HealthSpeak April 2016 by North Coast Primary Health Network

HealthSpeak

Connecting health care piece by piece page 13

NCPHN Needs Assessment

Improving

11 BreastScreening rates

ICE – a

18 personal story

Aboriginal Chronic

21 Care integration

issue 15 • April 2016

THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

Integration benefits everyone

T editor Janet Grist

Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au

Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

Health Speak Contacts Editor: Janet Grist Ph: 6627 3300 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2016 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by

enthusiasm and dedication to their particular system improvement tasks and their satisfaction when the patient’s journey is improved. There will be plenty more articles about Integration to come. Until next time, happy reading!

Commonwealth Intends to Revolutionise Health Care

Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au Northern Rivers Tarmons House 20 Dalley Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au

he Integration Feature (page 13) is just a taste of the many exciting projects in place across the North Coast making real strides in joining up the health system. Interviewing people and writing about their work, I was struck by their

ceo Vahid Saberi

he announcement on 31 March 2016 by the Government to revolutionise the way we care for Australians with chronic diseases and complex conditions – aiming to keep these patients well and out of hospital is noble and important. The announcement was considered as sufficiently weighty to be made jointly by the Prime Minister and the Minister for Health and Aged Care - and it is. The objective of the announcement, to reorganise payment and care arrangements for people with multiple and complex conditions, has its roots in the recently released ‘Better Outcomes For People with Chronic and Complex Conditions’ – the report of the Primary Health Care Advisory Group chaired by Dr Steve Hambleton. The intention is for patients with chronic and complex conditions to get customised care packages tailored to their particular needs - with the patients having a say in their care. Additionally, the aim is to have this care coordinated so they can find their way in the complex, at times maze like, health and social services system. The reasons why this announcement is important and well past its due time are numerous. As has been repeatedly reinforced by many over

the years, the big challenge the community and system faces is chronic disease. In March 2016 the Grattan Institute released its publication “Chronic failure in primary care”, which is well worth a read. It sets out the chronic disease challenge that we face as a nation. It highlights that 75% of people over the age of 65 have one or more chronic diseases and 90% of Australians die from chronic disease. Both these percentages are higher in disadvantaged communities. I am sure you have heard this before and it’s easy to glaze over the numbers. While the information is not surprising, what is surprising is how out of synch our health care system is to respond to this. For example, many chronic diseases can be self-managed with limited social and health support. This is especially true of the early stages of chronic disease. Hence if we build the support systems and the capacity of patients early, they can deal better with the later stages when the disease becomes more disabling. Our system responds well to acute episodes in a paternalistic manner, not to long term conditions, in an empowering way. The system’s incentives and approaches are all designed to cater to episodic care, not to chronic longer term care. I once heard someone say that policy makers will have a different perspective on health once they experience the system with a sick parent. This is true. Currently people with chronic disease see an array of clinicians, all fragmented - GPs, specialists, nurses, pharmacists, physiotherapists, psychologists, dieticians,

a publication of North Coast Primary Health Network

and the list goes on. It’s easy to see why the announced changes could potentially be game changing, shifting the health system to be driven from the perspective of the patient, instead of the service provider. The announcement implies that the issue we are facing isn’t a technical one, but systemic, and can be addressed by changing the way we organise ourselves and work together. The change intends to simplify the care of chronically ill patients by allowing them to nominate one GP practice as their ‘home base’. The patients will have tailored care plans developed in partnership with their families and their clinicians. Involving the patient and those that support them is to empower them. The ‘Health Care Homes’ will then co-ordinate the medical, allied health and out-of-hospital care of the patient. Health Care Homes can be GP practices or Aboriginal Medical Services. Patients will need to satisfy the requirements of the program and then enrol. The payments for Health Care Homes will be ‘bundled’ and paid quarterly. This signals a move away from the current feefor-service payment model for chronically sick patients. The announced new approach will be piloted initially, with an extra $21 million committed to support the rollout of trials. It is planned for 65,000 patients to participate in two-year trials in up to 200 medical practices beginning on 1 July 2017. Time will tell how successful this approach will be. What is sure is that change is needed and the status quo is untenable. healthspeak April 2016

Chronic Pain Workshop review

clinical editor Andrew Binns

The biopsychosocial approach produces the best outcomes

n Saturday 27 February 2016 the NCPHN held a workshop in Byron Bay on acute and chronic pain management. This large topic was dealt with over four hours and this article will review the highlights and take-home messages of an event that was well attended by GPs and allied health professionals. The Chair was well-known GP educator Hilton Koppe who ran the event with his usual skill. The program was well planned and gave practical advice for managing challenging patients with significant chronic pain. The keynote speaker was Professor Michael Nicholas, Pain Management Research Institute, University of Sydney, Royal North Shore Hospital. He pointed out that whilst acute pain is a useful warning signal, chronic pain causes major disability and suffering. Once pain following an injury persists beyond the normal healing time of up to three months the only realistic option is to reduce its impact. The focus needs to be on self management and daily functioning rather than trying to ‘fix up’ the pain. For a GP this revelation can be a relief from relying exclusively on the procedural or medication approach, which rarely seems to totally succeed for chronic pain sufferers, and may even make matters worse. Community surveys and clinical studies show consistently that people experiencing chronic pain who employ active self-management strategies, such as maintaining daily activities despite the pain, will undergo less pain-related disability than those who adopt more passive approaches, such as resting or April 2016 healthspeak

relying on others to perform their daily tasks. Whilst some people may be able to employ their own graded self-management strategies, many will require help in acquiring these skills. GPs will often need to refer chronic pain sufferers to appropriate structured multidisciplinary pain clinics that use cognitive behavioural methods. The problem here is that there is a dearth of such specialised public hospital based clinics, and as a result there are often long waiting lists. Access for people in rural areas is particularly difficult. As GPs today are collaborating more with allied health professionals there is scope for more community management of chronic pain, whether in the practice setting or private allied health facilities. These alternatives are probably going to be needed more in the future to keep up with the burgeoning demand. In an ageing population, and with surveys showing between 10-30% of the population suffering from chronic pain, the burden of this disease on individuals and the health system is huge. While more self-management is clearly needed, it is not yet evident exactly what works, and more research is needed in this area. For those with chronic pain, some 60% have disability, with depression also common (50%-80%), and the combination inevitably leads to a poorer quality of life. Acute pain treatments usually relieve occasional headaches, post surgical pain and epidurals for pain during childbirth, but

for those with chronic pain on average the reduction in pain with these commonly used treatments is about 30% at best.

For those with chronic pain, some 60% have disability, with depression also common (50%-80%)

So how effective are long term opioids? A review article in Annals of Internal Medicine ( January 2015) concluded there is a lack of evidence for the long term benefit of opioids for pain and daily functioning. In addition, there is evidence for dose dependent risk of harms, e.g. overdose, opioid abuse, fractures, myocardial infarction, opioid induced hyperalgesia and sexual dysfunction. The higher the dose, the higher the risk. There are also the well known side effects of opioids, which disappear with dose reduction. A comprehensive paper, ‘Reconsidering opioid therapy’, from the Health Professional Resources, Hunter Integrated Pain Service concluded that existing evidence Continued page 32

a publication of North Coast Primary Health Network

Revitalised NCPHN Board

he past few months have seen some changes to North Coast Primary Health Network’s Board of Directors. Including four GPs, the NCPHN Board now has nine members. The Board’s Constitution prohibits any one profession dominating its ranks, and the five other members are from differing professions. Two long-standing and valued members have retired from the Board – Professor Lesley Barclay and GP Dr David Gregory. Lesley has also stepped down from her role as Director of the University Centre for Rural Health in Lismore and moved to Sydney where she is Emeritus Professor within the Sydney Medical School at The University of Sydney. Lesley told HealthSpeak that she was delighted to join the original Medicare Local Board. “I was particularly delighted because the other Board members and the ML’s senior executive and subsequent PHN team also shared a similar vision and had the capacity and expertise to make this work. “Joining this team of committed and expert individuals was a privilege and a pleasure. Meetings were challenging and enjoyable as they pushed us to think through better ways of delivering

Warren Grimshaw AM

health care. I look forward to seeing how all this progresses as I am still on the NCNSW LHD Board,” she said. The other retiring Board member, David Gregory and his family have moved to Canberra. David said he’d thoroughly enjoyed his time on the Board of both the Medicare Local and NCPHN as well as his time spent as a clinical adviser at the Port Macquarie office. “It was great working with all the staff and also working with Tony Lembke to bring the vision of the Medicare Local to life. Now with NCPHN there’s great potential to continue to improve health outcomes for the North Coast and I wish the Board well,” said David. David will take some well deserved time out before considering what he’d like to do next. The new members of the

Dr Sharon Sykes

Board are Chair of the Board of the Mid North Coast Local Health District, Warren Grimshaw AM and Port Macquarie general practitioner Dr Sharon Sykes. A distinguished public administrator, Warren brings extensive experience to his new role. He was Executive Director/CEO of the NSW Ministry of Education and Youth Affairs where he demonstrated leadership and strategic vision in the formulation and implementation of Government Policy. In addition, he was responsible for the co-ordination of strategic policy across schools, TAFE and higher education. He also brings a great deal of knowledge of health issues to his appointment. Dr Sharon Sykes graduated from the University of Queensland in 2000 and is a

Fellow of the RACGP. Before studying medicine she had a successful career in medical science. Sharon is a clinical General Practitioner in Port Macquarie where she has lived since 2007 and has special interests in clinical governance and medical education She spent 19 years in the Royal Australian Airforce, has been on the boards of various not for profit organisations and is actively involved in Medical Education. Sharon believes strongly in the provision of primary health care to all, regardless of their socioeconomic situation. NCPHN’s Chief Executive Vahid Saberi welcomed the appointments of Warren and Sharon. “Warren brings exceptional leadership and strategic skills to his role and will further enhance Board representation of the Mid North Coast region. We are also fortunate to have Sharon’s skills on our Board and welcome her contribution both as a GP and a representative of the Hastings Macleay region.” The other members of the Board are: Chair, Dr Tony Lembke, Dr Diane Blanckensee, Dr Tim Francis, Mr Scott Monaghan, Mr Malcolm Marshall, Mr Philip Silver and Dr Jo Sutherland.

Final GP adviser appointed

Dr Graham Carey

CPHN is delighted to welcome our recently appointed Hastings Macleay GP adviser Dr Graham Carey. Graham has been a GP in Port Macquarie for 10 years. During this time he’s owned and run a group practice, been a GP registrar supervisor and maintained a keen interest in quality improvement through his work as a practice accreditation surveyor. He is also the GP VMO for the in-patient Pal-

liative Care Unit at Wauchope Hospital. As a GP adviser Graham’s role is to foster deeper communication and collaboration between General Practice, Allied Health and other primary care providers, and the secondary care services of the Local Health Network. “I look forward to empowering local health care providers in taking advantage of the exciting opportunities that are

a publication of North Coast Primary Health Network

being presented to us by the recent health care reforms. Specifically we find ourselves with opportunities like never before to directly impact on healthcare resources available to patients through the NCPHN’s new process of health care commissioning,” he said. NCPHN’s other GP advisers are: Dr Paul Davies, Dr Marion Tait, Dr Gull Herzberg, Dr Brett Lynam and Dr Dan Ewald.

healthspeak April 2016

Drug & Alcohol misuse biggest North Coast health concern

s many readers would know, North Coast Primary Health Network (NCPHN) recently completed a Health Needs Assessment for the North Coast, from the Queensland border down to Port Macquarie. A great deal of interesting health data was collected, but across the entire region the main concern expressed by community members through the online survey was alcohol and drug misuse (54%). Other major concerns were mental health issues (51%) and ageing issues (51%). In concert with community concerns, more than half of the health service providers surveyed in the region (60%) identified mental health as the top local health issue. The Needs Assessment, which began in February, is the largest exercise with the aim of identifying the region’s health needs ever carried out. The process involved analysing data and engaging with community members and clinicians. The information gathered will help identify and prioritise health areas of concern and access issues. NCPHN will work with the community and service providers to determine what can be done to address these concerns. The 2016 Needs Assessment process included: 1. Interviewing over 60 clinicians 2. Running community focus groups 3. Developing and disseminating a health survey for community members completed by 2,420 people 4. Service mapping and collation of health and service statistics 5. Holding two public presentations and round table discussions with clincians, service providers and community members to prioritise health needs and identify possible responses April 2016 healthspeak

• Lack of coordination between Non-Government Organisations • High rates of alcohol consumption • Increasing rates of crystal methamphetamine use What’s next?

Other key findings

Aboriginal and/or Torres Strait Islander respondents also most frequently identified drug and alcohol misuse as the most serious health issue locally (59%), followed by diabetes (44%) and mental health issues (39.5%). For those who have needed access to aged care services for themselves, or on behalf of an older person, 38.4% found it hard to access inhome domestic support, followed by in-home medical support (30%) and respite support for carers (30%).

Getting into a private psychiatrist in the Port Macquarie area is like getting an audience with the Queen…they’re full of chronic patients – General Practitioner With regard to drug and alcohol services, service providers and clinicians reported coordinated mental health and drug and alcohol services hard to access (62%), followed by residential rehab (49%) and early intervention (47%).

Needs Assessment Workshops

On 14 March in Coffs Harbour and 17 March in Lismore, public presentations attended by around 200 people, were held to share the findings of the health statistics analysis and service mapping. Following each of these sessions. a roundtable workshop, each attended by around 50 service providers, clinicians and community members, focused on prioritising identified needs and consulting on potential solutions. Issues most highly prioritised by stakeholders were: • Poor access to communitybased mental health programs • High rates of suicide (particularly Ballina, Byron, Lismore, Tweed and Clarence Valley) • Poor access to early intervention in mental health • Diabetes rates in Aboriginal and/or Torres Strait Islander communities, and high rates of renal dialysis • Poor access to dentists, and high rates of hospitalisation of Aboriginal people for dental conditions • Poor awareness of services by older people • High rates of concern about family violence among older people • Lack of coordination between Mental Health and Drug & Alcohol services

a publication of North Coast Primary Health Network

This process is just beginning. The North Coast Primary Health Network will further analyse the results of the Needs Assessment and will continue to develop proposed solutions with community members and service providers. Futher community presentations will take place in May.

I simply feel the access to drug and alcohol, acute drug and alcohol, detox and that sort of stuff is really, really difficult – General Practitioner

Want more information?

To help the community gain a greater understanding of the health and social landscapes across our region we have published a range of resources. This information will be a valuable tool to help identify and prioritise the health and access needs for our communities. It will also provide an evidence base on which to make resource allocation decisions and assist in planning solutions for better primary health care outcomes across our region. http://ncphn.org.au/needsassessment-2016/ For more information on the Needs Assessment please contact NCPHN on ph: 02 6618 5400.

CTG Health Screening Events As part of Close the Gap 10th anniversary celebrations, local health providers and services came together to host two highly successful 1 Deadly Step chronic health screening days on Thursday 17 March at Coffs Harbour Showground and on Wednesday 6 April at Casino’s Indoor Football Stadium.

Deadly Step is a footballthemed eight--stage screening initiative delivering free Chronic Disease Health checks in Aboriginal Communities across NSW. Health professionals test screen participants for chronic health conditions such as kidney disease, lung disease, heart disease and diabetes, which make up the majority of the Gap in Aboriginal health. The partnership between the Agency for Clinical Innovation, Country Rugby League and local health organisations to host 1 Deadly Step helps achieve the program’s objectives to • Increase awareness of chronic diseases • Promote prevention and management • Increase early detection of chronic disease • Provide timely referrals to specialists services • Improve chronic disease follow ups with local providers. The Coffs Event

The North Coast Primary Health Network’s Closing the Gap team worked together in Coffs Harbour with Galambila Aboriginal Health Service, MNCLHD, Key Employment, headspace, Southern Cross Uni, CHASE Coffs Harbour and Ngurrala Aboriginal Corporation, to host the event at Coffs Harbour showground. As well as the health screening, there was local entertainment, a BBQ lunch, family activities and health and community stalls. The presence of high profile Rugby League ambas6

sadors Dean Widders and Ricky Walford boosted attendance and helped promote the importance of screening for chronic disease. A total of 123 people from Coffs Harbour and the Nambucca Valley completed all the screening stages at the event. A unique part of 1 Deadly Step is the use of an iPad app which records and analyses each person’s screening results. The app provides a snapshot of each participant’s combined chronic disease risk and this information can then be accessed by the person’s GP to develop targeted care plans. Participants were pleased to

have the opportunity to learn more about their health status. One said: ““The 1 Deadly Step event was well organised and offered health checks I would not usually have.” Casino draws a crowd

Around 200 community members including mums and babies from Casino and surrounding villages turned out to be part of the 1 Deadly Step community event held at the Indoor Football Stadium. Health and community organisations held stalls to promote a healthy lifestyle and there was plenty of music from

a publication of North Coast Primary Health Network

Blakboi and the Brotherhood of the Blues. Football ambassadors Sebastian and Bill King from the Northern United Lismore team, and Dennis Moran, Matthew King and other community members made local children very happy. They spent about an hour showing the kids how to develop their footy skills on the field adjacent to the Stadium. More than 80 people completed the 1 Deadly Step screening program which will link up with the participant’s doctors to ensure follow up appointments are made to look at any chronic health issues. healthspeak April 2016

RN placement turns into permanent role

hen Southern Cross University student nurse Veronica Seymour came to Lismore Skin Clinic in October last year to do her final student placement , Kerry Gudmundsen knew very quickly that she’d like to offer Veronica a permanent job. Kerry is the senior RN at Lismore Skin Clinic which is owned and operated by dermatologist Dr Ken Gudmundsen and provides a wide range of services. These include general dermatology, skin checks, acne treatment, skin surgery, hyperhidrosis (excessive sweating treatment), Photodynamic Therapy and cosmetic dermatology. The clinic also offers a medi spa. “Veronica was a good all rounder and worked well with patients and staff, and importantly she got on well with our doctor, a big plus!” said Kerry. Veronica had originally wanted to do a surgical placement but as those positions in hospital are few, she told HealthSpeak that she thought outside of the square and realised that by going to a specialist Dermatology practice she’d be doing a lot of the things she wanted to learn about.

From left: RN Veronica Seymour, Dr Ken Gudmundsen and senior RN Kerry Gudmundsen

“I used to work in the pathology collection service located in the same building as Lismore Skin Clinic, so I knew the staff and a bit about what they did. But until my placement I didn’t realise how much Dermatology involved,” she said. Now Veronica works alongside Dr Gudmundsen, making nurse diagnoses under his supervision, conducting new patient assessments and performing the required dermatology. She sutures, gives local anaesthetic, performs biopsies, scrapings, collects pathol-

ogy, sterilises instruments and performs other tasks as needed. Kerry said she’d encourage nursing students to consider going into Dermatology. “It’s a very interesting field with big changes in treatment happening, especially in areas such as psoriasis.” Veronica said the work she did was often very satisfying. She said that some patients came in with severe psoriasis on most of their bodies and often didn’t think much could be done to arrest it. But she said treatment cleared up the unsightly scales very efficiently and patients were very happy with the results. Kerry and Veronica have also applied to do a 12-month primary care post graduate qualification with Kerry as the Preceptor and Veronica as the trainee. Veronica is one of two SCU student nurses who were taken on at the practices where they did their placements last year. The Lismore Skin Clinic and Southern Cross University are working together again this year to give nursing students an opportunity to experience this field of nursing.

Kempsey & Bowraville kids star in training videos

hen the students at Kempsey’s Macleay Vocational College were shown videos during the first day of a First Aid training workshop run by North Coast Primary Health Network (NCPHN), the kids told NCPHN’s Annie Orenshaw that ‘there’s nothing Australian in these videos, it’s all American’. Indeed, the content was entirely American and even included emergency contact numbers that were irrelevant in Australia. This got Annie thinking and she realised that a CPR training video starring the kids from the College would be the perfect platform for them to learn more about CPR and to gain some confidence and selfesteem as the stars of the clip. The North Coast Primary Health Network was able to find some funds in its budget

April 2016 healthspeak

to produce an Australian CPR training video using paramedic Pulse Start trainer Michael Johnson and the students. “It was a great opportunity. NCPHN’s videographer Sara Momtazian was in charge of the filming and she allowed the kids to help out with all aspects of the camera work, lighting and sound. They really learnt a lot that day and thoroughly enjoyed working

with us to create this totally Australian video clip,” said Annie. School Principal Mark Morrison was very encouraging of the project, but it didn’t end there. Annie’s colleague in Coffs Harbour, Helen Lambert, thought the kids at Bowraville High School would also benefit from the same experience. Again funds were found and a second Australian

a publication of North Coast Primary Health Network

training clip was born. Helen said that the remote community of Bowraville had experienced two deaths from drowning, so the students decided their scenario would be a ‘trip and fall incident’ near the river. “There is little or no network signal, so the alternative emergency call 112 was included in the script. We are very pleased with the result and the film has been shared by the students, who are proud of their achievement. They were also committed to making a culturally competent film and used Gumbaynnggirr language in the script,” said Helen. NCPHN’s vision is to produce DVDs and distribute them to the students, schools and community organisations. The students at Bowraville are creating artwork to complete the finished resource.

HealthPathways reaches the heart!

ebruary saw the official launch of three HealthPathways cardiology topics - Atrial Fibrillation (AF), Heart Failure and Chest Pain. A Cardiology Update evening was held at the NSW Rural Clinical School in Port Macquarie in February to showcase the Pathways and highlight how primary and secondary care can work together in the ongoing management of these conditions. The audience were privileged to have all three local cardiologists, Dr Kevin Alford, Dr Chris Alexopoulos and Dr Kristian Prados, make presentations on the key topics. The event was attended by 90 people - GPs, practice nurses, hospital staff and allied health. The speakers gave updates as well as a brief introduction to the new Cardiac Catheterisation Laboratory at Port Macquarie Base Hospital. Sue Sheeran, Heart Failure Specialist Nurse, also gave a brief summary on the Heart Failure service. The cardiology pathways were the culmination of a cardiology work group comprising our key speak-

reducing recurrent admissions. • Troponin testing in general practice remains complex

The three cardiologists - from left, Dr Chris Alexopoulos, Dr Kristian Prados and Dr Kevin Alford.

ers, general practitioners and specialist nurses. The clinical messages were: • Start anti coagulation early in AF • Aspirin has no role in anticoagulation in AF • Beta-blockers and ACE inhibitors are the mainstay of heart failure treatment • Patient self-monitoring and self-regulation of diuretics is essential and can reduce unnecessary admissions. Use of the Heart Failure diary will assist with this.

Coming together to look ahead

ore than 90 North Coast Primary Health Network staff from five offices came together in Coffs Harbour for a day/night event to consider some key aspects of the PHN and the way ahead. On the Wednesday night, teams were assigned and given a series of team-building games including word puzzles, building a freestanding paper edifice and how to build protection for an egg dropped from two metres! The natural engineers in the groups rallied and some creative and impressive efforts were put on display. The following day staff heard from Chief Execu-

tive Vahid Saberi on topics including Commissioning, Transitioning and Decommissioning; mental health and substance misuse; the Health Needs Assessment and what NCPHN might look like in twelve months time. There were also discussions around tables about NCPHN’s vision and strategy and a presentation on Circles, a new way of working. The yearly gathering of staff is always a valuable opportunity to have a chat face to face with people you otherwise only work with via the telephone and email. Thanks to Helen Campbell and Janet Gray for their efforts in organising the event.

• The Heart Failure Education Service and Cardiac Rehabilitation play a vital role in managing these patients and

The evening concluded with a Q&A session with all the speakers. The HealthPathways team would like to thank the entire cardiology team for their ongoing support of HealthPathways and for a really enjoyable and informative evening. To access HealthPathways cardiology topics, go to http:// manc.healthpathways.org.au The user name is manchealth and the password is conn3ct3d

NCAHA Forum: much enthusiasm for integration

NCAHA Board members pictured at the Forum. from left Chair Prof Susan Nancarrow, Rob Curry, Luisa Eckhardt and Nick Neville.

he North Coast Allied Health Association’s (NCAHA’s) Inaugural Forum at Coffs Harbour in March attracted delegates from as far away as Albury and Toowomba, although more than half of the 70 participants were from the North Coast. Highlights included some lively discussion around the opportunities presented by the upcoming roll out of the National Disability Insurance Scheme. A number of innovative ideas on delivering high quality services to this segment of the population came up. Keynote speaker Professor Kathy Refshauge inspired delegates with the message that this is the Decade of Allied Health and Dr Teresa Anderson gave practical examples of health care

a publication of North Coast Primary Health Network

integration with relevance to allied health. Clinical placements were highlighted as a challenge for clinicians and educators alike. Hopefully, NCAHA can start a dialogue locally and nationally to try to improve the situation. In feedback, delegates said they would like the NCAHA to provide them with more integration opportunities with students, senior managers, nurses and doctors; education events allowing allied health professionals to look beyond the boundaries of their own professions and more networking opportunities. Membership of NCAHA has increased substantially since the event. If you’d like to join, go to: http://ncaha.org.au/membership/ healthspeak April 2016

Commissioning to meet health needs

ommissioning is a new way in which Primary Health Networks will be working to improve efficiency, effectiveness and coordination of care. It’s different to contracting and purchasing of available health services as the commissioning approach relies upon a solid understanding of health needs and the co-design of services to fulfil them by multiple stakeholders. At North Coast Primary Health Network, our model of commissioning involves a four phase process including: a needs assessment, planning and design of services, delivery and procurement of services, followed by monitoring and evaluation. Commissioning for health is a process of identifying approaches to directly meet the community’s health needs. To illustrate what this means, imagine a community in our region where education is not available for its children. What solutions come to mind to respond to this need? First instincts might tell you that building a new school would fill the gap and that it should be built as soon as possible. But firstly it’s important to consider what the need actually is and whether a school would be the most appropriate solution. We need to consider what kind of data will inform us about the

kind of education is needed and what an appropriate solution might look like. Commissioning involves a number of steps between identifying the need and implementing its solution. To assess the need for education in the community, we would need to know how many children are in the area and what type of education is lacking. We would also need to answer questions such as: How old are the children? What is the distance of the children to nearby schools? What transport options exist? How or where do these children currently study? What market factors need to be considered? What type of education suits their socioeco-

nomic and cultural needs? There would also be a range of individuals and institutions to be consulted to gain insight into these questions. These include parents, teachers, students, local government, community leaders, police and neighbours, etc.

sychiatrist Dr Tim Amor is working two days in Kempsey and two days in Port Macquarie each week. In Port Macquarie, Tim is at The Port Macquarie Super Clinic, 38 Clifton Drive, Port Macquarie. His clinics are on Wednesdays and Fridays and referrals can be sent to the clinic by fax on 6584 4633. In Kempsey, Tim is working from About You Medical and Allied Health Clinic, 6

April 2016 healthspeak

Sea Street, Kempsey. His clinics in Kempsey are held on Tuesdays and Thursdays and referrals can be sent by fax on 6562 7228. All initial one hour consultations will be bulk billed. All follow up appointments will be booked for 40 minutes and a gap payment of $60 will be charged. Aboriginal patients, pension card holders and veteran card holders will be bulk billed.

For more information about NCPHN’s commissioning model go to: http://ncphn.org.au/ commissioning-in-primaryhealth-networks/ Or email commissioning@ncphn. org.au

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

New private psychiatrist in Kempsey/Port

For the sake of this illustration, let us assume that based on the data and consultations, building a new school is the best solution. What would need to happen next to ensure the type of school designed and built fulfils the identified needs? How would the process of building the school be monitored and evaluated? Who would need to be consulted along the way? It is clear from this example that identifying needs and fulfilling them is no easy task. It requires a robust process that carefully determines needs and design solutions that respond to them.

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

Nurse on Duty www.southsidehealthandhire.com.au

a publication of North Coast Primary Health Network

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

The need for Cultural Awareness

arch 17 marked the 10th anniversary of Closing The Gap, a national strategy to address health, education and employment disparities between the Indigenous population and the Non-Indigenous population. The recent Closing the Gap report revealed mixed success, outlining improved health inputs and mortality indicators, but no significant improvement in life expectancy. But the NCPHN Aboriginal Health team sees no reason to lose focus over what could be interpreted as disappointing results. “The changes we are hoping to see in life expectancy and mortality will take time to gain momentum and become mea-

sureable It takes many years to know if interventions are truly effective,” said NCPHN Aboriginal Health Programs Officer, RuthTaylor. In considering the barriers to Closing the Gap, there is agreement that increased advocacy and cultural awareness are instrumental to its success. Cul-

tural awareness is the foundation of effective communication, particularly where health is concerned. Over the past few years the Aboriginal Health team has delivered cultural awareness training days for hundreds of health providers In February, Bundjalung man Rob Monaghan delivered Cultural Awareness training to a fully booked group in Lismore and the feedback was overwhelmingly positive. Our shared Australian history is something that we all need to acknowledge. Without a level of respect, we cannot expect to have the engagement and the conversations that we need to address health disparities.

HealthPathways for story topics in this issue

ere are the HealthPathways topics related to health topics found in this issue of HealthSpeak. To get to the main website, go to: http:// manc.healthpathways.org.au The user name is manchealth and the password is conn3ct3d Then go to the desired topic. Cardiology:

• Absolute Cardiovascular Disease Risk Assessment • Advanced or End-stage Heart Failure • Atrial Fibrillation (AF) • Cardiac Catheterisation Complications

• Cardiac Drugs and Monitoring • Cardiac Rehabilitation Services • Chest Pain • Deactivation of Implantable Cardiac Defibrillators (ICDs) • Heart Failure • Hyperlipidaemia • Hypertension • Infective Endocarditis

Prophylaxis

• Long QT Syndrome • Palpitations • Acute Cardiology Assessment

Pain Management:

• Opioid Use in Persistent

Pain • Persistent Non-cancer Pain • Chronic Pain Clinic Osteoporosis

• Osteoporosis Breast screening/cancer

• Breast Screening Palliative care

• Advanced of End Stage Heart Failure • Deactivation of Implanted Cardiac Defibrillators • Referral to Palliative Care Services • Bereavement Support • COPD Diabetes

• Diabetes Assessment • Diabetes Physical Activity • Diabetes Support • Diabetic Eye Disease Screening • Managing Newly Diagnosed Type 2 Diabetes • Pre-diabetes • Screening and Diagnosis of Diabetes Methamphetamines use

New Hep C medications

ew generation, direct-acting antiviral medications are now available on the PBS to those living with chronic hepatitis C. These new interferonfree treatments may be prescribed by GPs in consultation with a gastroenterologist, hepatologist or infectious diseases specialist experienced in the treatment of hepatitis C. The three main treatment services in Port Macquarie, Coffs Harbour and Lismore (and their respective outreach clinics) will be using a fax back service although it is still early days and not all clinics have access to the above specialists yet. Faxback forms and details of referral requirements are available from the clinics. Clinicians are in the process of updating the HealthPathways website and the LHD websites, and information on management will be posted there soon. Local updates will be published in the NCPHN fortnightly newsletter. Any questions, please call the Liver Clinics: Lismore 6620 7539; Coffs Harbour 6656 7939 and Port Macquarie 6588 2750. Essential reading for GPs interested in prescribing the new drugs is available online at: http://www. gesa.org.au/professional. asp?cid=77&id=454

• Drug and Alcohol Services 10

a publication of North Coast Primary Health Network

healthspeak April 2016

What GPs need to know about BreastScreen NSW

he latest participation rates for breast screening of women aged 50 to 74 years on the North Coast are 57.3 per cent, with Aboriginal and Torres Strait Islander women’s participation rate at 46.3 percent. This falls below the target rates of 70% for both groups. HEALTHSPEAK spoke to the Director of BreastScreen NSW North Coast Service, Jane Walsh and radiologist Dr Nick Repin about the service. While Jane Walsh describes the participation rate of eligible women aged 50 to 74 in the BreastScreen program in Northern NSW as ‘above the State average’, the service is keen to see more women, especially Aboriginal women over 40 come through its doors. (See story page 20).

Why every two years?

Nick explained that the two year window was optimal for a few reasons. “Because if lesions are are going to grow they will develop in that time and if the screening intervals were longer than two years the lesion could develop to a size which has a poor outcome. The whole focus of the screening program is to try to detect small lesions early enough so there’s a good result – to save lives. The smaller the lesion when it’s found the better for the woman. But you don’t want to be screening too frequently because of the radiation, and there’s a physical cost to the patient to consider. However, there are some patient categories where we recommend one year recall – a strong family history (a first degree relative under 50 diagnosed with breast cancer, for instance.)” What BreastScreen offers

The program complies with the BreastScreen Australia standards offering screening mammograms every two years to women aged 40 years and over. Nick April 2016 healthspeak

Dr Nick Repin and Jane Walsh at the Lismore BreastScreen centre.

said it was important for GPs to understand that BreastScreen is a specialist screening service, not a diagnostic service and that women with a symptom such as a lump should be sent to a private screening service, not to BreastScreen. He also said that some GPs refer women to BreastScreen for a biopsy after a mammogram has been taken in a private service; this is not part of the role of BreastScreen. “And it’s not possible for a woman to come into the program half way through, having been screened outside of the BreastScreen Australia program. It comes back to the divide between screening and diagnostic services. It’s not uncommon for us to be sent patients who have a symptom requesting to have a screening mammogram. In theory we should refuse them but we don’t. It’s important to know that we do not triage the women.”

Jane pointed out that the process driven nature of the BreastScreen service means that a woman needing a biopsy might also end up waiting three weeks from her screening appointment

How GPs can help • Set up a reminder system for patient mammograms aged 50 to 74 as they are in the high risk age group • Don’t send symptomatic patients to BreastScreen, send them to a private radiologist • Be aware of when the mobile unit is in your area and let patients know • Organise to visit a BreastScreen clinic if you’d like to find out more

a publication of North Coast Primary Health Network

to getting a result. This is a long wait and an anxious time for any women, but within national timeframes. It would be very difficult for a women with a symptom to wait that long. While screening can be done in a private practice, BreastScreen NSW North Coast generally yields a better result due to the highly skilled staff working for the program on the North Coast. Screening and assessment of asymptomatic women is our job, that’s what we do, Jane said. It’s important to remember that a Medicare rebate is not available for asymptomatic women in private practice unless there is a history of breast malignancy in the patient of her family. (See item 59300/59303 descriptors.) BreastScreen fills the unfunded screening gap, operating with a robust internal QA process underpinned by double or triple reading, large read volumes, regular feedback to readers, and with continuous monitoring of both cancer detection rates and specificity. This process is rarely achievable in private practice. How screening works

Nick explains the radiologist’s role. “The radiologists read the mammograms as they come in and decide whether or not there’s something visible that needs the woman to be recalled to attend a special assessment clinic, usually held once a week in Lismore and with varying frequency at our other site at Tweed Heads. Radiologists run the assessment clinics and decide whether to take additional pictures, order an ultrasound to further assess the client and if necessary take a biopsy then and there,” he said. He emphasised that BreastScreen radiologists were not attempting to take breast care away from GPs.

Continued page 38

ADVERTORIAL

Is a Self - Managed Super Fund Right for ME? By Michael Carlton CEO & Senior Adviser, PECUNIA Private Wealth Management

Self – Managed Super Funds (SMSFs) have become extremely popular for many Australians as a way to manage their retirement savings as they grow and create wealth (Accumulation Phase); and as they enjoy the fruits of their labour (Pension Phase). Recently the Australian Tax Office (ATO) released figures showing the number of number of SMSFs at 556,998 with over 1.4 million members. The estimated net worth in these funds is some $571,802 million. This represents a staggering 30,000 plus increase in the number of funds since 30 June 2014 and approximately $33,720 million more in assets as at 30 June 2015. The average SMSF member has accumulated funds of $397,856 and the demand is growing. With these large sums involved, it’s little wonder that the ATO, the regulator of SMSFs is keen to see this sector managed correctly. As from 1st July 2016, the regulators have stated that new legislative guidelines will take effect around professional advice on Self - Managed Superannuation Funds. Many think that this is purely advice about setting up an SMSF. In fact, it means a whole lot more.

briefs

GPs most trusted A survey of 2100 parents and caregivers of children under 18 years shows more than 90% received health advice from a GP in the preceding six months. The research also found that GPs were, for parents, the most trusted source of health information – ahead of pharmacists, paediatricians, family and friends. Seventy-five per cent of respondents said they had “a lot” of trust in GPs with hospitals ranking second on 60% and paediatricians third on 54%. In fourth place were psy-

Important information and disclaimer This publication has been prepared by Michael Carlton, an Authorised Representative (AR No: 239724) and Carlton Family Trust ABN 51 283 954 577 t/a PECUNIA Private Wealth Management a Corporate Representative (CAR No: 1233485) of Dover Financial Advisers Pty (AFSL No: 307248).

Having fielded many questions on this topic, let’s look at some key questions to consider before you decide, or are advised that a Self - Managed Super Fund is RIGHT for YOU? 1) Do you have enough money in super to make it cost effective? 2) Are you prepared to take an active interest in your super? 3) Are you comfortable to act as a trustee of an SMSF? 4) Are you comfortable in making investment decisions for your super? 5) Do you have insurances in your current super fund? 6) Are you expecting to reside overseas? 7) Are you aware there is no statutory compensation for Self-Managed Superannuation Funds? Read the full article at www.pecunia.com.au/resources/selfmanaged-super-fund-right-me

chologists and psychiatrists (38%) with pharmacists in fifth place on 37%.

Obese outnumber underweight A global study published in The Lancet reveals that there are now more people who are obese than underweight in the world. Six nations, including Australia, recorded dramatic increases in obesity levels over the past 40 years. Senior researcher, Professor Majid Ez-

Any advice in this publication is of a general nature only and has not been tailored to your personal circumstances. Accordingly, reliance should not be placed on the information contained in this document as the basis for making any financial investment, insurance or other decision. Please seek personal advice prior to acting on this information. Information in this publication is accurate as at the date of writing (March 2015). In some cases the information has been provided to us by third parties. While it is believed the information is accurate and reliable, the accuracy of that information is not guaranteed in any way. Opinions constitute our judgement at the time of issue and are subject to change. Neither the Licensee nor Michael Carlton and any beneficiary of Carlton Family Trust ABN 51 283 954 577 t/a PECUNIA Private Wealth Management, nor their employees or directors give any warranty of accuracy, not accept any responsibility for errors or omissions in this document. Any general tax information provided in this publication is intended as a guide only and is based on our general understanding of taxation laws. It is not intended to be a substitute for specialised taxation advice or an assessment of your liabilities, obligations or claim entitlements that arise, or could arise, under taxation law, and we recommend you consult with a registered tax agent.

zati from the School of Public Health at Imperial College, London, said the findings provide more evidence of a widening gap between the haves and have-nots in the world. Prof Ezzati said that while some parts of the world are now entering an era of severe obesity some regions of South East Asia still have high levels of underweight people still remaining, meaning there is still extreme suffering from high levels of undernourishment.

a publication of North Coast Primary Health Network

View past issues

Did you know you can read HealthSpeak online? Go to www.issuu.com/ healthspeak and see all 15 issues.

healthspeak April 2016

Connecting health care piece by piece

anyone with health needs, but is particularly important for people with complex and long term conditions, helping them to manage their own health, keeping them healthy, independent and out of hospital for as long as possible. This includes people with chronic disease, the frail elderly, people with disability and those at the end of life.

How is it Happening at all happening? levels The Collaboratives

Delivering truly integrated care is one of three strategic directions in the NSW State Health Plan: Towards 2021. The NSW

Participants at the Integrated Care Planning Day held at Ballina last month with participants from NNSWLHD and North Coast Primary Health Network.

April 2016 healthspeak

Government has committed $120 million over four years to implement innovative, locally-led models of integrated care across the state. Integrated care is also a national priority with the Government now considering the findings of the Primary Health Care Advisory Group’s report tabled late last year.

The Australian Primary Care Collaboratives pioneered approaches to working with general practice to improve the care of patients with complex conditions through small measurable improvements. Building on this experience, NCPHN has been working with both Mid North Coast and Northern NSW LHDs with the support of The Improvement Foundation to develop new and unique Collaboratives programs that engage clinicians across various sectors. Across the North Coast, a number of exciting projects are underway through the Integrated Care Collaborative implemented by NNSWLHD and NCPHN

a publication of North Coast Primary Health Network

with the support of The Improvement Foundation. This Collaborative aims to effect incremental changes at the clinical level and build teams across organisational boundaries. In Northern NSW 17 general practices are involved in the Integrated Care Collaborative and on the Mid North Coast nine practices are signed onto the Musculoskeletal Collaborative, implemented by Mid North Coast LHD and NCPHN. In this Collaborative, health workers from different parts of the health system are working together to improve care of a number of medical conditions. Examples of this work appear later in this article. HealthPathways

An initiative of North Coast Medicare Local (now NCPHN) and both the NNSW and MNC Local Health Districts, Mid and North Coast HealthPathways is an online portal where health practitioners can assess and manage a wide range of medical conditions, with pathways for easy referral to local specialists and allied health practitioners. In late March there were 186 HealthPathways live on the portal for practitioners working on 13

Integrated Health

Integrated care involves the provision of seamless, effective and efficient care that reflects the whole of a person’s health needs; from prevention through to end of life, across both physical and mental health, and in partnership with the individual, their carers and family. It requires greater focus on a person’s needs, better communication and connectivity between health care providers in primary care, community and hospital settings, and better access to community-based services close to home. With an ageing population and more people living with chronic or complex health conditions, health needs are changing and demands on the health system are increasing. North Coast Primary Health Network and the Mid North Coast and Northern NSW Local Health Districts are responding to these challenges by investing in new, innovative models of integrated care. These changes will transform our health system to routinely deliver person-centred, seamless, efficient and effective care, particularly for people with complex, long term conditions. Integrated care can benefit

Feature

What is Integrated Care?

Feature

From left: A group photo of some important HealthPathways players on the Mid North Coast early in the development of the portal. From left: Fiona Ryan, Project Officer NCPHN; Clinical Lead Dr David Gregory NCPHN; Ian Anderson Streamliners NZ; Clinical Advisor Dr Dan Ewald, NCPHN; Juanita Gibson, Streamliners NZ; Graham McGeoch, Streamliners NZ; Bronwyn Chalker, Director Allied Health & Integrated Care, MNCLHD.

Integrated Health

the North Coast and Mid North Coast. Each HealthPathway starts with a particular health problem and defines a pathway for its management that reflects evidence-based best practice in the context of local resources and facilities. HealthPathways links GPs, hospital clinicians, allied health professionals and private medical specialists into the reform process. Representatives from all health sectors are involved in developing HealthPathways, with their services identified in the published product. Integrating care piece by piece

Through re-thinking how a particular medical condition is managed locally, groups of clinicians and health service managers are leading health system reform piece by piece. HealthPathways act to support care in the GP setting, access to specialists, more appropriately allied health, and improve patient experiences. Dr Brenda Rattray is a GP working in Port Macquarie and is also a clinical editor of HealthPathways. She said the benefit to GPs was that HealthPathways was a complete package. “I only have to have open one website to access clinical information, Australian guidelines, medication information as well as plenty of patient resources and most importantly local referral 14

information. In a busy general practice you only have to click a few links to get all the local service information available where previously it may have taken a fair few phone calls. “Healthpathways provides a useful checklist during consultations, but I find it also a powerful educational tool for medical students and registrars as well as for the patients themselves.” The HealthPathways portal can be found at: http://manc. healthpathways.org.au The username for the website is manchealth and the password is conn3ct3d

Healthenet Notifying GPs of unplanned admissions

IT is a vitally important tool for health communication and a team of people in the clinical information system unit at NNSWLHD are working on various fronts to upgrade communication systems. Their work

is part of a bigger NSW e-health focus using the Healthenet portal to streamline and integrate communication between hospitals, community health and general practice. One project focuses on unplanned admission and discharge notifications (ADNs). It is hoped this incredibly complex and ground breaking piece of work will provide enormous benefits, but the system is still being built. HealthSpeak spoke to one of the NNSWLHD Integrated Care IT team members, Tim Marsh, about this work. He explained that up to now, when a patient presented to an LHD facility, the GP had no way of knowing about an unplanned admission to the wards (with a few exceptions for Chronic Disease Management Program patients). But he said by harnessing the existing Healthenet system, such a notification service could now be built. “Often the patient will arrive at the Emergency Department, be admitted to a ward, and then present to the doctor for a follow up consultation. As the doctor is not aware of the admission he has no idea what’s happened to his patient. There is zero visibility in most cases. “So if the patient subsequently visits their GP and a discharge summary has not yet been completed, the patient is left sitting in an appointment and the GP has no clinical information about the patient’s status. The GP needs to ring medical records while the patient waits, and there’s a lot of wasted time. It’s a very poor experience for everyone,” said Tim. What the LHD’s Integrated Care team is setting up is a system where the patient’s GP is sent a notification about the unplanned admission directly into their practice management systems via secure message brokers (eg HealthLink and Medical Objects). This alerts the GP about the admission, where the patient is and the attending physician. It also provides important demographic information about the patient so the GP can iden-

a publication of North Coast Primary Health Network

tify the patient to the hospital. “So, if the GP wants to phone the hospital and liaise with the physician and talk about current medication and any other information the LHD might not have, he or she can do that. On the other side of things, when the patient is discharged the GP gets a discharge notification immediately. This is a separate mechanism to the discharge summary which might come 24 or 48 hours later,” said Tim. This discharge notification allows the practice to call the patient and organise a follow up appointment and if the discharge summary does not arrive in a timely manner, the practice can call medical records and ensure the document turns up before the patient’s appointment. The new system will be trialled with integrated care patients, and if successful rolled out wider in Northern NSW. This new communication capability will save a lot of otherwise wasted time and ensures discharge summaries are available when needed. Tim pointed out another important benefit of the admission and discharge notifications, which he said had excited GPs. “The discharge notification also highlights if the patient is deceased and avoids the embarrassment of the practice calling the family about a follow up appointment when the patient has died,” he explained. Further projects in the pipeline include the Orion shared care planning system which is just in the initial stages, although general practices involved in the Integrated Care Collaborative are aware of it. An Expression of Interest will be sent to GPs in the next few months to invite them to join the Orion project. Tim said the e-health work being done was making more parts of NSW Health electronic. “More and more discharges and letters will be electronic. So, GPs will see a lot more ‘stuff ’ coming through electronically as more LHD staff use the same system.” healthspeak April 2016

Examples of Collaboratives Work An Australian First, the MNC Musculoskeletal Collaborative ine progressive and committed practices are participating in the MNC Musculoskeletal (MSK) Collaborative targeting osteoporosis and refracture prevention. These teams have embarked on a shared journey to implement changes at practice level to bridge the gap between the evidence base and current practice in managing these conditions. This group will pave the way for future groups to build on their successes and lessons learned. It is well known that the Mid North Coast has a population older than the state average with a significant portion living with musculoskeletal disease. The burden of musculoskeletal disease almost outstrips all other chronic conditions in terms of years of life lost, disability adjusted life years, and cost to the health care system and society as a whole. However, the disability associated with conditions such as arthritis, back pain and osteoporosis should not be considered an acceptable part of aging. This collaborative effort is part of the larger Musculoskeletal Primary Healthcare Initiative targeting osteoarthritis and being jointly conducted by the North Coast Primary Health Network, the MNC Local Health District the NSW Agency for Clinical Innovation and the Improvement Foundation. It is about supporting general practice teams to appropriately identify, investigate and manage these conditions in a systematic and proactive manner through coordinated care planning with a focus on patient self-management. It also highlights the need for integration and developing April 2016 healthspeak

The MSK HealthPathways workgroup at Woolgoolga. From left: Standing Sam Dixon, physio at MNC Physiotherapy; Aaron Hardacker, Physio at MNC Physiotherapy; Dr John Kramer GP; Sally McCann, Practice Nurse; Dr Judy Haines GP; Lee Hayes, Practice manager, Beach St Family Practice. Sitting from left: Dr Genevieve Halligan GP registrar; Alex Brugisser, Exercise Physiologist, MNC Physiotherapy; Sheree Riley, Dietitian, Coffs Coast Nutrition.

ways to better work with others outside primary health to deliver multidisciplinary models of care. Relationship building is key with a multitude of health professionals and services including fracture liaison coordinators, private allied health providers, private radiology services, falls prevention services etc. Hats must come off to the participating professionals in this initiative that have formed coordinated teams to better understand their patient population and to develop systematic and proactive ways to manage these conditions.

CDM program joins up services Kerry Wilcox, NNSWLHD’s Cardiac Services & Chronic Disease Program Manager, is leading the LHD’s revamped Chronic Disease Management (CDM) program, which will see the team look like a seamless extension of the patient’s general practice, but one reaching into the home and hospital. Adults over 16 with chronic diseases and complex care needs not living in an aged care facility don’t have a case manager, apart from mental health. Such pa-

From left: NNSWLHD Chronic Disease Program Coordinator and Health Coach Judy Clark; chronic disease program support group members from Ballina, and social worker, Annelieke De-Vries on the right

a publication of North Coast Primary Health Network

tients would benefit from shortterm help and better sharing of information with their health care home (general practice). To assist these patients, the program is allocating a CDM team member and a mental health person to general practices who refer patients to the team. Working with the team results in effective linking of patients with appropriate services and sharing of information. “Our program is working to fill the gaps so that chronic disease patients are given the holistic care they need and helped to navigate the system easily. GPs are now working with the CMD team to ensure the ongoing needs of the patient are coordinated effectively. This is a big change from the previous model,” Kerry told HealthSpeak. Benefits for patients & GPs: Care navigation - The

NNSWLHD CDM staff liaise with patients, discharge planners, NGOs and the GP to identify needs when in hospital. They provide a ‘my home plan’ for patients so they know who will care for them on discharge and how to contact them. CDM staff contact the patient by phone within 48 hours of discharge. They provide a home assessment within a week of discharge (new patients) after discussing pertinent issues with the general practice. This information is provided to the GP for management and negotiation of roles occurs for ongoing care coordination. Case conferencing allowing an MBS claim by the GP is encouraged. Continued next page

Integrated Health

Feature

The burden of musculoskeletal disease almost outstrips all other chronic conditions

From previous page

Additional Options: 1. Case management – Li-

Feature

aise with health care home to provide short-term case management to chronic and complex patients to ensure they can access services needed, navigate the system, get assistance with selfmanagement strategies and contribute to a shared care plan. The CDM coordinator can contribute to case conferencing or care planning as required by the GP. 2. Health Coaching – option for the CDM team to provide individual health coaching to patients to address chronic disease risk factors, improve self-management and monitor patient progress for six months.

Excitement around new model

NSWLHD Chronic Disease Program Coordinator Judy Clark has been with the CDM Program for five years and has seen big improvements in systems and strong relationships formed with allied health services and community health services. She’s excited about the revamped program. “Until now we haven’t worked much within the general practice arena. The new integration process will really benefit patients as we will all be on the same page as the medical home. Strong communication is central to everything we do, but especially when we’re looking at safe transfer of care, not only out of hospital but in short-term case management. “After completing case management and working with the GP to incorporate patient support services and clinical pathways, we can transfer care back to the general practice, and importantly they know they can call us if they need further support for that

patient,” Judy said. In her care navigator role, Judy said patients really appreciated having her as a single point of contact after discharge from hospital. She told HealthSpeak that the 48hour follow-up phone call and home visit for new referrals after discharge was a vital part of CDM care. “Patients love the fact that someone calls them when they get home to check that all their services are in place. And through those calls we do occasionally find faults within the system, that transfer of care is not always 100 per cent. So that 48-hour follow up call fills the gap.” Judy hopes to see some staff familiarisation with the various roles within Chronic Disease Management, with practice nurses going into the patient’s home with the CDM health worker and CDM workers going into general practice to see what a practice nurse’s working day involves.

Jullums connects with nearby services

A Integrated Health

s part of the Northern NSW Integrated Care Collaborative, staff at Jullums Aboriginal Medical Service in Lismore were asked to collaborate with Health District staff, Improvement Foundation and the North Coast Primary Health Network. Jullums’ Practice Manager Christine Wilson said because the Service saw a lot of chronic disease patients who also had mental health issues impacting on their care, it was decided to focus on 11 clients for the Collaborative project. As Riverlands Drug and Alcohol Unit and the LHD’s Mental Health Unit were both close to Jullums, a decision was made to create a stronger relationship between the three services. The Collaboratives work organised by NNSW LHD’s Integrated Health Coordinator Sandra O’Brien involved these two services working together to better coordinate the care of Jullums’ clients. “We were close by but had not interacted at this level before. 16

The lines of communication between Jullums, Riverlands and the Mental Health Unit are now wide open

Some of the participants at a joint health services meeting at Jullums last month

We were all working as silos with none of us effectively exchanging information on our clients” said Christine. “After introducing ourselves, we set up regular meetings to work out an agreed pathway to streamline the referral process. Our first Case Conference is yet to be held. These will take place on at a mutually suitable time once a month, or more often if the need is there. Donna Evans, Chronic Care

worker from LHD; Riverlands; Mental health; Darren Pott from NCPHN and Jullums’ staff and clients will participate. Hopefully, clients will feel empowered in their health journey and participate in their case management.” Christine said that having Sandra O’Brien helping the staff at Jullums formulate the processes had made a big difference to getting the prompt care and attention that their clients

a publication of North Coast Primary Health Network

needed. The fine tuning of provision of Discharge Summaries is very important. “We had one client who was having difficulties getting his medication sorted. I’d organised a meeting with Sandra about the issue and the client himself wandered into the kitchen where Sandra was having a cup of coffee and she was able to hear his patient journey in his own words. “We need this kind of patient information to better integrate systems. Sandra was able to look into the situation and see processes which had taken place, why the client felt as he did, give us feedback and we knew then

Continued page 30

healthspeak April 2016

ICE forum promotes understanding

ore than 50 health workers and community members attended a community conversation about crystal methamphetamine (ICE) at Casino Civic Hall late last year. Other ICE community conversations have been run in Coffs Harbour, Nimbin and Tweed Heads with more planned. Organised by North Coast Primary Health Network (NCPHN), the network’s Senior Substance Misuse Officers Sam Booker and Kim Gussy gave a presentation on crystal methamphetamine, its effects, and what’s known about the use of the drug in Australia. Since 2010, the use of ICE has increased markedly. New figures from the National Drug and Alcohol Research Council reveal ICE use tripled between 200910 and 2013-14. Some facts: • One-tenth of a gram of ICE costs between $50 and $80 and will keep a person who doesn’t use regularly awake

men and Aboriginal people. • Frequency of use is going up along with purity and the high rates of poly drug use are causing harm and the greater visibility of users in the community

Kim Gussy presents on ICE at the Community Conversation at Casino

for three to four days • 2.1 per cent of the Australian population use methamphetamines and half of this number use ICE • Since 2007 fewer people are using powder methamphetamines and more are using the crystalline form (ICE). • 55 per cent of ICE users use fewer times than once

a month, 20% use monthly, and 25% are regular users and may go on to have behavioural and mental health issues. • ICE use is high among people who are taking other drugs, truck drivers, miners, 29 years to 39 years of age, men who have sex with men, unemployed single

People at the community conversation also had an opportunity to put questions about ICE to a panel made up of Addiction Medicine specialist Dr David Helliwell; Deb Felton, Casino Neighbourhood Centre’s practice manager with 15 years’ experience in Drug and Alcohol; Police Duty Officer Doug Connors; Greg Telford, CEO of Rekindling the Spirit; and NCPHN’s Substance Misuse Manager Christine Minkov. Breakout groups identified strengths and needs of the community to respond to ICE. Local working groups will be formed from the Community Conversations to implement strategies.

An ICE user’s story To give health professionals an insight into the potential chaos resulting from ICE misuse, HealthSpeak spoke with Sonia, (not her real name) about how ICE affected her life. Sonia is now clean and studying to help others as a Drug and Alcohol Counsellor.

onia went to a North Coast private school and was a social teenage girl until the age of 15 when she was lured away from her town to Sydney by an older man already in the drug scene. Isolated from her family she started using substances such as speed, marijuana and alcohol. After five years and a family intervention, Sonia returned to her home town and came back into the drug

April 2016 healthspeak

scene where she felt protected, secure and accepted. Here her life went downhill, her drug use soared as her drugs were supplied free, and she stopped looking after herself. She ended up with charges such as driving without a licence and minor drug charges which still affect her employment prospects today. “Drug people, drug scene, drug houses, drug people. Once you start living that, that’s what you live. You don’t go for coffee at the local café, you don’t do a big supermarket shop, you don’t do those normal sort of things, you just go to houses where you know everyone is doing drugs and you only really associate with people where you can get on or get something free that day.

Your whole focus is drugs,” Sonia told HealthSpeak. Sonia later got married and had kids but didn’t stop using alcohol and other drugs. She led a double life and eventually started using ICE. “While I was married my

a publication of North Coast Primary Health Network

intra-venous habit got pretty big, I had money. At the end, I was spending $2000 a day. My husband was in love with me and knew I was fighting an addiction and I suppose he just wanted to keep me happy. But

Continued next page

An ice user’s story continued

trying to be a mother and a wife but also feeding the addiction and fighting that demon – it was very draining.” With her marriage in jeopardy, Sonia started a relationship with a fellow drug user and began neglecting her family. “It just got too hard juggling everything, it all crashed with so much going on. I put all my energy into the new relationship and when you are using drugs with someone you are so protected and you just rely on that relationship so much. That’s why if you are going to rehab and the partner is outside and using that’s all you want to do, go back to that person.” It was a court order that put Sonia into a rehab program in a western NSW country town, around the same time her husband told her she could no longer see her children. “My children were very young when this was happening and I’m grateful for that.

I have four kids and at that time my ex just kept life very busy for them and my mother played a huge role in supporting my ex and the kids. I’m grateful for all of that.” Sonia said that users have to really want to recover, and

I think deep down inside I knew without the drugs, I’d be a great mum. And I am now

many can’t see any way out of the drug scene. “It’s a horrible existence and deep down inside those people do want a better life but just don’t know how to get it. We feel judged, we know society knows what we are up to, we know what we look like and we

know what you are thinking. Another obstacle is women with children, where are the kids going to go when they go to rehab? Who is going to look after my kids? I had support.” Following rehab and her divorce, Sonia lived in a caravan park where no one knew her or her story. She had to build a new life from scratch, avoiding people she’d previously associated with. She also got much needed support from her GP. “My doctor recommended a really good Drug and Alcohol counsellor. I think deep down inside I knew without the drugs, I’d be a great mum. And I am now. I’m like the best Mum and there are women out there who are still trying to get that balance.” Grateful that her intravenous drug use hasn’t left her with sexually transmitted diseases, hep C, or other permanent health damage, Sonia said it’s important in recovery to be honest with your doctor about what’s going on for you

so that they can work with you. “My GP and counsellor have been good to me and I think being able to access those people whenever I need to is helpful. Knowing that I can get an appointment the next day helps me stay safe that day.” Nowadays Sonia’s life is the complete opposite of her previous life. She is no longer living in chaos with people knocking on the door day and night, and she focuses only on positive things and people. She and her children do sporting activities together as a family, she attends parent teacher nights and she’s engaged in every part of their lives. With ICE use becoming more prevalent, Sonia is scared about its potential impact on youth. “It’s so strong, it’s poison, it totally removes the person and you totally lose yourself. It drowns you as a person, you are no longer that person, it denies you a decent life. Your existence is totally owned by this drug.”

Online ICE training

comprehensive training package has been developed as part of the Victorian Government’s ICE Action Plan. The National Centre for Education and Training on Addiction (NCETA) at Flinders University developed the online package designed to meet the needs of frontline workers. It was developed following an extensive consultation process. The package provides information and resources to enhance existing skills and knowledge. The Training Package is broad and comprehensive in its approach, but focuses on the identification and care of people who are intoxicated with, and/or withdrawing from, crystal methamphetamine and their families and carers. The package provides useful mate18

rial to guide workers’ practice when assisting clients and their families, and working with their colleagues. The package has seven independent but complementary modules. It’s designed to be flexible, you don’t have to work through all the modules. You may want to just select the modules and topics most relevant to your particular circumstances. The package covers issues including: • Information about crystal methamphetamine and its use and harms • How crystal methamphetamine use affects people and communities • Worker safety and preventing, managing and recovering from crystal methamphetamine-related

critical incidents • Legal issues • Using crystal methamphetamine with alcohol and other drugs • Communicating with and supporting people who use crystal methamphetamine • Preventing and intervening

a publication of North Coast Primary Health Network

in crystal methamphetamine use • Organisational responses to crystal methamphetamine. You can create an account and begin the training here: www.nceta.androgogic.com.au/ index.php healthspeak April 2016

What is Osteopathy?

What is?

steopathy is a form of manual healthcare which recognises the important link between the structure of the body and the way it functions. Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit. Using evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of dysfunction in your body. Osteopathic treatment uses techniques such

Profile

as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues. In Australia, osteopaths are government registered practitioners who complete a minimum of five years’ university training in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques. Osteopaths are primary healthcare practitioners and are trained to recognise conditions that require medical referral.

April 2016 healthspeak

A listing of osteopaths can be found by visiting www. osteopathy.org.au

Matt Hempsell, Osteopath, One Health Clinic, Port Macquarie

att’s career in health care began as an observer and patient. Initially, he became interested in physiotherapy which he received as an amateur AFL player. He then qualified as a personal trainer which led to further sports therapy qualifications in the UK. “During this time I worked with rugby union teams in the UK and also in private practice, giving me valuable insight into the amazing contribution that sports physicians, physiotherapists, chiropractors and osteopaths make to sports people and the general public,” he told HealthSpeak. After qualifying as a sports therapist in the UK, Matt worked in London and surrounding areas alongside highly regarded health professionals, gaining valuable experience and further training. “I went on to teach sports and remedial massage therapy for several renowned institutions in London and throughout the UK, which led to me designing and writing a bespoke sports and remedial

They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems. Osteopathy is covered by most private health funds and by Medicare’s Chronic Disease Management (CDM) Plans. No referral is needed to see an osteopath unless you wish to consult one under the Veterans’ Affairs scheme.

massage course for one of the UK’s leading vocational training institutes.” However, Matt found that sports therapy was not widely recognised in the UK health system and decided to pursue Osteopathy as a career. “I made this choice mainly because of the in-depth level of training required and the medically associated elements. In both the UK and Australia, all osteopaths complete a minimum of five years university education in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques,” he said. While he worked as a sports therapist, Matt completed his degree in osteopathy. Upon

qualifying, he worked in the UK for a time before moving with his family back to Australia and Port Macquarie where he built up his highly regarded allied health practice. “Our practice incorporates osteopathy, physiotherapy and remedial massage therapy. We have excellent local links with GPs, specialists and other allied health clinics, and continue to expand both our patient base and premises.” It’s the scope of osteopathy and its manual therapy practices that keep Matt excited about his profession. “I see a wide variety of patients, from children to the elderly, professional sports people to home gardeners seeking treatment. Witnessing not only their recovery but seeing our patients gain even more physical ability than what they sought help for, continues to inspire me and appreciate what osteopaths can achieve,” Matt said. For Matt, osteopathy is a thoroughly rewarding profession with everyday challenges that make each day different

a publication of North Coast Primary Health Network

and exciting. “Knowing you have benefitted someone’s health and recovery make for a very satisfying job,” he said. Working in allied health practice, Matt would like to see more cohesion between the professions to present a united health care approach. “Osteopaths, chiropractors and physiotherapists are all eminently suitable to address musculoskeletal issues, but no single profession has all the answers. “Working together for each unique situation where the most appropriate skills are presented to the patient leads to the most favourable outcomes. This is the ethos behind One Health Clinic - professions working together for the best and fastest outcomes for our patients, whether that is a one-off consultation or a series of consultations to best suit our patient’s needs. Our focus is always on our patients and their health benefits.” Contact Matt on 6584 5343 or info@onehealthclinic.com.au

Koori Grapevine Increasing breast screening rates

cross the North Coast, fewer Aboriginal women attend breast screening than non-Aboriginal (42% compared with 53%. With target breastscreen rates for both groups being 70% it is clear that rates need to be increased. As a result of fewer Aboriginal women having their breasts screened, they are more likely to present with cancers that are at a later stage and therefore often more difficult to treat successfully. Lea Clayden has been working in Aboriginal health for 10 years and has found that organising group bookings for Aboriginal women to attend the free NSW BreastScreen mobile unit when it comes to towns in the Clarence Valley has helped more women to have regular mammograms. A women’s health nurse at Bulgarr Ngaru Aboriginal Medical Corporation, Lea has been organising group bookings for the past four years in association with BreastScreen. The latest group booking attracted 30 women. Lea told HealthSpeak that the key to their success was to make the half-day booking a

Elder Margaret Barrett with women’s health nurse Lea Clayden

social opportunity. “We meet at Grafton’s Market Square, where the mobile unit is situated, and go over to the park for morning tea. We’ll sit around and yarn and the women go off to have their mammograms and return. When they’ve all been screened we go off to have lunch together in a local restaurant,” she said. Group bookings are also arranged in Maclean and Yamba when the mobile unit visits. Lea said annual health check days also provide an opportunity for Bulgarr Ngaru GP Dr Marion Leaver to remind women about

Lea told HealthSpeak that the key to their success was to make the half-day booking a social opportunity the BreastScreen group booking and to add their name to the list. Lea said that local Elders are vital in spreading the word about the group booking oppor-

tunity and encouraging women to come along. Margaret Barrett is an Elder living in South Grafton and an important figure locally to encourage women to come along to be screened for breast cancer. “I had a few ladies who would not come, they were frightened of having their breasts squeezed in the machine, but I told them it’s not for a long time, and after talking to them they have come along,” said Margaret. This Elder also takes every opportunity to speak to women about the importance of mammograms. “Often when the mobile breast screen unit is in town I’ll say to a woman ‘Have you had your breasts done?’ And I’ll talk to them about the importance of checking for cancer. A lot of them have ended up going along the next day after I’ve talked with them about having a mammogram,” said Margaret. Women can make an appointment at any Breast Screen office or mobile site on the North Coast, regardless of where they live. Phone 13 20 50.

Pamper days raising breast screening awareness

ith the breast screening rate on the North Coast lower for Aboriginal women than non-Aboriginal women, North Coast Primary Health Network in collaboration with BreastScreen NSW held a series of pamper days for Aboriginal women over the age of 40 to explore improving access to the BreastScreen Service. These pamper days were held in Bowraville and Coffs Harbour.

Pictured is Aunty Muriel of Bowraville enjoying a manicure from beautician Michelle Dundas. About 12 women attended the information session, and a group screening session at Coffs breast screen unit, was arranged later. Participants said they found the information very useful and would like to attend a group mammogram session.

a publication of North Coast Primary Health Network

healthspeak April 2016

Aboriginal health: new chronic care model

n 2014, Rebecca Davey, Clinical Nurse Consultant, Aboriginal Chronic Care at NNSW LHD and NCPHN’s Manager of Aboriginal Health Emma Walke discussed the importance of working together to provide a clear pathway for Aboriginal and Torres Strait Islander people living with chronic disease to access services. The two Aboriginal chronic disease programs differed slightly from each other but both recognised that joining forces would ensure better access and a wider range of services. Although nothing formal was in place, the two women knew that working together and streamlining processes would result in a much easier journey through the health system fro Aboriginal chronic care patients. A survey was developed and sent to all the chronic disease teams in the region – the staff working in Aboriginal and mainstream chronic care management in the LHD, general practice, staff at AMSs, and the chronic care (CCSS) teams at North Coast Primary Health Network. This information provided the basis for a workshop which attracted 27 people working in chronic disease management. From the workshop, a basic model of care was developed. In September last year, the model of care was funded as part of the Integrated Care partnership between NNSWLHD, NCPHN, AMSs and Ambulance

From left Rebecca Dave, Robert Monaghan and Emma Walke.

Services and the model’s implementation became part of the NNSW Integrated Care Project. “Our main intent is to ensure that we can set up a system where there are no wrong doors for Aboriginal chronic care patients. So that wherever people come into services – at AMSs, general practice, PHN or LLHD services, they get good assessment of their needs and are referred to the appropriate services,” Rebecca said Partners in the Integrated Care Project - representatives from the AMSs, the PHN and the LHD - are starting the next phase and designing in detail how this centralised intake system will work on the ground. The parties have agreed on a model in principle, but now the detailed work begins. “That will be really challenging because everyone will have

Advance Care yarning

comprehensive guide to Advance Care Directive (ACD) planning written especially for the Aboriginal community is now available. Written by Austin Health and made available through the South Australian government, the Respecting Patient Choices guide explains what an ACD is and why it is important in plain April 2016 healthspeak

language. It also outlines the circumstances in which an ACD would be useful and directions on how to get help to fill out a directive. Download the resource here: http://start2talk.org.au/ themes/wardsix/resources/ section_5/5.3.1.3%20 Advance%20care%20yarning. pdf

a different idea and it will need to look slightly different in each organisation,” Rebecca pointed out. A workshop will be held soon to bring everyone together to talk about how to manage the model, the risks involved, who will lead the implementation, and how to best make the centralised intake system work. Robert Monaghan

has been employed by the PHN and LHD to drill down into the proposed model and come up with the nuts and bolts to make it work. Rebecca said that having people from different organisations working together with a common goal presented its challenges. “Emma and I had worked together on other projects and there was some trust between us. We were very open with each other and said ‘we have to be really honest and call it as we see it’. However, we are still challenged by the fact that we are so used to protecting our own patches.” For these two women the key to success has been keeping the patient’s welfare in perspective and taking out the PHN’s and the LHD’s needs. “If we can all collaborate with the same motivation, to be of assistance to the patient, it helps to get rid of that patch defending stuff,” Rebecca explained.

Walk the Talk Nambucca

n December, a Walk the Talk day was held in Nambucca Heads with nine stallholders from various Nambucca Valley health services available to provide information and chat to the 120 people who came along to find out more about health and wellbeing. North Coast Pri-

a publication of North Coast Primary Health Network

mary Health Network’s (NCPHN’s) Closing the Gap team held a stall and they were an attractive sight sporting their colourful newly branded clothing. The event was organised in partnership with MNCLHD’s Macksville Campus, Darrimba Maarra Aboriginal Health Clinic and NCPHN.

Arts Health & Wellbeing Aged care music hits a roadblock

atling & Bates are a musical duo, partners in real life, and together they are carving out new territory in the arts and health arena. Kym Watling, a former scientist, and Geoff Bates, who was a sound technician in the music industry, live in the remote Northern Rivers locality of Unumgar and they are exploring the use of music in aged care facilities. But neither Geoff nor Kym are music therapists. They are skilled musicians who write songs about country towns, Australian history and love and hope. It was their performances at seniors’ concerts that saw them take up a New Enterprise Incentive Scheme (NEIS) to examine the business potential of their Bow & Curtsy Social Dance program for aged care residents. Bow & Cursty features old time music and song, stories, puppets, and show and tell objects. Participants may play percussion, the fiddle, dance assisted, examine historic images and natural objects, reminisce, sing along and socialise. Geoff explained that Bow & Curtsy started off with the premise of helping aged care residents to move around a bit and exercise without even realising it. But it’s grown from there. It was Helen Carbery and Joy Turner, Activities Officers at Richmond Lodge in Casino and Care Connections in Kyogle, who provided a variety of instruments for residents to try and this has really helped people interact and get involved. “So for an hour and a half away we go. We play old time songs, with catchy rhythms and repetitive choruses and they join in with shakers and other instruments and have a great time, it really brings them out.” 22

Geoff and Kym bringing joy to residents of Richmond Lodge, Casino.

The fake Stradivarius is a big hit. “When it comes out it creates this huge fear, expectation, excitement. They all back off. It’s hilarious. And then finally someone says Oh, I’ll give it a go. So Edna gets the fiddle and sits there and after getting some help to play it, she becomes a huge star and her self-esteem sky rockets. It’s very heartwarming,” said Kym. Although anecdotal evidence supports the many benefits of using music to stimulate aged care residents, there is little evidence-based research and this has prevented funding for such shows. “Unfortunately what we do is classed as entertainment and some hospitals or centres only

By singing the songs of the past, we were bringing back memories and bringing people more into the present have budgets of $250 a month for such things. Our NEIS advisers understand that we’d have to raise 20 to 50 thousand dollars in grants to run Bow & Curtsy. We funded our implementation trial at four aged care centres and our attendance at the Arts and Health conference in Sydney last year through crowdfunding.

a publication of North Coast Primary Health Network

But we don’t want to do rely on crowdfunding in future, so we’re not sure where to go from here. “We need to build links between the arts and health sectors so that there’s funding available for musicians like us to provide this program. At the conference, the NSW Health Minister Jillian Skinner said she was excited to be part of this burgeoning movement, but how quickly that translates to formal roles for artists like ourselves remains to be seen,” said Kym. Geoff and Kym have seen remarkable responses to their music and say doing the shows is very rewarding. “Every now and again we play to someone very disabled. There’s a lady in a Regency chair at Richmond Lodge in Casino. The first time she pretty much didn’t open her eyes the whole way through. The second time we played the eyes would open and about the third time she started smiling. By the end, the staff were quite excited because she had a maraca in her hand and was shaking it. They told us that this lady never moves, was almost catatonic and now the music is getting in,” said Geoff. Watling & Bates have also noticed the effects of the music and performance on dementia patients. “We started to realise that by singing the songs of the past, we were bringing back memories and bringing people more into the present. But we also write songs with themes they relate to, like country halls and dances which they all remember. So you are presenting a new song and laying down brain patterns that can link back. These songs are new but something they can really relate to,” Kym said. Continued page 30 healthspeak April 2016

Osteoporosis, under-recognised and treated By Martin Cushing NCPHN Project Officer, Musculoskeletal Primary Health Care Initiative

hy is osteoporosis in the background of the chronic disease family photo? It shouldn’t be. It is a big family with one in three women and one in five men suffering an osteoporotic fracture at some stage. The numbers eclipse heart disease, diabetes and neoplasms combined. It’s not as if osteoporosis is heinous and unruly and we want to hide it in the background. It is relatively easy to investigate, diagnose and manage. The problem is recognition. Osteoporosis is one of the most under-recognised chronic diseases because it often manifests as a fracture - most as a spinal wedge fracture reported as an incidental finding with imaging. If it manifests as a long bone fracture we are very good at fixing the fracture with pins, plates, plasters and splints. Yet we consistently forget to investigate the fracture for an underlying cause, as a possible sign of osteoporosis. Evidence worldwide demonstrates that fewer than 20% of osteoporotic fractures are identified. Even fewer are investigated and even fewer treated. The Institute for Healthcare Improvement identifies not recognising what

you are looking at as one of the common causes of health care harm. Imagine the harm if we didn’t associate crushing chest pain with the heart. Unfortunately, with osteoporosis the harm is real. While the first fracture may not be preventable, the second one could be. Nearly 50% of people who suffer a first osteoporotic fracture will suffer a second fracture within two years if untreated. While studies findings vary, they demonstrate that treatment for osteoporosis is 40-70% effective at preventing a subsequent fracture. While a fracture may be manageable, it is the loss of independence, the long term care and mortality associated with each fracture where the real harm occurs. This is measured in loss of quality of life, health care costs and years of life lost. What is really worth reflecting on is that each devastating hip fracture is probably preceded by lesser osteoporotic fractures (spinal wedge and wrist). So what can be done? Obviously a patient safety and risk management approach similar to crushing chest pain and the heart for those aged 50 plus with a fracture. Osteoporosis must be considered as the cause. To help with recognition the North Coast Primary Health Network in partnership with the MNCLHD is attempting to automate the ‘tagging’ of all

potential osteoporotic fractures with alerts sent to treatment decision makers. Similarly, the PHN is working with two local diagnostic imaging services to trial ‘tagging’ spinal wedge fracture as a ‘potential osteoporotic fracture alert’ - much the same as abnormal pathology results are highlighted. It is a start. So, if your patient is 50 years or older and has a fracture, consider osteoporosis as the underlying cause.

Nearly 50% of people who suffer a first osteoporotic fracture will suffer a second fracture within two years if untreated

After Hours GP Helpline

unded by the Australian Government, the After Hours GP helpline is available to provide patients with advice on self-management until they can see their GP or, depending on their health issue, be directed to the most appropriate after hours health service. Callers first speak to a regApril 2016 healthspeak

istered nurse for assessment. Based on the symptoms at the time of the call the nurse may offer a call back from a GP within 15 minutes or one hour depending on the severity and urgency of the health issue. The after hours GP helpline is available Monday to Friday from 6pm to 7.30am, Saturday from midday and Sunday and

public holidays all day. General practices should check that your details are upto-date in the National Health Services Directory so the after hours GP helpline can refer callers to your practice if appropriate and if you are available after hours.

a publication of North Coast Primary Health Network

The After Hours GP Helpline is 1800 022 222. If you would like further information about the after hours GP helpline or would like to receive copies of posters, brochures or magnets to distribute to patients, contact North Coast Primary Health Network on 6618 5400.

Silver Chain - End of Life Home Support

ilver Chain provides Palliative Care Last-Days-of-Life Home Support Services where medical governance may remain with the GP. The service works with the Local Health District specialist palliative care and generalist services to deliver seamless care, communication at all levels and to achieve the optimum result for the patient and their carers during the end stage of life. This service is now available from Tweed Heads to Evans Head, west to Kyogle and Casino regions, and on the Mid North Coast between Red Rock and Macksville, including west to the Bellingen region and further south in the Hastings Macleay region. Who is Silver Chain?

Silver Chain Group comprises

personal hygiene needs and/or respite for carers. Evening (1530 to 2300 hrs)

A Registered Nurse specialising in end-of-life care visits each evening to provide clinical care and support. Overnight (2300 to 0830 hrs)

Silver Chain in WA, NSW and Queensland, and Royal District Nursing Service in South Australia. Together we are one of the largest in-home health and care providers in Australia and have been delivering services for over 120 years. Silver Chain at a local level

Silver Chain has a contract with the NSW Ministry of Health to work in partnership with Local Health Districts (LHDs) to wrap around existing services and provide Last-Days-of-Life Home Support packages. Each

package of care is for a sevenday period and the packages are available to: • Clients in deteriorating or terminal phase, who wish die at home or remain home as long as possible • Clients with any diagnosis • Clients of all ages • Clients with more than one package of care

A Registered Nurse specialising in end of life care (who has access to the client’s clinical information) is on call to provide clinical advice and support.

The Service Daytime (0800 to – 1530 hrs)

For more information, phone 1300 758 566 (24 hours) to be

An Assistant in Nursing specialising in end-of-life care provides daily support to clients with

connected to the Clinical Nurse Consultant Manager in your region.

In addition, Silver Chain provides a tablet in the client’s home so that support can be provided via telephone or video at any time.

New degrees for future needs By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

new academic year has commenced and SCU’s School of Health and Human Sciences has 1,085 first year students enrolled in its health and well-being courses. This year the university expanded our Sport and Exercise Science degree to the Coffs Harbour Campus and established an under graduate degree in Biomedical Science at the Gold Coast. This undergraduate degree will help prepare the next generation of health scientists who will work in industries and services not really recognised yet. However, developments in genetics, nano-technology and digital experimentation will drive innovation and change as the world struggles with ageing

and chronic disease management. New roles and work practices are emerging and female participation is growing. Establishing such programs within a regional university is important, not only because rural and regional Australia faces unique health problems such as obesity, mental health, lifestyle impacts and access to services. But a regional university is well placed to offer a generation of women the opportunity to study these emerging fields. These degrees ensure a pathway to professional training at a post graduate level in a range of health disciplines. In the field of health care, it’s essential to study both the physical and social sciences! The need for relevant knowledge is driving higher numbers of students into pursuing post graduate study within the

School. The favoured offerings are around the themes of leadership and specialisation of practice. Health practitioners from across fields are drawn into the course with interest also being shown overseas. This is important because it’s estimated that the world economy will be short of twelve and a half million health workers by 2030. The provision of post graduate study is evolving because of the School’s and University’s success in research. The last Excellence in Research Assessment acknowledged the following results. Nursing gained a five, above world standard. Medical Science and Human Movement and Exercise both gained a four and world standard and Education gained a three, just below world standard. We plan to integrate basic and applied research into our

a publication of North Coast Primary Health Network

health and wellbeing research strategy. The disciplines within the School are playing a major role, in the development of knowledge from which health care practice arises. To work effectively we continue to build partnerships with key partners to understand the nature of illness prevention, health promotion, treatment and care. To this end our research and educational endeavours along with our collaborations are helping to build a culture of enquiry and innovation which will provide an overall benefit for society.

healthspeak April 2016

Oncology North Coast relocates

ast year Oncology North Coast (ONC) celebrated 10 years of operations in Lismore and its medical oncologists Dr Adam Boyce and Dr James Bull made the decision to move from within St Vincent’s Hospital to purpose built premises nearby. Practice Manager Jacqui Boyce showed HealthSpeak around the new building – a beautifully renovated 1920s bungalow. She said the new medical suite met both the requirements of staff and patients in that it was bigger, more comfortable and less clinical with its own parking lot behind the practice. And there are plans to give space to a dietitian or social worker at the practice next year. Following the move, Jacqui said that ONC was expanding its services. “We are looking at providing more services in the Clarence Valley region and it’s likely there will be an outreach clinic in Ballina, where our doctors already carry out treatment.” And in February, Dr Amy Scott, who was previously a trainee at ONC, joined the practice as a medical oncologist. With another trainee also working at the practice, staff numbers have doubled. There are also plans for the practice to become more involved in clinical trials which provide another treatment avenue for some patients. The new premises are at the back of St Vincent’s and easily accessible from the hospital through the rear car park. Moving off site has improved the

The impressive purpose-built new premises of ONC in East Lismore.

services for patients. ONC’s doctors are now able to visit St Vincent’s patients daily in their ward, whereas before patients

had to come to the practice rooms. Close relations continue with the St Vincent’s pharmacy staff

Dr Amy Scott Amy, a graduate of the University of Leeds, UK completed her medical oncology training in Lismore last year and has previously worked at several hospitals in Sydney. As well as consulting in Lismore, Amy will visit the Grafton Outreach Clinic on a monthly basis. Amy decided to specialise in oncology because it’s a multi-system, ever changing speciality with exciting new treatments developing. She enjoys the diagnostic challenges it can bring and feels that one of her strengths is her ability to communicate well with her patients to not only explain their diagnosis but also enable them to understand their treatment options.

“I enjoy the different challenges that oncology brings. Unfortunately, I do have to break bad news but I hope my personable manner puts the patient and their families at ease and helps them to come to terms with their diagnosis/ treatment in a way that they can understand.” Amy also appreciates that Oncology North Coast allows all its consultants to work with

who come to the practice for regular meetings about patient needs. Regarding referrals, Jacqui says if a GP has a preference for an oncologist, put that name on the referral, but if you want a patient seen as quickly as possible, then put all three names on the form. “We will then ensure they get in as soon as possible and our referral turnaround can be within one week now which is a big change from 10 years ago when Adam was the sole oncologist here,” she said. www.oncnorthcoast.com.au

every tumour group. “So you get exposure to a wide variety of different cancers which has its challenges but keeps it interesting and it’s a great opportunity for learning.” Amy is enjoying living in Lennox Head and the outdoor living that the Northern Rivers area can offer. She enjoys its relaxed feel and community spirit and was delighted to be able to continue working in the area and join the Oncology North Coast practice. “I couldn’t be more fortunate to come to a well established practice with an excellent reputation with all the necessary services and technology available locally to provide patients with a comprehensive service without having to travel,” she said.

New diabetes society for primary care

he University of Melbourne has formed the Primary Care Diabetes Society of Australia (PCDSA). The not-for-profit society supports primary health care professionals to deliver high quality, clinically effective care in order April 2016 healthspeak

to improve the lives of people living with diabetes. Associate Professor Mark Kennedy said most people with diabetes receive the bulk of their care through primary care yet there was no primary care-based multidisciplinary society to sup-

port these practitioners. Membership of the PCDSA is free for healthcare professionals who manage diabetes. Primary health care professionals can join the PCDSA and access the online journal at the website: www.pcdsa.com.au

a publication of North Coast Primary Health Network

Need for proactive primary care in RACFs By Erin Penny and Kate Russell Telehealth Specialist Geriatric Outreach Implementation Officers, Coffs Harbour Health Campus and Grafton Base Hospital

rafton Base Hospital and Coffs Harbour Health Campus were selected by the Agency for Clinical Innovation (ACI) to implement an 18-month Telehealth model of care into residential aged care facilities (RACFs). The Specialist Geriatric Outreach (SGO) into Residential Aged Care Facilities (SGO into RACF) project seeks to improve patient outcomes, experiences and lower per capita cost. The target group is residents of participating RACFs 65 years or older, or 50 years and older if Aboriginal or Torres Strait Islander residents. Of the five ACI supported sites, only Grafton and Coffs Harbour will use a Telehealth platform in their model of care. Telehealth infrastructure is being installed by the MNCLHD COAG RACF Telehealth project and is expected to be operational after Easter in participating RACFs. Common themes surfaced during the diagnostic phase of the project. Grafton Base Hospital’s top 10 presentations from RACFs were: falls, pain, urinary tract infection, congestive cardiac failure, pneumonia, catheter complications, fractures, wounds, cellulitis, and respiratory distress. These were similar for Coffs Harbour Health Campus. Their Emergency Department data for 2014/15 from five RACFs revealed that: 55% of presentations occurred after hours; 38% of all presentations were triage category 4 or 5; 31% (49) were potentially preventable; and 56% of presentations were by residents who had more than one ED visit. Few residents have chronic disease management plans, advanced care plans, palliative care plans and end of life plans. Even 26

Kate Russell, Geriatric Outreach Officer, Grafton

residents with an Advance Care Directive may die in hospital. In the words of a resident’s family member “Every time [Mum] is lucid, she wants to go home . . . She wants to be back in her room and they [the RACF] are keen to have her back.” This resident died in hospital before she could be transferred back to the RACF. The Gratton Report, Dying Well (2014) offers some explanation for these findings “dying in Australia is more institutionalised than in the rest of the world. Community and medical attitudes plus a lack of funds for formal community care mean that about half of Australians die in hospital and about a third in residential care. Often they have impersonal, lingering and lonely deaths; many feel disempowered.”

care staff specialist to meet the demands of an ageing population. The data, resident and clinician stories highlight the need for timely and proactive primary healthcare in RACFs. The SGO into RACF projects in Grafton and Coffs Harbour have brought together Local Health Districts, RACFs, NSW Ambulance and the North Coast Primary Healthcare Network as partners to devise and implement innovative local solutions. Mirroring the success of Coffs Harbour Health Campus’s SGO Nurse Practitioner, Grafton is working towards securing an SGO NP. They have a psychogeriatric nurse practitioner and just appointed a new palliative care nurse practitioner. Coffs Harbour Health Campus will be hiring a part-time palliative care clinical nurse consultant for their pilot sites. Both Grafton and Coffs Harbour clinicians will use mobile devices, tablets, computers and videoconferencing equipment to

connect hospital-based outreach to the participating RACFs. At the patient end, similar options will exist, with the addition of a mobile videoconferencing cart that can be taken to the resident’s bedside. The SGO teams are actively seeking ways to enhance the role of the GP as the primary healthcare provider, to improve coordination and continuity of care and to provide the best possible outcomes for our aging population. We are seeking GP input in the development and implementation of solutions. Grafton recently met with GPs who visit RACFs. Thanks to those who attended, your input was much appreciated. For further information contact Kate Russell (Grafton) Kate. Russell@ncahs.health.nsw.gov. au | 0428 447 814 or Erin Penny (Coffs Harbour) at Erin.Penny@ncahs.health.nsw. gov.au | 0491 757 834.

Often they have impersonal, lingering and lonely deaths; many feel disempowered

Capability to plan, identify and manage acutely deteriorating residents varies by RACF and GP. Coffs Clinical Network has a geriatrician and a palliative

Coffs Harbour team – Shin Hwa Kang-Breen, SGO Nurse Practitioner and Integrated Care Finalist for the 2015 NSW Health Innovation Awards and geriatrician Dr Vaibhav Tyagi are supported by staff specialists.

a publication of North Coast Primary Health Network

healthspeak April 2016

Jacob’s Wish

acob doesn’t ask for much, a few friends and the chance to finish his higher education at a state school, just like everyone else. After Jacob’s family moved from the Hunter Valley to the

Tweed in early 2015, he was told there were no places available for him at the local high school and that he would have to study by distance education. Without the opportunity of attending school, the chances

of Jacob meeting friends his age was difficult. “I’ve never had any friends. I don’t fit in. I think it’s my autism. And I like politics. That’s a subject not many people like to talk about,” Jacob says. After exhausting all the avenues they felt were open to them, Jacob’s mum decided to call Ability Links. The Linker contacted local schools and arranged appointments for Jacob and his mother to discuss enrolment options. The Linker also connected Jacob with Aspect Australia who provided a case worker to help build Jacob’s life skills and advocate with the school to support systems being put into place that will increase Jacob’s likelihood of success at school. As for meeting new friends… The local Linkers saw an opportunity to connect other young people in the area in similar situations and arranged a social evening for them. Following the evening, Jacob’s mum contacted the Linker to say she was extremely grateful for bringing the kids together and that Jacob had made some new friends. Jacob is now positive about the future and looking forward to continuing his education. “I was very disappointed in the education system,” Jacob said.

“I’m glad that there has been a real attempt made to support me in finishing my education.” About Ability Links

Ability Links NSW is a statewide program that works alongside people 0-64 with disability, as well as their families and carers to support them to fulfil their goals, hopes and dreams. Ability Links NSW Coordinators, known as Linkers, help participants: • Find ways to be a part of the local community • Set goals and plan for the future • Build confidence to achieve their dreams • Develop their existing support networks and create new networks. Linkers work with all people and communities, including people from culturally and linguistically diverse backgrounds, and Aboriginal communities. Individuals, clubs, groups and businesses can also access Ability Links NSW for information and support on inclusion of people with disability. To refer your clients to a linker or to find out more visit www. abilitylinksnsw.org.au

Reporting suspected Elder Abuse

esearch suggests that as many as 50,000 older people in NSW may have experienced some form of abuse, yet it’s estimated that only one in five cases of elder abuse is reported. Most alleged abusers are trusted family members, neighbours, friends of paid carers. On June 1, it’s National Elder Abuse Day, a day when this often hidden problem is being highlighted. The World Health Organisation says that elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect. Examples include • Someone threatening to hurt the per-

April 2016 healthspeak

son or damage their belongings • Being intimidated, humiliated or harassed • Being threatened with eviction or moving to a nursing home • Being denied the right to make your own decisions • Having your pension skimmed or belongings sold without permission • Being forced to change a Will • Slapping, hitting or restraining • Sexual abuse GPs and health professionals are in a position where they might be told of such Elder Abuse and if you are concerned that a client or patient is suffering elder abuse there is

Anyone can report suspected abuse and obtain resources by calling the NSW Elder Abuse Helping & Resource Unit on 1800 628 221.

help at hand. This unit has also produced some useful resources for health professionals to make a report. Go to http://www.elderabusehelpline.com.au/for-professionals/ responding-to-elder-abuse

a publication of North Coast Primary Health Network

About Tinnitus Tinnitus can be caused by several factors, such as age-related hearing loss, exposure to loud noise or earwax blockage.

• Check medications Some

medications can cause or worsen Tinnitus, so it’s wise to check medications • Limit caffeine Consuming caffeine can temporarily worsen tinnitus for some people.

How to manage Tinnitus

By Megan Hardie-Porter Australian Hearing Audiologist

What is Tinnitus?

The ringing noise people experience in their ears after going to a concert or listening to loud music can be described as Tinnitus. In some cases, Tinnitus is only temporary and goes away given time. Yet for others, the ringing noise is constant and interferes with their ability to concentrate or hear actual sound. One in seven Australians will experience Tinnitus at some point. It is not usually the presence of the Tinnitus that is an issue, but rather how an individual thinks and feels about it. When Tinnitus becomes problematic, sufferers often associate it with feelings of fear and anxiety leading to stress and frustration.

Unfortunately, there is no known cure for Tinnitus but it can be managed with the help of technology and lifestyle changes. Australian Hearing offers the latest in Tinnitus relief technology through the Neuromonics ™ range of devices designed to address both the auditory and emotional aspects that contribute to significant Tinnitus. There are models suitable for hearing aid users and those with normal hearing. Additionally, clinicians provide a structured rehabilitation program as part of this treatment pathway. Tinnitus sufferers are not limited to being fitted with devices and often report experiencing relief through our counselling program alone. Other helpful tips: • Avoid silence Keeping the

ears busy with background noise, such as television or radio, can help the brain focus on those sounds instead

Testing

of the ringing noise.

• Keep calm and relaxed

Tinnitus can be triggered by stress and tiredness, so activities like a massage or yoga can offer relief.

The first step is to identify what is causing Tinnitus and, if necessary, give the patient a hearing test. Given the many options available to Tinnitus sufferers, no one should be told that ‘nothing can be done’ and Australian Hearing encourages all sufferers to book a consultation for further information. Australian Hearing is the nation’s leading hearing specialist and largest provider of Government-funded hearing services. We are here to help all Australians manage their hearing health, ensuring that they stay connected with the world around them. To contact the nearest Australian Hearing centre, call 131 797 or visit www.hearing.com.au.

Simulation aid to train in treating older patients

ollywood-style silicon masks and body suits are being used by Southern Cross University to prepare students in the School of Health and Human Sciences to treat and interact with older patients. Known as MaskED, the simulation props enable the development of unique characters. Staff in the School have so far developed six characters: three elderly women and three elderly men, including 80-yearold ‘Milly Banks’ and 76-yearold ‘Dan Tucker' who visit the University’s campuses to help

train students. The simulation has proven effective for nursing students. Now teaching staff in other University health disciplines, like occupational therapy, social work and speech pathology, are being introduced to ways in which MaskED characters could be incorporated into their curriculum in roadshows at each of SCU’s campuses. Crucial to the success of MaskED are the educators who volunteer to become a character – and remain in character until they unmask.

In character, Dan Tucker’ (SCU staffer Andrew Woods) and ‘Margo Barrington-Smythe’ (SCU staffer Cathy Avila) . Credit: John Waddell/SCU

a publication of North Coast Primary Health Network

healthspeak April 2016

What is?

aediatric Occupational Therapy (OT) is a service aimed to maximise a child’s functional performance when completing everyday activities such as self-help, play and learning skills. Through the use of purposeful activities OT intervention promotes each individual’s ability to participate in what they want, need and wish to do in their daily lives. Occupational therapists help children to learn and master many of the skills required at school, in the classroom and playground, and at home.

Profile

What is paediatric occupational therapy? OTs provide assessment and/ or therapy services for children with a variety of diagnoses. OT assessment services may be requested for information contributing to a diagnosis, or for recommendations regarding management of a child with an established diagnosis. Common diagnostic groups include, but are not limited to, children with developmental delays, cerebral palsy, autism, and those whose ability to participate in play and daily activities is interrupted by an injury or disease process.

Jess Doyle, Paediatric Occupational Therapist, Physio Plus, Northern Rivers

t was during high school that Jess became interested in occupational therapy after a work experience placement at Ballina Community Health. She told HealthSpeak that the placement enabled her to see first hand what the job entailed and after her placement she knew she had to become an occupational therapist (OT). She then moved to Newcastle to study a Bachelor of Health Science (Occupational Therapy) at the university which has a strong health campus. “During my time at university I undertook pracs at Westmead Children’s Hospital and The Spastic Centre, which is where my interest in paediatrics was sparked. I have done lots of short courses in paediatrics and on specific areas of treatment. Most recently on the OT role in managing anxiety in children,” said Jess. Following university, Jess’s first role as an OT was in community aged care in Redcliffe in Queensland. From there she spent a couple of years in Port Macquarie doing occupa-

April 2016 healthspeak

tional rehabilitation in private practice. “This role helped me to understand my work from the business operations perspective, which was really beneficial.” Jess then spent a couple of years living and working in Ireland and England in aged care and paediatrics. She worked with children with cerebral palsy and it was during a work placement in County Kerry that Jess firmly decided she was destined to work with children and their families. “Upon returning to Ballina I worked for North Coast Area Health Service and the Cerebral Palsy Alliance (where I still work part time) before

establishing my private practice as part of the Physio Plus business operating in Ballina and Lismore. I also conduct preschool, school and home visits across the region. Jess really enjoys the people contact in her OT role, working in partnership with her clients and their families and putting together a support plan which is achievable in a busy household. “It’s a cliché, but working with people and helping them find solutions to everyday activities which most of us take for granted is really satisfying. Most of us assume that tasks such as having a shower, eating a meal, playing with our friends and doing school work are things that just happen, but for lots of young people these tasks are really challenging and I enjoy helping making them more achievable,” Jess said. One of Jess’s clients remains in her mind as she was able to help her with more than one aspect of her school life. “An eight-year-old girl was referred for a handwriting assessment as she was anxious

a publication of North Coast Primary Health Network

about going to school, but with further investigation and discussion it turned out that with a few simple interventions we got her up to speed with her peers. However her main concern about going to school was that she couldn’t play handball with friends. Following an assessment of her visual motor, motor planning skills and coordination we put together a handball program, and after a few months of practice she is a handball star! We are now working on skipping with a rope and cartwheels…” Jess would recommend OT as a profession to a young person as she says it provides her with great job satisfaction. Working with health professionals, teachers and others means there is a lot of variety in her daily work. And there’s also a lot of scope in OT. “You can reinvent yourself in another area of OT without having to do a new degree, just some on the job training and professional development. “ Contact Jess at PhysioPlus on 02 6621 8606.

Ironing out discharge problems

Feature Integrated Health

hen practice nurse Clair Woodham and practice manager Terence Dawson from Cornerstone Medical Centre at Tweed Heads sat down at the first Integration Collaborative workshop last year, they were put at a table with Tweed Hospital staff they’d never met before. This turned out to be the beginning of a path leading to better patient care. Francesca Leaton from the hospital’s heart failure team organised a group at the hospital and Kelli Babovic from North Coast Primary Health Network suggested for a Collaborative PDSA cycle (Plan Do Study Act) that the group focus on one aspect of care. After discussion, the group turned its focus to patients discharged without appropriate medication. “The problem was that a patient would get discharged on a Friday afternoon and would need to see their GP but the earliest appointment was Monday. In the hospital they’d been taken off their previous medications and started on new ones. But they were being sent home without understanding whether to take the old medications or not and when they should start and stop, so most patients weren’t taking any and were turning up to see us not at all well,” Clair said. The work group identified 11 Cornerstone patients for the project and through the hospital meetings Clair and Terence found out that there was a pharmacist on each floor of the hospital who could carry out a full medication review for patients prior to their discharge. The review ensures that patients are discharged with five days of appropriate medication and a print out for them to follow, so that they are on track before their follow up GP appointment. This review has now become standard practice. 30

Cornerstone Medical Centre’s practice manager Terence Dawson and practice nurse Clair Woodham are working with Tweed Hospital staff to improve hospital discharge practices

With hospital staff talking to Cornerstone staff about the 11 patients, it was also identified that one patient had been admitted to Lismore Base Hospital and could be followed up. In addition, Clair has instituted NSW Health’s ‘Red Book’ with 200 patients at the medical centre. The Red Book ‘My Health Record’ is a sturdy red plastic folder that patients can fit into a handbag and take with them to their GP, hospital and allied health visits. She’d like to see every medical centre using it. Clair said that previously she’d had problems with hospitals sending notification of patient admissions to GPs who weren’t their doctors. “Often the patient would get confused about who their GP was and the GP was wrongly recorded and the Red Book

fixes that,” she said. The Red Book contains a wealth of information about the patient and encourages them to take responsibility for their health care and Clair said that patients love it. Before the Collaborative began, Clair had two pages of ‘problems’ being experienced often due to a lack of communication between the clinic and the hospital and she said all of these have now been addressed. “Now the hospital understands what goes on in GP Land and we understand the hospital system a lot better. Terence and I are also noticing that all the various staff at the hospital are now speaking to each other on a regular basis. When we first met at the table most of them didn’t even know each other,” she said with a smile.

a publication of North Coast Primary Health Network

From page 16

where this client was going. “This information flow also gives the client the benefit of seeing mental health workers from the Mental Health Unit, drug and alcohol workers from Riverlands and the Jullums health workers all within the walls of the Aboriginal Medical practice. This practice then becomes like a family, their medical home, this is everything to them,” she explained. The lines of communication between Jullums, Riverlands and the Mental Health Unit are now wide open. “We can ring them if we have someone here who needs their help and they will send a staff member over if they are available. Our clients often feel more comfortable at the AMS, rather than going somewhere else to see a health worker,” Christine explained. Christine hopes to bed down a really efficient communication system between the services during this Collaborative so that their relationships can continue and grow. From page 22

“The funny thing is they sing along to songs they’ve never heard before and these are patients with the most severe dementia,” Geoff added. Aged care staff have also noticed a reduction in ‘sundowning’ after Watling & Bates perform. Sundowning is where residents who used to have busy lives get anxious and walk around without a purpose around 5pm – the part of the day when they would have been preparing dinner, bringing in the cows and other chores. Watling & Bates are keen to hear from anyone interested in Bow & Curtsy. Email them at contact@ watlingbates.com

healthspeak April 2016

Has The World Caught Japanese Flu? T

he world economy is not doing well. While far from terminal, the patient is feeble. Every few months it lifts itself on one elbow, gives a brave smile only to sink back with exhaustion. It has been like this now for nine years. The world’s central bank doctors are worried. They have put it on a continuous drip of money printing that lifts spirits for a while - but they know it’s only temporary. A permanent cure seems a long way off. One of the biggest problems is trying to form an accurate diagnosis and without one a proper treatment plan is not possible. Economists have generally been puzzled at the time it is taking for the world economy to return to “normal” – to its long term trend rate of economic growth. Most were expecting it to bounce back fairly quickly after the global financial crisis but it hasn’t happened. We are now looking at the prospect of a Japanese-style malaise where that economy has been moribund for 25 years US interest rates have been near zero for six years, in Europe they are negative and central banks have expanded their balance sheets by a staggering $US5 trillion. And despite the monetary measures, today Japan is still going backwards, China is slowing rapidly, Europe is feeble and the US is struggling. Australia is doing reasonably well considering, but it too is growing below trend and there is little optimism. Inflation remains too low and deflation is the real threat. Judging by the interest rates on long-term government bonds throughout the developed world, this state of affairs is expected to continue for at least 10 years. Finding the cause of this malaise is important because, depending April 2016 healthspeak

finance David Tomlinson

market – potentially creating asset bubbles. Many consumers were also burned by the GFC and remain wary about spending and debt. Putting more money aside seems the right thing to do. Many governments too are intent on cutting government spending by slashing health and retirement benefits. This makes people cautious about their futures and their ability to pay for health care. Increased savings provide some level of security. Investment too has slowed down with flat demand a major cause. The ageing of the population and in some countries declining populations, is also

acting as a brake on growth. Rapid changes in technology slow investment decisions as businesses watch warily. So what is to be done? Senior economists are saying that monetary policy, including lower interest rates and money printing, is not working. If a lack of demand is the problem, then policies such as cutting government spending, lifting taxes and moving towards a budget surplus are counter-productive. These reduce demand. So too are policies that advocate lower minimum wages, a more “flexible” workforce (read higher levels of insecurity) and reduced penalty rates. The solution appears simple. Somehow boost consumer demand. Government stimulus packages are being favoured, particularly in areas such as infrastructure spending and policies that encourage investment in industries such as renewable energy. Some suggest “helicopter” money where the government showers consumers, particularly the less wealthy, with government cash (memories of Kevin Rudd in 2008). Of course these policies will face opposition from those who dislike more government debt but where else is the stimulus to come from? One suggestion, which in the past would have caused apoplexy for central banks, is to buy government debt from the private sector and then effectively cancel it. As the government does not need to repay it, it has more cash to spend on other things. Once this would have been a sure recipe for runaway inflation, but with deflation a major problem in many parts of the world, this may not be an issue.

a publication of North Coast Primary Health Network

on the answer, the policy prescriptions are quite different. Many economists are coming to the view that the world is in a period of secular stagnation. This occurs when there is a major imbalance caused by too much saving compared with investment – a savings glut in other words. The result is that the excess savings decrease demand that in turn reduces economic growth, business investment and inflation. But why is consumer spending so weak? One explanation is that in the developed world income inequality has soared over the past three decades as a result of free-market neo-liberal policies and globalisation. In the US for example, economic growth has been enormous, yet the average real wage of Americans has not increased since the 1990s. All that extra wealth has gone to the top five per cent. We know that the wealthy have a higher propensity to save and the poor have a higher propensity to spend, thus savings are booming. Much of this saving by the wealthy has gone into real estate, the bond market and the share

One of the biggest problems is trying to form an accurate diagnosis and without one a proper treatment plan is not possible

Arts Health Taskforce for wellbeing

he NSW Government has established a taskforce to explore new ways in which the arts can benefit the health and wellbeing of people across NSW. The NSW Taskforce on Health and the Arts is chaired by Chris Puplick AM, a former senator. The other members are: Margaret Meagher, executive director, Australian Centre for Arts and Health; Tracey Callinan, executive officer, Arts OutWest; Kate Dundas, Deputy Secretary, Arts and Culture (NSW Government); Sam Sangster, chief executive, Health Infrastructure; Dr Emma O’Brien, executive director and board member, The Institute for Creative Health; Amanda Larkin chief executive, South Western Sydney Local Health District and Susan Pearce, NSW Chief Nursing and Midwifery Officer. Health Minister Jillian Skinner said that the experience worldwide was that exposure to the arts has a profoundly beneficial impact on a patient’s recovery in hospital and wellbeing in the community. “Health Infrastructure already incorporates the arts in the

From page 3

does not support the long term efficacy and safety of opioid therapy for chronic non-cancer pain. It provides useful tips for weaning a patient off opioids. http://www.hnehealth.nsw. gov.au/Pain/Documents/ Reconsidering_opioid_therapy_ May%202014.pdf A Cochran Study http:// www.bmj.com/content/350/ bmj.h444 showed a coordinated intervention covering several domains of the biopsychosocial model was more likely to benefit patients with chronic low back pain in the long term than usual GP or medical specialist care or physical treatment alone. This involved teaching patients

Wiradjuri Elder Robert Clegg with his cultural artwork.

It is well known that the arts and culture can go a long way to enhancing wellbeing design of hospitals and health facilities, from creative spaces to installations and artworks. This taskforce will explore broader ways in which art can inspire positive health outcomes in the community, from people living

with chronic pain how to limit its effect on their lives by having them play an active role. This includes adhering to medication, exercise, meditation etc – all with goals understood and agreed to by the patient. A biopsychosocial framework needs to be explained to the patient rather than simply saying “try this and see if it helps”. It is important to validate the pain the patient is experiencing and to differentiate between acute pain (a useful warning) and chronic pain with central nervous system sensitisation (fault in wiring). There are some excellent resources available for patients and health professionals. One

with dementia in nursing homes to jail inmates seeking rehabilitation or paediatric patients being inspired to explore creativity and imagination.” Deputy Premier and Arts Minister Troy Grant said it was well known that the arts and culture can go a long way to enhancing wellbeing. “This taskforce will examine how we can further harness this power to deliver positive health outcomes for the community,” he said. One example of art being used to support the wellbeing of local people is at the new Parkes

highly recommended is the Pain Management Network www.aci.health.nsw.gov. au/chronic-pain This is an easy-to-negotiate website for patients with video interviews and steps for self management. There is also a useful section for health professionals. For access to regional information on pain via HealthPathways, Mid & North Coast NSW go to: https://manc. healthpathways.org.au This can be uploaded onto a desktop short cut through Best Practice or Medical Director. For a purpose-designed care plan and team care arrangement template for GPs and practice nurses for chronic pain manage-

a publication of North Coast Primary Health Network

Hospital in central NSW which opened in November last year Local Aboriginal people who were consulted as part of the design and construction indicated they wanted representation of their culture to help people feel more comfortable coming to the health service. That has partly been achieved in the artwork on the hospital’s sliding front doors, designed by Wiradjuri Council of Elders chairman Robert Clegg, otherwise known as Ngangaanha. He said the design featured footprints representing a path to healing, and a goanna, or gwga, which was the symbol of the region’s Wiradjuri people. “If something’s wrong with the gwga, it splits in half and it dies,” he said. “But by putting it on opening doors, it opens up and splits [and] it means you’re ill, you go inside and it closes, and if you turn around and have a look at it, it’s starting to heal.” Further information on the Taskforce is available at: www.health.nsw.gov.au/ arts<http://www.health.nsw.gov. au/arts>

ment: http://www.aci.health. nsw.gov.au/__data/assets/ pdf_file/0003/212736/ACIGPMP-TCA.pdf So, rather than just writing analgesic scripts for patients re-presenting with chronic pain, aim for more selfmanagement. For those with internet access the Pain Management Network resources mentioned above may be helpful. For others, a care plan with appropriate referrals and reviews will be needed. For the most difficult of cases, referring to a local pain clinic for multidisciplinary care will be required. Whatever treatment is used, the biopsychosocial approach produces the best outcomes.

healthspeak April 2016

Please don’t call me mate, nurse

t can be confronting when the doctor becomes a patient. Sometimes it’s a serious business but I only had to go in for a routine but specialised scan, just a couple of hours. I didn’t bother to reveal my job, because what was the point? The depersonalisation started out well enough, with identification and name-banding efficiently attended. The next stage was gowning and trolleying, All fine. The nurse arrived, brusque and busy, but not finding the right equipment in the trolley drawer started to fly off about the inefficiency of nameless others in the institution. An assistant proceeded to identify my wrist band and asked me a number of questions including whether I had consumed Viagra within 24 hours. That was fair enough until I heard through the curtain the woman in the next cubicle get the same question. I suppose you have to ask. I was asked at least six times by different people about allergies, diabetes and so forth. It’s just the system at work keeping everybody out of court, I explained to myself. Then the nurse said to the other nurse, a trainee, ‘this April 2016 healthspeak

might be a good case for you to practice’. I felt a small cold sweat, even if everybody has to learn. So I informed the nurse that I was actually difficult to cannulate and could I please have the most experienced person present do it. She looked at me for the first time, ‘you’ll be all right, mate’. Now, I’m old school and not used to hospital nurses calling me mate. We were not even at Gallipoli together and my name band was quite clear. Sometimes I think everybody should wear a name badge with short CV, but that’s another story. So I don’t mind my name or even a Sir would do fine. I don’t think its very good manners to address a patient as mate. We might all look the same in our gowns, but being on the sharp end of the needle is a different experience for an old doctor. At least this nurse did not give the job to the trainee, but proceeded with a running commentary. ‘We use a really wide bore cannula for this.’ Then, ‘It was in the vein but it just jumped out and the blood has stopped flowing. I’ll just move it around and try to find it again.’ The junior was taking this all in and advising. ‘Don’t move

light airs David Miller

mate. You’ve got very difficult veins’. Doctors are very nervous about this sort of thing, knowing how hard it can be and what a mess can ensue. I knew it had missed and the probing became rather excruciating, especially in the certain knowledge that it was hopeless. The nurse tried again, missed again- always happens- hopelessly gouged around again. ‘I was in the vein, then advanced and it went out again,’ nurse announced to the suspenseful hovering student. I thought it was time to identify myself and to commiserate with the efforts. ‘I have missed many times,’ I suggested, ‘but after the second time I usually ask someone else to do it. Perhaps could you find an anaesthetist?’ ‘No chance of that, mate, not around here. Look, I’ve been doing this for 20 years,’ as another really wide bore needle was relentlessly prepared. I asked the student, thinking the nurse might concentrate rather than talk. ’Please don’t watch. I never like being watched if it’s hard.’ Then I thought I might give a tip. ‘Don’t look at the skin, see the vein under it with your mind’s eye.’ I was feeling helpless by now and ready to run out of the department. ‘We will try the ultrasound if this doesn’t work’. Now where would that be hiding? The most important thing, I had been told, was to keep calm for this procedure. Of course it all worked out because my case was gumming up the works.

a publication of North Coast Primary Health Network

Someone appeared to place the cannula and a couple of hours later I was out blinking in the sunshine. This little experience was less about the system than about my fearful response. In the knowledge of how simple things can become pear shaped, it was as well it was not Gallipoli because I might have been shot for cowardice, mate.

The junior was taking this all in and advising. ‘Don’t move mate. You’ve got very difficult veins’

GP specialises in sexual & reproductive health

orthern Rivers GP Dr Kate Bolam loves the variety of general practice and the relationships built with patients and their families over years. Kate and her family came to the North Coast in late 2014 after nearly 15 years working in Darwin. She has wasted no time in filling her professional dance card. Kate is working at Bangalow Medical Centre four days a week and at Family Planning in Lismore and Kyogle and is excited to be starting work with the Richmond Tweed sexual assault service in the coming months. There are also plans for Kate to be one of two GPs running a sexual health clinic at headspace in Lismore. Kate has a particular interest in sexual and reproductive health. “Helping girls and women from the start of periods right through to perimenopause and the menopause transition – contraception, fertility, pregnancy and antenatal care and supporting new parents, including

briefs

Cancer explodes in China Chinese academics writing in the American Cancer Journal for Clinicians say last year more than four million people were diagnosed with cancer and nearly three million died from it. But the journal report says cancer rates are expected to rise further. It cited prolonged exposure to pollution, chronic infections, and heavy smoking as risk factors. In China half of all men still smoke, consuming a third of the world’s cigarettes. It’s known that Chinese authorities routinely censor news reports about the health impacts of chronic pollution.

I spend a long time talking to young people about the difference between vulnerability and responsibility

Dr Kate Bolam

breastfeeding. I’m also pleased to be part of the new clinic at headspace, providing young people with access to sexual health services within a youth appropriate service,” said Kate. Assisting the police and dealing with victims of sexual assault is an area of work that might not appeal to many GPs. It’s often seen as thankless work and involves call outs in the middle of the night. But for Kate, who did the same work in the Northern Territory, this is satisfying medicine. “I have the opportunity to re-empower people who have been disempowered completely through an act of sexual violence. Providing their police examination if wanted, and giving advice

about risks after assault and tools to start to heal so that they leave feeling much more whole and healthy again,” she explained. Once she starts work with the Richmond Tweed sexual assault service, Kate will provide acute forensic and medical services to patients who’ve been sexually assaulted, but she’s also available for counselling and other services to victims of assaults that happened weeks, months or years before. Kate said that young people were also a big ‘at risk’ group when it came to sexual assault, with muddied perceptions surrounding sexual activity. “Often youth don’t understand the difference between vulnerability and responsibility. We might see a boy and girl having drinks together and she might be wearing a short skirt. The assumption might be that she was ‘asking

for it’ as she was a bit drunk and was wearing a short skirt. “However, while drinking with someone when you are dressed in a particular way might increase your vulnerability to attack, it doesn’t make you responsible for your actions. So I spend a long time talking to young people about the difference between vulnerability and responsibility and about making themselves sexually safe. Kate has found that both youth and older adults often have difficulty understanding what constitutes consensual sex. “For instance, you can’t consent to sex when you are intoxicated with drugs or alcohol and you can’t consent when you are under age. So having sex while drunk at a party can be fraught with danger. “ Kate’s sub speciality of sexual/ reproductive health means that she is equipped to deal with GP gynaecology - vulval pain, vulval dermatitis, dyspoenia and vulvodynia, which she says can be quite difficult to treat. Contact Kate at Bangalow Medical Centre on 6687 1079 and at Family Planning in Lismore on 6620 7660.

Online hub for carers

he Federal Government has launched Carer Gateway, making it easier for carers to access practical information and advice and connect with local services. Carer Gateway comprises a national telephone service, website and an interactive service finder to help carers locate their nearest support services. The current service system for carers is complex, meaning they cannot find the assistance they need. Carer Gateway provides carers with a central information gateway, making it easier to find the right services and support to

assist in their caring role. Federal Minister for Social Services, Alan Tudge said the Carer Gateway would make a real difference to the way carers access support. “Many carers do not have the time to go searching across multiple sites for reliable information on how to access local respite services or social support. Now carers will have

a publication of North Coast Primary Health Network

an easy to access gateway to help connect them with the local services they need.” Carers can call 1800 422 737, Monday to Friday between 8am and 6pm, and speak to an Australian-based team who can help with information and provide links to local services. Go to www.carergateway.gov.au to find out more.

healthspeak April 2016

Cure – A Journey into the Science of Mind over Body Jo Marchant Text $32.00

ruly a journey, as the subtitle puts it, this remarkable study by an award winning science writer ranges across a vast landscape – an ascent of Everest, the pain-wracked battlefields of Afghanistan, the 5,000 metres final at the London Olympics, the use of hypnotherapy for gut problems, mindfulness meditation for stress, and the frequent value of placebos, in many guises. While the scope is vast, the central tenet is not, regardless of how the indivisibility of mind and body, and the healing power of the former, tends to be challenged by modern medicine. “By denying what seems blatantly obvious to many people – that the mind does influence health; that alternative medicines in many cases do work – they [sceptics] contribute to a lack of trust in, if not a willful defiance of, science,” Dr Marchant writes. “What if we take a different approach. By acknowledging the role of the mind in health, can we rescue it from the clutches of pseudoscience?” This challenge involves facing “the limits of psychological tricks and treatments”; the need to consider what the mind cannot do; to assess holistic healers’ claims that “go too far”; and to April 2016 healthspeak

know how to act when the mind “makes things worse”. Like any good researcher, the author keeps an open mind about what she is told, even about what she sees or experiences first-hand: having a heated box strapped to her lower leg while watching ‘cooling’ snow scenes through 3D glasses is just one example of the author turning guinea pig. Noting that while clinical trials involving cancer patients have shown significant placebo effects for pain and quality of life, she notes that, “Placebos don’t create an all-powerful protective magic that can keep us well in every circumstance… [yet while] tumour growth and survival time are critical for a cancer patient, pain control and quality of life are important too.” Despite reporting that the top 10 highest grossing drugs in the US help only between 1-in-25 and 1-in-5 of those who take them, she writes, “We’re not going to be able to throw out physical drugs and treatments.” Conversely, “Just because the benefits mediated by placebos

book review Robin Osborne

One trial showed patients who got drugs from a doctor got 50% more pain relief, even with a placebo.” are mostly subjective, that doesn’t mean they have no potential value for medicine… A subjective improvement in suicidal thoughts in a patient with depression can mean the difference between life and death.” Among the fascinating

New pain management resources

wo years after the NSW Minister for Health launched a website in response to the NSW Health Pain Plan 2012 – 2016, the Agency for Clinical Innovation Pain Management Network website has been used by more than 46,000 people in 123 countries. To celebrate this second anniversary, new sections for GPs have been added to the website: • Quicksteps is a decision support tool which can help GPs work with patients to create individual chronic pain management plans. It provides a framework to direct care

and guidance on factors including psychological distress, medications, physical activity, sleep and nutrition. The GP and patient work together to create a guided self-management plan. • A new video series for GPs to increase understanding and awareness of the resources available and how to use them in daily practice. Learn more about how ACI at www.aci.health.nsw. gov.au/make-a-difference/ work or visit the ACI Pain Management Network Website at www.aci.health. nsw.gov.au/chronic-pain.

a publication of North Coast Primary Health Network

findings is the role of ‘human interaction and words’ in the treatment setting, with one trial showing that patients who got their drugs with a doctor present – even a ‘placebo’ doctor wearing a white coat and stethoscope – got up to 50% more pain relief. An anthropologist reported talking to his pills: “He tells me that he has a painful left knee, and that he uses this technique to boost the effect of his painkillers and get the relief he needs from one pill rather than two.” She concludes, “I’ve learned how our brains control many aspects of our physiology, including the tools that the body has available – from hormones and natural painkillers to the weapons of the immune system - to ease symptoms and fight disease…These processes can have an effect within seconds, or they can influence our physiology for years to come.” That said, “We can rarely deploy these tools at will; we can’t simply ‘wish’ ourselves better.” Nor, in her view, can we just wish for modern medicine to see less of a division between the mind and body - which have “evolved in exquisite harmony” - as much as we might hope for this occur.

Indigenous child injury

ndigenous children and youth are more than one and a half times more likely to have injuries requiring hospitalisation compared to other young Australians, an AIHW report has shown. The largest difference was between the ages of 18 to 24 years and the most frequent causes of injury were falls, then assault, transport crashes and intentional self-harm. The rate of assault injury among Indigenous girls (486) was 17 times higher than other Australians. (28). 35

How to help patients with legal problems guides for representing themselves in a court or tribunal. By referring patients to LawAccess NSW you will be helping to resolve your patient’s legal problem.

By Lisa McLoughlan Legal Officer and Team Leader at LawAccess NSW

eneral practitioners and other health professionals see the health impacts of legal problems in many people presenting in their clinics every day. Legal problems and health issues are interconnected. Either problem could be the cause or the result of the other. You may have a patient, such as Caroline, who has come to see you complaining of headaches and that she can’t sleep at night. Caroline says that she is so exhausted from lack of sleep that she can’t get out of bed most days and has been sacked from her job. Caroline tells you that her debts are getting on top of her now that she isn’t working. Despite tests and scans, no physical reason for the headaches is identified. Caroline is facing legal action

Contact LawAccess NSW: from creditors. Making sure that Caroline is getting the right support and medical treatment is just a part of helping her. Some of the most common legal problems that people generally encounter during their lives include; • consumer issues • employment issues - unfair dismissal, discrimination and disputes about entitlements • debt and mortgage problems; and • problems sorting out prop-

Intellectual Disability: Sexual health resources

eople with an intellectual disability can be significantly disadvantaged in relation to their health care overall and in particular may face barriers in accessing reproductive and sexual health services. In order to assist clinicians in supporting the decision making of clients with intellectual disability, Family Planning NSW has produced a tool kit focusing on decision making across a range of scenarios. These include whether to have a Pap test or what type of contraception to us. Access the tool at: http:// www.fpnsw.org.au/supporting_decision_making.pdf Family Planning also produce ‘easy to read’ resources to support people with disability to learn about their sexuality and relationships. Find these resources at: 36

www.fpnsw.org. au/832649_54.html Family Planning clinics also provide a safe place for people with disability to talk about intimate and challenging issues. If you have a client or carer that would like to make an appointment, phone 1300 658 886. Family Planning NSW also has a range of disability resources at www.fpnsw.org.au/disability All About Sex is a new series of 19 fact sheets for people with intellectual disability and the people who support them. The fact sheets are easy to read and include illustrations to help people with intellectual disability learn about sexuality and relationships. They cover a range of topics including bodies, relationships, sex, pregnancy and reproduction, sexual health and sexual assault.

erty and parenting arrangements after relationship breakdown. Similarly, some people have health problems that have resulted in legal issues. These health issues may have arisen from workplace injury or due to negligence of another person or organisation; such as an injury caused by tripping over on a footpath. You can refer your patients to LawAccess NSW to ensure that they talk to the right people to get legal help. LawAccess NSW was established as the first point of contact for all people with legal problems. It is a free government telephone and online service people who have a legal problem in NSW can get legal information, referrals and, in some cases, advice. Through the online service, people can access easy to read legal resources and detailed

Telephone: 1300 888 529 between 9am and 5pm, Monday to Friday (excluding public holidays). TTY: 1300 889 529 If a patient is deaf, hard of hearing or has a speech impairment, they can contact the National Relay Service (NRS) for assistance from an interpreter: • Voice: 133 677 • Speak and Listen 1300 555 727 • Internet Relay: www. relayservice.gov.au • Video Relay: choose the available NRS video relay contact on Skype and ask for LawAccess NSW on 1300 888 529. A patient requiring an interpreter can call the Translating and Interpreting Service first on 131 450 and ask for LawAccess NSW. www.lawaccess.nsw.gov.au

New Bulgarr Ngaru premises The Bulgarr Ngarui Richmond Valley Clinic (Casino Aboriginal Medical Service) now has a new home. It has relocated to a purpose built facility with a lot more space and an improved layout for both staff and patients. The new address is 153-157 Canterbury Street, Casino. The clinic’s number remains the same – 6662 3514.

a publication of North Coast Primary Health Network

healthspeak April 2016

The tender touch

ently pressed wine is simpatico with everything about the vine. Why do I say this? Well, as with food, the best things in life are slowly gained. The most delicious wagyu beef has been gradually created both before and after the death of the beast, and so it is with wine. Yes, old vines produce magical wine, and time in bottle equally produces ethereal characters which could not be manufactured instantly. The best rieslings and semillons take a decade or more to flesh out and produce a beautifully balanced wine which still has acid spine and maintains fruity attraction, after going into an awkward adolescence in their middle years (like us, really). So an unhurried, gentle, gravity-fed pressing of the grapes seems in keeping with the process As with acute care, where it is advisable to take your own pulse before approaching a car crash or Emergency Department crisis, so it is with wine. Best not to rush any part of the process, respecting the fact nature has taken many, many years to give you its fruit. With grapes, so often

April 2016 healthspeak

wine Chris Ingall the extraction of grape juice is a hurried and somewhat pressing affair, so how wonderful it is to chance upon wines which have been gently made. As if by way of reward, nature casts a fond nod to these wines and they tend to be delicious from birth, as well as ageing magnificently. Rockford Basket Press Shiraz is a standout example of what can be achieved when you go tenderly about things. It is a lovely, velvety, sweet Barossa Shiraz which maintains rich, soft, earthy notes, generosity to a fault, and with wonderful balance! Unfortunately it is becoming iconic, with at least an $80-160 price tag, so we need to cast our net more widely. Tyrrells in recent years have begun making a Johnno’s shiraz and semillon, beautifully soft and elegant wines, hand picked and gently pressed, for half the price! This wine, which used to be bottled under the ‘Long Flat’ label, comes from sandy soils and tastes like the old Hunter

River Burgundies from Lindemans. Aged in enormous French oak casks, it is softly, softly all the way into the bottle. Then the magic really starts, and the power of the fruit from these 108 year old vines comes into its own. Like the Rockford, velvet tannins cradling gorgeous sweet fruit. Delicious. And that’s just the shiraz! The Johnno’s semillon is similar in all respects, bar the use of oak. Softer, richer and with more texture than its more famous sibling Vat 1, it too is like the Hunter River White Burgundies of the 60s and 70s, wines which lasted decades in the bottle. I have tasted recent vintages, and they are more reminiscent of pear juice than an infant wine, such is their softness. Don’t be fooled however, they mature into glorious lemon-driven beauties over a decade or more. Moving across to the McLaren Vale, Reynella and Kay Brothers make lovely Basket Press shiraz in the $30-40 range. I have tasted the Reynella, and it is glorious! Soft, approachable when young, yet with great life in it for ageing. Reynella also make a basket press cabernet, again soft and velvety with age. And the difference? Why, the soft wrap of velvet is due to the more aggressive, assertive tannins from the skins being left behind, leaving the grape juice to run freely, unbruised. Whites are often treated like this, reds more rarely, as the extraction of flavour from lesser grapes needs more energy. You can be assured if a wine is labelled ‘basket press’ it will have glorious fruit, the lick of tannin almost unnoticeable throughout its life. Compare any of these wines with the more usual ‘wham bam thank you ma’am’ methods needed for profit (more pressure, more juice extracted, cheaper), and you will find an edge of hardness as your reward. But even these wines can have their attraction, chlled for the rellos at Christmas.

a publication of North Coast Primary Health Network

If a wine is labelled ‘basket press’ it will have glorious fruit, the lick of tannin almost unnoticeable throughout its life

Wine Tip Scurrilous pinot gris has usurped riesling as number four in the white wine plantings! Chardonnay, sauvignon blanc, semillon, pinot gris and riesling is the new order. And the only one which doesn’t go anywhere in the bottle is pinot gris. As a riesling lover I am in mourning.

Cellar Tip It has been a long, hot summer. If you have an air-conditioned cellar, and wines under cork, keep the air moist. If under Stelvin, and you can’t afford the electricity, they will have all aged a fraction more quickly than usual. Like Einstein’s traveller on a train however, any difference in speed of ageing will be hard to measure. Enjoy!

Raising awareness of coeliac disease

oeliac Australia has developed new resources for GPs as part of its campaign to help increase the awareness and diagnosis of coeliac disease. The Consider Coeliac Disease campaign encourages GPs to think of coeliac disease if patients present with at-risk clinical features. Coeliac disease is a serious medical illness, affecting one in 70 of the population. However, only 20 per cent of affected Australians are diagnosed despite an increase in screening in recent years. Typical symptoms include gastrointestinal upsets, anaemia and nutrient deficiencies, fatigue and joint pain. If the disease is left untreated, it can cause chronic ill health and lead to liver disease, cancer, osteoporo-

sis and infertility. The year long campaign launched by Coeliac Australia in March aims to raise the profile of the auto immune illness with practitioners to promote awareness of symptoms and best practice testing and management. New online resources for health professionals include a video Diagnosing Coeliac Disease – A Brief Guide for GPs and GP Fact Sheet, which are available at www. coeliac.org.au/resources A Chronic Disease Management template, incorporating GP Management Plan and Team Care Arrangement documents suitable for a variety of practice software is also available. For more information go to www. coealiac.org.au or phone 1300 458 836.

Nambucca Aboriginal Services Forum

CPHN’s Closing the Gap team hosted their fourth annual Aboriginal Services Forum in Nambucca heads in mid-February. The forum is held each year to enable local organisations that provide services and

From page 11

“We’re not trying to compete with GPs or private radiologists practices. We are running a service that complements what everyone else is doing, filling a gap. Also high quality surgeons work closely with radiologists at each BreastScreen site. All patients can be treated locally and there are accessible oncology services along the North Coast.” Communication with GPs

Procedures are in place at BreastScreen to keep GPs up to date with a patient’s status at all times. The GP will be notified that the client has been recalled to an assessment and notified of the outcome as soon as possible. Across NSW, BreastScreen is working with Primary Health Networks to improve the recall system for women eligible to have

a publication of North Coast Primary Health Network

programs to Aboriginal and Islander communities to come together. Each organisation has the chance to speak about what it does and how to access its services. Forty-five people from 30 organisations attended.

free mammograms, and the role of the GP is crucial. GP reminders vital

“We know if the GP reminds a woman to have a regular mammogram she’s more likely to do it, even though she doesn’t need a referral, she can ring herself and make the appointment. Most GP practices don’t have a recall system and even though we write to remind women they’re due for a mammogram, the doctor does not often remind the woman of the importance of a regular mammogram. “We’d really like to encourage GPs to remind women to have a two-yearly mammogram. For instance, we write and let them know when the mobile unit is coming to their area, so perhaps they could make their eligible patients aware of the arrival of the BreastScreen mobile unit,” said Jane.

healthspeak April 2016

NRHA appoints interim CEO

he Board of the National Rural Health Alliance (NRHA) is delighted to announce the appointment of Dr Kim Webber as Interim CEO of the 36-strong peak non-government organisation for rural and remote health. Kim took up her position on Monday 4 April. Longstanding CEO Gordon Gregory informed the Board last year of his decision to retire after 23 years leading the organisation. Chairperson of the NRHA, Geri Malone, said the Board obviously recognises the significance of the task it has of taking the organisation to the next successful stage of its development.

“It is a huge challenge to replace a foundation CEO who has done so much to shape our organisation, its work and its culture,” she said.

Career Medical Officer, Rehabilitation St Vincent’s Private Hospital Lismore The role of the Career Medical Officer (CMO), Rehabilitation is to assess and manage patients admitted to the Rehabilitation Unit under the direction of the VMOs. The CMO is required to exercise professional independence within the plans of the admitting doctors by providing safe, appropriate, patient focused, outcome directed, coordinated quality care that meets professional and best practice standards. In the position the CMO will provide consistent generalist medical services to patients; coordinate the clinical management of patients; improve the continuity of care; demonstrate a high level of professional independence (especially after hours); and deliver supervision and education to those involved in service provision at the facility.

Applications close Tues 26th April, 2016. For further information on selection criteria phone 6627 9239 or go to http://tinyurl.com/gnlrukk or go to www.seek.com.au

Geri said Board members were delighted to have secured Kim’s commitment to assist them with leading the ongoing work of the organisation in the period until appointment of the NRHA’s next substantive CEO. Kim Webber brings to the NRHA her extensive rural health policy experience across government, university and not-forprofit sectors. She was previously CEO of Rural Health Workforce Australia, during which time she also served as a Technical Advisor to the World Health Organization and as a member of Council of the NRHA. Kim has also held rural health roles at the Commonwealth Department of Health, the University of Sydney and beyondblue.

Open extended hours April 2016 healthspeak

HealthSpeak is the perfect place to let the north coast health community know about your practice, company, rooms for rent or anything at all! Display advertising is attractively priced. Simply email the editor to get a copy of our rates at: media@ ncphn.org.au

PATHOLOGICAL WASTE COLLECTION AND PROCESSING

BYRON: GP VACANCY

Sharps containers Sutures, gloves, dressings etc Frequency-based or on call Servicing Far North Coast of NSW

Cape Byron Medical Centre is looking for PT/FT VR GPs to join our friendly and progressive team. Excellent admin and nursing support with diverse patient base. Mixed Billings. Hours Mon – Fri 9 to 5pm.

www.richmondwaste.com.au Phone: 6621 7431 or rwaste@solo.com.au

OPEN EXTENDED HOURS GOONELLABAH PHARMACY IS NOW OPEN: MONDAY TO FRIDAY – 8.30AM TO 7PM SATURDAYS – 9AM TO 4.30PM SUNDAYS – 9.30AM TO 1PM

Competitive % of billings. We look forward to hearing from you. Please contact Dr Tonya Coren at info@ capebyronmedical.com.au Ph: 02 6685 6326.

GOONELLABAH PHARMACY FOR ALL YOUR HEALTH NEEDS GOONELLABAH VILLAGE, OLIVER AVENUE PHONE 6624 2449

Expressions of Interest sought

Female GP for Lismore AMS Jullums, Lismore Aboriginal Medical Service, is seeking a motivated & experienced GP to join its team on a contracting basis 1 or 2 days a week. Practice hours are 8.30am to 5pm, Monday to Friday and admin support is provided. Comfortable rooms close to Lismore Base Hospital and professional development opportunities.

Gabrielle Boyce and Associates 581 Ballina Road, Goonellabah Phone (02) 6625 2888

Advertise in HealthSpeak

Full professional registration, medical indemnity insurance, a current Working with Children clearance, ABN and eligibility to claim Medicare rebates are required. For more information contact Christine Wilson on 6621 4366 or email cwilson@ncphn.org.au

Trusted locally since 1992, at Physio Plus you’re in the right hands for: • Physiotherapy • Exercise Physiology • Occupational Therapy (Paeds) • Pain Management • Onsite gym & Pool Rehab • Custom Orthotics via Gaitscan technology • Waterproof casts/Braces/Splints • Manual Handling Training/Preemployment Screening Tony Morley, Emile du Plessis & Associates LISMORE – BALLINA – GOONELLABAH

FREE CALL 1800 662 125 www.physioplus.info

a publication of North Coast Primary Health Network