COVID-19 outreach program targets high risk patients with chronic conditions

  • A chronic conditions coordinator carrying out a phone follow up.

A chronic conditions coordinator carrying out a phone follow up.

WA Primary Health Alliance

Bucking the trend in other parts of the nation, and indeed the world, Western Australia’s regional health services combined forces early-on in the COVID-19 pandemic to develop a new and innovative way of supporting and caring for vulnerable patients at an increased risk of complication if they were to contract the virus.

In early 2020, the WA Country Health Service (WACHS), in partnership with WA Primary Health Alliance (WAPHA), established the WA Country COVID-19 Chronic Conditions Outreach Support program with the aim of helping patients to manage their existing condition and stay out of hospital, while providing a support network as they isolated at home.

WACHS Regional Chronic Conditions Care teams and WAPHA commissioned chronic conditions services, such as the Diabetes Telehealth WA s and COPD Telehealth WA, joined to proactively reach out to patients via telephone to help them navigate the complicated COVID-19 health guidelines and work through any problems related to their existing condition.

WACHS Acting Executive Director Health Programs, Margaret Abernethy, said COVID-19 was a challenging and worrying time for everyone, but more so for people managing existing chronic conditions also at an increased risk of COVID-19 associated complications.

“When we developed the program, we wanted to ensure our chronic condition consumers had access to culturally appropriate information to empower them to self-manage their conditions, protect their health and mitigate the risks of COVID-19 transmission,” Margaret said.

“It was important we equipped them with the knowledge and information they needed around managing their condition, hygiene, physical distancing, isolating at home, and environmental cleaning so they were well prepared to put their own health and wellbeing first,” she added.

Kate Cross, Operations Manager WA Primary Health Alliance, says “A key component of the program was to make sure patients were connected with their general practitioner and had an action plan in place should they become unwell. The result was people being empowered to self-manage their condition and know exactly when and how to get help”.

Jackie Rooney was one of the people living with a chronic condition who benefited from the service, including regular check in phone calls from her care coordinator. It was a wonderful surprise to her to receive these uplifting phone calls from the outside while in isolation and credits her care coordinator with helping to make that time bearable and support her physical and mental health.

“We even had a telehealth appointment via videoconference which was great to put a face to the name and gave me the experience to learn how to use telehealth for possible future appointments,” Jackie said.

The outreach services were set up as a coordinated and targeted response between WA Country Health Service, WA Primary Health Alliance, via the Country WA PHN, and other non-government organisations.

Partner agencies stand ready to redirect resources into the intensive program should a COVID outbreak occur in country Western Australia. WA Primary Health Alliance involvement in this activity was made possible through funding provided by the Australian Government under the PHN Program.

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