Better LTC self-management - starting small and thinking big

June 2015 Vol 15 (3)

Counties Manukau District Health Board is entering its fifth year of successive campaigns to foster community answers to better self-management of long-term conditions (LTC) and fewer hospital admissions. FIONA CASSIE finds out more about the latest campaign, Manaaki Hauora, and about 'Huff and Puff'; just one of the 20 plus projects now underway.

It is estimated there are over 67,000 people living with long-term conditions in the Counties Manukau District Health Board community. The DHB’s fairly ambitious aim is to be providing self-management support to 50,000 of them by the end of next year to reduce the impact of LTCs on both those people's lives and the demand on hospital services.

The campaign's first phase began in mid-2011 with the launch of the 20,000 Days campaign, which fostered 13 collaborative projects aiming to 'give back' 20,000 'well and health days' to people with long-term conditions and cut acute hospital admissions.

That project was declared a success two years later after reporting 23,060 fewer hospital bed days than expected and with at least two of the collaborative projects – the Healthy Hearts heart failure diagnosis and management programme and the Better Breathing community-based pulmonary rehabilitation programme – now well established.

Diana Dowdle was campaign manager for the initial 20,000 Days campaign, and the follow-up Beyond 20,000 Days campaign, and continues as programme delivery manager for its third phase, known as Manaaki Hauora. She works for the DHB's Ko Awatea centre for health system innovation and improvement, which coordinates this latest 'supporting wellness' campaign.

Interest growing rapidly

Dowdle says interest in the successive campaigns keeps building, with more and more proposals being put forward by usually multidisciplinary teams of health professionals, plus volunteers working in the community. About 40 proposals were put forward for the latest Manaaki Hauoracampaign and 20 collaborative projects were now getting underway – up on 13 for the first campaign and 16 in the second.

"More and more people are understanding how it works [as the campaigns continue]," says Dowdle. "They've all got different ideas about what they want to do and it's a really structured way to support people to implement their ideas in a sustainable way."

Meg Goodman, a primary health care (PHC) clinical nurse specialist with the DHB, says the growing number of PHC nurses doing postgraduate study and new graduate nurses doing postgraduate papers has also fostered nurse interest in LTC management and the campaigns.

While the campaign has funding support from the DHB, Dowdle says it also encourages the philosophy that "we've probably got the resources out there but we just need to do things in a different way to provide that connected support for people".

The selected collaborative teams get support from the campaign, including regular 'learning session' workshops, coaching and mentoring, data analysis, and leadership groups.

Plan, do, study, act

Dowdle says projects follow the PDSA (plan, do, study, act) approach and usually start small, maybe just in a few general practices or with a small group of patients in the community and once tested, refined and shown to be effective it can be scaled up to be delivered more widely.

She says examples of new projects include a team of occupational therapists and peer support workers going into general practices to work with the practice nurse and GP to support people with mental health and wellbeing issues related to their long-term condition. ProCare was also working on running self-management support education programmes within the GP practices.

Huff and Puff in the workplace

Goodman says one of the projects she has been involved in, Huff and Puff (or taking spirometry out into the community), came out of the Better Breathing project and is to be trialled in the Manukau area of the DHB. She says Huff and Puff will offer spirometry initially in one test workplace to screen people for chronic obstructive pulmonary disease (COPD) in the hope of catching people at a younger age when interventions like medication and pulmonary rehabilitation can be most effective.

She says it will involve a team of nurses, allied health and a physiologist going into the workplace to offer the screening and then linking back and working with the person's GP if evidence of COPD is found. "It is all about getting the person involved back into primary care and commencing pulmonary rehab that will also be happening in the community instead of coming into the hospital."

Goodman says it is easier for the patient if they can access quality spirometry in the community – and by using a physiologist the quality should be consistent and respiratory teams will be able to ensure the right interventions.

Kia Kaha goes nationwide

Dowdle says once project interventions have been trialled, tested and found to be keeping people healthy and out of hospital, they are spread wider. One such case is the Kia Kaha programme, targeted at patients with both medical and mental health conditions, which this year is spreading into all GP practices. The programme involves a health psychologist and PHC peer support specialist offering a self-management education-focused intervention that led to a major drop in emergency department presentations for the patients involved in the initial programme.

The DHB hopes that the latest Manaaki Hauora campaign will also have its success stories and help ensure more people are supported across the region to self-manage their long-term conditions.

More information on the campaigns and resulting collaborative projects can be found at

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