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HealthPathways, RACP & NICE guidelines - how do they fit together?

Discussion in 'Diagnostic Guidelines' started by Ravn, Nov 8, 2019.

  1. Ravn

    Ravn Senior Member (Voting Rights)

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    I used to think - wrongly - that HealthPathways was a NZ thing. Turns out there's a long list of Australian health districts participating, plus three British ones.
    https://www.healthpathwayscommunity.org/About.aspx

    So that's one set of guidelines. We all know about the NICE guidelines. And recently we learned that another set of guidelines by the Royal Australasian College of Physicians (RACP) are going to be updated (see post here: https://www.s4me.info/threads/news-from-new-zealand-and-the-pacific-islands.4230/page-16#post-210499).

    So in Britain, in some regions, we have NICE and HealthPathways.

    And in most of NZ and Australia we have RACP and HealthPathways.

    Do these different guidelines compete or do they complement each other in some way?

    They all seem to be being updated independently of each other and at different times. Wouldn't that create a risk of them containing contradictory information at times? Which would be confusing for doctors.

    As an aside, I don't like the word 'opinion' in the HealthPathways description: "Each health jurisdiction tailors the content of HealthPathways to reflect local arrangements and opinion".
     
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  2. Hutan

    Hutan Moderator Staff Member

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    My understanding is that the Health Pathways software was developed here in Canterbury, NZ. I think most of the regional health authorities (district health boards) in NZ use it, as well as a number of Australian and UK heath authorities. From memory, Health Pathways claimed that over 28 million people lived in health authorities using the Health Pathways software.

    It is really a method of delivery of best practice and local content (referral details for local specialists and patient groups and so on). Each regional health authority that is a member of Health Pathways agrees to let the others see their content and it can be copied. But each regional health authority has control over what they include. The content is written so that a GP can consult it during an appointment with a patient - so it's brief and concentrates on the key points.

    So, a UK health authority using the Health Pathways software would presumably make sure that their content reflected NICE guidelines as well as referring to respected local patient groups and specialists.

    My understanding is that if a regional health authority updates a pathway and feels that it is particularly good, they can mark it as one recommended to be used as a base for others.
     
    Last edited: Nov 8, 2019
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  3. Hutan

    Hutan Moderator Staff Member

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    Dr Graham McGeoch was a key person in the development of the Health Pathways software. He is the doctor that our local patient group has worked with to develop a Pathway for 'Chronic Fatigue and ME/CFS' for Canterbury.

    McGeoch G, McGeoch P, Shand B Is HealthPathways effective? An online survey of hospital clinicians, general practitioners and practice nurses. New Zealand Medical Journal 2015;128 (1408):36-46. http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1408/6413

    Abstract
    Aim: An online survey was used to determine the perceptions of healthcare professionals in Canterbury on HealthPathways, a website that provides clinical and referral information for general practice teams, relevant to locally available health services and resources.

    Methods: The survey questionnaire included questions on the effectiveness and ease-of-use of the website, computer literacy and use of online clinical guidance systems. Differences in the responses between work groups were analysed using the Mann-Whitney test.

    Results: 249/480 (52%) of general practitioners, 72/156 (46%) of practice nurses, and 43/66 (65%) of hospital clinicians completed the questionnaire. Approximately 90-95% of general practice teams considered the website was easy to use and had contributed to both an increase and improvement of care in the community, with about 50% stating that it had improved their relationships with patients and hospital clinicians. Minor concerns included the website’s increasing size and prescriptive nature and that it increased the duration of a patient consultation. Approximately 60% of hospital clinicians reported improvements in referral quality and triage and working relationships with general practices since the introduction of HealthPathways.

    Conclusion: HealthPathways has achieved a high level of acceptance in both primary and secondary care, and has therefore acted as a valuable change management tool increasing healthcare integration in Canterbury.
     
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  4. Hutan

    Hutan Moderator Staff Member

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    If your regional health authority uses the Health Pathway system, then I do think that it's worthwhile to get to see what the Pathway(s) relevant to ME/CFS says. As this is what a busy GP is likely to be looking at when they aren't quite sure what to do.

    If the Pathway is bad, then there may be scope to improve it, by finding a sympathetic person with responsibility for the content and presenting evidence (and pointing to improved recent Pathways that other regional health authorities are using).

    And if the content is good, then you can educate patients to remind GPs to look at the Pathway if they start talking about CBT and GET and thinking positively and don't know what PEM is.

    Once the NICE Guidelines are improved, the Pathways in the UK won't necessarily immediately be updated. The Pathways tend to be on a schedule for 3 year or so review unless there is a compelling reason for something to be changed earlier. So, some campaigning may help to get the Pathway relevant to ME/CFS updated as soon as possible in your region.
     
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  5. Trish

    Trish Moderator Staff Member

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    Is there any way we can find out whether it is used in our local area, and look at the content?
     
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  6. Hutan

    Hutan Moderator Staff Member

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    This was the list of participants in 2016, but I know there are more UK ones now.

    New Zealand DHBs
    Southern; South Canterbury; Canterbury; Nelson-Marlborough; West Coast; Auckland Regional; Northland; Wairarapa; Hutt Valley; Capital & Coast.

    Australia Local Health Districts
    New South Wales: ACT and Southern; Central Coast; Hunter New England; Illawarra Shoalhaven; Mid & North Coast; South Western Sydney; Sydney; Sydney North; Western Sydney.
    Queensland: Cairns; Central Queensland; Wide Bay; Sunshine Coast; Mackay; Townsville,
    Western Australia
    Victoria: Eastern Melbourne; Gippsland; Melbourne; Murray; Western Victoria,
    Tasmania.

    United Kingdom
    South Tyneside
    The Pathway material is strictly for medical professionals - they tend not to be too keen for anyone else to see it. But usually there is someone in a patient group who can get access to see what is in there. It's difficult to print it out, as it tends to be full of links e.g. if there are symptoms of multiple sclerosis, you get a link to the multiple sclerosis page, or there might be a link to the 'management of long term disabling conditions' page so that material about how to get your patient disabled parking doesn't have to be repeated on lots of pages.

    The Pathway material is 'translated' into information for public consumption on the 'HealthInfo' system - also locally based but accessible by everyone. So that should give you an idea of how bad or how good the content for doctors is.
     
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  7. Hutan

    Hutan Moderator Staff Member

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    Looks like it is in Cardiff and Vale UHB.
    https://shapingourfuturewellbeing.com/healthpathways/
    If you are in the Cardiff and Vale UHB it sounds as though now, or at least as soon as there are new NICE Guidelines, would be a good time to try to make sure the pathways relevant to ME/CFS are accurate and helpful.

     
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  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    It looks as if Health Pathways is chiefly about referral to other health professionals from primary care.

    NICE guidelines are about what sorts of medical modalities are considered worth providing within a healthcare system and at least in there they do not cover his you go about delivering those. So in theory they have a complementary function.

    The problem I see is that there is pressure on primary care to cut costs and to develop 'pathways' based on that rather than ensuring patients get the modalities they should. There is also an interest in keeping the process under GP control, so referring to a psychotherapy or physiotherapy service may look more attractive than referral to a hospital where someone else is in charge and takes the credit.

    In the UK the Royal College of General Practitioners is building up a list of 'toolkits' for managing problems in primary care rather than seeking expert advice. From what I have seen these may be produced by any enthusiast who gets the job. I think there is a major risk that following these guidelines will bypass NICE.

    The real problem here is the conflict of interest primary care in trying to cut costs and keep control. In my view primary care should not be separate from hospital care in any administrative way. For most conditions primary care is just an obstacle to effective management,
     
  9. Hutan

    Hutan Moderator Staff Member

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    That isn't correct, at least in my experience. The pathways in the CDHB that I have looked at or had input into cover diagnosis and management as well as referral. They do really condense what would be in a guideline into something the GP can use in the 15 minutes with a patient or perhaps the 5 minutes afterwards when the doctor wants to quickly find out what they should do next.

    But I agree with this, although it's more about health boards wanting to keep care at the primary level. I've been amazed to see what pressure there is from the District Health Board to keep patients away from specialists and hospital clinics. Some of it is fair enough; if GPs are resourced and supported adequately maybe they can cover most things. But it does mean that, in my region, it is unlikely that any one doctor will see enough patients with ME/CFS to ever become an expert or notice patterns that might move the understanding of the illness forward. Even things like multiple sclerosis are managed primarily by GPs after diagnosis.

    And it does seem to result in much more readiness to spend health funding on referrals to physios and psychologists than on medical specialists.

    Perhaps so, but where I live, primary care is pretty much all that we get, unless we are sufficiently close to death to warrant getting into hospital via the emergency department.
     
  10. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Yes, but in a sense they have to cover those in order to say anything sensible about referral. The GP accesses the software to decide who to send the patient to, or to have an excuse for not doing so and muddling through. A major motivation for these pathways is to reduce referral or delay referral. Another is to divert referral to cheap 'community based' services (which may be housed in a hospital but come under a community budget).

    But what is 'primary care'? Why should there be such a thing in an internet based society? I think we have been bamboozled into thinking that the GP model that was useful in rural communities in the 1950s is still suitable. It is absurd that MS is cared for by people who have only ever seen ten cases. We need to wake up to the fact that, at least in countries with NHS type systems, we are just not getting modern medicine much of the time. GPs pretend they can sort anything but the last time that was realistic was when I did some GP in 1980 and even then it was marginal. There are geographical constraints but if there was a will these could be overcome very easily.
     
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  11. Hutan

    Hutan Moderator Staff Member

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    Found the up to date list of coverage:

    Screen Shot 2019-11-08 at 9.39.09 PM.png
     
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  12. Ravn

    Ravn Senior Member (Voting Rights)

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    Which is just sooooo frustrating.
    No such luck. If anyone here happens to have a contact in the SDHB prepared to 'leak'....
    HealthInfo in NZ seems to be limited to Canterbury and the West Coast.
     
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