Wa morbid obesity model of care
Download
1 / 34

WA MORBID OBESITY MODEL OF CARE - PowerPoint PPT Presentation

WA MORBID OBESITY MODEL OF CARE THE BIGGER PICTURE Presented by: Professor Jeff Hamdorf Ms Karina Moore Health Networks Branch Outline What is the bigger picture? Let’s look at morbid obesity Synergistic therapeutic approaches Impact on Chronic Disease

Related searches for WA MORBID OBESITY MODEL OF CARE

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha

Download Presentation

WA MORBID OBESITY MODEL OF CARE

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


WA MORBID OBESITY MODEL OF CARE

THE BIGGER PICTURE

Presented by:

Professor Jeff Hamdorf

Ms Karina Moore

Health Networks Branch


Outline

What is the bigger picture?

  • Let’s look at morbid obesity

  • Synergistic therapeutic approaches

  • Impact on Chronic Disease

    Using the bigger picture model to manage better.

  • WA health networks and network processes

  • Model of care development

  • WA morbid obesity model of care highlights


Global Prevalence of Obesity


Projected Prevalence of Obesity by 2025


Estimating historical changes in physical activity levels

Australian settlers 150 years ago were 2.3 times more active than today’s office workers, with energy expenditures equivalent to walking 8 - 16 Km more each day

Egger GJ et al. Med J Aust 2001


DIET versus EXERCISE (Great Britain)


What’s so morbid about Obesity?

Ischaemic stroke

Depression

Coronary heart disease

Respiratory disease

Congestive heart failure

Gallbladder disease

Type 2 diabetes

Dyslipidaemia

Cancer (breast, endometrial,

colon, prostate)

Hormonal abnormalities

and pregnancy

complications

Osteoarthritis

Hyperuricemia

and gout


2.5

2.0

MortalityRatio

+ drugs

± CBT

1.5

Diet/Lifestyle

1.0

VeryLow

VeryHigh

Moderate

Low

Moderate

High

0

20

25

30

35

40

BMI

Obesity and Mortality Risk

+ Surgery

Gray DS. Med Clin North Am. 1989;73(1):1–13.


Treatment Team

  • Surgeon

  • Physician

  • Dietitian

  • Psychiatrist/psychologist

  • Exercise physiologist

  • Outpatient Nurse


Physician

  • Endocrinologist or primary care physician

  • Supervise investigations

  • Optimise reversible co-morbidities

  • Role in follow up


Role of the Dietitian

  • Initial assessment

    • Portion sizes, choices, “smart shopping”

  • Supervise lifestyle modification

  • Post op follow up


Psychologist

Problem-solving skills

Coping strategies

Goal setting

Monitoring Skills

Social skills


Surgeon

  • Team leader

  • Co-ordinate preparation

  • Select surgery to suit patient

  • Supervise stringent follow up


NIH Consensus Conference 1991

  • Surgery is the only approach that provides consistent, permanent weight loss for morbidly obese patients

  • Surgery indicated in patients with:

    • BMI of 40 or over

    • BMI of 35-40 with significant co-morbidity

    • documented dietary attempts ineffective


40 - 60 mL pouch

Restriction + satiety

Adjustable Gastric Band

  • Minimal access (100%)

  • Low morbidity

  • Negligible mortality

  • Adjustable

  • Readily reversible


LAGB vs RYGB EWL

O’Brien, Dixon Brown ANZJS 2004


Collated Outcomes LAGB

  • 7 - 10 x safer than bypass surgery

  • Perioperative complication rate 1- 2 %

  • Mortality negligible (0.3%)

  • Late morbidity (2 -3%)

  • Issues Late prolapse/slippage

    Erosion

    Port sepsis


Co-Morbidity Control

  • Type 2 diabetes

    • Remission at 1 yr in 64%, improved 26%

  • Hypertension

    • 60% normotensive off meds, 33% improved

  • Better control of asthma, GORD, lipids, OSA

  • Significant improvement in QOL measures


A Healthy Future for West Australians

  • 2004 - Health Reform Committee examined WA service delivery

  • A Healthy Future for Western Australians (2004)

    • 86 recommendations to guide health reform

    • Recommendation 23

      • Health Networks to support integrated models of care


What are Health Networks?

  • A group of interested people and organisations including health professionals, patients, non-government organisations, carers, consumers and others, coming together to talk, think, plan and develop health policy and services across the State


Why Health Networks?

An excellent means of forging new relationships with a much wider range of people and organisations to:

  • Plan better policy

  • Ensure better coordination and integration of services

  • Increase participation, partnerships, communication and accountability across WA Health

  • Clinician-led and clinician engaged


What Can Health Networks Offer?

  • Increased focus upon patient/patient journey

  • Engagement of stakeholders

  • Facilitation of communication

  • Breaking down of silos

  • Coordinated pressure on bureaucracy

  • Commitment to a vision


Who Is Involved?

Director General

State Health Executive Forum

Executive Director Health Policy and Clinical Reform

Health Network Lead

SHEF sub-committee Health Network Leads Forum

Health Network Exec Advisory Group

Non-government organisation,

private sector,

research group, academic,

indigenous health,

community/consumer/carer,

commonwealth sector & state sector

representatives

Health Networks

Branch

Working

& reference

groups


What Networks Do?

PERFORMANCE

Performance indicators across the system are driven by the Health Networks

POLICY

Health Networks lead and facilitate the development of evidence based policy

PLANNING

Strategic and operational planning for health and health service delivery is informed by Health Network advice

Working together to

create a healthy WA

PROTOCOL

Health Networks provide opportunities to develop systems and work practices that improve clinical expertise and encourage best use of both physical and intellectual resources

PEOPLE

Health Networks provide stakeholders with opportunities for leadership.

Opportunities to improve clinical workforce support, teaching and training are identified and advised upon

PRIORITIES

Health Networks align with the DOH (WA) Strategic Intent, focusing on the promotion of health and wellbeing


16 Networks so far…

  • Infections and Immunology

  • Injury and Trauma

  • Mental Health

  • Musculoskeletal Health

  • Renal Diseases

  • Respiratory Medicine

  • Neurosciences & the Senses

  • Women’s & Newborns

  • Acute Care

  • Aged Care

  • Cancer & Palliative Care

  • Cardiovascular Health

  • Child & Youth Services

  • Digestive Health

  • Endocrine

  • Falls Prevention


Network Processes

  • Tools for collaboration and engagement

  • Workshops & forums

  • Model of Care Development

  • Policies and Guidelines

  • Endorsement – best evidence, clinical expert and government and consumer/carer


Vision

The right care for the right person at the right time in the right place with the right team.

Model of Care

defines:

Health care services required to satisfy all consumer needs in the appropriate setting.

Principles, guidelines and criteria for health care services.

Integration of health care services in a seamless manner along the entire care continuum (evidence based pathways).

Focus

Enablers

Health Networks (GPs, Consumers, etc)

Prevention &

Promotion

Initiatives

(eg ABHI)

Early Detection &

Intervention

Frameworks

(eg National Service Improvement)

Integration &

Continuity of Care

Strategies

(eg Ambulatory Care)

Self Management

Care Continuum

Severe Fragility & Environmental Condition

Advanced Conditions

Advanced Conditions

Healthy

Healthy

High Risk

High Risk

Early Symptoms

Early Symptoms


Think tank to Workshop

  • Think Tank on Obesity- February 2007

  • Aim: To establish a shared vision for a coordinated approach on obesity

  • Morbid Obesity Workshop - November 2007

  • Aim: to foster interest in the development of a shared vision for morbid obesity management in WA.


Expert Reference Groups – Feb 08

  • Comprehensive primary care strategies for the management of morbid obesity

  • The role of General Practice in the care of the morbidly obese

  • Surgical interventions for treatment of morbid obesity

  • Health care services, equipment and facility issues/initiatives


Model of Care Recommendations

  • Develop and support a multidisciplinary team approach

  • Integrated Health promotion and prevention strategies

  • Promote morbid obesity as a chronic disease

  • Surgery should be appropriately credentialled

  • Implement surgical guidelines

  • Develop a statewide database with national capability

  • Promote management in a dignified manner

  • Develop transport guidelines


From policy to patient

Policy Development

Model of Care

Health Networks

Health Care Services Required

Guidelines and Criteria

Integrated Pathways

Translation to

Refinement of Clinical Service Framework

Planning – Strategic

Development of Proof of Concept

physical context

Service Model

AHS in consultation with Health Networks

Workforce

Infrastructure

Information & Communications Technology

Equipment and Resources

WA Health

Translation to

local setting

Planning – Operational Deployment

Local Implementation Model

AHS

Eg Multipurpose Health Care Facilities

Telehealth

Community Health Care Practitioners

Metropolitan

Rural

Community


Morbid Obesity – the bigger picture

Thank you

Contact Prof Jeff Hamdorf or Ms Karina Moore via:

Department of Health (WA)

Health Network Branch

PO Box 8172

Perth WA 6849

(08) 94892800

Email: healthpolicy@health.wa.gov.au

Link to the web version of the Morbid Obesity Model of Care:

www.healthnetworks.health.wa.gov.au

- ‘Models of Care’


Gastric banding technique


ad
  • Login