Population Health

By funding services to care for people with chronic conditions and supporting general practices to keep up to date with changes in immunisation and cancer screening, we are delivering better heath, together.

Our Priorities

• Improving the management of chronic disease in primary care and reducing rates of potentially preventable hospitalisations by working with primary care providers to target specific areas of need.
• Increasing childhood immunisation rates within regions not meeting national immunisation targets.
• Increasing access to cancer screening programs, by working with general practice and other stakeholders.

Key Activities

Integrated Chronic Disease Care: A service that provides country-based clients access to clinician treatment services and supports them to maintain independence, self-manage their condition and, most importantly, improve their health and wellbeing.

Immunisation Updates: An activity, in partnership with Department of Health, Communicable Disease Directorate, to update nurses on the Australian Immunisation Register Digital Handbook, HealthPathways WA and the ‘No jab, no pay’ policy, and to identify and support general practices with high numbers of overdue and incomplete immunisations.

Cancer Screening Plan Do Study Act: An initiative, co-designed with Cancer Council WA, with input from WA Cervical Cancer Prevention Program, BreastScreen WA and WA Cancer and Palliative Care Network, that implements quality improvement screening activities.

Chronic Heart Failure: A initiative to explore collaborative action on chronic heart failure and to increase capacity in primary care to manage patients living with this condition, as effective long-term management is key to reducing hospitalisations and improving survival rates.

Chronic Obstructive Pulmonary Disease Service: Delivered in partnership with Joondalup Health Campus and Silver Chain, this service helps people being discharged from hospital to keep on top of their condition and stay well in the community.

Obesity: Acknowledging the critical role primary care plays in prevention, WA Primary Health Alliance has formulated a plan to tackle obesity. We aim to:

• Improve access to evidence-based person-centred primary care for Western Australians with weight management challenges.
• Enable GPs to use their skills as expert generalists to manage this public health issue.
• Support people to reach a healthy weight and reduce their risk of chronic disease.

Key Achievements

• Reached a total of 7,610 Integrated Chronic Disease Care clients, a significant proportion of whom report mental health conditions, adding a complexity that can impact on the client achieving self-management.
• Funded Chronic Disease Project Officers in partnership with WA Country Health Service who work with our funded Integrated Chronic Disease Care providers to establish joint referral pathways, improve system connectedness and reduce service delivery duplication.
• Supported a cervical screening self-collection pilot project run by WA Cervical Cancer Prevention Program, with seven practices having completed the pilot and 33 more enrolled for a combination of breast, bowel and cervical activities.
• Completed Phase 1 of the Chronic Heart Failure Project, including planning for and funding nine initiatives to increase capacity in primary care and empower consumers, which included:
• Establishing six chronic heart failure nurse-led clinics.
• Increasing the capacity of local exercise physiologists to work with complex patients enabling care closer to home, reducing dependency on hospital services and up skilling workforce.
• Trialling a telehealth cardiac rehabilitation program to improve health outcomes for country patients with limited access to rehabilitation.
• Developing teaching vignettes for GPs, with feedback from cardiologists, in the contemporary treatment of chronic heart failure.
• Participated in the development of WA’s Healthy Weight Action Plan, which has a clear focus on early intervention and management of overweight and obesity in primary care.
• Attended the National Obesity Summit to represent Australia’s 31 Primary Health Networks (PHNs), ensuring primary care is integral in the development of multi-faceted and community wide approaches to addressing overweight and obesity.

Case Study

Getting to grips with obesity

Obesity is an urgent public health issue, with big plans afoot to halt its rise in WA

Population Health