Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
Shopping Cart: ( empty )
You are here: Home > Journals > PY > PY24142
RESEARCH ARTICLE (Open Access)
Contents Vol 31(2)

Factors influencing uptake and sustained utility of HealthPathways in Australian general practice: a qualitative study

Susan Saldanha https://orcid.org/0000-0002-6699-3688 A B , Riki Lane https://orcid.org/0000-0002-3334-5545 A B C , Sharon Clifford A B , Prisha Dadoo A B , Chris Barton https://orcid.org/0000-0001-9823-7425 A B Grant Russell https://orcid.org/0000-0003-3773-2355 A B *
+ Author Affiliations
- Author Affiliations

A Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, Vic 3004, Australia.

B School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic 3004, Australia.

C Gender Clinic, Monash Health, 79-81 Fitzroy Street, St Kilda, Vic 3182, Australia.

* Correspondence to: grant.russell@monash.edu

Australian Journal of Primary Health 31, PY24142 https://doi.org/10.1071/PY24142
Submitted: 9 September 2024  Accepted: 9 March 2025  Published: 27 March 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Formalised clinical pathways have become popular approaches to translate evidence into clinical recommendations, tailored for the local healthcare setting. In recent years, the HealthPathways platform has been used to implement a range of clinical and referral pathways in New Zealand and Australia. Despite widespread adoption, little is known of factors influencing the sustained use of HealthPathways in Australian general practice.

Methods

This qualitative study, conducted in three Melbourne Primary Health Network catchments, applied normalisation process theory to explore HealthPathways implementation. We conducted semi-structured interviews with 43 participants, including general practitioners (GPs), practice nurses, practice managers, Primary Health Network staff and key regional informants. Analysis combined inductive and deductive approaches.

Results

The findings suggest that although HealthPathways holds promise for enhancing clinical practice, its adoption and impact are currently limited due to low awareness and varied integration across Primary Health Network catchments. Recent medical graduates found it useful for helping patients access appropriate care. Adoption was influenced by peer recommendations and time constraints, although established GPs resisted change. Targeted education, effective promotion and improved monitoring systems were identified as crucial to facilitate wider and more effective use of HealthPathways, ultimately contributing to better patient care and streamlined clinical processes.

Conclusion

Although HealthPathways’ relative normalisation is evident, challenges in integration persist, requiring targeted strategies. Comprehensive promotion to GPs, standardisation across Australia and enhancing technical interoperability between digital interfaces is essential. Strong partnerships and feedback mechanisms can optimise HealthPathways’ impact on patient care, supporting the objectives of the Australian National Primary Health Care 10-year plan.

Keywords: clinical decision support, clinical pathways, general practice, HealthPathways, Normalisation Process Theory, primary health care, primary health network, referral pathways.

References

Australian Government Department of Health and Aged Care (2024) Australia’s Primary Health Care 10 Year Plan 2022–2032. Commonwealth of Australia. Available at https://www.health.gov.au/resources/publications/australias-primary-health-care-10-year-plan-2022-2032 [Verified 5 September 2024]

Campbell H, Hotchkiss R, Bradshaw N, Porteous M (1998) Integrated care pathways. BMJ 316, 133-137.
| Crossref | Google Scholar | PubMed |

Campbell S, Greenwood M, Prior S, Shearer T, Walkem K, Young S, et al. (2020) Purposive sampling: complex or simple? Research case examples. Journal of Research in Nursing 25(8), 652-661.
| Crossref | Google Scholar | PubMed |

Cooper R (2023) Healthpathways: what is healthpathways? Australian Pharmacist 42(3), 60-63.
| Google Scholar |

Creswell J (2013) ‘Qualitative inquiry & research design: choosing among five approaches.’ (Sage Publications Inc.)

Department of Health (2024) Primary health networks and health pathways. State Government of Victoria, Vic, Australia. Available at https://www.health.vic.gov.au/preventive-health/primary-health-networks-and-health-pathways [Verified 5 September 2024]

Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S, et al. (2009) An implementation research agenda. Implementation Science 4, 18.
| Crossref | Google Scholar |

Gill SD, Mansfield S, McLeod M, Von Treuer K, Dunn M, Quirk F (2019) HealthPathways improving access to care. Australian Health Review 43(2), 207-216.
| Crossref | Google Scholar | PubMed |

Goddard-Nash A, Makate M, Varhol R, Quirk F, Larsen R, McGeoch G, et al. (2020) Evaluation of HealthPathways: an appraisal of usage, experiences and opinions of healthcare professionals in Australia and New Zealand. Australian Health Review 44(4), 590-600.
| Crossref | Google Scholar | PubMed |

Gray JS, Swan JR, Lynch MA, Tay TM, Mackenzie M-J, Wiggers JH, et al. (2018) Hunter and New England HealthPathways: a 4-year journey of integrated care. Australian Health Review 42(1), 66-71.
| Crossref | Google Scholar | PubMed |

Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. The Lancet 362(9391), 1225-1230.
| Crossref | Google Scholar |

HealthPathways Community (2024) About HealthPathways. Streamliners NZ Ltd, New Zealand. Available at https://www.healthpathwayscommunity.org/About [Verified 5 September 2024]

Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9), 1277-1288.
| Crossref | Google Scholar |

Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. (2015) Achieving change in primary care – causes of the evidence to practice gap: systematic reviews of reviews. Implementation Science 11, 40.
| Crossref | Google Scholar |

Lincoln YS, Guba EG (1985) ‘Naturalistic inquiry.’ (Sage Publications, Inc.)

Lind KE, Jorgensen M, Stowers C, Brookes M (2020) HealthPathways: a detailed analysis of utilisation trends in the northern Sydney region. Australian Journal of Primary Health 26(4), 338-343.
| Crossref | Google Scholar | PubMed |

Mansfield SJ, Quirk F, Von Treuer K, Gill G (2016) On the right path? Exploring the experiences and opinions of clinicians involved in developing and implementing HealthPathways Barwon. Australian Health Review 40(2), 129-135.
| Crossref | Google Scholar | PubMed |

May C, Finch T (2009) Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology 43(3), 535-554.
| Crossref | Google Scholar |

McGeoch G, McGeoch P, Shand B (2015) Is HealthPathways effective? An online survey of hospital clinicians, general practitioners and practice nurses. The New Zealand Medical Journal 128(1408), 36-46.
| Google Scholar | PubMed |

McGlynn A, Shé ÉN, Bennett P, Liaw S-T, Jackson T, Harris-Roxas B (2023) Exploring the spread and scale of a web-based clinical decision support portal in Sydney, Australia, during COVID-19: a case study. Journal of Integrated Care 31(4), 315-330.
| Crossref | Google Scholar |

McGlynn A, Ní Shé É, Liaw T, Jackson T, Harris-Roxas B (2024) Mapping the HealthPathways literature: a scoping review protocol. HRB Open Research 7, 10.
| Crossref | Google Scholar |

Miles MB, Huberman AM (1994) ‘Qualitative data analysis: an expanded sourcebook.’ (Sage Publications Inc.)

Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. (2010) Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Medicine 8, 63.
| Crossref | Google Scholar |

Noy C (2008) Sampling knowledge: the hermeneutics of snowball sampling in qualitative research. International Journal of Social Research Methodology 11(4), 327-344.
| Crossref | Google Scholar |

QSR International Pty Ltd (2023) NVivo qualitative data analysis software. Version R1. [Computer software]. Available at https://help-nv.qsrinternational.com/20/win/Content/about-nvivo/about-nvivo.htm

Reyneke A, Jaye C, Stokes T (2018) Local clinical pathways: from ‘good ideas’ to ‘practicality’ for general practitioners. Journal of Primary Health Care 10(3), 215-223.
| Crossref | Google Scholar | PubMed |

Rotter T, Kinsman L, Machotta A, Zhao F-L, van der Weijden T, Ronellenfitsch U, Scott SD (2010) Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs. Cochrane Database of Systematic Reviews [3] CD010706.
| Crossref | Google Scholar |

Seckler E, Regauer V, Rotter T, Bauer P, Müller M (2020) Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review. BMC Family Practice 21, 113.
| Crossref | Google Scholar |

Senanayake S, Abell B, Novick M, Exley H, Dolejs W, Hutchinson K, et al. (2021) Impact and outcome evaluation of HealthPathways: a scoping review of published methodologies. Journal of Primary Health Care 13(3), 260-273.
| Crossref | Google Scholar | PubMed |

Shukla A (2023) Focusing on the challenges facing primary care. The Medical Journal of Australia 218(9), 383.
| Crossref | Google Scholar | PubMed |

Stokes T, Tumilty E, Doolan-Noble F, Gauld R (2018) HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research. BMJ Open 8(12), e025094.
| Crossref | Google Scholar |

Sturgiss E, Barton C (2023) Using normalisation process theory in general practice research. Australian Journal of General Practice 52(4), 243-245.
| Crossref | Google Scholar | PubMed |

Tomaszewski W (2012) Computer-Based Medical Decision Support System based on guidelines, clinical pathways and decision nodes. Acta of Bioengineering & Biomechanics 14(1), 107-116.
| Google Scholar | PubMed |

Toy JM, Drechsler A, Waters RC (2018) Clinical pathways for primary care: current use, interest and perceived usability. Journal of the American Medical Informatics Association 25(7), 901-906.
| Crossref | Google Scholar | PubMed |

Woolf SH (2008) The meaning of translational research and why it matters. JAMA 299(2), 211-213.
| Crossref | Google Scholar | PubMed |