| Project Objectives / Summary:
The aim of the project was to develop a specifically designed shared care delivery partnership between GPs and specialists for the care of haematology cancer patients. The main objectives of the project were to:
- Develop user friendly communication strategies between specialists and GPs that are effective and timely
- Design a Patient Held Record (PHR)
- Develop treatment guidelines and clinical pathways for cancer patients
- Provide professional forums for the specialists, GPs and nurses to discuss case studies and plan amendments to current practice
- Review information technology (IT) access by GPs
Project Collaboration:
The Haematology Cancer Patient Shared Care Project (SCP) was a joint project between the Perth Central Coastal Division of General Practice and the Sir Charles Gairdner Hospital in Western Australia. Funding was shared between the Innovations Grant & Sir Charles Gairdner Hospital. Twelve patients and their GPs, one specialist and several nurses participated in the project between February and August 2000.
Project Outcomes:
Overall, this small project was very successful in achieving its objectives. There was an increase in communication between the health providers caring for the patients and also between the providers and the patients. Most GPs were more involved in their patients' care as a result of the SCP. They also appreciated being kept informed of their patients' cancer treatment via the PHR and consequently were in a better position to support their patients during cancer treatment. GPs also found that the faxed material was of great value and found this method of communication much more timely and effective than tradition postal mail.
Most patients were positive and they felt they had benefited from the increase in communication between providers. They also felt more involved (and thus more in control) of their own care and treatment. The empowerment felt by most patients because they held their own PHR was overwhelming. The PHR offered reassurance for patients as they were safe in the knowledge that the information needed was well documented and clear for whoever needed to access it.
A number of educational and resources opportunities were provided for the GPs and were on the whole positively received. The brief review of IT access by GPs confirmed that for the time being the SCP would need to rely on faxes, phone calls, letters and PHR for communication between health care providers. The review of IT access by GPs showed that whilst most practices were computerised, few GPs were using computers in their consulting rooms and those that were, use them mainly for prescriptions.
Recommendations:
- A longer time period for such a project is required to ensure initiatives and changes do become part of our normal patient management and to fully evaluate the benefits of this approach to cancer care over time. Many patients have treatments over a period of at least six months. Evaluation of GP involvement in the follow-up phase was considered desirable.
- Provision of feedback on project developments to all stakeholders is important in maintaining project interest and support. The support from stakeholders and other interested parties in turn helps motivate the project team to keep going.
- Securing stakeholder ownership of the project through enlisting their involvement in the design and implementation of the model and giving them responsibilities to address ensures commitment to the changes in practice that can initially be more time consuming.
- Identification and education about the project for all staff members that are likely to be involved with patients using this model of care is important in ensuring completeness and accuracy of information.
Disseminating Project Information:
Publications:
- A newsletter article in the Sir Charles Gardiner Hospital Newsletter "About Charlies"
- Two newspapers articles, one in the local suburban newspaper and one in the "West Australian" newspaper.
- Regular updates on project progress in the Division of General Practice newsletters throughout the Perth metropolitan area.
- Development of a brochure providing general information.
Presentations/Conferences:
- Nursing staff at hospital (regular)
- Lunchtime forums
- Hospital Clinical Meeting
- Presentations to the Hospital Executive Committee and Heads of Department meetings
- Poster presentation at the ARCHI Tool Kit Seminar, March 2000
- Presentation at the 11tg Annual conference of the Australasian Association for Quality in Health, Darwin, June 2000
- National Demonstration Hospital Program conference presentation
- Clinical Oncology Society of Australia conference presentation
- Cancer Foundation of WA GP Education Seminar
Teleconference:
- Teleconference through the Westlink services to rural GPs
- Teleconference video supplied to all rural Divisions of General Practice
Resources:
- Production of a side effects table
Lessons Assessment:
The SCP improved patient confidence, as they knew that the Specialist and the GP were communicating and that the GP was able to help the patient in ways that the specialist could not or did not have time to do. It was interesting to note that patients perceived specialists as being busier than the GP.
The SCP is very dependent on patient and the GP willingness to participate fully. It is therefore essential that the patients and the GPs are fully aware of what participation means for them.
The development of a model of Shared Care for cancer patients has brought the GP back into the cancer patient care in a way that is clinically meaningful and useful to specialists & GPs as well as being highly beneficial to patients. Further study and evaluation of a larger group of patients is required to show the quantitative and qualitative care benefits to patients, GPs and specialists and to demonstrate predicted cost benefits over time.
This was a well-conducted project and a very good example of GP-Hospital integration. |
