HealthPathways, RACP & NICE guidelines - how do they fit together?

My understanding is that the Health Pathways software was developed here in Canterbury, NZ. I think most of the regional health authorities (district health boards) in NZ use it, as well as a number of Australian and UK heath authorities. From memory, Health Pathways claimed that over 28 million people lived in health authorities using the Health Pathways software.

It is really a method of delivery of best practice and local content (referral details for local specialists and patient groups and so on). Each regional health authority that is a member of Health Pathways agrees to let the others see their content and it can be copied. But each regional health authority has control over what they include. The content is written so that a GP can consult it during an appointment with a patient - so it's brief and concentrates on the key points.

So, a UK health authority using the Health Pathways software would presumably make sure that their content reflected NICE guidelines as well as referring to respected local patient groups and specialists.

My understanding is that if a regional health authority updates a pathway and feels that it is particularly good, they can mark it as one recommended to be used as a base for others.

 

Dr Graham McGeoch was a key person in the development of the Health Pathways software. He is the doctor that our local patient group has worked with to develop a Pathway for 'Chronic Fatigue and ME/CFS' for Canterbury.

McGeoch G, McGeoch P, Shand B Is HealthPathways effective? An online survey of hospital clinicians, general practitioners and practice nurses. New Zealand Medical Journal 2015;128 (1408):36-46. http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1408/6413

Abstract
Aim: An online survey was used to determine the perceptions of healthcare professionals in Canterbury on HealthPathways, a website that provides clinical and referral information for general practice teams, relevant to locally available health services and resources.

Methods: The survey questionnaire included questions on the effectiveness and ease-of-use of the website, computer literacy and use of online clinical guidance systems. Differences in the responses between work groups were analysed using the Mann-Whitney test.

Results: 249/480 (52%) of general practitioners, 72/156 (46%) of practice nurses, and 43/66 (65%) of hospital clinicians completed the questionnaire. Approximately 90-95% of general practice teams considered the website was easy to use and had contributed to both an increase and improvement of care in the community, with about 50% stating that it had improved their relationships with patients and hospital clinicians. Minor concerns included the website’s increasing size and prescriptive nature and that it increased the duration of a patient consultation. Approximately 60% of hospital clinicians reported improvements in referral quality and triage and working relationships with general practices since the introduction of HealthPathways.

Conclusion: HealthPathways has achieved a high level of acceptance in both primary and secondary care, and has therefore acted as a valuable change management tool increasing healthcare integration in Canterbury.

 

If your regional health authority uses the Health Pathway system, then I do think that it's worthwhile to get to see what the Pathway(s) relevant to ME/CFS says. As this is what a busy GP is likely to be looking at when they aren't quite sure what to do.

If the Pathway is bad, then there may be scope to improve it, by finding a sympathetic person with responsibility for the content and presenting evidence (and pointing to improved recent Pathways that other regional health authorities are using).

And if the content is good, then you can educate patients to remind GPs to look at the Pathway if they start talking about CBT and GET and thinking positively and don't know what PEM is.

Once the NICE Guidelines are improved, the Pathways in the UK won't necessarily immediately be updated. The Pathways tend to be on a schedule for 3 year or so review unless there is a compelling reason for something to be changed earlier. So, some campaigning may help to get the Pathway relevant to ME/CFS updated as soon as possible in your region.

 

Is there any way we can find out whether it is used in our local area, and look at the content?

 

This was the list of participants in 2016, but I know there are more UK ones now.

New Zealand DHBs
Southern; South Canterbury; Canterbury; Nelson-Marlborough; West Coast; Auckland Regional; Northland; Wairarapa; Hutt Valley; Capital & Coast.

Australia Local Health Districts
New South Wales: ACT and Southern; Central Coast; Hunter New England; Illawarra Shoalhaven; Mid & North Coast; South Western Sydney; Sydney; Sydney North; Western Sydney.
Queensland: Cairns; Central Queensland; Wide Bay; Sunshine Coast; Mackay; Townsville,
Western Australia
Victoria: Eastern Melbourne; Gippsland; Melbourne; Murray; Western Victoria,
Tasmania.

United Kingdom
South Tyneside
​

The Pathway material is strictly for medical professionals - they tend not to be too keen for anyone else to see it. But usually there is someone in a patient group who can get access to see what is in there. It's difficult to print it out, as it tends to be full of links e.g. if there are symptoms of multiple sclerosis, you get a link to the multiple sclerosis page, or there might be a link to the 'management of long term disabling conditions' page so that material about how to get your patient disabled parking doesn't have to be repeated on lots of pages.

The Pathway material is 'translated' into information for public consumption on the 'HealthInfo' system - also locally based but accessible by everyone. So that should give you an idea of how bad or how good the content for doctors is.

 

Looks like it is in Cardiff and Vale UHB.
https://shapingourfuturewellbeing.com/healthpathways/

If you are in the Cardiff and Vale UHB it sounds as though now, or at least as soon as there are new NICE Guidelines, would be a good time to try to make sure the pathways relevant to ME/CFS are accurate and helpful.

 

That isn't correct, at least in my experience. The pathways in the CDHB that I have looked at or had input into cover diagnosis and management as well as referral. They do really condense what would be in a guideline into something the GP can use in the 15 minutes with a patient or perhaps the 5 minutes afterwards when the doctor wants to quickly find out what they should do next.

But I agree with this, although it's more about health boards wanting to keep care at the primary level. I've been amazed to see what pressure there is from the District Health Board to keep patients away from specialists and hospital clinics. Some of it is fair enough; if GPs are resourced and supported adequately maybe they can cover most things. But it does mean that, in my region, it is unlikely that any one doctor will see enough patients with ME/CFS to ever become an expert or notice patterns that might move the understanding of the illness forward. Even things like multiple sclerosis are managed primarily by GPs after diagnosis.

And it does seem to result in much more readiness to spend health funding on referrals to physios and psychologists than on medical specialists.

Perhaps so, but where I live, primary care is pretty much all that we get, unless we are sufficiently close to death to warrant getting into hospital via the emergency department.

 

Found the up to date list of coverage:

 

Announcement of the publication of the Canterbury District Health Board's Chronic Fatigue and CFS HealthPathway here.
News from New Zealand and the Pacific Islands

 

In reply to @Yessica 's query elsewhere:
The HealthPathways material is owned by HealthPathways and can normally only be accessed by medical professionals. It's not ideal as far as transparency goes, but it's the system we are working in. Also, even if I was allowed to, it's quite hard to share as a document, because there are lots of links to other parts of the system and drop down sections.

The HealthInfo site translates the HealthPathways information for the public. It uses simpler language - with the result that references to the symptom of fatigue in the material for doctors were initially changed to 'feeling tired' in the public version . Here's a link to the old version that is still up - it's pretty awful.

The new version has been essentially ready to replace it since the beginning of the year, but a couple of things including the urgent need to produce public information about Covid-19 have, frustratingly, delayed it.

 

The new version of HealthInfo is up, replacing the old version. There's a random 'CFS' that will be fixed and not everything is precisely as I would have wished but I think it's reasonable.
The illness names is ME/CFS. There are links to the CDC information, Emerge (@Simone), MEAwareness and the local patient group.
https://www.healthinfo.org.nz/index.htm?Chronic-fatigue-syndrome-CFS.htm

I'll be interested to see what you think.

Edit - for some reason that link isn't taking you to the page. If you click on the link and then search for CFS or ME, you can get to the page.

 

I think it's a good, very basic, introduction to ME/CFS which should be pretty accessible to people of all educational levels and not frighten too badly newly diagnosed people.

Obviously it's just a starting point, and professionals and local support groups can provide more detailed input on what 'fatigue' means in this context, and more helpful guides on pacing.

 

Yes, I do think HealthInfo probably underestimates the public with the level they pitch things at. But yes, there's probably not a lot of harm in that so long as there are links.

 

There are many people in the public who struggle with written material for a variety of reasons. See this blog for more information from a content specialist https://contentdesign.london/reading/dumbing-down/