This document discusses several frameworks related to chronic illness management in primary care physiotherapy in Ireland. It summarizes frameworks from the HSE, WHO, and others that address chronic disease prevention and management through primary healthcare reform, with a focus on strengthening primary care services, developing guidelines and quality assurance, and empowering patients. The frameworks emphasize the role of physiotherapists in chronic illness care, exercise referral, health promotion, and developing partnerships across sectors to address public health challenges like obesity.

1. THE ROLE OF CHRONIC ILLNESS
FRAMEWORKS IN PRIMARY CARE
PHYSIOTHERAPY
Informing future practice

2. INTRODUCTION
● The HSE Chronic Illness framework refers to chronic disease as any long
term condition (6+ months) which can only be treated and not cured.
● Significant cause of morbidity and mortality and can significantly reduce
quality of life .
● Massive financial costs for both the patient and the health care system.
● Although population is now living longer, chronic conditions have reduced
the quality of those remaining years.
● This burden needs to be addressed or ‘we will continue to add years to our
lives without adding life to those years’ – (IPH making chronic conditions
count, 2010)

3. “PRIMARY HEALTHCARE: NOW MORE THAN EVER” (WHO
2008)
Four sets of PHC reforms:
Why primary healthcare?
1) Health inequality
2) Changing health
problems
3) Inflexibity of current
system

4. PRIMARY HEALTHCARE: WHERE IRELAND RANKS
IN EUROPE?
● Work force development - 6th in Europe
● The highest payments in the public system exist in Ireland, €45–60 for
each GP visit.
● Evidence-based clinical guidelines for GPs exists in all countries except
Ireland, Malta and Switzerland. - Quality assurance?
● Ireland had the lowest level of patient satisfaction with the costs of GP care
in 2007
● When considering all features of access to primary healthcare, Ireland
ranked lowest in europe

5. TACKLING CHRONIC DISEASE
Addresses the challenges of chronic disease to reduce the burden for individuals, their carers
and the health system here in Ireland.
Aim:
(i) to promote and improve the health of the population and reduce the risk factors to the
development of chronic diseases
ii) to promote structured and integrated care in the appropriate setting that improves
outcomes and quality of life for patients with chronic conditions.
● Reorientation towards primary care and the provision of integrated health services.
● The primary healthcare sector should play a central role in the care of patients with
chronic disease. Primary healthcare should be strengthened to meet the needs of
patients with chronic conditions.

6. HEALTHY IRELAND
A collective response to the risks that threaten Ireland’s
future health, wellbeing and economic recovery.
Health policy guidance for period (2013-2025), based on
analysis of social determinants of health.
Aims:
● Increase the proportion of people who are healthy at
all stages of life
● Reduce health inequalities
● Protect the public from threats to health and
wellbeing
● Create an environment where every individual and
sector of society can play their part in achieving a
healthy Ireland
https://www.youtube.com/watch?v=1dxILd49RAM&hc_location=ufi

7. RELEVANCE OF HI FOR PHYSIOTHERAPISTS
Broad framework mainly addressing public health from a governmental
and public policy perspective.
Reaffirms and updates government commitment to primary care policy
(2001) in light of the growing prevalence of chronic illnesses
Acknowledges the vital role of exercise promotion as a means of
addressing public health.
Calls for increased funding towards community based prevention
initiatives
Supports means of education that would improve health literacy

8. NATIONAL EXERCISE REFERRAL FRAMEWORK (NERF)
Model of best practice for inclusion of PA pathways in health care setting.
Aim: To increase PA levels in individuals living with an established NCD or
disability
How? Exercise Referral, develop knowledge of HCPs.
● NERF recommends that inactive/sedentary at risk of developing are given
brief advice/intervention
● Exercise Referral for those suitable: Assessment, develop tailored PA
programme, monitor progress and follow up
Integration of PA and NCD prevention into primary care systems is globally
recognised as one of the best investments for PA

9. FUTURE PHYSIOS...
Within NERF Physios can act as:
1.Referring Practitioner:
Recruitment, suitability, explain benefits
E-Learning training module ‘Promoting PA’ via HSE
2.Exercise Referral Unit:
Advice, can match patient to suitable service provider.
Must have significant knowledge of NCD’s.
3. Service Provider:
Lead patient within PA setting.
High Support Centres, Community Based PA
Programs+ Exercise Facilities, Self directed

10. HSE FRAMEWORK FOR ACTION ON OBESITY 2008-2012
Aim: Plan for how the HSE will facilitate the implementation of the
recommendations from The National Taskforce on Obesity 2005.
How?
● effectiveness in surveillance, research, monitoring and evaluation
● uniform approach to detection and management of obesity
● obesity prevention and health promotion
● effectively communicate message on obesity
● engage and support the work of other sectors in addressing determinants
of obesity and the obesogenic environment

11. GUIDE FOR FUTURE PHYSIOTHERAPISTS IN PRIMARY CARE
● Develop primary care networks - include the prevention, management and
treatment of overweight and obesity as part of their core service
● Develop, through the National Health Promotion Information Project, health
information materials on nutrition, physical activity and maintaining healthy
weight for adults and children.
● An individual’s interaction with health care services should be an
opportunity to develop life-skills and foster self-efficacy in support of
healthy eating, active living and positive self-image.
● Work with Local Authorities and Sports Partnerships to implement physical
activity programmes at community level.
Future development..preschool programmes, occupational health, Irish Sports
Partnership, Little Steps programme

14. COMMON THEMES
● Prevention & Management
● Government Policy
● Development of intersectoral partnerships (public & private)
● Patient empowerment
● Evidence Based Guidelines
● Education and Awareness
Implication for physiotherapy?
● Primary care - future employment
● Exercise
● Education
● Versatility of our profession

15. FRAMEWORK LINKS
● The HSE Chronic Illness Framework 2008
http://www.hse.ie/eng/About/Who/Population_Health/Population_Health_Approach/Population_Health
_Chronic_illness_Framework_July_2008.pdf
● IPH Making Chronic conditions count 2010
http://www.publichealth.ie/files/chronic_main.pdf
● Tackling Chronic Disease: A policy framework for the management of chronic disease.
http://health.gov.ie/wp-content/uploads/2014/03/tackling_chronic_disease.pdf
● Healthy Ireland
http://www.hse.ie/eng/services/publications/corporate/hieng.pdf

16. FRAMEWORK LINKS
● National Exercise Referral Framework: Second Draft
http://www.exercisereferral.info/wp-content/uploads/2014/10/NERF%20Draft%202.pdf
● Framework for Action on Obesity 2008-2012:
http://www.getirelandactive.ie/content/wp-content/uploads/2011/12/HSE-Framework-for-Action-on-
Obesity.pdf
● The Report of The National Taskforce on Obesity:
http://www.hse.ie/eng/health/child/healthyeating/taskforceonobesity.pdf

17. REFERENCES
Demaio, A., Nielsen, K., Tersbøl, B., Kallestrup, P., & Meyrowitsch, D. (2014). Primary Health Care: a strategic
framework for the prevention and control of chronic non-communicable disease. Global Health Action
WHO: The World Health Report 2008 - Primary Health Care (Now More Than Ever)
WHO, Building Primary Care in a Changing Europe (2015) Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson,
Richard B. Saltman
World Health Organization (2009). Action plan for the global strategy for the prevention and control of
noncommunicable diseases. Geneva: World Health Organization.