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HealthSpeak issue 20 • December 2017

THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

P H AR M A C Y

PUTTING DIGITAL HEALTH INTO PRACTICE

page 15

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Transformers II Series

Podiatry &

14 Diabetes care

Art of

19 Bundjalung shop

When I'm Sixty

36 Four


A glance in the rear-view mirror Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au Northern Rivers 2A Carrington Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

Health Speak Contacts Editor: Janet Grist Ph: 6618 5400 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2017 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by

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ceo Vahid Saberi

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he Reform of Federation White Paper, Roles and Responsibilities in Health, 2014, outlined the health care system challenge in Australia as follows, “… part of the problem is that there is currently no single overarching ‘health system’ in Australia. Rather, health care is a complex web of services, providers and structures…”. As we close 2017 let us look back at where we have come from and whether there have been any system improvements. The attempt at system improvement goes back to the 1970s. Since then there has been much discussion about enhancing primary health care and better care coordination to improve health outcomes and patient experience. To better organise primary health care, the Divisions of General Practice were established in 1992. By 2008 there were 110 Divisions of General Practice in Australia - 35 of them in NSW. In the late 1990s and the following decade, in pursuit of improving the quality of primary health care and integration, the Commonwealth introduced the Practice Incentive Program and Coordinated Care Trials, among other initiatives. In 2011 Medicare Locals were established and by 2012 the Commonwealth had recast regionally organised primary care from 119 Divisions of General Practice to 61 Medicare Locals. (17 in NSW). In April 2012 we became the North Coast Medicare Local – an amalgamation of four Divisions of General Practice on the North Coast. Our mantra was ‘connecting care’. Our job was to improve integration of services and support primary

Firstly and importantly we have been sincere in our approach to listen to clinicians and community health care. When we commenced as a Medicare Local, we carried a large portfolio of legacy programs and services - we managed general practice services, Aboriginal Medical Services, Family Care Centre, psychological services, speech pathology, headspaces and other allied health services. The next wave of change came in 2014, with the new Federal government announcing that Medicare Locals would be replaced by 31 Primary Health Networks (PHNs). These Networks were to be established through an open tender process, and operational by 1 July 2015. After having gone through the process of writing an extensive submission and waiting anxiously for a few months, finally on 1 July 2015 we became the North Coast Primary Health Network – with the instruction to never again refer to, or mention, ‘Medicare Local’! Our job was defined to be three-fold: 1) to glue the system together and bring about the long-heralded age of integration; 2) to address gaps in primary health care; and 3) to become a commissioning organisation. The last responsibility was touted as our big role - and to be honest, no one knew what commissioning meant. As a commissioning organisation we were told we could not deliver services unless there was ‘market failure’ – no other provider. Hence we spent the first year commissioning and decommissioning at the same time! We transitioned our large

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portfolio of services to other providers. This meant that we had to find providers to take over the Aboriginal Medical Services we operated, the Nimbin General Practice, the Family Care Centre, headspace centres and many more – not an easy task. While we were transitioning services, we were also putting out the considerable funds we received to commission. In this context, commissioning meant that we bring together our clinicians, service providers and the community to design local models of care and address local challenges. Needless to say, designing local models of care requires time, consultation, analysis of data and a good understanding of needs, prioritisation and planning. All this requires time; time we did not have. We had a good need assessment but no time to do extensive planning in the first year. I would be the first to confess that we cannot claim that in the first year all of our commissioning was done well. However we did the best we could in the timeframes we had. Despite this we learned a lot, we documented these well (see www.ncphn.org.au) and we will do better in 2018. So even though it is the first 18 months of our PHN life, we have much to be proud of. Firstly and importantly we have been sincere in our approach to listen to clinicians and community. The structures and systems we have established to do this are working reasonably well. We have endeavoured to think outside the box with programs such as the Winter Strategy, Patient Centred Health Care Home, Health Pathways, Community Voices, Health Literacy Program, Healthy Towns, our partnerships and collaborations and much more. We have built a good foundation and look to 2018 with optimism and expectation of greater achievements. healthspeak December 2017


Care plans for obesity without comorbidities?

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p until now GPs were unable to do care plans with team care arrangements funded by Medicare for obesity, unless there was associated chronic disease co-morbidities such as diabetes or chronic lung disease. This has changed on the controversial premise that obesity even without co-morbidities is a disease. In a recent media release by the RACGP it was stated that all Australians concerned about overweight or obesity must seek the advice and support of their GP if the nation is to avoid seeing 70 per cent of the population obese or overweight by 2025. RACGP President Dr Bastian Seidel said “obesity is a disease and like other diseases deserves immediate attention. As the first point of contact for most Australians seeking medical attention, GPs are in an unparalleled position to both identify those at risk of developing obesity and initiate treatment for those with established overweight or obesity.” At present, two in three Australian adults and one in four school-aged children are overweight or obese. Dr Seidel said “despite advances in global medical treatments and technologies, children above a healthy weight have a quality of life as poor as that of children with cancer. He also said these children may not outlive their parents.” The RACGP’s General Practice: Health of the Nation 2017 report found Australian GPs identified obesity and complications from obesity as one of the most significant health problems Australia faces today, and will continue to face in coming years as the incidence of obesity continues to rise. So what does this change in December 2017 healthspeak

It's me knees, Doc Hmm.. He's going to need a care plan

policy mean for GPs and allied health professionals providing services in our region? It does open the way for opportunistically targeting children and doing regular measurements when they present for whatever reason, with records being kept on percentile charts or even better age related BMI charts. Health assessments for Aboriginal children are an ideal opportunity to do these measurements and there is a specific Medicare item number 715 which allows referral for five visits per calendar year to allied health professionals such as dietitians and exercise physiologists. Care plans can also be performed allowing a further five visits if needed. For adults, it’s not just weight and BMI that should be measured, it is also waist measurement that is important to record as it forms an important marker

clinical editor Andrew Binns

GPs are in a position to both identify those at risk of developing obesity and initiate treatment for those with established overweight or obesity.

for the dangerous visceral fat which is a predictor of cardiovascular risk, type 2 diabetes, insulin resistance and the metabolic syndrome. Excessive weight also puts strain on the musculoskeletal system with increased potential for osteoarthritis. This can be a deterrent to exercising - a much needed therapy. Motivation can also be impaired due to pain, and this complex set of problems requires a team approach to assist with such a patient’s management. Care plans with appropriate allied health referrals are very effective. Shared medical appointments are also being trialed in Australia and overseas with good success rates compared to other interventions. Dr Georgia Rigas, chair of the RACGP’s obesity management network advises: “start screening ALL patients in general

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practice, young and old.” For children, their parameters need to be plotted on a BMI-for-age chart; for adults BMI and waist circumference should be measured, taking into account their ethnicity (as there are different cut- offs for different ethnic groups) and physical activity levels (if they are muscular or not) are important.” As a baseline of care, the RACGP says waist circumference and BMI need to be taken every two years in the general population. The same measurements should be taken annually for those with diabetes, cardiovascular disease, stroke, gout or liver disease or those in high risk groups, such as Aboriginal and Torres Strait Islanders or Pacific Islanders. These measurements are recommended twice a year for patients who are already overweight or obese. So these recent announcements by the RACGP are very significant and herald a major change in preventative health measures to address the chronic diseases that can result from being overweight or obese. 3


Services showcases prove popular and informative

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ore than 60 delegates attended the inaugural North Coast Primary Health Network’s (NCPHN) Mental Health and Alcohol & Other Drugs Showcase in Port Macquarie on October 11. The showcase opened with an announcement by Federal Assistant Minster for Health, the Hon. Dr David Gillespie MP and Federal Member for Cowper, the Hon. Luke Hartsuyker MP, outlining the substantial Commonwealth investment being made in alcohol and other drugs treatment services through NCPHN across the North Coast. Presenters from The Buttery; Mid North Coast Local Health District; EACH Social and Community Health; CRANES Community Support Programs; Headspace Port Macquarie;

Federal Assistant Health Minister Dr David Gillespie opened the event, outlining the Commonwealth's substantial financial investment in AOD services through NCPHN across the North Coast

Headspace Coffs - Gen Health Inc; and Wesley Mission – Community Care Services, spoke with passion about services they’re currently providing across the Mid North Coast. NCPHN’s Chief Executive, Vahid Saberi, hailed the show-

case as a great success and said “Many delegates stayed behind for the all-important networking session and exchanged views on how they can work together into the future”. Those attending said they really valued the opportunity to

meet their peers working in the same area of health as it enabled them to get a bigger vision of what was available locally for clients. A second showcase was held last month in Ballina, where North Coast providers of mental health and alcohol and other drugs gave presentations about their currently funded treatment services. One of the day’s highlights was an address by Goonellabah resident Mary Louise Myers who talked about her journey through a dysfunctional family, leaving home early and getting involved in drugs. It wasn’t until the age of 50 that Mary Louise found a health practitioner who helped her escape that life. There will be more on Mary Louise’s inspiring story in the next issue of HealthSpeak.

Conference highlights importance of exercise during cancer treatment

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ore than 170 GPs, nurses and Practice Managers came together during November in Port Macquarie and Kingscliff to hear the latest in breast and gynaecological cancer treatment. They attended NCPHN’s Women’s Health Conferences with the theme: ‘Improving how we detect and manage cancer’. Exercise was discussed as a significant complement to medication. Dr Carmen Hansen, Radiation Oncologist for the Mid North Coast Cancer Institute, told delegates that exercise could be just as important to cancer outcomes as adherence to medication protocols. Dr Hansen added that there was also emerging evidence that exercise can reduce the risk of cancer recurrence after treatment. “The Clinical Oncology Society of Australia’s (COSA) position is that exercise should be part of standard practice in cancer care to help counteract the adverse effects of cancer and its treatment.” 4

North Coast Primary Health Network is putting together a list of programs and providers for exercise during and after cancer treatment. This information will be made available via HealthPathways (see weblink below). So, watch this space! How GPs can improve screening rates

Did you know? • The NSW Pap Test Register gets around 200 ‘return to senders’ per day • Patients are up to 60% more likely to screen when reminded by their GP in addition to screening registries • Many practices are setting reminders when they get a screening result, but are overlooking patients who have never screened or have not screened for a long time • The service incentive payment for of $35 per patient (in addition to the MBS rebate) for women who are

Delegates came away with the latest data and information on cancer screening and treatment.

more than two years overdue for cervical screening is expected to continue until at least April 2018 • You can use CAT4 to easily identify and recall women more than four years overdue for screening • NCPHN can provide recall and reminder guides to help your practice strengthen your recall and reminder systems

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Visit ncphn.org.au/wcsc/takingaction/for more information. HealthPathways puts a host of information about cancer screening and treatment information at your fingertips. You can access HealthPathways by visiting: manc. healthpathways.org.au (log in: manchealth and password: conn3ct3d)

healthspeak December 2017


Minister visits NCPHN & makes funding announcement

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n early November, the Federal Indigenous Health & Aged Care Minister Mr Ken Wyatt OAM paid a visit to our Ballina office, made a tour of an Aboriginal controlled health organisation in Lismore and held a media funding announcement. Mr Wyatt is the first Aboriginal person to be elected to the Federal House of Representatives. NCPHN’s Chief Executive, Board members and staff gave Mr Wyatt a presentation on the broad range of work being done through NCPHN in both Aged Care and Aboriginal Health on the North Coast and talked about lessons learned and the importance of genuine community engagement. Mid-morning Mr Wyatt travelled to Lismore where he met with representatives from Rekindling The Spirit and Jullums Aboriginal Medical Service.

NCPHN’s Aboriginal Health Manager, Susan Parker Pavlovic, thanks the Federal Indigenous Minister Ken Wyatt (left), and the Member for Page, Kevin Hogan, for their addresses at the Aboriginal Health funding announcement.

From here the Minister went to the Lismore Quadrangle, adjacent to the new Lismore Regional Gallery where he announced to the media funding of more than $9m had been distributed through NCPHN for Aboriginal health programs and services across the North Coast. This funding, distributed through North Coast Primary

Cashflow management? By Michael Carlton CEO & Senior Adviser, PECUNIA Private Wealth Management

When we meet with new medical professionals one of the issues they want to tackle is their cash flow: how to optimise it, where they should be directing it (mortgage repayment, superannuation, investment, school fees, etc), and how to create more structure. To many it appears that all medicos must be ‘rolling in money’, yet the reality couldn’t be further from the truth. Many are stressed about their cash flow: high income tax liabilities, mortgage repayments and school fees take serious chunks out of, disposable income, and these clients are concerned that they are not actively building wealth. The reality is that unless you take a structured, goalbased approach to your cash flow, you will find it hard to generate surplus cash flow or savings capacity. This will result in frustration and rising stress levels. Why, despite an above-average income, can’t you make financial progress? So how should you implement a better cash flow structure for long-term wealth creation and peace of mind?

December 2017 healthspeak

Health Network enables 14 different service providers to deliver a range of services and programs from Tweed Heads down to the Clarence Valley. These services help fill identified health service gaps and provide specialised training for both health professionals and community members. Mr Wyatt told dignitaries and

health service providers that working and walking together with Aboriginal people to improve health and wellbeing was a top priority for his government. He praised the collaborative partnerships ensuring that Aboriginal community needs were met. “And the partnership of the Aboriginal controlled health sector with the PHN is a strength and I want to acknowledge all of you,” he said to the gathering. He said fresh local approaches were needed to take into account the wide range of factors that can influence health. “This means moving beyond the traditional definitions of health and ensuring that as much as possible Aboriginal people are driving the process and programs that will a difference. All of us have the capacity to make a difference to the lives of the people that we serve.”

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1: Set meaningful goals – How quickly do you want to pay off your mortgage? – Do you wish to start a private practice, or expand your current one? – What amount of school fees or other financial support for your children do you need? – At what age would you like to be able to make lifestyle choices, such as working less? 2. How Much & By When? Next work out how you will fund these goals and in what timeframe, as well as what trade-offs you need to consider. We can help by testing various financial models and scenarios. 3. Set up automatic payments Now it is time to set up your funding mechanisms, best done through automatic payments, such as direct debits. This leads to more discipline and quick results. 4. Monitor and review It is critically important to monitor and review your progress. Goals, legislation, markets and personal circumstances change.

Unlike many financial advisers, cash flow management is the centrepiece of our advice. As your income is your biggest asset, why ignore it? If you would like to do more with your money, we offer a complementary appointment. Contact us on 1300 112 676 or mcarlton@pecunia.com.au. Important information and disclaimer This publication has been prepared by Michael Carlton, an Authorised Representative (AR No: 239724) and Carlton Family Trust ABN 51 283 954 577 t/a PECUNIA Private Wealth Management a Corporate Representative (CAR No: 1233485) of Dover Financial Advisers Pty (AFSL No: 307248). His advice is general in nature and readers should seek their own professional advice before making any financial decisions.

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‘CRITICAL FRIENDS’ VISIT NORTH COAST TO HELP IMPROVE HEALTH CARE In early November, NCPHN’s Centre for Healthcare Knowledge & Innovation held Transformers II – Changing the Healthcare System for the Better. This second annual Special Event Series saw six international and one national scholar visit Ballina to share their expertise with the North Coast health workforce. “I am very pleased that the Transformers Special Event Series is becoming a recognised annual event for the North Coast,” said Dr Vahid Saberi, NCPHN’s Chief Executive. “We need to continually grow and adjust what we are doing in healthcare for the community and compare our work with the best international evidence. Having seven internationally recognised experts travel to the North Coast to be our ‘critical friends’ has given us many improvement ideas that will take our health system a step further.” The intensive three-day program was divided into five distinct sessions and explored how the ‘Healthy Towns’ movement can benefit the North Coast, focusing on the engagement and empowerment of people. Discussions were held around the impact of social determinants of health and the need for narratives and stories that turn patients into people and care into better care. Local programs critiqued by the international panel included the Northern NSW Health Literacy Program, the LinkMe Mental Health Program, and the North Coast’s own recently implemented, Healthy Towns Program. The Series opened with a presentation from Dr Kirsten Meisinger, Medical Staff President, Cambridge Health Alliance. Highlights from her address appear on the next page.

NCPHN’S CRITICAL FRIENDS Dr Nick Goodwin, Co-Founder and CEO, International Foundation for Integrated Care (IFIC)

Prof Anne Hendry, Clinical Lead for Integrated Care, IFIC

Dr Alexander Pimperl, Head of Controlling and Health Data Analytics, Optimedis AG

Dr Lucy Fergus, Geriatrician at Hawkes Bay District Health Board, New Zealand

IMPROVEMENT IDEAS Following the Series, participants were asked: Has the Transformers II Special Event Series inspired an idea for practical integration at the local level? Responses included: “Explore the four-person team used to manage a portion of patient load and exactly how much time can be offset with other roles without compromising duty of care and good health outcomes.” “Pay attention and work with “third places” – mainstays in a neighbourhood such as churches, beauty salons and libraries who offer accessibility and trustworthiness. Host webinars and training sessions for local librarians to become navigators of social services, ageing, mental health, welfare and public assistance, housing resources and more.”

Karen Barrie, IFIC Scotland researcher, Dr Peter McGeorge, Consultant

Dr Peter McGeorge, Consultant Psychiatrist, St Vincent’s Private Hospital, Sydney

Dr Kirsten Meisinger, Medical Staff President, Cambridge Health Alliance, USA.

“Embark on a ‘Better Posters’ campaign and provide material to ensure that clinic signage and posters are not confusing, out-ofdate, or offensive. Signage needs to be welcoming, inviting and clear.” “Use Emotional Touchpoints as a tool, particularly in older people’s care settings. Look at key moments or events that stand out for those involved as crucial to their experience of receiving or delivering the service.” “Perform information and tool design with Practice Nurses. This could be done as a PNs reference group or similar or it could be done on an individual practice basis as part of their ‘plan for tackling winter’ in a kind of workshop method. Steering committees, workshop/co-design opportunities with Practice Nurses should be a priority.”

For a full list of change ideas, outcomes and event resources, visit https://ncphn.org.au/resources#the-centre 6

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healthspeak December 2017


INSIGHTS FOR AUSTRALIA FROM A US PATIENT CENTRED MEDICAL HOME Dr Kirsten Meisinger is the Medical Staff President of the Cambridge Health Alliance, a public sector health care organisation in the USA. It describes itself as a ‘vibrant, innovative health system dedicated to providing essential services to all members of the community.’ It also provides a vital safety net for under-served populations facing barriers to care. While the US model has distinct differences with that in Australia, particularly with funding, Dr Meisinger’s presentation at Transfomers 2017 gave a clear picture of how an Accountable Care Model could benefit health care in Australia. Some suggestions for change are explored below. The full video presentation can be viewed at: ncphn.org.au/medical-home/ webinars In her address, Dr Meisinger said that while the Australian health care system was inherently superior to that in the US, the main area or improvement for general practice in Australia was chronic disease management. Describing herself as an expert at failure, some time back Dr Meisinger realised she had to change the way she worked and since then she’s worked in a ‘continual improvement vein’ to get to a place where she’s not struggling to see every patient in 15-minute consultations. “When I looked at my workflows it turned out that anything the patient wanted had to go through me. A referral request, a medication refill, an acute need, a prevention need… and you guys still have this model. So, there’s a bottle neck and you have to feed the bottle neck, and people were burning out for good reason. Over time, Dr Meisinger changed the way the practice operated – to working in a small team. She said it was about ‘having highly trained people taking away from you what are largely secretarial tasks, and what GPs here still largely do.’ She explained that the team, which is collocated in one room, allows for more fluid interactions outside the walls of your practice. Patients know they are part of the Meisinger team.

December 2017 healthspeak

DR KIRSTEN MEISINGER

collocated in one room during the day there are opportunities for team chats and catch ups. Dr Meisinger explained with the diad structure (GP and Assistant) it’s possible to get 95% continuity coverage and with a ‘pod’ which includes GP, Assistant, Receptionist and Nurse you can get 90% continuity for patients. And the practice also has professionals on site including a pharmacist, referral coordinator, nutritionist, psychiatrist, and on site behaviourist. The receptionist sets up what Dr Meisinger calls ‘inreach’. Because patients only come to the centre once or twice a year when a patient comes in, the doctor puts them forward for every population health screening or test relevant to them.

“NOW IT’S BETTER CARE, I’M HAPPIER AND ALTHOUGH THERE’S A LOT OF WORK STRUCTURING THESE THINGS, IT’S ABSOLUTELY WORTH IT.” While she conceded that it was hard to do health care teams really well, Dr Meisinger said the benefits that resulted in much better continuity of patient care were well worth putting the work in. In the Cambridge model, Physician Assistants are an important component. (There are only a handful of such people currently working in Australia.) They are paired with a doctor and share a panel of patients. So when the doctor isn’t available the Assistant is and the patient knows they can see either person. The Assistant also orders all the population health screenings required for each patient.

“So if you come in for a sprained ankle I’m going to get a mammogram ordered for you. There is no reason why we have to wait for people to come in for an annual physical to get prevention health screenings done,” said Dr Meisinger. This model of care which includes 20-minute consultations has brought joy back into this doctor’s professional life as she explained. “So my life is not patient after patient after patient, my life is I coming into work and thinking about all of my patients and what do I need today so they get what they need. It’s a team and I’m one of them and I get to do some of these things. But all of these activities used to have to occur through me and the bottleneck in 15 minutes. “Now it’s better care, I’m happier and although there’s a lot of work structuring these things, it’s absolutely worth it.”

And unlike in Australia where each GP has their own room, Dr Meisinger uses two rooms. In one room the patient is being given all their health interventions while the GP is in the other. She said it means there’s maximum efficiency in workflows. As often the team is a publication of North Coast Primary Health Network

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JEWELS OF THE NORTH COAST: EXCELLENCE AWARDS In September, NCPHN hosted the 2017 Primary Health Care Excellence Awards, featured in the September edition of HealthSpeak. We look at three finalists from the 55 wonderful award entries received from across the North Coast.

HEALTHY CHOICES THROUGH SOCIAL ACTION YOUTH THEATRE Submission from Lisa Apostolides, Byron Youth Theatre AIM: To empower young people aged 12 to 25 years to make positive decisions concerning their health and wellbeing by engaging them in youth devised performances and workshops. The health and wellbeing of our young people determines the future of our societies. Byron Youth Theatre’s core belief is that young people have the capacity to develop and share new ideas and approaches to issues they experience. Solutions can be reached through a collaborative framework facilitated in partnership with adults. Theatre productions and workshops empower young people to determine decision making and problem solving skills while fostering awareness of their own resilience.

COFFS COAST COLLABORATIVE HEALTHCARE Submission from Aaron Hardaker, Mid North Coast Physiotherapy AIM: To develop access for the Coffs Coast community to a genuinely collaborative healthcare model that creates lasting changes in lifestyle and wellbeing by bringing together the health and fitness industries. The collaborative health care model developed between Mid North Coast Physiotherapy and Coffs Coast Health Club has given clients access to a range of healthcare and fitness professionals working together to achieve the client's goals. The model focuses on ensuring clients get the right person providing the right care within their scope, backed by fluent communication channels and best practice guidelines. This project’s focus was to bring the knowledge, skills and expertise of both industries together to make lasting, positive health and wellbeing changes. We have been able to create outstanding health outcomes and client satisfaction, and foster an environment where all staff feel valued, supported and empowered to achieve great things as a team.

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To find out more about entrants, go to http://ncphn.org.au/excellence/

EMBEDDING DIGITAL HEALTH INTO GENERAL PRACTICE WORKFLOWS

Submission from Carol Pachos, Ochre Health Grafton AIM: To innovatively embrace the move towards a national digital health system in the Ochre Health Grafton practice by ensuring our practice is fully digitally ready. This involved upskilling nursing staff as practice champions for eHealth and embedding Shared Health Summary (SHS) upload practice into our Chronic Disease Management work via an in-practice nurse incentive scheme. Between June 2016 and June 2017, staff worked to become digitally ready as a practice and to embed SHSs into daily workflows so that consultations were not compromised, patients were fully engaged in the process and the practice met i compliance targets.The practice is uploading SHSs daily and exceeded its quota requirements. The identification of the practice nursing team as the champions for eHealth was driven by Practice Manager, Carol Pachos, who could see that the place for SHSs sat with nurse clinicians who were already assisting the GPs with patient assessment, patient needs and disease management plans. The success of the initiative was supported by the attention to upskilling and education around E-health policy and procedure. The practice is being championed within Ochre Health as a leader in eHealth implementation and their senior practice nurse Mary-Anne Cole is now writing a handbook on CDM for practice nurses.

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healthspeak December 2017


Our Healthy Clarence achievements By Sue Hughes Project Coordinator

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ince commencing as the Project Coordinator with Our Healthy Clarence in August, we have completed a number of initiatives associated with the Clarence Valley Mental Health and Wellbeing Plan. Mental Health Month was a great success with over 23 activities and events held during October. In association with CRANES and NCPHN, two Youth Mental Health First Aid courses were held in Grafton and Maclean. Our Healthy Clarence partnered with the following Steering Committee and community members during Mental Health month. Clarence Valley Council and On Track Community Programs held two Zombie Walks and Clarence Youth Action (CYA) and Clarence Valley Council hosted a Spookfest Dance Party targeting ages 12 to 25. In collaboration with RAMHP, CWA Maclean, Bunnings Grafton and Mitre 10 Yamba we held Sausage Sizzles, serving and having conversations to more than 270 people across the three events. In addition, RAMHP launched The Land 2017 Glove Box Guide at the Grafton Saleyards, which

From left: Samantha Osborne, RAMHP Rural Mental Health Coordinator and Sue Hughes, Our Healthy Clarence Project Coordinator getting the word out into the community about mental health and wellbeing resources and services

was also well attended and enabled us to talk to the farming community about their mental health and wellbeing. Working with Lifeline, CRANES and PHN, two ASIST Courses were held in Grafton in November and December. As part of a collaborative approach to improving mental health in the Clarence Valley, the New School of Arts, funded by NSW Health and the Ride for Youth, opened the two Pop Up Hubs during Mental Health Month. The Grafton Pop Up Hub is at 116B Prince Street, next to Charcoal Chicken,

NDIS

open Tuesday to Friday from 12 noon to 7pm and on Saturday from 9am to 4pm, with the Yamba Pop Up Hub at the Treelands Drive Community Centre on Thursdays and Fridays from 12 to 7pm. These Hubs are for all members of our community. They will provide: • Access to good quality health, wellbeing and service information • Supported referral to local services and programs • Safe community spaces to hold meetings and support groups • Community activities and events to enhance community connections Anyone and everyone is welcome to pop in, have a cuppa or a milkshake and meet our team and volunteers and find out about the many services available in the Clarence Valley. To contact Sue at Our Healthy Clarence, phone 0439 305 803 or email: ourhealthyclarence@nsoa.org.au

together

Life Planning & Skills Mentoring Employment Accommodation Assistance and more! 1800 899 017 www.chessemployment.com.au


Low Intensity Chronic Pain Management Trial

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uring 2017 NCPHN funded a new model of low intensity chronic pain management in general practices and with allied health professionals. The aim of the multidisciplinary trial was to improve the ability of people living with non-complex chronic pain to manage their pain using a skills-based approach. The model also looks to improve health literacy and physical and mental wellbeing, resulting in a potential reduction in hospital presentations. The project trained clinicians through a series of webinars with the opportunity to take part in a Pain Clinic Support Day to practice chronic pain management strategies and treatment skills. These new skills will benefit patient outcomes as well as developing professional capacity. This program is based on a low intensity program developed by the Agency for Clinical Innovation (ACI) and data evaluation is provided by the University of Wollongong. Additional mentoring and support was provided by the Northern Local Health District Specialist Pain Clinic and Royal North Shore Hospital Pain Clinic. Feedback following the trial included the fact that relaxation and self-talk strategies were found to make fast, positive changes to a person’s perception of pain and their overall pain experience. Within six weeks of the program many in the group found their functional capacity improved and they felt less pain. There were also reports of greater self-confidence and motivation after the fourth session. The project provided clinicians with training through a series of webinars and the opportunity to participate in a pain clinic support day to practice current chronic pain management strategies and treatment skills. These new skills will benefit patient outcomes as 10

Relaxation and self-talk strategies made fast positive changes to a person’s perception of pain

well as developing professional capacity. Multidisciplinary teams from two general practices and four allied health practices hosted the program to improve access to chronic pain management programs in their local communities. There were two streams in the trial: • ACI’s 18-Hour Allied Health Led Community Pain Management Program (CPMP) workshops consisting of three-hour sessions for six weeks for up to 10 patients at each location: Murwillumbah, Mullumbimby, Grafton Coffs Harbour, Kempsey, Wauchope and Port Macquarie. • ACI’s 10-Hour General Practice led Chronic Pain Program workshops consisting of two hour sessions for five weeks for 10 patients at each location: Mullumbimby and Kingscliff. The final week of workshop sessions was held by allied health in early November and the program is now in the evaluation phase at all locations. A total of 74 patients commenced the workshops. While the program had some patient drop out, sometimes it was for a good reason. For instance, a patient who completed the program at a general practice felt improved enough to accept a full-time positon, so they were not able to attend the final session!

Mullumbimby Psychology – from left: Nyssa Lonergan, Provisional Psychologist and Jacki Elphinstone, Psychologist.

Phyx You Physiotheraphy – from left: Sarah Curry, Leah Burton, Grayce Gerke

Wauchope Physiotherapy and Sports Rehab Centre – from left: Nathan Lynch, Physiotherapist and Gary Grant, Psychologist

Facilitators found the webinar training excellent and physiotherapist Nathan Lynch said he “enjoyed the experience of working together and found our professional skills complemented each other with the ‘task orientated’ physiotherapist paired with a ‘process orientated’ Clinical Psychologist.”

a publication of North Coast Primary Health Network

Participants from Wauchope Physiotherapy said the workshops provided a sense of camaraderie and encouragement among patients that could not be done in an individual consultation. “We enjoyed seeing people laugh and seeing the lighter side of their pain experiences,” they said. healthspeak December 2017


Don’t let mental health do your head in workgroup meetings. We also thank all of our Workgroup members (listed below) for their participation and expertise provided during this process. Local Health District Workgroup Members – Dr David Furrows, Clinical Director, Tweed/Byron Mental Health; Kim McGowan, Nursing Unit Manager, Tweed/Byron Mental Health; Terri Blake, psychologist, Byron Mental Health Assessment Team; Ciaran Carolan, Mental Health NUM, Byron Central Hospital; Dr Justine Hoey-Thompson, psychiatrist; Lucille Reynolds, Clinical Nurse Specialist, Tweed/Byron Mental Health; Dr Hilton Koppe; Dr Paul Davies; Dr Peter Silberberg; Olivia Pantelidis, Simon Dubois, psychologist; Brendan Koivu, New Access; Prem Dana Takada, psychologist; and Kerrie Keyte, HealthPathways Senior Project Officer.

Dr Hilton Koppe Senior Clinical Editor, HealthPathways

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he HealthPathways team has been working very hard over the past 12 months to increase resources for mental health topics. As always, we are guided by the following principles as we work on new Pathways for our site: 1. Adapting evidencebased best practice guidelines to our local requirements 2. Ensuring Pathways contain accurate and up to date referral contact information 3. Inclusion of reliable and Australian (where possible) patient information materials that meet health literacy standards Regular users of HealthPathways will have noticed that the follow mental health topics have recently been added to our suite of localised Pathways: Depression in adults; Depression in older people; Mental health treatment plan; Scheduling a patient; Suicide risk and Psychosis. We are working on developing pathways for eating disorders, depression in younger people and anxiety. There has also been a significant revamp of the mental health referral section to make this more user friendly. There are new pages packed with useful referral information. Have a look at Mental Health Psychosocial Support pages https:// manc.healthpathways.org. au/335273.htm to get an idea of these new pages. Below is a list of the new Table of Contents for mental health referrals. As always, if you find incorrect or missing information, please let us know by using the Feedback button at the top right hand corner of December 2017 healthspeak

every HealthPathways page. Mental Health Referrals Scheduling a Patient Acute Mental Health Assessment Non-acute Mental Health Referrals Non-acute Adult Mental Health Assessment Non-acute Child and Young Person's Mental Health Assessment Non-acute Older Adult Mental Health Assessment Non-acute Drug and Alcohol Assessment Psychological Therapy Mental Health Psychosocial Support Bereavement Support Child, Adolescent and Family Counselling Daily Living Community Support E-Mental Health Mental Health Helplines Problem Gambling Counselling

The review of the Mental Health referral pages and new Adults and Older People Depression HealthPathways were developed with the assistance of the Mental Health Workgroup members at Byron Central Hospital. We would like to thank Richard Buss, General Manager,

Mental Health & Drug and Alcohol and Stream Services, NNSW LHD, for nominating specialised LHD staff in the field of mental health to attend

LOOKING FOR SOME NEW WHEELS? Lismore’s Southside Health and Hire Centre (in association with Southside Pharmacy) have a large range of quality BARIATRIC and standard equipment for hire or purchase including shower chairs, lifters, electric beds, wheelchairs, seating, walkers, commodes and more.

SOUTHSIDE HEALTH & HIRE CENTRE Call us today on (02) 6621 4440 or come in and say hello at 5 Casino Street, South Lismore. Southside Health & Hire Centre Where your health is our total concern.

Nurse on Duty www.southsidehealthandhire.com.au

a publication of North Coast Primary Health Network

8:30am - 5pm Mon - Fri 8:30am - 12:00pm Sat Closed Sunday

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NCPHN’S revamped executive team

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n recent months, there have been some changes to our Executive Team. In late November, we said a sad farewell to Dr Megan Lawrance, a much valued staff member. Megan worked tirelessly as Director, Mental Health & Services Integration, for about two years to put in place

Vahid Saberi

the Commonwealth’s mental health reforms and ensure that NCPHN’s commissioned mental health services met community needs, were easy to access and would ensure better health outcomes for North Coast residents. Another highly regarded member of the Executive Team,

Geeta Chema

Deborah McPherson

Michael Carter, left NCPHN in July. In recent months, we’ve welcomed three new Executives: James McGuigan, Director Corporate Services; Geeta Cheema, Director, Innovation and Strategy; and Steve Mann, Director, Integration on the Mid North Coast. They join longstand-

James McGuigan

ing Executive Team members, Chief Executive Vahid Saberi; Sharyn White, Director, System & Service Integration Northern NSW and Deborah McPherson, Director, Primary Healthcare Support. We look forward to working alongside our revitalised Executive Team in the year ahead.

Sharyn White

Steve Mann

What the UCRH Simulation Centre offers the health community

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he Nyumbalihgu Simulation Centre is heading into its fifth year of operation. Located directly opposite Lismore Base Hospital, within the University Centre for Rural Health (UCRH), the Simulation centre provides clinicians and undergraduate medical and allied health students a safe clinical environment to further develop their clinical competency. Offering over 30 courses held multiple times per year the centre caters to a wide range of clinicians including residential aged care staff, critical care clinicians, General practitioners and practice nurses, undergraduate medical and allied health students, school students, ambulance officers, and members of the community. Some of the Simulation Courses available in 2018 include: Australian College of Critical Care Nurses (ACCCN) accredited and Royal Australian College of General Practitioner (RACGP) approved Advanced Life Support (ALS) - 2 day courses offered in Adult and Paediatric ALS for medical, 12

From left, registered nurses Helen Kane, Monique Neessen, Andrea Green and Jacqui Mallaby at the pilot of the ‘Managing the deteriorating patient on dialysis’ simulation workshop held in August.

paramedical and nursing staff. 1 day recertification is also available. RACGP approved Basic Life Support (BLS) and use of the Automatic External Defibrillator (AED)– as well as offering course in our simulation labs, we are in 2018 excited to be providing this practical course at individual health sites by request. Our clinical staff will travel to individual sites such as GP clinics with the required equipment to deliver after of hours training to staff. Participants find this course particularly useful

as they can practice CPR on a mannequin that provides visual feedback on the rate and depth of compressions. Aged Care- popular with clinical staff who work in residential aged care facilities, this course gives participants the opportunity to develop both the clinical and team skills required to manage an acutely unwell resident. Topics include chest pain, BLS, foreign body removal, asthma, head injury, hypoglycaemia and clinical handover. IV Cannulation- a practical course for GPs, registered

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nurses, practice nurses and JMOs. Some course topics include review of anatomy and physiology of veins/arteries, cannulation site and cannula selection, and infection control issues. Provides participants with the opportunity to practice and mater the skill on simulation model arm. Managing the deteriorating patient on dialysis – a newly developed course specifically designed to provide a unique method of learning and development to specialist nursing teams in haemodialysis. Topics include consolidation of recent changes in practice, application of recognised clinical tools in the systematic assessment of renal patients, and practice delivering Basic Life Support (BLS). Further information on the courses available in 2018 can be found at the UCRH Events and workshops webpage http://www. ucrh.edu.au/coming-events/ The simulation team can be contacted via email at simulation@ucrh.edu.au or phone 6620 7570 (select appropriate option).

healthspeak December 2017


Need to raise awareness about men and breast cancer

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n article in The Northern Star newspaper in October put the spotlight on the fact that many men are surprised to learn that they can develop breast cancer. In the article a 60-year old man diagnosed with breast cancer in June said he considered that male breast cancer was ‘a top secret thing that men don’t talk about’. Mr Gregory Moss first realised something was wrong when he felt pain after lifting a heavy object which rubbed against his breast, before discovering a two and a half centimetre lump. Mr Moss said he kept working and never said anything or thought anything about the lump because the pain only happened when something hard pressed against the breast tissue. It took three visits to a doctor and several tests before Ms Moss received the diagnosis. HealthSpeak approached Lismore breast surgeon Dr Rob Simon, from the North Coast Surgical Suite at St Vincent’s Hospital to comment on the topic. When asked about the incidence of breast cancer among men in Australia Dr Simon said

Male breast cancer was ‘a top secret thing that men don’t talk about’

it was difficult to estimate. “It’s not that well studied, but probably one in 200 or 300 men will develop breast cancer,” he said. Dr Simon said that while some men whose partners had developed breast cancer were aware that men were also vulnerable to the disease, in his experience most men weren’t aware. He said GPs needed to help men become aware of their bodies and to look out for changes.

“If there’s any change to their breast, it’s important they get it investigated. The best way to check breast tissue is to have a feel while under the shower.” In the newspaper article Mr Moss suggested that men of 50 years and over should go along to the BreastScreen bus and insist on a screening test, but Dr Simon said this approach would not be helpful. “Because the incidence of breast cancer in men is so low

Dr Rob Simon

and the pick up rate would be very low at an early stage, Mr Moss’s suggestion would not be cost effective,” said Dr Simon. He added that any swelling in the breast of a male could be breast cancer, although very unlikely. So it was important to investigate in the same way as females, with a mammogram and ultrasound.

Is this Australia’s oldest packaged medicine?

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his nerve and brain tonic was the winner of an Australian Journal of Pharmacy competition “Search for Australia’s Oldest Medicine” campaign. The winning entry was from Christian Rossi of Maddington Village Pharmacy in Western Australia - three bottles of Clements Nerve & Brain Tonic returned to their pharmacy. The packaging makes remarkable claims for the range of conditions the tonic may treat, including: weakness, nervousness,

December 2017 healthspeak

debility, premature decay, loss of nerve power and poorness of blood! Christian says the pharmacy staff searched for the age of the products and they “managed to find an advert in an online search advertising the product in a 1938 newspaper (The Argus, Monday 11 April 1938) on the Trove website”. He said they couldn’t bring themselves to dispose of these relics, so placed them in our museum of old bottles from yesteryear (well out of reach of children and the public).

a publication of North Coast Primary Health Network

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The Role of Podiatry in Diabetic Foot Care By Adam Jorgensen Podiatrist, Right Foot Podiatry

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ctober 2017 witnessed the launch of Diabetic Foot Australia’s “Australian Diabetes–Related Foot Disease Strategy 2018-2022: The first step towards ending avoidable amputations within a generation.” This strategy paper outlines the burden of Diabetic Foot Disease on the Australian population and how our health system can tackle this growing problem. One of the fundamental strategies advocated in the paper was the importance of access to footcare specialists such as Podiatrists in reducing this burden and improving outcomes. Podiatrists are a key resource for GPs in our health system, providing a wide range of services in managing the feet. Making use of the Podiatrists’ services is important in preventing diabetic foot amputations and keeping diabetic patients out of hospitals. A diabetic patient’s initial consultation with the Podiatrist will involve a comprehensive screening, risk assessment and development of a management plan for the patient. Screening includes vascular (palpation of pulses, perfusion, capillary refill, colour changes), neuro-

briefs

Hearing awareness PDSA Australian Hearing has put together a comprehensive Plan, Do, Study, Act (PDSA) education activity to help GPs and nurses learn more about identifying and managing hearing loss. The QI & CPD accredited program can be completed individually or as a group. Around 60% of Australian over 60 years are affected by hearing loss. If left

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logic (monofilaments, vibration perception, proprioception), orthopaedic (deformities, range of motion, muscle testing and gait analysis), dermatological (callosities, wounds and nail changes) and footwear assessment (fit and function). Risk Classification allows development of a management plan for the patient. All diabetics should have at least an annual screening for risk. Those with demonstrable risk factors such as neuropathy, PVD, deformity or skin lesions, must then be seen on a more frequent basis depend-

undetected, hearing loss can have serious consequences for health and wellbeing, increasing social isolation and causing depression. Nurses who are members of APNA can claim eight hours of CPD. GPs who are members of ACRRM can receive 40 accredited PDP points and RACGP members can receive 40 CPD points by undertaking the training. You can obtain this PDSA activity by phoning Australian Hearing on 1800 776 631 or your local Australian Hearing Centre on 02 6652 0700.

Diabetic foot ulcers are particularly challenging to manage ing upon their needs. Patients who are unable to self-care for the feet, or with pathological nail and skin lesions, may requires 8 to 10 weekly visits while patients with active neuropathic ulcers may require weekly visits for debridement and offloading of the lesions. The first step in managing diabetic feet is patient education. Education is tailored to the patient’s needs and risk factors and may include details on why the feet are at risk, how to care for the skin and nails, correct footwear selection and managing simple problems with the feet. Management of non-ulcerative lesions may be managing nails, particularly those diseased or deformed, and the debridement of hyperkeratotic skin which may indicate pressure lesions. Removal of these reduces immediate danger of ulceration, however the cause of the lesion must also be addressed. Hyperkeratosis is usually removed using scalpel

a publication of North Coast Primary Health Network

blades and steady hands. The cause of the callus, pressure, must also be addressed through offloading techniques utilising padding, insoles, custom orthotics and footwear. Diabetic foot ulcers are particularly challenging to manage. Podiatrists primarily deal with plantar neuropathic foot ulcers. Treatment begins with appropriate wound assessment. Careful debridement of slough and devitalised tissue aids in the wound healing. Offloading abnormal plantar pressures on the feet is critical in healing these wounds. This begins with the removal of callus which usually surrounds the neuropathic ulcers. Padding may be used, not as a cushion to the pressure point, but to deflect pressure away from the ulcer. Insoles and custom moulded orthotics may also improve pressure reduction, particularly when combined with medical grade footwear. Podiatrists will assess the footwear for fit and function and refer to Pedorthotists when medical grade shoes or custom footwear are required. More aggressive offloading may be achieved through the use of a moon boot or Total Contact Casting which both redistribute plantar pressures across the entire foot and onto the leg. In recent years Podiatrists with advanced training have increased their scope of practice to include prescribing rights to limited classes of drugs, and also more advanced surgical interventions beyond the standard nail avulsions. Podiatrists are key members of the diabetic foot team and are a ready and accessible resource for GPs. REFERENCES 2. International Working Group on the Diabetic Foot. International consensus on the diabetic foot and practical guidelines on the management and the prevention of the diabetic foot. 2007. Amsterdam, the Netherlands. 7-13. 3. National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes). Melbourne, Australia; 2011.

healthspeak December 2017


MY HEALTH RECORD: THE GREAT LEAP FORWARD DIGITAL HEALTH RECORDS ARE ABOUT TO TAKE A GIANT STEP FORWARD. FROM THE MIDDLE OF 2018, THE AUTOMATIC CREATION OF A MY HEALTH RECORD (MYHR) FOR EVERY AUSTRALIAN WILL BEGIN.

PHARMACY

Potential impact

Ensuring providers are ready for MyHR

The Federal Government claims that if all Australians signed up to MyHR, around 5000 lives could be saved a year. It could also help avoid two million primary care and outpatient visits, 500,000 emergency visits and 310,000 hospital admissions. Benefits of shared health information:

Senior Project Officer,

December 2017 healthspeak

Tony Browne, NCPHN’s Tony Browne

Digital Health, talks about My Health Record.

A lot of my work life has been involved in IT and ensuring people get the most out of technology. I've also enjoyed working on projects that make a positive difference to people's lives and having a My Health Record will help achieve this. Watching my parents grow older and deal with complex health issues from interstate was difficult. They were dealing with loads of paper and having to remember their medical history as they went from doctor to doctor was frustrating for them. It's on my ‘to do’ list to get Mum registered with a health record soon. When I started on this project, even though I've had a pretty good run with my health, I calculated that I'd been to at least 30 different GPs in my life. I signed up for a record straight away and it's now much easier to keep track of things like past check up dates, medications and vaccinations. I'm using Healthi app at the moment and it makes it really simple to access MyHR straight from

my phone. The general practices in our region have done a great job registering over half of the 95,000 people. I'd recommend that any health care provider not only get their organisation registered, but also sign up for a record for themselves. It's important to walk in the patient's shoes and understand how it all works before the national expansion happens in mid2018. Patients will be asking questions about MyHR from the people they trust, so it's important that their doctor is familiar with the platform. We're well into "provider readiness" mode now, supporting and training health care staff across the region to "be registered and ready" as everyone is given a record

a publication of North Coast Primary Health Network

M Y H EALTH REC ORD: THE GREAT LEAP FORWARD

• Provides access to more medical information • Includes allergies, drug reactions and medication history • Includes discharge summaries • Can lead to improved clinical decisions • Fewer adverse events for patients and fewer avoidable hospital admissions • Can be valuable when treating patients with a range of providers and those with complex health conditions • Helps care for patients without a regular doctor, or those travelling • And, if your data has been maintained, a Shared Health Summary can be created in two clicks!

FEATURE

THE NEW OPT-OUT POLICY WILL BRING MANY DIGITAL HEALTH BENEFITS TO BOTH CONSUMERS AND PROVIDERS. IN THIS SPECIAL FEATURE, HEALTHSPEAK LOOKS AT HOW VARIOUS HEALTH CARE SETTINGS ARE USING MYHR AND TELEHEALTH.

(unless they opt out). Security and privacy will be a big topic for us to cover off with practitioners and the broader community. We will need to ensure that everyone is well informed and comfortable with MyHR. There's been a transformation in how people collaborate across the globe for all types of professions and communities. And there's an underlying expectation from the community that their health information and history is available to people involved in their health care. That's not always the case. My Health Record enables health professionals to collaborate as part of patient centered care. I'm hoping that health care takes a big stride further down the online path.

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MyHR at Bawrunga Aboriginal Medical Service, Nambucca Heads

FEATURE

Lee Oliver

Practice Manager Lee Oliver’s enthusiasm for MyHR and for working with the PenCat tool to identify patients needing to register is infectious. Indeed, now that hospitals are really starting to use digital health records and providing detailed discharge summaries, she’s keen to get everyone registered. “If patients have a MyHR it saves us so much time faxing and printing their health information and sending it over to the hospital. With a MyHR the patient turns up at A & E and all their information can be used straight away,” she said. Lee is hopeful that My Health Records will soon be

used across the broader health community by specialists as well. “I educate every patient as they come in the door. I explain the benefits, such as how handy a MyHR is if they travel interstate, for example. I talk them into it because this is the way we have to go.” Lee says every day she is using PenCat to comb data and identify patients who can be signed up. “I’m addicted, it’s like (video game) Candy Crush - I love it. It’s like OCD,” she laughed. Lee said one of the benefits of My Health Records is that unlike faxing and printing patient’s health information to A & E, there is no danger

I’M ADDICTED, IT’S LIKE (VIDEO GAME) CANDY CRUSH - I LOVE IT. IT’S LIKE OCD

MY HEALTH RECORD: THE GREAT LEAP FORWARD

of breaking confidentiality. Everyone’s health information is secure. Lee also lets patients know that the only health professionals who can access a MYHR are those with a health ID number. “And I let them know that they can access and look at their own record through myhealth.gov.au.”

MyHR at Evans Head Medical Centre Practice Manager Paula Bale told HealthSpeak that patients at this busy practice range from babies to old people. Interestingly, they also have a lot of grey nomads coming through town and a large population of Melburnians come every year to spend winter in Evans Head. Naturally these travellers can really see the benefit in having a MyHR. Paula got involved in setting up My Health Records for patients about two years ago when she convinced the practice GPs that it was worthwhile. In fact, when the Department of Health set MyHR registration quotas, this Medical Centre was way beyond this number. They’d registered more than 300 patients. “Initially not everyone could see the benefit. I went to a couple of NCPHN meetings about it and once the hospital

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started to create electronic discharge summaries and could access someone’s health record after hours, that’s when one of the doctors here decided it was a good thing to pursue. Until that point it had been a bit of a hard sell,” she said. Paula got all of the practice nurses involved in registering patients for MyHR. “Our nurses enrol people and talk to them about MyHR when they draw up GP management plans and opportunistically when they can. Enrolling our Melbourne winter population has been really handy as they can see another GP here and we have access to their medical details.” Paula said the main benefits can be seen when one of their patients attends ED after hours. No longer are they getting so many requests to fax through people’s records as they used

The practice team, from left: Jenny Santin, Reception; Rhonda Hartley, PN; Jane Cornish PN; Kate Clifford RN; Dr Paul Eason; Paula Bale, Practice Manager and Marion Smith, Reception.

to have to do – something that was fiddly and time-consuming. “So now any patient who comes in with a MyHR, we can just look up their records for any information we need.” Looking ahead to next year, Paula doubts that anyone will wish to opt out of MyHR. She’s also noticed that older patients don’t usually want to be able to access their records

a publication of North Coast Primary Health Network

themselves. Paula is impressed by how little time it takes to set up a MyHR. “It only takes a couple of minutes. People think it’s an onerous task, it’s not. Yes, you have to have the right software and get all your certificates at the beginning, but once everything is set up, it only take a few minutes”

healthspeak December 2017


December 2017 healthspeak

of time pressure. So taking a couple of minutes out to do MyHR is not something people are keen about.” Practice Nurse Erica Walker was the one who encouraged and instructed the doctors on MyHR. Dr Vaughan said once you’ve done it a few times it only takes a minute or two to upload the information to the cloud. And now that there’s a PIP incentive payment that will encourage more doctors to use it. However, Dr Vaughan said until you have the other parts of the health system using MyHR constantly, it won’t be as effective as it could be. “When we send someone to A & E from here we still send a letter and a health summary. But when our patients present to ED after hours I’d imagine if the doctors on duty could access their MyHR it would make a big difference,” he said. He also gives an example of a patient with cognitive deficits. “If the patient has a MyHR then the doctor can at least get a medication summary and information about main medical events. So it has potential, I just don’t know that it’s being used as much as it could.”

FEATURE

Dr John Vaughan told HealthSpeak that the concept of MyHR was excellent. “Our population tends to move around a bit, not just around the country, but from one institution to another, whether from the hospital to the general practice or the pharmacy, and it’s a really great idea to share what common information we have.” “There’s a lot of repetition within the health system, confusing our patients and confusing ourselves, so it has the potential to eradicate a lot of that. That’s the theory behind it and the practice has been somewhat different from that, but the theory I applaud.” Ocean Drive practice started working with MyHR about two years ago. Dr Vaughan said there were a few barriers. “It was not something that our doctors saw as important. There was a time issue and a technical issue. Not all of us understood how to do it and if we were instructed how to do it there was often a period of time between the patients that were on the MyHR, so you’d forget how to do it. “In general practice you are constantly on the move and under an enormous amount

MyHR at Greenmeadows Pharmacy, Port Macquarie

From left Pharmacy Manager Jacki Smith with pharmacist Sue Clarke.

IT COULD BE FIVE DAYS UNTIL YOU KNOW THE MEDICATIONS AND WITH MYHR YOU CAN GET THAT INFORMATION IMMEDIATELY Pharmacist Sue Clarke said until NCPHN’s Tony Browne got in touch with the pharmacy earlier this year they weren’t aware of the benefits that MyHR could bring to their way of working. Pharmacy Manager Jackie Smith registered the pharmacy to the MyHR platform. Sue said the pharmacy is always keen to put in place anything that provides quality improvements. More than half of the pharmacy’s customers have a MyHR, according to Sue, which makes the life of a pharmacist easier. “You only go into it if you need to but we’ve got a lot of elderly customers and if they’ve just come out of hospital and they don’t know

a publication of North Coast Primary Health Network

what they need to be taking, you can just look at their My Health Record. “Whereas without a MyHR there’d be many, many phone calls and chasing around.” Sue also finds MyHR invaluable when putting together Webster packs for customers and believes all pharmacists would see the benefits. “If a customer is just out of hospital and you have to make a change to the pack, if you wait for the normal system it could be five days until you know the medications and with MyHR you can get that information immediately” Sue said customers are enormously grateful when you can sort out their medications quickly. “They’re confused, they’ve just been in hospital and they come out and they don’t know whether they should still be taking what they were taking before. From that perspective we are able to help them. And sometimes that’s a Saturday and to get onto their GPs on a Saturday is difficult.”

M Y H EALTH REC ORD: THE GREAT LEAP FORWARD

MyHR at Ocean Drive Family Practice, North Haven

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Community member a big advocate of MyHR

FEATURE

Yorkleigh resident David Bodsworth became registered for MyHR at the Riverside Family Practice in Casino a few months back. His GP, Dr Cathryn Amey, suggested a MyHR to David and practice nurse Carol Ramsey set up the health record for him. David, who has a chronic heart condition, told HealthSpeak that already he’s found his digital health record useful. He ended up in Casino Hospital ED one night recently, something which is sadly not an uncommon experience for him. “At Casino Hospital all the doctors aren’t familiar with your medical history. I told the doctor on duty that I had a MyHR and he looked it up

MY HEALTH RECORD: THE GREAT LEAP FORWARD

and could see all my medical history and medications since 2013 when I had a quadruple bypass. It’s very handy.” David and his wife enjoy caravanning and he feels secure in the knowledge that wherever he goes, doctors will be able to access his health records. He’s a big advocate of MyHR and recently suggested to a mate with a health condition that he also get registered. “Recently my cardiologist took me off a medication and I’m sure that change is now appearing on MyHR. It’s so useful to just be able to look up all my history on the computer. The doctor can see everything that’s been happening straight away.”

David Bodsworth

HE FEELS SECURE IN THE KNOWLEDGE THAT WHEREVER HE GOES, DOCTORS WILL BE ABLE TO ACCESS HIS HEALTH RECORDS

Telehealth helps avoid admissions for elderly A program designed to reduce hospital admissions and improve care for older people in the Residential Aged Care setting was launched at Grafton Base Hospital early this year, with the implementation of the Specialist Geriatric Outreach (SGO) service, which uses Telehealth to provide RACFs with clinical support and advice. The Specialist Geriatric Outreach (SGO) sees an integration of services between acute care services, primary care, and RACFs. The project is a partnership between the NNSW LHD, the NSW Agency for Clinical Innovation, NSW Ambulance, North Coast Primary Health Network and local Residential Aged Care Facilities. “We are committed to delivering appropriate, patientcentred care to residents residing in RACFs in order to help maintain their health and independence,” NNSW LHD

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Project Officer Kate Russell said. Kate told HealthSpeak that SGO involves all nine RACFs in Grafton, Yamba and Maclean being linked to Grafton Base Hospital’s Emergency Department through telehealth equipment installed in the RACFs. “This 24/7 service was set up to offer additional clinical advice and support to the RACFs and to reduce unnecessary presentations to ED,” Kate explained. The SGO services

aims to reduces unnecessary presentations for non-urgent cases only, it is not to be used for emergency situations. “We’ve had excellent feedback from the RACFs using SGO, and have had a number of successful patient stories where SGO has allowed a resident to be able to be treated in their own home, particularly palliative care residents requiring additional pain relief. “It’s distressing for a palliative care resident, or a resident with dementia or in a delirium to be taken out of their environment and travel via ambulance to hospital, where they may have to wait in ED for an extended period of time, to be assessed and treated. We aim to improve patient experiences by offering additional treatment options within their own home. “If the GP is unavailable and a patients requires oral antibiotics for cellulitisor a chest infection, SGO can help facilitate

a publication of North Coast Primary Health Network

this using the Telehealth link SGO has already proven its worth with a reduction in the number of presentations to Grafton Base Hospital from RACFs.” Kate said SGO had been quite successful so far and that all RACFs have welcomed the extra support. GBH has also implemented Aged Care Education days for RACF nursing staff and are currently holding two education days per year. To ensure the SGO service is sustainable, GBH holds management meetings twice yearly to give RACF managers, ANSW and LHD staff a chance to give feedback, discuss any issues and possible improvements. Contact Kate Russell on 66418988 or email: Kate. russell@ncahs.health.nsw.gov. au. For more info about the SGOP, visit www.aci.health.nsw. gov.au/make-it-happen/cip.

healthspeak December 2017


Bundjalung artworks ready for Gallery exhibition

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s HealthSpeak goes to press, the landmark Art of Bundjalung Country project moves into its final phase. In an exciting development, the project was given a shopfront in Lismore for five days in Late November/early December to showcase the wonderful array of work created for the Lismore Regional Gallery Exhibition that starts on December 9. A stunning collection of painting, weaving and ceramics was on display and the community enjoyed visiting the space and talking to artists about their work. Some of the work was available for sale. NCPHN, Arts Northern Rivers, Lismore Regional Art Gallery, Bulgarr Ngaru and UCRH North Coast are sponsors of the Art on Bundjalung Country project. Art on Bundjalung Country grew out of two Aboriginal art exhibitions held at the Lismore City Hall in 2004 and 2009. They were inspired by local doctors working in Aboriginal Medical Services and were successful on many fronts. There were sales of more than $50,000 for each of these exhibitions and this provided income for the artists along with some profit directed to further build an Aboriginal art industry and some for equipment for the Casino Aboriginal Medical Service. As part of the project, a series of workshops was held throughout the Northern Rivers with facilitators encouraging Aboriginal participants to create art forms including painting, basket weaving and ceramics. It is envisaged that the exhibition will further stimulate the art industry to meet the growing market for Aboriginal December 2017 healthspeak

Both established and emerging artists contributed to the project.

The shopfront gave people an opportunity to meet some of the artists and have a yarn about their work.

A section in the shop where basket weavers sat to display their skills.

work. It is hoped such work will be seen in health facilities, foyers, waiting rooms, shops and homes in the region and beyond. It’s hoped that Art of Bundjalung will continue and grow over coming years.

Art of Bundjalung Country runs from December 9 through until February 11, 2018 at the new Lismore Regional Gallery. Find out more about the exhibition at: issuu.com/ lismoreregionalgallery/docs/ lrg_6m-program

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Taking Charge of Your Health Workshops

Did you know that in one year a person will spend just three to four hours with health professionals and more than 8,000 hours managing their own health? To celebrate Health Literacy month in October, a series of free community workshops were held to support people to take charge of their health in between doctors’ visits. A number of health professionals attended the workshops to provide service information, have a chat and answer people’s questions in a relaxed setting. The workshops were a great success, with people telling us: “I was blown away by how much I didn’t know about what services are available.” “I would use the Health Direct phone line in future to have my questions answered by a registered nurse.” “I didn’t know about the free Get Healthy healthy lifestyle coaching service.” More than 50 community members from Casino to Tweed Heads attended the workshops, and learned about: Tips and tricks to stay on top of your health; Chronic disease management and Action Plans; My Health Record; Advance Care Planning and the Get Healthy free healthy lifestyle coaching phone service, available on 1300 806 258. More workshops are planned for 2018. If you are interested in holding a workshop in your community, please contact Taya.Prescott@ncahs. health.nsw.gov.au

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Goori Grapevine Indigenous First Aid Training Rhiannon Mitchell

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uring October NCPHN’s Aboriginal Health Team, in partnership with the Coffs Harbour Aboriginal Land Council, ran nationally accredited First Aid training for Aboriginal people in Coffs Harbour. The training is to help community members respond to minor injuries and to provide support until the ambulance or health professionals arrive. It’s particularly important that people have first aid training in more remote locations. Twenty community members attended the one-day course at Wongala Estate. Attendees learnt the DRSABCD action plan as well as resuscitation (Including defibrillation), how to deal with asthma, anaphylaxis and the management of various injuries and illnesses. They were also taught how to deal with

Participants at the Wongala Estate First Aid Training Day.

medical emergencies and how to respond to accidents. Everyone who attended was also provided with a first aid kit from North Coast Primary Health Network. Community members are now able to: • Recognise life-threatening situations, such as chest pain or a cardiac arrest • Have confidence in their decision to call for as-

sistance and know how to record the correct information • Offer vital (lifesaving) assistance before help arrives The more people in our Aboriginal communities who are trained in First Aid the more the entire community benefits. Feedback from participants was very positive. The training was provided by Pulse start Training Solutions Pty Ltd.

Nambucca Indigenous Service Provider Forum

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n late October NCPHN’s Coffs Harbour Indigenous Health team ran an Indigenous Service Provider Forum in Nambucca for services that work with the local Aboriginal community. It was pleasing to see a full house of 55 service representatives. Participants came from the Mid North Coast Local Health District, Community Health Services, Aboriginal Medical Services, wellbeing services, general practices, the local Land Council, employment services, education services, FACS, the Local Language Centre and other organisations. The purpose of the day was so that services could network, build on existing partnerships, make new ones and learn what is available in the community. 20

The Nambucca Forum was a sellout, and more provider forums are planned.

It’s hoped the event will help to ensure services work together more and that Aboriginal people get access to the most appropriate care. The all-day Forum featured presentations on the services and programs provided by each organization. Tables with an array of take away resources were a popular meeting

spot and the day began with a Welcome to Country from local Gumbaynggirr woman Virginia Jarrett. Feedback was positive with participants talking about the value of networking and sharing information. NCPHN will be holding more service provider forums in the future.

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Development of a Pharmacist career pathway In recognition of the growing number of pharmacists working in Aboriginal Community Controlled Health Organisations (ACCHOs), the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Pharmaceutical Society of Australia (PSA) held the first ACCHO Special Interest Group Committee meeting on the issue in November. The inaugural meeting took in Canberra. Committee members consisted of pharmacist representatives from every State and Territory who will provide peer support, advocacy and input into key medicinesrelated policy items for NACCHO and the PSA. PSA National President Dr Shane Jackson said the group’s authoritative knowledge would contribute to the development of PSA’s Aboriginal and Torres Strait Islander Health Service Pharmacist Career Pathway. “The Committee plays a valuable role in supporting pharmacists working in ACCHOs, particularly those in rural and remote areas,” Dr Jackson said. “Committee members are working to encourage the growth of this career path with a shared commitment to embedding pharmacists in ACCHOs nationally.”

healthspeak December 2017


Raising awareness about Strongoloides

By Harriet Whiley Lecturer in Environmental Health, Flinders University; Kirstin Ross, Senior Lecturer in Environmental Health, Flinders University and Meruvert Bekknazarova, PhD candidate.

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e all know about parasites, like tapeworms that can get into our intestines if we eat infected undercooked meat. There are many types, including flatworms and roundworms. But there’s one infection by a parasitic worm that, worldwide, makes more people ill than malaria, and yet hardly anybody has ever heard of it. It’s called Strongyloidiasis, and estimates suggest up to 60% of Indigenous Australians in some communities carry the infection. What is it?

Strongyloidiasis is an infection caused by a parasitic worm called Strongyloides stercoralis which infects the gastrointestinal system. Worldwide, it infects an estimated 370 million people. But so few people are aware of it that it has been described as the most neglected of all neglected diseases. Strongyloidiasis is generally considered a disease of developing countries, but we also see it in economically disadvantaged areas. In Australia, the worm is most common in Indigenous Australian communities, refugees, returning overseas travellers and Vietnam veterans. Estimates suggest the prevaDecember 2017 healthspeak

lence of infection in Indigenous Australian communities is 35 to 60%. Yet the true incidence in Australia could be much higher as the infection is difficult to detect, is often not tested for and is not a nationally notifiable disease. This means there is no centralised record of cases.

Estimates suggest up to 60% of Indigenous Australians in some communities carry the infection

How can you get infected?

The worm can be coughed up and then swallowed, which is how it ends up in the intestines. You can be infected with the worm by coming into contact with contaminated soil or faeces. First it enters your body through skin, normally the feet. From there it makes its way into the bloodstream and then the lungs. It is then coughed up and swallowed, which is how it ends up in the small intestine. It can live there for decades. Infection can be undetected for many years. Patients can show no symptoms or suffer vague ones like weight loss, indigestion, abdominal cramps, diarrhoea, coughing, wheezing or a rash like hives on the buttocks or waist. Diagnosis can be confirmed by detecting the worm in a stool sample or looking for antibodies in a blood sample. However, detection methods are not foolproof. Stool sample analysis can result in false negatives because the worms can move into the faeces at different times. If infection goes undiagnosed and your immune system

becomes compromised, or you are given steroids which suppress the immune response, the parasite can enter new phases of infection. These are hyperinfection or dissemination. Hyperinfection is when the worm reproduces rapidly. It’s often deadly. Dissemination is when the worms spread throughout the body. This is almost always fatal as the gut bacteria carried by the worm are moved into other organs, causing massive infection. How is it treated?

If diagnosed correctly, the infection can be treated by a drug called ivermectin, which is typically used against parasitic worms and other parasites including scabies. However, if one worm remains, it can reproduce (asexually), causing reinfection. Also, you do not develop immunity to the worm, so you can be immediately reinfected once the drug has left your system. The biggest issue with drug treatment is that we have already started to see ivermectin-

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resistant Strongyloides in sheep and horses. Another drug family, called benzimidazoles, is sometimes used against human Strongyloides, but we’ve also seen resistance to this in infected animals. Mass drug administration of ivermectin has been successful in significantly reducing the number of infected people in some communities in Australia. However, its roll-out has been patchy. Also reinfection can occur, suggesting the environmental part of the Strongyloides lifecycle plays an important role. Controlling the environment

Very little is known about how the worm survives outside a host and little has been done to control it in the environment. The worm can reproduce outside a host, but we don’t know how long it can survive in the environment, although it is thought to be quite a while. We must start targeting Strongyloides control in the environment and reduce our reliance on drugs. If human Strongyloides becomes resistant to ivermectin, the consequences could be devastating. However, the biggest challenge in fighting this disease is that many people have not even heard of the Strongyloides worm. Printed with kind permission from The Conversation. (theconversation.com)

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Much higher rates of illicit drug use among LGB population

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n Australian Institute of Health & Welfare (AIHW) report reveals higher rates of drug use, especially of ecstasy and methamphetamines, among people identifying as gay, lesbian or bisexual Homosexual and bisexual people were almost six times as likely as heterosexual people to use each of these drugs, and were also about 4 times as likely to use cocaine as heterosexual people, and 3 times more likely to use cannabis or misuse pharmaceutical drugs, the AIHW’s Matthew James said. Overall, about 1 in 20 Australians reported misusing pharmaceuticals, with 75% of recent painkiller users reporting misusing an ‘over the counter’ codeine product in the past 12 months. The AIHW will be publishing comprehensive data on pharmaceutical misuse later in 2017. The report National Drug Strat-

egy Household Survey: detailed findings 2016, also reveals that mental illnesses are becoming more common among methamphetamine and ecstasy users. It shows that among people who had recently (in the last 12 months) used an illicit drug, about 27% had been diagnosed or treated for a mental illness— an increase from 21% in 2013. Rates of mental illness were particularly high—and saw the most significant increases—for meth/ amphetamine and ecstasy users. Mr James said the report also shows that more Australians are in favour of the use of cannabis

in clinical trials to treat medical conditions. ‘Eighty-seven per cent now support its use, up from 75% in 2013. We also found that 85% of people now support legislative changes to permit its use for medical purposes in general, up from 69% in 2013,’ he said. The report also contains data for each state and territory in Australia, and shows differences in drug use between the jurisdictions. For example, recent use of meth/amphetamine was highest in Western Australia, but the use of cocaine was highest in New South Wales.

briefs

How olive oil is an anti-diabetic While the health benefits of olives and olive oil have long been recognised, little was known about specific compounds and interaction in the fruit. A US research team has discovered that the olive-derived compound oleuropein helps the body secrete more insulin, a central signalling molecule in the body that controls metabolism. The same compound also detoxifies another signalling molecule called amylin that overproduces and forms harmful aggregates in type 2 diabetes. In these two ways, oleuropein helps prevent the onset of disease. The findings were published in the journal Biochemistry.

Reporting on the 14th Annual Psychology Honours Research Conference By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

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his time of year sees the School host its various conferences, the Nell Riordan lecture, the Higher Degree by Research Symposium and the Psychology Honours students’conference. All of which are open to the public. The Honours Conference is now in its 14th year and provides the Psychology students from within the School of Health and Human Sciences an opportunity to present their research work to an audience. Prizes are afforded for the best presentations and the work is graded academically. After this students may progress into doctoral study or clinical psy-

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chology training; or other post graduate study or employment in a variety of local and other settings. The work presented covers a range of topics pertinent to contemporary needs and understanding. It demonstrates how the supervised student explores theoretical concepts, evaluates their significance and translates them into pragmatic knowing. Identifying new themes or theories often emerges from this work or at least new understanding or insights are gained! This year exploration of selfdetermination theory, psychological essentialism, cognitive processing, role adaptation theory and performance perception theory were some of the theoretical constructs under investigation as various

contemporary matters, facing our society, were considered. These matters ranged from anxiety and mindfulness, exertion and exercise, social understanding, memory failure, charitable behaviour, coping and endurance, overconfidence and performance, barriers to self-belief, resilience and experience as well as exercise

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motivations and deception and telling lies. As you can see, the students and their respective supervisors cover a range of cognitive and physical, as well as social and cultural aspects in the course of their studies. This research conference has become a major event in the School’s academic calendar and it is good to share the two-day event with the students, their families, colleagues from the School and the wider University and Coffs community. Planning for the 2018 Conference is already underway and students will be once again be presenting their work, often initiated by our community partners such as CHESS and Sawtell Aged Care, to a partially different audience. Hopefully you will be among them.

healthspeak December 2017


Clinical psychologist Gary Grant set to retire By Janet Grist

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fter a stellar career spanning 48 years, Port Macquarie based clinical psychologist Gary Grant is retiring in midDecember. Born in Canada, Gary attained his psychology qualifications there, along with a Degree in Commerce. His immensely broad range of roles reflects his curiosity in pursuing new avenues of employment -he’s worked in every state in Australia. I’d wager Gary’s enthusiasm for something new and his ability to take on a challenge have shaped his career. Some of Gary’s roles include setting up a pilot scheme for child and adolescent health in the Gosford area; setting up a forensic psychology service in Western Australia; establishing a child protection service in Queensland; working on a lead contamination project at Port Pirie; teaching at the University of Queensland, 18 years with the Mid North Coast Local Health District and 20 years in private practice. And for the past 16 years Gary has worked as an authorised clinician with the Children’s Court Clinic. Looking back on his professional life, Gary said that earlier on in his career work activities seemed more exciting and innovative, with people trying to deliver unique services. He recalls his time setting up Child & Family Health Services on the Central Coast. “We had seven outstations and rather than requiring people to come to hospital, we went out to see them. This lasted for about 10 years and then the bureaucracy wound it back so everyone had to come to the hospital.” Gary also enjoyed working at the University of Queensland after completing his Masters of Clinical Psychology and a degree in Organisational Behaviour. He December 2017 healthspeak

Gary and his wife Linda on an overseas trip.

explained his motivation for this latter study focus. ” I felt that clinically the psychologist focus was just on the individual and minimised the fact that that person was part of a family and also the work environment - both of which could have been dysfunctional.” Gary said teaching university students was like ‘bring thrown in at the deep end for him’. “In the past I was a shy, retiring guy and I’d never envisaged I’d stand up in public which is what I do now…I loved the students, they are bright sparks who keep you on your toes.” The work that Gary does for the Children’s Court is something he thinks he’ll keep doing while ‘trying out retirement’. He very much enjoys working with young children. “Kids don’t come along and check out your shingle and your qualifications and say ‘Wow, you must be a legend’. They just take you at face value and if you’re genuine and sincere it seems to work really well. And the other thing I find about working with kids is that it’s really energising.” Other career highlights include working in Corrections and setting up an Occupational Psychology service for people struggling to retain work or locate a job. When Gary began a private practice on the Mid North Coast 20 years ago he not only enjoyed his many different clients, but

also working with local GPs. “I’ve found all the Port Macquarie/Hastings GPs really supportive, although I must put in a plug for Dr David Gregory. I haven’t ever had to advertise, it’s word of mouth around here and I think the community is really blessed to have such a competent committed general practice team.”

Gary also has a lot of time for the younger generation of GPs. “There’s not that arrogance and they are open and pretty down to earth and I’ve had a really great time working in the area, the local GPs are good value. The only thing I did struggle with is that it’s not been easy to have any continuity with a consultant psychiatrist. We’ve had fly in VMOs…I think in some ways our mental health service has not kept pace with some other areas in Australia.” With a wife who’s also worked in health care, three daughters and five grandkids, Gary is looking forward to spending more time with the family and doing more travel. Although speaking to him, it seems he’s seen more of the globe than most. Congratulations Gary on a life of service to others and best wishes from NCPHN in the years ahead!

Afternoon tea raises breast screening awareness

Ballina’s Grant Street Clinic pulled out all stops to make their breast cancer screening awareness afternoon tea a colourful affair.

One Northern Rivers’ general practice involved in NCPHN’s Women’s Cancer Screening Collaborative held a colourful afternoon tea in November to raise awareness around breast cancer. The event at Grant Street Clinic in Ballina attracted more than 30 women who dressed in many hues of pink in

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keeping with the theme. The Women’s Cancer Screening Collaborative works with 25 general practices and Aboriginal Medical Services to lift participation rates of breast and cervical cancer screening. At Grant Street, practice manager Lesley Macey said they’d seen improved screening rates because of their education efforts.

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The many rewards of rural placements I Feature The many rewards of rural placements

t’s always inspiring to meet someone with real passion for what they do and Frances Barraclough, an academic at the University Centre for Rural Health (UCRH), is a shining example. Frances has a diverse nursing background and a Master of Philosophy which examined the role of nurse practitioners in primary health care settings. At UCRH she coordinates community placements and multidisciplinary education for students from various disciplines and universities from across Australia. HealthSpeak went along to find out more about UCRH’s community placements program which aims to give visiting students from four universities a rich, quality rural placement. “We want to give the students an experience that will leave a legacy, an experience they will love so much that they change their whole mindset about working in rural areas,” Frances explained. Occupational Therapy (OT) and Speech Pathology students are given placements in 13 primary/and or pre-schools in Casino, Coraki, Woodburn and Kyogle. These towns have high service needs with relatively high levels of families experiencing poverty. The placements are continuous with pairs of third or final year students working 24

in the schools for 8 to 10 week blocks. OT, Speech Pathology and Physiotherapy students are also given placements in Residential Aged Care Facilities (RACFs). Preparation and Support

A great deal of preparation goes into ensuring the placements are a success - it’s a big ask for the students to leave home and parttime jobs in Sydney and come to a rural area. “We spend a lot of time preparing the students before they arrive and they get help with accommodation. We also organise social events so that they stay connected and we have magnificent supervisors who love working with the students.” The students are also given some reading ahead of the placement about the role of a Speech

Frances said the students working in RACFs are welcomed and valued by staff as they are able to really add to the quality of life of residents Pathologist or OT in schools, as most have no experience working with children. The students work in schools/ RACFs four days a week and on Wednesdays they come to UCRH in Lismore for an education day where they learn and inform each other.

OT students working with pupils at Kyogle Public School. Photo: Robin Osborne.

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“We have a clinical reasoning session in the morning, talk about challenges in their placements and share some of the projects they are doing. We also provide them with motivational interviewing and cognitive behavioural therapy techniques that they can use in their practice,” said Frances. On Wednesday afternoons, the students are given education sessions on various topics including multidisciplinary management of conditions such as stroke or COPD for example, and guest speakers come to talk about My Health Record or contemporary resources such as HealthPathways. The students are also required to do a formal presentation about the quality projects they have put in place in their sites. Working in RACFs

Frances said the students working in RACFs are welcomed and valued by staff as they are able to really add to the quality of life of residents. “We went through a big winter flu outbreak so the senior students stepped up and were giving residents a lot of chest physio, they were running education programs, conducting mobility assessments and providing one on one interventions. They also work in small groups to develop programs for demenhealthspeak December 2017


tia clients, help with hydrotherapy programs, falls audits and education about topics such as contracture prevention and how to manage this condition.” Frances finds it very rewarding to see how the students grow in confidence and develop a passion and understanding for how health care is provided in a rural setting, outside of the traditional acute hospital environment. “With senior students the supervision they get is not one on one, so they have to step up and operate like a new graduate. It changes their focus and they develop this amazing rapport with residents and hear their stories. They have to be self-

starters and plan their day and step up into new roles. These are skills they may not get on other placements.” Working in schools St Mary’s Primary School, Casino

In Casino, the OT students work two days at Jumbunna early intervention pre-school and at St Mary’s Primary School. Paula McIntyre is the Intervention and Wellbeing and Learning Support teacher at St Mary’s. She told HealthSpeak that from the outset she was impressed by how the placement program was run and what the students brought to the school

Teacher Paula McIntyre

community. “I’ve been teaching for 20 years, and if pupils in country communities don’t get early intervention it really impacts on their learning and it shouldn’t be that way, we should have

access to interventions for our younger children. At school age it’s harder to provide support for our children, and the work of the students is very much appreciated. I’ve seen lovely rapport building between them and some of our really quiet students,” said Paula. A lot of parents aren’t aware of what an OT can offer their children. To educate parents, the OT students speak at the annual parent expo and hold an information booth about what they were doing at the school. The students work with individual pupils, in small group weekly therapy sessions for Continued page 30

I’ve been asked if I’m Indigenous. I think my cultural background is helpful in building rapport with the kids

She’s a beautiful young woman from Mauritius and believes because the kids can’t pinpoint where she’s from that her appearance has been an advantage. “I’ve been asked if I’m Indigenous. I think my cultural background is helpful in building rapport with the kids.” Describing her placements as ‘eye opening’ because of behavioural issues displayed by severely disadvantaged children in the classroom, Coralie has learned a lot about sensory deprivation and its impact on kids. “Some children are so deprived of things that we take for granted like nurturing and care, and often that impacts on their ability to handle their emotions. Before the placement I didn’t know much about sensory needs, so I’ve been learning, along with the teachers, about this topic,” she said. Because of challenging behaviours Coralie said some children were often taken aside because they were being disruptive. She’s been pleased that her OT skills have been able to help. “The kids need help with self-regulation.

At first it’s difficult to connect with them, but once you’ve built that rapport and break that barrier, slowly it becomes easier. But you have to be really sensitive about their issues.” Coralie explained that the core of her work in schools had been to educate teachers and provide them with basic insights into sensory needs and strategies to optimise what’s happening in the classroom. “It’s the finest details we look at. For instance, poor behaviour can come down to sensory overload. If there’s a lot of visual stimuli the child can react to that. We help put in place strategies and techniques to improve concentration and behaviour.” Coralie has also appreciated the supervision component of her placements. “The opportunities that I’ve been given as well as the type of supervision have been very different to what I’d have back in Sydney. It is more indirect supervision here. We have to step up. It’s very challenging, especially if you have confidence

December 2017 healthspeak

The many rewards of rural placements

Coralie is a final year OT student from the University of Western Sydney. She completed two placements with UCRH, the first at Baptist Care RACF in Coraki and the second in Coraki’s primary schools. After her experiences here Coralie is open to the idea of returning to work in the Northern Rivers.

Feature

STUDENT CORALIE CANGY

issues. But being forced to initiate everything and do your own clinical reasoning and justification really helps you understand what you are capable of.” When asked why she chose to do two placements in the Northern Rivers, Coralie said because ultimately the time spent was rewarding. “The first round was very challenging but I slowly warmed up to it and it’s really easy to make a difference. It’s very rewarding, changes can easily be seen.” Coralie recently set up a Girls’ Group for years 4 to 6, children who were moving on into the next phase of life but lacked emotional resilience and social skills. “I finished the final session with them yesterday and a few kids came up and hugged me. They don’t usually show affection and that really topped things off for me on my last day.”

a publication of North Coast Primary Health Network

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Lismore physician wins Award for trauma app

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trauma app developed in NSW has won the Public Sector and Government Market Division at the Australian Information Industry Association National iAwards. Trauma is the most common cause of death in the first half of life. The app was developed by a highly-skilled team of staff and clinicians from NSW Health, led by the NSW Agency for Clinical Innovation Institute of Trauma and Injury Management (ITIM). The team included Lismorebased Emergency Physician, Dr Yashvi Wimalasena, who designed the Trauma App to provide trauma clinicians with real time clinical guidance and information including flight and drive times to NSW hospitals, hospital blood stores, and specialty capabilities of NSW health facilities.

Winning team members – from left, Institute of Trauma and Injury Management (ITIM) Manager, Christine Lassen; Lismore Base Hospital Emergency Physician, Yashvi Wimalasena and ITIM Project Manager, Ben Hall with their trophy.

The iAwards are the biggest innovation and technology awards in Australia, attracting hundreds of entries. The Trauma App contains specialised medical calculators, guidelines, and checklists from

NSW trauma hospitals and speciality services as well as prehospital and retrieval providers. The pre-hospital component of the app was the brainchild of Dr Wimalasena and two fellow Retrieval Specialists Dr Karel

Habig, and Dr Cliff Reid. “Winning this award was very exciting as it was the culmination of many years of hard graft,” Dr Wimalasena said. The NSW Trauma App is a breakthrough innovation to support clinicians in caring for their trauma patients and ensuring they are able to meet each patient’s specific needs. Through the app, clinicians can locate blood products to give transfusions to critically injured patients prior to their hospital admission. The app is now being used by NSW Health, NSW Ambulance, Queensland Health and the New Zealand Major Trauma National Clinical Network. Recent monitoring shows that in the past 18 months 9622 clinicians used the app for over 31,084 clinical sessions in caring for injured trauma patients.

Local researchers identify novel anti-inflammatory

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n Australian sea snail is proving to be a powerhouse of medicinal compounds, with its anti-inflammatory properties the latest to be discovered by researchers at Southern Cross University (SCU) and the University of Southern Queensland. Published in PLOS ONE, the study investigated the effects of the snail extract and a pure brominated compound produced by the snail in a mouse model for acute lung inflammation. It builds on in vitro work previously published in the journal Marine Drugs demonstrating that the snail extract and compounds can inhibit inflammatory responses in cultured human cell lines. The research was undertaken by PhD student Tarek Ahmad, supervised by Associate Professor Kirsten Benkendorff, both from SCU, and in association with Professor Michael Kotiw 26

PhD candidate student Tarek Ahmad shows Australian marine snail Dicathais orbita, with Assoc Prof Benkendorff, both from Southern Cross University, and Prof Michael Kotiw of the University of Southern Queensland. (Credit: USQ Photography)

of the University of Southern Queensland. Prof Benkendorff has been investigating the promising anti-cancer activity of extracts from the Australian marine snail Dicathais orbita over the past decade in collaboration with researchers at Flinders University. “Inflammation is closely linked to cancer with many

shared molecular pathways. Therefore many anti-cancer agents have the potential to be used to treat inflammation,” said Professor Benkendorff. “Consequently, we initiated this new collaboration with researchers at USQ to determine if the snail compounds were an effective treatment in a live animal model of acute inflam-

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mation. The results were better than we expected.” After demonstrating that the snail extracts and compounds were effective at inhibiting key inflammatory pathways in human cells, Tarek selected one active extract and the compound 6-Bromoisatin for testing in the mouse model of lung inflammation. “The treatments significantly reduced the major molecular markers of inflammation in lung fluids, reduced the infiltration of inflammatory white bloods cells and preserved the lung architecture compared to the placebo control,” Tarek said. “New non-steroidal drug leads for the treatment of inflammation are urgently needed. Marine molluscs are widely used as traditional medicines for the treatment of inflammation, but few scientific studies have been undertaken to test the efficacy of these natural medicines.” healthspeak December 2017


Changing the world one conversation at a time

Jeff Richardson is retiring at the end of the year from his position as Service Manager and counsellor at Aboriginal community organisation Rekindling The Spirit in Lismore. North Coast Primary Health Network wishes Jeff much happiness in his retirement.

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mentor to many, Jeff ’s career in health began about 20 years ago after his experience working for the PMG and as a Telstra manager. He spoke to HealthSpeak about how his various roles have allowed him to see the health care sector from many different angles. In Jeff ’s first health service role, he made history, becoming a western Queensland Hospital’s first male Housekeeper. In charge of the laundry, the kitchen, the cleaning staff and wardsmen, it was Jeff ’s interest in systems and efficiencies that saw him make a major change in how the kitchen operated. “It was in this position that I developed a real interest in primary health care. Money was December 2017 healthspeak

tight in those days so we were really pushed to reduce costs. “It struck me as strange that in our kitchens separate meals were prepared for diabetics and those with low renal function. I came up with the idea, and talked it through with the nursing and kitchen staff, that surely a diabetic meal was suitable for any patient.” Jeff ’s suggestion led to discussions about new recipes and the creation of a suitable menu that met the needs of patients, including patients on special diets. “So with the exclusion of vitamised diets we were able to operate with just one hospital menu. That saved a bunch of money and also improved the quality of the food.” Having what he calls a systematic approach to life saw Jeff make a series of efficiency changes to the hospital’s systems. These included bringing in additional linen skips and separating the laundry items to follow infection control guidelines before they arrived at the

laundry. This saved money and staff time. “The real clanger was having three cleaning staff shifts a day starting from 6am. I asked the clinical staff whether or not we needed cleaning staff to start so early in the morning. No-one had an answer, it just didn’t make sense. “At that time the cleaners were doing their rounds and the breakfast trolleys were being cleaned up. It turns out that this practice went right back to the time when the doctor and matron used to come in and do the rounds of the hospital.

Everything had to be sparkling clean for when the doctor did his round,” said Jeff with a laugh. Jeff ’s questioning of old work practices meant that low traffic times were found to clean. But then Jeff was faced with the dilemma of potential pay cuts. “While this change was easy on paper, these people, many of whom were single mums and people with mortgages or loans, really depended on their penalty rates. And so often in hospitals, it’s the cleaners and operations staff who are cut, rather than clinical staff. So I had to strike a balance.” Now vigilant about possible efficiencies, the coke machine and chocolate dispensing machine in the hospital’s foyer grabbed Jeff ’s attention. “I thought, I’ve just put in place a healthy meals menu, I’m running around with the Australian Guide to Healthy Eating and pushing that, and the first thing you see in the hospital are these machines.” It turned out the people most resistant to removing the

a publication of North Coast Primary Health Network

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Having what he calls a 'systematic approach to life' saw Jeff make a series of efficiency changes to the hospital’s systems


machines were not community members but staff. “Like everything at the hospital, when I dug deeper it’s like what we believe here at Rekindling The Spirit - there’s always an underlying cause. Half the profits from the coke machine were used to buy “refreshments” for the Christmas Party! Not surprisingly Jeff became known as the ‘fun killer’. But as he climbed the ladder onto the Executive of the hospital, and later as Director of Corporate Services for the Local Health District, Jeff came up with a very important health message. “On Friday afternoons, when it had been a really rough day, I’d hear a staff member say ‘It will be a red wine night tonight’. And someone else would say ‘Yea, I think it will be a two bottle night’. At the time everyone laughed. “But I got to thinking about it, and at a team meeting one day I said ‘The day that you feel you need a drink is the absolute day you should never have that drink. Because from that time forward you are reliant on a mind altering substance to get you through.” Jeff felt strongly that if staff were relying on wine to wind down after work and Executives heard their comments about needing a red wine night, then there was something wrong with the business system. But he wondered if sharing his point of view had made an impact. “Some 10 years later I got a phone call from one of those Executives who said to me ‘I really want to thank you for that comment you made that time’. It turned out he’d been developing a real dependence on several bottles of wine to finish off work at home. It turns out it’s often the simple things we say and do that make a difference,” he said. When Jeff was working in the hospital before obtaining senior positions, he began providing staff with cultural awareness training which led him into training as an Aboriginal Health Worker. But he realised such a 28

While the effect that you are going to have at the bottom rung is wonderful, the higher you climb the more impact you are going to have position had limitations. “I found as an Aboriginal Health Worker I could only have a small amount of influence on the people I was working with. From there I ended up being Director of the Primary Health Care Unit for eight hospitals and a couple of nursing homes. “It was at that level that I started to influence policy and that’s when we were able to move out the chocolate dispensing machines or at least make them half fruit and half confectionery. “It’s been a really rich reward for me to see nearly 20 years later that such changes happen if you wait long enough. But I’ve always pushed these things and I wonder if these things would eventually happen or not if nobody pushed?” Jeff believes the way to

improve people’s diets is to stop talking about the foods they can’t eat and talk about the foods they can eat. And he’s realised that health messages spread to a few people can go on to have a ripple effect. “At one stage we were running a group for Aboriginal women wanting to lose weight in a small western town. We attracted about 15 people and were a bit disappointed with this number. We did an exit survey and talked to these women about the group. It turned out that they’d spread what they’d learnt to their sisters, husbands and mothers-in-laws etc…In reality there were around 200 people whose lives had been changed.” Jeff believes that it’s necessary to look for reasons that will help people to do things, such as encouraging overweight people to park a block away from the grocery store to gain incidental exercise. “It’s a method I like to give all Aboriginal people who work in health. While the effect that you are going to have at the bottom rung is wonderful, the higher you climb the more impact you are going to have. And when you start to impact on policy that’s when you really spread the influence.” Jeff said that when he worked in hospitals his aim was to

a publication of North Coast Primary Health Network

change staff attitudes around their eating, and encourage them to lead healthier lives. Then they could start spreading the word. Continuing along this theme, with the encouragement of a couple of talented nutritionists that Jeff worked with, he began to go into schools and talk about bush tucker and bush medicine. “Not separating the Aboriginal kids out, but talking to the whole school during NAIDOC Week. Sharing the bush knowledge I’d gained from my father and family.” When Jeff transitioned into managing Aboriginal Medical Services he continued to hold preventative health measures at the top of his mind. “I take quite a lot of exception to the notion that we need more and more hospitals. Everyone says we need more nurses and police. But if we reduced crime a bit we wouldn’t need more police. If we reduced disease we wouldn’t need more hospitals.” Jeff also believes that if affordable, quality housing was built the rate of hospitalisations could be reduced. At 65 Jeff thinks he should have retired 10 years earlier, not only to do some pottering and spend time with his ‘very beautiful wife and family’, but to make way for younger Aboriginal people. He does, however, still intend to make a contribution to health. “I’d be very interested in being on the board of Rekindling The Spirit, but I’d also be interested in providing some mentoring or training to managers. It’s important to develop good relationships in the workplace and with other organisations and then the work can flow. But those relationships have to come first.” He also believes that you can change the world one conversation at a time. “You can’t really afford to waste conversations, because your words mean something to someone and if they don’t then you should stop saying them.”

healthspeak December 2017


The NDIS, Mental Health & the Role of a GP mental illness will have psychosocial disability, those that do are considered to have a permanent and significant disability.

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ervices operating in the mental health sector have progressed the language around mental illness to promote recovery and wellness. With this culture of language in mind, the word 'disability' has not been used often within recovery focused organisations, such as CHESS Employment. So where does mental health fit within the NDIS, a scheme which demands 'permanent and significant disability'? Psychosocial Disability The scheme uses the term ‘Psychosocial Disability’. It is a term which describes the functional impact of severe mental illness and the detrimental effect it has on a person’s social, economical, physical and psychological wellbeing. While not everyone living with

The Role of the GP

GPs and other health professionals may be asked to provide evidence to support a patient’s request to access the NDIS. This could include: • Filling in an NDIS Supporting Evidence or Access Request Form • Evidence your patient’s disability is or is likely to be permanent • Providing evidence of diagnosis Access Request Forms (ARF)

Key points for GPs to consider when filling in this form are: • The request to fill out an ARF is the beginning of the application process for the NDIS to the NDIA • Be as thorough as possible. Not providing enough infor-

mation is the main reason the NDIA rejects requests to access the Scheme. • The form needs to identify a diagnosis for a disability that is permanent or likely to be permanent • How the diagnosis impairs ability is what the NDIA are looking for. How does the Impairment affect the person’s life? Detail the functional impacts and what supports will assist in allowing the individual to live an ordinary life of inclusion, social and economically. • Areas reviewed in the form are communication, mobility, social interaction, learning, self-care and selfmanagement • Detail the type of supports needed and the frequency that the supports need to be provided (this can be brief). A letter from a community worker would be helpful. If your patient is accessing community programs

they are likely to have a key worker that can provide information to support their request to access the NDIS. • If you have any reports completed by a specialist, providing them to your patient will support the information in the ARF. The NDIA needs as much information as possible to make a decision around supports that are reasonable and necessary. CHESS has already begun guiding clients through the NDIS process. We are experts in mental health and we are an NDIS register provider with a suite of services that support the scheme’s key outcomes of greater social inclusion and participation. We are happy to field any questions regarding the NDIS and any of our support services. Find out more by calling us or visiting our site. Phone 1800 899 017. Website: http://chessemployment. com.au/our-ndis-services/

Inaugural dementia conference inspires change and revolution

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f success and change is measured by the number of people willing to start a change revolution, than Omnicare Alliance’s inaugural regional dementia conference, The RED Conference – A Regional Experience in Practical Dementia Care was an enormous success. The conference was held at Port Macquarie in October. The change revolution theme was inspired by keynote speaker Dr Cameron Camp, an American Montessori dementia expert, who said the Montessori approach to dementia care and how the community embraced this approach would lead to a change revolution in dementia care. “I don’t think there was one person in attendance who didn’t leave the conference December 2017 healthspeak

Participants in the Intergenerational Program Art & Expressive Therapies Workshop at the RED Conference.

with a new sense of purpose and drive,” he said. Dr Camp and other speakers and workshop presenters provided delegates with a new way of approaching living well with dementia. They talked about how to effectively support someone living with dementia – either at home or at work. “The Montessori approach to dementia care focuses on de-

veloping meaningful and purposeful roles and activities for people living with dementia. It’s about enabling and encouraging independence, but more importantly meeting the needs of the individual person,” said Omnicare Alliance Joint CEO, Raymond Gouck. More than 200 people from across the North Coast, New England, Sydney and the

a publication of North Coast Primary Health Network

Northern Territory attended the conference. Speakers included Dr Camp, Julie Dunn, Dr Jim Donnelly, Andrew Hanna, Dr Matthew Kinchington and Suzanne Towsey. Workshops presenters were presented by Dr Cameron Camp, Dr Jim Donnelly, Lisa Hort, Yvonne Kiely, Jade Sinclair, Cath Manuel, Greta Warner, Lynette Murphy, Mitchell Nicholson, Alison Sherratt, Margaret Allen and carers and people living with dementia. Omnicare Alliance is one of the largest community aged and disability care support providers on the Mid North Coast. It provides services to the communities in Port Macquarie, Sawtell, Kempsey, Wauchope, Camden Haven, Taree and the Greater Lakes. 29


MNC Aboriginal woman shares her breast cancer experience on video To support Aboriginal women in their cancer journeys, Aunty Helen Archibald-Simmons has generously shared her story on video about how she dealt with a diagnosis of breast cancer. Aunty Helen worked with Ro-Anne Stirling-Kelly, Consumer Engagement Aboriginal Identification Officer at the Mid North Coast LHD Hastings Macleay Clinical Network, to produce the seven-minute video. The production not only tells Helen’s story but also provides some tips on support and getting through the treatment period. The video begins with Helen talking about how through a BreastScreen procedure a tiny lump was found in her breast. Helen candidly describes how she cried during a core biopsy and she also talks about when she saw her doctor and was told for certain that she had

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those in need. They also screen older pupils not previously assessed to see how they could be helped with issues such as handwriting, motor skills and concentration. In addition they put together visual perception resources for teachers which can be a big factor in reading development, and explain to teachers in detail what recommendations would fit into the daily routine of each child and the teacher. The students are also available to offer advice on purchasing resources and equipment. “They’ll bring a device over from UCRH such as a vibrating cushion or weighted blankets to improve concentration and settle children and we can try before we buy which is really useful.” Paula said everyone gets a great deal out of the placements. “I find the students start quite nervous as they’ve not had a lot of paediatric experience but midway through the term I enjoy seeing them blossom in their confidence, in their management of little

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Aunty Helen as she appears in the video.

breast cancer. In fact she was told she had an invasive cancer. Helen was given an information kit to take away to read and digest but she found it hard to take in all the information. She found a visit from the Port Macquarie Base Hospital

Aboriginal Liaison Officer really helpful for her to fully understand what the recommended treatment was and how it could affect her. We are taken on Helen’s journey through surgery and radiotherapy and she emphasises the importance of having someone beside you to support you when you visit the doctors and specialists and when you are undergoing treatment. She also talks about her coping mechanism during her treatment period which was to bake sugarless muffins for friends and family. Congratulations to the MNCLHD Integrated Multi Media Team for filming, editing and producing this valuable health resource. Helen’s story can be viewed at: https://www. youtube.com/watch?v=Dpl1R8DXCAw&t=84s

groups and their goals for the children.” Kyogle Public School

Leanne McLaughlin, Assistant Principal and Learning Support Teacher at Kyogle Public School told HealthSpeak that the student placements gave fantastic benefits to the school community. She pointed out that Kyogle children don’t have access to occupational therapy and only limited access to speech pathology through community health. “So the placement program is a win-win. The students get feedback from us about working with the children and with so many socio-economically disadvantaged kids they get to witness and work with some severe behavioural issues. We work as part of a team – they provide advice about OT and speech pathology and we provide back up to help them work successfully with difficult children.” Leanne said the students work with kids who are more seriously disadvantaged one on one, in small groups to deal with particular issues or in a

Leanne McLaughlin

whole of classroom setting. “Pupils at Kyogle Public School don’t have access to speech pathology so the student placements here are crucial in ensuring pupils get formally assessed and provided with individual advice and follow up.” Teachers meet with the students every Tuesday afternoon for some upskilling in a particular OT or speech pathology area. “We pick a focus that we’re seeing across a number of children, talk about that condition, the reasons for it, how to identify it and support strategies we can use in the classroom to address those problems,” Leanne explained. There have been definite

a publication of North Coast Primary Health Network

improvements seen since the placements began. “We had one child diagnosed through the OTs with something that was pretty rare. When we finally got an expert to see this child and confirmed the condition it explained so much about what was going on with that pupil.” The children also enjoy meeting the diverse range of students who come into their classrooms. “They don’t realise this support is improving them in lots of ways. They’re having fun, they see it as the people we play games with. One little boy could not go into the playground with other kids without monitoring. He’s been working through a special skills program and now he’s out playing with other kids, following the rules, making up rules and coping with all that’s happening, which is fantastic.” Leanne said the entire school community really valued the students’ support. “We are very thankful that we are part of the UCRH program.”

healthspeak December 2017


GFC 10 Years on

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t hardly seems possible, but 10 years ago the world economy was about to implode. It seems a long time ago but its legacy lingers on. The rumblings that something was terribly wrong began in June 2007 as big problems emerged in the US sub-prime mortgage market. Investment bank Bear Stearns was forced into a multibillion dollar bail-out for one of its mortgage investment funds. It caused some jitters, but worse was ahead. As the sub-prime worsened, in March 2009 Bear Sterns was sold to rival J P Morgan for a tiny fraction of the value it boasted only a few months earlier. The contagion spread and in September 2008 Lehman Brothers collapsed sending stock markets into free-fall. The collapse heralded the official start of the Global Financial Crisis (GFC) – the worst downturn since the Great Depression. At the time economists suggested that it would be 10 years before the world economy could recover. Financial crises tend to last much longer than a

December 2017 healthspeak

Markets seem unconcerned about the threat of nuclear war, peculiar things going on in the US and discontent from growing income inequality downturn in the normal business cycle. Trust disappears, the payment system freezes and international trade and economic transactions slow down and in some cases stop altogether. The causes of the GFC are many but they boil down to greed, excessive risk taking, complacency, poor regulation and most importantly, grossly inflated levels of debt. The cost to the world economy runs into many trillions of dollars. So here we are 10 years later. How are we going? Have we learned anything? If you believe government economic forecasts, things are on the up. China, Europe and Japan are all outperforming expectations. Trade is rising, economic activity is looking the strongest it has for years and financial and housing markets are booming. Inflation

seems to have been conquered – at least for now. The banks are being re-regulated and their capital positions are now stronger than ever. Company profits are up, productivity has been rising and wage growth is subdued. The VIX index - an indicator that measures stock market volatility and investor confidence - is the lowest it has been since 1990. Low is good. Markets seem unconcerned about the threat of nuclear war, peculiar things going on in the US and discontent from growing income inequality. The circulars from brokers, economists and others that regularly lob onto my desk are saying very loudly: this is as good as it gets. Boom times ahead. Sounds great? Yes, but there are risks. Some we know about. Others come in the form of those pesky black swans – disruptive events which we don’t see coming. The biggest problem we know about remains debt. Unfortunately most of this new-found stability and growth has been debt financed - rather than coming via economic reform, new investment or government infrastructure spending. Debt around the world has been rising rapidly since the GFC and is now way above the peaks reached before the crisis. Greed is back and so is complacency. During the GFC governments borrowed heavily to help banks and economies stabilise. Consumer borrowing is still rising much faster than incomes. Asset prices are soaring - much of it financed by debt. In Australia household debt is running at 189 per cent of in-

a publication of North Coast Primary Health Network

finance David Tomlinson comes and 123 per cent of GDP – record levels. The effects will linger for years. Debt is borrowing from the future and has to be repaid. Debt problems can be difficult to solve. High economic growth can help but when debt levels are high, consumer spending tends to be cut back along with growth. High inflation can help by eroding the real level of debt, but high inflation and high interest rates tend to go hand in hand. Debt default is another possibility but this tends to erode the confidence of lenders big time. Debt makes borrowers, including banks, vulnerable to shocks. The Reserve Bank and APRA have been trying to slow down lending and to regulate high risk products such as interest only loans. But if prices start to fall, investors are likely to flee. It doesn’t pay to be the last one out the door. It doesn’t look like there will be a jump in interest rates soon but we remain vulnerable to any external shock that could push up unemployment, most likely from offshore. China has huge debt levels after years of borrowing to keep its economy moving. We also have an unknown quantity in the form of linkages into the world economy. In its latest review of the financial system, the Reserve Bank says that moderate falls in asset prices or upticks in volatility are unlikely to threaten the system. But it says, a lack of transparency, leverage and interconnection across the financial system means that large losses in one area could affect other financial institutions. That is, contagion - the same weakness that caused the GFC. 31


No need to hit the gym to reduce risk of early death By Associate Professor Emmanuel Stamatakis Lifestyle & health Behaviours University of Sydney

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ost of us probably know exercising is associated with a smaller risk of premature death, but a new study has found that doesn’t have to happen in a CrossFit box, a ninja warrior studio or even a gym. Body weightbearing exercises such as sit-ups and push-ups staved off death just as much as other forms of weight-bearing exercise. Our study recruited just over 80,000 adults over 30 years living in England and Scotland between 1994 and 2008, who were followed up for an average of nine years. At the end of the follow up period, we calculated their risk of death according to their strength-promoting exercise and how much they did. What we found

Those who reported participation in any strength-promoting exercise (including gym workouts) averaged about 60 minutes a week and those who reported any own body weight exercises averaged 50 minutes a week. Participation in either gym workouts or own body weight exercises reduced the risk of early death by about 20%. Cancer-related deaths also decreased by 24-27%, but there was little evidence more was better. We also compared the risk of those who met the recommendation of two sessions of strength-promoting exercise per week, with those who met the recommendation of 150 minutes of aerobic physical activity such as walking (or 75 minutes more intense, such as running) per week. Compared to being inactive, meeting either guideline was associated with a 16-18% reduction in risk of early death. But the results on cancer death risk told us a very different story. Those who met 32

An American study found lifting weights or doing callisthenics was associated with a 31% decrease in risk of death from any cause

only the strength-promoting guideline by doing body weight exercises had a 31% lower risk of death from cancer. Those who met only the aerobic exercise guideline had no reduction in risk of cancer death. On the other hand, reducing the risk of death from heart disease was only associated with aerobic physical activity (21% reduction). Interpreting the results

Given this research is observational, there’s always a chance the relationship between exercise and early death could be due to other causes. Perhaps the people who exercised more were also just generally healthier in other ways. To reduce the possibility of alternative explanations, we adjusted our results for age,

sex, health status, obesity, other lifestyle behaviours (smoking, alcohol, diet), education level, mental health, and participation in other physical activity such as domestic activities, walking and aerobic exercise. People with chronic diseases are less likely to exercise, and more likely to die early. Therefore we excluded from the results all participants who had heart disease or cancer, as well as those who died in the first two years of the follow up (because their death was most likely caused by something they had prior to the study commencing). Other studies have examined the relationship between strength promoting exercise and early death. An American study found lifting weights or doing callisthenics was associated with a 31% decrease in risk of death from any cause, which is consistent with our results. But contrary to our results, the same study found no association with cancer death risk. Another study among cancer survivors showed lifting weights, but not aerobic activities, was associated with a 33% lower risk of death from any cause. What it all means

Our study suggests exercise that promotes muscular strength has unique health benefits and is

a publication of North Coast Primary Health Network

at least as important for health as walking, cycling, and other aerobic activities. We shouldn’t forget the most important principle for choosing an activity is being able to incorporate it into your routine and stick to it long term. The simplicity of body weight exercises makes them a very attractive option: they are inexpensive and require little skill and no equipment. Plus we now know they yield comparable benefits to similar gym-based activities. This is important given gyms can be daunting or unaffordable for many people. So in addition to doing enough moderate to vigorous intensity aerobic activity, good old fashioned push-ups or chinups at home, in the park, in the yard, or even in the office could be an excellent option. For most people two to three sessions a week would be sufficient for general health. The American College of Sports Medicine recommends 2-4 sets of 8-15 repetitions of each strength promoting exercise with 2-3 minutes rest between sets. As with any physical activity, the most important principle here is a little is better than nothing, and gradually build up from little to enough. First published in The Conversation

healthspeak December 2017


Cannabis - Friend or Fiend? T

he town of Casino is in for a whole other look. A Canadian company, PUF Ventures, has just been granted permission to grow greenhouse medicinal cannabis. Is it now the beef and reefer capital? It’s hard to imagine everyone over there being happy about that development and nearby Nimbin must be green with envy. ‘We have fifty years’ experience,’ commented a Nimbin Elder. HEMP embassy’s Michael Balderstone said, ‘The hippies are shell-shocked by this news. This is not what we meant by re-legalisation. We reckon there are 20 thousand jobs waiting to happen if they’d allow it to be a cottage industry’. Nimbinites deserve some sympathy, in that they will not be unpoliced to do what they know best. It’s only in recent times that medicinal cannabis is finding its way to respectability after many decades in that political peasoup fog - ‘the war on drugs’. The thing is, a lot of normal people are asking about it as a valid treatment for a raft of conditions - epilepsy, cancers, and extrapyramidal conditions, such as Parkinson’s, anxiety, insomnia and even restless legs. Some doctors are said to be giving tacit approval to patients to give it a try, but getting a prescription filled is an elusive task. The NSW government has approved trials, strictly controlled through clinical research centres, but until publication of any results there is only waiting space on the pharmacists’ shelves. To find out more, I interviewed Associate Professor Peter Grimson, an oncologist in charge of a scientific trial of medical cannabis at the Chris O’Brien Lifehouse cancer hospital, across the road from RPA Hospital in Sydney., He said that there are 10 centres involved in the trial, including Port Macquarie, Coffs Harbour and Orange, all run by December 2017 healthspeak

Some doctors are said to be giving tacit approval to patients to give it a try, but getting a prescription filled is an elusive task

medical oncologists. The side effects of chemotherapy is a chosen condition for research, specifically on patients with chemotherapy associated nausea and vomiting, for comfort and to boost appetite in this group. I was surprised that the medication in the double blind placebo controlled trial is THC: CBD in equal proportions, 5 mg total in each capsule. (THC is the psychotropic component of cannabis.) Medical grade cannabis is currently imported from the Tilray Company in Canada and prescribed by medical oncologists involved in the trial, 1 to 4 caps 3 times a day for 6 days per chemotherapy cycle. The dosage titration varies with dizziness and disorientation. It is dispensed through the hospital pharmacies. The trial is available to patients in whom conventional treatment has failed. It also aims to relieve related anxiety in the symptom complex. Overdosage causes psychotropic effects, described as ‘unpleasant’. No patient on the trial is allowed to drive. Peter said that the model of legalisation in California does not provide any medical oversight. ‘A letter from a GP opens the door to mushrooms, cookies and oil.’ In Australia prescribing is restricted to a limited number of specialists. He said that many in the medical community are sceptical about its benefits for medical conditions. Another

problem is that the police have increased difficulties controlling recreational cannabis. Lifehouse is responding by assessing benefits and side effects and the professor suggested that some results may be available in a couple of years. In the meantime, demand for cannabis as a medicine continues. Many people who have heard of the reported benefits want it for self or a loved one to relieve suffering without the mental derangement associated with narcotics. It is being supplied through websites and markets. Many of these suppliers are principled and have belief in the treatment, but some rascals are taking advantage of those in need, selling unregulated and even toxic products. As for consistency of dosage in unregulated products, who would know?

a publication of North Coast Primary Health Network

light airs David Miller For now, prospective consumers need to proceed with caution. Caveat Emptor. For future prescribers it’s also tricky. One doctor said he couldn’t ‘get his head around prescribing marijuana’, an understandable position after decades of political vilification. The term ‘marijuana’ does not add positively to the debate either. It’s Mexican slang, a pejorative term, as opposed to the proper botanical name, Cannabis Sativa. It’s also associated with smoking, hardly what the doctor ordered.

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Becoming Myself – a psychiatrists’ memoir Irvin D. Yalom (Scribe 343pp)

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t seems appropriate that what is likely to be Stanford Emeritus Professor Yalom’s last book is the story of his own life, and perhaps not a moment too soon, given he is in his mid-80s. Another fair bet is that sales may not rival those of a predecessor work (one of 17 others) The Theory and Practice of Group Psychotherapy, penned in the 1970s, which became a standard text for the training of group therapists. “The textbook has gone through five revised editions and sold over 1 million copies,” Yalom informs us, adding that

briefs

Speed networking works Over 40 health professionals came along to NCPHN's Speed Networking event held at Casino during September. These evenings are held to enable a range of local health professionals to meet and get to know each other. Physiotherapists, podiatrists, surgeons, pathologists, pharmacists, GPs and nurses embraced the opportunity to swap contact details, describe

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over time this gave him and his wife Marilyn “a new degree of financial security.” Better known to general readers was their co-written article on the psyche of Ernest Hemingway, based on a trove of unpublished letters, which was picked up around the world: “Nothing that either of us has written, before or since, has ever attracted such attention.” This extraordinarily interesting and literate man, the son of Jewish immigrants, has produced an array of both clinical and fictional works, the latter including When Nietzche Wept and The Schopenhauer Cure, lived in a wide range of countries, West and East, and befriended some of the leading thinkers of the past half-century. He tells many amusing stories, often against himself – how one of his first patients revealed being lesbian, something of which he was unaware; how as an intern at Mt Sinai Hospital he discovered that a page for “Dr Blackwood” was code for house doctors needing another player in a poker game; how he tried LSD and “spent an hour watching my wallpaper change colors and heard music in an entirely new way.” One of his most enjoyable

their services to each other and finally put a face to that name. New workshops and further opportunities for strengthening networks have already arisen. The Casino Kyogle Clinical Society (CKCS) was also launched at this event and places on the steering committee have quickly filled. NCPHN is planning further Speed Networking events across our footprint. If you don’t want to miss these opportunities, sign up for the NCPHN Practitioner Newsletter to stay in the loop. To subscribe, visit http:// bit.ly/2kXlA6H

book review Robin Osborne He tried LSD and spent an hour watching wallpaper change colours and heard music in an entirely new way stories involves a trip to Crete with his beloved Marilyn where they bought old coins from a shop named Sfica’s, near the National Museum. The owner assured them the purchase could be returned at any time if they were dissatisfied. Next day, after being told by a “wizened Jewish antique dealer” that the coins were fakes, they went back to Sficas. The owner returned the money, telling them they were no longer welcome in his shop. Later, people said, “You insulted Sfica? Sfica, the official appraiser for the National Museum?” They put their hands to their temples and rocked sideto-side saying, “You owe him an apology.” Feeling guilty, they defied Sfica’s ban and returned to his shop, stammering apologies. He cut them short, and without a word retrieved the coins, asking the same price as before. Back in Oxford, Yalom said, “If he and all the dealers on Crete are in cahoots, and if he had the balls to sell me the same phony coins twice, then I say “Hats off to you, Mr Sfica.” An expert on antiquities delivered them the verdict: “All the coins were fake except for the small Roman coins we had bought from the old Jewish

a publication of North Coast Primary Health Network

dealer in the small basement shop! Thus began a lifetime of adventures in Greece.” These ‘adventures’ would include achieving celebrity status for his writings. The pilot on their incoming plane had read When Nietsche Wept, the cab driver spoke of favourite parts of Lying on the Couch, and at a book signing in Athens the queue extended out of the store for eight blocks, causing traffic confusion. “I had the singular experience of having at least fifty lovely Greek women whisper in my ear, “I love you”. Nowadays, as he notes, “All the current developments - the new psychopharmacology for schizophrenia and bipolar disorders and depression, the new generation of drug trials in progress, high-tech treatments for sleep disorders, eating disorders and attention deficit disorder - much of this has passed me by.” At a conference he felt lost in many of the presentations, “None more so that when listening to a lecture on transcranial magnetic stimulation of the brain, which described methods of stimulating and inhibiting critical centers in the brain far more efficiently and precisely than can be done with medication, and without side effects.” (This is the subject of another book recently published by Scribe, Niels Birbaumer’s Your Brain Knows More Than You Think - the new frontiers of neuroplasticity). Yet in quasi retirement Prof Yalom writes for four hours each morning and sees patients daily, feeling that his ageing “makes me more able to understand and comfort people my age… so why give up?” The only comparable memoir is On the Move by the late Oliver Sacks – with whom Yalom coincidentally shared a passion for motorcycling. Like that pursuit, this book is an exhilarating experience. healthspeak December 2017


The relevance of sarcopenia in an ageing society

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n the rapidly growing obesity when ‘marbling’ or fat infiltration epidemic it is not surprising into muscle alongside a decrease that we focus a lot on fat that in type 2 muscle fibres lowers can so easily end up around our muscle quality work perforwaistline as metabolically danger- mance. ous visceral fat. But should we So as we age there is a decrease also focus more on the impliin strength and power, fast strong cations of lean muscle mass movements, fine dexterity, decline which we know endurance of sustained begins after the age of 50? power, acceleration/decelBy Andrew The term sarcopenia eration of movements and Binns entered our medical coordination. vocabulary in 1989 when Muscle mass and type 2 Irwin Rosenberg (1) stated that muscle fibres diminish, central ‘there is probably no decline in and visceral fat increases, and structure and function more bone becomes demineralised dramatic than the decline of lean leading to osteopenia and body mass or muscle mass over osteoporosis. Chronic disease the decades of life.’ He coined the and falls risk increase. There is an Greek term ‘sarcopenia’ (derived associated decrease in motor and from ‘sarx’ for flesh and ‘penia’ sensory neurons and reduced for loss) to describe the loss functional capacity and V02 max. of muscle mass amongst older Sarcopenia can be measured in people. different ways. Muscle mass can In 2010 the European Working be measured with CT, MRI, DXA Group on Sarcopenia in Older or more practically in a GP surPeople developed a clinical defigery with inexpensive BIA scales nition and consensus diagnostic (not highly accurate but good criteria for age related sarcopenia. for comparison after an intervenIt was based on 3 criteria. 1) tion). Strength can be measured low muscle mass, 2) low muscle easily with a grip strength strength 3) low physical perfordynamometer and physical permance. The diagnosis requires formance by gait speed or the so the documentation of criterion called ‘get up and go’ test. 1 plus documentation of either Progressive resistance training criterion 2 or 3. (2) is the best intervention to slow or Sarcopenia can be caused by reverse sarcopenia. Quality of life ageing alone or by sedentary and function (through strength, lifestyle, bed rest, and certain dis- endurance and balance traineases that involve organ failure, ing) maybe increased at any age inflammatory disease, maligso long as the exercise intensity, nancy or endocrine disease. Also duration and frequency are sufnutrition can have an impact with ficient to overload the system sarcopenia resulting from inadequate dietary intake of energy and/or protein as happens with malabsorption, gastrointestinal disorders or use of medications that cause anorexia. In other conditions such as malignancy, rheumatoid arthritis and ageing, lean body mass is lost whilst fat mass may be preserved or even increased. This is a state of sarcopenic obesity. Changes in Age 25 muscle composition is important December 2017 healthspeak

The benefits of progressive resistance training are: Increase in lean muscle mass and hypertrophy Fat replaced by lean mass Reduction in total and intra-abdominal fat Aerobic capacity and V02 max improvement (improved physical fitness) Improved joint mobility and flexibility for those with osteoarthritis Improved bone density Improved gait and gait speed Decrease in heart rate and diastolic blood pressure Improved insulin resistance Less risk of falls

without straining them. Changing the load may be necessary for progressive resistance training and working against a heavier load. All this surely adds up to more than poly pharmacy could possibly achieve and at much less cost for an individual and the health budget. A simple piece of equipment to recommend to a patient for resistance training is a simple and inexpensive body tube (rubber resistance tubing with handles).

Age 63

a publication of North Coast Primary Health Network

If walking or cycling look for hills rather than avoid them and gradually increase the volume of both resistance and aerobic exercise. Iphones and other electronic devices for fitness often measure floors climbed as well as steps and this can help with motivation. A good balanced diet with adequate protein such as in a Mediterranean diet also contributes to preserving muscle mass. An important message for patients is that as they tone up and gain muscle they may lose fat but not necessarily weight. However losing visceral fat as well as the fat that can infiltrate muscle will lead to better metabolic health. In addition there will be major improvements in day to day functioning and quality of life. (1) Rosenberg I, Am J Clin Nutr 1989: 1231-3 (2) Cruz-Jentoft AF et al Age Ageing 2010: 39 (4) 412-423

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Health&Lifestyle

When I’m Sixty-Four – activities for longer living

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geing can come as a surprise, even admitting it to one-self, because mostly that time in life just creeps up on us. In 1900 life expectancy in Europe was 42.7 years. Now it’s 80.67. That makes for an awful lot of us. By David A familiar scene in Miller Emergency Departments is an elderly person with an injury from a fall. These are often preventable. They can come from standing on a chair to changing a lightbulb or toppling off a ladder to clean the gutters, reaching sideways to get that last leaf. This sort of accident in the elderly is sad because there are often long-term consequences for continued good health. The medical system is good at dealing with emergencies and repairs, but for maintenance of body and mind, elders need to look further afield. the youth of old age. colleague, remarked, ‘Look how So, how can we stay not only Dr Mary, a Scottish friend, is the children play, always doing alive and intact, but also feel very sharp and fit in her late-60s. something different’. well? She sails and takes long walks Let me paint you a picture. A palliative care centre in We’re in a big room, set up with Malawi that I recently visited has but in a surprising throwaway, she commented, ‘Once past weights, balls and elastics. It’s a as its motto, ‘Add Life to Days, circuit training class and at the not just Days to Life’. Maybe this child-bearing age, nature has finished with you. You’ve done end of each minute the elderly idea from the world’s poorest your bit’. participants move to country could provide a lesson. A flinty lot, the the next station. For the new elders, the Baby Sparrow, an Boomers, now looking back, age Scots, with their 85 year old 64 was seen as old and unappeal- matter of fact A palliative care centre logic, but if ex-Wallaby, ing. In the heyday of the Beatles, in Malawi that I recently that’s right, is in charge. ‘Many years from now’. We have then why is He exhorts, visited has as its motto, been a lucky lot, born in droves Dr Mary so cajoles and after the Second World War and ‘Add Life to Days, not encourages. into an era of increasing prosper- chipper now just Days to Life’. and likely to His students ity, prolonged peacetime, social remain so for love it. And change and personal confusion. some time? they love the Could we have even imagined Today, one in retro music they’re that the time they sang about three people are defined “working” to. They are, would ever come to pass, for us, as inactive. Everybody knows many of them, retired academthe forever young? walking is healthy, better with ics and we’re in the Sydney some hills or steps but not University Gym. They came to ‘Will you still love me, enough for shoulders and neck. Sparrow hunched and seized Will you still need me, The idea of repetitive exercise in up. Now, in a very few weeks, When I’m sixty- four?’ a sweaty gym is irksome to many they’ve reversed the trend. I go people who, as a result, don’t do to Sparrow’s class whenever I’m The vantage point of sixty– anything. Dr Chris Ingall, paedi- in Sydney. “You can’t do enough four is a good place to change atrician and writer, a Healthspeak squats,” bellows Sparrow. I tell the story. It could be considered 36

a publication of North Coast Primary Health Network

him about the setup I have at home for doing squats. “But are you doing them?” he insists. “Are you doing them?” Good point, Sparrow. Tai-chi master Rod said something similar. ‘There is no good practice or bad practice - just practice or no practice’. Tai-chi training is part of the Tao’ist system. Originally evolved as a martial art, it has, over centuries, been adapted for health to improve posture, balance and body awareness. It is now recommended by the Arthritis association. Early morning travellers in China or Vietnam are surprised by the numbers of all age groups doing daily Tai-Chi in the park. Regular attendance in a group with a teacher is the basis for success. So, the truth is, no matter how old, unfit or disabled the beginner, some activity is doable, at least until extreme old age. The best thing about that last stage of life? It doesn’t last very long. healthspeak December 2017


Health&Lifestyle

The challenges of work life balance

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owards the end of every junior doctor’s assessment I am asked to sign off on their work/life balance ability. I invariably decline, citing ignorance. How can I possibly judge someone else's skills in an area where I have none myself? It would be like asking me to comment on an alien's mindset. I ask them how many hours a week they would like to work once established in their career, and they invariably say 0.6 FTE. Three or maybe four days a week at a push. This is sensible. But it comes at a cost, as the accumulation of both skills and money are largely dependent on hours worked at the coal face. Little wonder at the proliferation of SIM labs and acute care courses, as the young doctors coming through are just not seeing enough. It comes at a psychological cost as well, as the glass quickly becomes half empty if we are expecting much (time off). Entrance into a Registrar role can be a nightmare if your gaze is fixed on a three or four day week, with service provision alone carving considerably more out of the 168 hour week we call home. Little wonder reactive depression can raise its ugly head in those years.

December 2017 healthspeak

Generational gap fuels this of By ten o'clock he felt his world course. If you grow up in a five would fall apart if he stayed one to six working days a week culmore second with his wife at ture, your thoughts around what their picnic, the feeling of dread is a sensible work/life balance staying with him until he was are formed by it and carry safely back at his desk. through your working Given that we are all hostage life. Similarly if the to our youth, it is senseless for norm is less. one generation to judge the For an analogy, I next, though if we look at natuChris Ingall give you the young ral consequence a little more red blood cell. As closely, it is probably the lack of you know, they are skills gained rather than the popermeable (to sugar) tential monetary shortfall which for a short time soon after they impacts most in medicine. leave the marrow. They carry Junior doctors tell me they that information with are anxious they will them until their not know enough, senescence, and especially so it is with us towards the It comes at a and our early end of their psychological cost as environintern year, well, as the glass quickly ment. I call in large part becomes half empty if this the psydue to the we are expecting much chological low hours (time off). Hba1c effect. they work I hadn't realised compared to how powerful this previous generacould be until I listions. tened to an interview with Frank The doubling of graduate Lowy, where he related how he numbers is of course largely the had once tried to take a day off cause of this, as there is only so (he worked relentlessly) and had found by mid-morning he felt like the small near-destitute boy walking down the gangplank to his new life in Australia.

much work to go around. Given this (doubling) was a political imperative, we are all victim to it, and the potential negative impact on quality which it promised. I suggest to the junior doctors to spend some part of their remaining 130 hours each week with patients, either in a clinic or an acute setting, even if unpaid. Whether the eventual working of a shorter week through their careers impacts on the nest egg remains to be seen. I hope not, but fear it will. So if we accept the shift in what is regarded as an average medical week is here to stay, the pluses would appear to be less likelihood of burnout, better relationships among family and friends and less tiredness on a week to week basis. All laudable, and if levels of anxiety about skills remain manageable (use those Sim labs!), and superannuation contributions sufficient, maybe the new cohort of doctors can have their cake and eat it too. I watch the experiment with both curiosity and trepidation.

a publication of North Coast Primary Health Network

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Health&Lifestyle headspace MIND YOUR ART competition a big success

From left: Judging panel members Adam Murray, Simon Luxton and Melinda Casey with headspace Community Engagement Officer Julie Jamieson.

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n order to encourage young people aged 12 to 25 to engage in the arts during Mental Health Month (October), headspace Port Macquarie organised an art competition – MIND YOUR ART – at the GlassHouse Regional Gallery. The competition accepted entries of two or three dimensions on a small canvas, including drawing, painting, photography, mosaic and digital design. This year’s Mental Health Month theme was ‘Share the Journey’ and focussed on the importance of social connections to cope with life’s challenges. As we know, positive social connections not only improve mental health and wellbeing but also build resilience. headspace Port Macquarie was delighted to receive 102 entries in the competition and every artwork was on display at The GlassHouse during the month of October. There was a variety of prizes on offer for entrants in categories 12 to 17 years and 18 to 25 years. The judging panel, who faced a difficult task, comprised Simon Luxton, Adam Murray and Mel Casey. The Opening Night event was an amazing evening with more than 200 guests enjoying drinks, canapes, live music and art demonstrations, as well as an exclusive viewing of the competition artworks. Jules Jamieson, headspace Port Macquarie’s Community Engagement Officer said everyone was very happy about the success of this year’s MIND YOU ART event and hope to run it again. MIND YOUR ART also raised much 38

PRIZE WINNERS Peoples Choice: Sam Davison 12-17 years: Lili McLean Prosser, Bonnie Rudd and Sophie Jaggers Runners Up: Sam Davison and Lawson Sawtell 18-25 years: Amy Barnewall and Sigrid Wharton Runners Up: Joseph Hammerton, Jakob Purcell and Todd Burke

needed awareness about headspace, the services it provides, and the importance of good mental health. Congratulations to all who were involved in organising and participating in the event, including the sponsors.

a publication of North Coast Primary Health Network

healthspeak December 2017


briefs

Male baldness points to heart disease Male pattern baldness and premature greying are more of a risk factor for heart disease than obesity in men under 40, new research suggests. A study of more than 2,000 young men in India showed more who had coronary artery disease were prematurely bald or grey than men with a full head of hair. But the British Heart Foundation said other risk factors were important. Dr Mike Knapton, associate medical director at the BHF said hair loss and greying was something men couldn’t change. "However, you can modify your lifestyle and risk factors such as high cholesterol and blood pressure. These are far more important things to consider." The research presented at a conference in Kolkata studied 790 men under 40 who had coronary artery disease and 1,270 healthy men of a similar age, who acted as a control group. They discovered that the men with the heart condition were more likely to have gone prematurely grey - 50% compared with 30% of the healthy group - more than five times the risk of the control group. The heart condition group were also more likely to have male pattern baldness - 49% against 27% of those in the healthy group - a 5.6 times greater risk.

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Med students’ artistic farewell to uni

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inal year medical students at the University of Wollongong have presented a painting by well-known Bundjalung artist Noel ‘Charlie’ Caldwell to their alma mater as a token of their appreciation. Farewelling the university by presenting a gift has become a UOW tradition. Having thought long and hard about the most appropriate item, the students, many of whom had undertaken practicum training in the Northern Rivers, settled on an original creation from Bundjalung Country. ‘Goanna’ will be hung in a From left: Medical graduate Florence Huynh and Miss prominent place at the University Jodie Douglas, Head of Professional Staff (holding Charlie Caldwell’s ‘Goanna’ painting), Medical graduate to ensure maximum viewing of this Aiasha Saikal and Associate Dean, Professor Ian Wilson. wonderful work. Charlie Caldwell, who comes artist profile at Jambama Arts Centre in from Casino, has been painting Casino he is quoted as saying “painting is a since he was 15 and draws his inspiration big part of my life and I’ll never stop paintfrom his Aboriginal heritage. He has also ing till I die”. been a mural artist for local schools. In his

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Profile for North Coast Primary Health Network

HealthSpeak December 2017  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...

HealthSpeak December 2017  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...