Pika Wiya Health Service Inc Self-Management Support for Aboriginal people Kate Warren & Fiona...

Pika Wiya Health Service Inc

Self-Management Support for Self-Management Support for Aboriginal peopleAboriginal people

Kate Warren & Fiona Coulthard

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Overview

Background Self-Management & Self-Management

Support Principles of Self-Management Aboriginal Health & Self-Management LIFE Program Closing

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Background Part of a National Demonstration Project Sharing Health Care SA Project 2001 - 2004

Test self-management tools (interventions)Flinders ModelStanford ModelEnhanced Primary Care package (EPC)Health Promotion & EducationBest practice chronic disease management

3 SA sites: Port Augusta (PWHS), Port Lincoln & Whyalla

Ongoing data collection to test effectiveness of interventions during project

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ResultsGenerally: Increased self efficacy, increased quality of life, less

unplanned hospital admissions and casualty visits, less unplanned GP visits, increased planned GP and allied health visits

Pika Wiya Health Service: Increase self efficacy, better coordination of chronic

care through increased uptake of EPC items eg Aged Health Assessments & Care Plans

Other spin offs: Community acceptance of & participation in CCSM activities Staff empowerment & self-efficacy via training in CCSM Increased use of information technology – recognition of

problem areas and development of strategies to improve data systems

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The Centre for Advancement in Health (1996) proposed the following

definition:

“Involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.” (p.1)

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Kate Lorig (1993) states that self-management is also about enabling:

“Participants to make informed choices, to adapt new perspectives and generic skills that can be applied to new problems as they arise, to practice new health behaviours, and to maintain or regain emotional stability”.

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What is Self-management?

Self-management is the active participation by people in their own health care. Self-management incorporates health promotion and risk reduction, informed decision making, following care plans, medication management, and working with health care providers to attain the best possible care and to effectively negotiate the often complex health system.

National Chronic Disease Strategy, 2006

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What is Self-Management Support?

The care and encouragement provided to people with chronic conditions to help them understand their central role in managing their illness, make informed decisions about care and engage in healthy behaviours

Institute for Healthcare Improvement

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Self-Management Support Essential elements include:

Medical, behavioural and socio-economic models of promoting health

Ideally can be accessed across all levels: Practice Health System Community

Success dependent on: Relationships!

Underpins the quality of collaboration, negotiation and client centredness not just between the client and health care worker but also between health care workers who must work more as a team than individual practitioners

Communication – better electronic data sharing Support for health workers to provide self-management

support from all levels of management Changes to funding models Support systems

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Six Principles of Self-Management

1. Know your condition

2. Have active Involvement in decision making with the GP or health workers

3. Follow the Care plan that is agreed upon with the GP and other health professionals

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4. Monitor symptoms associated with the condition(s) and Respond to manage and cope with the symptoms.

5. Manage the physical, emotional and

social Impact of the condition(s) on your life.

6. Live a healthy Lifestyle

Six Principles of Self-Management

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Principles of Self management

Knowledge

Involvement

Care planning

Monitor & Respond

Impact

Lifestyle

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Why are our people dying?

Risk factors highHealthy lifestyle messages not getting

throughHigh rate of chronic disease

Focus on treatment instead of prevention

Lack of understandingSocial determinants of health more of a priority Mainstream services inadequate/under accessed

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Aboriginal Health Statistics

Difficult to obtain accurate dataATSI status not recorded

Not askedNot reported

Data only obtained fromHospitalisationsAge at deathCause of deathLots of gaps

Not all states & territories collect ATSI specific information

Moving population

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HEALTHIERABORIGINALCOMMUNITY

LIVING LONGER

Health Promotion

L.I.F.E Course

Holistic care coordination

PWHS health staff

SHC Team

Outside Providers

L.I.F.E ProgramLiving Improvements For Everyone

Self-Management message strong throughout

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HEALTHIERABORIGINALCOMMUNITY

LIVING LONGER

Health Promotion

L.I.F.E Course

Holistic care coordination

PWHS health staff

SHC Team

Outside Providers

L.I.F.E ProgramLiving Improvements For Everyone

Community Involvement!

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Health PromotionEmpower people through Prevention & early intervention: Adult Health Checks, Child Health

Checks (EPC), Immunisations, Ante-natal & baby care etc Building Self Efficacy – self confidence, self reliance Knowledge:

Services available and what’s works best at what timeHealthy lifestyle choices – education to link lifestyle risk factors with

diseaseDisease Specific Information

Art For Heart/Kidney Foundation/Cancer Council etcChronic Disease/Diabetes Camps

Community Activities:CrocfestHealth ExposCommunity DaysMedia – Umeewarra Radio, TranscontinentalFundraising & Awareness Raising Activities

All these activities involved, empowered and educated the community

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“If you don’t have diabetes now, then eat proper food so you don’t get it.”

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HEALTHIERABORIGINALCOMMUNITY

LIVING LONGER

Health Promotion

L.I.F.E Course

Holistic care coordination

PWHS health staff

SHC Team

Outside providers

L.I.F.E ProgramLiving Improvements For Everyone

Focus on TEAMWORK

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Holistic Care Coordination Chronic disease Triage

All clients screened at presentation Thorough assessment of health needs including EPC

items, immunisations, blood & other tests Flinders Model of Chronic Condition Self-

management Enhanced Primary Care (EPC) items

Care planning (GP & Health worker, TCA) Aged Health Assessments Diabetes Cycle of Care Asthma plans etc

Best practice chronic disease care plan templates Supportive IT system (Medical Director, CME, etc) Internal and external referral system Automated recall and review system

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Flinders Model of Chronic Condition Self-Management

Flinders Human Behaviour & Health Research Unit (FHBHRU)

Generic set of tools:Partners in Health (self assessment)Cue & Response (interview by HCP)Problems & GoalsSelf-management Plan

This process assesses the clients self-management skills and behaviours and ensures that social & emotional aspects of the clients life are identified and included in the medical management plan

EPC care plan and team care arrangement

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Impact of Flinders Tools

Traditional assessment methods focus on medical and physical

Structured approach builds rapport and mutual trust and respect

Identifies the social, economic, spiritual, emotional and cultural issues which may be barriers to self-management

Client agrees what is to be addressed, when and how. Their priorities are important!

Not all things can be tackled at once! Health workers need to look after themselves as

well! They are role models!

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Training involves

2 day workshop Flinders Resource Manual Open mind and willingness to participate Volunteers on 2nd day Certificate of competence issued when 3

completed plans evaluated by trainer within 3 months of completion of training

Tertiary qualification also available via Flinders online course

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Enhanced Primary Care (EPC) Care planning

Health worker involvement as advocate imperative! GP Management Plan – anyone who has a chronic condition Team Care Arrangement – multidisciplinary needs

Access to Private allied health services Via care planning process

Aged Health Assessment Over 55 if ATSI

Home Medicines Review Anyone with multiple medications – initiated by GP but anyone can

refer or recommend Case Conferencing

Used in conjunction with care planning for multidisciplinary meetings to plan or review care.

Adult Health Check for ATSI – 2 yrly Any person of ATSI 15 – 54 years of age

Child Health Checks Maternal & infant Checks

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Ms A, 55 year old lady with multiple chronic conditions, obese, hypertension, high cholesterol Care plan completed: Multiple medications…BSL 18.3 (random) – recurrent thrush & bleeding gums Attended most sessions and 2 camps. Formed friendship with other ladies in the group. Tried ten pin bowling for the first time in her lifeOutcomes:Medication reviewBlood tests & screeningReferrals & appointmentsFollow up

Care Plan Case Study

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Care Plan Review…

Care plan review - all clinical measures improved: BP↓, weight↓, cholesterol↓,HbA1c↓ (from 8 to 6.5)

She is also more confident in dealing with day to day problems.

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HEALTHIERABORIGINALCOMMUNITY

LIVING LONGER

Health PromotionL.I.F.E

Course

Holistic care coordination

PWHS health

workers

SHC Team

Outside providers

L.I.F.E ProgramLiving Improvements For Everyone

Focus on Peer Education

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Stanford Model of Chronic Disease Self Management

Follows the principles of self managementMeet once per week for 6 weeks - 2 ½

hoursFocus on group interaction & dynamicsPeople with different chronic health

problems attend togetherCourse is led by 2 trained leaders, at least

one should be peer educatorSkills learnt and practiced every week are

goal setting (action planning) and problem solving

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Other topics include:

Techniques to deal with difficult emotions such as anger, fear & frustration

Appropriate exercise to improve and maintain strength, flexibility and endurance

Safe use of medicinesCommunicating effectively with family,

friends and health professionalsNutritionCognitive symptom management

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Training involves

4 day intensiveExperience the course as a participantPractise teaching sessions (assessed)Bring a volunteer (1:1 ratio encouraged)Leave your HP hat at home!PROCESS VS CONTENT

Ideally split over 2 weeks (2 days per week) Text book “Living a Health Life with Chronic

Conditions” Leaders manual

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Stanford & Aboriginal Health

Presented course (in original format) to a group of Aboriginal community members who all have chronic conditions

Participants were invited to give feedback at every session

Through our observations, evaluation activities and a focus group after the course, we found that changes were needed

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Adaptation ProcessCourse re-presented with a few minor changes…

Findings: Difficulties with language predominant Some activities needed to presented in different

order Examples to reinforce concepts were made ‘real’ Grief & Loss recognised as having a major impact

on Aboriginal people’s health – new activity designed using the same process!

Less emphasis on people attending only one 6 week course

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Outline of ‘Understanding Grief & Loss’

Placed immediately after ‘Dealing with Difficult Emotions’

After a brief definition of ‘Grief’ we brainstorm “What are some of the feelings that people go through when they are grieving?”

Stages of Grief & explanation Brainstorm “What are some of the reasons for

people to feel grief?” Discussion around Coping with Grief Brainstorm “What are some ways for people to cope

with grief?” Further discussion leading to possible ways to get

help

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How did it go?

Previous sessions on grief and loss difficult – some people loathe to discuss - “taboo subject”

This session, based on the process designed by Stanford, was a gentler way to get people to open up and no one objected

The process allowed people to talk generally without feeling like they were in the spotlight

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.au Cover for the LIFE Course Manual reflecting the

overall theme of the course people looking after themselves and each other

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Session 1: reflecting the Keeping Active theme

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Session 2: reflecting the themes of relaxation, spirituality, grief and positive thinking

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Session 3: reflecting the themes of healthy eating and bush tucker including goanna’s, witchetty grubs, honey ants, quandongs, wild figs, bush tomatoes, bush bananas and bush berries

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Session 4: Reflecting the themes of communication, communities and relationships

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Session 5: Reflecting the themes of bush medicine, western medicine, doctors, health care workers, people and patients

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Session 6: Reflecting the themes of family, families, camps, shelter, water and being bored

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Master Training Implications

Leaders manual needed to be more user friendly

Aboriginal Leaders trained in the future need to be confident enough to lead courses in their own communities

Training competent and confident Leaders is an integral part of adapting the Leaders Manual

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LIFE Leaders Training

An extra day Rationale for change New manual

PaintingsDifferent order of activitiesLanguageNew activity modelledMore practice teaching (assessed)

Trainees encouraged to draw on local knowledge and adapt further as needed

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Organisational Change Management

Health care worker culture change Teamwork crucial Communication – meaningful and timely!! Commitment from key health care workers Staff acceptance Information systems Staff training & Education (ongoing) Marketing & promoting to staff & community Management commitment and support Administrative support Meetings and more meetings…

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Self management is an essential element across the care continuum:

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Something to think about…

“Mum, is it true that I am going to die 20 years before

my friend Sarah?”

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The L.I.F.E Program has the potential to turn that statistic

around.

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Our Contact DetailsKate Warren

Research Associate/Regional Chronic Condition Self Management Training Coordinator

Spencer Gulf Rural Health School/University of SA

Phone: (08) 86476001

Mobile: 0419 849 199

Email: kate.warren@unisa.edu.au

Fiona Coulthard

Community Development Officer

Australian Red Cross

(08) 86412495