Sustainable primary health care

As our population ages and medical technology and medication improves, an increasing proportion of our population will experience chronic disease. The current model of primary care, where a GP sees a patient for 15 minutes is considered unsustainable given our population demographics, patient presentations and number of GPs available.

Utilising Care Plus funding available in 2008, a practice nurse at Mornington Health Centre Anna Askerud, (now a lecturer in our School of Nursing), worked with GPs, nurses and the centre's management to help develop a new proactive approach to chronic conditions management. Under the programme, patients with chronic conditions were encouraged to book a subsidised appointment every three months. Before each appointment, the patient's file was reviewed to determine if any tests could be arranged prior to the appointments. The patient spent 30 minutes with the nurse who measured vital signs, reviewed any current issues and prioritised needs. The patients then saw their GP. This system maximised the patients' and health professionals' time and provided an enhanced quarterly appointment for those practice patients with multiple chronic conditions.

Five advanced practice nurses fulfilled the role of case manager for approximately 100 patients each. Having a case manager was appreciated by the patients, enabling them to phone in to ask what to do and having an accessible and timely point of contact. The case managers were also able to help patients take steps to address some of the issues they faced, for example arranging an exercise class, which helped meet social as well as physical needs, and helping connect patients with other community services.

There were positive outcomes for many patients and improved health management is likely to have reduced the number of emergency hospital presentations and resulted in an improved quality of life for patients and their caregivers. Anna's research showed that this model of patient centred care was highly accepted by patients and successfully utilised a multi-disciplinary and collaborative approach with potential for integration between primary and secondary care.

A well funded and long term national programme for high users of health care services becomes more urgent as our existing models of healthcare are increasingly unable to cope with an aging population with more chronic conditions.