The Western Sydney Integrated Care Program: Qualitative Evaluation

Abstract

Background: In 2014-17, the Western Sydney Integrated Care Program (WSICP) was implemented. It is a ‘Demonstrator’ partnership between the Western Sydney Local Health District and the Commonwealth’s Primary Health Network in Western Sydney - WentWest. Funded by the NSW Ministry of Health, it aims to integrate primary (community-based) and secondary (hospital-based) health care for patients with diabetes, cardiac failure and chronic obstructive pulmonary disease. Several strategies were used to build local community capacity in managing these conditions, integrate care between service providers, and develop shared-care protocols. Western Sydney University researchers here present a qualitative evaluation based on data from two interview rounds, conducted a year apart. These comprised 125 interviews with patients, carers, health care providers and WSICP management. Findings: By March 2017, after a slow start to the program, patients reported improved access to health services, including to Rapid Access Clinics. ‘Patient Hotline’ phone access to known clinic staff was an alternative to Emergency Department (ED) attendance and, sometimes, to clinic presentation. Community-based care facilitators (usually nurses), assisting patients to follow shared-care plans, were a vital link between hospitals and general practitioners (GPs); following up patients in transition from hospital to home; and sharing information across sectors. Interviewees valued holistic, team-based care provided by clinics, with their focus on giving patients knowledge and skill to better manage their illnesses. Shared patient-care plans and specialist action-plans improved communication and gave patients more confidence. Whereas relationships between GPs and hospital staff improved and disease-specific teamwork was demonstrated, inter-specialty collaboration did not improve as greatly. Although GPs were, at times, difficult to engage , they reported improved access to hospital specialist advice through telephone support, and improvements in clinical care as a result of practice-based education where specialists helped GPs and vice versa. Health Pathways assisted with evidence-based care, though some GPs found the on-line platform challenging. Information technology (IT) difficulties limited the use of shared records. Enrolment criteria were contentious. Many in need were excluded. Lack of transport and hospital parking were barriers, especially for the disabled. The fact of this being a short-term trial significantly impeded engagement with WSICP, staff recruitment and staff retention. Conclusions: We found achievement across all quadruple aims. Patients were better able to manage their health conditions, access hospital services and were highly satisfied with WSICP services. Improved population health is a likely longer term outcome, resulting from improved chronic disease management and a focus on preventive health care. Reduced health care costs were proposed as a consequence of reductions in ED attendance, admission rates, also through access to multiple providers in one hospital visit. Health care providers expressed satisfaction with team work, education, and strengthening of cross sectorial and interdisciplinary relationships