Patient-Centred Health Care

In this Issue May 2006

Patient-Centred Health Care

Farewell Frances

Vaccination Reminder

The IPCRG 3rd World Conference

Research Funding Opportunities

Conference Diary 2006

Patient-Centred Health Care

The National Asthma Council Australia convened the Patient-Centred Health Care Workshop in November 2005 to bring together stakeholder groups in chronic disease. The purpose of this workshop was to explore the benefits of patient-centred health care and team management of chronic disease, and how to bring this about in Australia.

The workshop focused on chronic disease in general, and took into account the National Service Improvement Frameworks (NSIF) and Quality Use of Medicines (QUM).

The objectives of the workshop include:

facilitating the shift from a medical model to a patient-centred health care model
shifting the culture of health professionals through enhancing patients’ and carers’ roles
strengthening our effectiveness by working collaboratively on common concerns, advocacy for shared objectives, strategies and resources
identifying the key elements and evidence base of patient-centred healthcare for consumers with chronic disease.

Why Patient-Centred Health Care is important

Dr Ron Tomlins GP, immediate past chairman, National Asthma Council Australia

For every 100 people with a long-term condition in Australia in 2005, only 10 are likely to achieve optimal outcomes!

For every 100 people with a long term condition, only 50% are likely to be diagnosed
(Ausdiab study quoted in Diabetes: Australian facts 2002 AIHW)
For every person with an established diagnosis, only 75% can be engaged into their treatment
(Asthma Partnerships Harris and Shearer, J Asthma 2001)
For every person who is engaged, only 50% are likely to receive guidelines-based treatment
(Ausdiab study, Kemp et al, Diabetes Care 2005)
For every person prescribed long-term medication, only 50% are still taking it after six months
(Simons et al, BMJ 2000).

Over the last 15 years, the focus of our strategies has been on service providers and practice systems and most of the policy initiatives have concentrated on guidelines, service delivery and adherence.

But we know that best practice guidelines do not always reflect real-life situations.

At a professional level, there is reluctance to accept that patients and carers make their own decisions about their health and their health care, and there is reluctance to accept that these decisions may not align with the doctor’s view of what is best for the patient.

We wonder about the place of complementary medicines. For some traditional cultures complementary medicines and traditional practitioners have great influence. Do we take a patient’s cultural values into account when planning their health care?

There is a Canute-like approach to the availability of information on the Internet. The Internet is a major source of information, yet we have given little consideration to how patients access information and the strengths of those information sources to patients. In many cases, the Internet may provide better information than a doctor or health educator. We have been slow to appreciate the changes in our society in relation to the availability of health information and the shift in the balance of decision-making.

Patient-centred or person-centred health care demands that, along with their medical needs, we consider the person with the long-term condition in the wider context of those other aspects which influence health care - their beliefs and attitudes, their ethnocultural context and their socioeconomic circumstances.

This workshop is a first step in that direction.

From Patient-Centred Health Care Workshop November 2005 - Report of Proceedings

The final report of proceedings from the Patient-Centred Health Care Workshop is now available.

Patient-Centred Health Care Workshop November 2005 - Report of Proceedings (662KB PDF File)

Participants in the workshop included Martyn R Partridge, Professor of Respiratory Medicine, Respiratory Health Services Research Group, National Heart and Lung Institute at Charing Cross, London. Professor Partridge's presentation "Medicine is changing – have services changed to match?" was delivered via videoconference from London, and is available for viewing online.

Professor Martin R Partridge: "Medicine is changing – have services changed to match?"

Farewell Frances

Ms Frances Pardo and Assoc Prof John Wilson Mr Peter Holder (left), Ms Kristine Whorlow, Ms Frances Pardo and Assoc Prof John Wilson The National Asthma Council farewelled Office Manager Ms Frances Pardo this month following her decision to accept a new work challenge.

Frances spent fifteen years with the NAC, playing a pivotal role in the smooth working of the NAC's small, dynamic administrative team.

With her renowned ability to multitask, Frances certainly has had an impact on every aspect of the NAC's activities. When searching for the definition of "work ethic'' no one need look further than Frances.

For those of us who have had the opportunity and good fortune to work with Frances, it has been most rewarding as she challenges everyone to do their very best for the job at hand.

A farewell dinner for Frances was held on May 12 in Melbourne hosted by the Chief Executive Officer, Ms Kristine Whorlow and the Chairman of the NAC, Associate Professor John Wilson.

For her colleagues it was an excellent opportunity to share the high opinions we hold of Frances and to express our mixed emotions about the joy we have gained from working with her and the sadness about her departure from the NAC.

Vaccination Reminder

Pneumococcal vaccination

The National Asthma Council Australia has recently updated its popular resource materials on the role of influenza and pneumococcal vaccinations for people with asthma, COPD, heart disease and diabetes to reflect the findings from a new study published in the New England Journal of Medicine.

The nested case control study, ‘Asthma as a Risk Factor for Invasive Pneumococcal Disease’¹, found that asthma is an independent risk factor for invasive pneumococcal disease and the risk among people with asthma was at least double that among controls. The authors concluded: “These data suggest that pneumococcal vaccination of persons with asthma maybe a worthwhile strategy to reduce the incidence of invasive pneumococcal disease in this at-risk group.”

The NAC has updated both its health professional information paper and consumer brochure accordingly. Both documents provide a definitive overview of the current Australian immunisation guidelines for each of the four chronic conditions, including information on who should be immunised and who shouldn’t, backed up by the latest research, including current Cochrane reviews.

Influenza and adult pneumococcal vaccines are also available on the PBS for people at high risk, including people with chronic respiratory diseases, diabetes and cardiovascular disease.

Annual 'flu vaccination

GPs, health professionals and those working with people aged over 65 years or with some chronic (long-term) medical conditions really do need to make sure that they have an influenza vaccination each year. When it comes to looking after their own health GPs do not appear to have a very good record and they often fail to follow current preventive health guidelines for their physical health.²

The case shown here concerns very unfortunate circumstances leading to the death of ten nursing home residents. Hopefully it is a salutary lesson to us all.

Case Study

Influenza outbreak at a Newcastle nursing home¹

It has been reported that an influenza outbreak killed 10 people (over one-fifth of the residents) at a Newcastle nursing home in September 2004. The NSW facility was closed to new residents and placed under quarantine when the outbreak was notified. Many of the residents were potentially vulnerable to influenza as the nursing home staff were unsure as to whether the patients had been vaccinated against influenza earlier that year.

Normally the nursing home would vaccinate all residents at the beginning of winter, but the Newcastle facility was newly opened and had admitted residents from many other facilities and elsewhere, therefore staff were unsure who had been vaccinated and who hadn’t.

Problems in caring for those affected by influenza were compounded as many of the nursing home staff also developed influenza. Only 10 of the 59 staff were known to have been vaccinated that year.² This is believed to have contributed to the ready spread of the infection within the nursing home.

The outbreak was not limited to one nursing home. Five nursing homes in the area closed their doors to new admissions and eight residents died at a neighbouring nursing home.³

Influenza vaccination is not currently compulsory for staff or residents of Australian nursing homes and hostels, although it is recommended.

Influenza can spread very quickly among those living in close proximity, where it can cause severe disease and is more likely to be fatal in the old and frail.

References

1. Pirani C, Tobler H. Nursing home flu outbreak kills 10. The Australian: 15 September 2004

2. Hunter Population Health. Data on file. 2004

3. Pollard R. Toll rises in flu outbreak. The Sydney Morning Herald: 5 October 2004

References

1. Talbot TR, Hartert TV, Mitchel E, Halasa NB, Arbogast PG, Poehling KA, Schaffner W, Craig AS, Griffin MR (2005) Asthma as a Risk Factor for Invasive Pneumococcal Disease. The New England Journal of Medicine 352:20

2. Kay MP, Mitchell GK, Del Mar CB. Doctors do not adequately look after their own physical health. Med J Aust 2004; 181: 368-370

Resources

Vaccine Update for people with asthma, COPD, or diabetes (for Consumers)

Roles of influenza and pneumococcal vaccinations in subgroups with asthma, COPD, diabetes or heart disease (for Health Professionals)

The IPCRG 3rd World Conference

The International Primary Care Respiratory Group 3rd World Conference will take place in Oslo, Norway, 8-11 June 2006. The conference theme is “Respiratory Disease in Primary Care – Quality of Care”, and will cover all facets of respiratory health including asthma, allergy, chronic lung disease, tuberculosis, pneumonia, infectious diseases and cough.

The conference is for all primary care health professionals with an interest in respiratory health and registrations to attend the conference in Oslo are still open (go to theipcrg.org/oslo2006) .

Just over two years have passed since the National Asthma Council hosted the IPCRG 2nd World Conference, The Way Forward in Melbourne. The conference provided a lively exchange of ideas and experience from around the world and from a wide range of areas within respiratory care.

Australian health professionals wanting to stay in the loop but unable to attend the Oslo conference can still get all the latest news, thanks to a new service that will be provided by the NAC. Ms Kathy Hope, NAC project manager, is attending the conference and will report on proceedings.

A special ‘highlights’ review will be prepared by Kathy and emailed to interested parties soon after the event.

For those local practitioners who participated in the Melbourne event and cannot take time away from their practice, the special ‘highlights’ review will be a great way to keep in touch with the Oslo conference.

To receive a copy of the highlights’ review simply register by following the link
Register for the NAC’s IPCRG Oslo Report

Research Funding Opportunities

The National Asthma Council would be pleased to list funding opportunities that may be available for asthma research. Submit brief details for consideration by email to editor@nationalasthma.com.au.

Conference Diary 2006

Submit brief conference/meeting details to the National Asthma Council for possible posting in our Conference Diary by email to editor@nationalasthma.com.au.

	IPCRG 3rd World Conference "Respiratory Disease in Primary Care – Quality of care" 8-11 June, 2006 Radisson SAS Plaza Hotel, Oslo, Norway. theipcrg.org/oslo2006 (http://www.theipcrg.org/oslo2006/)
	European Respiratory Society Annual Congress Sept 2-6, 2006 The International Congress Centre Munich Munich, Germany ERS Annual Congress (http://www.ersnet.org/ers/default.aspx?id=2112)
	17th ASCIA Annual Scientific Meeting Manly Beach, Sydney, Australia 7-10 September, 2006 ASCIA (http://www.allergy.org.au/)
	RACGP 49th Annual Scientific Convention Brisbane Convention and Exhibition Centre 5-8 October, 2006 Be the Future (http://www.racgp.org.au/asc2006/index.asp)
	PAC2006 Pharmaceutical Society of Australia Cairns Convention Centre 6-8 October, 2006 PAC2006 (http://www.astmanagement.com.au/PAC6/Default.htm
	2006 Australian Asthma Conference ‘Every Breath Matters’ Adelaide Convention Centre, South Australia 22-25 October, 2006 AAC 2006 (http://www.aomevents.com/conferences/AAC/)
	General Practitioner Conference & Exhibition 17-19 November 2006 Melbourne Exhibition Centre GPCE 2006 (http://www.gpce.com.au/melbourne/)
	ACRRM 4th Scientific Forum University of Adelaide 16-19 November, 2006 ACRRM (http://www.acrrm.org.au)