Report highlights failure in primary health care

The Grattan Institute, a public policy ‘think tank’, has just published a report entitled ‘Chronic failure in primary care’ (see here). It is disappointing there is little reference to nurses in the report but that aside, it does give a good insight into the problems (and some possible solutions) in Australian primary health care.

Some highlights of the report are as follows:

  • Ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million a year in avoidable hospital admissions.
  • Only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.
  • Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented. Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.
  • Three quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death. Social, economic and environmental changes are the best way to prevent these diseases, but there are much better outcomes where good quality primary care services are in place.
  • The focus must move away from GP fee-for-service payments for one-off visits; a broader payment for integrated treatment would help to focus care on patients and long-term outcomes.
  • PHNs should be given more responsibility for local primary care services. The evidence shows that a consistent, coordinated approach to specific diseases helps primary care more effectively prevent and manage chronic conditions. In regional areas, clear targets and well-designed incentives for disease prevention are vital.
  • There needs to be a focus on more flexible services, which might include greater use of nurses and allied health staff for assessment, planning, coordination, review and support of people with chronic disease.
  • Practice and incentive payments are not working.

Do you agree there are fundamental problems with our primary health care system? Are there any easy, or even achievable, solutions? We would love to know what you think.

Member stories

Carolyn’s story

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Carolyn Lally – General Practice Nurse, Virginia Medical Centre, Virginia, South Australia

I have enjoyed working as a primary health care nurse for around seven years, most of it at Virginia Medical Centre in semi-rural location north of Adelaide. I chose to move to general practice as a lifestyle change after many years in a variety of clinical and research positions around Australia – I just wish I had made the change sooner!

Catching up with fellow general practice nurses at education events had highlighted the need for more support for nurses who often feel isolated within their own practice and unsure of where to go for guidance. In early 2014 I started collecting email addresses with the plan to initiate a Nurse Network. A group of four nurses then met over dinner and planned our initial meeting, which was held in August 2014. Early on we approached APNA and came to be part of the Nurse Connect initiative, along with other groups Australia-wide. APNA has been very supportive of the coordinators, who were able to travel to Melbourne in February 2015 to share our ideas and learn some new skills to assist with setting up our networks.

Our group has been highly successful, with 16-30 nurses attending each meeting, and over 70 nurses having attended at least one meeting. We meet every six weeks, and enjoy roundtable discussions and guest speakers on topics that the group has chosen. Although we are well supported by APNA and the Northern Health Network (NHN) – who kindly provide us with a venue, catering and admin support, our group is independent and has evolved to meet its own demands. Our network is very dynamic and feedback so far has been very positive.

What’s your experience with nurse networks in your area? We would love to hear your story.

If you are interested in being involved in a nurse network see here.

AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.

New Atlas plots variation in healthcare across Australia

On 26 November the Australian Commission on Safety and Quality in Health Care (ACSQHC) launched the first Australian Atlas of Healthcare Variation (see here). The Atlas highlights the variation in healthcare provision across Australia, and importantly highlights the potential overuse of procedures, medication and interventions.

Key highlights of the Atlas are as follows:

  1. Antimicrobial dispensing – significant variation across the country, with the highest rate of total antimicrobial dispensing (Campbelltown, NSW) being almost 12 times more than the area with the lowest rate (Tiwi Islands/ West Arnhem). WA stands out as being more successful than other parts of the country in keeping rates of antimicrobial dispensing relatively low. Internationally, Australia has a very high rate of antimicrobial dispensing (more than twice the rates of the Netherlands for instance)
  2. Diagnostic interventions – wide variation of particular interventions across the country (an example being colonoscopies where the highest rate was 30 times that of the lowest).
  3. Surgical interventions – wide variation across the country (for example women living in regional areas of Australia were over five times more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas)
  4. Interventions for mental health and psychotropic medicines – the greatest variation was seen in in dispensing of prescriptions for psychotropic medicines for those aged 17 years and under (for example the number of prescriptions for attention deficit hyperactivity disorder (ADHD) medicines in the area with the highest rate was 75 times more than in the area with the lowest rate)
  5. Opioid medicines – a wide variety of rates of prescriptions for opioids across the country (the number of prescriptions dispensed was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate)
  6. Interventions for chronic diseases – reflective of the generally poorer health status of indigenous Australians, hospital admission rates for asthma, COPD, heart failure and diabetes-related amputations were markedly higher in remote areas of Australia.

What variations in healthcare provision have you seen or experienced? We would love to know.

The impact of asthma in Australia

A report recently issued by Deloitte Access Economics (commissioned by Asthma Australia and the National Asthma Council Australia) details the financial impact of asthma in Australia. The report (see here) is extremely comprehensive.

Some of the key points in the report are as follows:

  • There is estimated to be 2.4 million Australians with asthma in 2015
  • The prevalence of asthma in Australia is around 10%
  • Australia has the second highest prevalence of asthma among OECD countries – New Zealand has the highest at 14% and Korea the lowest at 1%
  • Australia’s high prevalence of asthma may be due to the variability of weather in Australia and the high prevalence of allergenic risk factors, including natural events such as thunderstorms and winds that distribute allergenic pollen, grasses and particles
  • The direct healthcare costs of asthma in Australia total $1.2 billion.

Some interesting food for thought for nurses.

Removal of healthy kids check from MBS

From 1 November 2015, Medicare benefits for the pre-school healthy kids check (including the nurse item #10986) will no longer be available. See here for the MBS notification.

The Australian Government has cited a lack of evidence around the current system providing a higher quality service and the increased annual cost of delivering pre-school health checks as factors behind its decision to remove the healthy kids check MBS items.

The four year old health check remains a recommended child health assessment, which can still be undertaken in general practice settings using time and complexity based MBS items #23, #36, #44 (and the Aboriginal and Torres Strait Islander health assessment item #715). The health checks can also be undertaken by State and Territory funded infant health clinics, where available.

With these changes in mind there is debate around whether the rebates for these consults accurately reflect the work required to undertake a comprehensive childhood health assessment or support the non face-to-face work undertaken outside of the consultation.

  • Do you believe there will be a change in your health assessment rates for children in your area as a result of the Government’s decision?

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Mental health of young people

On 7 August 2015, the Minister for Health, the Hon Sussan Ley MP, released The Mental Health of Children and Adolescents, a report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. The report, described as the largest ever national survey of youth mental health of its kind in Australian history, follows on from the first national survey of the mental health of children and adolescent which was undertaken 17 years ago.

Some key highlights of the report are set out below:

  • One in seven children and young people experienced a mental disorder in the previous 12 months – the equivalent of 560,000 young Australians
  • Attention deficit hyperactivity disorder (ADHD) was the most common mental disorder in children and adolescents
  • Just over one third (35%) of 4-17 year-olds with a mental disorder had seen a general practitioner in the past 12 months
  • Schools provided services to 40.2% of the children and adolescents with mental disorders who attended them, and 5.6% had seen a school nurse
  • Around one in 10 12-17 year-olds (10.9%) reported having ever self-harmed
  • Females aged 16-17 years had the highest rates of self-harm, with 16.8% having harmed themselves in the previous 12 months
  • About one in thirteen (7.5%) 12-17 year olds had seriously considered attempting suicide in the previous 12 months.

While some of the information contained in the report is concerning, there are a number of positives, such as the large increase in the number of young people seeking help.

What is your experience of dealing with young people with mental health issues? Do you think there are adequate processes in place to identify mental disorders and provide the care and support needed?