Putting the patient in driver’s seat
The Covid-19 pandemic appears to have changed this country, possibly permanently. In a week-long series, The Dominion Post considers those changes and their possible impacts on the Wellington region. Today, Bridie Witton looks at the future of healthcare.
It has been the best of times and the worst of times for our health system. Combatting the Covid-19 pandemic has exposed not only the hard-working heroes on the frontline of our national healthcare set-up but also many of the problems at its core.
These include a lack of leadership and co-ordination within the district health boards, chronic underfunding and antiquated systems that undermine efficiency and ease of access.
But we have also had a glimpse of the ways in which new technology and thinking might change national health, and maybe for the better.
Changes that are likely to put the patient in the driver’s seat.
Virtual consultations, by video or by phone, became the new normal as
physical interactions with clinicians and GPs were reduced over concerns about virus transmission.
That was a problem for some, but many doctors and patients found the new technology allowed for
more timely and convenient appointments.
Dr Ruth Large, chair of NZ Telehealth Forum, said virtual tools added to the patient’s experience.
‘‘What video does again is change the power dynamic . . . you are in your own environment, not someone else’s office.
‘‘We know an awful lot of patients won’t take advice from clinicians because they don’t trust it. People don’t take medicine because they don’t understand it, or they don’t believe it’s going to help them.
‘‘We want to be able to move that relationship so the patient has more power,’’ she said.
Healthcare systems expert Professor Robin Gauld said improved use of technology could help the sector focus more on patient experience and convenience.
‘‘At the moment you wait a whole day to see a specialist at a public hospital,’’ he said.
But with smart use of technology like QR codes, you could ‘‘scan in and scan out and you’re not wasting your time sitting in a waiting room’’.
One problem was that DHBs had ‘‘neither the will nor leadership capacity’’ for change.
Covid-19 has exacerbated existing issues in the health sector, like elective surgery wait lists.
‘‘We are already behind the eight ball with the ability to treat non-urgent or planned treatments,’’ Gauld said.
DHBs across the country will need to clear a backlog of some 20,000 elective surgeries, 60,000 specialist appointments and thousands more out-patient treatments deferred because of Covid-19.
The Association of Salaried Medical Professionals estimates as many as half a million sick Kiwis are missing out on treatment.
It appears there’s an app that could help with that.
One aimed to bridge the gap between patient and doctor was launched last month, called Well Revolution.
GPs can consult with patients through the app. Patients can use their regular GP or use doctors on standby.
A further GP app, Tend, is due to launch mid-2020.
But some experts have warned of the dangers of competing apps in an already-complicated health sector.
‘‘I liken it to building a home with competing architects,’’ Gauld said.
Large also warned of the disruption such apps could cause.
‘‘We have a firm view that there should be collaboration, and we should support good quality patient care and support a consistent relationship with the GP, or with a clinician.’’
Some of those GPs are struggling, with revenue locked down by fewer patient visits.
Gauld has called for GPs to be fully funded, while doctors could be upskilled to take on some follow-up appointments which usually take place at hospitals.
Primary Health Organisations and their general practices are funded according to the number of people enrolled, not the number of times a provider sees patients.
‘‘GPs are hurting badly,’’ he said. ‘‘We need to change the model for GP funding, we need to look at fully funding GPs,’’ he said
Auckland GP Dr Stephanie Taylor says many GPs are able to work from home through patient portals which allow video conferencing.
But the ability to send prescriptions to most pharmacies can be limited – especially as most GPs do not have a fax.
‘‘This presents challenges for many parts of the community, particularly the elderly, in accessing treatment and medicines in their normal way,’’ she said.
‘‘At the same time the impact on the continuity of GP practices and community pharmacies during this time has been significant.’’ Software which allows GPs to send a digital prescription to a pharmacy to be delivered by courier could be rolled out in all pharmacies by the end of the year. Variations in expertise across our hospitals, creating a postcode lottery of care, was ‘‘one of the scandals of our time’’, Gauld said.
‘‘DHBs, there are 20 of them, and they haven’t been ideal. Now there is a big coordination question.’’
He suggests a chain of managers operating across the country, who focus on sharing best practice and expertise – instead of DHBs operating as ‘‘a lot of big corporations.’’
But any serious reform depends on the final report of the Health and Disability System Review panel chaired by Heather Simpson, which was scheduled to be presented to Health
Minister David Clark in March.
It aimed to ensure the health and disability system was fair and inclusive, and its interim report found it was overcomplicated and fragmented.
‘‘Everybody is waiting for the Heather Simpson report to come out and see what it suggests,’’ Gauld said.