Team to Evaluate Primary Health Care Strategy

Research Team to Evaluate Primary Health Care Strategy Implementation

A multidisciplinary research consortium is to take a close look at the implementation and impact of the Government 's Primary Healthcare Strategy (PHCS).

The Health Research Council, Ministry of Health and ACC are jointly funding the three-year evaluation. It is a formative evaluation, aimed to assist the implementation of the PHCS. The evaluation will also consider the impact of the PHCS implementation on injury care services.

One of the key planks of the PHCS is the development of Primary Health Organisations (PHOs) and the implementation of PHOs will be an important part of the research.

PHOs bring together a range of primary health services from GPs and nurses to community health workers and health educators, and give them responsibility for the health of the people that register with them. Funding is provided on a capitation basis and the aim is to improve access to primary care and improve health promotion and illness prevention.

As of 1 July there were 47 PHOs with more due to come on stream in the coming months.

The research consortium will involve expertise from around the country, headed by Jackie Cumming and Antony Raymont from the Health Services Research Centre at Victoria University, and by Barry Gribben and Carol Boustead from CBG Health Research, an independent research group based in Auckland.

In addition to formal project reporting, the group will feed back information throughout the research process. Ms Cumming says "That's partly so that we can get out there and say this seems to be going well or that doesn't seem to be going well, to give people an opportunity to do things differently sooner rather than later."

Ms Cumming says the PHCS represents a major change in the way that primary care is funded and organised.

"The overall aim is to encourage a population focus in healthcare and to emphasise disease prevention and health promotion, and to coordinate management of chronic diseases such as diabetes," she says.

"We will look at how the implementation of the strategy is going. We'll be particularly interested in access to services and how health care delivery actually changes. We will assess the likely impacts on health status and the potential to reduce inequality in health outcomes."

The evaluation will start off with a series of interviews with key people in a sample of PHOs with a mixture of sizes, structures and geographical locations, and different types of enrolment systems.

"We want to find out what the issues are for them in terms of implementation, what their plans are, how the whole strategy is working for them."

Ms Cumming says that they will then analyse that data and use it to develop a postal questionnaire that will go out to all other PHOs. The aim is to understand the key issues and get all PHOs to describe their progress.

"We want to understand the structure of each PHO, find out who are the key people involved with it, what are the key goals that they are aiming for, how are they going about trying to achieve those.

"We also want to know what sort of service changes they are implementing, and how are they working with local communities. The evaluation will also focus on how PHOs work for Mäori communities, and for Pacific communities. It will look at the roles that general practitioners, nurses and other primary care providers play in delivering primary care services."

The second part of the evaluation will involve using more quantitative data to analyse the changes in activities and services, and to begin to assess outcomes for the patients.

"Our aim is to do before and after studies particularly looking at utilisation rates of different specific types of services to see, for example, if more Maori are being seen, whether there seems to be more preventive activity, whether there are more nursing services relative to services being delivered by GPs - that kind of thing."

The research team is also interested in the outcomes for health arising from the PHCS. They will look at what are called ambulatory sensitive hospitalisations, the types of hospitalisations that primary care can reduce, to see whether they are going down. They will also examine other indicators such as screening rates for cervical and breast cancer, immunisation rates, diabetes detection rates and prescribing indicators to see whether the PHCS is likely to lead to improved health over time.

In addition they plan to do an economic analysis of the distribution of expenditure by population group and service type.

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