Overview
The Queensland Strategy for Chronic Disease 2005 -2015 is being progressed in partnership with the Queensland Government and key partners. This statewide strategy aims to engage all stakeholders involved in the prevention, intervention and management of chronic diseases at a system, service and individual level across the continuum of care. It identifies evidence based approaches to prevent or reduce behavioural and lifestyle risk factors, and support better care for people with chronic disease and their carers/families. The strategy aims to address barriers to quality chronic disease care, address the current pressure on the acute hospital system by reducing avoidable hospitalisations, and identify more systematic and sustainable approaches to the prevention and management of chronic disease across Queensland.
Four Chronic Disease Coordinator positions (the Chronic Disease Team) have been established within General Practice Queensland to support the implementation of the Chronic Disease Strategy across the general practice network and the nursing and domiciliary services. Two of the four positions are auspiced on behalf of the Combined Health Agency Group (CHAG) – the state level alliance of the nursing and domiciliary services comprising OzCare, Blue Care, Spiritus and RSL Care.
Through these four positions, General Practice Queensland and CHAG engage with the Queensland Aboriginal and Islander Health Council (QAIHC) and the Ethnic Communities Council Queensland (ECCQ) as a collaborative Non-Government Chronic Disease Leadership Team (NGCDLT).
Vision Statement:
“To provide leadership and support that facilitates sustainable evidence based chronic disease prevention and management.”
Objectives
The Chronic Disease Team will work with the Divisional network and CHAG to:
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Support the adoption of evidenced-based best practice models and strategies to improve health outcomes;
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Scope, identify and embed capacity building strategies within and across the NGO sector to develop sustainability of partnerships, skills, knowledge and approaches to chronic disease;
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Leverage opportunities to increase funding and collaboration with existing services to facilitate innovative approaches to chronic disease prevention and management;
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Provide state-wide coordination, support and advice to the Divisions of General Practice and CHAG agencies regarding chronic disease partnerships opportunities and activities and;
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Create sustained improvement in health care through leadership and innovation.
Program Detail
General Practice Queensland Chronic Disease Coordinators
Jann Offer, Katie Griffin, Phillipa Grant and Sabrina Ostowari are responsible for the implementation of the Queensland Strategy for Chronic Disease 2005-2015 across both the Divisions of General Practice and the Community Services sector, in conjunction with other key government and non-government partners. Blue Care, RSL Care, Ozcare and Spiritus are our key partners in the Community Services sector.
Jann Offer
Senior Program Leader - Chronic Disease
Jann is the Senior Program Leader - Chronic Disease. Before coming to General Practice Queensland (GPQ), Jann was a Regional Care Manager at Blue Care with responsibility for the management of a diverse range of residential and community programs including allied health, domiciliary nursing and respite. With the team at General Practice Queensland, Jann will continue her engagement with the community health sector, working in partnership with the Divisions, to collaboratively address the proactive prevention and management of Chronic Disease.
Katie Griffin
Program Coordinator - Chronic Disease
Katie recently joined General Practice Queensland as a Program Coordinator - Chronic Disease. Prior to joining General Practice Queensland, Katie worked for Queensland Health as an RMO in Emergency. She also previously worked as an Occupational Therapist in both the hospital and community environments. Katie’s role will utilise her knowledge of the interface between the acute and primary care settings, particularly in relation to diabetes.
Phillipa Grant
Program Coordinator - Chronic Disease
Phillipa recently joined General Practice Queensland as a Program Coordinator - Chronic Disease. Prior to joining General Practice Queensland, Phillipa worked for Blue Care in clinical, management and project roles with a primary focus in the support and development of allied health sector initiatives. Phillipa’s role has a primary focus on working in partnership with the Divisions to provide leadership, advice and support in the promotion and implementation of a self management approach to chronic disease.
Sabrina Ostowari
Program Coordinator - Chronic Disease
Sabrina is a Program Coordinator – Chronic Disease. Previously employed with General Practice Queensland as Program Coordinator for Population Health, Sabrina worked across a range of program areas including Lifescripts, pandemic planning and immunisation. Prior to joining General Practice Queensland in June 2006, Sabrina worked with both The Cancer Council Queensland and Cancer Institute NSW in the development, implementation and evaluation of state-wide cancer control initiatives and programs specifically in the area of smoking cessation, skin, bowel and breast cancer. Sabrina’s primary role includes the state-wide coordination of the Capacity for Local Partnerships Initiative and leadership, advice and support for primary and secondary prevention initiatives (e.g. Lifescripts).
For more information, contact the GPQ Chronic Disease Team on 07 3105 8300.
The Chronic Disease team has established a broad but flexible approach to guide development and implementation of initiatives, facilitate partnership opportunities and create a platform to build capacity. Seven priority areas have been identified as an initial key focus:
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Development and Support for Divisions and CHAG agencies
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Partnerships with Key Stakeholders
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Research and Innovation
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Primary Prevention
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Secondary Prevention
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Self Management
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Quality Improvement / Evaluation
Specific and targeted strategies consistent with the objectives will occur under these broad priority areas.
Benefits for the Divisions Network and Key Stakeholders
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Marketing and Communication
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Dedicated web pages for chronic disease resources, updates, and contacts on the General Practice Queensland website;
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Profiling and sharing information in relation to chronic disease prevention and management;
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Providing opportunities to establish relationships, showcase programs and learn from case-studies; and
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Utilising updates and other mechanisms to promote the work of the Divisions Network.
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Knowledge Translation
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Identifying strategies and support mechanisms for Divisions and CHAG to implement evidenced-based models;
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Providing access to academic research skills and expertise on chronic disease and complex health conditions; and
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Publicising case studies and evidence-based best practice for chronic disease in the primary health care sector.
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Capacity Building
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Building evaluation skills within the Queensland Divisions Network;
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Providing access and support for training opportunities, seminars and workshops in relation to chronic disease e.g. self management, primary prevention, capacity building, skills development; and
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Developing resources, tools and templates to support program implementation and capacity building.
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Achievements
January 08 – June 08
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Launch of statewide workshop for Divisional Chronic Disease Program staff (18 Divisions). The workshop held in May 2008, was attended by Divisional Staff and other key stakeholders from across the State.
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The Type 2 Diabetes Standard Care Pathway tool was promoted at the workshop and opportunities for integration at the local level were identified.
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Feedback was provided to program staff managing Diabetes projects for the Capacity for Local Partnerships Initiative. Opportunities for integrating these projects with the CHIC initiative were discussed.
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Queensland Self Management Alliance (QSMA): GPQ has continued to work as a member of the Queensland Self Management Alliance (QSMA) and in collaboration with CHAG, QLD Health, ECCQ, and QAIHC to support the translation of self management knowledge into practice. See Self Management for information on activities and achievements.
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Funding application to the Department of Health and Aging approved to be an active member of the Australian General Practice Network (AGPN) and State Based Organisations (SBO’s) Chronic Disease Self-Management Support Network. See Self Management for further information.
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Statewide Chronic Disease Mapping and Consultation commenced to develop a profile of chronic disease activities and systems that are currently in place across the Division Network and CHAG agencies. Information collated is being analysed in order to identify gaps and areas of need for targeted funding and resources across the primary health care sector to inform future investments and evidence-based strategic decision making in chronic disease prevention and management. See Chronic Disease Mapping and Consultation for further details.
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Research has been completed in each of the identified key priority areas. This has culminated in the development of research papers detailing the recommendations for practice enhancement. A number of briefs summarising the key findings have been prepared to assist dissemination of the information and can be located on the Collaborative Research Hub webpage. The research papers will be submitted for publication in relevant journals.
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Queensland Divisions Forum – The inaugural Statewide CHIC Forum was held in conjunction with the QLD Divisions Forum in February. This Forum:
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showcased the progress of Partnership Councils
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provided knowledge of the range of initiatives funded through CHIC
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introduced the statewide evaluation of CHIC
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provided networking opportunities
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enabled specific professional development through capacity building sessions
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Evaluation of the Capacity for Local Partnerships Initiative (CLPI) has been undertaken and provided feedback in relation to the effectiveness of the strategy in relation to the development of partnerships and the realisation of program objectives. Further information has been gathered to identify measures that will enhance the sustainability of the projects developed under this initiative. See Capacity for Local Partnerships for further information.
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Maintained regular meetings with the Non-Government Leadership Team, linking with the Queensland Health Chronic Disease Coordinators and more recently with the Chronic Disease Implementation Team. GPQ shared resources with all Coordinators to enable a consistent approach to undertaking an environmental scan. E.g. Tools developed for the Chronic Disease mapping activities.
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Inform evaluation processes of the Queensland Strategy for Chronic Disease 2005 -2015 via ongoing representation to the Chronic Disease Evaluation Strategy
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Implementation of the communication plan including:
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Regular chronic disease updates to Divisions, CHAG agencies and key stakeholders.
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Access to ‘Fact Sheets’ which can be downloaded from the Chronic Disease page of the GPQ website. The fact sheets allow sharing of key information, resources and initiatives that support Divisions to promote and support chronic disease prevention and management strategies to members.
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A regularly updated webpage linking you to the latest information, evidence, education, training, funding opportunities, resources, tools and partnership opportunities as they become available.
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July 2007 – December 2007
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A strategy planning and consultation workshop was held with representatives of the Combined Health Agencies Group (CHAG) agencies on 19th September 2007.
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General Practice Queensland October Divisional Forum showcased a number of chronic disease initiatives (including the CLPI projects) that are managed by Divisions.
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A range of key documents have been developed to support the non government implementation of the Chronic Disease Strategy. These include:
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Annual Workplan 2007-2008 for the General Practice Queensland Chronic Disease Program. A diverse number of strategies have been identified under each of the following priority areas:
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Development and Support for Divisions and CHAG agencies
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Self Management
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Quality Improvement/ Evaluation
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Partnerships with key stakeholders
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Primary Prevention
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Secondary Prevention
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Research and Innovation
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Communication plan
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An overarching strategic brief for the Chronic Disease Program
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A business case was lodged and approved by Queensland Health for 2 specific projects which will support the implementation of the Queensland Chronic Disease Strategy.
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A research and scoping exercise to identify and develop resources outlining evidence based strategies and models of care.
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Development of tool kit and resources to support the implementation and uptake of the Queensland Health Diabetes Standard Care Pathway for Type 2 Diabetes in the general practice and community health sector.
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A research partnership has been established between General Practice Queensland and Griffith University to support the uptake of evidence based practice in chronic disease management within the general practice and community health sector. Priorities identified for collaborative research projects include:
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Understanding the enablers and barriers to the uptake and use of clinical pathways for COPD, heart failure, diabetes and renal disease.
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Understanding the enablers and barriers to the uptake and use of the Queensland Health Diabetes Standard Care Pathway in General Practice.
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Defining coordinated care/service coordination and investigating frameworks and models to support implementation across a continuum of care.
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The identification of strategies and/or resources to support the uptake of Self Management Principles in Primary Health Care settings.
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Identification of the predictors of Hospital Avoidance models.
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Examining the effectiveness of the Partnership Self Assessment Tool (developed under the Capacity for Local Partnerships Initiative) as a resource to support partnership and sustainability.
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See Chronic Disease Research for further information on the research projects undertaken
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General Practice Queensland received additional funding from Queensland Health to establish an independent website for the Connecting Healthcare in Communities (CHIC) Initiative.
Resources
- National Chronic Disease Strategy
- The Health of Queenslanders 2006
- AHIW Australia’s Health 2008
- Health Determinants Queensland 2004
- RACGP SNAP Guidelines: a population health guide to behavioural risk factors in general practice
- RACGP Guidelines for Preventative Activities in General Practice – The Red Book
- RACGP Putting Prevention into Practice – The Green Book
Links
Queensland Strategy for Chronic Disease 2005-2015
The existing Queensland Health chronic disease strategy webpage will be significantly enhanced to raise awareness of funded initiatives and innovative service delivery sites across the state. It is proposed that in addition to providing access to key documents and reports, information will also be provided about funded programs, services and positions, access to tools and resources that have been developed, linkage to related websites and promotion of examples of service innovation and best practice.
The Department of Health & Ageing: Resources and latest developments on Chronic Disease Management
Centre for GP Integration Studies: The Centre conducts research, evaluation and development programs on integration of care in primary care.
Australian Primary Care Collaboratives: The Australian Primary Care Collaborative (APCC) aims to find better ways to provide primary health care services to patients through shared learning, peer support, training, education and support systems and is funded by the Australian Government Department of Health and Ageing.
Rural Chronic Disease Initiative
Diabetes Australia
Good Life Club (Health Professionals): Whitehorse Divisions of General Practice
National Heart Foundation
The Cancer Council Queensland – Prevention
USA, Department of Health and Human Services, National Centre for Chronic Disease Prevention and Health Promotion, Chronic Disease Prevention
Feedback
Jann Offer
Senior Program Coordinator – Chronic Disease
Email: joffer@gpqld.com.au
Phone: 07 3105 8300
Sabrina Ostowari
Program Coordinator – Chronic Disease
Email: sostowari@gpqld.com.au
Phone: 07 3105 8300
Katie Griffin
Program Coordinator – Chronic Disease
Email: kgriffin@gpqld.com.au
Phone: 07 3105 8300
Phillipa Grant
Program Coordinator – Chronic Disease
Email: pgrant@gpqld.com.au
Phone: 07 3105 8300
Click here to download the Implementing the Queensland Strategy for Chronic Disease 2005-2015 fact sheet.
