When the 49-year old was referred to the Royal Flying Doctor Service (RFDS) Tasmania’s rural health program in July this year, she had high cholesterol and her diabetes “had been getting a bit out of control”.
“If the latest lot of medication didn’t work it was going to be insulin – that’s a big thing that I really want to avoid,” she says.
The former Queenslander – she and husband Kerry moved to Tasmania a year ago – knew she had to make some lifestyle changes. She needed to lose weight, eat more healthily, and get more exercise – but it was easier said than done. “In the past, people have said ‘this is what you’ve got to do’. And I’d think ‘yes, you’re telling me what I already know’, but I didn’t follow their advice,” Michelle says.
Award winning Tasmania rural and physical health worker Stephen Stone took a different approach. He spoke to Michelle about her health goals, and how confident she was about achieving them.
“I wanted to started eating properly, and I wanted to exercise more regularly. Because I wanted to be healthier, so I could live longer,” she says. “One of my problems with eating is that I don’t have breakfast – or if I have breakfast, I skip lunch. “Steve didn’t say ‘you have to start eating breakfast every day of the week’, he said ‘what do you feel comfortable you can achieve?’. “I guess that made the difference – it was coming from what I want and what I thought I could do, rather than someone just telling me what I need to do.”
The goals Michelle set for herself were to have breakfast three times a week, exercise four or five times a week – alternating between walking and home-based strength exercises – and lose one kilogram per week. She is meeting, and sometimes exceeding, those goals – losing two kilograms in the first week alone, eating breakfast most days, increasing her walking time, and doing her exercises before her reminder goes off.
“I can see the difference already, just with the readings I get from my diabetes – I’m pretty hopeful I won’t have to go on the insulin. “And I’m feeling a hundred percent better – I can keep going pretty much all day now, rather than having to have constant breaks because I got too tired. I’m finding I’m wanting to get up and move a lot more now; I can’t sit still as long.” These higher energy levels are particularly important when Michelle and Kerry travel back to visit their three adult children in Queensland. “They’re all really active kids and instead of just watching them do things, it’s nice be able to join in,” she says.
RDFS Tasmania CEO John Kirwan confirms his organisation’s rural health program focuses on helping people with chronic conditions take better control of their own health. “It is a case of tailoring it, it is a case of doing it within what is achievable for the person and within the evidence base of the program we’re delivering,” John says. The RFDS Tasmania model involves a general health worker, a physical health worker and a mental health worker working together in each of the five north eastern municipalities that the organisation services under this program. “The bulk of our staff are actually locals living in the community,” John says. “By having boots on the ground rather than visiting staff, it makes it easier to know what other services are available locally, who’s visiting, and how we can link our clients into those areas when we need to.”
In George Town, the program actually runs out of the same building as other medical facilities – as well as providing an outreach service for people living out of town. Integration of care is critical in a system that people can find difficult to navigate, especially if they have mental health problems and literacy and numeracy issues. “What we don’t want is a game of snakes and ladders. We want it to be all ladders, and no snakes.” The program also takes a holistic approach to care, because while a person might be referred for one medical condition, it’s not unusual for them to need care for other things too. “If someone has a mental illness and is taking prescription medicine they often put on weight, and that creates a whole range of other issues,” John says. “If we can manage all of it at the same time – either ourselves or through referral to another service – we end up with a better health outcome.”
John says feedback about the program from both clients and referrers has been very positive.
“What I’m hearing from GPs and other health professionals is that it’s working well; they like the fact that support isn’t limited to six visits; they like the fact that it’s outcomes-focused; they like the fact that our staff give them regular feedback about what’s happening to their patients,” he says. “I’m always a little cautious about premature celebration, but we think what we’ve got together here is different, it’s innovative, and the early signs are positive.”
For more information about RFDS Tasmania's Primary health Services, contact Nicole Grose at nicole.grose@rfdstas.org.au or on 0438 024 544
In early 2017, five organisations started delivering free services to people living with chronic conditions under a new rural primary health program. The program – funded by the Australian Government – has involved Primary Health Tasmania commissioning the services in 21 of the state’s 29 local government areas. It responds to the Government’s brief for primary health networks to improve the health care of people who have the highest needs. The services work closely with local GPs and other health professionals to provide coordinated care to people with chronic conditions and support them to stay healthy and out of hospital.
For more information go to www.primaryhealthtas.com.au/programs-services/rural-health, or contact Susan Powell at spowell@primaryhealthtas.com.au or on 6213 8200
This story was first published in Primary Health Tasmania’s Primary Health Matters magazine, online at www.primaryhealthtas.com.au
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