Latest figures from the Office of National Statistics continue to demonstrate marked health inequalities in the UK. Those populations who are most deprived, from certain ethnic minority or inclusion health groups experience worse outcomes. Developing pathways for use at point of care can help health professionals identify and address factors that are contributing to inequality.
Health inequalities refer to differences in health status, access to care or care received. The term inequity goes further and encompasses inequalities in outcome, which may exist despite perceived equality of access and treatment. These disparities can arise from various factors such as socioeconomic status, education, race, gender, and geographic location, and are prevalent in people who are socially excluded. The consequences of health inequalities are profound, leading to poorer health outcomes, and increased burden on individuals, families, and communities.
HealthPathways, a collaborative approach to healthcare delivery, offers a promising solution to help bridge the gap in healthcare access and outcomes. By guiding healthcare providers towards best practices and streamlining patient journeys, HealthPathways can play a crucial role in improving health equity by supporting specific healthcare professional actions at point of care.
The HealthPathways program was initially developed in New Zealand and has gained traction globally as method to enhance healthcare delivery, efficiency, and effectiveness. The HealthPathways Community is an international collective of 65 health organisations that collaborate to deliver locally relevant pathways of care. Participating geographical regions each have their own instance of HealthPathways, allowing for local tailoring of pathways and processes, but share the content and style of each other’s pathways so increasing efficiency of pathway production and facilitating continuous improvement.
Each implementation of the programme starts with conversations between primary, community and secondary care to agree the way they will support patients. The outcomes of that agreement are recorded on a digital platform. These are designed for use within a consultation and provide clinicians with evidence-based guidance, local support, and referral pathways, ensuring that patients receive consistent, timely and appropriate care.
The local HealthPathways platform contains symptom and condition-based pathways but also pages with resources, advice and contact information tailored for specific groups of patients who experience health inequality. These connect healthcare professionals with community resources and support services, such as local support for housing, heat, financial benefits, and employment. For example, HealthPathways in Cardiff and Vale in Wales has a page concerned with the healthcare for Homeless People which advises about the registration of a homeless patient and specific support relating to housing, the substance misuse service, rough sleeper support and Homeless health service.
One of the key strengths of HealthPathways is its ability to highlight and address the specific needs of underserved or vulnerable patients within the context of a condition-specific pathway. In New Zealand the national health pathways programme, in partnership with Health New Zealand (Te Whatu Ora) and the Māori Health Authority (Te Aka Whai Ora) has prioritised national pathways for conditions with known inequities. For those pathways the clinical editor applies an ‘equity toolkit’ during the writing process and an independent review of the equity content is undertaken prior to publication. The HealthPathway for Gout in Canterbury, New Zealand, informs the user that, despite higher rates of gout, Māori with gout are prescribed urate lowering therapies comparatively less than other ethnicities. It includes a series of points within the management section of the pathway advising specific actions to reduce this health inequality, including maintaining a register of Māori patients with a history of gout, and offering specific social prescribing and pharmacy support.
HealthPathways in Townsville, Australia, includes a webpage entitled Aboriginal and Torres Strait Islander Mental Health that page is about cultural factors that can impact the assessment and management of mental health concerns in Aboriginal and/or Torres Strait Islander people. It describes culture-bound syndromes including being ‘sung, cursed, or pointing the bone’, ‘sorry time’ and ‘longing for country’ which may all mimic mental illness and advises the user of the pathway to involve an Aboriginal Mental Health Worker and encourage the patient to use a culturally appropriate self-help app such as the AIMhi Stay Strong app.
When focusing on preventive care and early intervention strategies, HealthPathways can also help reduce the incidence and severity of chronic diseases in vulnerable populations and improve overall health outcomes. Examples include pathways designed to encourage screening and early intervention for those patients who have difficulty in accessing services, and pathways in which information about new therapeutic recommendations has been integrated quickly. The Alcohol Screening and Intervention HealthPathway in South Tyneside encourages the user to have a lower threshold for assessing and referring patients for help if they live in an area of deprivation are a refugee, transgender, have a learning disability or other risk factor for increased harm from alcohol.
In conclusion, HealthPathways can represent a valuable tool in the fight against health inequities. By promoting holistic, evidence-based practices, standardising care pathways, and fostering collaboration among healthcare providers, HealthPathways can help level the playing field in healthcare access and outcomes.
Authors
Dr Jonathan Tose, GP in Manchester, UK
Dr Helen Liley, GP in Howick, New Zealand
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests:
Dr. Jonathan Tose is a clinical editor for HealthPathways, South Tyneside and Clinical Lead for Streamliners, UK.
Dr. Helen Liley is a clinical editor for HealthPathways, Auckland and Platform Senior Clinical Editor for Streamliners.