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Chronic Disease Management

• A SYSTEMATIC REVIEW OF CHRONIC DISEASE MANAGEMENT 1 Page led by Nicholas Zwar
  
  Worldwide chronic disease is on the rise, placing an increasing burden on those affected, their carers and the health system. In Australia many chronic diseases are predominantly managed in primary health care (PHC) and there is a need to understand how to do this more effectively. A systematic review was conducted on chronic disease management in primary health care using the Chronic Care Model (CCM) as the conceptual framework.
  
  
  • Key Findings/Policy options (3 pages)
  • Full Systematic Review

  Sarah Dennis, who was part of the Nicholas Zwar led chronic disease research team, was a recipient of an APHCRI Linkage and Exchange Travelling Fellowship. Summary report.
  

• MODELS OF CHRONIC DISEASE MANAGEMENT IN PRIMARY CARE FOR PATIENTS WITH MILD TO MODERATE ASTHMA OR COPD 1 Page
  
  Mild to moderate asthma and chronic obstructive pulmonary disease (COPD) are health problems that progress into disabling conditions. Primary health care (PHC) is essential for the recognition and management of these illnesses. This role may be enhanced through: self management, general practitioners with a special interest (GPwSI) in respiratory care, respiratory practice nurses, clinical practice guidelines for asthma and COPD and spirometry programmes in primary care.
  
  
  • Key Findings/Policy options (3 pages)
  • Full Systematic Review
  
  
• SUSTAINABLE CHRONIC DISEASE MANAGEMENT IN REMOTE AUSTRALIA
  
  

  The Sharing Health Care Initiative (SHCI) demonstration project, which aimed to improve management of chronic diseases, was implemented in four small remote communities in the Katherine region which are serviced by the Katherine West Health Board, a remote Aboriginal-community controlled health organisation in the Northern Territory .

  We reviewed the project proposal, final report, evaluation reports and transitional funding proposal, and supplemented these with in-depth interviews with key individuals. We determined factors critical to the sustainability of the SHCI project in relation to context, community engagement, systems flexibility and adaptability, the availability and effect of information systems, and the human nature of health care and policy.

• CARING FOR A MARGINALISED COMMUNITY: THE COSTS OF ENGAGING WITH CULTURE AND COMPLEXITY
  
  

  The Care and Prevention Programme (CPP) began in 1998. It is based on the philosophy of primary health care, and has improved health among homosexually active men, including about a third of HIV-positive South Australians. The CPP was assessed using financial analysis and qualitative methods.

• SOUTHERN HIGHLANDS DIVISION OF GENERAL PRACTICE DIABETES PROGRAM - REPORT ON IMPLEMENTATION led by Beverly Sibthorpe
  
  

  A number of Divisions of General Practice, including the Southern Highlands Division of General Practice (SHDGP), have implemented diabetes programs, but there is little evidence concerning their effectiveness and efficiency. This project undertook an exploratory study of the implementation and costs and benefits of the SHDGP program. The results of the cost effectiveness component of the study are being published separately. This is the Report on Implementation.

• THE EUROPEAN OBSERVATORY ON HEALTH SYSTEMS AND POLICIES led by Nicholas Glasgow
  
  Professor Nicholas Glasgow is contributing to two parts of a major program of research by the European Observatory titled: 'Responding to the epidemic of chronic disease'.

The first component is a series of case studies exploring the burden of chronic disease in seven countries, the particular issues that arise, and the policy implications and responses. The case studies will become a book, expected to be published in January 2008. Professor Glasgow is leading the Australian case study.

The second component is the production of a book reviewing the evidence-base for chronic disease management and identifying best practices. It will set out strategies to optimise care delivery to the chronically ill, making best use of available resources. Professor Glasgow is co-authoring the chapter on decision support.

• SERIOUS AND CONTINUING ILLNESS POLICY AND PRACTICE STUDY led by Stephen Leeder and Nicholas Glasgow

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) is a five year, NHMRC-funded project examining best-practice care for chronic illnesses and which aims to develop policy and health system solutions to lower patient hospital admissions.