Introducing community-based lifestyle clinics to improve population health in Malta
- Growing burden of chronic disease, partly attributable to lifestyle-related risk factors.
- Limited availability of services focusing on health promotion and disease prevention.
- Limited time for general practitioners to spend with patients on health promotion and disease prevention.
- Lack of communication between professionals offering health promotion and disease prevention services.
- Lifestyle Clinics offering healthy-living support were introduced across Malta to expand availability of health promotion and disease prevention services.
- A motivated, multidisciplinary group of primary care professionals led the initiative through collaborative teamwork.
- The initiative capitalized on recent government policies supporting chronic disease prevention and a newly-established postgraduate community nursing programme.
- An initial information campaign helped raise awareness and gain public acceptance for new services.
- Patients responded well to being offered a more active role in their health; further, patients play a key advocacy role in expanding the initiative.
Like many European countries, Malta faces a high and rising burden of chronic disease, namely cardiovascular disease and cancer. Several lifestyle-related health risk factors that are prevalent in the population have been attributed to the chronic disease burden, notably smoking, high blood pressure and obesity. However, general practitioners’ ability to meet the wider health and social needs of patients during routine health visits, and to adequately provide personalized health promotion and disease prevention services, was hindered by the curative focus of primary care. Furthermore, general practitioners’ time constraints, the absence of referral guidelines for complementary health promotion services, and the lack of communication between providers across disciplines restricted the provision of holistic care.
Conditions were favourable for a community-based health promotion and disease prevention initiative to be developed: the government was implementing policies supporting the reduction of chronic disease and a postgraduate community nursing programme was recently established in Malta. This context caused a local primary health care centre to launch a Lifestyle Clinic service in 2011. “As a primary health care department, we realized we needed to focus on the preventive aspect of health more than anything.” After conducting a small-scale pilot, the Lifestyle Clinic model was gradually expanded to seven areas across Malta. In certain districts, Lifestyle Clinics are based in primary care centres; in others, they exist as separate entities within community settings. “We work in eight health centres, but we wanted to move away from these and encourage the idea that people seek health not just when they feel ill, but also when they feel well.” Lifestyle Clinics aim to empower patients to adopt healthy behaviours; the long-term goals of Clinics are to decrease patients’ risk for future health problems and to improve patients’ management of existing conditions. Community nurses oversee the operational management of Lifestyle Clinics and care for patients who self-refer to the service. Patients receive a comprehensive health and social needs assessment that includes a review of medical history, diet, substance use, sexual behaviours, social needs and mental well-being. Basic measurements (e.g. blood pressure, blood glucose and body mass index) are also taken as part of the assessment. Nurses then work in partnership with patients to develop personalized care plans and provide tailored support to enable health improvements, referring to other providers and services as needed. Lifestyle Clinics have proved very popular among patients and patient advocacy is helping to promote the initiative at the government level. Leaders of the initiative continue to oversee activities and work to extend Lifestyle Clinics to additional communities across Malta.
Fully implemented and scaled up
A group of health and administrative professionals working within a local primary care centre observed a need to “move away from being disease-oriented” and to “focus on preventive care”. In response, these professionals pushed for the establishment of the initial Lifestyle Clinic with support from the primary care centre’s director. A multidisciplinary organizing committee composed of a general practitioner, several nurses and members from the centre’s administration was formed to design and implement the initiative. Community nurses with postgraduate training were recruited to run Lifestyle Clinics and lead delivery of health promotion services. Leaders of the initiative continue to oversee activities, encourage the proliferation of Lifestyle Clinics and advocate for increased government support for the service.
Feedback on Lifestyle Clinics from patients is reportedly very positive. However, official outcomes and data are not currently available.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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Primary Health Care Centre