Hi, please shortly introduce yourself and your role within EUPAP project.
Hi, I am Mette Mærsk Clausen and together with Natasha Bøgh Harvey Engelbredt, who has recently returned from maternity leave, we have been involved in the EUPAP project since September 2019. We are both project leaders of the EUPAP in Denmark and are responsible for the strategic planning and execution of implementation activities facilitating the transfer of the Swedish model of PAP to our region. In Denmark, EUPAP is not implemented nation-wide but is lead by the Management of Strategic Health Randers. The Management of Strategic Health Randers is a cross-sectional health alliance consisting of Randers Regional Hospital, the four Municipalities of Randers, Favrskov, Syddjurs and Norddjurs, as well as general practitioners, whose purpose is to further develop and strengthen the relational ties across the different health sectors, as well as create change, improvement and solutions for a better health collaboration.
The Danish focus of implementing PAP is to engage a target group of mentally vulnerable patients into local activity organizations, communities, municipal facilities and/or sport clubs in order to make them stay committed to being more physically active over time. But also to bolster them socially and strengthen their feeling of self-efficacy and success.
Photo credit goes to photographer Helle Brandstrup Larsen
Could you present some of your recent activities regarding Swedish PAP method implementation in your region?
Currently, our main focus is on preparation prior to further implementation. We have already done one pilot study implementing PAP in a small scale in the Emergency Department of Randers Regional Hospital. This taught us valuable lessons, and we have since adjusted our implementation setup shifting focus from the Emergency Department to the hospital outpatient clinics. Due to Covid-19, our second pilot study hasn't yet taken off properly. Instead, we have focused on preparing implementation tools to be used for PAP prescribers and patients after the pandemic is over. For example, we have created a local flyer/pamphlet to hand out to patients when they receive a PAP in either the medical or psychiatric outpatient clinics. The pamphlet partially focuses on what the patients can expect from receiving a PAP (what will happen, continuity of care, and so on), as well as the benefits of being more physically active. We have created the pamphlet from the Swedish example.
A photo was taken by photographer Helle Brandstrup Larsen
Also, we are regularly organizing working group meetings to build and strengthen the relationship between PAP coaches and nurses (prescribers) to assist them in onboarding new patients, answer main questions or concerns they’re getting from patients, providing recommendations on how to follow up and effectively manage patients’ expectations. Initially, those meetings were meant to track the activity progress and provide status updates of where our PAP coaches and nurses are with new patients‘ recruitment stage, however, due to lockdowns caused by pandemic we had to refocus those meetings to provide additional value for our PAP coaches and nurses and continue their training.
Furthermore, after our first pilot study that we organized from November 2019 to August 2020 (extended due to Covid-19) we realized that recruiting patients from our Emergency Department at Randers Regional Hospital wasn't the right strategy for us to start with, since the patients are (rightfully) more concerned with their acute health problem and have difficulty finding the surplus and motivation to also focus on their physical activity and sedentary behavior habits. Therefore, following this hypothesis we‘ve now begun our second pilot study where we recruit patients from our medical and psychiatric outpatient clinics instead whenever they come for a regular visit or treatment consultation session with a specialist. As a result, we have worked with introducing our personnel in the outpatient clinics to the Swedish method and motivational interviewing techniques. To start with we have trained three nurses. However, most of these hospitals and psychiatric clinics have been shut down since Mid December– throughout January due to the second Covid-19 wave in Denmark. Nevertheless, this pilot study is constantly in motion meaning that we are ready to continue our activities and onboarding new patients once the Covid restrictions are lifted.
In addition to that, we have set up a local intranet page for the hospital employees working with PAP, where they can download the prescription form for PAP, SF-36 surveys, patient leaflet, Borg scale, evidence based recommendations for physical activity etc.
Also, we have shared special training videos with our PAP coaches so that they could share them with their patients. The videos are published on www.sundhed.dk website, which is the online public health portal for all citizens in Denmark that gathers health data, your own patient file, test answers, medical referrals etc. On the portal you can find a list of different exercise categories e.g. exercises for strengthening your elbow, lower arm, knee, lower back, hips, hands, shoulder, neck etc. All the videos help to address soreness and/or pain in the musculoskeletal system and are led by physiotherapists.
Finally, we also noticed that due to strict lockdowns and many people being stuck at home some of our national news broadcasters shared information and tips on how to stay healthy and physically active at home, which nicely aligns with EUPAP project topic. For example, there was an Instagram post shared by Danish Broadcasting Corporation "DR Nyheder" that gives 5 tips on how to exercise and be more physically active during COVID-19.
What were the main obstacles/challenges you faced when implementing EUPAP activities during pandemic?
Like most of the EUPAP partners we faced the same issues of many EUPAP activities being put on hold due to strict national lockdowns, severe restrictions for leisure and recreational activities and overall healthcare focus shifted towards the treatment of Covid-19 patients. Since most of the Hospitals and Psychiatric clinics have been closed since mid-December – throughout January our trained nurses were struggling to recruit new patients. Also, gyms, local society facilities and other community services have been closed, which is a great challenge to keep patients motivated and engaged because community and social factor plays an important role in keeping those patients engaged.
Do you have any recommendations for other EUPAP partners on how to overcome the challenges in EUPAP activities implementation because of Covid based on your previous experience?
We are not convinced that we have found the golden path, and we are sure that every EUPAP partner is doing their best in keeping and progressing with their EUPAP activities during this challenging period, however our recommendation would be to keep working on the preparation activities to build a solid ground prior to EUPAP implementation. According to our experience it has been possible to keep momentum and energy in our local partners, nurses/prescribers and PAP coaches by continuously having a contact with them, arrange virtual meetings and so on. This has helped us to prepare EUPAP coaches and prescribers involved in EUPAP implementation so that we are ready to kick off our planned activities straight away once the pandemic is at a more tolerable level. In line with this, we would encourage our EUPAP partners to keep organizing local steering groups and working groups to keep building relations between all personnel involved in EUPAP. This way our nurses are ready to confidently reach out to a familiar EUPAP coach once restrictions are lifted.