ALEC Pre-Budget Submission 2024-25: five key recommendations to build on Australian success as a global leader in living evidence & clinical guidelines

Living, evidence-based clinical guidelines are central to translating the results of health research into delivery of high value health care

Problem

• Outdated, traditional, inefficient systems are unable to maintain guidelines in line with the latest research. Therefore patients receive suboptimal care, leading to increased morbidity and mortality.
• Translation of research findings into clinical practice and policy is dangerously slow (average 5+ years)
• In Australia, there is no single home for trusted, up-to-date clinical guidelines to support adoption of evidence-based best practice
• Unnecessary waste results from duplication of guideline development effort at local, state and national levels

ALEC solution

For ALEC to be sustainably funded to:

• Provide coordination, training and support to enable living clinical guidelines
• Enhance technical systems and develop digital solutions to reduce unit costs and time to develop and maintain reliable, up-to-date guidelines
• Optimise the dissemination and use of evidence-based guidelines for improved health care
• Reduce duplication of effort, build efficiencies of scale, and encourage consistent evidence-based decision making across Australia
• Strengthen multi-stakeholder evidence partnerships to build capacity and strengthen co-production
• Ensure living guidelines benefit all Australians, including First Nations Peoples and rural/remote communities
• Expand research and evaluation of existing living guidelines

Another pandemic, natural disaster or other health crisis is inevitable – clinicians will need rapid, reliable, responsive guidance

Problem

• Lack of clarity on who holds responsibility and capability for the development of national clinical guidelines in response to health crises
• No national organisation or Department agency will be able to scale up to develop national clinical guidance in the event of another pandemic
• No delegation of responsibility for urgent clinical guidelines means that the health system cannot provide timely and trustworthy advice
• Risk that multiple health sector actors provide inconsistent and even conflicting advice

ALEC solution

Fund ALEC to provide capacity to prepare for and respond to emerging health threats by:

• Providing rapid response living guidelines for new health challenges
• As was demonstrated in COVID-19, ALEC has the established expertise, infrastructure and relationships to rapidly and effectively convene the multidisciplinary clinical panels, methods expertise and member organisations to develop clinical guidance for emerging health threats
• Continuing active engagement of ALEC’s 64 member organisations and contribution of 250+ clinical and consumer experts
• Developing living guidelines to underpin an Australian Centre for Disease Control (CDC) response – independent, scientifically robust, rapid and trusted
• Responding to other emerging health issues of national importance, such as climate change, where ALEC has already commenced evidence syntheses on the effects of climate change on health

Australian clinicians are increasingly caring for people with multiple complex chronic diseases – they need reliable, up-to-date guidelines to support their decisions

Problem

• As the population ages, the burden associated with chronic diseases will continue to rise
• 47% of Australians have one or more chronic conditions
• $320 million is spent each year on avoidable hospital admissions for chronic conditions
• $27 billion in 2008–2009 (36% of allocated health expenditure) attributable to cardiovascular diseases, oral health, mental illness and musculoskeletal conditions
• 87% of deaths are due to chronic conditions
• 87% of women aged 65 and over have a chronic disease
• In 2015 an estimated 2.3% ($2.7 billion) of total disease expenditure in the Australian health system was attributable to diabetes. Including indirect costs, the full cost of diabetes was estimated to be as high as $14 billion per year

ALEC solution

Ensure up-to-date, rigorous clinical guidelines are always available and used by all clinicians caring for Australians with chronic disease by funding ALEC to:

• Develop and update existing ALEC national living guidelines in chronic diseases (stroke, kidney, arthritis, diabetes) to national quality standards, and expand to develop guidelines for other chronic diseases of national priority, such as obesity, heart disease, cancer or mental health
• Convene broad guideline panels that reflect the complex, multidisciplinary, multisector nature of care for people with chronic disease, and include consumers and carers, enabling continuity and consistency of care –
• Expand the scope of the National Diabetes Living Guidelines in line with the National Diabetes Strategy to include topics such as diabetes prevention, gestational diabetes mellitus, and the needs of specific high-risk populations including people in aged care, Aboriginal and Torres Strait Islander peoples, and remote and rural populations
• Develop knowledge translation and decision-support tools and optimise their dissemination and uptake to help clinicians and consumers make the best possible, evidence-informed health decisions

A complex health system needs linked, curated data and robust analysis to underpin strategic decision-making and to optimise both health outcomes and budget efficiencies.

Problem

• The pace of research is accelerating, overwhelming individual and system level scientific understanding, and causing confusion and misinformation
• Complex health practice and policy decisions require the use of diverse types of health research and data
• Health data that could be valuable to support efficient, targeted decision-making are generated in a variety of places across the Australian health system and not systematically curated, analysed or used
• Use of data is not yet embedded within DoHAC, and key program and delivery areas, such as Primary Health Networks (PHNs), do not yet have data-driven metrics to support performance monitoring, or to assist in future policy development and design (p12 capability review)

Our solution

Fund ALEC as an enduring pathway to leverage a national health data system and work in partnership with clinicians, researchers, consumers and governments to:

• Prioritise clinical topics for guideline development/updating based on healthcare practice and outcome variation; supporting the generation of evidence-based clinical guideline recommendations that accurately reflect the size and nature of the population affected, the availability of recommended treatments, etc.
• Integrate data from the Australian healthcare system and beyond (e.g. MBS and PBS data, Person-Level Integrated Data Asset, National Integrated Health Services Information) with the syntheses of published research to refine, target and contextualise recommendations in living guidelines; including tailoring for priority populations, such as people with disability, indigenous Australians, culturally and linguistically diverse populations.
• Focus knowledge translation activities for living guideline recommendations to identified areas and populations of need to gain the most efficient and impactful uptake of guideline recommendations
• Evaluate the impact of living guidelines on practice and outcomes, and enable

National living clinical guidelines enable Australian health workers to provide consistent and continuous care

Problem

• The multidisciplinary primary care workforce (GPs, nurse practitioners, midwives, pharmacists, allied health workers and Aboriginal and Torres Strait Islander health workers) face multiple challenges to providing high-quality, integrated care, including out-of-date guidelines and lack of interoperability of digital systems. As a result they are not working to their full scope of practice.
• There is no single home of trustworthy, up-to-date clinical guidelines
• Clinical guidelines are not integrated into electronic medical software, meaning they are not efficiently or effectively enabling evidence-based decision making

Our solution

Fund ALEC to:

• develop up-to-date, multidisciplinary living clinical guidelines in national health priority areas that:
  1. provide health professionals with the knowledge/skills required to support an integrated, person-centred, team care approach
  2. encourage multidisciplinary and multi sector collaboration with clear pathways of care, allowing all health professionals, particularly in primary care, to work to their full scope of practice
  3. support development of, and align with,clinical quality standards
  4. enable consistency and continuity of care across the sector

• develop a bespoke living evidence digital platform integrated into electronic medical software and other digital health systems ensuring:
  1. an efficient and practical decision-support system for Australian health professionals regardless of occupation, role or setting.
  2. support for nationally consistent and accessible digital health capabilities
  3. guidelines underpinning clinical decision-making are continually up-to-date at the point of care