The University of Sydney Page 1
Implementing evidence into practice to improve chronic
lung disease management in Indigenous Australians
Professor Jennifer Alison&
David MehargProject 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
The University of Sydney Page 2
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 beforeand after BE WELL program
3. AboriginalMedical Service
• Respiratory services available for people with chronic lung disease
• Questionnaire
The University of Sydney Page 7BEWE= Breathe Easy, Walk Easy
KNOWLEDGE
BEWE resources
Level 1 evidence for Pulmonary Rehabilitation
Guidelines AustraliaCOPD-X & PR
ACTION CYCLEThe 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 toolsTailor Pulmonary rehabilitationReview Implementation strategy
Ongoing mentoringMonitoring of pulmonary rehabilitation sessions
Monitor Knowledgeretention and use
Evaluate:• Service delivery outcomes• Patient outcomes• Patient Experience • Implementation experience
SustainabilityPolicy 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 supportTelehealth SupportRecruit patients
Support to establish a PR
program on site
Develop & support the intervention (PR)
Data collectionEconomic and
hospital admission data
Qualitative interviews - all stakeholders
Collect outcome data for patients and servicesTelehealth support
of program
Pre-studyEngage
Communities Gain consentCommunity
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 Worker4. Physiotherapist GP referral letter to Health WorkerReferral to Physiotherapist
34
Clients
Patient has a consultation with GP
GP/Medical assessment
Suitable for BE WELL ‐Referral
Not suitable for BE WELL ‐No Referral
New client registrationNew client assessment
Client completes BE WELL
1 2
5Follow‐up letter to GP
BE WELL Program with
Physio and Aboriginal Health
Workers
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Walk20 min
Lower limb strength10 mins
Upper limb strength10 mins
Warm-up/Cool-downFlexibility and Stretches
5-10 mins
Cycle20 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
The University of Sydney Page 15
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