LEADING FOR OUTCOMES: Health system change / Community primary care / Population health / CVD / Diabetes

“An NGO has the advantage of being able to interact with a wide range of organisations. An NGO can often drive and support an initiative that would be much more difficult to achieve in some environments. An NGO can trail an initiative, evaluate it and disseminate it across the health sector.

“NGOs can support DHBs and PHOs. Some DHBS could be a lot more effective in collaborating. 21 DHBS don’t need to produce 21 individual cardiovascular risk assessment plans for example”.

The Heart Foundation is working on a number of initiatives that highlight how NGOs can work alongside DHBs and PHOs to reduce the burden of chronic conditions.

CARDIOVASCULAR REHABILITATION
“We’ve been working for three years with the Ministry of Health on cardiovascular rehabilitation, which has probably the best clinical outcome of any intervention currently in place. The Heart Foundation highlighted the fact that DHBs weren’t picking up even a third of the people who would benefit from a cardio-rehabilitation programme. The Foundation worked with the Ministry of Health, and the Ministry has now put in place key performance indicators. This is a good example of an NGO working alongside the Ministry.”

CVD RESOURCE
The National Heart Foundation is currently testing a CVD risk assessment and education resource called a “Change of Heart”, which is aimed at practice nurses working within primary health care teams. The resource consists of an A4-size flipchart for patients, which doubles as a risk assessment and education resource. The flipchart has been developed after extensive consultation with nurses, and comes with accompanying guidelines for patient consultations. The resource also provides advice for setting up a CVD risk assessment and management programme within a practice, and is intended to be a professional development resource for registered nurses.

“If we are going to make headway with cardiovascular disease we need to share national and international experience. International evidence would suggest that practice nurses hold the key for successfully implementing this initiative, but they need training if they are to effectively achieve this with patients.

“To achieve this goal we are planning to get PHO support for the Change of Heart resource. We will set up a couple of practices that can become hubs of excellence and work with them intensively. At the same time we plan to have a training seminar for 20-25 nurses. Nurses in practices need support to achieve new initiatives but many things like funding constraints and practice readiness can be significant inhibitors which need to be overcome if we are to make progress as a sector.”

PACIFIC ISLAND CHURCH-BASED CARDIO-VASCULAR RISK MANAGEMENT
“In conjunction with Auckland DHB and ProCare PHO, we are piloting a project in two Pacific Island churches. The churches have each set up a health committee to take responsibility for the health of the congregation. The health committee works with the Heart Foundation to train lead people on nutrition, smoking cessation and exercise. A cardiovascular risk assessment is done for individuals and they are put on a 12 week programme. In one church the health committee is weighing the whole congregation once a month. We are halfway through this pilot, and once it’s complete it will be disseminated to other DHBs working in churches.”

CARDIAC CLUBS
“We have a relationship with the community through over 50 community Cardiac Clubs that many PHOs and DHBs don’t. My dream is that the facilitators of these clubs will become a health resource to people with other chronic diseases. This is sustainable and cost-effective.

“Literature shows that people are often more influenced by somebody from their own socio-economic group than they are by a doctor or nurse.”