The Patient Wellness initiative is a new, innovative model of care, focused on supporting patients with a complex interplay of risk factors to reduce their risks as they await orthopaedic elective surgery.
The initiative transforms an everyday health system interaction into an opportunity for behaviour change, capitalising on the elective surgery waiting period, to unveil a broader discussion about overall health and wellbeing and opportunities for reducing health risks and changing behaviour. Patients will gain greater knowledge of their health risks and will be supported to seamlessly navigate the public health system to access ongoing coaching and support to improve their modifiable lifestyle risk factors.
Patient Wellness Initiative
Initiative Type
System Improvement
Status
Deliver
Added
Last updated
Summary
Key dates
Jan 2019
Dec 2021
Implementation sites
Across all orthopaedic sites in Queensland
Partnerships
State-wide initiatives require facility-level engagement, application and implementation. Each facility has differing operational and clinical processes. This engagement opened up a communication channel between the facility and the Department and enabled
Aim
To provide targeted, evidence-based wellness advice to patients with complex needs and implement a pathway to support them to make sustainable behaviour change across eight modifiable lifestyle risk factors.
Benefits
- no burden on existing clinical areas or positions to implement new processes
- clinicians feel they have support 'behind the scenes' to comprehensively support their patients to improve their risk areas and to reinforce the advice and information they provide patients
- patients have a platform for advice, information and support to increase their health literacy
Background
Patients have a right to feel valued and that they have a platform for discussing their overall health and wellbeing in detail and to seek advice, information and support which ultimately increases their health literacy that can reduce their risk and improve their health prior to and post-surgery.
The challenges facing health today:
Utilisation of health services is increasing and there is no sign of a slow demand.
While people are living longer, they are living longer with illness or disability.
One-third of the disease burden can be attributed to the combined effect of modifiable risk factors
Solutions Implemented
- Elective Surgery Waiting List Proactive Contact – In response to COVID-19 and ongoing feedback from clinicians regarding workload in the outpatient department, patients on the Elective Surgery Waiting List are proactively contacted via SMS to invite them to use the Way to Wellness service. This approach was trialed as an alternative to the Patient Wellness Clinical Pathway that was implemented as the referral method in January 2019.
- Way to Wellness service (WTW) – statewide, preventive telehealth service undertaking comprehensive risk assessment, providing brief advice in line with clinical guidelines, engaging patients in goal and action planning and offering referral to evidence-based programs and services. The service is funded by Queensland Health and delivered by the Health Contact Centre.
Evaluation and Results
- The WTW service has an opt-in rate via SMS of 25-40 per cent.
- Since 2020, 1,138 patients have opted-in to participate.
- The Way to Wellness service have completed over 2,500 risk assessments since implementation on 1 January 2019.
- The service evaluates patients at four weeks and six months post risk assessment. Some of the evaluation results include:
- 85 per cent of patients rate the WTW service as helpful or very helpful.
- Most changes reported for food and nutrition, physical activity and weight. Most reported benefits of these changes include lost weight (35 per cent), increased physical activity (28 per cent) and improved diet (21 per cent).
- Aspects of the service most helpful include the provision of advice, that it was a ‘positive experience’ and goal planning.
- 85 per cent of patients report seeing their General Practitioner since speaking with the WTW service.
- 84 per cent of patients report making behaviour change across at least one risk area (i.e. 16 per cent report making no changes)
- Broader evaluation results from referrer programs/services reveal patients have continued to report weight loss, smoking cessation and increased fruit and vegetable intake.
- Example of a service compliment: “The referrals made by WTW have been really helpful, I feel stronger, can deal better with different stresses in life. The collaborative approach from different teams within Queensland Health has helped me find the support that I've needed. I have lost 21 kilos and continue to work with psychologists, dieticians and my GP to manage my complicated relationship with diet and food.”
- The risk assessment data has quantified the complex risk profile of these patients. For example, over 90 per cent of patients are outside of the healthy weight range, over 60 per cent have scored ‘high risk’ of developing Type 2 Diabetes in the next five years, over 75 per cent are not meeting the fruit and vegetable guidelines, 33 per cent are exceeding at least one of the alcohol guidelines, 13 per cent are smokers and 34 per cent are at risk for emotional wellbeing.
Lessons Learnt
- Statewide initiatives require facility-level engagement, application and implementation. Each facility has differing operational and clinical processes. This engagement opened up a communication channel between the facility and the Department and enabled relationships with key staff. However, staff changeover dramatically impacts the sustainability of the relationship and thus the initiatives implementation and success.
- Prevention is important to clinicians in these settings, it is the practical barriers like operational flow, clinicians time and capacity that impede its success.
- Data exists within the system to appropriately identify and target patients with the greatest need.
- Patients value the tailored nature of the advice and welcome support and an opportunity to discuss their health and wellbeing and the complex interplay of their risk factors.
- Despite the significant efforts to support these patients in the community, patients with significant and complex risk profiles journey through the public health system, often without the intensive support they need. This is a missed opportunity for prevention activity which could improve the patient experience and further reduce demands on the health system.
