THE ROLE OF CHRONIC ILLNESS

FRAMEWORKS IN PRIMARY CARE

PHYSIOTHERAPY

Informing future practice

INTRODUCTION

● The HSE Chronic Illness framework refers to chronic disease as any long

term condition (6+ months) which can only be treated and not cured.

● Significant cause of morbidity and mortality and can significantly reduce

quality of life .

● Massive financial costs for both the patient and the health care system.

● Although population is now living longer, chronic conditions have reduced

the quality of those remaining years.

● This burden needs to be addressed or ‘we will continue to add years to our

lives without adding life to those years’ – (IPH making chronic conditions

count, 2010)

“PRIMARY HEALTHCARE: NOW MORE THAN EVER” (WHO

2008)

Four sets of PHC reforms:

Why primary healthcare?

1) Health inequality

2) Changing health

problems

3) Inflexibity of current

system

PRIMARY HEALTHCARE: WHERE IRELAND RANKS

IN EUROPE?

● Work force development - 6th in Europe

● The highest payments in the public system exist in Ireland, €45–60 for

each GP visit.

● Evidence-based clinical guidelines for GPs exists in all countries except

Ireland, Malta and Switzerland. - Quality assurance?

● Ireland had the lowest level of patient satisfaction with the costs of GP care

in 2007

● When considering all features of access to primary healthcare, Ireland

ranked lowest in europe

TACKLING CHRONIC DISEASE

Addresses the challenges of chronic disease to reduce the burden for individuals, their carers

and the health system here in Ireland.

Aim:

(i) to promote and improve the health of the population and reduce the risk factors to the

development of chronic diseases

ii) to promote structured and integrated care in the appropriate setting that improves

outcomes and quality of life for patients with chronic conditions.

● Reorientation towards primary care and the provision of integrated health services.

● The primary healthcare sector should play a central role in the care of patients with

chronic disease. Primary healthcare should be strengthened to meet the needs of

patients with chronic conditions.

HEALTHY IRELAND

A collective response to the risks that threaten Ireland’s

future health, wellbeing and economic recovery.

Health policy guidance for period (2013-2025), based on

analysis of social determinants of health.

Aims:

● Increase the proportion of people who are healthy at

all stages of life

● Reduce health inequalities

● Protect the public from threats to health and

wellbeing

● Create an environment where every individual and

sector of society can play their part in achieving a

healthy Ireland

https://www.youtube.com/watch?v=1dxILd49RAM&hc_location=ufi

RELEVANCE OF HI FOR PHYSIOTHERAPISTS

Broad framework mainly addressing public health from a governmental and public policy perspective.

Reaffirms and updates government commitment to primary care policy (2001) in light of the growing prevalence of chronic illnesses

Acknowledges the vital role of exercise promotion as a means of addressing public health.

Calls for increased funding towards community based prevention initiatives

Supports means of education that would improve health literacy

NATIONAL EXERCISE REFERRAL FRAMEWORK (NERF)

Model of best practice for inclusion of PA pathways in health care setting.

Aim: To increase PA levels in individuals living with an established NCD or

disability

How? Exercise Referral, develop knowledge of HCPs.

● NERF recommends that inactive/sedentary at risk of developing are given

brief advice/intervention

● Exercise Referral for those suitable: Assessment, develop tailored PA

programme, monitor progress and follow up

Integration of PA and NCD prevention into primary care systems is globally

recognised as one of the best investments for PA

FUTURE PHYSIOS...

Within NERF Physios can act as:

1.Referring Practitioner:

Recruitment, suitability, explain benefits

E-Learning training module ‘Promoting PA’ via HSE

2.Exercise Referral Unit:

Advice, can match patient to suitable service provider.

Must have significant knowledge of NCD’s.

3. Service Provider:

Lead patient within PA setting.

High Support Centres, Community Based PA

Programs+ Exercise Facilities, Self directed

HSE FRAMEWORK FOR ACTION ON OBESITY 2008-2012

Aim: Plan for how the HSE will facilitate the implementation of the

recommendations from The National Taskforce on Obesity 2005.

How?

● effectiveness in surveillance, research, monitoring and evaluation

● uniform approach to detection and management of obesity

● obesity prevention and health promotion

● effectively communicate message on obesity

● engage and support the work of other sectors in addressing determinants

of obesity and the obesogenic environment

GUIDE FOR FUTURE PHYSIOTHERAPISTS IN PRIMARY CARE

● Develop primary care networks - include the prevention, management and

treatment of overweight and obesity as part of their core service

● Develop, through the National Health Promotion Information Project, health

information materials on nutrition, physical activity and maintaining healthy

weight for adults and children.

● An individual’s interaction with health care services should be an

opportunity to develop life-skills and foster self-efficacy in support of

healthy eating, active living and positive self-image.

● Work with Local Authorities and Sports Partnerships to implement physical

activity programmes at community level.

Future development..preschool programmes, occupational health, Irish Sports

Partnership, Little Steps programme

COMMON THEMES

● Prevention & Management

● Government Policy

● Development of intersectoral partnerships (public & private)

● Patient empowerment

● Evidence Based Guidelines

● Education and Awareness

Implication for physiotherapy?● Primary care - future employment

● Exercise

● Education

● Versatility of our profession

FRAMEWORK LINKS

● The HSE Chronic Illness Framework 2008

http://www.hse.ie/eng/About/Who/Population_Health/Population_Health_Approach/Population_Health

_Chronic_illness_Framework_July_2008.pdf

● IPH Making Chronic conditions count 2010

http://www.publichealth.ie/files/chronic_main.pdf

● Tackling Chronic Disease: A policy framework for the management of chronic disease.

http://health.gov.ie/wp-content/uploads/2014/03/tackling_chronic_disease.pdf

● Healthy Ireland

http://www.hse.ie/eng/services/publications/corporate/hieng.pdf

FRAMEWORK LINKS

● National Exercise Referral Framework: Second Draft

http://www.exercisereferral.info/wp-content/uploads/2014/10/NERF%20Draft%202.pdf

● Framework for Action on Obesity 2008-2012:

http://www.getirelandactive.ie/content/wp-content/uploads/2011/12/HSE-Framework-for-Action-on-

Obesity.pdf

● The Report of The National Taskforce on Obesity:

http://www.hse.ie/eng/health/child/healthyeating/taskforceonobesity.pdf

REFERENCES

Demaio, A., Nielsen, K., Tersbøl, B., Kallestrup, P., & Meyrowitsch, D. (2014). Primary Health Care: a strategic

framework for the prevention and control of chronic non-communicable disease. Global Health Action

WHO: The World Health Report 2008 - Primary Health Care (Now More Than Ever)

WHO, Building Primary Care in a Changing Europe (2015) Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson,

Richard B. Saltman

World Health Organization (2009). Action plan for the global strategy for the prevention and control of

noncommunicable diseases. Geneva: World Health Organization.