success in practice
New service to help your patients lead a healthier lifestyle
August 2009 | Issue 3 2
Meeting the challenges of national health reform
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Pandemic (H1N1) 2009 puts infection control in the spotlight
gpns has launched a new service that offers easy access to two chronic disease risk programs that promote prevention and early intervention.
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Being networked a plus for practices
Reset your Life is a Commonwealth Government initiative for prevention of type 2 diabetes developed by the Baker IDI Heart and Diabetes Institute. This program targets 40-49 year olds (15-54 years for Aboriginal and Torres Strait Islander peoples), and will be delivered by gpns and other accredited providers at selected sites across southern Adelaide.
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‘Better outcomes’ for people with a mental health problem
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How to exercise your growing CAT
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e-Learning an option for busy practice nurses
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Systems support for managing chronic disease
General practice is a key setting for health promotion and illness prevention activity, including identifying and managing patients at risk of chronic disease.
Do it for Life is a SA Health initiative for preventing chronic disease. This program targets population groups more likely to be at risk of chronic disease due to economic, social and environmental factors. Eligibility to both programs is dependent on completion of a simple risk assessment (AUSDRISK tool), and Medicare Item Nos 710, 713 and 717 may be used as a pathway. Feedback on individual patient participation and progress will be reported to the referring GP on completion of the program. gpns staff can advise and provide practical support to identify and recruit patients to these programs. Patient resources, a referral form, templates for MBS items 710, 713 and 717 and the AUSDRISK tool are available on the new chronic disease prevention page at http://www.gpns.org.au/site/index.cfm?display=48517 If you’d like to know more about referring patients to our new ‘one stop’ chronic disease risk service, please contact us for an appointment at your practice: Chronic Disease Coordinator, wendy.saunders@gpns.org.au or GP Plus Nurse Systems Support, mary.dickson@gpns.org.au
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Meeting the challenges of national health reform Recently in Adelaide, around 250 GPs and executives from the national general practice network heard Dr Christine Bennett, Chair of the National Health and Hospitals Reform Commission (NHHRC), present relevant key primary health care recommendations from the Commission’s work. A fellow Commissioner, Professor Justin Beilby, Executive Dean, Faculty of Health Sciences, at the University of Adelaide and Professor of General Practice at the University of Adelaide, also attended. Those present felt that we are on the brink of the greatest changes to our health system in 30 years. The NHHRC was established in February 2008 to tackle the current and future challenges in our health system, including the ageing population, the increasing burden of chronic disease, rising health costs and systemic inefficiencies. Four themes emerged in the NHHRC report: 1. Taking responsibility: Individual and collective action to build good health and wellbeing – by people, families, communities, health professionals, employers, health funders and governments 2. Connecting care: Comprehensive care for people over their lifetime 3. Facing inequities: Recognise and tackle the causes and impacts of health inequities 4. Driving quality performance: Leadership and systems to achieve best use of people, resources, and evolving knowledge.
About this newsletter Editor: Sheryl Klingner, Corporate Communications Email: sheryl.klingner@gpns.org.au Phone: 8374 7000 We welcome your feedback so please send your comments and suggestions to the Editor. Download: pdf available under News & Events – Publications at www.gpns.org.au
Dr Bennett highlighted several recommendations in the report that offer both significant opportunities and challenges for general practice and the divisions network: • • • • • • • •
• •
strengthening and integrating primary health care investing in prevention with greater support for personal responsibility in making healthy decisions getting services to people and people to services in rural and remote areas establishing a Clinical Education and Training Agency clinical teaching and health services research focus establishing a person-controlled electronic health record connecting care across the service continuum through smart use of data and knowledge ‘Closing the gap’ through forming a national Aborignal and Torres Strait Islander peoples health agency to purchase services for Indigenous people evolving to a next generation Medicare – strategic purchasing, pay for performance and reshaping the MBS creating ‘one health system’ – introducing the Healthy Australia Accord and exploring the concept of ‘Medicare Select’.
The policy momentum that is building around primary health care-led health reform will clearly transform general practice networks. The proposal from the Commission that ‘service coordination and population health planning priorities should be enhanced at the local level through the establishment of Primary Health Care Organisations’ (Recommendation 21), reflects the role that many divisions have already taken on. The gpns Board is strongly committed to helping to build our future health system on a platform of high quality general practice. We believe that the results of strengthening the primary health care system based on, in and around general practice will be significant, provided that grass roots general practice is engaged in the redesign process. The next few months will be focussed on where we need to position ourselves strategically to move forward. To that end we will be building clinical leadership within gpns, and remaining strongly connected with our member practices, to ensure that when advocating for new models of primary health care we are advocating for general practice whilst meeting the needs of the broader community. A snapshot from the report, Blueprint for Reform, is available under Publications on our website, or for a full copy, please visit www.yourhealth.gov.au If you have any questions, please contact me on 0416 005 406 or helena.williams@gpns.org.au
Subscribe: To organise a copy delivered direct to your email inbox, email us at julie.canino@gpns.org.au
Dr Helena Williams Chief Executive
Success in Practice| August 2009
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Pandemic (H1N1) 2009 puts infection control in the spotlight gpns continues to assist general practice in responding to Pandemic H1N1 2009 by highlighting important and emerging issues and providing information and practical support. The current outbreak has highlighted the importance of good infection control, leading to discussion within practices and changes to procedure. All practice staff need ongoing education about standard and additional precautions to enable them to identify relevant management strategies to reduce potential cross infection. While the outbreak of H1N1 influenza has placed standard infection control procedures in the spotlight, it’s vital to regularly review work practices to reflect current standards. For example, asking the question ‘is this a single use item?’ The RACGP Infection Control Standards for Office Based Practices 4th edition (pp 92–93) lists single use items such as spacers, nebuliser masks and tubing. You can refer to this publication and the SA Health infection control website via the Influenza Noticeboard page at www.gpns.org.au Some practices have redesigned their office space and have designated one room for infectious patients. This has meant removing unnecessary equipment to reduce potential infection transmission, also making cleaning easier. As the H1N1 virus can survive for many hours on surfaces, it is important that all contaminated surfaces are cleaned with detergent and dried. This includes smaller items, like stethoscopes! Good communication between practice staff is a priority. Strategies might include holding more frequent staff meetings and setting up a noticeboard to post updates and visual alerts that remind staff to guard their own health. As a guide, we’ve developed an Infection Control Checklist for General Practice in the PROTECT phase which can be downloaded via the Influenza Noticeboard at www.gpns.org.au It is also useful for key staff to work through the RACGP Pandemic Flu Kit posted to all gpns practices in July 2009. For help to work through the modules in the kit, please contact gpns Immunisation/Quality Use of Medicines Coordinator, Julie O’Brien, on 8374 7000 or julie.obrien@gpns.org.au
Practical help to identify and manage domestic violence Intimate partner violence (or domestic violence) is the most common form of assault perpetrated against adult women in Australia today. It is estimated that full time GPs see up to five women per week who have experienced some form of Domestic Violence (DV) (physical, spritual, financial, emotional, sexual, elder) in the past 12 months. Pregnancy is a risk factor for abuse, with evidence suggesting that between four and nine women in every 100 pregnant women are abused. Taft A. Violence against women in pregnancy and after childbirth: Current knowledge and issues in health care responses. Sydney: Australian Domestic & Family Violence Clearinghouse, 2002. Available at www.adfvc.unsw.edu.au/PDF%20files/Issuespaper6.pdf [Accessed 3 April 2009].
General practice is an ideal setting for people experiencing DV to safely and confidentially disclose to a trusted health care provider and to access ongoing care, resources and support. While patients may be reluctant to raise the issue, sensitive questioning can help to encourage disclosure. gpns is committed to supporting the practice team in dealing with this often missed but major health issue. This includes providing education, onsite training and resources to increase understanding about DV and how to safely and sensitively question patients. Displaying consumer resources in the waiting room or in discrete areas, can help people affected by DV safely access information, while promoting general practice as a place to seek and receive support. Clinical guidelines for general practitioners are available under Violence at http://www.gpns.org.au/site/index.cfm?display=43888 For more information about DV training, resources or support, please contact gpns Health Promotion Coordinator, Ann Hine, on 8374 7000 or ann.hine@gpns.org.au
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www.gpns.org.au
“The gpns DV training made me see how important general practice can be for families.”
Will the Fair Work Act 2009 affect your practice? The new Fair Work system started on 1 July 2009. It’s Australia’s new national workplace relations system created by the Fair Work Act 2009 (Act). This legislation only applies to employers that are constitutional corporations* – generally speaking a business that is Pty Ltd, Ltd or Inc. Under this legislation, Fair Work Australia will replace the Australian Industrial Relations Commission, Australia Fair Pay Commission and the Workplace Authority as the body responsible for, amongst other things, the approval, variation and termination of agreements, federal wage case decisions and the conciliation and/or arbitration of workplace disputes and unfair dismissal claims. The Act sets a safety net of 10 minimum National Employment Standards (NES). These standards will apply to all employees of constitutional corporations regardless of industry or occupation from 1 January 2010. The NES are: 1. maximum weekly hours of work 2. the right to request flexible working arrangements
6. community service leave 7. long service leave
3. parental leave and related entitlements 4. annual leave 5. personal / carer’s leave and compassionate leave
8. public holidays 9. notice of termination and redundancy pay 10. a ‘Fair Work Information Statement’ for all employees that makes clear their rights and entitlements under the new system and how to get advice and help.
It is important for practices to be aware of their individual situation and to seek professional advice if unsure about whether they are a constitutional corporation for the purpose of applying the Act. gpns is hosting a Practice Managers/Admin Network event focussing on the Fair Work Act on 9 September. For more detailed information about the new Fair Work system, please visit http://www.fairwork.gov.au/The-new-Fair-Work-system For more information about any aspect of this article, please contact gpns Corporate Services Manager, Helen Shaw on 8374 7000 or helen.shaw@gpns.org.au *Important Note: The SA Government is considering legislation that will transfer its Industrial Relations powers to the Commonwealth. If this occurs all businesses will be covered by the Act.
Being networked a plus for practices Since its launch in mid-2006, 45 practices within gpns have participated in GP Plus Health Network activities. This has led to an increased number of nurses joining practice teams in the south and to practices working on a range of quality improvement activities such as disease registers and using data extraction tools to monitor quality care. The southern GP Plus Network is funded by the Southern Adelaide Health Service. Based on feedback from general practice, evaluation of the Chronic Disease training and our commitment to continuous improvement, we are offering the Network in a fresh format during 2009-10. All practices in the south will have the opportunity to access intensive tailored support to help build on the systems they already have in place to improve team-based patient care and safety. Participating practices will be offered a supportive assessment from the gpns team to identify priority areas for improvement. In close consultation with each practice, we will provide custom supports to address these priority areas with a focus on IT, chronic disease and addressing the physical health of people with mental illness. Important aspects of this approach will be: • • •
support with using data extraction tools to identify and manage patients assistance to identify and link in with local providers of allied health services education opportunities including in-practice skills training, inter-practice visits and clinical attachments to help build team skills.
For more information about participating in this Network initiative, please contact your gpns Practice Support Team member or gpns Chronic Disease/GP Plus Coordinator, Alf Martin on 8374 7000 or alf.martin@gpns.org.au
Success in Practice| August 2009
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Good systems the best line of defence for ‘success in practice’ The latest event in our popular Success in Practice series was held in July. Almost 50 GPs, Practice Managers and Practice Nurses heard presentations by David Dahm, Chief Executive of Health and Life supported by Warwick Westlake, Chief Executive Officer of Victor Medical Centre. The speakers highlighted how practices can use benchmarking as a quality improvement tool to help understand where they are efficient, identify areas for improvement and how their performance ranks against other practices. David also addressed practice accreditation and legal standards in respect to risk. He explored case examples that included triaging and the importance of asking the right questions, and how to document attempts to contact patients who have not attended appointments. A key message was the importance of maintaining good practice systems as the best line of defence to prevent adverse events. To suggest topics to be covered at future Success in Practice events, please contact gpns Medical Education Coordinator, Joslyn Hibberd, on 8374 7000 or joslyn.hibberd@gpns.org.au
‘Better outcomes’ for people with a mental health problem One in five Australians has a mental health problem, but less than 40 per cent will seek help. Of those who do seek help, 75 per cent will do so from their GP. It’s estimated that 85 per cent of the population sees a GP every year, and mental health is the second most common general practice co-morbidity. The Better Outcomes in Mental Health Care (BOIMHC) program was introduced in 2001 to help improve consumers’ access to high quality primary mental health care. A key component is Access to Allied Psychological Services (ATAPS), which enables GPs to refer consumers with high prevalence disorders to allied health professionals for six sessions of evidence-based mental health care, with an option of a further six (or up to 18 in exceptional circumstances) sessions following a mental health review by the referring GP. Results from the Fourteenth Evaluation of ATAPS and Perinatal Depression Initiative Report produced by the University of Melbourne show that between 1 July 2003 and 31 March 2009: • • • •
10,296 GPs (5,914 urban; 4,382 rural) referred consumers to 3,527 (2,548 urban; 979 rural) allied health professionals through the Access to Allied Psychological Services (ATAPS) projects 153,922 consumers (56 percent urban, 44 per cent rural) were referred to the ATAPS projects, 116,782 of whom took up the referrals provided 602,405 sessions (58 percent urban, 42 per cent rural) of care were provided through the projects, making the average number of sessions provided to consumers 5.1 The projects were shown to be achieving positive outcomes of large or medium magnitude in 86 per cent of cases.
gpns facilitates the BOIMHC program (Southern Wellbeing) and the rural More Allied Health Service (MAHS) program in the south treating high prevalence disorders with a brief therapy approach. These services are available for people on a low income, aged 12 years and above. Mental Health Shared Care supports general practice to manage more complex patients with an emphasis on physical and mental health care. The pathway to all programs is via a Mental Health Treatment Plan, Medicare item number 2710. Our mental health team continues to expand as a result of adopting an ‘employed’, rather than a ‘contracted’ service model. We’ve welcomed the following new clinicians in recent weeks: ! Gabriele Soeffky, Psychologist/Social Worker ! Danielle Relf, Social Worker ! Daniel Haebich, Social Worker
! ! !
Andrew Moulding, Social Worker (rural) Belinda Sanders, Psychologist (rural) Marc Wilson, Psychologist (rural)
We welcome the opportunity to support your practice in providing quality evidence based mental health care to your patients. Please contact the gpns Mental Health Team on 8374 7000 for any queries regarding our programs or advice about referral to other available mental health services.
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www.gpns.org.au
How to exercise your growing CAT This month Zedmed practices join Medical Director, Best Practice and Genie users who can all benefit from making informed population health decisions using the Clinical Audit Tool (CAT). How can your practice benefit from the National Performance Indicators (NPIs)? The NPI tables are standard reports in CAT. We are required to provide this de-identified statistical information to the Department of Health and Ageing. At the practice level you can use the NPI statistics to support improved patient care and better clinical recording. By using the table below as a template and adding information over time (i.e. monthly/quarterly) you can demonstrate trends and present the data at a clinical staff meeting to inform areas for improvement and success in practice. There are NPI tables for recording HbA1c in diabetics, blood pressure in chronic heart disease patients and Pap smears. Table 1 - NPI Indicator CDM-2 Diabetes patients: The number of patients whose last recorded HbA1c within the previous 12 months was:
<= 7.0%
> 7.0% and <= 8.0%
> 8.0% and < 10.0%
>= 10.0%
Not Recorded
Total
May 2009
34.02%
19.58%
8.46%
6.75%
31.19%
100.0 %
August 2009
35.06%
19.58%
8.46%
6.75%
30.15%
100.0 %
50%
25%
5%
0.0%
20%
100.0 %
Target November 2009
Using Table 1 as an example: Not recorded HbA1c and <=7.0% show a minor improvement between May and August with no change in the other measures. Your response to this could be part of a set of Plan Do Study Act cycles, using these key questions to guide your discussion: Q: Do our figures show a quality improvement? If not, why not? Or, which activities/initiatives have resulted in an improvement? A: We have not shown a quality improvement. Recording issues, possible causes being: patients’ results not being downloaded in HL7 format, patients under the care of an endocrinologist, patients reside in a nursing home, patients may have moved out of the area and record needs archiving, patient has slipped through the recall system. Q: Where do we need to improve? What strategies do we put in place for improvement? A: We need to improve our recording of HbA1c. Strategies: contact pathology laboratories to send results in HL7 format. Encourage specialists to send an electronic copy of results to the practice (add this preference to referral template). implement a system to manually enter HbA1c results in the patient record, recall patients who have no HbA1c recorded. Q: What will our target be for the next reporting period (i.e. next month/quarter)? Target-setting examples shown in red text above. A: Target: HbA1c not recorded down to 20% by December 2009. Be realistic with targets. Further information, including user forums, can be found at the new CAT website (an initiative of Pen Computer Systems and the RACGP) www.clinicalaudit.com.au For a free clinical audit tool or support queries, please contact gpns Practice Support Coordinator, Rachel Hayhurst, on 8374 7004 or rachel.hayhurst@gpns.org.au
Pathology results and clinical decision making Clinical software has the capacity to import results from pathology companies into the patient record; general practice can then use this data to support clinical decision making. If you want information to be transferred in this way, ask each of your pathology providers to send the results in HL7 LOINC format. HL7 (Health level 7) is a common ‘language’ that enables healthcare applications to share clinical data with each other. LOINC (Logical Observation Identifier Names and Codes) is a universal code to identify specific tests. Once the requesting clinician has actioned the HL7 LOINC format pathology result, the values are automatically populated into the relevant place in the patient record. This saves time in manually transferring the data and reduces the risk of error. Users can view pathology results over time or graph trends e.g. HBA1c values (Note: Capability may vary between clinical software). Transferring information this way also ensures that it’s correctly stored in the patient record for identification by data extraction tools. For information or support, please contact gpns Practice Support Coordinator, Rachel Hayhurst, on 8374 7004 or rachel.hayhurst@gpns.org.au or gpns e-Health Coordinator, James Scott on 8374 7000 or james.scott@gpns.org.au
Success in Practice| August 2009
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e-Learning an option for busy practice nurses e-learning is a flexible and accessible way to deliver education and training that considers the evolving roles and the existing responsibilities of practice nurses. Delivery methods include CD-ROMs, video conferencing, websites and e-mail. Among the benefits of e-learning are: • • •
the flexibility of self-paced learning availability 24 hours a day, 7 days a week, nationwide consistent training content.
The Australian General Practice Network (AGPN), in partnership with the Royal College of Nursing Australia (RCNA) and Batchelor Institute of Indigenous Tertiary Education, has launched the e-Learning Training Package to support Medicare Item 10997. The e-Learning package consists of a foundation unit and six disease-specific units. The foundation module incorporates three units: • • •
an overview of chronic disease care planning and management, including roles of health care team members and legal and practical information on accessing and utilising Medicare Item 10997 a self-management support unit.
This module is strongly recommended as a prerequisite before undertaking any of the disease-specific modules. These modules cover the topic areas of arthritis, asthma, dementia, diabetes, cancer and coronary heart disease. A new kidney health module is being developed for inclusion in the package. Participants receive a certificate upon successful completion of each module, together with RCNA Continuing Nurse Education (CNE) points. This package is available at no cost until 31 August 2009, after which a fee applies. To access this package, please visit www.3lp.rcna.org.au/10997 and follow the instructions under Getting Started. You do not need to be an RCNA member. For more information, please contact the Nursing in General Practice team on 02 6228 0800 or agpnreception@agpn.com.au or gpns GP Plus Nurse Program Development, Karen Smith, on 8374 7000 or karen.smith@gpns.org.au Interested in other online learning resources? APNA Online Learning provides a range of education and training, specific to the general practice clinical and business environment that enhances the professional role of practice nurses. Visit: http://www.learningseat.com/servlet/ShopFrontPage?companyId=APNA or contact APNA on Freecall 1300 303 184 or email education@apna.asn.au Queensland Health-Diabetic Foot Innovation Project (DFIP) toolkit provides a standardised suite of innovative best practice tools for the management of ambulatory based diabetic foot complications. It includes Clinical Assessment and Management tools, Diabetic Foot On-Line Education Program for health professionals and Patient Education Tools. Visit: http://www.health.qld.gov.au/cpic/resources/diabetic_foot.asp
Have you visited the gpns website lately? We continue to streamline and update our website with the aim of providing a ‘one-stop’ portal for up-to-date information that is useful and relevant to general practice. Recent changes include: • Information about our services and programs which is available under the Practice Support tab on the home page toolbar, previously titled Programs. • A new section on chronic disease prevention is now available under Practice Support (previously under Health Promotion). • An expanded Resources section offers several service finding functions and links to searchable databases. The new ‘Find a Service’ section, enables your practice to search for allied health professionals and community services and programs. Options include using the Human Services Finder, logging on to the Health Provider Registry or via accessing the allied health professional associations’ databases. • New graphic icons on the home page for quick access to topical issues. Your feedback is vital to help us make sure our website meets your needs. Please contact, gpns Corporate Communications, Sheryl Klingner, on 8374 7000 or sheryl.klingner@gpns.org.au with suggestions at any time. 7
www.gpns.org.au
Systems support for managing chronic disease Does your practice struggle with how and when to claim the Medicare Enhanced Primary Care (EPC) item numbers? What is meant by systematic chronic disease care? To support effective care for patients with chronic disease, practices need to be proactive and have robust systems in place that enable the consistent application of best practice guidelines. These include systems that promote regular reviews, screening and monitoring of complications and appropriate referral pathways. Processes that promote patient education and engagement with other health services help people to better understand their condition and actively care for themselves. To enable this high quality, structured approach, it is important that the whole practice team understands the Medicare EPC scheme. To assist, gpns has updated the EPC Item Number Claiming grid which highlights the waiting periods between the EPC Item Numbers. We have also developed a chart to help make claiming the diabetes cycle of care item numbers easier to track. The chart lists the individual components of the diabetes cycle of care and highlights how often they should be completed to enable claiming the appropriate item number. To download this chart, please click on www.gpns.org.au/client_images/284361.pdf For support to use these resources and implement systems of care that meet the needs of both practice and patients, please contact gpns GP Plus Nurse Systems Support, Carol Buchanan, on 8374 7000 or carol.buchanan@gpns.org.au
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Disclaimer: The information contained in this publication is offered by gpns solely for informational purposes and does not constitute professional, commercial or technical advice. It is not intended to be comprehensive and may not take into account all the factors that need to be considered before putting the information into practice. Accordingly, no person should rely on anything contained here as a substitute for specific advice. gpns will not be responsible for any loss caused by reliance upon this information.
Box 1, Level 3A, Mark Oliphant Building, Bedford Park SA 5042 T 8374 7000 F 8299 0362
gpns@gpns.org.au www.gpns.org.au
Success in Practice| August 2009
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