Synergia - Design Realise Sustain

Synergia developed a series of case studies profiling the use of information in primary health care to improve clinical practice, organisational performance and health outcomes. The overall aim of the project was to highlight successes and learnings to motivate wider health sector uptake of innovation in health care information.

Issue

The study began with an on-line survey of people working in information in primary care, to identify the breadth of existing activity occurring in the primary care information environment. The focus was on the everyday use of information, not on the technical detail of information systems, so that we could see the uses that information was being put towards in improving the functioning and outcomes of primary health care.

From the responses received, eight case studies were selected for more in-depth interviews, from Northland, Auckland, Waikato, Gisborne, Hawke’s Bay, Wellington, Wairarapa and Christchurch.

Solution

Some of the key findings included:

Patient registers can provide a population view for individual primary health care practices and for primary healthcare organisations, and can use that information to identify target populations, and to develop health services to meet those populations’ needs.

Effective targeting is a cornerstone of reaching high-need populations and for achieving efficient use of resources. The General Practice clinical information resource provides the core for this capability; when it is combined with analytical capability and communications and engagement with patient populations, sharply focussed and integrated services can be developed.

Many initiatives showed the effectiveness of tapping into a whole system response, reaching out to both health services and community networks. Key to this is starting at the stage of change appropriate to the patient, an assessment of the patient’s broader social conditions and use of that assessment to take the patient through other service pathways.

A number of the case study initiatives had a very clear ‘hub and spoke’ model that enabled effective coordination and integration of care. The hubs were the general practice settings, which offered the core GP overview and were also the information hub of practice-based clinical information sets. The spokes were specialties within primary health care, such as such as nurse practitioners, midwives, mental health care coordinators and other field workers.

Many outreach initiatives explicitly built in a patient self-management approach, through interacting with people in familiar settings, including homes, workplaces and marae; and developing care plans to support healthier living. People working in these initiatives also developed a clear understanding of the behaviours and interventions needed to improve health and/or manage conditions.

Where trust existed between people working in primary care, and PHOs and MSOs, the information that was gathered, analysed and fed back tended to have a high degree of engagement with patients and communities.

Outcome

An important function of some of the information systems in each of the case studies was their support to the day-to-day operations of primary health care as a small business. Some successful initiatives brought together collection of consultation data with facilitation of claims payment and other administrative processes, to ease the administrative burden.

More fundamentally, developing information capabilities honours the expertise and interest of health professionals, and their motivations for entering practice. Developing capabilities that integrate with existing systems allows practitioners to focus on providing care and supports improved patient outcomes.

Synergia is now leading a new phase of research in this area, looking at how information in primary care can better support self-management by people and their families or whanau, particularly those with chronic conditions.