We have the best of health care services, but are patients finding the care they need?
Patient navigation is pivotal to helping patients connect with services they need in Australia’s complex and fragmented health care system, the Consumers Health Forum says.
The latest edition of the Health Voices ejournal (published last week) covers the topic of patient navigation with 12 leading experts writing on patient navigation between services. Problems in poor patient navigation create barriers to accessing services, impediments to good outcomes from health care, and are costly for funders and administrators.
Consumers Health Forum CEO, Leanne Wells, said that for patients who need to access multiple services, the health system is difficult to understand without expert help.
Important findings from researchers, consumers and advocacy groups show how the mix of State and Federal funding, private health insurance and self-funded individuals, creates a complex system that patients need to navigate to access their care and treatment.
“Navigation between services delivered across primary health care, specialist, pathology and diagnostic services, hospital care, community services, and allied health (dental, psychology and physiology etc), is worrying, confusing and frustrating for patients, as well as bearing financial costs,” said Ms Wells.
“While patient navigation difficulties are caused from within the health care system, the role of the patient navigator in health care is a much-needed avenue to combat the difficulties and frustrations experienced by health care consumers,” said Ms Wells.
Researchers from the Australian Institute of Health Innovation and the HNMRC Partnership Centre for Health Systems Sustainability, Associate Professor Yvonne Zurynski, Dr Louise Ellis and Professor Jeffrey Braithwaite, specialists in health systems, find that international research has been warning that Australia’s health system is overly complex and this can potentially lead to medical errors.
“The health care system in Australia is more complicated and difficult to access than many other OECD countries with comparative development and standards of living,” said Ms Wells.
“With the focus on funding, and not outcomes, health consumers are not offered holistic care and services that best suits their needs,” she said.
Navigation falls into two categories: firstly, writes Professor Anne Duggan, Chief Medical Officer of the Australian Commission on Safety and Quality in Health Care, patient navigation needs to be embedded into health care services. This requires action and is the responsibility of service providers and clinicians. The Commission provides support and guidance for health services to implement systems and embed processes for partnering with consumers.
“With consumers embedded in health service design," said Ms Wells, “communication is improved, consumers can make informed choices about what is right for them, and non-medical or social options can be offered to help prevent the onset of serious or chronic conditions.”
“Overseas research continues to reinforce the idea that consumer co-design in health system design, improves health outcomes and can reduce costs for government funders,” said Ms Wells.
Learne Durrington is CEO of the WA Primary Health Alliance (WAPHA), which operates WA’s three Primary Health Networks (PHNs) and commissions a range of community-based treatment and support services, delivered across Western Australia. She writes that in addition to pressure on health care services from disconnected funding models, health equity and social determinants also drive fragmentation. Vulnerable populations fail to navigate the health system and access it. To combat this issue, WAPHA has created navigator roles to help disadvantaged and vulnerable populations find, access, understand and manage their treatment and care.
Bettina McMahon CEO of healthdirect Australia, explains how the government-funded service helps provide Australians with 24-hour instant access to health information, advice and referral, and how the service pivoted to respond to the crisis of the pandemic.
Liz Jones, Director of Partnerships and Growth with the Good things Foundation, a UK initiative with an Australian arm, takes us through the digital divide, and how barriers such as affordability, coverage and confidence and skill can prevent vulnerable groups from making use of the tremendous inundation of new digital technologies in healthcare. Programs to help improve digital literacy amongst at-risk people and digital health mentor roles are being rolled out or investigated.
Siân Slade, doctoral researcher at the Melbourne School of Population and Global Health, explores the history of the navigator role in various health disciplines and proposes that learnings from widespread examples throughout Australia and overseas can now be synthesized into a national approach.
Dr Leanne Beagley, CEO of Mental Health Australia, explains that mental health services can draw on long-term experience with peer support workers contributing to better outcomes for patients. Peer workers are conduits for safe access and provide navigation as a part of their role. Trials and individual programs have endorsed their patient outcomes. Peer workers have lived experience and expertise that could be better recognised, rewarded, and supported as they continue to work to support mental health patients live their best lives.
Corey Irlam, Deputy Chief Executive of COTA Australia and Andrew Clark, Project Manager, on the Aged Care Navigators Project write from the perspective of aged care consumers, one of Australia’s most vulnerable groups. COTA responded to a 2011 Productivity Commission Report recommendation to propose a single point of access for consumers - MyAgedCare - which was implemented in 2013. Further assessment identified the need for system navigators. A trial was developed run by a consortium of 30 organisations over 65 locations, testing several models. A combination of waged workers and volunteers assisted consumers with:
- help to understand and access aged care services
- help consumers complete the tasks required for applications
- help with selecting services
These trials also show that navigators are faced with individuals in crisis and need skills and networks to help people with complex needs requiring other services outside of aged care, such as housing. As part of the Federal Government’s response to the Aged Care Royal Commission, a national Care Finder program was announced to provide 500 care finders across the country, commissioned by primary health networks, starting in January 2023.
Cancer care is another speciality area where patient navigation and support have been pivotal to successful outcomes for decades. Timely access to diagnosis and treatment is critical in managing these life-threatening illnesses. Gail O’Brien AO, patient advocate and Board member of the Chris O’Brien Lifehouse Centre talks about the role, aim and values of the comprehensive cancer care facility that bears the name of her late husband, Professor Chris O’Brien AO.
An unusual combination of researchers, Dr Ruth Knight, from QUT Australian Centre for Philanthropy and Non-profit Studies, Associate Professor Belinda Luke from QUT's School of Accountancy and Anne Hodge, head of community services at Campbell Page, report on the evaluation of a navigation project with young mothers.
Trevor Rowe, is Healthcare Editor for IdeaSpies, an independent online discussion platform. He draws from his background in government and public policy, and his experiences as a caregiver when his mother was hospitalised to put forward the rationale for patients and their caregivers to consider using independent patient advocates to help cut through red tape, address healthcare power imbalances, and make informed decisions.
Dr Annette Peart, Research Fellow in Addiction Studies at Monash University, discusses how a relationship-centred approach can be used to bridge organisational gaps in services. She describes the principles of relationship-centred care, with examples drawn from a project with callers to a drug line telephone counselling service, encouraging them to take the next steps towards support and recovery.
“These widely encompassing articles give the reader a broad overview of patient navigation in Australia. Though these, the reader can drill down into the latest findings, funding complexities, opportunities for improvement,” said Ms Wells.
“ 1 out of 2 Australians (50%) have at least one chronic condition, and 60% of people aged over 65 years have more than one, which means needing to access health care services regularly. We must revisit the idea that access to basic health care is a right,” she said.
This edition of Health Voices for June 2022 is a source of ideas and real world examples as to how patient navigation issues can be addressed in our complex, fragmented health care system,” said Ms Wells.