Innovative Models Promoting Access & Coverage Team (IMPACT)

Project Short Title
IMPACT

Project Status
Current

Professor
Mark Harris (CPHCE, UNSW), Jean-Frederic Levesque (CPHCE and NSW Bureau of Health Informaiton), Catherine Spooner (CPHCE, UNSW), Courtney Whittaker (SWS Primary Health Network), Dianna Milosovic (SWSLHD), Shoko Saito (CPHCE, UNSW), Siaw-Teng Liaw (CPHCE and SPHCM, UNSW)

Overview

Innovative Models Promoting Access-to-Care Transformation (IMPACT) Research

You tube window:

https://www.youtube.com/watch?v=QOLBvxZ7a04

The IMPACT study is a five year research program that aims to develop and evaluate models of care that enhance access and reduce unmet need, avoidable emergency department visits and avoidable hospitalisations for vulnerable populations. The Centre for Primary Care and Equity has partnered with South Western Sydney Medicare Local and South Western Sydney Local Health District to undertake this project. The research is conducted by Local Innovation Partnerships (LIPs) set up in regions of 3 Australian states (New South Wales, South Australia and Victoria) and 3 Canadian provinces (Alberta, Ontario and Québec).  It has four main objectives:

  1. To develop a network of partnerships between decision makers, researchers, clinicians and members of the vulnerable communities to support the improvement of access to primary health care for vulnerable populations;
  2. To identify organisational, system level community based primary health care interventions designed to improve access to appropriate care for vulnerable populations, and establish the effectiveness and scalability of the most promising organisational innovations;
  3. To support the selection, adaptation and implementation of organisational innovations that align with local populations’ needs and priorities; and
  4. To evaluate the effectiveness and efficiency and further scalability of these organisational innovations.

The IMPACT program of research involves four interconnected research projects:

Project 1 – Scoping of organizational innovations

Project 2 - Realist view of potential innovations

Project 3 - Context and improving access

Project 4 - Trialling evidence based access innovations 

The LIPs identify regional gaps in access to community-based primary health care (CBPHC) for vulnerable populations, and then work with researchers to identify evidence based approaches to address these gaps. Promising innovations will be trialled in each of the LIP regions.

Follow the research team on twitter: @IMPACT_PHC

For details, please visit website http://www.impactresearchprogram.com/

Project 2: Realist systematic reviews

A project team including Sharon Parker, Louise Thomas, Hyun Song and Annette Riley have conducted systematic reviews of the literature with the Australian Learning Innovation Partnership (LIP) groups in Sydney, Melbourne and Adelaide.  These have been on the following topic areas:

a. Impact of e/m/telehealth interventions on access to care for vulnerable groups with chronic illness

b. Interventions that use health brokers to increase linkage to primary care

c. Programs to improve health care access for vulnerable populations transition from hospital to the community.

d. Interventions that use health brokers to increase linkage to primary care: a realist synthesis


Project 3: South West Sydney: Internet-supported diabetes self management and access to care

1. Project Aims

i. To evaluate a web-based intervention that supports general practice staff and patients in type 2 diabetes (T2D) management and access to referral services.
ii. To explore factors influencing the implementation and adoption of the web-based intervention by practices and patients.

2. Importance of the study

Development of the self-management capacity of patients through the use of an e-health portal will potentially improve appropriate primary care access and referrals and reduce inappropriate emergency department presentations and hospitalisations. This is especially important for socio-economically disadvantaged and culturally and linguistically diverse patients and those living in under-served areas.

3. Short summary of the project

The Innovative Models Promoting Access-to-Care Transformation (IMPACT) study represents an international research collaboration between consumers and providers in six communities (three in Australia and three in Canada). In one of these sites in South West Sydney we conducted a needs assessment and deliberative consultation process (SWSLHD Ethics Approval (E C00136) to identify access issues and possible interventions and then conducted a systematic review of the literature on e-health interventions. Based on the outcomes of this process, we designed a trial of the impact of a web-based diabetes self-management support e-portal for patients with poor diabetes control attending general practice. The study recruited general practices based on their geographic location in low socioeconomic and/or under served rural/semi­rural areas and asked them to recruit patients with poor diabetes control. ABS data and anecdotal reporting suggested that >75% of disadvantaged and culturally and linguistically diverse households in south west Sydney have access to the internet.

The intervention involved patients being supported to use a web portal which was developed based on the “5 As” model. This includes resources and services to aid in assessment of diabetes control and risk factors; provides advice and information for diabetes management; helps patients and providers to agree on personalised goals; assists the process of referral to other services and prompts for follow up GP visits. GPs and practice nurses received training on the use of portal, and were supported to implement it in their practice. Patients were invited by GP practices and introduced to the web portal by the GP and/or practice nurse.

We are evaluating the impact of the intervention on patient reported access to information and services for the management of their diabetes including appropriate use of general practice and hospital services. We are also assessing GP and practice nurse attitudes and practices and patient health and information literacy. Information was collected by surveys and interviews with practice staff and patients prior to the intervention and after 12 months. The findings of the study will be widely disseminated and made available to local primary health networks and the local health district to inform findings of the project and their policy implications.

The intervention involves patients being supported to use a web portal which has been developed based on the “5 As” model. This includes resources and services to aid in assessment of diabetes control and risk factors; provides advice and information for diabetes management; helps patients and providers to agree on personalised goals; assists the process of referral to other services and prompts for follow up GP visits. GPs and practice nurses will receive training on the use of portal, and be supported to implement it in their practice. Patients are being invited by GP practices and introduced to the web portal by the GP and/or practice nurse.

We are evaluating the impact of the intervention on patient reported access to information and services for the management of their diabetes including appropriate use of general practice and hospital services. We are also assessing GP and practice nurse attitudes and practices and patient health and information literacy. Information is being collected by surveys and interviews with practice staff and patients prior to the intervention and after 12 months. The findings of the study will be widely disseminated and made available to local primary health networks and the local health district to inform ongoing development of the portal.