HealthPathways Melbourne (HPM) is a website developed for General Practitioners (GPs) to be used at the point of care. HPM helps clinicians coordinate patient care across the primary, community and acute care system and provides guidance for GPs on assessment and management of both clinical and non-clinical conditions. HPM is a partnership between Eastern Melbourne PHN and North Western Melbourne PHN. The pathways are written by GPs in collaboration with specialists and other health professionals.
The Inner East Primary Care Partnership worked with HPM to extend the content of the HPM website to include community resources and information about services to meet the needs of patients with chronic and complex health needs, and provide new material for GPs and their clients about the range of services and supports available in their area.
A feature of the project was the strong collaborative partnerships, between Eastern Melbourne PHN and North Western Melbourne PHN (formerly Medicare Locals) and the Inner East PCP. Furthermore, the Inner East PCP engaged in extensive consultation with consumers with chronic conditions and carers, local community health services, subject matter experts and service providers working in relevant fields.
The Inner East PCP conducted focus groups, surveys and phone interviews with people with chronic illnesses and their carers to identify which services have been most useful to keep them well and independent in their own homes. This was to help identify which services would be most appropriate for GPs to refer to. The consultations were important in identifying the wide range of health and community services that people with chronic illnesses and their carers found helpful to managing their health and maintaining their wellbeing. This information was used to inform the development of the new resources.
The HealthPathways Melbourne Community Resources project demonstrated the complimentary skills and approaches of Primary Care Partnerships and the Primary Health Networks. Primary Care Partnerships have close working relationships with a wide range of community organisations and this created a unique opportunity to add “the next layer” to the information provided on HealthPathways. The project was funded by the Victorian Government Department of Health and Human Services.
HealthPathways Melbourne is designed to:
- Enhance clinical knowledge and promote best practice care
- Build collaboration and reduce fragmentation across the health service network
- Reduce the number of patients referred to specialist care who could be managed in a primary/community care setting.
With the HealthPathways Melbourne Community Resources project the Inner East PCP aimed to:
- Enhance and extend existing pathways to represent a wider range of health and community services
- Develop a range of new pathways for GPs on support services for patients with chronic and complex health conditions
- Source and/or develop a range of resources for GPs to print out for patients
- Document the process of developing these extended pathways for use in future projects.
Consultations with service providers were used to develop service categories consisting of: allied health, counselling and nursing; social support and activities; information and advocacy, and practical support. A total of 87 community members who were carers or people living with a chronic condition were consulted. The information and themes collected during this process were used to review the existing pathways on HPM to identify gaps in community resources.
“It is very difficult to find information initially. We were lucky to find Carers Vic. We know a number of carers who have no idea they exist. I did not know that gardening help is available – my garden is just a mass of weeds now, had gardening help been offered I would have accepted. Perhaps carers could be given info on where to look to find out about residential care and respite in the local area”. (Carer consultations)
“My GP’s knowledge, care and support was invaluable. It made me feel valued and supported which benefited my mental and physical well-being”. (Consumer consultations)
The HealthPathways Melbourne Community Resources project delivered community resources information to extend the existing localised cardiac, diabetes and respiratory pathways on HPM, and created a number of new pathways for the HPM website.
Resources were developed for:
- Elder abuse and neglect
- aged care assessment service
- younger onset dementia resources and support services
- community transport
- dementia care services
- carer stress
- bereavement, grief and loss
- carer resources and support services, and
- bereavement, grief and loss resources and support services.
The HealthPathways Melbourne Community Resources project was highly successful and is a continuing priority for the Inner East PCP and the Eastern Melbourne PHN. The work demonstrates strong Inner East PCP action to collaborate and partner for the sharing of expertise and work towards a common goal. We engaged with local services to add value to an existing e-health system utilised by GPs and incorporated consumer input to improve patient outcomes. The success of the project was demonstrated by increased traffic on the HPM website to the new pathways.