To integrate or not to integrate? Future considerations for chronic disease self-management programs in the health care system

Objective: The growing burden of chronic disease and the increasing realisation that the current health system is ill equipped to deal with this trend has resulted in a health policy shift away from the traditional medical model to a more patient centred approach. As such, chronic disease self-management programs (CDSMP) have emerged as a potentially important component within this approach. Policy and program trends at the international level highlight several critical factors that need to be considered by governments and health care providers alike if CDSMP are to be integrated within the broader health system. This study reviewed international and local policy literature and sought perspectives from key stakeholders to determine the value and potential for integrating a generic group-based CDSMP into the care continuum.
Method: Prominent self-management policies were identified through a comprehensive literature search. Interviews were conducted with policy makers across Australia (n=20), health practitioners (n=20) and consumers (n=42) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Results: Whilst CDSMP were viewed as having significant potential to be integrated into the health sector it was identified that the delivery and content of CDSMP needs to be flexible in order to address the needs of people across the disease, age and care continuums. Critical issues to be addressed if CDSMP are to be successfully integrated include increasing the profile of self-management; actively engaging and training health practitioners in self-management and overcoming system barriers such as lack of integrated referral pathways and networks.
Discussion: Policy directions at the national level suggest that self-management will be a centrepiece in forthcoming chronic disease initiatives. International evidence has highlighted the requirement for a ‘suite’ of programs to adequately cater to different stages of the disease continuum, age groups, ethnic backgrounds and sociogeographical areas. Furthermore engagement with key stakeholders (particularly GPs) is identified as critical to ensure the successful integration of CDSMP into the health system.
Conclusion: Evidence suggests that CDSMP is an important facet in improving care of people with chronic conditions. Findings from this study suggest that current infrastructure and policy direction, which have been found to be critical factors in facilitating integration of CDSMP into the health sector, are either absent or inadequate in Victoria. CDSMPs are currently lacking a sustainable workforce, referral infrastructure and specific policy. Such factors need to be addressed before the integration of CDSMP can be considered across the healthcare continuum in Victoria.

People management issues in a third sector health care organisation: preliminary findings

Objective – To use inductive convergent interviewing to generate the perceived critical people management issues of the day as perceived by staff. This was used as preliminary to longitudinal ongoing survey in a third sector health care organisation.

Design – Convergent interviewing is a qualitative technique that addresses research topics that lack theoretical underpinning and is an inductive, flexible, evolving research instrument. The key issues converged after six rounds of interviews as well as a further round to ensure that all of the common people management issues had been generated.

Setting - There is very little in the way of tested models of predictors of employee behaviour in third sector organisations in the Australian health care industry. This study investigates a range of facilities and positions, in various hospitals and aged care facilities within the one third sector health care organisation.

Subjects – The study proposed twenty seven extensive interviews over a range of facilities and positions. Twenty one interviewees participated in the final convergent process.

Conclusions - Critical issues included: workload across occupational groups, internal management support, adequate training, the appropriate skill mix in staff, physical risk in work, satisfaction, as well as other issues. These issues confirm the proposition of sector-ness in health organisations that are multi-dimensional rather than uni-dimensional.

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery