Transcript Who is HealthChange Australia?

Introduction to HealthChange® Methodology
for GPs and Practice Managers:
How to improve patient compliance and outcomes
through enhanced care planning
for
Presented by HealthChange Australia
www.healthchange.com
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© 2015 HealthChange Australia
Slide 1
Who is HealthChange Australia?
1. Why run The secret to successful care
planning for Practice Nurses: 1-day
workshop?
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Better understanding of care planning purpose and
processes
Reduce the impact of PN practice idiosyncrasies
Deal more confidently and efficiently with chronic and
complex patient cases
Increase patient adherence to recommendations
2. Why run this presentation for GPs and
Practice Managers?
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Understand what training PNs have been given and the
need to adjust care planning tasks, documentation and
processes to support practice change
Tips to understand and deal with low patient
adherence rates for CDM items
© 2015 HealthChange Australia
Slide 2
Australian and Overseas programs and services
Primary Care
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Prevention
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GP & Allied Health consultations
ACT Health/Medicare Local/Heart Foundation
HeartLink Program
Practice Nurse Care Planning
NSW Get Healthy Telephone Coaching
NSW Live Life Well Diabetes Prevention
VIC WorkSafe WorkHealth Coach
Program
Clinical Research
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Chronic Condition Management
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NSW CDM Connecting Care
Home & Community Care (HACC)
VIC Early Intervention (EICD)
VIC HARP programs
Heart failure & Cardiac rehab
Diabetes, HIV, Disability, Aged Care
Mental health
QLD Health Call Centre Cardiac Triage
QLD Disease Management Services
TAS Diabetes services
Deakin University – HIPP/Healthy Pregnancy Study
Melbourne University – Knee Osteoarthritis, Diabetic Retinopathy, Lung Cancer
Wollongong University – Practice Nurse Care Planning Studies
Monash University – Positive Ageing with HIV
Ottawa Regional
Cancer Foundation
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Survivorship support
coaching
Alberta Health Services
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Chronic Disease
Management Services
© 2015 HealthChange Australia
Denmark - Copenhagen
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Metropolitan University College
Slide 3
Presentation Topics
1. The problem of low compliance with treatment,
lifestyle and referral recommendations
2. Key aspects of using of HealthChange
Methodology (HCM) in care planning to
improve compliance to treatment and referral
advice
3. Personal experience of HCM from an
alternative application perspective
© 2015 HealthChange Australia
Slide 4
Topic 1:
The problem of low compliance
with treatment, lifestyle and
referral recommendations
© 2015 HealthChange Australia
Slide 5
How big a problem is adherence?
66%
Patients with hypertension who have poor BP control due
to non-adherence
31%
Patients who fail to fill initial prescriptions
50%
Overall adherence to chronic conditions treatment
50%
Patients who act on physician referrals to other
practitioners and services
50%
Maintenance of new exercise behaviours following
cardiac rehabilitation
About half the time patients won’t act on medical advice
(Barclay 2014; Family practice clinic audit 2010; WHO 2003; Oldridge 1991)
© 2015 HealthChange Australia
Slide 6
Client Reflections
Video - Geoff
• Back injury (medical discharge from Navy)
• Chronic pain
• PTSD, depression & other psychosocial
• Diabetes type 2
• Prostate cancer previously
• High cholesterol
• Weight management issues
• Resistance from previous experiences
© 2015 HealthChange Australia
Slide 7
Hot topics in health service delivery
Patientcentred Care
Best Practice
Adherence,
Compliance,
Engagement…
Behaviour
Change
Support
© 2015 HealthChange Australia
Integrated
Care
Health
Literacy
Chronic Disease
Selfmanagement
Shared
Decision
Making
Slide 8
Person-centred Care
shared decision making, health
care team approach, behaviour
change support, consideration of
patient beliefs, cognitions, social
and cultural contexts **
Intuition is not enough – HealthChange Methodology
provides clinicians with a systematic approach
** Bauman et al. 2003
© 2015 HealthChange Australia
Slide 9
Is the health system
encouraging better
outcomes?
Patient-centred or
Patient-centric?
Support
Coordination
Observations
Education
Care
Coordinator
or Planner
Information
Medications
Referrals
Nurse
Psych
Treatment
Assessment
Pathology
GP
Mental
Health
Health
Service
Patient
Allied
Health
Assessment
Treatment
Advice
Patient
Advocates
Health &
Legal Advice
Emotional
buy-in &
Persuasion
© 2015 HealthChange Australia
Family &
Friends
Advice &
Financial
Decisions
Rehab
Program
Education
Assessment
Advice
Aboriginal
Health
Worker
Health
System
Navigation
Education
Advice
Advocacy
Medical
Specialists
Treatment
& Procedures
Education
Tests
& Skills
Appointments Development
Procedures
Slide 10
Care planning can reduce ‘messy head’ syndrome and
anxiety for patients and clinicians and can increase
compliance, but only if it is done effectively
© 2015 HealthChange Australia
Slide 11
}
Readiness
Importance
Confidence
knowledge
© 2015 HealthChange Australia
Mini Guide p. 12
Action
Slide 12
What causes patients to go into denial?
High emotion + low confidence → denial or avoidance
© 2015 HealthChange Australia
Slide 13
Topic 2:
Use of HealthChange
Methodology (HCM) in care
planning to improve compliance
to treatment advice
© 2015 HealthChange Australia
Slide 14
HealthChange® Methodology (HCM)
A health service delivery methodology
used to deliver person-centred care and
promote health literacy, shared decision
making, behaviour change and selfmanagement to support adherence to
evidence-based recommendations for
improved health and quality of
outcomes
See healthchange.com to view short videos on
HealthChange® Methodology and to download
other resources
© 2015 HealthChange Australia
Mini Guide p. 1
Slide 15
HCM is founded on 3 evidence-based sets of
processes required to facilitate behaviour change:
Processes required to build a personcentred, non-judgemental working
relationship that respects patient autonomy
Health literacy,
motivation, values,
priorities
Processes required for a patient to form
an intention to act on health advice
Processes required to convert that
intention into action and self-regulation
From: Gale & Skouteris (2013)
© 2015 HealthChange Australia
Trust,
respect
Planning, barriers
enablers, selfefficacy, problem
solving
Slide 16
Complementary clinical pathways:
Clinical condition pathway / HealthChange® Methodology
Clinical Assessment
Health Behaviour
Change Assessment
Clinical Decision-making
Framework
Behaviour Change Decisionmaking Framework
Diagnosis
RICk Clarity
E-b Treatment Plan or
Recommendations
E-b Behaviour Change
Recommendations
RICk = readiness, importance, confidence, knowledge
E-b = evidence-based
© 2015 HealthChange Australia
Slide 17
Layers of HealthChange® Methodology: An integrated suite of tools
PSMP*
Decision
Framework
Essential Behaviour
Change Techniques
BEST Barriers & Facilitators
Behaviours
Emotions
Situations
Thinking
Person-Centred Practice Principles
HealthChange® Behaviour Change Pathway
*PSMP: Personal Self-Management Plan
© 2015 HealthChange Australia
Mini Guide p. 2
Slide 18
HealthChange® Behaviour Change Pathway
(What people need in order to take action on their care plan items)
Knowledge & Understanding
Health Literacy
Motivation & Expectations
Decision & Commitment
Decision Line
Macro view
Ready to take action
Micro view
Planning & Problem Solving
Action
Self-regulation
Build Importance
© 2015 HealthChange Australia
Build Confidence
Mini Guide p. 3
See healthchange.com
to view video
Slide 19
What can health service providers do to
facilitate action for better patient outcomes?
Knowledge & Understanding
Motivation & Expectations
Decision & Commitment
1. Set up a healthy working
alliance (build trust)
2. Identify and address
motivational barriers to
action (build importance)
Decision Line
Ready to take action
Planning & Problem Solving
Action
3. Identify and address
practical barriers to action
and self-regulation (build
confidence)
Self-regulation
From: Gale & Skouteris (2013)
© 2015 HealthChange Australia
Mini Guide p. 4
Slide 20
What clinicians need to ask themselves above the decision line to
facilitate patient action and adherence to recommendations
Does the patient know and understand their health issues and clinical
targets?
Do they know and understand the broad treatment, lifestyle and referral
categories applicable to these?
Have they been assisted to collaboratively prioritise these categories?
Are they ready, willing, able and committed to taking action?
Decision Line
Macro view
Ready to take action
Micro view
Build Importance
© 2015 HealthChange Australia
Mini Guide p. 5
Slide 21
How HealthChange® Methodology saves time
1. Targeted and streamlined assessment
2. Targeted and individualised education
3. Targeted and meaningful dialogue
4. Speedy identification and troubleshooting of barriers to action
on referral, treatment and lifestyle recommendations
Quickly builds
rapport and trust
Avoids needless discussion of things
that other clinicians have already
covered
Avoids irrelevant and nonproductive conversations
Avoids unproductive discussion
of things the client does not
want to do
Minimises time discussing
things the client is already doing
Keeps the conversation
focused & on track
© 2015 HealthChange Australia
Slide 22
People’s experience of micro advice from multiple sources
Manage Health
Condition/s
Hospital-based
Procedure
Know and
understand own
medications
Use accurate
dose and timing
Clinical Targets
Receive home
nursing visits
Have pathology
and other tests as
required
Visit General
Practitioner
Recognise and
act on signs of
Speak with Care
improvement
Coordinator
Recognise and
act on signs of
deterioration
Identify and
manage triggers
Manage alcohol
consumption
Do specific
rehabilitation
activities
Manage nutrition
and eating
Avoid infections
and illnesses
Visit medical
Recognise and
specialist/s
act on side effects
Use bracing,
supports and aids
Monitor and
effectively
manage pain
Take care of
Know and use
equipment
emergency action
plan/s
Manage wounds
and dressings
effectively
Use nutritional
supplements
effectively
Seek a
medications
review
© 2014 HealthChange Australia
Manage weight
Other...
and waist
Manage physical circumference
Address
activity
recreational drug
use
See Diabetes
Manage stress
Educator
and mood
Manage fatigue
effectively
and energy
Engage social
support
Go to physio clinic
Reduce or quit
smoking
Monitor and
Receive Social
manage other
Services
symptoms
Attend education
Arrange transport
or assistance
and other access
program/s
to services
Slide 23
HealthChange® self-management menu of options:
to support health literacy and engagement
Manage Health
Condition/s
Manage
Medications
Effectively
Engage in
Specific
Treatment
Activities
Monitor and
Act on
Symptoms
Attend
Services and
Appointments
Clinical
Targets
Manage
Triggers and
Risk Factors
Manage
Healthy
Lifestyle
Factors
Group patient tasks into overarching behavioural
categories (self-management objectives) in order to
create a person-centred self-management plan
© 2014 HealthChange Australia
Mini Guide p. 10
Slide 24
HealthChange®
Menu of Options
Manage return to
Prevent
Falls
previous
functioning
ManageOsteoarthritis
Heart
Disease
Manage
Manage
Cancer
Manage
ManageHealth
COPD
Condition/s
Manage
Medications
Effectively
Engage in Specific
Treatment
Activities
Monitor and Act
on Symptoms
Clinical Targets
Attend Services
and
Appointments
Manage Triggers
and Risk Factors
Manage Healthy
Lifestyle Factors
Know and
understand own
medications
Do specific
rehabilitation
activities
Know and use
emergency action
plan/s
Have pathology
and other tests as
required
Identify and
manage triggers
Manage nutrition
and eating
Use accurate
dose and timing
Avoid infections
and illnesses
Recognize and
act on signs of
improvement
Visit Doctor
Manage alcohol
consumption
Manage physical
activity
Recognize and
act on side effects
Manage wounds
and dressings
effectively
Recognize and
act on signs of
deterioration
Visit medical
specialist/s
Address
recreational drug
use
Manage stress
and mood
effectively
Take care of
equipment
Use bracing,
supports and aids
effectively
Monitor and
manage pain
Attend education
or assistance
program/s
Reduce or quit
smoking
Manage fatigue
and energy
Seek a
medications
review
Use nutritional
supplements
effectively
Monitor and
manage other
symptoms
Arrange transport
and other access
to services
Manage weight
and waist
circumference
Engage social
support
Other...
Other...
Other...
Other...
Other...
Other...
©2014 HealthChange Associates
www.healthchange.com
The HealthChange®
Click to edit master title
Carestyle
Planning Tool
© 2015 HealthChange Australia
Slide 26
How can you use HCM to make care plans patient-centred?
Client problems, needs &
relevant conditions
Clinical goals
Required
treatment &
services
Provider for
treatment & services
Type 2 Diabetes
HbA1c < 7%
3 monthly checks
Diabetes Education
Exercise Program
Foot care
Physician/Nurse
D. Educator/Dietitian
Ex. Physiologist
Podiatrist
Hypercholesterolaemia
TC: < 4mmol/L
LDL < 2.5mmol/L
HDL> 1.0mmol/L
TG < 2.0 mmol/L
Cholesterol meds
10mg
Low saturated fat
diet
Physician/Nurse
Dietitian
Obesity
BMI < 25
Maintain a healthy
diet
Physician/Nurse
Dietitian
Back pain
Reduce pain &
improve mobility
Physiotherapy
Bone density scan
Physiotherapist
Nuclear imaging
© 2015 HealthChange Australia
Slide 27
HealthChange® Personal Self-Management Plan
The patient’s personal roadmap and ongoing plan
General Referral,
Treatment, Lifestyle
Recommendations
Priority
Decision
Action Time
Frame
Patient’s Agreed
Actions
Comments
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Agree
Disagree
Unsure
NA
Step 2
Step 3
© 2015 HealthChange Australia
Step 4
Mini Guide p. 44
Steps 5-10
Slide 28
HealthChange®
Manage Diabetes
Menu of Options
Manage
Medications
Effectively
Engage in Diabetes
Treatment
Activities
Manage Diabetes
Monitor and Act on
Diabetes
Symptoms
Clinical Targets
HbA1c, BP, Chol, Eye
health, Kidney function
etc.
Attend Services
and Appointments
Manage Symptom
Triggers and Risk
Factors
Manage Healthy
Lifestyle Factors
Know and understand
your medications
Know and understand
about diabetes
Monitor blood sugar
levels consistently
Have regular
pathology tests and
checks
Identify what affects
your blood sugars
Manage nutrition and
eating to control
blood sugars
Use accurate dose
and timing
Record blood sugar
levels regularly
Adjust medications in
response to blood
sugar levels
Visit your General
Practitioner regularly
Manage alcohol intake
Manage physical
activity to control
blood sugars
Recognise and act on
side effects
Avoid infections and
illnesses
Know and use your
emergency action plan
Visit your diabetes
team for regular
check-ups
Manage caffeine
intake
Manage stress and
mood to control blood
sugars
Take care of
monitoring and
injecting equipment
Manage wounds and
dressings effectively
Recognise and act on
signs of improvement
Attend a diabetes
education program
Reduce or quit
smoking
Manage fatigue and
energy
Seek a medications
review
Check feet and legs
daily, manage blisters
or other problems
Recognise and act on
signs of deterioration
Compile and maintain
personal medical
records
Manage weight and
waist circumference
Engage social support
Other...
Manage other health
conditions effectively
Other...
Other...
Other...
Other...
©2015 HealthChange Australia
www.healthchange.com
Personal Self-Management Plan:
Referral, Treatment,
Lifestyle
Recommendations
Priority
Patient’s
Decision
Action
Time
Frame
Patient’s Agreed
Actions
Comments
1. Manage medications
effectively
2. Do specific treatment
activities
3. Monitor and act on
symptoms
4. Attend services and
appointments
5. Manage triggers and
risk factors
6. Manage healthy
lifestyle factors
© 2015 HealthChange Australia
Slide 30
Patient exit surveys:
1. Does the patient know and understand the implications of their diagnosed
conditions to the extent that they have motivation to manage them?
2. Do they know the overall referral treatment and lifestyle categories and options
that are appropriate for effective management of their condition/s over time?
3. Where they assisted to collaboratively prioritize these action categories? Were
they given any choice or simply advised what they must do in a prescriptive
way?
4. Where they asked to consider what might possibly prevent them from engaging
in the recommended treatment and self-management tasks?
5. Were they invited to take notes during the consultation?
6. Were they asked to what extent they thought they could do the tasks that were
agreed upon, within the agreed time frame?
7. Are they aware of other support mechanisms and services that might be
available to help them?
© 2015 HealthChange Australia
Slide 31
The Big Challenges!
HealthChange Methodology requires:
• Top down direction
• Staff engagement and attitude
change
• Bottom up practice change
• Microsystems change
• Quality control / Accountability
• Resources allocation
© 2015 HealthChange Australia
Slide 32
Topic 3:
And now for something completely
different…….
Using HCM in care planning and disease
management has a completely different
focus and feel compared with healthy
lifestyle applications
© 2015 HealthChange Australia
Slide 33
Healthy Lifestyle Application
Are you ready to do something
about your own health?
Knowledge & Understanding
Motivation & Expectations
Decision & Commitment
Decision
Line
Planning & Problem Solving
© 2015 HealthChange Australia
Slide 34
Other?
Health
Checks?
ZZZZZ…
© 2015 HealthChange Australia
Slide 35
Motivation & Expectations: Importance
How important is it to you personally to work
on this issue (given all the other priorities
currently in your life)?
© 2015 HealthChange Australia
Slide 36
Motivation & Expectations: Confidence
How confident are you that you will make
some manageable and sustainable behaviour
changes in relation to this issue?
© 2015 HealthChange Australia
Slide 37
Decision & Commitment
In relation to your chosen health issue consider...
1. If you continue to do what you are currently doing (or
not doing), what will the long-term consequences be for
you? What about the people or things that are important
to you?
2. If you do make some manageable and gradual changes,
what immediate or long-term benefits would you expect
to gain? What would the impact of this be?
3. Do these expected negative or positive outcomes make it
important enough for you to work on this issue now?
© 2015 HealthChange Australia
Slide 38
Decision & Commitment
• Are you ready to do something about this?
• Is it relatively important to you?
• Are you confident that you will take some action?
• Do you have all the information you need to make a
decision and take action?
Did your RICk levels change
in either direction?
© 2015 HealthChange Australia
Slide 39
Planning and Problem Solving:
Create a wish list of possible options for
pursuing your health aims
• Write down at least 6 or more different ways that
you could take action in the lifestyle or treatment
category that you selected
• Think of this as a wish list: for the time being ignore
any barriers that might come to mind for any of the
options you consider
• Try to include some options that you have not tried
before
© 2015 HealthChange Australia
Slide 40
BEST barriers to action and facilitators for change
Behaviours
Social circle
dynamics
Emotions
Situations
Thinking
Personal
Medical & Factors
rehab
system
dynamics
Physical
and other
external
factors
If you take barriers at face value, you may go looking
for the wrong solutions
© 2015 HealthChange Australia
Slide 41
What might get in the way for you?
Common everyday thinking barriers…
© 2015 HealthChange Australia
Slide 42
Activity: Using HealthChange® Essential Behaviour
Change Techniques
Person 1 – The Service Provider
•
Use reflection, summarising and questioning
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Provide NO suggestions or advice for this exercise
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Guide partner toward creating a goal and an action plan
•
Use prompt questions (from slide or workbook)
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Respect confidentiality
Person 2 – The Client
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Choose a REAL change that you are very ready to work on from the options list
you created
•
Avoid story telling! (10 mins each – we will tell you when to swap)
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Write down your personal goal and action plan
•
Give your partner a big cheery “yes but” if they give suggestions!
© 2015 HealthChange Australia
Slide 43
Optional prompt questions
© 2015 HealthChange Australia
Slide 44
How did you go?
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What was it like being the client?
What was it like being the service
provider?
© 2015 HealthChange Australia
Slide 45
HealthChange® Methodology within care
planning consultations:
• Integrates person-centred information exchange and
behaviour change support into a decision framework
that guides health service providers
• Actively promotes patient health literacy, shared
decision making, motivation and confidence
• Makes care planning more time efficient and
clinically effective
© 2015 HealthChange Australia
Slide 46
Thank you for your participation!
Find videos, case studies and practice tools at
www.healthchange.com
HealthChange® tools can be used freely in clinical practice
and programs as long as HealthChange® Australia intellectual property
is visibly acknowledged by displaying the HealthChange® Inspired logo
Contact us for more information
Use of any of the content contained in this workbook for training
purposes outside of HealthChange® workshops and without written
permission from HealthChange® Australia is a breach of Copyright and
Intellectual Property Laws and legal action may be taken against
persons or organisations that engage in this activity
© 2015 HealthChange Australia
Slide 47
© 2015 HealthChange Australia
Slide 48
Client case – ‘toxic wasteland’
• Male, mid-30’s, BMI = 34 (96 kg), elevated BP, BGLs & Chol.,
married, 2 children, manager in hospitality industry
• Told to: change diet, lose weight, start exercising, reduce alcohol
and caffeine dramatically, quit smoking
• 18-24 shots per day espresso per day
• 1 bottle of wine per night, plus multiple martinis
• 15 cigarettes/day
• Low energy, poor sleep, frequent waking, needed naps on
days off
• Very little water – doesn’t like it
• No exercise, poor diet, hardly any fruit and vegetables
© 2015 HealthChange Australia
Slide 49
1 x 20 minute intervention
Reaction to Dr’s advice: “What can I do? I would have to quit my job!”
• Main barrier: completely overwhelmed and didn’t know how to take
action
• Key principle to overcome barriers: One thing at a time, one step at
a time, adding up over time
• Prioritised category: alcohol reduction
• Strategies: eat dinner early with the children and don’t have chilled
wine available
• No review consultation
© 2015 HealthChange Australia
Slide 50
Behaviours at 1.5 years:
• 5 alcohol free days/week, 1 bottle of wine over 2 nights, no martinis
• No more than 2 x skinny latte’s per day
• 2-3 cigarettes per day, work days only
• 1.9ℓ jug of water/day (hot water + ice + touch of cordial)
• 1 x vegetarian meal per week, aims for daily vegetables + 2 x fruit per
day
• 3 x per week on exercise bike, plus conscious use of (many) stairs at
work
• No longer takes naps on days off
Behaviours at 2.5 years:
• 5 serves vegetables plus 2 serves of fruit per day
• 5 x exercise sessions per week
© 2015 HealthChange Australia
Slide 51
Results at 1 & 1.5 years:
• BMI 29 (82 kg) - previously 34 (96 kg)
• BP, BGLs and Chol. in normal range – previously all
elevated
• No longer gets daily headaches
• Sleeps through the night and reports increased energy
Results at 2.5 years:
• 76 kg
• Waist circumference 88 cm (previously 110 cm)
• BP, BGLs and Chol. All in normal range
© 2015 HealthChange Australia
Slide 52
Client’s reflection
“What the Dr told me to do was impossible”
“I am thankful that she told me (about the critical nature of
my health issues) but I expected more help with how to do it”
“The Dr doesn’t know why I do what I do and why it is hard
to change. Health professionals need to know why!”
“I was in a nasty evil cycle”
© 2015 HealthChange Australia
Slide 53
Return
© 2015 HealthChange Australia
Slide 55
Handout Contents
Booklet
1. Title page
2. Permission to use materials for clinical practice
3. Contents
4. Glossary
5. 2-page excerpt from Gale and Skouteris, 2013
6. Copies of slides – exact match to presentation
7. Manage Diabetes Goal Hierarchy (grey scale)
8. PSMP (patient/client pre-populated version, 2 pages)
9. Lined pages
Loose Leaf
1. Care planning task list (purple & green flow chart) – NOT laminated
2. A5 card with clinical condition and healthy lifestyle hierarchies
3. Evaluation (generic)
4. Mini Guide
5. PN workshop brochure
© 2015 HealthChange Australia
Slide 56
Notes for facs to emphasise:
© 2015 HealthChange Australia
Slide 57