| Project Objectives / Summary:
This project came about after the Late Effects Oncology Clinic of the Children's Hospital at Westmead approached the Hornsby Ku-ring-gai Division of General Practice about developing a joint project that would enable the transfer of the everyday care and special monitoring for some of the patients back to their GP. Many of the clients of the LEC had developed a co-dependency with the hospital. The target group were patients who were seemingly using the Children's Hospital at Westmead and in particular the Late Effects Clinic (LEC) for their everyday medical care. These patients are survivors of childhood cancers and their attendance at the LEC indicates it has been 5 years since they last received active treatment for their cancer.
Project Collaboration:
- Late Effects Oncology Clinic at the New Children's Hospital
- Many participating GPs and consumers of the LEC.
Project Objective and Outcomes:
1. Development of a multi-division approved guidelines for GPs to use to monitor the late effects of childhood cancer.
Outcome: GP Guidelines for Long-term Surveillance of Survivors of Childhood Cancer developed. The guidelines contain information about the longterm effects of treatment on different body systems and how the problems may be managed. These have been developed using evidence from the Literature Review where it exists and best practice at CHW. Each guideline contains an individualised schedule of investigations that each particular patient requires. Also included in the folder is drug information with specific regard to long term side effects of the most commonly used chemotherapy agents.
2. Improved monitoring for the survivors of childhood cancer.
Outcome: This outcome was difficult to measure in such a short project. Ifpatients and GPs follow their monitoring schedule, then this should occur in the long-term as patients under the care of their GPs. Patients should have better access to care as they will not have to wait for an appointment to attend the Late Effects Clinic. The Late Effect Clinic should hopefully reduce its waiting list and provide an improved service to the patients it sees.
3. Development of a Patient Passport.
Outcome: Patient Passport (entitled Treatment Summary) produced and sent to the fifty patients involved in the project. It is planned that this document will be used on an ongoing basis with further patients being discharged.
4. Transfer of care in a case conference setting.
Outcome: In the first contact letter, all GPs involved were offered the option of a face to face or teleconference with an Oncologist and nurse from the Late Effects Clinic. This was again offered during phone interview. No GPs chose to take up this option, however is still available to them if they request it at a later date.
5. Improved treatment choices for patients.
Outcome: With the use of GPs now established, the majority of patients will now have the choice of being managed by the hospital or their GP. Some will be offered the option of joint management (Late Effects Clinic and GP). For country patients this should reduce considerably the amount of time it takes to undergo follow up surveillance.
6. More appropriate use of specialist clinic.
Outcome: This is another outcome that will need to be assessed in the long-term but it is hoped that patients will discuss any health concerns with their GPs rather than ringing the Late Effects Clinic or waiting for their next appointment to discuss the matter .
7. A collaborative relationship between Children's Hospital at Westmead and at least six GP divisions.
Outcome: Western Sydney Division of General Practice had 3 representatives on the Steering Committee and was fully involved with all aspects of the project. The other collaborating divisions were all offered CME evenings but were unable to fit them into their timetables, however individual GPs from Nepean and Northern Sydney Divisions who had patients in the project did attend the CME evenings. All six of the collaborating divisions had a number of GPs that had patients discharged to them under this project and received the GP Guidelines.
8. Development of an RACGP QA and CME approved educational package.
Outcome: The staff at CHW developed a power point presentation that was used at the two CME evenings. This could be developed further and used as a teaching tool for GPs. The committee considered the production of a video as a way of more broadly disseminating education but felt costs would be too high.
9. Fifty patients whose health is managed by their own GP.
Outcome: Forty seven patients out of 50 selected as eligible for the project are currently being managed by their GP. One patient chose to stay with the clinic and one requested follow up with their paediatrician (patient only 10yrs old). A transfer protocol was also produced to assist in the selection of suitable patients.
Recommendations:
- That Children's Hospital at Westmead continues to discharge patient from its Late Effects Clinic to the care of their GP using the Guidelines and Patient Passports.
- That Children's Hospital at Westmead employ a nurse to manage the discharge of these patients.
- That GPs continue to receive education from Children's Hospital at Westmead about new developments in the field of Paediatric Oncology, in both the areas of current treatment protocols and late effects findings.
- That Children's Hospital at Westmead examines the issues surrounding long-term survivors of childhood cancer particularly relating to lifetime screening and data retrieval.
- It would be ideal if the original 50 patients could be followed for a further 2-3 years to examine their compliance with the suggested surveillance tests and the ongoing satisfaction of GPs with the guidelines.
Disseminating Project Information:
- Two CME evenings were held, HKRRDGP and WSDGP.
- Presentation of a paper at the Nurses day of the Australian & NZ Children's Cancer Study Groups annual conference and the RACGP Conference in Sydney 2001.
- Poster presentation at annual ADGP National Forum, November 2001.
- Abstract submitted for the GPLO Conference March 2002.
Lessons / Assessment:
The funding period has been too short for a long term evaluation on the effectiveness of GP management and whether the monitoring schedules are adhered to.
Evaluations both for patients and GPs took longer than expected. Difficulties arose trying to facilitate call backs to patients during the program officer's work hours (four hours two days per week). Administration hitches particularly around incorrect contact details for patients.
For further details contact: office@hkrdgp.org.au |
