Improving Access to Primary Health for Aboriginal and Torres Strait Islander People

IMPROVING ACCESS TO PRIMARY HEALTH FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE GP Resource July 2019

For more information or support contact the Practice Support team at Country SA PHN on: P: 08 8565 8900 E: practice.support@countrysaphn.com.au W: countrysaphn.com.au

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INTRODUCTION This Desktop Guide is intended as a resource manual to assist General Practice staff to effectively coordinate care for their Aboriginal and Torres Strait Islander patients. Additionally, it provides comprehensive information regarding the cultural capable registration, allocation & patient support in general practice.

ACKNOWLEDGEMENTS Country SA PHN acknowledges and thanks the organisations that contributed to the content used in this Desktop Guide. They include former Divisions of General Practice and Medicare Locals and Commonwealth Agencies. While the Australian Government Department of Health has contributed to the funding of this document, the information on this website does not necessarily reflect the views of the Australian Government and is not advice that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not responsible in negligence or otherwise for any injury, loss or damage however arising from the use of or reliance on the information provided in this document.

DISCLAIMER Variation to this document must be justified and the reason documented in the patient or corporate record.

SCOPE Aboriginal and Torres Strait Islander Primary Health Care Specific Information to support Practices in the registration, allocation, provision of care and screening of appropriate patients for Health Care Homes Project

GOAL Information for General Practitioners on improving access to primary health for Aboriginal and Torres Strait People On 1 July 2014, the Australian Government established the Indigenous Australians’ Health Program (IAHP). The Indigenous Australian’s Health Program is a response to the Council of Australian Governments (COAG) strategy on Closing the Gap in health equality between Aboriginal and Torres Strait Islander people and other Australians. The IAHP consolidated four previously existing funding streams which had been in effect from 2008 to 2013.

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IMPROVING ACCESS TO PRIMARY HEALTH CARE FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE: A KEY THEME UNDER THE PROGRAM There are two outcomes of the Indigenous Australian’s Health Program by funding activities that support improving access to primary health care services, including: • •

To contribute to closing the gap in life expectancy within a generation (by 2031) Halve the gap in mortality rates for Aboriginal and Torres Strait Islander children under five within a decade (by 2018).

COAG have since issued a refresh of these targets on the 12th December 2018, to include: • •

Close the Gap in life expectancy between Aboriginal and Torres Strait Islander and nonIndigenous Australians within a generation, by 2031 By 2028, 90-92 per cent of babies born to Aboriginal and Torres Strait Islander mothers have a healthy birthweight

OBJECTIVES The objectives under the theme are to improve access and to build capacity of mainstream primary health care to deliver culturally safe services to Aboriginal and Torres Strait Islander people. There are incentives to assist with this. These incentives support you and your team in providing quality primary health care to Aboriginal and/or Torres Strait Islander people with chronic disease; and at risk of developing chronic disease.

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CONTENTS No.

Page Improving Access to Primary Health for Aboriginal and Torres Strait People: The Need to Improve

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Addressing the Barriers in Access: • Logistical and Personal Reasons • Cost • Cultural Appropriateness of the Service • Steps for Implementing Access Initiatives for Aboriginal and Torres Strait Islander People

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Prepare the Practice

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Aboriginal and Torres Strait Islander Identification

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Overview of Services for Aboriginal and Torres Strait Islander Patient

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Preventative Health Assessments for Aboriginal and Torres Strait Islander People a. Details of the 715 Health Assessment b. Child Health Assessment Criteria c. Adult Health Assessment Criteria d. Older People Health Assessment Criteria e. 715 PN or AHP/AHW Follow Up Items 10987 f. 715 Allied Health Follow-Up Items

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Aboriginal and Torres Strait Islander Patient Registration to the PIP & PBS Co-Payment • Confirming a patient’s registration • Annotation of prescriptions under the PBS co-measure • Processing annotated prescriptions • Referring registered patients to a specialist • PBS co-payments under the measure

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Chronic Disease Management a. CDM MBS Care Plan Items b. 732 GPMP / TCA Reviews c. CDM Practice Nurse or Allied Health Professional/Aboriginal Health Worker Follow Up Items 10997 d. Allied Health Referrals I. Individual Allied Health Services Items II. Group Allied Health Services MBS Items (Type 2 Diabetes)

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PIP Outcome payments

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Integrated Team Care

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Quality Improvement a. National Safety and Quality Health Service Standards (NSQHSS) b. Support on National Safety and Quality Health Service Standards and Quality Improvement Cycles.

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Accreditation a. RACGP 5th Edition Culturally Safe Care Items

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Appendix A

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Further information and references

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IMPROVING ACCESS TO PRIMARY HEALTH FOR ABORIGINAL AND TORRES STRAIT PEOPLE The need to improve According to the Australian Institute of Health and Welfare’s Australian Burden of Disease Study 2011, Chronic diseases caused 64% of the total disease burden among Indigenous Australians in 2011. This burden is 2.3 times higher than non-Indigenous Australians. There is a range of information including disease specific information available through the Australian Institute of Health and Welfare. In South Australia, there are significant disparities in health outcomes between Aboriginal and Torres Strait Islander people and non-Aboriginal people. In terms of chronic disease, the major burden of disease for South Australia includes: • • • • • •

Cancer Chronic kidney disease Circulatory diseases, including Rheumatic Heart Disease (for which South Australia is one of three states in which RHD is present, and is not normally found in developed countries) Diabetes Mental health and substance use disorders Respiratory Diseases

Ear Health and Eye Health are also areas needing consideration, particularly for Aboriginal and Torres Strait Islander children and people with Diabetes. This is due to the high rates of hearing and sight loss from preventable reasons. In addition, injuries (which includes suicide) contributes significantly to the fatal burden in South Australia. For more information about the health needs of Aboriginal and Torres Strait Islander people in the Country SA PHN service area please see the CSAPHN Needs Assessment Report.

Access There are lower access rates to primary health services for Aboriginal and Torres Strait Islander people than for non-Aboriginal people. However, access has been improving, particularly in access to MBS items and PBS where there was traditionally low access. However, the improvements are not sufficient to contribute to addressing the burden of disease that currently stands. The target for closing the gap in life expectancy within a generation (by 2031) is not on track. Further information can be found in the Closing the Gap Report 2019: The annual report to Parliament on Progress in Closing the Gap. This report is updated annually and can be sourced from the Department of the Prime Minister and Cabinet. The 2012-13 National Aboriginal and Torres Strait Islander Health Survey demonstrated that 29.5% of Aboriginal and Torres Strait Islander people in South Australia reported an instance where they needed to go to a health provider but didn’t. The following reasons were provided (responses are not mutually exclusive): • • • •

Personal reasons 53.2% Logistical reasons 35.5% Cost 35% Cultural appropriateness of the service 33.3% (AIHW, 2017). 6

All General Practices within the Country SA PHN service area, in addition to the Aboriginal Community Controlled Health Organisations in very remote locations, have an Aboriginal and Torres Strait Islander population to whom they provide services. The following table demonstrates the distribution of Aboriginal and Torres Strait Islander population (2016 ABS Census). You can access Aboriginal and Torres Strait Islander population profiles in your local area on the ABS Website or contact your local Indigenous Health Project Officer for support.

Location SA3

Aboriginal and Torres Strait Islander Population

Outback - North and East Eyre Peninsula and South Murray and Mallee Limestone Coast Mid North Fleurieu - Kangaroo Island Yorke Peninsula Gawler - Two Wells Adelaide Hills Barossa Lower North

5,453 3,188 2,570 1,218 916 717 679 593 581 390 387

% Aboriginal and Torres Strait Islander Population

% Aboriginal and Torres Strait Islander Population to Total Population

32.7% 19.1% 15.4% 7.3% 5.5% 4.3% 4.1% 3.6% 3.5% 2.3% 2.3%

20.8% 5.6% 3.7% 1.9% 3.4% 1.4% 2.7% 1.7% 0.8% 1.1% 1.7%

1. Addressing the Barriers in Access The Indigenous Australians Health Programme is designed to address the primary barriers in access. It does this through systematically looking at and addressing these barriers in multiple ways.

Logistical and Personal reasons

Logistical and personal reasons affect the access of many Aboriginal and Torres Strait Islander people. For example, a patient may need to catch a flight to Adelaide from the closest regional centre but not have access to transport to that centre. Alternatively, they may have family or work commitments that prevent service access. The following two services can assist with addressing these barriers:

•

Integrated Team Care

Care coordination services in the Integrated Team Care program try to address any logistical reasons that may prevent health care on an individual client basis. This is centred on the principle of selfmanagement and services arrange directly with the client when and where is the most suitable time for follow-up health care provision.

• Medical Outreach- Indigenous Chronic Disease Program (RDWA)

The Medical Outreach – Indigenous Chronic Disease program run by RDWA increases access to a range of health services for Aboriginal and Torres Strait Islander people, including expanded primary care in the treatment and management of chronic disease. There are twenty two different types of specialist providers currently delivering services across 16 locations throughout South Australia. It reduces the need for patients to travel, and deal with the logistics required in travelling for health care. 7

Cost Cost of health services can affect the access of many people to health services. The following programs have been introduced to help address these issues: •

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Practice Incentive Program- Indigenous Health Incentive: Provides financial incentive support to General Practice to provide comprehensive chronic condition care to Aboriginal and Torres Strait Islander people. Pharmaceutical Benefits Scheme Closing the Gap Co-payment: Provides financial support to Aboriginal and Torres Strait Islander people to access medication. Medical Outreach- Indigenous Chronic Disease Program (RDWA): Provision of health services in remote locations significantly reduces client cost in accessing specialist care where travel and time off work is required. Integrated Team Care: Provides support to clients via Supplementary Services funding, which provides conditional gap funding for consults with Specialist and Allied Health Providers, select medical aids and for transport and accommodation where health services are not available locally.

The Medicare Benefits Schedule also has Aboriginal specific items to address access issues. This is separate to the IAHP. These items include: • • •

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The 715 Preventative Health Assessment for Aboriginal and Torres Strait Islander people; Specific follow-up items for Practice Nurses, Aboriginal Health Practitioners and Aboriginal Health Workers; Specific follow-up items for Allied Health services that can be provided in addition to those allied health services available to eligible patients with chronic disease under MBS items 1095010970. Items for preventing the onset of, investigating the risk of or monitoring the progression of chronic disease in a patient. For instance, facilitating diagnosis and monitoring of diabetes as a part of the Quality Assurance in Aboriginal Medical Service (QAAM) Program items.

One initiative under the Stronger Rural Health Strategy, announced in the 2018-19 Budget, was the reform of MBS access for doctors. The aim of the reform was to reward investment in attaining general practice fellowship and encourage more doctors to work in regional, rural and remote areas of Australia. One part of this reform was to close the Other Medical Practitioner (OMP) programs to new participants on 1 January 2019. These programs were: • • • •

Medicare Plus for Other Medical Practitioners Program (MOMPs) Rural Other Medical Practitioners Program (ROMPs) After Hours Other Medical Practitioners Program (AHOMPs) Outer Metropolitan Other Medical Practitioners Program (OMOMPs)

The Stronger Rural Health Strategy also committed to providing extra funding to support Aboriginal and Torres Strait Islander Health Professional Organisations (ATSIHPOs). Over four years from 1 July 2018, $33.4 million is being provided to continue the role of four ATSIHPOs to support and develop an appropriately trained health workforce and improve service provision to Indigenous Australians. For further information, please click here.

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Cultural Appropriateness of the Service There are a range of support services available to enhance the capacity of General Practices to deliver services that are culturally appropriate for Aboriginal and Torres Strait Islander patients. These supports are in the form of: • • •

Tools and resources that can be implemented in the Practice; Access to Cultural Awareness and Safety Training; and Indigenous Health Project Officer knowledge, advice and support.

Resources The RACGP An Introduction to Aboriginal and Torres Strait Islander Health Cultural Protocols and Perspectives RACGP Online Cultural Awareness and Safety Training Five steps towards excellent Aboriginal and Torres Strait Islander healthcare • • •

Five Steps Guide Five Steps Visual Poster Five Steps Summary Sheet

Department of Human Services Indigenous Health e-Learning Program Indigenous Health MBS Items e-Learning Program Australian Commission on Safety and Quality in Health Care User Guide for Aboriginal and Torres Strait Islander Health (National Safety and Quality Standards) Improving Care for Aboriginal and Torres Strait Islander People

Integrated Team Care Resources Indigenous Health Project Officers (IHPOs) provide support in building the capacity of mainstream primary health services to deliver culturally appropriate care. IHPOs can offer support by providing knowledge and different resources which are subject dependent. Cultural Awareness Training is provided throughout the year within local areas and your local IHPO can provide you with further information (please see below for contact details). The IHPOs can assist General Practice through the Five Steps Process. IHPOs cannot undertake the work for a General Practice as it will require internal General Practice staff to complete any required changes.

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Integrated Team Care Indigenous Health Project Officers Organisation

Far West & Lower Eyre

Port Lincoln Aboriginal Health Service

Contact Details

Ph: (08) 8683 0162 Fax: (08) 8683 0126 Email: reception@plahs.org.au Web: http://www.plahs.org.au/ Service Location: 19A Oxford Terrace, Port Lincoln SA 5606

Upper Eyre, Far North, Flinders and Outback Country and Outback Health

Ph: (08) 8643 5600 Fax (08) 8642 3766 Web: http://cobh.com.au/ Service Location: 12 Chapel Street, Port Augusta SA 5700

Barossa, Gawler, Mid North and Yorke Peninsula Sonder

Ph: (08) 8209 0700 Fax: (08) 8252 9433 Email: info@sonder.net.au Web: http://sonder.net.au/ Service Location: 2 Peachey Road, Edinburgh North SA 5113 South and East

Moorundi Aboriginal Community Controlled Health Service

Ph: (08) 8531 0289 Email: admin@macchs.org.au Web: https://www.moorundi.org.au/ Service Location: Ninkowar, Murray Bridge, SA 5253

RACGP Five steps towards excellent Aboriginal and Torres Strait Islander healthcare The Five Step Process set out by the RACGP includes the following: 1. Prepare the practice 2. Identify your Aboriginal and Torres Strait Islander patients 3. Offer the patient an Aboriginal and Torres Strait Islander health assessment (MBS Item 715) and make arrangements for appropriate follow up 4. Register eligible patients for the PIP and the Closing the Gap PBS co-payment 5. Use appropriate clinical guidelines and programs from the RACGP, Medicare and PHNs to enhance access and quality of care. These steps assist General Practice in implementing access initiatives for Aboriginal and Torres Strait Islander people.

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Steps for implementing access initiatives for Aboriginal and Torres Strait Islander People

Resources Department of Health Indigenous Health MBS Items e-Learning Program Aboriginal and Torres Strait Islander MBS Item Cheat Sheet

Benefits for Aboriginal and Torres Strait Islander Patients of undertaking steps to improve access Early detection of chronic disease and risk factors

Aboriginal and Torres Strait Islander patients are eligible to receive annual Aboriginal and Torres Strait Islander Health Assessments. These help to screen for risk factors and identify chronic diseases that could be managed through medical treatment.

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Practical Support Local Aboriginal and Torres Strait Islander Outreach Workers may be available to organise transport or help organise attendance for patients at follow-up appointments and appointments with other health providers. The Care Coordination and Supplementary Services Program provides a flexible funding pool to enable Aboriginal and Torres Strait Islander patients with chronic disease to access specialist and allied health services, as outlined in their care plan.

Improved access to affordable medicines Accredited practices and practices working towards accreditation, including Aboriginal Community Controlled Health services, can prescribe more affordable PBS medicines for eligible Aboriginal and Torres Strait Islander patients with, or at risk of, chronic disease, and who meet the measure’s needs-based criteria.

Benefits for General Practices of undertaking steps to improve access Additional resources Accredited General Practices and those working towards accreditation are eligible to access significant additional resources through the PIP Indigenous Health Incentive.

Ability to prescribe PBS medicines that patients can afford, in order to continue treatment Access to a variety of PBS medicines will help improve the prevention and management of chronic disease for Aboriginal and Torres Strait Islander people. The PBS Co-payment measure (CTG Scripts) is available for patients with, or at risk of, chronic disease who also meet needs-based criteria. Services that have the ability to complete ‘CTG Scripts’ usually have higher rates of Aboriginal and Torres Strait Islander engagement into their services.

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2. Prepare the Practice The first step in preparing the Practice is to register the Practice for the Practice Incentive Program’s Indigenous Health Incentive. Registration to this initiative will allow both the Practice and Aboriginal and Torres Strait Islander patients significant benefits, including incentive payments for the Practice, and CTG-Scripts for the patients. Registration is relatively easy. It can be done in HPOS or it can be done using the Department of Human Services hardcopy forms. A Summary of the Payments in the Incentive are shown below. Component Payment

Activity required for payment

(i) Sign-on payment

$1000 per practice

One-off payment to practices that agree to undertake specified activities to improve the provision of care to their Aboriginal and/or Torres Strait Islander patients with a chronic disease.

(ii) Patient registration payment

$250 per eligible patient per calendar year

(iii) Outcomes payment—up to $250

Tier 1: $100 per eligible patient per calendar year

A payment to practices for each Aboriginal and/or Torres Strait Islander patient aged 15 years and over who are registered with the practice for chronic disease management. A payment to practices for each registered patient where a target level of care is provided by the practice in a calendar year.

Tier 2: $150 per eligible patient per calendar year

A payment to practices for providing the majority of care for a registered patient in a calendar year.

There is a $1000 one-off sign on payment to assist with preparing the practice, a registration payment of $250 per eligible patient per calendar year and an outcomes payment per eligible patient per Calendar year (if delivering the majority of care). The following weblinks provide some useful information regarding the incentive payments. Department of Human Services e-Health Learning Program PIP-Indigenous Health Incentive Guidelines PIP-Indigenous Health Incentive – Patient Registration and Consent

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a.

Practice Registration

By registering the Practice for the Practice Incentive Program’s Indigenous Health Incentive, an organisation is committing to undertake specified activities to improve the care to Aboriginal and Torres Strait Islander patients with a chronic disease. This includes a one-off Sign-On Payment: $1000

Practice Incentive Payment Registration Create and use a system to make sure their Aboriginal and/or Torres Strait Islander patients aged 15 years and over with a chronic disease are followed up (for example through use of a recall and reminder system, or staff actively seeking out patients to make sure they return for ongoing care)

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Undertake cultural awareness training (minimum 2 people within the Practice, with at least one person being a General Practitioner) within 12 months of joining the incentive, unless exempt.

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Agree to offer to register Aboriginal and/or Torres Strait Islander Patients with a diagnosed chronic disease for the PIP Indigenous Health Incentive Agree to offer to register Aboriginal and/or Torres Strait Islander Patients with a diagnosed chronic disease for the Pharmaceutical Benefits Scheme (PBS) Co-payment Measure (PBS – CTG Copayment) (access to CTG Scripts) Agree to receive consent from the Patient for the PIP- IHI Individual Registration Agree to receive consent from the Patient for the PBS- CTG Co-payment

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Annotate PBS prescriptions for Aboriginal and/or Torres Strait Islander patients participating in the PBS Co-payment Measure (CTG Scripts)

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☐ ☐ ☐

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3. Aboriginal and Torres Strait Islander Identification Why ask the question? Improving access to Aboriginal and Torres Strait Islander people relies on practices having a system in place to ask all patients whether they are of Aboriginal and/or Torres Strait Islander origin. That is, to deliver the right services at the right time, you must identify the individual needs of your patients. In addition, the 5th Edition Standards for General Practice outlines the recording of Aboriginal and Torres Strait Islander status patients as a standard. This can be found in “Standard 7: Criterion C7.1E”: •

Standard 7- Content of patient health records: Our patient health records contain an accurate and comprehensive record of all interactions with our patients. C7.1 E Our practice routinely records the Aboriginal or Torres Strait Islander status of our patients in their patient health record.

There are tools available to help your practice achieve this. Indigenous Health Project Officers within your region are also able to support the work of General Practice in this area by providing knowledge around Aboriginal and Torres Strait Islander identification, Aboriginal and Torres Strait Islander engagement, strategies and supporting resources that can assist the practice in creating welcoming environments for Aboriginal and Torres Strait Islander people to feel safe to identify. The protocol in Health is to undertake a self-identification process of Aboriginal and Torres Strait Islander status.

Suggestion on obtaining the necessary demographic information Putting in place a PDSA or continuous quality improvement cycle around the issue is likely to yield good results. Example of some quality improvement activities include: • • • •

Asking the question on new patient forms. Asking the question at the time of patients making an appointment. Asking the question at the next consult/during a consult. Identify the patient records for which there is no available information surrounding Aboriginal and Torres Strait Islander status and contact the patients (in various forms) to update their patient records.

An example of how this could be approached includes: Aboriginal and Torres Strait Islander people are at risk of certain illnesses more than nonAboriginal people. We want to make sure that we give you thorough and proper care which is tailored to your needs. You can ask: ‘Are you (is the person) of Aboriginal and/or Torres Strait Islander origin?’ Or you can include the following text in a form when updating client information: Question ‘Are you (is the person) of Aboriginal and/or Torres Strait Islander origin?’ (For persons of both Aboriginal and Torres Strait Islander origin, mark both ’yes’ boxes.) • No • Yes, Aboriginal • Yes, Torres Strait Islander 15

Alternatively, a fourth response category may also be included if this better suits the data collection practices of the agency or establishment concerned: • Yes, both Aboriginal and Torres Strait Islander Source: Australian Institute of Health and Welfare’s 2010 National best practice guidelines for collecting Indigenous status in health data sets

Resources RACGP Identification of Aboriginal and Torres Strait Islander Status in General Practice

Standards for General Practice (5th edition). Australian Institute of Health and Welfare

The National Best Practice Guidelines for collecting Indigenous Status in health datasets Taking the next steps: Identification of Aboriginal and Torres Strait Islander status in General Practice Training Tool on Asking the Question Asking the Question Brochure Asking the Question Poster Asking the Question Fact Sheet

Indigenous Health Project Officers Indigenous Health Project Officers can support your changes by providing strategies, ideas and some resources to assist you in Aboriginal and Torres Strait Islander identification.

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4. Overview of Services for Aboriginal and Torres Strait Islander Patients Your Patient identifies as Aboriginal and/or Torres Strait Islander Has your patient had a 715 Aboriginal Health Check in the last 12 months? Yes

No Complete a 715 Aboriginal Health Check (Consent)

Is your patient at risk of developing a Chronic Disease or is further follow- up or investigation/information required? Yes

No

81300-81360 Allied Health Referrals (x 5) 10987 PN/AHW Follow-ups (x 10) GP Consults as required to address Risk.

No further action required please continue patient services as required

Is your patient at risk of developing or has been diagnosed with a Chronic Disease?

Register your Patient with PIP (Consent) Register your Patient with PBS-CTG

No No further action, please continue patient services as required

Complete a 721 Chronic Disease Management Plan if agreed (12 Months) OR Health Care Homes Registration 10950–10970 Allied Health Referrals (x 5) 81100–81125 Group Allied Health 10997 PN/AHW Follow-ups (x 5) GP Consults if required

732 Review of a GPMP (3 Monthly) Does your patient require Multidisciplinary Care Planning? 723 TCA (2 Years)

Does your patient need help with: • Accommodation and transport to see specialists? • Gap payments to see specialists? • Urgent allied health professional assistance? • Medical aids to help in the management of their chronic disease? • Coordinating health services needed as part of their management plan?

Yes Complete an ITC Program Referral 17

5. Offering Aboriginal and Torres Strait Islander Patients Preventative Health Assessments As there is a greater burden of disease specifically in the Aboriginal and Torres Strait Islander population within country South Australia, offering preventative health services and ensuring risk assessment and screening is occurring for your patients is key to improving population health outcomes overall. The key policy driver for Aboriginal and Torres Strait Islander Health nationally is the National Aboriginal and Torres Strait Islander Health Plan. In the Implementation Plan, preventative health assessments are targeted at a 60% Uptake Rate for 715 Health Assessments (number of people undertaken a 715 Health Assessment divided by the population within the area x 100) by 2023. The current uptake rate in CSAPHN is 35% and the lowest uptake rates are in regions that are closer to metropolitan Adelaide. In addition, as part of improving the quality of care the RACGP 5th edition Standards for General Practice provides that: Core Standard 4 – Health promotion and preventative activities: C4.1 A Our patients receive appropriately tailored information about health promotion, illness prevention, and preventive care. You must document in the patient’s health record discussions or activities relating to preventive health. Core Standard 5- C5.1 Diagnosis and management of health issues: C5.1 B Our clinical team supports consistent diagnosis and management of our patients. Use relevant clinical guidelines for treating patients who identify as Aboriginal or Torres Strait Islander origin, and for preventing and managing chronic diseases in these patients. There are two types of preventative health assessments for Aboriginal and Torres Strait Islander patients within the MBS as well as follow-up items for Practice Nurses and Aboriginal Health Practitioners/Workers: Item 228

Fee (100% Benefit)

Description

Time

Professional attendance by a medical practitioner at consulting rooms or in another place other than a hospital or residential aged care facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent—this item or item 715 not more than once in a 9 month period.

No time requirements but must meet MBS criteria

$172.50

Non-Specialist Practitioner health assessments 715

Professional attendance by a general practitioner at consulting rooms or in another place other than a hospital or residential aged care facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent-not more than once in a 9 month period

No time requirements but must meet MBS criteria

$215.65

10987

Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health assessment to a maximum of 10 services per patient in a calendar year

No time requirements but must meet MBS criteria

$24.40 (x 10)

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Communication with the Patient It is important to communicate with the patient and to receive consent to conduct a 715 Health Assessment. This could be done at the time they make the appointment i.e. ask the medical receptionist to ask the patients when they make appointments and make a corresponding long appointment time to conduct the assessment. This is an example of an opportunistic strategy to ensure Aboriginal and Torres Strait Islander patients in your Practice are offered a preventative health assessment annually. In addition, it may be that the patient has already had a 715 Health Assessment, or they have a usual clinic in which they attend for the assessment and resulting investigations. This can help avoid unpleasant situations for both parties. Ask the patient, “Have you had an Aboriginal and Torres Strait Islander Health Check in the last 12 months?” If no, then obtain consent to conduct one, “Would you like me to do make the appointment to do the comprehensive preventative health check when you come in for your current issue?” Note: General practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment). In addition, there are extra Allied Health Services that can be used to assist in the preventative health actions that are being undertaken to support the Preventative Health Assessment. These items include: Allied Health Area

Item

Allied Health Area

Item

Aboriginal Health Worker

81300

Physiotherapist

81335

Diabetes Educator

81305

Podiatrist

81340

Audiologist

81310

Chiropractor

81345

Exercise Physiologist

81315

Osteopath

81350

Dietitian

81320

Psychologist

81355

Mental Health Worker

81325

Speech Pathologist

81360

Occupational Therapist

81330

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Resources RACGP Standards for General Practice (5th edition). RACGP & NACCHO National Guide to a Preventative Health Assessment for Aboriginal and Torres Strait Islander People (3rd Edition) SA Aboriginal Chronic Disease Consortium Risk Assessment and Screening Protocol MBS MBS Online Department of Health The Australian Type 2 Diabetes Risk Assessment tool AUDRISK Fact sheets Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715) Follow-up Health Services provided by a Practice Nurse or registered Aboriginal health worker for an Indigenous Person who has received a health assessment Follow-up Allied Health Services for People of Aboriginal and Torres Strait Islander Descent (MBS Items 81300-81360)

a.

Details of the 715 Health Assessment

It is recommended that MBS items are checked via MBS Online Items Checker in HPOS to check both patient claiming conditions for items and practitioner eligibility or updates at MBS Online.

Background The aim of this MBS Aboriginal and Torres Strait Islander health assessment item is to help ensure that Aboriginal and/or Torres Strait Islander people receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early mortality.

Health assessment components A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function. This health assessment must include: • • • • •

Information collection: patient history and undertaking examinations and investigations as required; Overall assessment of the patient; Recommending appropriate interventions; Providing advice and information to the patient; Recording the health assessment; and 20

•

Offering the patient a written report with recommendations about matters covered by the health assessment.

Optional Offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

Eligible practitioners A 715-health assessment may only be claimed by a general practitioner. A health assessment should generally be undertaken by the patient's 'usual doctor'. For the purpose of the health assessment, "usual doctor" means the general practitioner, or a general practitioner working in the medical practice, who has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months. MBS health assessment item 715 must be provided by a general practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses, Aboriginal health workers or Aboriginal and Torres Strait Islander health practitioners employed and/or otherwise engaged by a general practice or health service, may assist general practitioners in performing this health assessment. Such assistance must be provided in accordance with accepted medical practice and under the supervision of the general practitioner. This may include activities associated with: • •

Information collection; and Providing patients with information about recommended interventions at the direction of the general practitioner.

Patient eligibility The Aboriginal and Torres Strait Islander Peoples Health Assessment is available to: a) Children between ages of 0 and 14 years, b) Adults between the ages of 15 and 54 years, c) Older people over the age of 55 years. For the purpose of this item, a person is an Aboriginal and/or Torres Strait Islander person if they, or their parent or carer, identify them as being of Aboriginal or Torres Strait Islander descent. The MBS Aboriginal and Torres Strait Islander health assessment covers the full age spectrum. The requirements for the Aboriginal and Torres Strait Islander Peoples Health Assessment MBS item 715 vary depending on the age of the Aboriginal and/or Torres Strait Islander person. Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment provided to an Aboriginal and Torres Strait Islander person, provided the conditions of item 10990 and 10991 are satisfied. The Health Assessment for Aboriginal and Torres Strait Islander People may be provided once every 9 months.

Restrictions MBS item 715 does not apply for services that are provided by any other Australian Government, and most state funded services. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal and Torres Strait Islander Community 21

Controlled Health Service or state/territory government health clinic, MBS item 715 can be claimed for services provided by medical practitioners salaried by or contracted to, the service or health clinic so long as all requirements of the item are met.

Resources MBS Online The Australian type 2 diabetes risk assessment tool (AUSDRISK) is a short list of questions to help both health professionals and consumers to assess the risk of developing type 2 diabetes over the next five years. Click here for an Interactive tool. Information about the Australian type 2 diabetes risk assessment tool (AUSDRISK) is available here.

b.

Child Health Assessment Criteria

An Aboriginal and Torres Strait Islander child health assessment must include: a. A personal attendance by a general practitioner; b. Taking the patient's medical history, including the following: i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii. xiii. xiv. xv. xvi. xvii. xviii. xix.

Mother's pregnancy history; Birth and neo-natal history: Breastfeeding history; Weaning, food access and dietary history; Physical activity; Previous presentations, hospital admissions and medication usage; Relevant family medical history; Immunisation status; Vision and hearing (including neonatal hearing screening); Development (including achievement of age appropriate milestones); Family relationships, social circumstances and whether the person is cared for by another person; Exposure to environmental factors (including tobacco smoke); Environmental and living conditions; Educational progress; Stressful life events; Mood (including incidence of depression and risk of self-harm); Substance use; Sexual and reproductive health; and Dental hygiene (including access to dental services).

c. Examination of the patient, including the following: i. ii. iii. iv.

Measurement of height and weight to calculate body mass index and position on the growth curve; Newborn baby check (if not previously completed); Vision (including red reflex in a newborn); Ear examination (including otoscopy); 22

v. vi. vii. viii. ix. x. xi. xii.

Oral examination (including gums and dentition); Trachoma check, if indicated; Skin examination, if indicated; Respiratory examination, if indicated; Cardiac auscultation, if indicated; Development assessment, if indicated, to determine whether age appropriate milestones have been achieved; Assessment of parent and child interaction, if indicated; and Other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment.

d. Undertaking or arranging any required investigation, considering the need for the following tests, in particular: i. ii.

Haemoglobin testing for those at a high risk of anaemia; and Audiometry, if required, especially for those of school age.

e. Assessing the patient using the information gained in the child health check; and f.

Making or arranging any necessary interventions and referrals and documenting a simple strategy for the good health of the patient.

Resources RACGP Child Health Assessment Lifecycle Chart Young Persons Assessment Lifecyle Chart Department of Health Child Health Assessment (0-14) Proforma (RTF 3880 KB) Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations (2010)

c. Adult Health Assessment Criteria An Aboriginal and Torres Strait Islander adult health assessment must include: a. A personal attendance by a general practitioner; b. Taking the patient's medical history, including the following: i. ii. iii. iv. v. vi. vii.

Current health problems and risk factors; Relevant family medical history; Medication usage (including medication obtained without prescription or from other doctors); Immunisation status, by reference to the appropriate current age and sex immunisation schedule; Sexual and reproductive health; Physical activity, nutrition and alcohol, tobacco or other substance use; Hearing loss; 23

viii. ix. x.

Mood (including incidence of depression and risk of self-harm); and Family relationships and whether the patient is a carer, or is cared for by another person; and Vision

c. Examination of the patient, including the following: i. ii. iii. iv. v. vi.

Measurement of the patient's blood pressure, pulse rate and rhythm; Measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity; Oral examination (including gums and dentition); Ear and hearing examination (including otoscopy and, if indicated, a whisper test); Urinalysis (by dipstick) for proteinuria; and Eye examination

d. Undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs): i. ii. iii. iv.

Fasting blood sugar and lipids (by laboratory-based test on venous sample) or, if necessary, random blood glucose levels; Cervical screening; Examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35years); and Mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral).

e. Assessing the patient using the information gained in the adult health assessment; and f. Making or arranging any necessary interventions and referrals and documenting a simple strategy for the good health of the patient. An Aboriginal and Torres Strait Islander Adult health assessment must also include: a. Keeping a record of the health assessment; and b. Offering the patient, a written report on the health assessment, with recommendations on matters covered by the health assessment;

Type 2 diabetes risk management Patients between 15–54 years of age who are at high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), may be referred to a subsidised lifestyle modification program. The Australian Type 2 Diabetes Risk Assessment tool AUDRISK.

Resources RACGP Young Persons Assessment Lifecyle Chart Adult Health Assessment Lifecycle Chart 24

Department of Health Adult Health Assessment (15-54) Proforma (RTF 3885 KB) The Australian Type 2 Diabetes Risk Assessment tool AUDRISK

d. Older Person’s Health Assessment Criteria An Aboriginal and Torres Strait Islander Older Person's health assessment must include: a. A personal attendance by the general practitioner; b. Measurement of the patient's blood pressure, pulse rate and rhythm; c. An assessment of the patient's medication; d. An assessment of the patient's continence; e. An assessment of the patient's immunisation status for influenza, tetanus and pneumococcus; f. An assessment of the patient's physical functions, including the patient's activities of daily living and whether or not the patient has had a fall in the last 3months; g. An assessment of the patient's psychological function, including the patient's cognition and mood; h. An assessment of the patient's social function, including: i. The availability and adequacy of paid, and unpaid, help; ii. Whether the patient is responsible for caring for another person; i. An eye examination An Aboriginal and Torres Strait Islander Older Person's health assessment must also include: a. Keeping a record of the health assessment; and b. Offering the patient, a written report on the health assessment, with recommendations on matters covered by the health assessment; and c. Offering the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

Resources Department of Health Older person (55+) Health Assessment Proforma (RTF 923 KB)

e. 715 PN or AHP/AHW Follow Up Items 10987 Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health assessment if: 25

a) The service is provided on behalf of and under the supervision of a medical practitioner; and b) The person is not an admitted patient of a hospital; and c) The service is consistent with the needs identified through the health assessment; To a maximum of 10 services per patient in a calendar year. Item 10987 may be claimed by a medical practitioner, where a follow up service is provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of that medical practitioner for an Indigenous person who has received a health check. Item 10987 may be used to provide: • • • • • •

Examinations/interventions as indicated by the health check; Education regarding medication compliance and associated monitoring; Checks on clinical progress and service access; Education, monitoring and counselling activities and lifestyle advice; Taking a medical history; and Prevention advice for chronic conditions and associated follow up.

Patients whose condition is unstable/deteriorating should be referred to their GP for further treatment. (Separate consult item). For further information about the follow-up health services, please see the following Department of Health Fact Sheet

f. 715 Allied Health Follow-Up Items Individual allied health items are available to support the preventative health needs of Aboriginal and Torres Strait Islander patients. A maximum of five (5) allied health services are available per patient each calendar year. These services are in addition to allied health services available to eligible patients with chronic disease under MBS items 10950-10970. The five services can be provided by one eligible allied health professional (e.g. five physiotherapy services) or a combination of allied health professionals (e.g. one dietetic, two podiatry and two physiotherapy services). Services must be of at least 20 minutes duration and must be provided individually to the patient, in person, by the eligible health professional. A written report must be provided to the referring GP after the first and last service, or more often if required.

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Allied Health Area

Item

Allied Health Area

Item

Aboriginal Health Worker

81300

Physiotherapist

81335

Diabetes Educator

81305

Podiatrist

81340

Audiologist

81310

Chiropractor

81345

Exercise Physiologist

81315

Osteopath

81350

Dietitian

81320

Psychologist

81355

Mental Health Worker

81325

Speech Pathologist

81360

Occupational Therapist

81330

Resources Department of Health Fact Sheet Follow-up Allied Health Services for People of Aboriginal and Torres Strait Islander Descent (MBS Items 81300-81360) Referral Forms Referral Form for follow-up allied health services under Medicare for people of Aboriginal and Torres Strait Islander descent - PDF 283 KB

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6. Aboriginal and Torres Strait Islander Patient Registration to the PIP and PBS Co-Payment The PIP Indigenous Health Incentive aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease. Practices who register their patients to the PIP and PBS Co-Payment receive a patient registration payment once per year. Practice eligibility includes: • • • •

The Practice has offered the patient a 715 Health Assessment, however the patient has not consented or The Practice has undertaken a 715 Health Assessment as consented by the patient. The Practice has obtained consent from the patient to be registered for the PIP Indigenous Health Incentive. The Practice must offer the PBS Co-payment Registration

Practices are not eligible for registration payments if the patient does not consent to the PIP Indigenous Health Incentive. However, patients can obtain the PBS-Co-payment independently of the consent to the PIP and CTG Scripts can still be received. The consent needs to be recorded in the patient’s file. Patient eligibility for the PIP includes: • •

Has a chronic disease; Has a current Medicare card

Patient eligibility for the PBS Co-Payment includes whether the patient: • •

Would experience serious setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and Are unlikely to adhere to their medication regimen without assistance through the measure.

Resources Department of Human Services Patient registration and consent form (IP017) Multiple patient registration and consent form (IP019) PIP Indigenous Health Guidelines Indigenous Health Services eLearning Program

Confirming a patient’s registration You can confirm a patient’s registration by: • •

Using HPOS to access the practice’s list of registered patients or Contacting the Department’s Incentives Programs on 1800 222 082

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Annotation of prescriptions under the PBS Co-measure Once the patient is registered, you will need to annotate the prescriptions to indicate that they are to be dispensed with co-payment relief. Upon presenting a correctly annotated prescription to a pharmacy for dispensing, your patient will be supplied the medicine at the reduced rate. Reduced rate means that: • • •

General patients will be charged concessional rates for medications Concessional patients will not be charged anything in most situations. Some medications do attract a co-payment.

Processing annotated prescriptions Prescribers must annotate the prescription with the letters 'CTG', their initials and signature. When you receive a manually annotated prescription and are processing that prescription through your dispensing software, you must ensure that the Closing the Gap code is entered correctly into your processing software either manually or automatically. The correct code to use will depend on your dispensing software. For example, using a correct Closing the Gap code of H, 00B or CTG00B will make sure the manual annotation is valid. Using an invalid code will result in an incorrect calculation of the payment due from the patient for their prescription. Closing the Gap - PBS Co-payment Measure • • • • • •

Eligibility Closing the Gap PBS prescriptions Closing the Gap and PBS Safety Net Processing and dispensing Closing the Gap PBS prescriptions Claiming Closing the Gap PBS prescriptions Helping you reconcile Closing the Gap PBS prescriptions

For more information, please click here for information from the Department of Human Services.

Referring registered patients to a specialist Medical Specialists to whom a registered patient has been referred are also able to annotate ‘CTG’ prescriptions under this measure. To help inform the specialist of the benefits of the measure for your referred patient, you may wish to include the following words or similar in your referral: “John Citizen is eligible for extra assistance with the cost of medicines. To ensure he is able to access this, please annotate the top of any prescriptions with the letters ‘CTG’ and initial.”

PBS co-payments under the measure Eligible patients who would normally pay the full PBS co-payment will pay the concessional rate. Those who normally pay the concessional price will not be required to pay a PBS co-payment, with the exception of a small number of medicines which have premiums that will still need to be paid by the patient. All PBS medicines are covered under the measure whether or not the medicines are being used to treat chronic or acute medical conditions. 29

The cost of filling dose administration aids such as Webster packs is a service fee that is negotiated between the individual patient and pharmacist and is not covered under the PBS measure. However, if referred to the Integrated Team Care Program, the patient may be eligible for Supplementary Services Support to cover the cost of dose administration aids. The measure only relates to the cost of the PBS medicines that the patient receives. In addition, vitamins and other dietary supplements are not covered under this measure.

Further information Please click here for detailed information about the eligibility requirements for the PIP Indigenous Health Incentive and the PBS Co-payment content: • • •

About the Closing the Gap-PBS Co-payment Measure Case study Summary

Department of Human Services Indigenous Health Services eLearning Program

7. Chronic Disease Management Chronic disease management (CDM) services help General Practice coordinate health care for patients with chronic or terminal medical conditions. These medical conditions are present or are likely to be present for 6 months or longer or are terminal. Common chronic conditions for Aboriginal and Torres Strait Islander people include: • • • • • • •

Cardiovascular disease; Cancer Diabetes; Chronic kidney disease; Mental health and Chronic respiratory disease; Musculoskeletal conditions.

a. CDM MBS Care Plan Items These items are NOT specifically for Aboriginal and/or Torres Strait Islander people but have been included here because they can be accessed as part of chronic disease management. Chronic Disease Management Planning consults also provide an opportune time to register patients with the Indigenous Health Incentive PIP and can facilitate medication management discussions, particularly with PBS Co-payment (CTG Scripts).

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The table below provides CDM service descriptions, item numbers and information about claiming frequency for General Practitioners. Item

Description

Fee

Benefit

Frequency

721

Preparation of a GP Management Plan (GPMP) Coordination of Team Care Arrangements (TCAs) Contribution to, or review of, a Multidisciplinary Care Plan for patients not in a residential aged care facility Contribution to, or review of, a Multidisciplinary Care Plan for patients in a residential aged care facility Review of a GP Management Plan or coordination of a review of Team Care Arrangements

$146.55

75% = $109.95 75% = $87.15 100% = $71.55

12 months

$71.55

100% = $71.55

3 months

$73.20

75% = $54.90

3 months

723 729

731

732

$116.15 $71.55

12 months 3 months

The table below provides CDM service descriptions, item numbers and information about claiming frequency for Non-Specialist Medical Practitioner management plans. Please note: members of the community have a 100% benefit paid. Item 229 230 231

232 233

Description

Fee

Preparation of a GP Management Plan (GPMP) Coordination of Team Care Arrangements (TCAs) Contribution to a Multidisciplinary Care Plan or to a review for a patient who isn’t in a residential aged care facility

$117.25

Contribution to, or review of, a Multidisciplinary Care Plan for patients in a residential aged care facility Review of a GP Management Plan or coordination of a review of Team Care Arrangements

Benefit

Frequency

100% = $117.25 100% = $92.90 100% = $57.25

12 months

$57.25

100% = $57.25

3 months

$58.55

100% = $58.55

3 months

$92.90 $57.25

12 months 3 months

Resources Department of Human Services HPOS MBS Item Checker Flyer CDM Item Education Guide Indigenous Health MBS Items eLearning Program Indigenous Health Services eLearning Program

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Chronic Disease Management Provider Information http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-factsheetchronicdisease.htm

b. 732 GPMP / TCA Reviews Attendance by a general practitioner to review or coordinate a review of: (a) A GP management plan prepared by a general practitioner (or an associated general practitioner) to which item 721 applies; or (b) Team care arrangements which have been coordinated by the general practitioner (or an associated general practitioner) to which item 723 applies It is a condition of the 721 and 723 that the plan is reviewed at least once per annum, however reviews need to be undertaken when it is clinically relevant to do so. For example, for patients that have been newly diagnosed with diabetes, it is likely all four reviews are needed within the 12-month period. Item

Description

Fee

Benefit

Frequency

732

Attendance by a general practitioner to review or coordinate a review of 721 or 723

$73.20

100%=$73.20

3 monthly

75% = $54.90

c. CDM PN or AHP/AHW Follow Up Items 10997 These items are NOT specifically for Aboriginal and/or Torres Strait Islander people but for eligible persons with a chronic condition. Item 10997

Description Service provided by a Practice Nurse or registered Aboriginal Health Practitioner

Fee $12.20

Benefit 100% = $12.20

Frequency 5 services per calendar year

Item 10997 may be used to provide: • • • •

Checks on clinical progress; Monitoring medication compliance; Self-management advice; and Collection of information to support GP reviews of care plans.

Eligible practitioners • •

An eligible Aboriginal Health Practitioner is an Aboriginal Health Practitioner who has certificate level 4 and is registered with Medicare Australia to provide the MBS Item. Practice Nurse means a registered or enrolled nurse or Nurse Practitioner who is employed by, or whose services are otherwise retained by, a General Practice.

Additional MBS items provided by a Nurse or registered Aboriginal Health Practitioner These items are NOT specifically for Aboriginal and/or Torres Strait Islander patients but have been included here because they can be provided by an Aboriginal Health Practitioner.

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Item

Description

16400

Antenatal service by a Midwife, Nurse or registered Aboriginal Health Practitioner provided at or from a practice in RRMA Immunisation provided by a registered Aboriginal Health Practitioner Wound treatment by a registered Aboriginal Health Practitioner Aboriginal or Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner (Only on Allied Health Referral, using approved referral forms).

10988 10989 10950

Fee

Benefit

Frequency

$27.70

85% = $23.55

10 services per pregnancy

$12.20

100%= $12.20 100% = $12.20 85% = $53.80

12 months

$12.20 $63.25

3 months Maximum 5 services per Calendar Year.

d. Allied Health Referrals i. Individual Allied Health Services Items As part of the Chronic Disease Management Plans and Team Care Arrangements, patients are eligible for up to 5 allied health services in the calendar year to support management of their chronic disease. These services are in addition to the 81300-81360 services allowable under the 715 Health Assessments. If a provider accepts the Medicare benefit as full payment for the service (85% of the fee), there will be no out-of-pocket cost. If not, the patient will have to pay the difference between the fee charged and the Medicare rebate. Fee

Benefit

Frequency

$63.25

85% = $53.80

Maximum five health services per calendar year

Patient Eligibility

Patients must have a chronic disease and • •

Patients must have a GP Management Plan and Team Care Arrangements prepared by their GP; or Be residents of a residential aged care facility who are managed under a multidisciplinary care plan.

The services must be referred from GPs. Allied health providers must report back to the referring GP.

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The following individual Allied Health services relate to chronic disease management: Allied Health Area

Item

Allied Health Area

Item

Aboriginal Health Worker

10950

Physiotherapist

10960

Diabetes Educator

10951

Podiatrist

10962

Audiologist

10952

Chiropractor

10964

Exercise Physiologist

10953

Osteopath

10966

Dietitian

10954

Psychologist

10968

Mental Health Worker

10956

Speech Pathologist

10970

Occupational Therapist

10958

Resources Department of Health Individual Allied Health Services Fact Sheet Referral Form (Word).

Integrated Team Care Care Coordination and Supplementary Services Funding is available for those Aboriginal and Torres Strait Islander patients that need support accessing Allied Health or Specialist Services, including gap funding between private allied health providers and specialist providers. Your patient may need a referral to the ITC in order to access this support.

ii.

Group Allied Health Services MBS Items (Type 2 Diabetes Management)

Patients with type 2 diabetes can receive Medicare Rebates for group services provided by eligible diabetes educators, exercise physiologists and dietitians on referral from a GP. Group services are in addition to the five individual allied health services available to eligible patients who have a chronic or terminal condition (listed above). Patients who will most benefit from group services are likely to be those who demonstrate a readiness to change, are able to contribute to group processes effectively and have a potential for self-management. If a provider accepts the Medicare benefit as full payment for the service, there will be no out-ofpocket cost. If not, the patient will have to pay the difference between the fee charged and the Medicare rebate. 34

Patient Eligibility People with type 2 diabetes and • • •

A GP Management Plan – item 721; or The GP must have contributed to, or reviewed, a care plan prepared by the residential aged care facility (item 731) for a resident of a residential aged care facility; or; Health Care Homes Shared Care Plan

If there is any doubt whether a patient has already claimed the maximum number of assessment or group services items in the calendar year, the allied health provider can check with Medicare Australia on 132150.

Services Included There are two elements to provision of allied health services under these items - an initial assessment of individual patients, followed by provision of group services.

Assessment for group services Patients are eligible for one allied health assessment for group services (item 81100 or 81110 or 81120) per calendar year. It is intended to be generic in nature, covering factors relevant to all three professions. Patients can then be directed to any combination of group services. The Australian Diabetes Educators Association, Exercise and Sports Science Australia and the Dietitians Association of Australia have developed a generic assessment checklist that may be useful in undertaking the assessment of patients. The checklist is available on their respective websites. Allied Health Area

Item

Description

Fee

Benefit

Diabetes Educator

81100

Diabetes education health service provided to a person by an eligible diabetes educator for the purposes of assessing a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services

$81.15

$69.00

Exercise Physiologist

81110

Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of assessing a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group service.

$81.15

$69.00

Dietitian

81120

Dietetics health service provided to a person by an eligible dietitian for the purposes of assessing a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services

$81.15

$69.00

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Service Requirements • • •

Taking a comprehensive patient history, Identification of individual goals and preparing the patient for an appropriate group services program. Must be undertaken by an eligible diabetes educator, exercise physiologist or dietitian, on referral from a GP (see above).

•

Must be provided to an individual patient in person.

•

The service must be at least 45 minutes duration.

•

To direct patients to group services, the allied health provider undertaking the assessment will need to complete Part B of the referral form. This form is required by each provider of group services.

In the case of a service in respect of which a private health insurance benefit is payable- the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Group services Group services can be provided to a maximum of 8 services per year. Where clinically relevant, up to two group services may be provided consecutively on the same day by the same allied health provider. Allied health group services may be delivered by one type of allied health provider (eg eight diabetes education services) or by a combination of providers (eg three diabetes education services, three dietitian services, and two exercise physiology services). An eligible allied health provider with more than one Medicare provider number (eg for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers. In some areas, different types of group services may be offered by allied health providers (eg courses targeting newly diagnosed patients, refresher courses, or courses covering specific types of treatment and self-management).

Patient eligibility • •

The person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and The person is not an admitted patient of a hospital;

Service Requirements • • • •

The service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and The service is provided to a person involving the personal attendance by an eligible provider (dietician, diabetes educator, exercise physiologist); and The service is of at least 60 minutes duration; and After the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible dietitian, diabetes educator and/ or exercise physiologist 36

•

prepares, or contributes to, a written report to be provided to the referring medical practitioner; and An attendance record for the group is maintained by the eligible provider; and

In the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit; Allied Health Area

Item

Description

Fee

Benefit (85%)

Diabetes Educator

81105

Diabetes education health service provided to a person by an eligible diabetes educator, as a group service for the management of type 2 diabetes

$20.20 $17.20

Exercise Physiologist

81115

Exercise physiology health service provided to a person by an eligible exercise physiologist, as a group service for the management of type 2 diabetes

$20.20 $17.20

Dietitian

81125

Dietetics health service provided to a person by an eligible dietitian, as a group service for the management of type 2 diabetes

$20.20 $17.20

Reporting requirements On completion of both the assessment for group services and the group services program, each allied health provider must provide, or contribute to, a written report back to the referring GP for each patient. After the assessment service, the allied health provider should supply the GP with a written report outlining the assessment undertaken, whether the patient is suitable for group services and, if so, the nature of the group services to be provided. After the group services program, the allied health provider should supply the GP with a written report describing the group services provided for the patient and indicating the outcomes achieved.

Resources Department of Health Group Allied Health Services Fact Sheet Referral Form (Word). Integrated Team Care Care Coordination and Supplementary Services Funding is available for those Aboriginal and Torres Strait Islander patients that need support accessing Allied Health or Specialist Services, including gap funding between private allied health providers and specialist providers. Your patient will need a referral to the ITC Program in order to access this support. 37

8. PIP Outcome Payments Tier 1 outcome payment – Chronic disease management $100 per patient paid in the quarter following the provision of required services to practices/services that: • Prepare GP Management Plan (GPMP) (Item 228 and 721) or coordinate the development of

Team Care Arrangement (TCA) (Item 723), and undertake at least one review of the GPMP or TCA (item 732) within the same calendar year; OR • Undertake two reviews of the patients’ existing GPMP or TCA during the calendar year; OR • Contribute to the development or review of a multidisciplinary care plan for a patient in a Residential Aged Care Facility (Item 731) on two occasions during the calendar year.

Tier 2 outcome payment – Total patient care $150 per patient to the practice/service (regardless of where initial registration occurred) that provides the majority of eligible MBS services for the patient (minimum of five MBS item services) during the calendar year (includes Tier 1 services).

For more information Practices/services can phone the PIP Team on 1800 222 032 to confirm whether or not an eligible patient is currently registered with another practice/service.

9. Integrated Team Care Integrated Team Care (ITC) is a summation of the former Care Coordination and Supplementary Services and Improving Indigenous Access to Mainstream Primary Care programs. It was established to help Aboriginal and Torres Strait Islander people with complex chronic diseases unable to effectively manage their conditions through access to one-on-one assistance by Care Coordinators. Since the establishment of the ITC, the provision of care coordination, expediting access to necessary services, and developing care pathways and service linkages has resulted in an improved quality of life for clients enrolled on the program. The aims of the ITC Program are to: •

•

Contribute to improving health outcomes for Aboriginal and Torres Strait Islander people with chronic health conditions through access to care coordination, multidisciplinary care, and support for self- management; and Improve access to culturally appropriate mainstream primary care services (including but not limited to general practice, allied health and specialists) for Aboriginal and Torres Strait Islander people.

This can be split up into two separate services operating in the one program. Patient Services and General Practice Support. In the Country SA PHN service area, there is a regional service model in operation, that has 9 service providers in 10 locations. These organisations are listed in the table on the following page.

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Region

Service Provider

Contact Details Ph: (08) 8626 2500 Fax: (08) 8626 2530 Email: website@ckahsac.org.au Web: http://www.ckahsac.org.au/ Service Location: 1 Eyre Hwy Ceduna, SA 5690

Far West Coast

Ceduna Koonibba Aboriginal Health Service

Southern Eyre

Ph: (08) 8683 0162 Fax: (08) 8683 0126 Email: reception@plahs.org.au Port Lincoln Aboriginal Health Service Web: http://www.plahs.org.au/ Service Location: 19A Oxford Terrace, Port Lincoln SA 5606

Country and Outback Health

Ph: (08) 8643 5600 Fax (08) 8642 3766 Web: http://cobh.com.au/ Service Location: 12 Chapel Street, Port Augusta SA 5700

Umoona Tjutagku Health Service Aboriginal Corporation

Ph: (08) 8672 5255 Fax: (08) 8672 3349 Email: umoona@uths.com.au Web: www.uths.com.au Service Location: 8 Umoona Rd, Coober Pedy SA 5723

Nganampa Health Council

Ph: (08) 8954 9040 Fax: (08) 8956 7850 Web: http://www.nganampahealth.com.au/ Service Location: Umuwa

Sonder (formerly Northern Health Network)

Ph: (08) 8209 0700 Fax: (08) 8252 9433 Email: info@sonder.net.au Web: http://sonder.net.au/ Service Location: 2 Peachey Road, Edinburgh North SA 5113

Murray Mallee incorporating Adelaide Hills, Fleurieu and Kangaroo Island

Moorundi Aboriginal Community Controlled Health Service

Ph: (08) 8531 0289 Fax: (08) 7089 0450 Email: admin@macchs.org.au Web: https://www.moorundi.org.au/ Service Location: Lot 1 Wharf Road (Ninkowar), Murray Bridge SA 5253

Riverland

Ph: (08) 8582 3823 Fax: (08) 8582 3190 Focus One Health (formerly Riverland Email: info@focusonehealth.com.au Division of General Practice) Web: http://www.focusonehealth.com.au/ Service Location: 3 Riverview Drive, Berri, SA, 5343

Port Augusta and Flinders Whyalla and Upper Eyre

Coober Pedy and Surrounds

Anangu Pitjantjatjara Yankunytjatjara Lands

Barossa, Gawler, Yorke Peninsula and Mid North

Limestone Coast

Pangula Mannamurna Inc

Ph: (08) 8724 7270 Fax: (08) 8724 7378 Email: reception@pangula.org.au Web: http://pangula.org.au/ Service Location: 191 Commercial St West, Mount Gambier SA 5290

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Patient Services Patient services incorporates: •

• •

Individual access support to mainstream primary health care services, usually undertaken by an Aboriginal Outreach Worker. These services could include: o Support to obtain Medicare Cards o Support to access medical appointments o Support to obtain a 715 Health Assessment o Support to obtain a 721/723 GPMP or TCA. Care Coordination services for people with chronic conditions that requires supported access to different follow-up allied health and specialist services. Supplementary Services funding to access medical aids, gap funding for allied health and specialist services, and travel and accommodation where the closest allied health and specialist service is outside of the local area of the patient. The use of these funds can only be provided where the service or medical aid is required as part of the patient’s care and is within the care plan and every other option is exhausted. o Dental Services are excluded

Patient eligibility To be eligible for care coordination under the ITC program, Aboriginal and/or Torres Strait Islander people need to; • • •

Have a GP Management plan, or be supported to work through that process with their GP Be enrolled for chronic disease management in a General Practice or Aboriginal Controlled Health Service; and Be referred by their GP or other health service.

Priority should be given to patients most in need of care coordination services to obtain improved health outcomes. •

As a guide, patients most likely to benefit from the service include: o Patients who are at greatest risk of experiencing otherwise avoidable (lengthy and/or frequent) hospital admissions; o Patients at risk of inappropriate use of services, such as hospital emergency presentations; o Patients not using community-based services appropriately or at all; o Patients who need help to overcome barriers to access services; o Patients who require more intensive care coordination than is currently able to be provided by General Practice or Aboriginal Health Service staff; and o Patients who are unable to manage a mix of multiple community-based services.

Referral Forms You can ascertain referral forms by contacting the Integrated Team Care service provider in your region.

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General Practice Support Part of the Integrated Team Care services is support provided to primary health services including General Practice to build capacity to deliver culturally appropriate services. Under these services there are four Indigenous Health Project Officers who can assist General Practice to: • • • • • • •

Provide resources and advice surrounding Aboriginal and Torres Strait Islander identification Provide assistance regarding Culturally appropriate services including assisting the Practice to access cultural awareness training. Provide support to the practice to sign up to the Practice Incentive Program: Indigenous Health Incentive Provide resources and advice surrounding applying a cultural lens to models of care which can assist the delivery of services to Aboriginal and Torres Strait Islander patients. Provide resources and advice surrounding 715 Health Assessments Provide resources and advice surrounding quality improvement activities. Provide resources and advice surrounding General Practice standards that are concerned with Aboriginal health such as Aboriginal and Torres Strait Islander identification.

INTEGRATED TEAM CARE. Please click here to access the Integrated Team Care Program Implementation Guidelines(Updated April 2019).

10. Quality Improvement a. National Safety and Quality Health Service Standards The Australian Commission on Safety and Quality in Healthcare have issued new standards for health care around Australia for different sectors the 2nd Edition of the National Safety and Quality Health Service Standards. This generated a change in the standards for General Practice and are included in the 5th Edition of the RACGP Standards for General Practice. There are specific actions which are directed at Aboriginal and Torres Strait Islander Health specifically which have been identified for action across health services and have been further identified in a User Guide. In addition to this, there are seven resources, an overview and 6 specific action areas, which provide further information about improving the quality of care for Aboriginal and Torres Strait Islander patients. Overview: Guide to better care for Aboriginal and Torres Strait Islander Consumers (Word 503KB) 1. Setting safety and quality goals for Aboriginal and Torres Strait Islander people in health service organisations (Word 576KB) 2. Cultural competence in caring for Aboriginal and Torres Strait Islander consumers (Word 421KB) 3. Improving identification rates of Aboriginal and Torres Strait Islander consumers (Word 397KB) 4. Creating safe and welcoming environments for Aboriginal and Torres Strait Islander consumers (Word 408KB) 5. Effective and safe communication with Aboriginal and Torres Strait Islander consumers (Word 417KB) 6. Comprehensive care for Aboriginal and Torres Strait Islander consumers (Word 419KB) The six areas for action guides contain editable text boxes for those health service organisations who wish to include local content. 41

b.

Support on National Safety and Quality Health Service Standards and Quality Improvement Cycles.

Running a PDSA cycle or continuous quality improvement (CQI) cycle on a particular action contained within these resources are likely to prove beneficial for your Practice in terms of financial, accreditation and quality improvement purposes, but in engaging your local Aboriginal and Torres Strait Islander communities. Using CQI within Aboriginal and Torres Strait Islander Health as it relates to different health conditions that are shown in population health as an issue, either widely in the area and within your practice, can demonstrate multiple areas in which accreditors can assess Practices against the standards. There are some measurements used at a national level and by Aboriginal Community Controlled Health Organisations that can support specific PDSA or CQI cycles that are being implemented. These are available through the Australian Institute of Health and Welfare, which have a User Guide specifically on these measurements, National Key Performance Indicators for Aboriginal and Torres Strait Islander Primary Health Care User Guide. As there are annual updates to this particular health service data, and it is in the primary health care setting, the Practice will be able to benchmark the quality of service being delivered by the practice versus peers delivering the KPIs. These make the measures, relevant and appropriate to General Practice and CQI cycles. In addition, there are measurements that could be adapted from the Aboriginal and Torres Strait Islander Health Performance Framework Performance Measures and are also included in resources available under the AIHW resources. Indigenous Health Project Officers can support the work you do surrounding improving the safety and quality of services for Aboriginal and Torres Strait Islander patients and may have specific tools and other resources which can help you to do so. Indigenous Health Project Officers will always verify with that the Practice has undertaken activities which improve the identification rates of Aboriginal and Torres Strait Islander patients, whether the Practice undertakes 715 health assessments regularly and whether the Practice has undertaken PIP: Indigenous Health Incentive registration. This ensures that internal capacity within the Practice is improved to undertake improvement activities into the future. Please contact the local Indigenous Health Project Officer to ascertain advice and assistance in implementing these action areas for improving care to Aboriginal and Torres Strait Islander patients.

11. Accreditation a. RACGP 5th Edition Culturally Safe Care Items Below is a list of items within the RACGP 5th Edition Standards for General Practice that relate to the activities listed above in the NSQHSS and participation in the responses to improve access to primary health for Aboriginal and Torres Strait Islander people. Indigenous Health Project Officers can provide support in the capacity of General Practice to meet these criteria as it relates to the responses to improve access to primary health for Aboriginal and Torres Strait Islander people. 42

Criterion

Description

Actions

C1.3- Informed patient decisions

C1.3 B Our patients receive information to support the diagnosis, treatment, and management of their conditions.

Have information relating to culturally specific health information (e.g. Aboriginal and Torres Strait Islander health) in the waiting room and consultation rooms.

C1.4- Interpreter and other communication services

C1.4 C Our patients can access resources that are culturally appropriate, translated, and/or in plain English.

Maintain a list of websites and services from which patients can access translated resources.

C2.1 A Our practice, in providing patient healthcare, considers patients’ rights, beliefs, and their religious and cultural backgrounds.

Maintain a cultural safety policy for the practice team and patients so that your practice team knows they are required to provide care that is respectful of a person’s culture and beliefs, and that is free from discrimination.

C2.1 Respectful and culturally appropriate care

Keep information sheets in the common languages of the patient population in the consultation spaces.

Provide appropriate training and education so that the practice team knows how to help patients feel culturally safe in the service. Maintain a policy about patients’ rights and responsibilities. Maintain a policy about the ceasing of a patient’s care. Maintain policies and processes about patient health records. Maintain an anti-discrimination policy. Provide access to cultural awareness and cultural safety training for the practice team and keep records of the training in the practice’s training register. Meet a patient’s request for a practitioner of a specific gender, if possible. Have separate sections of the waiting room for men and women, if possible and culturally appropriate for your patient population. Use a clinical audit tool to identify cultural groups in your population. Display signs acknowledging the traditional custodians of the land. Display Aboriginal or Torres Strait Islander art and flags. Display organisational cultural protocols within the office, waiting areas and consultation rooms. Provide resources appropriate to the health literacy and cultural needs of your patients.

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Criterion

Description

Actions

C3.6 – Research

C3.6 A Our practice has all research approved by an ethics committee and indemnified.

Consider the ethical needs of Aboriginal and Torres Strait Islander peoples.

C4.1 Health promotion and preventive care

C4.1 A Our patients receive appropriately tailored information about health promotion, illness prevention, and preventive care.

Provide culturally appropriate material (e.g. for Aboriginal and Torres Strait Islander patients).

C5.1 Diagnosis and management of health issues

C5.1 B Our clinical team supports consistent diagnosis and management of our patients.

Use relevant clinical guidelines for treating patients who identify as Aboriginal or Torres Strait Islander origin, and for preventing and managing chronic diseases in these patients.

C7.1 Content of patient health records

C7.1 E Our practice routinely records the Aboriginal or Torres Strait Islander status of our patients in their patient health record.

Document the patient’s Aboriginal and/or Torres Strait Islander status in patient health records.

C8.1– Education and training of non-clinical staff

C8.1 A Our non-clinical staff complete training appropriate to their role and our patient population.

Training may cover areas such as: • Aboriginal and Torres Strait Islander health • Aboriginal and Torres Strait Islander cultural awareness • Cross-cultural safety

QI1.1 Quality improvement activities

QI1.1 B Our practice team internally shares information about quality improvement and patient safety.

Activities to improve a general practice can involve examining the practice’s structures, systems and clinical care. Relevant patient and practice data can help you identify where quality improvements can be made (e.g. patient access, management of chronic disease, preventative health). Have a system to identify quality improvement activities. Suggested QI Activities: • Aboriginal and Torres Strait Islander identification • 715 Health Assessment Performance • Aboriginal and Torres Strait Islander Chronic Disease Management Performance.

QI1.1 Quality improvement activities

QI1.1 D Our practice team can describe areas of our practice that we have improved in the past three years.

Keep records of quality improvements made to the practice or practice systems in response to feedback, complaints or audits.

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Criterion

Description

Actions

QI 2.1 Health summaries

QI2.1 B Each active patient health record has the patient’s current health summary that includes, where relevant: • Adverse drug reactions • Current medicines list • Current health problems • Past health history • Immunisations • Family history • Health risk factors (e.g. smoking, nutrition, alcohol, physical activity) • Social history, including cultural background.

Keep a current health summary in each active patient’s health record. Conduct a regular audit of patient health records.

GP 1.1 Responsive system for patient care

GP 1.1 A Our practice provides different consultation types to accommodate patients’ needs.

Provide a variety of consultation types and retain evidence of this.

GP2.1 B Our practice provides continuity of care and comprehensive care.

Demonstrate that the practice provides comprehensive care.

GP2.1 Continuous and comprehensive care

Activities could include ensuring Aboriginal and Torres Strait Islander patients have access to Level C and D consults to facilitate culturally competent communications.

Use a clinical handover system when clinicians are away or on leave. Have a process for recall. Document management plans in patient health records, especially for patients with complex or chronic health problems. Have a policy and procedures for recall and reminders. Provide a list of services offered by the practice on your website or in an information leaflet.

GP2.2 – Follow-up systems

GP2.2 B Our practice recalls patients who have clinically significant results.

Document in the patient’s health record each attempt to contact and recall patients about clinically significant results. Have a process for recalling patients with clinically significant results.

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Criterion GP2.2 – Follow-up systems

Description GP2.2D Our practice initiates and manages patient reminders.

Actions Document in patient health records when reminders have been initiated by the practice and acted upon by the patient. Document the recall and reminder system, including who is responsible for monitoring and follow-up. Maintain templates in a clinical software program to trigger recalls and reminders. Educate the practice team so they can tell patients about the process of sending out reminders Have reminders sent through the clinical information system.

GP2.3 Engaging with other services

GP2.3 A Our practice collaborates with other health services to deliver comprehensive care.

Be able to demonstrate that your practice collaborates with other healthcare services. Provide evidence that the practice team has been made aware of local healthcare providers. Maintain an electronic or paper-based register of healthcare service providers and organisations for patient referrals. Regularly update the register and include the date of the update. Keep an easily accessible list of pharmacies, including the roster of on-call pharmacists. Include discharge letters in patient health records, along with records that show they are acted on appropriately.

GP3.1 – Qualifications, education and training of healthcare practitioners

Practitioners must consider what CPD and other training is relevant to their position and patient population.

This may include development related to: • Aboriginal and Torres Strait Islander health • Aboriginal and Torres Strait Islander cultural awareness.

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Appendix A Further information and References

1. Aboriginal and Torres Strait Islander Social Justice Commissioner, Steering Committee for Indigenous Health Equality. Close the gap: national Indigenous health equality targets. Sydney: Human Rights and Equal Opportunity Commission; 2008. 2. Department of the Prime Minister and Cabinet, Closing the Gap 3. Council of Australian Governments, Closing the Gap Refresh Statement 4. Department of the Prime Minister and Cabinet, 2019 Closing the Gap Statement 5. Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013– 2023 6. Chronic Disease and the Indigenous Australians' Health Program (IAHP) 7. Aboriginal and Torres Strait Islander Health Performance Framework (HPF) Performance Measures 8. National Key Performance Indicators for Aboriginal and Torres Strait Islander Primary Health Care User Guide 9. Indigenous Eye Health Measures Fact Sheet (2017) 10. Indigenous Australians' Health Programme (IAHP) Chronic Disease 11. Primary care (GP, nursing, allied health) Medicare primary care items Allied health providers need to meet specific eligibility requirements, be in private practice and register with Medicare Australia. Registration forms are available from the Department of Human Services (Medicare) or can be obtained by phoning 132 150 (found on the Australian Government Human Services website) 12. Chronic Disease Management - Individual Allied Health Services under Medicare - Provider Information available here and here. 13. Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS Better Access Initiative 14. PIP Indigenous Health Incentive – read more here. 15. A guide to Medicare for Indigenous Health Services, Indigenous Access Program for health professionals The Indigenous Access Program helps Aboriginal and Torres Strait Islander Australians access our services, including health assessments, adult health checks. The program also supports our network of Medicare Liaison Officers and the Aboriginal and Torres Strait Islander Access Line. We also promote voluntary identification within Aboriginal and Torres Strait Islander communities. To learn more about providing health services to Aboriginal and Torres Strait Islander patients download the guide to Medicare for Indigenous health services complete our Indigenous health education program. The guide was developed to support staff working in organisations that provide Medicare services to Aboriginal and Torres Strait Islander Australians. It provides easy to understand advice about Medicare health services and programs. 16. Australian Indigenous HealthInfoNet 17. Healthdirect Indigenous Health and Healthdirect’s The Free Health app 18. Australian Government – Department of Health, The Indigenous Australians’ Health Programme Funding Agreement Update – The Progress and Future 19. Australian Health Survey, 2011-2012 Fact sheet for GPs 20. Australian Indigenous Doctors’ Association (AIDA) 21. Indigenous Australians’ Health Program (IAHP) 22. Queensland Government’s Primary Clinical Care Manual 9th Edition and Chronic Conditions Manual: Prevention and Management of Chronic Conditions in Australia (1st edition 2015) 47

23. ACRRM's downloadable clinical guidelines (The Chronic Conditions Manual: Prevention and Management of Chronic Conditions in Australia 1st edition 2015 (CCM) or for Mobile Devices contact Heather Allwood at ACRRM on Free call: 1800 223 226 or email h.allwood@acrrm.org.au. This manual is available for download in pdf format from the ‘Print Version’ page of the ACRRM Clinical Guidelines for Mobile Devices module or directly from https://www.health.qld.gov.au/rrcsu) 24. National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy 25. Aboriginal Mental Health Clinical Practice Guideline and Pathways: A culturally appropriate guide for working with Aboriginal mental health consumers 26. Head to Health: Supporting Aboriginal and Torres Strait Islander Peoples – resources and information for providers, patients and carers on addressing mental wellbeing for Aboriginal and Torres Strait Islander peoples. 27. InsideOut Institute for Eating Disorders – Resources for Professionals 28. Treatment for Eating Disorders: Continuum of Care from the InsideOut Institute for Eating Disorders. 29. Rural Other Medical Practitioners Program (ROMPs) 30. Explaining the Standards in a meaningful way for Aboriginal community controlled health services- Interpretive Guide to the RACGP Standards for general practices (4th edition) for Aboriginal community controlled health services 31. CountrySA PHN Website access, in particular Aboriginal Health 32. Optimal Care Pathways for Aboriginal and Torres Strait Islander people with Cancer The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer was developed by Cancer Australia in partnership with the Department of Health and Human Services Victoria and Cancer Council Victoria, and has been endorsed by the Australian Health Ministers’ Advisory Council. The Optimal Care Pathway is accompanied by consumer resources. There is also a YouTube video which provides more information about the importance of the Optimal Care Pathway.

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