PowerPoint Presentation
Limiting the effects of disease,
disability and injury
Module 5 Week 9-10
Dr Hannah Wechkunanukul
PhD, MHA, MPharm(Community Pharmacy), GDipPHC, BPharm, MPS
Module 5 Overview
WEEK 9
• Tertiary Prevention
• Community based Rehabilitation
• Self Management
• Injury Prevention
WEEK 10
• Group presentation (9.00am-11.30am)
Week 9 Outline
• Tertiary Prevention
• Community based Rehabilitation
• Self Management
• Injury Prevention
• Assessment 2 Group presentation
• Assessment 3 Emergency response plan
Week 10 Group presentation
Date: Wed, 22 April XXXXXXXXXXTime: 9.00 am XXXXXXXXXXam
Group Start time Finish time
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Break 10 minutes
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Concept of
Tertiary
Prevention
Tertiary prevention
Tertiary prevention focuses on reducing or minimizing the consequences
of a disease once it has developed. The goal of tertiary prevention is to
eliminate, or at least delay, the onset of complications and disability due
to the disease. Most medical interventions fall into this category.
Example
A person with diabetes keeps their blood glucose under tight control to
prevent diabetic complications.
See this video about the self management of Diabetes Program
https:
www.youtube.com/watch?v=1JEoCRZ_wSk
https:
www.youtube.com/watch?v=1JEoCRZ_wSk
Disability
According to the World Report on Disability (WHO 2011),
Disability refers to the negative aspects of the interaction
etween individuals with a health condition ( for example;
cere
al palsy, Down syndrome, depression) and personal and
environmental factors (for example; negative attitudes,
inaccessible transportation and public buildings, and limited
social supports).
According to ICF, disability is defined as an um
ella terms for
impairments, activity limitations and participation restrictions.
What do we know about disability?
Higher estimate of prevalence
About 15% of world’s population live with some form of disability.
Growing numbers
The number of people with disability is growing and the pattern is influenced by the
trend of health conditions as well as environmental and other factors.
Diverse experiences
Women with disabilities experience gender discriminations as well as disabling ba
iers.
People with more severe impairments often experience greater disadvantage.
Vulnerable populations
Disability disproportionately affects vulnerable populations. There is higher disability
prevalence in low income countries.
Source – World Report on Disability, WHO, 2011.
Disabling Ba
iers
According to the World Report on Disability (WHO 2011),
common disabling ba
iers are;
• Inadequate policies and standards
• Negative attitude
• Lack of provision of services
• Problems with service delivery
• Inadequate funding
• Lack of accessibility
• Lack of consultation and involvement
• Lack of data and evidence
People Living with Disability
• Poorer health outcomes – comparing with general
populations
• Lower educational achievements – comparing with non-
disabled populations
• Less economic participation – more likely to be unemployed
and earn less even when they are employed
• Higher rates of poverty – food insecurity, poor housing,
inadequate access to health care, fewer assets
• Increased dependency and restricted participation – leads
to social isolation and depression
Addressing Ba
iers and Inequalities related to Disability
• Addressing ba
iers to health services - making all levels of existing health care
system and programs more inclusive and accessible;
• Addressing ba
iers to rehabilitation - incorporating rehabilitation into general and
specific legislation on health, employment, education and social services;
• Addressing ba
iers to support and assistance services – enabling people with
disability to live in the community with better access to support and services;
• Creating enabling environment – removing ba
iers in public accommodations,
transport, information and communication.
• Addressing ba
iers to education – creating inclusive learning environment for
children with disability.
• Addressing ba
iers to employment – endorsing antidiscrimination law in
workplaces, training, mentoring and community based rehabilitation.
Rehabilitation
The Convention on the Rights of Persons with Disabilities, Article 26, calls
for “appropriate measures, including through peer support, to enable
persons with disabilities to attain and maintain maxi- mum independence,
full physical, mental, social and vocational ability and full inclusion and
participation in all aspects of life” XXXXXXXXXXSource: World Report of Disability, WHO)
Rehabilitation for an older person who has diabetes and recently had both
legs amputated below the knee might include strengthening exercises,
provision of prostheses and/or a wheelchair and functional training to teach
mobility and transfer skills and daily living skills to maintain the self esteem
and quality of life of individual.
Rehabilitation Process
Rehabilitation involves problem solving process (WHO, Wade, 2005, Wade 2005)
Assessment
Identify needs/modifiable factors
Goal setting
Measurement, planning & implementation of interventions
Evaluation of change & effectiveness
NSW
• Rehabilitation MOC
Western Australia
• Amputee Services &
Reha
• Stroke
• Rehab & Restorative
Care
• Elective Joint
Replacement
South Australia
• Cardiac Rehabilitation
Victoria
• Victorian Paediatric
Rehab Service
Others:
• Transport Accident Commission
• Heads of Workers Compensation Authorities
• Department of Veteran Affairs
Community based Rehabilitation Program
• Rehabilitation is relevant to people experiencing disability from a
oad range of
health conditions and therefore the Community based Rehabilitation (CBR) Program
makes reference to both habilitation and rehabilitation.
• Habilitation aims to assist those individuals who acquire disabilities congenitally or
in early childhood and have not had the opportunity to learn how to function
without them.
• Rehabilitation aims to assist those who experience a loss in function as a result of
disease or injury and need to relearn how to perform daily activities to regain
maximal function.
The Goal and Role of CBR Program
Goal
People with disabilities have access to rehabilitation services
which contribute to their overall well-being, inclusion and
participation.
Role
The role CBR is to promote, support and implement
ehabilitation activities at the community level and facilitate
efe
als to access more specialized rehabilitation services.
CBR Program Outcome Strategies
• Person led assessments and rehabilitation plans outlining the services they
will receive;
• People with disabilities and their family members understand the role and
purpose of rehabilitation and information about services they can access;.
• Access to specialized rehabilitation services with follow-up to ensure that
these services are received and meet their needs;
• Basic rehabilitation services are available at the community level;
• Resource materials to support rehabilitation activities undertaken in the
community are available for health professional, individual and families;
• CBR personnel receive appropriate training, education and support to
enable them to undertake rehabilitation activities.
CBR Interventions – Some Examples
• Rehabilitation for a young girl born with cere
al palsy might include play activities to
encourage her motor, sensory and language development, an exercise program to
prevent muscle tightness and development of deformities and provision of a wheel-
chair with a specialized insert to enable proper positioning for functional activities.
• Rehabilitation for an adolescent girl with an intellectual impairment might include
teaching her personal hygiene activities, e.g. menstrual care, developing strategies
with the family to address behavioural problems and providing opportunities for social
interaction enabling safe community access and participation.
• Rehabilitation for a young man with depression might include 1:1 counselling to
address underlying issues of depression, training in relaxation techniques to address
stress and anxiety and involvement in a support group to increase social interaction
and support networks.
Community based Rehabilitation Services
Community-based services may also be required following
ehabilitation at specialized centers. A person may require
continued support and assistance in using new skills and
knowledge at home and in the community after he or she
eturns. CBR programs can provide support by visiting people at
home and encouraging them to continue rehabilitation activities
as necessary.
Watch this video to see the example of CBR Project in Ethiopia
https:
www.youtube.com/watch?v=9r5_rc8dV3w
https:
www.youtube.com/watch?v=9r5_rc8dV3w
Rehabilitation Plan
Developing a community based rehabilitation plan for
individual living with disability involves following;
• Identify need
• Facilitate refe
al and follow up
• Facilitate rehabilitation activities
• Develop and distribute resource materials
• Provide training
See CBR Guidelines developed by WHO XXXXXXXXXXfor more details.
Chronic Diseases Self Management
•Managing the work of dealing with a chronic disease and/or
multiple disease conditions
•Staying involved in daily activities in light of debilitation and
disability
•Managing emotional changes resulting from or exace
ated
y the disease conditions
Once a chronic disease is present, one cannot NOT manage,
the only question is ‘how.’ XXXXXXXXXXBateson 1980, Lorig, 2003
Self Management is Critical
Because people living with Chronic Diseases:
•Significantly reduced productivity
•Living with less income
•Accomplishing less
•Spending more time in bed—sick
•Having poor mental health
Source: Stanford University, (Lorig, K.); Center on an Aging Society, National Institute on
Aging
Chronic Diseases Self Management Model
•Patient education program
(“Living Well”)
•Highly structured six-week
series of workshops
•Participative instruction with
certified leader peer support
Designed to enhance medical
treatment
Outcome-driven: impacts show
potential for reduced or avoided costs
Evidence-based: a tested model
(intervention) that has demonstrated
esults
Stanford University Model
Reference: http:
www.aoa.gov/evidence/evidence.asp; www.healthyagingprograms.org
How does the model works?
•Person with chronic condition accepts responsibility to
manage or co-manage your own disease conditions
•Person with chronic condition become an active participant
in a system of coordinated health care, intervention and
communication
•Person with chronic condition is encouraged to solve your
own problems with information from professionals
Source: Stanford University Patient Education Center; Center for Healthy Aging (NCOA)
Why is this model effective? How this model is effective?
This model involves:
•Peer educators
•Constant modeling
•Brainstorming
•Active problem-solving
•Action planning
•Goal-setting
Which are unique to meet the need of individual in tailored way.
Impact of Stanford Model of Self Management
•Improved self-efficacy
•Improved quality of life
•Improved healthy behavior
•Reduced use of doctors, hospital emergency rooms
•Improvements in overall health status— identified by BOTH the
participant and the health provide
•Reduced disability rate
Source: Stanford University Patient Education Center; Society of Behavioral Medicine publication (2003)
Healthy Living
Chronic Diseases Self Management Stories
Please the following video to hear stories how Peer leaders from the
Toronto Central Self-Management Program (TC SMP) have been able
to maintain their quality of life.
•https:
youtu.be/ywOyxpe3P5M
https:
youtu.be/ywOyxpe3P5M
Patient Empowerment in Self Management
•“Patient empowerment is simply a process to help people gain control,
which include people taking the initiative, solving problems, and making
decisions; and can