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Choices reduces strain on hospital emergency

A new evaluation shows the Choices service is driving a significant decline in presentations to hospital emergency departments.

Prepared by the the University of Western Australia’s School of Population and Global Health, the Choices report demonstrates that recurrent emergency department presentations can be reduced through peer support, clinical care coordination, person-centred case management and connecting clients to existing community-based services.

Delivered by Ruah Community Services  and funded by the WA Primary Health Alliance, Choices is the first service of its kind and was developed in response to substantial evidence of the over-representation of people with multiple health and social needs presenting to emergency departments.

Since launching in late 2017, the innovative program  has connected with more than 3000 people via peer and case workers stationed at hospitals and the courts. A key focus of the service is to provide people with care coordination and support to help them access and remain connected to primary health services in the community.

In 2017-18 there were more than one million presentations to emergency departments in Western Australia. It was estimated that around 19 per cent of these, or 190,000, could have been avoided if patients sought treatment in primary care or community settings.

A unique aspect of the Choices program is the use of peer support workers who draw on their lived experience in similar situations to offer supportive intervention.

The evaluation found mental health, alcohol and other drug use and accommodation were substantial issues faced by Choices clients and more than half of Choices clients presented with issues relating to accommodation and homelessness that had led to deteriorations in health.

Ruah Chief Executive Debra Zanella said the program is a great example of how peer engagement, individualised support and flexibility can help those at risk of poor health outcomes in our community.

“Social isolation, harmful substance use, family breakdown, homelessness, trauma and domestic violence are among factors that contribute to frequent emergency department presentations and interactions with the police,” said Debra.

“People who present frequently to emergency departments often have underlying needs and challenging life circumstances which often means that treating the immediate issue will not break the re-presentation cycle. Choices is premised on identifying and addressing these underlying and inter-related needs through peer and community support.

The evaluation highlights the positive impact the service is having on the lives of those clients supported and I am thrilled with the results we are seeing,” explained Debra.

WA Primary Health Alliance, Principal Advisor and Research Director, Dr Daniel Rock said the development of trusting relationships with non-clinical staff can be key to ongoing and sustained engagement with services, and Choices offers just that.

“Choices enables clients to navigate the system whilst receiving personalised support from peer support workers who have been in their shoes.  We know that care centered around individual needs and preferences helps those at risk of poor health outcomes establish a safe and stable link back into the community, and as the evaluation shows, ultimately reduces recurrent emergency department presentations,” said Dr Rock.

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