Primary Care Fracture Clinics

John Adie

The Sunshine Coast Hospital and Health Service (SCHHS) is located in Queensland, Australia and services a population of about 390,000. The Primary Care Fracture Clinic (PCFC) is an integrated care partnership between the Orthopaedic Department of a regional public hospital and general practice. This is a " hospital alternative " model of care. Public hospitals in Queensland are dually funded by the state and federal governments. General practice is run as a small business/fee-for-service private enterprise with funding derived from the Australian Government (Medicare) and fees (paid by patients). This presents challenges for patients needing treatment which require consumables (not provided for in fee for service payment) which the patient cannot afford to fund e.g. casting. This model of care offers right care, right place, right time for patients. • Prior to the intervention fracture clinics at SCHHS hospitals were operating over capacity on a daily basis with approximately 400 referrals for fracture management received each month. • Overflow fracture management appointments were allocated in orthopaedic (non-fracture) clinics and patients waiting for orthopaedic specialist opinion were routinely waiting beyond the clinically recommended time frames. Assessment of problem and analysis of its causes: • Review of surgical conversion data identified an increasing number of patients not requiring specialist orthopaedic intervention. • Primary care providers lacked resources such as direct access to imaging providers and ability/resource to apply plaster casts. Aims: 1. Reduce demand on specialist services by redirection of non-specialist cases. 2. Improve access for patients requiring non-specialist services with increased conversion to surgery rate at specialist fracture clinics 3. The model offers an opportunity for building skill capacity in primary care in the context of changing health system requirements. Intervention Orthopaedic Clinical Nurse Consultant and staff specialist worked with G.P. liaison officer and G.P.s to develop a model of care allowing for management of clinically appropriate patients in a hospital alternative/PCFC by: • Developing list of " in scope " fractures for primary care • Circulate EOI for interested practices, evaluation panel and SLA • Up skilling of general practice nurses by SCHHS plaster technicians • Ask hospital staff to advise patients of this community alternative model of care • Development of close working relationship between orthopaedic staff and G.P.s, built confidence in both parties and allowed for timely transfer of care for patients with more complex needs than initially determined. • Develop process for transfer of images from hospital Department of Emergency Medicine to PCFC should the patient choose to access this model of care. Study design Longitudinal observational comparing difference between SCHHS and PCFC • Effectiveness of treatment-patients seen in clinically recommended timeframe • Patient experience data routinely collected in SCHHS and was used in comparison with data from primary care already collected as part of the evaluation process • Efficiency of service (number of patients seen and surgical conversion rate). Strategy for change • Key stakeholders engaged • Processes developed and agreed (referrals, consumables, medical imaging transfers) • Patient information developed • Set date for commencement of primary care clinic • Review meetings with stakeholders to identify/resolve issues. Measurement of improvement • Patient experience data evaluated pre and post implementation of the PCFC • Conversion to surgery rates compared pre and post implementation of the PCFC • Treatment failure and re-referral was monitored. No cases of non-union or re-referral post discharge from the PCFC to the SCHHS reported to date. • No clinical incidents reported through external governance quality assurance.

Primary Care Fracture Clinics

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