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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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

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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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Disclaimer | Comments | Publishing | Training

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

eps@health.qld.gov.au

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