The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia

BACKGROUND: It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of sev...

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Autores principales: Maguire, Sarah, Maloney, Danielle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480076/
https://www.ncbi.nlm.nih.gov/pubmed/34583782
http://dx.doi.org/10.1186/s40337-021-00476-8
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author Maguire, Sarah
Maloney, Danielle
author_facet Maguire, Sarah
Maloney, Danielle
author_sort Maguire, Sarah
collection PubMed
description BACKGROUND: It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. METHODS: In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a ‘core’ part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of ‘doorways’. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. CONCLUSIONS: In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general.
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spelling pubmed-84800762021-09-30 The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia Maguire, Sarah Maloney, Danielle J Eat Disord Review BACKGROUND: It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. METHODS: In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a ‘core’ part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of ‘doorways’. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. CONCLUSIONS: In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general. BioMed Central 2021-09-28 /pmc/articles/PMC8480076/ /pubmed/34583782 http://dx.doi.org/10.1186/s40337-021-00476-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Maguire, Sarah
Maloney, Danielle
The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title_full The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title_fullStr The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title_full_unstemmed The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title_short The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia
title_sort implementation of large-scale health system reform in identification, access and treatment of eating disorders in australia
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480076/
https://www.ncbi.nlm.nih.gov/pubmed/34583782
http://dx.doi.org/10.1186/s40337-021-00476-8
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