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Rapid Review: Integrated Primary Care Centres

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Rapid Review: Integrated Primary Care Centres AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE THE AUSTRALIAN NATIONAL UNIVERSITY (ANU) CENTRE FOR PRIMARY HEALTH CARE AND EQUITY THE UNIVERSITY OF NEW SOUTH WALES (UNSW) INTEGRATED PRIMARY CARE CENTRES AND POLYCLINICS A RAPID REVIEW Gawaine Powell Davies Julie McDonald Yun Hee Jeon Yordanka Krastev Bettina Christl Nighat Faruqi June 2009 AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE __________________________________________________________________________________________________ ACKNOWLEDGMENT The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy. The information and opinions contained in it do not necessarily reflect the views or policies of the Australian Government Department of Health and Ageing. This review was commissioned by the Australian Primary Health Care Research Institute (APHCRI) as part of its Stream 16 program of rapid systematic reviews. It was conducted by Gawaine Powell Davies, Julie McDonald, Yordanka Krastev, Nighat Faruqi and Bettina Christl from the Centre for Primary Health Care and Equity, UNSW and Yun Hee Jeon from the Australian Primary Health Care Research Institute. We are grateful to APHCRI for the opportunity to review this important area of primary health care development, and thank them for their support. We received valuable information and advice from many people in the course of this review. We would particularly like to thank Caroline Nicholson, Dr Andrew Dalley, Dr David Perkins, Dr Di O’Halloran, Terry Findlay, Dr Lucio Naccarella, Martin Mullane, Dr Tony Hobbs, Associate Professor Elizabeth Comino, Professor John Dwyer and Professor Mark Harris from Australia, Susan Dovey, Professor Peter Crampton and Dr Jacqueline Cumming from New Zealand, Professor Martin Roland, Helen Parker, Dr Candace Imison and Helen Dickinson from England, Dr Grant Russell from Canada, Gun Eklund from Finland and Dr Julie Will from the US. We thank them for their contributions, which have greatly benefitted the report. Australian Primary Health Care Research Institute (APHCRI) ANU College of Medicine and Health Sciences Building 62, Cnr Mills and Eggleston Roads The Australian National University Canberra ACT 0200 T: +61 2 6125 0766 F: +61 2 6125 2254 E: [email protected] W: www.anu.edu.au/aphcri ii ___________________________________________________________________________________ _____ AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE __________________________________________________________________________________________________ TABLE OF CONTENTS Acknowledgment............................................................................................... II Abbreviations..................................................................................................... v 1. Introduction................................................................................................... 1 2. History And Policy Background ........................................................................ 2 Australia.........................................................................................................2 Canada ..........................................................................................................3 New Zealand ..................................................................................................4 Europe ...........................................................................................................5 United States Of America.................................................................................8 3. Methods ........................................................................................................ 9 4. Countries With Integrated Primary Health Care Centres, And Their Characteristics11 Broader Primary Health Care Models............................................................... 20 Secondary Care Focus Models ........................................................................ 22 5. The Effectiveness Of Integrated Primary Health Care Centres .......................... 23 6. Discussion ................................................................................................... 29 Implications For Australia............................................................................... 32 Appendix 1: Summary Description Of Models By Country..................................... 34 Australia....................................................................................................... 34 Canada ........................................................................................................ 35 Europe ......................................................................................................... 36 New Zealand ................................................................................................ 37 United States Of America............................................................................... 38 Appendix 2: Methods........................................................................................ 39 iii ___________________________________________________________________________________ _____ AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE __________________________________________________________________________________________________ Appendix 3: Outcome Articles By Model Type ..................................................... 48 References ...................................................................................................... 71 Bibliography .................................................................................................... 78 iv ___________________________________________________________________________________ _____ AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE __________________________________________________________________________________________________ ABBREVIATIONS APHCRI Australian Primary Health Care Research Institute ACCHS Aboriginal Community Controlled Health Services CHC Community health centre CHCC Community Health Care Centre D&A Drug and alcohol EPC Enhanced Primary Care FFS Fee for service FMG Family Medicine Group FTE Full time equivalent GMS General Medical Services GP General practitioners MBS Medicare Benefits Schedule NGO Non-government organisation NP Nurse practitioner NSW New South Wales PHC Primary health care PMS Personal Medical Services RN Registered nurse QOF Quality and Outcomes Framework SA South Australia UK United Kingdom US United States of America v ___________________________________________________________________________________ _____ AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE __________________________________________________________________________________________________ INTRODUCTION The purpose of the report is to summarise what is known about the use of integrated primary health care centres in Australia and comparable countries, what is known about their effectiveness and to identify what Australia can learn from this. This reflects a long standing concern in Australia and other countries about heath care integration, which has been variously expected to improve consumers and provider satisfaction, achieve better health outcomes and reduce the use of specialist and hospital services (Kodner and Spreeuwenberg 2002). Interest in integrated primary health care centres is not new. In 1920 Lord Dawson wrote: The domiciliary services of a given district would be based on a Primary Health Centre – an institution equipped for services of curative and preventative medicine to be conducted by the general practitioners of that district, in conjunction with an efficient nursing service and with the aid of visiting consultants and specialists… it would be impossible to exaggerate the benefits that would accrue to the community by the establishment of Health Centres. (Dawson cited in Imison, Naylor et al. 2008) Almost ninety years on, these are now seen as by many as a logical ‘next step’ in primary health care development. Two Australian states have programs (HealthOne NSW in New South Wales and GP Plus in South Australia) and the Commonwealth has a national initiative (GP Super Clinics). They are also included in the reforms suggested in the Interim Report of the National Health and Hospitals Reform Commission (National Health and Hospitals Reform Commission 2009). This makes it timely to review Australian and international experience of this approach to providing primary health care provision. This review should be read with due attention to its limitations. It does not consider whether integration is a ‘good thing’ or, more realistically when it is beneficial and for whom. It focuses on organisations rather than the processes such as teamwork through which integrated care is produced and which may occur in many different types of organisation. It focuses on individual centres or services without taking account of the integration which may occur at other levels of the system. Finally, it does not compare the performance of integrated primary health care centres with alternative structures such as networks, virtual organisations, or centres where services are co-located but not integrated. These issues are re-visited in the discussion. The report begins with an overview of the history and policy background relating to integrated primary health care centres in Australia and
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