FNQ HealthPathways: the vital tool for healthcare integration

Aim

To assess the development, implementation and acceptance of HealthPathways, specifically in Obstetrics and Gynaecology in FNQ.

Outcomes

• 89% of respondents were confident in identifying red flags and 61% were confident in determining
  when to refer for a pelvic ultrasound.
• Respondents were less confident with diagnosing the causes and starting medical treatments. 50% used HealthPathways every day or a few times a week (28%) most often during the consultation (72%).
• About 75% reported that  HealthPathways enables them to manage patients they would have previously referred and also improves the quality of their referrals. 85% of patients had been appropriately tested for iron deficiency anaemia and 70% were referred for an ultrasound prior to  referral.
• However, only 56% of patients had been prescribed first line medications. 74% of patients were referred for appropriate reasons.

Background

HealthPathways is a decision support tool used in primary care for evidence-based guidelines  on patient management. It is also used as a healthcare services directory containing referral information. The Far North Queensland HealthPathways covers a unique geographical footprint including regional areas of Cairns but also very remote communities in  the Torres Strait Islands and Cape York Peninsula. Local pathways relating to women’s health are consistently among the highest viewed pathways in the Far North Queensland region. The most viewed pathway ‘Antenatal – First Consult’ has been viewed 3016 times  since it was released in 2020. The ‘Heavy Menstrual Bleeding’ pathway has been viewed 793 times since it was released in 2018.

Through collaboration between local primary care and hospital services HealthPathways aims to promote healthcare integration, improve  access to services and improve patient outcomes. Research was needed into whether the implementation of HealthPathways in the region has influenced referral quality, working relationships between clinicians or innovative models of care. The management rate  for HMB in Australian general practice is increasing over time (1).

This is reflected in the fact that HMB is a common reason for referral to Cairns Hospital gynaecology outpatient services. Like other regions of Australia, it was identified there is a large  variation in management of heavy menstrual bleeding in the Cairns region. A need to assess local GP knowledge of and quality of referrals for heavy menstrual bleeding was identified after discussions between the HealthPathways team and the gynaecology department  at the Cairns Hospital.

Discussion

The results showed that the survey respondents were confident in identifying causes and red flags of HMB but less confident in determining when to refer for ultrasound or how to medically manage HMB. This may be because many of the respondents were GP registrars - they have good theoretical knowledge but less clinical experience managing HMB at the start of their GP training. Only 29% knew that hormonal contraception was least likely to contribute to HMB. Hormonal contraception is first-line for treatment of HMB. However, 61% correctly answered that the levonorgestrel IUD is the most effective medical option. All the respondents knew when to appropriately refer to gynaecology. Many respondents use HealthPathways regularly, it often saved them time and it improved patient management and quality of referrals. This may be because many of the respondents were starting training and rely more on point of care tools and guidelines to ensure patients are safely and appropriately assessed and treated. Currently, management of HMB in primary care in the Cairns region appears to be varied.

Most patients are appropriately investigated but it appears that only a minority are prescribed medical treatment at the first presentation for HMB or referred for IUD insertion if appropriate. It is difficult to ascertain from the referrals whether patients are being offered appropriate
treatment or being offered and declining treatment. Many referrals to gynaecology were for significant pathology such as suspicion of cancer or after an unsuccessful trial of medical treatment. However, 37% of referrals were for reasons that most likely could be managed in primary care. Hopefully, with appropriate education, the knowledge and confidence of managing HMB in primary care will improve. Managing patients with HMB appropriately, using tools such as HealthPathways, may mean that many patients may not need to be referred, reducing the pressure on specialist services. And, importantly it ensures that patients receive the right care, at the right time, by the right healthcare professional.

References

1. Ashworth G, Bateson D, Britt H, McGeechan K, Harrison C. Australian Journal of General  Practice. Management of heavy menstrual bleeding in Australian general practice – an analysis of BEACH data. 2021. doi: 10.31128/AJGP-08-20-5570. https://www1.racgp.org.au/getattachment/a5cc67f1-8280-44f8-82ea-21be8419a718/Management-of-heavy-menstrual-bleeding-in-Australi.aspx
2. Australian Commission On Safety And Quality In Health Care. Heavy Menstrual Bleeding – Clinical Care Standard. June 2024. https://www.safetyandquality.gov.au/sites/default/files/2024-06/heavy-menstrual-bleeding-clinical-care-standard-2024.pdf