Aged Care Royal Commission

Prestantia Health's Dr. Paresh Dawda provided evidence today at the Aged Care Royal Commission.

He was asked questions about many aspects of aged care and health. He discussed fit for purpose funding models to improve healthcare for those in residential aged care, the value of teamwork and need for multi-disciplinary teams, value-based approaches to providing healthcare for elderly, the integration of care including record systems.

His statement can be reviewed at https://agedcare.royalcommission.gov.au/hearings/Pages/hearings/2019/public-hearings-9-13-december-2019.aspx

His evidence can be viewed at  https://webstreaming.lawinorder.com.au/acrc day 69 9/12/2019 at 2:09.

A transcript can be found at https://agedcare.royalcommission.gov.au/hearings/Documents/transcripts-2019/transcript-9-december-2019.pdf 

He was featured in the Canberra Times.

An article from Canberra Times about the #AgedCareRC https://t.co/GSRTW4tL9b via @canberratimes

— Dr. Paresh Dawda (@pareshdawda) December 9, 2019

Prestantia Health's Dr. Paresh Dawda and Principal Consultant, Angelene True facilitated at the Australian Commonwealth Department of Health's Healthcare Homes Forum in Melbourne on 8-9 November 2019.

Dr. Dawda was on a subject matter expert on the program advisory group as well as delivering and facilitating a number of sessions including:

• Keynote presentation on Person Centred Care
• Facilitation of breakout sessions on
  • Leadership
  • Shared care planning
  • Data driven improvement

Angelene True led and facilitated the training and coaching session for PHN facilitators.

Dr. Paresh Dawda has been appointed to the Clinical Council for Calvary Health.  Calvary Health is a not for profit healthcare organisation with a mission to provide quality, compassionate healthcare to the most vulnerable, including those reaching the end of their life.  This is a privileged advisory position supporting an organisation delivering hospital, community and aged care services.

ABC 730 ran a story on the Government's crackdown on prescription opioids.  Prestantia Health's Dr Paresh Dawda was interviewed for this story.  Our views are summarised in this article:

1.  We recognise the importance of the public health issue raised by the misuse of opioids.

2.  We accept the Chief Medical Officer's (CMO) letter was well intentioned

3.  We believe the opioid issue is an extremely complex one and its solution lie in a joined up multi-faceted approach

4.  The letter sent by the CMO was simply based on statistical variation.  There are two types of variation, unwarranted variation and warranted variation.  The letter did not differentiate between these two types of variation.  Our understanding is that the granularity of dataset the government has access to is unable to do this

5.  The unintended consequence is that many doctors who received the letter were in the group of warranted variation.  For example,  these were doctors working in aged care and with patients who have limited life expectancy and would benefit most from a palliative care approach.  For this group of patients appropriate treatment with opioids not only helps pain management but also the management of distressing symptoms such as shortness of breath in end stage heart diseases and lung diseases

6.  Our experience is that many doctors are just refusing to prescribe opioids including for patient groups described above, leaving this vulnerable group unable to receive palliative care, a human right

7.  The letter from the CMO acknowledged in some cases may represent appropriate prescribing as in palliative care.  It was however followed by a stronger emphasis on the ongoing monitoring of the prescribing and the possible referral of a doctor to the Practitioners Review Committee.  There is no current mechanism where the ongoing monitoring can identify if it is appropriate prescribing or not.

Our approach has been to continue to prescribe responsibly and adopt a quality improvement approach.  We have a register of patients on opioids.  We use a team based approach to review their care which includes our practice pharmacist but also the staff at residential aged care facility.  Our practice pharmacist uses multiple sources of information and develops a care plan for our GP to review which once agreed is provided to the facility to incorporate in their care plan.

Having identified an opportunity to trial video conferencing offered by a Commonwealth Government Department of Health initiative we are pleased to soon begin video conferencing for health consultations.  We are grateful to Capital Health Network who facilitated the approach to the Commonwealth.

We will be piloting this across four Residential Aged Care Facilities for urgent clinical issues only.  We are very excited by this initiative which supports all of our values of Excellence, Equity, Collaboration and Innovation.

Our practice pharmacist, Nicole McDerby, with our GP, Dr Paresh Dawda, are leading a quality improvement project addressing the management of patients with chronic pain in residential aged care. A key aspect of this project is the production of a comprehensive document contributing to the care plan held by the residential aged care facility. Nicole delivered a presentation to one of the facilities as part of their staff’s in service training on the managing chronic pain in residential aged care.

Our team are currently undertaking a quality improvement project aimed at improving chronic pain management for our patients in residential aged care. This complex condition is challenging to manage and requires effective collaboration and expertise from multiple health care professionals. This project is designed to improve communication and therefore collaboration between the Prestantia Health team as well as the nursing and care teams across Canberra’s aged care homes. Our team are developing a multi-disciplinary care plan approach to improve documentation and communication of evidence-based chronic pain monitoring and management plans and between members of the care teams. The intended outcome of this quality improvement project is to strengthen collaboration between care providers and improve control of chronic pain symptoms for our patients.

For more information on pain in aged care please visit https://www.painaustralia.org.au/media/newsletters/issue-82/aged-care-in-pain 

The Australian Electoral Commission has a form for those who are unable to vote on the ground of dementia.  This form needs to be completed by a member of the family/Enduring Power of Attorney.    Once complete the doctor needs to confirm that the patient is unable to vote.  You can email the form to us at clinical@prestantiahealth.com.

Note this form can only be used for those 'who are of unsound mind and incapable of understanding the nature and significance of enrolment and voting.'  For those with a disability or mobility restriction please visit the Australian Electoral Commission site for more guidance.

Paresh Dawda will be presenting on integrated care at Clair Holland House.  A copy of the presentation is below.

He discusses the definitions of integrated care and the need to focus on a person-centred approach.  He discusses the different lenses through which integrated care may be seen, how a self-assessment may be undertaken, a case study of an integrated palliative care service from the UK and ends with sharing lessons on integrated care.

Claire Holland House Mar 2019

Dr. Dawda attended an expert reference panel for a pilot program being run in three areas of NSW.  The Collaborative program for Healthcare Neighbourhoods aims to build and strengthen the relationship between clinicians and local care providers to improve the experience of patients.

We are experienced in quality improvement techniques and approaches in healthcare.  We have published on quality improvement and delivered training to build capacity and capability in a wide range of organisations including provider organisations such as general practices and hospitals, Residential Aged Care Facilities as well as Clinical Commissioning Groups (CCGs), Primary Health Networks (PHNs), and other organisations.