HealthSpeak December 2016 by North Coast Primary Health Network

HealthSpeak issue 17 • December 2016

THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE

Art on Bundjalung Country page 39

BONUS LIFTOUT: D & A REFERRAL GUIDE

Mental health on the North Coast

Roundup of Excellence Awards

Feature: Alcohol

13 & other drugs

GPs and the

31 NDIS

Much to celebrate this year and more to come

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 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

editor Janet Grist

hanks so much to Bundjalung artist Digby Moran whose stunning painting graces

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

ber 5 to 23. In other news, congratulations to our very own columnist David Miller, who along with three other GPs on the North Coast, has been recognised for his many years of health care and service to his community. Wishing you all a happy and safe holiday season and speak to you in the New Year.

The Chase is on for a Value Based Payment Model!

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

Health Speak

our front cover. It points to an exciting project of which NCPHN is a sponsor. It’s the Bundjalung Art Project, which will encourage members of the Northern Rivers Aboriginal community to create an artwork, potentially for an exhibition at the new Lismore Gallery next year. Check out more of Digby’s art at an exhibition at the SCU Lismore campus from Decem-

ceo Vahid Saberi

ll things considered, in Australia we have generally got it good when it comes to the essentials of life. We have a good health care system, reasonable welfare, legal and education systems and a peaceful community. Before I am reminded, I am not suggesting that we have achieved ideal society status! Can we do better? The answer is a resounding “YES”! And it is important that we not be satisfied with what we have but aspire, and reach out for higher goals – for example, expediting the closure of the gap between the health of our Aboriginal brothers and sisters and the mainstream community. In late November we had an incredible opportunity to have five international scholars with us on the North Coast. We were able to engage with them, and with each other, in discussion about how to “change health

care for the better”. Many issues of great importance came up. One that is worth talking further about is Value Based Care. Recent studies in the US suggest that a staggering 35% to 50% of all health care spending is wasted on “inadequate, unnecessary, uncoordinated, inefficient care and suboptimal business processes”. While no similar study has been done in Australia, all the deficiencies noted could apply to the Australian health care system and some suggest that at least the lower end of the suggested figure could well apply to us. In Australia we primarily assess health care by output (how many) not by outcome (how good for the patient) – volume not value. Value based care attempts to invert this. This means that ‘access’ is not enough; ‘effectiveness’ is as important. The move to value based care is not easy. There are many barriers. Among these is our ability to develop good patient outcome measures and assess care delivery based on these. The proverbial elephant in the “clinician” room however is the way we pay for health care. The current dominant method is

called fee for service which pays for intervention volume with little to no regard for efficiency or effective outcomes. Fee for service is currently applied to hospital care as well as primary health care. There is universal agreement that this prevailing reimbursement method fuels waste and does not promote high-quality care. Under this model clinicians receive higher benefits if they see as many moderately ill patients as quickly as possible and avoid chronically ill and complex patients. The grail-chase for a value based reimbursement is on. The race is on to find a value based reimbursement model that incentivises good practice and quality health care. Two models are currently the frontrunners. You are probably familiar with these - Capitation and Bundled Payment. This is the last edition of HealthSpeak for 2016. This year, like the previous year has raced by. I do wish you the warmest greetings of the season and every good wish for 2017 – no doubt this conversation about value based care and value based reimbursement will continue then.

Cover image: Sea Turtle Feeding by Digby Moran. An exhibition of Digby's works Past and Present is showing at SCU Lismore's Gallery Space from 5 to 23 December 2016 a publication of North Coast Primary Health Network

healthspeak December 2016

The importance of decreased foetal movements in pregnancy clinical editor Andrew Binns

orty years ago after an overland trip to the UK via the Middle East, I landed an obstetric senior house officer job at the Upton Hospital in Slough, 34 km west of London. This was a 57 bed obstetric hospital in a working class area that was closed down soon after I left. My consultant was Obstetrician Dr Stanley Simmons who eventually became The President of the Royal College of O&G and was knighted for his services in 1994. He was a great educator. The reason I recently reflected on his distinguished career is that he was a leader in the field of antenatal surveillance monitoring with cardiotocography (CTG) and other measures of foetal wellbeing. In our antenatal clinics it was mandatory to ask all pregnant women greater than 28 weeks about how active their foetus was. Any decrease in foetal movements was actively monitored with CTG review and full assessment sometimes leading to induction and early delivery if indicated. I was astounded to hear recently that the President of the AMA Dr Michael Gannon, an Obstetrician, said that pregnant women worried about reduced foetal movements should have a

December 2016 healthspeak

cold drink to wake their baby up. There is no supporting evidence that this works and RCOG guidelines contradict this advice. Dr Gannon was concerned that emphasis on reduced foetal movements may result in significant numbers of worried women whose babies are healthy presenting to hospitals for assessment. GPs looking for advice on this issue can get some practical advice from this Australian Family Physician article. Normal foetal movements can be defined as 10 or more foetal movements in two hours felt by a woman when she is lying on her side and focusing on the movement. Maternal factors to be focused on are hypertension, small for dates, primiparity, obesity, racial or ethnic risk factors. When it comes to potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and foetal growth restriction together account for 56.1% of the stillbirths. Failure to recognise foetal growth restriction by regular fundal height measurements with a simple tape measure, and organising an ultrasound when indicated, is the largest risk factor for stillbirth. This topic recently came

up at the NCPHN antenatal update workshop and there was a general view expressed that if a woman was experiencing reduced foetal movements they should either present to their GP or go straight to the nearest Obstetric unit for assessment. Although 70% of pregnancies with a single episode of decreased foetal movements go on to a live healthy birth, we cannot afford to be complacent, particularly if there are risk factors or recurring abnormalities in foetal movements. Countries such as Finland and Norway have stillbirth rates around 20-30% lower than Australia. Our stillbirth rate is about 2.9 per 1000 births for non Indigenous women and twice that rate for Indigenous women. Lives could be saved if we took warning signs more seriously. More research, clear guidelines and education for all health professionals involved in antenatal care is needed. Australia is ranked 15th in the world for the rate of stillbirths, but the situation for the Indigenous population is much worse. If counted alone it would be ranked 56th. Hopefully we can improve on these statistics.

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Australia is ranked 15th in the world for the rate of stillbirths, but the situation for the Indigenous population is much worse

TRANSFORMERS THE TRANSFORMERS SPECIAL EVENT SERIES ADVANCES THE INTEGRATION PROCESS

n a significant step to improving healthcare and the health system on the North Coast, in late November/December the NCPHN hosted a series of workshops and events for health professionals featuring world experts. The Transformers Special Event series, an initiative of the Centre for Healthcare Knowledge & Innovation, brought five scholars from the International Federation for Integrated Care to the North Coast to share their experience and help local health providers explore the essentials for transformation of the health system.

Among the events held in the four intensive days were symposiums; workshops; clinician dinners and service visits. Over 350 clinicians, community members and health professionals from the North Coast attended these events which were held in Coffs Harbour, Grafton, Lismore, Ballina, Byron Bay and Tweed Heads. The five international experts took the stage in a panel discussion, compered by NCPHN Board Chair Dr Tony Lembke. The panel was made up of Dr Richard Antonelli from the Boston Children’s Hospital and Harvard University; Dr Robin Miller, Director Evaluation University in

Birmingham; Geriatrician Prof Anne Hendry, Clinical Lead for Integrated Care, Scotland; Dr Nick Goodwin CEO International Foundation for Integrated Care in the UK; and Dr Viktoria Stein, Head of the Integrated Care Academy, IFIC. A great deal of the discussion was around the Patient Centred Medical Home (PCMH). Dr Antonelli said that the best starting point is to, “ask your stakeholders ‘what can we do to make your life better?’” Ultimately patient-centeredness is care that focuses on the needs of the patients and their care experience. “Bring patients with complex conditions into your team. Having them makes the issues real and highlight the importance connecting care. Professionals can easily get stuck in silos and

interprofessional tribalism,” said Dr Anne Hendry. The presence of five distinguished international scholars in the region was a unique opportunity which has resulted in increased knowledge, renewed commitment, and determination to continue to integrate healthcare and to place patient outcomes and experience at the front and centre of our reform process. The visiting scholars observed and commented on the close interaction between the primary and secondary health sectors on the North Coast and the high level of engagement of general practice and other primary healthcare providers in the reform process. This indeed is a strength of our region that we need to treasure and build on.

CENTRE FOR HEALTHCARE KNOWLEDGE & INNOVATION is a partnership with the aim of increasing knowledge and innovation in health and social services. Find out about future Centre for Knowledge & Innovation events here: www.ncphn.org.au/the-centre TRANSFORMERS 2016 SPECIAL EVENT SERIES partners and sponsors: 4

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healthspeak December 2016

CHANGING THE HEALTH SYSTEM FOR BETTER

LAUNCHES: PATIENT CENTRED MEDICAL HOME & THE HEALTH CARE NEIGHBOURHOOD

General practices and Aboriginal medical services on the North Coast and Mid North Coast are invited to register their interest in taking part in NCPHN’s Patient Centred

Medical Home (PCMH) program. This program is complementary but different to the Commonwealth’s Health Care Home Trial. Practices who register for the program are expected to strive to make time to implement quality improvement strategies and attend periodic events for training and refinement. A handbook has been produced by the PHN to assist general practices and Aboriginal medical services to traverse the continuum to

the PCMH model. Support will also be provided by NCPHN’s Quality Improvement Support officers. To register or find out more and to download this useful handbook, go to: ncphn.org.au/medical-home

The NSW Agency for Clinical Innovation’s new Health Care Neighbourhood website was

also officially launched. This informative resource defines the basic principles of the Patient Centred Medical Home model and its place in the Health Care Neighbourhood. It showcases work happening across NSW and provides links to relevant state, national and international resources for consumers and health professionals. Visit preview site: aci.health.nsw.gov.au/nhn Username – nhn_preview Password – aci?nhn11

“It takes a lot of work to make a team function and you need to put that time in, especially for team leaders.” – Robin

December 2016 healthspeak

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Celebrating Quality and Continuous Health Care Improvement Forty-one health care project submissions were considered in the inaugural Primary HealthCare Excellence Awards held this year. An initiative of North Coast Primary Health Network, the Excellence Awards are aligned to one of the goals of NCPHN’s Strategic Plan with a view to building strong governance and striving for excellence.

Inspired by the Network’s Quality Management Policy, the Awards are a small part of a bigger picture – building a culture of continuous improvement in health care on the North Coast. The criteria for submissions centred on the design, delivery and outcomes of projects, with an emphasis on the quality PDSA (Plan, Do, Study, Act) cycle. With the face of health care changing in Australia and emphasis shifting from the provider’s perspective to that of the client, new models of integrated care are needed to provide seam-

less, effective and efficient care reflecting the whole of a person’s health needs. NCPHN is working closely with health and community organisations to achieve this systemic change. As we connect and integrate the services in our

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region, we have been constantly inspired by the enthusiasm and dedication of all those who contribute to quality out-ofhospital care provision in our communities. In recognition of the contributions of these stars of primary

healthspeak December 2016

health care on the North Coast, and building on the success of our internal awards celebration in 2014, the inaugural Primary Health Care Excellence Awards were established. Submissions

Staff and contractors from health, social services and community organisations; and university students and PhD candidates on the North Coast were encouraged to submit their programs and projects for consideration by the judges. Award Recipients

Congratulations to all those who were presented with awards on the night and many thanks to all those who submitted their projects. Category 1 – Innovation, Integration and Partnership

Joint recipients: 1 Deadly Step – Casino, a health screening event for the Indigenous community: ACI, NCPHN, NNSWLHD, Bulgarr Ngaru Aboriginal Medical Corporation, NSW Country Rugby, UCRH and the Solid Mob • No Longer on the BACK BURNER – redesigning Musculoskeletal models of care on the Mid North Coast: NCPHN

December 2016 healthspeak

Category 2 – Improving Health Care Access and Outcomes

• NCPHN Needs Assessment: NCPHN Category 3 – Reducing Health Inequity

• Early Detection of Chronic Kidney Disease in Aboriginal People: NNSWLHD Renal Services / Bugalwena General Practice Category 4 – Promoting Healthy Living

• eVillage: Bay Medical Centre and Feros Care Special Awards

On the presentation night at Opal Cove Resort, Coffs Harbour in September, NCPHN also presented some special awards. The Community Choice Award Joint recipients:

Improved health for the disadvantaged through the operation of the Winsome Health Outreach Clinic (Lismore): NCPHN Early Detection of Chronic Kidney Disease in Aboriginal People: NNSWLHD Renal Services / Bugalwena General Practice

The People’s Choice Award

Improved health for the disadvantaged through the operation of the Winsome Health Outreach Clinic (Lismore): NCPHN Outstanding Service to Community Award

There were two recipients: Dr Andrew Binns and Auntie Sue Follent. The Awards ceremony

The ceremony was a glittering and fun night with 80 guests including finalists, award recipients, and members of health and community groups across the NCPHN footprint. NCPHN was pleased to welcome the Assistant Secretary PHN of the Department of Health Chris Bedford, and Vicki Ellem, Director, NSW/ACT Branch. Both Chris and Vicki, and many guests, commented on the wonderful work happening across the region showcased on the night. For a comprehensive list of finalists and award recipients along with videos of their projects, go to www.ncphn.org. au/excellence

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Access to Mental Health Services in our region

very year, millions of Australians suffer some form of mental health issue. Many also have problems with alcohol or other drugs. Mental Health issues are the third largest chronic disease in the country. However, when it comes to mental health, not everyone is the same. The vision for the mental health system is that it will provide a wide range of services so community members can access the right level of care when they need it. The National Mental Health Commission’s Review of Mental Health Programs and Services has given Primary Health Networks the responsibility to help local communities develop local solutions, understanding that all communities have different strengths and needs. The first step in this process is to understand the needs of local communities. This will be done by combining local data, information about good practice and information about the experiences of local consumers, their families and service providers. To aid the process, the PHN has collated public information about access to local health services which identifies some strengths and weaknesses within our region. It is not always clear, however, which camp some information falls into - a strength or a weakness. This article doesn’t attempt to provide commentary on this data, but simply provides key data outcomes for consideration by health care providers. Hospitalisations

• Across all mental health hospitalisations, and for schizophrenia and delusional disorders, the NCPHN region has a higher rate of admissions per 100,000 people than any other PHN region in Australia • Compared to other PHNs, NCPHN has the second highest rate of admissions per 100,000 people for drug 8

Figure 1: Benefits paid per 100,000 people for all mental health MBS items 2014/15 Not age standardised

$57.09

Overall Benefits Paid

$50.53 $27.89

Psychiatry Items

$12.29 $19.12

Allied Health Items

$23.72 $10.08

GP Items

$14.52

Australia

NCPHN

Figure 2: Number of allied mental health MBS services per 100,000 2014/15 Not age standardised Australia

18216

NCPHN

23333

Tweed Valley

25549 21643

Richmond Valley - Hinterland

26342

Richmond Valley - Coastal Port Macquarie

22697 13291

Kempsey - Nambucca Coffs Harbour

22530 10554

Clarence Valley

and alcohol use and intentional self-harm, and the third highest rate for bipolar and mood disorders • There is significant variation within the region in rates of hospitalisation and number of bed days for mental health admissions Utilisation of the MBS

• While the NCPHN region has high rates of utilisation of GP and allied mental health-related MBS item number usage for mental health, use of Psychiatryrelated item numbers is low. (Figure 1) • The Clarence Valley and Kempsey/Nambucca regions appear to have much lower usage of allied mental health MBS item numbers than the rest of the region (Figure 2)

Dispensing of Psychotropic Medications

• The NCPHN region generally has higher rates of dispensing of psychotropic medicines per 100,000 people than across Australia • The rates differ more greatly for people under 65 years than those over 65 • The rate of dispensing antipsychotic medicines per 100,000 people aged 17 years and under in Kempsey/Nambucca is the second highest in Australia, and in Port Macquarie the third highest. The rate of dispensing ADHD medicines per 100,000 people aged 17 years and under in Kempsey-Nambucca is the second highest in Australia, and in the Clarence Valley the sixth highest rate in the country.

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If you’d like to share your thoughts on this data, or get involved in the mental health reform process, email mentalhealth@ncphn.org.au. To find out more go to ncphn.org.au/ mental-health-reforms All hospitalisation data from: Australian Institute of Health and Welfare, 2016. Healthy Communities 1

Hospitalisations for mental health conditions and intentional self-harm in 2013–14. [Online] Available at: http:// www.myhealthycommunities.gov.au/ Content/publications/downloads/ AIHW_HC_Report_Mental_Health_ September_2016.pdf?t=1475111127719, [Accessed September 2016] Medicare Benefits item number data from: Department of Health, 2015. Primary Health Networks Data: Medicare Benefits Schedule Data. [Online] Available at: http://www.health.gov.au/ internet/main/publishing.nsf/Content/ PHN-MBS_Data. ATAPS and Mental Health 2

PBS data appearing from National Health Performance Authority, 2015. Australian Atlas of Healthcare Variation. [Online] Available at: http://meteor. aihw.gov.au/content/index.phtml/ itemId/623427 [Accessed September 2016]. 3

healthspeak December 2016

Youth and health centre stage at Ballina

orthern NSW hosted a Youth Health Consultation in September to gather information about young people’s health and wellbeing and to collect feedback on their experience of health services. Held at the Ballina Surf Club, 41 young people aged 12 to 24 gathered for the workshop to help inform NSW Health’s Youth Health policy. The forum was supported by North Coast Primary Health Network, Northern Rivers Social Development Council, headspace and North Coast TAFE. The young people who attended were quizzed on issues including what health and wellbeing issues were important to them, what their health concerns were, and where they went to obtain health information and advice. They were also asked about what they liked about the health services they

Dr Sally Gibson and Dr Carmen Jarrett facilitated the Youth Health Consultation. They are from the NSW Health’s Youth Health & Wellbeing Team. Photo by Robin Osborne, GPSpeak.

used, what worked well and not so well. Another area of questioning was the health promotion arena with the young people asked what health promotion activities they were aware of and how appropriate these were for young people – eg sexual health, smoking, alcohol and drugs, coping with stress/mental wellbeing, healthy eating and exercise. The general consensus from the youth present at the forum was that they learnt a lot from

the day, and are now more aware of how to access health services. They would like to see more youth friendly services and be encouraged to improve their health through positive relationships with health professionals. They also understand the importance of early intervention through education and mentoring. Participants were keen to keep the conversation going and for opportunities to engage further with health issues.

STOP PRESS Congratulations to four North Coast GPs who have been recognised by the NSW Rural Doctors Network for their many years of outstanding service to their communities. NCPHN is delighted that these significant contributions have been recognised. Congratulations to • Dr David Miller for his service to the Mullumbimby/ Brunswick Heads communities • Dr Juriaan Beek for his service to Casino • Dr Robin Mathews for his service to Maclean • Dr John Kramer for his service to Woolgoolga

Need NDIS Advice? Need help to understand the National Disability Insurance Scheme (NDIS)? DAISI is your North Coast disability information service and can assist you and your client in navigating the National Disability Insurance Scheme.

We can also assist by connecting people to local services and resources that enable greater community participation.

Give DAISI a call on 1800 800 340

Our friendly Case Coordinators can help people understand what the NDIS means for them, and how they can get the most out of their NDIS plan.

December 2016 healthspeak

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A new and exciting beginning for Jullums Aboriginal Medical Service

orth Coast Primary Health Network (NCPHN) is delighted to announce the transition of the Jullums Aboriginal Medical Service Lismore ( Jullums AMS) to an Aboriginal Community Controlled Health Organisation (ACCHO). This transition will see Rekindling the Spirit (RTS), a Lismore based ACCHO, take over the operation of the service from North Coast Primary Health Network. The process of transition included an approach to market wherein the submissions received were reviewed by an independent review panel. The awarding of the contract to RTS included a dialogue between NCPHN and RTS to ensure the sustainability of the service into the future. “The dialogue was an important part of awarding the contract as it ensured that Rekindling the Spirit had all the required capabilities for the delivery of quality and safe healthcare to the Aboriginal community of Lismore” said Dr Vahid Saberi, NCPHN Chief Executive. The RTS CEO, Mr Greg Telford, told Healthspeak that his organisation will continue the track record of Jullums AMS as a high quality service ensuring the community has a strong say in the design and delivery of the care they receive.

Jullums AMS is a long-standing service at Lismore providing a range of primary healthcare services, including general practice, mental health and specialist services. The success of the service has been due to the commitment of its outstanding staff and excellent clinicians including a number of general practitioners who have stayed with the service through challenging times. NCPHN and RTS owe a debt of gratitude to these clinicians and staff of Jullums. RTS Services Manager, Mr

Jeff Richardson said that Jullums will continue to operate with the same staff who have served the community with distinction over the years. Mr Greg Telford and Mr Richardson extended their appreciation to NCPHN for managing Jullums AMS over many years and establishing a sound process for its handover to RTS. RTS will operate the service with the support of Aspen Medical, a global health care provider and philanthropic organisation. Aspen will be available to support the AMS with clinical governance advice and will provide healthcare staff to fill gaps should it be needed. Mr Richardson said “Our intention is to have a wellness and holistic approach to healthcare. We are interested in keeping well

RIP Fax machine

hen fax machines became commonplace in offices in the 1980s, they were hailed as an invaluable form of sending and receiving documents quickly and effectively. But it seems that in the Australian health care system, the end is nigh for the humble fax. The RACGP has released a position paper calling for all healthcare services and govern-

ment agencies that communicate patient information with general practices to eliminate paper forms and faxes within three years and to replace them with secure digital communications. “It is somewhat bizarre that in an advanced era of rapid and timely electronic communications many Australian healthcare organisations still use

the fax machine as the most important document communications device,” RACGP president Dr Frank R Jones said. “Fax machine, rest-inpeace. General practice has been equipped to communicate digitally for over a decade and we must embrace it now as the benefits for patients and practices will be enormous,” Dr Jones added.

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people well, not just treating sick people. Focusing on addressing social determinants and chronic disease risk factors will help us prevent many illnesses such as cancers, cardiovascular disease and renal disease that burdens our community. We don’t have to have that burden of disease and we’ll work to get the community to believe that they have the power to improve their health,” he said. Jullums AMS will benefit from RTS’s Community Advisory Committee which provides grassroots guidance to the organisation. For more information on the services provided by Jullums AMS, please visit www.lismoreams.org. au or contact practice manager, Vickie Williams, on 6621 4366.

In loving Memory Facsimile 1880-2019

healthspeak December 2016

Preliminary DaPPHne Project results: It’s Complicated

nterim findings of a Mid North Coast research project into Potentially Preventable Hospital (PPH) admissions show that for one third of the chronic disease patients involved in the study nothing could have been done to prevent their admission to hospital. Interim results of the DaPPHne project at two Mid North Coast hospitals were provided to HealthSpeak. When complete, the results will provide a clearer understanding of so-called Potentially Preventable Hospital (PPH) admissions and whether and how they can be reduced. The project explored potentially preventable hospital admissions among people with chronic disease 45 years and older at Port Macquarie and Coffs Harbour Hospitals. The study was run by the University Centre for Rural Health in collaboration with, and funded by, North Coast Primary Health Network, Mid North Coast Local Health District and the NSW Agency for Clinical Innovation. Lead investigator Dr Megan Passey told HealthSpeak that the aim of the research was to generate an evidence base to reduce preventable admissions and improve measures of health system performance. “We looked at the people admitted with unplanned admissions to our two hospitals with target conditions – COPD, heart failure, angina and diabetes with its complications,” she said. A range of data was collected about the patients including what brought them to hospital, what service patterns they had beforehand, their social circumstances and other important information about their daily life. This included interviews with the patients themselves, review of hospital notes, the use of a preventability assessment tool by senior registrars and nurses and GP interviews about the individual patients and what December 2016 healthspeak

Participants at the workshop in Port Macquarie in October.

care they’d received. The project’s early findings were presented at a workshop in Port Macquarie in October. Essentially the preliminary findings indicate that one-third of the admissions could not have been prevented from entering hospital; for around one third it wasn’t clear whether their admission could have been prevented and for around one third something could have been done differently to prevent the admission to hospital. However, Dr Passey said that no ‘silver bullets’ were identified. “It would have been nice to have identified something clear cut that could be addressed. But for most patients it’s multi factorial, there was no one thing that would have made the difference. But for those classified as being possibly preventable, there was no simple, easy solution.” Some identified factors included • Patient behaviours - not taking diuretics as they interfered with their lifestyle, not following diet restrictions etc; not seeing their GP often enough, not engaged with their care management; patients not going to specialists as often as they should – some said it was the cost, distance and access. • Less than optimal care management by the GP.

Some didn’t have an action plan for the patient. Missing or inadequate referral to specialist services. • From the system perspective – poor communication linkages between services, lack of access to community services such as diabetes educators, heart failure services and specialists. Overall though Dr Passey said the picture was complicated, with patients in the study having an average of seven diagnoses

and needing complex care arrangements. “While no silver bullets were identified, a number of ideas were generated at the workshop and so now we are going to be working with the PHN and LHD to move ahead with these ideas,” she said. Dr Passey said that a key message for government from the research was that it’s not going to be easy to solve “Potentially Preventable” admissions. “We keep putting PPHs as a KPI and asking people to reduce them and we keep making it an outcome indicator for new programs but it’s not that simple. These are really sick people with multiple comorbidities. The simple answer is it’s hard, it’s complicated.” The DaPPHne project involved a number of arms. Dr Passey said it was very much a team effort with thanks due to the research team, the research nurses, the steering committee and the expert panels. The final results will be released next year.

Antidepressants: 68%f MH scripts

ntidepressant medication was the most frequently dispensed medication, accounting for about 68% (24 million) of mental health-related prescriptions, according to an Australian Institute of Health and Welfare (AIHW) report. However, while more subsidised mental healthrelated prescriptions are being dispensed in Australia, government spending on these medications has fallen, the report states. It shows that $753 million was spent by the Federal Government on mental health-related subsidised prescriptions under the PBS

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and RPBS, accounting for about 8% of all PBS/RPBS subsidies. AIHW spokesman Tim Beard said that spending on subsidised mental healthrelated prescriptions fell by 1.4% per year between 2009/10 and 2013/14. “Despite this, more prescriptions were dispensed— rising by an average of 2.6% per year over the five years from 2010/14. This was largely due to the decreased cost of many subsidised medication,” Mr Beard said. In total, there were 35 million prescriptions dispensed to 3.9 million patients during 2014/15.

Vege boxes help raise healthy kids

wenty-two families in Aboriginal communities in the Richmond Valley without easy access to fruit and vegetables are benefiting from a scheme which delivers a box of 80% veges and 20% fruit to them each week. The families with young children under the age of eight live at Box Ridge, Coraki, Tabulam, Jubullum, Mulli and Casino. Funding has been provided by NSW Health’s Aboriginal Environmental Health Unit and North Coast Public Health Unit to complement the Housing for Health program which ensures homes have workable kitchens safe and healthy places to cook. Bulgarr Ngaru’s Clinical Nutritionist at Casino AMS, Anne Criner, told HealthSpeak that

since the scheme began in August she has seen a big change in the families receiving the vege boxes. “In all the participating families there has been an increase in the daily intake of vegetables and the children are excited to see what is in the box each week,” said Anne. To help mothers, Anne includes a flyer with kid friendly vege recipes in each box to introduce new vegetables to the families. “When we were setting up the scheme our doctors wanted to focus on pregnant women and families with small children as an intervention to prevent chronic disease. Getting more fruits and veg into young children improves their dietary habits, and in turn improves their dental

Natasha Davis of Coraki

health, speech and general health outcomes.” To take part in the scheme, the families had to agree to complete regular medical checks at Bulgarr

Ngaru. Families which were previously not interacting with AMS staff are now up to date with their health checks and immunisations. Anne is also organising to book a kitchen in a local church early next year and with the help of three women Elders will run cooking classes there for Mums. “It will be a safe place where the mothers can bring their young children so that they can attend these classes to learn how to better feed their families,” she said.

Financial Tips for Medical Professionals By Michael Carlton CEO & Senior Adviser, PECUNIA Private Wealth Management

plan. I have witnessed the impact on families when professionals become the victim of a traumatic illness or injury or premature death. Plan for the unexpected.

Having advised many medical professionals over the past 24 plus years, we have compiled a list of financial tips.

How can we help?

1 Start investing young – Start with a key asset – your own home, paying off this non-deductible debt as quickly as you can. 2 Use our Tax System to Your Advantage – Be aware of good and bad debt and leverage wisely off tax effective borrowings to buy investment assets such as property and shares. Remember this is for the long term. 3 Start Your Own Practice – Considered one of the best investment for medical professionals. Whether you are in a rural town, regional hub or larger city you will be busy with an endless stream of paying patients. 4 Diversify – Whilst this may seem obvious many professionals lack diversity in their investments. 5 Use of Self-Managed Superannuation Funds (SMSF) – SSMSFs can help one acquire premises for a practice. Transfer of Ownership (watch CGT and Stamp

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Duty issues), Limited Recourse Borrowing Arrangements and CGT Rollover relief are but a few. The key is to obtain good collaborative advice between your solicitor, accountant and adviser. 6 Superannuation – It is never too late to start and best to start early. So work with your adviser and ensure they know what Div 293 rules are. 7 Surround Yourself with a great team – Save time (thus money) and have skilled professionals who understand your profession such as specialist accountant, financial adviser, lawyers and finance brokers (bankers) on your team. 8 Plan for Contingencies – As we know, life does not always go to

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Simple, by asking yourself the question: Have I looked at these key tips to creating, building and/ or protecting my and/ or my family’s future financial well-being? If the answer is no then engage a professional who understands your profession to work with you in a collaborative manner to set the motions in place. Call 1300 112 676 to arrange an obligation and cost free initial diagnostic consultation. For further information see our website: www.pecunia.com.au 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). His advice is general in nature and readers should seek their own professional advice before making any financial decisions.

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ALCOHOL & OTHER DRUGS ON THE NORTH COAST BY JANET GRIST

ISSUE OF GREATEST CONCERN For people living on the North Coast, drug and alcohol misuse is the health issue that concerns them most. In NCPHN’s 2016 Needs Assessment, 56% of those surveyed gave this response. And among service providers surveyed, alcohol and other drugs were rated as one of the five local health issues of most concern. Backing this up, across the North Coast 29.4% of residents over 16 years of age consume alcohol at levels that pose a lifetime risk to health (more than two standard drinks a day) – above the state average of 27.4%. And how does this alcohol consumption play out in our health system? In hospital admissions in our region, 698 per 100,000 of population are related to alcohol, again higher than the state average. Alcohol related violence Alcohol is estimated to be involved in up to half of partner violence in Australia and 73% of partner physical assaults. More than one woman a week dies as a result of domestic violence in Australia. It’s also a major cause

December 2016 healthspeak

of road and other accidents. Alcohol misuse and tobacco consumption are major risk factors for cardiovascular, respiratory, cancer and renal chronic diseases. Effects of alcohol Alcohol is a central nervous system depressant. Initial effects are feelings of relaxation, wellbeing and loss of inhibitions. However, as the intake of alcohol increases, these effects are counterbalanced by drowsiness, loss of balance, nausea and vomiting. Higher alcohol intakes can lead to life-threatening events such as unconsciousness and, eventually, inhibition of normal breathing which may be fatal. Cumulative effects Alcohol consumption has been associated with a range of diseases that may cause death and adverse effects that reduce quality of life. Among these are: cardiovascular disease, cancers, diabetes, nutritional deficiencies, obesity, foetal alcohol risks to unborn babies, liver diseases, mental health conditions, longterm cognitive impairment and self-harm (Taken from an Australian Institute of Health & Welfare report on the National Drug Strategy Household Survey 2013)

DRUGS & ALCOHOL ON THE NORTH COAST

Research shows that GPs have the most influence on the behaviour of patients around alcohol and other drugs from the age of 30. Could you be doing more to help your patients exhibiting risky drinking behaviour to cut back or stop drinking?

DID YOU KNOW? Person most likely to drink daily at harmful levels is a 70 year old male People in their 40s most likely to drink at risky levels 42% of women in NSW drink during pregnancy Drinking is the leading cause of death among adolescents (Australian Drug Foundation)

ALCOHOL IS ESTIMATED TO BE INVOLVED IN UP TO HALF OF PARTNER VIOLENCE IN AUSTRALIA AND 73% OF PARTNER PHYSICAL ASSAULTS

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D & A DURING PREGNANCY

FEATURE DRUGS & ALCOHOL ON THE NORTH COAST

D & A during pregnancy Mandy Carpenter is a Registered Nurse who works in the NNSW LHD’s Mums Using Substances (MUMS) Program and is based at the Riverlands Drug and Alcohol campus at Lismore. This service is free and confidential and works with a multi-disciplinary team which aims to help women to reduce any harm that may occur to both themselves and their baby during pregnancy and after the birth. There are also MUMS’ staff in Grafton and Tweed Valley and within the NNSW MNC LHD at Coffs Harbour and Port Macquarie. “Babies can be affected by their mother’s drug use and sometimes might need weaning off them if Mum has been using them during pregnancy. We do a score sheet of the babies’ withdrawal symptoms and depending on what signs and symptoms the baby displays they might need medical intervention,” Mandy told HealthSpeak. However, the biggest risk to babies remains the use of alcohol during pregnancy. It’s recommended that women not drink alcohol at all during their pregnancy and while breast feeding. Drinking during pregnancy places their baby at risk of being born with FASD – Foetal Alcohol Spectrum Disorder. FASD children experience a spectrum of physical and behavioural issues including: abnormal facial features, a small head, low body weight, poor coordination, hyperactive behaviour, attention difficulties and poor memory. If clinically indicated, babies are weaned off alcohol using phenobarbitone. “Alcohol is the biggest cause of intellectual disability in the western world. Ninety-six per cent of women who drink through their pregnancy will be fine but 4 % won’t be. But FASD is difficult to diagnose; there are no tests available for it. It’s usually diagnosed some years down the track – maybe the child is not appearing at its best, kindy teachers might notice and encourage the parent to seek GP advice and alcohol use during the pregnancy might be then be looked at. But it can be very difficult to diagnose. “Fifty per cent of pregnancies are unplanned and if mothers continue their usual drugs or alcohol use, it can often be a few months down the track until they realise they are pregnant,” said Mandy. How GPs can help Mandy would like to see more GPs starting conversations about contraception and the 14

SOMETIMES BY THE TIME YOU KNOW YOU ARE PREGNANT THE DAMAGE HAS BEEN DONE effects of drugs and alcohol during pregnancy with all female patients of child-bearing age, especially as the first trimester is crucial for the baby’s health and development. “It would be great if women went to GPs before they were planning to fall pregnant and have that conversation – how can I produce the best baby I can? – and the GP would then discuss any substance use. Also, the partner needs to be involved. It’s been shown that DNA can change with alcohol abuse and it can go on through generations. It’s always been the female who’s been the focus but we need to look much more closely at men, especially if they are using alcohol and / or cannabis,” Mandy explained. These conversations, including the dangers of smoking, should also be had at a woman’s first GP appointment after discovering she’s

DASAS: professional advice for GPs If you are a health professional seeking advice about the diagnosis and treatment of a patient with alcohol or other drug issues the 24-hour helpline DASAS (Drug & Alcohol Specialist Advisory Service) can assist. Call DASAS on 1800 023 687.

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pregnant. “Sometimes by the time you know you are pregnant the damage has been done. It’s really a conversation that needs to happen early,” Mandy said. “At this appointment GPs, could say something like “it is natural for mothers to want to do their best for their babies so I would like to give you some information about the possible harms that drugs or alcohol could do to you baby if you were to use them during your pregnancy”. Further resources: To help start a conversation with a female patient, please refer to these guidelines: http://bit.ly/2fGET6L

Also useful are these NHMRC guidelines: nhmrc.gov.au/health-topics/alcoholguidelines?

There are also FREE online courses with CPD accreditation for Health Professionals through the RACGP and Australian College of Midwives: http://www.racgp.org.au/education/courses/ activitylist/activity/?id=8081&q=keywords%3 dalcohol learn.midwives.org.au/moodle/course/index. php?categoryid=3

If you are in the NNSW LHD region and have a patient who is drinking or using drugs during pregnancy and desires help, they can call Tweed Valley/Byron Shire on 07 5506 7010, Lismore/Coraki/Evans Head/Casino on 6620 7600 and Clarence Valley 6640 2402. If the patient is in the Northern Rivers, they can attend in person to Riverlands D&A service in Lismore, speak to an intake officer and be assessed for the MUMS program straight away. On the Mid North Coast or in Hastings/ Macleay, the number to call is 1300 662 263.

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CRYSTAL METHAMPHETAMINE: SUPPORTING WITHDRAWAL

DEPRESSION, ANHEDONIA, AGITATION AND SLEEP DISTURBANCE CAN LAST FOR UP TO EIGHTEEN MONTHS AFTER LAST-USE December 2016 healthspeak

D & A Related Pathways Alcohol Intervention; Long Term Medications for Alcohol Dependence; Alcohol Withdrawal & Detoxification Psychosis Psychosis - Medications and Sideeffects; Poisoning & Drug Overdose D&A Related Support Services

nationaldrugstrategy.gov.au/internet/ drugstrategy/publishing.nsf/content/ psychostimulant-gp

CANNABIS DEPENDENCE Typically, people who use cannabis do not progress to using the drug regularly, or for long periods of time. Most will experiment every now and then during adolescence and early adulthood and stop using once they are in their late 20s. However, some people will become dependent on the drug, meaning that they need to use cannabis just to feel normal. Consequences of dependency People dependent on cannabis are at a higher risk of suffering from short-term

Medications in Pregnancy

FEATURE

risk. Supported withdrawal should be seen as the first step in a comprehensive treatment plan, including counselling, relapse prevention, engagement in a peer-based support group in conjunction with a psychosocial program. GP guidelines for assisting withdrawal can be found here: Management of Patients with Psychostimulant Use Problems: Guidelines for General Practitioners

Drug & Alcohol Services; Depression Counselling

Mental Health Assessment; Urgent Mental Health Assessment; Mental Health Community Support; Mental Health E-Therapy; Social Work Referrals; Healthy Lifestyle Support; Medication Review Services; Schedule 8 Medicines. All HealthPathways are available at: http://manc.healthpathways. org.au (user name: manchealth and password: conn3ct3d)

DRUGS & ALCOHOL ON THE NORTH COAST

Many methamphetamine users will experience a ‘crash’ when they stop using, which might last for a few days. During this time the person is likely to experience periods of prolonged sleep, increased appetite, some irritability and a sense of feeling flat, anxious or dysphoric. As dopamine stores begin to replenish, the person improves rapidly. Similar to a ‘hangover’ from alcohol, this crash period is not a clinical withdrawal and specialist intervention is usually not required. In contrast, users who experience methamphetamine dependence can experience more significant withdrawal syndrome when they stop using. Signs and symptoms of clinical methamphetamine withdrawal can include: • General dysphoria through to significant, clinical depression and suicidal thoughts • Mood swings • Inability to experience pleasure • Decreased energy • Irritability or anger • Agitation, anxiety, panic • Sleep disturbance, lethargy, exhaustion, insomnia • Poor concentration and memory • Strong cravings to use methamphetamine. The acute phase of withdrawal can peak around day two or three after use and generally begins to ease after ten days. However, some cognitive symptoms can last for much longer. For many dependent user’s symptoms of depression, anhedonia, agitation and sleep disturbance can last for up to eighteen months after last-use. In addition, longer term crystal methamphetamine use has been associated with significant cognitive impairments due to the damage caused to the dopamine system in the brain. Withdrawal is most often undertaken at home, but a specialist hospital or residential setting is suitable for people at heightened

HEALTH PATHWAYS

memory impairment, mental health problems and respiratory diseases (if cannabis is smoked). Regular use and dependence can also lead to problems with finances, difficulties in relationships with family and friends and employment problems. It has been estimated that there are at least 200,000 people dependent on cannabis in Australia. The earlier a person starts using cannabis, and the more they use, the more likely they are to become dependent. Studies have shown that males are more likely than females to become dependent on cannabis. People can also become addicted to the nicotine they use to add to their cannabis

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SEE CENTRE PAGES FOR D & A REFERRAL LIFTOUT when smoking the drug. Symptoms of dependence One of the most common symptoms is the experience of discomfort when undergoing withdrawal. Studies with cannabis users who have recently quit report that withdrawal symptoms start on the first day, peak in the first two to three days, and with the exception of sleep disturbances are usually very mild by the end of the first week of abstinence. Withdrawal symptoms usually last

around two weeks. The most common symptoms include: anxiety/nervousness, physical tension, reduced appetite, mood swings/irritability, cravings to smoke cannabis, insomnia and strange dreams. Treating dependency Studies have shown that even a single session with a counsellor can assist the cannabis-dependent person to bring about significant improvements in their level of use

and wellbeing. The intensity of treatment varies. Some people respond to education and information about managing cravings and high risk situations for relapse, others may need inpatient management for cannabis withdrawal and rehabilitation. As yet, there are no effective pharmacological treatments to help reduce cannabis withdrawal symptoms or to block the effects of cannabis. (Information from Alcohol and Drug Foundation)

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SMART RECOVERY GROUPS

DRUGS & ALCOHOL ON THE NORTH COAST

NCPHN is supporting trained Facilitators to establish and manage SMART Recovery groups in the Grafton area. These groups will soon be established in other centres across the region. These groups are an alternative to Narcotics Anonymous and Alcoholics Anonymous. The SMART Recovery program offers peer-based support based on a Cognitive Behaviour Therapy model designed to assist people to deal with their additive behaviours and bring about long-term behavioural change. In 2016 the NCPHN team has run training for community based providers to qualify as SMART program facilitators, with 32 people now able to lead these groups across Northern NSW.

GPs can now manage up to 10 methadone patients without special training. To register interest in methadone management in Northern NSW contact the NUM of the Riverlands’ Opioid Treatment Unit, Ray Bogearts on 6620 7600. For Coffs Harbour & Hastings/Macleay inquiries phone 1300 662 263.

ICE Task Force funds specialist nurses Kate Willock is one of six Clinical Nurse specialist positions within the NCPHN footprint funded by the ICE Taskforce in Northern NSW. Kate consults with Lismore Base and Casino Hospital patients, creates patient management plans and provides education and capacity building for health staff. Because of the nature of the funding the focus is on methamphetamine clients. 16

From left: Kate Willock, Dr Hannah Visser and Hank Hickling at Casino AMS.

The four clinical nurse specialists working in Tweed, Ballina, Lismore and Grafton meet monthly to confer about data and look at clinical case reviews. When HealthSpeak visits Kate she is just back from Lismore Base ED after seeing a young Indigenous man, who is an alcohol and psychedelic drugs user. She tells me that if there was a crystal methamphetamine primary user also in need of a visit, she’d have to triage her workload to meet this need. “The priority is for me to see stimulant clients because we know how hard they are both to engage and retain in treatment,” she said. The outreach work Kate does at Casino includes half a day a fortnight based at Bulgarr Ngaru Medical Aboriginal Corporation Richmond Valley Clinic in Casino. “When we were planning how this role would operate in Casino, we met with senior hospital staff and I suggested that because of the Indigenous population and the mortality and morbidity rates, it was important to include the AMS in our work. That’s the population more likely to be hospitalised, and one of the target groups,” Kate said. Kate’s work complements the role of the AMS’s Drug & Alcohol worker, Hank Hick-

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ling. Uncle Hank works at the AMS and also goes to outlying communities. With no Aboriginal mental health worker in the area, as well as looking after D & A patients, Hank’s role expands to community engagement and health promotion - counselling people around grief and loss, justice issues, probation and parole, and people coming back into the community after a jail term. Kate works closely with the AMS GPs. They refer patients to her, primarily around withdrawal management and she works with them on a management plan. “So, there’s a conversation with GPs to be had – is the patient doing an ambulatory or home withdrawal; is it being undertaken safely? Do they need a hospital or Riverlands Clinic admission? There are also some situations where an ambulatory withdrawal is not recommended, for instance if there are other substance users in the home or if there is a history of domestic violence – the situation could be unsafe.” Casino AMS’s Programs Manager Troy Combo says it’s invaluable having Kate’s clinical expertise. “She fills a massive gap, bringing a clinical service here and allowing our patients to have healthspeak December 2016

ted for a drug-induced psychosis and I play the waiting game until they are well enough to be seen and try to engage them. So, it’s a challenging role.” Kate explained that her methamphetamine clients are mostly ‘functional’ people, in relationships, often with children, employed, socially connected, giving rise to a whole other life, separate to their substance use. “And often they are enjoying using, so they’re less likely to have a discussion around adverse effects. So, in a 24-hour period they may have had some medication, an assessment and started to clear mental health wise and then they’re gone. Or they may come in with another injury and admit during the assessment they’ve been using a bit of methamphetamine. If they are admitted to the ward, there’s more chance of me seeing them and doing a brief intervention.” From a trauma, informed approach to clinical practice, Kate believes it is crucial that the patient feels they have as much power as they

MELISSA: A CARER’S PERSPECTIVE Melissa (not her real name) spoke to HealthSpeak about her experience caring for her 22-year old daughter Sonia who has battled significant mental health issues and used cannabis and ICE. “From the age of 15 Sonia smoked dope but it became more and more and she left school in Year 11. She’s one of those kids who attracts attention – she argues and she’s out there. The first time she experienced cannabisinduced psychosis she rang me and I just knew she was psychotic. “Mum, I’m outside this MP’s office, do you think they can help me?” She was more than an hour away so I got in the car and drove there, but I also rang the police because I was worried about her scarpering and not being able to find her. The police arrived at the scene at the same time as I did. She was totally psychotic and the next thing I know Sonia is under arrest. The police had asked her if she had any dope and she said ‘Oh yes, here’s my bong.’ and we were at the police station until midnight. Sonia was in the mental health unit at the hospital for six weeks and after getting back into drugs again we managed to get

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her into a rehab centre on the Gold Coast where she spent nine months. She signed herself out early and relapsed. She had another psychosis and was arrested again. Sonia assaulted a police officer and at that stage she’d started using ice and was all of 40 kilos. We went to court but it was the wake up call she needed. She’s moved to Sydney now and lives with her father and she’s studying and going well, so I’m incredibly grateful. But I’m also incredibly grateful for the psychosis which allowed us to intervene. I remember through those years thinking ‘if your kid had cancer there’d be people knocking on your door with casseroles and cakes, but with mental health, nobody

can over their care, whether as an inpatient or as an outpatient. This relies on transparency, explanation and reassurance of her role in their care. Kate is keen to work with GPs and include them in what’s going on. “Often people say I have a GP but they don’t know about this (drug use). I offer to write or ring their GP, with the patient’s consent. It can sometimes be easier for me to tell them. It’s a bit more paperwork or investment but it’s an important connection and part of holistic care and an opportunity for me to advocate substance use as a health issue and as such the GP is a vital component.” Kate said to make it easier for people to access drug and alcohol services, she’d like to see more GPs bulk bill. “Also, I’d encourage GPs who are interested to sign up to take on up to 10 opioid dependent patients and become prescribers without any special training, although of course we’d encourage them to do the training of course.”

wants to know about it, everybody judges you as being a bad parent.’ The stigma and shame around D & A and mental health issues is huge. There’s a lot of shame, guilt and isolation and loneliness as a carer. I knew there’d be help somewhere but it wasn’t easy to find. I’d moved and a lot of my friends were in Sydney, but reaching out and finding support is really important. CODA – Co-Dependents Anonymous – was where I found real help. I went to CODA for three years and learnt a lot about the importance of boundaries and how family dynamics can play out. I came to accept that we could lose Sonia and as an addict she will never be totally safe. Mission Australia’s staff were also a wonderful support for me. They provide education sessions for carers around boundaries and understanding stigma and shame. You also get to meet other people in similar situations. Self care is really important as a carer. Setting boundaries and journaling helped me a lot. I now understand that Sonia’s journey in life is her responsibility. I can’t do any more; but I do maintain my love and respect for her. Some people feel that when they put boundaries in place they have to cut people off. But that’s not necessary. It’s their journey, they will make their own choices.”

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a choice about whether they want to be treated for D & A in hospital or undergo a managed withdrawal at home and seen as an outpatient.” Kate’s model of care means she might see patients at Casino AMS two or three times and inpatients three or four times. “We’ve altered the traditional hospital consultation/ liaison model of care, in that, particularly with crystal methamphetamine clients who are difficult to engage and don’t necessarily see their use as problematic, we have allowed for up to four outpatient appointment to undertake brief intervention, stabilisation and transfer of care, if required. This is a different substance using demographic, they are often seeing their use as part of ‘normal’ socialising, and then they’ve tipped the edge a bit too far. So usually they discharge quickly once they’ve been through an initial crash. “Even in ED, once they feel relatively stable they often self discharge, so I’m not getting to see them before they go unless they are admit-

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COFFS HARBOUR AND HASTINGS MACLEAY DRUG AND ALCOHOL SERVICES Clinical advice for GPs available at all times: • Drug and Alcohol services intake line 1300 66 22 63 - Mon to Fri 8.30am to 5pm • Drug and Alcohol Specialist Advisory Service (DASAS) - 24 hours 7 days, 1800 023 687

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The Mid North Coast Local Health District provides D & A Services across two clinical networks that fall within the NCPHN footprint, the Coffs Clinical Network and the Hastings/Macleay Clinical Network. The Service Managers for the D & A Services in the Hastings/Macleay Clinical Network and Coffs Clinical Network are Wendy Munro and Linda Fawcett respectively. “It all begins with a call to our centralised intake number, which is the same for both clinical networks – 1300 662 263 from Monday to Friday – 8.30am to 5pm,” Linda said. “Anyone can call including health professional referrers, individuals and their family or carers. The line is staffed by a clinician, so if a GP calls they can get up to date clinical information about withdrawal or rehabilitation or other advice.” “When we are aware that the referral is made by a GP, the intake worker will send a letter to the referring GP letting them know of the outcome of that referral.” “The health service encourages collaboration between our services and GPs.” In the Hastings/Macleay region there’s also a generic intake email address for referrals: portmacquariedrugalcoholintake@ncahs. health.nsw.gov.au For clinical advice, out of hours GPs are encouraged to contact the Drug and Alcohol Specialist Advisory service on 1800 023 687.

Counselling/psychosocial interventions D & A counsellors are available by appointment at the Coffs Harbour Health Campus and outreach sites in Woolgoolga, Bellingen, Nambucca and Macksville. In the Hastings/ Macleay region, counsellors are available in Port Macquarie, Wauchope, Camden Haven Community Health, Kempsey and South West Rocks.

Outpatient Withdrawal Management Wendy said the Hastings/Macleay Clinical Network has an outpatient withdrawal management service. “Staff work in consultation with GPs who prescribe medication with support from the nurses who see patients or in their homes if suitable,” Wendy said. Home withdrawal management is possible if the patient isn’t likely to experience severe symptoms and there are no medical complications. A new withdrawal management position will be created in Coffs Harbour early next year. “This person will liaise with GPs in the Coffs Clinical Network to let them know that the service exists. We are happy to talk GPs through withdrawal management and negotiate individual treatment plans for people,” said Linda.

IF GPS ARE INTERESTED IN BECOMING AN OPIOID TREATMENT PRESCRIBER, THEY ARE WELCOME TO COME AND SPEND SOME TIME WITH US Cannabis Clinics Cannabis clinics were set up several years ago, with a clinician operating under the Cannabis Clinic banner located in each network. They are located at discrete sites. Appointments are made via the central intake number. The counsellors use a Cognitive Behaviour Therapy approach. Opioid treatment MNCLHD has three Opioid Treatment clinics located at Port Macquarie Community Health Centre, Kempsey District Hospital and the Coffs Harbour Health Campus. All the sites have limited public prescribing, including an Addiction Medicine Specialist in Hastings/ Macleay Network. The public services can work with private GP prescribers to support the initiation and stabilisation of treatment. “In Coffs Harbour, we are happy to act as a dosing point and work with GP prescribers to support patients. If GPs are interested in becoming an opioid treatment prescriber, they are welcome to come and spend some time

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with us,” Linda said. Wendy said the LHD provides an important support when people are withdrawing from opioids. “When patients are being initiated into treatment their social and emotional wellbeing can be put under stress and life becomes a little chaotic. The public clinics can assist GPs by stabilising treatment and assisting in providing psychosocial support and case management to get people to a point where they are ready to move into the private sector. If a private patient become destabilised, then the GP can refer the patient back in to the public system for re-stabilisation until they are ready to move back into private care.” Wendy said. Wendy and Linda encourage private prescribers to initiate treatment and stabilise patients in the LHD’s program first. Inpatient withdrawal management The Coffs Clinical Network uses Riverland’s Clinic at Lismore for inpatient withdrawal management. Residential Rehabilitation Adele House is a non-government residential rehabilitation program in the Coffs Clinical Network. It is a skill based program for men clients only. Phone 6699 1031. Further south there is Bennelong’s Haven, a family residential rehabilitation service near South West Rocks. It houses 60 people and welcomes families. Phone 65674856.

NEW SERVICES Stimulant Treatment The MNCLHD has been funded by the Ministry of Health for two consultation liaison positions until 2018. These clinical consultant nurses work with the EDs and inpatient areas of three hospitals – Coffs Harbour, Port Macquarie and Kempsey District Hospital. Their primary focus is working with methamphetamine users however the majority of referrals are for alcohol use problems. MNCLHD also provides Drugs in Pregnancy services in both networks and welcomes referrals to this service from GPs. FibroScan service The LHD has purchased FibroScan machines for each site In Hastings/Macleay Network. “We work with the HIV and related programs and can provide Fibro Scanning for people accessing D&A services. It’s a non-invasive procedure to assess the degree of liver fibrosis,” Wendy said. healthspeak December 2016

Stroke HealthPathways now live tors are trained to know how to respond if a caller says a patient is “FAST positive” • I learnt that thrombolysis needs to be administered within 4.5 hours of commencement of symptoms. As a result of the Workgroup, I now • use the FAST tool if I suspect a stroke • get a clear history of the time symptoms started • instruct our nursing or reception staff to say the patient is FAST positive if they make the 000 call.

Workgroup members share their knowledge of stroke.

Since attending the Workgroup, I have been involved in a suicide prevention Workgroup and an antenatal education planning group. And so the learning just keeps on coming.”

he Stroke and Transient Ischaemic Attack (TIA) HealthPathways have recently gone “live” on the manc. healthpathways.org.au site. The Pathways were developed in a partnership between NCPHN and the NNSW and MNC LHDs. These new Pathways were developed using an integrated Workgroup of primary, community and secondary care clinicians gathered from our region. The aim was to identify specific management issues already done well and other areas for improvement. The goal was to facilitate agreement on consistent care across the footprint. HealthPathways is an online tool that assists GPs and clinicians to provide evidence-based care locally for their patients. They can be accessed from desktop, tablet and mobile devices in any clinical setting. Dr Hilton Koppe, Clinical Editor with HealthPathways, shares his experience of attending this Workgroup meeting.

Such an esteemed gathering, but what a treat it was. The meeting was expertly chaired by a GP colleague who ensured any discussion remained focused on the real world issues. The specialist and hospital clinicians gained insight into the challenges that we face, and were able to make meaningful suggestions for changes to standard guidelines to take into account our local needs and resources. One of the great joys of working on HealthPathways is that I am learning all the time. And most of what I learn has immediate clinical relevance as a GP. I learnt most from the Ambulance Service paramedic.

“As a new member of the HealthPathways team, I was daunted at the prospect of attending the stroke Workgroup meeting.

• I learnt about the FAST tool for rapid assessment of stroke risk • I learnt that the 000 opera-

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NCPHN appreciates the time and expertise given by Workgroup members to create the new Stroke topics. The Stroke Workgroup members were Kim Hoffman, Stroke Care Coordinator LBH; Kelly Anderson, Occupational Therapist, The Tweed Hospital; Brett Lynam, GP Advisor, Tweed NCPHN; Tim Peacock, GP Clinical Editor Tweed NCPHN; Anthony Zwegers, Intensive Care paramedic; Paul Davies, GP Adviser Tweed NCPHN; Emily Ahern, GP and Geriatrician; Stephen Moore, VMO Physician, LBH; Hilton Koppe, GP; Karen Kostal, Manager Speech Pathology, LBH; Alasdair Arthur, Deputy Director, Emergency Department, The Tweed Hospital. The feedback has been encouraging. Paramedic Anthony Zwegers said “The Workgroup was run well with lots of knowledgeable people in attendance.” To become involved in a HealthPathways workgroup or

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Workforce: more female GPs

The past decade has seen a shift toward a medical workforce with more specialists and a six percent rise in female GPs. A report by the Australian Institute of Health and Welfare (AIHW) states that the number of GPs changed little between 2005 and 2015, ranging from 109 per 100,000 people in 2008 to 114 in 2015. “In contrast, the supply of non-GP specialists increased from 121 to 143 per 100,000 people between 2005 and 2015 and specialists-intraining increased from 43.4 to 74.8 per 100,000,” said AIHW spokesman Dr Adrian Webster. “A greater proportion of non-GP specialists in clinical roles were female in 2015 (30%), up from 21% in 2005 and a higher proportion of GPs were women - 42% in 2015, up from 37% in 2005,' Dr Webster said. GPs had the highest proportion aged 55 or older (40%) of all clinician groups in 2015.

provide feedback, contact Kerrie Keyte: kkeyte@ncphn.org.au or Fiona Ryan: fryan@ncphn.org.au HealthPathways is at: manc. healthpathways.org.au, user: manchealth, pass: conn3ctcd. 19

Brilliant achievement by Integrated Dance group

n October HealthSpeak attended a performance of Encounters by Integrated Dance Theatre Inc SPRUNG!! at Park Lane Theatre, Lennox Head. In a few short years this group has grown tremendously and with the help of Artistic Director Michael Hennessy has become a world class act. Encounters featured 10 dancers includ-

ing some with disabilities. The program included clowning, light hearted pieces and atmospheric, moody dance performances that were made even more powerful through the wonderful music composed by Fred Cole. The choreography was imaginative and engaging and the skill of the dancers rivalled any major dance company.

After the performance there was a panel discussion which included NCPHN’s Dr Hilton Koppe. Topics included What makes art? How can the creative arts heal? Do you need to suffer to create great art? Congratulations to SPRUNG!! for a fabulous evening. Find out more at www.sprung.me

Being relevant in contemporary healthcare By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

eople are becoming very 'au fait' with the health issues of a contemporary society. Lifestyle diseases such as obesity, drug and alcohol use, sexual health and anxiety and depression run concurrently with the consequences of an ageing population and chronic disease. And of course there are the unique challenges faced by our Indigenous community. All western countries are grappling with these challenges. For a University School of Health educating the next generation of health workers, the challenge manifests itself by ensuring curricula with appropriate professional experience are in place to provide the relevant knowledge and skills. Across the western world

we are seeing a shift from a hospital-centred and illnessbased system of care to a person-centred health-based system of care - the 'healthcare home' and the beginnings of what Florence Nightingale said in 1859...'I look to the future, where the sick are cared for in their own homes and the abolition of all hospitals...” In September, SCU hosted the Australian and New Zealand Higher Education Health Providers’ conference in Ballina. This organisation represents university clinics which provide university populations with health care services. The presentations were varied and interesting. A thought provoking paper centred upon the future of general practice management and its evolution given the challenges we face. The paper addressed the impact of innovation, the role of technology and what health care

based in the home might look like. Drawing upon sources from five countries a picture of truly integrated health and social care was depicted, with student learning and continued professional development central to this. What was heartening to hear was the commendations our own clinic received when its activities were presented to the audience. An update was given on the healthy university initiative - the establishment of integrated student led clinics, focusing on promoting health and wellbeing, which help students learn about the social determinants of health and increase their understanding of society’s health gaps Students also learn vital skills such as team work, leadership, entrepreneurial ability, critical thinking, data management and the translation of research into practice. The value of the use

a publication of North Coast Primary Health Network

of the SCU University Clinic to educate the emerging health workforce is being realised and emulated by our sister university health providers, many of whom have visited since the conference to learn more. This learning laboratory idea, which seeks to combine service improvement with new learning and research, exposes health students to the possible future. Our learning laboratory provides students with the opportunity to experience the emerging world of health care before they graduate. It is gratifying to know that we are establishing ourselves as a national leader in this regard.

healthspeak December 2016

24-HOUR SUPPORT

1300 368 186 • www.fds.org.au

Telephone support to families in need due to drug and alcohol issues. Operates 24 hours.

Family Drug Support

FAMILY SUPPORT

Headspace

1800 551 800 • www.kidshelpline.org.au

Telephone and online counselling support service for young people aged between 5 and 25 years.

Kids Help Line

YOUNG PEOPLE

Drug & Alcohol Quick Referral Guide – Additional Supports Drug & Alcohol Specialist Advisory Service (DASAS)

NARANON

Health professional service only Specialist medical consultants provide advice on diagnosis and clinical management of alcohol and drug-related issues. Includes drug effects and withdrawal symptoms, referral options, therapeutic and counselling techniques. Operates 24 hours.

02 6687 2835

Free and confidential alcohol and drug counselling for individuals aged 12-24 years.

INTRA Youth Service – The Buttery

02 6620 1800 • www.socialfutures.org,au

Getting it Together (GIT) helps young people aged 12-25 find opportunities for positive change in relation to their drug and alcohol use; building self-esteem and improving their life skills through individual and familyfocused interventions and group work.

Getting it Together – Social Futures

www.headspace.org.au

Lismore: 02 6625 0200 Tweed Heads: 07 5589 8700

A self-help group for families affected by a loved one’s use of illicit substances.

1800 023 687

02 6623 7401

Support, education and services for families and carers of people with a mental illness or drug and alcohol issue. Services in Lismore, Tweed, Ballina and Byron Bay.

Family and Carer Program – Mission Australia

1300 252 666 • www.al-anon.org.au

A self-help group for families and friends affected by a loved one’s use of alcohol.

ALANON

02 8004 1214 • www.naranon.org.au

Comprehensive support and counselling for people aged between 12 and 25 years. No referral necessary. Offices at Tweed Heads and Lismore. Online counselling.

Stimulant Treatment Line (STL) Advice, support, referral and counselling for people concerned about stimulants or for information on the Stimulant Treatment Program. Operates 24 hours. 1800 101 188

Alcohol and Drug Information Service (ADIS) Education, information, referral, crisis counselling and support. Anyone can call. Operates 24 hours. 1800 422 599 • www.yourroom.com.au

Counselling Online Online counselling service for people using alcohol and other drugs, family members and friends. Operates 24 hrs. www.counsellingonline.org.au • 1800 888 236

Lifeline Crisis support and suicide prevention services to anyone experiencing distress. Operates 24 hrs. 13 11 14 • www.lifeline.org.au

Approved Counselling Service – NSW Justice Free counselling to victims of violent crimes that have occurred in NSW. 1800 633 063 • www.victimsservices.justice.nsw.gov.au

Self-help, abstinencebased group for people wishing to cease using illicit substances.

Mutual-aid group program using CBT and motivational tools to help participants change behaviours.

DESCRIPTION

Self-referral

1300 652 820 na.org.au

For meeting times and locations www. na.org.au

All drugs

Free

Self-referral

smartrecovery australia.org.au

For meeting times and locations smartrecovery australia.org.au

Alcohol and all other drugs (and other problematic behaviours – gambling, cigarettes, food, shopping etc)

Free

12 step model

Narcotics Anonymous

SMART Recovery

PEER SUPPORT

REFERRAL

LOCATION

SUBSTANCE

Free

Alcohol

For meeting times and locations www. aa.org.au

(02) 6686 8599 aa.org.au

Self-referral

12-step model

Self-help, abstinencebased group for people using or in recovery from alcohol use.

Alcoholics Anonymous

Free

Alcohol and all other drugs

Lismore, Ballina, Kyogle, Grafton, Maclean, Tweed Valley, Byron Bay, Mullumbimby.

Tweed/Byron: 07 5506 7010 Lismore/Clarence: 02 6620 7600

Self-referral Phone Intake line

Drug and alcohol services including: consultation liaison; information and education; assessment and referral; counselling and support; relapse prevention; Opioid Treatment Program, Cannabis Clinic, MERIT Program, MUMS Program (Drug Use in Pregnancy), Stimulant Treatment Program and young people.

Northern NSW LHD – Drug and Alcohol Service

Free

Alcohol and all other drugs

Lismore, Byron Bay, Tweed Heads, Ballina

Lismore: 02 6622 0429 Tweed/Byron: 02 6680 9098

Self-referral

Outreach program of The Buttery’s that operates across the NSW Northern Rivers Region. Offers individual counselling and group programs. Adults and young people.

INTRA The Buttery

COMMUNITY

Free

Alcohol and all other drugs

Lismore

02 6622 5534 rekindlingthe spirit.org.au

Self-referral

Assessment and referral, counselling and support, group programs, relapse prevention, information and education for Aboriginal people and their families.

Rekindling the Spirit

Riverlands

DETOX

Free

Alcohol and all other drugs

Lismore

02 6620 7600

Self-referral

16 bed drug and alcohol withdrawal management unit. Also comprises pharmacotherapy clinic and counselling services. Addiction Medicine Specialists available.

Drug & Alcohol Quick Referral Guide – Northern NSW

SERVICE

COST

Contribution of 80% of Centrelink payment

All illicit drugs, prescribed legal drugs and alcohol

Bangalow

02 6687 2399 (9am – 1pm and 2-4:30pm Fridays only)

Self-referral

Long-term residential treatment program which operates as a therapeutic community. Men and women.

The Buttery

Contribution of 65% of Centrelink payment. Linen bond required

Alcohol and all other drugs

Alstonville

02 6628 1098 during office hours

Self-referral

Residential Drug and Alcohol rehabilitation program for Aboriginal men.

Namatjira Haven

RESI-REHAB

DESCRIPTION

1300 652 820

smartrecovery australia.org.au

For meeting times and locations

www.na.org.au

All drugs

Free

smartrecovery australia.org.au

Alcohol and all other drugs (and other problematic behaviours – gambling, cigarettes, food, shopping etc)

Free

REFERRAL

For meeting times and locations

na.org.au

Self-referral

Free

Alcohol

www.aa.org.au

For meeting times and locations

aa.org.au

(02) 6686 8599

Self-referral

12-step model

12 step model.

Self-referral

Self-help, abstinence-based group for people using or in recovery from alcohol use.

Self-help, abstinencebased group for people wishing to cease using illicit substances.

Mutual-aid group program using CBT and motivational tools to help participants change behaviours.

Alcoholics Anonymous

Narcotics Anonymous

SMART Recovery

PEER SUPPORT

Free

Alcohol and all other drugs

Lismore, Ballina, Kyogle, Grafton, Maclean, Tweed Valley, Byron Bay, Mullumbimby.

Lismore/Clarence: 02 6620 7600

Tweed/Byron: 07 5506 7010

Self-referral Phone Intake line

Drug and alcohol services including: assessment and counselling; home and outpatient detoxification service (drugs and alcohol); consultation liaison; information and education; referral; relapse prevention; Opioid Treatment Program, Cannabis Clinic, MERIT Program and Drugs in Pregnancy Program.

Northern NSW LHD – Drug and Alcohol Service

COMMUNITY

Once off admission fee of $150 and then residents contribute 80% of Centrelink benefit or other income fortnightly (to a maximum of $700/fortnight) OR full fee places available at $1820/fortnight.

Alcohol and all other drugs Clients must not have consumed drugs or alcohol in the last 3 days prior to admission.

Moonee/Coffs

(02) 6653 7070 (Monday to Friday to book an assessment)

www.adele.org.au

Self-referral.

Medium to long-term rehabilitation program for men only who are affected by alcohol and other drugs.

Adele House

One-off initial cost of $135. Adult residents then contribute $360.50 per fortnight. Children aged 2-15 years $123.20/ fortnight and children 0-2 years $92.40/fortnight.

Aboriginal men and women between 18 and 55 years. Accommodation is provided for single males, rooms for couples with or without children and single women.

Kinchela/South west Rocks

benelongshaven.com.au

02 6567 4880

Residential rehabilitation program for Aboriginal men and women with a dependence on alcohol or other drugs and their families.

Benelong’s Haven

RESI-REHAB

Drug & Alcohol Quick Referral Guide – Mid North Coast NSW

SERVICE

LOCATION

SUBSTANCE

COST

$120/week to cover expenses. Financial hardship is available.

Alcohol and all other drugs Referral through Juvenile Justice Case Worker or Psychologist

Coffs Harbour

missionaustralia.com.au

02 6651 3418

Intensive residential rehabilitation program for 13-18 year olds. Must be clients of Juvenile Justice NSW with a history of alcohol and other drug use and offending behaviour.

Junaa Buwa! Centre for Youth Wellbeing

24-HOUR SUPPORT

1300 368 186 • www.fds.org.au

Telephone support to families in need due to drug and alcohol issues. Operates 24 hours.

Family Drug Support

FAMILY SUPPORT

Headspace

1800 551 800 • www.kidshelpline.org.au

Telephone and online counselling support service for young people aged between 5 and 25 years.

Kids Help Line

YOUNG PEOPLE

Drug & Alcohol Quick Referral Guide – Additional Supports Drug & Alcohol Specialist Advisory Service (DASAS)

NARANON

www.headspace.org.au

Coffs Harbour: 6652 1878 • Port Macquarie: 6588 7300

Comprehensive support and counselling for people aged between 12 and 25 years. No referral necessary. Online counselling.

1300 252 666 • www.al-anon.org.au

A self-help group for families and friends affected by a loved one’s use of alcohol.

ALANON

02 8004 1214 • www.naranon.org.au

A self-help group for families affected by a loved one’s use of illicit substances.

1800 023 687

Stimulant Treatment Line (STL) Advice, support, referral and counselling for people concerned about stimulants or for information on the Stimulant Treatment Program. Operates 24 hours. 1800 101 188

Alcohol and Drug Information Service (ADIS) Education, information, referral, crisis counselling and support. Anyone can call. Operates 24 hours. 1800 422 599 • www.yourroom.com.au

Counselling Online Online counselling service for people using alcohol and other drugs, family members and friends. Operates 24 hrs. www.counsellingonline.org.au • 1800 888 236

Lifeline Crisis support and suicide prevention services to anyone experiencing distress. Operates 24 hrs. 13 11 14 • www.lifeline.org.au

Approved Counselling Service – NSW Justice Free counselling to victims of violent crimes that have occurred in NSW. 1800 633 063 • www.victimsservices.justice.nsw.gov.au

MyHealth Record support makes all the difference Ocean Drive’s experience

Lismore Clinic’s experience

cean Drive Family Practice at North Haven, near Port Macquarie, is making great strides with registering patients for MyHealthRecord (MHR) and practice manager Christine Kingsbury told HealthSpeak she could not have managed this process without the support of North Coast Primary Health Network. “The assistance from NCPHN’s Susan Mainey has been exceptional,” said Christine. “When the pressure began to set up MHR, staff numbers were very thin and I had limited time. But Susan fitted in around me, came back with email answers to any questions I had and was constantly in touch. It was so good to have someone ringing me on a regular basis and keeping everything flowing.

With MHR they just pop into a GP, get a new script and be on their way “At the time I was stabbing in the dark with MHR and I’d get busy and think ‘I really need to read all about this’, but the PHN was able to simplify the information and provide me with what I needed to know, making it easy for me,” Christine added. While some GPs were reluctant to work with MHR initially, the practice is now signing up six times more patients a week than 18 months ago. Christine said her approach to encourage the practice GPs December 2016 healthspeak

Ocean Drive PN Erica Walker registers a patient.

was to explain the benefits of MHR for the patient. “With our GPs already having a busy day and time restraints in consults, it was perceived as an extra task to perform. But once I explained it from the patient’s viewpoint and how helpful it would be for elderly travellers for example, they became much more approachable ,” she said. North Haven is a lawn bowls destination for many older folks and the more people who have a personal health record, the easier trips away will be for them. “If patients go somewhere and forget a script, without a health record they have to find a pharmacist and ask them to fax us to send through their script, but if all their medication is available on MHR they just pop into a GP, get a new script and be on their way,” Christine said. At this practice most patients are signed up by nursing staff for a health record during a health assessment or following discharge from hospital. Christine usually does the paperwork around the registration and then all the GP has to do is to upload the patient’s health summary. Posters on the practice walls also prompt patients to ask about the health record and a television monitor runs ads about the benefits of MHR throughout the day.

ractice Manager Jodie McLean from Lismore Clinic, a large practice with 10 doctors and nursing staff, told HealthSpeak that she was initially really daunted by having to sign up patients for MyHealthRecord (MHR). “Our patient database is very large and I thought ‘there’s no way we are going to meet this required quota’. The first quarter was really intimidating but we managed and since then I’ve tripled the number of registrations in the second quarter and already met the third quarter quota in just two weeks,” Jodie said with a smile. She said that NCPHN’s Practice Support staff had been a big help in encouraging her to persevere, especially in the beginning. To promote the benefits of MHR, there are signs in the waiting room and on the front door. They also changed their phone message to include an ad for MHR. Jodie said these initiatives ensured patients asked reception staff about signing up. Nurses also include an introduction to MHR during health assessments. “Often by the time we were ready to speak to patients, they’d already come in and asked us about it. So, during the last quarter we went from 67 registrations to 178, double what we needed to achieve.” However, as in most practices, Jodie said that not all doctors had embraced MHR, but that was changing. She said it had helped that doctors had been seeing uploaded summaries from other practices and noticing the amount of information that was shared and how

a publication of North Coast Primary Health Network

Jenny Routley and Jodie McLean of Lismore Clinic

some of these records were very well written. Seeing other examples has encouraged them to participate. Another strategy Jodie has used is to give a powerful example to her GPs about the benefits of MHR.

I’ve tripled the number of registrations in the second quarter and already met the third quarter quota in just two weeks “I have a friend who works at Tennant Creek Hospital who’s told me how they access MHR summaries immediately when someone comes in who is not a local. They might have been in a car accident or another traumatic event.” Lismore Clinic has a lot of nursing home patients and is working to encourage these patients to sign up. “Practice Nurse Jenny Routley goes out to nursing homes and she will be working with staff there to hopefully upload patient information,” said Jodie. 25

Koori Grapevine Care Coordination – Steering our mob towards better health

t has been well established that Aboriginal and Torres Strait Islander people face disproportionately higher rates of chronic illness, as well as poorer access to health services. It is felt that these factors contribute significantly to the lower Aboriginal life expectancy. NCPHN's Care Coordination and Supplementary Services Program (CCSS) aims to improve health outcomes for Aboriginal and Torres Strait Islander people with chronic health conditions through improved access to coordinated and multi-disciplinary care. CCSS Coordinators work closely with patients, sharing their day to day health journey and helping them with things from transport to specialist care and equipment. For patients facing significant health care barriers, or those with more complex needs, CCSS can make a huge difference. Care Coordinator Rhiannon Mitchell has been involved with the program for more than two years.

Uncle Mick Olive

Gaye Lutherborrough

“It’s very rewarding working with my people to keep them well and out of hospital. I really like that I get to see the actual day to day impact it has on my

Aboriginal kids’ immunisation rates top the nation

he most recent Australian Immunisation Register quarterly data shows childhood immunisation rates for Aboriginal and Torres Strait Islander children up across the board, with five-year-old children having higher immunisation coverage than non-Indigenous five-year-olds. Coverage for these five-yearolds is on track to meet the 96 per cent immunisation goal set in the Implementation Plan for the National Aboriginal and

Torres Strait Islander Health Plan 2013-2023, and one--yearold children have coverage rates also exceeding the 88 per cent goal in the plan. “These results are impressive and show important progress,” said Assistant Health Minister Ken Wyatt. North Coast Primary Health Network’s Immunisation Project Officer Tiffany Sullivan said the most recent immunisation coverage rates for Aboriginal Children living on the North

clients,” she said. CCSS patients who have shared their stories report that involvement with the CCSS program not only improves their health, but also their social wellbeing and quality of life. Uncle Mick Olive, an Elder in Gumbaynggirr country (Coffs Harbour) told HealthSpeak that the program has made a big difference to mentally, socially and health-wise. “I went from being 95 kilos to 75 kilos. My sugar level has dropped. CCSS bought me a Medi Alert system so I feel a little easier knowing if I have a fall at home I have the device to call the emergency department. “They have also helped me out with medical shoes which are great help when exercising. I now look forward to getting up and enjoying my days. I feel happy. I am out socialising and spending time with people I care about and I feel better in myself. I exercise everyday now!” Another patient, Gaye Lutherborrough from the Tweed area, said that the CCSS Program had

Coast were remarkable. “Most notably, our 5-yearold cohort is sitting at 96.47%, and our 1 year and 2 year old cohorts are tracking nicely at 92.16% and 91.52% respectively. This result reflects the extraordinary collaborative efforts put in by our community, families and health workers to ensure all aboriginal children are protected against preventable diseases,” she said. Other important Closing the Gap programs showing good results include The New Directions: Mothers and Babies Services Program. This program supports Aboriginal moth-

a publication of North Coast Primary Health Network

allowed her to gain access to a dietician, podiatrist and many other supports. “They also help me with transport and without the program I wouldn't be able to get around to my appointments.” Gaye also appreciates the helpful nature of the Care Coordinators. “I like that I can phone Leisa and Talisah at any time I need help and they talk to me and give me support with all sorts of things. Even family matters.” Phillipa Hudson from Coffs Harbour said the CCSS program had given her the freedom to live a normal life. “I currently go to radiotherapy at the Cancer Institute for regular treatment. The CCSS program helps me with weekly transport and also assists with paying for specialist appointments,” she said. For further information: Tweed Heads: (07) 5523 550; Lismore: (02) 6627 3300; Coffs Harbour: (02) 6659 1800 Port Macquarie: (02) 6583 3600

ers with antenatal care, baby care, breast -feeding, nutrition, parenting, immunisation and pre-school health checks. NCPHN’s Acting Aboriginal Health Program Manager Claire Malseeed said that Bulgarr Ngaru Medical Aboriginal Corporation- Richmond Valley, Jullums AMS and NCPHN were implementing a range of programs and services under the New Directions program. “The outreach services, child health clinics and resources provided through New Directions have contributed a great deal to the positive immunisation rates in the region,” she said.

healthspeak December 2016

Gap closing in newborn deaths

ustralia is one of the safest places in the world to give birth. However, almost 1 in 100 pregnancies at or beyond 20 weeks gestation ends with the death of a baby. An AIHW report, Perinatal Deaths in Australia 1993–2012, shows that during 2011 and 2012, 6,065 babies were stillborn or died within the first four weeks of life (neonatal deaths). These deaths are collectively described as 'perinatal deaths'. 'About three-quarters of perinatal deaths (4,485) during

2011 and 2012 were stillbirths, while the remaining 1,580 deaths happened in the first four weeks of life,' said report author Associate Professor Georgina Chambers. 'The overall perinatal mortality rate has remained fairly stable over the last 20 years; however, the stillbirth rate has increased by 13%, while the neonatal death rate has decreased by 18%.' The report found that several factors are associated with perinatal deaths, including char-

SAFETY FIRST at Tabulam

acteristics of the mother, the pregnancy and baby. 'For example, the perinatal death rate of babies born to Indigenous mothers was 1.8 times that of babies of non-Indigenous mothers—approximately 17.1 compared to 9.6 deaths per 1,000

births,' A/Prof Chambers said. While the perinatal death rates for babies of Indigenous mothers are high, the report reveals some promising trends, showing a 20% decrease over the last 20 years—a 16% drop in the stillbirth rate and a decrease of almost 30% in neonatal mortality rate. Death rates also varied considerably depending on the remoteness of the mother's location, her socioeconomic status, her BMI and whether she smoked during pregnancy.

Wellness day features health checks

First Aid training: being prepared is one of the best strategies.

n small and remote communities, First Aid plays a crucial role in supporting the health of community members, particularly where immediate access to emergency and tertiary medical services is limited. In such communities, resilience is key, and it is important that a percentage of the population has an understanding and some knowledge when it comes to First Aid. Being prepared is one of the best strategies when it comes to any unexpected situation, especially emergency situations where being aware is convenient when needing to take immediate action. In August, North Coast Primary Health Network teamed up with Pulse Start to provide First Aid training to Tabulam community members. The trainDecember 2016 healthspeak

ing day was successful with 12 participants, some from Casino as well as Tabulam taking part. Throughout the day participants shared stories, laughs and learnt that First Aid can literally save peoples lives along with its other benefits. The day was one of learning and socialising and enjoyable for both the trainer, NCPHN staff and community members. “Running these First Aid training days provides us with a really valuable opportunity to build capacity and resilience in communities which tend to be underserved when it comes to health services. We also thoroughly enjoyed the chance to build further connection with participants throughout the day,” said Ruth Taylor, NCPHN Aboriginal Health Programs Officer.

ort Macquarie Medical and Dental Centre hosted a Wellness Day for its Aboriginal clients with support from NCPHN staff. Practice staff produced a flyer and sent it to all the Aboriginal clients on their books and made health check appointments for those who were interested. Reminder texts were sent to ensure the day went smoothly. NCPHN’s Annie Orenshaw and Josie Dungay positioned themselves in the waiting room to register clients for the Closing the Gap program so that they were able to have their health check carried out under item 715 – Annual Health Check. Dr Ray Jones conducted the health checks and there were healthy snacks available and lots of health information and information about other programs and services available. Seven health checks were completed and several clients expressed an interested in joining NCPHN’s

a publication of North Coast Primary Health Network

From left: Annie Orenshaw, Dr Ray Jones and Josephine Dungay.

Aboriginal Advisory Group. There were also referrals to the Care Coordination Supplementary Scheme. Josie took part in one of the health checks which enabled her to fulfil a requirement for her Certificate IV in Aboriginal Health. Port Medical and Dental Centre intend to hold similar health check days in other areas where they operate.

Bowel Cancer Screening P

Investment in bowel cancer awareness is vital, however, screening campaigns must motivate action that drives participation

articipation in the National Bowel Cancer Screening Program (NBCSP) has remained stagnant according to figures released by the Australian Institute of Health & Welfare (AIHW). Bowel Cancer Australia Chief Executive Julien Wiggins said recent participation is on a downward trajectory from a high of 43.5% in 2008-09, to 37.3% in 2013-14 even when based on newly applied participation indicators. The NBCSP continues to play catch-up with medical guidelines which recommend screening every 1 to 2 years for average risk Australians from age 50. Two point three million Australians were eligible to receive a tax-payer funded kit through the program in 2013-14, but with full implementation not expected until 2020 for people aged 50-74, its life-saving potential is far from optimal. By the time the NBCSP is fully implemented it will have been nearly two decades since

first piloted – three times longer than it took to implement BreastScreen Australia. Participation in the NBCSP is also well below other government screening programs, including Breastscreen Australia (55%) and Cervical Cancer Screening Program (57%). According to a recent NBCSP awareness campaign evaluation, the main reasons given for not completing the NBCSP test were that respondents had ‘undergone a colonoscopy’ (25%), or that they were ‘too lazy’ (16%). “Investment in bowel cancer awareness is vital, however, screening campaigns must motivate action that drives participation,” Mr Wiggins said. “That’s why Bowel Cancer Australia has launched the 75 by 2025 initiative. Our goal is for 75 percent of people aged 50 and over to t regularly screen for bowel cancer through the NBCSP by 2025. If achieved, the result would double the current participation rate within 10 years.” The purpose of screening is to detect bowel cancer at its earliest stage when 90% can be successfully treated. Screening can also prevent cancer through

the detection and removal of precancerous polyps. Bowel Cancer Australia encourages all Australians at average risk to screen themselves every 1 to 2 years from age 50, in accordance with medical guidelines. People ineligible to participate in the NBCSP are strongly encouraged to talk to their GP or pharmacist about the BowelScreen Australia Program. Break the ice

In order to overcome the challenge of getting people comfortable talking about poo and bowel screening, nurses from Ward 6E at Wesley Hospital in Brisbane have started an Instagram account called ‘The Sisterhood of the Travelling Poo.’ The account tracks the travels of their brown mascot, Bristol. Named after the Bristol Stool Chart which is used to classify faecal matter, the plush toy helps break the ice for nurses when starting conversations about bowel health. With the help of Ward 6E nurses, Bristol has become quite the jet-setter. Travelling across Australia and beyond to Scotland and Brazil, Bristol has taken the internet and the world by storm raising awareness about Australia’s second biggest cancer killer. Over the next 10 years 42,000 Australians are projected to die from bowel cancer. However, the disease is largely preventable and treatable, if caught early. Unfortunately, around 80% of Australians surveyed in research said they avoided bowel cancer screening because they believed it was messy and embarrassing. Yet we know once a person participates there is a 60% chance they will take the test again. The role of GPs

GPs play a key role in the screening pathway. They deliver clini-

a publication of North Coast Primary Health Network

healthspeak December 2016

NBCSP participation rates 43.5%

44 43 42 41 40 39 38 37 36 35 34 2007-08

42.8% 40.3%

38.1% 36.9%

2008-09

2009-10

2010-11

2011-12

37.3% 36%

2012-13

2013-14

cally appropriate advice, services, treatment and care, and provide data on participants and their outcomes to the Program Register. Help patients screen by: • Encouraging those sent a screening test to participate • Assessing those with a positive result and refer them for further examination, eg a colonoscopy • Indicating whether a patient referred for colonoscopy is a program participant to help with reporting to the Program Register. Program stickers are available by calling 1800 118 868 • Notifying the Program Register of referral/non referral for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the program’s GP Assessment Form by fax, post or electronically. Provision of information will attract a payment. • Managing individuals identified as at increased risk of bowel cancer in accordance with the NHMRC Guidelines. • Informing individuals at average risk, or slightly above, that the NHMRC Guidelines recommend screening

December 2016 healthspeak

A GP recommendation to bowel screen motivates patients

Many patients said they were 'too lazy' to do the screening test.

at least once every two years from the age of 50. Supporting participation

Research demonstrates that a recommendation from a GP to screen for bowel cancer is an important motivator for participation. General practices can encourage their patients to participate by: 1. Displaying brochures, flyers and posters 2. Talking to patients aged 50 to 74 years about bowel cancer screening 3. Sending a letter to 49 year old patients to encourage participation

4. Knowing the Program

There are brochures and resources available to help support your patients through the screening process. Please visit http://cancerscreening.gov.au/ internet/screening/publishing. nsf/Content/bowel-screening-1 Or contact your NCPHN Practice Support Team. HealthPathways

HealthPathways on the topics of Colorectal Cancer Screening & Screening and Surveillance Colonoscopy may be viewed at: http://manc.healthpathways. org.au

a publication of North Coast Primary Health Network

What is? What is Orthoptics?

Profile Sue Heathcote, Orthoptist, Mid North Coast

rthoptics is a discipline in eye healthcare specialising in the assessment, diagnosis and non-surgical management of eye disorders. Orthoptists were traditionally involved in managing patients with eye movement disorders and specifically with strabismus (squint), double vision and amblyopia (lazy eye). Over time orthoptists have expanded their role and not only specialise in eye movement disorders but also deal with eye disease such as cataracts, glaucoma, diabetic eye disease, age related macular degeneration, systemic or View past issues

Did you know you can read HealthSpeak online? Go to www.issuu.com/ healthspeak and see all 17 issues.

neurological vision disorders and low vision. Through a unique set of skills, orthoptists play a crucial role in the detection, diagnosis and management of eye diseases in both adults and children. Their specialty areas include • Children’s vision • Eye movement disorders • Low vision care / rehabilitation • Cataract care and retinal disorders • Neurological vision disorders • Laser eye surgery and corneal conditions • Driver and sports vision • Clinical Research and Education Orthoptists work in a range of settings, including hospitals, private practices, low vision and rehabilitation settings, community health, clinical research centres and universities. There is a strong demand for orthoptists in Australia and overseas. Information from Orthoptics Australia website: https://www. orthoptics.org.au/

hen Sue finished school she had no idea what she wanted to do, so she did some research. “I investigated every career that I knew nothing about, and then invited myself to Sydney Eye hospital to spend the afternoon with the Orthoptic department. I was hooked. “In those days we were trained at Cumberland College of Health Sciences and graduated with an Associate Diploma. More recently Orthoptics has moved to UTS in Sydney and runs as a post graduate degree course. However, you can still study as an undergraduate in Melbourne at LaTrobe University” Over the years, Sue’s work has changed greatly. “As a new graduate I set up my own practice specialising in childhood vision and strabismus. I also worked for a stroke rehabilitation unit as part of their multidisciplinary team and also in what was then known as the school vision screening program.” Sue then took some years off, moving to the Mid North Coast and enjoying time with her two children. “ For the past 25 years I have been working in a slightly different role, as an Orthoptist assisting in Ophthalmology practices. Apart from general patient work

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–up and care, we Orthoptists may perform ocular ultrasound, biometry, perimetry and ocular imaging. “I asses children’s vision and recommend treatment regimes for patients with diplopia (double vision) strabismus and children with amblyopia. I may assist with minor procedures, also pre and post operative care. I’m also involved with Statewide Eyesight Preschool Screening run by NSW Health, both as a trainer and as a secondary screener,” Sue added. The variety of her work in rural medicine is something Sue very much appreciates. “It’s incredibly satisfying to help improve sight in a child, or restore an elderly person’s ability to read. I’m amazed at the speed of medical technology, we now have ocular imaging that we could only dream of 10 years ago. I also really enjoy having students visit the practice and watch them blossom as they gain confidence.” Sue recommends Orthoptics as a career because it provides the opportunity to branch out into many aspects of eye care from paediatrics to teaching, from vision rehabilitation to research. Another plus of choosing Orthoptics as a profession is that there’s a shortage of the profession right around Australia, with the situation more acute in rural areas.

healthspeak December 2016

What is the NDIS?

Already the NDIS provides funding packages to more than 25,000 Australians under 65 with a permanent impairment that substantially reduces their psychological, physical, intellectual, cognitive, sensory and social functioning. When the scheme is fully operational in 2019, around 460,000 Australians are expected to be part of the scheme. When participants turn 65, they can stay in the scheme or be supported through aged care services. Many Australians with mild to moderate disability or impairment will not meet the criteria to receive NDIS support. Why do we need it?

It was set up in response to the 2011 Productivity Commission Report which found that disability services were ‘underfunded, unfair, fragmented and inefficient’. It was recommended that a scheme involving flexible, individual packages be established for participants to purchase disability supports. December 2016 healthspeak

The NDIS replaces the previous model where state governments contracted service providers to deliver specified. Who is eligible?

The easiest way to find out is to use the NDIS Access Checklist. https://www.ndis.gov.au/ndisaccess-checklist.html The NDIS website (ndis.gov. au) has a number of fact sheets and publications to assist participants and their carers. Supports can be purchased from any registered disability or mainstream service as long as they are in line with the person’s goals. A formal review meeting is held after 12 months and changes made as required. Individuals with allocated funding can select a registered service provider to manage and provide their support, or they can self-manage and negotiate the supports specified in their agreed plan, including employing their support workers. What GPs need to know

To find out where things are at in terms of the rollout and how it will affect health professionals in the short-term, HealthSpeak spoke to Joanne McLean, the NSW NDIS representative for Mid North Coast, Northern NSW and Upper New England. Joanne explained that be-

NDIS contacts Website ndis.gov.au Inquiries 1800 800 110

Under the scheme people can hire their own workers, get their own workers compensation insurance organised and have their own risk assessments carried out tween July 2016 and 2017, the priority for the NDIS will be to get people already accessing some kind of disability support into the system. “It’s about rolling eligible people into the system. These clients are the priority in the first 12 months. After that there’ll be emphasis on new clients – those who’ve not previously accessed

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disability support - entering the scheme.” The good news for GPs is that the NDIS referral pathways are simpler than they used to be and Joanne expects that most people with a disability will already have a relationship with a GP. “So people will be coming in when they need to and if patients want advice on the NDIS, GPs should direct them to the main phone number – 1800 800 110. If the patient is already getting some disability support, then they can talk to their current provider. Normally the client or a family member calls the 1800 number to make inquiries. If the patient has no support, a phone call from a GP is acceptable,” Joanne explained. Assessing someone for the NDIS

Before people can access NDIS support they need to provide evidence of their disability. For many people their disability will automatically make them eligible and no medical evidence is required. However, for others, GPs, specialists and allied health professionals will be asked to fill in the Evidence of Disability Form for patients, outlining their diagnosis, current treatment and the functional impact of their disability on their life. 31

GPs and the NDIS

In July 2017, the National Disability Insurance Scheme will commence on the NSW North Coast. Janet Grist explores what the NDIS offers and how it will impact on GPs, health professionals and their patients.

Feature

GPs and the NDIS

tion insurance organised and have their own risk assessments carried out. Or they can opt to go with a service provider who will manage all that for them. “Clients can also elect to have some of their funding put towards a Plan Manager if they want assistance to manage their own package.”

Meet NNSWLHD’s Transition Manager

So, who can help with this process of decision making?

Feature

NNSWLHD’s National Disability Insurance Scheme (NDIS) Transition Manager Paul Todoroski’s role is to help the Health District manage the changes that the NDIS start up will bring and to be the interface between Health and the disability sector.

GPs and the NDIS

Paul spent with 10 years in Ageing Disability and Aged Care in a number of roles including casework, community development roles and most recently as Community Support Team Manager. Some GPs are asking which conditions are covered by Health or the NDIS. “There is Information on the NDIS website around differentiation. But the general rule of thumb is that treatment, rehabilitation and medical conditions fall under Health and if the issue is about maintaining a person’s functional ability and access to community that’s part of the NIDS,” Paul explained. His message for health services is that the NDIS is going to bring significantly more resources to the disability sector, with spinoffs to health. “But we need to be patient, it’s a huge piece of reform and initially there will be teething problems. But we will get there.”

The helpful DAISI team at their Ballina office.

Who is likely to need GP help?

DAISI is a community based organisation with its offices in Ballina, Northern NSW. Its employees provide advice on supports and services for people with disabilities and the ageing. HealthSpeak visited the DAISI office and spoke to Executive Officer Brett Carn and Support Planner Leah Louise. In DAISI’s experience the biggest barrier to understanding the NDIS for people is navigating the website. “We can help by getting on the website together with a client to help them find their way around it. Some of those who will need assessment help from their GP are those who are very socially isolated,” said Leah. Brett said that most people already receiving disability supports through a service provider will not need the support of a GP to access the NDIS. As well as filling out the disability evidence, GPs will also be involved in the review of NDIS clients every 12 months. This is more likely to happen in the case of someone with a mental health condition. “Because the NDIS is recovery focused around mental health issues, the client might be eligible for some funds and support for three to six months but then they need to be medically

reviewed. Oher people might be permanent in their diagnosis and won’t need to be reviewed so frequently,” Leah explained. Leah and Brett emphasise that the NDIS is changing all the time and recommend calling the 1800 800 110 number to make any inquiries as the website may not be up to date. How DAISI can help

Because the NDIS is such a huge reform, people want to know what it means for them. But it’s not simple because each person’s situation is unique. Brett explained the scheme is all about choice and control, with the client being able to choose their own supports. They have to decide whether to manage their own fund package or go shopping to the major agencies and register with them. “Under the scheme people can hire their own workers, get their own workers compensa-

On the North Coast DAISI is one organisation. Leah emphasised the importance of people making sure they are fully informed. “This is your life, your right. And if people can’t do it themselves, find someone who can.” Under the NDIS people are encouraged to talk about their life and their aspirations, topics many people haven’t talked about before. They need to work out what supports they need and how those will fit into their lives. “It’s quite something to sit down with someone who’s never thought about this…it’s beautiful, you explain that they can take ownership of their life, get empowered and for people there’s often a lot of personal growth involved as it’s their life and their future,” said Leah. DAISI staff are happy to talk on the phone to anyone wanting more information on the NDIS, or if you are local, come in for a cuppa and a chat. Call DAISI staff on 1800 800 340. Another support service is Ability Incorporated at Alstonville. Their phone number is 1800 657 961.

NCPHN is actively involved in the Northern NSW Disability Action Group, a collaborative forum between the Department of Family and Community Services, NSW Health and key disability service providers. NCPHN will keep health care professionals up-to-date with information on the NDIS roll out. In the meantime, please refer to the NDIS HealthPathway available at: http://manc.healthpathways.org.au Username: manchealth Password: conn3ct3d.

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healthspeak December 2016

New Lismore oncologist keen for referrals

r Joe Gormally commenced consulting at Oncology North Coast in late September. He will be working two days per week and supervising chemotherapy treatments at Lismore Base Hospital, Grafton Base Hospital, Ballina Base Hospital, and St Vincent’s Hospital. In addition, Joe will be providing inpatient services at Lismore Base Hospital and St Vincent’s Hospital, and will consult monthly at the Grafton Oncology Unit and attending clinical trials in Lismore. Joe completed his undergraduate medical training at the University College in Dublin and underwent his medical oncology training at Royal Prince Alfred Hospital in Sydney. He also spent one year as an advanced oncology trainee at Lismore Base Hospital and Oncology North Coast in 2014. Before coming to Lismore Joe completed his core years of oncology training at the Mater Hospital in North Sydney.

Dr Joe Gormally

Joe told HealthSpeak that when he was in Lismore in 2014 he fell in love with the area and wanted to come back. “I have an interest in regional oncology and was keen to get out of the city. My wife Louise and I are living in Lismore Heights and enjoying it here. Louise is working as a final year haematology trainee and we are committed to this region.” Oncology was Joe’s choice of specialties although he has an

interest in general medicine and trained in both oncology and palliative care. “But I really loved the oncology component and felt it fitted my skills better, so I pursued that. I still retain an interest in holistic support for the patient in general. “I value the clinical relationship between patient and doctor and have good communication skills. I am able to relay information in understandable terms. It’s one of my main strengths.” Joe has a lot of experience in breast cancer, melanoma and soft tissue sarcoma, but one of the attractions of joining Oncology North Coast was the range of cancers patients present with. He is also keen to teach med students at the UCRH. “My colleague here Dr Amy Scott and I are keen to provide students with a more robust oncology curriculum and do some more broad based teaching in general medicine and oncology.” Joe is happy to speak to GPs. His phone number is 6622 1865.

Book review Happy Apples by Helen Back All Sorted Australia

“One a day keeps depression away”

appy Apples is written not only for depressed people, but specifically to suit the depressed brain. People who are depressed find it difficult to absorb and retain information. The author, Queensland psychotherapist Helen Back has counteracted this by taking the scientific elements of depression and amalgamating them into a story. She has created a story that not only makes it easy to learn how depression operates, but doubles as a tool parents can use to correct depressive thinking styles in their children. In addition, the December 2016 healthspeak

book is rich with tools, techniques and strategies to kick the Black Dog out of anyone’s life. Helen Back has suffered from depression several times in her life and became a Harley Street practitioner specialising in the treatment of the condition. Happy Apples came after seven friends and family members suicided. Helen says in a letter to readers that the book contains

everything a person needs to know about depression and how to rid themselves of it forever. This book is not just for people who are depressed. It explains what ingredients are required for a happy life and provides methods to produce your own personal happiness. For more information, go to www. happyapples.com.au/about

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Guideline for Autism Diagnosis A major study has been launched to develop Australia’s national diagnostic guideline for Autism Spectrum Disorder (ASD) led by The Cooperative Research Centre for Living with Autism (Autism CRC). There is strong evidence of substantial variability in autism assessment processes between clinicians, between states and rural and metropolitan areas. This is leading to delays in diagnosis, misdiagnosis, and inequity in access to services. Autism CRC will undertake the work in collaboration with the National Disability Insurance Agency (NDIA). A national guideline will ensure that each individual across Australia has knowledge of, and access to, best practice in autism diagnosis. The Guideline will be developed by a Research Executive, with additional input from a Steering Committee and regular reviews by a Management Committee. NDIA Deputy CEO Louise Glanville said the Scheme must be informed by the lived experiences of participants and people with disability. While access to the National Disability Insurance Scheme (NDIS) is not dependent on a diagnosis, the team will be working closely with the NDIA to ensure the guideline aligns with the processes for entry into the NDIS.

Latest on Parkinson’s

Interested in pro bono work for refugees?

he importance of early diagnosis was a recurring theme at the inaugural MoveIt Parkinson’s Symposium at Lennox Head in September. The seminar followed a workshop on how to diagnose and recommend treatment for a patient presenting with specific symptoms. This comprehensive learning and awareness day was made possible through the efforts of “MoveIt” for Parkinson’s Northern Rivers and sponsored by Parkinson’s NSW. Five key note speakers talked about the latest developments, treatment and management of this crippling disease. Around 70 local medical practitioners, physiotherapists, nurses and allied health workers attended. Professor Simon Lewis spoke on the latest research and how neuroplasticity was a key factor in the management of Parkinson's. He outlined the history from when this brain plasticity was identified through to the latest thinking on the topic. Dr Bob Lodge from Bangalow spoke on the value of specific

From left: Prof Simon Lewis, Carmelle Moore, Adrian Unger, Melissa McConaghy and Dr Bob Lodge.

exercise programs in maintaining the physical condition of patients and their ongoing health for people diagnosed with Parkinson’s. He said that while general exercise was good, multi-faceted exercise had much greater value in coordinating brain and muscle. Speech Pathologist Carmel Moore spoke about the practicalities and importance of voice strengthening. Melissa McConaghy, a neuro-physiologist and PD Warrior program founder outlined the evidence and back-

ground of the successful intense exercise program. Adrian Unger - founder of the Punch n Parko’s Boxing program explained the benefits of boxing for people living with Parkinson's. Finally, the gathering heard from Erica Rose through a video about her Dancing for Parkinson’s program. All the programs presented are being trialled in the Northern Rivers. For more information contact Kerryn Meanwell on 0427 884 434.

Orion: a care planning tool

he Orion shared care planning tool will provide North Coast clinicians with an electronic shared care planning and collaboration tool and secure communication platform. Adult patients needing help and coordination for chronic, complex and mental health issues will be enrolled on the system and clinicians added to each patient’s care team by the GP. Care team members can then collaborate on the patient’s care plan and communicate directly with each other. All team members will be able to access a patient’s care plan and communicate with each other via a secure web portal. Patient information is instantly updated with new and modified information ensuring everyone 34

has up to date information about the patient. The tool was offered to GPs who participated in the North Coast Integrated Care Collaborative. GPs were invited to participate via an Expression of Interest (EOI). GPs were asked to nominate the the private allied health, private specialists and LHD services they wished to work with and invite into a patient’s care team. Participants will be trained to use the system from early 2017. The trial will run for at least 12 months and there will be no cost to users. . The project is sponsored by NSW Health, NNSW LHD and NCPHN’s Integrated Care initiative, with dedicated support provided by the LHD and PHN.

Where we are now

The tool has been developed in conjunction with clinical users over multiple workshops during 2016. The Orion project has now closed its EOI for GPs to nominate for participation. Participating GPs are currently nominating private allied health, specialists and LHD services they wish to have involved. Once this process has finished, training will be scheduled prior to rolling out and going live across the region in early 2017. For more information, contact Kelli Babovic (07) 5589 0500. The Orion website will be ‘live’ soon and GPs will be notified when this happens.

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A Northern Rivers refugee support group – Ballina Region for Refugees – is hoping to identify Northern Rivers health professionals prepared to consult for free to help refugees needing medical attention during homestays to the area. The organisation’s Sue Kelly said that there are around 28 generous people who host refugees currently living a life in limbo in Sydney for homestays of 4 to14 days to give these people a much needed break. “These are people who are emotionally exhausted and not sure what their future holds. Usually they are not permitted to earn money or hold a Medicare card. We are looking for health professionals – doctors and dentists – who would be prepared to treat one of these people for free if the situation came up that they needed medical treatment during a homestay,” said Sue. If you are interested in helping the organisation out, please contact Sue Kelly at ballinarr@gmail. com

healthspeak December 2016

Trump is a Game Changer

December 2016 healthspeak

It is easier to blame a foreigner for your woes than an arcane economic philosophy unemployment. The Keynesians did not know what to do. Taking advantage of this Keynesian dilemma, the neo liberals pushed for more market orientated policies. You know the stuff: lower taxes (both personal and corporate), cuts to government spending, free trade, globalisation, more foreign investment, less unionism, increase labour “flexibility”, privatisation of government assets, no budget deficits and less red tape. Many of these policies were adopted around the world with varying degrees of enthusiasm by Thatcher, Reagan, Hawke and Keating, through much of Europe, Canada and New Zealand. They were also embraced by the World Bank, the IMF, the World Trade Organisation, the major political parties and became known as the Washington Consensus. The left leaning parties tried to moderate the harsher effects of the policies because it was clear that there were going to be both winners and losers. But generally Keynesianism became a dirty word. We know what happened. There was a major transformation of the world economy. China surged ahead and became the factory of the world. There were major benefits. In developing countries, rapid growth saw employment surge and millions were taken out of

poverty. At first things also went well in the west. Consumers gained access to much cheaper products and living standards rose. China was earning so much in foreign exchange that it sent it back to the west in the form of investment capital and cheap money. Western consumers could borrow as much as they wanted at very cheap rates. But underneath it wasn’t going so well. Millions of jobs were lost in manufacturing and services. While jobs were disappearing, consumer demand was maintained by increasing levels of debt and by a reckless financial system freed from regulation. The result was the Global Financial Crisis. Since then the grumblings from those missing out have been growing. Very little has been trickling down. For most the economic model was not delivering. In the US election, Hillary represented the status quo. Donald Trump did promise change: to bring back the lost manufacturing jobs, a 45 per cent tariff on Chinese goods and to rip up the free trade agreements. He promised big spending in

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finance David Tomlinson infrastructure and the military, big corporate and private tax cuts but nothing much on how this was to be paid for. If he fails to deliver, the discontent may grow and anything could happen. We are also likely to see extremist parties in Europe gain power in the next year or so with much of the discontent being focused on refugees and immigrants. It is easier to blame a foreigner for your woes than an arcane economic philosophy. But whatever happens from here on, it will be a brave politician who advocates for the now unpopular free trade and neo-liberal economic policies of the last 30 years. The question is, will the elites adjust to this new reality or continue pushing policies that hurt the majority of the population and drive inequalities?

MADE IN CHINA

rump hasn’t yet taken the Presidential Oath, but already there are signs that this election will mark a paradigm shift in world economic policies. It doesn’t happen very often, but when it does the effects are gargantuan. In short it seems that the once all-powerful Washington Consensus is crumbling. We cannot yet be certain about what Trump will do. If he manages to implement some of his more extreme policies, we could well see trade wars, confrontations with China, a huge blow-out in the US federal budget deficit, sharply higher interest rates and a severe recession. But even if nothing much happens, it seems likely that we are seeing the end of hard core economic neo-liberalism – an economic philosophy that has had a stranglehold for more than 30 years. Just the fact that an extreme outsider like Trump was able to win enough support from disgruntled mainstream voters to gain the top job will be sending shockwaves through the US establishment. The rich and powerful in the US have had control of government for decades and have been using their power largely to their own advantage. While the rich have become fabulously wealthy, the poor and middle classes have been going backwards for more than 30 years. They were hit not only by the neo-liberal globalisation policies that saw jobs transferred to China and other developing economies, but also the move to automation. Even though some manufacturing is returning to the US, new factories are highly automated and need little traditional labour. Neo-liberalism, you may recall, blossomed when its predecessor, Keynesianism, failed in the late 1970s to control the oil-shock induced twin evils of high inflation and rising

Profile

New UCRH Director Ross Bailie

he Northern Rivers landscape is not unfamiliar to the new Director of the University Centre for Rural Health. Professor Ross Bailie grew up on a dairy farm in South Africa and in the 1980s worked as a GP for five years in a New Zealand town not unlike Lismore. Ross has attained a wealth of experience in his medical career to date. Most recently he worked with the Menzies School of Research for 19 years, in both Darwin and Brisbane. His research interests centre on Population Health. “My role initially in Darwin was coordinating the Master of Public Health program and teaching the Flinders University students enrolled in the graduate medical programs. In fact, 1998 was the first year that Flinders sent graduate entry students to the Northern Territory Clinical School and it was a quite innovative move in those days. I really enjoyed the exposure to med students and working with them during such a time of change,” said Ross. Ross completed his Medicine degree in South Africa and also did his specialist training in Public Health in Cape Town. He also worked in Canberra coordinating a training program on general practice evaluation at the time when Divisions of General Practice were operating; and in South Africa where he worked in clinical roles in hospitals serving urban townships and rural areas. “It was my work in general practice and in hospitals serving low socio-economic groups that stimulated my interest in primary health care. But my interest in public health probably originates from my childhood. I grew up in apartheid South Africa where farm labourers and their families were living in very poor conditions with no access to education and health services. I think that really shaped my

interest in Public Health and comprehensive primary care.” While working in Darwin, Ross’s research interest moved from general public health research into remote Aboriginal and Torres Strait Islander communities into the community environment – housing, sanitation – looking at more comprehensive primary health care in the form of social determinants and quality of care. Ross comes to the UCRH looking for new challenges and ways to make a broader contribution to health care. He will continue to pursue his research as he helps to shape and build on the Centre’s significant achievements. “We clearly have a very strong platform to build on. The Centre has grown enormously in a relatively short period of time and has been very successful, and there are a lot of excellent people here,” he said. “The range of education programs and the breadth of research happening through this organisation is very interesting.” Ross said one of his main interests is in promoting the use of good quality information to improve the quality of health care and environmental health for people and populations. “The work happening here is very much working to that end, with the increasing shift to integrating research and education. I’m really interested in health systems and health services and

contributing to the development of health in this region. The UCRH has a very important role to play.” Partnerships are a vital part of the bigger health picture. “The role and the orientation of the North Coast Primary Health Network in supporting health system integration through partnerships between the PHN and the LHDs will bring about significant developments. And UCRH can contribute a lot to that partnership. We are shifting health education here to a more multidisciplinary approach…getting allied health students, nursing students and medical students training together. “And the other really important development is getting students trained in community based organisations like aged care facilities and schools. Having students trained in these environments gives them community exposure and gets them thinking about how these organisations pertain to their

own roles. This exposure also gives the health sector a wider influence, and it’s about getting students to recognise the roles of those organisations in health development,” Ross said. He is also impressed by the innovative work being done at Southern Cross University in health education. “The University Health Service they have developed is really exciting. It provides great opportunities for students to gain valuable experience while studying.” The central location of UCRH, just across the road from Lismore Base Hospital, is one that Ross intends to take advantage of. “We’re well placed to increase the connections between the hospital practitioners and practitioners in the community; and through our education and research roles we can contribute to developing connections between the secondary and tertiary system and community based services.”

NCPHN’s MICHAEL CARTER JOINS NNSWLHD BOARD The Minister for Health Jillian Skinner has appointed five new Board members to the NNSWLHD. They are Michael Carter, NCPHN’s Director of Corporate Services; Patrick Grier, former Chair of Ramsay Health; Mr John Griffin, Ms Carolyn Byrne and Professor Susan Nancarrow, Chair of the North Coast Allied Health Association. Announcing the new Board members, Chair Dr Brian Pezutti paid tribute to two Board members, Malcolm Marshall and Rosie Kew who have resigned after serving on the Board since 2011. Dr Pezutti also paid tribute to outgoing Board Members who have left as part of the NSW Board Refresh – Professor Lesley Barclay, Dr Jean Collie and Dr Sue Page Mitchell, thanking them for the contributions to health services over many years

Walking the rabbit proof fence

er fingers were curled inwards, unable to be easily straightened, she explained. She had not come to see me as a patient but her condition seemed like a repetitive strain injury. It was interesting to hear how this came to be. She had been pushing a trolley weighing 30 kilograms for hundreds of kilometres during the winter of 2016. Lindsey Cole was not a bag lady, pushing her plastic-bagged hoardings around suburban streets, but a vibrant Englishwoman in her 30s, golden blonde curls tumbling around her intelligent face. She explained how she had pushed her trolley for 10 weeks, covering 1500 kilometres, on an amazing quest through the Australian outback desert. It came to pass that in the year before her journey, she had suffered a severely comminuted ankle injury in a foolish prank in 2007 which required internal fixation and weeks off her feet. During this enforced stoppage she read books and watched movies, as one does. One movie 'Rabbit Proof Fence' inspired her so much that she also read the original book, 'Following the Rabbit Proof Fence' written by Doris Pilkington Garimara and published in 1996 by UQP. Doris, the storyteller, was the daughter of Molly, one of three sister/cousins who at age 13 ran away from Moore River Native Settlement in WA in 1931. The other two were Daisy aged 7 and Gracie 10. Gracie was recaptured and taken back to Moore River Native Settlement. The purpose of the journey was to return to their home country and family at Jigalong, far to the north, from where they had been recently abducted on the orders of Mr Neville, the December 2016 healthspeak

Chief Protector of Aboriginals. Molly knew that if they could find the fence they could follow it home. So they fled. It's worth remembering the girls were moving through occupied territory and were being

but no-one had attempted this journey of escape by children. Lindsey had some support, such as water left out by the station owners along the way. She carried a GPS and an EPIRB in case of emergency and attended

light airs David Miller

Lindsay Cole pushed a trolley for 10 weeks, covering 1500 kilometres on an amazing quest through the outback.

She got lost a few times, but remembered the essence of her course, 'Don't panic'. an outback survival course in preparation for the journey. In spite of that, Lindsey said she got lost a few times, but remembered the essence of her course, 'Don't panic'. The old fence had disappeared in many sections of the journey. Some sections were very sandy, requiring great perseverance to push or pull her trolley. Other parts were rocky and she had to climb boulders. There were salt lakes too in this difficult desert country. Lindsey wanted to recount

her journey to the screen writer of the movie, Christine Olsen, whom she met in Byron Bay and I was present at this meeting. As a doctor I was curious about her motivation, if the journey had changed anything for her and her future plans. 'It has changed me completely,' she said. 'I have no plans, happy not knowing and letting my life unfold. Unlike the girls who must have been happy to end their journey and get home, I never wanted it to end'.

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pursued. They had to live off the land. Two of the three got home to their mothers. 85 years later Lindsey decided she wanted to walk in the steps of these children. She had been counselled about the dangers and foolhardiness of this walk but persevered anyway. There is nothing new about journey re-enactments. The illfated exploration of Burke and Wills, the forced march of Australian soldiers on the Kokoda trail have all been re-enacted,

The Death of Cancer Vincent T DeVita & Elizabeth DeVita-Raeburn Farrar, Straus and Giroux 324pp

ith a gloomy cover suggesting a more apt title might be ‘death from cancer’, rather than discussing how “the war on cancer in winnable”, this is an unusual account of how an esteemed American oncologist has spent a lifetime battling the medical system as much as the disease itself. Professor DeVita was the head of the US National Cancer Institute for three decades. He has teamed with his daughter to produce an impassioned plea for pulling no punches in striving to conquer an illness that has become one of society’s new normals and, according to some, defying every effort to defeat it.

Yet as DeVita explains, significant progress has been made and is continuing, despite the excessive caution of many colleagues - who will hardly welcome this contribution to the debate - and he believes that praise is due to those clinicians and funding bodies that have literally refused to say die. “People still get cancer, and people still die from it,” he writes. “But thanks to this concentrated effort, far more people survive than was true when this war was launched…By 2005, the absolute number of people in the USA who died of cancer declined even as the population was growing and ageing.” A similar claim could be made in Australia where encouragement for earlier diagnosis, and improved diagnostic and treatment methodologies have seen better outcomes for many cancer sufferers. As he writes, “Even in the case of cancers for which we don’t have an outright cure, we can stop many if diagnosed early. We can even prolong the lives of those in whom cancers are diagnosed at advanced stages. “Mortality from colon cancer has dropped by 40 per cent in the last two decades. Mortality from breast cancer dropped by about 25 per cent. We’re seeing major advances in difficult-to-treat

book review Robin Osborne tumors, such as ovarian cancer, small-cell and not-small-cell lung cancer, advanced melanoma, and prostate cancer.” So there’s plenty of good news. Yet the ‘natural’ progress of a cancer is often not the only factor at play, as the author notes. “We are not limited by the science; we are limited by our ability to make good use of the information and treatments we already have. Too often, lives are tragically ended not by cancer but by the bureaucracy that came with the nation’s investment in the war on cancer, by review boards, by the FDA, and by doctors who won’t stand by their patients or who are afraid to take a chance.” Death by bureaucracy then, rather than by a life threatening illness, with the identified enemies being faintheartedness and limited imagination. Charting his 50 years in the profession, DeVita has produced a fascinating account of the multipronged fight against the disease. “A remarkable change began to take hold in the field of cancer treatment. Surgeons began to

shape their operations around the availability of these other treatments; radiotherapists did the same. You didn’t need to do the classic ‘cancer operation’ if the drugs were going to take care of any escaped cells anyhow.” Despite media claims that the war on cancer is being lost, the reverse is true, he says. “The cancer cell is no longer a black box: it’s a blueprint. We understand the cancer cell’s stages, how it thinks, what drives it. And we have the tools to attack each of the steps on the way to malignancy. “There isn’t a question about cancer we can’t address, at this point, without the expectation of a usable answer…I do think we’re heading for a time when we’ll be able to cure almost all cancers. And those that we can’t cure will be converted to chronic, manageable diseases.” Comfortable that the light at the end of the tunnel is hope, not an oncoming train, we discover that the author himself is diagnosed with prostate cancer after a visit to ED. His ‘physician’s vice’, he admits, was avoiding regular medical checkups. Like many patients he feared the worst, but fortunately the cancer had not metastasized. He lived to tell the tale and to (co)write this cracker of a book.

David Butt new NRHA CEO The National Rural Health Alliance Chair Geri Malone said she was delighted to announce that David Butt is the new Alliance Chief Executive Officer. David took up the role in October. Most recently David was CEO of the National Mental Health Commission. His previous experience includes CEO of the Little Company of Mary and CEO of the Australian General Practice Network.

Ms Malone said David Butt was an outstanding choice to become the NRHA’s CEO. “He is an experienced, effective and capable senior executive with a demonstrated commitment to rural and remote health issues. His David’s unique background, working at a senior level in both federal and state Departments of Health and in organisations concerned with primary care,

acute care and aged care provides the NRHA with an excellent understanding of the complex environment that underlies rural and remote health,” she said. David was involved in the introduction of Medicare in 1984, and later in Australia’s initial response to HIV/AIDS, and in the early establishment of the National Campaign Against Drug Abuse. Mr Butt has an MBA and is a Fellow

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of the Australian Institute of Management and Associate Fellow of the Australian College of Health Services Management.

healthspeak December 2016

Addressing the social and cultural determinants of Aboriginal health

he recent Boyer Lectures on ABC RN by health inequity expert Sir Michael Marmot provided a stark reminder that ill health has a strong link to social determinants. We often look at the causes of disease around risk factors - smoking, drinking, poor diet, lack of exercise etc, without focusing on why people pursue such ill-advised lifestyles. So, what causes unhealthy lifestyles and what can be done about them? In Australia, despite having one of the highest living standards, there are dramatic health inequalities. Here are just two - the life expectancy gap between Indigenous and nonIndigenous Australians is about 11 years; and Aboriginal women are 11 times more likely to die of ischaemic heart disease than non-Indigenous.

determinants issue? It seems we can. In his lectures, Marmot cited examples where progress was being made by committed health professionals and socially conscious organisations. Facing past wrongs

In addressing Aboriginal health we need to look at our history and not ignore past actions that make us feel uncomfortable. One of the problems Andrew of dispossession Binns of land, language and culture is that it still causes feelings of societal exclusion played out through generations of our colonial history. If anything, this feeling of exclusion is getting worse. To restore pride and a spirit of belonging to a community requires understanding and respect from all – with this there is hope for healing, reconciliation and improved participation Disturbing figures for Aboriginal people. Without Indigenous people make up this respect and understanding 2.5% of the population and yet there is a lack of hope, struggle account for 28% of the prison and sometimes despair that can population. The statistics of lead to suicide. disproportion create a long list Looking at education, we and and the alarming suicide rates our children and their children of young Aboriginal people in have been brought up with a the Kimberley and other regions version of Australian colonial have recently been in the media history from the time of various spotlight. explorers and British Could our tiers of settlement from government alone 1788 onwards. Aboriginal art is a address the health Australia’s history powerful way of inequity probbefore colonial understanding and lem? It seems settlement has building respect for unlikely without been largely hidKoori culture people power and den. influence. Can we It’s time to change as individuals, comthis. Future generations munity groups and organisaneed to hear the 60,000 year tions - particularly in health - do version of Australian history anything to address the social including the massacres and December 2016 healthspeak

painting by Anthony Hickling

stolen generation issues of more recent times. There are early signs of shifting conversations around our true history and what is taught in schools about the remarkable Indigenous story of survival and connection to the land. Art builds understanding

similar to Indigenous participation in sport. Incarcerated Aboriginal people often suffer multiple and complex mental health problems and art workshops have been shown to play a significant role in their healing and in building resilience.

Listening to Aboriginal Elders, Art heals & empowers leaders and community is vitally A well known Aboriginal artist, important in building awareness the late Dr Pamela Johnston, and respect for our Indigenous taught extensively in jails using culture. Aboriginal art is also art workshops for healing and a powerful way of discovering, empowering Aboriginal prisonunderstanding and building reers. In an essay “Talking You spect for Koori culture. Talking Me Talking That is art in all its Aborigine” she forms - paintwrote: ings, sculpture, ‘Through Art displayed in health dance, music, painting and facilities can help break writing, the exploration down the barriers including theatre, film, of culture and racism for Aboriginal people presenting to craft, hip hop identity my health services etc. students have Creating art been led into a can also serve as desire for a wider therapy. For those language. Given curwho suffer from post rent recidivism rates many traumatic stress, major trauma of my students have become quite and mental health problems, skilled. It is a sad indictment that art is a safe, effective form of young Aboriginal people have non-verbal communication. We more chance of being exposed to see so many examples of art as structured educational processes a therapy and healing process inside prison than they would Continued page 43 in our Indigenous community,

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Health&Lifestyle

Everybody knows

lder doctors may have trouble remembering any mention of health related nutrition from medical school. The only thing I recall was a biochemistry professor saying that ‘the body does its own arithmetic' in the uptake and digestion of nutrients from food. We were trained in the medical and surgical correction of disease, the inevitable consequences of being alive. Food and medicine were unrelated except in defined clinical deficiency conditions such as scurvy or beri-beri. By contrast today, health shops and naturopaths promise longevity and energy with exotic products. It’s ‘Healthy this’ or David ‘Rainbow that’ in the Miller choice of vitamins and supplements. In the clash between science and superstition, confusion is alchemical. Back in 1972, during a London hospital job, I attended by chance a lunchtime meeting which started to change my thinking about the relationship of food and health. These meetings were sometimes educational but this one promised to be amusing. The speaker, Professor Denis Burkitt had an original message. This tall and angular, eccentric Englishman showed an extensive slide collection of the excrement of animals and humans from various parts of the world. He was very enthusiastic about the role of fibre in diet which resulted in differences in the stools of herbivores such as elephants and rabbits in comparison with tigers and dogs.

More to the point for us, natives of Papua New Guinea, who mostly ate yams, had more fluffy stools than English people. The low fibre western diet of the time produced stools which he described as being of 'toothpaste' consistency. He went on to discuss the difference in the incidence of diverticulitis in the two groups. The rest is now so much history that we don't even remember the question, but looking back, Burkitt was a man so much ahead of his time that no-one took any notice for years to come. The point is not to extol the virtues of fibre, including cholesterol lowering effects. Most everybody knows that by now. But it was not always so. Fibre, once considered a nothing food by doctors, is now recommended as a health supplement by most gastro-enterologists. Psyllium husk is even available flavoured and packaged. Everybody also knows that fruit and vegies are healthy, especially the colourful ones, because of the vitamins, bioflavinoids and antioxidants they contain. Recommendation is high in the current food pyramid, five a day. More recent tradition accepted that fruit juices are healthy. They are delicious to drink and juicing machines make it easy, but the machine is messy to clean. All that pulp (fibre) is thrown away. Herein lies the trap. This fresh juice is high in sugar and low in fibre. With the best of intentions, something natural has become a processed food. Contemporary opinion leans towards fruit juices being high in fructose, an even bigger sugar vil-

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lain than sucrose. The sugar industry used to promote its product as 'a natural part of life', but the evidence about sugar is horrifying, worse than fat as the cause of obesity, diabetes and a constellation of modern disease including fatty liver and vascular disease. Everybody knows that by now. The point is that food science is still evolving, a cause for the exciting confusion. Let us go into a virtual shop to find the truth about what passes for food. The health food shop has a confusing and expensive array of supplements, vitamins, large plastic jars of protein powder, shark cartilage with chondroitin. In the corner are bulk dispensers of coconut sugar, millet flours and ancient grains. Let's leave that and stroll into the more familiar aisles of Coles or Woolies to find an endless choice of packaged products. What about the low fat products? ‘All rubbish,’ says Jamie Oliver. What to do? An American food expert Michael Pollan summed it up in seven words, 'Eat food, not too much, mostly plant'. What then, is food? Pollan advises, ’Don’t eat anything your grandmother wouldn’t recognise as food’. Even Grandma got it wrong, cooking the crap out and destroying soluble fibre. So why not try that celery stick raw? But there is more - those farm poisons. Sorry, have to rush because Tuesday is farmers’ market around here. Everybody Knows. Vale Leonard Cohen.

healthspeak December 2016

Health&Lifestyle

Add exercise and stir!

ow many patients will 63.4% of Australians aged 18 you see today who are years and over were overweight overweight? How many will have or obese (11.2 million people), a lifestyle which is contributcomprised of 35.5% overweight ing to that? And how many will (6.3 million people) and 27.9% you silently despair over, obese (4.9 million suspecting (or even people). knowing!) nothing While the prevayou say to them in lence of overweight the next 15 minutes and obesity Chris Ingall or so will make the increased in Ausslightest bit of diftralia between 1995 ference to their health (56.3%) and 2011-12 trajectory? If you are (62.8%), there was no nodding, read on. significant increase between What are the tools at your 2011-12 and 2014-15. Good disposal to turn things around in news. Overall however, 70.8% of this tiny fragment of time? What men were overweight or obese in leverage can you provide, or 2014-15, compared with 56.3% strategies germinate, which will of women. That is a lot of fat. kick-start the alchemy you desire Little wonder nearly 300 for your patient? You can run Australians develop some form some tests, revealing raised this of diabetes daily, with 1.7 million or that, alarming you more than already living with it and the they. You can measure stuff like total cost an estimated $14.6 bilweight, height and girth, which lion, and we are in the poll spot will probably trouble your sleep to do something about it! more than that of your patient. We are battling the dotcom You can look at the two 'sizes', of the food industry, insidiously portion size and exercise, and reaching our patients through discover whether either or both every screen which informs their are culprits. Well done, but then lives, ensuring salt, sugar and fat what? snacks are their bedfellows. More Many of you will have a dietielastic perhaps is their activity tian attached to your practice, level. At least there is no active someone you can call antagonist (maybe on for nutrition apart from screens and caloric again) to battle. advice. But Shouldn't we most doctors admit to how many as docs be not having the skills of you have more active or referral network an exercise in engagto make suggestions physiologist ing, or even to get their patients (or a list of embedding, active them) on the activity-creatbooks to auging folk in our ment your efforts practice? to change your patients’ The four year Exercise ways? If obesity is the modern Physiology course includes a sigepidemic, and in truth it is out nificant psychology component of control, we docs may have so they would complement the to act outside the square more dietitians’ work beautifully, as effectively to get better results. of course weight loss and fitness (Check out Item No. 10953) needs diet and exercise! We have The stats are grim, and are Medicare backup with a Care coming to us wherever we look: Plan in place, and my suspicion is According to the Australian as the Health Funds are starting Bureau of Statistics, in 2014-15, to baulk at insuring obesity-relatDecember 2016 healthspeak

ed morbidity. Calls are going out to fund gastric sleeves through Medicare, this less expensive and potentially more effective middle ground of increasing exercise (70% of us do too little) will attract more thought and funding. To quote Exercise and Sports Science Australia: “Despite 8 out of 10 people having a chronic health condition in Australia, and 11.2 million Australians at risk of further chronic disease due to being overweight or obese, only 1% of these people are referred to exercise physiologists. According to the American College of Sports Medicine surveys, 66% of patients would be more interested in exercise if advised by their doctor. However, most doctors admit to not having the skills or referral network to make suggestions to get their patients active. So the future is clear. Involve both a dietitian and an exercise physiologist in your practice and use them to give legs to the strategies you outline for patients during the consultation, virtually outsourcing motivation! The results may well be rosier, as your

a publication of North Coast Primary Health Network

patients get fit, lose weight and feel better. Even their numbers in the lab may improve! And you of course will experience lower blood pressure and higher dopamine levels, basking in your patients' successes. Only a good thing that.

HEALTH PATHWAYS HELP Check out HealthPathways to find out how to refer to Exercise Physiologists and other support for exercise in your area. The website is at: manc.healthpathways. org.au – user name manchealth and password: conn3ct3d Relevant HealthPathways topics: Exercise Physiologists Healthy Lifestyle Support Physical Activity Support Exercise groups

Health&Lifestyle

Singing brings joy & belonging

he “Absolutely Everybody” engage in the arts and develop Choir, Port Macquarieskills, confidence and a capacity Hastings School of Hard to take new steps in their lives”, Knocks, took a huge leap forsaid Ms Humble. ward with its first concert “It’s is open to anyone at St Columba Anglican living with challenges School last month. At including those with By Sonia Fingleton the same time a major disabilities, those who fund raising campaign was are homeless, those exlaunched to buoy the choir’s periencing mental ill health, future. at risk or victims of domestic Special guest at this event violence. Together they sing, was founder of the expanding make new friends and now have School of Hard Knocks national taken the big step into their first network, Dr Johnathon Welch, independent concert. who and performed with the “There is absolutely no Dr Jonathon Welch at the November 12 concert in Port Macquarie. choir at the concert in the experience necessary to join school Chapel. the choir. Anyone can join as https://www.facebook.com/ It was a joyous occasion for long as they are 18 years or Nationally, the School of SOHK.PMH/ all, particularly the 25-strong more and want to enjoy their Hard Knocks has hundreds of Potential corporate sponsors choir that rehearses with Choir love of singing or learn how to choir members in Melbourne Leader Marie van Gend and sing. It’s a great opportunity to where there are several different should contact Sonia Fingleton on 0414 376 868. accompanist Miriam Lattimore try something new, learn some choral groups including one for every Tuesday at the Port more skills, make new friends refugees. Macquarie Conservatorium. and just have fun.” The original Choir of Hard The Choir is supported by The choir volunteers “buddy” Knocks, that featured in the well Coordinator Katrina Humble, with choir members and known ABC television series, Volunteer Coordinator Judy prepare and serve lunch, assist has about 22 members who Ryan, and up to 14 regular volwith transport and planning are still together after a decade unteers who sing and prepare and logistics for performances. of singing, with some having lunch provided by REAP Food More volunteers are always passed on and others who have rescue. welcome. joined recently. This This choir started in March The “Absolutely year they toured 2016 and now, only nine Everybody” to celebrate the months later, can perform an Choir of choir’s 10th anThis Choir is an initiative extensive repertoire. the Port niversary. of the Port Macquarie The fund raising campaign in- MacquarieKey partners Community College cludes donations given through Hastings supporting the and the first major step the choir’s Facebook page and School of PMH SOHK in its “Creative Arts to Recovery Program” website and invitations to busiHard Knocks are Mid North nesses to contribute through (SOKH) is Coast Area their Corporate Social Responthe first regional Health Service, sibility programs. choir in the SOHK the community based This Choir is an initiative of national family. Dr rehabilitation centre, the Port Macquarie CommuJonathon Welch loves Port Mac- Endeavour Clubhouse; Mental nity College and the first major quarie and has often performed Health, Community Health, Write for step in its “Creative Arts to Rehere in his own shows. Disability Support and Social covery Program”. The College is The local choir is led by Service Agencies; The Mid HealthSpeak dedicated to serving the needs local musician, singer and North Coast Human Services Are you interested in of vulnerable communities by choir leader Marie van Gend Alliance; Community Colleges writing an article for our building confidence, educating, supported by Ruth Allen. Marie Australia and business sponsors. new Health & Lifestyle sharing new skills and social is well known for many choral section? inclusion. directing roles, including Kala To donate and for more We’d love to hear from “This choir is an opportunity Rala and other mass choir information, visit: http://www. you. Get in touch with for people in our community activities. Accompanist Miriam portace.com.au/pmh-sohk or Editor Janet Grist on who experience homelessness, Lattimore is equally well known Contact Coordinator, Katrina jgrist@ncphn.org.au disadvantage, or have been mar- for her musical accomplishHumble on 0413 309 383 or join ginalised or excluded socially to ments throughout the region. the conversation on Facebook 42

a publication of North Coast Primary Health Network

healthspeak December 2016

From page 39

Bundjalung Art Project

outside prison. To address this need and help create Where traditional European society is a demand for such artwork, the North Coast literate society – by that I mean that writPrimary Health Network is involved with ten word is the predominant language…for a health project (Art on Bundjalung CounAboriginal individuals and communities a try) in partnership with Bulgarr Ngaru visual language fulfils that role. Thus, in order Medical Aboriginal Corporation, the of importance, oral skills and visual University Centre for Rural Health, skills are primary and literacy the Lismore Regional Gallery, and numeracy skills in the and Arts Northern Rivers. European educational There will be workshops In order of importance, framework, come after oral and visual skills are run by Aboriginal artists that. This is where Abprimary, and literacy and for emerging artists to original art classes are numeracy skills in the help develop their skills European educational so important, particuin a supportive environframework, come after larly in a Correctional ment. that setting and this is their This will lead to an exdifference from the nonhibition in September 2017 Aboriginal art classes, which I in the new Lismore Regional emphasise here, also have a vital Gallery. Work with be promoted for role to play in education and in society.’ sale. Community involvement, sponsorArt displayed in health facilities can help ship and tax deductible donations to this break down the barriers including racism project are currently being sought. for Aboriginal people presenting to health services. In the broader community there Enquiries to Anne Maree Parry is plenty of wall space in foyers and offices on 6618 5400 for Aboriginal art. or email aparry@ncphn.org.au

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