Implementing evidence into (BE WELL) practice to improve chronic - - PowerPoint PPT Presentation

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Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians

Professor Jennifer Alison & David Meharg Project Manager & PhD student Faculty of Health Sciences and the Poche Centre for Indigenous Health, University of Sydney

Breathe Easy Walk Easy Lungs for Life (BE WELL)

AIs: Kylie Gwynne, Boe Rambaldini, Heather Allen and Debbie McCowen CIs: Jennifer Alison, Christine Jenkins, Graeme Maguire, Stephen Jan, Tim Shaw, Sarah Dennis, Zoe McKeough and Vanessa Lee

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BE WELL Overview

– Aim and research question – Study design, methods and outcome measures – Knowledge to Action Framework – BE WELL study flowchart – Project to date – Reflections

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Aim and Research Question

BE WELL aims to: – Build the capacity of Aboriginal Medical Services in New South Wales, Australia to provide effective management of Chronic Obstructive Pulmonary Disease (COPD), through pulmonary rehabilitation. Research Question – Can pulmonary rehabilitation be implemented in Aboriginal Medical Services and achieve improved health outcomes for Aboriginal people with chronic lung disease?

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Study Design – Implementation Science

Source: NIH, CTSA model Thanks to Dr Nicole Rankin

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Methods and outcome measures

– Research uses mixed methods – Participants:

• 1. Aboriginal Health Workers trained as BE WELL program

leaders

• 2. Aboriginal people with chronic lung disease completing

BE WELL

• 3. Aboriginal Medical Services implementing BE WELL

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Participants What to measure How (Pre and Post BE WELL) 1. Aboriginal Health Workers

• Knowledge and

confidence managing COPD

• Questionnaire

2. People with chronic lung disease

• Quality of Life
• Exercise capacity
• Experience of care
• COPD hospital

admission and cost of care

• Questionnaire
• 6-minute walk test
• Yarning circle
• Compare COPD hospital

admissions 12 months before and after BE WELL program 3. Aboriginal Medical Service

• Respiratory services

available for people with chronic lung disease

• Questionnaire

The University of Sydney Page 7 BEWE= Breathe Easy, Walk Easy

KNOWLEDGE

BEWE resources Level 1 evidence for Pulmonary Rehabilitation Guidelines Australia COPD-X & PR

ACTION CYCLE

The Problem - COPD

Indigenous communities:

• High incidence COPD
• High rates hospitalisation
• Limited access to best-practice

management COPD Adapt knowledge to Local Context in 4 Distinct Aboriginal Medical Services Assess Barriers to Implementation:

• Service Delivery Inventory
• Focus Groups

Select Assessment tools Tailor Pulmonary rehabilitation Review Implementation strategy Ongoing mentoring Monitoring of pulmonary rehabilitation sessions Monitor Knowledge retention and use Evaluate:

• Service delivery outcomes
• Patient outcomes
• Patient Experience
• Implementation experience

Sustainability Policy impact Evaluate pre / post workshop: Health worker outcomes:

• Knowledge, confidence, skills

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BE WELL flowchart

Complete Service Questionnaire Recruit Aboriginal Health Workers Start Cert IV Allied Health Assistant BE WELL Workshop Pre/Post Survey

Recruitment & Training & Baseline data collection

3 month follow up support Telehealth Support Recruit patients Support to establish a PR program on site

Develop & support the intervention (PR)

Data collection Economic and hospital admission data Qualitative interviews - all stakeholders

Collect outcome data for patients and services

Telehealth support

• f program

Pre-study

Engage Communities Gain consent Community supports research protocol Ethics approval

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Project to date

 Commenced BE WELL at first site and delivering a second program and adapting to local context  Conducted a BE WELL Awareness Day  Completing a systematic literature review - Global Indigenous Pulmonary Rehabilitation  Reviewing 18 years of NSW COPD hospitalisation data  Identifying three additional NSW Aboriginal Medical Services to implement BE WELL

BE WELL Program Pathway

• 3. Health Worker
• 4. Physiotherapist

GP referral letter to Health Worker

Referral to Physiotherapist

3 4 Clients Patient has a consultation with GP GP/Medical assessment

Suitable for BE WELL ‐ Referral Not suitable for BE WELL ‐ No Referral

New client registration New client assessment Client completes BE WELL 1 2 5 Follow‐up letter to GP BE WELL Program with Physio and Aboriginal Health Workers

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Walk 20 min Lower limb strength 10 mins Upper limb strength 10 mins Warm-up/Cool-down Flexibility and Stretches 5-10 mins Cycle 20 min

BE WELL Exercise Program – Session time ~ 1.5 hours

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– Welcome to Country by local Aboriginal Elder – Community BBQ – BE WELL show bags and T-shirt giveaways: program and lung disease information – Aboriginal community consultation: self reported knowledge of lung disease, service delivery preference, smoking status and spirometry completed – BE WELL exercise program showcased – Potential participants toured the gym and viewed the BE WELL exercise program

BE WELL Aboriginal Community Awareness Day

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BE WELL Community Awareness Day – October 2018

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Reflections

• 1. Huge commitment of Aboriginal Medical Services and

Aboriginal Health Workers to implement a new program

• 2. Aboriginal Medical Services strong commitment, accountability

and leadership with limited pulmonary rehabilitation funding

• 3. Importance of incorporating Aboriginal Health Workers as

leaders in pulmonary rehabilitation service delivery

• 4. Care needed when engaging Aboriginal community and

service partners to ensure real partnership

• 5. Challenge of remote partnerships

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Acknowledgements

– Aboriginal communities and traditional nations implementing the BE WELL program – Aboriginal Medical Services, staff and BE WELL Ambassadors – Poche Centre for Indigenous Health and the Faculty of Health Sciences, University of Sydney, Australia – Lung Foundation Australia – BE WELL Investigators