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Care Coordination
Tackling chronic ailments; two examples from the curative sector
Still little coordination of care for the chronically ill.
People with a chronic ailment often see several care providers. The latter need to work together to prevent patients from being given conflicting medical advice, having to repeat their case histories time and again, and incurring unnecessary costs. To what extent were agreements on continuity of care between care providers achieved in 2006?
Continuity of care has been on the policy agenda of the Ministry of Health, Welfare and Sport since 1991. However, tools such as regional coordinating structures and electronic patient records are not really getting off the ground.
The Court of Audit examined how and to what extent the policy of the Minister of Health, Welfare and Sport promotes continuity of care agreements in the case of patients with chronic ailments. Using data relating to two clinical groups of patients, the Court tried to draw some general conclusions about continuity of care, both in Ministry policy and as implemented by the decentralised parties involved.
Conclusions
The answer to the main question is that care providers at local and regional level are still largely failing to coordinate care for patients with chronic ailments.
One in three patients with chronic ailments finds coordination between care providers mediocre to poor. Around a quarter are of the opinion that care providers almost never make satisfactory arrangements with each other. Half have to repeat their case history quite frequently. Half also find that care providers are "almost never" properly informed or only "sometimes" informed as to the appointments made by the patient with other care providers. And according to 56% of those questioned, appointments at the same institutions are "almost never" or only "sometimes" planned in combination on the same day.
In practice, the Court did find laudable initiatives in the shape of protocols, guidelines and multidisciplinary networks. A regional partnership of hospital psychiatric departments, mental health care institutions, front-line psychologists and GPs has for instance been set up for patients suffering from depression. Multidisciplinary guidelines on depression have also been drawn up. A cottage hospital has set up a spinal column surgery for patients with back, neck and shoulder problems, and the Court visited an outpatients department specialising in pain and back complaints, where multidisciplinary treatment is provided. But many of the initiatives are small-scale, continuity is not always guaranteed, and they tend not to be adopted more widely.
In other words, improvement is still necessary and possible.
UpRecommendations
The Court of Audit's recommendations included a call on the Minister of Health, Welfare and Sport to adopt a more pro-active attitude, set quantifiable policy aims and respond more adequately to signals from policy evaluations. It also urged the Minister to encourage the systematic evaluation of initiatives aimed at coordination and a wider dissemination of the results. The Court also called upon the Minister to take action if parties in the care system fail to play their designated role.
UpMinister's response
The Minister expressed the conviction that the new, market-driven system would enhance coordination. He believed that coordination should be geared to protecting consumer interests more effectively, arguing that market forces reward those providers who succeed best in establishing a coordinated system. In the Minister's opinion, market forces and coordination could thus combine very effectively.
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