HealthPathways improving access to care

Abstract

HealthPathways (HPW) is an international web-based information portal that provides health practitioners with guidelines and referral pathways to specialists and services. The present study explored usage of HPW by general practitioners (GPs) in the Barwon region, south-west Victoria, and any benefits and barriers to its use. Approximately 421 GPs provide services in 86 clinics across the Barwon region, south-west Victoria and Barwon Health is the public health service providing acute, subacute, residential aged care and community health services to approximately 350000 people. The present study was a mixed-methods analysis of all GPs in the region, who were invited to complete a survey in two waves (2014 and 2016) and participate in focus groups. Data were survey/questionnaire (fixed response and free text options, analysed with descriptive statistics and content analysis), and focus groups (interview and facilitated group discussion, analysed using the principles of thematic analysis). Most GPs surveyed used HPW and usage increased over time from 2014 to 2016 (67% vs 77% respectively). Junior GPs used HPW more often than the more experienced practitioners. GPs reported that HPW was easy to access and navigate, improved their knowledge of local services, improved their confidence, changed their clinical management and saved them time. Main barriers to use of HPW were: GPs did not think to look at HPW, or simply did not know about it. HPW has the potential to improve patient management and health outcomes, and use of HPW is increasing over time. Initiatives such as HPW are viewed positively by clinicians and have the potential to address challenges at the primary-secondary care interface, specifically, referral to secondary specialists. Proof of concept that the ongoing availability of localised HPW for common clinical conditions improves GP usage of HPW and has increased access to HPW as the first source of clinical information. Benefits and barriers to use have been identified. HPW improves knowledge of local services and provides GPs with easy access to referral pathways.

Local clinical pathways: from ‘good ideas’ to ‘practicality’ for general practitioners

“…), online portal VOLUME 10 • NUMBER 3 • SEptEMBER 2018 J OUrNal OF PrimarY HealtH Care access, 25 systematic review of peer-reviewed and grey literature, 6 online survey questionnaire 26 or mixed-method approaches. 7,24 Qualitative research allowed a more nuanced understanding of the barriers and facilitators to acceptance and use of BNPs, facilitating deeper insight into GP uptake and engagement with BNPs, and showing how general practice is oriented towards improved patient experiences and outcomes.…”

“…24 Similar to other researchers, we found that opinion leaders and specialist involvement in the development and promotion of BNPs can be pivotal to uptake by GPs. 8,26 This not only improves primary-secondary care relationships, Gill et al 7 and Gray et al 25 also indicated that a comprehensive approach to Pathway implementation and service redesign can lead to improved access to specialist care. BNPs can be a centralised information hub, with local information at the users' fingertips.…”

“…28 The vision of BNPs, if barriers to uptake and implementation can be resolved, is that patients will benefit from reduced patient waiting times and improved access to secondary and tertiary services. 6,7,24,25 When discussing treatment plans with patients and their whānau, BNPs can be a valuable source of information and reassurance.…”

“…2 in both New Zealand (NZ) 3 and australia, 4 clinical pathways have been widely adopted as a way to provide localised evidence-based clinical practice and referral, notably through the Canterbury HealthPathways initiative, which is now widely used in both countries. 3 There is, however, limited evaluation of their effectiveness in improving clinical care [5][6][7] and in assessing the barriers and facilitators 8 to their use by general practitioners (GPs).…”

Letter to the editor

“…While HealthPathways is not yet available in our local health district, use of the portal around Australia has been shown to improve the quality of referrals and access to care. 4 We found a significant amount of information lacking in GP referrals to our paediatric outpatient clinic. Using paediatricspecific referral guidelines could improve the quality of referrals, improve the triage process, reduce the number of rejected referrals and help patients receive timely, appropriate care.…”