Exercise is Medicine Australia Education evaluation summary

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1 Exercise is Medicine Australia Education evaluation summary Exercise is Medicine Australia (EIM Australia) seeks to support health care providers to become consistently effective in counselling and referring patients as to their physical activity needs. Understandably, GPs in particular can be reluctant to raise issues if they are not convinced they have a management option which is going to help. This is especially the case given the time pressured nature of general practice, where the average consultation length is approximately 14 minutes. The time available for discussing issues not directly related to the person s presenting complaints has been estimated to be one to two minutes. Between August and December 2013, EIM Australia facilitated 22 workshops across Australia and launched an online set of modules for those that could not attend a workshop. In five months, education has been provided to over 700 health care professionals. The EIM Australia education in conjunction with existing EIM Australia resources supports GPs, nurses and allied health professionals in their assessment and management of patients with and at risk of chronic disease. FACE TO FACE WORKSHOPS Providing workshops without a registration fee usually means high registration numbers, but tend to translate to more no-shows than a paid workshop. All workshops took extra registrations to cover the gap and ensure an interactive session. Table 1: Registrations, attendance, evaluation comparison Table 2: Represented professions Registrations Attendance Evaluations GPs 52 Other: 16 Nurses 207 Health Promotion 1 Allied Health: 70 Community Health 2 Exercise Physiologists 20 Mental Health 1 Physiotherapists 13 Social Worker 2 Occupational Therapists 7 Student 3 Psychologists 9 Personal Trainer 4 Pharmacists 6 Practice Manager 1 Dietitians 4 Care Coordinator 1 Podiatrist 3 Medicare Local Staff 1 Aboriginal Health Worker 2 Paramedic 1 Diabetes Educator 5 Not specified 65 Speech Pathologist 1 Total 410

2 EVALUATION DATA From 410 attendees, 322 evaluations were completed by GPs, nurses and allied health professionals. The intent to change clinical behaviour is obvious in evaluations, with numerous attendees identifying that they are now more confident to engage their patients in a conversation about physical activity, and that they have the resources and referral pathways they need to support long term behaviour change in their patients. Participants also note that they have more knowledge and understanding of the role of accredited exercise physiologists (AEPs) in chronic disease prevention and management. The benefits of such a multidisciplinary audience were also noted throughout the evaluations. With 99% of evaluations showing that all learning needs were met and 100% showing that the content is relevant to practice, it is obvious that the workshop hit the mark. Patient compliance and fast consultations were highlighted as barriers to increased physical activity, with many clinicians indicating that the patient expectation to receive a medical prescription plays a large role in the lack of physical activity. Respondents to this evaluation highlighted a range of strategies which may be used to address these low activity levels. Such strategies have a focus on multidisciplinary care and service integration to increase awareness of available pathways to care and improve communication between services. There is also a need to up-skill healthcare practitioners in health coaching and assessment techniques and to introduce a range of strategies for the self-management of physical activity for this patient group. Financial incentives for practitioners, targeted projects and programs, and ongoing education and networking opportunities will be required to support these strategies and embed these processes into every day practice. Please see the next page for a detailed summary of responses to the evaluation. ONLINE MODULES The content of the face to face workshops was adapted to suit an online learning environment to capture clinicians who could not attend a face to face session. With over 300 registrations to date, the online platform has proven a necessary addition to the EIM education suite. 84% of participants rated the online course as excellent or good, and 88% would recommend the course to colleagues. A high proportion of allied health providers completed the online modules compared to GPs and Practice Nurses. Interestingly, this is the opposite of the face to face workshops. Table 3: Online registration split GPs Nurses Allied Health Total

3 RATE TO WHAT DEGREE THE LEARNING OBJECTIVES HAVE BEEN MET: Rate to what degree the learning objectives have been met: Understand the mechanisms of exercise in managing chronic conditions including in older Australians Recognise the benefits of aerobic, strength and flexibility training in the prevention and management of chronic disease Not Partially Entirely Total Met Met Met responses 1% 20% 79% 310 1% 14% 86% 311 Understand the importance of graded exercise therapy 1% 23% 76% 310 Feel confident in working with allied-health providers (e.g. accredited exercise physiologists) to provide multi disciplinary care to patients Apply behaviour-change principles specific to adoption of physical activity Demonstrate knowledge and understanding of the Australian physical activity guidelines Integrate existing resources to support primary care e.g. factsheets, Adult Pre-exercise Screening System tool, Healthcare provider s action guide, Physical Activity Calendar of Events, prescription/referral form. Understand the appropriate safety management of a patient regarding physical activity intervention 0% 17% 82% 308 1% 25% 73% 405 1% 25% 74% 322 1% 26% 73% 320 1% 27% 72% 321 Rate to what degree your learning needs have been met 1% 29% 70% 287 Rate to what degree this activity is relevant to your practice 0% 17% 83% 317 Overall result 1% Not Met WHAT DID YOU FIND MOST INTERESTING/RELEVANT? 22% Partially Met 77% Entirely Met Theme Clinician behaviour change Representative comments How to commence discussions with patients to their level of fitness and amount of exercise they complete per week. Incorporating exercise in management of my patients in light of the time saving resources available (GP) Encouraging physical activity more in assessment This has been very encouraging. This would come into 90% of my consults as a practice nurse Suggestions of how to initiate discussion re physical activity with patients (profession not specified) I can refer chronic disease patient to exercise physiologist with Team Care Arrangements - very helpful (GP) Very interesting - great to know protocols to use for my patients. Will be very handy

4 Role of an AEP Statistics and specifics EIM resources Multidisciplinary Care General The most relevant is recognising the increasing number of chronic disease patients who would benefit from professional exercise programs done by AEPs (GP) Most of this was new to me - I had not heard of an exercise physiologist - great ideas Highlighting differences between personal trainers, physios and exercise physiologists Research - evidence base of benefits of exercise (Psychologist) Relevance of information to older population (mostly in regards to balance confidence & reduction of falls) (profession not specified) Benefits of exercise in multiple conditions. Very good YouTube video with stats that I will share with colleagues (profession not specified) The whole concept of 'exercise is medicine', the statistics of how exercise improves health and outcomes for chronic disease Thinking about different requirements of activity for different conditions. The statistics for reducing heart disease mortality even with mild-moderate exercise (Practice manager) Physical activity screening tool information (GP) EIM website and factsheets. I will use them! Healthcare Provider Action Guide EIM website should be in the drinking water (GP) Prescription for differing chronic conditions - good to hear advice and knowledge of other medical professionals Hearing the information presented to GPs and other allied health. Good networking in primary health care (AEP) Discussing with other healthcare professionals about what they recommend to patients at acute/gp care (AEP) Extremely interesting workshop and extremely relevant to my role as a practice nurse Group discussions and perspectives (GP) Insights from GPs (Physiotherapist) Case studies, finding out about group sessions - 8 for diabetes The presenter was knowledgeable and interesting very enjoyable and informative. Really good. Small effort with high return Fabulous presentation EXTREMELY informative and helpful information Great workshop, I wish more GPs and nurses come along in the future (AEP) Agree with EIM 100% but motivation & compliance is the problem (GP) WHAT DID YOU FIND LEAST RELEVANT? Theme Representative comments Notes Case studies and content General case studies - would have been more relevant and interesting if had been locally experienced case studies Mostly reinforced prior knowledge as an allied health professional The case studies were a good way to see how exercise assists in a variety of patients. Case studies have been reviewed and updated.

5 Length of the session Presentation style Perhaps breaking into groups to work out a plan, then evaluate may work better to engage the group The session did feel long Would like a longer, more practical session It is time to change the way similar presentations are delivered. We could have listened to the lecture while exercising ourselves Involving the audience in say, a balance assessment, would be fun and informative (GP) A 1 hour session has been developed and will be piloted in early Demonstration of some simple stretches and exercises has been built into the workshop.

6 REFERENCES Blair, S Physical inactivity: the biggest public health problem of the 21 st century. British Journal of Sports Medicine, 43; 1: 1-2. Goss J Projection of Australian health care expenditure by disease, 2003 to Cat. no. HWE 43.Canberra: AIHW. Sallis RE. (2009) Exercise is medicine and physicians need to prescribe it! Br J Sports Med January 2009 Vol 43 No 1. Evaluations collected at Exercise is Medicine Australia workshops held between August and December 2013 Evaluations collected from the Exercise is Medicine Australia online modules between September and December 2013

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