Patient self-management of risk factors


Lifestyle change is difficult.  Even amongst patients who initiate changes, longterm maintenance of new health behaviours is rare. With funding from Australian Rotary Health, we developed the Beating Heart Problems program based on the self-management model, using principles of motivational interviewing and cognitive behaviour therapy. This 8-session modulated program addressed physical activity, dietary change, smoking cessation, and medication adherence, depression, anxiety, anger and social isolation. A randomised controlled trial of the intervention involving 275 cardiac patients demonstrated substantial improvements in physiological, behavioural and psychosocial risk factors compared to usual care.

Recent Australian audits show that many health professionals lack the knowledge and/or skills to incorporate self-management and patient-centred care into practice. Targeted training of cardiac rehabilitation (CR) professionals is required to support the integration of a self-mangement approach within CR programs. With funding from the Commonwealth Department of Health and Ageing, we developed a face-to-face training program for health professionals based on self-management and patient-centred care principles. We then translated the training into a 5-session online training program – Supporting chronic disease self-management – which has now been completed by several thousand health professionals working in CR and other clinical settings in Australia.

We have also developed patient support programs: a telephone program Teleheart, and an online program Back on Track, both designed to support cardiac patients in their emotional and behavioural recovery.  Both are extensions of our successful Beating Heart Problems group program for patients.

‘Back on Track': An online support program for cardiac patients

Many cardiac patients want home-based alternatives to centre-based support programs such as cardiac rehabilitation. 'Back on Track' is an online self-management program for cardiac patients and companion to the successful 'Beating Heart Problems' group-based program and the 'Teleheart' phone-based support program.

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‘Teleheart’: A telephone-delivered support program for cardiac patients

To complement our online 'Back on Track' program and our group-based 'Beating Heart Problems'' Program, we have developed a telephone-delivered version of the program – 'Teleheart'. The program has been pilot-tested with patients at Southern Health.

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HRC Network: Connecting health professionals for improved practice

The newly-formed HRC Network is an exciting project that aims to connect health professionals across Victoria and improve their skills in chronic disease self-management.

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