Country SA PHN Needs Assessment 2022-2025

Country SA PHN Needs Assessment Report 2022 - 2025 November 2022

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Executive Summary Country SA PHN covers rural and remote South Australia. Our mission is to bridge the gap of health inequality and access in rural South Australia by building a collaborative and responsive country South Australian health care system.

Summary The Country SA PHN Needs Assessment 2022-2025 builds on previous Needs Assessments. It further investigates the health needs of country South Australian communities, the corresponding required services and identifies populations and communities which may be particularly disadvantaged.

Using an iterative approach, information is gained between submissions, including emerging needs to be incorporated to refresh analysis and triangulation 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. Country SA PHN incorporates various organisational processes to facilitate Needs Assessment activity, including internal governance to oversee development and continuous improvement.

Integrating 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, Country SA PHN also utilises evidence obtained through stakeholder consultation.

A triangulation matrix approach bringing together information and data sourced from various agencies was applied to synthesise and triangulate the finding of the health and service needs analysis and identify key issues and themes. The analysis affirmed Country SA PHN priorities have not shifted from the previous Needs Assessment and remain current.

Naming conventions were adjusted to support improved clarity in communication of priorities and identified needs.

A range of indicators associated with these priorities can be measured to assess both absolute and relative levels of health and service needs in the many Country SA PHN communities. These indicators include demographic, health status and risks, and service statistics. These indicators provide information about the issues and the locations where Country SA PHN can contribute to improving health outcomes through strategic commissioning activities, leadership, and collaboration in the coordination and integration of services.

Stakeholder and community views serve to complement and contextualise information gathered from regional health and health service statistics. As such, they represent an essential element of both the needs assessment process and ongoing activity planning and implementation. Country SA PHN developed a stakeholder consultation strategy (20202022) to improve our knowledge and understanding of regional characteristics and community needs, and effectively inform the Needs Assessment. Consultation activity relative to priority health and service needs is embedded within Country SA PHN business through a collection of mechanisms including forums, workshops, meetings, online surveys and other opportunities for input and feedback. Consultation represents a wide coverage of stakeholders including; SA Health, Wellbeing SA, six regional Local Health Networks, Country SA PHN Clinical Council, Country SA PHN 11 Local Health Clusters, state and regional network groups, service providers and health professionals in the region, and community members.

Consultation information is incorporated in this report within overall health and service needs analysis, and at times highlighted in Community Voice.

As part of a continuous improvement approach, an evaluation of the Needs Assessment process will be completed following submission of the report. The result of which will inform the process going forward including; planning and operational approach, data and analysis approach, systems and resources.

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Additional Data Needs and Gaps The needs assessment process highlights the importance of investigating chronic conditions and their risk factors, including resultant progression to multimorbidity, to fully realise opportunities for primary and secondary prevention in future Country SA PHN 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.

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 Country SA 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 further investigation.

Data collection and analysis is an ongoing process that represents an integral part of systematic stakeholder engagement and collaboration in Country SA PHN’s 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 Local Health Clusters (Community Advisory Committees). 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-toreach 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.

Country SA PHN continues to work with key partners in undertaking the continuous consultation and engagement needed for joint planning with the newly formed regional Local Health Networks. 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.

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 general 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 Country SA PHN activities.

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Contents Contents ....................................................................................................................................................................... 4 Introduction ................................................................................................................................................................. 5 Aboriginal Health .........................................................................................................................................................12 Ageing Populations ......................................................................................................................................................19 Child & Youth Health ...................................................................................................................................................22 Chronic Conditions and Risk Factors ............................................................................................................................24 Population Health........................................................................................................................................................27 Palliative Care ..............................................................................................................................................................31 Populations of Special Interest ....................................................................................................................................33 Potentially Preventable Hospitalisations .....................................................................................................................36 Alcohol and Other Drugs .............................................................................................................................................38 Mental Health .............................................................................................................................................................44 Health Workforce ........................................................................................................................................................55 Health Information and Technology ............................................................................................................................58 Opportunities, Priorities and Options ..........................................................................................................................60 References ...................................................................................................................................................................78

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Introduction Country SA PHN applies a consumer focus of John and Jenny as a whole person living in country SA to support a holistic approach that considers multiple factors that may impact their ability to experience health optimisation and wellbeing as they go about their daily lives.

John and Jenny represent as individuals, families, all members of the community, across all age groups, cultural diversity and values, family groupings, ability or disability, advantage or disadvantage, sexual orientation.

This introduction is to provide a broad overview of the population within the Country SA PHN region: who we are, where we live and how we live.

Country SA PHN Region The region covers all of South Australia, apart from the Adelaide metropolitan area. Covering the peri-urban, the Country SA PHN region covers 99.8% of the state geographically and approximately 30% of SA’s total population. Country SA PHN boundaries align with the six regional Local Health Networks (LHNs).

Geography

Figure 1: Country SA PHN Region Areas

The Country SA PHN region covers a region of over 980,000 square kilometres, which encompasses all of South Australia outside the core metropolitan area. The landscape ranges from fertile hills and intensive agriculture land of the Adelaide Hills, Barossa and Fleurieu Peninsula to vast broad acre farming regions, as well as Flinders Ranges and outback.

The data in this report is presented primarily by Statistical Area Level 3 (SA3); a census statistical geography that provides a framework for data analysis at a regional level; and/or by Local Government Area (LGA) or Statistical Area Level 2 (SA2) where data is available at a smaller geographical area. For a listing of country SA LGA and SA3 regions, refer to Appendix 1: Country SA PHN Region by SA3 and LGA.

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Population The 2021 estimated resident population for the Country SA PHN region was 508,269 people, which represents almost 29% of the total South Australian population (2).

Male to female proportion is relatively even, with slightly more males than females, and the region has a noticeably lower proportion of young adults (aged 20 to 39 years) compared to the whole of South Australia (5).

The population is widely dispersed across the region, which impacts provision of health services, workforce distribution and patient access to services. 47% of the region’s population are found in following areas: • •

•

Mount Gambier, Whyalla, Murray Bridge, Port Lincoln, Port Pirie and Port Augusta are collectively home to over 110,000 people and each serve as a hub for health and other services for the area and surrounding regions.

Gawler, Mount Barker and Aldgate-Stirling are located nearer to the Adelaide metropolitan boundary, and account for 63,000 people. These areas have a relatively high access to local and metropolitan health services, as well as other services.

Victor Harbor-Goolwa has over 25,000 people with a high proportion of their population over 65 years of age (1).

The remainder of the population live in small towns of up to 5,000 people, (many with less than 500 people), or are dispersed in the agricultural and outback regions of the state (6).

Remoteness In 2021, approximately 46% of the Country SA PHN population lived in areas classified as Outer Regional, Remote and Very Remote; representing a reduction of approximately 4% since 2016 (see Table 1) (7).

Figure 2: Country SA PHN Remoteness Area Map (2021)

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Table 1: Distribution of Country SA PHN Population by Remoteness Area (2021) (7)

Total Persons

% of Population

Area (Km2)

% of Area

Major Cities

51,265

10.1

290.8

0.03

Inner Regional

222,509

43.8

15,088.9

1.54

Outer Regional

175,752

34.6

79,289.0

8.08

Remote

45,208

8.9

118,574.3

12.09

Very Remote

13,535

2.7

767,850.5

78.26

TOTAL

508,269

100.0

981,093.5

100.00

Older Persons Overall, 23% of people living in the Country SA PHN region are over 65 years. The coastal city of Victor Harbor is a wellknown retirement destination, with more than 39% of their population aged 65 or over. Yorke Peninsula and Barunga West LGAs both have over 32% of their population aged over 65 years (2, 8).

Figure 3: Persons Aged 65 and over by Local Government Area (LGA) (2021) (2)

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Aboriginal Population The term Aboriginal is used throughout this document to refer to people who identify as Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander. This has been done as the people indigenous to South Australia are Aboriginal and Country SA PHN respects that many Aboriginal people prefer the term ‘Aboriginal’. Country SA PHN also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language group(s). The 2021 ABS Census reports an Aboriginal population of 20,128 in the Country SA PHN region, representing 4% of the region and almost half (47%) of South Australia’s Aboriginal population. This significantly exceeds the proportion of the total population who reside in Country SA PHN (29% of the SA population)(2, 8).

Concentrated in the regional towns and small Aboriginal communities, the Aboriginal population is a young population(9).

Figure 4: Aboriginal population distribution (2019) (1)

Port Augusta LGA has the highest proportion of the region’s Aboriginal population (14.9%). followed by Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands, 11.2%). Whyalla (6.1%) and Murray Bridge (5.7%)(1).

People from Culturally and Linguistically Diverse (CALD) backgrounds Figure 5: People born in non-English speaking countries by LGA (2019) (4)

The proportion of people born overseas in predominately nonEnglish speaking countries is highest in Coober Pedy followed by Renmark Paringa, Naracoorte, Lucindale and Tatiara LGAs (4).

The same areas experience the highest proportion of persons born overseas who speak English not well or not at all (4).

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Disadvantage Overall disadvantage measured by the Index of Relative Socio-Economic Disadvantage (IRSD) is a general index that summarises a collection of economic and social condition information for people and households within an area including employment, income, levels of education, disability, homes with internet and ability to speak English.

Figure 6: Index of Relative Socio-Economic Disadvantage (2016) (1)

In the Country SA PHN region, indexed disadvantage can be identified widely across the region.

Of note, two areas are identified by the index as experiencing the highest level of disadvantage are the APY Lands and Maralinga Tjarutja. These are followed by Peterborough, Coober Pedy and Port Pirie LGAs (1).

Health and Service Needs The Country SA PHN region is large in geographical size, small in population with high spread of the population across the regions, each community has different population distributions and significant diversity, making each one unique in its focus and service requirements.

There are significant socio-economic disparities as the distance increases from metropolitan Adelaide. Infrastructure, education opportunities, economic participation, physical environment and access to basic needs, such as potable water, housing, and food supply is for different for each community, resulting in distinct health and service challenges.

Differing needs across dispersed communities, and lack of economies of scale is an ongoing challenge for service providers in establishing sustainable models. This is further heightened with significant health professional shortages and healthcare infrastructure making it difficult to match the level and type of services required to meet the need.

Disadvantage is further heightened with concentration of health care in metropolitan Adelaide. Participation in care away from home and family requiring time away from work, carer roles, access to transport and overall costs further increasing disadvantage experienced by these communities.

Country SA PHN works to identify specific and targeted opportunities for improving the health of communities across the region given the contextual environment and relative needs outlined in this Needs Assessment. For a summary of identified priorities from the health and service needs analysis, and options for how they may be addressed refer to the Opportunities, Priorities and Options section of this report. _______________________________________________________________________________________

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List of Abbreviations ABS ACCHO ADAC ADIS AH AHS AIHW APHN AOD APY Lands CALD CKD COPD CRM CSAPHN CVD ED ERP ESKD FTE GP HPV IRSD LGA LHN MBS NCETA NCIS NDIS NHSD NHMRC MMM PBS PHIDU PHN PPH RACF RDWA RFDS RHD SA SA# SEIFA

Australian Bureau of Statistics Aboriginal Community Controlled Health Organisation Aboriginal Drug and Alcohol Council (SA) Alcohol Drug Information Service After hours Australian Health Survey Australian Institute of Health and Welfare Adelaide Primary Health Network Alcohol and Other Drugs Aņangu Pitjantjara Yankunytjatjara Lands Culturally and Linguistically Diverse Chronic Kidney Disease Chronic Obstructive Pulmonary Disease Customer Relationship Management System Country SA Primary Health Network Cardiovascular Disease Emergency Department Estimated Resident Population End Stage Kidney Disease Full-time Equivalency General Practice or General Practitioner Human Papillomavirus Index of Relative Socio-Economic Disadvantage Local Government Area (local councils) Local Health Network Medicare Benefits Schedule National Centre for Education and Training on Addiction National Coronial Information Service National Disability Insurance Scheme National Health Service Directory National Health and Medical Research Council Modified Monash Model Pharmaceutical Benefits Scheme Public Health Information Development Unit Primary Health Network Potentially Preventable Hospitalisation Residential Aged Care Facility Rural Doctors Workforce Agency Royal Flying Doctor Service Rheumatic Heart Disease South Australia Statistical Area, Level 1, 2, 3, etc.

Socio-Economic Indexes for Areas

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List of Figures Figure 1: Country SA PHN Region Areas ............................................................................................................................... 5 Figure 2: Country SA PHN Remoteness Area Map (2021) .................................................................................................... 6 Figure 3: Persons Aged 65 and over by Local Government Area (LGA) (2021) (2) ............................................................... 7 Figure 4: Aboriginal population distribution (2019) (1) ........................................................................................................ 8 Figure 5: People born in non-English speaking countries by LGA (2019) (4) ........................................................................ 8 Figure 6: Index of Relative Socio-Economic Disadvantage (2016) (1) ................................................................................... 9 Figure 7: Harms associated with comorbidity (3) ............................................................................................................... 43 Figure 8: SA Mental Health and Suicide Prevention Regional Plan (2017) (153) ................................................................ 47 Figure 9: Country SA PHN client access across stepped levels of care (2016-2018) (153) ................................................. 49 Figure 10: Country SA PHN region Modified Monash Model (MMM) remoteness area map (2021) ................................ 56

List of Tables Table 1: Distribution of Country SA PHN Population by Remoteness Area (2021) (7) ........................................................ 7 Table 2: Uptake of 715 Preventative Health Assessments for Aboriginal and Torres Strait Islander People by SA3 region and financial year (FY)......................................................................................................................................................... 16 Table 3: Self-reported Psychological Distress in Country SA PHN and SA regions (2018)(70) ............................................ 45 Table 4: Diagnosed mental health conditions in Country SA PHN and SA regions (2017) (70) .......................................... 46 Table 5: National Australian suicide rates per 100,000 persons by remoteness (2020) (167) ........................................... 53

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Aboriginal Health Nationally, it has been well documented that Aboriginal and Torres Strait Islander people are significantly more likely to experience poorer health outcomes than non-Aboriginal people in almost every domain, and this is certainly true of the Country SA PHN region (10). 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 and is commonly associated with increased rates of chronic disease (10). The term Aboriginal is used throughout this document to refer to people who identify as Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander. This reflects South Australian Aboriginal community preferences as specified by the Council of Aboriginal Elders of SA. Country SA PHN also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language group(s).

Key Points • •

Complex interplay between the determinants of health and the health status of Aboriginal people in the region Access to primary health services is low, resulting in poorer health outcomes particularly in chronic conditions contributing to poor life expectancy and reduced quality of life across whole of life There are gaps in service area coverage of Aboriginal Community Controlled Health Organisations across the Country SA PHN region

•

Key areas

Identified Needs

-

1.

2.

Chronic Conditions Eye and Ear Health Sexual Health Early Detection and Treatment Mental Health

3.

Access to culturally appropriate health services.

ACCHOs are supported to improve the individual and community health experience.

Improve individual and community health outcomes.

Mental health is an important part of the wholistic health and wellbeing of Aboriginal people in South Australia. Analysis of mental health and service needs have been incorporated in this Needs Assessment Report within sections: Mental Health and Alcohol and Other Drugs. _______________________________________________________________________________________

Health Needs Chronic Conditions Chronic and preventable disease is a major factor behind the reduced life expectancy experienced by Aboriginal people.

• • • • • •

For Aboriginal people in South Australia chronic conditions are mostly preventable, however remain an issue across the region with high rates of potentially preventable hospitalisations (11, 12) Generally, diagnosis of conditions occurs late in the disease progression, leading to poor quality of life outcomes and/or mortality.

Higher rates of chronic disease in general are found with greater distance from metropolitan areas.

Cost impacts access and use of medication, resulting in poor medication management and adherence (11).

One in three people experience comorbidities of chronic conditions (2 or more conditions simultaneously) (11).

Management of chronic conditions is a growing problem with access to adequate services remaining limited particularly for rural and remote communities.

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Heart disease and Stroke Circulatory diseases, commonly known as heart and stroke, are the leading cause of mortality for Aboriginal people in South Australia. Aboriginal South Australian’s are three times more likely to be hospitalised for circulatory diseases than their non-Aboriginal counterparts and are at risk of developing issues at a much younger age (11) .

Cancer Cancer is the second highest leading cause of mortality for Aboriginal people in country SA. Late-stage diagnosis and poorer access to health services are contributing factors to the high mortality rate, resulting in low rates of cancer survivorship (11).

Cancer types responsible for the most deaths in the SA Aboriginal population, include: • • • • • • •

Lung cancer Head and neck cancers Colon and Rectal Cancers Men’s Cancers Women’s Cancers Hepatocellular cancer and, Pancreatic cancer (11).

Diabetes Type 2 diabetes accounts for 25% of the burden of disease for Aboriginal peoples across Australia and is a key priority within country South Australia , leading to further chronic conditions including vascular and kidney disease, Diabetes additionally increases an individual’s risk of disability in sight and physical movement (13). For these reasons prevention and appropriate management of Type 2 diabetes is a prime issue within Country SA PHN. Approximately 1 in 5 Aboriginal people in Country SA PHN region will develop diabetes, compared to 1 in 8 nationally.

This rate increases to 2 in 5 for Aboriginal people living in remote areas of South Australia (13).

Comparatively, 1 in 5 Aboriginal people in Country SA are hospitalised due to diabetes complications compared to 1 in 6 nationally, suggesting the issue is more prominent in South Australia (13).

Gestational diabetes is a highlighted concern for Aboriginal people in the Far West with 1 in 10 being diagnosed compared to 1 in 20 state-wide, with rates considerably higher than those observed in the non-Aboriginal population. The condition increases risk of complications during pregnancy and risk of mother and child developing type 2 diabetes later in life (13).

While prevention or delayed onset of type 2 diabetes can be controlled through modifiable lifestyle factors, population experiences of barriers across social determinants of health including access to preventative health services suggest access to support in management of diabetes is an ongoing issue for the region.

Acute Rheumatic Fever and Rheumatic Heart Disease In Australia, the prevalence of Rheumatic Heart Disease (RHD) is highest among rural and remote Aboriginal people.

Typically, these conditions are not found in developed countries due to the predominant risk factors being associated with poverty, overcrowding and limited access to health care services. Despite this, RHD is prevalent in SA, NT, WA and QLD (14, 15).

RHD is a potentially fatal disease, linked with reduced quality of life. Across Country SA PHN region, while incidence rates have remained stable (0.3 per 1000), prevalence rates are increasing (3.1 per 1000); this indicates that a growing portion of the population is living with and requiring long term care for RHD (11).

Rates of Acute Rheumatic Fever (ARF) and RHD are high in the Aņangu Pitjantjatjara Yankunytjatjara (APY) Lands, linked to housing conditions with significant overcrowding within the community(16).

Regular antibiotic prophylaxis for people confirmed or suspected to have ARF, and for those who are confirmed to have RHD, is one clinical intervention pathway that requires regular and consistent administration over extended periods for Page 13 of 84

effectiveness. In 2020, on average patients in SA participating in regular antibiotic prophylaxis received 78% of scheduled doses. However, there is variation in participation and adherence across the region with remote areas having higher rates of adherence, while populations in regional areas have the lowest adherence rates to ongoing scheduled secondary prophylaxis doses (17).

Chronic kidney disease Chronic kidney disease in South Australia is high, with the incidence of end stage kidney disease occurring at 6.8 times that of non-Aboriginal people in the area (11).

Respiratory disease Chronic Obstructive Pulmonary Disease (COPD) is one of the leading avoidable causes of mortality for Aboriginal people. Chronic respiratory conditions affecting the airways can cause ill health, disability and death. Respiratory disease is responsible for 69% of the deaths in Aboriginal people, experienced at twice the rate of non-Aboriginal populations (11).

Sexual Health In South Australia, the Aboriginal population commonly experience high rates of blood borne viruses and sexually transmitted infections (STIs) and lower levels of sexual health literacy.

Syphilis Syphilis is highly infectious during the first two years of infection and can be transmitted in pregnancy to the foetus, resulting in perinatal death, premature delivery, and congenital abnormalities. Furthermore, syphilis increases the risk of HIV transmission (18).

An outbreak of infectious syphilis was declared in the Country SA regions of Far North and Western & Eyre from November 2016, affecting predominantly Aboriginal and Torres Strait Islander persons aged 15-34 years (18).

As of March 2022, 157 cases of infectious syphilis have been notified among Aboriginal and Torres Strait Islander people in SA, representing 93% of all cases in the state (19).

Gonorrhoea The rate in the Aboriginal population was 813 per 100,000 population in 2018 compared to 55 per 100,000 population in the non-Indigenous population (20).

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 (20).

HIV HIV notification rates in the Aboriginal population should be interpreted with caution as changes in the rates can appear larger due to small case numbers per year. The notification rate for SA reduced to 2.3 per 100,000 in 2018 from 11.8 in 2017 (20). Notification rates in the non-Indigenous population were similar to the Aboriginal population in 2018, 2.2 per 100,000 (20).

Eye and Ear Health In Country SA PHN region, eye and ear health is of growing concern with rates of vision and hearing loss at higher rates than necessary. The high rates of vision and hearing loss are commonly preventable and/or treatable with early diagnosis.

Delayed diagnosis leads to increased levels of disability (21). Good eye and ear health are key in contributing to positive outcomes in social determinants such as early childhood development, educational outcomes, employment, and income outcomes.

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Vision Loss and Blindness Preventable diseases and conditions of the eyes are a prominent issue within South Australia’s Aboriginal populations.

Overall, one in four Aboriginal people will experience vision loss and blindness in remote areas of South Australia. Eye health is a particular priority for diabetic patients who have greater risk of cataract and diabetic retinopathy (22). These are the second and third leading causes of blindness and vision loss (21).

Hearing loss Important to overall health and quality of life, poor ear health and hearing loss have long term impacts on overall wellbeing as well as participation in education and employment. Inflammation and infection of the middle ear (otitis media) is a significant cause of hearing loss in Aboriginal children, with the World Health Organisation identifying Aboriginal and Torres Strait Islander children experience some of the highest rates of ear disease and associated hearing loss in the world (21).

Hearing loss is experienced nationally for Aboriginal people at 1 in 8, and at 1 in 6 South Australia (11). _______________________________________________________________________________________

Service Needs Access to Services There is a lack of access to services for Aboriginal people (11). Main barriers identified to accessing appropriate services are: • • • •

Low access to services in the health system when care is required.

Increased distances to services for rural and remote living residents (23-25).

Lack of tailored health services to Aboriginal holistic health perspectives (24-28).

Transportation access - Mobility of Aboriginal peoples to and from communities, across state borders, 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.

Higher rates of hospitalisations occur for Aboriginal people including potentially preventable hospitalisations (11, 29).

This is indicative of services being accessed too late in the issue/disease progression and resulting in emergency assistance or further complications.

Of those who are accessing services, chronic condition services are accessed through GP Management Plans and/or Team Care Arrangements at higher rate than non-Aboriginal people further indicating the issue of chronic disease for Aboriginal people in South Australia. Adequate access to appropriate services to support both prevention and condition management (follow-up services, allied health and specialist care) continues to be an ongoing issue (11).

Hospital stays tend to be briefer for Aboriginal people with many discharging themselves early, against medical advice (11).

Antenatal and Birthing Antenatal and birthing services in the Far West have been affected by lack of required specialties. People in the Far West required to travel up to 900kms from the local community to Port Lincoln or Adelaide for birthing services. Lack of access for family members to state funded patient travel support (PATS) for accommodation when travelling with birthing mothers.

Aboriginal Health Service Providers Regional coverage of tailored Aboriginal specific service providers such as Aboriginal Community Controlled Health Organisation (ACCHO) health services is limited. Riverland, Mid North, Lower North or Yorke Peninsula do not have an operational ACCHO despite sizeable Aboriginal populations in several LGAs for these regions including: • Berri/Barmera, estimated at 605 residents or 5.8% of the total population • Mount Remarkable, estimated at 113 residents or 4.1% of the total population Page 15 of 84

• •

Port Pirie, estimated at 655 residents or 3.7% of the total population Yorke Peninsula, estimated at 421 residents or 3.8% of the total population (30).

Capacity issues affecting ACCHO service and sustainability include: • Workforce barriers and limitations: Lack of housing options for health staff in remote areas Lack of available Aboriginal health professionals in the workforce (refer to section: Health Workforce) (31) Low recruitment, development and retention of workforce, particularly in rural and remote areas, including general practitioners, nurses, allied health and Aboriginal health practitioners (25, 27).

• Limitations in establishing sustainable service models due to barriers in usage of primary and follow-up MBS items (27).

• Limitations in both currency and ongoing maintenance of clinic infrastructure and telecommunications are barriers to maintaining and implementing effective service delivery (32).

• Lack of social and emotional wellbeing programs are being raised as an issue within communities and has been a central point raised with ACCHO nationally (24, 33).

Culturally Appropriate Care Nationally, 44.8% of Aboriginal and Torres Strait Islander people identified being treated unfairly over a 12 month period when accessing services, with 19.5% indicating specific unfair treatment by doctors, nurses or other staff in hospitals or doctors’ surgeries (11).

Lack of culturally competent and appropriate service provision impacts access of services by Aboriginal peoples. In South Australia, it was found that a third of Aboriginal people who needed to go to a health provider but did not, identified cultural appropriateness of the service as the reason for choosing not to engage in accessing care (11).

In 2012-13, there were 29.5% of Aboriginal people 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 (11).

Early Detection and Treatment Cancer Screening Cancer screening rates for breast, cervical, prostate and bowel for Aboriginal people in South Australia is low (11). There is a lack of screening programs for cancer types identified as issue of importance in the SA Aboriginal population: lung, head and neck, hepatocellular and pancreatic cancers.

715 Health Check The 715 Preventive Health Assessment for Aboriginal and Torres Strait Islander people (715 Health Check) are a primary healthcare mechanism to identify risk factors for chronic disease and to identify a strategy to support good health with the person, including access to lifestyle support activities and preventative health care services.

Uptake rates of 715 Health Checks are below national uptake rate (32%) and the targeted goal for 2023 (60%), across most country SA regions except for Outback – North and East.

715 Health Check uptake rate is lower with areas where there are no ACCHO, and in areas that are closer to metropolitan Adelaide (28, 34, 35).

Table 2: Uptake of 715 Preventative Health Assessments for Aboriginal and Torres Strait Islander People by SA3 region and financial year (FY)

SA3 Region

FY 2015-2016

FY 2016-2017

Adelaide Hills

6%

3%

Barossa

No data

3%

Eyre Peninsula and South

29%

29% Page 16 of 84

Fleurieu-Kangaroo Island

9%

7%

Gawler-Two Wells

No data

15%

Limestone Coast

27%

27%

Lower North

3%

3%

Mid North

23%

21%

Murray and Mallee

19%

21%

Outback – North and East

62%

66%

Yorke Peninsula

25%

20%

Workforce Overall, the Country SA PHN region experiences issues with workforce, including difficulties in recruitment, development and retention of staff in rural and remote areas. Regions with an especially high demand for general practitioners, nurses, allied health and Aboriginal health Practitioners include: • Far West • Riverland • Eyre Peninsula • Port Augusta and surrounds (24, 25, 27, 28) Proportions of health professionals who identify as Aboriginal are low, well below population rates and in the cases of nurses and midwives is the third lowest rate in Australia. Low rates of Aboriginal and Torres Strait Islander health professionals affect access to health services.

Mainstream services including general practitioners, pharmacists, allied health and other services may require ongoing cultural competency training and facilitation to engage with Aboriginal specific providers (24).

Limited primary health care provider knowledge in application and use of 715 Health Assessment to support culturally appropriate care. This includes utilising the 715 Health Assessment to normalise sexual health assessment and annual testing for BBV and STIs, particularly in designated outbreak regions (28, 34, 35).

Lack of workforce and primary health services support with culturally appropriate care for Aboriginal sexual health issues, cultural communication and available Aboriginal specific resources (28, 34, 35).

COVID-19 has greatly impacted the number and availability of available workforce, particularly in remote locations.

Service provider focus on COVID-19 activity reduces provider capacity to facilitate in care delivery other than COVID-19 management (including vaccinations).

• Far West loss of 49% of health professionals during COVID-19 while restrictions under the Biosecurity (Human Biosecurity Emergency) (Human Coronavirus with Pandemic Potential) Emergency Requirements for Remote Communities) Determination 2020 were in place (36).

• Port Augusta and surrounds continued reduction of health professionals including general practitioners, nursing staff, Aboriginal health practitioners and health workers (21).

• Australian state and territory boarder restrictions have resulted in: APY Lands loss of interstate health professionals providing outreach services (29) Southern Eyre loss of interstate health professionals (returning to home state) and inability to recruit (37). _______________________________________________________________________________________

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Community Voice Country SA PHN regularly engages with key stakeholders, service providers and community representation to ensure their thoughts and views are heard. While distinct key issues are identified here, they all reflect a core issue of lack of access to appropriate health care services in local regions that meet community needs to stay well in community.

•

Dental health – There is a lack of dental services in remote areas. Getting dental care is difficult with people needing to travel to regional centres however getting there requires transport and state funded patient transport is not available for dental care. This issue is more prevalent in the Far West region.

•

Giving birth - Having to travel away from home, family and community to access care to support giving birth and following pregnancy is a highlighted concern with communities, with options to support birthing on country as a key issue. In the Far West region there are high rates of fertility in the Aboriginal population, and low access to required health services. Access to key specialty services in remote areas are limited or not present, and state funded patient transport services limit access to funded transport and accommodation for fathers, or other family members.

•

Cancer services - Regionally located cancer healing services are limited or not available requiring travel for care away from community.

_______________________________________________________________________________________

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Ageing Populations 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 home support and services packages enabling them to stay in their own homes.

Ideally, quality and appropriate care in place supports reduced need for age-related hospitalisations.

Key Points • • • •

Higher percentage of older people in country regions than metro Adelaide Projected increases in 65+ population Limited regional residential aged care facilities 96% of older people in country SA PHN region living at home (38)

Identified Needs 1.

2.

3.

Older persons are supported to stay healthy and well in their place of residence.

Medication management.

Access to specialist services to support ageing well.

_______________________________________________________________________________________

Health Needs Ageing population 23% of Country SA’s population is over 65 years compared to 18% in metropolitan Adelaide. Population projections over the next decade show Country SA’s population over 65 increasing and remaining in greater proportions to that of Adelaide (5, 39).

Highest concentration of ageing population reside in outer regional locations, especially in the Fleurieu Peninsula, Yorke Peninsula and Barunga West LGAs (40).

Some regions in Country SA have over 30% of the population over 65 years such as Victor Harbor (40.3%) and Yorke Peninsula (34.1%). Over the next decade, Victor Harbor is predicted to have minimal growth in its population over 65 years (+2.5%), while other areas in Country SA will see very large growth in their ageing populations. Areas such as the Flinders Ranges, Lower Eyre Peninsula, and Robe are predicted to increase their over 65 population by over 10% within the next 10 years (1).

96% of older people in country SA PHN region are living at home(38). Just over 4,000 people aged over 65 years are living in residential aged care, with 116 residential aged care facilities (including multi-purpose services and National Aboriginal and Torres Strait Islander services) located across the Country SA PHN region (41).

Conditions of significance As people age, there is increasing incidence of age-associated disability and disease, dementia and frailty with increased risk of falls and subsequent hospitalisation (42).

COPD/Asthma: • •

Admissions to hospital for respiratory conditions are highest in LGA of Unincorporated SA and Port Augusta with over 7,000 admissions per 100,000 compared to 4,302 admissions for Country SA as a whole (39).

Just under half of the LGAs in Country SA had admissions to hospital for respiratory conditions at a rate higher than Country SA PHN overall (39).

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Dementia: • • •

Dementia is the second leading cause of death of Australians (43).

In 2021, it was estimated that between 29,235 and 39,200 people (1.6% - 2.2% of the population) were living with dementia in South Australia. This figure is projected to double by 2058 (44, 45).

Prevalence increases with age and is more common in females than males (45).

Disability: • • •

12% of those over 65 years in Country SA are living in the community with a profound or severe disability (39).

In Anangu Pitjantjatjara, 38% of the population over 65 are living in the community with a profound or severe disability (39).

Orroroo/Carrieton, Karoonda East Murray, Southern Mallee, and Whyalla have the next highest proportion of older persons living in the community with a profound or severe disability (17%).

Falls • • • •

The average length of stay in SA hospital for older people injured after a fall was 7.4 days (39, 46).

405 older people died in SA hospitals as a result of injury from a fall (46).

3,493 people in country SA over 65 were admitted to public hospitals for falls in 2018-19(39).

The highest age standardised rate of falls was in Elliston, Renmark Paringa, and Naracoorte and Lucindale (39)

Medication management Complexity with managing medications increases with polypharmacy, common in older populations as they often requiring multiple medicines to manage and prevent illness.

75% of all Pharmaceutical Benefit Scheme (PBS) medicines dispensed in 2016–17 were reported for people aged 50 and over, with the majority dispensed to those aged 65 and over (47). Within residential aged care facilities, systems and practices of prescribing, dispensing, administration and monitoring of medication involves multiple health professionals and carers, increasing complexity of medication management in this area (48). ________________________________________________________________________________________

Service Needs Older people are high frequency users of primary health care services (42). The past 10 years has seen a dramatic shift in the delivery of services for older people including the diversity of types of home support and home care services and funding of these aged care services (38). Overall, the number of people using aged care services (residential care, home care, home support, transition care) has increased in the past 10 years across Australia (38).

2.6% of older Aboriginal and Torres Strait Islander people are using aged care services, with 40% of those using home support and 22% using permanent residential aged care aged under 65 years old (38). People from CALD backgrounds represented 12% of all people using aged care services, with the majority of people using aged care services speaking English as their preferred language (38).

In 2019-2020, Commonwealth funded aged care and support (at home or in place) available across the Country SA PHN region: •

•

Home care services – providing higher level care or support to meet increased needs of clients (49) 43 service providers 43.4 people in 1000 used this service This was below the national average Home support services – providing lower care or support to maintain health and wellness (49) 149 service providers 352.9 people in 1000 used this service This was above nation average Allied health and therapy services were the most common services accessed Page 20 of 84

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Nationally, South Australia had the highest proportions of older people using permanent residential aged care (4.7%) and of older people using home support services (25%)(49).

In 2021, 116 public and private residential aged care facilities were sited across country SA PHN region (41). Access to residential aged care facilities is limited with lack of places available for current and projected population need. Areas of concern are Flinders & Far North, Hills, Mallee, & Southern, the Eyre Peninsula, and Riverland Aged Care Planning regions where aged care places are between 13 and 20 places less per 1,000 population compared to all of South Australia (38, 39).

From January 2023, CSAPHN will commission services to provide specialist and intensive aged care navigation support as part of the national Care Finder program. A supplementary Needs Assessment will be made available on the CSAPHN website. ________________________________________________________________________________________

Community Voice Country SA PHN regularly engages with key stakeholders, service providers and community representation to ensure their thoughts and views are heard.

Service providers from the aged care sector have expressed how complex and challenging accessing support and services is for older people and their families, and how this complexity is challenging as well for service providers in supporting people in accessing the right care (50). The challenges of maintaining a skilled and consistent workforce in aged services is a fundamental issue for regional and remote service providers. Appropriate remuneration, training and education and value-based recruiting are identified as key for providers to respond to the recommendations from the Royal Aged Care Commission (50). _______________________________________________________________________________________

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Child & Youth Health 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 (40).

Key Points • • •

Projected decline in youth population across most of country SA region Children report experiencing asthma at a higher rate than those living in metro Adelaide Childhood weight management is an area of concern

Identified needs 1.

2.

Access to health care services and preventative care.

Access to specialist services to support developmental health and wellbeing of children and youth.

_______________________________________________________________________________________

Health Needs Analysis In 2019, 21% of South Australian population was aged 18 and under, with 2.7% of children in South Australia were under six years of age, 34.5% six to 11 years old, and 32.8% aged 12 to 17 years (51).

In 2018, 25.4% of South Australian children and young people were estimated to be living in the most disadvantaged socioeconomic circumstances, compared to 18.5% nationally (51).

The proportion of the youth population of country South Australia (0-14 years) will overall decline by 1% over the next decade (52, 53). Expected small growth in the youth population in the areas of Coober Pedy and Ceduna over the next decade with all other LGA areas declining.

Perinatal Health The perinatal period is broadly considered to encompass from one year before birth to 18 to 24 months after the birth of the child. The health of both mother and baby at birth can affect their wellbeing throughout the rest of their lives (54).

The APY Lands experience the highest infant mortality, followed by Port Augusta and Murray Bridge.

Higher proportions of both low birthweight babies and mothers who smoked during pregnancy exist in Port Augusta and the Outback regions. Pregnancy smoking rates were also high in Peterborough and Ceduna (55).

Developmental Vulnerability The Australian Early Development Census (2018) defines developmental growth domains as: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who experience vulnerability in key areas of developmental need are at risk of poor health outcomes over their lifespan (56).

1 in 4 South Australian children and young people are developmentally vulnerable in one of more of the domains under the Australian Early Development Census when they enter school (51).

Across country SA, areas of need: • •

APY Lands - 71% of children were reported as experiencing vulnerability on two or more domains compared to 11% for the rest of Australia (57).

Peterborough, Roxby Downs, Port Lincoln, Ceduna, and Unincorporated SA LGAs - had a proportion of children identified as experiencing vulnerability in two of more domains, these proportions are more than double the Australian average (57).

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Child and Youth Health Asthma In 2018, Asthma was the leading cause of disease burden for children in Australia, and is one of the most common causes of hospital admission and visits to the doctor (58, 59).

• • •

17.9% of children in rural areas of South Australia report having asthma, compared to 13.8% in metropolitan Adelaide (60).

Children living in lower socioeconomic areas are more likely to report having asthma than those living in higher socioeconomic areas (60).

Nationally, prevalence for asthma is twice as high for children with disability than with those with no reported disability (61).

Disability Children and youth with disability may experience limitations or barriers to participating in a range of activities that support developmental growth.

• •

Estimated 7.4% of children aged 0-14 across Australia having a level of disability (62).

1 in 4 suspensions from SA government schools have been identified as students with disability (51).

Weight management Overweight and obesity in children and youth is associated with poorer health and wellbeing and higher health-care costs. Nationally obesity and being overweight affects 25% of Australian children and youth (63).

In rural South Australia 17.5% of children aged 5 to 17 were overweight and 19% were obese meaning almost 40% of children were an unhealthy weight (60).

Child and Youth Mental Wellbeing Youth are experiencing increased prevalence of psychological distress(64). Refer to Alcohol and Other Drugs and Mental Health sections of this report. ________________________________________________________________________________________

Service Needs General practice is the most accessed health care provider for children and youth with 86% of rural South Australian children visiting a general practitioner in 2018-2019 period (60). In 2019, 24.4% of rural South Australian children travelled over 75km to use a health service in 2019, compared to 1.8% in metropolitan Adelaide. The majority of those who travelled did so due to lack of services in the local community (65). ________________________________________________________________________________________

Community Voice In 2020, young people across regional South Australia identified a need for more GPs with expertise in working with and providing care for youth. In addition to young people wanting greater choice in primary care providers to enable seeking care from a GP that does not provide care to immediate family members or carers (51).

Limitations in access to specialist care locally required regionally based young people to worry about issues of affordability with transport and the distance with travelling to Adelaide for care (51). Privacy and confidentiality were also highlighted concerns by young people in accessing care in a small community.

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Chronic Conditions and Risk Factors Chronic conditions are the leading cause of illness, disability, and death in Australia (66). The increasing burden of chronic conditions, is placing greater demands on the health care system, and requires a consistent and integrated approach for effective prevention and management to improve health outcomes for all Australians (66).

Key Points • • •

73.3% of the population in country SA are estimated as being overweight or obese High potentially preventable hospitalisations for chronic conditions High rates for diabetes across most country SA region

Identified Needs 1.

2.

3.

Chronic disease multidisciplinary care and prevention.

Reduce potentially preventable hospitalisations.

Access to health care services and preventative care.

_______________________________________________________________________________________

Health Needs In 2021, it was estimated that almost half of Australians (47%) had one or more of 10 selected chronic conditions (67).

The 2021 Census was the first Census to collect data on long-term health conditions in Australia. In the Country SA PHN region, the age-standardised rate having one or more long-term health conditions was 30.1 per 100 persons, exceeding the SA average (29.5 per 100 persons). SA3 regions with the highest rate were Gawler - Two Wells, Mid North, Yorke Peninsula, Lower North and the Barossa (8).

Potentially Preventable Hospitalisation hot spots for chronic conditions are more than 1.5 times higher than the state average in in Port Augusta, Berri, Renmark, Port Pirie, Millicent, and The Coorong (68).

Rates for Aboriginal people experiencing chronic conditions are extreme compared to other population demographics in the Country SA PHN region and likely driving the high rates across the Outback (69). Analysis of chronic conditions experienced by Aboriginal people in country SA have been incorporated in the Aboriginal Health sections of this Needs Assessment Report.

Conditions of Significance Diabetes The Country SA PHN region has a higher age-standardised rate of self-reported diabetes (excluding gestational) (5.1 per 100 persons) than the national average. Risk of diabetes increases with age, with prevalence reaching 1 in 5 by age 75 (8). SA3 regions with the highest age-standardised rate of diabetes (excluding gestational) are Outback - North and East, Mid North, Gawler - Two Wells, Eyre Peninsula and South West, and the Yorke Peninsula (8).

Outback North and East more than double the proportion of SA population reporting a diagnosis of diabetes, and nearly double the proportion of country SA population with diabetes (70). This region is also the highest for diabetes complication hospitalisation (3.2 per 1,000).

Despite Barossa SA3 having one of the lowest diabetes prevalence for the Country SA PHN region, it is the second highest area diabetes complication hospitalisation (3.1 per 1,000)(70).

Cardiovascular Disease (CVD) Circulatory system diseases include a range of cardiovascular and cerebrovascular conditions. Deaths due to cardiovascular disease were 50% higher in the lowest socioeconomic group compared with the highest (6). The Page 24 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

prevalence of CVD increases with growing remoteness and double the proportion of men (4%) than women (2%) have a diagnosis of CVD (6).

SA3 regions with the highest age-standardised rate of self-reported heart disease (including heart attack or angina) are Gawler - Two Wells, Outback - North and East, Mid North, the Yorke Peninsula, and Fleurieu - Kangaroo Island (8).

Respiratory Disease SA3 regions with the highest age-standardised rate of self-reported asthma are Gawler - Two Wells, followed by the Yorke Peninsula, Mid North, Lower North and Barossa (8).

Outback North and East had the highest age-standardised rate of potentially preventable admissions for asthma, followed by Fleurieu – Kangaroo Island (71).

Nationally, chronic obstructive pulmonary disease (COPD) was the 5th leading cause of death for non-Indigenous Australians and the 3rd highest for Indigenous Australians from 2016-2020, with 1 in 20 Australians over the age of 45 reporting being diagnosed with COPD (72, 73).

The Country SA PHN region has a high age-standardised rate self-reported lung conditions (including COPD or emphysema) of 1.9 per 100 persons, compared to the SA and national average (1.8 and 1.7 per 100 persons, respectively). SA3 regions with the highest rate are the Mid North, Gawler - Two Wells, the Yorke Peninsula, and Murray and Mallee (8).

The highest rates for Potentially Preventable Hospitalisations related to COPD are in Berri, Port Augusta, Quorn-Lake Gillies, Ceduna, The Coorong, Port Pirie, Renmark, Naracoorte and Murray Bridge at least 1.5 the average state rate (68).

Arthritis and Osteoporosis SA3 regions with the highest age-standardised rate of self-reported arthritis are Gawler – Two Wells, followed by Mid North, Yorke Peninsula, the Lower North and Murray and Mallee (8).

Highest proportion of the population reporting osteoporosis were in Gawler - Two Wells followed by Yorke Peninsula and the Mid North; all other areas were below both the SA and Country SA PHN proportions (6).

Chronic Kidney Disease SA3 regions with the highest age-standardised rate of self-reported kidney disease are the Outback - North and East, Mid North, Gawler - Two Wells, and Lower North (8).

Prevalence is shown to increase with age and is more common in females than males. The prevalence of end stage kidney disease requiring dialysis is twice as high in remote areas compared to metropolitan areas (74).

Post-COVID-19 Syndrome Post-COVID-19 syndrome, commonly known as ‘long COVID’, is characterised by a range of symptoms extending several weeks or months after infection with COVID-19. Knowledge of this condition, including its definition and impact to the primary health care system, is still evolving. Current evidence estimates that the national incidence of post-COVID-19 syndrome is between 10-35% of people who test positive for COVID-19, and that incidence increases with age, number of comorbidities and severity of the acute illness (75, 76). Country SA PHN is monitoring the evolving evidence on postCOVID-19 syndrome and will continue to respond to emerging health and service needs in the region.

Chronic Condition Risk factors Tobacco Smoking An estimated 15% of South Australians over 18 years are current smokers, with the exception of Gawler – Two Wells which was equal to this, and Adelaide Hills which was below, all other areas in the Country SA PHN region had agestandardised rates of smoking above the rate for SA (1).

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Alcohol consumption An estimated 15% of South Australians over 18 years consume more than two standard alcoholic drinks a day on average, with the exception of Gawler – Two Wells which was slightly below (1).

All other areas in the Country SA PHN region had age-standardised rates of alcohol consumption above the rate for SA (39).

Nutrition In general, rates of fruit and more specifically vegetable consumption are very poor throughout country SA region with the exception of the Adelaide Hills which was the highest in the region for consumption of recommended daily serves of fruit and vegetables.

Yorke Peninsula SA3 had the lowest consumption of recommended serves of vegetables. Eyre Peninsula and South West, Lower North, Gawler – Two Wells, and the Mid North were also below the state average (77).

Gawler – Two Wells SA3 had the lowest proportion of respondents consuming the recommended serves of fruit per day (77).

Weight 34.3% of South Australians reported as being overweight with 29.5% being in the obese category (60). It is estimated 73.3% of the population across the Country SA PHN region as overweight or obese, and above the national average of 63.4% (78). In country SA region, 78.6% of Outback North and East surveyed had a BMI placing them in the range for being overweight or obese (60). With the exception of Gawler – Two Wells which were lower, all other SA3 regions in country SA were above the state average for being overweight and/or obese (70).

High Blood Pressure Approximately a quarter of the population over 16 years in the Yorke Peninsula, Eyre Peninsula & South West, Outback North & East, and the Murray Mallee report having high blood pressure (70). ________________________________________________________________________________________

Service Needs Patient-centred care approaches facilitated by the GP, including regular contact, individualised care plans, multidisciplinary shared care and patients being involved in decision making about their care have identified as effective for improving the health outcomes of patients with chronic conditions.

Three quarters (73%) of general practitioners reported care coordination activities post-hospital discharge and 87% reported coordination of care with social services and community providers (79).

People in Outer Regional and Remote/Very Remote areas face barriers in this approach to chronic care management, being least likely to have a usual GP or place of care, to facilitate a coordinated approach to care. This is further limited with lack of access in regional areas to specialists or faculties for medical testing (80). In addition, information sharing between health providers is reported by heath care users as decreasing as distance to metro areas and remoteness increases (80). _______________________________________________________________________________________

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Population Health There are a wide range of indicators that describe the health of a community and individual including where people live, what culture they are born into, socioeconomic status across life, health status and risks, and ability to access required services that are close to home. Other factors include living in a healthy community with access to clean water and sanitation, where government supports health preventative measures such as screening, immunisation against common communicable diseases and promotion of a healthy lifestyle.

Key Points • • •

Childhood vaccination rates below 95% across most of region Lack of access to oral health care High levels of disadvantage experienced in areas of region

Identified needs 1. Improve immunisation and vaccination rates.

2. Access to oral health services.

3. Access to health care services and preventative care. _______________________________________________________________________________________

Health Needs Immunisation and vaccination Childhood immunisation The National Immunisation Program (NIP) Schedule is a series of immunisations given at specific times ranging from birth through to adulthood.

Limited vaccination rate coverage exists for key age groups across several Country SA PHN regions (81): Age

SA3 Regions with vaccination rates at or above 95%:

1 Year

Barossa, Yorke Peninsula, Limestone Coast

2 Year

Nil

5 year

Eyre Peninsula South & West, and Limestone Coast

Influenza vaccination General practice is the primary provider for flu vaccinations. Vaccinations for influenza for SA in 2021 (March to October) were reported as totalling 757,678. With 273,206 administered to people aged 65+, and 455,031 aged 5-64 years old (82).

Vaccine preventable Potential Preventable Hospitalisation (PPH) conditions include hospitalisations due to diseases that can be prevented by vaccination, such as influenza, measles and whooping cough. Port Augusta has been an identified as a continual hotspot for vaccine preventable hospitalisations 2004 to 2018 (68).

COVID vaccination At October 2021, 6 Commonwealth vaccination clinics (through general practice clinics), 9 Aboriginal Community Controlled Health services and 41% of pharmacies in the Country SA PHN region were administering COVID-19 vaccinations (83). Ninety percent of Country SA PHN residential aged care staff are fully vaccinated with a COVID-19 vaccine, with the exception of Barossa SA3, which has 80%-89% of staff fully vaccinated (84).

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Japanese Encephalitis In March 2022, Japanese encephalitis was declared a Communicable Disease Incident of National Significance. As at October 2022, the first nine cases of the virus have been detected in people living in SA. Presence of the virus in mosquitoes and animals has been confirmed in the SA3 regions of Murray and Mallee, Gawler-Two Wells, the Barossa and the Lower North. Vaccinations are being rolled-out to high risk and vulnerable populations (85).

Monkeypox In July 2022, monkeypox was declared a Communicable Disease Incident of National Significance. As of September 2022, two cases of the virus have since been confirmed in people living in SA. Vaccines are being provided to persons at high-risk of contradicting monkeypox, including confirmed close contacts, vulnerable populations and people whose occupation may put them at increased risk (86).

Sexual Health Sexual health includes having access to contraception, awareness of preventative behaviours to protect self and partners from sexually transmissible infections and access to testing and treatment(87).

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 (refer to section: Aboriginal Health of this report)

Syphilis In South Australia there is an ongoing infectious syphilis outbreak, first declared in the Far North and Western & Eyre regions from November 2016 (18).

As of March 2022, 169 cases of infectious syphilis have been notified in SA, marking a sharp increase over the last three years. Of these, 157 (93%) cases were Aboriginal and Torres Strait Islander persons, and 67% were persons aged 15-34.

Three cases of congenital syphilis have been reported in SA since the start of the outbreak (19).

Chlamydia Chlamydia is the most commonly notified STI in South Australia. The notification rate of chlamydia in 2018 for South Australia was 360 per 100,000 population, and has been stable over the past five years, with a similar number of notifications in 2019 and 2020 (88)

Gonorrhoea Rates of gonorrhoea were stable over 2017 and 2018 with a rate of 74 per 100,000 population in SA or just under 1,300 notifications (88). This increased to just over 2,000 notifications in 2019 and slightly reduced from that to just under 1,700 in 2020 (88).

Cancer Screening In 2017, in South Australia, people aged over 65 accounted for 62.7% of all cancers and 78.9% of all cancer deaths, with a lifetime risk of being diagnosed with cancer (calculated to age 75) at 1 in 3 for males and 1 in 4 for females (89). In the Country SA PHN region, the age-standardised rate of self-reported cancer (any type, including remission) is slightly below the state and national average at 2.8 per 100 persons (8).

The most common reported cancers in South Australia (2017) (89): Male • Prostate 28.5% • Colorectal 10.6% • Lung 9.1% • Melanoma of skin 7.8% • Non-Hodgkin lymphoma 5.5%

Female • Breast 29.2% • Colorectal 12.0% • Lung 9.8% • Melanoma of skin 6.8% • Uterine 4.8%

These accounted for 61.1% of all newly diagnosed cancers among males in 2017.

These accounted for 62.7% of all cancers among females in 2017.

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Cancer screening programs are evidenced to increase detecting cancer early, to support improved outcomes for treatments, while awareness of and avoidance where possible of associated risk factors associated can help to reduce chances of getting cancer (90).

Breast screening Participation in breast screening for the eligible population (50-79 years) in 2018-19 for Country SA PHN is 58%. The regions which are below the Country SA PHN participation rate are the Lower North, Limestone Coast, Outback North & East, with the lowest being the Mid North with 48% participation (91).

Cervical screening Outback North and East were below 40%, followed by the Murray and Mallee, Mid North, Limestone Coast, Yorke Peninsula, Gawler – Two Wells, and Eyre Peninsula and South West were also below the Country SA PHN overall participation rate of 48.5% (91).

Bowel screening For persons invited to participate in bowel screening in 2018-19 in all areas of Country SA PHN except for Outback North & East (40.6%) had a greater participation rate than the overall national average (43.5%)(91).

Skin cancer 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. 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)(92)

Similarly, the highest rate ratios for non-melanoma compared to South Australia were (92, 93); • • • • •

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

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 (93).

Oral Health Essential to general health and wellbeing, oral health impacts quality of life. Oral health can be considered 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.”(94) As an identified Potentially Preventable Hospitalisation, acute dental condition hotspots across country are: Renmark, Barmera, Nuriootpa, Tanunda, Berri, Ceduna, Goolwa-Port Elliot, Port Pirie and Port Augusta (68). Renmark has the highest admission rates for South Australia at a rate of 2.6 that of the state average.

Renmark and Berri have been hot spots for Dental conditions for 15 and 14 years, followed by Port Pirie and Port Augusta which have been hot spots for 13 years (68).

For children living remote or very remote areas in South Australia, there is a higher prevalence and severity of untreated dental decay and total decay experience (95). For adults, decay experience is disproportionate across the Page 29 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

social gradient and for specific populations including: rural and remote populations, Aboriginal people, frail older people, people with disabilities, those living with mental illness and culturally and linguistically diverse people (95).

Disadvantage Socio-economic factors are universally recognised as key in determinants of health for population groups. Communities where groups of people experience socio-economic disadvantage are generally identified as being of greater risk of poorer health with higher rates of illness, disability and death than those from higher socioeconomic groups (96).

AIHW (2015) national analysis found overall burden of disease at 1.5 times higher for people located in low socioeconomic areas in comparison to than those in high socio-economic areas, with estimates for specific diseases at: • •

2.5 times as high for type 2 diabetes 2.0 times as high for lung cancer

•

1.4 times as high for stroke (97)

Concentration of disadvantage are experienced by communities in the APY lands, Maralinga Tjarutja, Peterborough, Coober Pedy, and Port Pirie (40).

Nationally, locational disadvantage is experienced in remote and very remote communities, with burden of disease being 1.4 times as high as major cities and potentially preventable hospitalisations being 2.5 times as high (98). _______________________________________________________________________________________

Service Needs Local access to GP and specialist health professionals is limited across region, often requiring travelling long distances to access services. Community consultation across the region identified only half of respondents accessed a GP within their own suburb, and only 5% accessed other health professionals in this same area (99). 48% of respondents travelled over 450kms to access a specialist health professional. Time, cost and access to transport were highlighted barriers to accessing care outside local area (Refer to: Health Workforce section of this report)(99).

Outreach programs administered by the Rural Doctors Workforce Agency and Royal Flying Doctor Service contribute to closing local services gaps in rural and remote locations across country SA (99).

Access to dental services in Country SA are limited with limited availability of dentists and private dental services in regional and remote areas (95). _______________________________________________________________________________________

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Palliative Care Palliative care helps people with a life-limiting illness to live comfortably at home, hospital, hospice or aged care facility.

It involves a range of general and specialist care services to improve overall quality-of-life for patients and their families through holistic management of disease and symptoms as well as any associated needs including psychological, spiritual and social wellness.

Key Points • • •

Ageing population with high burden of life-limiting conditions requiring palliative care Populations with unique care considerations Major data gaps in palliative care service delivery and access

Identified Needs 1.

2.

3.

4.

Access to health care services and preventative care Reduce potentially preventable hospitalisations Integrated and coordinated care across the health system Older persons are supported to stay healthy and well in their place of residence

______________________________________________________________________________________ The Country SA PHN region has an ageing population experiencing a high rate of chronic and long-term health conditions. Further, there is a high burden of conditions associated with palliative care needs, including cancer, dementia and heart disease (8).

It was recently estimated that up to 72% of persons who die from a life-limiting illness in SA could benefit from palliative care services (100). In the Country SA PHN region, this would account for over 2,800 persons every year (2, 101). Of these, around 9 in 10 palliative care encounters are predicted to be persons aged 65+ (102).

The demand for palliative care services is projected to increase further over time and requires coordination of multidisciplinary care teams to accommodate individual needs of patients and their families. Several population factors are associated with increased complexity of needs relative to palliative care. Persons who are Aboriginal, CALD, or living with a severe or profound disability may have additional care considerations based on cultural or other diversities. Similarly, people living in rural and remote areas have a high rate of disease and risk factors leading to increased complexity of care (refer to Aboriginal Health and Populations of Special Interest sections of this report) (100).

Further, Aboriginal persons and those living in regions classified as having the lowest relative socioeconomic status are at increased risk of palliative care-related hospitalisation. Aboriginal persons in South Australia have double the rate of palliative care-related hospitalisations than non-Indigenous persons (45.6 vs 23.3 per 10,000 persons) (100). The same trend exists for those living in the lowest socioeconomic areas compared to those in the highest socioeconomic areas of Australia (102).

Persons considered frail are at increased risk of adverse clinical events and outcomes including falls, unplanned hospitalisation and acute health complications. Consequently, the anticipation of decline and palliative care planning is an important consideration for frail patients (103). While there is no standard measure for frailty, it has been estimated that around 21% of persons aged 65+ are frail in Australia, with prevalence increasing with age (104). Similarly, unpaid care provision is an indicator of demand for health care services including palliative care. Over 12% of persons (age 14+) in the Country SA PHN region currently provide unpaid care to someone due to disability or a long-term illness (8). _______________________________________________________________________________________

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Service Needs Despite major national reforms of palliative care, data on service delivery and access is poor both on a national and local level (105). Access to services to facilitate palliative care is reduced in regional SA relative to service availability in metropolitan Adelaide, including specialist end-of-life care, 24/7 clinical and nursing care, equipment and medication (100). Multidisciplinary care delivery incorporating regional palliative care, general practitioner, community nursing, home support and allied health services including pharmacy are pivotal to provision of palliative care in regional and remote areas. Limitations in workforce impact service capacity and capability (refer to Health Workforce section of this report).

Consultation with palliative care general and specialist services, peak bodies and service providers across 2022 identified the following key themes relative to service need: •

• •

Limited services in most regional areas to deliver palliative care in the home including: clinical care medication administration equipment provision care in the after hours Lack of electronic and coordinated information sharing across care providers, including care goals, medication and clinical needs Lack of early stage goal planning with person, carers and family (106).

Country SA PHN continue to build on existing knowledge, resources and relationships by partnering with local stakeholders, service providers, consumers and carers in a multi-phased approach focussed on improving components of the local palliative care experience including; pathways, models of care, workforce capacity, engagement and datadriven quality improvement. ________________________________________________________________________________________

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Populations of Special Interest While many Australians experience poor health outcomes, concentrated inequalities in health exist in some population groups. Populations experiencing inequity due to cultural, ethnic or health characteristics, and social disadvantage are at risk of disparate access to health care and outcomes. For detail regarding Aboriginal and Torres Strait Islander health and wellbeing refer to Aboriginal Health section of this report.

Key Points • • • • •

Culturally and Linguistically Diverse (CALD) communities LGBTQI+ communities People experiencing disability People providing informal care Rural and remote communities

Identified Needs 1. Access to culturally appropriate health services.

2. Access to health care services and preventative care. ______________________________________________________________________________________

Health Needs Culturally and Linguistically Diverse (CALD) communities Country SA PHN region population is diverse and includes people who were born overseas, have family members who were born overseas or speak a variety of languages. While these groups are distinct and unique, they are identified here as CALD populations.

English proficiency can impact health by hindering an individual’s access to health services (107). Coober Pedy, Naracoorte and Lucindale, Renmark Paringa, and Murray Bridge have higher proportions of persons born overseas who report speaking English not well or not at all (53).

Just under half of country SA surveyed respondents from General Practice and Allied Health reported seeing clients who are not proficient in English occasionally or (very) frequently, with allied health providers indicating a higher frequency.

Refugee and Special Humanitarian Visa migrants entering Australia under the Offshore Humanitarian Program between 2000 and 2016 are settling more frequently in the south east of SA (53). Specific health needs for individual new arrivals, and those from refugee background communities will vary depending on their refugee experience, region and country of origin. Common health concerns across communities can include trauma from violence and injury, communicable and non-communicable diseases have been poorly managed in the past, and limited or disrupted access to preventative care and mental health support (108).

LGBTQI+ communities There is complexity and severe limitations in identifying national, state and regional level data and reporting for people identifying as being LGBTQI+. This is due to both lack of data sources including information on diverse sex, gender and sexual orientation, and the complexity of how individuals identify themselves (109). It is acknowledged that grouping people identifying as lesbian, gay, bisexual, transgender, intersex or other gender or sexual orientation into a single group (LGBTQI+) is limited in effective representation.

While reporting is identified as limited, national findings indicate a disproportionate number of people identifying as LGBTIQ+ experience have poorer mental health outcomes and have higher risk of suicidal behaviours than their peers (109, 110). It is surmised experiences of stigma, prejudice, discrimination and abuse by those who identify as being LGBQI+ have a direct impact on health behaviours including risk and help seeking (110). Only 34% of people who identify as LGBTI reported hiding their sexuality or gender identity when accessing services (111).

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Mental health is a highlighted issue with older Australians who identify as lesbian, gay, bisexual, transgender or intersex have lived experience of discrimination, criminalisation, family rejection and social isolation, resulting in anxiety (111, 112).

People experiencing disability Nationally, 18% of the population have disability, with prevalence increasing with age. Around 1 in 8 people aged under 65 have some level of disability, rising to 1 in 2 for those aged 65 and over (113).

In 2019, 20.3% of South Australian adults reported having a disability with a higher proportion of females (22.1%) than males (18.2%). In the same year, a total of 9.7% of South Australian adults reported providing long term care at home for a parent, partner, child, relative or friend (60).

Higher proportion of people with a disability are living in country SA than metropolitan Adelaide (53).

Health risk factors and behaviours (such as poor diet, physical inactivity, and smoking) can have a detrimental effect on a person’s health (113): • • • •

72% of people with a disability are overweight or obese, compared to 55% of people without a disability.

72% do not do enough physical activity for their age compared to 52% of people without a disability.

54% had hypertension compared to 27% of people without a disability Those with a disability were less likely to exceed the guidelines for single occasion risk for alcohol consumption

People providing informal care In 2018, 3.5% of all Australians aged 15 years and over were the primary carers (informal) to a person with disability, with those aged 55-64 the highest proportion of providers, followed by 65–74-year-olds (114).

Just over 12% of country South Australians spend time providing unpaid care, help or assistance to family members or others because of a disability, a long-term illness (lasting six months or more), and/or problems related to older age (8).

Carer SA consultation with SA based carers in 2020 found carers experienced a lack of inclusion and consideration by GPs and hospitals in regards to care planning. Carers who are unpaid and are most often caring for a family member at home reported NDIS services as not easy to organise and that their own needs are not considered, asked for or met.

91% of those consulted reported caring role resulted in a negative impact to self, and 86% reported their caring role resulted in a negative impact on important relationships (partner, family, friends) external to the person they were caring for (115).

Remote communities Approximately 54% of the Country SA PHN population live in areas classified as Outer Regional, Remote, and Very Remote Australia. Just over 42% of the Country SA PHN ’s population reside in Outer Regional areas, and 35% in Inner Regional areas (40).

With increasing remoteness, access to GP and specialist care becomes increasingly difficult and reduces participation in care. 3 in 5 people residing in Remote/Very Remote areas identify a lack of healthcare providers nearby stopped them from accessing care (80, 98). People living in Outer Regional and Remote/Very Remote areas are unlikely to have a usual GP with populations living in these areas being the most likely to access emergency care due to lack of access to a GP (80, 98, 116). _______________________________________________________________________________________

Service Needs Culturally appropriate care Surveyed respondents in a 2019 state-wide health survey identified the most common reasons they experienced discrimination was because of race (11.7%), age (11.2%), gender (10.3%), disability (5.4%), and religion (5.0%)(60).

Persons identifying as LGBTQI+ are likely to feel their sexual orientation or gender identify is not respected in mainstream services, and are more likely to access services that are accredited or identified as LGBTQI+ inclusive (117).

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Joint consultation (2021) with South Australian people of lived experience and service providers, identified key needs for provider education in LGBTQI+ health needs, improved access to and choice of providers for LGBTQI+ people (118).

For people from culturally and linguistically diverse communities, there is an overall reliance on healthcare provider multilingual capabilities and use of family members as interpreters to support language assistance for persons to efficiently participate in health and wellbeing activity, including discussions with GPs, specialists, allied health and other professionals (108, 119). Time intensive consults involving interpretation services and associated costs find GP access and use of government subsidised interpretation services in consultation is historically low (108, 119).

Access Carers experience exclusion by GPs and hospitals regarding care planning for those they care for. In addition, carers experience a lack of consideration for their own needs in the delivery of the care. 63.7% of SA carers surveyed in 2020 reported hospitals did not ask about their needs as carers, with 57% experiencing the same with GPs (115). Difficulty in organisation of services for those they care for through National Disability Scheme (NDIS) is a highlighted issue for SA based carers (115).

Services are concentrated in Metro and Inner Regional areas, resulting in barriers for Regional, Outer Regional and Remote communities in access with travel, expense, and time away from the community required in order to participate in health care(80, 98). In 2019, 13.6% of South Australians were required to travel over 75kms from their homes to use a health service. While 15% chose to access a service further away, 74% were required to do so as the required services were not located or accessible locally. ________________________________________________________________________________________

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Potentially Preventable Hospitalisations Potentially preventable hospitalisations (PPH) are identified admissions to a public or private hospital for a condition where the hospitalisation could have potentially been prevented through appropriate preventative health care interventions and early disease management (120). Primary and community based care provided by general practitioners, medical specialists, dentists, nurses, and allied health professionals are identified as essential in supporting people with maintaining health and wellbeing for potentially potential hospitalisations (120).

Key Points • • •

Potentially preventable hospitalisation rates are above the state average across most of Country SA PHN region Chronic condition PPH – Port Augusta, Berri, Renmark are all the highest hot spots in SA Acute condition PPH - Ceduna, Renmark, Port Pirie, Port Augusta are all the highest hot spots in SA

Identified Needs 1.

2.

Reduce potentially preventable hospitalisations.

Integrated and coordinated care across the health system.

_______________________________________________________________________________________

Health Needs Potentially preventable hospitalisation (PPH) rates are above the state average in all regions except the Adelaide Hills, Barossa, and Fleurieu-Kangaroo Island. Rates in the Outback - North and East are the highest, followed by the Mid North (71).

Acute Conditions Acute PPH conditions are a defined set of conditions that usually have quick onset and may not be preventable but are identified as potentially not requiring hospitalisation with timely and adequate care delivered in the community (121).

Ceduna had the highest acute PPH for all SA. Renmark, Port Pirie, Port Augusta, Berri, Millicent, Cooper Pedy and the Coorong all have high rates of acute PPH (68).

Conditions of significance: • •

Ear Nose and Throat Infections: Highest admission rate in The Coorong, 3.7 times higher than the state average (68) Dental conditions: Highest admission rate was Renmark, 2.6 times higher than the SA average (68)

Chronic Conditions Chronic PPH conditions are a defined set of long-lasting conditions that may be preventable through lifestyle change and be managed in the community to prevent symptoms becoming worse and requiring hospitalisation (68).

Port Augusta has the highest chronic condition PPH for all SA. Berri, Renmark, Port Pirie, Quorn-Lake Gillies, Millicent and the Coorong all have high rates of chronic PPH (68).

Conditions of significance • • • •

Angina: Highest admission rate was Port Augusta, 4.5 times higher than SA average (68) Asthma: Highest admission rate was Nairne, 3.8 times higher than SA average Diabetes complications: Highest admission rate was in Karoonda – Lameroo, 3.4 times higher than SA average (68) Chronic Obstructive Pulmonary Disease: Port Augusta, Port Pirie, Renmark, Berri and Ceduna have been identified areas with high rates of COPD PPH for more than 10 years in the period 2004-2018.

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Service Needs Primary health care interventions are identified as the key mechanisms to support people in health and wellbeing and potentially avoid preventable hospitalisations for some conditions. This care is usually delivered by general practitioners, medical specialists, dentists, nurses and allied health professionals and may be accessed through a variety of community settings, including general practice and Aboriginal and Community Controlled Health Services and may include vaccination, early diagnosis and treatment with ongoing management of conditions or risk factors. As such, workforce shortages and ongoing difficulty in attraction and retention of health professionals to rural and remote areas limits delivery of effect care (refer to: Health Workforce section of the report). ________________________________________________________________________________________

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Alcohol and Other Drugs The consumption of alcohol and other drugs (AOD) is a major cause of preventable disease, illness and death for Australians (122). In South Australia, this trend continues with the misuse of alcohol and illicit substances having a significant impact on service provision and the health of a community.

Alcohol, amphetamines and cannabis have been the most prevalent and misused drugs in SA for the past 10 years and they remain the principle drugs of concern within country SA (123). The large geographic region of country SA denotes different region classification, different population cohorts and therefore disproportionately affected areas.

Key Points • • • • • •

Amphetamines, alcohol and cannabis are the most common drugs of concern in the Country SA PHN region.

Amphetamines replaced alcohol as the most common principal drug of concern in 2019 and is a growing concern within Country SA PHN. There is a high demand for alcohol and other drugs in outer regional, rural and remote areas of SA. Males more likely to engage in alcohol and other drug use.

Areas with the highest level of need for AOD services in rural and remote areas include the APY lands, Port Augusta, Outback and the Riverland specifically Renmark and Berri.

Lack of access to the right services at the right time is an ongoing issue across the region.

Priorities 1.

2.

3.

Delivery of specialist AOD services.

Community appropriate MHAOD rehabilitation services.

Integrated and coordinated care across the health system.

_______________________________________________________________________________________

Health Needs Overall use of illicit drugs in regional and remote areas is similar to that in metropolitan areas, however the principal drug of concern and frequency of drug use varies considerably across the regions (124).

AOD service use is often collated in terms of closed treatment episodes, these are a key means of measuring drug service use within the region. A closed treatment episode is a period of contact between a client and a treatment provider that is closed when treatment is completed.

Understanding the extent of alcohol and other drug use in South Australia is important as they influence health, social and economic outcomes in the community. Increased use of these substances increases risk of disease, injury, road trauma, mental illness, family and domestic violence and crime overall. The use and misuse of AOD additionally imposes a huge financial burden on the state.

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Alcohol Risky drinking increases the risk of injury, illness and can correspond with mental illnesses. Most adults consume alcohol and do so responsibly, however a substantial proportion drink in excess of the recommended amount and in turn increase their risk of alcohol related harm and adverse health outcomes (125). Risky alcohol consumption is consistently higher in regional, rural and remote communities (126).

COVID-19 has impacted type and frequency of drug use with Country SA. The use of cannabis, and alcohol increased relative to use before March 2020 while the use of MDMA, cocaine and ketamine mostly decreased over the same period (127).

Issues such as stress, anxiety, domestic violence, social isolation and suicidality additionally increased during the COVID19 active lockdown periods, in correspondence to increased alcohol consumption (127).

Lifetime and short-term risk Alcohol use is measured in terms of long-term lifetime risk and short-term risk. Lifetime risky drinking is drinking more than 2 standard drinks per day while short term risky drinking is drinking more than 4 standard drinks on any single occasion.

In South Australia in 2019, • higher percentages of risky drinkers than the national level, 26.6% of males and 10.3% of women compared to 24.4% and 9.4% nationally (128), and • 28% of people consumed more than 4 standard drinks on a single occasion at least once in the previous month, placing a high percentage of South Australians at short term risk (128).

Alcohol was the principal drug of concern for people receiving AOD treatment during 2018/19 (124), accounting for 60.9% of closed treatment episodes in outer regional areas and 39.5% in inner regional catchments.

Lifetime risk from alcohol in Country SA PHN region increased from previous years(2016-2019) with 20% of people aged 14 years and over consuming more than 2 standard drinks per day on average (128).

In terms of treatment, counselling was the most common main treatment type(41.3%) followed by assessment only (26.8%) for closed episodes in 2019-20 (129).

Prevalence Despite males drinking at higher rates, women were more likely to seek treatment for an AOD issue within the Country SA PHN region (129), highlighting the need for a targeted approach to help-seeking within the male population.

Males accounted for 63.6% of treatment episodes conducted in 2019-20 for AOD concerns. Fourteen percent of those treated were Aboriginal persons (129).

Country SA PHN region had 20.1% of individuals exceeding the lifetime risk guideline compared to 17.5% in APHN, highlighting an increased need for alcohol education and treatment services (129).

One fifth of high school aged students consumed more than four standard at least once on a single occasion of drinking within the past two weeks, and 26.8% within the last month (128). This is despite the consumption of alcohol in minors being illegal.

Older Australians (70 years and over) were more likely to drink daily than younger cohorts (18-30 years). However individuals aged in their 40s and 50s were more likely to exceed the single occasion guideline at least monthly, thus drinking 4 or more standard drinks increasing their short term risk (128).

Approximately 31% of Aboriginal persons in SA drink at levels placing them at risk of lifetime harm, a further 25% drinking at levels placing them at risk of acute harm at least once a week (130).

People residing in remote and very remote areas were 1.6 times as likely to consume alcohol at levels that increased their risk of injury compared with those in major cities (128). Within Country SA PHN region, the Outback region Page 39 of 84

recorded the highest weekly risky drinking while the Adelaide Hills had the highest proportion of risky month and yearly drinking rates (131).

Positively, the proportion of people classified as ex-drinkers increased from 7.6% to 8.9% from 2016 to 2019, suggesting more Australian’s are giving up alcohol (128).

Illicit drugs Illicit use of drugs includes use of illegal drugs, misuse of pharmaceutical drugs, and inappropriate use of other substances such as inhalants (132). Illicit drug use varies across rural classification (128).

Harms from illicit drugs affects individuals, families and communities alike, either directly or indirectly. Extended use is associated with increased burden of disease, illness, injuries, trauma and mental illness. Furthermore, heavy use can have significant costs on the health care system and create financial burden for those directly affected (128). In 2018, 1,780 deaths were directly attributed to drug use and contributed to 2.7% of the overall burden of disease and injury (128).

Prevalence In 2019 in South Australia, • • • • •

More than 1 in 7 people in South Australia had used an illicit drug in the past 12 months (128) Amphetamines replaced alcohol as the most common principal drug of concern in 2019 (129).

Individuals aged 30-40 were the most likely to have ever used an illicit drug, whereas in 2001 it was highest among individuals aged 20-30 years (128).

15.7% of people in Country SA reported using an illicit drug in the past 12 months compared to 14.8% in the metropolitan area.

The most common drug of concern for individuals seeking AOD treatment, was amphetamines at 35% of episodes, followed by methamphetamines at 79% of treatment episodes.

The types of illicit drugs used most frequently in Country SA PHN region are cannabis and amphetamines. Unlike cocaine and ecstasy these drugs are more likely to be used regularly. 37% percent of cannabis users and 17% of amphetamine users used weekly compared to 6% and 4% of cocaine and ecstasy users. While these drugs have seen increase of use from 2016-2019 while use of pain-killers and opioids decreased across both lifetime and recent use categories (128). The use of cocaine and ecstasy has however been increasing in recent years (128).

There has been a significant increase in the proportion of people aged 60 and over who have used an illicit drug over their lifetime (128).

Recent surveys highlighted the age at which people started drinking and using illicit drugs to be between 17-20 years of age, suggestion a greater effort is required for education and training into drug use and abuse (128).

Illicit drug use in South Australia is associated with increased risk of criminal conviction and imprisonment.

Cannabis Long term cannabis use has been linked with significant psychological and physical consequences including psychosocial impacts and cognitive problems. Furthermore, the risk of developing psychotic symptoms doubles among heavy users (133). The median age of individuals who used cannabis increased from 26 to 31 between 2016 and 2019 (128).

• •

•

Approximately 10.6% of the general population in South Australia used cannabis in 2018-19. In recent years an increase in cannabis potency has been noted due to an increase in hydroponic production (127).

Males (14.7%) are more likely to have recently used cannabis than females (8.6%). In the 30-50 age cohort men were twice as likely to use compared to females (128).High rates of cannabis use were more commonly seen in inner regional areas with highest use in the Adelaide Hills and Barossa region (131) Cannabis use disproportionately affects the Aboriginal population, accounting for a high proportion of closed treatment episodes (127).

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Methamphetamines Regular and heavy use of methamphetamines has numerous links with poor health outcomes, including heart, kidney and lung problems, poor dental hygiene, skin infections, stroke and weight loss(134). Methamphetamine users additionally pose a risk to the community due to increased likelihood of violent and aggressive behaviour, untreated psychosis and potentially brain damage (134).

The median age of individuals using methamphetamines increased from 23 in 2001 to 32 in 2019(128). Amphetamine use in South Australia is 10% higher than the national average (127). Amphetamines accounted for the largest proportion of AOD treatment episodes in 2019 (127).

Crystal methamphetamine is the most common form of methamphetamine used in SA, and is attributed with an increase in harm and violence (127). Use of methamphetamine has been on the increase since 2006 among previous drug users, in contrast use in the general population has decreased in recent years (135).

Methamphetamine lifetime use was higher in rural and remote areas (124, 131). From 2016-2019, the proportion of victims of an incident related to illicit drug use increased.

Pharmaceutical drugs The misuse of pharmaceuticals refers to the consumption of a prescribed or over-the-counter drug for non-therapeutic purposes.

• • • •

Use of non-medical pharmaceuticals declined between 2016 and 2019. In 2016, they were the second most commonly used illicit drug, however in 2019 they ranked fourth behind cannabis, cocaine and ecstasy (128).

In South Australia, illicit use of pharmaceuticals decreased from 5.5% in 2016 to 4.1% in 2019 (127).

In 2018, 1,740 deaths were directly attributable to drug use, and opioids were present 64.5% of these deaths (132).

Within Country SA, a social gradient was apparent in regard to dispensed prescribed opiates; with lower Socioeconomic areas having higher rates of prescribing and usage overall (131).

AOD and Mental Health Comorbidity Comorbidity refers to the presence of two or more illnesses simultaneously in the same individual. For individuals experiencing an alcohol or other drug misuse problem it is not uncommon for them to additionally be diagnosed with a mental illness (136). Just over half of individuals experiencing an AOD use disorder reported a co-occurring mental illness, likewise three quarters of individuals with a mental health disorder experience some kind of AOD dependence (136).

The co-occurrence of a mental illness and drug misuse problem is therefore bi-directional, alcohol misuse can occur as a coping mechanism for an individual with anxiety, likewise depression can occur as a result of alcohol dependence. Illicit drug use is prevalent amongst South Australians being treated for a mental illness or with high or very high levels of psychological distress (123, 131). Many individuals self-medicate with drugs and/or alcohol to ease mental health symptoms or alternatively can develop mental illness as a result of prolonged drug use.

• • • •

Estimated 35% of individuals with a substance use disorder have at least one co-occurring affective or anxiety disorder (3).

Depression and anxiety are common among illicit opioid users. Heavier illicit opioid use is associated with more severe depression (3).

Stimulants are amongst the most commonly used substances in individuals with psychosis (123). Trends highlight stimulants to be a form of self-medication.

50-73% of Australians meet the diagnostic criteria for at least one comorbid mental disorder, with 1 in 3 having multiple comorbidities (3). Furthermore of individuals in residential rehabilitation experience a current anxiety disorder (70%) and depression (55%).

_______________________________________________________________________________________

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Service Needs Specialised Drug and Alcohol Services Excessive alcohol consumption was responsible for increased demand and pressures on the limited country healthcare services. AOD related illness accounted for the highest proportion of emergency department presentations, hospital separations and specialised treatment episodes (137).

•

11% of South Australia’s AOD services are located in remote and very remote regions of South Australia. Overall accounting for 54 agencies, 23 in the Non-government sector and 18 in the Government sector (129).

•

Highest level of need for AOD services in rural and remote areas include the APY lands, Port Augusta, Outback and the Riverland specifically Renmark and Berri (123).

•

In 2019-20, 41.7% of closed episodes were via the main treatment method of counselling, followed by assessment only and withdrawal management (129). 79.5% of closed episodes were completed within a non-residential treatment facility.

People receiving treatment for AOD issues were: • 63.6% males, 36.3% females • 73% were aged between 20 and 49 years of age • 80% of clients were non-Aboriginal and 14.4% Aboriginal Recruitment and retention of experienced and qualified staff is difficult due to short-term funding cycles and unclear career pathways (138).

There is a lack of capacity in the system, leading to extensive waiting lists for services (127).

Large proportions of the workforce who deliver support for AOD service clients are nearing or reaching retirement.

This, coupled with the difficulty to recruit staff members, is leading to a reduced workforce size.

Lack of access to suitable training for clinical and non-clinical workforce, leading to increased clinical risk and inconsistency of service provision.

A training need for AOD service staff around reducing judgement and stigma, which is highlighted as a barrier for clients when presenting to services.

Residential and Non-residential Rehabilitation Rehabilitation programs are usually based in community treatment centres or residential rehabilitation services (139).

Rehabilitation approaches vary from patient to patient, where some require counselling while others benefit most from medications (139). Rehabilitation is not always successful the first time and many need to go through the process more than once.

Currently in the Country SA region there are eight registered residential rehabilitation centres, three of which are Aboriginal and Torres Strait Islander population specific. In terms of non-residential rehabilitation, the region has four: Coober Pedy, Mount Gambier, Berri, and Murray Bridge.

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Mental Health and Drug and Alcohol Comorbidity High levels of comorbidity places increased pressures on AOD workers as they are required to manage complex psychiatric symptoms which can interfere with their ability to treat clients AOD use (3). Patients with a comorbidity tend to exhibit a more complex and severe clinical profile including poorer physical and Mental Health , greater drug use severity, and poorer everyday functioning and quality of life (3).

The treatment of comorbidities required skilled professions which are limited at best in remote and regional South Australia.

Figure 7: Harms associated with comorbidity (3)

________________________________________________________________________________________

Community Voice Consultations in late 2020 facilitated across the sector involved community members, providers and key stakeholders. The following were highlighted as key themes; • •

•

Need for more culturally appropriate services to enable better treatment and navigation through the system.

Inequality of access for rural and remote clients. Most services are found located in urban centres, such as Adelaide, which require impractically long journeys for clients who live in rural and remote areas. Stakeholder groups described the current resources in rural and remote locations as being limited.

Impacts of COVID-19 may have caused increases in AOD usage across the overall population as well as increasing the risk of relapse. They felt that this was potentially linked to both an increase in the time available for people to consume substances, as well as a reduction in ‘face to face’ AOD and GP services.

________________________________________________________________________________________

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Mental Health Mental health is ‘a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’ In the average lifetime, 50% of people will have a lived experience of mental illness and the remaining 50% will know or care for someone experiencing mental illness (140). Fifty percent of people will have experienced some form of mental illness by age 14, increasing to 75% by the age of 24 (140).

Key Points • • • • • •

Low intensity service delivery to reduce waiting lists and increase access to areas of high disadvantage Lack of mental health support for young people Address service gaps in the provision of psychological therapies and outreach to rural and remote areas Integrated and coordinated holistic mental health services Step up and down interface with acute services Community education and training opportunities for sector staff

Identified Needs 1.

2.

3.

4.

5.

6.

7.

8.

Access to specialist mental health services.

Access to specialist mental health services for young people.

Access to low intensity mental health services.

Access to mental health services in rural and remote areas.

Access to suicide prevention and services.

Community led suicide prevention approaches.

Integrated and coordinated care across the health system.

Whole of person care for people with complex mental illness and psychosocial disability.

__________________________________________________________________________________

Health Needs Mental Health Mental illness is widespread in Australia, having substantial impacts at the personal, social and economic levels (141). While rates of mental illness are generally consistent across metropolitan and rural Australia, access to services and exposure to external stressors are a considerable problem in rural and remote communities (142, 143). Harsh climates, higher occupational risks, geographic isolation and long distance travel are a normal part of rural community life, however fewer resources and a general lower social economic status add to these challenges (144). With limited access to mental health services and poorer health outcomes, rates of self-harm and suicide increase with remoteness (142).

South Australia is rich with diversity across outer regional and remote areas. The diversity in these areas include variations in demographic composition. Therefore, understanding the unique diversity of a region is a critical element to providing appropriate services (144).

Many of the risk and protective factors for mental health issues have their origins in early and middle childhood, including the development of adaptive coping and problem-solving skills, and exposure to supportive, caring parenting (145). The onset of Mental Illness is typically around mid to late adolescence. The emergence of disorders during this period can have a lasting impact on the health and wellbeing of the individual and their families (145).

People in Country SA PHN region self-report higher psychological distress in comparison with the state average, with Barossa Hills Fleurieu and Yorke & Northern regions being the highest.

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Table 3: Self-reported Psychological Distress in Country SA PHN and SA regions (2018)(70)

Region Barossa Hills Fleurieu Yorke & Northern Flinders and Upper North South East Eyre and Far North Riverland Mallee Coorong Country SA South Australia

Percentage reporting Psychological Distress 17.9% 15.1% 10.9% 9.1% 6.5% 6.3% 13.0% 11.9%

Rural communities are subject to unique challenges, particularly economic and environmental changes including fire and droughts, which strain resilience and potentially leads to increased familial conflict, social isolation, and increased rates of mental illness (144).To address the needs of our population Country SA PHN region commissions a range of mental health services to deliver Low intensity services, Psychological therapies and acute coordinated care.

Generally, data for mental health, Alcohol and Other Drugs and Suicide Prevention grows more limited with increasing remoteness. Due to small community sizes, a majority of the data is unable to be deidentified and released publicly. Not knowing and/or including data from the rural and very remote areas of the state, skews the overall data presented. Whereby statistics may show a reduction in mental illness, rather it may simply portray lacking/ or incorrectly coded data, limiting the knowledge and therefore impact a service could have on a region at need.

Psychological distress In the country SA PHN region, an increase in psychological distress is commonly observed with growing remoteness (146). Psychological distress can have a significant impact on an individual’s life and can develop into more serious mental Health disorders. Factors unique to living in rural and remote areas are often heavily associated with increased levels of distress (70).

Within Country SA PHN region: • •

•

25-34 year old experienced the highest rates of psychological distress across both male and female cohorts (147).

Psychological distress was the highest in the Barossa Hills Fleurieu region followed by the Yorke Peninsula regions.

A significant increase in the use of low intensity mental health services was identified in the 2017-18 period. Low Intensity services were delivered to 1,303 compared to 133 clients in the previous year (148).

Living with a Mental Health condition Over the last decade, there has been a statistically significant increase in the proportion of individuals living with a mental health condition in the region.

• •

•

334 people per 1000 (approx.) reported having a mental health condition in 2017. Most commonly diagnosed were anxiety (9.8%) and depression (10.8%) (70).

An estimated 14.4% of South Australian adults reported experiencing an anxiety disorder in the previous 12 monthsm; this was followed by affective disorders, including depression (6.2%) and substance use disorders (5.1%)(149).

Based on 2021 Census data, SA3 regions with the highest age-standardised rate of self-reported anxiety or depression are the Mid North, Gawler - Two Wells, Fleurieu - Kangaroo Island, Lower North and the Yorke Peninsula (8, 53).

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•

Prevalence of multiple diagnosed mental health conditions (including anxiety, depression, stress related, and other) was previously reported to be highest in Barossa, Yorke and Northern and Flinders and Upper North (70).

Table 4: Diagnosed mental health conditions in Country SA PHN and SA regions (2017) (70)

Region Barossa Hills Fleurieu Eyre and Far North Flinders and Upper North Riverland Mallee Coorong South East Yorke & Northern Country SA South Australia

Percentage diagnosed with mental health concern 21.2% 10.8% 21.9% 15.4% 12.2% 25.6% 19.0% 20.9%

Self-reported mental health service utilisation was highest in the Fleurieu – Kangaroo Island (8.0%) followed by Lower North (7.6%), Limestone Coast (6.5%), and Murray and Mallee (5.6%).

Hospital admissions for a primary diagnosis of a mood and anxiety disorders was highest in outer regional and very remote regions. For many of these people, early identification, support and intervention are provided by general practitioners and other community or primary care providers (147).

In terms of LGA’s, Murray Bridge, Millicent, and several areas in the Riverland had consistently high rates across all mental health diagnoses (147).

The lowest rates of use and access for psychological services are Outback North and East, and the Eyre Peninsula. Despite these regions were amongst the highest rates of schizophrenia disorders for the state, these regions also had the lowest rates accessing clinical psychology, despite higher rates of need (147).

Adelaide Hills Fleurieu has the highest number of GP Mental Health plans prepared (per 1,000 population), while Eyre Far North and Flinders Upper North had the lowest (147). This could indicate lower rates of illness in these areas, poor data collection or a lower rate of individuals seeking help.

Youth Mental Health Youth mental health within this document reflects children or young adults aged up to 25 years.

• •

• • •

The prevalence of psychological distress among youth has increased over the past seven years, particularly among females (64).

27.1% of Youth (aged 15-19) in South Australia in 2018 reported psychological distress, compared to 19% in 2012. (64).

36% of youth with psychological distress did not seek help, despite thinking they needed to (64).

1 in 7 young people aged 4-17 years were assessed as having had a mental health disorder(s) in the previous 12 months (150).

40% of Aboriginal youth indicated concerns about suicide compared to 35.6% of non- Indigenous respondents (64).

The key barriers indicated to help-seeking among youth are stigma and embarrassment, fear, lack of support and accessibility (64).

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Mental Health Hospitalisation In 2016, across Country SA PHN region, the highest rates of mental health related Emergency Department presentations were: • • • •

Ceduna/West Coast (3,158), Flinders Ranges/ Port Augusta (2,870) Barmera/ Berri (2,680), and, Port Pirie (2,295).

Outer regional areas had the highest age-standardised rate per 100,000 persons for schizophrenia, mood and anxiety disorders. Similarly remote regions had increased rates of anxiety and very remote regions showed heightened rates of depression and schizophrenia (147, 151).

•

•

Males had higher mental health admission rates in the outer regional areas while females were highest in very remote areas. Aboriginal and Torres Strait Islander admissions were highest in the very remote areas (152).

The Murray and Mallee region had the highest proportion of mental health admissions for both males and females in the region, followed by the Outback-North and East and the Mid North regions.

Figure 8: SA Mental Health and Suicide Prevention Regional Plan (2017) (153)

Community Awareness Individuals with mental illness are often stigmatised and excluded in the community and workplace (154).

Community mental health training and suicide prevention activities have shown to increase levels of knowledge and attitudes toward mental health and in turn create safer, supportive communities and workplaces (153, 154).

•

1 in 6 working age people will be struggling with mental illness, 1 in 5 workers will take time off work each year and on average 3-4 sick days are taken each month due to untreated moderate depression across our population (154).

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Despite the growing prevalence of mental illness in Australia; literacy on knowledge, education and training about it remain limited in comparison to general health. Good mental health literacy is to have the knowledge, understanding and skills necessary to promote mental health and enhance the ability to recognise, manage and prevent poor health. Learning the early warning signs of poor mental health, and taking action can help reduce the severity of the illness, and possibly prevent or delay the development of a major mental illness (155-157).

Psychosocial Support Encompassing a holistic approach to health including the mental, emotional, social, and spiritual dimensions of what it means to be healthy, psychosocial health is the result of complex interaction between a person’s history and his or her thoughts about and interpretations of the events and circumstances in their life.

Psychosocial support includes a range of non-clinical, community-based supports that can be either group based or individual, depending on one’s needs. Programs may assist people with severe mental illness to participate in their community, manage daily tasks, undertake work or study, find housing, get involved in activities, and build on one’s social connections and support networks. While psychosocial supports are nonclinical in nature, services should ideally be embedded within or linked to clinical services to support a team approach, form part of a multiagency care plan and provide holistic healthcare.

In the Country SA region (2021): • • •

•

20,629 (6.9%) of individuals aged 16 to 64 were on a disability support pension and a further 7,448 were receiving a carer payment.

6.7% of persons needed assistance with core daily activities and approximately 11,133 were unemployed.

578 individuals were accessing capacity building supports under NDIS. Capacity Building Supports enable NDIS participants to build their independence and skill and must be used to achieve the goals set out in their NDIS plan.

13% experienced high or very high levels of psychological distress, exceeding the state average of 11.9% (2).

_______________________________________________________________________________________

Service Needs Low Intensity Service Delivery Low Intensity services appropriately support individuals with or at-risk of mild mental illness at a local level, providing an initial service ‘step’ within the primary health stepped care framework. Through adopting a stepped care approach, services match individuals to a service adequate for their need and reduce waiting lists for more intense therapies.

As of July 2022, Low Intensity Services are operating in the following regions: • • • • • •

Riverland Mallee Coorong Limestone Coast Barossa Hills Fleurieu Flinders Upper North Eyre Far North Yorke and Northern (148)

For regions without a physical service in place, Regional Access (24/7 phone and online services) and the Royal Flying Doctors Service are available.

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Psychological Therapies Psychological therapies are delivered to mild to moderate groups within the stepped care approach. Clinical outcomes for people receiving Psychological Therapies showed 71% of clients had a decrease in levels of distress after receiving a service (148).

Currently psychological therapies are delivered in most regions of Country SA PHN region. However, service provision rates are lower than the state average across all regions in country SA, indicating an imbalance with service provision in the metropolitan area despite equal or greater need in many rural areas.

Generally, there is a workforce shortage across the region. Psychologists are in high demand and yet are limited particularly in rural and remote areas(158). Workforce availability in rural regions impacts consistency of delivery for psychological therapies and clinical care coordination services despite most Country SA PHN regions having some level of need.

Where Psychologists are available, extended waiting periods exist and/or high cost gap payments prevent consumers from attending their services.

The need for psychological therapies is growing consistently, whereby client access for moderate mental illness increased significantly from approximately 3800 to 6800 between 2016-2018.

Figure 9: Country SA PHN client access across stepped levels of care (2016-2018) (153)

Youth Mental Health Youth mental health services are directed at children or young adults aged up to 25 years. Services range from Low Intensity, across Psychological Therapies and are primarily delivered via Headspace centres.

Workforce shortages and retention of appropriately qualified staff impact delivery of Youth specific mental health services in the country region. These limitations affect all aspects of health in the region and are not specific to youth mental health (146, 159). Commissioned service providers and tertiary partners across country region have identified heightened and escalating demand for service resulting in extended wait times (160).

For youth aged 12-25 years, Headspace is the predominant mental health service provider across the region with eight operational centres in the Country SA PHN region.

The 8 Headspace centres in Country SA PHN are located in: •

Port Augusta Page 49 of 84

• • • • • • •

Berri Murray Bridge Mount Gambier Victor Harbour Port Lincoln Whyalla Mount Barker (148)

In the 2021-22 period, Headspace delivered 12,203 occasions of service to 2,935 young persons, including 1,631 new clients. This represents an increase of 863 clients since 2017-18 (161). Occasions of service was highest for centres located in: •

Mount Gambier (1,874)

•

Mount Barker (1,809)

•

Port Augusta (1,792) (161)

Integrated and coordinated holistic care Integrated care is the organisation and delivery of health services to provide seamless, coordinated, efficient care that responds to a person’s health needs. An individual engaged within an integrated care model will receive a continuum of care inclusive of health promotion, disease prevention, diagnosis, treatment, disease management and rehabilitation coordinated across different levels and sites of care, accounting for comorbidities and external factors that influence ones health (144, 162).

Community consultation consistently identifies the lack of cohesive and integrated services and health provider communication across the care continuum.

Step up and Down Interface For many rural communities, Emergency Departments are the only option for people experiencing an acute mental health crises(163). The national average wait for 90% of patients with mental health conditions was 11.5 hours compared to just 7 hours for physical conditions (163).

In SA, the average waiting time in an Emergency Department for a mental health crisis is 16.5 hours (163).

Currently help seeking at the emergency department (ED) for acute mental and behavioural care currently sits at 185 per 100,000 in remote areas compared to 101 in major cities, highlighted an issue in rural and remote regions (163).

The step up and down interface provides an intermediate level of care between the inpatient and community setting, used as a bridging support between pre and post-acute services (164). The step up and down services provide an alternative to hospital admission in addition to a support mechanism following hospital discharge, ensuring consumers remain supported through out.

The Mental Health Shared Care program aims to assist individuals with complex mental health needs to increase their capacity to manage their physical and mental health, avoid relapse through early intervention or the onset of acute symptoms(164). A key element of the service is the communication and integration between the services involved in a person’s care including their GP. In Country SA, the shared care locations are Port Augusta, Whyalla, Kadina, Murray Mallee, Berri, Mount Gambier, Adelaide Hills, Fleurieu and Kangaroo Island.

The Clinical Care & Coordination (CCC) program is aimed at providing clinical care and coordination of services for an individual experiencing severe and persistent mental illness. Consultation and liaison may occur with primary healthcare providers, acute health, emergency services, rehabilitation and support services, family, friends, other support people and carers and/or other agencies that have some level of responsibility for the client’s treatment and/or well-being. In the 2021-22 period, Clinical Care Coordination (CCC) was delivered to 6,893 service contacts across the Country SA PHN region. CCC is delivered by 4 regional providers in: Port Lincoln, Barossa Hills Fleurieu, Yorke and Northern, Murray Mallee Coorong, Limestone Coast and the Riverland (161). ________________________________________________________________________________________

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Community Voice – Mental Health Face to Face consultations, paper based and online surveys in conjunction with community forums have been both participated in and facilitated by Country SA PHN to hear directly from the community, key stakeholders and service providers alike to ensure their thoughts and views are heard. The below summarises key community or stakeholder consultations conducted in the region over the past 6 years.

1.

• • • 2.

• • • • • •

3.

• • •

Services that work together collaboratively Integrated service delivery, with holistic view on health to encompass all aspects of an individuals life Service providers talk to one another for a seamless referral pathway from low intensity to acute care A coordinated approach to the promotion of mental health and wellbeing and early-in-life intervention Accessibility and meeting the needs of the population More mental health services based in rural and remote regions to reduce travel, distance, and time away from work Youth mental health specific services and trained health professionals within this field After Hours services – available outside 9-5 and on weekends and after work hours Confidentiality around seeking help in small communities, where everyone knows each other Utilising technology and digital media to reach those in more remote and rural communities Services and interventions which recognise that some population groups are at higher risk of having or developing mental health issues or have diverse needs Improve community awareness and reduce stigma Forums and workshops for community members and health workforce, from basic to advanced knowledge bases (Mental Health First Aid, ASSIST, Question Persuade Refer) Improve knowledge and skills of health staff in rural and remote areas – particularly around the increased stressors experienced with drought, bushfires, and floods.; Having strategies in place and training for managers from all walks of life so people feel confident to disclose knowing they will be cared for by their employer

4.

• •

Simple and clear pathways of care Knowing where to go and that you will be referred to the right level of care Communication between providers, to ensure information is passed on rather than having to start from scratch at each level of care.

5.

•

Importance of strong leadership, governance, planning and funding South Australians and organisations are seeking greater sustainability in funding models which support innovation, opportunities for collaborative or shared approaches to developing best practice in care delivery, and excellence in service provision Improved governance of services to ensure person-centred, recovery-focused and outcomes-oriented approaches

•

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Health Needs – Suicide Prevention While suicide is an infrequent occurrence in Australia, the effects and aftermath can be both traumatic and long-lasting for families and communities alike. Across Australia, people residing in rural and remote communities have a higher risk of suicide than those living in metropolitan areas. Particular rural communities across the state experience significantly higher rates of attempts and deaths, compared to the national and state averages (153).

Rural and remote South Australian communities are diverse with each varying in size, population dispersion, culture, ethnicity, proximity to other towns and regional centres, and other demographic factors (165). Rural communities face a higher threat of periods of adversity due to natural events including fire, drought and flood (165). When these occur, the wellbeing and economic security of rural communities are negatively impacted often for prolonged periods causing significant effects for the residents within these communities (165). Planning for the prevention of rural suicide at the local and regional level needs to take this diversity and variation into account.

In response to the growing rates of suicide in rural and remote communities, part of the Country SA PHN region was selected as one of the 12 National Suicide Prevention Trial sites in 2017. The trial brought significant resources, activity, and funding to areas of need throughout the Country North region of South Australia, including Whyalla, Port Augusta, Port Pirie, Port Lincoln and the Yorke Peninsula. The trial was placed at a regional level to respond to local needs and identify new learnings in relation to suicide prevention strategies. The trial has adopted elements of the Black Dog Institute’s LifeSpan model – a system-based approach to the delivery of suicide prevention services, targeting populations identified at a local level as ‘at-risk’.

The pathway to suicide is varied and complex, particularly so when comparing Indigenous and non-Indigenous Australians. Generally, Indigenous Australians are more likely to experience racism, disempowerment, cultural dislocation, increased rates of trauma and grief, involvement in the justice system and a myriad of physical illness and chronic disease (166). These factors in addition to high proportions living in rural and remote communities, further increases an individual’s risk of suicide and self-harm.

In 2020: • • • • • •

Country South Australia had a higher rate of suicide compared with the greater Adelaide region Country SA saw a decrease in the age-standardised rate of suicide from 16.1 per 100,000 in 2019 to 15.4 per 100,000 in 2020 Females accounted for 62.9% of intentional self-harm hospitalisations in Country SA PHN The highest age-standardised rate of death by suicide was in the Eyre Peninsula and South West (16.9), Yorke Peninsula (16.8) and Limestone Coast (17.6) Suicide accounted for 5.5% of all deaths of Aboriginal persons compared to 1.9% for their non-indigenous counterparts Twenty five percent of all deaths by suicide in Indigenous people were female, this was greater than that seen in the non-Indigenous population (23% females) (167).

Within Country SA PHN region, the highest rate of suicide was in Eyre Far West, Flinders Upper North and Yorke Peninsula, while the highest attempt rates were in the Limestone Coast, and Riverland Murray Coorong (168, 169).

Hospitalisation for Intentional Self Harm In 2018-19, South Australia recorded 2,506 hospitalisations for intentional self-harm. The highest rates were in the Mid North, Outback and Murray Mallee regions (167).

Females are more likely to be hospitalized than males for intentional self-harm (152) based on intentional self-harm and hospital separations data. This difference is likely due to males being more than three times as likely to complete suicide than females.

Emergency Department presentations for intentional self-harm are difficult to capture because the recorded data is only for principal diagnosis and does not include an external cause code for intent. This makes it likely that many occasions of intentional self-harm are underestimated due to clinical coding limitations.

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At-risk groups The causes of suicide are complex. A range of factors can contribute to suicide and self-harm, however particular groups/communities are identified as being at a higher risk than others. Within Country SA PHN region rurality, gender, cultural background and age contribute to the most at-risk populations.

Rurality Data on suicide and self-inflicted injuries in Australia shows that with growing remoteness there is an increased death rate from such causes (165). Country SA PHN is predominantly regional, rural and remote communities. The table below depicts the change in prevalence and rate of suicide from major cities to very remote communities within Australia (144).

Table 5: National Australian suicide rates per 100,000 persons by remoteness (2020) (167)

Location Major Cities Inner Regional Outer Regional Remote Very Remote

Suicide Rate per 100,000 people 10.3 15.1 19.3 18 22.9

The increased risk within rural communities relates to unique challenges, particularly economic and environmental circumstances including fire, floods and droughts within these regions (165). Such events can create, anxiety, loss of income, social isolation, increased familial conflict, mental illness and lowered resilience which in turn can increase suicide risk (144). Additionally, access to mental health service is limited in some rural communities, in turn reducing help-seeking and appropriate counselling or treatment options.

Gender Males die by suicide at a greater rate than females, however females attempt suicide more often than males (151). In Country SA PHN region males accounted for 79% of all deaths by suicide, a ratio of more than 3:1 (168). Comparatively females accounted for the highest rates of suicide attempts and self-harm(170). 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 of lethality of mechanism (165).

Culture In 2020, the suicide rate among Aboriginal and Torres Strait Islander people was approximately twice that of nonIndigenous Australians (167, 171). Factors specific to culture, racism and general health all contribute to these rates.

Suicide was the second leading cause of death among male Aboriginal and Torres Strait Islander people in 2019 and 7 th for females (171). The majority of suicide deaths Aboriginal people occur before the age of 35 and rates of self-harm within these communities are significantly higher than those observed within other communities (166). In accordance with national trends, males represent the majority of Indigenous suicides (151).

Suicide is a considerable issue for Aboriginal youth. Persons aged 15-24 years of age were over five times as likely to suicide as non-indigenous counterparts (165). Aboriginal youth currently account for 30% of suicide deaths in those under 18 years of age in Australia (165). ________________________________________________________________________________________

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Community Voice – Suicide Prevention Face to Face consultations, paper based and online surveys in conjunction with community forums have been both participated in and facilitated by Country SA PHN to hear directly from the community, key stakeholders and service providers alike to ensure their thoughts and views are heard.

Accessible Services •

•

Main barriers to accessing Suicide Prevention services: Availability of services Limited access to integrated suicide prevention services within the region Waiting times Distance of travel required to attend service Lack of targeted services for social minority groups such as lesbian, gay, bisexual, transgender, and intersex community (LGBTIQ+) people and people from CALD backgrounds

Follow up Care • •

The risk of suicide attempts and death is highest within the first 30 days after a person is discharge from an ED or inpatient Psychiatric unit, yet in Country and regional areas, follow up care is limited Aftercare services are needed across the region – particularly Aboriginal aftercare services

Need for community training in suicide prevention • • •

More community suicide prevention training for the general public (e.g. ASIST) Training in risk assessment and safety planning is required for all of community and employers alike as identifying the at-risk person is inconsistent and often missed Communities and front-line worker need awareness raising and training

Workforce Collaboration • •

Prevention services exist in some areas but are not well integrated or known Appropriate service mapping is required and needs to be transparent and show how services interconnect

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Health Workforce 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.

Key Points • • •

Most regions across country SA are nationally designated GP Distribution Priority Areas Recruitment and retention of primary health workforce remains a challenge Rurality and remoteness impact workforce distribution

Identified Needs 1.

Workforce and service sustainability.

Service Needs Regional and rural areas face health workforce challenges related to an ageing workforce, a rise in the number of patients experiencing chronic disease and the complexity of a diverse geographic environment and changing community demographics. There is a continued difficulty in attracting, recruiting and retention of health professionals to rural and remote areas.

Community issues of concern are availability of General Practice, Allied Health, and Specialist services; physical access given limited transport options; and affordability.

General Practitioners (GPs) GPs in country SA not only provide primary health care services via general practice, they also provide medical services in local Emergency Departments, and procedural services such as minor surgery and Obstetrics.

Nationally, the Distribution Priority Area classification identifies locations where people don’t have enough access to doctors, based on the needs of the community. Following an updated classification in July 2022, all regions in Country SA are identified as Distribution Priority Areas for GPs, with the exception of two GP catchments in Mount Barker (172).

In 2021, the average GP full-time equivalency (FTE) in SA was 11.8 per 10,000 persons and ranged between 7.2 – 12.9 FTE based on remoteness, as classified by the Modified Monash Model (MMM). Regions with the lowest GP FTE per 10,000 persons were those classified as Modified Monash (MM) categories 2 (regional centres) (7.2 GP FTE) and 7 (very remote communities) (7.5 GP FTE). This was followed by regions classified as MM5 (small rural towns) (9.1 GP FTE) and MM6 (remote communities) (9.9 GP FTE). Whilst MM2 regions had the lowest reported GP FTE per 10,000 persons, it should be noted that these populations may often access GPs in MM1 (metropolitan) regions, which had the highest GP FTE per 10,000 persons (12.4 GP FTE)(173).

Access to available GP services is limited with 38% of adults in the Country SA PHN region reporting that at some point over a 12 month period they could not access their preferred provider, and 28% felt they waited longer than acceptable to get an appointment with a GP (174).

Nurses and Midwives The Mid North had the greatest number of Nurses and Midwives practicing in the area per 1,000 population (92.6 per 1,000) if the majority of nurses are living within the area, this means just over 9% of the Mid North population are a registered or enrolled nurse. In contrast, Adelaide Hills, Gawler – Two Wells, and Barossa had the lowest ratio per

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1,000, but this could be due to the proximity and thus possibility of their primary place of employment being within the metro area (31).

An estimated 97% of General Practices in Country South Australia employ at least one practice nurse (i.e. 1 FTE), exceeding the national average (79).

Allied Health: Podiatry, Physiotherapy, Occupational Therapy The number of professionals delivering Occupational Therapy (OT), Podiatry, and Physiotherapy services decreases the further travelling away from metro areas, with only 13% of these professions having their primary place of practice in regional, rural and remote areas (MM3 – MM7) of South Australia (175).

Figure 10: Country SA PHN region Modified Monash Model (MMM) remoteness area map (2021)

Physiotherapists are reasonably well distributed in MM 3 – 4, and MM6 areas (10.5 – 12.9 per 10,000 population) but reduce to 6 per 10,000 population in MM5 areas and down to 2.2 per 10,000 in MM7 areas (175).

Podiatrists are similar in their distribution between MM 1 – MM4 areas but decline in MM5 to 1.5 per 10,000 and further down to 0.6 per 10,000 population in MM7 areas (175) There are 8.6 OTs per 10,000 population in MM3 (large rural towns) areas compared to 12.4 per 10,000 in MM1 & 2.

Numbers of OTs reduce with remoteness, down to 2.2 therapists per 10,000 population in MM7 (175).

Dentists and oral health professionals The private dental sector is the largest provider of oral health care in South Australia. Fewer dental professionals practice in rural and remote areas, with recognised maldistribution of oral workforce between Adelaide and country SA resulting in insufficient workforce in regional and remote areas, and a reliance on public dental services for regional and remote populations (95).

Pharmacists Pharmacy services are an important part of the primary health care system, providing vital access to prescription medications, professional advice and other health and wellness supplies and programs. While medications can still be Page 56 of 84

obtained through pharmacy depots or online in some remote locations, the presence of a pharmacist and fullservice pharmacy is an advantage to a community.

The highest ratio of pharmacists to population was in the Mid North, with 4.3 pharmacists per 1,000 population, the lowest was the Barossa with 2.3 per 1,000 (31).

After hours care The provision of sustainable after hours medical services within rural and remote regions of Australia is an ongoing challenge for providers and coordinating agencies. It is reliant on not only the existence of the workforce, but also the ability of practitioners to participate in on-call, after-hours activity, especially in areas with workforce shortage where the distribution of workload disproportionately falls on very few practitioners.

After hours (AH) services within the Country SA region are available through hospital emergency departments (EDs) and/or through extended hours offered by GP clinics. In the majority of hospitals in the Country SA region, EDs are serviced by on-call GPs from the area. The highest number of AH GP sites are located the Adelaide Hills, followed by the Eyre Peninsula and South West (see Table 6). However, the Eyre Peninsula and South West region has a very large area and a high number of sites located within the regional cities of Whyalla and Port Lincoln, meaning AH service is sparsely distributed throughout the remainder of the region (161).

The Country SA PHN region has less than half the rate of AH GP attendances than the SA and national average, indicating potential gaps in service provision or challenges with access. SA3 regions with the lowest ratio of AH GP services provided (per 1,000 persons) are the Limestone Coast, Eyre Peninsula and South West, the Yorke Peninsula, Mid North, and Fleurieu - Kangaroo Island (see Table 6).

Lower urgency ED presentations are indicative of health conditions or events that could often be more appropriately managed in the primary care setting (176). A high rate of presentations in the AH period may therefore indicate gaps in use or availability of alternative services. Analysis of restricted SA Health ED data identified Country SA regions with a high proportion and per-capita rate of lower urgency AH presentations, and this was used to inform internal planning.

Table 6: Use of general practice (GP) services and number of general practices with after hours (AH) services in Country SA SA3 regions (2020/21).

SA3 Region

AH GP services provided per 1,000 persons # GP sites with AH services (2021)

Eyre Peninsula and South West 88

21

Outback - North and East

251

12

Mid North

117

6

Murray and Mallee

234

14

Gawler - Two Wells

326

5

Limestone Coast

82

18

Lower North

140

9

Yorke Peninsula

106

13

Barossa

173

9

Adelaide Hills

202

22

Fleurieu - Kangaroo Island

126

9

CSAPHN Region

168

138

Table Notes: • Estimated resident population calculated based on average of 2020&2021 ABS data; SA3 region counts based on primary residence of patient.

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Health Information and Technology 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 remain disconnected impacting integration and the patient journey.

Key Points • • • •

Low use of telehealth by general practice and specialist services Electronic referrals limited Low uptake of secure messaging Limited awareness of required web services transition for Department of Human Services

Priorities 1.

2.

3.

Effective uptake of telehealth and secure messaging Supporting web services transition Supporting Real Time Prescription Monitoring

_______________________________________________________________________________________

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

Continued use by GPs and use and uptake by the general public is variable. The core activity for use has been with General Practice and Pharmacy.

Use of the My Health record for cross views is dependent upon allied health, specialists, aged care and hospitals also being able to upload. Registration and use by other provider groups is required in order for effective uptake.

Telehealth There is a low uptake of uptake of telehealth by providers as an ongoing service delivery model. Lack of permanence of relevant MBS item numbers and standards for platforms has contributed to the reticence by general practice to introduce regular and consistent use when appropriate (177).

Electronic referrals Across Australia electronic referrals and transfer of patient information between health providers is limited, with only 40% of GP and specialist letters or referrals being electronic (79). Faxed transfer of information maintains the continued practice with a high proportion of general practices and allied health providers across country SA using this method to send referrals or clinical reports.

Across country SA region: • • • •

Only 46% of general practitioners and 22% of allied health professionals are employing secure messaging software to send information (79) No RACFs across Country SA PHN region have secure message facilities (178) Discharge summaries faxed from SA Health experience around a 40% failure rate Local hospitals do not have secure messaging facilities

In circumstances of shared care such as aged care it has a negative impact upon information being consistent or timely.

Allied health providers are less likely than general practice to use electronic patient records (61% vs. 99%)(178). As a result, only about 50% of allied health professionals report that they can easily generate a clinical summary to share with patients or other health care providers, compared with around 90% of GPs (79).

Page 58 of 84

Web Services Transition From March 2022, all payments to healthcare providers will be processed by a web service connection to Department of Human Services. Verification of the Healthcare provider and location of service will be using a combination of the Australian Business Register, Provider numbers and allocated Facility numbers. The change will impact all My Aged Care, NDIS, PBS, MBS, and private health insurance payments.

Transition impacts general practice, pharmacy, allied health, and dental services, requiring complex business system, software and administrative changes. There are identified delays from software providers with bringing requirement ready updates and products to market to support service providers.

Allied Health service providers have low awareness of transition requirements and an impact on Allied Health business service delivery is anticipated (178).

Real Time Prescription Monitoring (RTPM) RTPM is a nationally implemented system, to monitor the prescribing and dispensing of controlled medicines.

Monitored drugs include all Schedule 8 medicines (drugs of dependence) and Schedule 4 medicines. It is expected that it will become mandatory for SA prescribers to utilise the digital platform ScriptCheckSA before prescribing a monitored drug by April 2022.

Dentists have had limited engagement and support in preparation for required deadlines, and dental software is nonconformant for RTPM (41).

Secure messaging Secure Messaging is the intentional end-to-end sending of encrypted information in a format which enables data transfer. Although the majority of General Practice is able to use – the value is only fully realised when those with whom they share care such as Allied health and Aged Care are also connected.

The recent transition to Interoperable Secure Messaging allows for differing secure messaging vendors to share directories and communicate between systems.

However, interoperability is built upon the use of the Healthcare Identifier (HI) Service so Allied Health, Residential Aged Care Facilities and Dentists will need to be registered for the HI Service. Registration is a requirement for Real Time Prescription Monitoring.

As at 2021, for registrations for HI Service as at October 2021: • • •

Allied Health: 65 or 14% of providers Residential Aged Care Facilities: 25 or 37% of providers Dentists: 1 or 0% of providers (179)

Electronic referrals uptake and implementation by SA Health is another function of Secure Messaging. ________________________________________________________________________________________

Community Voice Telehealth became a more used mechanism during 2020 with face-to-face access to GPs reduced due to COVID-19 restrictions. 73% of survey respondents accessed telehealth during this period and there was overall support for continued and ongoing use of telehealth for delivery of care to support.

Specific consultation identified support for use of telehealth for: • • •

GP consults for minor or non-clinical needs such as proof of vaccination, confirming details when there has been a change in care, or a prescription Specialist follow-up appointments to reduce time off work, costs associated with travel and accommodation for short consults Services that can be delivered via video or telephone but otherwise usually require travel (e.g. dietician, mental health services) (99)

________________________________________________________________________________________ Page 59 of 84

Opportunities, Priorities and Options This section summaries priorities from the health and service needs analysis, and options for how they may be addressed.

Priorities 1.

2.

3.

4.

5.

6.

7.

Aboriginal and Torres Strait Islander Health Aged Care Alcohol and Other Drugs Mental Health Population Health Digital Health Health Workforce

Identified needs 1. Access to afterhours services 2. Access to culturally appropriate health services 3. Access to health care services and preventative care 4. Access to low intensity MH services 5. Access to Mental Health services in rural and remote areas 6. Access to oral health services 7. Access to specialist MH services 8. Access to specialist MH services for young people 9. Access to specialist services to support ageing well 10. Access to specialist services to support developmental health and wellbeing of children and youth 11. Access to suicide prevention and services 12. ACCHOs are supported to improve the individual and community health experience 13. CALD communities are supported to engage and participate in health prevention and health care 14. Chronic disease: multidisciplinary care and prevention 15. Community appropriate MHAOD rehabilitation services 16. Community led suicide prevention approaches 17. Delivery of specialist AOD services 18. Improve immunisation and vaccination rates 19. Improve individual and community health outcomes 20. Integrated and coordinated care across the health system 21. Medication Management 22. Older persons are supported to stay healthy and well in their place of residence 23. Reduce potentially preventable hospitalisations 24. Utilisation of technical solutions to facilitate integrated and coordinated care across the health system 25. Whole of person care for people with complex mental illness and psychosocial disability 26. Workforce and service sustainability _______________________________________________________________________________________

Page 60 of 84

Aboriginal and Torres Strait Islander Health Identified Need

Sub Priority

Opportunity

Expected Outcome

Options

Potential Lead

Access to culturally appropriate health services

Appropriate care (including cultural safety)

Support Access to Care Health Services

Increase individual and community access to health care services.

Support Health Services General Practice/ ACCHOs

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

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

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

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.

ACCHOs are supported to improve the individual and community health experience

Potentially Preventable Hospitalisations (PPH) Workforce

Improve the Health System - System Integration & Coordination

Improve individual and community health outcomes

Chronic Disease (Screening/ Management/Coo rdination)

Support Access to Care Health Education

Support Health Services General Practice/ ACCHOs

Improve the Health System - Health Technology

Early Intervention Prevention / Social Determinants Multi-Disciplinary Care

Increase individual and community access to resources that effectively assist use of health knowledge and understanding, increasing choices and supporting decisions on health care Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Support Access to Care Prevention Activities

Increase individual and community access to preventative health care services.

Support Health Services General Practice/ ACCHOs

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Improve the Health System - Health Technology

Commission activity to facilitate coordination of care for individuals who experience frequent or high levels of hospitalisation.

In partnership with ACCHOs provide material support according to identified needs to facilitate operational, workforce, service improvements.

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.

Linking of chronic care programs for Aboriginal and Torres Strait Islander people as they move across and through the region, through: Multiparty conferencing for case conferencing with health professionals in different locations; and Promotion of My Health Record Investigate opportunities that support prevention, early identification and treatment activities.

Support the RFDS to continue to build capacity in providing primary health services to remote communities.

Facilitate 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.

Page 61 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Aged Care Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Older persons are supported to stay healthy and well in their place of residence

Access

Support Access to Care - Health Services

Increase individual and community access to health care services.

Delivery of services to support staying well at home, including support for self-navigation and service access via My Aged Care, preventing decline in function and staying well in place.

CSAPHN Regional LHNs

Health Literacy

Support Access to Care - Health Education

Increase individual and community access to resources that effectively assist use of health knowledge and understanding, increasing choices and supporting decisions.

Facilitate supporting older people to access to information and services.

CSAPHN COTA Dementia Australia Alzheimer’s Australia SA Palliative Care SA Active Ageing CSAPHN

Workforce

Potentially Preventable Hospitalisations (PPH)

Medication management

Access to specialist services to support ageing well

Potentially Preventable Hospitalisations (PPH) HealthPathways

Partner with peak bodies and relevant groups for collaborative on activity to facilitate knowledge, understanding and support decision making.

Delivery of skill and knowledge opportunities to improve workforce capability in deliver of quality care including: dementia, palliative, functional fitness.

Support Health Services - Workforce Training and Development Support Access to Care - Health Services

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

Increase individual and community access to health care services.

Work in partnership to implement effective service models to support GP care and management of older persons staying well in place.

CSAPHN SA Health Rural Support Service (RSS)

System integration and coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Explore opportunities for facilitating safe transition of care between home, RACF and hospital.

Improve the Health System - Health Technology

Facilitate delivery of service utilising technology to support access and integrated multidisciplinary care, including telehealth.

Support Access to Care - Health Services

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Increase individual and community access to health care services.

CSAPHN SA Health Regional LHNs SAAS Rural Support Service (RSS) CSAPHN ADHA

Facilitate access to medication reviews and support for medication management for people living at home and in RACF.

CSAPHN WBSA

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Prioritise aged care pathways in the HealthPathways project.

CSAPHN APHN WBSA CSAPHN APHN WBSA

Identify referral pathways and services for community physical activity for older persons

Page 62 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Alcohol & Other Drugs Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Delivery of specialist AOD services

Aboriginal and Torres Strait Islander Health

Engage with Stakeholders Community

Increase knowledge and understanding of community health and wellbeing needs to support CSAPHN with effective commissioning of activity and advocacy for communities.

Work with Aboriginal communities to implement communityspecific responses and support models to address identified drug and alcohol issues and hospital separations.

CSAPHN MHAOD Community

Engage with Stakeholders - Health Service Sector

Increase knowledge and understanding of local, state and national health service sector to support CSAPHN with effective commissioning of activity and advocacy for primary health care.

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

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

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

Support Access to Care - Health Services

Increase individual and community access to health care services.

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

Commission brief intervention, withdrawal management and counselling with alcohol and amphetamines focus.

Facilitate establishment of long term rehabilitation programs in country regions.

Improve the Health System - System Integration & Coordination Support Access to Care - Health Services Support Health Services - Workforce Training & Development Support Health Services - Workforce Training & Development

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase individual and community access to health care services.

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

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

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

Facilitate drug and alcohol upskilling across existing mental health programs and funded activity.

CSAPHN ADAC ACCHOs

Co-design and commission AOD services responsive to community need.

Facilitate drug and alcohol upskilling across existing mental health programs and funded activity.

Page 63 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Alcohol & Other Drugs Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Community appropriate MHAOD rehabilitation services

Access

Improve the Health System - System Integration & Coordination Support Access to Care - Health Services

Advocate for community health and wellbeing needs and primary health care at a local, state and national level.

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

CSAPHN ADAC

Increase individual and community access to health care services.

Explore required support measures to address lack of residential services in rural areas.

CSAPHN Regional LHNs Private Sector

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Investigate continuity of care with discharge from acute care to inform commissioning and system improvement activity.

Inclusive of medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

CSAPHN Regional LHNs Hospitals

Integrated and coordinated care across the health system

Potentially Preventable Hospitalisations (PPH)

Page 64 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Mental Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Access to low intensity MH services

Access

Support Access to Care - Health Services

Increase individual and community access to health care services.

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

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

CSAPHN SA Health

Improved demand management strategies.

CSAPHN SA Health Regional LHNs

Care Coordination

Workforce

System Integration

Access to Mental Health services in rural and remote areas

Access to specialist MH services for young people

Access

Early Intervention Prevention / Social Determinants

Support Access to Care - Health Services Improve the Health System - Advocacy Improve the Health System - System Integration & Coordination Support Access to Care - Health Services Support Health Services - Mental Health and AOD Improve the Health System - System Integration & Coordination Improve the Health System - System Integration & Coordination

Increase individual and community access to health care services.

Advocate for community health and wellbeing needs and primary health care at a local, state and national level.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase individual and community access to health care services.

Health Service providers are supported to improve individual and community health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Support Access to Care - Health Services

Increase individual and community access to health care services.

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

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

Review feasibility and efficiency of centralised regional triage and intake.

LHNs APHN

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

Work with identified service providers and sector representative bodies to facilitate improved clinical governance practices.

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

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.

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.

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

Explore effective early intervention models and linkage into youth health services.

CSAPHN SA Health Regional LHNs Headspace

CSAPHN SA Health Regional LHNs RFDS

Page 65 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Mental Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Access

Support Access to Care - Health Services

Increase individual and community access to health care services.

Work in partnership to support organisations that provide family and community programs in the target regions.

Headspace

Increase individual and community access to health care services.

Commission youth focussed MHAOD services in communities of need including engagement with the RFDS and Headspace sites for improved outreach services.

Promote better mental health for youth through support to Headspace and community programs and education and youth support and counselling activities.

Facilitate telehealth options for increased access to psychiatry services.

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

Targeted commissioning to meet areas of need.

Co-design activity through flexible funds.

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

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

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.

Increase individual and community access to health care services.

Access to suicide prevention and services

Access

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Support Access to Care - Prevention Activities Improve the Health System - System Integration & Coordination

Increase individual and community access to preventative health care services.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Access

Support Access to Care - Health Services

Increase individual and community access to health care services.

After Hours

Engage with Stakeholders Community

Increase knowledge and understanding of community health and wellbeing needs to support CSAPHN with effective commissioning of activity and advocacy for communities.

Improve integration of systems and coordination of care across health services for

Care Coordination

Community led suicide prevention approaches

Improve the Health System - System

Co-design activity through flexible funds.

Commission Aboriginal and Torres Strait Islander suicide prevention through psychological therapy for underserviced groups.

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

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.

Work in partnership with Aboriginal communities to implement community-specific response and support models

CSAPHN SA Health Regional LHNs Black Dog Institute Commonwealth Suicide Prevention Networks

CSAPHN SA Health Regional LHNs Black Dog Institute Commonwealth Suicide Prevention Networks

Page 66 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Mental Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Integration & Coordination Improve the Health System - System Integration & Coordination

improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Appropriate care (including cultural safety)

Support Access to Care - Health Services

Increase individual and community access to health care services.

Health Literacy

Improve the Health System - System Integration & Coordination Improve the Health System - System Integration & Coordination Support Access to Care - Health Services Support Access to Care - Health Services

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase individual and community access to health care services.

Increase individual and community access to health care services.

to address episodic mental health occurrences in the afterhours period through the delivery of training and education 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.

Commission culturally appropriate community-led suicide prevention activity in communities of need.

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

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

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

Care Coordination

Access to specialist MH services

Access

Facilitate transparency of services available to increase awareness of service providers and commissioned services

Potential Lead

CSAPHN SA Health Regional LHNs Headspace

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

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

Commission existing Commonwealth funded psychosocial support Commission existing funded psychosocial support Commission new psychosocial services under Continuity of Support for Country South Australia

Page 67 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Mental Health Identified Need

Integrated and coordinated care across the health system

Sub-Priority

Opportunity

Expected Outcome

Options

Health Literacy

Engage with Stakeholders Community

Facilitate community forums and development of community knowledge and awareness.

Care Coordination

Improve the Health System - System Integration & Coordination

Increase knowledge and understanding of community health and wellbeing needs to support CSAPHN with effective commissioning of activity and advocacy for communities.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Workforce

Support Health Services - Workforce Training & Development Improve the Health System - System Integration & Coordination

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

Support Health Services - Workforce Training & Development Improve the Health System - Health Technology

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

Care Coordination

Workforce

System Integration

Whole of person care for people with complex mental illness and psychosocial disability

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Access

Support Access to Care - Health Services

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Increase individual and community access to health care services.

Care Coordination

Improve the Health System - System Integration & Coordination Support Health Services - Mental Health and AOD

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Health Service providers are supported to improve individual and community health outcomes and experience of health care.

Potential Lead

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.

Specialised upskilling across existing mental health programs and funded activity.

CSAPHN SA Health Regional LHNs

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.

Specialised upskilling across existing mental health programs and funded activity.

CSAPHN ACCHOS Black Dog Institute Commonwealth

Support quality improvement with service provider data practices including data collection, coding, reporting and dissemination across region.

CSAPHN SA Health Regional LHNs Black Dog Institute Commonwealth

MHAOD ITA as part of Most Competent Provider (MCP) process.

Co-design activity through flexible funds.

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

CSAPHN SA Health Regional LHNs

CSAPHN SA Health Regional LHNs

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.

Page 68 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Mental Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Support Access to Care - Health Services

Increase individual and community access to health care services.

System Integration

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Support design and implementation of sustainable and appropriate care coordinator models within various employment models.

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

Promotion of a stepped care model as part of greater synergy and interaction with mental health services.

Work with inter-sectoral partners and use research to develop a primary health services, ‘Service Delineation Model’ for rural SA. CSAPHN will work with and support GPs, Adelaide Primary Health Network (APHN), the Regional LHNs and metro LHNs in the implementation of integrated systems.

Facilitate integration of support facilitation models in commissioned activity.

Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Access to culturally appropriate health services

Vulnerable People (Non-First Nations specific)

Support Health Services - General Practice/ ACCHOs

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Allied Health service providers are supported to improve individual and community health outcomes and experience of health care.

Advocate for community health and wellbeing needs and primary health care at a local, state and national level.

Increase individual and community access to health care services.

Increase knowledge and understanding of local, state and national health service sector to support CSAPHN with effective commissioning of activity and advocacy for primary health care.

Support general practice and service providers to ensure delivery of culturally appropriate services.

CSAPHN SA Government Cultural Diversity leads

Population Health

Support Health Services - Allied Health Improve the Health System - Advocacy

Access to health care services and preventative care

Access

Support Access to Care - Health Services Engage with Stakeholders - Health Service Sector

Support allied health providers to ensure delivery of culturally appropriate services.

Leverage existing partnerships and relationships with state and other institutional providers to facilitate inclusion of population demographics experiencing vulnerability.

Delivery of services that respond to the identified needs for population demographics experiencing vulnerability.

Engage with local providers to explore regional access to services and uptake of preventative care.

CSAHPN State Government Commonwealth

Page 69 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Population Health Identified Need

Sub-Priority

After Hours

Early Intervention Prevention / Social Determinants Access to oral health services

Access to specialist services to support developmental health and wellbeing of children and youth CALD communities are supported to engage and participate in health prevention and health care

Access

Opportunity

Expected Outcome

Options

Potential Lead

Support Access to Care - Health Services

Increase individual and community access to health care services.

Delivery of regionally appropriate services for communities and population groups at risk including people living with disability.

Improve the Health System - System Integration & Coordination Support Access to Care - Health Services

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase individual and community access to health care services.

Work with state and Commonwealth governments to improve public facing health professional and health service directory/database information for the after hours period.

Regional LHNs Community leaders CALD community Service Providers Relevant NGOs

Support Access to Care - Health Services Engage with Stakeholders Community

Increase individual and community access to health care services.

Increase knowledge and understanding of community health and wellbeing needs to support CSAPHN with effective commissioning of activity and advocacy for communities.

Increase knowledge and understanding of local, state and national policy and direction to support CSAPHN with effective commissioning of activity and advocacy for community health and wellbeing needs, and primary health care.

Increase individual and community access to health care services.

Delivery of preventative and emergency dental services.

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

Delivery of specialist child and youth services.

CSAPHN Regional LHNs SA Health Relevant NGOs

Increase knowledge and understanding of community health and wellbeing needs to support CSAPHN with effective commissioning of activity and advocacy for communities.

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Engage with culturally, ethically and linguistically diverse populations to identify concerns of significance.

CSAPHN SA Government Cultural Diversity leads

System Integration

Engage with Stakeholders Government

Access

Support Access to Care - Health Services

Vulnerable People (Non-First Nations specific)

Engage with Stakeholders Community Support Health Services - General Practice/ ACCHOs

Identification of communities at risk and in need of targeted services.

Work with local communities to understand concerns and opportunities for access.

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

Primary Health Care Communities SA State Government IPHCS Providers RFDS Dental and Oral Health Associations

Facilitate use of interpreter services and alternative technological communication support options.

Page 70 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Population Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Chronic disease: multidisciplinary care and prevention

Chronic Disease (Screening/ Management/Coor dination)

Support Access to Care - Health Services

Increase individual and community access to health care services.

Virtual/telephone support service for people with heart disease.

Increase individual and community access to preventative health care services.

Delivery of regional and remote service models that support multidisciplinary care for chronic conditions.

Partner with organisations that promote health risk behaviour modification and community education and or services.

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

CSAPHN Peak bodies including but not limited to: Asthma Foundation Diabetes Australia Cancer Council Heart Foundation Kidney Foundation Dementia Australia Alzheimer’s Australia State and Local Government

Work with local government in the development and implementation of local population health plans with focus on better health through lifestyle and environment modifications.

CSAPHN SA Health Local Government

Delivery of cancer screening services and supports in identified areas of need.

CSAPHN Regional LHNs Cancer Council CSAPHN Peak bodies including but not limited to: Asthma Foundation Diabetes Australia Cancer Council Heart Foundation Kidney Foundation Dementia Australia Alzheimer’s Australia State and Local Government

Support Access to Care - Prevention Activities Support Access to Care - Health Education Support Health Services - General Practice/ ACCHOs Early Intervention Prevention / Social Determinants

Engage with Stakeholders Government

Support Access to Care - Health Services System Integration

Early Intervention Prevention / Social Determinants

Improve the Health System - System Integration & Coordination Support Access to Care - Prevention Activities

Increase individual and community access to resources that effectively assist use of health knowledge and understanding, increasing choices and supporting decisions General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Increase knowledge and understanding of local, state and national policy and direction to support CSAPHN with effective commissioning of activity and advocacy for community health and wellbeing needs, and primary health care.

Increase individual and community access to health care services.

Partner with peak bodies for community education activities focussed on cancer prevention and screening: skin, breast, bowel and cervical

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase individual and community access to preventative health care services.

Facilitate integrated approaches to chronic condition prevention and management promotional activity across peak bodies, general practice, allied health, pharmacy and community health services.

Delivery of prevention programming around lifestyle-related chronic disease risk factors.

Page 71 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Population Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Improve immunisation and vaccination rates

Access

Support Access to Care - Prevention Activities

Increase individual and community access to preventative health care services.

Facilitate opportunities for hard-to-reach populations to access vaccinations.

Workforce

Support Health Services - Workforce Training & Development

Health professionals are supported to increase skills, knowledge and capability, and improve workforce sustainability.

Identify and support immunisation champions in general practices and communities.

Facilitate health provider education and training, and access to immunisation support via HealthPathways SA and other avenues.

CSAPHN working primarily with DATIS (SA Health) and the APHN Aboriginal Health Council of South Australia ACCHOs CSAPHN General Practice CSAPHN APHN WBSA

Access

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Work with communities, ACCHOs, general practice, the six regional LHNs, metropolitan LHNs and the Rural Doctors Workforce Agency to identify opportunities for delivering integrated health services for coordinated care.

HealthPathways

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Engage GPs, medical specialists, allied health and other service providers to develop locally relevant pathways of care.

Integrated and coordinated care across the health system

Engage GPs, medical specialists, allied health and other service providers in the use of HealthPathways SA. Enable multi-party virtual case conferencing to enable activities such as case conferencing with health professionals within across general practice and SA Health.

Multi-Disciplinary Care

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Potentially Preventable Hospitalisations (PPH)

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Facilitate coordination of care for individuals who experience frequent or high levels of hospitalisation.

System Integration

Support Access to Care - Health Services

Increase individual and community access to health care services.

Enable delivery of consistent coordinated team care.

CSAPHN SA Health Regional LHNs General Practice RDWA ACCHOs CSAPHN APHN WBSA Regional LHNs

CSAPHN SA Health Local Health Networks General Practice CSAPHN SA Health WBSA Local Health Networks CSAPHN LHNs ACCHOs General Practice Page 72 of 84

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Population Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Support Health Services - General Practice/ ACCHOs

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Increase knowledge and understanding of local, state and national health service sector to support CSAPHN with effective commissioning of activity and advocacy for primary health care.

Facilitate Patient Centred Medical Home model of care coordination across health sector.

CSAPHN ACCHOs General Practice

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

CSAPHN SA Health Regional LHNs General Practice CSAPHN

Improve the Health System - System Integration & Coordination

Improve the Health System - Health Technology Engage with Stakeholders - Health Service Sector

Reduce potentially preventable hospitalisations

Facilitate capacity building and sharing of information between pharmacy, general practitioners and patients.

Facilitate shared clinical reviews to patients with complex conditions working with multiple health care professionals.

Explore opportunities to further develop Stakeholder engagement program – functional relationships with the pharmacy and allied health sectors.

Chronic Disease (Screening/ Management/Coor dination)

Support Access to Care - Health Services

Increase individual and community access to health care services.

Work with RFDS and other providers to enable expansion of services to include chronic disease and mental health nursing services for existing clinics.

Multi-Disciplinary Care

Support Access to Care - Health Services

Increase individual and community access to health care services.

Delivery of locally based intermediary and home-based care in local areas of need.

Facilitate individual alternative care arrangements including for people in palliative stages of life.

Potentially Preventable Hospitalisations (PPH)

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Partner with LHN and key stakeholders to address identified risks resulting in preventable Emergency Department admissions and hospital re-admissions.

System Integration

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Partner with LHN and key stakeholders to define a Country SA Primary Health delineation model.

CSAPHN ADHN Chronic disease peak bodies CSAPHN Allied Health Pharmaceutical Society of Australia CSAPHN RFDS Regional LHNs

CSAPHN Regional LHNs Palliative Care SA CSAPHN APHN SA Health Regional LHNs CSAPHN Regional LHNs

Page 73 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Population Health Identified Need

Sub-Priority

Access

Opportunity

Expected Outcome

Options

Potential Lead

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

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

Enable multi-party virtual case conferencing with health professionals across primary care and LHNs. 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.

CSAPHN ACCHOs RDWA Regional LHNs

Aged Care

Care Coordination

Implement projects in partnership with residential aged care facilities to increase virtual care provision and supports.

Improve the Health System - System Integration & Coordination

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Partner with LHNs to improve discharge planning and communication with patient, general practice, health and wellbeing services.

Facilitate private health providers, including pharmacy, to develop the capacity of the region to engage with care coordinators.

CSAPHN Regional LHNs RACFs CSAPHN Regional LHNs CSAPHN PSA Private providers Peak bodies

Digital Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Integrated and coordinated care across the health system

System Integration

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Facilitate implementation and promotion of My Health Record ongoing.

Maintain regional service directories.

Enable delivery of secure telehealth services for private and public providers and increased promotion and support of telehealth initiatives through direct practice support activities.

Support health service providers to adopt and actively use secure messaging.

Support Web Services Transition through communicating healthcare providers awareness and changing of system.

CSAPHN ADHA CSAPHN CSAPHN ADHA CSAPHN CSAPHN

Page 74 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Digital Health Identified Need

Sub-Priority

Opportunity

Expected Outcome

Options

Potential Lead

Utilisation of technical solutions to facilitate integrated and coordinated care across the health system

Multi-Disciplinary Care

Improve the Health System - Health Technology

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

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

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

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

Delivery of secure telehealth services by private providers.

CSAPHN SA Health Regional LHNs General Practice Allied Health Other stakeholders

Care Coordination

System Integration

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.

Support development of technological solutions (e.g. apps) to collect more accurate and timely feedback from consumers Work with and support GPs, Adelaide Primary Health Network (APHN), the six regional LHNs and metro LHNs in the implementation of integrated systems.

Engagement with service providers in the information, set-up and use of Real Time Prescription Monitoring.

Regional LHNs

CSAPHN SA Health Regional LHNs ADHA General Practice Private Sector APHN CSAPHN SA Health

CSAPHN Pharmaceutical Society of Australia

Page 75 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Health Workforce Identified Need

Sub-Priority

Opportunities

Expected Outcome

Options

Potential Lead

Access to afterhours services

Allied Health

Support Health Services - Allied Health

Allied Health service providers are supported to improve individual and community health outcomes and experience of health care.

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

Practice Support

Support Health Services - General Practice/ ACCHOs

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

Aged Care

Improve the Health System - Health Technology

Allied Health

Support Health Services - Allied Health

Practice Support

Support Health Services - General Practice/ ACCHOs

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

Increase health service implementation and application of technical solutions to improve integration of systems and coordination of care across health services.

Allied Health service providers are supported to improve individual and community health outcomes and experience of health care.

General Practices and Aboriginal Controlled Health Organisations are supported to improve individual and community health outcomes and experience of health care.

CSAPHN RDWA SA Health University sector General Practice GP peak bodies ACCHOs AHCSA

Workforce and service sustainability

Medication Management

Support implementation and operationalising afterhours GP telehealth service in residential aged care facilities.

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

CSAPHN Allied Health

Support general practice and other primary health service providers with sustainability business modelling in workforce planning, recruitment and retention initiatives.

Support RFDS and other providers build capability with delivery primary care services in remote communities.

CSAPHN Regional LHNs

CSAPHN SA Universities RACGP Rural Support Services Regional LHNs SA Health CSAPHN

Workforce

Improve the Health System - Workforce Sustainability

Support improving the training, supply and retention of the regional, rural and remote primary health care workforce.

Facilitate sustainable workforce strategies and approaches for student, new practitioner and permanent practitioner placements in rural areas.

Workforce

Support Health Services - Quality Improvement

Provide material support to general practice, community health services, ACCHOs, and allied health services in all areas of quality improvement and practice sustainability.

System Integration

Improve the Health System - System Integration & Coordination

Health service providers and organisations are supported to improve quality and sustainability in the delivery of health care services to individuals and communities.

Improve integration of systems and coordination of care across health services for improved individual health outcomes and experience of health care.

Facilitate capacity building and sharing of information between pharmacy, general practitioners and patients.

RFDS CSAPHN

CSAPHN

Page 76 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Appendix 1: Country SA SA3 and LGA Regions SA3

LGA

SA3

LGA

Adelaide Hills

Adelaide Hills

Outback - North and East

Anangu Pitjantjatjara

Gawler - Two Wells

Barossa

Mount Barker

Coober Pedy

Gawler

Flinders Ranges

Light

Port Augusta

Mallala (63%)

Roxby Downs

Barossa

Unincorporated SA (84%)

Light (61%)

Lower North

Yorke Peninsula

Kangaroo Island

Barunga West

Victor Harbor

Clare and Gilbert Valleys

Yankalilla Limestone Coast

Grant

Wakefield

Kingston

Mount Remarkable

Mount Gambier

Northern Areas

Naracoorte and Lucindale

Orroroo/Carrieton

Robe

Peterborough

Tatiara

Port Pirie City and Districts

Wattle Range

Copper Coast Yorke Peninsula

Eyre Peninsula and South West

Alexandrina

Mallala (37%)

Goyder

Mid North

Fleurieu - Kangaroo Island

Ceduna

Murray and Mallee

Berri and Barmera Karoonda East Murray

Loxton Waikerie

Cleve

Mid Murray

Elliston

Murray Bridge

Franklin Harbour

Renmark Paringa

Kimba

Southern Mallee

Lower Eyre Peninsula

The Coorong

Maralinga Tjarutja Port Lincoln Streaky Bay Tumby Bay Whyalla Wudinna Unincorporated SA (15%)

Page 77 of 84 Country SA PHN Needs Assessment Report 2022-2025 (November 2021) V1

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