What if I said, go to the doctor even when you are feeling good – healthy, and relatively symptom-free? You aren’t facing an emergency and things appear to be going fine. Why then, with all my years of experience in healthcare, would I suggest a visit to the doctor?
Before I answer, let’s take a step back. Even before the COVID-19 pandemic changed lives across Australia, our health system was under pressure. With an ageing population and two in three Australians experiencing chronic ill-health, resources were already stretched.
Recently the NHMRC Partnership Centre for Health System Sustainability and the Consumers Health Forum of Australia asked people what they thought of the health system, and 33% of respondents said they found it difficult to find the right healthcare. My own research at the Australian Institute of Health Innovation (AIHI) has shown that on average 60% of care delivered to adults and children in Australia is in-line with best practice guidelines, similar to results from studies conducted in the US and UK. We have also shown that 30% of all healthcare is waste or low-value. Waste represents treatment that is not needed in order to improve the health or wellbeing of the patient. This includes for instance the 40% of prostate cancer that is overdiagnosed (meaning it could have been left untreated and would not have caused harm in the person’s lifetime. That’s a longstanding story by the way – many men die with prostate cancer not of it).
With this combination of increased demand, limited resources, waste and low-value care, the signs are clear that change is needed. At the heart of the solution will be the consumers of healthcare, like you and me.
So, two key factors are required to drive change for the future of healthcare:
- Consumers who seek wellness
- A health system that learns and adapts
Consumers who seek wellness
Let’s return to my suggestion of going to the doctor even when feeling fighting fit. You go in and say “Doctor, I’ve come to see you because I’m feeling good at the moment”. And the doctor says “Then why are you here?” and you respond “Because I’d like to work in partnership with you to keep me that way.”
With this powerful statement, we demonstrate an understanding of our own health and are prioritising wellness. We are recognising the key ingredients of diet, exercise, continuity of care and prevention that will decrease the likelihood of experiencing severe or chronic ill-health. The aim is to keep you and as many other people as possible out of hospital by providing high quality services in general practice and the community, freeing up hospitals for more acute care and emergencies.
Take for example, diabetes which as the world’s fasted growing chronic condition effects more than 400 million people worldwide, or one in 11 adults. By far the most common form of diabetes is type 2 which is closely linked to obesity, a diet high in sugar and salt combined with a sedentary lifestyle. It can be largely prevented or managed with personal modifications to lifestyle, something a GP can provide guidance on.
A key component of managing type 2 diabetes is continuity of care including self-monitoring of blood glucose and regular monitoring by a GP using the HbA1c test. During the COVID-19 pandemic, our research showed a fall in the total volumes of HbA1c testing during the first wave of COVID-19. Further, the percentage of patients outside the target HbA1c level increased during 2020 putting more people at risk of complications.
Even after the restrictions brought about by COVID-19 are eased, the health system must work with consumers to develop strategies that better support a self-care regime including regular testing. A step in the right direction has been taken by several primary health networks in response to these findings. They have put in place measures to alert GPs of changes in trends of diagnosis and treatment and encourage them to reach out to patients who have missed appointments and, by reinforcing the need for regular care, avert the risk of a routine health issue escalating to an emergency or a serious complication.
This emerging era of consumers embracing wellness with health practitioners in support, and a health system that is guided by research evidence, is essential to a sustainable health system.
A health system that learns and adapts
Building into the system a capacity to learn and adapt, makes for a better outcome for patients and the system alike. Sitting at the intersection of technology and human behaviour, this is known as a learning health system. By harnessing information technologies, data mining, machine learning, genomics and individual experience, the learning system will drive toward more personalised, precision healthcare. It will put the latest evidence and best practice guidelines at the bedside of every patient, wherever they are located, ensuring high value care, reduced waste and less harm.
Serving people better is one issue, being easier to navigate is another challenge for the health system. More than a third of children have at least one long term health problem (such as asthma, diabetes or allergies) and require ongoing healthcare, often from several providers. This leads to multiple visits to emergency departments, GPs, hospitals, and specialists where each encounter requires families to recount the present concern as well the medical history, often after also managing a plethora of tests from various providers. The health system should do better.
Based on evaluation research in this area involving an implementation science specialist from AIHI, Associate Professor Yvonne Zurynski, a team of clinicians and managers from Sydney Children’s Hospitals Network set up care coordination teams to support families, developed a smart phone app to make information more accessible and established a 24-hour helpline. With this new support, emergency department presentations dropped by 40% for the children involved.
So, we can have a health system that values wellness and one that’s more flexible and constantly up to date. Let’s work on this together, with CHF in the lead.
About the author
Professor Jeffrey Braithwaite is Founding Director of the Australian Institute of Health Innovation, Director of the Centre for Healthcare Resilience and Implementation Science, and Professor of Health Systems Research at Macquarie University. He is Chief Investigator, NHMRC Partnership Centre for Health System Sustainability. Professor Braithwaite is a leading health services and systems researcher and implementation scientist with an international reputation for his work investigating and contributing to systems improvement. He has particular expertise in the culture and structure of acute settings, leadership, management and change in health sector organisations, quality and safety in healthcare, accreditation and surveying processes in the international context and the restructuring of health services.