This panel discussion was recorded and originally published by Medical Director, here.
Panellists
Professor Rosemary Calder, Professor of Health Policy, Mitchell Institute Victoria University
Emma Lonsdale, Executive Officer, Australian Chronic Disease Prevention Alliance
Jane Calligeros, Registered Nurse and CEO, CDM Plus
Natalie Raffoul, Cardiovascular Risk Reduction Manager, Heart Foundation
Harry Iles-Mann, Health Consumer Co-design and Engagement Consultant
Key insights
The latest figures show that almost one in two Australians are living with a chronic condition in Australia. And when you factor in family, friends and carers, there’s very few Australians who are not affected by chronic disease.
“It’s an enormous burden and has a huge impact on Australians,” says Emma Lonsdale, Executive Officer of the Australian Chronic Disease Prevention Alliance.
Worryingly, the number of cases of chronic disease is on the rise. Emma points to two main reasons for this increase: our ageing population means people are living longer with chronic conditions, and an increase in modifiable risk factors like obesity.
By changing these risk factors, Emma reasoned, we could significantly reduce the impact of chronic disease. “If everyone in Australia was a healthy weight, we could reduce diabetes burden by over 50% and chronic kidney disease burden by 38%.”
Early detection is one of the most important tools in the fight against chronic disease, but there are significant barriers – most notably a system that is not set up to support prevention, Emma points out.
“Our MBS items don’t always align with the guideline recommendations. For example, chronic kidney disease is one of those conditions where you can lose 90% of kidney function before you show symptoms. GPs don’t always have the resources to be able to detect those conditions early enough.”
A national framework for prevention
Having a focused and systematic way of dealing with prevention at a national scale is something that the panel agreed should be a top priority in Australia.
However, this model of prevention needs to be properly resourced according to Professor Rosemary Calder, Professor of Health Policy at the Mitchell Institute Victoria University.
“GPs are set up to respond to illness, not to prevent illness, or to address risk factors for preventable disease. We need to help shift the model.” She points out that the burden of change can’t rest on the shoulders of GPs alone.
“We’re expecting general practitioners, who are largely small businesses, to also manage a business process that changes the way in which they function and practice. All this requires a policy framework that helps drive prevention and early intervention into the system. We can’t expect GPs to be the ones to make it happen.”
Balancing self-management and intervention
Health Consumer Co-design and Engagement Consultant, Harry Iles-Mann agrees that GPs shoulder a significant burden and should be recognised for this.
“GPs are considered the gatekeepers to the health system and that’s an enormous weight to carry. Unfortunately, the public, the government, and the people that resource general practice and primary care, don’t afford it the same gravitas of resourcing as the expectation that they’re attaching to it.”
As a patient who has lived with multiple chronic issues for more than two decades, Harry urged patients to take a more active role in managing their conditions.
“One of the most powerful mechanisms that I’ve found I can use in managing my chronic health issues is what I do on my end.”
Harry has crunched the numbers and found that of the 8760 hours in every year, 99% of that is spent self-managing his condition.
“Less than 1% of my time is spent with a specialist, a general practitioner, an allied health professional, or in an environment that you would consider traditionally hospital or health-based.”
He believes one of the unfortunate perceptions amongst the public is that it is an ‘all or nothing’ approach when it comes to managing chronic conditions.
“Patients feel either the solution is purely medical and comes from a point of professional medical authority, or they don’t want any involvement and they resign themselves to changing nothing about their lifestyle. The sweet spot is recognizing that there are unfortunately factors that you can’t control and accepting those.
Harry is pushing for a renewed approach to finding a better balance in the way we administer health care for chronic conditions.
“I think that general practice in combination with home care and self-management, is going to play a really key role in that in the future.”
Wearables helpful, but not without GP input
Natalie Raffoul, Cardiovascular Risk Reduction Manager at the Heart Foundation, says building awareness around prevention is an ongoing challenge.
“Most people are not even thinking about preventing their chronic disease, they’re just not engaged with their health until something happens. And so one of our biggest challenges is to get them to even think about how diabetes, cardiovascular disease, and chronic kidney disease could be relevant to them.”
She suggests wearable technology such as heart monitors, fitness trackers and health apps could be one solution, helping to bring greater awareness, improve health literacy and engage people in their health.
“We’ve seen an exponential increase in fitness, wellness and health-related apps. But I think the jury is still out as to whether or not these wearables can effectively screen, particularly compared to the tools we have available at our fingertips in a medical setting.”
“There’s no doubt that the advent of these wearables means there’s more information. The challenge will be how we use that information,” she warns.
Emma Lonsdale agrees that wearables are a step in the right direction when it comes to empowering patients, but it’s important to use them in conjunction with health professionals.
“They might pay a bit more attention to their heart rate and it might be an incentive to go to their GP. But there are lots of health apps out there and they’re not all regulated, so it’s really important that people feel comfortable to work with their GP using these apps,” she says.
Technology can help ease the burden, but nail the basics first
Jane Calligeros Registered Nurse and CEO of CDM Plus says technology can help GPs manage the influx of chronic conditions, but many are turned off by the complexity of change.
“The barriers that we see all the time in clinics that we work with are issues around the software they’re using. There’s often no set systems or processes for chronic disease management.”
“There’s so many challenges that we face to get the chronic disease management even up and running. And the problem is, it’s a long time solution that we’re looking for. But a lot of clinics get frustrated and it just falls over and they give up. It’s just too hard,” she notes.
Jane advises practices to get “back to basics” when it comes to using technology to manage chronic conditions. She says ensuring people know how to use the underlying software first is key.
“I find a lot of the issues when we’re doing training is if you go to add a new system or process on top of what you assume they’re already doing, it’s just setting them up to fail because they haven’t got the basics right.”
“The best place to start is to recognize what you do well in your clinic and to recognize where you could improve in a couple of the areas. Changing processes and adoption of new systems takes time, don’t rush it,” she concludes.