Web-based resources provide pathways to healthcare
Western Sydney is introducing a HealthPathways program for local healthcare providers, based on the system pioneered by the Canterbury Initiative in New Zealand and also up and running in the Hunter New England region of NSW.
HealthPathways is a web-based information portal for a range of common conditions that is tailored for local healthcare practitioners based on the resources available in the area.
It has been used since 2011 in the Hunter New England region, and is now being introduced to the Barwon region in Victoria, the NSW central coast and in western Sydney, where it is being championed by the Western Sydney Local Health District (WSLHD) and the Western Sydney Medicare Local (WSML).
Tim Usherwood, a professor of general practice at the University of Sydney and deputy chairperson of WSML, said the original concept for HealthPathways was developed by the Canterbury Initiative, although there is a similar project running in the UK called Map of Medicine.
“The Canterbury Initiative essentially provides a website to be accessed by general practitioners and other healthcare providers in the Canterbury region, and it provides care pathways for a long list of common health problems,” Professor Usherwood said.
“It's an idea that has been around in hospitals for a long time, where it is possible to map the care of conditions and hence to standardise them. This is a similar model for the community.”
The care pathways are evidence-based and reflect national standards of care, but they are tailored to the local resources and services available. The tailoring of the information means that it will be easier for practitioners to identify locally available services for particular health problems, and to find out their criteria for referrals and accepting new patients.
For type 2 diabetes, for example, the HealthPathway would include information on local dietetic or podiatry services, but also locally agreed guidelines for referring retinal abnormalities to an ophthalmologist.
“Another example is chronic kidney disease,” Professor Usherwood said. “A nephrology clinic is likely to prefer to see only people with more advanced disease or with particular complications. It would also want specific things done before the patient is referred.
“With HealthPathways, you can have a local conversation about the referral criteria, what things might be required before referral, and then write those things into the local pathway. There is a national standard of care, which is evidence-based, but this tailors it to local needs.”
The information portal will only be accessible by healthcare practitioners and will be password-controlled, although a parallel site for consumers is also being considered, he said.
The western Sydney partnership has been given permission to use the framework for the website developed by the Canterbury Initiative, which will be repopulated with local information.
“If the GP sees a condition that perhaps they haven't managed regularly or if they are wondering if there is some new local service that they can refer the patient to, they log in and they click on the particular health problem they have identified,” Professor Usherwood said.
“Let's say it is cognitive impairment and dementia. They can click on that and it will start with a brief description of what the pathway is about, and then it would include a recommended test of cognitive function, which the GP can administer to the patient.
“If there is a concern then the pathway would include a list of recommended tests that the doctor can do, and perhaps some initial advice on risk stratification – say mild or significant impairment – and then based on that it might give information on local aged care assessment teams and their contact details and referral criteria.
“It might also include links to information about NGOs concerned with aged care and cognitive impairment, and perhaps information sheets available for consumers and carers. Then there would be advice on follow-up.”
WSLHD and WSML have begun work on several of the pathways, the first for diabetes and the second for cognitive impairment and dementia, but there is a whole host of other common conditions that will be included, he said.
The two organisations will be responsible for maintaining the currency of the information, but they are also looking to include the private specialist and allied health sectors, and non-government organisations in the program. Professor Usherwood said the Sydney Children's Hospital Network had also expressed interest in taking part.
“We see this initiative as a really important way of promoting quality of care within the region,” he said. “The reality is that most of a GP's work is dealing with 30 to 40 common conditions but there is a very large number of other conditions that we don't see that often, but we see enough that we need some help with it. A lot of care can be provided in the community with some advice, not just on best practice but how you implement that best practice within your particular region.”
The initiative is also being supported by the Agency for Clinical Information. For more information, see the project's website at wsproject.healthpathways.org.au.
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