"My Health" - A new coaching approach for empowering people to health activities in an integrated care setting

Abstract

Introduction: Gesundes Kinzigtal offers a broad range of activities and services within their integrated care model for all ages in the region. These are for example lecture series or seminars about health topics, nutrition consultation, education programes, training courses for different needs of activity, equipment training. Since the start of Gesundes Kinzigtal 2006 those services were composed into special care programes covering different chronic diseases. Starting point for these care programes is the physician´s practice, who enrols the patient and initiates care pathway including rigid procedure structure. Practice change, theory, current status and timeline: Providing the right care at the right time and a continuous improvement of care services are guiding principles of the GK model, which is about empowerment and vertical and horizontal integration of the healthcare services. Mainly huge workload for practice staff in the enrolling procedure as well as patient´s wish being more empowered was reason of developing a new care approach named “My Health” in the beginning of 2016. Final Implementation for region Kinzigtal is planned during 2017. The overall aim of “MY Health” lies in the ability to adapt the existing programmes to the specific needs, wishes of people living in Kinzigtal region and get much closer to the subject of multi-morbidity. With regard to the new developments Gesundes Kinzigtal is about breaking down the rigid structures of the programmes and to give the patient the opportunity to individually put its elements of former programmes together. These kind of modules are very clear topics, such as medicine, therapy, medication, exercise, relaxation. Every module has a huge bunch of health offers that could be either a training module, a self-management module, a psychotherapeutic brief intervention or a particular module where the physician assistant regularly. To handle this procedure a new profession called “Consultant – My Health” will be responsible for the consultation and planning of those individual offers. All the physician practice has to do is to prescribe the consultation with his recommended modules and makes an appointment for their patients. The consultation takes place in during define opening hours at different locations (office Gesundes Kinzigtal, citizen office, practice) with respect to multi-morbid persons with limited mobility. Innovativeness, impacts, sustainability, and transferability: Within the scope of the planned care approach “My Health” the introduction of a new professions lowers the barriers for patients to enter in health activities and improves cost effectiveness of the integrated care model in the long term. Tasks of this new profession, which doesn´t exists so far in the german health care system will incorporate mainly the arrangement of the new care modules and health care services based on physician´s recommendation and the individual preferences of the patient. The physicians can be relieved from their burocratic workload for enrolment and giving detailed information about care services. But still they are up to date of the care treatment process by looking in to their electronic patient record, where the consultant puts the results that were agreed with the patient directly after the consultation appointment. Consultants will be qualified and trained to be prepared for this kind of tasks. But there is no need for extensive medical knowledge because ultimately the direction is already determined by the physician and by the modules and contraindications. Therefore, this approach can be easily transferred to other regions in Germany. My Health is currently tested in 7 GP practices and provides relevant lessons to optimize the approach and the transferability.