Human hands holding earth global over blurred city night background. Elements of this image furnished by NASA
This edition of Health Voices brings together two concepts: personalised care and social prescribing. These ideas at first might seem quite distant, yet on deeper reflection we see they can have a powerful synergy.
For the good of the planet we are urged to “Think globally, act locally”. For our own health we can all benefit if we “Think socially, care personally.”
By learning from the health experiences of our society, we can adopt the lessons to our own health care. There are a variety of strands to ideas about social prescribing and personalised care on offer from around the world and around Australia.
We are fortunate to have once again a diverse range of knowledgeable writers for Health Voices, in this case stretching from England to New Zealand to Alice Springs.
James Sanderson of England’s National Health Service writes that clinicians will always be experts in conditions and diseases. But people are experts in themselves. It is the combination of this expertise that can unlock different routes of care. People need to be able to make a fully informed choice as part of this process, he says.
Meanwhile from New Zealand GP innovator, Dr Kerry Macaskill-Smith, shares the latest developments in personalised medicine that only a few years ago seemed more like science fiction. She predicts that by 2025 every doctor will be using pharmacogenomics (Pgx) – a personalised medicine tool – for all of their patients in the same way that doctors use any other lab test like blood counts.
From Central Australia, Donna Ah Chee presents a different perspective on personalised care in writing about Aboriginal Community Controlled Health Services. These have demonstrated both the benefits and limits of personalised care, showing how personal choice in health needs to be supplemented and supported by processes of collective empowerment, she says. Such collective empowerment then supports and reinforces the capacity to engage in personalised health care at the individual level.
Consumer advocate Linda Beaver reports on a variety of patient encounters where the reasonable and individual needs of patients are not met. People just want to feel included in the decision-making process and respected for making an informed choice. These may not align with the health professional opinion, but it is relevant to patients she says.
Tim Usherwood points out that precision therapeutics is not the only emerging aspect of personalised healthcare. Healthy living groups can use social media to connect patients with real humans and with an avatar coach which uses artificial intelligence to personalise its messages to the patient’s needs.
Anna Peeters has explored the very personalised focus of rapidly emerging precision care. “Potential consumer benefits of precision public health include supporting a more informed consumer, through increases in direct to consumer testing, and improved health outcomes and reductions in inequalities in health, as health education and promotion strategies become more tailored to an individual’s genetic make-up. One example of this genetically tailored prevention is the development of new heart disease risk prediction scores, taking in genetics as well as the traditional risk factors such as smoking and high blood pressure.”
On the same theme, Jeffrey Braithwaite says we need a “learning health” system. “By assembling knowledge, data and practice information in real time to support the best diagnosis and care decisions, a learning health system could help avoid the very real problem of providing too much care, too little care, or care where there is little benefit. Equally, care may be missed where it is needed most. “
Award-winning pharmacist, Brad Butt, can demonstrate just how varied are the calls for personalised care at his pharmacy. In just a few days recently, he and his team of six pharmacists performed a variety of personal care services which included removing an overgrown earring from a seven-year-old’s ear lobe and providing after-care support, counselling in two cases of self-harm, referring these patients to their GP, dressing wounds and reviewing their medication regimens, and removing a small piece of LEGO from a four-year-old boy’s external ear canal.
The benefits of social prescribing can come in many forms, not least in countering the impact of social isolation on mental health. Jeremy Kennett writes examples where supporting people living with loneliness results in mental and physical benefits. One patient referred to the social prescribing program, was supported to qualify for the Disability Support Pension, which meant he could now afford his medication. “He’s using his medication now and his blood sugars are down. But then his overall mental health and thinking as well is much better. When he came before, he was just bitter about everything. And now when he comes, he’s happy, smiling.”
Christine Morgan has travelled around Australia listening to communities about mental health issues. She advocates thinking broadly. “While our health services, community organisations and funded mental health and suicide prevention programs certainly have a critical role to play, we must consider the broad range of issues impacting on people’s lives and consider all of the touchpoints where we have an opportunity to make a positive difference.”
Deb Kay proposes five goals for our health system. In ten years’ time, she says we could be looking at health and social care systems which are collaboratively led, informed by consumer-principles with quality processes to improve the health care people need, efficiencies gained by integrating people’s goals and self-management; and greater accountability for providing health care in ways people need, want and value. “Now that’s exciting,” she says.
When frequent patients come seeking a chat and reassurance, GPs provide that immediate social outlet. We then look for ways to help them re-engage, to stop them falling out of society, writes Dr Harry Nespolon. “We know now that loneliness and social isolation are major risk factors for mental illness, particularly when it comes to depression.”
As Gabrielle O’Kane says, focussing on single diseases is no longer adequate. Contemporary health care also demands greater consideration of patient preferences, motivation and personal goals for treatment, underpinned by effective therapeutic partnerships between patients and health care professionals.
Jason Kevin Groves is positive about his personal experience with mental health care although acknowledging others might see differently. “Perhaps one day, we will have a perfect system, but until then more public dialogue is needed to lessen stigma of mental illness so that people who have issues will feel free to speak up and get the help they need.”
Karen Booth highlights five roles nurses can play in patient-centred care. Community-based, practical, patient-centred care is exactly what primary care should be. As she says it is what we know that keeps people well and out of hospital.
The strong demand from consumers to know more about their pathology tests has been demonstrated by Lab Tests Online Australasia, says its chair Susan Benson. LTOAU is a non-commercial online consumer health resource explaining laboratory tests in plain language which has drawn 2.2 million users in the past 12 months.
General practice leader, Charlotte Hespe, who describes herself as a “specialist generalist” describes her care of an elderly patient with multiple conditions, Dr Hespe writes: “My role is to assist in ensuring she has appropriate health literacy (the ability to process and understand the health information and health services that inform health decision making) and health activation (engagement in managing her health care with the appropriate knowledge, skills and confidence).”
The variety of contributions to this edition of Health Voices reminds us that health care is fundamentally about people and the health outcomes and experiences of care they achieve is very much a product of how activated they are.
We leave the last word to CHF’s latest research study Patient Activation in Australians with Chronic Illness which canvassed a nationally representative sample of over 1,700 respondents to gauge their level of active engagement in their own health care. The results suggest that chronically ill patients with the highest levels of patient activation have improved health care experiences and outcomes compared to those with the lowest patient activation levels. It supports CHF’s long held view that more consumer engagement in health care, both at an individual level and in the design and management of health systems would yield significant advances for health care overall.
CHF’s key recommendation from this research is that primary health care and prevention plans need to include measures to support personalised care and strengthen the capacity of people to manage their own health care. Leveraging patient activation to navigate the range of services they need to exercise choice and control in their healthcare as part of a comprehensive national primary health care reform strategy would deliver high value care for those with chronic illnesses.
