The University of Sydney Page 1

Implementing evidence into practice to improve chronic

lung disease management in Indigenous Australians

Professor Jennifer Alison&

David MehargProject Manager & PhD student

Faculty of Health Sciences and the Poche Centre for Indigenous Health,

University of Sydney

Breathe Easy Walk Easy Lungs for Life(BE WELL)

AIs: Kylie Gwynne, Boe Rambaldini, Heather Allen and Debbie McCowen

CIs: Jennifer Alison, Christine Jenkins, Graeme Maguire, Stephen Jan, Tim Shaw, Sarah Dennis, Zoe McKeough and Vanessa Lee

The University of Sydney Page 2

BE WELL Overview

– Aim and research question

– Study design, methods and outcome measures

– Knowledge to Action Framework

– BE WELL study flowchart

– Project to date

– Reflections

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Aim and Research Question

BE WELL aims to:– Build the capacity of Aboriginal Medical Services in New South

Wales, Australia to provide effective management of Chronic Obstructive Pulmonary Disease (COPD), through pulmonary rehabilitation.

Research Question– Can pulmonary rehabilitation be implemented in Aboriginal

Medical Services and achieve improved health outcomes for Aboriginal people with chronic lung disease?

The University of Sydney Page 4

Study Design – Implementation Science

Source: NIH, CTSA model Thanks to Dr Nicole Rankin

The University of Sydney Page 5

Methods and outcome measures– Research uses mixed methods

– Participants: 1. Aboriginal Health Workers trained as BE WELL program

leaders

2. Aboriginal people with chronic lung disease completing BE WELL

3. Aboriginal Medical Services implementing BE WELL

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Participants What to measure How (Pre and Post BE WELL)

1. Aboriginal Health Workers

• Knowledge and confidence managing COPD

• Questionnaire

2. People with chronic lung disease

• Quality of Life• Exercise capacity• Experience of care • COPD hospital

admission and cost of care

• Questionnaire• 6-minute walk test• Yarning circle• Compare COPD hospital

admissions 12 months beforeand after BE WELL program

3. AboriginalMedical Service

• Respiratory services available for people with chronic lung disease

• Questionnaire

The University of Sydney Page 7BEWE= Breathe Easy, Walk Easy

KNOWLEDGE

BEWE resources

Level 1 evidence for Pulmonary Rehabilitation

Guidelines AustraliaCOPD-X & PR

ACTION CYCLEThe Problem - COPD

Indigenous communities:• High incidence COPD• High rates hospitalisation• Limited access to best-practice

management COPD

Adapt knowledge to Local Context in 4 Distinct Aboriginal Medical Services

Assess Barriers to Implementation: • Service Delivery Inventory • Focus Groups

Select Assessment toolsTailor Pulmonary rehabilitationReview Implementation strategy

Ongoing mentoringMonitoring of pulmonary rehabilitation sessions

Monitor Knowledgeretention and use

Evaluate:• Service delivery outcomes• Patient outcomes• Patient Experience • Implementation experience

SustainabilityPolicy impact

Evaluate pre / post workshop:Health worker outcomes:• Knowledge, confidence, skills

The University of Sydney Page 8

BE WELL flowchart

Complete Service Questionnaire

Recruit Aboriginal Health Workers

Start Cert IV Allied Health Assistant

BE WELL Workshop

Pre/Post Survey

Recruitment & Training & Baseline data collection

3 month follow up supportTelehealth SupportRecruit patients

Support to establish a PR

program on site

Develop & support the intervention (PR)

Data collectionEconomic and

hospital admission data

Qualitative interviews - all stakeholders

Collect outcome data for patients and servicesTelehealth support

of program

Pre-studyEngage

Communities Gain consentCommunity

supports research protocol

Ethics approval

The University of Sydney Page 9

Project to date

Commenced BE WELL at first site and delivering a second program and adapting to local context

Conducted a BE WELL Awareness Day

Completing a systematic literature review - Global Indigenous Pulmonary Rehabilitation

Reviewing 18 years of NSW COPD hospitalisation data

Identifying three additional NSW Aboriginal Medical Services to implement BE WELL

BE WELL Program Pathway

3. Health Worker4. Physiotherapist  GP referral letter to Health WorkerReferral to Physiotherapist

34

Clients

Patient has a consultation with GP

GP/Medical assessment 

Suitable for BE WELL ‐Referral

Not suitable for BE WELL ‐No Referral 

New client registrationNew client assessment 

Client completes BE WELL

1 2

5Follow‐up letter to GP

BE WELL Program with 

Physio and Aboriginal Health 

Workers

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Walk20 min

Lower limb strength10 mins

Upper limb strength10 mins

Warm-up/Cool-downFlexibility and Stretches

5-10 mins

Cycle20 min

BE WELL Exercise Program – Session time ~ 1.5 hours

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– Welcome to Country by local Aboriginal Elder– Community BBQ – BE WELL show bags and T-shirt giveaways:

program and lung disease information– Aboriginal community consultation: self reported knowledge of

lung disease, service delivery preference, smoking status and spirometry completed

– BE WELL exercise program showcased– Potential participants toured the gym and viewed the BE WELL

exercise program

BE WELL Aboriginal Community Awareness Day

The University of Sydney Page 13

BE WELL Community Awareness Day – October 2018

The University of Sydney Page 14

Reflections

1. Huge commitment of Aboriginal Medical Services and Aboriginal Health Workers to implement a new program

2. Aboriginal Medical Services strong commitment, accountability and leadership with limited pulmonary rehabilitation funding

3. Importance of incorporating Aboriginal Health Workers as leaders in pulmonary rehabilitation service delivery

4. Care needed when engaging Aboriginal community and service partners to ensure real partnership

5. Challenge of remote partnerships

The University of Sydney Page 15

Acknowledgements

– Aboriginal communities and traditional nations implementing the BE WELL program

– Aboriginal Medical Services, staff and BE WELL Ambassadors– Poche Centre for Indigenous Health

and the Faculty of Health Sciences, University of Sydney, Australia

– Lung Foundation Australia– BE WELL Investigators