Australia: the healthiest country by 2020
National Preventative Health Strategy - Overview
7. Refocus primary healthcare towards prevention
Table of contents
- Chair's Foreword
- The purpose of the Strategy; What is in the Strategy?
- The need for urgent, comprehensive, prioritised and sustained action; What will be different because of the Strategy?
- Prevention works; Progressive, staged and comprehensive action
The Strategy – summarised, prioritised and phased- The conceptual framework for the Preventative Health Strategy
Strategic directions- 1. Shared responsibility – developing strategic partnerships
- 2. Act early and throughout life
- 3. Engage communities
- 4. Influence markets and develop connected and coherent policies
- 5. Reduce inequity through targeting disadvantage
- 6. Indigenous Australians – contribute to ‘Close the Gap’
- 7. Refocus primary healthcare towards prevention
- Ensuring effective implementation – the national infrastructure for prevention
- Conclusion – a call to action
- References
- Acknowledgements
There is a place for preventative health in all elements of the healthcare system, including within the acute care and hospital setting, community health and across primary healthcare. The NHHRC has been tasked with the review of Australia’s healthcare system, and the Primary Health Care Expert Reference Group with reform for primary healthcare. The Preventative Health Taskforce has both contributed to their work and sought advice from the Commission and the Expert Reference Group in developing this Strategy.
The primary healthcare system has a great capacity to care for Australians across a vast range of disciplines, with multi-disciplinary team-based care increasingly recognised as the best approach to high-quality chronic disease management and prevention.
The Primary Health Care Strategy is supportive of focusing the whole system of primary healthcare on prevention as appropriate through the development of practice incentives and referral pathways. Other approaches include a strong focus on community development and community health outreach activities.
The role of primary healthcare in preventing chronic disease
Early in 2006, COAG’s Plan for Better Health for All Australians[47] identified the importance of promoting healthy lifestyles, including addressing alcohol use, nutrition, smoking and physical activity. Strategies to promote healthy lifestyles include:- Supporting the early detection of lifestyle risks and chronic disease through a ‘Well Person’s Health Check’ in general practice for middle-aged people with one or more identifiable risks that lead to chronic disease
- Supporting lifestyle and risk modification through referral to services that assist people who are wanting to make changes to their lifestyle
Targeted prevention for disadvantaged populations
In addition to population-wide prevention measures, targeted preventative activities are required to address the health needs of individuals and communities where:- Existing basic services may not cope with the level of illness and need present in the community (such as in some Aboriginal and Torres Strait Islander communities)
- There are adverse health outcomes resulting from factors that may discriminate against disadvantaged groups (such as the cost of services or discrimination)
- There are specific cultural factors and conditions that make mainstream basic services inappropriate (such as Indigenous health and refugee health services)
The following are critical to an integrated primary healthcare system that puts preventative health at the forefront of quality practice:
Critical success factors for integrated primary healthcare
A system that:- Provides a viable option for people to enrol in a comprehensive primary healthcare system based on residential location – especially those who are disadvantaged or who have multiple needs
- Responds to the changing health needs of people throughout their lives and to those of their families
- Provides quality preventative healthcare in the most appropriate setting
- Promotes patient- and community-centred preventative healthcare with genuine options for community involvement in planning and service delivery
- Develops blended payment models that provide for payment of clinicians through a combination of fee for service, salaries, capitation and performance-based payments accompanied by a single fundholder for primary and community care and public healthcare, ideally funded through a ‘needs adjusted’ capitated formula
- Harnesses and coordinates the contribution to preventative health made by a wide range of health professionals
- Networks primary care organisations, avoiding silos and gaps in care
- Provides a comprehensive clinical governance and quality audit system
- Introduces an electronic patient record
In summary, the Taskforce notes the current limitations of the primary healthcare system in Australia in its ability to address lifestyle factors, and considers that a primary healthcare setting which works effectively for prevention should at a minimum be able to:
- Systematically identify people at risk and effectively assess the level of risk and readiness for change
- Deliver appropriate interventions on-site or refer to external services
- Have in place referral processes that allow ready access to appropriate, quality-assured lifestyle modification providers and programs
- Monitor and assess outcomes and sustain improvements over time
- A multidisciplinary workforce with relevant skills and expertise
- Appropriate tools and resources
- Information systems that provide risk data on the practice population
- Effective linkages to wider community services.