
How will health promotion be integrated into the work of Medicare locals. How will it link to existing state-based services?
Ben Stock, President, Australian Society of Physician Assistants
What research is being conducted regarding the addition of non-doctor health practitioners to the primary care health workforce, in particular Physician Assistants? Noting the body of work being conducted by HWA on this area, and there is a NZ PA trial as well as the successful QLD and SA PA trials, and now qualified Australian trained PAs, one would expect that identifying how to assimilate these health professionals into primary care would be an area which needs attention?
Dr Jan Savage, public health
If we agree that a multidisciplinary, coordinated, collaborative approach to primary health care provision which is driven by the community and their needs is our preferred model, how do we ensure that this is reflected in research, policy and programs priorities and that the changes this encompasses are managed effectively and implemented in a sustainable way?
Professor Gavin Andrews, psychiatrist
Why do the Medical Colleges and DoHA still believe that patients want to see the Doctor? For anxiety and depressive disorders pre-programmed internet treatment is 13 times more cost effective than seeing a skilled clinician.
Excerpt below is from a forthcoming editorial
Comparing face to face group cognitive behaviour therapy with internet CBT for social phobia Andrews et al found both equally effective but that internet therapy required less clinician time and was 13 times more cost effective (Andrews G, Davis M, Titov N: Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry. 2011, 45(4): 337-340). Andrews reports that over 95% of people attending the St Vincent’s Public Hospital, Sydney. Anxiety and Depression Clinic opt for internet CBT over face to face CBT. No travel costs, ability to redo lessons and the convenience of doing the lessons at any time were the principal reasons. Andrews says: “Only the Medical Colleges and DoHA still think that patients want to see the doctor. Actually they just want to get better as quickly and cheaply as possible”.
Professor John Dwyer
Co-locating clinicians in a government funded building does not guarantee “Integrated Primary Care”. Does the panel agree that we need some MBS funded “teams” of doctors, nurses and allied health professionals offering truly Integrated Primary Care from the one practice in a “proof of concept” approach to determining the best model of Primary Care for Australians?
Many countries are encouraging people to enrol in prevention programs featuring personalised evaluation and longitudinal follow up. How could we introduce such programs in Australia and which health professional disciplines should offer the service?
Salvation for our ever more stressed hospital system is surely dependent on reducing the demand for hospital services through better community care. We need to be able to care for more patients in a community/home setting rather than a hospital. How can new models of Primary Care tackle this imperative?
Many would argue that the Federal Government wasted a mandate to create a truly integrated health system when it failed to structure the integration of hospital and community medicine. Now it has created large “Medicare locals” which are anything but “local” some being larger in geographic terms than the adjacent Local Hospital Network? The Rudd government’s plan was for a far more intimate arrangement. Despite these problems can the panel see ways of creating a much more patient focused health system than the one we currently provide?
An imperative for rural Australia is a return to the era of the competent “GP proceduralist”. How can we encourage this reform?
GPs will now be asked to document the health outcomes of their patients. Many are already swamped with paper work. How will doctors be able to cope with these demands? Is a “hub and spoke” model with centralized quality control and documentation the answer?
GPs are “specialists” with their generalist skills more necessary than ever before. Despite rigorous training equivalent to that of physicians and surgeons Medicare does not remunerate them as “specialists”. How can we convince the Government that increased payments for consultations would be cost effective and improve equity especially in areas where bulk billing (and the associated” turnstile medicine”) is essential and health outcomes are demonstrably compromised?
I could go on and on Melissa but all these questions stem from my frustration at the lack of vision in Canberra of what is needed to swing an unsustainable hospital centric system around to concentrate on prevention and better community care
Update: More questions have landed:
Sally Crossing, Co-Chair, Health Consumers NSW
Q: How will primary health care programs decisions include meaningful health consumer participation?
When will we have a debate/forum to discuss the best ways of doing this, particularly looking at best practice principles in use already?
Shannon McKenzie, Deputy Editor, Medical Observer
1. Do you think that GPs have now accepted – if somewhat reluctantly – the Super Clinic program?
2. In terms of medical registration, there is still some confusion over whether retired doctors would be able to teach. What do you think could be the ramifications if they were not permitted?
3. There are early reports from some divisions that GPs are not happy with the contracts for Medicare Locals, in particular a clause that states no one profession should dominate an ML board. Do you think GPs are holding too tightly to their role as directors of patient care? Do they need to relinquish their grip on primary care a little and invite more professions to take part?