GPQ Programs

General Practice Queensland

Together we can build a better health system

Supporting the Queensland Strategy for Chronic Disease 2005-2015

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.

Two Chronic Disease Coordinator positions have been established within GPQ to support the implementation of the Strategy across the divisions. Through these positions, GPQ engages with the Queensland Aboriginal and Islander Health Council (QAIHC); Ethnic Communities Council Queensland (ECCQ); and Combined Health Agencies Group (CHAG) as a collaborative Non-Government Chronic Disease Leadership Team (NGCDLT).

For future information, please contact Jann Offer enior Program Coordinator - Chronic Disease joffer@gpqld.com.au

Key Focus Areas

The Chronic Disease Team, in collaboration with key stakeholders, has identified key focus areas that align with the GPQ Statement of Strategic Intent 2007 - 2011 as follows:
  • Statewide advocacy and representation to inform best practice chronic disease prevention and management with consideration of the diverse needs of communities across Queensland.
  • A ‘whole of population’ approach in preventing and managing chronic disease for all Queenslanders.
  • Partnership development between key stakeholders across primary health care and the wider community to respond to local needs.
  • Integration of the primary health care services to support individuals at risk or with chronic disease.
  • Enhanced uptake of self management approaches.
  • Identification and support for funding for the implementation and expansion of best practice initiatives to prevent and/or manage chronic disease.
  • Research and innovation through quality improvement and evaluation processes.
The work of the Chronic Disease Coordinators is guided by the outcomes from a mapping and consultation exercise and informed by the recommendations from the Health Summit - Chronic Disease (2008).

Collaborative feedback from across the primary health care sector, presented in Chronic Disease - A Call to Action, highlighted the need to focus on:
  1. Advancing a whole of population approach in preventing chronic disease
  2. Enhancing system elements - Embedding Self Management
  3. Enhancing system elements - Building Workforce Capacity
  4. Providing effective systems for Coordinated Care

Achievements

The following are key achievements of the Chronic Disease Coordinators from July 2009 to November 2009:

To advance a whole of population approach in preventing chronic disease
To provide effective systems for Coordinated Care
To enhance system elements - Embedding Self Management
To enhance system elements - Building Workforce Capacity

To advance a whole of population approach in preventing chronic disease
  • Maintained circulation of the Chronic Disease Update, a weekly e-Newsletter to division staff, CHAG and external key stakeholders. Evaluation of this communication strategy was undertaken revealing good uptake and opening rates across partners. Further enhancements identified through the review will be addressed into the future.
  • Worked in partnership with QAIHC to develop and align strategies to respond to the Council of Australian Governments (COAG) Closing the Gap initiative. Through this initiative, a Program Coordinator was recruited to the GPQ Chronic Disease Team to support identification and sharing of best practice models and information.
  • Worked with colleagues from ECCQ to address the needs of this marginalised group. The Chronic Disease Coordinators contributed to development of programs and resources and supported accreditation for a culturally appropriate lifestyle modification program.
  • Worked with the Chronic Disease Reference Group to progress the priorities identified by CHAG.
  • Advocated for and supported programs that address the needs of individuals with co-morbid chronic conditions and mental illness. In particular, the Chronic Disease Coordinators participated in a Reference Group for the Activate: Mind and Body Project, supporting self management for those with severe mental illness.
  • Continued to support and advocate for programs that focus on chronic disease prevention:
      • Provided representation on the Queensland Public Health Forum (QPHF) where GPQ is contributing to the development of the ‘Eat Well’ Resources
      • Explored opportunities to enhance patients’ health literacy as a factor that will contribute to advancing health outcomes
To provide effective systems for Coordinated Care
  • Launched the Map – The Chronic Disease Map provides a profile of chronic disease activity occurring across the Queensland Divisions Network, in collaboration with local partners and key stakeholders. All stakeholders have access to this information to enhance sharing of project goals, evaluation processes and outcomes. The Map:
      • Provides ready access to resources, promotes information sharing and has the potential to reduce duplication of activities
      • Informs strategic partners about the breadth of work occurring enabling identification and promotion of new opportunities
  • Continued to progress work with the NGCDLT, including the identification of opportunities to promote and raise awareness of team members through development of an orientation package.
  • Ensured cross program internal engagement to enhance communication, make effective use of existing resources and reduce duplication and promoted: 
      • A continuous quality improvement approach, supporting the uptake of the Australian Primary Care Collaboratives (APCC)
      • GPQ’s information management systems, increasing levels of electronic enablement, improving the quality of clinical and administrative data and enhancing the levels of clinical data sharing using e-systems
      • The uptake of evaluation methods and processes to further contribute to building the evidence base
To enhance system elements - Embedding Self Management
  • Provided support to all divisions to implement local self management education and training, applying the core principles and enabling activities identified through the Framework for self-management 2008 – 2015.
  • Promoted the repository of self-management resources available on the GPQ website which aims to guide providers through the evidence and available resources that support effective delivery of best practice, patient centred, holistic chronic disease self-management
  • Advanced the development of a Position Statement for ‘The role of the Queensland Divisions Network in Self Management’. This Position Statement will be ready for release in early 2010, following further consultation with the Network.
  • Presented at a workshop held for Service Managers at Spiritus to support work being undertaken in this CHAG agency to develop a framework for self management that was applicable across all services in the organisation.
  • One of the Chronic Disease Coordinators is completing training to become a Master Trainer for the Flinders Self Management Program. This will enhance health professional access to training in Queensland.
To enhance system elements - Building Workforce Capacity
  • Supported representation on a number of Queensland Health Statewide Clinical Networks including the Statewide Diabetes, Renal, Cardiac and Respiratory Networks. This facilitated advocacy for engagement with general practice to achieve best practice care across the continuum.
  • Hosted the Connecting Care Workshop delivered in collaboration with staff from the Primary Health Care Research and Information Service (PHCRIS) to address program planning, evaluation and reporting.
  • Contributed to and participated in the October 2009 Qld Divisions Forum. The program focused on developing networking skills. Discussion was also focused on the implementation of Closing the Gap initiatives.
  • In partnership with Queensland Health (QH) progressed a project to provide Brief Intervention Workshops to encourage uptake of brief interventions by general practice and QH staff.
  • Contributed to planning for the Chronic Condition Self Management Support Workforce Forum facilitated by the Health and Community Services Workforce Council. This forum provided the opportunity to identify a collective industry approach to building CCSM capacity in the ‘support’ or ‘assistant’ workforce.

Resources


Together we can build a better health system

Last updated: 21/08/2008 Print this page