An integrated system of care

Teaching in an integrated care model across metropolitan and rural Victoria shows students the different pressure points which are specific to that local community.

This article originally appeared in Voice, Volume 11 Number 7.

View the original here.

ABC's Doctor Blake Mysteries series, filmed in Ballarat, depicts Dr Blake as the local GP who grew up in the area, knows the town and its inhabitants, and who has just taken over his late father's practice.

Murders aside, this series presents a somewhat romanticised picture of medical care in the 1950s when the local doctor and district nurse took care of everyone in the area. A true, albeit outdated, picture of integrated care that is delivered largely through community networks.

Even in our busy modern times rich with medical discovery, specialities and emerging illnesses, a personalised and contextual model of care is not a thing of the past but something that continues to be refined with the advances of technology and with a truly engaged community.

We can look at the portrait of a village doctor such as ABC's Doctor Blake, and think that a time when the village doctor knew you, your family, its history and socioeconomic background, who conducted most of the cradle to grave care, is outdated, impractical and hopelessly idealistic.

But a modern integrated health system can deliver the essential healthcare services which were once the domain of the village doctor.

A village doctor must respond to the needs of their immediate surroundings, as must an integrated healthcare system. In teaching hospitals in Melbourne and regional Victoria, the needs of the community drive the research, which in turn drives improved policy and patient care. From Melbourne to Bendigo, the Hume to the Grampians, each health system has its own priorities, its own projects and above all, its own patients and medical staff.

Integrated healthcare is a worldwide trend in healthcare reform, focusing on more co-ordinated and integrated forms of patient care. In Australia, integrated healthcare is generally understood to be the development of a patient-centred integrated health system, with connected service provision across different healthcare providers and greater emphasis on community-based services.

Teaching in an integrated care model across metropolitan and rural Victoria shows students the different pressure points which are specific to that local community. While accidents and emergencies might dominate the landscape in some areas, others are groaning under the weight of diabetes, heart disease and other non-communicable diseases.

The new expectation of health professionals is to work within an integrated system where data is shared across a number of specialists and is available to general practitioners who have ongoing direct contact with patients. A co-ordinated and connected network of health professionals covering dental, primary care, nursing, allied health, maternal and child health, and medical specialists, is becoming increasingly important.

Managing these expectations in the 21st century requires better record-sharing and medical history across disciplines, understanding and adapting to the needs of the patient and the community, and training health professionals accordingly.

For example, at the Ballarat and District Aboriginal Co-operative clinic, optometrists, doctors and nurses work in a team with their patients always at the centre of care. Each healthcare professional brings their own specialist knowledge but also understands the expertise of others so that they work cohesively and refer appropriately.

Integrated healthcare forms an inherent part of the Faculty's research and teaching programs and the drive to modernise the health system. Academics from all disciplines have conducted deliberate research translation projects to establish and evaluate integrated health services initiatives.

"Integrated care promises a better and more personalised experience for the patient and community at a lower cost as hospitals, clinics and health workers become more efficient and connected," says Professor Terry Nolan, Head of the School of Population and Global Health. "It also provides continuity of contact and access to the patient history that facilitates greater emphasis on prevention of disease and other health promotion activities."

Research, teaching and practice networks all contribute to exposing students to integrated care.

With the health of the individual and the community at its heart, integrated care provides a village doctor for a new generation – providing care from one to many.

By Lisa Mamone

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