Background: The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population.
OPEN ARCH was established in 2017 by the Cairns and Hinterland Hospital and Health Service in Far North Queensland. This Australian-first model of care integrates care at the primary-secondary interface to improve access to specialist assessment and comprehensive care for older persons with complex needs.
Change: OPEN ARCH challenges the traditionally physician-only model of assessment via introduction of a multidisciplinary approach to client assessment and intervention. OPEN ARCH takes hospital-based clinics to the community via home visit and primary-care based consultation. Integration with primary care is achieved through co-location of clinics, shared medical records, case conferencing and shared care planning. The OPEN ARCH service flow is characterised by five stages: client identification and referral; Comprehensive Geriatric Assessment (CGA); person-directed care planning; coordination of supports; and transfer of care. OPEN ARCH has developed a culturally safe model to promote service access for Aboriginal and Torres Strait Islander clients. Flexibility in service flow, utilisation of the Aboriginal and Torres Strait Islander Health Worker in assessment and coordination, and a patient-directed pace of program delivery support engagement of Aboriginal and Torres Strait Islander clients.
Learnings Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people’s needs. Integration at the primary–secondary interface is the sweet spot for this with significant opportunity for improved access to specialist care and enablement early in the trajectory of the person’s illness.