1. Lecture 3 Primary Health Care and
major frameworks

2. „Essential health care based on practical,
scientifically sound and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation
and at a cost that the community and the
country can afford to maintain at every stage
of their development in the spirit of self-
reliance and self-determination‟

3.  The WHO Alma-Ata Declaration defined
Primary Health Care (PHC) as incorporating
curative treatment given by the first contact
provider along with promotional, preventive
and rehabilitative services provided by multi-
disciplinary teams of health-care
professionals working collaboratively
(Anderson, Bridges-Webb and Chancellor, 1986)

4.  PHC is socially appropriate, universally accessible,
scientifically sound first level care provided by a
suitable trained workforce supported by integrated
referral systems and in a way that gives priority to
those most in need, maximises community and
individual self-reliance and participation and
involves collaboration with other sectors. It
includes the following:
- Health promotion
- Illness prevention
- Care of the sick
- Advocacy
- Community Development
(Australian Primary Health Care Research Institute, Australian University. Cited in Primary
Health Care-2006. Available http://www.ama.com.au/node/2502

5.  Within Australia, the primary health care
services are a complex combination of State
and Commonwealth funded initiatives with
both public and private providers
 Services include General Practitioners,
community health care centres, private allied
health professionals such as dietitians,
pharmacies and complimentary therapists
 GPs provide majority of primary health care
services
◦ 85% of the population see a GP at least once a year
◦ average Australian person would visit a GP 6.5 times
per year.

6.  Broader population health focus than hospital
and specialist care
◦ population health activities better delivered through
primary care eg immunisation, health promotion and
screening
 More continuity of care- people receiving
ongoing care from a trusted doctor or other
health professional achieve better health
outcomes than those receiving care from a
number of doctors
 Greater accessibility (financially,
geographically, culturally)
(Doggett, 2007)

7.  International evidence suggests strength of a
country‟s primary care system is associated with
improved population health outcomes for all-cause
mortality from respiratory and cardiovascular
disease
 Health systems that include strong primary medical
care are more efficient and have lower rates of
hospitalisation.
 Continuity of care with the same primary care
provider or service has been associated with lower
use of hospitals and greater patient satisfaction
with all care
(Harris, Kidd and Snowdon, 208; WHO Regional Office for Europe‟s Health Evidence
Network (HEN), 2004)

8. Conventional Disease control People-centred
ambulatory medical programs` primary care
care in clinics or
outpatient
departments
Focus on illness and cure Focus on priority diseases Focus on health needs
Relationship limited to the Relationship limited to Enduring personal
moment of consultation program implementation relationship
Episodic curative care Program-defined disease Comprehensive,
control interventions continuous and person-
centred
Responsibility limited to Responsibility for disease- Responsibility for the health
effective and safe advice to control interventions of all in the community
the patient at the moment along the life cycle;
of consultation responsibility for tackling
determinants of ill health
Users are consumers of the Population groups are People are partners in
care they purchase targets of disease-control managing their own health
interventions and that or their community
(WHO, 2008, p.43)

9.  Primary Health Care‟s focus is on providing “health
for all” through health systems that put “people at
the centre of their own care”
 WHO Primary Health Care- Now More than Ever
(2008)
◦ evaluates events that have been undertaken to address health
over the last 30 years
◦ provides recommendations to decrease global health
inequalities
Available at: http://www.who.int/whr/2008/whr08_en.pdf

10.  Disproportionate focus on narrow offer of
specialized curative care
 Command and control approach to disease
control focused on short-term results
 Hands-off approach to governance allowing
unregulated commercialization of health to
flourish

11.  Inverse care – people with the most means
and often less needs consume the most care
 Impoverishing care – where lack of social
protection and payment for care is largely
out-of-pocket and can result in poverty
 Fragmented and fragmenting care – excessive
specialization of health care providers and
narrow focus discourage a holistic approach

12.  Unsafe care – poor system design cannot
ensure safety and hygiene standards leading
to hospitalized infections and other errors
 Misdirected care – resources allocation
clusters around curative services at great
cost, neglecting potential of primary health
care and health promotion to prevent up to
0% of disease burden.

13. Main Reforms Recommended include:
 Universal coverage reforms
 Public policy reforms
 Leadership reforms
 Service delivery reforms

14. Main Areas of Concern
 Provides many of the required services,
however there are still many people with
multiple and complex health conditions
receiving inadequate care
 There is a general lack of GPs in some areas
 Poor access to GP services for some groups
in the community eg rural/remote,
indigenous communities

15.  High out of pocket expenses for many allied
health services and some pharmaceuticals
 Many people require a variety and number
of health professional services and the lack
of coordination of health care can ultimately
contribute to poor health outcomes and an
 in emergency and hospital admissions,
placing a great burden on the health system

16.  An insufficient focus on prevention and
population health
 Inflexible funding system that does not
always allow consumers to gain access to the
most suitable form of care for their condition
 Primary Health Care has been regarded in
Australia as being fragmented, difficult to
navigate and prone to gaps and inequities in
access to services- A REFORM of the system
including a coordinated and universal
approach to Primary Health Care is required.
(Doggett, 2007)

17.  The National Primary
Health Care Strategy
confronts the
challenges relating to
health care in the
present and the
future. The priorities
of the Primary Health
Strategy:

18.  Better rewarding prevention
 Promoting evidence-based management of chronic
disease
 Supporting patients with chronic disease to
manage their condition
 Supporting the role GPs play in the health care
team
 Addressing the growing need for access to other
health professionals, including practice nurses and
allied health professionals eg dietitians and
physiotherapists
 Encouraging a greater focus on multidisciplinary
team based care
(Department of Health and
Ageing, 2008)

19.  Regional integration
 Information and technology,
including eHealth
 Skilled workforce
 Infrastructure
 Financing and system performance

20.  Key Priority Area 1: Improving access and
reducing inequity
 Key Priority Area 2: Better management of
chronic conditions
 Key Priority Area 3: Increasing the focus on
prevention
 Key Priority Area 4: Improving quality,
safety, performance and accountability

21. http://www.yourhealth.gov.au/internet/yourhe
alth/publishing.nsf/Content/publications?Ope
nDocument&ct=2011%20Health%20Reform

22.  Research from the USA and New Zealand
suggest that primary health care is
contributing to a in the life expectancy gap
for indigenous peoples
 Indigenous Australians continue to
experience poor access to primary health
care, despite the higher levels of morbidity
and the large gap in life expectancy.

24.  Developed in the USA by Edward Wagner
 Describes the essential elements for
improvements in the care of people with
chronic conditions with a focus on primary
care
 Aim of the CCM is to develop well informed
patients and a healthcare system that is
prepared for them

25. Epping-Jordan, J E et al. Qual Saf Health Care 2004;13:299-305

26.  Delivery System Design
◦ Create teams with a clear division of labour
◦ Separated acute care from the planned care
◦ Planned visits and follow up are important features
 Self-management support
◦ Collaboratively helping patients and families to
acquire the skills and confidence to manage their
condition
◦ Provide self management tools, referrals to
community resources and routinely assessing
progress

27.  Decision Support
◦ Integration of evidence based clinical guidelines
into practice and reminder systems
 Clinical Information Systems
◦ Reminder system to improve compliance with
guidelines, feedback on performance measures and
registries for planning the care for chronic diseases

28.  Community Resources
◦ Linkages with hospitals providing patient
education classes or home care agencies to
provide case managers
◦ Linkages with community based resources-
exercise programs, self help groups and senior
centres
 Health Care Organisation
◦ The structure, goals and values of the provider
organisation. Its relationship with purchaser,
insurers and other providers underpins the model

30.  Harris, Kidd and Snowdon (2009) have
adapted Wagner‟s CCM to address issues
relating the PHC in Australia
 Provides a framework for an effective and
accessible national primary health care
system
 Evidence that this model will provide a more
effective way of ensuring access, quality
and equity of care for all people in Australia

31. Model for Primary and Community Care to meet the challenges of chronic
disease prevention and management
• Reengineering the
organisation of health care
• Modification of primary care
organisations
• Engaging the community
• Monitoring performance and
accountability
• Self management and health literacy support
• Redesign of the primary health care team
• Shared information systems
• Decision support
Informed patients Proactive Team
Better Prevention and management
of chronic disease
Harris, Kidd and Snowdon, 2008, p. 7

32.  Developed by the WHO in response to the
increasing prevalence of chronic diseases in both
developed and developing countries.
 Adapted from CCM
◦ Shift from acute care for chronic disease to a more
preventative and long-term health care management
model.
 Composed of fundamental components at the
patient (micro), organisation/ community (meso)
and policy (macro) levels

33.  Macro Level - governments developing and
implementing policies to prevent and manage chronic
disease.
 Meso Level - systems to manage care over time. This
will include education of health professionals,
evidence based guidelines, prevention strategies,
information systems and linking with community
resources.
 Micro Level – The micro level of the model elevates
the role of patients and their families, and partners
them with communities and healthcare organisations.

35. National strategic policy approach to chronic disease prevention and care
in the Australian population.
 Overarching framework which encourages coordinated action nationally.
 Five supporting National Service Improvement Frameworks (asthma;
cancer; diabetes; heart, stroke and vascular disease; osteoarthritis,
rheumatoid arthritis and osteoporosis).
Primary objectives of the NCDS are to:
 Prevent/delay the onset of chronic conditions
 Reduce the progression and complications of chronic conditions
 Maximize the wellbeing and quality of life of individuals living with
chronic disease and their families and carers
 Reduce avoidable hospital admissions and health care procedures
 Implement best practice in the prevention, detection and management of
chronic disease
 Enhance the capacity of the health workforce to meet population
demand for chronic disease prevention and care into the future

36.  Key principles
◦ Adopt a population health approach
◦ Prioritise health promotion and illness prevention
◦ Achieve person-centred care and optimise self-
management
◦ Provide the most effective care
◦ Facilitate coordinated and integrated
multidisciplinary care across services setting and
sectors
◦ Achieve significant and sustainable change
◦ Monitor progress

37.  Action areas
1)Prevention across the continuum
2)Early detection and early treatment
3)Integration and continuity of prevention and care
4)Self-management
 Action implementation areas
1) Building workforce capacity
2) Developing strategic partnerships
3) Enhancing investment and funding opportunities
4) Developing infrastructure and information technology
support

38.  National agreement between the Commonwealth
and the States and Territories.
 Clarifies the roles and responsibility of
Commonwealth and State governments to guide
the delivery of health services
 Defines objectives for chronic condition
prevention, primary and community care,
hospital and related care and aged care
 Provides a description of the outputs and
performance indicators to measure success.

39.  National preventative task force
 National partnership on closing the gap in
Indigenous health outcomes
 Australian Better Health initiative
 National Health Priority Area initiative

40.  GPs play a major role in the prevention and
management of chronic diseases
◦ First point of contact
◦ First to diagnose conditions
◦ Can provide counseling services, prescription & referral
◦ Strategies to support and facilitate role of GP in PHC
essential
 Enhanced Primary Care Plan
 Lifescripts (discussed later in semester)
 SNAP methodology (discussed later in semester)

41.  MBS items were introduced for health
assessments and care planning
◦ GPs could receive a MBS rebate for initiating and
participating in health assessments and care planning
 Other EPC initiatives
◦ Healthy Kids Check
◦ 45 year old Health Check
◦ Type 2 Diabetes Risk Evaluation
◦ Incentive Programs
◦ Practice Nurses

42.  In the 2005-2006 Budget, the Australian
Government announced funding for the Healthy for
Life program
 The objectives are to :
◦ improve the availability of child and maternal health
care;
◦ improve the prevention, early detection and
management of chronic disease;
◦ improve men‟s health;
◦ improve long term health outcomes for Aboriginal
and Torres Strait Islander Australians;
◦ increase the capacity of the Aboriginal and Torres
Strait Islander health workforce through the Puggy
Hunter Memorial Scholarship Scheme.
◦ http://www.health.gov.au/internet/h4l/publishing.n
sf/Content/home-1

43.  Anderson, N., Bridges-Webb, C. and Chancellor, A. (1986). General practice in Australia. Sydney University Press, Sydney
cited in Primary Health Care-2006. AMA. Available at http://www.ama.com.au/node/2502
- Australian Primary Health Care Research Institute, Australian University. Cited in Primary Health Care-2006. Available
http://www.ama.com.au/node/2502
- Department of Health and Ageing (2008). Primary Health Strategy. Available at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/D66FEE14F736A789CA2574E3001783C0/$File/Discussio
nPaper.pdf
- Doggett, J. (2007). A New Approach to Primary Care for Australia. Centre for Policy Development, Sydney.
- Harris, M., Kidd, M. and Snowdon, T. (2008). New models of Primary and Community Care to meet the challenges of chronic
disease prevention and management: a discussion paper for the NHHRC.
- Harris, M., Laws, R. and Amoroso, C. (2008). Moving towards a More Integrated Approach to Chronic Disease Prevention in
Australian General Practice. Australian Journal of Primary Health. 14(3), 112-118.
- National Heart Foundation and Kinect Australia for Lifescripts Consortium. (2005). Lifescript in your Division: supporting
lifestyle risk factor management in general practice. A guide for Division of General Practice. Canberra, Commonwealth of
Australia.
- World Health Organisation. (2008). Primary Health Care: Now More than Ever. Available
at:http://www.who.int/whr/2008/whr08_en.pdf
- WHO Regional Office for Europe‟s Health Evidence Network (HEN). (2004). What are the advantages and disadvantages of
restructuring a health care system to be more focused on primary care services. Cited in Primary Health Care- 2006. AMA.
Available at http://www.ama.com.au/node/2502.