GP NSW NEWS - 1 December 2011
GENERAL HEALTH NEWS
GREAT FINDS WORTH SHARING
GP NSW NEWS
GP NSW's innovative coordinated care project has not been funded beyond the end of this year, despite the pilot program's significant impact on drug addicted patients with mental and physical health issues. The program employed 10 mental health nurses and three psychologists, who worked closely with GPs while coordinating the broad range of health professionals often required to provide adequate care.
More than 100 GPs across NSW have referred 420 patients with complex needs to the pilot program since September last year. NSW Health funded the pilot. Natalie Healey, who coordinates the Mental Health and Drug and Alcohol Shared Care Clinical Coordination program at GP NSW, said it had reduced hospital admissions and addressed a range of gaps between state and federally funded health services.
"While we're focussing on individuals' needs, we're also making broader improvements to the health system, as care coordinators clarify referral and discharge processes and improve health professionals' understanding of what local resources are available and what assistance they offer." Natalie said while the pilot program expected to focus on comorbid patients, many had multiple morbidities and required extensive support. Assisting one drug-addicted homeless client with mental and physical health issues required her care coordinator to work with the local Area Health Service, her GP, the department of housing, Centrelink, the justice system, an international consulate, the department of immigration and a range of non-government organisations.
GPs who have seen benefits from the program are calling on NSW Health to fund the program beyond 31 December.
Central Coast GP, Dr Rodney Beckwith, believes the program has decreased hospital admissions for patients with mental illness.
"I strongly support the continuation of funding for the vital work of the project," he said. Dr Nigel Bacon, a GP from Grafton, says the program has improved patient care. He strongly supports the service continuing and being expanded to cover the Clarence Valley.
The weekly newspaper for GPs, Australian Doctor, reported last month that NSW Health had made no decision on funding, and it was awaiting evaluation findings to determine whether it was cost-effective and delivered intended outcomes.
GP NSW CEO, Jan Newland, said the department had been kept up-to-date with the pilot's costs and achievements since it had started.
"Waiting until the project finishes in order to evaluate it will unfortunately have a serious impact on its viability," she said.
"Our care coordinators, who have developed a rapport with patients, GPs and a range of local health services, will have to move on and secure other work as soon as funding stops," Jan said.
"Delaying ongoing project funding now is creating a time lag that is undermining continuity of care." Jan said the program's impact in reducing hospital admissions created a strong case for it being cost effective.
Patients' health is likely to suffer as a result of GP NSW's coordinated care program being discontinued, according to one Sydney doctor who has seen great results from the program. Newtown GP, Dr Hester Wilson, said she has a significant proportion of patients with mental health and drug and alcohol comorbidity.
She said GP NSW's Mental Health and Drug and Alcohol Shared Care Clinical Coordination program has enhanced her ability to provide a high level of medical care for these patients, particularly given the "high calibre and clinical acumen" of the nurse employed through the program."
Dr Wilson said she had no doubt the program had improved short term outcomes and would continue, if funded, to do so over the longer term. "It would be very disappointing if the project were discontinued," she said. "I am concerned that my patients' health will suffer as a result."
She said the program had helped her patients to attend appointments, follow up investigations and adhere to treatment. She said this enabled her to see more patients and be more effective, which had increased her work satisfaction.
Gosford grandmother Terena Shiner was smoking 40 cones a day as she struggled with depression and anxiety, but last month she celebrated 300 days of being drug free.
Terena, 48, is grateful that her Gosford GP, Dr Nicole Avard, referred her to GP NSW's coordinated care program, which Terena credits with having saved her life and relationship with family. She is concerned that NSW Health has not funded the project beyond 31 December, for herself, and the many other people in the community who have also struggled to address multiple morbidities.
Terena smoked her first joint at 13, shortly after her mother's funeral. The young orphan, whose parents both committed suicide, lived in charity clothing bins and later with a biking gang, smoked pot for the next 35 years. Like many people who have experienced trauma, Terena had complex mental health, physical health and drug addiction issues, which were not easily addressed by one health care professional. On several occasions she sought support to overcome her addiction, but found "nothing was available as it was only pot".
"It seemed that no one cared because it was a lesser evil than the hard drugs," Terena said. But the Mental Health and Drug and Alcohol Shared Care Clinical Coordination program, developed by GP NSW, enabled her to access a broad range of support which was coordinated by a nurse specialising in mental health care.
Terena was the first of 50 patients to have their care coordinated by Adam Rice, a credentialed mental health nurse working on the NSW Central Coast. Adam focussed on Terena's substance use, anxiety and depression. He sourced a suitable place for her to detox, and in the first few weeks after she was discharged, visited her each day at home to offer encouragement and support.
He referred Terena to a psychologist, who is using cognitive behavioural therapy to teach her coping strategies. Adam is also working closely with Terena's GP, who has focussed on her physical health issues.
"Terena needed a lot of input from a range of different services," Adam said. "This program meant that I was able to bring all of those services together, so she got input when it was needed. I was also able to make sure that all the people supporting Terena were communicating."
Terena says the program has enabled her to learn coping skills that other people take for granted, which she wasn't able to learn from her parents. "I can honestly say that without the help of Adam and his team, I would probably be dead today. I now have a wonderful granddaughter, but when she was first born, my daughter felt uneasy at leaving her with me, due to my addiction.
"I beg the government and other officials to please continue this wonderful program for the sake of all the people that have no-one and are not yet aware that people like Adam are around to help them. "Thank you Adam Rice for having the courage to stand beside me and the understanding to stand behind me when I needed you. You saved my life and my family and we will forever be in your debt."
GENERAL HEALTH NEWS
Chair of the GP NSW board, Dr Jenny Beange congratulated the latest round of successful Medicare Local applicants announced by the Federal Health Minister and said they could continue to rely on GP NSW for support.
Five new Medicare Locals will operate in NSW from January - Illawarra-Shoalhaven, Nepean-Blue Mountains, North Coast NSW, North Sydney and Western NSW. A further nine will start from July next year.
Jenny, who is also CEO of the Dubbo Plains Division, said she understood how much work Division staff have put in so far and the scale of the task ahead as the new organisations become established.
"GP NSW looks forward to maintaining a close relationship with Divisions to assist with the establishment of Medicare Locals across the state and support Divisions' needs as they arise," Jenny said.
"We will continue playing a lead role in brokering between State and Commonwealth health ministries to ensure their health reform policies are successfully aligned.
"We are working to ensure that our expert knowledge of general practice and primary care informs their strategic direction.
"We are also working at a local level, helping to build relationships between Divisions and Local Health Districts."
Jenny said the GP NSW board had resolved to continue as an independent organisation and would maintain its key advocacy role for general practice in NSW.
Minister for Health and Ageing, Nicola Roxon, announced the latest NSW Medicare Locals along with another 24 across the country. She said once the new Medicare Locals were all operating, there would be a network of 62 nationally.
"In addition to identifying gaps in local health services, Medicare Locals will help patients to navigate the health system to find the right services at the right time and place, better connecting and improving local services," Minister Roxon said.
"Importantly, Medicare Locals will maintain and build on the excellent work already done by the local Divisions of General Practice, with GPs and general practice being at the centre of a strong, integrated primary health care system."
GP NSW is encouraging Medicare Locals to apply now for Federal Government grants which support a broad range of health initiatives. Divisions continuing to operate after July 2012 are also eligible to apply.
The grants cover a broad range of priorities, ranging from mental health and substance misuse to chronic disease and aged care.
One of the 10 grant categories will fund organisations supporting population health improvements by focussing on social determinants of health. Another aims to prevent blood borne viruses and sexually transmissible infections.
Grant applications for telehealth support projects close on 13 December, while most others close on 23 December.
Clinicians, public health and health services professionals undertaking research linked to their practice or policy may wish to apply for an NHMRC Practitioner Fellowship this month.
"Practitioner Fellowships are open to all active clinicians in Australia who have a sustained track record to significant research output as demonstrated in peer-reviewed literature, and a strong commitment to quality research outputs as judged relative to opportunity," the NHMRC says.
Applications for Practitioner Fellowships open on 12 December 2011 and close on 9 February 2012.
The same dates apply for Research Fellowships for high performing mid-career health and medical researchers. These fellowships are generally awarded to researchers in the top 10% of their field, who are "pushing the boundaries of research", according to the NHMRC.
Funding under the fellowship scheme starts in 2013.
Medicare Locals needing access to population health profiles for planning can download a significant amount of local data from a tailored website.
The online Medicare Locals Population Health Atlas has a help section, but the data is complex. GP NSW suggests consulting a population health planner to ensure it is interpreted accurately.
The online data was produced by AGPN to support Divisions during their transition to Medicare Locals. The project was funded by the Commonwealth Department of Health and Ageing.
Network members wishing to determine whether their communities have key attributes that underpin a healthy community may be interested to read an American account of how these features can be audited.
The article, published in the November edition of Preventing Chronic Disease, explains how to assess factors such as footpaths, parks, inexpensive gyms and fast-food restaurants in the context of demographic areas. It provides the basis for evaluating whether communities have adequate resources to support residents adopting healthy lifestyles.
GP NSW Manager of Policy, Development and Communication, Carla Saunders, said Medicare Local and Division staff may find the authors' research techniques useful when planning health campaigns and programs.
"The article is written in plain English and gives practical insights into quantitative and qualitative research methods," Carla Saunders said.
GREAT FINDS WORTH SHARING
GP NSW gives a big thumbs-up to an independent website that makes it easy to compare private health insurance policies.
The site, managed by the Private Health Insurance Ombudsman, explains the Private Health Insurance Rebate, membership categories and differences between hospital and general insurance. It also explains the differences between top, medium, basic and ancillary coverage.
The comparison tool asks a series of questions before providing a list of suitable policies, their maximum excess and monthly premium.
Medicare Locals seeking resources to build resilience in young men are likely to share GP NSW's enthusiasm for the WorkOut online training program.
The site, created by the Inspire Foundation and Brain and Mind Research Institute, provides a series of activities which likened to a personalised exercise routine.
They enable users to target aspects of their thinking, including confidence, practicality, control and ability to handle pressure.
Through comprehensive results and recommendations, the program aims to de-stigmatise the idea of getting help and lay the foundations of good mental health.
GP NSW supports the Cancer Institute NSW's latest mass media campaign, which highlights that melanoma also affects young people.
It features the true story of Wes Bonny, an Australian man who was diagnosed with a 1.4mm melanoma on his neck at 23 years of age. Wes died in March last year, aged 26.
GP NSW CEO Jan Newland said frontline health managers are likely to find the campaign useful to reinforce skin cancer prevention messages.
"It's a moving campaign, because it tells a true story," Jan said. "It highlights the impact of this young man's diagnosis and passing on his family and friends, bringing home just how dangerous sun exposure can be."
GP NSW encourages readers to view the full 90-second cinema advertisement online and email it to colleagues, family and friends.
The campaign, which started airing last month, will run until March next year.