FUTURE CARE: The future is delivery models based around prevention, prediction, personalised medicine and participatory health.
FUTURE CARE: The future is delivery models based around prevention, prediction, personalised medicine and participatory health. Eva Katalin Kondoros

Outreach and e-health is expert's prediction

HOSPITAL care is already changing in many ways as technology and consumer demand drives the way in which medicine is delivered in Australia.

Overseas there are already virtual hospitals such as America's John Hopkins Hospital control centre which has staff equipped with real-time and predictive information. They prevent or resolve bottlenecks, reduce patient wait time, coordinate services and reduce risk. Australia doesn't have this the type of centre yet, but it's not impossible that we could see it sooner rather than later.

Associate Professor Ian Scott, director of Internal Medicine and Clinical Epidemiology at Brisbane's Princess Alexandra Hospital, provides Seniors News with other fascinating insights to both the changes we are encountering now and the ones we should expect soon as we move towards delivery models based around prevention, prediction, personalised medicine and participatory health.

Participation in our health

Professor Scott says we all have a duty to take an active interest in our health and the care we are receiving; to understand the rationale for the treatments and the prescribed drugs, the possible side-effects, what needs to be monitored, and become more confident in self-managing. "With digital guidance and the other resources, we can put in place, we can help people to become a bit more confident and competent in managing their own treatment," he says.

Avoid hospital

The future is home care and out-reach services which will allow people to stay at home with care provided by other health teams. "Even through nursing homes, we try not to transfer patients to hospitals if we can avoid it, allowing them to stay in the nursing home and receive care there," Prof Scott says. "We have a very successful program here at PA where we provide outreach to nursing homes provided by our emergency staff and paramedics." They have been able to avoid noticeable numbers of hospitalisations of those patients who needed "relatively simple therapy" and would have previously been treated in a hospital.

"I think it's a theme that many hospitals are progressing, providing outreach services and trying to get community services to be a bit more proactive, and trying also to get general practitioners to be more proactive by identifying a person who may be heading towards a problem, getting in and being aggressive to prevent them from getting so sick they need to go to hospital," he adds.

Professor Scott also expects there to be a shift to more ambulatory, home-based and digitally mediated care so that patients come to hospital only when really need to.

FUTURE CARE: The command centre at The Johns Hopkins Hospital in Baltimore, Maryland.
FUTURE CARE: The command centre at The Johns Hopkins Hospital in Baltimore, Maryland. Keith Weller

Changing scope of practice

Highly specialised roles are unlikely to change, but Prof Scott thinks other specialists will need to blur the boundaries of their role outside of their expert area so that they can understand the impact of what they do has on other organ systems.

"In other words, they don't just look at one organ system, they should be aware of what the whole patient is like in terms of other disease conditions because that is the demographic we are increasingly dealing with," Prof Scott says.

"We are trying to get away from this process where older folk have to see four or five specialists for each of their organ systems and no one is coordinating the show and we are not aware of what is happening with interactions of one drug or another drug that someone else is maybe prescribing. We have problems with older people being on multiple drugs because they are seeing multiple specialists who really don't understand the full picture.

"There needs to be more generalist training. People will be able to practice in other areas. They may not be fully qualified specialists in that area, but at least they have enough knowledge to handle a lot of problems in older patients to the point where we can avoid sending them to multiple different clinics."

Professor Scott also extends this comment to GPS and allied health professionals, where he sees them already developing specialised interests which they can then treat their patients within their practices.

e-Health interventions

There is more focus on digital monitoring through tele-medicine and remote sensor techniques which may help to slow down the flow of patients into hospitals. Patients will remain at home where they are monitored for various health issues and that collected data is fed back to a hospital. "Doctors can make changes to therapy if they think a patient is stepping outside desired parameters and they need to intervene otherwise the patient is going to deteriorate and land in hospital," Prof Scott says.

As seniors become more tech-savvy, the value and understanding of e-Health will allow them to participate a great deal more in their health management.

"We are tailoring our care to your individual parameters," Prof Scott adds.

e-Consultations

He sees tests being done externally and patients receiving an e-message from the doctor advising the test outcomes and what actions the patient needs to take.

Smaller hospitals

"I don't think we can no longer afford these great behemoths; building brand new hospitals of hundreds and hundreds of beds occupying entire city blocks," Prof Scott says.

"I think those hospitals are no longer viable. I think they are going to become somewhat of a dinosaur since a lot of the space and a lot of activity goes on in those hospitals can be shifted into an outpatient or home-based setting."


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