A significant feature of the 2019–20 Federal Budget for healthcare professionals, and patients and their carers was that it foreshadowed a shift in funding arrangements for chronic disease management within primary care for people aged over 70.
The changes provide for more flexible, personalised and coordinated care, and may well transform how we deliver palliative care within primary healthcare.
The $448.5 million investment provides additional funding to participating general practices to better support high-needs patients. Voluntary enrolment of patients with their general practitioner at their chosen general practice will provide an annual incentive payment to support the new more flexible care arrangements.
The changes should encourage the primary care team to provide some consultations, referrals, prescriptions, test results and monitoring remotely.
While precise details of the new annual funding to practices per patient have not yet been released, it will be used to enrol approximately 100,000 patients over three years.
How the additional funding is used by practices will vary—but there is no reason it could not be used to improve access to primary care nurses for people with palliative care needs.
Palliative care is defined by the World Health Organization as ‘an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.
For some people palliative care is needed only during the last few days or weeks of life; however for others, it may be for months or years. Primary care providers must be able to recognise when a patient is approaching death and when they would benefit from palliative care.
Care for these patients centres around making sure their physical, emotional, spiritual and cultural needs are met, and that their dignity and privacy is respected. Primary care nurses—as part of the multidisciplinary primary care team—are well suited to delivering this kind of holistic patient-centred care. However, in order to provide such care primary care nurses require appropriate skills, knowledge of referral pathways and confidence, as well as funding for this type of care.
Access to palliative and primary care by older Australians either with chronic disease or life-limiting illnesses can be very difficult and in this context providing some care using non face-to-face methods has several advantages. Care can be more responsive—primary care nurses can ‘check in’ with patients, allowing early identification of any changes. It can also facilitate easier and less burdensome monitoring of symptoms, allowing care to be more personalised.
Australian studies show that 60–70% of Australians wish to die at home. Primary care providers are integral to providing appropriate at-home care, which may reduce unplanned after-hours hospital admissions and can improve timely access to specialist palliative care when necessary.
As part of the End of Life Directions for Aged Care (ELDAC) consortium the Australian Healthcare and Hospitals Association (AHHA) has created the ELDAC Primary Care toolkit to support health professionals such as primary care nurses in providing high-quality care to older Australians.
The Primary Care Toolkit sets out the various steps involved, including catering for people of diverse religious and cultural backgrounds. There are links to fact sheets, guides, discussion starters, patient resources and podcasts, as well as resources supporting quality improvement in the primary care setting.
Access to clinically appropriate, high-quality and safe palliative care must be improved. We believe that the resulting benefits to older Australians will include better health, fewer hospital admissions, shorter hospital stays when admitted, and improved quality of care overall.
Katharine Silk, Integration and Innovation Manager at Australian Healthcare and Hospitals Association (AHHA)