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Needs Assessment Data Report 2018

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Contents Glossary........................................................................................................................................................ 5 1 Introduction ............................................................................................................................................ 6 2 Geography............................................................................................................................................... 8 2.1 Remoteness ................................................................................................................................... 10 2.2 Population Centres ........................................................................................................................ 11 2.3 Population Structure ...................................................................................................................... 11 2.4 Vulnerable Populations .................................................................................................................. 12 2.4.1 Aboriginal South Australians ................................................................................................ 12 2.4.2 Persons from Culturally and Linguistically Diverse (CALD) backgrounds ............................ 14 2.4.3 Older Persons ....................................................................................................................... 15 2.4.4 Socio-Economic status (SES) ................................................................................................ 17 3 Data and Sources .................................................................................................................................. 18 4 Chronic Conditions and Risk Factors .................................................................................................... 18 4.1 Diabetes........................................................................................................................................... 18 4.2 Chronic Kidney Disease ................................................................................................................... 20 4.3 Respiratory System Conditions ....................................................................................................... 21 4.4 Circulatory System Diseases ............................................................................................................ 23 4.5 Cancer .............................................................................................................................................. 26 4.6 Arthritis and Musculoskeletal Conditions ....................................................................................... 29 4.7 Risk Factors ...................................................................................................................................... 30 4.8 Aboriginal Preventative Health Assessment .................................................................................. 32 5 Mental Health ......................................................................................................................................... 32 5.1 General Mental Health .................................................................................................................. 32 5.2 Suicide Prevention ......................................................................................................................... 35 6 Drugs and Alcohol ................................................................................................................................. 36 6.1 Drug and Alcohol in the Aboriginal Population ............................................................................. 38 7 Health Workforce ................................................................................................................................. 39 7.1 Health Workforce Statistics ........................................................................................................... 40 7.1.1 General Practitioners ........................................................................................................... 40 7.1.2 Pharmacists .......................................................................................................................... 40 7.1.3 Podiatrists ............................................................................................................................ 41 7.1.4 Psychologists ........................................................................................................................ 41 7.1.5 Nurses and Midwives ........................................................................................................... 41 7.1.6 Optometrists ........................................................................................................................ 41 2


7.1.7 Physiotherapists ................................................................................................................... 41 7.1.8 Occupational Therapists....................................................................................................... 42 7.1.9 Dentists ................................................................................................................................ 42 7.1.10

Aboriginal Health Practitioners ....................................................................................... 42

8 Immunisation ........................................................................................................................................ 44 9 Aged Care .............................................................................................................................................. 46 10 Potentially Preventable Hospitalisations............................................................................................. 47 11 After Hours ............................................................................................................................................ 48 12 eHealth .................................................................................................................................................. 51 References ................................................................................................................................................. 52 Appendix 1: Summary of Stakeholder Consultation Activities ............................................................... 54 Summary of Country SA PHN General Practice and Allied Health survey ............................................ 54 Summary of Regional Consultation Results .......................................................................................... 55 Catchment-wide Themes ............................................................................................................... 55 Local Health Cluster Summaries .................................................................................................... 56 Mental Health Drug and Alcohol Community Consultations ................................................................ 61 Submissions to the SA Parliamentary Inquiry into Regional Health Services (2016) ............................ 61

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List of Tables Table 1: SA3 and LGA in CSAPHN ................................................................................................................ 9 Table 2: Distribution of CSAPHN Population by Remoteness Area............................................................ 10 Table 3: Diabetes Data Summary .............................................................................................................. 19 Table 4: Hospitalisations for Diabetes Complications ................................................................................ 20 Table 5: Chronic Obstructive Pulmonary Disease, Diagnosis, and Hospitalisation .................................... 21 Table 6: Hospitalisation for Chronic Pulmonary Disease and Respiratory Conditions .............................. 22 Table 7: Asthma Data Summary ................................................................................................................ 23 Table 8: Circulatory System Disease Data Summary ................................................................................. 24 Table 9: Hospitalisation for Circulatory System Diseases, Aboriginal Persons .......................................... 25 Table 10: Cancer Data Summary ............................................................................................................... 27 Table 11: Participation in Cancer Screening Programs .............................................................................. 28 Table 12: Arthritis and Osteoporosis Data Summary ................................................................................. 29 Table 13: Health Risk Factors Data Summary ............................................................................................ 31 Table 14: Mental Health Service Data Summary ....................................................................................... 33 Table 15: Mental Health Hospital Separations .......................................................................................... 34 Table 16: Hospitalisation for Intentional Self-Harm .................................................................................. 35 Table 17: Hospitalisation for Alcohol and Other Substance Use Disorders ............................................... 38 Table 18: Prevalance, Prescriptions, and Emergency Department Presentations for Alcohol and Other Drugs .......................................................................................................................................................... 38 Table 19 Health Workforce Data summary................................................................................................ 43 Table 20: Childhood Immunisation Coverage, 2018 .................................................................................. 44 Table 21: Childhood Immunisation Coverage for Aboriginal Children ...................................................... 45 Table 22: Human Papillomavirus Vaccination Coverage............................................................................ 46 Table 23: Aged Care Data Summary........................................................................................................... 47 Table 24: Potentially Preventable Hospitalisations.................................................................................... 48 Table 25: MBS After Hours Items ............................................................................................................... 50 Table 26: My Health Record Summary Data .............................................................................................. 51

List of Figures Figure 1: Former Medicare Local Regions within South Australia ............................................................... 6 Figure 2: CSAPHN SA3 Boundaries .............................................................................................................. 8 Figure 3: CSAPHN Remoteness Areas........................................................................................................ 10 Figure 4: Population Distribution by Age and Sex ..................................................................................... 11 Figure 5 : Aboriginal Population of CSAPHN By LGA .................................................................................. 12 Figure 6 Distribution of Aboriginal Population of CSAPHN BY LGA........................................................... 13 Figure 7: People Born in non-English Speaking Countries by LGA ........................................................... 14 Figure 8: People Born Overseas Reporting Poor Proficiency in English ................................................... 15 Figure 9: Persons Aged 65 and Over ......................................................................................................... 15 Figure 10: Index of Relative Socio-Economic Disadvantage, 2016 ............................................................ 17 Figure 11: Practices Registered for After Hours PIP ................................................................................... 49

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GLOSSARY ABS

Australian Bureau of Statistics

ADIS

Alcohol Drug Information Service

AHS

Australian Health Survey

AIHW

Australian Institute of Health and Welfare

AIR

Australian Immunisation Register

APHN

Adelaide Primary Health Network

AOD

Alcohol and Other Drugs

APY Lands Anangu Pitjantjara Yankunytjatjara Lands

K10

Kessler 10 psychological distress scale

LGA

Local Government Area (local councils)

MBS

Medicare Benefits Schedule

NCETA

National Centre for Education and Training on Addiction

NCIS

National Coronial Information Service

NHSD

National Health Service Directory

NHMRC

National Health and Medical Research Council

NP

Not Published

PBS

Pharmaceutical Benefits Scheme

PHIDU

Public Health Information Development Unit

ASR

Age-Standardised Rate

CALD

Culturally and Linguistically Diverse

CKD

Chronic Kidney Disease

COPD

Chronic Obstructive Pulmonary Disease

PHN

Primary Health Network

CRM

Customer Relationship Management System

PPH

Potentially Preventable Hospitalisation

RACF

Residential Aged Care Facility

RDWA

Rural Doctors Workforce Agency

RFDS

Royal Flying Doctor Service

RHD

Rheumatic Heart Disease

SA

South Australia

SA#

Statistical Area, Level 1, 2, 3, etc.

SAMSS

SA Monitoring and Surveillance System

SEIFA

Socio-Economic Indexes for Areas

SES

Socio-Economic Status

CSAPHN

Country SA Primary Health Network

CSD

Circulatory System Disease

CVD

Cardiovascular Disease

ED

Emergency Department

ERP

Estimated Resident Population

ESKD

End Stage Kidney Disease

GP

General Practice or General Practitioner

HPV

Human Papillomavirus

IRSD

Index of Relative Socio-Economic Disadvantage

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1 INTRODUCTION “BRIDGING THE GAP OF HEALTH INEQUITY AND ACCESS IN RURAL SOUTH AUSTRALIA BY BUILDING A COLLABORATIVE AND RESPONSIVE COUNTRY SA HEALTH CARE SYSTEM ” Established by the Federal Government to replace Medicare Locals, 31 Primary Health Networks became operational throughout Australia on July 1st, 2015 with primary objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and to improve the coordination of care to ensure patients receive the right care in the right place at the right time. The Country SA Primary Health Network (CSAPHN) region covers all of South Australia except the Adelaide metropolitan area. Incorporating an estimated 99.8% of the state geographically, the CSAPHN region is home to approximately 30% of SA’s population. The CSAPHN region encompasses territory previously managed by all five of the former South Australian Medicare Locals (MLs). The majority of the PHN area was formed from the entirety of the Country North and Country South Medicare Locals, with smaller areas but significant population numbers being incorporated from the three remaining MLs. (Table 1). FIGURE 1: FORMER MEDICARE LOCAL REGIONS WITHIN SOUTH AUSTRALIA

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CSAPHN's mission is to bridge the gap of health inequity and access in rural South Australia by building a collaborative and responsive country SA health care system, with a commitment to improving the patient experience of the health system. Since the start of the 2016-17 financial year, CSAPHN has been strategically commissioning health services tailored to regional and local needs. Through the establishment of local Primary Health Care Committees across the catchment, CSAPHN is working to ensure that local clinical and community voices are systematically included in this process. Stakeholder and community views serve to complement and contextualise information gathered from regional health and health service statistics. As such, they represent an essential element of both the needs assessment process and ongoing activity planning and implementation. This document is an update of the November 2017 Needs Assessment Data Report, and as an adjunct to the CSAPHN Needs Assessment – 2018. The CSAPHN Needs Assessment – 2018, covers the entire CSAPHN catchment area, investigating the distribution of health issues and corresponding services and identifying populations and communities which may be particularly disadvantaged. The following issues and special needs populations have been highlighted as national priority issues for all Primary Health Networks: • • • • • • •

Aboriginal and Torres Strait Islander Health Aged Care Alcohol and other drugs eHealth Health Workforce Mental Health Population Health

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

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2 GEOGRAPHY CSAPHN covers a region of over 980,000 square kilometres, which encompasses all of South Australia outside the core metropolitan area. The landscape ranges from the green hills and intensive agriculture land of the Adelaide Hills, Barossa and Fleurieu Peninsula, to vast broad acre farming regions, as well as the rugged Flinders Ranges and arid outback. The data in this report is presented primarily by Statistical Area Level 3 (SA3); a census statistical geography that provides a framework for data analysis at a regional level; and/or by Local Government Area (LGA) or Statistical Area Level 2 (SA2) where data is available at a smaller geographical area. There are 11 SA3s in CSAPHN and 54 LGAs which includes the Unincorporated areas of the state. The CSAPHN SA3s are illustrated in Figure 2, and the associated LGAs (several of which cross SA3 boundaries) are listed in

Table 1.

FIGURE 2: CSAPHN SA3 BOUNDARIES

SOURCE: ABS, ASGS 2016

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TABLE 1: SA3 AND LGA IN CSAPHN SA3

LGA

SA3

LGA

Adelaide Hills

Adelaide Hills

Outback - North and East

Anangu Pitjantjatjara

Gawler - Two Wells

Barossa

Mount Barker

Coober Pedy

Gawler

Flinders Ranges

Light (39%)

Port Augusta

Mallala (63%)

Roxby Downs

Barossa

Unincorporated SA (84%)

Light (61%) Lower North

Fleurieu - Kangaroo Island

Kangaroo Island

Barunga West

Victor Harbor

Clare and Gilbert Valleys Goyder Mid North

Limestone Coast

Eyre Peninsula and South West

Yankalilla Grant

Wakefield

Kingston

Mount Remarkable

Mount Gambier

Northern Areas

Naracoorte and Lucindale

Orroroo/Carrieton

Robe

Peterborough

Tatiara

Port Pirie City and Districts Yorke Peninsula

Alexandrina

Mallala (37%)

Copper Coast

Wattle Range Murray and Mallee

Berri and Barmera

Yorke Peninsula

Karoonda East Murray

Ceduna

Loxton Waikerie

Cleve

Mid Murray

Elliston

Murray Bridge

Franklin Harbour

Renmark Paringa

Kimba

Southern Mallee

Lower Eyre Peninsula

The Coorong

Maralinga Tjarutja Port Lincoln Streaky Bay Tumby Bay Whyalla Wudinna Unincorporated SA (15%) SOURCE: ABS 2016A

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2.1 Remoteness Approximately 54% of the CSAPHN population live in areas classified as Outer Regional, Remote and Very Remote Australia (Table 2 and Figure 3). TABLE 2: DISTRIBUTION OF CSAPHN POPULATION BY REMOTENESS AREA

Remoteness Area

Area (Km2)

% of Area

Total Persons

% of Population

290.8

0.03

46,438

9.9

Inner Regional

15,088.9

1.54

165,492

35.4

Outer Regional

79,289.0

8.08

197,875

42.3

Remote

118,574.3

12.09

44,100

9.4

Very Remote

767,850.5

78.26

14,217

3.0

TOTAL CSAPHN

981,093.5

100.00

468,122

100.0

Major Cities

SOURCE: ABS,

2016A

FIGURE 3: CSAPHN REMOTENESS AREAS

SOURCE: ABS 2016A

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2.2 Population Centres According to Census 2016, the six rural cities of Mount Gambier, Whyalla, Murray Bridge, Port Lincoln, Port Pirie and Port Augusta are collectively home to over 110,000 people. These population centres serve as hubs for health and other services for the area and its surrounding regions. Nearer to the metropolitan boundary, Gawler, Mount Barker, and Aldgate - Stirling areas account for a further 63,000 people. These areas have a relatively high access to local and metropolitan health services, as well as other services. Over 25,000 people live in the Victor Harbor – Goolwa area which has a high proportion of their population over 65 years of age. These areas combined are home to about 225,000 people, or 47% of the total CSAPHN population. The remainder of the CSAPHN population live in small towns of up to 5,000 people, (many with less than 500 people), or are dispersed in the agricultural and outback regions of the state.

2.3 Population Structure The 2016 estimated resident population (ERP) for CSAPHN was 496,635 people, which represents almost 29% of the total South Australian population (ABS 2016a). Within the CSAPHN catchment area, the male to female proportion is relatively even, with slightly more males than females. CSAPHN has a noticeably lower proportion of young adults aged 20 to 39 years compared to South Australia (Figure 4) FIGURE 4: POPULATION DISTRIBUTION BY AGE AND SEX

SOURCE: ABS 2016A

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2.4 Vulnerable Populations Vulnerable populations are those which are marginalised in some way; they may be excluded from mainstream economic activity, reach lower standards of education, and experience higher levels of poverty than the rest of the population. This report identifies four different population groups as vulnerable: Aboriginal and Torres Strait Islander people, Culturally and Linguistically Diverse (CALD), Older persons, and regions with lower Socio-Economic Status (SES).

2.4.1 Aboriginal South Australians CSAPHN recognises Aboriginal people are the original inhabitants of South Australia, and to reflect the very low population demographic identifying as Torres Strait Islander within South Australia, the term Aboriginal is used within this document. When referring to characteristics of the Australian population, the term Aboriginal and Torres Strait Islander is used. The ABS Census 2016 reports the Aboriginal population of CSAPHN as 16,946 or 3.5% of the total CSAPHN population. At an LGA level, the proportion of Aboriginal persons within an LGA is highest in the more remote areas of SA (Figure 5). FIGURE 5 : ABORIGINAL POPULATION OF CSAPHN BY LGA

SOURCE: ABS 2016A

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Figure 6 shows the distribution and proportion of the CSAPHN region’s Aboriginal population. CSAPHN’s Aboriginal populations are most concentrated in the regional cities and small Aboriginal communities. Port Augusta LGA has the highest proportion of CSAPHN’s Aboriginal population (14.9%). followed by Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands, 11.2%). Whyalla (6.1%) and Murray Bridge (5.7%) also have a high proportion of CSAPHN’s Aboriginal population. FIGURE 6 DISTRIBUTION OF ABORIGINAL POPULATION OF CSAPHN BY LGA

SOURCE: ABS 2016A

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2.4.2 Persons from Culturally and Linguistically Diverse (CALD) backgrounds ACCORDING TO ABS CENSUS 2016, PEOPLE BORN OVERSEAS IN PREDOMINATELY NON-ENGLISH SPEAKING COUNTRIES IS HIGHEST IN COOBER PEDY (22%), FOLLOWED BY MURRAY BRIDGE (9.9%), RENMARK PARINGA (9.9%), AND NARACOORTE AND LUCINDALE (9.0%) LGAS (FIGURE 7). UNSURPRISINGLY, THE SAME AREAS HAVE THE HIGHEST PROPORTION OF PERSONS BORN OVERSEAS WHO SPEAK ENGLISH NOT WELL OR NOT AT ALL (

Figure 8). FIGURE 7: PEOPLE BORN IN NON-ENGLISH SPEAKING COUNTRIES BY LGA

SOURCE: PHIDU 2015

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FIGURE 8: PEOPLE BORN OVERSEAS REPORTING POOR PROFICIENCY IN ENGLISH

SOURCE: PHIDU 2015

2.4.3 Older Persons Local Government Areas and their proportion of persons aged over 65 years is shown in Figure 9. The coastal city of Victor Harbor is a well-known retirement destination, more than 39% of their population are aged 65 or over. Yorke Peninsula and Barunga West LGAs both have over 32% of their population aged over 65 years. FIGURE 9: PERSONS AGED 65 AND OVER

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SOURCE: ABS 2016A

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2.4.4 Socio-Economic status (SES) Socio-Economic Indexes for Areas (SEIFA) ranks areas in Australia according to relative socioeconomic advantage and disadvantage based on Census information. Overall disadvantage is measured by the Index of Relative Socio-Economic Disadvantage (IRSD), based on an Australian average of 1,000 and disadvantage is measured relative to this (ABS, 2016). In CSAPHN, the most disadvantaged areas are the APY Lands with an IRSD score of 593, followed by Maralinga Tjarutja (692). Peterborough, Coober Pedy, and Port Pirie LGAs also fall into the more disadvantaged range, with scores between 700-900 (Figure 10). FIGURE 10: INDEX OF RELATIVE SOCIO-ECONOMIC DISADVANTAGE, 2016

SOURCE: ABS 2016A

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3 DATA AND SOURCES The health-related data presented in the following sections represents a selection of the health and program data available to CSAPHN and has been organised within the PHN priority areas and aligned with the national health priorities. The data used in this report is the most recent and relevant available at the time from a wide range of sources. Some data is acquired directly by CSAPHN, some is sourced by the Department of Health and made available to PHNs, and some are publicly available. Where data has been supplied at SA3 level, it should be noted that this has often been aggregated from postcode data by the custodian. In other cases, CSAPHN has aggregated data from postcode, SA2 or LGA level as noted below. Percentages and rates have been calculated using the Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) 2016 unless otherwise noted.

4 CHRONIC CONDITIONS AND RISK FACTORS Chronic conditions are defined as any condition which is long lasting and with persistent effects. Chronic conditions are a leading cause of illness, disability, and death in Australia (Department of Health, 2015). Conditions which affect a high proportion of the population and have the greatest impacts on quality of life are considered high priorities for monitoring and intervention in the primary care. Communities with high levels of socioeconomic disadvantage often also have high rates of chronic conditions and the associated risk factors. The magnitude and distribution of selected chronic conditions within the CSAPHN region, all of which are National Health Priority Areas are discussed below.

4.1 Diabetes Approximately 5.1% of Australian adults are diagnosed with diabetes (all types) across their lifetime, with an additional 3.1% of adults at high risk of developing the condition (AIHW, 2015b). At a national level, diabetes is more common in men (6.3%) than women (3.9%) and increases with age (ABS, 2012). South Australia is slightly higher than the national percentage with 5.6% of the population estimated to have diabetes. By age, 0.7% of South Australians aged 0-24 years have diabetes, this rises to 7.8% in the 45-64 years age group, and 18.3% in the 65 years and over population (ABS, 2015). Diabetes prevalence is highest in the lowest SEIFA quintile, and lowest in the highest SEIFA quintile (AIHW, 2016b). Diabetes complications accounted for 1,236 potentially preventable hospital admissions for Country SA residents in 2015-2016, and 1,218 in 2014-2015 (AIHW, 2017b). In South Australia’s Aboriginal population, from July 2013 to June 2015, age-standardised hospitalisations with a principal diagnosis of diabetes was 8.6 per 1,000 (AIHW, 2017a). The South Australian Aboriginal Health Survey 2012 reports the prevalence of all diabetes types in the Aboriginal South Australian population as: • • •

17.4% for South Australia, 24.4% for country South Australia and; 40.2% in remote areas of South Australia.

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Diabetes Diagnosis SAMSS Respondents were considered to have diabetes if they had ever been told by a doctor that they had diabetes (including gestational diabetes). The highest proportion of respondents reporting a diagnosis of diabetes was in the Outback North and East (21.6%), followed by Eyre Peninsula and South West (14.4%), and the Limestone Coast (12.1%). Hospitalisation for Diabetes Complications The Outback North and East was also the highest for diabetes complication hospitalisation (3.2 per 1,000), followed by the Barossa (3.1 per 1,000), this is high given the Barossa SA3 has one of the lowest diabetes prevalence for the CSAPHN region. Conversely, the Limestone Coast SA3 has one of the highest diabetes prevalence, while having one of the lowest rates of hospitalisation for diabetes complications (1.5 per 1,000) however, the Limestone Coast SA3 had the highest average number of bed days for diabetes complication hospitalisation with an average of 8.9 days, the Outback North and East was the next highest with an average of 6.0 bed days for diabetes complication hospitalisations. TABLE 3: DIABETES DATA SUMMARY

SA3

SAMSS respondents 16 years and over 2016- 2018 % population

Diabetes Hospitalisations 2015-16 ASR per 1,000 population

Average Length of Stay 2015-16 (Days)

Adelaide Hills

6.2%

1.0

3.8

Gawler - Two Wells

10.8%

1.7

4.5

Barossa

5.2%

3.1

4.4

Lower North

6.8%

1.7

3.6

Mid North

10.9%

2.8

4.5

Yorke Peninsula

11.1%

2.1

4.8

Eyre Peninsula & South West

14.4%

2.6

4.7

Outback - North & East

21.6%

3.2

6.0

Fleurieu - Kangaroo Island

10.8%

1.1

3.8

Limestone Coast

12.1%

1.5

8.9

Murray & Mallee

9.1%

2.3

4.8

CSAPHN

10.8%

2.0

5.0

South Australia

9.3%

SOURCE: SAMSS 2016-2018, AIHW 2017B

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Hospitalisations for diabetes complications in the Aboriginal population are highest in the Eyre Indigenous Area (25.2 per 1,000), followed by Port Augusta (18.1 per 1,000), and Ceduna – West Coast Indigenous Area (13.4 per 1,000). TABLE 4: HOSPITALISATIONS FOR DIABETES COMPLICATIONS

Indigenous Area 2016

Hospitalisations for diabetes complications Aboriginal persons 2012/13 to 2014/15 Average annual ASR per 1,000

Adelaide Hills - Mount Barker Barossa Berri - Barmera Fleurieu - Kangaroo Island Gawler Loxton - Waikerie - Mid Murray

0.0 #

5.7 #

7.7 #

Murray Bridge

2.3

Murray Mallee

6.0

Renmark Paringa

#

South-East

1.3

Wakefield - Clare and Gilbert Valleys

0.0

Yorke Peninsula

8.6

Anangu Pitjantjatjara

1.1

Coober Pedy - Umoona

8.0

Eyre

25.2

Flinders

3.1

Port Augusta

18.1

Whyalla

6.7

Ceduna

13.4

Ceduna - West Coast

8.4

Port Lincoln

4.1

South Australia

5.2

# ASR NOT CALCULATED DUE TO COUNT BEING UNDER 5 PERSONS, DUE TO POPULATIONS UNDER 100, OR DATA NOT AVAILABLE SOURCE: PHIDU 2018

4.2 Chronic Kidney Disease Chronic kidney disease (CKD) is often comorbid with other chronic conditions such as Type II Diabetes and cardiovascular disease (CVD), and all three share common risk factors. The early stages of CKD are often unnoticed and despite reduced kidney function, patients can be unaware of their kidney disease (AIHW, 2015a), therefore, prevalence data is difficult to measure. The 2014-2015 Australian Health Survey (AHS) found 0.9% of persons self-reported CKD in South Australia, 0.6% of men and 1.0% of women (ABS, 2015). The highest proportion of CKD was in the

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age group 65 years and over (3.0%). In South Australia, higher proportions of kidney disease were found in the most disadvantaged (1.7%) as well as the most advantaged populations (1.3%) (ABS, 2015). Age-standardised rates for hospitalisation with the principal diagnosis of chronic kidney disease, excluding dialysis, was 5.1 per 1,000 for Aboriginal South Australians and the incidence of end stage kidney disease (ESKD, the most severe form of CKD, usually requiring dialysis and/or transplant) is 0.6 per 1,000 for the period 2012-2014. (AIHW, 2017a).

4.3 Respiratory System Conditions The most common chronic respiratory conditions are hayfever and allergic rhinitis, however these do not cause as much issue as when they are combined with other respiratory conditions such as asthma (ABS, 2015). Deaths due to asthma and chronic obstructive pulmonary disease (COPD) in Australia are higher among people who live in remote areas, Aboriginal and Torres Strait Islander people, and people living in areas of greater socioeconomic disadvantage (AIHW, 2014). SAMSS data shows Outback – North and East SA3 has the highest prevalence of COPD (11.2%) and the highest rate of admissions for COPD (5.4 per 1,000) in the CSAPHN region. Fleurieu – Kangaroo Island had the second highest prevalence of COPD (7.2%), and the Eyre Peninsula & South West had the greatest average length of stay for hospitalisations for COPD (6.2 days). TABLE 5: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, DIAGNOSIS, AND HOSPITALISATION

SA3

Current COPD Diagnosis 16+ years 2016-2018 % respondents

Hospitalisations for Average Length of Stay COPD (days) 2015-16 2015-16 ASR per 1,000

3.2

2.0

5.3

#

3.4

4.5

Barossa

4.8

2.0

5.2

Lower North

4.7

2.3

NP

Mid North

4.4

3.4

6.0

#

2.3

4.3

Eyre Peninsula & South West

5.3

2.8

6.2

Outback - North & East

11.2

5.4

4.9

Fleurieu - Kangaroo Island

7.2

2.4

4.2

Limestone Coast

5.1

3.0

5.0

Murray & Mallee

4.8

3.3

4.5

CSAPHN

5.6

2.8

5.0

South Australia

4.9

Adelaide Hills Gawler - Two Wells

Yorke Peninsula

SOURCE: SAMSS 2016-2018, AIHW 2017A NP: NOT PUBLISHED

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Hospitalisations for COPD was highest in the Murray Mallee Indigenous Area (21.1 per 1,000), followed by Berri – Barmera (14.8 per 1,000), and Port Augusta (14 per 1,000). Hospitalisations for respiratory conditions was very high in the Eyre Indigenous Area (155 per 1,000), followed by Coober Pedy – Umoona Indigenous Area (93.3 per 1,000). TABLE 6: HOSPITALISATION FOR CHRONIC PULMONARY DISEASE AND RESPIRATORY CONDITIONS

Indigenous Area 2016

Adelaide Hills - Mount Barker

Hospitalisations for COPD Aboriginal persons 2012/13 to 2014/15 Average annual ASR per 1,000

Admissions for respiratory system conditions Aboriginal persons 2012/13 to 2014/15 Average annual ASR per 1,000

0.0

20.1

#

10.3

Berri - Barmera

14.8

36.2

Fleurieu - Kangaroo Island

0.0

15.4

Gawler

#

29.5

Loxton - Waikerie - Mid Murray

#

12.1

Murray Bridge

5.9

29.8

Murray Mallee

21.1

58.4

#

21.3

3.8

19.6

#

#

4.5

26.5

#

8.7

Coober Pedy - Umoona

7.3

93.3

Eyre

6.1

155.3

Flinders

5.2

34.6

Port Augusta

14.0

61.2

Whyalla

3.0

37.8

Ceduna

9.2

60.5

Ceduna - West Coast

7.0

34.7

Port Lincoln

6.0

34.7

South Australia

5.7

33.1

Barossa

Renmark Paringa South-East Wakefield - Clare and Gilbert Valleys Yorke Peninsula Anangu Pitjantjatjara

SOURCE: PHIDU 2018 # ASR NOT CALCULATED DUE TO COUNT BEING UNDER 5 PERSONS, DUE TO POPULATIONS UNDER 100, OR DATA NOT AVAILABLE

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Asthma SAMSS respondents were considered to have asthma if they had been told by a doctor that they had asthma and had experienced symptoms and/or treatment in the previous 12 months. Please note, SAMSS data does not include children under 16 years. The Mid-North Region had the highest proportion of respondents reporting an asthma diagnosis, while the adjacent Lower North had the lowest. In contrast, Outback North and East had the highest age-standardised rate of potentially preventable admissions for asthma, followed by Fleurieu – Kangaroo Island. TABLE 7: ASTHMA DATA SUMMARY

SA3

Current Asthma Diagnosis 16+ years 2016-2018 % respondents

Hospitalisations for Average Length of Stay Asthma (days) 2015-16 2015-16 ASR per 1,000

Adelaide Hills

12.3

1.7

1.8

Gawler - Two Wells

12.0

1.9

3.0

Barossa

16.2

1.8

2.0

Lower North

11.3

1.9

3.1

Mid North

23.4

2.0

2.6

Yorke Peninsula

19.6

1.7

2.5

Eyre Peninsula & South West

17.4

1.9

1.9

Outback - North & East

12.1

2.2

1.9

Fleurieu - Kangaroo Island

14.8

2.1

1.9

Limestone Coast

16.8

1.5

1.8

Murray & Mallee

12.8

1.7

2.1

CSAPHN

15.3

1.8

2.1

South Australia

14.5

SOURCE: SAMSS 2016-2018, AIHW 2017A

4.4 Circulatory System Diseases Circulatory system diseases (CSD) include a range of cardiovascular and cerebrovascular conditions. Deaths due to cardiovascular disease were 50% higher in the lowest socioeconomic group compared with the highest. The prevalence of CVD increases with growing remoteness and rates are twice as high among men (4%) than women (2%) (AIHW, 2015a). Circulatory diseases were the leading cause of mortality for Aboriginal South Australians, with rates of 2.2 per 1,000 (AIHW, 2017a).

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Cardiovascular Disease Respondents were considered to have cardiovascular disease if they had ever been told by a doctor that they had cardiovascular disease, a heart attack, angina, heart disease, or stroke. SAMSS data shows residents of the Yorke Peninsula had the highest prevalence of cardiovascular disease at 11.3%, while the Adelaide Hills had the lowest with 2.7%. The highest rate of hospital admissions for angina occurred in the Yorke Peninsula (2.3 per 1,000), followed by the Lower North (2.0 per 1,000). Adelaide Hills region was well below all other CSAPHN SA3 areas for Angina admissions. The highest rate of hospital admissions due to congestive heart failure was in the Outback - North and East region (2.7 per 1,000). Gawler – Two Wells and Limestone Coast were also among the highest, while Adelaide Hills had the lowest rate in the CSAPHN region (AIHW, 2017b). TABLE 8: CIRCULATORY SYSTEM DISEASE DATA SUMMARY

SA3

Current CVD Diagnosis 16+ years 2016-2018 % respondents

Hospitalisations for Angina 2015-16 ASR per 1,000

Hospitalisations for Congestive Heart Failure 2015-16 ASR per 1,000

2.7

0.6

1.3

#

1.6

2.4

4.3

1.3

2.0

#

2.0

1.8

Mid North

7.4

1.7

1.9

Yorke Peninsula

11.3

2.3

2.1

Eyre Peninsula & South West

6.0

1.4

2.0

#

2.2

2.7

Fleurieu - Kangaroo Island

8.5

1.2

1.7

Limestone Coast

7.6

1.7

2.4

Murray & Mallee

8.9

1.4

2.2

CSAPHN

7.1

1.5

2.0

South Australia

7.8

Adelaide Hills Gawler - Two Wells Barossa Lower North

Outback - North & East

SOURCE: SAMSS 2016-2018, AIHW 2017

24


For Aboriginal South Australians, the rate of hospitalisation for circulatory system diseases is highest in the Eyre Indigenous Area (59.4 per 1,000), followed by Ceduna and Coober Pedy.

TABLE 9: HOSPITALISATION FOR CIRCULATORY SYSTEM DISEASES, ABORIGINAL PERSONS

Indigenous Area 2016

Admissions for Circulatory System Diseases Aboriginal persons 2012/13 to 2014/15 Average annual ASR per 1,000

Adelaide Hills - Mount Barker

6.8

Barossa

4.8

Berri - Barmera

21.5

Fleurieu - Kangaroo Island

12.6

Gawler

20.6

Loxton - Waikerie - Mid Murray

14.6

Murray Bridge

22.2

Murray Mallee

11.8

Renmark Paringa

#

South-East

11.6

Wakefield - Clare and Gilbert Valleys

6.5

Yorke Peninsula

17.5

Anangu Pitjantjatjara

4.8

Coober Pedy - Umoona

30.1

Eyre

59.4

Flinders

16.2

Port Augusta

27.2

Whyalla

23.1

Ceduna

31.9

Ceduna - West Coast

14.7

Port Lincoln

16.0

South Australia

16.4

SOURCE: PHIDU 2018

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Acute Rheumatic Fever and Rheumatic Heart Disease South Australian cases of Rheumatic Heart Disease on the RHD register show the largest proportion of the country SA cases are in the far north-west of the state from Coober Pedy to Anangu Pitjantjatjara Yankunytjatjara (APY) Lands. Other cases on the register are in Port Augusta, Whyalla, and Ceduna and a few cases scattered across the Eyre Peninsula, York Peninsula, Port Pirie, the Riverland, and Mt Barker. In South Australia 92% of patients on the register identify as Aboriginal, with the remaining 8% identify as migrants from countries with high prevalence of RHD (Somalia, Burma, Iran, Afghanistan, Bhutan), or are Caucasian Australians (SA Health, 2017a). Of the register patients in South Australia who were adhering to their scheduled secondary prophylaxis regime, 8% of the population received less than 50% of the required doses, 20% of the population received between 50% to 79% of the doses, and 72% of the population received greater than 80% of the required doses in 2017 (SA Health, 2017a). Hospitalisations for Aboriginal South Australians with a principal diagnosis of Acute Rheumatic Fever or Rheumatic Heart disease, was 0.6 per 1,000 population for the period July 2013 to June 2015 (AIHW, 2017a).

4.5 Cancer In Australia, the age-standardised rate of all cancers combined is highest in inner regional areas and lowest in very remote areas, however the age-standardised mortality rate is highest in very remote areas (AIHW, 2017c). There are well over 100 different types of cancer, but the most common include prostate, breast, bowel, lung, and melanoma of the skin. For some cancers, such as breast, bowel, and cervical cancers, early detection and treatment lead to more positive outcomes which is why they are part of a national screening programme. Cancer is the second leading cause of mortality in the Aboriginal population in South Australia during the 2011-2015 period. The rate for neoplasms is 2.3 per 1,000 for the Aboriginal population (AIHW, 2017a). Within South Australia the most common primary site cancer types for Aboriginal people are respiratory (particularly lung), and upper gastrointestinal cancers. The stage of the cancer at time of diagnosis for the Aboriginal population in South Australia indicates cancers are more likely to be diagnosed later than non-Aboriginal populations. Survival rates are also much lower in the Aboriginal population, no matter the stage of cancer at diagnosis (SA Health, 2017b).

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Cancer Incidence There are only small variations in cancer incidence within the CSAPHN region. Yorke Peninsula was the highest with 5.1 per 1,000 followed by Eyre Peninsula and South West. Cancer mortality was lowest for the Adelaide Hills SA3, while Mid North, Yorke Peninsula, Eyre Peninsula and South West, and Outback North and East SA3s were the highest. TABLE 10: CANCER DATA SUMMARY

SA3

Cancer Incidence 2009-2013 ASR per 1,000

Cancer Mortality 2011-2015 ASR per 1,000

Adelaide Hills

4.7

1.4

Gawler - Two Wells

4.7

1.7

Barossa

4.7

1.7

Lower North

4.9

1.7

Mid North

4.9

1.9

Yorke Peninsula

5.1

1.9

Eyre Peninsula & South West

5.0

1.9

Outback - North & East

4.8

1.9

Fleurieu - Kangaroo Island

4.8

1.5

Limestone Coast

4.9

1.7

Murray & Mallee

4.7

1.7

CSAPHN

4.8

1.8

SOURCE: AIHW 2017

27


Cancer Screening – Bowel, Breast, Cervical Table 11 shows the proportion of those who participated in the national screening programs for breast, bowel, and cervical cancer. While screening participation was generally high across CSAPHN compared to the other PHNs, there was considerable variation between CSAPHN areas. The Outback – North and East region had the lowest percentage of people screened in all three of the programs. The highest bowel cancer screening participation was in the Fleurieu – Kangaroo Island SA3, followed by the Yorke Peninsula. Cervical screening participation was good across the CSAPHN region, the highest participation was seen in the Adelaide Hills. Participation in breast cancer screening was also good across the CSAPHN, with Yorke Peninsula having the highest participation (63%). TABLE 11: PARTICIPATION IN CANCER SCREENING PROGRAMS

SA3

National Bowel Cancer National Cervical Breast Screen Australia Screening Participation Screening Participation Participation 2016-17 2015-16 2015-16 % % %

Adelaide Hills

49.0

64.3

59.5

Gawler - Two Wells

43.8

59.8

61.4

Barossa

49.5

60.6

61.1

Lower North

47.6

60.7

55.5

Mid North

45.5

52.7

57.2

Yorke Peninsula

52.8

56.1

63.0

Eyre Peninsula & South West

44.7

57.9

60.2

Outback - North & East

39.3

46.7

48.9

Fleurieu - Kangaroo Island

53.6

56.6

58.5

Limestone Coast

45.4

56.5

61.3

Murray & Mallee

46.2

52.9

59.1

CSAPHN

47.5

57.0

59.1

SOURCE: AIHW

2018B

Aboriginal and Torres Strait Islander participation in Cancer Screening Breast Cancer Screening Participation rates for breast screening rely on Indigenous status being self-reported by women at the time of their screen, participation might be underestimated due to this. In Australia in 2015-16 the age-standardised participation rate for Aboriginal and Torres Strait Islander women aged 50-74 was 39.1% (AIHW, 2018). Cervical Cancer Screening In 2012-2013, 73% of Aboriginal South Australian women aged 20-69 reported having regular pap smear tests, a further 23.3% indicated that they have had more than one, but do not have it done regularly. For those women who reported having regular pap smears, 22.4% indicated that they have a pap smear annually, and 72.3% indicated that they have one at least every two years, which

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suggests that for those who have regular pap smears, 94.7% have pap smears within the recommended time frame (AIHW, 2017). Bowel Cancer Screening In 2012-2013, and estimated 13% of Aboriginal men, and 3% of Aboriginal women in South Australia reported ever having been tested for bowel cancer. These rates should be interpreted with extreme caution as they are based on survey data and have a relative standard error between 25% and 50%, and for women the relative standard error is greater than 50% (AIHW, 2017).

4.6 Arthritis and Musculoskeletal Conditions Arthritis and other musculoskeletal conditions are a cause of pain and disability which reduces quality of life and increases use of hospital and primary health care services (AIHW, 2014). Arthritis and musculoskeletal conditions affect an estimated 29.9% of Australians (ABS, 2015). In South Australia, 1 in 4 individuals suffer from arthritis. Comorbidities are reported in conjunction with arthritis for 3 out of 4 people diagnosed. Furthermore, 1 in 3 people with arthritis reported being obese (32.1%) (AIHW, 2016a). Arthritis SAMMS respondents were considered to have arthritis if they had ever been told by a doctor that they had arthritis. Respondents from the Gawler – Two Wells SA3 had the highest proportion of arthritis (31.1%) in the CSAPHN region, while the Murray and Mallee SA3 was the lowest (17.1%). Osteoporosis SAMMS respondents were considered to have osteoporosis if they had ever been told by a doctor that they had osteoporosis. The Gawler – Two Wells SA3 was also highest for Osteoporosis (11.9%), and almost double the next highest area which was Yorke Peninsula SA3 (6.2%). TABLE 12: ARTHRITIS AND OSTEOPOROSIS DATA SUMMARY

SA3

Arthritis (16+ years) % respondents 2016-18

Osteoporosis (16+ years) % respondents 2016-18

Adelaide Hills

18.3

3.0

Gawler - Two Wells

31.1

11.9

Barossa

17.8

4.0

Lower North

17.9

2.7

Mid North

25.0

5.6

Yorke Peninsula

25.9

6.2

Eyre Peninsula & South West

23.9

4.5

Outback - North & East

26.0

#

Fleurieu - Kangaroo Island

23.9

4.6

Limestone Coast

20.2

2.2

Murray & Mallee

17.1

3.1

South Australia

21.1

5.1

SOURCE: SAMSS 2016-2018

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4.7 Risk Factors Chronic conditions also include many other conditions which have not been included above. Each chronic condition has potentially modifiable behavioural and lifestyle element such as obesity, smoking, or alcohol intake among others. Insufficient physical activity was reported in 56% of Australian adults in addition to inadequate fruit and vegetable consumption in 52% and 92% of Australians, respectively (AIHW, 2016c). Adults living in regional and remote areas were less active than those living in metropolitan areas. Furthermore, the proportion of people not meeting the physical activity guidelines increased with socioeconomic disadvantage. One in 4 Australian children are overweight or obese compared to 2 in 3 Australian adults and 15% more people living in rural and remote areas are overweight compared to metropolitan areas. High blood pressure was reported in 1 in 3 adults, 16% of adults smoked, and 20% were categorised as having excessive alcohol consumption (AIHW, 2016c). Tobacco use for Aboriginal people in South Australia was reported in 40.4% of the population. In the inner regional areas of South Australia, 84.2% of Aboriginal persons were considered overweight or obese. This reduces to 67.9% in the outer regional areas of South Australia, 78.5% for remote areas, and 69.9% for very remote areas (AIHW, 2017a). In Aboriginal children aged 4-14 years, it is estimated 44.8% have insufficient consumption of fruit 97.5% were estimated to have insufficient consumption of vegetables. An estimated 70.7% of Aboriginal children are not meeting a base level of at least 60 minutes a day of exercise. High Blood Pressure Respondents were considered to have current high blood pressure if they had been told by a doctor that they had high blood pressure and/or were on antihypertensive treatment. The highest proportion of SAMMS respondents reporting high blood pressure was in the Yorke Peninsula (25.6%), followed by Eyre Peninsula and South West (25.1%). High Cholesterol Respondents were considered to have current high cholesterol if they had been told by a doctor that they had high cholesterol and/or were on medication for high cholesterol. The Yorke Peninsula region had the highest proportion of respondents reporting high cholesterol (22.1%). The lowest was in the Lower North SA3 (8.9%), almost half of the SA average. Physical Activity As per the physical activity guidelines for Australian adults, respondents were considered to have had sufficient physical activity if they had completed 150 minutes of moderate intensity physical activity per week (NHMRC, 2013). Outback North and East SA3 (31.9%) had the lowest proportion of respondents reporting to have exercised for 150mins per week, followed by the Murray and Mallee SA3 with 36.4% of respondents. The Lower North, Fleurieu – Kangaroo Island, and the Adelaide Hills SA3s had over 50% of respondents reporting to have exercised more than 150mins a week. Unhealthy Weight Respondents were considered to have an unhealthy weight if their BMI (calculated from selfreported height and weight) was ≼ 25 (overweight or obese). 78.6% of respondents in Outback North and East have a BMI which places them in the overweight or obese range. All other SA3s were above the state average of 61.4% with the exception of Adelaide Hills and Gawler – Two Wells.

30


Fruit and Vegetable Consumption Respondents were considered to have consumed the recommended serves of fruit or vegetables as per the Australian Guide to Healthy Eating (NHMRC, 2013). The Yorke Peninsula SA3 had the lowest proportion of respondents (5.9%) consuming the recommended serves of vegetables, Eyre Peninsula and South West, Lower North, Gawler – Two Wells, and the Mid North were also below the state average. The Gawler – Two Wells SA3 had the lowest proportion of respondents consuming the recommended serves of fruit per day. The Adelaide Hills SA3 was the highest in the CSAPHN region for respondents consuming the recommended daily serves of fruit and vegetables. TABLE 13: HEALTH RISK FACTORS DATA SUMMARY

High Blood Pressure SA3

High Cholesterol

Physical Activity

Unhealthy Weight

Vegetable Fruit Consumption Consumption

(16+ years) (16+ years) (18+ years) (18+ years) (18+ years) (18+ years) 2016-2018 2016-2018 2016-2018 2016-2018 2016-2018 2016-2018 % respondents % respondents % respondents % respondents % respondents % respondents

Adelaide Hills

14.6

13.3

50.6

50.3

15.4

51.9

Gawler - Two Wells

18.3

19.1

49.2

57.2

6.8

27.5

Barossa

16.7

13.2

43.2

63.2

14.7

36.5

Lower North

14.5

8.9

55.7

65.3

6.4

36.5

Mid North

20.7

20.6

37.3

70.0

7.3

33.4

Yorke Peninsula

25.6

22.1

41.9

63.2

5.9

38.4

25.1

18.6

38.7

71.0

6.3

33.3

24.2

12.7

31.9

78.6

12.3

33.3

22.3

14.8

51.6

63.5

13.3

42.5

Limestone Coast

22.5

15.3

38.1

70.5

11.1

31.2

Murray & Mallee

24.1

17.0

36.4

71.6

12.6

41.9

CSAPHN

20.8

16.0

43.1

65.9

10.2

36.9

South Australia

21.6

16.4

46.7

61.4

10.5

42.1

Eyre Peninsula & South West Outback - North & East Fleurieu Kangaroo Island

SOURCE: SAMSS 2016-18

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4.8

Aboriginal Preventative Health Assessment

The Preventative Health Assessment for Aboriginal and Torres Strait Islander people, Medicare Benefits Schedule (MBS) item 715 is the main platform for preventative health, early detection, and annual monitoring of issues for Aboriginal and Torres Strait Islander people. In the 2015-2016 financial year in the CSAPHN region 5,538 (26%) of Aboriginal South Australians had a 715 Health Assessment. The billing of MBS 715 as a proportion of the population by SA3 are as follows: • Adelaide Hills 6% • Eyre Peninsula and South 29% • Fleurieu - Kangaroo Island 9% • Limestone Coast 27% • Lower North 3% • Mid North 23% • Murray and Mallee 19% • Outback - North and East 62% • Yorke Peninsula 25% The Barossa and Gawler - Two Wells regions did not have the MBS 715 data published (AIHW, 2017a)

5 MENTAL HEALTH Mental health is a national health priority area, and PHNs have been tasked with assessing, coordinating, and integrating services according to the specific needs of their populations. In the CSAPHN region there are variable levels of access to mental health services, and this issue featured strongly in stakeholder consultation forums and surveys across the whole CSAPHN region

5.1

General Mental Health

Current Mental Health Condition Respondents were considered to have a current mental health problem if they had been told by a doctor in the last twelve months that they had anxiety, depression, a stress related problem or any other mental health condition, as well as whether they were currently being treated for a mental health condition. The highest proportion of people reporting a current mental health condition was in the Lower North, with the Mid North, Barossa, and Gawler – Two Wells all above the state average. Psychological distress Respondents’ level of anxiety and depressive symptoms in the most recent 4-week period was measured on the Kessler 10 Psychological Distress Scale (K10), the data presented is for those who scored high to very high psychological distress (K10 score of 22 or above). The highest proportion of people reporting high to very high psychological distress was in the Mid North followed by Gawler – Two Wells and Barossa SA3 areas. Youth Mental Health Services Youth Mental Health Service aims to better engage young people and work with them to develop the skills and supports they need to manage mental health distress and enjoy the best health possible.

32


Headspace was a predominant service offering Mental Health Services to Youth in the Country SA PHN region. Overall a total of 10,579 Occasions of Services were logged, equating to 2,148 serviced young people in the region. Since this data collection an additional Headspace Centre in Mount Barker has opened. The previous two years of Headspace service have seen a visit frequency of 5. Psychological Therapies Psychological therapies are delivered to mild to moderate groups within the stepped care approach, services commissioned under this level of intervention within a stepped care approach must be evidence based for the population group being targeted. In the 2017-18 period, psychological therapies were delivered to 6,020 clients, equating to 9% of our target population compared to 3,190 clients in the previous year. The clinical outcomes for people receiving psychological therapies showed 71% of clients had a decrease in levels of psychological distress after receiving services. GP Mental Health Plans This data was compiled from MBS billing data for GP mental health treatment plan item numbers. Because patients can be billed for several items in a year, the data is based on the number of patients who claimed at least one service, rather than services per 1,000 population. There is a noticeable difference between the number of patients per 1,000 who accessed mental health treatment item numbers in the Fleurieu – Kangaroo Island, Gawler – Two Wells, and Adelaide Hills SA3 areas, compared to the lowest areas, Outback North and East, Mid North, and Lower North. This could be due to different factors such as access to, or supply of the professionals in those regions (these SA3 areas also have a corresponding higher and lower supply of psychology workforce, see: Table 19). TABLE 14: MENTAL HEALTH SERVICE DATA SUMMARY

Current Mental Health Condition

Psychological Distress

Mental Health Service Utilisation

GP Mental Health Treatment Items

SA3

(16+ years) 2016-2018 % respondents

(16+ years) 2016-2018 % respondents

(16+ years) 2016-2018 % respondents

2016-17 Patients per 1,000

Adelaide Hills

18.0

13.3

3.2

69.3

Gawler - Two Wells

20.4

17.4

#

78.5

Barossa

20.6

17.0

4.5

58.8

Lower North

26.4

12.9

7.6

32.3

Mid North

22.2

19.7

3.6

30.4

Yorke Peninsula

14.1

10.0

3.4

40.4

Eyre Peninsula & South West

17.1

11.3

2.1

40.9

Outback - North & East

11.9

#

#

28.8

Fleurieu - Kangaroo Island

15.0

6.2

8.0

84.2

Limestone Coast

15.2

11.3

6.5

55.9

Murray & Mallee

17.3

9.0

5.6

56.1

CSAPHN

18.0

12.8

4.9

56.2

South Australia

19.6

11.4

5.6

SOURCE: SAMSS 2016-2018; DEPARTMENT OF HEALTH

2018B

33


Hospital Mental Health Separations Overall, mental health separations by type varied across the CSAPHN region with Major Affective and Other Mood Disorders being a more common hospitalisation than the other diagnosed mental health admissions. In terms of schizophrenia, schizoaffective and psychotic disorders, the highest rate was in the Outback North and East SA3, and Murray Mallee SA3. The Mid North, Outback North and East, and Murray Mallee SA3 areas were all higher than the rest of the regions for admissions for Major Affective and other Mood Disorders and Post Traumatic and Other Stress Related Disorders. TABLE 15: MENTAL HEALTH HOSPITAL SEPARATIONS

SA3

Mental Health Hospital Separations (rate per 1,000) Schizophrenia, Major Affective Post Traumatic Schizoaffective and Other Mood and Other Stressand Psychotic Disorders related Disorders Disorders 2015-2016 2015-2016 2015-2016

Anxiety Disorders

Personality Disorders

2015-2016

2015-2016

Adelaide Hills

0.4

3.2

0.8

n.p.

0.5

Gawler - Two Wells

0.3

4.0

0.8

n.p.

n.p.

Barossa

0.3

3.6

0.6

n.p.

0.2

Lower North

0.4

3.6

0.9

n.p.

n.p.

Mid North

0.7

4.9

1.2

0.3

0.3

Yorke Peninsula

0.4

3.7

0.9

0.4

0.8

Eyre Peninsula & South West

0.8

3.1

0.8

0.1

0.2

Outback - North & East

1.2

4.5

1.1

n.p.

0.5

Fleurieu - Kangaroo Island

0.5

3.5

0.7

0.3

0.3

Limestone Coast

0.4

3.7

0.6

0.2

0.2

Murray & Mallee

1.1

4.8

1.3

0.2

0.5

SOURCE: AIHW

2017D

Aboriginal Mental Health In South Australia, Aboriginal persons aged 18 years or over reported high or very high psychological distress in 33.5% of the population. Admissions to hospital for mental and behavioural disorders for Aboriginal South Australians was 45.9 per 1,000 between July 2013 to June 2015 (AIHW, 2017a). Within this principal diagnosis group the rates for specific mental health conditions were as follows: • • • • •

Mental & behavioural disorders due to psychoactive substance use at 13.9 per 1,000 Schizophrenia, schizotypal and delusional disorders at a rate of 11.3 per 1,000 Mood disorders at a rate of 11.0 per 1,000 Neurotic, stress-related disorders at a rate of 5.6 per 1,000 Disorders of adult personality and behaviour at a rate of 0.7 per 1000 (AIHW, 2017a).

34


5.2

Suicide Prevention

From 2013- 2017, the Country SA PHN region saw a 1.4% increase in suicide overall, while state averages remained stable with suicide accounting for 1.6% of all causes of death (ABS 2017b, ABS, 2017c). Current reporting mechanisms for suicide and attempts varies across the region, leading to data gaps and lack of consistency overall. In line with national trends, attempts were more common among females, almost double the male rate. In terms of completed suicide, males accounted for most deaths within the region (ABS 2017b). The highest rate of suicide was in the 40-50 year age cohort, and overall, over a third of suicides were undertaken by married individuals (National Coronial Information System, 2017). In 2017, 224 deaths in South Australia were attributed to suicide or intentional self-harm (164 males, 60 females). In over half of the recorded suicides reported by the National Coronial Information Service (NCIS), the Indigenous status of the deceased is unknown, limiting the knowledge on the Aboriginal and Torres Strait Islander populations (NCIS, 2017). National Coronial Information System – Intentional Self-Harm Fatalities In the Country SA PHN region, there were five-hundred and four (504) deaths reported to the South Australian Coroner between 2007 and 2015 where the deceased died as a result of intentional selfharm. Of these deaths, 78.8% were males and 50.2% used asphyxiation as the mechanism of death. Across the region, Mount Barker, Adelaide Hills, and Alexandrina LGAs had the highest number of suicides (NCIS, 2017). Intentional Self-Harm Hospital separations In 2015-16, the CSAPHN region had 1,041 hospitalisations for intentional self-harm. The highest rates were in the Yorke Peninsula SA3 (3.6 per 1,000), Limestone Coast (3.1 per 1,000), and Fleurieu – Kangaroo Island (2.9 per 1,000). Emergency department presentations for intentional self-harm are difficult to capture because the recorded data is only for principal diagnosis and does not include an external cause code for intent. This makes it likely that many occasions of intentional self-harm are underestimated due to clinical coding limitations. TABLE 16: HOSPITALISATION FOR INTENTIONAL SELF-HARM

SA3

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

2015-16

Intentional Self-Harm hospitalisation number of bed days ASR per 1,000 2015-16

1.5 2.7 2.7 2.5 2.2 3.6 2.0 2.1 2.9 3.1 2.7 2.5

4.5 8.0 6.6 4.4 6.6 8.8 5.6 5.0 6.9 7.1 6.4 6.3

Intentional Self-Harm hospitalisations ASR per 1,000

SOURCE: AIHW, 2017D

35


National Suicide Prevention Trial Country SA PHN was selected as one of twelve sites nationally to take part in the trial which aims to reduce suicide at a local level. The three-year trial adopts a systems-based approach to the delivery of suicide prevention services, targeting populations identified as at-risk. The National Suicide Prevention Trial has been operating in the North/West region of the CSAPHN catchment, encompassing Port Lincoln, Whyalla, Port Augusta, Port Pirie and Yorke Peninsula areas. The process involved extensive community consultations reaching 16,000 people. Key gaps highlighted within the region were: - Follow up Care - Reducing the stigma around Suicide - Suicide Prevention Training - Workforce collaboration Furthermore, the key factors contributing to suicide in the region were believed to be due to - Drug and Alcohol use - Family breakdown - Poor mental health literacy and - Unemployment Through the National Suicide Prevention Trial small grants scheme, approximately 1,714 persons have been reached with the aim to promote help-seeking and train the community to recognise and respond to suicidality. Furthermore, as part of the trial, the first Aboriginal After-care service has been established and is operating in Port Augusta.

6

DRUGS AND ALCOHOL

Drug and Alcohol is a relatively new field for the PHN, with commissioning beginning July 2016. The PHN strategic vision for Drug and Alcohol treatment aligns to the National Drug Strategy aiming to contribute to ensuring safe, healthy and resilient communities through minimising alcohol, tobacco and other drug related health, social and economic harms. Alcohol Overall, the prevalence of risky alcohol use was higher in the County PHN region, with regional males being more likely to drink at risky levels compared to their urban counterparts. Within the Country PHN, the SA3/SA4s with the highest prevalence of monthly risky drinking were the Adelaide Hills SA3, Barossa SA3, South Australia – Outback SA4 and South Australia – South East SA4. However, there was no consistent pattern in risky drinking by socioeconomic status or SEIFA rating (NCETA, 2017a). Cannabis, Meth/Amphetamines & Opioids/Painkillers (non-medical use) Cannabis was the illicit drug most commonly used in the Country PHN for the 12 months prior to data analysis. The highest rate of recent cannabis use was found in the Gawler – Two Wells and Barossa SA4 regions both with approximately 18%. In terms of prescribed Opioids, the Country region had a higher amount of prescriptions dispensed compared to the Adelaide PHN region. Rates of prescriptions dispensed ranged from 53,757(Adelaide Hills) to 94,892(Barossa). Lower socioeconomic status additionally corresponded with higher rates of prescriptions dispensed. The data contained however does not include over the counter codeine-containing medications, nor indicate risky use or how many prescriptions per person, per year so interpretation of the PBS data is limited. The highest rates of opioid prescriptions were observed in the Lower North and Mid North regions. Methamphetamine data is limited due to small sample size in country LGAs which in turn impact on confidentiality. There was a slight decrease in the use of crystal methamphetamine in

36


2016, however it remains the main form of methamphetamine used in the same year. (AIHW 2017b). PBS Prescribed Anxiolytics There was a wide variation in the dispensing rate of anxiolytics across SA3 regions. In the Country SA region, the dispensing rate was 78% higher for persons aged 65+ years than their younger counterparts. The highest rate of anxiolytic dispensing was in the Outback North and East region. Key targets for the prevention and intervention for alcohol and other drugs (AOD) in Country region South Australia include targeting risky alcohol consumption particularly among 25-64 year old males. Identifying factors associated with increased cannabis use were found in the Barossa, Hills and Gawler SA3 regions. In terms of opioids and anxiolytic prescriptions, Gawler- Two Wells, Yorke Peninsula, and the Murray and Mallee were the regions with the highest rates recorded by PBS but planning interventions without information on risky use or prescriptions per person is limiting. Alcohol and Other Substance Use Disorder Hospital Separations The highest rates of AOD hospital separations 2015-2016 across the PHN region was in the Outback North and East, Murray and Mallee, and Eyre Peninsula and South West for both males and females. Male separation rates were often double that of females, with an increase for males in the Outback North and East region from 2014-2015 to 2015-2016. Overall, males had a higher increase in separations over the 2-year period compared to their female counterparts. NCETA Patterns and Prevalence of AOD At-Risk Groups In the Country SA region, alcohol accounted for the highest proportion of AOD emergency department presentations, AOD hospital separations, specialised AOD treatment episodes, and reason for contacting Alcohol Drug Information Service (ADIS). The South East SA4 alone accounted for 48% of the Country SA PHNs AOD ED presentations. The South Australian South East region recorded the highest number of AOD related presentations while the Adelaide Hills had the lowest. In terms of regions, the Adelaide Hills had the highest risky drinking levels, but the lowest rate of recent cannabis use. Among South Australian school aged students (aged 12-17) prevalence of lifetime illicit drug use ranged from 8% (South East) to 18% (Outback North and East). State prevalence of ever having used drugs was 14%. Furthermore, rural Australians were significantly more likely than other Australians to have used methamphetamine in their lifetime. Prevalence of recent methamphetamine use was 4% in the South Australia – Outback SA4 while the prevalence rate for SA was only 2% (NCETA, 2017a; NCETA, 2017b).

37


TABLE 17: HOSPITALISATION FOR ALCOHOL AND OTHER SUBSTANCE USE DISORDERS

Alcohol and Other Substance Use Disorder Alcohol and Other Substance Use Disorder Males, Rate per 1,000 Females, Rate per 1,000 SA3 2014-2015

2015-2016

Change

2014-2015

2015-2016

Change

Adelaide Hills

0.3

0.7

+ 0.4

0.6

0.5

- 0.1

Gawler - Two Wells

0.8

1.0

+ 0.2

0.9

0.7

- 0.2

Barossa

0.8

1.4

+ 0.6

0.6

0.4

- 0.2

Lower North

1.1

1.1

0

0.7

0.4

- 0.3

Mid North

1.6

1.0

- 0.6

0.4

0.8

+ 0.4

Yorke Peninsula

1.2

1.2

0

0.6

0.5

- 0.1

Eyre Peninsula & South West

1.8

1.7

- 0.1

0.9

1.1

+ 0.2

1.7

3.0

+ 1.3

1.2

1.2

0

1.2

1.1

- 0.1

0.3

- 0.4

Limestone Coast

1.1

0.8

- 0.3

0.7 0.7

0.3

- 0.4

Murray & Mallee

1.3

1.8

+ 0.5

1.2

+ 0.2

Outback - North & East Fleurieu - Kangaroo Island

1.0

SOURCE: ABS 2017A TABLE 18: PREVALANCE, PRESCRIPTIONS, AND EMERGENCY DEPARTMENT PRESENTATIONS FOR ALCOHOL AND OTHER DRUGS

SA4

Recent cannabis use

Prescribed Opioids Per 100,000

Prescribed Anxiolytics Per 100,00

SA AOD ED Presentations

Adelaide Hills

43%

9%

53,757

48,886

11%

Barossa

40%

18%

94,892

57,029

15%

SA- Outback

35%

10%

71,337

51,156

22%

SA- South East

23%

N/A

86,339

57,421

43%

Gawler

N/A

18%

88,139

66,436

8%

SOURCE: NCETA

6.1

Risky Drinking levels

2017A

Drug and Alcohol in the Aboriginal Population

Risky Alcohol Consumption Aboriginal and Torres Strait Islander mortality rates related to alcohol use have been declining across Australia, however, these rates remain high in comparison to the non-Aboriginal population (AIHW, 2017a). For Aboriginal people within South Australia, 9.6% of those in non-remote areas and approximately 13% in remote areas report exceeding the lifetime risk alcohol guideline in 2014-15 (AIHW, 2017a). Drug and other substance use including inhalants In South Australia, 37.3% of Aboriginal people reported substance use in the last 12 months (201415) These rates were higher for Aboriginal men (42.5%) than for Aboriginal women (30.8%) (AIHW, 2017a).

38


The types of substances reported as having been used within the previous 12 months of the 20142015 National Aboriginal and Torres Strait Islander Social Survey included: • • •

Marijuana, hashish, or cannabis resin with 19.6% of the non-remote area population, and 18.4% of the remote area population Amphetamines or speed for 5.9% of the non-remote area population and 0.7% of the remote area population Pain-killers or analgesics for non-medical purposes with 14.6% of the non-remote population and 2.5% of the remote population (AIHW, 2017a).

Hospitalisations with a principal diagnosis related to drug use in Australia between July 2013 and June 2015 occurred at a rate of 6.2 per 1,000 for Aboriginal and Torres Strait Islander population and 2.3 per 1,000 for non-Aboriginal people (AIHW, 2017a). Access to Alcohol and Other Drug Services In 2014-2015, as a proportion of all the treatment episodes for alcohol and other drugs, 15.6% of the treatment episodes were provided to Aboriginal and Torres Strait Islander people (AIHW, 2017a).

7

HEALTH WORKFORCE

Health Workforce issues continue to be a recurring theme for stakeholder and community consultations throughout the country region. While many respondents felt there were not enough General Practitioners (GPs) available to serve their regions, many also expressed concern about access to allied health professionals and specialists. Even if there are GPs to service the region, 38% of adults in the CSAPHN region who indicated they had a preferred GP reported that at some point in the previous 12 months they could not access them, while 28% felt they waited longer than acceptable to get an appointment with a GP (NHPA, 2015). The distribution of the health workforce in various professions is of relevance in rural and remote regions where the distance to a clinic or practice can be extreme, and public transport is limited or unavailable. Comprehensive and accurate service mapping is one of the more difficult data collection tasks to achieve, especially throughout an extensive region like CSAPHN. The number of different professions and their sub-specialties, the number of potential locations, public and private clinicians, visiting and part time services, as well as utilisation of different modes of service delivery (including telehealth) and the dynamic nature of the industry make this a very complex data environment. The presence of a clinician does not necessarily equal a particular level of service. It is also imperative to note that in smaller population areas which only usually has one or two (or zero) clinicians, the inclusion or exclusion of a single practitioner results in considerable change in the quantitative measure of service. Outreach programs administered by the Rural Doctors Workforce Agency (RDWA) contribute to closing local services gaps in rural and remote locations across country SA. The following schemes are part of the outreach services provided by the RDWA and funded by the Commonwealth: The Rural Health Outreach service facilitates access to various medical specialists. At present, these range from the provision of one specialty service such as a visiting psychiatrist in Renmark and Tailem Bend to the provision of a range of different services. In Kingscote, Mount Gambier, Oak Valley, Port Augusta, Port Lincoln, Whyalla, Wudinna, and Yalata, more than six different medical specialties are accessible through the outreach program (RDWAa). Among those services are specialists visiting though the Medical Outreach Indigenous Chronic Disease program which focuses on the specific needs of Aboriginal communities. RDWA reports that 22 medical specialists

39


are currently providing services to Aboriginal patients in 16 South Australian locations, focussing on the management of Diabetes, Cardiovascular Disease, Chronic Respiratory Disease, Chronic Kidney Disease and various cancers (RDWAb). In addition, the Healthy Ears - Better Hearing, Better Listening scheme focuses on specialist medical and allied health care to prevent and treat ear disease and associated hearing loss among Aboriginal and Torres Strait Islander children and youth in 21 South Australian locations (RDWAc), while the Visiting Optometrists program services both Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander clients in 44 locations (RDWAd) The work of the Royal Flying Doctor Service (RFDS) in providing outreach and emergency services as well as retrieval throughout South Australia is also vital. Bearing these outreach services in mind, and in the absence of other comprehensive data sources, the registration data compiled by Health Workforce Australia (Table 19) has been used to provide an overview of the distribution of selected health practitioners within the CSAPHN region.

7.1

Health Workforce Statistics

Health Workforce data for 2016 has been aggregated to SA3 and presented as a rate per 1,000 population. The data extracted has been limited to practitioners currently employed as clinicians, in either the public or private sectors, and is based on their primary practice location so it does not reflect outreach (Table 19). These data also do not include the hours of work by any practitioner, nor is geographic distribution accounted for – practitioners might be spread out in a number of smaller localities throughout the SA3 region or concentrated in a major town. These issues make it difficult to compare regions and to benchmark CSAPHN against state and national rates.

7.1.1 General Practitioners GPs are the foundation of the primary health care system and the presence of an adequate GP service in a region is necessary for an essential level of population health care. It should be noted that GPs in country SA not only provide primary health care services via general practice, they also provide medical services in their local Emergency Departments, and procedural services such as minor surgery and Obstetrics. The rate of GPs to population varied throughout the CSAPHN area, with the highest being Fleurieu – Kangaroo Island SA3 (5.0 per 1,000) and Adelaide Hills (4.0 per 1,000), and the lowest was in Yorke Peninsula SA3 (2.6 per 1,000) and Limestone Coast (2.7 per 1,000).

7.1.2 Pharmacists Pharmacy services are also an important part of the primary health care system, providing vital access to prescription medications, but also professional advice and other health and wellness supplies and programs. While medications can still be obtained through pharmacy depots or online in some remote locations, the presence of a pharmacist and full-service pharmacy is an advantage to a community. The highest ratio of pharmacists to population was in the Mid North, with 4.3 pharmacists per 1,000 population, the lowest was the Barossa with 2.3 per 1,000.

40


7.1.3 Podiatrists Podiatry services are particularly important as part of the diabetes cycle of care, which can contribute to reducing hospital admissions due to ulcers poor foot care. The rate of podiatrists to population was lowest in the more regional areas, Eyre Peninsula and South West, Outback North and East with 0.4 podiatrists per 1,000 population with a primary practice in the area.

7.1.4 Psychologists Mental health is a high priority for PHNs nationally. While there are a range of different clinicians and counsellors who provide mental health services, access to a psychologist who can provide higher level care for conditions of increasing severity is particularly valuable, especially for vulnerable communities. The highest ratio of psychologists to population was in the Adelaide Hills (2.4 per 1,000), Gawler – Two Wells (2.3 per 1,000), and Fleurieu – Kangaroo Island (2.0 per 1,000) SA3 areas. In contrast, the Mid North (0.4 per 1,000) and Outback – North East (0.5 per 1,000) were much lower.

7.1.5 Nurses and Midwives Nurses are an important primary health workforce in any community, whether working in a GP practice, in community health, staffing a residential aged care facility, and/or the local hospital. While they are often employed in the acute sector, nurses can perform vital primary health care functions which enable patients to stay out of hospital in the short term, and/or improve their knowledge and monitoring of chronic conditions which may keep them out of hospital in the long term. The Mid North had the greatest number of Nurses and Midwives practicing in the area per 1,000 population (92.6 per 1,000) if the majority of nurses are living within the area, this means just over 9% of the Mid North population are a registered or enrolled nurse. In contrast, Adelaide Hills, Gawler – Two Wells, and Barossa had the lowest ratio per 1,000, but this could be due to the proximity and thus possibility of their primary place of employment being within the metro area.

7.1.6 Optometrists Ageing populations are high users of optometry services, and eye checks are an important part of the diabetes cycle of care. As such, the level of service in each region can have a high impact on the ability of affected populations to monitor and manage their vision. Rates per 1,000 population varied little across the CSAPHN region for optometrists who primarily practice within each area.

7.1.7 Physiotherapists Physiotherapy services are important to a wide range of people of all ages, they provide treatment and recovery from injuries or surgery, as well as many other functions in their scope of practice. Rates per 1,000 for physios primarily practicing within each area varies across the CSAPHN region, with the lowest rate in the Yorke Peninsula followed by Outback North and East.

41


7.1.8 Occupational Therapists Occupational therapists (OTs) play a key role in assisting clients with short or long term disabilities and conditions to regain or improve their maximum level of functioning for activities of daily living. They work across the spectrum of acute and primary care and are particularly valuable in the rehabilitation and aged care sectors. There were 239 OTs who identified a location in the CSAPHN region as their main place of work in 2016. The rate of OTs per population varies from a low of 39.9 per 100,000 population in the Lower North to a high of 77.0 per 100,000 in the Mid North. All CSAPHN regions are below the state rates. There were 3 OTs in the CSAPHN region who identified as being of Aboriginal or Torres Strait Islander origin, which is the total for South Australia.

7.1.9 Dentists General dental services in regional South Australia are largely provided by private practitioners, predominantly dentists. The South Australian Dental Service also operates some school and community dental clinics private dentists can also be funded to deliver these public services. These are mostly school services, with public funded adult services highly limited in geographic reach and restricted to clients with a pensioner concession card or health care card. Other than private dentists play a major role in offering dental care for the CSAPHN communities. 7.1.10 Aboriginal Health Practitioners There were 24 Aboriginal Health Practitioners in the CSAPHN region, with a total of 42 for South Australia.

42


TABLE 19 HEALTH WORKFORCE DATA SUMMARY

General Practitioner

Pharmacists

Podiatrists

Psychologists

Nurses and Midwives

Dentists

ATSI Health Practitioners

Occupational Therapists

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Per 1,000

Adelaide Hills

4.0

2.7

0.7

2.4

40.6

0.3

4.7

0.5

0.0

2.1

Gawler - Two Wells

3.5

3.0

0.8

2.3

48.8

0.4

2.6

0.5

0.0

1.8

Barossa

3.5

2.3

0.8

1.2

47.5

0.4

2.6

0.1

0.0

1.5

Lower North

3.4

3.0

0.6

0.8

80.0

0.2

3.3

0.3

0.0

1.9

Mid North

2.9

4.3

0.8

0.4

92.6

0.4

2.4

0.5

0.0

2.7

Yorke Peninsula

2.6

3.5

0.6

1.1

73.7

0.5

1.7

0.3

0.0

2.0

3.6

3.1

0.4

1.0

80.3

0.6

3.1

0.4

0.5

1.9

3.8

3.5

0.4

0.5

83.9

0.4

1.9

0.3

0.9

1.7

5.0

3.4

0.8

2.0

58.6

0.5

3.4

0.3

0.0

1.5

Limestone Coast

2.7

3.1

0.8

0.8

65.1

0.5

2.0

0.4

0.0

1.7

Murray & Mallee

3.1

3.1

0.5

1.0

63.6

0.4

2.5

0.3

0.1

1.7

CSAPHN

3.5

3.1

0.7

1.3

63.5

0.4

2.9

0.4

0.1

1.8

SA3

Eyre Peninsula & South West Outback - North & East Fleurieu Kangaroo Island

Optometrists Physiotherapists

SOURCE: DEPARTMENT OF HEALTH 2017

43


8

IMMUNISATION

The Australian Immunisation Register (AIR) is a national register of vaccinations given to Australians of all ages. This includes all vaccines funded under the National Immunisations Program, most school-based vaccines provided under State or Territory vaccination programmes, as well as most privately funded vaccines such as influenza and travel vaccines. Childhood immunisation coverage for 2018 varied depending on age-cohort and location. Just under half of the SA3 areas in the CSAPHN region achieved at least 95% coverage for the 12-<15 months age-cohort, the remaining areas were all above 90% coverage. Only the Mid North SA3 achieved 95% coverage for the 24-<27 months age-cohort, while the Adelaide Hills, Outback North and East, Fleurieu â&#x20AC;&#x201C; Kangaroo Island, and Murray Mallee SA3 areas had coverage which dropped below 90% for this age-cohort. A drop in the rates for this age-cohort is consistent throughout the historical coverage data. Except for the Adelaide Hills, all CSAPHN areas achieved 95% coverage for the 60-<63 months age cohort. TABLE 20: CHILDHOOD IMMUNISATION COVERAGE, 2018

SA3

Fully Immunised 12-<15 Months 2018 %

Fully Immunised 24-<27 Months 2018 %

Fully Immunised 60-<63 Months 2018 %

Adelaide Hills

90.1

88.9

92.8

Gawler - Two Wells

96.2

93.2

95.8

Barossa

97.2

92.9

96.9

Lower North

92.9

93.2

96.2

Mid North

94.4

94.8

97.0

Yorke Peninsula

94.6

91.7

95.0

Eyre Peninsula & South West

93.5

90.8

95.5

Outback - North & East

92.7

89.3

95.5

Fleurieu - Kangaroo Island

90.5

89.5

94.6

Limestone Coast

95.8

91.2

97.0

Murray & Mallee

95.7

88.8

96.1

CSAPHN

93.7

90.9

95.5

SOURCE: DEPARTMENT OF HEALTH 2018A

Published immunisation rates for Aboriginal children in South Australia at lower geographical levels are limited due to privacy. SA Health published data by Local Government Area for 2017 which is summarised in Table 21. Where there are less than 10 children in the LGA or in the age-cohort, the data is not provided and as such, not all LGAs in the CSAPHN region are listed, nor all the agecohorts.

44


Ceduna, Gawler, and Port Pirie City and Districts all achieved above 95% vaccination coverage for the 12-<15 months age-cohort in 2017, with only a few LGAs below 90%. For this age-cohort, the overall CSAPHN coverage increased between 2017 and 2018. As is the case in immunisation coverage reports, there is reduced coverage for the 24-<27 months age-cohort, with Port Lincoln being the lowest in the CSAPHN region for 2017, while Berri and Barmera and Mount Gambier achieved 100% vaccination coverage. Overall, the CSAPHN coverage for this age-cohort increased between 2017 and 2018. Except for Berri and Barmera, and Unincorporated SA all LGAs in the CSAPHN region achieved above 95% vaccination coverage for Aboriginal children in the 60-<63 months age-cohort. The 2017 agecohort in CSAPHN had 96.4% vaccination coverage overall, while the 2018 cohort achieved 95.5% vaccination coverage. TABLE 21: CHILDHOOD IMMUNISATION COVERAGE FOR ABORIGINAL CHILDREN

LGA

Fully Immunised 12-<15 Months 2017 %

Fully Immunised 24-<27 Months 2017 %

Fully Immunised 60-<63 Months 2017 %

Alexandrina

n.p.

92.3

n.p.

Berri and Barmera

n.p.

100

92.9

Ceduna

96.8

89.3

94.7

Copper Coast

n.p.

91.7

n.p.

Gawler

100

92.3

n.p.

Mount Gambier

94.4

100

100

Murray Bridge

81.5

81.8

95.7

Port Augusta

86.8

85.0

96.2

Port Lincoln

87.5

77.4

97.0

Port Pirie City and Districts

95.2

81.0

100

Unincorporated SA

81.8

92.3

91.7

Whyalla

90.0

87.5

94.6

Yorke Peninsula

91.7

n.p.

n.p.

CSAPHN

91.3

87.1

96.4

2018

Fully Immunised 12-<15 Months

Fully Immunised 24-<27 Months

Fully Immunised 60-<63 Months

CSAPHN

93.7

90.9

95.5

SOURCE: SA HEALTH 2017B

Human Papillomavirus (HPV) is a viral infection which is sexually transmitted. It can cause genital warts and some types of cancer. The National Immunisation Programme vaccinates both males and females, through a school-based programme. To be fully immunised against HPV, a three-dose course of the vaccine need to be completed.

45


The lowest coverage for both males and females was in South Australia â&#x20AC;&#x201C; Outback SA4, while the highest was in the most metro and surrounding area of Adelaide - Central and Hills. Coverage for males was slightly lower than for females. TABLE 22: HUMAN PAPILLOMAVIRUS VACCINATION COVERAGE

SA4

Females 15 years 3 doses 2015-16 %

Males 15 years 3 doses 2015-16 %

Adelaide - Central and Hills

80.3

75.6

Adelaide - North

76.7

70.5

71.1

67.6

62.2

65.7

75.3

71.2

72.5

69.1

Barossa - Yorke - Mid North South Australia Outback South Australia - South East CSAPHN SOURCE: DEPARTMENT OF HEALTH

9

2018A

AGED CARE

Aged care is a national priority due to our ageing population. Ageing populations face an increasing incidence of age-associated disability and disease (e.g. dementia, stroke, diabetes) and become higher frequency users of primary health care services. Increasing frailty, polypharmacy, and dementia (among other factors) also greatly increase the risk of falls and subsequent hospitalisation in older populations (Department of Social Services, 2015). The aged care system currently offers two main care options â&#x20AC;&#x201C; residential aged care and communitybased aged care. Clients will often enter the aged care system through community based care and progress to residential care as needed. Residential care can also be provided on a respite basis and can also be tailored for people suffering from dementia (AIHW, 2016a). Aged care services in Australia are funded and delivered in regions called Aged Care Planning Regions, data relating to aged care has been summarised in Table 23. The operational ratio for residential aged care places is highest in the Flinders & Far North with 118.2 operational places per 1,000 persons aged over 70 years. The rest of the Aged Care Planning regions have smaller variance between their operational ratios, slightly under that of South Australia. Older people are increasingly receiving care in the community for longer periods of time with availability of Home Care Packages Program, enabling them to stay in their own homes and avoid institutionalisation for as long as possible. The Home Care Packages program has been through significant reform, and from February 2017 all home care packages are provided to individual consumers rather than awarding packages to approved providers. This gives the consumers the ability to choose their provider and change their provider.

46


Because the packages are awarded to individuals rather than providers, comparing data between locations is of limited value, however the number of Home Care Packages within each location, as well as the state total, as at March 2018 is shown in Table 23. TABLE 23: AGED CARE DATA SUMMARY

Aged Care Planning Region

Residential Aged Home Care Care Packages Operational Ratio As at March 2018 Places per 1,000 Number of aged 70+ years persons

Eyre Peninsula

72.8

225

Flinders & Far North

118.2

90

Hills, Mallee & Southern

64.6

Mid North

80.0

112

Riverland

77.2

217

South East

75.0

277

Yorke, Lower North & Barossa

83.3

South Australia

83.5

SOURCE: AIHW

10

859

470 6382

2018A

POTENTIALLY PREVENTABLE HOSPITALISATIONS

Potentially preventable hospitalisation (PPH) are a PHN key performance indicator. These include conditions such as diabetes complications, asthma, chronic obstructive pulmonary disorder (COPD), dental conditions, skin and other infections, pneumonia, and iron deficiency. They were originally designed to measure quality of out-of-hospital care at a population level. The challenge with using PPH as a key performance indicator is that not all the hospitalisations are completely preventable. Primary care interventions may only lead to reductions in the severity of the condition, leading to a better patient outcome and shorter hospital stay, but ultimately not preventing the hospitalisation. For chronic conditions there is a noticeably low rate in the Adelaide Hills SA3 (8.4 per 1,000) compared to the rest of the regions, with Outback - North and East (18.9 per 1,000) and Mid North SA3 (16.2 per 1,000) being the highest. A similar pattern is also found in hospitalisations for acute conditions. Outback – North and East also has the highest rate for vaccine preventable conditions, while Yorke Peninsula has the lowest for the region. Vaccine preventable conditions include pneumonia (vaccine preventable) and influenza hospitalisation. It is important to note that diabetes complications and COPD are both included within the Total Chronic Conditions rate, they have been separated out and included individually within this table because of the differences that these conditions highlight within the CSAPHN region. Outback -North and East (5.4 per 1,000) was the highest in the region for hospitalisations for chronic obstructive pulmonary disease, followed by Gawler – Two Wells, and Mid North. Similarly, Outback – North and East is also highest for hospitalisations for diabetes complications with that high rate also observed in the Barossa.

47


TABLE 24: POTENTIALLY PREVENTABLE HOSPITALISATIONS

Total Chronic SA3

ASR per 1,000 2015-2016

Total Vaccine Diabetes COPD* Preventable Complications ASR per 1,000 ASR per 100,000 ASR per 100,000 ASR per 100,000 2015-2016 2015-2016 2015-2016 2015-2016 Total Acute

Adelaide Hills

8.4

10.8

1.8

2.0

1.0

Gawler - Two Wells

13.1

13.4

2.2

3.4

1.7

Barossa

12.0

13.4

1.6

2.0

3.1

Lower North

12.5

12.9

1.6

2.3

1.7

Mid North

16.2

18.8

1.9

3.4

2.8

Yorke Peninsula

13.3

15.7

1.4

2.3

2.1

Eyre Peninsula & South West

12.4

14.9

2.2

2.8

2.6

Outback - North & East

18.9

20.5

5.0

5.4

3.2

Fleurieu - Kangaroo Island

10.9

13.1

1.9

2.4

1.1

Limestone Coast

12.5

14.9

2.0

3.0

1.5

Murray & Mallee

13.4

17.6

2.1

3.3

2.3

CSAPHN

12.4

14.8

2.1

2.8

2.0

SOURCE: AIHW

2017B

*COPD: Chronic Obstructive Pulmonary Disease

For Aboriginal South Australians, the age-standardised rate of potentially preventable chronic conditions, is 36.8 per 1,000, 29.0 per 1,000 population for acute conditions, and 9.6 per 1,000 for vaccine preventable conditions. All these rates are noticeably higher compared to the whole CSAPHN region shown above (AIHW, 2017a).

11

AFTER HOURS

The provision of after-hours medical services within rural and remote regions of Australia is an ongoing challenge for providers and coordinating agencies. It is reliant on not only the existence of the workforce, but also the ability of practitioners to participate in on-call, after-hours activity, especially in areas with workforce shortage where the distribution of workload relies disproportionately falls on very few practitioners which can lead to burnout. After hours services within the CSAPHN region are available through hospital emergency departments and/or through extended hours offered by GP clinics. Distribution of the practices registered for After Hours PIP is shown in Figure 11. The highest number of sites are located within the Eyre Peninsula (Figure 11), however this region has a very large area and a high number of sites located within the regional cities of Whyalla (8) and Port Lincoln (4), meaning after hours service is sparsely distributed throughout the remainder of the region.

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FIGURE 11: PRACTICES REGISTERED FOR AFTER HOURS PIP

Coober Pedy

Roxby Downs

Ceduna Port Augusta Whyalla

Port Pirie

Kadina Nuriootpa

Berri

Port Lincoln

Kingscote

Victor Harbor

Location of PIP AH Practices All Practice Locations (including outreach) Mount Gambier

Hospital locations Source: SA Health, 2015

SOURCE: PIP STATISTICS PROVIDED BY THE DEPARTMENT OF HEALTH (2015); HOSPITAL LOCATIONS PROVIDED BY SA HEALTH (2015)

Practices Registered for PIP After Hours Incentive October 2015

In the majority of hospitals in the CSAPHN region, emergency departments double as after-hours, serviced by on-call GPs from the area. This makes it difficult to separate after-hours activity in emergency departments from MBS billing for after-hours, because the majority of the time they are the same event, measuring after-hours ED activity in Country SA is very unlike permanently staffed inner regional and metro hospitals. The data presented in Table 25 is the proportion of patients from the services provided, this gives a relative measure of patient access to after-hours MBS services no matter where they are delivered. MBS after-hours for Residential Aged Care (RACF) facilities should be interpreted with caution as there are unknown amounts of RACF patients incoming and outgoing throughout the year.

49


TABLE 25: MBS AFTER HOURS ITEMS

MBS After-hours MBS After-Hours MBS After-Hours MBS Urgent AfterIn rooms (nonResidential Aged Home visit Hours urgent) Care Facility Avg. Services per Avg. Services per Avg. Services per Avg. Services per patient patient patient patient 2015-2016 2015-2016 2015-2016 2015-2016

SA3

Adelaide Hills

1.2

1.5

1.2

1.6

Gawler - Two Wells

1.3

1.3

1.7

3.1

Barossa

1.0

1.0

1.1

1.5

Lower North

1.0

n.p.

1.2

1.0

Mid North

1.1

1.5

1.2

1.5

Yorke Peninsula

1.0

1.2

1.1

1.6

Eyre Peninsula & South West

1.2

1.2

1.1

1.6

Outback - North & East

1.3

1.0

1.1

1.2

Fleurieu - Kangaroo Island

1.2

1.1

1.2

3.8

Limestone Coast

1.1

1.2

1.1

2.1

1.2

1.0

1.1

1.2

Murray & Mallee SOURCE: DEPARTMENT OF HEALTH

2018B

In 2012-2013 11.3% of Aboriginal South Australians reported the need for urgent care in the afterhours period, and 13.3% who had a doctor consultation in the after-hours period in the last twelve months. For MBS billed activities in 2014–2015 to 2015–2016 the age-standardised rate for accessing after hours MBS items is 689 per 1,000 for Aboriginal and Torres Strait Islander people (AIHW, 2017a).

50


12

EHEALTH

The eHealth program is now known as â&#x20AC;&#x2DC;My Health Recordâ&#x20AC;&#x2122; and has been designated as a PHN priority area. Statistics on the consumer and provider registrations and use of My Health Record at the PHN level only have been extracted and supplied by the Department of Health through the PHN website. Data are provided as raw numbers and are cumulative through to August 2017. Crude population rates have been calculated by CSAPHN, using 2016 Census as the base population. The data for South Australia is summarised in Table 26. TABLE 26: MY HEALTH RECORD SUMMARY DATA

Consumer Registration Male Country SA

Female

Total

Census 2016

% of total population

39,807

50,537

90,344

484590

18.6%

Adelaide

105,004

130,533

235,537

1189192

19.8%

SA

144,811

181,070

325,881

1673782

19.5%

Primary Care Provider Registration General Practice

Approx. GP %*

Pharmacies

Approx. Pharmacy %*

Other

Grand Total (incl. hospitals)

Country SA

131

76%

23

12%

11

177

Adelaide

273

NA

46

NA

22

359

SA

404

NA

69

NA

33

551

*Number of General Practices HIPOs (172) and pharmacies (187) recorded in CSAPHN's Client Record Management system as of 1 November 2016

Providers Uploading by Document Type Shared Health Summary

Discharge Summary

Event Summary

Specialist Letter

Diagnostic Image

Prescription Record

Dispense Record

Grand Total

Country SA

193

7

31

0

0

199

0

430

Adelaide

438

55

64

0

0

495

0

1,052

SA

631

62

95

0

0

694

0

1,482

Shared Health Summary

Discharge Summary

Event Summary

Specialist Letter

Diagnostic Image

Prescription Record

Dispense Record

Grand Total

Country SA

1,307

69

301

0

0

8,105

0

9,782

Adelaide

2,684

1,831

435

0

0

20,257

0

25,270

SA

3,991

1,900

736

0

0

28,362

0

34,948

Documents Uploaded by Document Type

Consumer registrations in the CSAPHN region are not far below the state average. General Practice provider registrations are approximately 76%. The regular use of the system is increasing, with the majority of the uploaded documents being prescription records, followed by Shared Health Summaries. A steady increase in Event Summary uploads indicates increased use by non-GP providers.

51


REFERENCES ABS. (2012). Australian Health Survey: Biomedical results for chronic disease. Canberra. ABS. (2015). National Health Survey: First Results, 2014-15. ABS. (2016). Census of Population and Housing. Canberra. ABS. (2017c). Alcohol and Other Substance Use Disorder Hospital Separations. Canberra. ABS. (2017a). Causes of Death Data: Intentional self-harm customised report CSAPHN. Canberra. ABS. (2017b). Intentional Self-Harm Hospitalisations CSAPHN. Canberra. AIHW. (2014). Arthritis and Other Musculoskeletal Conditions across the Life Stages. Arthritis Series no. 18. Cat. No. PHE 173. Canberra. AIHW. (2014). Mortality from Asthma and COPD in Australia. Canberra. AIHW. (2015b). Cardiovascular Disease, Diabetes, and Chronic Kidney Disease – Australian Facts: Prevalence and Incidence. Canberra. AIHW. (2015c). Diabetes. Canberra. AIHW. (2016d). Aged Care. Retrieved from Australian Institute of Health and Welfare: http://www.aihw.gov.au/aged-care/ AIHW. (2016b). Diabetes 2016 Data Tables. Canberra. AIHW. (2016c). Risk Factors to Health. Retrieved from Australian Institute of Health and Welfare: http://www.aihw.gov.au/risk-factors AIHW. (2017a). Aboriginal and Torres Strait Islander Health Performance Framework. Canberra. AIHW. (2017e). Alcohol and Other Drugs: South Australia. Canberra. AIHW. (2017c). Cancer in Australia. Canberra AIHW. (2017d). Hospitalisations for mental health conditions and intentional self-harm in 2015–16. Canberra. AIHW. (2017b). My Healthy Communities – Potentially Preventable Hospitalisations Update 2015-16. Canberra. AIHW. (2018a). GEN Aged Care Data. https://www.gen-agedcaredata.gov.au/Resources/Access-data AIHW. (2018b). National cancer screening programs participation data. Canberra. Department of Health. (2015). Chronic Disease. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-disease Department of Social Services. (2015). Preventing Falls in the Elderly. Retrieved from: http://www.myagedcare.gov.au/healthy-and-active-ageing/preventing-falls-in-elderly Department of Health. (2017). Health Workforce Dataset. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Health_Workforce_Data

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Department of Health. (2018a). Childhood immunisation coverage data. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Immunisation_Data Department of Health. (2018b). Medicare Benefits Schedule Data. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-MBS_Data NCIS. (2017). Intentional Self-Harm Fatalities in Specified South Australian Local Government Areas 2007-2015. NCIS. NCETA. (2017a). Alcohol and Other Drug Use in South Australia: Country SA Primary Health Network Patterns and Prevalence. Flinders University: Adelaide. NCETA. (2017b). Drug and Alcohol Use Among Selected South Australian At-Risk Groups. Flinders University: Adelaide. NHMRC. (2013). Australian Dietary Guidelines 2013. Canberra. NHPA. (2015). My Healthy Communities. Retrieved from National Health Performance Agency: http://www.myhealthycommunities.gov.au/primary-health-network/phn402 PHIDU. (2015). Social Health Atlas of Australia: South Australia. Data by Local Government Area. The University of Adelaide: Adelaide. PHIDU. (2018). Aboriginal and Torres Strait Islander Health Atlas. Data by Indigenous Area. University of Adelaide: Adelaide RDWA. (undated b). List of Services by Location. Retrieved from Rural Doctors Workforce Agency: https://www.ruraldoc.com.au/Media/Default/PDFs/Outreach%20List%20of%20Services.pdf RDWA. (undated c). Medical Outreach – Indigenous Chronic Disease. Retrieved from Rural Doctors Workforce Agency: https://www.ruraldoc.com.au/medical-outreach-indigenous-chronic-disease RDWA. (undated d). Healthy Ears – Better Hearing – Better Listening. Retrieved from Rural Doctors Workforce Agency: https://www.ruraldoc.com.au/healthy-ears-better-hearing-better-listening RDWA. (undated e). Visiting Optometrists Scheme. Retrieved from Rural Doctors Workforce Agency: https://www.ruraldoc.com.au/visiting-optometrists-scheme SA Health. (2017a). SA Rheumatic Heart Disease Control Program. Annual Report 2017. SA Health. (2017b). South Australian immunisation coverage rates. Retrieved from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+res ources/clinical+topics/immunisation+for+health+professionals/immunisation+provider+information /south+australian+immunisation+coverage+rates South Australian Department of Health and Ageing. (2017). South Australian Cancer Control Plan 2016-2021. South Australian Department of Health and Ageing: Adelaide.

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APPENDIX 1: SUMMARY OF STAKEHOLDER CONSULTATION ACTIVITIES In order to complement and contextualise the information obtained from health and health service statistics, CSAPHN has engaged in a number of systematic, catchment-wide engagement activities since the completion of the March 2016 needs assessment. The results from two key consultations are presented below and have been taken into account in both the preparation of the updated needs assessment and in ongoing activity planning and implementation. In addition to these engagements with Mental Health, Suicide and Alcohol and Other Drugs forums from which key information has recently been collated. Information from these forums informs the CSAPHN Needs Assessment – November 2016 and commissioning of services in these areas. While a summary for these consultations have not been provided here, the top 10 priorities have been identified and included in this section.

Summary of Country SA PHN General Practice and Allied Health survey A survey of General Practice and Allied Health was commissioned in April 2016 to establish a set of baseline indicators across the CSAPHN catchment area. 461 General Practices (167 responses, 36% response rate) and 143 allied health providers (62 responses, 43% response rate) were approached. While principally intended to capture aspects of the PHN relationship with providers, including requirements for practice support activities and continuing professional education programming, the survey also provides insights into health service delivery. The following indicators are of particular interest to the health service analysis component of the needs assessment: •

The percentage of solo General Practitioners in Country South Australia slightly exceeds the national average (15% vs. 12% nationally).

97% of General Practices in Country South Australia employ at least one practice nurse (i.e. 1 FTE), exceeding the national average by 34 percentage points.

61% of CSAPHN General Practices are co-located with at least one allied health provider.

26% of General Practices and 10% of Allied Health providers reported that they offered outreach services into rural areas.

Allied Health providers are considerably less likely than General Practice to use electronic patient records (61% vs. 96%). As a result, only about 50% of allied health providers report that they can easily generate a clinical summary to share with patients or other health care providers whereas over 90% of General Practices can easily do so. Allied health providers are also less likely to communicate electronically with local hospitals (15% vs. 28%) and pharmacies (13% vs. 22%), although the percentages are low for both types of providers. By contrast, allied health providers are more likely to use mobile text messaging with patients than General Practice (71% vs. 50%).

High percentages of both General Practices and allied health providers still use fax to send referrals or clinical reports, with only 46% of General Practices and 22% of allied health providers employing secure messaging software to send information. Slightly higher

54


percentages of providers (72% of General Practices and 26% of allied health providers) use secure messaging to receive information. •

A quarter to a third of General Practices report using manual processes to manage core quality improvement processes, including reminders to patients for preventive care and prompts to follow up on test results.

The extent of patient access was measured by several indicators of patient-practice interaction: while half of allied health respondents offered patients the opportunity to engage via e-mail, only 34% of General Practices provided this option. By contrast, despite overall low uptake of online appointment systems, twice as many General Practices (38%) offered an online option compared to allied health providers. In this context, it is notable that only about half of General Practices and 14% of allied health providers actively manage their appointment systems using any formal calendar system.

General Practices assumed care coordination responsibilities much more frequently than allied health providers, with three quarters of General Practices reporting care coordination activities post-hospital discharge and 87% reporting coordination of care with social services and community providers.

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

More than 90% of General Practices inquire about Aboriginal and Torres Strait Islander status routinely for either new patients or for new and existing patients. This stands in contrast to allied health providers, where a relative majority only pose the question when staff consider it relevant. Approximately 60% of General Practices are registered for the Indigenous Health Initiative PIP and slightly fewer report using MBS item 715 for Aboriginal and Torres Strait Islander health assessments.

Summary of Regional Consultation Results Local primary health care committees, operating under different individual names, have been established in twelve geographical ‘clusters’ across the CSAPHN catchment area. These committees were provided with customised regional data reports presenting a range of socioeconomic, health, and health service information at Statistical Area 3 and Local Government Area levels. Committees were asked to review the report for their region and to complete the accompanying questionnaire, either collectively or through key members. The aim of the consultation was (1) to supplement regional summary measures of health status and health service patterns with more localised insights into the underlying drivers of outcomes captured by the data and (2) to provide an opportunity to communicate local community views and preferences. Nine clusters (75% response rate) completed the questionnaire. Their submissions are summarised in the following sections.

Catchment-wide Themes Issues of concern across the CSAPHN catchment area include the following: • •

Access to health services, incl. availability of General Practice, Allied Health, and Specialist services; physical access given limited transport options; and affordability Availability and appropriateness of local mental health services, incl. drug and alcohol services

55


â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

High prevalence of chronic disease risk factors, partly attributable to socioeconomic status and cultural acceptability of unhealthy lifestyles Care of vulnerable populations, incl. recent migrants, Aboriginal and Torres Strait islander people, and low SES populations Disinvestment in primary prevention programs

Local Health Cluster Summaries Barossa Consultation body: Barossa Local Health Cluster, no demographic information provided Population Profile: The committee explains a concentration of relative disadvantage in the Mallala, Light and Gawler LGAs with the relatively lower cost of living in these areas compared to low housing affordability in the Barossa Council area. Coupled with the trend of young people leaving the region for education and career opportunities, they observe a return of adults aged 40 years and older due to lifestyle and retirement options. Youth unemployment is highlighted as a major socioeconomic problem, in part due to issues with transport that generally affect financially disadvantaged groups throughout the region. Health and risk factor distribution: The committee notes that there is a strong drinking culture facilitated by wine industry presence. They highlight an increasing prevalence of substance abuse, including in older adults <60 years of age and stress un-identified mental health issues in rural males and young people. Health service gaps: The committee highlights the effects of the NDIS rollout on services, particularly increased demand for local disability and mental health services. They are concerned that the volume of local services and the qualification of workers will not match health and service needs. Concrete gaps in service are seen with regard to face-to-face mental health support services and affordable/available drug and alcohol support services. Challenges to service delivery: With regard to disability and mental health workforce needs, the committee stresses the view that maintaining a TAFE presence in the region would help building an appropriately trained local health and disability workforce. With regard to access to General Practice, the committee states that there are no bulk billing doctors in the Barossa region.

Far West Consultation body: Far West Local Health Cluster, no demographic information provided Population Profile: Observation of increased number of retirees in Ceduna and an influx of new residents from surrounding farming communities. Health and risk factor distribution: Ceduna is a trial site for the cashless welfare card. The respondents believe that there have been positive effects on drug and alcohol as well as on childhood nutrition. However, there are also suggestions that Ceduna residents may be relocating to non-trial towns such as Port Augusta and Port Lincoln. Diabetes is highlighted as a particular problem for Aboriginal communities, caused in large part by lifestyle factors and their underlying socioeconomic determinants. Cardiovascular disease and related acute heart events are also confirmed as major burdens of diseases attributable to lifestyle risk factors. Drug and alcohol, including alcohol injury, are further highlighted as major concerns in the Far West region.

56


Health service gaps: The respondents find Ceduna to be well-serviced by both General Practice and specialists. However, they note that the Ceduna Koonibba Aboriginal Health Service has been lacking a GP for more than 12 months and that that all current GPs in Ceduna are International Medical Graduates requiring extensive professional education. Preventative health services are described as limited, with outreach services for two-yearly breast screening being highlighted as working well. The committee is not aware of any promotions for other recommended screening. Mental health services are described as insufficient and marred by confusing referral pathways, particular for nonacute patients. For acute mental health emergencies, patients are routinely referred to metropolitan services. In addition, the committee reports that the introduction of the NDIS has resulted in an increase in disability support services and housing. Challenges to service delivery: The respondents believe that General Practitioners are not adequately trained to meet mental health needs and note that that specialist services appear to be limited to occasional visits from one visiting metal health nurse.

Fleurieu Consultation body: Fleurieu Region Community Services Advisory Committee, no demographic information provided Population Profile: In addition to the regionâ&#x20AC;&#x2122;s status as a popular retirement destination, the respondents highlight trends in young parents, including single parent families, moving to the region due to perceived lower housing costs. For single parent families, the committee also cites avoidance of former partners and DSS scrutiny as motivating factors. Health and risk factor distribution: Apart from the impact of an older than average population, the committee highlights unhealthy lifestyles, compounded by social isolation, as drivers of chronic disease prevalence. Health service gaps: Concrete gaps are reported for youth-specific mental health services. The committee also reports a reduction in the promotion of screening programs. Anecdotal evidence of a lack of respite care for carers of people under the age of 65 is cited. A local focus is placed on the coordination and extension of Dementia care and advocacy. Challenges to service delivery: With regard to immunisation, the respondents observe an increase in families that do not keep appointments as well as an increase in the number of young people who miss school-based vaccination campaigns due to non-attendance. The committee also notes disinvestment in preventive health programming such as Do-It-For-Life and Eat Well Be Active, coupled with a shift in focus to clinical services at CHSA.

Flinders and Port Augusta Consultation body: Port Augusta, Roxby Downs, Woomera HAC, no demographic information provided Population Profile: The committee notes that Port Augusta is currently experiencing growing unemployment, while many farming families in the Flinders Ranges have been struggling with droughts and the economic climate. The large Aboriginal population in the region is also highlighted. Health and risk factor distribution: High levels of socioeconomic disadvantage are identified as drivers of high chronic disease prevalence. Socioeconomic disadvantage includes a lack of appropriate housing for segments of the population. The committee also notes a strong drinking

57


culture and the exposure of some local populations to dust and emissions from the Port Augusta power station. Health service gaps: The respondents note a lack of access to a range of specialists. They also find that service availability is low for chronic diseases due to a lack of GP services and primary preventative programs. Drug and alcohol services are described as lacking and in need of improvement where available. Mental Health services, particularly community-based services and child psychology services are also insufficient to meet demand. There are challenges in ensuring adequate GP services in aged care facilities/to aged care beds at local hospitals. In addition, the region is experiencing difficulties in the transition of community-based aged care to the My Aged Care platform. Challenges to service delivery: The committee notes distance to services, lack of transportation, and lack of provider options as major challenges for access to health care and disability services. Retention and recruitment of GPs that are qualified to work effectively with Aboriginal clients and the prison population at Port Augusta are noted as a challenge to service provision. The respondents further report that staff at local A&D departments feel underprepared and unsupported with regard to an increasing number of presentations due to Mental Health issues and/or substance abuse. A lack of investment in preventative health initiatives is compounded by â&#x20AC;&#x153;some country people and males still resisting preventative, early intervention and rehabilitative health programs even where they are available.â&#x20AC;?

Limestone Coast Consultation body: Limestone Coast Community Services Round Table, 16 participating members (75% female, age range 25 to 64) Population Profile: A higher proportion of residents aged 20-39 in the region is considered a consequence of the presence of university campuses at Mount Gambier and associated employment. The committee notes the high numbers of male migrants aged 25-39 years in Naracoorte as well as the presence of retirement communities and a seasonal influx of tourists in Kingston SE and Robe. Health and risk factor distribution: The respondents stress low incomes and time constraints as facilitators of unhealthy lifestyles, particularly around nutrition and sedentary behaviours. They also note a pronounced drinking culture in some industries. Chemical use in Tatiara and Wattle Range Council areas is named as a risk factor for cancer. Health service gaps: The respondents note a lack of GP services and primary preventative programs. Access to local specialist health services is described as limited, with long waitlists. The committee also observes a lack of trust in the competency of local health care providers due to a lack of experience and (possibility perceived) quality of the workforce willing to work in the region. Mental Health services, particularly early intervention services are described as difficult to access outside the regional area of Mount Gambier. There appears to be limited coordination of care/provision of integrated services for dual AOD and Mental Health needs. Challenges to service delivery: The lack of transport is linked to a lack of access to services. The committee highlights challenges in providing comprehensive immunisation coverage to migrant families in Tatiara and children in schools where attendance is problematic. They further believe that screening options are not promoted. Denial of benefits, particularly access to the Disability Support Pension for elderly clients leads to difficulty in accessing needed health services.

58


Lower Eyre Consultation body: Lower Eyre Local Health Cluster, 6 participating members (100% female, age range 25 to 64) Population Profile: In addition to pockets of retirement communities, the committee indicates an increase in young families moving (back) to the region. Low housing costs tend to attract low income households to the region. Health and risk factor distribution: The respondents stress that societal norms favour unhealthy lifestyles, particularly around alcohol consumption and nutrition. Unhealthy behaviours are further compounded by low incomes and time constraints. A particular concern for the region is vulnerable children. Health service gaps: The committee notes a lack of specialist services as well as a lack of preventative programs. In addition, respondents also see a lack of disability services and are concerned about wait lists for mental health services and a lack of early intervention/preventative mental health programs. Screening for chronic disease appears to be lacking both with regard to availability and active recruitment of participants. Challenges to service delivery: Transport is a major issue that limits access to services. A lack of awareness of services is also highlighted. In Elliston, respondents note scepticism towards immunisation. A shortage of bulk billing GPs may also constitute a barrier. The committee further observes continued stigmatisation of mental health help seeking in some segments of the population.

Mid North Consultation body: Mid North Local Health Cluster, 3 participating members (67% female, age range 45 to 64) Population Profile: Economic changes, resulting in fewer long-term employment opportunities, are seen as the drivers of population losses in the region. The exception of Peterborough LGA to the pattern of young people moving away for university or employment is explained as a reflection of lower ATAR scores and a lack of family support to pursue higher education. The respondents report that families with school-aged children have been leaving the area in response to changes in government policies, reflecting behaviour such as employment avoidance. At the same time, an increase in affordable housing options has increased the percentage of transient families without steady employment. Health and risk factor distribution: The committee believes that disadvantage leads to “a culture of apathy and a lack of motivation” which exacerbate unhealthy behaviours such as sedentary lifestyles and poor nutritional habits, driving high chronic disease prevalence. The respondents also consider poor childhood nutrition a reason for issues related to developmental delays, school attendance, and student mental health. Environmental factors, including limited affordability of healthy food, lack of transport, and food outlet portion sizes further contribute to high chronic disease and risk factor prevalence. A strong drinking culture is also noted. Health service gaps: The respondents highlight a lack of “services ‘in the region’ as opposed to ‘to the region’”, particularly with regard to Mental Health and Drug and Alcohol. Gaps in mental health services are highlighted particularly with regard to psychology and low level interventions. E-health approaches appear to be of limited use due to poor internet connectivity in the region. The committee also notes that services are not well advertised, and referrals and transitions are poorly

59


managed. Primary prevention of chronic diseases and their risk factors has declined and is insufficient. With regard to disability services, there appears to be a lack of services, both state and NGO run, with limits on regional reach from the main regional centres. Challenges to service delivery: Respondents note a decrease in funding for primary prevention. Transport is an issue that negatively impacts access to services, particularly for residents of aged care facilities who are not covered by the local passenger transport scheme or volunteer schemes.

Upper Eyre Consultation body: Upper Eyre Health Cluster, no demographic information provided Population Profile: The respondents highlight recent economic challenges in Whyalla as the industrial centre of the region. Whyallaâ&#x20AC;&#x2122;s community is described a transient multicultural community, with pockets of entrenched disadvantage and multigenerational reliance on welfare. The committee notes that the sizeable Aboriginal population in the region tends to increase over the summer months. The University of South Australia presence in Whyalla is seen as an opportunity to grow the local workforce for social work and nursing. Truancy and teenage pregnancy in Whyalla are reported to be comparatively high. Health and risk factor distribution: Financial constraints are cited as a barrier to the use of needed medications and medical devices. Low household income also negatively impacts on physical activity levels, particularly for children. The committee notes a high level of drug and alcohol abuse and increasing ICE use. Health service gaps: Access to allied health services is considered poor and complicated. In addition, available specialist services have shifted to outreach and are frequently changing. Aged care residents access to GP services is reported to be frequently delayed and there appears to be a tendency to transfer residents to Emergency Departments instead. Mental health services are considered insufficient, particularly non-pharmaceutical management approaches. Part of the problem appears to be located with limited capacity of General Practice to provide assessments and referrals to recently introduced services. Challenges to service delivery: The committee notes a â&#x20AC;&#x153;generational acceptance of chronic disease as part of lifeâ&#x20AC;? that negatively impacts on help-seeking behaviours. It further highlights that consumer knowledge of health services available is poor, in part due to social isolation. It also notes a decline in health promotion activities. Transport is a major issue limiting the accessibility of services.

Roxby Downs Consultation body: Roxby Downs Community Board Health Forum, 10 participating members (80% female, age range 35 to 64) Population Profile: Roxby Downs experienced a recent population loss after job cuts at Olympic Dam Mine. The committee explains that generally, adults leave when they reach retirement age and young people leave for boarding schools/university or families with teenagers move away for better schools. Health and risk factor distribution: A considerable part of mortality recorded in Roxby Downs is due to accidents. There is a strong drinking culture. Health service gaps: The committee highlights a lack of alcohol counselling service availability and utilisation. It also expresses concern regarding a recent CHSA directive limiting x-ray taking at the

60


local hospital to emergencies. Patients requiring non-emergency x-rays need to travel to Port Augusta (distance ~ 250 km). Challenges to service delivery: The committee reports that for immunisation, the main barrier is high household mobility, while public awareness of cancer screening programs is poor. Poor uptake of disability services is attributed to residents' lack of knowledge regarding service availability and access modalities.

Mental Health Drug and Alcohol Community Consultations Between early April and mid-June 2016 Country SA PHN (CSAPHN) conducted extensive community engagement into mental health, drugs and alcohol needs, 409 participants attended 33 engagement forums across rural South Australia. From this engagement 10 priorities across the Country SA region were established including:

• • • • • • • • • •

A desire for a strategy to raise awareness of what services are available and how to access these services. This was common between service providers and communities. A strong recommendation for greater collaboration between services to improve efficiencies and remove duplication The lack of long-term rehabilitation facilities in rural SA was seen to have a direct negative affect on treatment Greater education for both community and agencies (including schools) was encouraged for greater understanding of mental health (in particular) and drugs and alcohol and their impacts on society 24/7 access to services was citied across rural SA as a high need as current services appear lacking in services outside “business hours” (i.e. Monday to Friday, 9am to 5pm) Participants believed that the coordination of services (including information sharing) would increase quality of services, reduce duplication and provide more services overall Lack of drug and alcohol services was a wide spread criticism throughout the forums A central access point for information, on-line as well as paper-based which was up to date was seen as a key driver for successful access into the system for getting the right service Early intervention programs were seen to be lacking and a potential source to reduce the number of crisis acute cases developing Waiting times for intervention were considered too long and contributing to issues escalating, due to delays in treatment.

Submissions to the SA Parliamentary Inquiry into Regional Health Services (2016) CSAPHN reviewed the written submissions to the SA Parliament Social Development Committee’s inquiry into regional health services to identify common themes relevant to the primary health care space. The following health and health service issues were the most frequently cited concernswhere a response was collective or the affiliation of the respondent was evident, the organisation is indicated in brackets: •

SA Ambulance - gaps in service provision due to declining volunteer workforce, patient transfers prevent crews from being available for emergency response (raised by Mid North HAC, HAC Leigh Creek, Mallee Health Service, Quorn HAC, SAAS Volunteer HAC).

61


Transport/physical access to services (raised by Lower Eyre HAC, District Council Orroroo & Carrieton, Mannum District Hospital HAC, Port Pirie HAC, Mid Murray Council).

Lack of adequate GP services (raised by Mid West HAC, District Council Cleve, Millicent and Surrounds Health Support Group, HAC (Leigh Creek HS), District Councils of Karoonda & East Murray).

Lack of Mental Health services/staff trained to provide Mental Health Services (raised by District Councils of Karoonda & East Murray, Limestone Coast LGA, Lower Eyre HAC, Renmark Paringa HAC, Mount Barker Council).

GP scope of practice/Maintenance of skill levels due to withdrawal of specialist and emergency services from regional locations (raised by Millicent and District HAC, Mallee Health Service, Mid North HAC, Lower Eyre HAC).

Increase of AOD presentations/lack of AOD services (raised by Whyalla HAC; Renmark Paringa HAC).

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Profile for CSAPHN

Country SA PHN Needs Assessment Data Report 2018  

Country SA PHN Needs Assessment Data Report 2018  

Profile for csaphn