A new service designed to support patients with complex and chronic needs will start in August 2020 in north-eastern and eastern Melbourne, recognising the importance of wrap-around services to support people who need it most.
The Right Care = Better Health Service is funded by Eastern Melbourne Primary Health Network (EMPHN) and delivered by EACH and DPV Health in collaboration with participating general practices.
The Right Care = Better Health Service aims to support referred patients to receive personalised support in finding, accessing and fulfilling complex care requirements through local services. The project aims to provide patients with:
- appropriate and timely, individually tailored, person-centred care
- improved quality of life
- lowered rate of avoidable hospital admissions
Many patients with complex and chronic conditions are not accessing a full range of clinical and support services that can improve their sense of well-being and reduce avoidable hospital admissions.
Health outcomes and quality of life can be improved for patients by providing care coordination and self-management support in the community, including through information and supported access to community services.
The Right Care = Better Health Service will employ complex health coordination and linkage workers, integrated within up to 10 general practices across the EMPHN catchment.
The complex health coordination and linkage role will work with general practice to identify patients, support and enhance team based and shared care practices.
A key feature of the program is the input that EACH, DPV and general practices will have to refine the service model, develop appropriate referral and communication pathways and contribute to the evaluation framework.
This will provide an opportunity for shared learning and a general practice-led response to transform the management of complex and chronic conditions in primary care.
 Batterham R, Osborne R, McPhee C, Mech P, Townsend B. Consumer enablement: An evidence check rapid review brokered by the Sax Institute for the Agency for Clinical Innovation. Ultimo, NSW: Sax Institute, 2017