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Chronic Illness frameworks and Primary Care Physiotherapy
- 1. THE ROLE OF CHRONIC ILLNESS FRAMEWORKS IN PRIMARY CARE PHYSIOTHERAPY Informing future practice
- 2. INTRODUCTION ● The HSE Chronic Illness framework refers to chronic disease as any long term condition (6+ months) which can only be treated and not cured. ● Significant cause of morbidity and mortality and can significantly reduce quality of life . ● Massive financial costs for both the patient and the health care system. ● Although population is now living longer, chronic conditions have reduced the quality of those remaining years. ● This burden needs to be addressed or ‘we will continue to add years to our lives without adding life to those years’ – (IPH making chronic conditions count, 2010)
- 3. “PRIMARY HEALTHCARE: NOW MORE THAN EVER” (WHO 2008) Four sets of PHC reforms: Why primary healthcare? 1) Health inequality 2) Changing health problems 3) Inflexibity of current system
- 4. PRIMARY HEALTHCARE: WHERE IRELAND RANKS IN EUROPE? ● Work force development - 6th in Europe ● The highest payments in the public system exist in Ireland, €45–60 for each GP visit. ● Evidence-based clinical guidelines for GPs exists in all countries except Ireland, Malta and Switzerland. - Quality assurance? ● Ireland had the lowest level of patient satisfaction with the costs of GP care in 2007 ● When considering all features of access to primary healthcare, Ireland ranked lowest in europe
- 5. TACKLING CHRONIC DISEASE Addresses the challenges of chronic disease to reduce the burden for individuals, their carers and the health system here in Ireland. Aim: (i) to promote and improve the health of the population and reduce the risk factors to the development of chronic diseases ii) to promote structured and integrated care in the appropriate setting that improves outcomes and quality of life for patients with chronic conditions. ● Reorientation towards primary care and the provision of integrated health services. ● The primary healthcare sector should play a central role in the care of patients with chronic disease. Primary healthcare should be strengthened to meet the needs of patients with chronic conditions.
- 6. HEALTHY IRELAND A collective response to the risks that threaten Ireland’s future health, wellbeing and economic recovery. Health policy guidance for period (2013-2025), based on analysis of social determinants of health. Aims: ● Increase the proportion of people who are healthy at all stages of life ● Reduce health inequalities ● Protect the public from threats to health and wellbeing ● Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland https://www.youtube.com/watch?v=1dxILd49RAM&hc_location=ufi
- 7. RELEVANCE OF HI FOR PHYSIOTHERAPISTS Broad framework mainly addressing public health from a governmental and public policy perspective. Reaffirms and updates government commitment to primary care policy (2001) in light of the growing prevalence of chronic illnesses Acknowledges the vital role of exercise promotion as a means of addressing public health. Calls for increased funding towards community based prevention initiatives Supports means of education that would improve health literacy
- 8. NATIONAL EXERCISE REFERRAL FRAMEWORK (NERF) Model of best practice for inclusion of PA pathways in health care setting. Aim: To increase PA levels in individuals living with an established NCD or disability How? Exercise Referral, develop knowledge of HCPs. ● NERF recommends that inactive/sedentary at risk of developing are given brief advice/intervention ● Exercise Referral for those suitable: Assessment, develop tailored PA programme, monitor progress and follow up Integration of PA and NCD prevention into primary care systems is globally recognised as one of the best investments for PA
- 9. FUTURE PHYSIOS... Within NERF Physios can act as: 1.Referring Practitioner: Recruitment, suitability, explain benefits E-Learning training module ‘Promoting PA’ via HSE 2.Exercise Referral Unit: Advice, can match patient to suitable service provider. Must have significant knowledge of NCD’s. 3. Service Provider: Lead patient within PA setting. High Support Centres, Community Based PA Programs+ Exercise Facilities, Self directed
- 10. HSE FRAMEWORK FOR ACTION ON OBESITY 2008-2012 Aim: Plan for how the HSE will facilitate the implementation of the recommendations from The National Taskforce on Obesity 2005. How? ● effectiveness in surveillance, research, monitoring and evaluation ● uniform approach to detection and management of obesity ● obesity prevention and health promotion ● effectively communicate message on obesity ● engage and support the work of other sectors in addressing determinants of obesity and the obesogenic environment
- 11. GUIDE FOR FUTURE PHYSIOTHERAPISTS IN PRIMARY CARE ● Develop primary care networks - include the prevention, management and treatment of overweight and obesity as part of their core service ● Develop, through the National Health Promotion Information Project, health information materials on nutrition, physical activity and maintaining healthy weight for adults and children. ● An individual’s interaction with health care services should be an opportunity to develop life-skills and foster self-efficacy in support of healthy eating, active living and positive self-image. ● Work with Local Authorities and Sports Partnerships to implement physical activity programmes at community level. Future development..preschool programmes, occupational health, Irish Sports Partnership, Little Steps programme
- 14. COMMON THEMES ● Prevention & Management ● Government Policy ● Development of intersectoral partnerships (public & private) ● Patient empowerment ● Evidence Based Guidelines ● Education and Awareness Implication for physiotherapy? ● Primary care - future employment ● Exercise ● Education ● Versatility of our profession
- 15. FRAMEWORK LINKS ● The HSE Chronic Illness Framework 2008 http://www.hse.ie/eng/About/Who/Population_Health/Population_Health_Approach/Population_Health _Chronic_illness_Framework_July_2008.pdf ● IPH Making Chronic conditions count 2010 http://www.publichealth.ie/files/chronic_main.pdf ● Tackling Chronic Disease: A policy framework for the management of chronic disease. http://health.gov.ie/wp-content/uploads/2014/03/tackling_chronic_disease.pdf ● Healthy Ireland http://www.hse.ie/eng/services/publications/corporate/hieng.pdf
- 16. FRAMEWORK LINKS ● National Exercise Referral Framework: Second Draft http://www.exercisereferral.info/wp-content/uploads/2014/10/NERF%20Draft%202.pdf ● Framework for Action on Obesity 2008-2012: http://www.getirelandactive.ie/content/wp-content/uploads/2011/12/HSE-Framework-for-Action-on- Obesity.pdf ● The Report of The National Taskforce on Obesity: http://www.hse.ie/eng/health/child/healthyeating/taskforceonobesity.pdf
- 17. REFERENCES Demaio, A., Nielsen, K., Tersbøl, B., Kallestrup, P., & Meyrowitsch, D. (2014). Primary Health Care: a strategic framework for the prevention and control of chronic non-communicable disease. Global Health Action WHO: The World Health Report 2008 - Primary Health Care (Now More Than Ever) WHO, Building Primary Care in a Changing Europe (2015) Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson, Richard B. Saltman World Health Organization (2009). Action plan for the global strategy for the prevention and control of noncommunicable diseases. Geneva: World Health Organization.
Editor's Notes
- Chronic diseases account for two thirds of emergency medical admissions to hospitals. 60% of hospital bed days are related to chronic diseases and their complications Increases with age Higher in males (except diabetes) Higher in lower socio-economic classes Nearly 1.25 million adults aged 16 years and over have hypertension Overall increased prevalence of chronic illnesses projected is projected to be 40%
- reforms that ensure that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection – universal coverage reforms reforms that reorganize health services as primary care, i.e. around people’s needs and expectations, so as to make them more socially relevant and more responsive to the changing world while producing better outcomes – service delivery reforms; reforms that secure healthier communities, by integrating public-health actions with primary care and by pursuing healthy public policies across sectors – public policy reforms; reforms that replace disproportionate reliance on command and control on one hand, and laissez-faire disengagement of the state on the other, by the inclusive, participatory, negotiation-based leadership required by the complexity of contemporary health systems – leadership reforms. Health Inequality: the substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, with a considerable number of countries increasingly lagging behind or losing ground. Furthermore, there is now ample documentation – not available 30 years ago – of considerable and often growing health inequalities within countries. Changing health problems: the nature of health problems is changing in ways that were only partially anticipated, and at a rate that was wholly unexpected. Ageing and the effects of ill-managed urbanization and globalization accelerate worldwide transmission of communicable diseases, and increase the burden of chronic and noncommunicable disorders. The growing reality that many individuals present with complex symptoms and multiple illnesses challenges service delivery to develop more integrated and comprehensive case management. Inflexibility of current system: the responses of the health sector to the changing world have been inadequate and naïve. Inadequate, insofar as they not only fail to anticipate, but also to respond appropriately: too often with too little, too late or too much in the wrong place. eg aging population, obesity epidemic. cancers, diabetes and heart diseases worldwide are currently preventable and prevention is cost-effective. This group of chronic conditions is not only associated with high levels of mortality, but also long-term disability and morbidity. Community participation in physiotherapy led primary healthcare initiatives such as screening programs will help prevent this PHC encourages an integrated approach to healthcare and prevention PHC emphasizes community participation
- What is the irish government doing?
- highlight youtube video as a resource
- Summary of literature on PA and health Model of best practice for inclusion of PA pathways in health care setting. Outlines roles and responsibilities, competencies and training of the referring practitioners and service providers. Recent findings have indicated the need for a new national framework for exercise referral. Offers huge opportunity to be a key participate in the delivery of future health interventions Ex referral=1 pathway that exists in health care setting. How? ex ref to quality, safe and effective supervised pa opportunities. develop knowledge of hcps in relation to pa and its role for primary prevention for individuals with CI. Target Population: 3 categories of patients. 1=moderate to severe NCDs impacting on QoL 2=definite but mild NCDs, not yet impacting 3= inactive, sedentary, at risk of developing
- Must understand: NERF protocols +procedures, benefits + risks of PA, MI training. Physiotherapists are an important influence of patient behaviour and key initiators of NCD prevention actions within HC system Ref Practitioner: Recruit, determine suitability, benefits to pa, ER- intermediary role: matches, also gives advice to referring practitioners. MI training to determine the patient's stage of behaviour change. review. E- Learning training module is recommended. Available to those working in HSE or as CPD. ERU-Provide medical, exercise specific and behaviour change expertise to referring practitioners. Cat B: BSc honours degree in exercise science, NCD management or a related topic and for Cat A: MSc.
- Obesity in itself represents a major chronic illness but is also a major contributor to other chronic illness’s. It has been highlighted as a government priority in addressing the determinants of chronic illness. This framework was evidence based on NICE, WHO and The National Taskforce on Obesity 2005 etc.
- *communication aim *working with other sectors pre screening etc is in an ideal world..not feasible with the current service that exists
- The prevalence of obesity in Ireland is a consequence of multiple determinants. Intra personal, Inter personal, (Family & Psychological), Environmental. This is the evidence of the determinants of obesity from the taskforce which we have discussed in detail in college.
- As physiotherapists in the primary care setting we have the ability to influence many of these determinants through education and effective communication. *primary care is the future