why prevention is better than cure: an ngo perspective · why prevention is better than cure: an...
TRANSCRIPT
Why PREVENTION is better
than cure: An NGO perspective
Rachelle Foreman – Health Director, Heart Foundation
Michelle Trute – CEO, Diabetes Queensland
Session Overview
• The importance of prevention/lifestyle management
across the health continuum
• Potential roles of different stakeholders
• Real world collaborative examples:
– Life diabetes prevention program in primary care
– Heart failure management programs
Chronic diseases:
The epidemic of the 21st century
• #1 cause of death globally (36 million deaths/year)
• One third (33%) of the burden of disease in Qld is due to
modifiable risk factors (CHO report 2012)
• These known and preventable risk factors account for
80% of deaths (WHO 2011):
– tobacco, physical inactivity & sedentary behaviour,
unhealthy diets, harmful use of alcohol
• The overall costs associated with obesity, smoking and
harmful consumption of alcohol alone are:
– almost $6 billion per year to the healthcare system
– almost $13 billion due to lost productivity
Risk factors in Queensland
• 58% are overweight (35%) or obese (23%)
• 44% are not sufficiently active to achieve health benefits
• 29% have high blood cholesterol
• 29% have high blood pressure
• 14% smoke daily
• 21% drink at levels considered harmful to their health (>2 standard drinks per day)
• Depression, social isolation, poor social support
• Poor nutrition – 92% don’t eat enough fruit & veges
– 33% have takeaway weekly
Australia’s ageing population
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Chronic disease and ageing
P e rs o n s re p o r tin g o n e o r m o re c h ro n ic c o n d it io n s , b y a g e g ro u p
S o u rc e : A B S N a t io n a l H e a lth S u rv e y 2 0 0 1 , u n p u b lis h e d d a ta
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The importance of prevention across
the health continuum Figure 1
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Primary prevention includes the promotion of healthy behaviours and environments across the life course, and universal and targeted approaches.
The majority of the population with chronic conditions who have a relatively low level of need for healthcare:
Their chronic condition is reasonably under control, with support for self management of their condition provided through the primary care team.
Individuals whose condition is unstable or could deteriorate unless they have additional support through specialist disease management.
Individuals who have highly complex needs and/or high intensity use of unplanned care (i.e. emergency presentations or hospital admissions)
Require active case management and coordinated care
End of Life Care
70-80% of chronic
care population
High risk
population
Complex
population
Well population
Le
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5 Principles of Self-Management
1. Illness management skills are learned
– taught, practiced, reinforced, corrected
2. Patients can take a primary, active role
– self-efficacy is crucial, not passive recipients of care
3. Learning to live well with illness
– learn skills & make necessary changes
4. Regular follow-up & communication
– listen & interact
5. Social environment
Queensland Chronic Disease
Management Framework • A population-based approach
• Identifies strategies and actions, which can be taken to improve
the organisation and delivery of chronic disease Px and Mx
within their local community
• The primary focus is on reducing the demand of clients with
chronic disease and complex needs on the acute hospital
system
• Key interventions include:
– Keeping the ‘well population’ well through prevention & screening
– Improving the management of ‘at risk’ patients
– Improving access and support for self-management
– Intensive case management and care coordination for those at
highest risk
Need a progressive, staged and
comprehensive approach – Ottawa charter
Coordinated, integrated and patient-
centred
• Majority of care is provided in the community setting with
linkages between the acute care sector and the
community care sector
• Shared responsibility – developing strategic
partnerships – at all levels of government, industry,
business, unions, the NGO sector, research institutions
and communities
• Needs service planning, implementation and coordination,
and integration of services across sectoral boundaries
Evidence based
Prevention in primary care setting
Partnerships across the sector
Life! Program
To prevent people developing T2
diabetes
To contribute to early diagnosis in those
who have T2 diabetes but are not aware
Program aims
Program design
Program
implementation
Social Marketing
Established state-wide prevention system
Trained 375 health professionals
137 organisations accredited
Established Riskline
Social Marketing and communication
Over 26,000 referrals
20,000 people assigned to high risk prevention courses
A significant reduction in modifiable risk factors
We know it
works!
NGOs with a state overview to coordinate program
Medicare Locals and HHS as local service providers to meet local
needs
LGAs with grassroots connections to build community’s
engagement with health and wellness
Applying the
model in Qld:
Real world example:
Heart failure Hospital to Home program
The evidence base for CHF
Management Programs • Strong level 1 evidence for post discharge support
(and patients also want it)
• Systematic reviews show:
– ↑ Quality of Life
– ↓ readmissions
– ↑ survival
– Cost neutral or save money
Key elements
• Multi-disciplinary team
• Follow up - home visits, telephone, clinics (in general, home visits are more effective than telephone contact only)
• Patient and Carer education regarding importance of adhering to medications and monitoring for signs and symptoms of worsening heart failure
• Self management strategies every day
• Weight monitoring, dietary advice and exercise
• Action Plan - advice on what to do about worsening signs and symptoms of heart failure, and access to a Specialist Heart Failure Nurse
• Communication to GP’s and with Community Service Providers
• Medication review & titration
• Social and psychological support
©2010 National Heart Foundation of Australia
Name of presentation in footer Slide 23
Heart Failure Service Model
Acute Phase • Inpatient management
Post-Acute Phase
• follow-up (phone,
home visit, clinic)
• GP review
• Medication Mx
Maintenance Phase
• Wean follow-up Hospital-
Community Liaison
• Exercise program
• GP review – medication
titration
Pre-Acute Phase
• Early identification
of deterioration
• Self-monitoring
• GP consult
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Copyright © Queensland Government
Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates.
For information contact: EPS
Telephone: (07) 323 41853
Queensland Health Funding
$ allq he p s p ro d S e arc h
Statewide support assists to:
• Adapt elements of model to local conditions
• Collect common patient information
• Measure common clinical indicators
• Provide a clinical information system to collect data
• Provide templates for assessment
• Support Advanced CHF training of all health professionals