chronic illness alliance – regional forums traralgon april 2006 a broad approach to chronic...

Chronic Illness Alliance – Regional Forums

Traralgon April 2006

A Broad Approach to Chronic Disease

Management in a Rural Setting

Chris ShoemakerAsthma Educator, Smoking Cessation

EducatorPulmonary Rehabilitation Coordinator

Bairnsdale Regional Health Service



Defining Health

……………. not merely the absence of disease or infirmity. (WHO)

Well being = Wholeness…is not the same as being happy or living without pain, frustration or handicaps. (De Vries)

Inextricable link between mind and body

More important elements of healthiness being balance & potential and being given an opportunity to personalise.



Defining illness• Disease - objective biological

abnormality, changes in the body that a physician treats. (Body)

• Illness - subjective experience of the disease, the feelings associated with changes in bodily states. (Individual experience)

• Sickness - social & functional consequences that follow the disease or illness, to a role justified on the basis of disease or illness. (Society)

Response dependant on family or societal attitudes to changing health status

(Altschuler, J. (1997) Working with Chronic Illness.)



Levels of Prevention• Primary - precedes disease or

dysfunction, health promotion/ risk identification (cause & effect).

• Secondary - screening activities & treating early stages of disease by averting or delaying the consequences of advanced disease.

• Tertiary - minimisation of complication/s or deterioration due to a defect or disability as a result of permanent or irreversible disease.

Edelman & Mandle (2002) Health Promotion – Throughout the Lifespan

DOWNSTREAM FACTORS

MIDSTREAM RISK FACTORS

UPSTREAM DETERMINANTS

OF HEALTH

Social, Physical, Economic and Environmental

Factors

(NSW Health, 2002)

Psychological Factors & Health

Behaviours

Physiological Systems & Biological Reactions

EducationOccupation

Working ConditionsIncome

Housing Age of Residence

Control Stress

Demand-strainDepressionSelf-esteem

HopelessnessSocial Support &

NetworksIsolation &

Marginalisation

Food & NutritionSmoking

Physical ActivityAlcohol

Self-harmPreventative Health

Care

Endocrine & Immune System

ResponsesHypertension

Fibrin ProductionAdrenaline

Blood- Lipids BMI



Tertiary Prevention

Pulmonary Rehabilitation &

Better Health Self-Management (CDSM)

Courses



What is Pulmonary Rehabilitation?

• A multi dimensional continuum of services directed to persons with pulmonary disease, and their families,

• Involves an interdisciplinary team of specialists,

• With a goal of achieving & maintaining the individual’s maximum level of independence & functioning in the community.



Aims

• Increasing knowledge and understanding about their condition,

• Nurturing an increased confidence and skill to better [self-] manage their condition,

• And therefore supporting an improvement in their quality of life.



Program Objectives

• Reduce the impact of deconditioning, while increase 6MWT

• Reduce sense of breathlessness, while QOL increases.

• Reduce frequency of admissions, while increase primary care visits.

• Reduce length of stay in hospital.



BRHS program format

• 12 sessions over 6 week program-Twice weekly -2½ hours per session (30 min

cuppa)-Exercise - individualised &

monitored-Information-Socialisation

• Pre and post assessment



Presentations topics can include:

• Self- Management principles• Structure and functioning of the lung• Mechanics of breathing & more

efficacious technique• Medication Regimes and use of

devices• Emotional challenges of living a

chronic condition• Diet and Nutritional Issues

0%

50%

100%

150%

200%

250%

Percentage Improvement

Client Number

6 Minute Walk Test - Improvement compared to Pre-Test

Improvement 237 35 68. 50. 14. 42. 50. 36. 0% 18 0% 26 8% 24 9% 15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

(ACUTE)



Secondary Prevention

ChIPSAsthma Education



Ch- ronicI- llness

P- eerS- upport

E-ducation, R-creation & S-ocialisation



About ChIPS

Developed in 1992

At the Centre for Adolescent Health at the Royal Children’s Hospital, Melb.

Generally Melbourne & Metropolitan based with over 300 participants

No known other rural groups



Philosophy of ChIPS

• Based on the concept that all young people who live with a chronic illness will experience similar life-style, social and emotional concerns.

• Does not categorise the person to the illness.



Some expected benefits of ChIPS

• Improve (adolescent) adjustment to life with a chronic illness.

• Increased independence & sense of control over health status.

• Develop a range of personal abilities.

• Become more active in the local community.



Consider the young person’s knowledge

• Having managed their condition most of their life, young people have their own valid knowledge, based on experiences, that should be considered while in healthcare.

• Better management of a chronic illness must be a partnership.



Communication with Health professionals

• Use appropriate Language.

• Speak to young person not parent.

• Discussion, not judgement, around better management of condition.

• Listen to underlying reasons for challenges.



Actual Achievements.

• More accepting of chronic illness and able to talk about it [with others].

• Being able to share on ‘common ground’ with no judgements.

• Developing close friendships and ability to express ‘inner’ feelings.

• Increased involvement in organisation of activities.



Primary Prevention

Tobacco Control, Smoking Cessation and Health Promotion.

Integration = Intersectoral collaboration =TEAM!!!



Tobacco and health

• Information sessions provided to primary, secondary & adult level students to either encourage quitting or discourage commencing tobacco use.

• One-to-one smoking cessation sessions



Asthma Education

Emergency Asthma Management in Sports (&

camping)



E.A.M.

• Emergency Asthma Management sessions provided to schools, child care centres, sporting & recreational groups and organisations.

• Asthma management and most efficacious device use in sessions provided to individual clients and/or their carers.



Workforce Recruitment -Another opportunity to

provide health promotion



Uni’s Consortium Health Day

• Health Careers Day for senior secondary students considering a career in health.

• Following an enacted scenario, students are able to observe and participate in the ‘care’ of a ‘patient’ by many of the varied health disciplines.

• Information is also provided regarding university entry criteria and available scholarships.



Developing Community Infrastructure -

Affordable & Accessible



Supporting Peers

Smoking Cessation

Guidelines for Australian

General PracticeTo Reorder: phone 1800 020 103

http//www.health.gov.au/pubhlth/publicat/order.htm



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Health Professional’s Toolkit

Draft launched April 2005 at TSANZ Scientific Meeting

Yesterday launched online!!!!

Committee of Australian Lung Foundation in collaboration with the Australian Physiotherapy Association



Designing & Coordinating a PRP.

Course for Health Professionals



Future Needs

• Strengthen Evaluation• Support Research• Sustainability

- Facilitator Succession Planning

- Hub & Spoke Approach.



“A life-saving pathway between

inactivity and activity,

isolation and socialisation,

depression and hope, and from being an

observer to life to an active participant in

it.”

chronic illness alliance – regional forums traralgon april 2006 a broad approach to chronic...

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