Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians Breathe Easy Walk Easy Lungs for Life (BE WELL) Professor Jennifer Alison & David Meharg Project Manager & PhD student Faculty of Health Sciences and the Poche Centre for Indigenous Health, University of Sydney CIs: Jennifer Alison, Christine Jenkins, Graeme Maguire, Stephen Jan, Tim Shaw, Sarah Dennis, Zoe McKeough and Vanessa Lee AIs: Kylie Gwynne, Boe Rambaldini, Heather Allen and Debbie McCowen The University of Sydney Page 1
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 The University of Sydney Page 2
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? The University of Sydney Page 3
Study Design Implementation Science The University of Sydney Source: NIH, CTSA model Thanks to Dr Nicole Rankin Page 4
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 The University of Sydney Page 5
Participants What to measure How (Pre and Post BE WELL) 1. Aboriginal Health Workers 2. People with chronic lung disease 3. Aboriginal Medical Service Knowledge and confidence managing COPD Quality of Life Exercise capacity Experience of care COPD hospital admission and cost of care Respiratory services available for people with chronic lung disease Questionnaire Questionnaire 6-minute walk test Yarning circle Compare COPD hospital admissions 12 months before and after BE WELL program Questionnaire The University of Sydney Page 6
Evaluate pre / post workshop: Health worker outcomes: Knowledge, confidence, skills Select Assessment tools Tailor Pulmonary rehabilitation Review Implementation strategy Assess Barriers to Implementation: Service Delivery Inventory Focus Groups KNOWLEDGE Level 1 evidence for Pulmonary Rehabilitation Guidelines Australia COPD-X & PR BEWE resources Ongoing mentoring Monitoring of pulmonary rehabilitation sessions Monitor Knowledge retention and use Evaluate: Service delivery outcomes Patient outcomes Patient Experience Implementation experience Adapt knowledge to Local Context in 4 Distinct Aboriginal Medical Services ACTION CYCLE The Problem - COPD Indigenous communities: High incidence COPD High rates hospitalisation Limited access to best-practice management COPD Sustainability Policy impact The University of Sydney Page 7 BEWE= Breathe Easy, Walk Easy
BE WELL flowchart Engage Communities Complete Service Questionnaire Support to establish a PR program on site Telehealth support of program Gain consent Recruitment & Training & Baseline data collection Recruit Aboriginal Health Workers Recruit patients Start Cert IV Allied Health Assistant Develop & support the intervention (PR) Data collection Pre-study Community supports research protocol Telehealth Support Collect outcome data for patients and services Economic and hospital admission data Ethics approval BE WELL Workshop Pre/Post Survey 3 month follow up support Qualitative interviews - all stakeholders The University of Sydney Page 8
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 The University of Sydney Page 9
BE WELL Program Pathway 1 2 Patient has a consultation with GP Clients 5 Follow up letter to GP GP/Medical assessment New client registration New client assessment 4 BE WELL Program with Physio and Aboriginal Health Workers 3 Client completes BE WELL Suitable for BE WELL Referral Not suitable for BE WELL No Referral 4. Physiotherapist Referral to Physiotherapist 3. Health Worker GP referral letter to Health Worker
BE WELL Exercise Program Session time ~ 1.5 hours Warm-up/Cool-down Flexibility and Stretches 5-10 mins Walk 20 min Upper limb strength 10 mins Lower limb strength 10 mins Cycle 20 min The University of Sydney Page 11
BE WELL Aboriginal Community Awareness Day 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 The University of Sydney Page 12
BE WELL Community Awareness Day October 2018 The University of Sydney Page 13
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 The University of Sydney Page 14
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 The University of Sydney Page 15