Introduction to Concepts - Queensland Health...Introduction to Concepts - Chronic Disease Care 4...

Introductionto ConceptsChronic Disease Care

Participant Manual

Introduction to Concepts - Chronic Disease Care Version1 (2014)

IN2300 Chronic Disease Care

Name

Community

Site

Position

Date Completed

Introduction to Concepts - Chronic Disease Care Version1 (2014) 2

Contents

IN2300 Introduction 3IN2300 Chronic Disease Pre-Session Survey 5IN2301-1 Introduction 6IN2301-1 Learning Activity 11IN2301-2 Aboriginal and Torres Strait Islander Health 14IN2301-2 Learning Activity 19IN2302-1 Screening 21IN2302-1 Learning Activity 24IN2302-2 Prevention Strategies - Brief Intervention 25IN2302-2 Learning Activity 28IN2303-1 Self Management - Introduction 30IN2303-1 Learning Activity 35IN2303-2 Self Management Strategies 36IN2303-2 Learning Activity 39IN2300 Theory to Practice Activity 40IN2300 Quiz 44IN2301-1 Learning Activity Feedback 47IN2301-2 Learning Activity Feedback 49IN2302-1 Learning Activity Feedback 51IN2302-2 Learning Activity Feedback 52IN2303-1 Learning Activity Feedback 53IN2303-2 Learning Activity Feedback 53IN2303 Theory to Practice Feedback 55IN2300 Quiz Feedback 58IN2300 Chronic Disease Post-Session Survey 61IN2300 References 62


IN2300 Introduction

Session Overview

This session discusses the burden of chronic disease in Australia and examines the health of Aboriginal and Torres Strait Islander populations. It reviews and discusses preventative strategies for chronic disease including screening and brief intervention and introduces chronic disease self-management and discusses strategies that support clients to manage their health.

Introduction

“In Australia … chronic disease is a major contributor to the burden of disease. Factors contributing to this increasing burden of disease include an ageing population, increasing prevalence of lifestyle and behavioural risk factors, improved survival from advances in treatment and an increased prevalence of some chronic diseases.

The burden of chronic disease is shared unequally across the population. People in low socioeco-nomic circumstances, Aboriginal and Torres Strait Islander peoples, and people from culturally and linguistically diverse backgrounds and people from rural and remote areas have higher levels of disability, morbidity and mortality from chronic disease, compared to the rest of the population.

Learning Objectives

On completion of this session participants will be able to: •Define the key terms related to chronic disease• Identify the problems contributing to the burden of chronic disease in Aboriginal and Torres Strait Islander populations•Discuss the benefits of routine screening in vulnerable populations•Discuss brief intervention•Describe the stages of change and how this impacts on health behaviours•Discuss chronic disease self-management• Identify strategies for supporting chronic disease self-management


Modules

1. Introduces chronic disease and discusses the burden of chronic disease on the health system.

2. Discusses Aboriginal and Torres Strait Islander health including the factors contributing to the increased burden of disease for these populations

3. Introduces screening and discusses the benefits of routine screening in vulnerable populations

4. Introduces brief intervention and discusses its benefits in preventive health

5. Introduces the concept of chronic disease self-management and discusses the characteristics of an effective self-manager.

6. Reviews and discusses chronic disease self-management strategies

Pre-Session Survey

Before you commence, we ask you to complete a quick survey to identify current knowledge base. This will provide a baseline you can refer to once you have completed this topic.

Quiz

Once you have completed the modules in this topic, you are asked to complete an interactive quiz which is graded. You can review your results and complete the quiz as many times as you like until you feel you have mastered the topic.

Post Session Survey

When you have completed this session, we ask you to complete another quick survey to determine if we have met your learning needs.

Certificate

The final section is the completion of a personalised certificate which provides evidence of your training. If you complete this course using the manual only, you will need to email it to [email protected]. Your certificate will be issued on receipt of the completed manual. Included on this is the average time the session takes which can be used for professional development points.


IN2300 - Chronic Disease Pre-Session Survey

Before you commence this session we ask you to take a few moments to complete the pre-session survey for this topic. This will give us some indication what your learning needs might be.

At the end of this session we will also ask you to complete another survey to see how well we have met your needs.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I can define the key terms related to chronic disease

I can identify the problems contributing to the burden of chronic disease in Aboriginal and Torres Strait Islander populationsI understand the benefits of routine screening in vulnerable populationsI understand the concept of brief intervention and can describe the stages of change and how this impacts on health behaviours

I understand the concept of chronic disease self-management

I am aware of strategies for supporting chronic disease self-management

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IN2301-1 Introduction

Learning Objectives

On completion of this module learners will be able to:

•Define the key terms related to chronic diseases•Discuss the problems contributing to the burden of chronic diseases •Utilise strategies that will assist in reducing the causes of chronic diseases

Key Concepts

The key concepts associated with chronic disease will be explored in detail in this unit include:

•Chronic disease•Determinants of health•Preventable diseases•Chronic Disease Strategy•Primary health care•Comprehensive primary health care

Chronic Diseases

Chronic diseases are:

•Diseases that require ongoing management over a period of years or decades. They have a gradual onset with ongoing deterioration•Chronic diseases occur across the lifespan, so are more prevalent in older age. Age is the greatest risk for chronic disease•Chronic diseases have long term effects on quality of life including physical limitations, disability and social and emotional well being

Queensland Health (2007) Chronic Disease Guidelines 4th edition 2010 pp.1-3 WHO (2002) Innovative Care for Chronic diseases

Chronic diseases are caused by multiple complex inter-relating causes and the determinants of health. Some examples of chronic diseases are:-

•Diabetes•Renal disease•Cardio-vascular disease, including hypertension•Depression•Asthma•Sexual health diseases


Determinants of health

1. Determinants of health include:

Social, economic and environmental factors e.g. living conditions, working environments, education, income, food quality, water and air quality, social support, age, geographic location, ethnicity

2. Health behaviours and risk factors which contribute to the development of chronic disease include:-

•Smoking•Poor Nutrition•Risky Alcohol drinking • Lack of Physical activity •Unsafe sex •Poor social and emotional health •Poor early life health determinants

These risk factors are often referred to as SNAP or SNAP + (the + including mental health and sexual health)

The Data

The burden of Chronic disease in Australia is becoming unmanageable.

In 2007 2.5 million Australians had a chronic disease which are the leading cause of hospital admissions and preventable deaths. Chronic disease care consumes 70% of the health budget.

By 2016 it is projected that 3.5 million Australians will have a chronic disease and by 2030 entire state budgets will be consumed by chronic diseases (Battersby, 2008)

10% of Australian children 0-14 years had three or more long term conditions.

There is a belief that the children of today will have a shorter lifespan then their parents if factors leading to the development of chronic diseases are not addressed now.

The burden of chronic disease increases to more than 80% for those aged 65 years and over.

More than half of all GP consultations in Australia are with people with a chronic condition.

Chronic care consumes 70% of the health budget.

Unless addressed entire state budgets will be consumed by chronic diseases by 2030.


What is the problem?

A study by the Australian Institute of Health and Welfare (AIHW) on Chronic Diseases and AssociatedRisk Factors in Australia 2006, AIHW: Canberra. found: [1]

•More than 91% of adults are not consuming enough vegetables•One in two adults are not getting enough physical activity•Almost 50% of adults are not consuming enough fruit•About 21% of adults smoke tobacco•Compared with major cities, regional Australia experienced higher prevalence of many of the risk factors for chronic diseases, such as:

- higher rates of smoking- excess weight- higher death rates from - coronary heart disease, - chronic obstructive pulmonary disease - diabetes

The least advantaged areas of Australia have higher levels of smoking, physical inactivity and obesity.

They experience higher prevalence of diabetes, behavioural problems, asthma, heart disease and arthritis, and have higher mortality across most chronic diseases.

Aboriginal and Torres Strait Islander people have the highest chronic disease rates in Australia.

Others at greatest risk of developing chronic disease are older Australians and people with mental illness and physical and intellectual disabilities.

Message

An important message for all health service providers is that

“When the health problems are Chronic the acute practice model doesn’t work”Wagner EH 1998


Biomedical approaches

The focus of care and the health budget is on the acute medical needs of the patients which in many cases is expensive and does little to fix the cause of the disease. This includes interventions and treatments such as dialysis, coronary and bypass surgery of those with an existing chronic disease.

There is also the added out of pocket costs to the patient, such as travel and medications, along with inconvenience and lose of income.

There is a need to reorient health care towards prevention strategies because prevention in the long term is more cost effective. For example health promotion and early detection in the well or at risk population can detect chronic diseases in early stages and decrease morbidity and mortality through ealry interventions.

Acute model of care

Added to the problem of high costs associated with secondary and tertiary levels of care, is the way in which chronic disease care has been managed in the past.

Normally a person suffering from an exacerbation of their chronic disease would present to a hospital and receive potentially expensive short term treatment.

They would be discharged when they are stabilised with little being done to ensure the disease was better managed over a longer term.

A different approach is needed – health services should be identifying and responding to risk factors long before chronic disease develops and once developed, it needs to work with the clients to manage their disease and ensure they remain as healthy as possible for as long as possible.

What can we do?

In order to reduce the incidence of chronic disease, the focus of care should be widen to ensure it is not just acute care that is being provided.

Chronic disease care should be approached across the domains of prevention, early detection – including management of risk factors.

It is also important to ensure appropriate ongoing management once a chronic disease has developed.

The focus needs to be on the causes of illness not just on illness management.


A thought ...

“The mark of a good primary health care service is not only how it cares or those who seek them out, but how it cares for those who don’t.”World Health Organisation

Remember the whole population is your target group, not just the sick population.


IN2301-1 – Learning Activity

1. What are the main chronic diseases or risk factors in your community?

Feedback

2. How can you or your profession contribute to?

1) Promoting wellness? Feedback


2) Preventing Chronic Disease?

Feedback

3) Early detection?

Feedback


4) Chronic disease management?

Feedback


IN2301-2 – Aboriginal and Torres Strait Islander Health

Learning Objectives


•Discuss Aboriginal and Torres Strait Islander health issues•Discuss of factors contributing to poor Aboriginal and Torres Strait Islander health•Discuss the Close the Gap priorities and how these can be addressed in Primary Health Care

Health Status

When compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander Australians:

•Have a lower life expectancy, dying on average 10 years earlier•Are more likely to die as a baby•Have greater difficulty accessing health care•Carry a greater burden of chronic disease•Are 2-4 times more likely to be hospitalised

Inequalities in Health

Although the burden of chronic disease in Queensland is great, Aboriginal and Torres Strait Islander people carry an even greater burden.

90% of presentations to rural and remote health services are related to chronic disease.

A large number of Aboriginal and Torres Strait Islander Australians live in rural and remote areas.

Some jurisdictions have shown slight reductions in mortality in recent years along with declines in infant mortality.

While mortality rates have improved, birth weights still remain about 200g less than birth weights of babies born to non-Indigenous mothers.


Contributing factors

Slightly more than 50% of Aboriginal and Torres Strait Islander people live in cities and towns, with around 25% living in areas classified as ‘remote’ or ‘very remote’.

The poor health status of Aboriginal and Torres Strait Islander people is impacted by social, environmental and economic factors which is made worse by a lack of access to health care services.

This includes:

1. Housing and the physical environment•Substandard living conditions are characterised by overcrowding, inadequate water and washing facilities, •Poor sanitation and sewage disposal, limited food storage, and poor food preparation facilities

2. Education

Aboriginal and Torres Strait Islander people reported:• 17% completed year 12 or equivalent compared to 38% of non-Indigenous population• <15% had a post-secondary school qualification compared to 35% of the non-Indigenous population•

3. Employment and income

•Unemployment rate for Indigenous males was 22% and for females 18%, compared to non- Indigenous rates of 7.7% and 6.5%.•Excluding those employed under Community Development Employment Program (CDEP) this rate would increase to around 34%•The median weekly family income for Aboriginal and Torres Strait Islanders was $630 compared to $1188 for non-Indigenous

(Couzos & Murray 2008)

Areas of health concern

The leading causes of disease burden in Aboriginal and Torres Strait Islander peoples include:

•Cardiovascular disease 18%•Mental disorders 16%• Intentional and unintentional injuries 13%•Chronic respiratory disease 9%•Diabetes 9%

With 65% of people reporting at least one long term condition in the 2008 Australian Institute of Health and Welfare report.


Health beliefs

Health beliefs form the basis for what we think cause ill health and the impacts ill health has on our lives. These beliefs are embedded within social and cultural contexts.

Family, extended kinship, community, and connections to land, past and culture are prominent within Aboriginal and Torres Strait Islander health beliefs.

Socioeconomic disadvantage alone cannot be used as an indicator for increased risk for a chronic illness. A community in the Northern Territory that is connected to culture, family and land and that has the opportunity for self determination is able to demonstrate significantly lower risk factor prevalence, including reduced impaired glucose tolerance, smoking in men and hypercholesterolaemia.(Rowley, O’Dea et al 2008)

Individual, family and community systems need to be considered when addressing individual risk factors, such as diet and exercise.

Having an understanding of the meaning of what is being recommended is important.

For example, exercise based interventions could focus on sport and everyday activity rather than individual based activities.

Reading IN2102-1 Health Beliefs (appendix 1) provides more information.

Closing the gap

The National Partnership Agreement on Closing the Gap (CTG) on Indigenous Health Outcomes and identified five (5) key outcome areas.

1. Child and maternal health2. Address chronic disease factors through adult health checks;3. Improve chronic disease management and follow up care;4. Workforce expansion and support5. Address smoking rates


Addressing CTG priorities

The Chronic Disease Strategy in rural and remote Queensland addresses the CTG priorities across the lifespan.

Maternal health and antenatal care is an important component of a program to address the health of Aboriginal and Torres Strait Islander peoples.

Ideally antenatal care will start in the first trimester and involve at least four visits.

Child health checks are recommended at each immunisation visit and health check forms are available for each check from 1-6 weeks to 5-14 years.

Adult health checks provide evidence based screening and are available for 15-54 years and 55+ years. The screening tests and age for screening are based on population level risk.

With increased risk, for example a family history of diabetes, there may be a need for earlier or more frequent screening.

The aim of primary health care is to keep people well. By identifying risk factors for chronic disease early, they can be addressed early, hopefully preventing progression or cause of a chronic disease. For example, if hyperlipidaemia or high blood pressure are treated early, further progression of cardiovascular disease, or renal disease may be prevented.

Once a chronic condition has been identified, the Chronic Disease Guidelines (and many other evidence based guidelines) provide management protocols to manage the conditions.

This may involve follow up checks e.g. blood pressure, long term medication use and referral to other team members or specialists.

The referral to other providers may involve visiting teams in the community, or travel to larger centres. A population register and recall system, can assist in planning this care and following up on how well patients are managed.

Providing continuous quality improvement in primary health care by auditing clinical records, results interpretation and feedback, and action planning in a twelve month cycle, which will also assist in addressing these priorities.


Addressing the CTG priorities continued

Workforce development requires significant investment from both the employer and the employee in order to support closing the gap. The PaRROT program is an example of a workforce support program to assist in the orientation and training of those providing services in rural and remote PHC centres. This program can be used in conjunction with other online and District based orientation and clinical education and training.

While CTG specifically address smoking as a major risk factor, poor nutrition, alcohol misuse and lack of physical activity are also risk factors for the development of chronic disease.

These can be addressed firstly by asking the patient about them, then if required, providing a brief intervention based on the patients stage of change related to the risk factor.


IN2301-2 Learning Activity

1. Patrick is an experienced remote area nurse, leading a multidisciplinary outreach team whose main role is managing clients with diagnosed chronic conditions in small Aboriginal communities in Queensland. He feels the approach of the team is not having any impact on clients’ health and wants to review the service delivery model. He has spoken to the leaders and health team in one community who are happy to lead discussions and trial a different service model. What things should the team be considering in tackling the issue of poor health in the community?

Choice Tick

History of the Aboriginal and Torres Strait Islander population

Racism

Poverty and social class

Income and social capital

Education

Employment and welfare

Relationship to country

Housing

Policy processes

Human rights issues


2. How could the team change its approach to better manage the poor health of the community?

Choice


IN2302-1 Screening

Learning Objectives


•Discuss the rationale for adult and child screening•Define the relationship between screening and health checks•Discuss the benefits of screening in at risk populations

Rationale for Screening

Routine screening has been identified as an important strategic approach in rural and remote and Aboriginal and Torres Strait Islander population in response to:

•Poor health of individuals•Poor Health of the population. •Higher than average infant mortality rate, •Decreased life expectancy •Greater burden of chronic disease

Screening & Chronic Disease

Screening is an important process in the preventative approach to Chronic Disease. It allows health practitioners to:

•Monitor a child’s growth•Monitor individual health status • Identify risk factors and existing health problems •Respond to risk factors early to prevent the development of chronic disease

Health Checks

Health checks have been demonstrated to improve the frequency of preventive care and support for behaviour change.

They focus on specific evidence based preventive actions and involve the use standardised resources such as Lifescripts and integrated health risk assessment tools.

The Chronic Disease Guidelines Health Checks are an example of an integrated health assessment developed specifically for a vulnerable population.

(Harris 2008)


Well persons and well child health checks are an essential component of chronic disease care.

They are an effective strategy for prevention of chronic disease. They are recommended for screening of all adults and children in rural and remote and Aboriginal and Torres Strait Islander populations.

The aim of the checks is to identify the early markers for the development of chronic conditions which, if left untreated are likely to result in the development of chronic disease.

Health Checks are compiled and developed based on Medicare mandatory requirements and are linked to Medicare Items.

They are also based on recommendations by:

•Office of Aboriginal and Torres Strait Islander Health•Queensland Aboriginal and Torres Strait Islander Health Council•Royal Australian College of GP’s - General Practitioners• Local stakeholders (Health Workers, Registered Nurses, Medical Officers and Specialists)•National and international standards, research and quality evidence reviews.•Conducting and collecting information from screening programs provides important information on the health of the individual and the population.

Chronic Disease Care

Health checks are part of a three tiered approach to Chronic Disease Care. They are used in conjunction with brief intervention which raise awareness of and provide support for the management of risk factors.

And chronic disease self-management programs, which empower the individual to take control of their health.


Summary

Health checks are part of three tiered approach to holistic chronic disease care.

The well child and adult health checks provide a means to individually screen adults and children.

Conducting routine screening enables a health service to collect population data which can be collated and used to identify population health issues and assist with the planning of health services.

Considerable research has identified that routine screening of “high risk” populations is an effective approach in the prevention of chronic disease.

Clinicians working in rural and remote areas with “high risk” populations are encouraged to conduct regular screening programs.



Which of the following statements are correct?

1. Routine screening is an important strategic process which

Tick Choice

Monitors a child’s growth

Monitors and individual’s health status

Identifies risk factors for the development of chronic disease

Identifies current health issues

Provides information on population health

2. Which of the following factors impacts on a person’s health?

Tick Factor

The environment

Genetics

Socioeconomic factors

Social and cultural factors


IN2302-2 Prevention Strategies - Brief Intervention

Learning Objectives

On completion of this module participants will be able to:

•Define Brief Intervention•Discuss the stages of change• Identify the 4 steps to brief intervention•Discuss the SNAPE process and brief interventions associated with them

Brief Intervention

Brief Intervention is the provision of tailored health education when risky health behaviours are identified.

The intention is to not attempt to change client behaviour but to provide information from which they can make an informed decision about their behaviour

Brief intervention is the second of three components of chronic disease care.

It is often provided as part of routine screening including health checks.

It can also be utilised at any time of an interaction with clients including presentations for acute or other interventions.

States of Change

It is important for the health practitioner to understand the stages of change before they start practis-ing brief intervention. The five stages are:

•Pre-contemplation - a person is not concerned about their behaviour and are not thinking about changing•Contemplation - an individual is unhappy but undecided about their behaviour but they are actively thinking about changing•Action - A person is concerned about their behaviour and has made a lifestyle change.•Maintenance - Change has been made and the individual is attempting to maintain the change.•Relapse - A normal part of the change process. A person has returned to previous behaviour or dropped the new healthy behaviour.


Steps to Brief Intervention

Effective brief intervention follows a series of steps including:

1. Assess the need. This should be done opportunistically with any client encounter. An ideal opportunity is for inclusion as part of the normal health check when risk factors are assessed.

2. Determine a client’s readiness for change by identifying risk factors that may be causing concern for the client e.g. asking “How do you feel about your smoking?”

3. Match the intervention to the client’s stage of change. E.g. if the client is not concerned about their smoking, give some basic information on smoking and leave it at that. If the client is concerned, give information on ways to quit.

4. Carry out the intervention – suggestions are included in the health check guidelines.

Health Damaging Behaviours

Brief intervention programs and resources focus on the major health damaging behaviours including tobacco smoking, poor nutrition, alcohol misuse, physical inactivity and emotional wellbeing.

The SNAPE framework provides the basis for brief intervention – with a number of resources developed to support this brief intervention.

Tobacco Smoking

Brief interventions that can be used for tobacco smoking include:

•Using the decisional balance tool in the Chronic Disease Guidelines – Section 5 Adult Health Check – Alcohol Tobacco and Other Drugs•Queensland Health - The SmokeCheck program•Queensland Health - The Quit Campaign•Flinders Closing the Gape – Living Well Smoke Free•Other Quit programs available in other states

Poor Nutrition

Information on brief intervention for poor nutrition can be found in the Chronic Disease Guidelines.

Other useful tools can be found at the websites below:

http://www.eatforhealth.gov.au/

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-guide-guide2.htm

http://www.eatforhealth.gov.au/




Alcohol Misuse

Brief intervention which can be used for Alcohol Misuse include: Tips for easing up on grog in the Chronic Disease Guidelines.

Using the standard drink guide in the Chronic Disease Guidelines and also available from the websites below:

Standard Drink Guide: View PDF [12] More information can be found at: http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/home

Physical Inactivity

Brief interventions for physical inactivity include the brief intervention guide included in the Chronic Disease Guidelines – Adult Health Check – Physical Activity section

More information can be found at the following website:

http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guide-lines

Social and Emotional Status

Social and emotional brief intervention should only be provided for minor concerns about an adult or child – more information is available in the Chronic Disease Guidelines 3rd edition, 2010.

Moderate or serious concerns for the client needs to be referred to the social and emotional health team.

Lifestyle Modification Chart

The Chronic Disease Guidelines provides more information on Brief Intervention including:

•The Lifestyle Modification Chart on the back cover• Information included in section 5 – Adult Health Check

http://www.health.qld.gov.au/cdg/docs/cdg_drink_guide.pdf%20or%20http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/36E6FEE732C8DF1BCA25767200769CD8/%24File/adult.pdf

http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/home

http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/home

http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

http://www.health.qld.gov.au/cdg/html/cdg_resource.asp



1. Mary is a 20 year old living in Riverville. When you do her well adult health check, you discover she is 3 months pregnant and smoking 20 cigarettes a day. What question would you ask to determine her stage of change?

Answer

2. When Mary answers your questions you find she is at the contemplation stage of change – what action will you now take?

Answer


3. How can you support Mary to make the changes?

Answer

4. How can you support Mary to maintain the changes?

Answer


IN2303-1 Self Management - Introduction

On completion of this module participants will be able to:

•Discuss the concept of self-management• Identify strategies for supporting chronic disease self-management• Implement strategies for supporting chronic disease self-management

Defining Self-Management

Self-management is the ability to manage one’s life . Everyone manages their lives, but some do it better than others.

Central to the idea of self-management is an individual’s wants and needs. This is why it is called self-management – not health management!

Health management is perceived as an absence of illness and is measured by how well an individual is eating, taking medicines, or exercising.

Self-management is when an individual identifies priorities and identifies how they will meet their priorities, this assists with health management.

Chronic disease is a good example of this. Individuals with chronic disease need to understand it will not be cured, and they need to factor the management of the condition into their life management.

Effective self-managers

An effective self managers is someone who:

•Asks questions which keeps informed about their condition and various treatment options• Is involved in the decision making with their general practitioner and other health professionals•Follows the care plan agreed upon with health professionals, e.g. taking medications, exercising, going to the doctor and changing diet•Monitors symptoms associated with their condition and informs their health care team about problems and changes•Maintains the things that are meaningful to them. This may mean adapting to different ways of doing things, but still carrying on normal activities to the best of their ability•Manages the emotional ups and downs as a natural path we all have•Tries new things and gives them a fair trial•Sets goals and work towards them• Lives a healthy lifestyle!


Self-Management approaches

Self-management can be supported through the use of tools or existing programs including.

•Flinders Closing the Gap – Chronic Disease Self Management Program•Self-management courses developed by Stanford University. These courses are run in conjunction with Arthritis Australia.

- They are 6 week, 2 hour a week courses, run by two leaders (preferably a health professional and a lay leader). - These courses give participants the opportunity to learn and practise skills to do with effective self-management.

•Community-based rehabilitation teams have used self management principles in setting up new programs.

- One local example is pulmonary and cardiac rehabilitation groups in which goal-setting and action plans are part of the education series. - Participants are asked to set goals weekly and report back their successes. - This ensures that the group participants always understand that they are responsible for their health, and that we are all working together to improve health

• Incorporating self-management into professional practice when working one-on-one with individuals.

- The main focus of working with self-management is working in partnership with clients. - The self-management approach encourages health professionals to refocus their client encounters from ’giving advice and prescriptions’ kind of approach to a ’discussing options and making a plan together’ approach.

Self Management Strategies

Self-management strategies incorporate:

• Individual management (with health care provider as facilitator):- agenda setting- motivational interviewing- health education- coaching- information technology directed education- personal guidelines, e.g. symptom action diaries- care plans

•Group management- peer support groups, e.g. exercise, dieting and lay person led groups (Stanford Model)- condition-specific groups, e.g. Arthritis Foundation groups


Agenda Setting

Agenda setting is an effective first strategy in supporting self-management. This can be a relatively easy process – and the key is in the question!

The agenda is set by asking questions such as :

•What would you like to discuss today•Do you feel there is a need to make changes to any behaviours e.g. smoking, diet, exercise•Do you feel there is a need to change your diet•Do you think you are ready to reduce or give up smoking• I know most people understand about the need to exercise, but how important is it to you•How confident are you about taking your medications

Motivational Interviewing Motivational interviewing is a counselling technique for eliciting behaviour change by helping the cli-ent explore and resolve ambivalence about change. The health professional seeks to:

•Express acceptance and support•Elicit and reinforce the client’s own statements about the problem, concern, desire and intent to change and ability to change•Monitor the client’s degree of readiness to change and ensure resistance is not generated by ‘jumping ahead’ of the client•Accept the client’s freedom of choice and self-regulation

It will not always be appropriate to use motivational interviewing. For example, a person may be do-ing well with an action plan, or someone is not ready to change anything.

It is often best to rely on professional judgement of the situation.

The key concepts of motivational interviewing are to:

• create awareness and explore ambivalence• be aware of and be guided by resistance• create awareness of differences between behaviour and goals• discuss change including the ‘pros’ and ‘cons’ of change versus not changing• explore self-efficacy and confidence in achieving goals


Motivational interviewing questions include questions like:

•What do you think you need to do in order to improve your health?• Is that something you are prepared to work towards?•What could you do to make a small change in that direction?•How would you feel about yourself if you were to do this?•How might your quality of life change?

Goal Setting

It is usually appropriate to set a goal at the end of a session. When setting a goal with a client it is important to make sure that it is something the client wants to do.

A simple way to have effective goal-setting is to remember that a goal must be SMART:

Specific when the goal is clear• not specific, e.g. I think I might start walking a bit more• specific, e.g. I will walk 3 times this week for 10 minutes each time

Measurable when the goal is easily measured• not measurable, e.g. I will try to eat more vegetables•measurable, e.g. I will eat two servings of vegetables every day this week

Attractive because the client wants to do it.• not attractive: My doctor says I should stop smoking, so I will try that (something the doctor wants – NOT the client!)• attractive: I will read the pamphlets I have been given about stopping smoking (something the client is ready for)

Realistic , the client is confident that he/she will achieve the whole goal.• not realistic: someone starting exercise for the first time and planning to run 5 kilometres every day• realistic: someone starting exercise for the first time and planning to walk 10 minutes daily for a week

Time-framed when the time frame for achieving the goal is clear• not time-framed: I will try to start walking soon• time-framed: I will start my walking program on Thursday


Other top tips for goal-setting

• the goal is something the client wants to do•write the goal down• have a way to monitor progress• rate the client’s confidence in achieving the goal • rate the client’s importance level, i.e. how important it is to achieve the goal. Good for motivation!•make a time to check in about the goal.

Action Planning

An action plan developed in partnership between the health profession and client, assists client to achieve their goal. They include:

• Identifying ways to achieve goals, e.g. for an exercise goal, riding a bike, walking or playing basketball• Identifying the steps needed. For example, for a quit smoking goal, cleaning out the ash trays and putting them away•Preparing client . For example, for a diet goal, may include buying vegetables at the shop on Friday•Things that will help clients achieve goals. For example, tell the family, ask a friend to join in and write a note on the fridge•Things that could be said to help achieve goals. Clients will have their own words to motivate themselves

Health Education

Health education is not just a matter of ‘telling’ people what they ‘need to know’. Rather, it is any combination of learning experiences designed to facilitate voluntary adaptations of behaviour ben-eficial to health. Either with individuals or groups, the focus of health education must be on skills enhancement to facilitate informed decision-making.

Health education strategies include but are not limited to:

• formal or informal teaching• giving clients pamphlets containing information on their health conditions• using the media to give out health messages• conducting healthy cooking demonstrations• organising ‘green food’ programs in stores• assisting new mothers to continue breastfeeding



1. Match the component with the definition using the SMART way of setting goals

Component Choice Definition

1 Specific Time frame for achieving the goal is clear

2 Measurable Client is confident they can meet the goal

3 Attractive Client wants to achieve the goal

4 Realistic Goal is easily measured

5 Time framed Goal is clear


IN2303-2 - Self Management Strategies

Learning Objectives

On completion of this session participants will be able to:

• Identify some chronic disease self management strategies that could be adopted in care provision•Discuss appropriate tools or strategies for use in chronic disease self management

Introduction

There are a number of strategies that could be adopted to support self-management.

The previous module discussed some of these.

This module introduces commercial tools and resources that can be utilised to support self management

Flinders Program

Flinders model of chronic condition self management has a generic set of tools and processes that enables clinicians and clients to undertake a structured process to chronic disease self-management.

It supports assessment of self-management behaviours, collaborative identification of problems and goal-setting, leading to the development of individualised care plans.

Indigenous specific tools include:

• ‘My Health Story’ – a booklet clients use to identify their goals, strengths and challenges, a means of recording their journey and a care plan for use in partnership with a health provider.• Living Well Smoke Free – a tobacco management care planning tool kit

More information is available on the web site - http://www.flindersclosingthegapprogram.com

http://www.flindersclosingthegapprogram.com


Stanford Model

The Stanford Chronic Disease Self-Management Program is often referred to as the Lorig or the Arthritis Foundation model.

This model of self-management is held over six weeks in a group setting and covers topics such as:

• techniques to deal with problems such as frustration, fatigue, pain and isolation• appropriate physical activity for maintaining and improving strength, flexibility and endurance• appropriate use of medications• effective communication with family, friends and health professionals• nutrition•methods for evaluating new treatments

http://patienteducation.stanford.edu/programs/cdsmp.html

Health Coaching

Health coaching uses evidence-based principles and techniques from health psychology and coaching psychology to assist clients to achieve positive health and lifestyle outcomes through attitude and behaviour change.

It embraces the notion that health behaviour change is an individual process that people must work their way through.

Each person’s change process will require different interventions.

It also incorporates fundamental cognitive changes in order to change their health behaviours.

Health coaching helps people with areas of their lives they have control over.

It does not tell the client what to do, but helps the client to work through barriers to make positive health change that they identify.

More information can be found at www.healthcoachingaustralia.com

http://patienteducation.stanford.edu/programs/cdsmp.html

http://www.healthcoachingaustralia.com


Self Management Plans

All secondary prevention tools and chronic disease care plans include areas for documentation of actions for good health.

Self-management plans include objective measurements for symptom control such as blood glucose levels (BGL) or peak flow are effective in helping clients manage their conditions.

This has been found to work particularly well in clients with asthma, diabetes and chronic obstructive pulmonary disease (COPD).

Diary

Keeping a diary helps clients know when, how much and in what situations their symptoms change.

These are most effective when used in combination with client action plans.

Diaries can be used as a record for review by health professionals.

Diaries have been used effectively by people with diabetes or asthma often use diaries to keep track of their symptoms.

Telephone Coaching

Telephone coaching applies the principles of support and counselling using the telephone.

Emails and SMS can also be used to provide clients with chronic conditions with support and advice.

This method has been used for clients with coronary heart disease and has been found to significantly lower cholesterol after six months.

The COACH program and Quitline are an evidence based, telephone delivered program for people with cardiovascular disease or who want to quit smoking.

• Information on COACH can be found at qheps.health.qld.gov.au

•The Quitline 13QUIT (137848) is available 24 hours 7 days a week - www.health.qld.gov.au

Personal Health Record

The Managing well…Staying well, personal health record is available for people with chronic disease to assist in goal setting and action plans.

An A5 hand held wallet can be ordered via Fax 07 38660292, email [email protected] or available online at www.health.qld.gov.au

http://qheps.health.qld.gov.au

http://www.health.qld.gov.au

mailto:bookshops%40sds.qld.gov.au?subject=Personal%20Health%20Record

http://www.health.qld.gov.au


IN2303-2 - Learning Activity

1. Which, if any, chronic disease strategies have you utilised in the provision of care for clients with chronic disease?

Feedback

2. What reason, if any, have you for not utilising these strategies?

Feedback

3. What strategies would you consider utilising, and why?

Feedback


IN2300 - Theory to Practice Activity

Please read the scenario and complete the questions.

Scenario:

Ruby is a 43 year old Aboriginal woman who has presented recently at your centre for a check-up. She is the mother of 4 children ranging in age from 5 years to 15 years. After the birth of each child she has put on weight that she has been unable to lose.

At her last adult health check screening her weight was 83 kg and her BMI was calculated to be 31. Ruby’s blood pressure was also slightly elevated at 140/90. She says as she gets older she is finding it harder to keep up with her children.

Ruby has a busy life, she works part time in office administration and is fairly heavily involved with sporting and school based activities for her children, spending many hours a week and most of the weekend volunteering to raise money or run events. Her partner, Ted works full time in road maintenance, and often travels away from home for work. Ruby considers herself a ‘social’ smoker and drinker, which means she has one or two cigarettes with the three standard drinks she has every Friday evening or at occasional social gatherings.

1. What questions could you ask Ruby to ascertain her readiness for change?

Choice


On interview you find she is very motivated to make changes to her lifestyle. She feels her weight is having an impact on her mobility and energy levels and thinks it is the main reason why she can’t keep up with her children. Ruby also states she is concerned about getting coronary artery disease which debilitated both her mother and aunt in their late 40s.

She says she has considered losing weight but finds it hard to stick to a diet and really doesn’t have time to prepare special food for herself. She admits it is quite difficult to make changes as her husband is often away and she is too busy playing the role of mother and father to really think about it.

She also understands the impacts smoking may have on health, but is not too concerned about this at the moment as she doesn’t smoke very much and is usually when she is having a drink to unwind.

2. Complete the table overleaf (see Chronic Disease Guidelines 3rd edition 20101 Section 7 – Management of Diagnosed Conditions) outlining the self-management strategies you might discuss with Ruby.


Target Strategy Tools

Lifestyle Modification and Education

Weight reduction

Nutrition education

Increased physical activity

Smoking cessation support

Alcohol use education

Overall health management


2. What else could you do to support Ruby? Feedback


IN2300 - Chronic Disease Quiz

1. Which of the following statements about Chronic Disease are true?

Tick Choice

Requires ongoing management

Gradual onset

Can be cured

Occurs across the lifespan

Is an inevitable part of the aging process

2. Which of the following statements about Aboriginal and Torres Strait Islander health when compared with the health of non-Indigenous people are true?

Tick Choice

Die on average 10 years earlier than non-Indigenous people

Have a higher burden of chronic disease

Have equal access to health care

Are 2 to 4 times more likely to be hospitalised

There is no difference in infant mortality rates


3. Conducting routine health checks is an effective preventive approach to the health of vulnerable populations

True False


Order Stage of change

Maintenance

Action

Pre-contemplation

Contemplation

Planning

5. Which of the following are characteristics of an effective self-manager?

Tick Statement

Accept what is being said without asking questions

Are involved in decision making

Expects the health care team to monitor symptoms and manage care

Sets goals and works towards them

Tend to stick to what they know rather than try new things


6. Match the self-management strategy with its correct definition

Strategy Order Definition

1 Agenda Setting Documented plan for action and identified outcomes

2 Goal setting Determining topic for discussion

3 Health Coaching Pre-determined aims to improve health

4 Flinders program Tools and processes to support a structured approach

5 Care plans Assist clients to positive health achieve outcomes


IN2301-1 – Learning Activity Feedback

1. What are the main chronic diseases or risk factors in your community?

Feedback

These answers will depend on the community in question. It is expected a number of communities will have high numbers of patients with diabetes, renal disease, cardiac disease and respiratory dis-ease. Risk factors are likely to include smoking, alcohol and substance use, overweight and obesity, poor nutritional status, poor dental health, hypertension, asthma etc.

2. How can you or your profession contribute to?

1) Promoting wellness? Feedback

Answers here might include health promotion programs which may include involvement in commu-nity education, development and distribution of information pamphlets, etc. immunisation programs, sexual and reproductive health promotion.

2) Preventing Chronic Disease?

Feedback

Targeted health promotion programs like Smoke Check, Nutrition, dental or environmental health programs, nose blowing and ear care programs.


3) Early detection?

Feedback

Screening programs like health checks, sexual health, breast, cervical cancer, bowel and child health screening.

4) Chronic disease management?

Feedback

Self-management programs, falls prevent, rehabilitation, cardiac rehabilitation


IN2301-2 Learning Activity Feedback

1. Patrick is an experienced remote area nurse, leading a multidisciplinary outreach team whose main role is managing clients with diagnosed chronic conditions in small Aboriginal communities in Queensland. He feels the approach of the team is not having any impact on clients’ health and wants to review the service delivery model. He has spoken to the leaders and health team in one community who are happy to lead discussions and trial a different service model. What things should the team be considering in tackling the issue of poor health in the community?

Choice Tick

History of the Aboriginal and Torres Strait Islander population

Racism

Poverty and social class

Income and social capital

Education

Employment and welfare

Relationship to country

Housing

Policy processes

Human rights issues


Feedback

The team needs to consider all of the above and to acknowledge and be aware of the factors spe-cific to the community. In consultation with the community they need to look at ways in which health services should be delivered in order to prevent the on-going issues of chronic disease.

2. How could the team change its approach to better manage the poor health of the community?

Feedback

The team needs to consider re-orientating their approach from the current reactive service to one that incorporates prevention, early intervention and management. They also need to adopt a sys-tematic ‘whole person’ approach, to implement evidence-based care and standard protocols and individual and population based care plans. The team needs to be more involved in promoting healthy choices, screening for and managing risk factors such as poor nutrition, overweight and obesity, smoking, alcohol use, physical inactivity and mental illness if it is present.



Which of the following statements are correct?1. Routine screening is an important strategic process which

Tick Choice

Monitors a child’s growth

Monitors and individual’s health status

Identifies risk factors for the development of chronic disease

Identifies current health issues

Provides information on population health



1. Mary is a 20 year old living in Riverville. When you do her well adult health check, you discover she is 3 months pregnant and smoking 20 cigarettes a day. What question would you ask to determine her stage of change?

Answers

Have you thought about giving up smoking while you are pregnant?

2. When Mary answers your questions you find she is at the contemplation stage of change what action will you now take?

Answers

Give Mary some information pamphlets on smoking and pregnancy

3. How can you support Mary to make the changes?

Answers

Work with Mary to set some short term goals – for example cutting down the number of cigarettes she smokes in a day, setting a realistic time frame to quit smoking altogether

4. How can you support Mary to maintain the changes?

Answers

Provide positive reinforcement every time you see Mary. Discuss the good things about not smokingReinforce the health messages about not smoking



1. Match the component with the definition using the SMART way of setting goals

Component Choice Definition

1 Specific 5 Time frame for achieving the goal is clear

2 Measurable 4 Client is confident they can meet the goal

3 Attractive 3 Client wants to achieve the goal

4 Realistic 2 Goal is easily measured

5 Time framed 1 Goal is clear


1. Which, if any, chronic disease strategies have you utilised in the provision of care for clients with chronic disease?

Answers

There is no correct answer – this is a personal reflection of practice

2. What reason, if any, have you for not utilising these strategies?

Answers



3. What strategies would you consider utilising, and why?

Answers



IN2303 - Theory to Practice Feedback

Scenario:

Ruby is a 43 year old Aboriginal woman who has presented recently at your centre for a check-up. She is the mother of 4 children ranging in age from 5 years to 15 years. After the birth of each child she has put on weight that she has been unable to lose.

At her last adult health check screening her weight was 83 kg and her BMI was calculated to be 31. Ruby’s blood pressure was also slightly elevated at 140/90. She says as she gets older she is finding it harder to keep up with her children.

Ruby has a busy life, she works part time in office administration and is fairly heavily involved with sporting and school based activities for her children, spending many hours a week and most of the weekend volunteering to raise money or run events. Her partner, Ted works full time in road maintenance, and often travels away from home for work. Ruby considers herself a ‘social’ smoker and drinker, which means she has one or two cigarettes with the three standard drinks she has every Friday evening or at occasional social gatherings.

1. What questions could you ask Ruby to ascertain her readiness for change?

Answers

•Why do you think it is getting harder for you to keep up with your children?•You have mentioned some concerns about your weight and how it might be affecting your health? Have you thought about or ever tried to lose weight. •Have you thought about the affects smoking may be having on your health?•Have you ever considered giving up smoking?• I noticed your blood pressure was a bit high – what do you think is causing this?


On interview you find she is very motivated to make changes to her lifestyle. She feels her weight is having an impact on her mobility and energy levels and thinks it is the main reason why she can’t keep up with her children. Ruby also states she is concerned about getting coronary artery disease which debilitated both her mother and aunt in their late 40s.

She says she has considered losing weight but finds it hard to stick to a diet and really doesn’t have time to prepare special food for herself. She admits it is quite difficult to make changes as her husband is often away and she is too busy playing the role of mother and father to really think about it.

She also understands the impacts smoking may have on health, but is not too concerned about this at the moment as she doesn’t smoke very much and is usually when she is having a drink to unwind.

2. Complete the following table (see Chronic Disease Guidelines 3rd edition 20101 Section 7 – Management of Diagnosed Conditions) outlining the self-management strategies you might discuss with Ruby.

Target Strategy Tools

Lifestyle Modification and Education

Weight reduction Healthy eating planPhysical activity plan

Nutrition education Refer to nutritionist / dieticianEat well be Active resources

Increased physical activity

“Find your 30” program and re-sourcesProvide information from the Physi-cal Activity website (DOHA)

Smoking cessation support

Quitline Quit smoking resourcesSmoke Check resourcesFlinders Living Well Smoke Free programInformation pamphlets on smoking and quitting.

Alcohol use education Talking about alcohol resources

Overall health managementFlinders Chronic Disease Self-Man-agement program utilising the ‘My Health Story” resource.


3. What else could you do to support Ruby?

Answers

•Work with Ruby to identify her priorities including the strengths and challenges which will impact on her plan to make changes in her life.•Provide on-going monitoring with regular check-ups.•Work with Ruby to set some short and longer term goals•Provide positive reinforcement each time you see Ruby•Reinforce the messages about healthy lifestyle choices.


IN2300 - Quiz Feedback

1. Which of the following statements about Chronic Disease are true?

Tick Choice

Requires ongoing management

Gradual onset

Can be cured

Occurs across the lifespan

Is an inevitable part of the aging process

2. Which of the following statements about Aboriginal and Torres Strait Islander health when compared with the health of non-Indigenous people are true?

Tick Choice

Die on average 10 years earlier than non-Indigenous people

Have a higher burden of chronic disease

Have equal access to health care

Are 2 to 4 times more likely to be hospitalised

There is no difference in infant mortality rates



True False


Order Stage of change

5 Maintenance

4 Action

1 Pre-contemplation

2 Contemplation

3 Planning

5. Which of the following are characteristics of an effective self-manager?

Tick Statement

Accept what is being said without asking questions

Are involved in decision making

Expects the health care team to monitor symptoms and manage care

Sets goals and works towards them

Tend to stick to what they know rather than try new things


6. Match the self-management strategy with its correct definition

Strategy Order Definition

1 Agenda Setting 5 Documented plan for action and identified outcomes

2 Goal setting 1 Determining topic for discussion

3 Health Coaching 2 Pre-determined aims to improve health

4 Flinders program 4 Tools and processes to support a structured approach

5 Care plans 3 Assist clients to positive health achieve outcomes


IN2300 - Chronic Disease Post-Session Survey

Now that you have completed this session we ask you to take a few moments to complete the post-session survey for this topic. This will give us some indication about how well we have met your learning needs. Once submitted you will be eligible to receive your certificate.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to describe the objectives and principles of the PaRROT programI understand the benefits of undertaking this program

I understand the links between the PaRROT program and enhanced practice in the rural and remote primary health care settingI understand how adults learn

I can define the different types of learning style

I know my preferred learning style

I am confident in my ability to develop strategies for learning based on my preferred learning style.

What, if anything could have been added to this session?

Stro

ngly

Agr

ee

Agr

ee

Neu

tral

Dis

agre

e

Stro

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Dis

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IN2300 References

1. Australian Institute of Health & Welfare (2008). Australia’s health 2008 (Chap. 4. Determinants – keys to prevention) http://www.aihw.gov.au/publications/aus/ah08/ah08-c04.pdf

2. Chronic diseases & associated risk factors in Australia (2006) http://www.aihw.gov.au/publications/index.cfm/title/10319 National Chronic Disease Strategy

3. CDS & National Service Improvement Frameworks http://www.aodgp.gov.au/internet/main/publishing.nsf/Content/pq-ncds-strat

4. QLD Strategy for Chronic Disease 2005-2015 http://www.health.qld.gov.au/publications/corporate/chronstrat2005/default.asp

5. Smith, J.D. (2007). Australia’s rural and remote health: A social justice perspective. (3rd ed.). Croydon, Vic: Tertiary Press.

6. World Health Organisation report, Preventing Chronic Diseases a vital investment. 2006

7. National Health Priority Action Council, National Chronic Disease Strategy. 2006, Australian Government Department of Health and Ageing: Canberra

8. Standing Council on Health. (2013) National Primary Health Care Strategic Framework (2013). Australian Government Department of Health and Ageing: Canberra

9. Australian Government. (2013) National Aboriginal and Torres Strait Islander Health Plan (Closing the Gap) 2013 – 2023. Australian Government Department of Health and Ageing: Canberra

10. Preventative Health Taskforce (2009). National Preventative Health Strategy. Australian Govern-ment Department of Health and Ageing: Canberra

11. Queensland Health and the Royal Flying Doctor Service (Queensland Section), Chronic Disease Guidelines. 3rd ed. 2010, Cairns.

12. Queensland Health. SmokeCheck. May 2009 [cited 2009 8/12/09]; Available from: http://www.health.qld.gov.au/atod/prevention/smokecheck.asp.

13. Standard Drink Guide

http://www.aihw.gov.au/publications/aus/ah08/ah08-c04.pdf

http://www.aihw.gov.au/publications/index.cfm/title/10319

http://www.aodgp.gov.au/internet/main/publishing.nsf/Content/pq-ncds-strat

http://www.health.qld.gov.au/publications/corporate/chronstrat2005/default.asp

http://www.health.qld.gov.au/atod/prevention/smokecheck.asp

http://www.health.qld.gov.au/cdg/docs/cdg_drink_guide.pdf%20or%20http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/36E6FEE732C8DF1BCA25767200769CD8/%24File/adult.pdf

If you or someone you know needs support and treatment to reduce your alcohol Intake, you should contact:

Yourdoctor

Yourlocalcommunityhealthservice

AnalcoholorotherdrughelplineinyourState/Territory:

ACT (02)62054545

NSW (02)93618000(Sydney)1800422599(NSWcountry)

NT (08)89228399(Darwin)(08)89517580(CentralAustralia)1800131350(Territorywide)

QLD 1800177833

SA 1300131340

TAS 1800811994

VIC 1800888236

WA (08)94425000(Perth)1800198024(WAcountry)

reduce your rIsk

New NatioNal guideliNes for alcohol consumptIon

1.1285mlFullStrength4.8%Alc.Vol




130mlHighStrengthSpiritNip40%Alc.Vol

1.5375mlFullStrengthPre-mixSpirits5%Alc.Vol

1.2330mlFullStrengthReady-to-Drink5%Alc.Vol

1.4150mlAverageRestaurantServingofWhiteWine11.5%Alc.Vol

1.4150mlAverageRestaurantServeofSparklingWine12%Alc.Vol

1.6150mlAverageRestaurantServingofRedWine13.5%Alc.Vol

staNdard driNk guide

Beer

wIne

spIrIts

Theadviceinthisbrochuredoesnotreplaceadvicefromyourhealthcareprovider.

For more information about the new Australian Guidelines to Reduce Health Risks from Drinking

Alcohol go to www.alcohol.gov.au

10/0

9

what do I need to know?

Factorssuchasgender,age,mentalhealth,druguse,andexistingmedicalconditionscanchangehowalcoholaffectsyou.Responsibledrinkingisaboutbalancingyourenjoymentofalcoholwiththepotentialrisksandharmthatmayarisefromdrinking–especiallyifyougobeyondlowriskdrinkinglevels.

what do the guIdelInes recommend?

Forhealthymenandwomen,drinkingno more than two standard drinks on any dayreducesyourriskof harmfromalcohol-relateddiseaseorinjuryovera lifetime.

Drinkingno more than four standard drinks on a single occasionreducestheriskofalcohol-relatedinjuryarisingfromthatoccasion.

what are the health rIsks?

Thehealthrisksthataccumulateoveralifetimefromalcoholincreaseprogressively–thismeansthatthemoreyoudrink,thegreatertherisk.

Drinkingalcoholcanaffectyourliverorcausebraindamage,heartdisease,highbloodpressureandincreasesyourriskofmanycancers.Itmayalsoincreaseyourriskof injurythroughroadtrauma,violence,fallsandaccidentaldeath.

what Is a standard drInk?

Astandarddrinkcontains10gramsofpurealcohol.

Itisimportanttonotethatdrinkservingsizesareoftenmorethanonestandarddrink.TherearenocommonglasssizesusedinAustralia.

Thelabelonanalcoholicdrinkcontainertellsyouthenumberofstandarddrinksin the container.

New national guidelines for alcohol consumption have been developed by the National Health and Medical Research Council to help you reduce your risk of harm from alcohol.

Theguidelinesarebasedonthemostcurrentandbestavailablescientificresearchandevidence.

Howmuchyoudrinkisyourchoice,buttheguidelinescanhelpyoumakeinformedchoicesandhelpkeepyourriskof alcohol-relatedaccidents,injuries,diseasesanddeath,low–bothintheshortandlongterm.

tIps to reduce the rIsk to your health when drInkIng

Itispossibletodrinkatalevelthatislessrisky,whilestillhavingfun.Thereareanumberofthingsyoucandotomakesureyoustaywithinlowrisklevelsanddon’tgetto a stagewhereyouarenolongercapableofcontrollingyourdrinking.

Theseinclude:

Setlimitsforyourselfandsticktothem

Startwithnon-alcoholicdrinksandalternatewith alcoholicdrinks

Drinkslowly

Trydrinkswithaloweralcoholcontent

Eatbeforeorwhileyouaredrinking

Ifyouparticipateinroundsof drinkstrytoincludesome non-alcoholicdrinks

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