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Country SA PHN Needs Assessment Report 2019 - 2022 Update: November 2019


Contents Contents ........................................................................................................................... 2 EXECUTIVE SUMMARY .......................................................................................................... 3 GENERAL POPULATION HEALTH ........................................................................................... 6 Ageing Populations (GEN-10 & 14).................................................................................... 6 Childhood Development and Youth (GEN- 12) .................................................................. 9 Culturally and Linguistically Diverse Populations (GEN 13) ............................................. 10 Chronic Conditions and Risk Factors (GEN 4) .................................................................. 12 Population Health and Other Factors (GEN - 5, 11, 15, 16) ............................................. 18 Reducing Potentially Preventable Hospitalisations (GEN-8, 9) ........................................ 23 Health Workforce (GEN 2,7)............................................................................................ 26 Health System Integration and Coordination (GEN- 6).................................................... 30 Health Information and Technology (GEN- 3) ................................................................. 34 INDIGENOUS HEALTH ......................................................................................................... 37 Aboriginal Health (GEN- 1) .............................................................................................. 37 MENTAL HEALTH AND ALCOHOL AND OTHER DRUGS ........................................................ 48 Alcohol & Other Drugs .................................................................................................... 48 Primary Mental Health ................................................................................................... 56 Suicide Prevention .......................................................................................................... 70 Service Needs analysis .................................................................................................... 77 PROCESS CHECKLIST............................................................................................................ 80

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EXECUTIVE SUMMARY Preamble Country SA PHNs (CSAPHN) geographically large and demographically diverse region creates some interesting complexities for a needs analysis. The analysis describes an overall picture of the needs of the region, though perhaps in a somewhat generic way. Due to data aggregation and suppression in fundamental administrative datasets, the needs of the smaller communities within the broader geography are not identified using this method alone. In managing this the CSAPHN has provided a general needs analysis of our sub-regions but works at a more localised level with our Local Health Clusters (Community Advisor Committees) to identify needs targeted to individual or small groups of individual communities. The overarching context for consideration by this needs assessment, is a region covering an area greater than 900,000 square kilometres and a population density fewer than 2 persons per square kilometres. Our region comprises over 100 communities of significant size, with only 10 communities over 10,000 persons and the remainder in the range of approximately 500 to 2000 persons. Given the geographically large and demographically diverse region it serves, CSAPHN considers the assessment presented here as a stepping stone towards continual, in depth assessment of the local context, needs and priorities.

Summary The Country SA PHN (CSAPHN) needs assessment utilises an iterative approach where information gained between submissions, including emerging needs, is incorporated to refresh analysis and triangulation for determining opportunities for action. Over time, it is expected that large parts of the documentation will remain static. This reflects the incremental shifts in population demographics, health risk behaviour, disease prevalence and improvements in health outcomes in response to implemented initiatives or other factors. CSAPHN’s needs assessment approach, integrates data available publicly or obtained confidentially from the Australian Department of Health and key partners such as SA Health and the six South Australian regional Local Health Networks, with additional evidence collected through stakeholder consultations. An overview of the principal data sources used is documented in the Needs Assessment Data Report - November 2018 which includes a holistic look at demographic, health, and health service patterns to identify locations and populations with particular health and service needs as well as country SA-wide priorities. The needs assessment process highlights the importance of investigating chronic condition and their risk factors, including resultant progression to multimorbidity, to fully realise opportunities for primary and secondary prevention in future CSAPHN work. Commonly identified examples include; type 2 diabetes, cardiovascular disease, chronic kidney disease, as well as chronic pain, which can relate to a wide range of other chronic conditions including the afore mentioned, arthritis, cancer and depression or pain resulting from another unresolved issues or injury. However, the magnitude of these disease burdens and service needs are likely to be underestimated owing in part to the difficulty of timely diagnosis along with the difficulty in obtaining accurate statistics, especially at the small area level.

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Moreover, the interrelated nature of socioeconomic determinants, risk factors, and health status, suggests that acting on any one of the principal needs identified in this report will positively impact on other needs, stated or unstated. In addition, missing a key need relevant to service access, even where the actual need is located further upstream and not necessarily within the purview of the PHN, risks diminishing the success of programs designed to increase service availability and appropriateness. The data illustrates that remote regions within our catchment are predominantly home to higher concentrations of disadvantaged populations with less equitable access to services than the rest of South Australia and indeed, Australia. There is a continuing need to investigate and advocate for services that enable access to services in rural and remote regions that are critical to improving health and wellbeing but are not within the remit of PHNs. The issue of transport availability as a determinant of access to service is raised consistently across the region as an important issue impacting on health service access and utilisation. Continuation of activities in a local setting, supplemented with or totally replaced with innovative solutions, palatable to consumers and providers, needs to be investigated further.

Data Needs and Gaps Data collection and analysis is an ongoing process that represents an integral part of systematic stakeholder engagement and collaboration in the PHN commissioning cycle. As pointed out above, there continues to be gaps in the data currently available to Country SA PHN, some of which will be addressed through continual service mapping. This includes data on private providers in the allied health, aged care and disability spaces for which assessment of the actual level of care and operating hours, including afterhours, are made available by providers. Stakeholder consultations have been integrated into the agreed mission of both Clinical Councils and the Community Advisory Committees (Local Health Clusters or LHCs). These permanent structures provide a springboard for periodic consultations with the wider community to obtain a broad and localised perspective, including the views of hard-to-reach consumers. Meaningful engagement and consultation with consumers, carers, local councils, and localised service providers are essential to provide context and add affirmation to data and priorities obtained through more traditional research and needs analysis modalities. In addition, the translation of the results from the needs assessment into service design and commissioning depends on an accurate understanding of existing local context. With PHN responsibilities in the areas of mental health, suicide prevention and alcohol and other drugs programs, there has been focus on sourcing locally relevant health data and a detailed understanding of the spectrum and capacity of services provided to inform commissioning processes. To investigate needs and service gaps specifically related to alcohol and other drugs, in addition to utilising the PHN Drug and Alcohol toolkit and secure data, CSAPHN formulated a targeted survey focusing on identified parties and in-scope interventions. During the 2016 – 2017 period community consultations focusing on mental health, alcohol, and other drugs were conducted. Local service providers and community members engaged to provide context to data already gathered through the literature. Moreover, CSAPHN continues to engage in ongoing consultations and joint development of service delivery models and resource distribution with key stakeholders. The PHN continues to work with key partners in undertaking the continuous consultation and engagement needed for joint planning with the newly formed country based LHNs. The continuation of efforts will be crucial to ensuring effective and informed commissioning not only in general and mental health, but in all priority areas.

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Requirements for further developmental work relate predominantly to (1) continuing comprehensive, in depth service mapping; (2) obtaining and analysing quality practice data from a range of GP practices throughout the region, and (3) building and refining stakeholder engagement structures that enable ongoing consultation. These three requirements will form the foundations of ongoing CSAPHN activities.

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GENERAL POPULATION HEALTH Ageing Populations

(GEN-10 & 14)

People are living longer and an increasing amount of older people are receiving care in the community for longer periods of time with the availability of Commonwealth Home Service Packages (CHSP), enabling them to stay in their own homes and avoid institutionalisation for as long as possible. Ideally, appropriate care at home also reduces the need for age-related hospitalisations. Identified Need Ageing Populations outcomes of health needs analysis

Key Issue Increased risk of age-related hospitalisation ∙ Increased risk of falls ∙ Increasing rates of dementia ∙ Increased rates of chronic conditions and multiple comorbidities ∙ Social isolation RACF residents at higher risk of transfer to an acute facility for ‘low level’ health events.

Description of Evidence ∙ Leading issue in priority matrix ∙ Government aged care portals and publications (AIHW 2016a, Australian Government Department of Social Services 2015) ∙ My Aged Care website ∙ CSAPHN analysis of SA Health inpatient admissions database by LGA and SA3 ∙

Concentration of ageing population in outer regional locations where age-specific services are more limited, especially in the Fleurieu Peninsula, Yorke Peninsula and Mid North.

∙ ABS Census 2011 and ERP 2013 (via PHIDU)

Projected increases in aged population throughout the region, particularly in the Riverland, Mallee and South East

∙ Department of Health Aged Care Data Warehouse

∙ CSAPHN service mapping ∙ Stakeholder consultation and feedback

∙ Feedback from LHN Community Home Support staff

∙ Projected increasing demand for both home based and residential aged care services throughout the region ∙ Projected increase in dementia diagnoses. Residential Aged Care Facility (RACFs) places ∙ No RACF places in Robe or Mallala ∙ Very low rate of RACF dementia specific places in the Outback, Adelaide Hills and Gawler. Commonwealth Home Support Program ∙ No CHSP places in many of the LGAs in the Mid North, Eyre Peninsula, Mallee and Fleurieu-Kangaroo Island

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Identified Need Ageing Populations outcome of service needs analysis - continued

Key Issue ∙ Referrals are affected by operation of My Aged Care portal ∙ Increase in complex clients requiring higher level of care than their current package can support ∙ Increased numbers on waiting lists.

Description of Evidence

Gap in timely primary care services to RACFs leading to increased ED presentations of residents. Lack of access to geriatricians throughout country SA.

See above…

Inadequate nursing workforce to support both in-home and residential aged care needs. Community allied health providers only able to support the most complex clients. As people age, they often have reduced access to private transportation. Requests for domestic assistance often related to social isolation. Priority Ageing populations (GEN 10, 14) opportunities, priorities and options

Possible Options While aspects of aged care are identified elsewhere in this needs analysis, there is a community interest in how the CSAPHN may meet these needs more widely. In general, community identified needs fall outside the PHN purview, relating more to areas of activity that fit within acute care, aged care placements or activities that relate to social services. However, the following ‘possible options’ may be useful.

Expected Outcome ∙ Increased clinical understanding of dementia, Alzheimers disease, palliative care, advanced care directives and Increased community understanding of resources for older persons

1. Partner with peak bodies that focus on the older person for clinical educational opportunities and community literacy for older persons 2. Commissioning services that contribute to functional abilities and wellbeing to prevent falls and injury

∙ Decreased risk of falls

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Potential Lead ∙

CSAPHN

Dementia Australia

Alzheimers Australia SA

Palliative Care SA

Active Ageing

Council on the Ageing

Pharmaceutical Society of Australia

The six regional Local Health Networks


Priority Ageing populations Opportunities, priorities and options - continued

Possible Options

Expected Outcome

3. Identify pathways for community physical activity for older persons

∙ Mapping of aged care activities within regions

4. Commissioning services that support older persons to understand and navigate the My Aged Care online and telephone systems

∙ Older persons supported to stay at home for longer

5. Commission services that support general practice to undertake medication review, adherence for older persons

∙ Decrease risk of medication misadventure and PPH

6. Work in partnership to develop services related to the appropriate RACF triaging of older persons complications

∙ Older persons are managed appropriately within RACF settings and decrease PPH

7. Prioritise aged care pathways in the “Health Pathways” project

∙ Referral pathways and resources decrease PPH ∙ Providers are delivering primary care within RACFs

8. Prioritise PHN Performance and Quality Framework indicators AC 1 & 2

∙ Increased rates of 75+ GP health assessments are reported

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Potential Lead

See above…


Childhood Development and Youth

(GEN- 12)

Giving every child the best start in life is crucial to reducing health inequalities across the life course. What happens during these early years (starting in the womb) has lifelong effects on many aspects of health and wellbeing, from obesity, heart disease and mental health, to educational achievement and economic status. (http://www.instituteofhealthequity.org/resources-reports/give-every-child-the-best-start-in-life) Identified Need Childhood Development and Youth - outcomes of health needs analysis

Key Issue Developmentally vulnerable children are at risk of poor health outcomes over their life span ∙ Over 2/3 of children in the APY lands are vulnerable on 2 or more domains of the Australian Early Development Census ∙ Communities in the Eyre and Western region more likely to be above the state and national average of children developmentally vulnerable in 2 or more domains ∙ Port Augusta and Murray Bridge both have a higher proportion of children developmentally vulnerable on one or more domains.

Description of Evidence ∙ Australian Early Development Census – 2015 results by communities ∙ Issue of concern in priority matrix ∙ Stakeholder consultation and feedback

Early childhood development is perceived to be an issue across the CSAPHN region. ∙

Priority Childhood Development and Youth (GEN – 12) opportunities, priorities and options

Possible Options 1.

2.

Support organisations that provide family and community programs in the target regions.

Place youth workers with expertise in mental health, alcohol and other drugs in communities of need including engagement with the RFDS and headspace sites for improved outreach services.

Expected Outcome

Potential Lead

1.

Improved health outcomes for developmentally vulnerable children

∙ Mid Murray Family Connections and/or similar local organisations

2.

Appropriate services available to and easily accessible for youth in need.

∙ NGOs e.g. Uniting Care Wesley

3.

RFDS and headspace partnering in youth services in remote regions.

∙ Autism SA ∙ SA Health ∙ Institute of Health Equity ∙ Port Augusta headspace and RFDS.

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Culturally and Linguistically Diverse Populations

(GEN 13)

While many Australians suffer from poor health outcomes, it is apparent that concentrated inequalities in health exist in some population groups, including people from Culturally and Linguistically Diverse (CALD) backgrounds, older people and those living in lower socio-economic areas. For Aboriginal and Torres Strait Islander, CALD and ageing populations, health inequalities are often magnified by socioeconomic disadvantage. Identified Need CALD Populations outcomes of health needs analysis

Key Issue Ageing Culturally and Linguistically Diverse populations in the Riverland. Increasing number of humanitarian visa arrivals in the South East and Murray Bridge, primarily from Africa and the Middle East. Stigma around illnesses in some CALD populations, specifically mental health. Low level of health service utilisation.

Description of Evidence ∙ Issue of concern in priority matrix ∙ PHIDU analysis of ABS Census 2011: persons born overseas reporting poor proficiency in English, by LGA ∙ CSAPHN analysis of Department of Immigration and Citizenship Settlement Reports by LGA ∙ Health Performance Council Scoping Study (Principe 2015) ∙ FECCA review of Australian Research on Older people from CALD backgrounds (FECCA 2015)

High risk of hospital readmission for CALD patients. Effective use of health services in general and medications in particular. High rates of non-English speaking migrants in the Riverland, Mallee (specifically Murray Bridge) and South East regions. More recent arrivals clustered in the regional cities plus Naracoorte and Tatiara. Humanitarian visa holders most likely to settle in the South East.

∙ Issue of importance in priority matrix ∙ PHIDU analysis of ABS Census 2011 ∙ Department of Immigration and Citizenship Settlement Reporting ∙ Health Performance Council scoping study (Principe 2015)

Presence of discrete communities with different cultural backgrounds in dispersed locations throughout the region ∙ Lower level of health service utilisation ∙ Populations ageing with lack of culturally specific services ∙ Language barriers ∙ Varying levels of health literacy ∙ Difficult to access interpreters outside of the metro area.

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Identified Need CALD Populations outcome of service needs analysis- continued

Key Issue New arrivals need support to settle and integrate, particularly humanitarian visa holders. Refugee experiences and cultural norms may result in poorer physical and mental health and form barriers to accessing and engaging with mainstream health services.

Description of Evidence see above…

CALD needs often not considered in service planning. Priority CALD Populations (GEN – 13) opportunities, priorities and options

Possible Options 1.

Engage with culturally and linguistically diverse populations through community leaders and state and NGO provided CALD activities to ensure prioritisation of and connection to all of the activities of the CSAPHN in community support ‘Potential Options’ as identified in this Needs Assessment.

Expected Outcome ∙ Partnerships achieved with community leaders and CALD community services ∙ Connection of partners to mainstream services ∙ CALD need is identified in all CSAPHN activities.

2. Provide awareness and support to general practice and service providers to ensure culturally appropriate services. 3. Encourage appropriate use of interpreter services and explore other technological communication support options where feasible.

∙ CALD populations have timely access to primary health care services appropriate to specific needs as required ∙ Health literacy of CALD populations is improved ∙ Confidence in navigating health system and ability to access referrals

4. Advocacy provided to the state and other institutional providers to ensure inclusion of CALD population in service prioritisation.

∙ State and NGO providers have incorporated CALD need into local activities.

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Potential Lead ∙ Integral lead activity for CSAPHN working with SA Govt. and Cultural Diversity leads.


Chronic Conditions and Risk Factors

(GEN 4)

Chronic conditions are a leading cause of illness, disability, and death in Australia (Australian Government Department of Health, 2015) and are defined as any condition which is long lasting and with persistent effects. The chronic conditions which affect the greatest proportion of the population and have the greatest impacts on quality of life are the ones most often considered high priorities for monitoring and intervention in the primary health care setting. Communities with high levels of socioeconomic disadvantage often also have high rates of chronic conditions and the associated risk factors (AIHW, 2015a). Identified Need Chronic Conditions and Risk Factors - outcomes of health needs analysis

Key Issue Potentially Preventable Hospitalisation rates for chronic conditions are higher than the state average in most regions, with the highest rates in Outback North and East, followed by the Mid North. Murray Mallee, Yorke Peninsula and Gawler Two Wells are slightly higher than the overall CSAPHN rate. Aboriginal rates are extreme compared to other population demographics in the CSAPHN region and likely driving the high rates across the Outback.

Description of Evidence ∙ Leading issue in priority matrix

Chronic disease rates in country SA are consistently above the state average.

∙ PHIDU estimates of risk factors

Arthritis and Osteoporosis ∙ Arthritis – Highest rates were Gawler – Two Wells, followed by Outback North and East, Yorke Peninsula and the Mid North; all other areas are close to SA and CSAPHN rates or below. ∙ Osteoporosis - Highest rates were Gawler - Two Wells followed by Yorke Peninsula and the Mid North; all other areas were below both State and CSAPHN rates. Cancer ∙ Prevalence of cancer is highest in the Fleurieu Peninsula and Kangaroo Island followed by Murray Mallee, Yorke Peninsula and the Barossa; all other areas were equal to or below State and CSAPHN rates. ∙ Cancer screening rates continue to be poor across the CSAPHN region including:

∙ Key theme in stakeholder discussions ∙ South Australian Monitoring and Surveillance System (SAMSS) survey of residents aggregated by SA3 ∙ National Diabetes Services Scheme (NDSS) registrations by LGA and SA3 ∙ Public Health Information Development Unit (PHIDU) cancer screening participation and premature mortality by LGA

∙ NHPA analysis of cancer screening rates ∙ Department of Health Chronic Disease portal (Australian Government Department of Health 2015) ∙ CSAPHN analysis of SA Health inpatient admissions database by LGA and SA3 ∙ AIHW Chronic Disease portal (AIHW 2015a) ∙ AIHW report: ‘Mortality from asthma and COPD in Australia’ (AIHW 2014c) ∙ AIHW report: ‘Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: Prevalence and incidence’ (AIHW 2015b) ∙ AIHW overview of cancer screening by PHN (AIHW 2016b) ∙ AIHW Risk Factor portal (AIHW 2016c)

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Identified Need Chronic Conditions and Risk Factors - outcomes of health needs analysis continued

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Key Issue Bowel: Outback North and East at 40.1%. Only Yorke Peninsula and Fleurieu Peninsula and Kangaroo Island were above 50% participation across the CSAPHN region. Breast: Outback North and East were under 50% participation followed by Lower North, Mid North, Fleurieu Peninsula and Kangaroo Island, Murray Mallee and Adelaide Hills which were all under 60% Cervical: Outback North and East were below 50%, followed by the Mid North, Murray Mallee, Yorke Peninsula, Limestone Coast, Fleurieu Peninsula and Kangaroo Island, Eyre Peninsula and Gawler - Two Wells which were rates are lowest under 60%. HPV vaccination for both girls and boys in the South Australian Outback (SA4) region.

Description of Evidence ∙ AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW ∙ Adelson, P et al. Keratinocyte cancers in South Australia: incidence, geographical variability and service trends. Aust N Z J Public Health. 2018 Aug;42(4):329-333 ∙ Britt H, Miller GC, Bayram C, et al. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press, 2016. ∙

AIHW 2019. Cancer statistics for small geographic areas: Statistical Area Level 3 (SA3), 2010–2014. Canberra: AIHW.

Skin Cancer Skin cancer is a core component of general practice. Melanoma and non-melanoma are the highest diagnosed types of skin cancer in Australia and rank in the top 5 causes of cancer overall. Melanoma is the third most common type of cancer and data is routinely collected by cancer registries regarding its prevalence. Comparatively, non-melanoma statistics are not collected by cancer registries despite being the leading cause of cancer across the country. In South Australia, the age standardised rates for melanoma were highest in; ∙ Mid North (0.51 per 1,000) ∙ Yorke Peninsula (0.48 per 1,000) ∙ Eyre Peninsula and South West; and ∙ Fleurieu – Kangaroo Island (both 0.46 per 1,000) Similarly, the highest rate ratios for non-melanoma compared to South Australia were;

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Identified Need Chronic Conditions and Risk Factors - outcomes of health needs analysis continued

Key Issue ∙ ∙ ∙ ∙ ∙

Description of Evidence

Mid North (1.31) Eyre Peninsula and South West (1.26) Lower North (1.26) Yorke Peninsula (1.23) Fleurieu – Kangaroo Island (1.18)

These findings correlate with MBS data showing higher rate ratios in agricultural and coastal areas of South Australia. Rates of skin cancer increase with age, with males having higher age-specific rates across all age brackets. Diagnosis of skin cancer is achieved by excision and pathology, despite the higher prevalence of skin cancer in remote and regional South Australia, there is a significant lack of specialised staff and workforce availability. These gaps create an opportunity to upskill regional staff and increase education about skin cancer in these regions.

see above…

Chronic Kidney Disease – national trends ∙ Estimated that 9 out of 10 cases of chronic kidney disease go undiagnosed ∙ Prevalence increases with age and level of disadvantage ∙ End stage kidney disease requiring dialysis, twice as high in remote areas compared to metropolitan areas. Cardiovascular Disease ∙ High rates of cardiovascular disease found in the Yorke Peninsula followed by Murray Mallee and Fleurieu Peninsula and Kangaroo Island; all other areas were equal to or below the SA and CSAPHN rates. Diabetes

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Identified Need Chronic Conditions and Risk Factors - outcomes of health needs analysis – continued

∙ ∙

Key Issue While high rates of diabetes are recorded across the CSAPHN region, the Barossa, Adelaide Hills and Lower North are well below CSAPHN overall rate The SA 3 level areas that were above the SA rate included Mid North, Lower North, Yorke Peninsula, Gawler-Two Wells, Murray and Mallee, Eyre Peninsula and South West and Outback North and East Outback North and East is nearly double CSAPHN rate and more than double the SA rate Outback North and East were also highest for hospitalised diabetes complications and the second highest for number of bed days.

Description of Evidence

Respiratory conditions ∙ Asthma - The SA3 level areas which had the highest rates above the state level included Mid North, Eyre Peninsula, Limestone Coast and Yorke Peninsula. The Fleurieu Peninsula and Kangaroo Island were almost equal to SA rates, whereas other areas are below CSAPHN and SA rates. ∙ COPD - SA3 level areas which had the highest rates included Outback North and East which were over double the SA rate, followed by the Fleurieu Peninsula and Kangaroo Island; all other areas were equal to or less than the SA rate.

see above…

Chronic Conditions Risk Factors Rates of high blood pressure, high cholesterol, insufficient physical activity, and unhealthy weight are highest in the Yorke Peninsula and above SA averages for almost every region. Smoking and alcohol consumption rates highest in the Mid North and Eyre Peninsula. PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 15


Identified Need Chronic Conditions and Risk Factors - outcomes of health needs analysis continued

Key Issue Rates of fruit and more specifically vegetable consumption are very poor throughout South Australia, including CSAPHN regions.

Chronic Conditions and Risk Factors - outcome of service needs analysis

High chronic conditions rates, high rates of potentially preventable hospitalisations due to chronic conditions, low rates of allied health professionals practicing in rural and remote areas.

∙ Leading issue in priority matrix

Need for more sub-acute care options (e.g. nurse led clinics, support groups), especially outside of the major population centres.

∙ Integrating Primary Health Care provider local need assessments

Higher rates are found in the Aboriginal and Torres Strait Islander population when compared to non-Aboriginal populations, for all chronic diseases and risk factors.

Description of Evidence

see above…

∙ Key theme in all stakeholder engagement and feedback ∙ HWA rates of health practitioners

Education and awareness of risk factors and preventative measures for chronic conditions must be maintained and improved in all communities, but especially those that are identified as being at higher risk. Support for rural and remote residents after an acute event to prevent relapse and/or rehospitalisation. Support for rural and remote residents after diagnosis of a chronic condition. Communities may not support ‘healthy lifestyles’ – built environment, community programs, information and resources. Priority Possible Options Chronic Conditions and Risk 1. Partner with organisations that promote health risk behaviour modification and community education and or Factors (GEN – 4) services. opportunities, priorities and options 2. Facilitate connection between chronic condition peak bodies and general practice, allied health, pharmacy and

Expected Outcome ∙ Communities and individuals have access to lifestyle modification programs and information locally ∙ Better access to targeted and specific chronic condition education

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Potential Lead CSAPHN initiative to be managed as a partnership engagement with peak bodies who may be commissioned as


Priority Chronic Conditions and Risk Factors (GEN – 4) opportunities, priorities and options - continued

Possible Options community health services. Provide material support to connections and promotional activities and programs.

Expected Outcome and primary health care treatment for patients in rural and remote South Australia.

3. Engage with local government in the development and implementation of local population health plans with advocacy and support to activities that promote better health through lifestyle modifications.

∙ Local government plans include lifestyle options for implementation in local communities.

4. Maintain and seek partners to ensure continuity of the ‘Country Access to Cardiac Health’ telephone support service for residents with heart disease.

∙ Patients complete a cardiac rehabilitation program and are less likely to have a repeat hospitalisation.

5. Plan and establish multi-dimensional chronic condition teams to be based in areas of need and provide outreach services in extended communities.

∙ Care coordination work providing chronic disease education to individuals and groups.

6. Support providers in rural and remote regions to develop sustainability in business models.

∙ Reduced potentially preventable hospitalisations due to chronic condition.

7. GP led skin cancer screening and excision clinics in areas without access to regular GP services and/or upskilling of GPs in skin cancer screening and surgical excision skills

∙ Patients have access to local skin cancer checks and excision services

8. Partner with peak bodies for community education activities focussed on skin cancer prevention

∙ Reduced travel promotes timely checks and management ∙ Self-awareness and behaviour management is supported

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Potential Lead required, including but not limited to: ∙ Asthma Foundation ∙ Diabetes Australia ∙ Cancer Council ∙ Heart Foundation ∙ Kidney Foundation ∙ Dementia Australia ∙ Alzheimers Australia ∙

State and Local Government


Population Health and Other Factors

(GEN - 5, 11, 15, 16)

There are a wide range of indicators that describe the health of a community and individual including where you live, what culture you were born into, your socioeconomic status across life, health status and risks, and ability to access required services that are close to where you live. Other factors include living in a healthy community with access to clean water and sanitation, where government supports health preventative measures such as immunisation against common communicable diseases and promotion of a healthy lifestyle. The following topic areas span from life to death in public and population health. Identified Need Immunisation - outcomes of health needs analysis

Key Issue Childhood immunisation for 2015-2016 varied depending on age cohort and location, with few SA3 areas achieving 95% coverage. Barossa, Yorke Peninsula and Limestone Coast all achieved the national target of 95% for 1 year of age. No SA3 area achieved 95% coverage for 2 years of age, and only two SA3s achieved 95% coverage for 5 years of age which were Eyre Peninsula South and South West and Limestone Coast.

Description of Evidence ∙ NHPA analysis of ACIR data by SA3 ∙ SA Health reporting of ACIR data ∙ NHPA analysis of National HPV Vaccination Program Register by SA ∙ Issue of importance in priority matrix ∙ Concerns raised by immunisation nurses throughout the region

Lack of coordination between different providers (e.g. GP, local council, ACCHO clinic). Uncertainty around the validity of ACIR data. ∙

Priority Immunisation (GEN 11) opportunities, priorities and options

Possible Options 1. Continue to support the Immunisation Hub for SA in partnership with APHN including: ∙ Explore ways to gather and maintain accurate ACIR data for CSAPHN ∙ Identify and support immunisation ‘champions’ in local practices and communities ∙ Commission and distribute immunisation resources to providers and communities. 2. Explore alternative opportunities for hard to reach populations to increase uptake of childhood immunisation.

Expected Outcome ∙ Childhood immunisation rates reach national target (95%). ∙ Older children – especially CALD – to have immunisation status accurately recorded and updated. ∙ Increased community awareness of the benefits and availability of immunisations and the recommended schedule. ∙ Improvements in childhood immunisation rates for Aboriginal and Torres Strait Islander children

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Potential Lead ∙ CSAPHN working primarily with DATIS (SA Health) and the APHN ∙ Aboriginal Health Council of South Australia ∙

ACCHOs


Identified Need Oral Health - outcomes of health needs analysis

Key Issue “Oral health is essential to general health and wellbeing and greatly influences quality of life. It is defined as a state of being free from mouth and facial pain, oral diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking and psychosocial wellbeing.” Anecdotally, there are increasing rates of poor oral health across the CSAPHN region particularly where low sociogenic disadvantage has added tyranny to accessible service.

Description of Evidence ∙ http://www.euro.who.int/en/health-topics/disease-prevention/oralhealth Accessed 04 May 2018 ∙ Identified area for investigation including sourcing evidence and data ∙ Issue of concern in priority matrix ∙ HWA rates of health practitioners

Low rates of accessible dental practitioners in country SA. ∙

Priority Oral Health (GEN – 16) opportunities, priorities and options

Possible Options 1. Undertake an inventory of oral health providers across the CSAPHN region.

Expected Outcome ∙ Improved understanding of needs and service availability.

Potential Lead ∙ Primary Health Care Committees (PHCC)

2. Work with local communities to understand issues of access and needs.

∙ Ability to work with partners on oral health from a position of knowledge.

∙ SA State Government

3. Work with state and Commonwealth governments to address access issues particularly for rural and remote disadvantaged populations.

∙ Development of partnerships to undertake low cost local activities to improve oral health.

∙ IPHCS Providers ∙ RFDS ∙ Local Dentists and oral health professionals ∙ Dental and Oral Health Associations

Identified Need Other Population Health Factors - outcomes of health needs analysis

Key Issue Socio-demographic disadvantage ∙ High rate of single parent families in the Mid North, Yorke Peninsula and Riverland ∙ Homelessness is not well recognised or documented throughout the region ∙ Affordability of health care for disadvantaged people ∙ Health literacy is perceived to be an issue across the entirety of the CSAPHN catchment. Of particular concern are those areas identified as being of low English

Description of Evidence ∙ PHIDU analysis of ABS Census 2011 ∙ PHIDU analysis of births and deaths registry data ∙ PHIDU analysis of DSS data ∙ The Kirby Institute, 2015 ∙ Stakeholder consultation and feedback ∙ STI and Blood Born Virus Advisory Committee (SABSAC)

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Identified Need Other Population Health Factors - outcomes of health needs analysis continued

Key Issue proficiency and where there are high rates of disadvantage ∙ Concentration of disadvantage in Peterborough, Coober Pedy, Port Pirie, the APY lands and other remote South Australian Aboriginal communities. Perinatal health ∙ Infant mortality highest in the APY lands, followed by Port Augusta and Murray Bridge ∙ Child mortality rates are generally below metropolitan rates, but not reported for many areas due to low numbers ∙ Higher proportions of both low birthweight babies and mothers who smoked during pregnancy exist in Port Augusta and the Outback regions. Pregnancy smoking rates also high in Peterborough and Ceduna.

Description of Evidence ∙ Issues of concern in priority matrix ∙ AIHW report on rural, regional and remote health system performance indicators (AIHW 2008) ∙ Proportion of region classified as outer regional, remote or very remote by ABS classification of remoteness ∙ CSAPHN analysis of SA Health inpatient admissions database by LGA and SA3 ∙ Issue of importance in priority matrix ∙ Extensive community engagement done within PHNs ∙ Report on transport options within the former Country South SA Medicare Local region

Disability and carers ∙ Higher proportion of people with a disability living in country SA than metropolitan Adelaide. Sexual Health ∙ Aboriginal and Torres Strait Islander populations have higher rates of blood borne virus and sexually transmissible infections, including HIV, Hepatitis C, Hepatitis B, gonorrhoea, chlamydia and syphilis. Remoteness ∙ Financial and time costs borne by patients to attend regular/recommended appointment ∙ Increasing rates of morbidity and mortality with increasing remoteness ∙ Access to appropriate transport to attend appointments ∙ No public transport throughout most of the region. Some local bus services operate with varying regularity.

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Identified Need Other Population Health Factors - outcomes of health needs analysis continued

Priority Other Population Health Factors (GEN – 5) opportunities, priorities and options

Key Issue ∙ Residents of areas with no or limited public transport options face significant barriers to accessing timely primary health care and can have difficulty coordinating appointments. ∙ Services provided from centralised locations create a burden of cost, time and loss of income on clients and client support or carers. ∙ The great majority of specialist services are accessed from Adelaide and, to a lesser extent, regional centres which are remote from populations in need. ∙ Significant travel cost (time and financial) is often required to facilitate follow up appointments of short duration. The issue is felt across the region but accentuated the further the travel demand from Adelaide. Possible Options 1. Engage with local providers of services that enable equitable access to health services

Description of Evidence

see above…

Expected Outcome Mitigation of socio-demographic disadvantage with regard to health care access.

2. Commissioning to respond to the identified needs of particular population demographics (eg. Aboriginal and Torres Strait Islander people, CALD communities and identified localities)

Improved risk behaviour in participants of targeted communities, activities or improved environmental context (e.g. food security, use of space).

3. Support for local evidence-based programming around lifestyle-related chronic disease risk factors that responds to an unmet health and/or service need.

Improved knowledge of the impact of health risk behaviours on individuals and communities. Better prevention and management strategies around population health issues.

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Potential Lead ∙ CSAPHN and selected community partners


Priority Other Population Health Factors (GEN – 5) opportunities, priorities and options - continued

Possible Options 4. Review the need for education, awareness and targeted services to be incorporated into the overall health service delivery picture for at-risk communities including:

Transport (GEN – 15)

This is an area that does not necessarily fit the purview of the PHN but is a widely identified issue for country regions in SA. As such the following potential option for work has been identified. The CSAPHN can work toward this option as an underlying area of need in conjunction with local government public health planning.

Expected Outcome Improved organisational knowledge of the overall picture of local communities.

Potential Lead See above…

∙ perinatal care ∙ sexual health ∙ people living with a disability and their carers.

1.

Identification of communities in need and their prevalence of service support need ongoing monitoring.

Additional mapping of impact for access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas. Data use to advocate for continuation of activities in a local setting or replacement with technological solutions where best.

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CSAPHN leading these activities in consultation with SA Health, Local Government, the six regional Local Health Networks and metropolitan LHNs with support provided from the APHN as the PHN with primary and first engagement with the Metro LHN’s.


Reducing Potentially Preventable Hospitalisations

(GEN-8, 9)

Potentially preventable hospitalisations (PPH) can result from chronic health conditions (e.g. asthma, diabetes), acute conditions such as throat infections and from vaccine preventable conditions such as influenza or whooping cough. Hospitalisation incurs a high financial cost to the health care system, especially when a proportion of these admissions could potentially be avoided by the timely use of primary health care services. Identified Need Reducing Potentially Preventable Hospitalisations - outcome of health needs analysis

Key Issue Potentially preventable hospitalisation rates are above the state average in all regions except the Lower North and Adelaide Hills. Rates in the Outback - North and East are almost double the state and national rates, while the Adelaide Hills is around three quarters of the state average.

Priority Reducing Potentially Preventable Hospitalisations (GEN – 8, 9) opportunities, priorities and options

Possible Options 1. Partnership with RFDS to improve chronic disease care by employing a chronic disease and mental health nurse to support existing clinics.

Description of Evidence NHPA analysis of the Admitted Patient Care National Minimum Data Set

Expected Outcome Better access to chronic disease and mental health support for remote patients.

Potential Lead RFDS

CSAPHN

Reduction in hospitalisations due to chronic disease and mental health support for remote residents.

2. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management.

Improvements achieved in discharge ∙ planning. Improved connection between the acute care and primary care sectors for discharge management.

3. Create strategies that facilitate and enable LHNs and private providers, including pharmacy, to develop the capacity of the region to engage care coordinators in routine activities to implement better discharge planning.

The efforts of the PHN to implement a patient-centred care model widely includes attention to discharge planning and coordination and practical examples.

Care coordinators implemented in a variety of models as defined by local resource capacity and systems management.

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CSAPHN partnering with the six regional Local Health Networks

CSAPHN

CSAPHN facilitating and supporting LHN/GP led local initiatives


Priority Reducing Potentially Preventable Hospitalisations (GEN – 8, 9) opportunities, priorities and options - continued

Possible Options 4. Implement projects that reduce the number of older Australians’ residing in residential aged care facilities (RACFs) for low level health events including technology assisted GP After Hours services to RACFs.

Expected Outcome Projects and applications achieved, and evidence of reduced demand achieved in identified areas of need or application of the activity.

Potential Lead CSAPHN

Issues identified and partnership occurring with the LHN to manage potential outcomes.

CSAPHN facilitating and supporting GP led local initiatives

6. Support appropriate peak bodies in capacity building and the sharing of information to pharmacy managers and practitioners, including retail managers, for upskilling with GP practice managers.

Evidence demonstrated of a connection of pharmacy to the discharge planning activity including routine MMR of patients associated with the discharge activity.

Peak bodies in partnership with CSAPHN

7. Using Primary Health Care Service delineation model and health data in conjunction with LHNs, define and implement a multilevel predicative modelling framework and process to inform decision making.

Improved capacity for effective discharge planning through appropriate resource allocation.

CSAPHN in partnership with the six regional LHNs

8. Investigate implementation of intermediary care and home-based care in local setting.

General practice, allied health and pharmacy included in acute care sector planning of out of hospital services.

CSAPHN facilitating with LHNs and supporting GP led local initiatives.

Reduced evidence of the prevailing disconnection between public and private sector in this regard.

Provide an advocacy platform to ∙ achieve better coordination of local resources enabling better cost effect and coordination of care.

5. Identify main causes of Emergency Department admissions and hospital re-admissions. Design and implement projects that address identified risks leading to Emergency Department admissions and hospital re-admissions in conjunction with Local Community Advisory Committees, Clinical Councils and key stakeholders.

9. Promote and facilitate alternative care arrangements especially for people in palliative stages of life.

10. Investigate healthcare needs in small communities where inpatient care best utilises available resources rather than trying to provide an alternative service.

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CSAPHN facilitating and supporting GP led local initiatives.


Priority Reducing Potentially Preventable Hospitalisations (GEN – 8, 9) opportunities, priorities and options - continued

Possible Options 11. Multi-party conferencing to enable activities such as case conferencing with health professionals in different locations including those within SA Health.

12. Work with communities, ACCHOs, general practice, the six ∙ regional LHNs and metropolitan LHNs and the Rural Doctors Workforce Agency to identify needs for provision of specialist services via telehealth.

Expected Outcome Links established ensuring effective communication between all health professionals engaged in passage of the patient back to community.

Effective linking of specialist and ∙ niche providers to the issue of out of hospital opportunities for care.

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Potential Lead CSAPHN facilitating and supporting GP led local initiatives. CSAPHN initiative in collaboration with ACCHO’s AMS’s RFDS and RDWA and the six regional LHNs


Health Workforce

(GEN 2,7)

The health of individuals and communities is poorer the further the distance from a metropolitan centre; holding positions of trust with patients, rural and remote GPs provide health care to the majority of people in the community in which they reside and have little day-to-day contact with others of their profession which often leads to a feeling of isolation and challenges in maintaining a healthy work-life balance. This is true also for other health professionals including nurses and allied health professionals. Retention of health professionals in rural and remote locations is an ongoing challenge requiring input from the whole community, state and Australian Government to resolve. Identified Need Health Workforce outcome of service needs analysis

Key Issue There is a continued difficulty in attracting, recruiting and retention of GPs and allied health professionals to rural and remote areas ∙ All of the CSAPHN region except Port Augusta, Whyalla, Gawler, Mount Barker and Victor Harbor are considered GP distribution priority areas ∙ GPs often responsible for ED and acute hospital services as well as primary health care via general practice ∙ Many localities with limited or no services ∙ Rates of podiatrists, psychologists, registered nurses, optometrists and physiotherapists are below state averages in all CSAPHN regions, despite higher rates of chronic disease and mental illness ∙ Rates of GPs, pharmacists and dentists are below state averages in nearly all CSAPHN regions ∙ Long wait times to see a practitioner ∙ Ageing of the rural and remote health workforce.

Description of Evidence ∙ Leading issue in priority matrix ∙

∙ HWA rates of health practitioners ∙ DoH distribution priority areas mapped via DoctorConnect ∙ Key theme in all stakeholder engagement and feedback ∙ NHSD and CSAPHN internal service mapping ∙ SA Health inpatient data ∙ HWA report: National Rural and Remote Health Workforce Innovation and Reform Strategy (HWA 2013) ∙ RDWA Medical Outreach programs by specialty and location (RDWA undated a, undated b, undated c)

All of the CSAPHN region is considered a district of workforce shortage for medical specialists. Challenges in accessing business improvement and professional development opportunities for rural and remote practitioners.

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Identified Need Health Workforce outcome of service needs analysis - continued

Key Issue Impact on prescribing practices and medication management, especially for patients with chronic and complex conditions. Lack of connection and communication between various health providers both within and between rural communities.

Description of Evidence

see above…

Difficulty of acquiring accurate, comprehensive service data around allied health – particularly level and quality of outreach services. Priority Health Workforce (GEN – 2) 1. opportunities, priorities and options

2.

Possible Options Local quality improvement in general practice and other local service providers through: ∙ Facilitation of service satisfaction and provider retention through provision of material support to general practice, community health services, ACCHOs, and allied health services, covering; ∙ Better business modelling and forward planning ∙ Practice sustainability ∙ After hours business modelling ∙ Strategy and improvements in data use and utilisation of technology, including promotion of data cleansing ∙ Participation in improvement programs ∙ Coordination of continuing professional development. ∙ Facilitating knowledge and skill development to build cultural awareness and cultural competency across the health workforce. Advocacy and support with relevant GP and other health professionals in workforce planning, recruitment and retention initiatives.

Expected Outcome General Practice, allied health and pharmacy, ACCHO’s and AMS achieve increased capacity to provide quality services.

Potential Lead ∙ CSAPHN

Evidenced improvement in financial capacity redirected to service provision.

University sector

General Practice

GP peak bodies

ACCHOs and AHCSA

Evidence provided of increased quality of patient throughput and patient outcomes.

Retention of providers improved through increased satisfaction with working environment.

Increased access to health service providers

Improved patient access, experience and journey.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 27

∙ RDWA ∙ SA Health


Priority Health Workforce (GEN – 2) 3. opportunities, priorities and options - continued

Possible Options Support allied health providers to build business capacity through outreach and multi-modality service delivery options.

4.

Support appropriate peak bodies in capacity building and sharing of information to pharmacy managers, general practitioners, and practice managers.

5.

Recognise the RFDS as a general practice (albeit mobile) in all areas of practice support and support the development of business models that will capacity build RFDS as an on-ground provider of services in remote communities.

RFDS demonstrating enhanced provision of comprehensive services more widely across the region.

6.

Work with RDWA to integrate practice quality improvement initiatives as part of workforce placement and retention.

Functional partnership achieved with RDWA to tailor and adapt activities to the region according to evidence-based needs.

7.

Engage with universities to promote student and new practitioner placements in rural areas.

Partnership achieved facilitating placement of students and new graduates in rural areas.

Identified Need After Hours Access – outcome of service needs analysis

∙ ∙ ∙ ∙ ∙

Key Issue No/limited after hours sites in the Tatiara and upper South East regions. Reliance on country hospital EDs for after-hours treatment in many country locations. Many country hospital EDs do not have a doctor on-site and available for consultation. PIP scheme inadequate to fully resource some practices for necessary after-hours operations. Difficulty in distinguishing need from service availability through MBS after-hours billing rates.

Expected Outcome

Improvements achieved in awareness of principles and practical application of principles for quality use of medicines.

Potential Lead

see above…

Description of Evidence CSAPHN internal service mapping database and listing of PIP practices.

After hours clinics and hospital ED locations mapped

Issue of importance in priority matrix

Key theme in stakeholder consultations

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Priority After Hours Access (GEN – 7) opportunities, priorities and options

1.

Possible Options Provide material support to general practice to enable better business modelling for sustainable after-hours services.

Expected Outcome More timely attention to residents’ primary health care and less need for transfer to Emergency Departments.

Provide material support to key required allied health and or pharmacy to enable better business modelling for sustainable after-hours services as identified and required.

3.

Work with the six regional Local Health Networks to identify options for improvements in after-hours primary health services to redirect or improve primary health after hours service demand.

Partnership with LHN focussing on better data intelligence on needs and sentinel activity achieved implementing alternative service provision in out of hours.

4.

Support a GP to RACF telehealth service.

Continuance for progression of existing CSAPHN work that facilitates increased uptake of simplified local telehealth platforms in small communities. Evidenced by, timelier GP ‘attendance’ to needs and reduced demand on hospital attendances.

2.

Partnerships with identified providers according to community need and extension of services occasioned.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 29

Potential Lead CSAPHN

Six regional LHNs

Private Allied Health and IPHCS Providers

General Practice / ACCHOs

Pharmacy

RWDA


Health System Integration and Coordination

(GEN- 6)

Over the last 20 years, there have been a number of attempts to lessen the fragmentation within the Australian health system with varied outcomes. As we move further into the technological age, some system boundaries are gradually shifting, but barriers continue to ensure that critical areas are not quite connected. As the backbone support organisation, CSAPHN in partnership with other key players, will provide resources and expertise to enable collective initiatives to succeed, thus improving system integration and the patient journey. Identified Need Health Systems integration and coordination – outcome of service needs analysis

Key Issue Referral pathways can be unclear. Practitioners may not be aware of all referral options. Having to travel long distances to access multiple consultations/treatment, patients are often unable to coordinate appointments and/or face hardship in affording transport, accommodation, absence from home, etc.

Description of Evidence Issue of importance in priority matrix

Key theme in ML and PHN stakeholder consultations

Issue highlighted by the six regional Local Health Networks

Gaps identified in discharge planning. Patients with complex conditions require care input from multiple practitioners, which is currently difficult to coordinate effectively in many regions. Palliative care ∙ Palliative care options are perceived to be limited in smaller communities ∙ Limited information available about current services and care pathways throughout the region. Priority Health Systems integration and coordination (GEN – 6) opportunities, priorities and options

1.

Possible Options Engage with all providers to develop the capacity of the ∙ region to: ∙ engage care coordinators in routine activities ∙ identify opportunities and create strategies to implement consistent coordinated team care.

Expected Outcome Patients will be able to access specialist and allied health consultations as close as possible to their place of residence as evidenced by increased uptake of coordinated care services.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 30

Potential Lead CSAPHN


Priority Health Systems integration and coordination (GEN – 6) opportunities, priorities and options - continued

Possible Options Promotion and facilitation of the Patient Centred Medical Homes. ∙ Review and redesign of integrated health systems ∙ Work with and drive inter-sectoral partners supported by research to develop a primary health service delineation model for rural SA ∙ Identifying and seeking to rectify inequalities in services delivered regionally. 3. Use existing resources, redirected to engagement of care coordinators in various employment models. 2.

Expected Outcome Mapping, collaboration and education activities resulting in real restructuring of local activities to include models of coordinated care in service delivery.

Potential Lead CSAPHN and other public and private providers

Commissioned activities reflect the placement of care coordination in local models of connected care.

CSAPHN and other public and private providers

4.

Implementation of a project which enables shared clinical reviews that are evidenced to be a useful tool in managing complex conditions, particularly for people who blur the eligibility lines across services and whose needs vary from time-to-time.

Shared clinical reviews reported to be occurring in sentinel sites and expanding.

CSAPHN facilitating and supporting GP led local initiatives

5.

Multi-party conferencing to enable activities such as case conferencing with health professionals within SA Health.

Shared clinical reviews reported to be occurring in sentinel sites and expanding.

CSAPHN

6.

Implementation and promotion of My Health Record.

Better coordinated care through use of shared electronic records.

CSAPHN facilitating and supporting GP led local initiatives.

7.

Investigate potential models for support to or coordination of activity to assist the management of high or frequent users of the health system, as an avenue for hospital avoidance and support for patients with complex needs.

Partnership with LHN and other ∙ providers achieved, focussing on better data intelligence of needs and sentinel activity achieved and implementation of alternative service provisions out of hours.

8.

Stakeholder engagement program – Primary Health Care ∙ Nurse Networks and Clinical Councils; provide access to relevant resources, training and guidance on MBS item use including care plans and practice nurse support chronic disease of self-management.

Resources provided consistently across the region with evidence of uptake and use identified.

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CSAPHN

CSAPHN facilitating and supporting GP led local initiatives.


Priority Health Systems integration and coordination (GEN – 6) opportunities, priorities and options - continued

Possible Options

Expected Outcome ∙

Medication management review activities in place.

Inclusion of inter-sectoral partners such general practice and community health services.

Resources provided consistently across the region with evidence of uptake and use of same identified.

10. Review current models of care and patient journey for people with cancer in the country including cost to the system and person.

Cancer Council engaged and working ∙ in partnership to improve the cancer patient journey.

Cancer Council

11. Work with communities, ACCHOs, general practice, the six regional LHNs, metropolitan LHNs and the Rural Doctors Workforce Agency to identify needs and enable or facilitate for provision of specialist services.

Effective linking of specialist and ∙ niche providers to the issue of out of hospital opportunities for care.

CSAPHN initiative in partnership with APHN, RDWA, AHCSA and the six regional LHNs

12. Enable delivery of secure telehealth services for private and public providers and increased promotion and support of telehealth initiatives through direct practice support activities. 13. Continue development of local and regional heath pathways (HealthPathways SA) from general practice to medical specialists, allied health and other service providers.

General practice, allied health ACCHO’s and AMS’s supported to develop and use telehealth.

CSAPHN facilitating and supporting GP led local initiatives

Improved access to services identified to meet patient need.

SA Health, APHN, CSAPHN and general practices and other key stakeholders.

9.

Stakeholder engagement program – strengthening relationships with pharmacy sector.

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Potential Lead CSAPHN initiative to be managed as a partnership engagement with peak bodies who may be commissioned as required. DATIS and CSAPHN


Priority Health Systems integration and coordination (GEN – 6) opportunities, priorities and options - continued

Possible Options 14. Partner with LHNs to improve discharge planning and communication with general practice for post-acute care.

15. Develop regional service directories.

Expected Outcome Improved timeliness of GP receipt of discharge plan

Discharge planning undertaken appropriately with patient and carer, and documentation provided.

Local service directories created and promulgated electronically.

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Potential Lead CSAPHN, LHNs and general practices.

CSAPHN and other key stakeholder.


Health Information and Technology

(GEN- 3)

Over the last 20 years, there have been a number of attempts to lessen the fragmentation within the Australian health system with varied outcomes. As we move further into the technological age, some system boundaries are gradually shifting, but barriers continue to ensure that critical areas are not quite connected. As the backbone support organisation, CSAPHN, in partnership with other key players, will provide resources and expertise to enable collective initiatives to succeed, thus improving system integration and the patient journey. Identified Need Health Information and Technology - outcome of service needs analysis

Key Issue Process for roll out of ‘My Health Record’ impacts on knowledge and understanding of patient history and care.

Description of Evidence Issue of concern in priority matrix

DoH eHealth statistics

Continued use by GPs and use and uptake by the general public is variable due to perceived security.

Country SA PHN General Practice and Allied Health survey (April 2016)

Expected Outcome Better coordinated care through use of shared electronic records.

Low uptake of telehealth. Electronic transfer of patient information between health providers is limited ∙ ∙

High proportion of general practices and allied health providers using fax to send referrals or clinical reports Only 46% of general practices and 22% of allied health providers are employing secure messaging software to send information Allied health providers are less likely than general practice to use electronic patient records (61% vs. 99%)

General practices and allied health providers are less likely to communicate electronically with local hospitals and pharmacies. Priority Health Information and Technology (GEN – 3) opportunities, priorities and options

Possible Options 1. Support health service providers to adopt and actively use My Health Record (MHR).

Increased patient knowledge of and management of health.

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Potential Lead CSAPHN


Priority Health Information and Technology (GEN – 3)

opportunities, priorities and options - continued

Possible Options 2. Multi-party conferencing to enable activities such as case conferencing with health professionals in different locations including those within SA Health.

3. Work with communities, ACCHOs, general practice, the six ∙ regional Local Health Networks, metropolitan LHNs and the Rural Doctors Workforce Agency to identify needs for provision of specialist services via telehealth.

4. Work with and support GPs, Adelaide Primary Health Network (APHN), the six regional LHNs and metro LHNs in the implementation of integrated systems.

5. Delivery of secure telehealth services by private providers. ∙

6. Work with vendors in the investigation and implementation of technologies that will enable connections for health care in rural and remote regions whilst endeavouring not to penalise individuals and communities with prohibitive cost.

7. Develop technological solutions (e.g. apps) to collect more ∙ accurate and timely feedback from consumers

Expected Outcome Improved communication, connection and integration between service providers. Patients will be able to access specialist and allied health consultations as close as possible to their place of residence.

Potential Lead CSAPHN facilitating and supporting GP led local initiatives

Improved coordination of diverse efforts to implement telehealth solutions, with a view to common platforms and resource sharing and promotion and or recruitment of specialists and others to the activity.

CSAPHN partnership with RDWA, AHCSA and the six regional LHNs

As above with a particular focus to metropolitan and SA Health connections.

CSAPHN initiative in partnership with APHN, RDWA, AHCSA and the six regional LHNs

Increased access to telehealth services.

CSAPHN facilitating and supporting GP and local service provider led local initiatives

Partnership occurs following the ∙ review of technological opportunities for better connectivity of remote and rural areas to services and data access.

CSAPHN

CSAPHN

Platforms under development to provide better local resources and connectivity to community education and awareness of issues and services.

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Priority Health Information and Technology (GEN – 3)

opportunities, priorities and options - continued

Possible Options 8. Work with SA Health, the six regional LHNs, general practice, allied health and other stakeholders to develop and implement a secure messaging service to support electronic transfer of health information between providers including: ∙ GP care plans ∙ Care summaries ∙ Discharge plans ∙ HealthPathways program implementation

Expected Outcome Better health system integration and ∙ communication

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Potential Lead CSAPHN, SA Health, the six regional LHNs and APHN


INDIGENOUS HEALTH (including Indigenous chronic disease)

Aboriginal Health

(GEN- 1)

Nationally, it has been well documented that Aboriginal and Torres Strait Islander people are significantly more likely to have poorer health outcomes than their nonAboriginal counterparts in almost every domain, and this is certainly true of the CSAPHN region. Aboriginal and Torres Strait Islander people are also more likely to carry a greater burden of disease than non-Aboriginal people living in the same area (AIHW, 2015d). Poorer Aboriginal and Torres Strait Islander health is commonly associated with increased rates of chronic diseases. Identified Need Chronic Conditions Outcomes of the health needs analysis

Key Issue High overall burden of disease compared to the nonAboriginal and Torres Strait Islander population, associated with acknowledged systemic disadvantage and increased rates of chronic disease characterised by: ∙ ∙ ∙ ∙

High rate of hospitalisation, including potentially preventable hospitalisations Increased perinatal and child mortality Decreased life expectancy Health disparities increase with distance from metropolitan areas.

∙ ∙

Consultation with and feedback from South Australian Aboriginal communities and health workers.

CSAPHN analysis of SA Health inpatient admissions database by LGA and SA3

AIHW national reports on Aboriginal and Torres Strait Islander people health and welfare (AIHW 2015c, 2015d)

ABS Australian Aboriginal and Torres Strait Islander Health Survey

AIHW ‘Closing the Gap Clearinghouse’ Report: Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander People (AIHW 2014b)

Wardliparingga Aboriginal Research Unit South Australian Aboriginal Heart and Stroke Plan (SAHMRI 2016)

ACIR data (compiled by both SA Health and NHPA) immunisation rates for Aboriginal and Torres Strait Islander children by SA3

NHPA Healthy Communities: Immunisation rates for children in 2014–15

AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW.

Chronic disease areas included: Circulatory diseases ∙

Leading cause of mortality in South Australia at a rate of 218.2 per 100,000 and a ratio of 1:2 to the nonAboriginal population with a rate difference of 41.0 Age-standardised hospitalisations by age indicates a younger profile.

Acute Rheumatic Fever and Rheumatic Heart Disease ∙

2013-15 incidence of acute rheumatic fever was 0.3 per 1,000

Description of Evidence Leading issue in priority matrix

∙ PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 37


Identified Need Chronic Conditions Outcomes of the health needs analysis - continued

Key Issue ∙ ∙

In December 2015, the prevalence of rheumatic heart disease in Aboriginal and Torres Strait Islander people in South Australia was 3.1 per 1,000 RHD register has a large proportion of the country SA ∙ cases in the far north-west of the state from Coober Pedy to Anangu Pitjantjatjara Yankunytjatjara (APY) Lands. ∙ Other cases on the register are in Port Augusta, Whyalla, and Ceduna with a handful of cases scattered throughout ∙ the Eyre Peninsula, Yorke Peninsula, Port Pirie, the Riverland, and Mt Barker

Description of Evidence Gibson O, Eltridge F, Luz Z, Stewart H, Westhead S, Zimmet P, Brown A. The South Australian Aboriginal Diabetes Strategy 2017 – 2021. Wardliparingga Aboriginal Research Theme, South Australian Health and Medical Research Institute: Adelaide. 2016. South Australian Aboriginal Cancer Control Plan 2016-21, South Australia Department for Health and Ageing. PHIDU, Aboriginal and Torres Strait Islander Atlas https://www.sahealth.sa.gov.au RHD Program Annual Report

Diabetes ∙

∙ ∙

Prevalence rate of 24.4% in country South Australia, increased to 40.2% for remote South Australia for all types of diabetes Gestational diabetes was highest in the remote Far West at 10.7% of all pregnancies Average annual age-standardised rate for hospitalised chronic diabetes complications is highest in Eyre (Indigenous Area IARE) with 25.2 per 1,000 followed by Port Augusta and Ceduna.

Chronic kidney disease ∙

The incidence of end stage kidney disease in Aboriginal and Torres Strait Islander people is occurring at a rate of 57.8 per 100,000 versus 8.5 per 100,000 in the nonAboriginal population in South Australia.

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Identified Need Chronic Conditions Outcomes of the health needs analysis - continued

Key Issue

Description of Evidence

Cancer ∙

∙ ∙

Second highest rate for leading causes of mortality at 232.1 per 100,000 compared to a rate of 171.6 per 100,000 with a rate ratio of 1:4 and a rate difference of 60.6 Stage of diagnosis occurring later Survivorship rates lower.

see above…

Respiratory diseases ∙ Sexual Health

COPD is one of the leading avoidable causes of mortality.

Chlamydia rates are consistently higher in Aboriginal and ∙ Torres Strait Islander populations with a rate of 10.4 per 1,000 in 2018. This was an increase on the previous year which was ∙ 8.3 per 1,000. ∙ 60% of the total notifications were from the Country SA PHN region.

South Australian Aboriginal Sexually Transmissible Infection and Blood Borne Virus Action Plan 2019-2024 South Australian Syphilis Outbreak Response Plan April 2019. SA Health. Surveillance of sexually transmitted infections and bloodborne viruses in South Australia 2018

Gonorrhoea rates are consistently higher in Aboriginal and Torres Strait Islander populations with a rate of 8.3 per 1,000 in 2018. This was an increase on the previous year which was 6.1 per 1,000. 88% of the total notifications were from the Country SA PHN region. In South Australia there was an infectious syphilis outbreak declared in the Far North and Western and Eyre regions from November 2016. As of April 2019, 68 cases of infectious syphilis have been notified among Aboriginal and Torres Strait Islander people in the outback regions of SA. 69% of cases are in the Far North and 7% are in the Eyre and Western region, the remainder in Adelaide.

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Identified Need Eye health

Ear health

Key Issue ∙

Preventable diseases and conditions of the eyes which lead to blindness and vision loss in the South Australian Aboriginal and Torres Strait Islander population is an issue, particularly regarding diabetic patients who have greater risk of cataract ∙ and diabetic retinopathy. These are the second and third ∙ leading causes of blindness and vision loss. In South Australia ∙ 22.2% of Aboriginal and Torres Strait Islander people reported eye health problems. The rates in non-remote areas included 21.3% and remote areas included an estimate of 26.2%.

Description of Evidence AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW. AIHW 2016. Indigenous Eye Health Measures, Canberra: AIHW. AIHW 2011. Indigenous Eye Health Report, Canberra: AIHW. The Retinal photography with a non-mydriatic retinal camera in people with diabetes, MSAC application no. 1181 Assessment report submitted to the Medicare Service Advisory Committee.

AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW.

Vaccination occurs at a higher rate for Aboriginal and Torres Strait Islander children at age 5 years, however, is lower in other age groups.

AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW.

Vaccinations for people who are at a high risk of influenza and pneumococcal hospitalisations and people with a diagnosis of CVD, diabetes or respiratory disease are low.

ACIR data (compiled by both SA Health and NHPA) immunisation rates for Aboriginal and Torres Strait Islander children by SA3

NHPA Healthy Communities: Immunisation rates for children in 2014–15

Vaccinations for HPV are also occurring at a lower rate for Aboriginal and Torres Strait Islander people in South Australia.

NHPA analysis of National HPV Vaccination Program Register

In South Australia in 2012-13 hearing problems reported as experienced by Aboriginal and Torres Strait Islander people are occurring at a much higher rate than found in other states and territories at 15.8%. The proportion in remote areas is 16.2%. The national statistic for reported problems with hearing in 2012-13 was 12.3%. Otitis media is the most common issue within Aboriginal and Torres Strait Islander children in South Australia.

Immunisations

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Identified Need Early detection and treatment

Key Issue In the 2016-17 financial year in the CSAPHN region 5,884 (35%) Aboriginal and Torres Strait Islander people had a 715 Health Assessment. The standout region in CSAPHN is Outback North and East where 66.3% of the Aboriginal and Torres Strait Islander population accessed a health assessment.

Description of Evidence AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW. 2016-17 MBS Data

The CSAPHN regions with the lowest proportion of the population accessing a health assessment was the Adelaide Hills, Barossa, and Lower North where 3% of the population were billed for a 715 health assessment. Cancer screening for Aboriginal and Torres Strait Islander people in South Australia is low in comparison to the nonAboriginal population across: ∙ ∙ ∙ ∙ Access to services

Breast Cervical Prostate Bowel

There is a general lack of access to services for Aboriginal and ∙ Torres Strait Islander people with 24.4 per 100 people accessing doctor consultations in South Australia in 2012–13.

AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. No. WEB 170. Canberra: AIHW.

Of those accessing services, there is a rate ratio of accessing GPMP and TCAs at 1:5 to non-Aboriginal people, however follow-up services and access to allied health and specialist care remains an issue. Access to prescription medication remains an issue with reduced levels of PBS medications being filled. Cost is cited as an issue. In addition, there is a lack of access to hospital procedures and Aboriginal and Torres Strait Islander people tend to stay in hospital for shorter periods and discharge themselves against medical advice. PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 41


Identified Need Cultural competency

All needs and issues listed in the following sections also apply to Aboriginal and Torres Strait Islander people and communities, and there are often additional challenges to meeting these needs within these populations

Key Issue

Description of Evidence AIHW 2017. Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables. Cat. no. WEB 170. Canberra: AIHW.

In the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey, 97.3% of Aboriginal or Torres Strait Islander people felt they were treated unfairly in the last 12 months. This is different to the 2014-15 National Aboriginal and Torres Strait Islander Social Survey where 44.8% of people felt they were treated unfairly in the last 12 months. 19.5% had indicated they were treated unfairly by doctors, nurses or other staff in hospitals or doctors’ surgeries. In 2012-13, there were 29.5% of Aboriginal and Torres Strait Islander in South Australia who needed to go to a health provider but did not, where 33.3% provided cultural appropriateness of the service as the reason.

Mobility of Aboriginal and Torres Strait Islander peoples to and from communities, across state boarders, and into metropolitan or regional centres, add to the challenges of accessing multi-disciplinary coordinated care, information sharing across the system, maintaining accurate health records and supporting self-management.

Leading issue in priority matrix

PHIDU analysis of ABS Census 2011 and ERP 2013

AIHW ‘Closing the Gap Clearinghouse’ Report: Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander People reports significant rates of poor social and emotional wellbeing outcomes. (AIHW 2014b)

Interplay between environmental and socio-economic factors heavily influencing health outcomes that act as barriers to health behaviours (e.g. food security and healthy eating) increasing challenges in chronic condition care and management. Barriers are further exacerbated as distance increases from metropolitan Adelaide. This is likely to result in increased frequent use of the acute care health system, particularly in remote areas. Communities struggle to respond appropriately to individuals with mental health episodes, especially in the after-hours period.

Consultation with and feedback from Aboriginal communities and health workers

CSAPHN service mapping – geographic distribution of ACCHOs

RDWA Indigenous Medical Outreach programs ((RDWA undated c, undated d)

PHIDU, August 2016 update

Roxanne Bainbridge, Janya McCalman, Anton Clifford and Komla Tsey (for the Closing the Gap Clearinghouse). (2015). Cultural competency in the delivery of health services for Indigenous people. Canberra: AIHW.

Aboriginal Community Controlled Health Organisations consultations

Integrated Team Care Activity Service Provider Staff Forum

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Identified Need Continued…

Key Issue Lack of social and emotional wellbeing programs are being raised as an issue within communities and has been a central point raised with ACCHO OSRs nationally. Minimal engagement and access in the health care system occurring due to lack of tailored health services to Aboriginal and Torres Strait Islander holistic health perspectives.

Lack of culturally appropriate service provision ∙

∙ ∙ ∙ ∙

No operational ACCHO in the Riverland, Mid North, Lower North or Yorke Peninsula despite sizeable Aboriginal and Torres Strait Islander populations in several LGAs in these regions, including; Berri/Barmera, estimated at 605 residents or 5.8% of the total population in 2015 Mount Remarkable, estimated at 113 residents or 4.1% of the total population in 2015 Port Pirie, estimated at 655 residents or 3.7% of the total population in 2015 Yorke Peninsula, estimated at 421 residents or 3.8% of the total population in 2015.

Description of Evidence Integrated Team Care Activity Service Provider Reports

Health Navigator Project Community Consultations

Health Navigator Project Service Consultations.

AIHW 2018. Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17. Cat. no. IHW 196. Canberra: AIHW. Viewed 05 September 2019, https://www.aihw.gov.au/reports/indigenous-health-welfareservices/health-organisations-osr-key-results-2016-17

Local Health Clusters

South Australian Aboriginal Sexually Transmissible Infection and Blood Borne Virus Action Plan 2019-2024

SA STI and BBV Action Plan Reference Group

South Australian Syphilis Outbreak Response Plan April 2019.

South Australian Syphilis Outbreak Working Group

ACCHO capacity issues affecting service effectiveness and sustainability, including: ∙

Limitations in both currency and ongoing maintenance of clinic infrastructure and telecommunications are barriers to maintaining and implementing effective service delivery

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Identified Need Continued…

Key Issue Limitations in workforce including: ∙ ∙

Description of Evidence

Lack of available Aboriginal health professionals in the workforce see below Low recruitment, development and retention of workforce in general, particularly in rural and remote areas, including general practitioners, nurses, allied health and Aboriginal Health Practitioners Several barriers in accessing MBS items affecting the sustainability of the organisation, including use of services which prevents usage of MBS items and therefore follow-up items associated.

Overall issue with workforce, difficulties for service providers in recruitment, development and retention of workforce in general, particularly in rural and remote areas, including general practitioners, nurses, allied health and Aboriginal Health Practitioners in: ∙ ∙ ∙ ∙

Far West Riverland Eyre Peninsula Port Augusta and surrounds

See above…

Existing GPs (including Royal Flying Doctor Service), pharmacists and other mainstream services may require ongoing cultural competency training and facilitation to engage with Aboriginal and Torres Strait Islander specific providers. Minimal knowledge surrounding strategies in the use of the 715 Health Assessment to assist in cross cultural communication, and specific types of health services affecting access to and quality of health services. For example, using sexual health aspects of the 715 Health Assessment to normalise annual testing for BBV and STIs,

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Identified Need

Key Issue particularly in designated outbreak regions, and as a means to reduce shame associated with BBV and STI screening.

Description of Evidence

Lack of communications and workforce support of sexual health issues, responses and available Aboriginal and Torres Strait Islander specific resources and supports for primary health services. Aboriginal Workforce

Low numbers of Aboriginal and Torres Strait Islander health professionals, in the CSAPHN region including: ∙ ∙ ∙

Health Workforce Data 2015

General practitioners at a proportion of 0.7% of the total, compared to a proportion of 0.45% across SA Nurses and midwives at proportion of 1.54% of the total, compared to a proportion of 0.8% across SA Allied health professionals at a proportion of 1.7% of the total, compared to 0.7% across SA.

High employment rates for health professionals. Priority Aboriginal Health

Possible Options 1. Investigate opportunities that support prevention, early identification and treatment activities.

Expected Outcome Improved connection of community to services provided by ACCHO’s, AMS and general practice.

2. Investigate opportunities that support Aboriginal and Torres Strait Islander patients with chronic disease conditions in self-management, with the aims of improving individual and community health outcomes and reducing avoidable hospitalisation.

Improved connection of community to services provided by ACCHO’s, AMS and general practice.

3. Investigate opportunities that support provision of culturally safe care that incorporates Aboriginal and Torres Strait Islander understandings of health and wellbeing.

Improved connection of community to services provided by ACCHOs, AMS and general practice.

Improved capacity to deliver culturally respectful/culturally competent services.

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Potential Lead In all activities in this area and below; CSAPHN leading activity in partnership and consultation with Aboriginal Community Controlled Health Organisations, Aboriginal Health Council SA (AHCSA) and SA Health AMS leads. For targeted sub activities also engaging the APHN and RFDS


Priority Aboriginal Health – continued

4.

5.

Possible Options Investigate potential models for support to or coordination of activity to assist the management of high or frequent users of the health system, as an avenue for hospital avoidance.

Expected Outcome Better connection of frequent service users to consistent care and reduced attendance at acute service by frequent user.

In partnership with ACCHOs provide material support according to identified needs that covers:

ACCHOs and AMS achieve increased capacity to provide quality services.

∙ ∙ ∙ ∙

Evidenced improvement in financial capacity redirected to service provision.

Evidence provided of increased quality of patient throughput and patient outcomes.

∙ ∙ ∙ ∙

6.

Business modelling and forward planning options Service sustainability options After hours business modelling options Strategy and improvements in utilisation of technology Participation in improvement programs Support of continuing professional development Support to recruitment and retention of GP and other health professionals Facilitation of engagement by the pharmacy with ACCHOs to provide material assistance to stock control management in remote dispensaries

Recognise the RFDS as a general practice to remote areas and support the development of business models that will capacity build RFDS as provider of services in remote communities.

7. Support cultural competency in services delivered by mainstream health services to Aboriginal and Torres Strait Islander peoples.

Potential Lead

See above…

RFDS providing enhancements in service to Aboriginal and remote communities.

Develop the capacity of mainstream practices to deliver culturally competent services in partnership with key stakeholders.

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Priority Aboriginal Health continued

8.

Possible Options Linking of chronic care programs for Indigenous people as they move across and through the region, through: ∙

9.

Multiparty conferencing to enable activities such as case conferencing with health professionals in different locations including those within SA Health Implementation and promotion of My Health Record

Implementation of a project which enables Shared Clinical reviews which are evidenced to be a useful tool in managing complex conditions, particularly for people who blur the eligibility lines across services and whose needs vary from time to time.

Expected Outcome Increase in uptake of My Health Record and use of same across the ACCHO’s and AMSs through the region and into Alice Springs.

Potential Lead

See above…

Evidence of improvements in connection of Aboriginal clients to all relevant service providers and services.

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MENTAL HEALTH AND ALCOHOL AND OTHER DRUGS Alcohol & Other Drugs In general, alcohol is consumed in Australia at levels of low immediate risk. However, some people drink at levels that increase their risk of developing health problems over the course of their life, as well as increasing their risk of alcohol-related injury. Illicit drug use is an increasing concern for local communities and is associated with a range of adverse effects on both physical and mental health. Identified Need DA 1- Increase of specialised drug and alcohol treatment services

Key Issue Drug and alcohol is a relatively new field for the PHN, with commissioning beginning July 2016. The PHN strategic vision for drug and alcohol treatment aligns to the National Drug Strategy aiming to contribute to ensuring safe, healthy and resilient communities through minimising alcohol, tobacco and other drug related health, social and economic harms.

Description of Evidence Drug and Alcohol Stakeholder Survey

SA Health Hospital Separations 2013-14 and 2014-15

My Healthy Communities 2015/16

Estimated resident population 2014.

Estimated resident population Aboriginal and Torres Strait Islander 2011

In the Country SA PHN catchment, the following has been found:

IHW 2016. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011

Identifying the Gaps: Report on SA Drug and Alcohol Services Planning, DASSA

Drug and Alcohol Use among Select South Australian At-Risk Groups, NCETA, 2017

My Health Communities 2017

Alcohol and Other Drug Treatment Services in Australia 2016-17

∙ ∙

High prevalence of risky alcohol consumption, particularly among males aged 25-64 in the Country SA PHN catchment The highest prevalence of risky alcohol consumption was in the Adelaide Hills, Barossa, Outback and South East regions High prevalence of recent cannabis use was in Gawler, Barossa and the Adelaide Hills The level of prescribed opioids dispensed in SA3 areas across Country SA PHN ranged from 53,757 (SA40102, Adelaide Hills) to 94,892 (SA405, Barossa). Prevalence of lifetime illicit drug use for school aged children (12-17) ranged from 8% in the South East to 18% in the Outback North and East, while state prevalence was 14%

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Identified Need Increase of specialised drug and alcohol treatment services - continued

DA 2- Deficit of residential and non-residential rehabilitation options

Key Issue Prevalence of recent methamphetamine use was highest in South Outback South Australia (4%) whilst state-wide prevalence was 2% Alcohol accounted for the highest proportion of AOD ED presentations, AOD hospital separations, specialised AOD treatment episodes, and reason for contacting ADIS. The South East SA4 accounted for 48% of the Country SA PHNs AOD ED presentations. The Country SA PHN SA4 area had the highest prevalence of monthly risky drinking with Adelaide Hills (43%), Barossa (40%) and Outback North and East (35%) Treatment for alcohol as a principal drug of concern was most common in very remote areas (64% of all treatment episodes) compared with 30% of treatment episodes in major cities (30%)

Description of Evidence

see above…

Residential Rehabilitation The actual number of residential rehabilitation beds fell short of the estimated optimal number (38% of the estimated optimal). This shortfall is a little less than that in metropolitan Adelaide in terms of percentage. Furthermore, the actual number of residential rehabilitation separations fell short of the estimated optimal number (24% of optimal). This shortfall was similar to that in metropolitan Adelaide in percentage terms. *The DASSA data compiled the estimated optimal vs actual number of withdrawal management and residential rehabilitation beds for country SA and metropolitan Adelaide.

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Identified Need DA 3- Drug and alcohol hospital separations

Key Issue

Description of Evidence

The highest annual rate of separations for drug and alcohol related primary diagnosis was the Outback North and East with 4.6 per 1,000 followed by Murray and Mallee with 4.0 per 1,000 and South West with 3.0 per 1,000. Furthermore, bed days per 1,000 was highest in the Outback North and East followed by the Murray and Mallee and Mid North. Withdrawal Management The actual number of withdrawal beds in country SA was short of the estimated number by 17 beds (11% of the optimal). This shortfall is greater in terms of percentage than in metropolitan Adelaide. Furthermore, the actual number of withdrawal management separations in Country SA was short of the estimated optimal number by 654 (23% of the estimated optimal).

see above‌

Rurality and drug use ∙ The 2013 National Drug Strategy Household Survey shows that the proportion of those who recently used an illicit drug varies with growing rurality: remote/very remote areas (18.7%), outer regional (16.7%) inner regional (14.1%), and major cities (14.9%). People living in remote and very remote areas were twice as likely as people in major cities to have recently used illicit methamphetamines or amphetamines. Furthermore, the proportion of South Australians who had consumed alcohol at levels that increased their risk of disease or injury over a lifetime was higher in the country regions of the state (17% vs. 20%)

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Identified Need ∙

DA 4- Aboriginal and Torres Strait Islander specific drug and alcohol services

Key Issue Illicit use of ice (or crystal methamphetamine) has more than doubled, from 22% in 2010 to 50% in 2013. In 2013, people living in remote and very remote areas were twice as likely as people in major cities to have recently used illicit methamphetamines or amphetamines.

Description of Evidence

Aboriginal and Torres Strait Islander people, of whom 70% live in rural Australia, were 1.7 times more likely to have recently used illicit drugs compared to the general population. The highest average annual rate of AOD separations as the primary diagnosis for Aboriginal and Torres Strait Islander people was the in the Yorke Peninsula SA3, other areas with high proportions included: ∙ ∙ ∙

see above…

Murray and Mallee Lower North Eyre Peninsula and South West

The high rates experienced are primarily attributed to lack of services on the lands and lack of continuity of care from acute to community settings. Furthermore, Aboriginal and Torres Strait populations experience high comorbidities with mental health. A higher proportion of Aboriginal and Torres Strait Islander people in South Australia drank at levels that increased their risk of injury from a single occasion of drinking, and also drank at levels that increased their risk over a lifetime. Nearly one quarter of Aboriginal and Torres Strait Islander people aged 15 years and over had used at least one illicit substance in the past 12 months in South Australia.

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Identified Need DA 4- Aboriginal and Torres Strait Islander specific drug and alcohol services continued

Key Issue Mental and substance use disorders accounted for 19% of the total burden of disease for Aboriginal and Torres Strait Islander persons, the highest of all categories. The high population of Aboriginal and Torres Strait Islander persons in regional SA suggests these figures would further increase in these communities. Additionally, 22% of mental health disease burden was attributed to alcohol use among Aboriginal and Torres Strait Islander people in Australia.

DA 5- Mental health & drug and alcohol comorbidity

Service gaps and co-morbidity Service gaps and comorbidity of mental health conditions with drug and alcohol is evident in the hospital separations for each region, correlating as high for both. Furthermore, client needs go unmet while waiting for services. ∙

Description of Evidence

see above…

Stakeholder consultation indicated extensive waiting times – clients are unlikely to be re-motivated after waiting. Resulting in clients continuing to use illicit substances while they wait for a service. Extensive waiting lists indicate service capacity is unable to meet the need.

Aboriginal and Torres Strait Islander clients in more remote dry zones must travel to regional areas which are not dry to withdraw/sober up. Stakeholders indicate this can cause issues, particularly when clients return to their areas post rehabilitation. Clients are then lacking in follow-up and outreach back in the community. Areas with low service capacity and/or no outreach service, require additional hours or more providers to bring waiting times down, especially in areas where there are higher rates of drug and alcohol admissions, as well as mental health admissions.

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Priority 1.

Increase of specialised drug 2. and alcohol treatment services (DA 1) 3.

Deficit of residential and non-residential rehabilitation options (DA 2)

Drug and alcohol hospital separations (DA 3)

Possible Options Encourage and nurture cross sector referral and integration within CSAPHN MHAOD comorbidity reform agenda.

Expected Outcome

Potential Lead CSAPHN

Improved integration and patient journey through escalation and deescalation of severity within an adopted stepped care model.

∙ ∙

MHAOD Community Consultations

Improved integration and patient journey through escalation and deescalation of severity within an adopted stepped care model.

CSAPHN/six regional Local Health Networks/Private Sector

CSAPHN/six regional LHNs/Hospitals

Analysis of market for successful models and expansion through targeted commissioning to meet areas of need. Co-design activity through flexible funds, feeding off community consultations held through the region

4.

Drug and alcohol upskilling across existing mental health programs and funded activity.

1.

Encourage and nurture cross sector referral and integration within CSAPHN MHAOD comorbidity reform agenda.

2.

Co-design activity through flexible funds.

3.

Look at more support measures to address lack of residential services in rural areas.

Increase of available in scope treatment options

1.

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

Engage widely across the sector nationally and internationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and its connection to the flow of coordinated care.

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Priority Aboriginal and Torres Strait Islander specific drug and alcohol services (DA 4)

Expected Outcome

Possible Options Improved consultation and engagement with Aboriginal and ∙ Torres Strait Islander people specific AOD sector 1.

2.

Further develop partnerships within Aboriginal and Torres Strait Islander communities to implement community-specific responses and support models to address identified drug and alcohol issues and hospital separations.

Encourage and nurture cross sector referral and integration within CSAPHN MHAOD comorbidity reform ∙ agenda.

3.

Further engagement and consultation with the sector via ongoing community and service provider consultation forums.

4.

Targeted co-planning and co-design with ADAC and ACCHOs to realign currently funded and new activity within CSAPHN AOD scope and funding.

5.

Analysis of market for successful models via ITA process and expansion through targeted commissioning to meet areas of need.

6.

Co-design activity through flexible funds.

7.

Drug and alcohol upskilling across existing mental health programs and funded activity.

8.

Brief intervention, withdrawal management and counselling with alcohol and amphetamines focus.

9.

Encourage and nurture cross sector referral and integration within CSAPHN MHAOD comorbidity reform agenda.

Better connection of community to ACCHO’s AMS and local delivery of services. Local ownership of community mental health. Improved integration and patient journey through escalation and deescalation of severity within an adopted stepped care model. Improved relationships and engagement with the sector.

10. Analysis of market for successful models and expansion through targeted commissioning to meet areas of need.

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Potential Lead ∙

CSAPHN/ADAC/ACCHOs


Priority Aboriginal and Torres Strait Islander specific drug and alcohol services (DA 4)

Mental Health & Drug and Alcohol Comorbidity (DA 5)

Expected Outcome

Possible Options 1. Incorporate long term rehabilitation programs in country ∙ regions.

Improved integration and patient journey through escalation and deescalation of severity within an adopted stepped care model.

CSAPHN/ADAC/ACCHOs

Improved integration and patient journey through escalation and deescalation of severity within an adopted stepped care model.

CSAPHN/ADAC

Increase of targeted cross-sector activity.

2. Drug and alcohol upskilling across existing mental health programs and funded activity. 1. Encourage and nurture cross sector referral and integration within CSAPHN MHAOD comorbidity reform agenda. 2. Promotion of a stepped care model as part of greater synergy and interaction with mental health services. 3. MHAOD ITA as part of Most Competent Provider (MCP) process.

Potential Lead

4. Co-design activity through flexible funds.

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Primary Mental Health Primary mental health care is usually the first port of call for mental health issues and forms a necessary part of comprehensive mental health care, as well as an essential part of general primary care. Populations seen within the primary mental health setting can range from at risk groups with early symptoms through to individuals with severe mental illness and complex needs. Identified Need MH 1- Low intensity service delivery to reduce waiting lists and increase access to areas of high disadvantage

Key Issue Low intensity services delivered In the 2017-18 period, low intensity services were delivered to 1,303 clients equating to 1.1% of our population compared to 133 clients in the previous year (total PHN population 484,609 at-risk groups 21.3% = 111,949). These numbers indicate a 5% growth in the number of people accessing low intensity episodes or where service capacity has been reached, a maintenance of the previous year’s rate. The clinical outcomes for people receiving low intensity Mental health services showed 100% decrease in psychological distress as reported by the K10. Psychosocial health Currently the reporting mechanisms for psychosocial needs and trends within country South Australia is limited at best. Previously such data was collected in collaboration with mental health data and thus is difficult to isolate. The estimates reached were mainly drawn from Government pension numbers, carers support, Personal Helpers and Mentors Service (PHaMS) and Partners in Recovery (PIR) provider statistics. ∙

For the 2017 period ABS data country South Australia reported 18,011 persons on a disability support pension and 5,436 persons receiving a carer payment. Overall, 6.2% of country South Australians needed assistance with core daily activities and approximately 11,133 were unemployed

Description of Evidence Leading issue in priority matrix

Key area of concern in stakeholder consultation and feedback

SAMSS 2016/18

Characteristics of people using mental health services and prescription medication, 2015 ABS

SA Health Hospital Separations data 2015-16

Estimated resident population 2016.

ATAPS MDS data 2015-16

ABS- Data by Region

PHaMS (Personal Helpers and Mentors Service)

PIR Country SA PHN Statistics

Country SA PHN MHAOD consultations

SAMSS, SA Health

Leading issue in priority matrix

Key area of concern in stakeholder consultation and feedback

SAMSS survey of residents aggregated by SA3

AIHW: Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm

Headspace Centres Country SA PHN (FY2017-18)

MBS data by Statistical Area 2016-17

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Identified Need Low Intensity Service delivery to reduce waiting lists and increase access to areas of high disadvantage - continued

∙ ∙

Key Issue Psychological Distress Measurements revealed 13% of country South Australian’s experienced high or very high levels of distress, compared to the state average of 11.9%. Furthermore, this level increased for Aboriginal and Torres Strait Islander people with distress levels equating to 31.8% PHaMs data was similar to ABS statistics with 2,152 participants registered in the 2014/15 reporting period PIR client’s Needs Assessment files in 2016/18 highlighted 2041 clients with needs, 1095 of these needs remained unmet. Despite services being in place to assist clients, the demand exceeded capacity, thus for regions without PIR would equate to a higher percentage of unmet needs Of the PIR clients during this period 85% were unemployed or not in the labour force and their main source of income came from pensions or government benefits.

Description of Evidence

See above…

For country South Australia, PIR is only functioning in the Country North region, leaving a significant gap in the Murray Mallee, Riverland and South East. Through community consultations conducted in 2016 on MHAOD, significant issues were evident in rural and remote communities in regard to; access to services, cost of services and service waiting periods. These factors were believed to increase mental health problems and burden in the region. MH 2- Lack of mental health support for young people

Youth Mental Health Service aims to better engage young people and work with them to develop the skills and supports they need to manage mental health distress and enjoy the best health possible. Youth Mental Health Service provides a range of services to young people with mental

see above…

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Identified Need MH 2- Lack of mental health support for young people - continued MH 7- Community education and training opportunities for sector staff

Key Issue health issues ranging from low intensity to acute care, including: ∙ mental health assessment and care planning ∙ individual therapy, group work and family work ∙ Care coordination ∙ In-patient care including step-down care Physical assessment ∙ Alcohol and other drugs assessment ∙ Co-care with GPs, partner agencies and other service providers ∙ Consultation and liaison services to support youth and community services ∙ Referrals to other services/agencies as appropriate

Description of Evidence

Child 0-11 years mental health 1 in 7 young people aged 4-17 years were assessed as having had a mental health disorder(s) in the previous 12 months. The main treatment services utilised for the younger child cohorts were psychological therapies.

see above…

MBS subsidised mental health - related services The proportion of population aged 12-24 years who accessed at least one MBS service from a clinical psychologist was highest in the Mid North (2.9%), followed by the Lower North (1.9%) and Gawler - Two Wells (1.8%). For the 0-11yrs cohort, the proportion of population accessing at least one MBS services was highest in the Mid North (0.6%), followed by the Yorke Peninsula (0.3%) and Eyre Peninsula and South West (0.3%). Non-PHN commissioned services targeting this age cohort include Child and Adolescent Mental Health Service (CAMHS) whom currently have 11 country-based services in the region (for children 0-15 years).

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Identified Need MH 2- Lack of mental health support for young people - continued MH 7- Community education and training opportunities for sector staff

Key Issue Youth 12-24 years mental health – headspace For youth aged 12-24 years, Headspace is the predominant mental health service provider across the region. Headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year old’s, along with assistance in promoting young peoples’ wellbeing. Headspace undertakes a range of activities to increase the awareness of services and how to access them among young people, their families, friends and the broader community. Headspace has six operational centres in the country SA region ∙ Port Augusta ∙ Berri ∙ Murray Bridge ∙ Mount Gambier ∙ Whyalla ∙ Mt Barker

Description of Evidence

see above…

Child and youth mental health services - delivered In the 2017-18 period, Headspace delivered 10,579 occasions of service to 2,148 young persons and 1,409 new clients. The average visit frequency was 4.9 for the total 2,276 clients compared to 4.7 for 1,654 clients in the previous year. Occasions of service was highest for the Port Augusta Headspace Centre (3,092), followed by Mount Gambier (2,695) and Murray Bridge (2,635). Comparatively, the number of serviced young people was highest in Murray Bridge (638), followed by Mount Gambier (506). In terms of new clients visiting the centres, Murray Bridge and Port Augusta were the highest.

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Identified Need

Key Issue Mental health support specifically targeting youth and younger people is limited across the country SA region.

Description of Evidence

Key reasons include: ∙ ∙ ∙

Clients experience considerable waiting periods due to low service availability Limited number of practitioners, specifically skilled in youth mental health Difficulties retaining rural/regional workforce.

Resilience in rural and remote communities and increased stigma around mental health MH 3- Address service gaps in the provision of psychological therapies and outreach to rural and remote areas

Psychological therapies Psychological therapies are delivered to mild to moderate groups within the stepped care approach, services commissioned under this level of intervention within a stepped care approach must be evidence based for the population group being targeted.

see above…

In the 2017-18 period, psychological therapies were delivered to 6,020 clients equating to 9% of our population compared to 3,190 clients in the previous year (total PHN population 484,609 mild to moderate groups 13.6% = 65,906). These numbers indicate a 5% growth in the number of people accessing psychological therapies. The clinical outcomes for people receiving psychological therapies showed 71% of clients had a decrease in levels of distress after receiving a service. Better Access (MBS) Access to mental health services billed to the MBS varied across the PHN, the lowest for each profession was consistently found in the Outback North and East (0.6%), Eyre Peninsula and South West (1.0%). The highest access for the CSAPHN region was in the Mid North.

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Identified Need Address service gaps in the provision of psychological therapies and outreach to rural and remote areas continued

Key Issue Access to MBS billed clinical psychology was lowest in the Eyre Peninsula and South West where 0.4% of the population had at least one session billed to MBS, this was followed by Outback North and East with 0.6%. Highest access was in the Adelaide Hills, Gawler – Two Wells, and Barossa. Access to MBS billed mental health services by allied health professionals was lowest in both Eyre Peninsula and South West and Outback North and East, equally providing at least one session for 0.6% of the population. Highest access for the CSAPHN region was in the Limestone Coast, Gawler -Two Wells, and Fleurieu – Kangaroo Island.

Description of Evidence

see above…

GP mental health care plans (2016-17) The preparation of GP mental health care plans per 1,000 population was highest in ∙ Gawler – Two Wells ∙ Adelaide Hills ∙ Fleurieu – Kangaroo Island And lowest in ∙ Lower North ∙ Eyre Peninsula and South West ∙ Mid North MH 4- Mental Health Hospital Separations

Mental health related hospital separations Mental health hospitalisations are a method for measuring unmet health needs due to the acute nature of a hospitalisation being a proxy of the gap between known prevalence and available/suitable treatment options. If client needs escalate beyond service availability or appropriateness, they become visible as acute hospital

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Identified Need

Key Issue admissions (and potentially also drug and alcohol, and selfharm hospitalisations).

Description of Evidence

The highest age-standardised rate of mental health related hospital admissions (2015/16) was in; ∙ ∙ ∙

Mid North SA3 Murray and Mallee SA3 Outback North and East SA3

Females were admitted to hospital for mental health issues slightly more often than males. The Murray and Mallee region had the highest proportion of admissions for both males and females in the region, followed by the OutbackNorth and East and the Mid North regions. Specific mental health conditions were varied in type of admissions across the CSAPHN region. These are summarized by SA3 below: ∙ Schizophrenia and other delusional disorders were highest in Outback North and East followed by Mid North and Eyre Peninsula and South West (2015-16). Of interest, the Mid North had the highest access to MBS psychiatry while the Outback North and East and Eyre Peninsula had the lowest ∙ Depressive episodes were highest in the Murray and Mallee, followed by Mid North, and Outback North and East (2015-16) ∙ Anxiety and stress disorders were highest in Mid North, Yorke Peninsula and Murray and Mallee (2015-16) ∙ Bipolar and mood disorders were highest in the Yorke Peninsula followed by the Lower North, then the Mid North (2015-16).

see above…

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 62


Identified Need MH 5- Integrated and coordinated holistic mental health services MH 7- Community education and training opportunities for sector staff

Key Issue Remote, rural and regional communities face a range of stressors unique to living outside of a metropolitan centre. Generally, demographics have lower socioeconomic status, reduced access to services, difficulties retaining health workforces, greater exposure to natural disasters, increased distance between communities, reduced access to transport and fewer employment opportunities, all of which influence mental health.

Description of Evidence

Mental health and psychological distress Mental health conditions are self-reported in high proportions across the region, generally increasing in prevalence with increasing remoteness. The highest rates within the country SA region were for the following areas, all of which were above the state average ∙ ∙ ∙ ∙

see above…

Lower North (26.4%) Mid North (22.2%) Barossa (20.6%) Gawler and Two Wells (20.4%)

Psychological distress can have a significant impact on an individual’s life and correlates with numerous mental health disorders. Furthermore, increased psychological distress is strongly associated with numerous factors unique to country region. For the 2016-18 period, psychological distress was highest in the Mid North (19.7%) followed by Gawler - Two Wells (17.4%), Barossa (17%), and Adelaide Hills (13.3%). Diagnosed vs Undiagnosed mental illness Low proportions of reported mental illness in the Outback North and East (SA3) contradict the high rates of hospitalisations for mental health related conditions. This suggests rates of undiagnosed mental illness rather than lower occurrence. PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 63


Identified Need

Key Issue

Description of Evidence

Self-reported mental health service utilisation (2016/18) The highest self-reported mental health service utilisation was in the Fleurieu – Kangaroo Island (8.0%) followed by Lower North (7.6%), Limestone Coast (6.5%), and Murray and Mallee (5.6%). MH 6- Step Up and Down interface with acute services

Step Up and Down offer clinically supported services providing short term care to manage the interface between inpatient and community settings. They provide an alternative to hospital admission (pre-acute) and provide bridging support following discharge from hospital (postacute). Step Up and Down services are usually delivered through staffed residential facilities but may be delivered in the person’s home MBS psychiatry The state average for MBS psychiatry services is 5.8 sessions per client. For the CSAPHN, only the Adelaide Hills (6.6 sessions per client) was above the state average, while all other SA3s were below the state average. The lowest average services for MBS psychiatry was the Eyre Peninsula and South West (average 2.9 sessions per client), followed by; ∙ ∙

See above…

Outback North and East (3.1 sessions per client) Murray and Mallee (3.2 sessions per client)

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Identified Need MH 6- Step Up and Down interface with acute services - continued

Key Issue MBS clinical psychology The state average for MBS Clinical Psychology services was 4.3 sessions per client. For CSAPHN, access to MBS Clinical Psychology services ranged between an average of 3.5 sessions per client in Outback North and East to an average of 4.4 sessions per client in Adelaide Hills. SA3 regions with the lowest average services were; ∙ ∙ ∙ ∙

Description of Evidence

Limestone Coast Yorke Peninsula Murray and Mallee Outback North and East

Clinical Care Coordination services delivered In the 2017-18 period, Clinical Care Coordination was delivered to 2,002 clients equating to 13.3% of our population compared to 500 clients in the previous year (total PHN population 484,609 severe mental illness groups 3.1% = 15,022). These numbers indicate a 5% growth in the number of people accessing Clinical Care Coordination. In the CSAPHN catchment Clinical Care Coordination is delivered in the following regions; Lower North, Eyre Peninsula and South West, Murray and Mallee, Adelaide Hills, Gawler- Two Wells and Limestone Coast. Priority Low Intensity Service delivery to reduce waiting lists and increased access of mental health to areas of high disadvantage (MH 1)

Expected Outcome

Possible Options 1.

Improved demand management strategies.

Decrease of wait times.

2.

More focus on low intensity intervention through the implementation of a stepped care model through mental health and alcohol and other drugs reform.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

3.

Review feasibility and efficiency of centralised regional triage and intake.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 65

Potential Lead ∙

CSAPHN leading these activities in consultation with SA Health and the six regional Local Health Networks and metropolitan LHNs with support provided from the APHN as the PHN with primary and first


Priority Low Intensity Service delivery to reduce waiting lists and increased access of mental health to areas of high disadvantage (MH 1) continued

Expected Outcome

Possible Options 4.

Capacity building to address clinical governance deficiencies.

More streamlining of access and decrease of inappropriate referrals.

5.

Implementation of a stepped care model through mental health and alcohol and other drugs reform.

Improvement of quality, access and safety.

6.

Analysis of market for successful models and expansion through targeted commissioning to meet areas of need.

7.

Support region-specific, cross sectoral approaches for children and young people with, or at risk of, mental illness.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Increased options of evidence-based models to targeted areas of high disadvantage.

Consolidated up to date inventory of available services and workforce spread.

Additional mapping of impact on access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas.

Improved integration and patient

8.

Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

9.

Identification of communities in need and their prevalence of service support need ongoing development.

10. Support region-specific, cross-sectoral approaches for people with, or at risk of, mental illness.

journey through escalation and deescalation of severity within the stepped care model.

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Potential Lead engagement with the Metro LHN’s.


Priority Lack of mental health support for young people (MH 2)

1. Support organisations that provide family and community programs in the target regions. 2. Place youth workers with expertise in alcohol and other drugs and mental health in communities of need including engagement with the RFDS and headspace sites for improved outreach services. 3. Promote better mental health for youth through support to headspace and community programs and education and youth support and counselling activities.

Address service gaps in the provision of psychological therapies and outreach to rural and remote areas (MH 3)

Expected Outcome

Possible Options

1.

2.

3.

4.

Address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and/or hard to reach populations. Identification of communities in need and their prevalence of service support need ongoing development. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, assessment and diagnosis post admission, identification and integration of drug and alcohol needs. Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

Improved health outcomes for developmentally vulnerable children.

Appropriate services available to and easily accessible for youth in need.

RFDS and headspace partnering in youth services in remote regions.

Youth activities expanded from regional centres to all areas.

Improvements achieved in awareness of principles and practical application of principles for quality use of medicines.

Additional mapping of impact on access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas.

Consolidated, up to date inventory of available services and workforce spread.

Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 67

Potential Lead ∙

CSAPHN/country SA headspaces and RFDS

CSAPHN

Headspace


Priority Mental health hospital separations (MH 4)

Expected Outcome

Possible Options 1.

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling continuity of care, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

2.

Mental health upskilling across existing mental health programs and funded activity.

3.

Improved data entry/coding and dissemination across region.

Integrated and coordinated 1. holistic services (MH 5) 2.

Implementation of a stepped care model through mental health and alcohol and other drugs reform. Engage with all providers to develop the capacity of the region to engage care coordinators in routine activities and to identify opportunities and create strategies to implement better discharge planning.

3.

Promotion and facilitation of the Health Care Homes, review and redesign of integrated health systems.

4.

Work with and drive inter-sectoral partners and use research to develop a primary health services, ‘Service Delineation Model’ for rural SA.

5.

Use existing resources, redirected, to engagement of care coordinators in various employment models.

6.

CSAPHN will work with and support GPs, Adelaide Primary Health Network (APHN), the six regional Local Health Networks and metro LHNs in the implementation of integrated systems.

7.

Utilise learnings from PIR and integrate support facilitation models.

Engage widely across the sector nationally and internationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and its connection to the flow of coordinated care.

More accurate data of mental health admissions and separations.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Patients will be able to access specialist and allied health consultations as close as possible to their place of residence as evidenced by increased uptake of care coordination packages.

Mapping and education activity resulting occasions real restructuring of local activities to include care coordination models of service delivery.

Effective linking of metropolitan based services for care provided in a local rural setting. Targeting of total GDP cost of health occasioned through travel.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 68

Potential Lead ∙

CSAPHN initiative in collaboration with APHN and all six regional LHN’s and SA health.

CSAPHN initiative in collaboration with APHN and all six regional LHN’s and SA health.


Priority Step Up and Down interface with acute services (MH 6)

1.

Implementation of a stepped care model through mental ∙ health and alcohol and other drugs reform.

2.

Explore telehealth options for increased access to psychiatry.

3.

Community education and training opportunities for sector staff (MH 7)

Improved service mapping for efficient commissioning and targeting of services (MH 8)

Expected Outcome

Possible Options

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

1.

Specialised upskilling across existing mental health programs and funded activity.

2.

Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

3.

Community forums and awareness.

4.

Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

5.

Transparency of mapping to increase awareness of service providers and commissioned services

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Potential Lead ∙

Patients will be able to access specialist and allied health consultations as close as possible to their place of residence.

Engage widely across the sector nationally and internationally to define best practice, simple and cost-effective options and practices.

Improvements achieved in ∙ awareness of principles and practical application of principles for quality use of medicines.

Consolidated up to date inventory of available services and workforce spread.

Consolidated up to date inventory of ∙ available services and workforce spread.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 69

CSAPHN initiative in collaboration with all six regional LHN’s and SA Health.

DATIS & CSAPHN partnership

CSAPHN


Suicide Prevention Suicide prevention is a complex issue. Causes of suicidal behaviour can stem from a complex mix of factors such as adverse life events, social and geographical isolation, socio-economic disadvantage, mental and physical health, lack of support structures and individual levels of resilience. In addition to the premature loss of life, suicide can have a profound and lasting negative impact on families, workplaces and communities. Identified Need SP 1- Community-led approaches to Suicide prevention

Key Issue Rates of self-harm and suicide increase with remoteness, suggesting that there are significant mental health issues to be addressed in rural and remote areas. Across all states and territories, the suicide rate was lower in capital cities compared to regional areas.

Description of Evidence ABS - Suicides, Australia, 2010

ABS - Causes of Death, 2017

SA Health Hospital Separations 2015-16

NCIS – Intentional Self Harm Fatalities in Specified South Australia Local Government Areas (2007-2015)

Country SA PHN region In country SA, from 2015 to 2016 rates of suicide have decreased across all age groups with the exclusion of the 2444 age cohort, which has increased by 8%. Approximately 504 suicides (2007-2015) and 1,830 suicide attempts were reported within the Country SA PHN region between 2013 and 2016. In 2017, 224 deaths in South Australia were attributed to suicide or intentional self-harm (164 males, 60 females). Overall 7.2% of deaths reported were linked to suicide in South Australia.

NSPT – Survey Data Report, 2018

Stakeholder consultation (Data

Australian Bureau of Statistics (ABS) Catalogue 3303.0 Cause of Death Australia, 2015

The highest rate of suicide was in Eyre Peninsula and South West, Yorke Peninsula and Murray and Mallee, while the highest attempt rates were found in the Limestone Coast, Murray and Mallee and Eyre Peninsula and South West regions. Additionally, the Outback North East experienced high rates of suicide, however limited data is available throughout their LGAs.

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Identified Need SP 1- Community-led approaches to Suicide prevention - continued

Key Issue Suicide prevention/aftercare services delivered Over the 2013-16 period, 840 males and 1393 females were identified through intentional self-harm hospital separations. Within the overall catchment the Murray Bridge (Murray Mallee) followed closely by Whyalla (Eyre Peninsula) and South West. Additionally, for the reporting period 511 people were followed up by a PHN commissioned service following a recent suicide attempt.

SP 2- Rural and male specific suicide prevention services and activity. Rural and male specific suicide prevention services and activity

National Suicide Prevention Trial

Description of Evidence

The National Suicide Prevention Trial has been operating in the North and West region of the CSAPHN catchment, the process involved extensive community consultations reaching 16,000 people. Key gaps highlighted within the region were: ∙ ∙ ∙ ∙

Follow up care Reducing the stigma around suicide Suicide prevention training Workforce collaboration

See above…

Furthermore, the key factors contributing to suicide in the region were believed to be due to: ∙ ∙ ∙ ∙

Drug and alcohol use Family breakdown Poor mental health literacy Unemployment

Through the National Suicide Prevention Trial small grants scheme, approximately 1,714 persons have been reached with the aim to promote help-seeking and train the community to recognise and respond to suicidality.

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Identified Need SP 2- Rural and male specific suicide prevention services and activity. Rural and male specific suicide prevention services and activity - continued

SP 3- Intentional self-harm and hospital separations

Key Issue Gender difference Males in the country SA region accounted for 79% of all deaths by suicide, a ratio of more than 3:1. However females accounted for the highest rates of suicide attempts. ABS statistics (2001-2010) show males in South Australia suicided at a rate (1.8 per 10,000) three times than that of females (0.5 per 10,000). With slightly higher rates for males in ‘rest of SA’ (1.9 per 10,000) and slightly lower rates for females in ‘rest of SA’ (0.4 per 10,000). Hospital separations for intentional self-harm See above… Females are more likely to be hospitalized than males for intentional self-harm. This difference is likely due to males being more than three times more likely to complete suicide than females. This is not a difference in need for suicide prevention, but a reflection on lethality of mechanism. The most common mechanism used for suicide was asphyxiation (hanging) compared to poisoning in most cases of attempt. Areas above the CSAPHN annual average rate (2.5 per 1,000) were: ∙ Yorke Peninsula (3.6) ∙ Limestone Coast (3.1) ∙ Fleurieu - Kangaroo Island (2.9) ∙ Gawler – Two Wells (2.7) ∙ Murray and Mallee (2.7) ∙ Barossa (2.7)

SP 4- Community- led culturally appropriate approaches to Suicide Prevention

Indigenous suicide prevention Aboriginal and Torres Strait Islander South Australians completed suicide at a rate more than twice that of nonAboriginal and Torres Strait Islander people in South Australia, at 25.5 deaths to 12.5 per 100,000 respectively.

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Description of Evidence


Identified Need

Key Issue Suicide was the second leading cause of death among Aboriginal and Torres Strait Islander men at a rate of 39.2 per 100,000

Priority Community- led approaches to suicide prevention (SP 1)

Possible Options Develop partnerships within local communities to implement community-specific response and support models to address episodic mental health occurrences in the after-hours period through the delivery of suicide prevention trainings.

1.

2.

Rural and male specific suicide prevention services and activity (SP 2)

Implementation of a stepped care model through mental health and alcohol and other drugs reform.

3.

Analysis of market for successful models and expansion through targeted commissioning to meet areas of need.

4.

Co-design activity through flexible funds.

5.

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

6.

Plan, develop and implement National Suicide Prevention Trial in the Country North region.

1.

Implementation of a stepped care model through mental health and alcohol and other drugs reform.

2.

Analysis of market for successful models and expansion through targeted commissioning to meet areas of need.

3.

Description of Evidence

Expected Outcome Better connection of community local delivery of services. Local ownership of community mental health and Suicide Prevention.

Reduction in stigma around suicide.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

An increase in sustainable suicide prevention and suicide aftercare programs across the Country North and Yorke Peninsula regions.

Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Co-design activity through flexible funds.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 73

Potential Lead The six regional Local Health Networks

Black Dog Institute

Commonwealth

CSAPHN

Suicide Prevention Networks

CSAPHN/the six regional Local Health Networks/Hospitals

Black Dog Institute


Priority Rural and male specific suicide prevention services and activity (SP 2) continued

Intentional self-harm and hospital separations (SP 3)

4.

Possible Options Plan, develop and implement National Suicide Prevention Trial in the Country North region.

1.

Implementation of a stepped care model through mental health and alcohol and other drugs reform.

2.

Explorations of early intervention options and linkage into youth health services.

3.

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

Expected Outcome An increase in sustainable malefriendly suicide prevention and suicide aftercare programs. Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff.

Reduction in the stigma associated with suicide and help-seeking behaviour.

Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Increased options of evidence-based models of counselling to areas of need.

Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 74

Potential Lead Commonwealth

CSAPHN

Suicide Prevention Networks

See above

CSAPHN/six regional LHNs/Hospitals


Priority Community-led culturally appropriate approaches to Suicide Prevention (SP 4)

1.

2.

Possible Options Develop partnerships within Aboriginal communities to implement community-specific response and support models to address episodic mental health occurrences in the after-hours period through the delivery of training and education Implementation of a stepped care model through mental health and alcohol and other drugs reform

3.

Analysis of market for successful models and expansion through targeted commissioning to meet areas of need

4.

Co-design activity through flexible funds

5.

Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs

6.

7.

Continuation of Aboriginal and Torres Strait Islander suicide prevention through psychological therapy for underserviced groups

Expected Outcome Better connection of community to ACCHO’s AMS and local delivery of services. Local ownership of community mental health. Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Increased options of evidence-based models of counselling to areas of need.

Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

An increase in sustainable suicide prevention and suicide aftercare programs across the Country North and Yorke Peninsula regions.

Reduction in preventable suicides through workforce capacity building and upskilling of rural/remote staff.

Culturally appropriate suicide prevention services.

Plan, develop and implement National Suicide Prevention Trial in the Country North region.

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Potential Lead CSAPHN/ACCHOS

Black Dog Institute

Commonwealth

CSAPHN

Suicide Prevention Networks


Psychosocial Support The National Psychosocial Support Measure (NPSM) is available for people with severe mental illness who are not more appropriately funded through the National Disability Insurance Scheme (NDIS) to increase their ability to do everyday activities through a range of non-clinical community-based supports. Identified Need NPS 1 - Commission existing funded psychosocial support Service Providers to deliver Transitional Support for 12 months COS 1 - Commission existing Commonwealth funded psychosocial support COS 2 - Commission new psychosocial services under Continuity of Support for Country South Australia

Key Issue Psychosocial health Currently the reporting mechanisms for psychosocial needs and trends within country South Australia is limited at best. Previously such data was collected in collaboration with mental health data and thus is difficult to isolate. The estimates reached were mainly drawn from Government pension numbers, carers support, PHaMs (Personal Helpers and Mentors Service) and Partners in Recovery (PIR) provider statistics. Evidence and data For the 2017 period ABS data for country South Australia reported 18,011 persons on a disability support pension and 5,436 persons receiving a carer payment. Overall, 6.2% of country South Australians needed assistance with core daily activities and approximately 11,133 were unemployed. Psychological Distress Measurements revealed 13% of country South Australian’s experienced high or very high levels of distress, compared to the state average of 11.9%. Furthermore, this level increased for Aboriginal and Torres Strait Islander people with distress levels equating to 31.8%. PHaMs data was similar to ABS statistics with 2,152 participants registered in the 2014/15 reporting period. PIR Client’s Needs Assessment files in 2016/18 highlighted 2,041 clients with needs, with 1,095 of these needs remained unmet. Despite services being in place to assist clients, the demand exceeded capacity, thus for regions without PIR would equate to a higher percentage of unmet

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 76

Description of Evidence


needs; of the PIR clients during this period 85% were unemployed or not in the labour force and their main source of income came from pensions or government benefits. For country South Australia, PIR is only functioning in the Country North region, leaving a significant gap in the Murray Mallee, Riverland, and South East.

Service Needs analysis Identified Need Service needs across mental health, suicide prevention and alcohol and other drugs sectors

Key Issue Generally, there is a workforce shortage across the region, particularly within programs designed to minimise costs for eligible patients. Psychologists are in high demand and yet are limited particularly in rural and remote areas. Where psychologists are available, large gap payments prevent consumers from attending their services or extended waiting periods exist. Psychological Therapy service provision rates are lower than the state average across all regions, indicating an imbalance with service provision in the metropolitan area despite equal or greater need in many rural areas. Service is not provided at all in some areas, particularly for youth. Neither Psychological Therapies nor Clinical Care Coordination services are consistently provided within all regions, despite most having some level of need, this is directly dependent on workforce availability in rural regions. Once more, where services are provided, consumers are subject to high waiting periods.

Description of Evidence Leading issue in priority matrix

Recurring themes in ATAPS provider needs assessments

DoH District of Workforce Shortage

Drug and Alcohol Stakeholder Survey

NCETA – Patterns and Prevalence & At-Risk groups AOD 2017

ATAPS referral rates

CSAPHN ATAPS Provider evaluation report, 2016

Drug and Alcohol Stakeholder Survey, CSAPHN - 2016

SA Health Hospital Separations 2015-15

Estimated resident population 2014.

MBS mental health providers

ATAPS – DoH

Areas with high rates of hospitalisation for mental health and low service capacity need resources to minimise the risk of both ‘well’ populations and ‘at risk’ populations, from requiring higher level services through unmet lower level need. Currently clients’ needs go unmet while waiting for PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 77


Service Needs analysis Identified Need Service needs across mental health, suicide prevention and alcohol and other drugs sectors - continued

Key Issue services, leading to progression in illness in most cases. Further analysis to determine if the service capacity needs to increase or is inappropriate would assist in closing this gap.

Description of Evidence

A substantial benefit for the region, is its selection as one of the National Suicide Prevention Sites. This achievement will bring considerable funding and resources into the region with the sole purpose of addressing prevention and aftercare of suicide. Other areas in need of improvement or further analysis to improve the sector include: ∙ Range and coordination of services to better address different stages and severities of mental illness along the continuum ∙ Service appropriateness - areas with high female mental health admissions, and/or high Aboriginal and Torres Strait Islander female mental health issues require more specific services for females and Aboriginal and Torres Strait Islander females ∙ Lack of coordination for drug and alcohol co-morbid conditions such as mental health and suicide prevention ∙ Lack of service continuity for rural patients from acute to community care to facilitate a stepped care model ∙ A structured stepped care approach is limited and fragmented due to limited access, lengthy waiting periods and often excessive travel required for care. For residential treatment, rural patients have no option but to relocate to metro areas for treatment.

see above…

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 78


Service Needs analysis Identified Need Service needs across mental health, suicide prevention and alcohol and other drugs sectors - continued

Key Issue Alcohol and other drugs Service gaps and comorbidity of mental health conditions with drug and alcohol is evident in the hospital separations for each region, correlating as high for both. Furthermore, client needs go unmet while waiting for services; ∙ Stakeholder consultation indicated extensive waiting times – clients are unlikely to be re-motivated after waiting., resulting in clients continuing to use illicit substances while they wait for a service. ∙ Extensive waiting lists indicate service capacity unable to meet need. Aboriginal and Torres Strait Islander clients in more remote, dry zones have to travel to regional areas which aren’t dry to withdraw/sober up. Stakeholders indicate this can cause issues, particularly when clients return to their areas post rehabilitation. Clients are then lacking in follow-up and outreach back in the community.

Description of Evidence

see above…

Areas with low service capacity and/or no outreach service, require additional hours or more providers to bring waiting times down, especially in areas where there are higher rates of drug and alcohol admissions, as well as mental health admissions.

PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 79


PROCESS CHECKLIST This checklist confirms that the key elements of the Needs Assessment process have been undertaken. PHNs must be prepared, if required by the Department, to provide further details regarding any of the requirements listed below.

Requirement

Governance structures have been put in place to oversee and lead the needs assessment process. Opportunities for collaboration and partnership in the development of the needs assessment have been identified. The availability of key information has been verified. Stakeholders have been defined and identified (including other PHNs, service providers and stakeholders that may fall outside the PHN region); Community Advisory Committees and Clinical Councils have been involved; and Consultation processes are effective. The PHN has the human and physical resources and skills required to undertake the needs assessment. Where there are deficits, steps have been taken to address these. Formal processes and timeframes (such as a Project Plan) are in place for undertaking the needs assessment. All parties are clear about the purpose of the needs assessment, its use in informing the development of the PHN Activity Work Plan and for the department to use for program planning and policy development. The PHN is able to provide further evidence to the Department if requested to demonstrate how it has addressed each of the steps in the needs assessment. Geographical regions within the PHN used in the needs assessment are clearly defined and consistent with established and commonly accepted boundaries. Quality assurance of data to be used and statistical methods has been undertaken. Identification of service types is consistent with broader use – for example, definition of allied health professions. Techniques for service mapping, triangulation and prioritisation are fit for purpose. The results of the needs assessment have been communicated to participants and key stakeholders throughout the process, and there is a process for seeking confirmation or registering and acknowledging dissenting views. There are mechanisms for evaluation (for example, methodology, governance, replicability, experience of participants, and approach to prioritisation).

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PRIMARY HEALTH NETWORKS Needs Assessment 2019-2022 (2019 Update)V2 Page 80

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Profile for CSAPHN

Country SA PHN Needs Assessment 2019-2022  

Country SA PHN Needs Assessment 2019-2022  

Profile for csaphn