Dr. Trent Watson - ethos Health
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Transcript of Dr. Trent Watson - ethos Health
Effectively Combining People, Systems and
Technology to Achieve Improved Quality of Care,
Patient Safety and Cost Efficient Care Delivery
Integrating Technology into Practice
Benefits:
• Improving access, efficiencies and equity in
health care,
• Better management of chronic disease,
• Increased focus on prevention,
• Improved quality, safety, performance and
accountability of health care services.
Type 2 Diabetes
• Type 2 diabetes is the most rapidly growing health
problems in Australia (AusDiab, 2012)
• 1 in 4 Australians either have diabetes or the signs
that they will develop diabetes. (AusDiab, 2012)
• 280 adults develop diabetes daily, 1 every 5 mins
• Estimated: for every 5 diagnosed cases, there are 4
undiagnosed cases. (Valentine et al., 2011 – in Shaw & Tanamas 2012)
Diabetes prevalence has risen
from 8.5% to 12% over 12 years
Source: AusDiab Study 12-year follow-up, 2012.
Australia’s diabetes prevalence has
already exceeded forecasts (IDF 2006)
Serious complications arising from
diabetes are increasing
Source: Diabetes: The silent pandemic and its impact on Australia (2012).
Annual number of people with diabetes commencing
dialysis or having a kidney transplant.
Diabetes will be the highest
contributor to the disease
burden in Australia by 2017
Source: A National Diabetes Strategy and Action Plan: Federal Election 2013. Diabetes Australia.
Trends in leading causes of burden of disease
(Australian Institute of Health and Welfare, 2010).
What can we do about it?
Annual incidence of diabetes, by BMI
Source: AusDiab Study 12 year follow-up, 2012.
Source: AusDiab Study 12 year follow-up, 2012.
Annual incidence of diabetes, by activity
What are we doing about it?
12% spent on primary health care
Australian General Practice Consultations
'Exercise Is Medicine‘: Curbing the Burden of Chronic Disease and Physical Inactivity. Jeff S. Coombes et al.
Published online 9 April 2013 Asia Pac J Public Health
4.2% provided advice on
nutrition and weight
1.3% included counseling
advice on exercise
Diabetes treatments:
Change over the past 12 years
Use of treatments for diabetes: the AusDiab Study 12-year follow-up. 2012.
The Health Care System
Process
Disease SystemConventional medical care
Health SystemPrimary care
Testing
(Diagnostic)
Markers of disease
•Pathology
•Scan (e.g. endoscope)
•Scope (e.g. x-ray)
Determinants of health (poorly
measured)
•Smoking, Nutrition, Alcohol, Physical
activity, Obesity, Mental Health, Sleep
Diagnosis Medical Practitioner Medical Practitioner
Treatment Focus: Disease (Cure)
What: pharmaceuticals, injections,
surgery.
Who: Medical Practitioner
How: Episodic
Focus: Health (Prevention)
What: SNAPOMS
Who: Patient/GP/PN/AHP
How: Uncoordinated & episodic
Testing
(Diagnostic)
Markers of disease Determinants of health
Capacity & Capability of our front line Medicine in
Chronic Disease Management
Knowledge │ Skill │ Resources │ Drive
Key pad questions
What’s your competency?
I am confident that I can calculate an individual’s energy requirement.
a) True
b) False
Integrating Technology into Practice
to better manage Chronic Disease
People
Systems Technology
Replicable Accessible
Scalable
Measurable
Health
outcomes
MeasurementDISEASE HEALTH
Keeping Score changes the
way we play the game
Better Measurement…Better Management
The ability to tangibly measure a range of primary health indicators (mental health, physical and functional health, sleep, social health and nutrition)
– WILL engage the individual to have a conversation with their health practitioner about addressing the determinants of health, rather than SUPERVISE THEIR DECLINE until they can be diagnosed with a disease
– WILL focus practitioners on improving primary health indicators and prevent lifestyle-related disease rather than burden acute medical treatment services (Prevention focused).
– WILL enable the individual and their health practitioner to direct and prioritise (integrate & coordinated) an intervention according to the cause, patient’s needs, preferences and motivation (client centred approach).
– WILL create an ability to measure changes in outcomes with Primary Health care intervention (outcomes focused, evidence-base, accountable)
– WILL create a drive to improve scores for the client (client centred) as consistently (replicable model) and efficiently as possible (innovation). Interventions that lead to demonstrated and exceptional outcomes can then be communicated to target markets, professions, industry and government for better health outcomes (leadership and universal recognition).
Management: Integrating People, Systems, Technology
Timeline Face-to-face Appointments Outcome MeasuresOnline Learning Module #
Start-up GP Blood pressure
Pathology referral for:HbA1c, Fasting BGL, Lipids
Week 1 Dietitian (AHP)
Health Risk Assessment (online) ***
Weight & Height (to calculate BMI)
Introduction to food and activity tracker
Introduction & getting started
Week 2 Dietitian (AHP) Weight & BMI
Review food & activity tracker
Energy balance
Week 3 Carbohydrates
Week 4 Exercise Physiologist (AHP) Weight & BMI
Review food & activity tracker
Exercise
Week 5 GP Review test results
Review medication
Portion control
Week 6 Dietitian (AHP) Weight & BMI
Review food & activity tracker
Creating a healthy environment
Week 7 Resistance & stretching exercises
Week 8 Dietitian (AHP) Weight & BMI
Review food & activity tracker
Shopping & Nutrition Labels
Week 9 GP Review test results
Review medication
Goals & barriers
Week 10 Meal planning
Week 11 Support
Week 12 Dietitian (AHP)
Weight & BMI
Review food & activity tracker
Health Risk Assessment 2 (online) ***
Future: What now?
Post-program GP Blood pressure
Pathology Review medication
Accessible
Accessible
Scalable, Replicable
Diet & exercise trackingClear, practical and visual resources
Master: Measurable Outcomes18mths of usual care in 12 weeks
* p-value<0.05 ** p-value<0.01 *** p-value<0.001
Blackberry ID, et al. Effectiveness of a general practice based, practice nurse led telephone
coaching on glycaemic control of type 2 diabetes: the PEACH pragmatic cluster randomised
controlled trial. BMJ 2013;347:f5272 (Published September 2013).
Thankyou