Changing Practice

Embedding a Broader Needs Assessment

Framework

Julie White

Why?-Plan Background•Acknowledges an identified need for a more holistic, coordinated and systematic approach to client care and a move away from the current problem-oriented/discipline-specific focus on health.

•Adopting a holistic and sensitive approach to client needs in context of their physical, social, emotional and cultural environments

•Supporting the transfer of care between settings to facilitate the provision of integrated care

•Reducing assessment duplication

•Integrating self management, health promotion & prevention within the assessment phase of the client journey

•The Broader Needs Assessment does not replace clinically specific assessments however it aids in identifying the interrelated factors(social determinants) identified by the World Health Organisation that impact a client’s capacity to self-manage their chronic condition

Do-Getting the evidence to drive change

•Benchmarked 11 assessment templates in community health against an existing validated assessment template

•A medical record audit of 120 files was also undertaken with a focus on best practice chronic care e.g. does evidence based decision support drive the care pathway

•Findings analyzed and benchmarked against Wagner Chronic Care /and Victorian Service Coordination Practice Manual.

Study

• 0% of assessment templates captured – depression and anxiety, – oral health, – transport issues, – financial concerns, – formal supports and– carer involvement

• 27.3% of assessments captured smoking and client identified needs

• 18.2% of assessments captured pain, nutrition and weight• 9.1 % of assessments captured cognition and memory, falls,

living arrangements and informal supports

Study-Governance- Formation of working group-Key stakeholders from multiple settings and sectors were engaged. Department of Health Industry advisor/DHSV/ Acute Mental Health -key members of working group Developed -Overarching principles aligned with National and State Policy directions

All domains sought clinical expertise aligned with evidence based practice and identified locally relevant pathways

Obtained consensus and agreement around question set to be trialed

Consumer input- we trialed question set with focus group and also utilized a mental health community advisory committee

Implement-ACTThree month pilot across multiple services and settings e.g. Koori / PenDAP / Mi Health / Early Intervention /HARP/ Domiciliary Care /Counselling

Study-Outcomes/Evaluation

• File Audit • Applicability and Practicality of the template questionnaire• Post pilot Focus Group• Consumer feedbackMENTAL HEALTH &WELLBEING

%that asked about domain prior

%asked about domain after BNA

Living Arrangements 52% 94.2%

Relationships 52% 88.8%

Depression, Anxiety and Stress

50% 86.1%

Social Activities (isolation flag)

39 .5% 80.50%

Culture, Values and Religion

0% 50%

Study-Domain %that asked about

domain prior%asked about domain after BNA

Medical Conditions 96.3%

75% 96.3%

Client stated issue (client centred care)

47.9% 86%

Monitoring Signs and Symptoms

29.1% 63.6%

Ability to get to appointments (transport)

6.25% 77.7%

Confidence at appointments

2.08% 77%

Medication management

27% 88.23%

Pain 48% 91.6%

Integrating Self management into

assessment

HEALTH RELATEDBEHAVIOURDomain

Domain% of files that askedabout the domainPRIOR to the BNAtemplate

% of files that askedabout the domainWITH the BNA pilottemplate

Oral Health 17.0% 87.87%

Smoking 31% 88.57%

Client importance and confidence

Of the clients whoanswered yes tosmoking 7.1% askedabout clientimportance andreadiness to change

Of the clients whoanswered yes tosmoking 53% askedabout client importanceand readiness to change

Collaboration-Shared Learning's & expertise

The Frankston Mornington Peninsula Primary Care Partnership-had identified through a large catchment wide scoping activity that Assessment was an area its partnership would like to focus on

A proposal was put fourth that the work undertaken by Peninsula Health could be shared and further roll out could occur across the catchment for a more consistent approach to assessment could be