Health reform needs to be championed by health leaders

Health reform needs to be championed by health leaders, responsive to community needs and securely funded, to be sustained and benefit the health of Australians according to a new research published in the Medical Journal of Australia.

The research reports the results of the first work program of the Australian Primary Health Care Research Institute (APHCRI) at ANU. It examines the sustainability of five regional primary health care programs in terms of economic, political, institutional, financial, client, and workforce factors.

APHCRI's Deputy Director, Dr Beverly Sibthorpe, who co-ordinated the work, said the focus on sustainability was important in a world where multiple local and national health reform strategies were being implemented.

"There are many initiatives aimed at improving primary health care services for patients, but without acknowledgement of key ingredients to keep those programs going - like established funding and State and Federal organisations working together - they could be lost," she said.

Five programs around Australia were examined. The will and commitment of people running the programs was an important factor, Dr Sibthorpe said.

The RAISE Wellbeing program in Port Augusta brought various Aboriginal health services and mainstream mental health groups together to tackle shortcomings in Aboriginal mental health services.

Links formed between the organisations and the development of mutual respect between mental health workers and Aboriginal health workers were key to its success.

Other groups, including the Sharing Health Care Initiative in Katherine, which looked at ways to manage chronic disease through self-care and education in remote Australia, identified leadership, champions of the program and financial sustainability beyond pilots as important drivers.

Services for other marginalised communities in Australia were included in the research. South Australia's Care and Prevention Programme, which offers support and medical services to people living with or at increased risk of HIV, was examined.

This group found the sustainability of the service was threatened by inadequate income generated in general practice through MBS billing of the longer consultations these patients needed. This program has shown measurable health benefits for patients, including significantly improving quality of life and reduced prevalence of depressive disorders in its patient population.

In Melbourne, mental health treatment programs, one Internet based, were evaluated for economic sustainability. While both programs were seen to be successful in dealing with patient depression and anxiety conditions, workforce issues and the cost of the programs affected their ability to be sustained.

The final project examined the use of motivational interviewing to help GPs support patients with risk factors for chronic disease by the implementation of a SNAP (smoking, nutrition, alcohol and physical activity) plan.

The program assisted GPs in developing skills to feel more confident helping patients, but the impact of the program was affected by a lack of teamwork within practices, poor linkages with referral services and the need for a business model to run the program.

Dr Sibthorpe said the research highlighted the need for sustainability to be considered in the development and testing of new initiatives in primary health care.

"As pressure on health care increases wise investment in sustainable programs will become increasingly important."