Sammi: Good evening everybody and welcome to this evenings twilight online Supporting Patient Care: Free Telehealth Services for Improving Health Outcomes. My name is Samantha and I am your host for this evening. Before we get started, I would like to just make a quick Acknowledgement of Country. We recognise the traditional custodians of the land and sea on which we live and work. So in saying that, I would like to introduce our presenters for this evening. So we are joined tonight by Dr Georgia Regis. Georgia is a general and bariatric medical practitioner at St. George Private Hospital in Kogarah. She is also the current Chair of the RACGP’s specific interest, Obesity Management Network. We are joined by Leah Choi, the State Program Manager for the Go4Fun program from the Office of Preventative Health at the New South Wales Ministry of Health. And we are also joined by Ruth Chesser-Hawkins who is the Senior Project Officer for the Get Healthy Service who is also from the Office of Preventative Health at the New South Wales Ministry of Health. So, in saying that, I will hand over to Georgia now to take us through the learning outcomes for this evening and make a start on the presentation.
Georgia: Thank you, Sam and thank you everyone for joining us tonight. By the end of this online QI and CPD activity, you should be able to discuss telehealth program options for New South Wales patients who want to make a healthy lifestyle change, explain the elements of the Go4Fun online program to a family, including positive health outcomes, explain the features of the Get Healthy information and coaching service, including the different health coaching programs offered, incorporate referral of eligible New South Wales patients to the Go4Fun and Get Healthy services into routine consultations using the different referral mechanisms, and finally, to utilise the feedback from the programs as part of our ongoing consultations with patients and their families, so as to improve the health of our patients and also their health outcomes.
The alarming statistics speak for themselves. About one in four children and adolescents are above a healthy weight and it has been observed that about 75% of these adolescents will eventually grow up to be adults with obesity. And we know this is already associated with higher rates of cardiovascular disease and overall mortality. As it currently stands, two out of three Australian adults are above a healthy weight as is. Unfortunately, indigenous Australians, people outside major cities and those from lower socioeconomic groups are more likely to be above a healthy weight. Now as fellow GPs, I am sure you are aware of the myriad of health complications that are associated with being above a healthy weight. We have early onset of type 2 diabetes, fatty liver, hyperlipidaemia and the list goes on. But let’s not forget the psychosocial complications that are quite disturbing, low self-esteem, poor body image, higher rates of depression. Often these kids will do less well at school and often will drop out early. Weight is the most common reason for children being bullied at school and so we cannot say that puppy fat is harmless. And so, it is really incumbent on us as GPs to be proactive and tackle the issue. However, it has to be done in a sensitive and non-judgemental manner. And remember, for those of us that are already in clinical practice and are seeing a lot of children of school age and also adolescents, we know that they often do not come in because of their weight and their obesity, they usually come because of something else and it is up to us to be able to read between the lines and take advantage of that opportunity.
As GPs, we have got a long standing therapeutic relationship with our patients, in particular children and adolescents, because we were likely there when we told their mother that they were pregnant, were there when we gave them their vaccinations, were when we nursed them through cuts and grazes and otitis media and other common childhood illnesses, going to the adolescent woes of acne and poor sleep hygiene and all the rest. So the point that I am trying to make is that we have that continuity of care. We know our patients. They trust us. And for many young people, we are the only point of contact they have had with the Australian health care system. We are also champions at chronic disease management and with our multidisciplinary teams but also initiatives such as the Go4Fun and Get Healthy services, we can work together to try to change this weight gain trajectory that these children and adolescents often find themselves on. However, it is imperative that as GPs, we have a clear and consistent message. We are addressing the young person’s weight as part of a normal growth and development assessment. We do not want to isolate them nor add to their stigma and the shame that they already feel because of their weight.
Last year, we held a series of webinars informing GPs and other health care professionals of the numerous New South Wales Health initiatives such as the Go4Fun and Get Healthy services. A common question that was raised by GPs was about those who either live remotely or because of the child or adolescents health condition, is not able to attend face to face sessions, and so this is where telehealth services offered by Go4Fun and Get Healthy, have come into play. Telehealth offers benefits not only to the patients, but also their carers, health care workers and the health system as a whole. How? I hear you ask. By improving the access and availability of health care services but also efficient and good quality health care. And that is what as health practitioners we are always aiming for.
The disparity of access to various health care services is well documented between urban and rural centres. And so telehealth has been particularly important for rural and remote areas where it has had a positive impact, not only for patients and clinicians through reduced travel time and improved access to specialists and their advice, but it has also reduced the burden on carers. And most importantly it allows for patient-centred care with increased independence and self-management which as GPs we know is critical when we are dealing with chronic diseases.
Leah: Okay. So it would be great if I could first of all get an indication of those online listening, if they actually have heard of the Go4Fun program? So if you could type in, you know, a yes or a no just so I can sort of gauge how many people are aware of the program or not. Okay, so we are actually getting a few mixes, so yes and no’s, and I guess I will start to talk about the Go4Fun program first, but then what it is we have actually just released an online version, which is what we are really talking about and focussing on tonight, which is part of I guess the telehealth service that you can now pretty much offer all clients if they meet our criteria.
So first of all, just to touch on those who do not know about the Go4Fun program for me to be able to talk about and explain it in a bit more detail. So it is a completely free community based program for children who are above a healthy weight. It is funded by the New South Wales Ministry of Health. So first of all, access for families in terms of I guess, paying for anything should not be a burden because this program is completely free. Next, the aim of the program is to support children and their families in adopting a healthy lifestyle and we focus on dietary habits, fitness and confidence. Now, I just need to emphasise that this is not positioned as actually a weight-loss specific program. So obviously we are dealing with children who are still growing at the moment. The way it is framed is still a healthy lifestyle program, but obviously if we can see some benefits in weight reduction for those who are overweight or obese, that could be beneficial. So someone has just actually asked how long has the program been in use for. So the program actually commenced in 2009, so it has been in place for a little while, but essentially it has expanded. So we used to do the face to face version initially, but now we have opened up a culturally adapted version for Aboriginal and Torres Strait Islanders, or those who identify and also online, which has literally just started, which is why I am sort of really focussing on talking about this so you are all aware of the online program. Unfortunately, it is not available in the ACT, so we have just had a question to see if it is. It is only in New South Wales. So you must hold a New South Wales address or post code to be eligible for the program.
So I will keep going on about the program and criteria. So it is delivered by qualified health professionals, so dieticians, exercise physiologists, some psychologists, nurses et cetera. And the focus of the program revolves around I guess as I mentioned before, nutrition, increasing physical activity, behaviour change and the key component of family involvement. So a carer or parent must be involved. So, just a little bit before we go into the eligibility criteria, I will just talk a bit more about the program. So it is run once a week for 10 weeks. It is actually parallel with the school term and each session goes for two hours. Now the first hour, the children and parents or carers, they learn about nutrition together and they will do a specific topic. So for example, it might be one week on fats and sugars. It might then be another week on processed foods. So they will delve into 10 different topics each week, parent and child together. And then in the second hour, what they will do is they will split off. The parent will then do a parent only session and this gives I think the parent the opportunity to maybe discuss things that they might not want to in front of their child. So you know, whether it is issues about you know, children eating at night or certain behaviours that they are not comfortable sharing with their child, what they can do is have I guess a support group with the leader and other parents as well to discuss issues or you know, the learnings from the week before, or even the learnings of that session. While the parents are doing that session, what we then have the children doing is being led by a physical activity leader, so as I mentioned an exercise physiologist running that session and they will do one hour of physical activity catered around sort of fun activities, so it is not sort of like a boot camp or fitness camp, anything like that. But they will do sort of fun games to ensure that sort of, heart rate increases and that they are sort of getting quite a bit of puff. And just getting them back involved into activity. I think a lot of these children, you know, they might not be sort of the soccer stars at school or you know, the ones out there and excelling in PE, and maybe not that confident. So I think that this exercise session really brings out a social element that they can play with peers, but at the same time be involved in physical activity as well. So you know, quite a number of benefits to this session.
Now, so we have actually just had a question, so is an overseas visitor who resides in New South Wales eligible? Now we sort of take, this can happen and what we do is take it on a case by case basis. So if the parent and the child call our line, and you will get details about this later, what they will do is they will be taken to the centralised line and someone can have a chat to that family to determine whether this program is the right thing for them. You know, are they going to be around for 10 weeks? You know, do they meet the criteria and is this going to benefit that particular family? So, we do take it on a case by case basis.
Okay, so back to eligibility. Now, so four main criteria. They must number one be a New South Wales resident as I emphasised earlier with a New South Wales residential address. The child needs to be aged between seven and 13 years old. Now, they need to be above a healthy weight, so greater than the 85th BMI percentile for age and gender. I think that was a question that has come up as well. So that is greater than or equal to the 85th BMI percentile for age and gender. And they must have a parent or carer attending each session with them. You know, Go4Fun is a family program. Parents and carers have a lot of purchasing power. They need to be involved in this program. It is not a baby sitting service, you know where people, where parents just drop their children off. They need to be involved as well because we need to see changes throughout the household and we are quite sort of strict on that as well. Now at the moment, programs are actually delivered through the local health districts in New South Wales. We have about 12 of them and since 2009, we have actually run more than 1,000 programs and more than 10,000 children entered the program as well. So this is I guess, a brief overview of Go4Fun. I have not really emphasised the Go4Fun online part. You know, as I said, we do do it face to face and we have done it for a long time, but now we have this new role out of doing it online and from your home.
Okay. So this is where I am going to start to delve into some of the detail about online. So, the reason why it was developed was to provide access to families who were unable to join our face to face Go4Fun program. And this is for a myriad of reasons. So, you know, people live in rural or regional areas and they cannot travel to a face to face group, it was just too far away. So that was obviously a clear-cut reason to sort of bring this program to life. People have personal circumstances, we understand that families are extremely busy, you know day to day they have got sort of school drop offs, pickups, you know, multiple children. So some families just could not get to our program.
Now, additional needs. This has been asked a few times as well. Now, we are still sort of from our pilot and pre-pilot, we actually have some anecdotal, I guess evidence, that additional needs children who are entering our program are actually finding the program extremely positive. So, we may have had children who had additional needs enter a face to face program and with you know, up to 14 other children and parents and carers, sometimes the environment was a bit too much for them and they you know, either may have sort of dropped out of the program or struggled a bit throughout it. So what we are finding, is that children with additional needs are really doing well in this program. And it is not to say at all that face to face is limited and additional needs children cannot enter that program. I am not saying that at all. I think it is a case by case basis for each child. If the child can cope in a face to face group and manage completely fine, then that is no problem. Each group will work with that specific child to find out what needs… sorry they will make sure that child’s needs are met and if they are not met, maybe online is the answer for these children so they can still participate but maybe without the additional pressures that they may find with a face to face version and a lot of people around. So as I mentioned, yes, those who find group environments challenging, can definitely do the online program and parents – I mean, a lot of parents work you know, 9 to 5.30. Some parents do shift work, so we have really tried to allow them to be able to do this program whenever it suits them in their own home.
Now, this seems like a repeat slide, but I think it is actually just to emphasise the fact that the eligibility is very similar to online as face to face. The main difference of course, is instead of attending the face to face session, the parent or carer will still need to support the child in online modules. So it still remains that family focus and that family program. So although there is flexibility in being able to do it whenever you want, I think it does need to cater for the child to be doing the session as well as the parent or carer. And once again, you need to be, the participant and the family need to reside in New South Wales as well. So, yes, once again the modules are not just for children to complete, but for the parent to be involved as well. As I said, the real benefit of Go4Fun online, is that it can be undertaken in the comfort of the family’s home with flexibility around the time of when the family completes the different elements.
Now, I am going to talk about the various elements now and what is involved in the program. So families will complete this over 10 weeks in line with the school term and it involves them completing 10 online modules, one each week. So families will also receive their own qualified personalised health coach and they will receive a call from their health coach each week to go through that content. So not only are they doing the content, but then if they have questions or they need support, they will have a health coach allocated to them who will call them after that session and check on, I guess, how they went with the module and to make sure the family feel supported and to answer any questions that the family have as well. It will actually also be a really great motivator to sort of ensure the family are staying on track with some of the changes that they might be wanting to make week to week. I think there is that aspect of you know, someone calling you and checking in on you, it makes you I guess, want to achieve or do the activity and make sure it is completed and be able to tell your coach. I mean, this does not always work with everyone but I think it is you know, a form of motivation that really does help families from week to week and that is what we have found so far in the families who have participated. We also have not only that, but a closed Facebook group. So this is for I guess a social element that families and parents can sort of chat to each other. They might share recipes with each other, or you know trouble shoot, give each other activity ideas. It is a really great way to be able to share information with each other and also for that social element, because they know that other families are going through the exact same experience as them. Families will also receive hard copy resources. So in the image, I mean there is a token sheet, but they will get welcome pack, physical activity equipment sent to them, recipe books, activity sheets, hand outs and there will be four mail outs throughout the 10 weeks as well. And the token stickers that you can see are an incentive essentially. So if you are reaching your goals every week, families will get tokens and children will be able to redeem them for prizes at the end as well. So the more tokens you receive, the better the prize as well.
So Go4Fun online was designed to be accessed on a laptop or a desktop. As the program requires a parent and child to complete the online module together, we often say a large screen is ideal. So, the modules have been optimised for viewing on a mobile tablet, but not on a mobile telephone, as obviously it is much more difficult for two people to really engage over a little small mobile screen. So all they need is a laptop or a desktop type computer.
Okay. So I am just going to give you an example, just so you sort of know what type of content we are talking about. I mean, we have really, this program has actually gone through user experience testing and we have tried to make it as engaging as possible. So for example, design a healthy breakfast. You know, there is a whole series of like drag and drop activities. In the case of this one, they will be trying to design their healthy breakfast and there are a whole series of activities that are very similar to this, but also different ones throughout. Okay, so once again as I mentioned, there is also resources which get mailed out to the participants. So this activity, they have obviously got food cards, and they will sort them into five food groups and also every day and sometimes foods as well. So these get sent out to families in the mail as the activity comes up as well. And the coaches will obviously discuss this with them.
A real benefit of the program is that we have actually been able to also incorporate a Garmin fitness tracker. So someone actually asked the question, so with the online version, how does physical activity occur? You know, is it supervised on Skype or is it face to face? So what it is, parents will obviously and the children will be talking to their coaches week to week. But what we have done is try to send them physical activity equipment, activity cards and also a fitness tracker so that they are able to see how many steps they are doing. I think children really love receiving this. You know, they are not expecting it and you know, it is a really good quality fitness tracker as well so they can put it on and take it to school. They do not need to take it to school, they can wear it after. But I think it really incentivises them and really encourages them to do more physical activity and keep track of you know, how many steps they are doing. So, as I mentioned, four mail outs throughout the week, and this is all for free. So, you know, we just actually completed interviews with families who are completing this terms program and a lot of them are really impressed with how resourced this government program actually is.
Georgia: Now, as GPs, we like to practice evidence-based medicine, so though this online program sounds great in principle, I do acknowledge having asking the Go4Fun team when I met them last year, you know does it actually work? Are there are any measurable outcomes? And the answer is yes and it was published as the Fusion Report. It was pre-pilot testing of this Go4Fun online program that occurred last year and that included 41 children from 35 children across New South Wales and for me the numbers really speak for themselves. I am just going to highlight a couple of things that really stood out for me. Pre-program only 15% of children were eating three or more serves of fruit a day, which increased to 53% by the end of the program. 57% of parents and carers reported an increase in the serves of vegetables that kids were consuming. 62% of parents / carers reported an increase in their children’s water consumption. Pre-program, 39% of children were not active or were only active on one day per week. By the end of the program, we had 61% of children who were active five or more days per week, so that is a major win. And a similar one was, the reduction in screen time and I suppose that is a reciprocal expectation. On school days, 70% of parents / carers reported a decrease in the time the children spent on screen-based activities. So I think the results really speak for themselves, so I am very comfortable referring families to this program and I think it is quite a very good resource. It is going to continue to add value to communities, but also to us as health care professionals. As you will see on the next slide, we see that this pilot testing occurred with a number of families, some were in rural and regional New South Wales which is very impressive, and that really reflects New South Wales Health commitment to try and address this inequity in service provision for those that live in rural / regional areas compared to those that live in urban locations. And the great thing with the Go4Fun program is that we see that these kids by the end of it not only have they acquired some positive healthy lifestyle changes that we hope they will continue to follow throughout life, but we also see positive changes in their self-esteem and I think that is really valuable, especially given the number of kids that report depression and low self-esteem and other negative psychosocial aspects because of being above a healthy weight.
Leah: So we actually have some testimonials on screen, you know from families who have participated and really found benefit with the program. Just for everyone’s information, so for GPs, if you are sort of not sure, does this person go to face to face or do they go to online, all you need to do as a GP is to make the referral which Georgia will go through in detail later on in the slides, but is make the referral and the centralised line will actually sort of do the rest of the assessment with the family and find out you know, can they go to face to face, can they, you know, is it better done at home? So you do not need to worry about that. You might just need to tell them, like if they ask, a little bit of information about the program. But even if you are not sure, the centralised line can also provide that information too. So really it is just about making the referral and the rest can be done from I guess, our sort of headquarters.
Ruth: Okay, hi everyone. It is Ruth here and over the next few slides I will be providing an overview of the Get Healthy information and coaching service. So, I will just start by asking if anyone out there has heard of the Get Healthy service? Okay, that is great. A few of you have heard of the service, which I guess is always a positive as it has been around since 2009. But today I will provide a general overview of the service and also spend time to discuss some of the new enhancements to our coaching offering for those who perhaps already know and use the service might not have been aware of.
So in terms of what is the Get Healthy information coaching service, it is a free telephone based service which aims to support its participants to achieve healthy lifestyle changes in relation to healthy eating, physical activity and alcohol reduction or in terms of our pregnant participants, abstinence and also in relation to healthy and also healthy gestational weight gain. It aims to build the capacity in the individual and it does this by using motivational interviewing techniques which is all delivered by our university qualified health coaches. And for that, that means all of our coaches are either dieticians or exercise physiologists.
Whilst our service is available to all New South Wales residents 16 years and over, we do have priority groups for those who are at risk of developing chronic disease. It is also important to highlight, whilst we are focussing on New South Wales here, the service is also available in Queensland and South Australia.
So we will just move on to the next slide. So, as this slide shows, we offer two levels to the service. So, when someone signs up to the service which I will show you on a later slide how they do that, they can then opt if they would just like to find out more information at this stage. And if that is the case, they can ask to be enrolled in our information only branch of the service. So this is where they would receive an information booklet that provides evidence-based advice on healthy eating, exercise, healthy weight and alcohol consumption. And they are also offered a one-of coaching session with our health coaches, where the coach can use that session to work with the participant to help them to identify their own healthy lifestyle goal which then the participant can work on in their own time. However, if someone comes to the service, they can also choose to do our coaching stream of the service, and this is where they would receive 10 or 13 telephone based coaching calls which we usually say takes around six months to complete with the coaching calls starting off quite close together, usually once a fortnight, but then they are spread out based on the participants preference. All the coaching calls are organised at a time that suits both the participant and the coach and our operating hours are between 8 am and 8 pm.
So after the initial allocation of the 10 or 13 coaching calls is over, then they have the chance to re-enrol at any time. So later as we go on to explain about how you can refer to Get Healthy, it is helpful to point out that your one referral form does not just lead to this one off ten coaching calls, but it can lead to the person remaining in the service for quite a long period of time, until they reach their own healthy lifestyle goal. So, as I just mentioned the service is offering the coaching aspect of the service. Within that, we offer six tailored coaching programs and these are all tailored to meet the different needs of its participants. So these needs are identified during the initial registration call and that is the first contact that the health coaches have with the participant. During this call, the participants are asked a series of screening questions to find out more about their lifestyle, their circumstances as well as chronic disease risk. Following this, the coaching participants will then enrol into one of our programs. So this can be our standard program, or it can be an Aboriginal and Torres Strait Islander specific program. We also have a type 2 diabetes prevention program. So in relation to these two that I have just mentioned, the Aboriginal and type 2 diabetes prevention, the main difference between these coaching programs are that the participants receive an additional three calls where they then focus on, it is just more time with the coach to focus on their individual risk factors. In relation to the Aboriginal program, we do also have now an Aboriginal liaison officer who is there is provide additional support to the participant as well as having their own health coach.
So launched back now in 2016, we also have our alcohol reduction program. So for this, anyone who is 18 years and above when they are entering the service, they are screened using the audit screening tool. Based on their scores, if the audit score identifies that they are using risky drinking behaviours then they will be encouraged to enrol within our alcohol reduction program, where they will have support and motivation to reduce their alcohol intake to be more in line with the National Guidelines. So it is important to highlight here that this is for those who have risky drinking behaviours, but anyone who is identified as potentially a dependent drinker will be referred to an alcohol specific support service. So that will be a referral out of our service. Also launched in 2016, we have a Get Healthy in pregnancy service. So this is to support pregnant women to stay healthy during their pregnancy and also to provide them with support and motivation for a healthy gestational weight gain, and that is a weight gain which is in line with the National Guidelines. This is by no means to encourage anyone to diet during their pregnancy, but it is just to support them to achieve a healthy weight gain.
So, since this service started in February 2009 now, so it is coming up to its 10th anniversary, we have had over 43,000 people engage in the service. As Georgia mentioned before, kind of the all-important factor is what is the evidence that this works? Why are we speaking to you today as general practitioners? Is there any evidence of if this works and why you should refer your participants? And so we have had an independent evaluation of the service completed. What it found was those who complete our six month coaching program, so yes it is important to reference that this is in relation to the standard program that I have mentioned previously, on average, participants lost just under 4 kg of weight. They also lost 5.1 cm off their waist. But other than this, there is hard measurements. We did also see that our participants generally improved their level of fruit and vegetables that they consumed daily. Also, that they did increase their physical activity levels as well.
Georgia: If you do not mind Ruth, I will just add to that. As we know, an average weight loss of about 4 kg probably represents about 5% weight loss and we know that is clinically meaningful. And when I see 5.1 cm off their waist as a clinician, I am thinking that is definitely going to improve their metabolic health. Because we know that weight that is around the central abdominal area is going to be a lot worse for them, i.e. related to the chances of developing type 2 diabetes, cardiovascular disease, fatty liver and the list goes on. So we cannot be dismissive. Though the numbers may look modest, in the clinical translation, these are actually clinically meaningful results. Thanks, Ruth.
Ruth: Thank you for that. So I guess then aside to those measurements, is the testimonies that we have from participants who have completed the service. So whilst it is great to see the measurements, we do also regularly receive feedback in relation to the fact that the service does improve someone’s confidence to make these lifestyle changes and whether it is a small change or a large change, it is building that capacity in the individual and the motivation to keep going.
So in terms of what we have told you about these two services gets me now to the all-important fact of how to people actually register into the programs? So, families or adults themselves can self-refer into either one of these services by online registration forms, or they can pick up the phone and they can call either one of the services to enrol there and then. Equally, yourselves as health professionals can also refer participants using several different channels which we will start to discuss in more detail now.
Georgia: Thank you, Ruth. So, um, for those of you who use MedicalDirector, I would like to just bring to your attention as you can see on the screen, if you look under the supplied templates, you will then scroll down in alphabetical order and see Go4Fun, childhood obesity treatment programs and then once you click on that, then essentially you will see the form and you can start to add in information. And it is very user friendly, and take it from me who is not that IT savvy, so if I can use it then anyone else can use it. Similarly once we are looking for the Get Healthy program, same kind of thing. We look at the supply tab and then scroll down for a referral form and then Get Healthy New South Wales. Click okay and then start to manually enter in the personal details so that we can complete the referral.
Best Practice is slightly different. Firstly we start off by selecting a patient from the database, for example we will type in A for you know, surname Adams. There we are. And then basically identify the patient and once you select then that is going to automatically enter the data and then as we will see here, we have to manually enter, you know, which parent or carer, or carers because sometimes it might be a grandparent or a foster parent or a parent or there might be a couple that are going to do a rotation, and what their relationship is with the child, and just some other particulars. The more information that we provide, the greater the preparation that either the Go4Fun or the Get Healthy service can pre-prepare. Just like when you know, we refer a patient to a specialist the more information we provide the better the quality of care and service that will be provided.
Leah: And there is also a website which some of you may have heard of before, if you have sort of dialled into some of these previous webinars. It is called Healthy Kids for Professionals. And essentially, this website was formed by the New South Wales Ministry of Health and it contains a lot of resources targeted at health professionals and clinicians, aimed to support them to manage children and families above a healthy weight. They go through actually four stages in which resources in the website can actually assist a clinician or health professional and that is through assessing, advising, assisting and also arranging referrals. So you will be able to sort of see those sort of sub headings as you go through the website. In terms of referrals and referral forms, that is under the arrange tab, but we have got a lot of promotional materials for the Get Healthy service and Go4Fun as well.
One thing that I would sort of like to flag, is that there is a weight status calculator as well. So you can sort of see that image on the left of the screen on the moment. So on the right is the promotional material. If you look on the left, you are able to put in your client’s details and then basically this weight status calculator will be able to sort of, I guess indicate to you whether your client is above a healthy weight, well above a healthy weight, healthy weight or below a healthy weight. And once the result is up, it will provide pop-up indications of what programs might be available for that particular patient or client. And the calculator plots that child’s age and BMI on the US Centre for Disease Control’s BMI for age chart for girls and boys. And yes, just makes it much easier for you to sort of work that out.
Sammi: I would just like to also add the three part webinar series that we did run last year, the Healthy Kids for Professionals. The recordings of those are on the RACGP website so you can actually go back if you are interested in looking into those five steps Leah was talking about a bit more. It goes through it in a bit more detail. If you have got any questions about where you can find those, I will post an email address for you now.
Georgia: Fantastic. Our practice actually uses the Genie software, so actually have to revert to pen and paper which is not a problem, because I have got both the Go4Fun and the Get Healthy websites as one of my favourites so it is easy find and also the forms, we have got them on our practice intranet under “Georgia’s favourites” so people know where to find anything that is to do with healthy lifestyle and assisting people whether they are young or adult age that are above a healthy weight. So, very user friendly and a very good resource. So they cater for all kinds. The IT savvy and the dinosaurs like me.
Now, I do not know if anyone with us tonight can relate to this, but often when I refer a patient to an external service, whether it is an Allied Health professional or a community service, I rarely get any feedback or any communication other than what the patient self-reports, and speaking to my GP colleagues this is really a big bug-bear of ours. This is where the Go4Fun and the Get Healthy services are different, and I can personally vouch for this because I have used them. We receive communication at different time points along the program, when they register, half way through when it is the Get Healthy program and also upon completion of the program. This is important because it assists us with making sure that any information and any care that the care is providing, we as the primary team are also reiterating the same consistent health messages. Similarly, if a family does drop out for whatever reason, we are also notified and this provides us with an opportunity to establish contact with that young person, family et cetera and explore the reasons why they dropped out and to trouble shoot. It might have been things like being able to attend or some other minor thing that if we are aware of it we can help them to overcome. Obviously such a discussion has to be done in a non-judgemental and a very sympathetic manner.
A couple of slides ago, Leah did show us this initiative from New South Wales Health, which showed that bar graph that showed whether a child was under a healthy weight, a healthy weight, above a healthy weight et cetera. So that was in the green and other colour spectrum. This is a pictorial representation. This is the kind of letter that I have received and many other GPs that use the facility have used. So this is the report. It obviously tells us the particulars, the anthropometry, the child’s height, weight, waist circumference et cetera and what centile weight they were. So I know the numbers are not very clear, but the pink in the graph is basically above the 85% centile, and then we have got you know, the yellow and the green. So when I see my children above a healthy weight and also adolescents, what I say to them is I am not particularly fussed where you start, but I want to see is that eventually you start to get out of the pink and closer to one of the other colours. And that is our initial goal. We do not want to be seeing an upward trend. And even if we are stating somewhere in the pink but heading closer to one of the other colours, that is a positive thing. We have to be realistic, especially if many of these kids are very well above the 85th centile, reaching somewhere low in the green is unlikely to happen, and this is not necessarily a target that we have to be aspiring for. As I said earlier, a 5-10% weight loss translates to very clinically meaningful improvements. This makes the difference between a child having pre-diabetes and then not having pre-diabetes versus continuing to put on weight and actually developing type 2 diabetes and the like. But the report goes on to also show us in a very easy to read and easy to understand format, because let’s remember we are busy. Our in tray is full of lots of paper work and reports and pathology to look at, so we want a very easy to read and easy to understand pictorial representation of what has been achieved, and how the child or adolescent is progressing so that we know where they are at, and similarly when we do see them, we can also promote similar positive health messages and encourage them to keep on with these positive health lifestyle changes they have adopted, because if they keep on with the healthy lifestyle habits then there is a good chance they will keep doing that as adults. And that is really what we want.
Leah: Okay, so we do also get questions about whether participants can re-enrol into the program or not. So I will go through the two specific programs. So, in Go4Fun, if a participant enters the program and then for whatever reason does not finish it, the thing is, we want participants to be committed to the program, and I think we understand that there are times when they are not. So if there is a health professional referral, we will allow participants to re-enter the program. We also have a criteria for re-entry in which there has been illnesses or emergencies, you know, special family circumstances et cetera, and they are judged on a case by case basis as well. So the best thing to do is, yes to refer them to the central line if you would like them to sort of re-enter the program. However, the participant will be going through the exact same content, so you know in that sort of case if we have someone who has done all 10 sessions, you know if they are going to re-enter the program, they are going to be learning the exact same thing. So I guess that is why Go4Fun is a little bit more strict in terms of actually having re-entry for a particular reason ort if they were not being able to engage at the time.
In terms of Get Healthy however, because participants are working on their own individual goals, they are actually allowed to re-enrol at any time and there is no limit on the number of re-enrolments. So I think you know, there are some participants who have been with the Get Healthy service for quite a number of months or even years, because you know, they can change goals throughout and essentially you know, they might have started in the first six months on a nutrition goal and then worked on a physical activity one or for various reasons. So I guess it just sort of clears it up between both programs.
Georgia: So why refer? So I would like to ask you why not? Many of us as GPs are very busy and very caring, but do we think that we could actually sit there and do all of the intense work that these programs can offer? I have got to be honest I do not think we could. I am not saying that we are not able, but we do not have the skill set and the time to be able to do it at this degree of patience and also the chronicity of it, being able to do over such a you know, a 10 week program. However what we can do in primary practice is to re-enforce these healthy messages and so for people like myself who have used the Go4Fun and Get Healthy service, getting the feedback is invaluable. It makes our life as clinicians a lot easier because we can ensure that we are all on the same page. Because let’s face it, if patients get mixed messages from the health care professionals, then they are likely to disengage and then we have lost them. And that is definitely not what we want to happen. Secondly, these services are very accessible. There are not long waiting lists, whereas some times in general practice there can be waiting lists to see us and also our Allied Health care team members, but essentially to answer the question why refer, like I said at the beginning, why not? We have got nothing to lose but only to gain. And I think we would be doing our patients and their families a disservice if we did not offer them a referral.
So just remember, as GPs we are in a very privileged position. We are a trusted source of information. We are well-placed to offer both young people and their families the motivation that they need to continue with the healthy lifestyle programs. We know that these programs are effective. We have seen the results and we know that this does translate to clinically meaningful improvements in their health. Also, we know that they get these rewards and these incentives such as physical activity equipment, such as the trackers, the fitness trackers et cetera. I think these are all great resources that keep the family engaged and hopefully they will be resources that they can continue to use as adults. As a true testament to the number of people just here this evening that are wearing their own Fitbit you know, as a physical fitness tracker. So we are trying to nurture these young people to adopt some healthy lifestyle habits that they will continue to practice later on as adults.
So thank you everyone for you questions and comments this evening. I know that we are slowly coming to an end, but do not fret, we will be able to answer a few questions before we close off tonight and as Samantha said earlier, we will be able to answer some of the outstanding questions in the upcoming weeks. I am hoping that by the end of this webinar this evening that you feel comfortable in discussing telehealth programs for New South Wales patients who want to make healthy lifestyle changes, that you feel that you could explain the elements of the Go4Fun online program to a family including the possible positive health outcomes, that you feel comfortable explaining the features of the Get Healthy information and coaching service, including the different health coaching programs that are offered, that you feel comfortable incorporating the referral of eligible New South Wales patients to the Go4Fun and Get Healthy services into routine consultations using the different referral mechanisms and finally and most importantly, to use the feedback that we receive from such programs as part of our ongoing consultations with our patients and with their families because when it comes to the crunch, our goals are to improve our patients’ health and wellbeing. Thank you.
Sammi: Fantastic. That brings us through to smack bang on 8.30 to the end of this session. I would just like to say a big thank you to Georgia, Leah and Ruth for joining us tonight. Thanks again everyone for joining us and good night.