Patient Wellness initiative

Aim

The Patient Wellness initiative is aimed at supporting Queensland public orthopaedic patients to reduce and improve their modifiable lifestyle risk factors as they await orthopaedic elective surgery, to reduce surgical complications, improve surgical outcomes and improve the patient's overall health and wellbeing, through sustainable behaviour change.

Outcomes

• Patients feel 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.
• 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.

Background

• When patients are listed for elective surgery, they are particularly attentive and more likely to act on advice – the so-called ‘teachable moment’.
• Many patients have time between their appointments and elective surgery procedures to make meaningful lifestyle changes that could improve their surgical outcomes.
• There is strong evidence and associations between behavioural and biomedical modifiable chronic disease risk factors and surgery pre- to postoperative outcomes. Many chronic diseases share behavioural and biomedical risk factors that are largely preventable. Modifying these risk factors can reduce an individual's risk of developing a chronic disease and result in large health gains and optimised health towards surgery.

Discussion

The Way to Wellness service has completed over 1,500 risk assessments. The service evaluates patients at four weeks and six months post risk assessment. Some of the evaluation results include:

• 85% of patients rate the service as helpful or very helpful
• most changes reported for food and nutrition, physical activity and weight
• aspects of the service most helpful include the provision of advice, that it was a ‘positive experience’ and goal planning
• 87% of patients report seeing their General Practitioner since speaking with the WTW service
• 84% of patients report making behaviour change across at least one risk area (i.e. 16% report making no changes)
• broader evaluation results from referrer programs/services reveal patients have continued to report weightloss, 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.”

Lessons learnt

• State-level 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 and business that impede its success.
• 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.

References

• journal articles (a Model of Care exists with 70 references)
• stakeholder expertise and experiences
• data insights (as a result of the initiative)
• consumer feedback

Further Reading

Patient Wellness Clinical Pathway | Queensland Health Intranet