Helping disadvantaged patients
Sydney GP and academic Dr David Peiris has spent his career working to help disadvantaged patient populations in Australia and overseas.
Much of Associate Professor David Peiris’ career path was set in motion shortly after obtaining his medical degree from the University of Sydney in 1994.
While working as a resident in Darwin, Peiris also spent time as a district medical officer for a remote Aboriginal community on Elcho Island off the coast of Arnhem Land in the Northern Territory. It was during this time that his desire to work in general practice, and more specifically offer support to those most in need of medical care, was solidified.
‘While I was up in the Territory I saw the light on primary healthcare as being the thing I wanted to do,’ he said. ‘I really saw the power of what primary healthcare could deliver in remote area medicine for people that miss out on good healthcare. ‘That was when I decided I would do general practice training.’
Peiris’ general practice career has also involved being an integral part of the board of the RACGP’s National Faculty of Aboriginal and Torres Strait Islander Health. He was part of the faculty when the idea was first put forward by inaugural Chair, Associate Professor Brad Murphy.
‘I joined right at the inception, when it was a national standing committee,’ Peiris said. ‘So when it transitioned to becoming a faculty I applied for a role on the board and I am currently the academic representative.’
After spending several years as resident GP on Elcho Island, Peiris moved back to Sydney and began the next stage of his career by completing a master’s degree in international public health at the University of Sydney. It would be his next move, however, that would start him on the road the current stage of his career.
‘My partner is a specialist and she had to complete part of her final training in New Zealand so we had a year there, where I took on the role of Clinical Director of a Maori Primary Health Organisation in Auckland,’ he said. ‘That was the beginning of my focus on looking at primary healthcare more at an organisational level and how we could support GPs and community controlled health services to deliver the best possible care, especially for populations that experience socioeconomic hardship.
‘I managed some New Zealand ministry-funded programs and other programs around quality improvement. I also coordinated GP CME [General Practice Conference and Medical Exhibition] professional development events. So I had a lot of close engagement with many GPs. ‘Following that year, I decided I would get into academia full swing.’
This ‘full swing’ move into academia involved returning to Sydney to undertake PhD studies at the George Institute for Global Health, an independent medical research institute dedicated to improving global health. The PhD involved studying improving the quality of care in Aboriginal and Torres Strait Islander health services. Peiris remained with the George Institute from 2007 and ultimately became head of primary healthcare research.
‘The role is to lead research around primary healthcare and I have a particular interest in the use of mobile and desktop IT tools to improve healthcare quality,’ he said.
‘The George Institute is unique because we work both domestically and internationally. We have offices in Australia, India, China and the UK.
‘About half of my work is Australia-focused and a lot of that is around Aboriginal and Torres Strait Islander health, but also working with private general practice. The other half is projects running in India and China.’
The international focus of his work at the George Institute, as well as his previous academic work related to healthcare access in lower socioeconomic communities, put Peiris in a good position to make the most of being named the Australian recipient of the 2015–16 Harkness Fellowship.
The Harkness Fellowship is administered by the US-based Commonwealth Fund and provides an opportunity for future leaders in health policy from Europe, Australia and New Zealand to spend a year in the US to conduct research and work with other leading health policy researchers.
‘The point of the Fellowship is to facilitate exchange between the partner countries and the US,’ Peiris said. ‘It’s really for people who are looking to grow their leadership potential and have exposure to new environments, new collaborators in the US, and to get to understand US healthcare policies.
‘It’s a two-way exchange: bring new knowledge based on work that the Fellows have done in their home countries to the US, and similarly to take new knowledge back from the US to their home country when they have finished the Fellowship program.’
The opportunity to get a first-hand look at changes to the US healthcare system currently taking place under the Patient Protection and Affordable Care Act – ‘Obamacare’ – and see how they apply to Australia has always appealed to Peiris.
‘America is so different to Australia in terms of basic structures around the healthcare system, particularly around universal healthcare access that we have through Medicare. That just doesn’t exist in the US,’ he said. ‘Obamacare has really changed that dramatically. In only a short amount of time the number of newly insured Americans has risen dramatically.
‘But one consequence of that is that now a lot of people are actually able to afford going to the doctor or healthcare provider. How does the healthcare system reorient itself to be able to deliver that care?’
That reorientation is of particular interest to Peiris in an Australian healthcare context.
‘There are so many interesting and innovative initiatives happening in the US around financing mechanisms, new models of care to engage care providers, both primary healthcare and specialists working together, pay-for-performance mechanisms, use of e-health,’ he said.
‘There’s a lot of things that are, to me, very relevant to Australia because we are exploring all those things ourselves.’
But, as Peiris said, the Harkness Fellowship is a two-way exchange of information between the US and Australia.
‘Take e-health, for example. The adoption of electronic health records in Australia is much higher than it is in the US and has been for a number of years,’ he said.
‘Of course we are not perfect, but it’s uncommon for a GP in Australia to not use the electronic health records for some aspect of their clinical care.
‘In Australia we have had this building block in place for a while and we are at the next stage in that journey, which is how do you optimise the potential for what an electronic health record can offer?
‘Things like secure messaging, decision support, audit and feedback, performance monitoring, patient portals where they can access their data and test results, online prescription ordering.
‘I think there is a lot we can contribute because America is just turning the corner now and realising the potential of all those things.’