Study highlights healthcare failings

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A new study has found serious shortfalls in the standard of healthcare for patients visiting GPs and local hospitals.

Researchers from the universities of New South Wales and South Australia who looked at the treatment of more than 1,100 patients found that 43 per cent of them received sub-standard care.

Professor Jeffrey Braithwaite from the University of New South Wales says the patients suffered from a range of 22 common conditions, including heart disease, asthma and type 2 diabetes.

"The proportion of best practice care across these 22 conditions to Australian patients is 57 per cent; a little over half the care delivered is best practice in line with international and national evidence," he said.

Professor Braithwaite says the quality of care received by the remaining 43 per cent of patients varied significantly.

"Some care would be just a little bit out of date, maybe you're getting version two of a drug, not version three, and some care that really isn't what we would like, it's below standard," he said.

Although there were pockets of excellence and some aspects of care were well managed across health care providers, the consistent delivery of appropriate care needs improvement, and gaps in care should be addressed. There is a need for national agreement on clinical standards and better structuring of medical records to facilitate the delivery of more appropriate care. There is an urgent need to agree at a national level what constitutes basic care for important conditions, to embed this information in clinical standards, and for groups of experts to ensure that these standards are kept up to date. This must be a dynamic process that takes into account the relative importance of different indicators in different contexts and at different stages of life. Redundant guidelines must be retired and, with better structured medical records, continuous improvement based on ongoing monitoring of the appropriateness of care should become an intrinsic part of health care. CareTrack study findings

'Work on the gaps'

The study found that nearly 90 per cent of patients with sinus problems were prescribed antibiotics which are known to be ineffective for the condition.

It found that only 18 per cent of patients with asthma were given a documented action plan.

Professor Braithwaite says opening up communication between patients and doctors could go some way to overcoming the problems.

And he says smart phone apps could be part of the solution.

"We need, for example, not to have doctors having to rifle through 57 pages of a clinical guideline to try and figure out what the best care is for a given condition," he said.

"What we need to do is provide these standards and a tool, summarised down, so anyone can understand it, and anyone can deliver care at the best practice level.

"And we think what we'd like to do is put in the hands of patients, on their smart phone, an app for each of those conditions that says exactly what you would expect if you were getting best practice care. That would be available for doctors and patients."

AMA president Dr Steve Hambleton says the majority of GPs are delivering top-class medical care.

But he said he had some concerns about the quality of the study and the guidelines doctors have to work within.

He said the system needed to make it easier for doctors to update their skills and spend more time with patients.

"We actually in general practice need to demonstrate the quality of care that we're actually providing, and we need to, I guess, audit our practices to make sure that we are doing that," he said.

"The great majority of GPs are up to speed. The quality of care in this country is excellent, the outcomes are very, very good. We do need, in a first world country though, to keep on the crest of the wave and keep improving."

It is only the second time in the world that a study like this has been conducted.

The first study in the United States was carried out 10 years ago and found 55 per cent of medical consultations provided appropriate care.

Professor Braithwaite says the findings provide a good starting point to improve the health care system.

"We think this is a blue print, it's shown the strengths of the health system, but it's shown where the gaps are. We now can work on the gaps, there's a lot of wastage in the gaps, there's a lot of not best practice care," he said.

"If we can improve that, all of us benefit. Patient populations, doctors feeling more on top of things, the whole system delivers better care."

The study is published in today's Medical Journal of Australia.

Topics: health, healthcare-facilities, doctors-and-medical-professionals, australia

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