CPHA CONFERENCE

Strengthening Chronic Disease Prevention & Management

A Regional Pilot Project

OUTLINE

• Overview of CPHA Pilot Project• The Planning & Assessment Tool• Key Findings and Next Steps• The Cumberland Story

CAPACITY-BUILDING

•Organizational development•Workforce development•Resource allocation•Leadership•Partnership development

• Reference: A Framework for Building Capacity to Improve Health, NSW Health, 2001.

AIMS TO:

• Engage stakeholders in dialogue • Promote information exchange• Assess current policy, planning and

practice• Identify actions, roles and shared

responsibilities for strengthening prevention and management of chronic disease

CRITICAL SUCCESS FACTORS

1. Common Values and Shared Goals2. Focus on Determinants of Health3. Leadership, Partnership and Investment4. Public Health Capacity and Infrastructure5. Primary Care Capacity and Infrastructure6. Community Capacity and Infrastructure7. Integration of Chronic Disease Prevention and

Management8. Monitoring, Evaluation and Learning

METHOD/APPROACHEvidence-Informed

The Tool was developed through:Working with an expert advisory

committeeReview and synthesis of peer-reviewed,

indexed journal articles and grey literature

Key Informant InterviewsFocus GroupsPiloting in Four Health Regions

WORKSHEETS AND RATING SCALES

• Cues to help assess current capacity• Where are we now in our practice?• What opportunities are there to build

capacity/improve practice?

• Question with explanation/example• Rating scale with qualitative indicators

(0=nothing in place; 4=best/promising practice)

• Space for local indicators, notes

Chronic Disease Prevention and Management Continuum

Well Population

Primary Prevention

At Risk Population

Secondary Prevention

Established Disease Controlled Chronic Disease

•Surveillance of diseases & risk factors

•Promotion of healthy behaviours

•Creation of supportive environments

•Universal & targeted approaches

•Screening

•Case finding

•Periodic health examinations

•Early intervention

•Medication to control

•Universal & targeted approaches

•Treatment and acute care

•Complications management

•Self-management

•Continuing Care

•Maintenance

•Rehabilitation

•Self-Management

Health Promotion Health Promotion Health Promotion Health Promotion

Prevent movement to at-risk group

Prevent progressionTo established disease

Prevent progression to complications and/orhospitalizations

Tertiary Prevention

REGIONAL PILOT PROJECT

REGIONAL PARTNER SITES

Health Region Contact Position Location GeographicalRegion

Champlain Local Health Integration Network

Karen Patzer SeniorPlanner

Ottawa, ON Central

Cumberland District Health Authority

Camille Dumond Health Promotion Coordinator

Amherst, NS Eastern

Capital District Health Authority

Dr. Gaynor Watson-CreedWith Michelle Le Drew & Shannon Ryan

Medical Officer of Health

Halifax, NS Eastern

Five Hills Health Region

Dr. Mark VooghtWith Audrey O’Reilly &Karen Lehman

Medical Officer of Health

Moose Jaw, SK

Western

PROJECT OVERVIEW

• Engage Stakeholders, Pilot Tool, Track Learnings and Evaluate

• Identify four pilot sites• Provided process support• Partner to engage regional

stakeholders• Held workshops – orientation to the

Tool• Tracked site experiences using the

Tool• Facilitated learning exchange across

jurisdictions

WHAT DID WE LEARN?

SELECT FINDINGS

• Use of tool varied with each site and depended on context

• Flexible, multiple approaches• Complex, takes time• Process was as important as the Tool

itself• Learnings came from engagement at

project level and at the regional level• Participatory approach was key• Nature of engagement and support

provided helped to build capacity in different ways

HOW MIGHT THE TOOL BE USED?

Our CDPM JourneyOur CDPM Journey

Small CDPM Planning TeamSmall CDPM Planning Team Environmental ScanEnvironmental Scan Steering committee / Stakeholders – Steering committee / Stakeholders –

CPHA Orientation to ToolCPHA Orientation to Tool 2 Stakeholder Forums2 Stakeholder Forums Criteria and Priority SettingCriteria and Priority Setting Identified actions to move forwardIdentified actions to move forward

The CPHA ToolThe CPHA Tool

Common Values/ Health Goals Common Values/ Health Goals / Integration // Integration /

Determinants of HealthDeterminants of Health

Stakeholder ForumsStakeholder ForumsPovertyPoverty workshop workshop

(Multi-sectoral partners)(Multi-sectoral partners)

Indirect

Staff Groups, Staff Groups, Steering CommitteeSteering CommitteeHP Working Group HP Working Group

DirectDirect

Dialogue PotentialUnderstanding Validation Capacity Building

Poverty Reduction Poverty Reduction ForumForum

1.1. How aware are people of the link between How aware are people of the link between the social determinants of health and the social determinants of health and chronic disease? How do people see the chronic disease? How do people see the social determinants as informing social determinants as informing approaches to this work?approaches to this work?

2.2. What are some supports for taking a What are some supports for taking a social determinants of health approach to social determinants of health approach to addressing chronic disease in this region?addressing chronic disease in this region?

3.3. What are some of the barriers to taking a What are some of the barriers to taking a social determinants of health approach to social determinants of health approach to addressing chronic disease prevention and addressing chronic disease prevention and management?management?

Priority AreasPriority AreasReorienting Reorienting

Health Health ServicesServicesKey Strategy Key Strategy

Areas Areas

-Increasing -Increasing AwarenessAwareness

Knowledge Knowledge translationtranslation

Self Self ManagementManagement

Chronic Disease Chronic Disease Self ManagementSelf ManagementProvincial Provincial

Initiative SSMInitiative SSMPatient data – Patient data –

health passportshealth passportsHealth Care Health Care

providersproviders

Priority AreasPriority AreasCommunity Community

ActionAction

Workplace Workplace SettingSetting

Inter-sectoral Inter-sectoral Approach to Approach to SDOH / Health SDOH / Health Inequity Inequity reductionreduction

Information Information SystemsSystems

IT / IM Strategic IT / IM Strategic PlanningPlanning

Systems and Systems and Decision support Decision support ToolsTools

RedesignRedesign Linking systems for Linking systems for

information sharing information sharing across the systemacross the system

Moving Forward with Moving Forward with IntegrationIntegration

What is moving us forward?What is moving us forward? Increased awareness - concept of IntegrationIncreased awareness - concept of Integration

Connection with CD Accreditation standardsConnection with CD Accreditation standards

Overlapping Collaborating committees for Overlapping Collaborating committees for Self Management / Health Promotion Self Management / Health Promotion work/CCCPwork/CCCP

Opportunities - Self Management training in Opportunities - Self Management training in MarchMarch / / Promising Health Promotion Promising Health Promotion PracticesPractices

Moving Forward With Moving Forward With IntegrationIntegration

Transformation within Transformation within existing structures – CCCP existing structures – CCCP shift / IM srategic planningshift / IM srategic planning

Provincial / National supports Provincial / National supports – resources, strategies, – resources, strategies, training opportunitiestraining opportunities

Moving Forward With Moving Forward With IntegrationIntegration

Leadership Development and Leadership Development and SupportSupport

Building capacity - Strong / varied Building capacity - Strong / varied partnerships and commitment – partnerships and commitment – Community centre - SpringhillCommunity centre - Springhill

Health Promotion WG meeting Health Promotion WG meeting regularly (Multi layerd approach)regularly (Multi layerd approach)

Cumberland Health Authority Cumberland Health Authority Draft CDPMDraft CDPM

Support FrameworkSupport FrameworkNova Scotia Chronic Disease Prevention Strategy

Health Promotion Steering Committee (CDPM)Key Systems Level Stakeholders

Health Promotion Working GroupCollaborating Committee of Key (Intersectoral) Stakeholders

Cumb Collective Partnerships

Self Management Collaborating committee

Organizational Health / Workplace Coalition

Communications

Families Schools Workplaces CommunitiesHealthcare Settings

Social inclusion and Cultural Diversity

Holding us BackHolding us Back

• A solid strategy for introducing A solid strategy for introducing the tool and piloting – workplan the tool and piloting – workplan

• No provincial framework yetNo provincial framework yet• Lack of a Communication PlanLack of a Communication Plan• Understanding the Lay of the Understanding the Lay of the

Land – Integration pointsLand – Integration points• Awareness Building is Huge – Awareness Building is Huge –

needs to come firstneeds to come first

• Overlapping responsibilities - Time Overlapping responsibilities - Time Crunch – ie: Steering Committee – Crunch – ie: Steering Committee – More streamlined support structure More streamlined support structure Structure requiredStructure required

• Need to Build more capacity – tool Need to Build more capacity – tool should be usefulshould be useful

• Competing priorities – AccreditationCompeting priorities – Accreditation• Ruralness of the district – travel, Ruralness of the district – travel,

timetime

Learning re: Using Learning re: Using TOOLTOOL

CDPM Steering Committee – Values and RoleCDPM Steering Committee – Values and Role Communications is High PriorityCommunications is High Priority Need an Inventory of CDPM workNeed an Inventory of CDPM work Develop a working group and plan for using Develop a working group and plan for using

ToolTool Tool is an extremely useful catalyst Tool is an extremely useful catalyst Potential to adapt / use tool with for Potential to adapt / use tool with for

integration of other priority areas - Cultural integration of other priority areas - Cultural Diversity and SI discussions – ie: Common Diversity and SI discussions – ie: Common ValuesValues

CDPM work needs bilateral movement of ideasCDPM work needs bilateral movement of ideas

Next StepsNext Steps

Taking a step backTaking a step back Developing the bigger frameworkDeveloping the bigger framework

Strategic plan / evidence / standardsStrategic plan / evidence / standards Integrating priority goals and Integrating priority goals and

objectivesobjectives Healthy Discussions – knowledge Healthy Discussions – knowledge

exchangeexchange Increasing awareness of what Increasing awareness of what

“integration” might look like“integration” might look like Looking at the Lay of the land – Looking at the Lay of the land –

integration points and alignmentintegration points and alignment

What will be KeyWhat will be Key Maintain Balance - Prevention with Maintain Balance - Prevention with

ManagementManagement Restructuring – system support and Restructuring – system support and

relationship buildingrelationship building Maintain focus on Stakeholder Priorities – in Maintain focus on Stakeholder Priorities – in

work-planswork-plans Continued Communication and EngagementContinued Communication and Engagement Use evidence to support Decisions and Use evidence to support Decisions and

RedesignRedesign Continue to Focus on theContinue to Focus on the Critical Success Critical Success

FactorsFactors