Don Allan, General Manager, Adelaide Western GP Network
Effective links are the result of successful partnerships between Divisions and researchers. As interest in these partnerships grows, we at PHC RIS thought it would be fitting to highlight these to exemplify the different stages of effective links. In this issue of 'PHC RIS infonet' we highlight a different category of effective links. Don Allan is the General Manager of the Adelaide Western GP Network. He has had a long standing interest in research from a Division perspective, has attended and presented at GP & PHC Research conferences, and recently has had a major role in developing the Practice Health Atlas and Division Health Atlas with Dr Peter del Fante and Liz Babbidge. This month we asked Don Allan to reflect on his attendance at the Health Outcomes Conference, and the key points raised, for the benefit of other Divisions.
 Health Outcomes Conference
8-10 July 2006
Rydges Lakeside, Canberra
The 2006 Health Outcomes Conference was held at Rydges Lakeside, Canberra. The key theme of this year's conference was Managing Health and Disease in Today's Society.
The main reason I attended this conference was to increase my knowledge and skills in the area of Measuring Health Related Quality of Life using Multi-Attribute Utility Instruments. This is not for everyone, I admit, but I would contend that Health Related Quality of Life Instruments are going to play a fairly significant role in primary health care in the next five years as we strive to develop better systems to measure the effectiveness of self-management programs.
A/Prof Graeme Hawthorne, of the University of Melbourne, was one of the key presenters. As he says, assessing health related quality of life (HRQoL) is rapidly becoming routine practice in outcome evaluation, where the effects of a health related intervention are to be assessed. Increasingly, economic evaluation of interventions is also being asked for. In the past, economic evaluation has ignored the effects of an intervention because there was no means of satisfactorily capturing data. With the publication of multi-attribute utility (MAU) measures, this barrier has been removed and the patients' or consumers' perspective can be captured for use in cost - utility measures.
I see this area as particularly exciting for general practice. For example, by incorporating decision support tools (such as the Practice Health Atlas, viz clean data, mapped and base line data), we can now invite GPs to consider assessing the patient in base line HRQoL. Why is this useful or relevant? Because the HRQoL can assist the GP in diagnosing the self management programs that are appropriate for the patient. Self management programs are becoming very important to the Commonwealth and increasingly they will want to know that they are getting value for money in the programs available as well as favouring those programs which can demonstrate a validated health outcome. By assisting the GP in appropriate diagnosis of self management interventions, the HRQoL can become an important diagnostic tool in general practice in a very cost effective way. Most HRQoLs take less than ten minutes to complete and are simple to interpret.
Prof Hawthorne was involved with the recently completed SA Burden of Disease study where over 3,000 consumers were tested with the AQOL (Assessment Quality of Life) Instrument, so this instrument is particularly useful for Divisions to consider, rather than the ubiquitous SF36.
I encourage all Divisions to take a closer look at considering how HRQOL instruments can be incorporated in programs. Divisions who seize the initiative here would be in a strong position to demonstrate to governments the proof of concept of the value of more widespread use of HRQoL as a valid instrument to justify investment of funds in chronic disease management.
E: don.allan@awgpn.org.au
Managing health & disease in today's society
Health Outcomes Conference
9-10 August 2006, Canberra
Attended by Libby Kalucy and Ann-Louise Hordacre, PHC RIS
In opening the Health Outcomes conference, Professor Kathy Eagar, University of Wollongong, outlined some key points about health reform and health outcomes. She described health outcomes as a "change in an individual or group of individuals that can be attributed (at least in part) to an intervention or series of interventions". Health outcomes can be assessed by the person, the provider and the payer, each with legitimate but different outcome criteria. She also asserted the importance of routine measurement, culture change and engagement of consumers.
The clinical outcomes that really matter are length of life and quality of life both during and while recovering from an illness. Professor David Osoba, University of British Columbia, emphasised the usefulness of providing health outcome results in terms of numbers of patients who report clinically meaningful change in health related quality of life (HRQOL) domains, to allow easy calculation of the number of patients who need to be treated for one patient to benefit. A widely accepted rule of thumb is that a definite change perceptible to patients equates to a change of 10% of HRQOL scale breadth.
For several years there has been lively debate at the Health Outcomes conference about health related quality of life, quality of life, and how to measure these concepts. Professor Robert Cummins, Deakin University, continued the debate in his customary clear and provocative manner. Professor Cummins recommends using instruments which are sensitive to what we are trying to change. He ironically recommended that "investigators should use the SF-36 to give themselves a really good chance of finding whether their intervention lacks effectiveness in bringing about change".
Dr Robin Harvey from Sentiens in Perth presented a moving video demonstrating the use of an e-Disease management system to identify the prevalence of psychological distress in post-disaster Louisiana. An expert choral director from Perth skilfully formed the large choir whose members frequently completed outcomes measures using the Internet - wireless networks were surprisingly robust in post-disaster context. The system allowed researchers in Perth to identify who was struggling, who was resilient, demonstrating proof of concept of the e-health monitoring system. Previously computer illiterate choir members were pleased to acquire a new skill, increased social support and community cohesion, and built a relationship with researchers from Australia.
Over the last 12 years this event has brought policy advisors and health service managers together with researchers. This year, a central theme of many presentations was that of getting research into practice and policy - recognising that obtaining the research findings are just the beginning. National initiatives such as continence management, palliative care, arthritis, dementia, and chronic disease self management were well represented with a range of papers, providing much valuable information for the COAG initiatives. Papers will be published on a CD-ROM later in the year.
For further information:
Web: www.uow.edu.au/commerce/ahoc/upcomingconference.html
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