Responding to a chronic condition
ALMOST half of all admissions to Sunshine Coast Hospital and Health Services are patients with chronic disease and the number of people with chronic illnesses and diseases is increasing steadily.
The result, of course, is a significant increase in health care demand.
By 2026-27, unless changes are made to how this group is cared for, that figure could increase by as much as 116%.
Chronic diseases include coronary heart disease and heart failure, stroke, diabetes, renal disease, respiratory disorders, chronic mental illness, cancer, arthritis and osteoporosis.
It costs the health system about $70,000 a year for a patient requiring in-patient haemodialysis.
One in five admitted to hospital has diabetes.
For this reason, the SCHHS plans to develop specialised share care pathways for chronic diseases.
This proposed model could save the Queensland health system more than $500,000 a year.
Measures can be taken to minimise the burden of these diseases, not only for the patient but also for the service. Ideally, patients receive interim treatment in the community.
Type 2 diabetes is an example where shared care clinics have been set up so treatment of uncomplicated diabetes can be treated in the community.
Clinical Director of Endocrinology and Diabetes, Dr Shyam Sunder said the health service had strategies to liaise with general practitioners and the community at large.
"We have partnered with the Sunshine Coast Division of General Practitioners (Focus Health Network) to take hospital outpatient clinics to the community," he said.
Dr Sunder said local specialist endocrinologists had regular sessions in GP clinics, giving a seminar and then reviewing patients with the general practitioner.
This provides the GPs with education and upskilling in the management of complex issues.
This system benefits patients and GPs, and reduces the burden on outpatient services at the public hospital.
The same shift in community-based education and provision of care is happening for patients with chronic obstructive pulmonary disease, a chronic lung disease.
Dr Michael Bint, director of Respiratory Medicine, said chronic lung disease was the fourth largest cause of death and it was a disease that could, in many cases, be helped with preventative measures.
"Seven to 10% of the adult population have a chronic lung disease, mostly chronic bronchitis and emphysema," Dr Bint said.
"If we have about 380,000 people on the Coast, about 300,000 of them are adults.
"That means we've got about 20,000-30,000 people with COPD, 50-60% of those would be severe and only about 10-20% would know they have the disease," he said.
"We have a huge population, most of whom don't even know they have a problem, and so aren't doing what they need to be doing.
"They become acutely unwell with an infection in their lungs, they require admission to hospital and receive treatment and then they leave the hospital only for it to happen again," he said.
"We're trying to break that cycle. We plan to identify the patients when they're in hospital and then involve a respiratory care team to follow them up in the community maintaining close liaison with the patient's GP.
"What we want to do is have staff who work in the community so a patient can be discharged from hospital and followed up with their GP with the help of the respiratory nurses.
"Then the next time they get into trouble, they don't need to come to hospital."
That's different to what happens now.
Currently patients face an average of six to seven days spent in hospital, they come back to the hospital as an outpatient where they see the specialist a couple of times and then go back to the community only for the cycle to happen again.
The primary cause of chronic kidney disease in our community is diabetes. Chronic kidney disease has a significant cost to the community, particularly if patients require dialysis treatment.
Across the Coast there are in-centre haemodialysis treatment units in Caloundra, Nambour, and Gympie. Nambour General Hospital has a home haemodialysis training unit and a peritoneal dialysis unit.
Dr Peter Hollett, a service director for Medical Services Group and a renal specialist, said the Sunshine Coast Hospital and Health Service offered a comprehensive home dialysis service.
These patients would otherwise be admitted.
"Because of the complexity of the medical conditions our patients suffer from, our models of care need to be responsive to these demands," he said.
"In the future we're planning multi-disciplinary clinics with a number of different sub-specialists and general physicians seeing the patients.
"This will hopefully improve the efficiency of the services in the sense that the patient won't have to come and see multiple specialists at different times on different days."