Iolanda Principe

1
Developing and Implementinga Vision for Chronic
Disease Prevention and Management in South
Australia

• Iolanda Principe
• Director, Primary Health Care Branch

2
Outline

• South Australia Strategic Plan
• SA chronic disease framework
• An example of NSIF use in SA
• Systems of Care issues
• Models of Care

3
Headlines

• Approximately 80 of the total burden of disease
  in Australia arises from long term conditions
  such as CVD, diabetes, asthma, arthritis,
  cancers, and mental illness.
• 51 of Australian adults in 2001 had one or more
  chronic diseases, which may have resulted in
  disability or death.
• Heart disease, stroke, cancers and lung diseases
  are the underlying cause of more than 75 of all
  deaths in Australia.
• 40 of South Australian adults (gt447,000) have at
  least one of the following chronic conditions
  arthritis, current asthma, CVD, current COPD,
  diabetes or osteoarthritis.

4
South Australias Strategic Plan

• South Australias Strategic Plan (March 2004)
  clearly articulates key objectives for this State
  over the next decade.
• The plan makes specific commitment to implement
  recommendations of the Generational Health Review
  including

• provide health services closer to home
• give greater priority to prevention, early
  intervention and health promotion
• strengthen primary health care services
• improve health services for the most vulnerable
  people in the community
• develop a health system that focuses on the needs
  of the population rather than those of health
  institutions.

5
South Australias Strategic Plan

• Objectives
• Growing Prosperity
• Improving Wellbeing
• Attaining Sustainability
• Fostering Creativity
• Building Communities
• Expanding Opportunity
• Objectives 2 and 6 provide specific targets for
  the health system.

6
South Australias Strategic Plan

• Objective 2 Improving Wellbeing
• Increase healthy life expectancy of South
  Australians to lead the nation within 10 years.
• Reduce the percentage of young cigarette smokers
  by 10 within 10 years.
• Reduce the percentage of South Australians who
  are overweight or obese by 10 within 10 years.
• Exceed the Australian average for participation
  in sport and physical activity within 10 years.

7
South Australias Strategic Plan

• Objective 6 Expanding Opportunity
• Reduce the gap between the outcomes for South
  Australias Aboriginal population and those of
  the rest of South Australias population,
  particularly in relation to health, life
  expectancy, employment, school retention rates
  and imprisonment.

8
Chronic Disease inSouth Australia 2004
9
Key Directions for SA

• Overarching Strategy
• Adopt a clustered approach to chronic disease
• prevention and management
• Action Strategies
• 1. Increase system coordination and integration
• 2. Increase the availability of a system for
  self- management
• 3. Increase primary health care capacity for
  prevention, early detection, early intervention,
  and chronic disease management

10
Risk Factor and Chronic Disease
Inter-Relationships
11
Are the NSIFs useful?Cancer NSIF into action

• NSIF Cancer is being used to inform the
  development of the Statewide Cancer Control Plan
  (SCCP)
• Principles in the National Framework have been
  embedded into the principles in the SCCP.
• The NSIF Cancer has a focus on the patient
  journey across the continuum of care.
• To be relevant as a framework for SA, the SCCP
  goes beyond this to also encompass
  infrastructure, workforce and also sets a cancer
  research agenda for SA.

12
Statewide Cancer Control PlanCancer NSIF into
Action

• NSIF Cancer is a high level framework for
  consumers, clinicians, planners and designers,
  policy makers, funders, professionals and
  managers on achieving person focused, equitable,
  timely and effective cancer care for all
  Australians.
• SA Department of Health in collaboration with The
  Cancer Council SA is developing a Statewide
  Cancer Control Plan as a strategic planning tool
  to inform development and improve cancer control
  in SA

13
Statewide Cancer Control PlanCancer NSIF into
action

• In developing the SCCP, real congruency with the
  directions in the NSIF has been achievable
• a reflection of the level of consultation with
  the stakeholders during the development phase of
  the NSIF
• also a reflection of the integrity of the
  consultation process in informing the final NSIF
  -Cancer.
• SCCP Discussion Paper prepared by end April 2005.
  
• Discussion Paper will form the basis of a
  consultation process being undertaken in May
• SA SCCP completed by June 2005.

14
Systems of Care Applying Evidence

• We know what is required to improve our systems
  of care and patient health
• but
• we dont apply what we already know.

15
Health care for chronic conditions What do we
know?

• Disease burden has changed towards chronic
  conditions world wide. Health systems have not.
• Highly effective interventions exist for most
  chronic conditions, yet patients do not receive
  them.
• Current health systems are designed to provide
  episodic, acute health care and fail to address
  self management, prevention and follow-up.
• Chronic conditions require a different kind of
  healthcare (mismatch).

16
TYPICAL CARE - The Radar Syndrome

• The Radar Syndrome
• Patient appears
• Patient is treated find it and fix it
• Patient is discharged
• then disappears from radar screen

17
Radar logic inappropriate care for chronic
conditions

• System oriented to acute illness
• Patients role not emphasized
• Follow-up sporadic
• Prevention overlooked

18
Missed opportunities for clinicalprevention
What is the impact?

• Tobacco smokers have 18 higher medical charges
  than non-smokers
• A one-unit increase in BMI raises medical charges
  by 1.9
• Each additional day of physical activity per week
  reduces medical charges by 4.7
• Study conclusions
• Health plans that do not systematically support
  members efforts to improve health related
  behaviours may be incurring significant
  short-term health care charges that may be at
  least partly preventable. JAMA. 1999 282
  2235-9

19
Chronic conditions require an evolution of
health care

• .from typical (radar care) to achievable
  Innovative Care
• No longer is each risk factor and chronic illness
  being considered in isolation.
• Awareness is increasing that similar strategies
  can be equally effective in treating many
  different conditions.
• Organised systems of care, not simply individual
  health care workers, are essential in producing
  positive outcomes.

20
Conceptual Frameworks for Chronic Disease

• A range of conceptual frameworks have been
  developed for the prevention and management of
  chronic disease
• A whole of system approach is required to be
  effective
• For successful implementation, an active change
  management process is required

21
Wagner Chronic Care Model 1997
Community
Health System
Resources and Policies
Health Care Organizations
DeliverySystem Design
ClinicalInformationSystems
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Improved Outcomes
22
Wagner Chronic CareModel Elements

• Self-management support Empower and prepare
  patients to manage their health and health care.
• Delivery system design Assure the delivery of
  effective, efficient clinical care and
  self-management support.
• Decision support Promote clinical care that is
  consistent with scientific evidence and patient
  preferences.
• Clinical information system Organize patient
  and population data to facilitate efficient and
  effective care.
• Health care organization Create a culture,
  organization and mechanisms that promote safe,
  high quality care.
• Community Mobilize community resources to meet
  needs of patients.

23
WHO Innovative Care for Chronic Conditions (ICCC)
Framework 2002
24
NSW Chronic Care Model 2004
Reference Modified from World Health
Organisation and Wagner and Colleagues
25
Queensland Chronic Care Model (Draft 2005 - see
handout)
26
Issues to be given further consideration today.

• How can a systematic quality improvement process
  be incorporated into current chronic disease
  developments in SA?
• How can a systematic process to develop service
  standards for the prevention and management of
  chronic disease be created?
• How can a systematic process to develop/adopt
  evidence based guidelines for the prevention and
  management of key chronic diseases be created?