Some procedures don’t need a trip to the specialist
Having a vital but routine medical procedure delivered in primary care, instead of hospital, means shorter wait-times and less travel for many women in the Southern district.
Since 2017, pipelle biopsies – procedures evaluating abnormal uterine bleeding to rule out endometrial cancer and other conditions – are being performed by specially-trained primary care providers, rather than gynaecologists at Dunedin or Southland hospitals.
A recent review shows the programme is effective at improving access to care: So far, more than 713 biopsies have been performed in general practice - 569 of which did not have to be referred on to secondary care for further investigation.
“Some procedures don’t need a trip to the specialist and pipelles are a very good example of care that can be delivered in general practice,” says Dr Elvira de Jong, a GP with Alexandra Family Medical, one of 36 GPs, two nurses and one nurse practitioner in the district trained in the procedure. “Patients are usually surprised it was ever done in hospital.”
While more than 500 specialist appointments have been freed up in the first 18 months, WellSouth PHO Director of Nursing Wendy Findlay, who helped roll out the programme in primary care, says the real benefit is for patients who receive health services more quickly, closer to home and in a setting where they are likely more comfortable.
“There is less worry. Needing a pipelle can be stressful enough, so having the procedure done by a family doctor, sometimes in your own general practice, makes it is easier,” Mrs Findlay explains, noting that WellSouth’s support means there is no cost to the patient, the same as if the biopsy was delivered in secondary care.
The programme benefits GPs as well, enabling them to work at the top of their scope, reducing the need to refer patients on to secondary care and expanding the range of services provided in the community.
Health Central GP Dr Katya Bazley performs pipelles for patients enrolled at her own Alexandra practice and those referred from other doctors and says beyond helping patients, the programme has further fostered connections with secondary care.
“We have a good relationship with Women’s Health, as we’re demonstrating our skills in this area and they respect the work we are doing,” Dr Bazley explains.
“I’d be keen for this service to expand and for more training to be available to continue to improve my skills.”
Other areas where general practice could be funded to deliver additional services include insertion of Mirenas and other IUDs, Dr Bazley says.
“These are very effective treatments and if we were funded we could avoid unnecessary outpatient visits for patients who can’t afford the insertion fee.”
Critical in facilitating the change in pipelle biopsy service delivery has been Southern HealthPathways, a patient assessment, management and referral information website for clinicians working in the Southern district.
Southern HealthPathways are evidence-based terms for referral and management, developed by secondary and primary care clinicians working together. They support consistency and equity of access across the district.
“HealthPathways is more than just a website. Pathways are developed by collaboration between clinicians, which builds relationships and trust. This collaboration between primary and secondary care clinicians is one of the key benefits of the HealthPathways approach” says Dunedin GP and clinical lead for Southern HealthPathways Dr Peter Gent.
“The pipelle programme demonstrates the value HealthPathways brings in supporting change in models of care,” says Bridget-Mary McGown, Southern DHB HeathPathways manager. “And with more patients being managed in the community, without compromising quality of care, this is a true example of the Southern’s primary and community strategy in action.”
Southern DHB is working to embed HealthPathways early on in Quality Improvement activities, with the aim of capturing change as new ways of working are being developed.