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Quality Use of Pathology

Quality Use of Pathology Consumer Consultation Report

This report was produced by the Consumer Health Forum of Australia resulting from a scoping study of existing literature related to the quality use of pathology and an on-line discussion forum.

Executive Summary

Pathology is an integral part of the Australian health system with over 30 million tests being carried out each year. Access to pathology services is an essential part of comprehensive healthcare for Australian consumers. However, increasing costs, quality of services, and ease of access are presenting increasing problems for consumers. These are three key issues emerging from a series of consultations on pathology services conducted by the Consumers Health Forum of Australia (CHF) with health consumers around Australia.

CHF is the national peak body representing the interests of Australian healthcare consumers. CHF works to achieve safe, quality, timely healthcare for all Australians, supported by accessible health information and effective systems.

Pathology testing can include the testing of blood, body tissues and bodily fluids, which are then analysed to identify diseases and their causes, assess disease severity and monitor disease progress over time. It can also involve genetic testing. Approximately 40 percent of pathology testing in Australia is for diagnostic purposes, 40 percent for monitoring and 20 percent for preventative purposes ¹. The testing process also includes the provision of reports to assist in the diagnosis and management of disease.

In 1999-2000 the Federal Government spent $1.09 billion on pathology services. This rose to $1.5 billion in 2007. In 2008, GPs in Australia ordered nearly 18 million more pathology tests than they did in 2000 ². An estimated further $1 billion per annum is spent on pathology testing for patients in the public sector to support both admitted and outpatient care. This funding is provided under the National Healthcare Agreement, which is a joint Commonwealth/State funding arrangement in each State/Territory jurisdiction. Pathology plays an integral part in the Australian health system.

In September 2009, CHF was funded by the Commonwealth Department of Health and Ageing (the Department) to undertake the Pathology Consumer Consultation Project (the Project). Consumer input, particularly in the context of current reviews of pathology services, is essential. It allows those who pay for, and use, health services to have a role in determining the future of pathology services. The Project aimed to establish an evidence base through consultation with consumers to identify consumer issues, including gaps and opportunities, and facilitators and barriers, to the quality use of pathology (QUP) in Australia.

From a series of eight workshops carried out across Australia in late 2009 and a national workshop in Melbourne in March 2010, as well as through continued input from consumers, CHF gained a wide range of consumer views about, pathology as well as suggested strategies to improve consumers’ pathology experiences.

As part of the Project, CHF also developed a literature scoping study of existing academic research related to the quality use of pathology.

From consultations with consumers and written comments on earlier draft reports, a number of issues and concerns were raised, from which a series of recommendations emerged.
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Under the broad heading ‘Quality Use of Pathology’ issues discussed in these consultations included:

• Safety and quality of service
• Equity of access, including availability and affordability
• Adequate availability of an appropriate workforce
• Communication between consumer, referrer and provider
• Privacy
• Point of Care Testing (PoCT)
• Direct Access Testing (DAT)
• Rural/Remote Issues that relate to pathology
• eHealth and access to pathology results
• Genetic testing.

From consultations on these topics CHF has recommended the following strategies:

• The development and implementation of tools to prompt health practitioners to provide better quality information for those undergoing or considering pathology testing
• The development and provision of generic QUP information to consumers
• The development of resources to enhance self management skills and capabilities for consumers
• Prompt access to results for consumers and prompt explanation of their meaning followed by written information on those results and subsequent recommendations
• Introduction of a Medicare Item Number for a ‘Pathology Results’ consultation with a GP or other requesting practitioner
• Investigation of more widespread implementation of PoCT
• Workforce initiatives to deal with shortage of expertise
• Increased funding to aid the expansion of mobile collection services to more rural and remote communities
• Improved availability of telemedicine services, particularly for the explanation of results
• A greater emphasis on informed financial consent for pathology services
• Ongoing consumer consultation and input into any changes to current pathology funding arrangements
• Creation of stronger links with other accreditation processes
• Implementation of a transparent complaints process to encourage and review consumer complaints in relation to pathology testing
• Credentialing of the people who collect samples at collections centres
• Continued consumer education about the role of eHealth in improving privacy by enabling secure electronic transmission of information, and the benefits to consumers in improving communication, efficiency, safety and quality.

_{1 National E-Health Transition Authority –Environment Scan June 2009 www.nehta.gov.au
2 “Soaring Pathology tests costing taxpayers” Lexi Metherell for ABC News, posted July 8 2009 www.abc.net.au/news/stories/2009/07/08/2619987.htm}

The report can be downloaded in full from the following link. Quality Use of Pathology Consumer Consultation Report (PDF 352 KB)
If you are having difficulty accessing the PDF document, please contact qupp@health.gov.au for an alternative version to be sent to you.