Community Physiotherapy 20012015 - Student Copy - Handout Format

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Community physiotherapy + working in teams

OPPORTUNITIES FOR PHYSIOTHERAPISTS

Loretta Andersen

http://www.forbes.com/sites/theyec/2012/12/12/can-working-in-teams-build-your-intelligence/

Explore………

• Thinking about where CDM is best delivered…

• Who are CDM team members….

• What role does physiotherapy have in CDM….

• What opportunities exist for physiotherapists

working in CDM teams ……

Example…Osteoarthritis chronic Care Program (OACCP)

Learning Outcomes

2. Justify the role of PT in the prevention +/or management of chronic illness or disease

3. Critically reflect on the contributions of an �interdisciplinary team

4. Research + determine a client-centred approach in the design of a physiotherapy management plan for the management of CD

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Explore………

Thinking about where CDM is best delivered…

QUIZ ACUTE HEALTH CARE CHRONIC HEALTH CARE

Specialist care

PATIENT & Carers

emotional

CVD

MSK

Chronic Care

Primary Care

Diabetes

Respiratory

cancer

functional

Adhere to treatment

Manage impact

Physical Activity Weight control

Monitor

Self management

Education

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Level 1

High complexity

Level 2

High Risk

Disease management

Level 3

Self-management

70-80%

Levels of

health care in

CD

Where can CDM be provided…

• GP surgeries

• Homes

• Workplaces

• Schools / Playgrounds

• Social + Sport clubs + Youth Centres

• Outpatient clinics

• Specialist program venues

• Hospitals

OPPORTUNITIES

CHALLENGE EXISTING PHILOSOPHIES of PRACTICE + DELIVERY

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Explore………

Who are CDM team members….

Individual with Chronic Disease

diabetes

Medical Nursing Dietician Occupat. Th

Physio Ex. Phys.

Psych Social W.

cardiac

CVD

arthritis

MSK respiratory cancer

cognitive/

emotional

Ms. “M” • 54 year old lady, advanced hip OA, smoker

• Married with 2 x children: Ages 8 and 14 (asperger’s)

• Husband. Works FT. Ms.� “M” reports little empathy

• Carer for in-laws both with dementia (live in own home + declining provided package of care)

• Works part time as cook in ACF

• Awaits left total hip replacement. Requires crutches x 2 to ambulate secondary to extreme pain

• Difficulties driving due to pain

• MHx: HT, tingling in both feet past 3/12 + 1 x recent fall, recent weight gain 5kg.

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Who might you want /need on your

team and why……..

OPPORTUNITIES

CHALLENGE EXISTING PHILOSOPHIES of PRACTICE + DELIVERY

BROADEN + BUILD TIES WITH TEAMS COMMUNITY SUPPORT + PROVIDERS

Explore………

What role does physiotherapy have in CDM….

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Ms. “M” • 54 year old lady, advanced hip OA, smoker

• Married with 2 x children: Ages 8 and 14 (asperger’s)

• Husband. Works FT. Miss “M” reports little empathy

• Carer for in-laws both with dementia (live in own home + declining provided package of care)

• Works part time as cook in ACF

• Awaits left total hip replacement. Requires crutches x 2 to ambulate secondary to extreme pain

• Difficulties driving due to pain

• MHx: HT, tingling in both feet past 3/12 + 1 x recent fall, recent weight gain 5kg.

What questions need to be clarified�?

• Medical History, meds + CD Manage’t� plans

• Social situation + responsibilities

• Function + Mobility + exercise/ activity levels

• Support networks (services)

• Emotional wellbeing / support/ needs

• Priorities / goals

• Values/ beliefs/ barriers/ facilitators

Physiotherapy roles……

• broad based ‘needs’ assessment / screening

• treatment / advice (professional boundaries)

• Referral / interdisciplinary approaches

• Build personal capacity

• health-coaching (goal setting)

• harm-minimisation

• health promotion

• Assisted navigation service delivery systems

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Where can I get more information?

OPPORTUNITIES

CHALLENGE EXISTING PHILOSOPHIES of PRACTICE + DELIVERY

BROADEN + BUILD TIES WITH TEAM COMMUNITY SUPPORT + PROVIDERS

EXTEND TRADITIONAL ASSESSMENT + TREATMENT ROLES, SKILLS +

KNOWLEDGE

Explore………

• Where CDM is best deliverer ✓

• Who are CDM team members ✓

• What role does physiotherapy have in CDM ✓

• What opportunities exist for physiotherapists

working in CDM teams ✓

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Tsunami of chronic disease

By 2020 ¾ of all deaths will be from chronic disease

WHO

78% with arthritis report having at least one other chronic disease

http://www.aci.health.nsw.gov.au/models-of-care/osteoarthritis-chronic-care-program

Managing Arthritis with the

OSTEOARTHRITIS CHRONIC

CARE PROGRAM

Background

Unsustainable increase in personal, societal + health care costs (ageing, obesity and injury)

Increasing burden

( OA leading cause of disability among older Australians)

International/National/State = ACTION

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EVIDENCE: Zhang et al 2010, OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009, Osteoarthritis and Cartilage, vol, 18, no. 4, pp. 476-499. Hochberb et al , 2012, American college of Rheumatology 2012 recommendations for the use of Non- pharmacologic and Pharmacologic Therapies in Osteoarthritis of the hand, Hip and Knee, Arthritis care & Research, vol. 64, no. 4, pp. 465-474. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis, 2013, Ann Rheum Dis, vol. 72, pp. 1125-1135

• Exercise (aerobic + resistance): land or water

• Injury avoidance �

• Weight control

• Pharmacologic treatment

• Timely access to surgery

• �Psychosocial

safe and cost effective TREATMENT

Osteoarthritis chronic care program OACCP

• Point of access

• Conversation

• Interdisciplinary

• Co-ordinated

• Conservative

• Responsive

OACCP aims:

• Manage symptoms

• Optimise function / QOL

• Limitation disease progression

• Screen/ Identify co-morbidity risk

• Maximise self-management

• Dispel myths about OA

• Effective health care utilisation

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Target areas

• Arthritis education

• Healthy weight control

• Physical exercise/activity

• Harm minimisation

• Co-morbidity risk identification/management

• Emotional well-being

• Pharmacologic control

Level 1

High complexity

Level 2

High Risk

Disease management

Level 3

Self-management

70-80%

Levels of

health care in

CD

Builds personal capacity by:

• building confidence

• increasing knowledge

• identify needs + preferences

• translates needs + preferences into realistic and relevant goals

• Supports navigation and access to systems + resources

• Raising self-efficacy

Chronic Disease Management:

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PHILOSOPHY

• Access to safe, effective and timely care

• Participants are expert – opportunity

• Health practitioners are facilitators

advise support guide

• Self-management is key

“you have + are the solution”

• Window of opportunity

What CAN I do ??

Unalterable

• Age

• Gender

• Race

• Genetics

Modifiable

• Body Weight

• Diet

• Muscle Weakness

• Injury

• Mechanical load

• Control of other chronic disease

Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

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Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

Medication

Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

Walking aids

Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline: Healthy Eating / Weight Control

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Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

Negative Emotions

Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

Exercise

Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Other Conditions

Timeline:

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Family Doctor

Surgery Surgeon = Ortho waiting list for joint replacement

Timeline:

Medication Exercise

Walking aids

Healthy Eating / Weight Control

Negative Emotions Other Conditions

Learning

CHALLENGE EXISTING PHILOSOPHIES

of PRACTICE + DELIVERY

Shared decision-making

Building personal capacity

Thinking outside the “box”

Work in “teams of partnership”

EXTEND TRADITIONAL ASSESSMENT + TREATMENT

ROLES, SKILLS + KNOWLEDGE

Broad based needs based assessment

Dual ‘expert role’

Goal orientated evidence based treatment

Recognition of professional boundaries + limits

Communication quality and content

Explore wide + varied learning opportunities

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BROADEN + BUILD TIES WITH TEAM COMMUNITY SUPPORT +

PROVIDERS

Identify and nurture key partnerships

Refer appropriately + timely

Think more broadly than ‘health’ for partnerships

Be familiar with support networks + local champions

Advocate

Learning Outcomes

2. Justify the role of PT in the prevention +/or management of chronic illness or disease ✓

3. Critically reflect on the contributions of a interdisciplinary team ✓

4. Research a client-centred approach in the design of a physiotherapy management plan for the management of CD ✓

The bottom line…

Not rocket science

Complex + Challenging

Dual ‘expert’ role

Extend self as practitioner

Highly Rewarding

Community based: anywhere and anytime

Wont have all the answers

Building personal capacity

Foster partnerships of care

Have fun

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References: 1. Australian government: Department of Health and Ageing, National Physical

Activity Guidelines, accessed September 10th 2011,

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-

pubhlth-strateg-phys-act-guidelines#rec older

2. Depression Anxiety Stress Scale (DASS (21)

viewed: 26th January 2013

http://www2.psy.unsw.edu.au/groups/dass//

3. Euro Quality of life (EQ-5D-5L)

viewed 26th January 2013

http://www.euroquol.org/

4. Hip and Knee disability and osteoarthritis outcome score (HOOS)

viewed 26th January 2013

http://koos.nu/index.html

5. Levels in healthcare

viewed 26th January 2013

http://www.health.gov.au/internet/main/publishing.nsf/content/7E7E9140A3D3A3BCCA257140007AB32B/$File/stratal3.pdf

6. National Health Priority Action Council (NHPAC) 2006, National Chronic Disease Strategy

viewed 15th March 2010,

http://www.health.gov.au/internet/main/publishing.nsf/Content/7E7E9140A3D3A3BCCA257140007AB32B/$File/stratal3.pdf

.

References:

7. NSW Chronic Care Program: rehabilitation for chronic disease volume 1.& 2, (2006), NSW Department of Health: North Sydney

8. Osteoarthritis Chronic care Program

Viewed 17th September 2012

http://www.aci.health.nsw.gov.au/models-of-care/osteoarthritis-chronic-care-program

9. Taylor, Foster & Fleming, 2008, Health care Practice in Australia, Oxford University Press, Oxford, UK

10. The Dreaded Stairs

Viewed 26th January 2013,

http://www.youtube.com/watch?v=Qx_8gxh76iM

11. Zhang, W, Moskowitz, R, Nuki, G, Abramson, S, Altman, R, Arden, N, Bierma-Zeinstra, S, Brandt, K,Croft, P, Doherty, M, Dougados, M, Hochberg, M, Hunter, D, Kwoh, K, Lohmander, S & Tugwell, P 2008, ‘OARSI recommendations for the management of hip and knee osteoarthritis, Part 2: OARSI evidence-based, expert consensus guidelines, ‘ Osteoarthritis and Cartilage, vol. 16, pp. 137-162

12. Zhang, W., Nuki, G., Moskowitz, r.W., Abramson, S., Altman, r.D., Arden, N.k., Bierma-Zeinstra, S., Brandt, k.D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D.J., kwoh, k., Lohmander, L.S. and Tugwell, P. (2010), OArSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and Cartilage. 18(4):

p. 476-499

Screening tools:

1. DASS(21)

2. Mini mental state examination (MMSE)

3. Timed up and Go (TUG)

4. Mini nutritional Assessment (MNA)

5. Opioid risk tool (ORT)