Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia; and Corresponding author. Email:
Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia.
Aust J Prim Health. 2020 Apr;26(2):104-108. doi: 10.1071/PY19184.
Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary-secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.
为有复杂需求的社区居住的老年澳人提供最佳护理是国家的当务之急。目前的护理不尽人意，反应式、间歇性且碎片化，不仅耗费卫生系统资源，还会对老年人的生命造成威胁，增加护理人员的负担。如果服务（卫生和社会）向以社区为基础、全面和预防为重点的护理方向调整，那么健康结果将会得到改善。综合护理以面向个人为展望，摒弃以疾病为中心的医疗服务提供方法。整合是支持初级保健的一种手段，以应对人口老龄化所带来的患者需求的数量和复杂性。《复杂健康状况下的老年人赋权和康复（OPEN ARCH）》是一种有针对性的护理模式，旨在为有功能下降、住院或机构化护理风险的老年人获得专家评估和全面护理提供更多机会。OPEN ARCH 以初级保健为中心整合功能而开发，建立在质量护理的四项价值观之上：在离家更近的地方提供预防保健；专业和通科护理的协调一致；护理协调和赋权；以及初级保健能力建设。通过在初级-二级医疗界面的垂直整合，OPEN ARCH 不仅可以提高客户的护理质量，还可以提高初级保健满足这一人群需求的能力。
