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.

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

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: ∙ Leading issue in priority matrix ∙ 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 ∙ PHIDU estimates of risk factors ∙ 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)

Description of Evidence

∙ 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)

Identified Need Chronic Conditions and Risk

Factors - outcomes of health needs analysis continued

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.

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; ∙ 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.

Description of Evidence

Identified Need Chronic Conditions and Risk

Factors - outcomes of health needs analysis continued

Key Issue

∙ 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.

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. see above…

Diabetes Description of Evidence

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.

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.

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. see above…

Description of Evidence

Identified Need Chronic Conditions and Risk

Factors - outcomes of health needs analysis continued

Chronic Conditions and Risk

Factors - outcome of service needs analysis

Priority Chronic Conditions and Risk

Factors (GEN – 4) opportunities, priorities and options

Key Issue

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

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.

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

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.

Possible Options

1. Partner with organisations that promote health risk behaviour modification and community education and or services. 2. Facilitate connection between chronic condition peak bodies and general practice, allied health, pharmacy and ∙ Communities and individuals have access to lifestyle modification programs and information locally ∙ Better access to targeted and specific chronic condition education CSAPHN initiative to be managed as a partnership engagement with peak bodies who may be commissioned as

see above…

Description of Evidence

∙ Leading issue in priority matrix ∙ Key theme in all stakeholder engagement and feedback ∙ HWA rates of health practitioners ∙ Integrating Primary Health Care provider local need assessments

Expected Outcome Potential Lead

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.

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.

4. Maintain and seek partners to ensure continuity of the

‘Country Access to Cardiac Health’ telephone support service for residents with heart disease.

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

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

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

Expected Outcome

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

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

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

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

∙ Reduced potentially preventable hospitalisations due to chronic condition.

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

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

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