Published on 24 January 2019
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With an ageing population, unhealthy lifestyles, rising obesity rates and mental health issues, a new way of working using digital technology could tackle pressures on the UK’s health and social care system while improving patient care.
Pioneered in New Zealand, HealthPathways (HP) has been piloted in the UK in South Tyneside, with our University evaluating its impact and potential to be rolled out nationally.
HP acts as a central online repository for hundreds of care pathways for specific conditions. These pathways have been developed locally by general practitioners and local subject matter experts. Each pathway is evidence-based and reflects national standards of care. Tailoring information to reflect local services means that it will be easier for practitioners to identify what is available to support patients and determine their criteria for referrals and accepting new patients.
For example, for type 2 diabetes, the care pathway would include information on local dietetic or podiatry services, as well as guidelines for referring retinal abnormalities to an ophthalmologist.
“HealthPathways are not just evidence-based clinical guidelines. Each condition specific pathway includes a whole range of information about local health, social care, voluntary care services and resources for clinicians, patients and their families. It’s all about using a whole range of available resources to improve care for patients,” explains lead researcher Joy Akehurst, former Principal Lecturer in Integrated Care and retired Executive Director of Nursing and Quality in Sunderland.
“The HP initiative began in Canterbury, New Zealand, which has seen its health system move from a position, not unlike our NHS, where its main hospital in Christchurch regularly entered ‘gridlock’ – with patients backing up in its emergency department and facing long waits as the hospital ran out of beds – to one where that rarely happens. It now has low rates for acute medical admissions compared to other health boards in New Zealand and has a system that has good-quality general practice that is keeping patients who do not need to be in hospital out of it; is treating them swiftly once there; and discharging them safely to good community support.
“This is the first study to explore users’ views of online localised evidence-based care pathways across a health care system in England. We included GPs, nurses, practice managers, hospital consultants and system leaders.
“Our research aimed to understand what influences the implementation and use of HP in South Tyneside, to inform further development in the UK.”
GPs are the main users initially as they have the primary responsibility for patient referral to services and for managing patient care in the community.
During their study, University of Sunderland researchers discovered that existing well-developed strong relationships were a key driver for engagement with HP across the health and social care system.
Most stakeholders were willing to support the implementation of HP because they were encouraged by its ethos of ‘right care, right place, right time’, believing it would aid decision making and referrals for their patients, rather than the overall strategic goal of reducing hospital attendance or admissions.
Jonathan Ling, Professor of Public Health at the University, added: “The study found most users were positive about the principle of care pathways and that HP was a useful tool to help them in their work. They also felt HP could improve relationships between primary and secondary care.”
Dr Jon Tose, GP Clinical Director at NHS South Tyneside Clinical Commissioning Group, said: “HealthPathways is a tool being used for a whole system change, reducing the number of unnecessary referrals, ensuring patients who should be referred are being referred and supporting GPs to offer the most effective investigations and treatments to their patients. It aims to remove organisational boundaries between primary and secondary healthcare and help us to work more collaboratively for the benefit of our patients.
“The CCG has been working with the Canterbury District Health Board, New Zealand, for over three years now to integrate HealthPathways into our current system. The real benefit for patients is that they get answers they need quicker. Often, when making a referral to hospital, patients could have to wait weeks to be seen, we can now resolve some issues in a single consultation.”
The programme manager for the implementation in South Tyneside, Mark Girvan added: “The collaborative process which is required to develop these pathways is having a significant impact on the blurring of boundaries between primary and secondary colleagues within South Tyneside. By coming together, discussing, developing and agreeing the pathways, we have a much greater understanding of roles and responsibilities across our care system. Having seen the impact that HealthPathways and the wider whole systems way of working has had, not only in Canterbury but across Australasia, we are delighted to be starting to see some of these positive early outcomes within South Tyneside.”
Researchers recommend further work to focus on the patients’ perspective and their engagement in discussions about their own care. This may provide additional insights into the drivers to use online care pathways, and potential outcomes for patients.
The University of Sunderland evaluated the Health Pathways pilot in South Tyneside on behalf of NECS (North of England Commissioning Support Unit).
Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care has now been published online by the BMJ Open.