Primary Care Integration
Overview:
Improving integration and coordination of care is an identified priority area within the Australian Better Health Initiative (ABHI) – a $500 million joint Australian, state and territory government initiative announced by the Council of Australian Governments (COAG) in February 2006 to promote good health and reduce the impacts of chronic disease for all Australians.
In July 2006, Australian Health Ministers approved the ABHI implementation plan, including approximately $28 million in Australian Government funding to be used to improve the ‘integration of primary health care service’ – what the Department of Health and Ageing (DoHA) has called the Primary Care Integration Program.
State and territory governments have also contributed funding to this component of ABHI and are progressing their own integration initiatives.
The overarching national aim of the ABHI Primary Care Integration Program is to promote solutions to primary care integration between general practice and other local health providers that will assist in delivery of more ‘seamless’ patient care. This is particularly important in the context of better managing patients with chronic or complex conditions who often receive care from multiple providers, funded by different sources, across different settings.
In South Australia, General Practice SA was funded to implement the ABHI Primary Care Integration Program across the state to further support and encourage general practice to incorporate integrated primary health care into their core business and to work more collaboratively with other primary care providers in the prevention and management of chronic disease.
An essential requirement of integrated care is to establish collaborative relationships between the different primary care service providers. This Program will help to either establish or strengthen communication channels and information sharing between the public and privately funded primary care sectors so that patients receive more streamlined care.
SA Network Integration directions
Program Objectives:
The objective of this Program is to encourage more integrated patient centred care by supporting general practice across South Australia to:
- Engage with the work of local GP Plus Health Care Initiatives, and other state funded primary care initiatives that seek, to improve service co-ordination and integrated chronic disease prevention and management;
- Communicate and link better with other primary care providers;
- Make better use of existing primary and community care services including commonwealth, state and non-government organisation funded services with a focus on patients with chronic disease;
- Utilise tools/strategies that will assist in better managing patients with chronic disease (e.g. disease registers, referral, recall & reminder systems, care planning); and
- Contribute to work around developing local chronic disease care pathways (generic or specific) or other priority activities with a Chronic Disease Management (CDM) focus.
Another key objective is that Divisions progress sustainable systems changes that support more integrated primary and community care services into the future.
Regional Coordinators
There are currently 13 Regional Coordinators for the ABHI PCIP across SA. The Regional Coordinators' activity will primarily be focused on improving outcomes in Chronic Disease Management by working collaboratively with general practice and other primary care providers at the local level. Regional Coordinators will work closely with their local Health Services in meeting the Program objectives to minimise the risk of duplication and lack of coordinated effort in the primary care integration area.
This may include (but is not restricted to):
Working with GP Plus Health Care Network (or other local health networks in rural areas) member agencies, non government organisations and general practice to
- develop and test practical arrangements for a shared approach to identifying clients/patients with chronic disease for whom comprehensive health and medical assessment and/or multi-disciplinary/multi-agency care planning is needed;
- Facilitate access to CDSM programs and lifestyle and risk factor programs; and
- initiate, facilitate and coordinate multidisciplinary care planning that meet MBS guidelines and accessing MBS rebateable allied health services where appropriate.
- Develop care planning arrangements to enable the systematic provision of care by the participating agency(ies) and the general practice(s) for these clients/patients requiring multidisciplinary care.
Australian Department of Health and Ageing ABHI Overview
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/feb2006coag03.htm
http://www.health.vic.gov.au/communityhealth/gps/mbs_gp/
http://www.health.vic.gov.au/communityhealth/gps/index.htm
Program Contact(s):
| Name: | Cathy Zesers |  |
| Position: | Member Services Manager, Primary Care | |
| Email: | cathy.zesers@gpsa.org.au | |
| Phone: | (08) 8179 1733 | |
| Fax: | (08) 8271 8344 |