HOSPITAL PASS: A MEDICAL HOME:

focus
AUTUMN 2015 | EDITION 12
A MEDICAL
HOME:
Putting people
at the centre
HOSPITAL
PASS:
Community
care to the fore
PRIMARY FOCUS
2
PRIMARY NOTES
It’s time to look forward.
Another year is well and truly upon us, one that heralds significant
changes in the coordination and delivery of primary health care not
only for our region but right across Australia.
From July this year the new Primary Health Networks (PHN) will be in place
to act as facilitators and funders of primary health services, with our region
being absorbed into a much larger PHN stretching from Cocoroc in the
south past Lancefield in the north, and as far west as Bacchus Marsh.
At the end of January we submitted a tender to the Federal Department of
Health to operate the North Western Melbourne Primary Health Network,
as the lead agency in the Melbourne Primary Care Network (MPCN)
consortium.
Bringing together the care networks and health system expertise of some
exceptional partners, MPCN will champion a new focus on integrated,
person-centred and GP led care.
We are excited by the challenges ahead and are confident that together we
can make a real difference to health in north-western Melbourne.
We say ‘together’, because we couldn’t have got to this point without the
wonderful support of our health community, especially our foundation and
supporting partners and the individuals and organisations that provided us
with formal letters of support.
Contents
03 News
07 Member Profile
08 Medical Home
10 Hospital Pass
13 Focus On
For now, we await the results of the PHN tender process, which the
Department has advised should be announced by April.
We will keep you informed as the process comes to its conclusion, but in
the meantime it really is business as usual at Inner North West Melbourne
Medicare Local: we’re still here to deliver better primary healthcare for our
community until 30 June 2015, and hopefully for much longer as the North
Western Melbourne Primary Health Network.
Some of the ways we are doing that are showcased in this edition, with
a focus on two areas of enduring importance: improving patient care and
reducing costs by cutting avoidable hospitalisations; and supporting GPs
to play the lead role in delivering person-centred, whole-of-life care to the
community.
You’ll also find articles on our new program in advanced care planning, an
update on HealthPathways Melbourne and the latest on our burgeoning
Immunise Melbourne campaign.
Clearly there’s a lot happening already and we’re looking forward to much
more to come as we march into 2015.
ASSOCIATE PROFESSOR CHRISTOPHER CARTER
CHIEF EXECUTIVE
PRIMARY FOCUS
3
NEWS
CARING IN ADVANCE
Health professionals will have more support to discuss future care
needs with their patients and clients through a new Advance Care
Planning project being developed by INWMML.
Advance Care Planning (ACP) is where people can consider and talk with
those close to them – including their doctor or other health professionals
– about what would be important for them if they could no longer make
decisions for themselves.
This can include nominating a substitute decision maker and writing down
a plan about future health decisions.
INWMML was one of three Medicare Locals in Victoria to succeed in a highly
contested process for the Enabling State Wide Advance Care Planning
project, an initiative funded by the State Government and facilitated by
Networking Health Victoria to develop a system-wide approach to ACP
in Victoria.
INWMML CEO Associate Professor Christopher Carter said ACP is only
going to become more important as our population ages and medical
technology continues to advance.
“Making sure everyone involved has a clear idea of what is important
to a person, what type of care they want to receive, and under which
circumstances, is a great way to provide peace of mind in their future care,”
A/Prof Carter said.
“It also helps loved ones and family members who will often need to make
decisions for the person. Part of the ACP process can involve nominating
a substitute decision maker and making sure that they understand the
person’s wishes.”
“We understand having these conversations and completing an advance
care plan can be challenging, which is why this new project will have strong
focus on support and training for health professionals involved”.
“This will support other work being undertaken by the Health Issues Centre,
which is focusing on how to best support community members.”
The project will sit within the Inner North West Melbourne Health
Collaborative, which has had strong success in developing coordinated care
approaches in chronic disease and eHealth through its foundation partners
Melbourne Health, cohealth and Merri Community Health Service.
The project’s main focus will be on Priority Action Area 1 of the statewide
strategy, which is about establishing robust organisational systems to
support ACP. The main objective is to embed ACP within usual practice,
and ensure the transfer of information between those involved in providing a
person’s care.
The project will also include partnerships with Royal District Nursing Service,
the North West Metropolitan Palliative Care Consortium, Inner North West
Melbourne Primary Care Partnership, and Medical Deputising Services.
For more information about ACP, including links to key websites and current
resources for patients and health professionals, visit our new Advance Care
Planning webpage at www.inwmml.org.au
DECISION ASSIST is an exciting program
that is enhancing the delivery of advance
care planning and palliative care to older
Australians, by providing education
and support to GPs andaged care staff
nationally.
It includes an Advance Care Planning
and Specialist Palliative Care Telephone
Advisory Service for health professionals
– 1300 668 908, specialised workshops,
improved linkages between palliative care
and aged care services and a dedicated
website featuring the latest information
and advice about advance care planning
and palliative care.
For more information, go to
www.decisionassist.org.au.
GROWTH CONTINUES
FOR NATIONAL HEALTH
SERVICES DIRECTORY
The National Health Services Directory
(NHSD) is consolidating its position as
the leading directory for health services
in Australia as monthly searches hit
4.6 million.
Now featured on more than 80 websites
nationally as well as being downloaded
thousands of times as a mobile app, the
NHSD allows users to search based on
service type and location, with other filters
including opening hours and bulk billing status.
The NHSD widget available on the INWMML
website is one of the latest versions, with
enhanced functionality such as being able
to search by languages spoken by the
practitioner and their gender.
INWMML eHealth Project Officer Gary Morris
said the increasing popularity of the service
means it’s more important than ever for local
practitioners to start listing their services or
update their existing service information.
“With more than 40,000 practitioners listing
over 150,000 services on the NHSD, it really
is the one-stop shop for locating health
services, and best of all it’s free,” Gary said.
Service providers can email
[email protected] and provide
details of any changes required. Services
will then be contacted by the NHSD Team
to confirm their information.
For further information please contact Gary
Morris eHealth program officer INWMML on
93471188 or email [email protected]
PRIMARY FOCUS
4
109 AND GROWING
FOR HEALTHPATHWAYS MELBOURNE
Momentum continues to build for HealthPathways Melbourne with
109 best-practice assessment, management and referral pathways
now available to help local GPs treat a range of common conditions.
One pathway soon to be released covers low back pain, a very common
complaint in general practice that can have a range of causes and
presentations.
GP Clinical Editor Dr Debra Wilson said the nature of the condition means
that it has taken 12 months to create and localise the pathway.
Assessment and management of low back pain can include a wide range
of diagnostic, allied health and specialist input and it has been important to
bring together all those perspectives in the development of the pathway.
The back pain pathway joins a range of others covering areas as diverse
as gastroenterology, diabetes, cardiology and Ebola management.
Acting as a memory jogger and supporting the expertise of the general
practice community is one of the key goals of HealthPathways Melbourne,
a joint project from the Royal Melbourne, Royal Women’s, St Vincent’s
hospitals and Eastern Health, along with Inner North West Melbourne and
Inner East Melbourne Medicare Locals.
Localised referral information and the collaborative design process for the
pathways between GPs, specialists and hospital networks is also helping to
improve care coordination, making the local health system easier to navigate
for doctors and patients alike.
And while the project has reached its target of 100 localised pathways six
months ahead of schedule, there is no sign of slowing down with another
50 pathways being actively localised.
General practitioners in the inner north west and inner east of Melbourne can
contact [email protected] for more information and to get
access to this free system.
With more than 100 pathways
developed HealthPathways is
helping to improve the patient
journey in inner Melbourne.
NEW PATHWAY TO
HELP EASE BACK PAIN
PRESSURE
Better care for people with low back
pain and shorter hospital waiting lists are
possible following the development of a
new HealthPathway on low back pain.
The new pathway will focus on managing low
back pain within the general practice setting,
motivated by concerns from hospitals about
inappropriate referrals and long outpatient
waiting times.
HealthPathways GP Clinical Editor Dr Debra
Wilson said the combination of access and
management issues in our region made the
low back pain pathway particularly important.
“It’s a really common thing – around 90%
of us will have back pain at some point in
our lives so it’s really important that we get
treatment right,” Dr Wilson said.
The multi-disciplinary pathway development
team included at least 15 clinicians from
four Victorian health services and across
primary care, representing neurosurgery,
orthopaedics, rheumatology, pain, allied
health, pharmacy and general practice.
The team, led by Dr Wilson, has worked
for a year to bring the pathway to fruition.
“Given that it’s not a disease it’s really
difficult and complicated to determine a
straightforward pathway for identification
and management,” Dr Wilson said.
“The two main things we have stuck very
closely to are; what is the evidence telling
us; and what will cause the least harm.”
One thing the evidence shows is that less
than 5% of people who present with low back
pain will have a serious cause, with most
back pain being related to simple, mechanical
issues that should improve within two weeks
with conservative management.
“Then it comes down to managing
expectations within the patient, who may not
have gone back to what they were prior to
their event of pain and they’re thinking there
must be some more serious cause for that,”
Dr Wilson said.
Helping GPs to better explain and
implement appropriate pain management
strategies could help limit costly and
potentially unnecessary hospital referrals
for MRI testing.
PRIMARY FOCUS
5
New mum Emily
knows immunisation
is the way to go for
her family.
LOCALS JOINING THE FIGHT AGAINST
INFECTIOUS DISEASE
Local parents are sharing their positive immunisation stories to help
others make the right choice when it comes to immunising their kids
and preventing further outbreaks of diseases like whooping cough
and measles.
Reported cases of whooping cough jumped by more than 50% last year in
Victoria, including steep rises in Melbourne (55 cases, up 77%), Yarra (59
cases, up 26%), Moonee Valley (36 cases, up 44%) and Moreland (62 cases,
up 59%).
Doing her bit to stop a resurgence of dangerous diseases was behind Emily’s
decision to be part of the Immunise Melbourne campaign, which aims to
boost immunisation rates for children aged 0-4.
The Glenroy local’s story is one of several from local parents across the
region featured in the campaign, explaining why she made the choice to fully
immunise her child.
“I have a science background and wanted to make a truly informed decision,
so I did my research,” Emily said.
“I read lots of papers and studies and eventually came to the conclusion that
immunising our daughter was not only in her best interest, but also our social
responsibility.”
The motivation for Airport West mum Krissi was even more personal,
after she came into contact with a child with suspected chicken pox while
pregnant.
“My close contact with this child and his mother meant I had to have blood
tests and be monitored in case I contracted chicken pox, as this could affect
my baby,” Krissi said.
“Thankfully, as it turned out, this child had another illness. All the stress and
worry that we went through – not to mention the extra medical costs and the
time of the midwives and doctors, was totally avoidable.”
For working mum Lidia, having the support of a well-informed GP helped
overcome any initial concerns she might have about immunisation.
“My GP is fantastic and I chose to listen to her, and I listened to my
obstetrician too,” Lidia said.
“They are experts who study these things in depth, and are paid to know all
the details. My GP is particularly thorough in explaining the potential risks,
side effects and benefits of each vaccination.
“That’s been extremely important to me, particularly when I was a new mum
who was a little uncertain about vaccinations.”
Inner North West Melbourne Medicare
Local (INWMML) along with the Melbourne,
Moreland, Moonee Valley and Yarra councils
are backing the Immunise Melbourne
campaign, responding to a small but
increasing trend of non-immunisation in
the inner Melbourne region.
“These stories show the real human face
of immunisation – it’s about people making
an informed decision to protect themselves,
their families and their communities,”
INWMML CEO Associate Professor
Christopher Carter said.
“Hundreds of rigorous studies have
conclusively shown immunisation is
responsible for saving millions of lives and
is the safest and most effective way we can
protect our children from infectious diseases.”
The campaign has struck a chord with the
community, at a time when controversy over
a now cancelled visit to Australia by antivaccination campaigner Dr Sherri Tenpenny
has regularly put immunisation in the news.
The Facebook page for the campaign has
ballooned to over 1,000 followers since the
controversy began in January, becoming
a hub for parents to share pro-vaccination
stories and support.
An Immunise Melbourne stall at the recent
Pregnancy, Babies and Children’s Expo at
the Melbourne Exhibition centre was also
well attended, with further stalls at upcoming
community events and festivals planned.
You can see all the stories and get more
information about immunisation at
www.immunisemelbourne.org.au,
or join the conversation at the Facebook page
www.facebook.com/immunisemelbourne
Immunise Melbourne is also looking to expand
the campaign with more real stories from more
parts of Melbourne, so if you have a positive
immunisation story to tell get in touch at the
Facebook page or email [email protected]
PRIMARY FOCUS
6
MOMENTUM GROWING FOR VIDEO
CONSULTATIONS
People living in residential aged care facilities (RACFs) in our region are
getting better access to care through an INWMML supported program
of video-based GP consultations.
16 supported consultations have taken place between GPs and residents of
participating RACFs since the trial went live last year as part of the Australian
Government’s Better Health Care Connections program.
Consultations are conducted between the GP’s office and the RACF using
a videoconferencing system such as Skype™, with all necessary equipment
and support provided by INWMML.
The initial consultations have been used for scheduled reviews and catch
ups, but the program has identified that it may also be useful for both
scheduled and unscheduled sessions; regular reviews related to chronic
disease; and for GPs who are not at their practice full time.
One GP has now progressed to conducting the consultations independently
with her three RACF residents, and two more RACFs with over 200 beds
between them are soon to come on board.
INWMML Program Coordinator Samantha Milford said the recent growth was
a positive sign and she was looking forward to seeing what benefits broader
use of video consulting can provide for RACF residents, staff and GPs caring
for older adults.
THE HEPATITIS B STORY
NOW AVAILABLE IN
MULTIPLE LANGUAGES
A plain English language teaching tool
for discussing care and management
of chronic hepatitis B (CHB) is now
available in a range of targeted
community languages.
The hepatitis B story, developed in
partnership between INWMML and St
Vincent’s Hospital Melbourne, uses
informative images and plain text to help
health professionals when discussing care
and management of CHB with people who
have low health literacy.
Melbourne’s inner north west region has a
higher than state average number of people
living with CHB. CHB is the main cause of
liver cancer and is the fastest increasing
cause of cancer death in Australia.
In 2013, approximately 43% of people
living with CHB were unaware they had
the disease, and only five percent of those
that had been diagnosed were receiving
treatment.
Strong uptake of the Hepatitis B Story
as a tool for educating people who have
CHB has precipitated the translation of
the resource. The Hepatitis B story is now
available as an animated video with voice
over in Vietnamese, Mandarin, Karen and
Cantonese as well as a take home booklet
in these languages.
Infectious diseases expert Dr Nadia Chaves
said the Hepatitis B story has been a
fantastic resource for clients and providers.
“I use it with all my patients with hepatitis
B and also with their families,” Dr Chaves
said. “I just wish it was available for other
diseases.”
All of these resources are available on the
INWMML and St Vincent Hospital websites:
www.inwmml.org.au/hepb
www.svhm.org.au/gp/clinics/Pages/
Gastroenterology.aspx
Video consultations are
offering another way for
GPs to keep in touch
with their patients.
PRIMARY FOCUS
7
FOCAL POINT
Dee Wardrop Speech Pathology
and Occupational Therapy Services
WHAT IS IT THAT YOU DO?
We provide a range of Speech Pathology and Occupational Therapy
services for children and adults. We offer clinic based sessions (Thornbury
and Seddon) and also a mobile service for our clients at their home,
kindergarten/day-care, school, or nursing homes.
Our speech pathologists have expertise in all areas of speech, language and
communication. We support clients with a range of delays and disorders,
including early language development, feeding difficulties, stuttering,
voice, literacy and reading skills, autism spectrum disorders, hearing loss
and learning difficulties in children, and acquired/progressive neurological
conditions of language, cognition or swallowing in adults.
Our occupational therapists are paediatric specialists, supporting children to
improve their performance in everything they do – including early play skills,
handwriting and self-care, socialisation, participation, self-regulation and
sensory integration.
WHO IS THE SERVICE FOR?
Assessment and Individual Therapy Services are the main part of our
practice. These services are provided to any client requiring support for their
speech, language, swallowing or communication difficulties, or difficulties
with any aspect of their participation in home or school life. Clients can be
referred directly via a primary care provider, or self-refer.
We also provide a group therapy program for children to support a range of
goals; including social skills, friendship, communication, handwriting, literacy
or a combination of sensory integration and early language development.
Diagnostic and funding assessments, communication check-ups, talking
time playgroups, music, movement and language groups and education/
training services are some of the other things we provide.
We love what we do and we are passionate about providing the best care
we can for every client. When we get emails like this from our clients – we
know we’re getting it right.
“I just felt really compelled to email and let you know how much we love
our speech therapist. She’s such a pleasure to work with and my son
really responds so well to her. It’s great seeing someone doing a job that
they love and to see her develop such a lovely rapport with children just by
being herself.”
WHY DO CLIENTS CHOOSE YOUR SERVICE?
Clients often come to us by word-of-mouth or referrals from other health
professionals who we have worked with in the past. Our reputation for
excellence, our team of communication specialists and the length of time we
have been operating are the biggest drawcards for our clients.
Since adding our Occupational Therapy services in 2011, we have found
even more clients choosing our practice because of the convenience of
having all their needs met in one clinic.
One of the most exciting parts of working in private practice is the
opportunity to innovate. Clients choose us because we’re prepared to think
outside the square to offer the best service we can.
Practice Principal
Dee Wardrop at her
Thornbury practice.
WHAT DO YOU SEE AS THE BENEFITS
OF BEING A MEMBER OF INWMML?
By being an active part of INWMML, our
practice remains up to date on new services
and initiatives within our local community. This
benefits our team by providing opportunities to
be involved, provide information to our clients
and to innovate with new programs or services
that align with the needs identified in the
INWMML catchment.
For example, upon reading about the lengthy
waitlists for speech pathology assessments
in our local area in 2013, we developed our
low cost Communication Check Up Service
and were able to offer this as a way of giving
families some immediate input about their
child’s speech and language needs.
Above all, we really enjoy working within the
collaborative model of INWMML. We love
networking with general practice teams to
promote our services, and we work to support
local primary care providers, such as GPs and
practice nurses, to remain informed about the
assessment and treatment options available
in our team, and how we can all work together
to help each client or family to achieve their
best outcomes.
If you would like to be profiled in a future edition
of Primary Focus, please contact Julie Sucksmith
on (03) 9347 1188.
PRIMARY FOCUS
8
Technology is driving
a new era of person
centred care.
THE PERSON
CENTRED MEDICAL HOME
– A MODEL FOR THE FUTURE OF CARE
WHAT IS IT?
The person centred medical home (PCMH) is
a model of primary healthcare that is personcentred, comprehensive, team-based,
coordinated, accessible and focused on
quality and safety.
Developed in the US, the model focuses on
the potential of an effective primary health
care system to improve health outcomes and
costs while improving the care experience
for patients.
It works by enhancing the core values of
traditional general practice of providing
comprehensive, coordinated and integrated
care with a holistic approach to patient illness
and wellness supported by the whole general
practice team.
New health technology plays a key role in enabling general practices to
become PCMHs, with electronic health records and usable patient data
allowing GPs to better respond to the needs of their patient cohorts, and
electronic decision support applications and patient care reminder systems
improving care quality.
The medical home is not a destination – it is a model for continually moving
towards realising the vision of care provided in the right place, at the right
time and in the manner that best suits a patient’s needs.
HOW DOES IT HELP?
The PCMH model aims to reduce fragmentation of care by better
integrating all the services a patient needs around their core general
practice provider.
It is especially important in both the prevention and management of chronic
disease, helping general practices to organise patient data to highlight
current and future areas of need and to respond by offering appropriate
interventions.
PRIMARY FOCUS
9
Professor Rick Kellerman from the University of Kansas School of Medicine
says the PCMH model has an important potential role in Australian general
practice for patients with limited access to medical care.
“On a broader scale, such a model has the potential to facilitate team care
arrangements for patients with chronic disease, and to reduce fragmentation
of medical records and the associated patient safety issues that occur from
incomplete medical information,” Professor Kellerman said.
The PCMH model has also been associated with reduced costs for both
health funders and service providers, through reduced hospitalisations and
by improving the efficiency and utilisation of the entire general practice team.
THE MEDICAL HOME IN ACTION
The PCMH model of primary care has been implemented in a range of
public and private health markets in the US, and a there is a growing body of
evidence that it is having a positive impact on health costs and improved use
of the health system.
A systematic review by the by the Australian Primary Health Care Research
Institute’s Centre for Research Excellence in Primary Health Care (CRE)
showed the PCMH could improve a range of health outcomes, including
access to care and management of chronic and complex diseases.
The RACGP is a major supporter of the PCMH model, and a number of
health organisations and providers, including INWMML, are using the model
to inform the delivery and structure of their programs and services.
“The medical home model is known as a positive advancement in primary
care delivery and for delivering better health outcomes for patients at a lower
economic cost to government,” RACGP President Dr Liz Marles said.
“The CRE’s focus on the medical home concept supported by the
development of improvement tools for general practice adds further weight
to the benefits of implementing a medical home concept in Australia.”
More than 75% of Australian GPs surveyed by the AMA also support the
introduction of the PCMH model, provided linkages are voluntary and
reversible and fee-for-service is maintained.
BRINGING THE MEDICAL HOME CONCEPT TO
NORTH WESTERN MELBOURNE
As the lead organisation in the Melbourne Primary Care Network consortium,
the Person Centred Medical Home (PCMH) is one of the key models that
underpins our vision for the future of primary health care in the North
Western Melbourne Primary Health Network.
A better connected, coordinated and integrated health system, centred
around enhanced and fully supported general practice, has huge potential
to deliver the better quality, lower cost health care required to meet future
demand.
We’re already moving to provide general practices with the tools and
support they need to become PCMHs, by improving patient and population
data, increasing their uptake and use of eHealth services and systems
and connecting GPs to best practice information on managing a range of
common conditions.
Increased use of the PEN Clinical Audit Tool (PENCAT) has been one key
focus, allowing practices to better identify both individual needs and broader
population trends in their patient cohort, leading to a number of practices
offering new or refined services that better reflect demand.
This push for better quality and access
is further supported by work to increase
the number of local people signing up for
a Personally Controlled Electronic Health
Record (PCEHR), with over 10,000 new users
signed up directly by INWMML in the first six
months of 2014.
In addition to bringing on thousands of new
users, we also surveyed over 500 health
providers, including 130 general practices,
about their eHealth awareness and readiness
to identify any knowledge and usage gaps.
From there we’ve been moving from ‘knowing
to doing’, focusing on helping practices to
become eHealth ready and make meaningful
and consistent use of the PCEHR as part of
their regular clinical practice.
As well as using eHealth to help practices
identify issues and access better quality
patient information, we’re also supporting
their ability to take the lead role in managing
an ever increasing range of conditions
through the HealthPathways Melbourne
program.
HealthPathways provides best practice
and localised information to assist GPs
with assessment, management and where
necessary referral for a range of common
conditions. More than 100 pathways are now
available, including everything from neurology,
to diabetes care and management and
cardiovascular disease.
Taken together these programs are helping
to form the structure of the PCMH model for
GPs in the inner north west of Melbourne,
and potentially a broader region once
Primary Health Networks are instituted from
July this year.
To find out more information about Primary
Health Networks and INWMML’s focus for the
future, visit www.inwmml.org.au/phnnews
PRIMARY FOCUS
10
TAKING A
Hospitals like the Royal Melbourne are
centres of medical excellence, but aren’t
always the best place for chronic care.
HOSPITAL PASS
Hospitals have
come a long way
since they were
seen as being
only for those too
poor to afford to
be treated in their
own homes, or
where the sick
would go to die.
While many hospitals have now become centres of medical and
scientific excellence, it remains true that they aren’t always the
best place to receive medical care: especially when it comes to the
prevention and management of chronic disease.
Seven percent of all hospital admissions in Australia in 2011/12 were
considered to be potentially avoidable, driven mainly by admissions for
vaccine-preventable diseases and chronic conditions that could have been
avoided through more effective community based care.
As well as taking patients out of their communities, hospital care is often
also the most expensive treatment option, with avoidable admissions
placing a strain on the system that will only grow as chronic diseases
become more prevalent.
Reducing the pressure on hospitals isn’t as simple as cutting hospital
treatment for chronic disease – many potentially avoidable admissions are
necessary by the time a patient presents at a hospital.
The opportunity to prevent these admissions comes earlier, by identifying
prevention, management or treatment needs and providing targeted
services that stop those needs going unmet and resulting in hospitalisation.
Hospitals themselves are playing a key role in keeping people healthy in
the community, with Hospital Admission Risk Programs (HARP) being
supported by major hospital networks across Victoria.
HARP provides specialist treatment, care planning, education and support
to help people with chronic and complex health issues to self-manage at
home and reduce hospital admissions.
PRIMARY FOCUS
11
Royal Melbourne Hospital HARP General Physician Dr Amira Mahboub
says it’s about providing a seamless transition from the hospital to
the community for people who are at risk of readmission, rather than
continuing to see the hospital as the centre of all care.
“Now I think that sort of view has changed and the hospital is just a sort
of hiccup in their journey, and we’re supposed to get them back to their
normal baseline in the community,” Dr Mahboub said.
Dr Mahboub works with a range of HARP clinicians and other community
practitioners in areas as diverse as nursing, allied health and pharmacy to
ensure that patients have access to all the services they need and their GP
is connected throughout.
As well as improving the delivery of care, programs like HARP are
becoming increasingly important for their ability to lower health expenditure
by potentially avoiding acute care episodes.
“I think with healthcare costs it’s not feasible anymore to keep people in
hospital for weeks at a time, and there are really simple things that can be
done that can keep people out.”
Mental health is one area where the shift from an institutional focus to a
community based model has long been established. However preventing
avoidable hospitalisations in this area, particularly emergency department
presentations in crisis situations, can often be quite challenging.
The Inner West Police and Clinician Emergency Response Service (Inner
West PACER) is one way local emergency mental health services are
looking to meet this challenge, working with police to provide an effective
model of care for responding to mental health crises in the community.
Operated by the Royal Melbourne Hospital Emergency Mental Health
Team, Inner West PACER operates in the afternoons and evenings seven
days a week, providing early intervention and assessment in response
to a behavioural event in the community that has necessitated police
attendance, and which may involve a person with a mental illness or
condition.
As well as responding to the initial crisis, follow up care and coordination
of services is a crucial part of the program, especially where a person
receives a PACER interaction and is not immediately referred to an inpatient unit or emergency department.
INWMML has provided funding to support care coordination in these
circumstances, including provision of information to the patient’s usual
general practitioner (where possible and with patient consent) to ensure
continuity of care.
INWMML General Manager of Primary Care Services and Clinical
Psychologist Julie Borninkhof says supporting communication between the
different services involved is vital to ensure the individual receives the best
possible care.
“Having information available about each incident and any interventions
that may have been provided is really important for consistency of care,
especially for the person’s GP who is working with them on a regular
basis,” Ms Borninkhof said.
Another field where consistency of care and a community based approach
are of primary importance is aged care.
Older people are more likely to live with multiple chronic conditions and be
at risk of hospitalisation than the general community, with 49.6% of people
aged over 65 having two or more chronic conditions.
Conversely older people often do not cope well with hospitalisation,
particularly people living in Residential Aged Care Facilities (RACFs) who
Dr Amira Mahboub.
may find the process of going to hospital
especially difficult.
“Older people deteriorate very quickly when
they come into hospital,” Dr Mahboub said.
“They might be very independent at home
and the minute they come into hospital they
decline very rapidly.”
To help keep RACF residents well and out
of hospital where possible, St Vincent’s
Hospital Residential In-Reach (RIR) services
bring hospital like care into RACFs,
providing assessment and management of
acute medical conditions.
Staffed by hospital-based nurses and
doctors and supported by INWMML,
RIR services often reduce the need for
hospitalisation of a resident.
RACF staff who responded to a survey
on the RIR program were extremely positive
about its benefits for residents, many of
whom are frail and require complex,
ongoing care.
“In-Reach has made a big difference to
the care delivered [to] our residents,”
one respondent said. “Transfer to ED
has been avoided many times. Also, the
services around End of Life decisions and
discussions have been of great benefit.”
These programs represent just a few of
the many services seeking to keep people
well in their own community and in their
own homes.
And while there are many changes emerging
in the way primary health is coordinated
and delivered in the coming year, keeping
people healthy, independent and out of
hospital where appropriate will always
remain a priority.
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Coburg local
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INWMML would like to acknowledge the Immunisation Alliance WA, which has granted approval for use of their I Immunise concept for this campaign.
© MPCN 2014 All rights reserved
PRIMARY FOCUS
13
FOCUS
ON:
MUSCULOSKELETAL CONDITIONS
Each issue we profile a treatment, condition or practice management
tool. This issue we look at musculoskeletal system conditions, with
assistance from Arthritis and Osteoporosis Victoria.
ABOUT
Musculoskeletal conditions, including arthritis, osteoarthritis, osteoporosis
and other conditions, affect more people in Australia than any other type of
chronic disease – surpassing rates of cancer, diabetes and heart disease.
29 out of 100 people in our region (ASR) are affected by a musculoskeletal
condition, and across Australia more than 6 million people are estimated to
have some type of musculoskeletal disease.
While musculoskeletal conditions such as arthritis can often be seen as
‘older person’s diseases’ or a natural part of ageing, in fact more than half of
people living with such conditions are aged between 25 and 64 – the prime
working age population.
The A Problem Worth Solving report by Arthritis and Osteoporosis Victoria
estimates that by 2032, as the population ages, the number of cases of
arthritis and other musculoskeletal conditions in Australia will increase by
43% to 8.7 million, affecting 30.2% of the projected 2032 population of
29.1 million.
IMPACT
In terms of total economic impact, it was calculated that arthritis and
other musculoskeletal conditions resulted in a $55.1 billion cost to the
Australian community, comprised of $9.2 billion direct health costs (including
hospitalisation, pharmaceuticals and aged care), $11.7 billion other financial
costs (including $7.4 billion productivity cost) and $34.2 billion burden
of disease.
Following the launch of A Problem Worth Solving in 2013, the Victorian
Department of Health established the Musculoskeletal Clinical Leadership
Group with the purpose of providing expert guidance and advice to develop
a coordinated approach across all health settings to improve outcomes for
Victorians with, or at risk of, musculoskeletal conditions.
For further information about Arthritis and Osteoporosis Victoria,
its work and the report A Problem Worth Solving, please refer to the
website www.arthritisvic.org.au
MANAGEMENT IN OUR REGION
HealthPathways Melbourne is developing a
range of best practice clinical assessment,
management and referral pathways to assist
GPs to better manage musculoskeletal
conditions in the community.
The first of these pathways covers low back
pain, and is due to be released in the next
couple of months following more than a year
of development by leading specialists from
the Royal Melbourne Hospital, St Vincent’s
Hospital Melbourne and Eastern Health,
in conjunction with general practice and
community allied health professionals.
The pathway supports diagnosis and
treatment at the primary care level where
possible, with the aim of providing better
patient care and reducing unnecessary
referrals and hospital outpatient waiting lists.
You can read more about the low back
pain pathway on page four, and GPs can
obtain a username and password for the
site by contacting
[email protected]
PRIMARY FOCUS
24
IN ONE EAR
twitter.com/inwmml
YOUR PRACTICE
Keep up to date with Your Practice, our fortnightly
newsletter covering all our upcoming events as
well as the latest news and information from across
the primary health care sector.
Subscribe to Your Practice through [email protected]
or read it online at www.inwmml.org.au
ACKNOWLEDGEMENTS
We acknowledge the Wurundjeri people and
other peoples of the Kulin nation as the Traditional
Owners of the land on which our work in the community
takes place. We pay our respects to their Elders past
and present.
Medicare Locals gratefully acknowledge the financial
and other support from the Australian Government
Department of Health.
Missed out on the big tips?
Here’s our news in 140
characters or less.
Make sure you catch everything next time by following us at
twitter.com/inwmml
INWMELBMEDICARELOCAL @INWMML • FEB 11
New @AusHealthcare report highlights importance on healthcare
collaboration, praises @INWMML program http://inwmml.org.au/news/fxnews.cfm?loadref=6&id=121…
INWMELBMEDICARELOCAL @INWMML • FEB 4
Are you an #ImmuneHero? Great information for students, parents and
everyone at http://immunehero.health.vic.gov.au/ @BetterHealthGov
INWMELBMEDICARELOCAL @INWMML • JAN 27
DISCLAIMER
This magazine is provided for information only. Although
every effort is made to ensure accuracy of information,
it is presented without warranty of any kind either
expressed or implied. The reader assumes the entire
risk as to the use of the magazine and the material in it.
The views expressed in this magazine are those of the
authors and do not necessarily reflect the official position
of Inner North West Melbourne Medicare Local.
Time to #RethinkSugaryDrink? Check out these tips from @NutritionAust
http://www.rethinksugarydrink.org.au/go-free
INWMELBMEDICARELOCAL @INWMML • JAN 17
ICYMI: RT @AusHealthcare: Find out how @INWMML is providing a helping
hand to young ppl doing it tough in #Melbourne: http://goo.gl/41qCa7
INWMELBMEDICARELOCAL @INWMML • JAN 14
INNER NORTH WEST MELBOURNE
MEDICARE LOCAL
‘100 day cough’ making a comeback in Melbourne – pertussis on the rise
in the city @melbtimes @MelbourneLeader http://inwmml.org.au/news/fxnews.cfm?loadref=6&id=118…
ABN 95 153 323 436
INWMELBMEDICARELOCAL @INWMML • JAN 9
Telephone: (03) 9347 1188 Fax: (03) 9347 7433
Street address: Level 1, 369 Royal Parade, Parkville,
Victoria 3052
Postal address: PO Box 139, Parkville, Victoria 3052
Email enquiries: [email protected]
ADVERTISE WITH US
Standard advertising rates for the
magazine (excluding GST):
NON-
MEMBER
INWMML
MEMBER
•Quarter page $450
•Half page
$800
•Full page
$1,500
$225
$400
$750
All material is subject to editorial review.
Please contact Julie Sucksmith on
(03) 93471188 for more information.
This comic strip sums up why vaccines are so important @sciencecomic
@thenib – https://medium.com/the-nib/vaccines-work-here-are-the-facts5de3d0f9ffd0
INWMELBMEDICARELOCAL @INWMML • JAN 8
The #Hepatitis B Story education tool is now online in plain Karen
language – funded by @INWMML with @StVincentsMelb http://vimeo.
com/114616160#t=0s
INWMELBMEDICARELOCAL @INWMML • DEC 23
Some fantastic news to end the year… http://www.inwmml.org.au/news/fxnews.cfm?loadref=6&id=115… #Melbourne #healthcare
INWMELBMEDICARELOCAL @INWMML • DEC 18
Great article in @AusHealthcare ‘#Health Advocate’ on @Youth_Projects
program in #Melbourne #homelessness
PRIMARY FOCUS
15
EVENTS
www.inwmml.org.au/events
The Manipulative
Patient – GP Mental
Health Series
17 March, 6:30–9pm
Secure Messaging
19 March, 6:30–8:30pm
Cervical Screening
19 March, 6:30–8:30pm
Asthma Update
and Inhaler Devices
14 April 2015, 6.30–9pm
Care Plans
and Coaching
The Melbourne Clinic,
130 Church St, Richmond
RSVP 10 March
Dr Michael Moloney, Director of The Melbourne Clinic Drug and
Alcohol Rehabilitation Unit, will explore the how to recognise
manipulative behaviours and develop strategies to assist in dealing
with these patients.
Speaker: AJ Williams-Tchen
The Treacy Centre,
126 The Avenue, Parkville
RSVP 11 March
Level 1,
369 Royal Parade, Parkville
RSVP 12 March
The Treacy Centre
126 The Avenue,
Parkville
RSVP 7 April
The Treacy Centre,
126 The Avenue, Parkville
24 March, 6.30–9pm
UPCOMING EVENTS
• CPR update – 15 April
• Alcohol and Drugs – LGBTIQ sensitivity
and cultural competency training – 28 April
• Family Violence – 7 May
• Advance Care Planning – April (date tbc)
RACGP: 4 category 2 points
Are you considering secure messaging to enhance your business.
Do you want to learn more about the benefits of secure messaging?
Do you have Argus but not currently fully utilising it? Then this event
is for you.
For practice nurses: Join the discussion with expert Kirsten
Hausknecht and learn about the importance of screening for cervical
cancer, and the current renewal of the National Cervical Screening
Program.
For GPs and practice nurses: This update covers the essentials of
best-practice asthma and respiratory management for primary care
health professionals and includes an interactive demonstration on
the correct use of inhaler devices.
For GPs and practice nurses: Help your patients identify goals
and improve their confidence to self-manage! Improve medical
compliance in patients with cardiovascular disease! Training
also includes a revision of the MBS item requirements for GP
Management Plans, Team Care arrangements and Reviews.
MORE INFORMATION
For more information and registration visit www.inwmml.org.au/events
OR make sure you read our fortnightly newsletter, Your Practice.
Feedback: We welcome your feedback about our events,
email [email protected].
Sponsorship: If you would like to sponsor an INWMML event call
Julie Sucksmith on (03) 9347 1188.
ADVERTISEMENT
Real Solutions for Dementia Family Care Providers
For more information, visit us at:
www.dementiaconsult.com.au
hyperbaric-OBC_Layout 1 27/02/14 12:17 PM Page 1
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