One Size Does Not Fit All
18 November 2016 Last updated:
16 December 2016
One Size Does Not Fit All
This project provides support to consumers at risk of developing one or more lifestyle-related chronic diseases, with increased access to healthcare services and programs that help them make healthy lifestyle choices.
View a poster from the Centre for Healthcare Redesign graduation, December 2016.
- To ensure 50% of 20-55 year olds not known to a general practitioner (GP) in Broken Hill and who have three or more risk factors for chronic disease, are actively engaged in their health and making healthy lifestyle choices by 2018.
- To identify person-centred engagement models that reduce the rate of avoidable emergency department (ED) presentations at Broken Hill Health Service, by June 2018.
- To provide consumers, clinicians and healthcare services in Broken Hill with a tool for shared care planning, by January 2017.
- Improves long-term health outcomes for consumers and reduces the risk of chronic disease.
- Increases access to local health services and engagement with GPs.
- Improves health literacy in the community.
- Reduces the demand on acute care services.
- Reduces hospital length of stay.
- Allows healthcare providers to deliver services that suit the needs of their patients and the community.
- Improves communication and collaboration among acute care and community health services.
Broken Hill is one of the most socially disadvantaged local government areas (LGAs) in NSW, ranked eight out of 153 LGAs across all four Socio-Economic Indexes for Areas (SEIFA) measures. The SEIFA ranks areas in Australia according to relative socio-economic advantage and disadvantage, based on information collected in the five-yearly census. The 2011 census revealed that education levels in Broken Hill are significantly lower than the rest of NSW, with only 17.4% of people in Broken Hill completing Year 12 or equivalent, compared to a state average of 38.4%. In addition, 20% of the Broken Hill population have not completed up to Year 10, compared to a NSW average of 11.2%.
The poor education levels in the Broken Hill community have impacted social, health literacy and lifestyle behaviours. Over 70% of the adult population is overweight or obese, 27% smoke and 7% consume alcohol at harmful levels. The community’s lack of engagement with GPs and capacity to understand how lifestyle behaviours impact their health have resulted in chronic disease rates that are substantially higher than national levels, with the highest potentially-avoidable deaths per 100,000 people for both males and females in NSW. The chronic disease burden is greatest on the Indigenous community (7.5%) and people over the age of 65 (20%).
If the escalating rates of lifestyle-related chronic diseases in Broken Hill continue, acute care and primary care services will struggle to cope. Historically, GP and other primary healthcare services are only accessed by consumers when serious health problems become evident, despite the fact that many of these diseases present symptoms long before this occurs. Encouraging consumers to proactively manage their health and address the risk factors of chronic disease may reverse this trend and help the Broken Hill community improve their health and reduce their risk of chronic disease or long-term illness in the future.
- A steering committee, clinical working party and consumer working group were established to manage and oversee the project.
- A number of potential solutions were identified. These included:
- the introduction of an iPad into the Broken Hill Health Service ED waiting room, to increase GP access and engagement through online appointment scheduling
- development of a local app for consumers and healthcare providers, to access services
- the Town Health Challenge, which will aim to improve lifestyle behaviours across the community.
- An iPad was purchased for the ED and configured with secure access to the GP appointment schedule.
- Staff education was undertaken, to increase awareness of the new system and help them understand how to support the consumer and schedule online appointments for people who present to the ED.
- A quick guide was created for consumers, to help them schedule appointments with a GP, if required.
- A media release was distributed to increase awareness in the community about the importance of engaging a GP and reducing the risk of chronic disease.
- Patient and staff experience surveys were undertaken, with results compared to baseline data.
Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
February 2016 – December 2018
- Emergency Department, Broken Hill Health Service
- Fast Track Clinic, Broken Hill Health Service
- GPs, Broken Hill
- Centre for Healthcare Redesign
- Nachiappans, Broken Hill
- Broken Hill GP Super Clinic, Broken Hill
- Williams Street Surgery, Broken Hill
- Royal Flying Doctors Service, Broken Hill
- Maari Ma Aboriginal Medical Service, Broken Hill
- Western NSW Primary Health Network
- University Department of Rural Health, Broken Hill
- Broken Hill Health Council
- Broken Hill City Council
- Charles Perkins Centre, University of Sydney
- Broken Hill Health Service Consumer Representatives
A full evaluation of Solution 1 will be undertaken in February 2017 and include the following measures:
- number of GP appointments made using the iPad
- number of GP presentations (triage 4/5) to ED or Fast Track Clinic.
The final evaluation of the project will be undertaken in December 2018 and include the following measures:
- number of 20-55 year olds engaged with a GP
- number of 20-55 year olds with GP-type care (triage 4-5) that present to the ED or Fast Track Clinic
- patient and staff experience surveys.
- Baseline data was difficult to obtain from consumers, community health services, GPs and the Far West Local Health District.
- As it is a multi-agency project, it is difficult to keep stakeholders engaged and motivated when they have competing priorities, resources, agendas and availabilities.
- It’s important to negotiate increased timeframes between deliverables, to increase consumer and stakeholder engagement, access to resources and knowledge sharing.
- Recognising the skills of each team member and supporting each other by sharing the load is critical to the success of the project.
- It’s important to work with stakeholders in new ways and with new processes, to diagnose issues and develop solutions.
- Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study: Impact and causes of illness and deaths in Australia 2011. Australian Burden of Disease Study Series no. 3. BOD 4. Canberra: AIHW; 2011.
- Far West Local Health District. Broken Hill Health Service Clinical Services Plan; 2015.
- Far West Local Health District. Staying Healthy Integrated Care Project Model of Care; 2016.
- Far West Local Health District. Far West Local Health District Health Services Plan 2015-2020; 2015.
- Ministry of Health. Healthstats NSW. NSW Government; 2016 [accessed 12 February 2016].
- Reading CL, Wien F. Health inequalities and social determinants of Aboriginal People’s health. Prince George, BC, Canada: National Collaborating Centre for Aboriginal Health; 2013.
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