Respiratory Network Achievements
1. Model of Care for Chronic and Complex Respiratory Patients
An innovative proposal 'Respiratory Coordinated Care Program: A Proposal for an Improved Model of Care' to improve respiratory services for patients with respiratory infection and COPD has been developed by the GMCT Respiratory Infection Working Group.
Based on the success of a working model at St George Hospital the 'Respiratory Coordinated Care Program (RCCP)' has the potential to substantially reduce hospital admissions and average length of stay for this large cohort of patients.
The proposal, including cover letter from GMCT Chief Executive and Ministerial Briefing, was submitted directly to the Director General via the GMCT Executive in September 2007. Letters were sent to heads of respiratory (or medical) departments encouraging them to bring the proposal to the attention of their respective Directors of Clinical Operations and relevant hospital administrators.
The proposal has generated substantial interest. In March 2008 Sydney South West Area Health Service undertook a clinical redesign project 'Respire' aimed at improving services for chronic and complex respiratory patients at Royal Prince Alfred and Balmain Hospitals informed - among other sources - by the GMCT proposal.
Respiratory Chronic & Complex Clinical Redesign Project 'Re-Spire' - SSWAHS
The project completed as scheduled following three months of consultation with a comprehensive list of local stakeholders including local clinicians of all disciplines and levels, general practitioners, community health workers, hospital managers / administrators and patients.
Copies of the reports of the three phases of the project; 'diagnostic', 'solution design' and 'implementation planning' can be obtained from the Network Manager. The reports are also available on the ARCHI website.
In summary; two working parties addressing 'capacity' and 'care coordination' issues, developed solutions to the high priority concerns identified in the diagnostic phase of the project.
The care coordination working party largely discussed a model of care for complex chronic respiratory patients, essentially comprising an outreach care coordination team to augment existing services. Components identified in the Care Coordination Service Model included self-management education, case management for high risk patients, a rapid response service including rapid advice line, pulmonary rehabilitation, smoking cessation interventions, and in-hospital care coordination.
Royal Prince Alfred Hospital has committed to piloting the new model of care for 6 months commencing 1 July 2008. An evaluation will be conducted at the conclusion of the pilot period (January 09).
2. Smoking Cessation Proposal
A widely consultative proposal to improve access to the treatment of tobacco dependence has been developed by the Airways Diseases & Smoking Cessation Working Group. The proposal consists of three key initiatives including workforce enhancements and subsidisation of nicotine replacement therapy in a population-based approach to clinical tobacco control.
If implemented, the recommendations will have a synergistic impact on smokers with a chronic dependence on nicotine and will substantially reduce the cost burden of tobacco dependence on the NSW health system.
The proposal's three key recommendations are:
1. The provision of area-based 'Smoking Cessation Coordinators' to promote, coordinate and facilitate smoking cessation services, foster clinical smoking cessation networks, and develop a variety of other smoking cessation initiatives;
2. The provision of facility-based smoking cessation clinicians to deliver professional smoking cessation interventions in hospital and community settings;
3. The provision of heavily subsidised nicotine replacement therapy for high risk smokers.
These initiatives are complimentary and, if implemented, will substantially improve smoking cessation services for smokers, and significantly reduce the burden of tobacco dependence on the NSW health system.
Support for the recommendations is being sought from other relevant organisations and clinical groups.