While Australia’s primary care reform agenda may be ‘on track’, we need to improve connectivity with social services and other specialties to keep pace globally.
Primary care issues are global but Australia seems to be falling behind the pack in some aspects of care coordination and continuity, new Commonwealth Fund research suggests.
The study collated data from the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians and the 2023 International Health Policy Survey to analyse primary care services in Australia, the United States, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom from a patient and provider perspective.
Unsurprisingly, the researchers found that primary care is struggling worldwide, particularly in coordination of care with other specialities, accessibility and continuity of care.
Speaking to The Medical Republic, GP and AMA vice president Dr Danielle McMullen said the research “highlighted that many of the issues that we face here in primary care are not unique to Australia”.
“The issues of access, continuity, integration and coordination really do seem to be universal challenges, with some countries doing better than others here and there, but overall facing similar challenges across the world.”
Dr McMullen said that the universality of the roadblocks, many of which the AMA and others are targeting in their reform agendas, suggested that Australia was “on the right track”.
In fact, across all 10 countries, between 86% and 99% of the respondents reported having a regular place of care or regular doctor, with Australia in the middle of the pack at 94%.
But despite access to a regular place of care, only 45% of Australian had a long-standing relationship with their primary care provider of five years or more.
“Having a longstanding relationship with a primary care physician deepens patient trust and is associated with lower total health care costs and hospitalisations,” the researchers noted.
Dr McMullen said the data highlighted the need for a “connected system” to ensure that whichever doctor a person visits, they feel like part of one team.
“Also, things like My Medicare, where we can strengthen that relationship with the usual GP and the usual practice will help that patients feel more connected to the place that they usually get their care,” she said.
The study also analysed the comprehensiveness and breadth of primary care across the ten countries.
According to the research, 78% of Australian primary care providers surveyed offered home visits, surpassing the USA’s 29% but falling short of the impressive 100% of Germany, where it is a legal requirement, and the Netherlands.
Australia was, however, one of the frontrunners in offering after-hours primary care, with 82% of the physicians surveyed offering appointments after 6pm on weekdays or during the weekends.
According to researchers, “screening for the drivers of health, like housing instability or food insecurity, allows physicians to understand the social and economic circumstances that affect their patients’ health”.
“It is also an initial step in addressing those needs,” they said.
But only 13% of Australian healthcare providers were found to assess patients for their social needs and the vast majority, 82%, said there were major challenges that complicated coordinating this care, including the amount of paperwork required, not having systems or staff to make referrals, or limited information about available services.
“General practice does look at a person’s whole health and that extends beyond their physical health,” said Dr McMullen.
“Domestic violence, social isolation and loneliness, housing security are all vital to someone’s health.
Dr McMullen said the data may suggest GPs should be asking quesitons about these aspects more often.
“But doctors also need to be supported when they identify a patient who has social support issues,” she said.
“We’ve had callouts from a number of doctors that having social workers, for example, more integrated into general practice here would really be helpful for doctors and for patients.”
According to the research, coordination with other specialities also remains a problem.
Despite a third of adults reporting that their regular doctor “often” or “always” helped coordinating specialist care, only 53% of Australian primary care providers reported “usually” receiving information from specialists about medication or care plan changes for their patients.
Dr McMullen said the data echoed the rhetoric that has been circulating for years.
“It’s a 50/50 chance as to whether you get a good quality summary back from [other parts of the health system], whether it’s a discharge summary or an outpatient specialist appointment or even some private specialist appointments,” she said.
“That conversation and communication back to general practice is essential.”
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According to Dr McMullen there have been some improvements across some states and territories, “but we need to do better”.
“That’s where the national digital health strategy will play a part in having streamlined standards and interoperability across our IT systems, so that that stuff that’s a no brainer is more automated and we have a connected system,” she said.
“It’s not just about being making our jobs easier.
“It’s about making sure that that essential information is where it needs to be for patient care.”
