Home' Australian Ageing Agenda : AAA Sept-Oct 2017 Contents Dr Edwin Kruys
Support digital health solutions
THERE HAVE been many occasions where I have been
able to avoid a hospital admission through a visit or phone
call with staff at residential aged care facilities. It helps
if doctors know their patients and vice versa. Looking
after our elderly, often more fragile, population requires
continuity of care and a whole-person approach.
Continuity is the bread and butter of general practice
so it makes sense that the usual GP practice continues the
care once people move to a residential facility or, failing
that, a new GP practice takes over the care from that point
There are a few enablers for better integration between
residential aged care and primar y care.
First of all, Medicare Benefits Scheme (MBS) funding
for digital health solutions such as phone and video
consultations and secure electronic messaging between the
GP, facility, pharmacy and other parties would help to solve
many problems during the in-hours and after-hours period.
Secondly, the national digital My Health Record has
the potential to play an important part if used by all
health professionals and hospitals looking after a resident.
Although it is a work in progress and there are some
important issues to sort out with the My Health Record,
having a shared electronic record would
Thirdly, digital solutions will not work
if people are not on the same page. We
used to have funded joint meetings with
residential facilities, which were ver y
beneficial for integration between aged care and primar y
care. During these meetings shared goals were formulated
and systems and procedures were reviewed and, if necessar y,
adjusted to make them work for all parties.
Finally, if we want GPs to visit aged care facilities it
should be incentivised appropriately. For many GPs who
have a practice and staff to look after, it makes more sense
from a business perspective to work in the practice rather
than to travel to a facility.
The MBS should also acknowledge that a large part of
the work GPs do in aged care includes non face-to-face time
including coordination of care, administrative procedures
and meetings with staff, family and allied health.
Dr Edwin Kruys is a GP on the Sunshine Coast and vice
president of the Royal Australian College of General
Embed integration in care standards
THAT WE NEED to ask ourselves such a question reflects
a troubling disconnect in our health system.
In an ideal world residential aged care would be an
everyday part of our primar y care system, where those
people most likely to have chronic medical conditions and
who are at risk of social isolation, are routinely placed in the
centre of our health system.
A primar y healthcare system that accepts and is supported
to make residential aged care a central priority could go a
long way to improve the lives of many thousands.
There are key challenges in integrating aged care with
primar y care, not least the special challenges of care for the
aged, the residents’ loss of social contacts and the physical
separation from community inherent in residential care.
In many cases the resources to maintain an effective
integrated primar y care approach are just not available in
residential institutions: doctors may visit rarely and access to
allied therapies and support may be unavailable.
The layers of regulator y provisions and oversight aimed
at maintaining quality care often falter. What is needed is an
effective, coherent set of standards to stimulate integrated
primar y care for residential patients.
The solutions are not easy to provide or pay for. But a
useful start would be to establish a set of agreed goals to
stimulate integration and emergent new models of care.
These new models could feature in-reach primar y health
care services, geriatric outreach assessment ser vices and
digitally-enabled care through to support to uptake the My
Health Record in aged care facilities. Many of these exist in
pockets, but we want to see much wider
Integration is best achieved closest to
where care is planned and delivered and
where relationships between providers
are more easily fostered. Primary Health Networks working
locally with the aged care sector and local hospital networks
have a key stewardship role to play in improving the
integration of our aged and primary care systems.
The following seven principles of consumer-centred
healthcare advocated by CHF would provide a framework
and impetus for integrating primar y care with aged care:
• coordinated and comprehensive care
• trust and respect
• appropriate care
• planning and governance
• whole-of-person care
• informed decision-making
• accessible and affordable care
These principles when applied to integration in
residential aged care provide a rationale for promoting the
sort of care we expect in the community.
They have the potential to challenge those attitudes which
tend to put residential aged care in a separate, overlooked
categor y of the health system bereft of integrated care.
Leanne Wells is CEO of the Consumers Health Forum
20 | SEPTEMBER – OCTOBER 2017
We asked four industry figures:
How do we better integrate residential
aged care with primary care?
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