Creating a Successful Health Pathway to Support the Integration of Patient Care

Introduction:

HealthPathways (HPW) is an online health information portal which provides General Practitioners (GPs), guidance on the assessment, management, and referral of a range of conditions linked to local resources.  It has been adopted as an aid to improve the integration of patient care across the health system. However, there is a lack of understanding of the acceptance of pathways within primary health.

Theory/Methods

This qualitative study identified baseline factors that promote the successful implementation of HPW in a major Local Health District (LHD) in Australia. The development, implementation and acceptance of Diabetes HPW was evaluated using semi-structured interviews with purposive samples. Interviews were digitally recorded, transcribed, and analysed qualitatively using a thematic analysis approach.

Results

A total of 16 interview transcripts were analysed. Four core themes were identified in relation to the processing of implementing the HPW: 1. The importance of creating & maintaining collaborative partnerships through the development of the pathways (engagement); 2. the process promoted trust and understanding between organisations and made their individual aims, processes and values clearer to one another (transparency); 3. HPW implementation was also seen as means of committing individual organisations to provide standardised and consistent care across the Local Health District (accountability); and, 4. the importance of providing adequate funding and resources to support the ongoing development and revision of HPW (Sustainability).

Discussions

This process evaluation provides additional, qualitative evidence about what facilitates the successful implementation of HPW and identifies barriers that hinder its success. Researchers anticipated the interview protocol would elicit an overall discussion about the strengths and limitations of HPW, as opposed to only about the Type 2 DM pathways; in particular its usability and utility, and suggested improvements or factors that might contribute to its success. An inductive approach was employed to conduct an analysis that extracted common themes amongst the qualitative data.

Conclusions:

This study provides an insight into the development and implementation of Type 2 Diabetes Mellites HPW across different levels of the health system in the LHD. The feedback and experiences from implementation and utilisation of the HPW across different levels of the health system and program implementation, provides the GP with an overall informed perspective on the acceptability of the pathways, what the general consensus is on its applicability and a transparent view on the impacts that the HPW may have on its day-to-day use.

Lessons learned

Collaboration between individuals and organisations has strengthened the development and implementation of the HPW. Engagement and transparency have demonstrated the significance of establishing collaborative partnerships to implement HPW.

Limitations

Despite a number of strategies to encourage the participation of GPs, the recruitment of GPs to take part in interviews was a challenge for the research team.

Suggestions for future research

Further research would be useful to investigate and explore the health outcomes and impact of HPW on the community including broader scope for evaluation of multiple pathways to identify the best ways of ensuring sustainability and uptake of the program.