Carl's Corner - Reflections of a Clinical Lead, Gold Coast Primary Health Network
Transitions of care are like raisins in the sun
Last month I had the privilege of attending the National Medicines Leadership Forum hosted by the Society of Hospital Pharmacists for Australia (SHPA) in Canberra. The main finding of the 2019 ‘Medicine Safety: Take Report’ was shared with us: an estimated quarter of a million Australians are admitted to hospital each year because of medication-related issues.
The reasons are well-known and summarized by the World Health Organisation (WHO) in ‘Medication without harm’ as: polypharmacy, high-risk situations and transitions of care. We now have more than twenty years of literature and recommendations that unequivocally and strongly support improvements in transitions of care. Primary care, general practice clinicians and staff and many hospital colleagues understand this truth intimately. How much longer then will we have to wait until meaningful improvements are made to ensure all transitions of care and clinical handover are safe and reliable?
There may be answers and inspiration from events half a century ago. Fatalities from motor vehicle accidents in Australia increased insidiously from the beginning of the twentieth century until the 1970s, when there were more than 3000 deaths per year. Despite the significant human and financial costs, and despite knowledge and availability of relatively simple and cheap solutions, there seemed to be public and policy inertia. There are several potential explanations for the inactivity, but one reason is the weary resignation of many that fatalities were associated with the increase in the number of cars on the road and were therefore perceived as inevitable.
Then, in 1970, the Government of Victoria took the unprecedented step in the western world to legislate the compulsory wearing of seat belts. Within 14 months the other Australian states followed. Seat belt compliance increased to more than 90% per cent in 1977. Fatalities decreased by more than half and remained low until now, despite significantly more cars than ever before.
Meaningful change requires courage, conviction and perseverance. It also requires leadership, systems and culture change and strong clinical and consumer advocacy for the importance of transitions of care. While caught up in World War II a young Anne Frank wrote: "How wonderful it is that nobody need wait a single moment before starting to improve the world." Her message echoes through the ages - we do not need to wait any longer.
Dr Carl de Wet
Clinical Lead, Gold Coast Primary Health Network