Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia.
BMC Health Serv Res. 2020 Oct 7;20(1):925. doi: 10.1186/s12913-020-05794-2.
In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.
We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.
Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.
Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
在澳大利亚和其他发达国家，慢性病的患病率不断上升，医疗保健成本也在上升，尤其是基于医院的护理。整合医疗保健并在社区中支持疾病管理是预防疾病、改善结果和减少不必要住院的一种手段。西悉尼地区的糖尿病、心脏病和呼吸道疾病发病率较高，新南威尔士州卫生部通过西悉尼综合护理计划（WSICP）为这些疾病的患者在医院和社区环境中提供了一系列关键策略，以整合护理。除了我们之前报道的与特定 WSICP 策略相关的分析之外，这项研究还提供了有关 WSICP 实施和整体综合护理的总体经验和观点的信息。
我们在 12 个月内进行了两轮共 125 次深入访谈，参与者包括患者及其照顾者、护理促进者、医院专家和护士、联合健康专业人员、全科医生和初级保健护士以及项目管理人员。一半的参与者（n=42）接受了两次访谈。我们对访谈记录进行了归纳主题分析。
主要主题涉及 WSICP 的设立和运作；遇到的挑战；以及该计划的附加值。实施 WSICP 是一项庞大而耗时的工作，但包括人员配备和信息技术在内的挑战正在得到解决。WSICP 被认为在减少因患者自我管理改善和预防重点、医疗保健提供者在卫生部门之间加强沟通和协作以及提高在初级保健环境中管理慢性病的能力而导致的住院人数方面具有价值。
患者、照顾者和医疗服务提供者将 WSICP 视为一种创新的综合护理模式，并重视其以患者为中心的方法，认为该方法提高了获得护理的机会、增强了患者自我管理和疾病预防能力，并减少了住院人数。WSICP 的长期可持续性将取决于保留关键工作人员、更有效地共享信息，包括在卫生部门之间，以支持增强的协作，以及将活动套件扩展到其他疾病领域和地点。加强与医院专家合作，为基层医疗机构提供支持，以管理社区中的慢性病，这一点至关重要。及时的评估为持续的项目实施提供信息。
