Avoiding unplanned readmission into hospital is important. A significant proportion of hospital readmissions are avoidable and vulnerable groups, such as older people, are disproportionally affected by unplanned readmissions. Unplanned readmissions are associated with poorer health outcomes, lower satisfaction with healthcare, and increased health system costs.
The transition process between hospital and home is risky for the patient, however it is also a phase where patients may not necessarily need the intensity of a hospital bed, nor might patients actually want to remain in hospital especially if the same level of patient safety could be assured in the patient’s own home.
Tracey Johnson is the CEO of Inala Primary Care, a not-for-profit general practice located in Inala serving approximately 7000 patients; 4400 of whom attend clinic regularly. Inala is a suburb of Brisbane, Queensland and has a population of great cultural and linguistic diversity, with just under 40% of residents speaking English at home. It is also one of Queensland’s most socioeconomically marginalised urban areas.
Australian Health Journal spoke with Tracey on the role of Inala Primary care in reducing hospital admissions.
The delivery of care in a culturally and linguistically sensitive manner across all levels of the healthcare system is seen as deficient. In an effort to improve healthcare access and equity, Inala Primary Care and the Mater Integrated Refugee Health Service (MIRHS) co-developed the Mater Culturally & Linguistically Diverse Healthcare Coordinator Service (MCHooSe).
Commonly delivered services included following up with external health services, chart reviews and helping patients coordinate external health care appointments. Surveys of primary care clinicians (GPs and practice nurses) revealed that MCHooSe improved patient access to external health services and improved patient understanding of their treatments.
The data also revealed that the primary care clinicians felt the patients’ wellbeing improved after their patients had access to the service and that patients were more likely to be compliant with attendance and treatments. Most importantly, primary care clinicians said they received communications from the hospital quicker if MCHooSe was involved.
In combination, these factors are known to reduce the risk of hospital readmissions. MCHooSe highlights the potential to improve hospital outcomes through better healthcare coordination and improved healthcare equity for multicultural patients.
Tracey also talks about the outcomes of non-dispensing pharmacists in general practice in a pilot running at Inala Primary Care. Prior health research has shown the integration of non-dispensing pharmacists in the general practice clinic has significantly reduced emergency department presentations and hospital readmissions in certain patient groups (long-term polypharmacy suffering from congestive heart failure or chronic obstructive pulmonary disease).
As part of the pilot, pharmacists are working towards averting hospital readmissions, new hospital presentations and adverse health outcomes. Formal evaluation of the pilot is currently being completed by Brisbane South PHN and Griffith University.
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Role of the Chief Nursing Officer
Professor Alison McMillan PSM spoke with Australian Health Journal about the role of Chief Nursing and Midwifery Officer at the Australian Government Department of Health and Aged Care.
Alison was appointed as our Chief Nursing and Midwifery Officer in November 2019.
In June 2021 Alison was awarded a Public Service Medal for outstanding public service to driving the Government’s national health response priorities during the COVID-19 pandemic, particularly to infection prevention measures.
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Smarter investment in the research long game
In this Op-Ed, Nadia Levin, CEO of Research Australia, spoke with the Australian Health Journal about the need for smarter and more strategic investment in Australia’s health and medical research sector.
Levin argued that Australia’s approach to health and medical research has been shaped too heavily by short-term political cycles rather than a long-term national vision. She emphasised that meaningful progress in science, innovation, and healthcare requires sustained investment over many years.
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The role of genomic screening in transforming public health
Dr Jane Tiller is a lawyer, genetic counsellor and public health researcher. She is Ethical, Legal & Social Adviser in Public Health Genomics at Monash University, and a National Health and Medical Research Council Investigator Grant holder. Jane is passionate about the use of genomics to prevent disease, and in delivering equitable access to preventive genetic information at the population level. She is co-lead of DNA Screen, a world-first study piloting the offer of preventive DNA screening to the Australian adult population. DNA Screen has tested over 10,000 young people for genetic high risk of medically actionable conditions such as cancer and heart disease, finding about 2% of participants had genetic high risk. Jane is leading efforts to secure Commonwealth Government funding to expand the DNA Screen program, with the eventual goal of the development of a public health population screening program for disease prevention based on high genetic risk.
