Paul Cooper, Clinical Lead, Primary Care
Last month saw the release of the Stay Independent: Falls Prevention Toolkit for Clinicians developed by the Health Quality & Safety Commission in association with BPACnz.
The toolkit and its message recognised the Commission’s desire to expand the scope of the Reducing Harm from Falls programme to include primary and community-based care.
It also recognised a need to ensure the future of the programme so generations of ageing New Zealanders will continue to receive its benefits.
As a primary care practitioner I am delighted to see the expansion of the falls programme into the community. The toolkit developed by the Commission provides excellent resources to address falls risk in a positive and proactive way. The emphasis on prevention and the focus on integration of health services provide the best opportunity to address the challenges presented by New Zealand’s rapidly ageing population.
All three arms of the New Zealand Triple Aim for health care improvement are included in this long-term view, with individuals receiving improved quality, safety and experience of care, ensuring population health and equity are addressed and thus making the best use of health system resources.
The challenge for primary care teams is to take the resources available and incorporate them into the health care services we already offer to ageing New Zealanders. We need to make the assessment of falls risk a fundamental part of health care.
Many district health boards are working on the development of pathways and guidelines for different conditions affecting the ageing population, such as cognitive impairment/dementia, falls, frailty, bone health/osteoporosis, palliative care and directories of elder health services. The primary care sector is in danger of being overwhelmed by multiple guidelines and pathways. There is an urgent need for a rationalisation of these pathways or patient maps to produce a limited number of guides to assist clinicians. The pathways will have agreed assessment tools and outcomes which can be usefully applied in a setting which best meet an individual's needs.
There is a lot of innovative work occurring throughout New Zealand in the falls area but currently there is no easily identifiable national forum for sharing these ideas or learning from each other. We are a small country with limited resources and hence national cooperation and integration are critical to make best use of health funding.
What should the system look like in five years?
Falls risk assessment will be an important part of a comprehensive wellness assessment offered to our patients as they age. Falls assessment will be integrated with other health assessments, such as cardiovascular disease risk, and will be seen as routine practice by primary care teams. These assessments will start at 55-60 years of age and place an emphasis on primary providers becoming partners with individuals to maintain their independence in the community for as long as possible.
Common assessment tools will be validated and used by all agencies involved in the individual's care. The tool will be in electronic form with easy access and sharing between providers, the consumer and their family. Where problems are identified or a fall has occurred, there will be easy access to local rehabilitative services with electronic referral between community-based providers.
Preventative programmes promoting healthy strength and balance exercises will be easily accessible promoting mobility, social interaction and general wellbeing
Funded DEXA scanning will be available to individuals with risk factors or meeting agreed criteria as an important part of the prevention programme.
We talk a lot about the integration of health systems and this lifetime view of reducing harm from falls requires all individuals and agencies to work together. This is not about primary and secondary care or specialists vs generalists. It is about what is best for patients and designing a multidisciplinary system which truly responds to the needs of individuals and promotes healthy ageing and wellbeing. While patient pathways are useful tools, a really effective service is more about the relationships which are developed between different providers. Teamwork is crucial and really effective teamwork is all about relationships and good communication.
We need to encourage innovation with individuals supported to work at the top of their scope.
Paraphrasing one of the slogans of the falls programme – ‘this is everyone’s problem - we need to work together to assist patients. As Professor Ngaire Kerse, a general practitioner with training in geriatric medicine and extensive experiences with the Commission’s falls programme puts it: ‘Staying upright is everyone's responsibility’.