Home' Australian Ageing Agenda : AAA Spt-Oct 2013 Contents Like most aged care providers, Bupa Care Services has
struggled with the well-documented challenge of getting
doctors to make timely visits to a residential aged care
home. It's a vexing problem but Bupa has an idea that
they think will reap results -- for residents, for the wider
health system and ultimately both themselves and other care
providers -- and they're willing to bankroll the experiment.
Bupa has established a trial involving recruiting its own GPs,
putting one in each home -- on staff and on the payroll -- and
seeing how that works to improve health outcomes for residents,
increase skills and professionalism for other care staff, and
hopefully positively influence the educational and professional
appeal of aged care within the health sector.
In the bigger picture, it could also lead to fundamental
changes to the way the aged care system is designed, funded and
accredited in the future.
The randomised controlled trial over two years is being led by
Andrew Robinson, professor of aged care nursing and co-director
of the Wicking Institute at the University of Tasmania.
It involves 15 Bupa residential aged care facilities in seven
geographical clusters around Australia. As the 'controlled'
part of the study, a range of variables are being measured for
up to 12 months prior to the GP coming on board, to establish
benchmarks. The three principle variables in the study are
transfers to hospital, polypharmacy and falls; with a large number
of sub variables also being measured.
The 'GP intervention' -- meaning the point at which the GP
joins the staff -- is being rolled out progressively across the seven
clusters of homes every nine weeks over the first 12 months of
the 'stepped-wedge' study design. In effect it means that all 15
facilities in the study will receive the intervention, although at the
end of the first 12 months, the first cluster in the trial will have
been operating with the GP on staff for most of the year while
the last cluster to come on line will have had almost a year as
the control and will have only just begun the intervention. Data
collection will continue for another 12 months.
A BIG IDEA
Putting a GP on the payroll in every residential care home might
sound like a big call but it's not a revolutionary idea per se. The
Netherlands has offered postgraduate training for doctors to
specialise as nursing home physicians since 1990 and Bupa's own
Spanish operation, Sanitas, also has doctors on staff.
But funding systems and cultures vary from place to place, and
bringing doctors onto staff isn't an easy task in Australia. It's rare if
not unheard of; and while some facilities have negotiated GP clinics
for a day or two each week or fortnight, it's a very different prospect
to bringing the GP in-house as a permanent employee. There is no
established workforce model for it, much less a funding equation.
So Bupa hasn't entered into this initiative lightly. They admit
they have been prepared to take a risk. But the benefits could be
seismic in scale.
Medical director, Dr Daniel Valle Gracia, who has come to
Bupa Australia from Sanitas in Spain, says the model represents a
paradigm shift in the way medical care is provided to frail elderly
people in care homes. Not only does the model bring care to the
point of need, it opens it up to include prevention.
"It's a paradigm shift," says Gracia. "At the moment, when
medical care is provided, people usually ask about 'what
happened'? But we are working on what we can do proactively to
prevent the problem happening in the first place and improve the
health and quality of life for residents.
"It is putting the residents and their families at the centre of
everything and seeing what we can do to get the best results. It will
help provide more sub-acute care in the homes and avoid hospital
transfers. Also, better palliative care and more choice to residents
about where and how to have treatment," said Dr Gracia.
A HOLISTIC APPROACH
Managing Director of Bupa Care Services Australia, Louis Dudley,
says the trial, if successful, could alter the way we provide aged
care in Australia.
"Doing primary and preventative care for people is a worthy
science; to try to find out how it can change or influence outcomes
for people and ultimately the way we provide care," he says.
Dudley acknowledges that there are costs involved in
establishing the model but insists that looking at individual cost
centres and expenses is unhelpful.
"If you were to look at particular costs, you might say, oh that
costs more than this so we can't afford to do that. We are taking
a holistic approach to both the costs and benefits, so upfront we
are measuring what we currently do and how much that costs in
terms of both care outcomes for people and financial costs for us
and the system generally.
Professor Andrew Robinson
In one carefully conceived
audacious initiative, Bupa
has opened the prospect
of a whole new model
of residential aged care
with spin-off benefits for
workforce and potentially,
for government policy too,
writes Keryn Curtis.
36 | SEPTEMBER -- OCTOBER 2013 | AAA
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