Background Barwon Health’s community implementation of advance care planning (ACP) supports the belief that conversations regarding a person’s values, goals and treatment decisions are best facilitated in the absence of acute illness.

Aim To promote an integrated ACP program into the community and primary care, enabling increased awareness, accessibility and participation.

Methods Cross-sectorial training and education provided to health professionals to enable promotion of ACP to consumers at multiple intersections of health service delivery.

Focussed projects to embed ACP processes.

A robust alliance with local General Practices to support ACP from referral to completion in primary care.

Results Data demonstrates that introduction to ACP in General Practice effectively initiates conversations in the community.

The provision of skilled trained ACP clinicians in General Practice continues to have high referral rates and uptake to document completion (88%) when compared with other referral sources.

Clients are predominately referred through the >75 yrs Health Assessment including those with chronic or life limiting illness.

Discussion Success is largely dependent on raising community awareness and a multi-pronged approach, with General Practitioners (GP) as major investors.

Client satisfaction surveys provide evidence that individuals want to discuss and document their medical treatment and care preferences, and high confidence and trust exists when endorsed by their GP. GP responses are also positive.

Conclusion These initiatives have resulted in an increased proportion of patients acutely presenting to Barwon Health who have a pre-existing ACP. These provide a basis for further conversations with patients or families and convey important information to guide treatment decision making.