Webinar: How alternative models of care are changing the health system

The third webinar in the PCHSS 2020-2021 Webinar Series was on how alternative models of care are changing the health system and healthcare.

Event summary:

As healthcare costs continue to rise and inequities in access grow, the need for a greater diversity in models of care – models that are high-value, effective, and affordable – has never been more apparent. Moderated by Professor Len Gray (PCHSS and University of Queensland), the session featured presentations by Professor Rachelle Buchbinder (PCHSS and Monash University) and Dr Tracey Tay (ACI).

Professor Buchbinder shared her work on evaluating early supported discharge and hospital in the home, discussing the extent to which early supported discharge and hospital and the home actually reduce cost and improve patient outcomes.

Following this, Dr Tay discussed the work by NSW Health in developing a virtual care accelerator in response to COVID-19. She highlighted the increase of clinical consultations through platforms such as MyVirtualCare during the pandemic.

During the session, the speakers received several questions from attendees and they provided the following responses:

Are there HitH data available for children aged <15?

Prof Buchbinder: Yes we have the data across all ages. In the public setting most of all the admissions of children aged <1, and between aged 1 and 5 a high proportion of them are Hith, but it didn’t seem to be a factor in the private setting.

Is there information about how best to utilise ‘modalities’ for patients in lower socioeconomic areas/lower literacy with technology and also requiring interpreters?

Dr Tay: it is a very good question and a real concern. To have access to telehealth you have to have phones, computers and data. For people for whom data has been a problem, what they tend to do is switch on their camera briefly show the wound (or whatever it might be) and then switch back to phone.

Is there much data about staff members involved in HiTH models of care e.g. medical vs. allied health vs. nursing?

Prof Buchbinder: In our hospital in the home setting there is a GP that that usually visits daily for the strokes, there is a rehab physician that might go less frequently, and predominantly the care is delivered by nurses and physiotherapists.

Has your project looked at virtual care across multidisciplinary team which includes primary care as part of the team?

Dr Tay: Yes. Some of the exemplar models identified have connected GPs/community nurses and allied health with specialists – high risk foot services, virtual critical care hubs. There are many examples that are business as usual where specialists (medical, nursing, AH) meet patients with their GP in their GP’s surgery eg diabetes care in the community.

With the mentioned preference for telephone consultation, particularly for socioeconomically disadvantaged, do you anticipate telephone consultation being included in the virtual care NWAU loading in NSW?

Dr Tay: This is an ongoing discussion.

Was there a longitudinal look at decline in patients accessing virtual care towards the end of 2020, preferring face to face and are there any patterns as to the reason why?

Dr Tay: The trend is definitely back to f2f although still higher than pre-COVID. It also varies significantly between clinical contexts and with the degree of local support. There is a lot written about what is required to do “good” virtual care. I believe that the better way to look at it is to understand what do clinicians/managers require to make virtual care a normal option in the course of providing care. It is a mix of the right technology and skills available but with the ability to redesign work processes and flow to provide an experience and outcome that is as good or better than f2f. I’ve attached a good reference to describe the change management elements required. The ACI/eHealth partnership aims to address the tech/clinical change management aspects over time.

Any PROMs and PREMs being collected? Any difference in those between virtual and usual?

Dr Tay: In NSW, the Bureau for Health Information (BHI) has collected the first patient/client questionnaire. PREMs are collected in many sites e.g. outpatient clinics for both f2f and virtual so we now have to split those and compare.

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