Health initiative leading to better future
Designed as a tool to help doctors across the region provide consistent standards of care, Health Pathways have taken some unexpected turns, health reporter Mike Houlahan finds.
THEY would not know it, but somewhere in the southern region yesterday someone got to see a specialist because of a website they have probably never heard of.
Health Pathways, an online resource for GPs created and maintained by WellSouth primary health organisation, is a localised version of databases available across New Zealand.
Each of the 636 live pathways available to GPs sets out clinical details of a particular illness or condition, what specialist services might be available to treat it, and any diagnostic issues doctors should be aware of.
The Pathways are being reviewed, a regular refresh to make sure they remain uptodate.
A mobile devicefriendly version of Health Pathways has recently been developed, and a southern version of ‘‘Health Info’’ — a version of the programme designed for patients — will soon be rolled out.
Its proponents were always confident that it would be an invaluable database, but Health Pathways have also provided other, unforeseen benefits, the programme’s primary health clinical leader Peter Gent said.
One example he is keen to promote is that of the pipelle biopsy, a test carried out to determine the cause of abnormal uterine bleeding.
Before Health Pathways was rolled out, the standard procedure had been to send a patient to a specialist, often at an outoftown hospital, in the case of patients in the provinces.
However, when writing that individual pathway, doctors began to question why the test, which is simple to perform and takes up little time, needed to be done that way.
As a result, there are now 36 southern GPs, two nurses and one nurse practitioner trained to carry out pipelle biopsies; and since the change of tack 18 months ago, 713 patients have had the test in their doctor’s surgery, with 144 then needing to be referred for followup procedures.
The 569 women who tested clear for endometrial cancer and other conditions found out quickly, often without the hassle of travelling, and the specialist appointments which they would have taken up were then freed for other women with diagnosed ailments which needed treatment.
‘‘We had this phrase, ‘‘better, sooner, more convenient’’ and we were hopeful we would do that,’’ Dr Gent, also a GP at Mornington Health Centre, said.
‘‘We were thrilled that we have managed to achieve that, and that only 20% of women who have had pipelle sampling have had to move on from a GP setting, and that 80% have had their tests done quicker by a local GP . . . there are now three clinics worth of appointments available which would previously have been filled up with pipelle sampling.’’
That is the ‘‘poster child’’ example of what may be many more procedures which could be better provided in primary care, assuming the funding was in place for costs and training, Dr Gent said.
Treatment of some skin infections, particularly ones requiring intravenous antibiotics, was another area where hospital procedures could be set off along a Health Pathway and taken up by a GP practice.
‘‘It is a lot more convenient for the patient, and could save people [who] are not actually that unwell from having to go to hospital . . . but we will have to change some perceptions of what GPs are and what they are capable of doing.’’
The Southern District Health Board has supported and assisted with the scheme, and is working towards it being a part of its quality improvement programme.
Dr Gent said while at its most basic, Health Pathways was a medical website, it also provided a diagnostic backstop for doctors confronted with unusual symptoms, and a public health bulletin board; the Southern District Health Board’s updates were posted on the Health Pathways home page as they came out.
‘‘But there is also the whole process, which involves collaboration between primary and second care, between GP and hospital, where we say ‘we have got this condition, what is the best way to manage this? What should the flow be?’
‘‘I have and expect that this collaborative approach can be rolled out in many more areas.’’
While Health Pathways has made some shortterm gains, there are longterm goals in mind.
Several GP practices across the South have become a ‘‘health care home’’, a modernised, integrated, more techfriendly version of the traditional GP.
The next phase of the strategy which brought that shift will be the establishment of health care hubs, facilities bringing together a mix of general practice and hospitalbased healthcare, along with some community services.
Looming behind both developments is the new Dunedin hospital; as planners decide what services will and will not be provided within its walls, Health Pathways may well provide guidance as to where general practice could step up and take over.
‘‘There is a lot of work being done around models of care and, of course, that feeds into Health Pathways, because that will have to reflect the model of care,’’ Dr Gent said.
‘‘Ultimately, Health Pathways is how a clinician can log in and see what the locally accepted management of a particular condition is, but the real win in Health Pathways is the collaboration which has gone into creating them.’’