Summary services and workforce

Respond to issues relating to suicide 26% non-Aboriginal, 30.8% Aboriginal and Torres Strait Islander

Respond to issues relating to drug and alcohol misuse including access to services 52.9% non-Aboriginal, 71.8% Aboriginal and Torres Strait Islander

58% non-Aboriginal, 72% Aboriginal and Torres Strait Islander

Respond to issues relating to ageing issues Difficulty accessing 54% non-Aboriginal, 56% Aboriginal and Torres Strait Islander

Ageing issues 58.5% non-Aboriginal MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole

MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

MPHN 2021: Table 193: Aboriginal and Torres Strait Islander five most serious health and wellbeing concerns for your community as a whole

MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access

MPHN 2021: Table 207: Service access

MPHN 2021: Table 194: Aboriginal and Torres Strait Islander service access

MPHN 2021: Table 206: Five most serious health and wellbeing concerns for your community as a whole

General practice attendances in MPHN are lower than Australia. MPHN has a lower proportion of adults who have had a usual GP for more than five years compared with Australia. MPHN residents report waiting longer than acceptable to get an appointment with their GP and are less likely to report that explanations of their test results are given in a way that’s easy to understand. MPHN residents are less likely to report quality of healthcare received from their usual place of care being excellent.

In the after-hours period attendances at GPs are much lower in MPHN compared with NSW and Australia and availability of a GP weekdays after 6pm or on the weekends is significantly lower than Australia and NSW. GP attendance in residential aged care facilities are also lower in MPHN compared with Australia and NSW. Less adults reported speaking to their health professional about emotional or psychological health, or saw a health professional when they needed to, mostly due to embarrassment.

Reduced attendance in general practice in hours and after hours highlights the potential for workforce shortages that exist through most rural and regional areas, this is the case in the Murrumbidgee region. Additionally results suggest that health literacy could be impacted by MPHN results.

Of the general practices in the Murrumbidgee region in 2020-21, the main areas of interest are women’s health, dermatology, mental health and paediatrics. The majority of practices completed cultural training more than two years ago. Several programs such as GoShare (health literacy), Lumos (data linkage), emergency response planning tool and winter strategy are delivered in general practice often with engaged practices participating in all programs on offer. Continuous professional development was attended mainly by practice nurses and medical personnel.

General practice patients span all age groups with a quarter being under the age of 24 years and a further quarter approximately being over 65 years of age. Less than 5% identify as Aboriginal and Torres Strait Islander however nearly a quarter inadequately describe their Aboriginal status. Approximately half the population are married, more than a third are pensioners. Slightly more than half of the population are female.

For both incidence and prevalence respiratory disease is the highest health condition managed in general practice followed by mental health issues and cancer. In relation to Medicare Benefits Scheme (MBS) items unsurprisingly in this financial year COVID GP telephone items were the highest reported MBS billing item. The prevalence of GP management plans either in preparation or in team care arrangements billed second highest.

For specialist use, potentially there is less access to specialists as is the case in rural and regional Australia with lower specialist attendances compared with Australia. There is a higher proportion of patient with out of pocket costs associated with specialist care in the MPHN compared with Australia.

Community health centres are reported higher as usual place of care settings compared with Australia. Allied health attendances are lower in MPHN compared with Australia. In MPHN people report a lower selfassessment on the quality of the healthcare received from their usual practice in relation to excellence. More patients report an out of pocket cost for non-hospital Medicare services compared with Australia and in particular for imaging. Lower allied health attendances are confirmed with lower rates of MBS allied health service claims compared with Australia, ranking in the bottom third of the nation. In particular for physiotherapy, speech pathology, occupational therapy, physical healthcare and other medical practitioners.

Allied health mental health, psychiatry, clinical psychology and other psychologist services are all lower for MBS claims in MPHN compared with Australia.

There is a significantly lower proportion of cervical screening participation in MPHN compared with Australia and NSW.

For alcohol and other drug (AOD) services, there is a lower rate of clients in MPHN compared with Australia. More referrals come from self or family or health services in MPHN compared with Australia. Less referrals in MPHN come from corrections, diversion or other compared with Australia. Support and case management is higher in MPHN compared with Australia as is assessment only as a service type. The most common setting for AOD services in MPHN was non-residential. The most common principal drugs of concern are alcohol, amphetamines and cannabis.

MPHN has a higher proportion of Indigenous health checks compared with Australia, particularly face to face and for follow up checks.

MPHN has a lower proportion of five or more antenatal visits compared with Australia.

Emergency Department (ED) presentations for low urgency care across all hours is higher in MPHN indicating that there is a higher reliance on hospital ED service for lower acuity care. Reasons for using the ED included waiting times for general practice. More people thought their care could have been provided by a GP in the MPHN compared with Australia.

Types of health conditions where MPHN has higher rates and ranks in the lowest third of the nation include circulatory diseases; digestive diseases; genitourinary diseases; injury; poisoning and other external causes; infectious and parasitic diseases; musculoskeletal and connective tissue issues; respiratory issues; other conditions; and mental and behavioural disorders.

MPHN has 33 hospitals and Multi Purpose Services (MPS) across the region with a higher total admission rate compared with NSW, in particular to public hospitals. This is supported by a higher proportion of adults reporting they were admitted to any hospital in the previous 12 months. Admissions for total chronic

conditions (potentially preventable hospitalisations) and all potentially preventable conditions are higher in MPHN compared with Australia. Admissions for Aboriginal and Torres Strait Islander are not in the lower third of the nation although generally are higher than Australia and NSW.

Admissions for health conditions which are higher in MPHN include chronic congestive cardiac failure; chronic diabetes complications; type 1 and 2 diabetes; injury; poisoning and other external causes; genitourinary issues; kidney disease; infectious and parasitic diseases; respiratory issues; chronic asthma; chronic obstructive pulmonary disease; influenza, particular over 65 years of age; digestive diseases; and congenital malformations. For Aboriginal and Torres Strait Islander people higher admissions are reported for genitourinary diseases; acute urinary tract infections; kidney disease; intentional self-harm; respiratory issues; chronic asthma; chronic obstructive pulmonary disease; digestive diseases; chronic iron deficiency anaemia; and acute convulsions and epilepsy.

MPHN commissions a number of different services to address high rates of PPH including allied health services (WARATAH); integrated care coordination; health navigation for chronic diseases; family violence; Murrumbidgee HealthPathways; integrated team care (Aboriginal and Torres Strait Islander chronic disease); mental health (including Gidget and headspace); alcohol and other drugs; vitality program (aged people in community and RACF); and after hours general practice. Commissioned services are in line with the seven priority areas of the Commonwealth and are captured in MPHN’s Activity Work Plans (AWPs).

There are 13 identified needs from the service information in this report where MPHN rank in the bottom third of the nation indicating issues with access to and availability of services. Table 11 describes the priority areas and the population groups affected relating to service use. Table 12 provides a description of evidence that indicate an issue related to service use in MPHN.

Table 11: Priority areas for action for population groups from service use

Lower general practice attendances

Lower GP attendances after hours

Lower GP attendances residential aged care facilities Lower GP attendance about emotional health Lower specialist attendances

Lower allied health attendances

Lower cervical cancer screening participation Lower proportion of antenatal visits

Higher out of pocket costs

Lower MBS mental health services

Higher use of Emergency Department for low urgency presentations Higher total admissions to hospital

Lack of dentists Aboriginal and Torres Strait Islander people Maternal, Child and Youth Older persons Population

Table 12: Summary of evidence for priority areas service use

Outcomes of the health needs analysis

Identified Need Key Issue Lower general practice attendances Lower GP attendances – potentially indicating less access to GPs both males and females (MPHN 546.9 per 100, Aust 604.9 per 100) Less time associated with usual GP – potentially indicating transient GP workforce (rank 29/31, variance to Aust -14%) Waited longer than acceptable to get an appointment with GP (rank 28/30, variance to Aust -37%) Lower health literacy - explanations of test results easy for patient to understand (rank 25/31, variance to Aust -5%)

Lower GP attendances after hours Lower GP attendances after hours – potentially indicating less access to GPs both males and females (MPHN 18.7 per 100, Aust 48.6 per 100) Less access - Usual place of care has a GP available to visit or talk with on weekdays after 6pm (rank 31/31, variance to Aust -51%) Less access - Usual place of care has a GP available to visit or talk with on Saturdays after midday (rank 30/31, variance to Aust -50%) Less access - Usual place of care has a GP available to visit or talk with on Sundays (rank 31/31, variance to Aust -61%) Lower MBS GP after hours services delivered (level 3) (rank 28/28, variance to Aust -60%)

Lower GP attendances residential aged care facilities Lower GP attendances RACF – potentially indicating less access to GPs (MPHN 13.0 per 100, Aust 17.8 per 100)

Lower GP attendance about emotional health

Lower specialist attendances

Lower allied health attendances Less adults who spoke to a GP about their own emotional or psychological health (rank 26/31, variance to Aust -5%) More people who needed to see a health professional for psychological health but didn't (rank 28/31, variance to Aust -16%) Reason for not seeing a health professional for psychological health – embarrassment (rank 21/25, variance to Aust -22%) Lower specialist attendances – potentially indicating less access to specialists (specifically females) (MPHN 78.9 per 100, Aust 88.5 per 100) More patients with out-of-pocket costs for nonhospital Medicare services – Specialists (rank 28/31, variance to Aust -9%) Lower allied health attendances – potentially indicating less access to allied health (MPHN 70.7 per 100, Aust 91.2 per 100) Lower self-assessed quality of health care received from usual place of care is excellent (rank 25/31, variance to Aust -9%) Lower allied health services (rank 26/28, variance to Aust -24%) Description of Evidence AIHW 2018: Table 208: General practice attendances

AIHW 2016: Table 213: Length of time with usual GP

AIHW 2016: Table 220: GP usage

AIHW 2016: Table 224: Patient experience

AIHW 2018: Table 231: General practice after hours

AIHW 2016: Table 232: Usual place of care after hours

AIHW 2017-18: Table 233: MBS GP attendances after hours

AIHW 2016: Table 218: GP attendance residential aged care facilities

AIHW 2016: Table 229: GP consulted for emotional health

AIHW 2016: Table 230: Psychological health – reasons for not using

AIHW 2018: Table 235: Specialist attendances

AIHW 2016: Table 237: Specialist cost implications

AIHW 2018: Table 241: Allied health attendances

AIHW 2016: Table 246: Self assessed care

AIHW 2017-18: Table 251: MBS Allied health services

Lower cervical cancer screening participation

Lower proportion of antenatal visits

Higher out of pocket costs

Lower MBS mental health services

Higher use of Emergency Department for low urgency presentations Lower MBS Allied Health – Physiotherapy (rank 25/28, variance to Aust -32%) Lower MBS Allied Health – Speech pathology (rank 20/26, variance to Aust -29%) Lower MBS Allied Health – Occupational therapy (rank 17/22, variance to Aust -15%) Lower MBS Allied Health – Other non-referred medical practitioner (rank 25/28, variance to Aust -53%) Lower MBS Allied Health – Physical health care (rank 24/28, variance to Aust -28%) Lower cervical cancer screening participation (rank 30/31, variance to Aust -14%)

Lower than five or more antenatal visits (rank 28/31, variance to Aust -3%)

More patients with out-of-pocket costs for nonhospital Medicare services (rank 27/31, variance to Aust -17%) More patients with out-of-pocket costs for nonhospital Medicare services – Imaging (rank 28/31, variance to Aust -51%) Lower MBS allied health mental health (rank 27/28, variance to Aust -44%) Lower MBS psychiatry (rank 25/28, variance to Aust 33%) Lower MBS clinical psychologist (rank 27/28, variance to Aust -78%) Lower MBS other psychologist (rank 25/28, variance to Aust -42%) High use of ED for low urgency presentation all hours (rank 26/28, variance to Aust -120%) High use of ED for low urgency presentation after hours (rank 26/28, variance to Aust -116%) High use of ED for low urgency presentation in hours (rank 26/28, variance to Aust -124%)

Across all age groups and both genders for all hours, after hours and in hours

Main reason for most recent ED visit – Waiting time too long (rank 22/26, variance to Aust -124%) More patients who thought care could have been provided by a GP for most recent visit to ED (rank 28/31, variance to Aust -49%) Higher use of ED for non-urgent disease:

Circulatory system (rank 27/28, variance to Aust 588%) AIHW 2018-19: Table 288: ED presentations circulatory system

Digestive system (rank 27/28, variance to Aust -367%) Table 289: ED presentations digestive system

Genitourinary system (rank 27/28, variance to Aust 311%) Table 290: ED presentations genitourinary system

AIHW 2017-18: Table 252: MBS Allied health provider services Level 3

AIHW 2018: Table 259: Cancer screening

AIHW 2019: Table 272: Antenatal visits

AIHW 2016: Table 249: Out of pocket expenses

AIHW 2017-18: Table 254: MBS mental health services

AIHW 2018: Table 275: Low urgency ED presentations

AIHW 2018: Table 276: ED low urgency presentations all hours by age

AIHW 2018: Table 278: ED low urgency presentations after hours by age

AIHW 2018: Table 277: ED low urgency presentations in hours by age

AIHW 2018: Table 279 : ED low urgency presentations by gender

AIHW 2016: Table 286: Reasons for ED visits

AIHW 2016: Table 287: General practice ED visits

Injury, poisoning and other external causes (rank 27/28, variance to Aust -393%)

Infectious and parasitic disease (rank 27/28, variance to Aust -491%)

Musculoskeletal system and connective tissue (rank 27/28, variance to Aust -348%)

Respiratory system (rank 27/28, variance to Aust 531%) Table 291: ED presentations injury, poisoning and other external causes

Table 292: ED presentations infectious and parasitic diseases

Table 293: ED presentations musculoskeletal system and connective tissue

Table 294: ED presentations respiratory system

Other conditions (rank 27/28, variance to Aust -393%) Table 295: ED presentations other conditions

Mental and behavioural disorders (rank 28/28, variance to Aust -2848%)

Higher total admissions to hospital Higher total admissions to hospital (rank 18/21, variance to NSW -14%) Higher admissions to public hospitals (rank 27/31, variance to Aust -21%) More adults who were admitted to any hospital in the preceding 12 months (rank 29/30, variance to Aust 30%) Higher admissions for total chronic conditions (PPH) (rank 30/31, variance to Aust -40%)

Higher admissions for all potentially preventable conditions (rank 28/31, variance to Aust -30%)

Higher admissions for total acute preventable conditions (rank 20/21, variance to Aust -35%)

Higher admissions for chronic congestive cardiac failure (PPH) (rank 28/31, variance to Aust -29%)

Higher admissions for chronic diabetes complications (PPH) (rank 28/31, variance to Aust -33%)

Higher Type 1 diabetes hospitalisations (rank 9/10, variance to NSW -71%)

Higher Type 2 diabetes hospitalisations (rank 10/10, variance to NSW -50%)

Higher admissions for injury, poisoning and other external causes (rank 26/31, variance to Aust -21%)

Higher admissions for genitourinary system disease (rank 29/31, variance to Aust -30%)

Higher Aboriginal admissions for genitourinary system disease (rank 27/31, variance to Aust -17%)

Higher Aboriginal admissions for acute urinary tract infections, including pyelonephritis (PPH) (rank 26/31, variance to Aust -8%) Higher admissions for kidney disease, all (rank 8/10, variance to NSW -1%) Table 296: ED presentations mental and behavioural disorders

PHIDU 2017: Table 298: Total admissions

AIHW 2018: Table 299: Total admissions 12 months

PHIDU 2017: Table 300: Admissions for total chronic conditions (potentially preventable)

PHIDU 2017: Table 301: Admissions for potentially preventable conditions

PHIDU 2017: Table 303: Admissions for acute conditions

PHIDU 2017: Table 307: Admissions for chronic congestive cardiac failure

PHIDU 2017: Table 312: Admissions for chronic diabetes complications

NSW Health 2018-19: Table 313: Admissions for diabetes by type

PHIDU 2017: Table 315: Admissions for injury, poisoning and other external causes

PHIDU 2017: Table 316: Admissions for genitourinary system disease

PHIDU 2016: Table 317: Admissions for urinary tract infections

NSW Health 2018-19: Table 318: Admissions for kidney disease

Higher admissions for infectious and parasitic diseases (Public Hospitals) (rank 29/31, variance to Aust -26%)

Aboriginal admissions for kidney disease (rank 8/10, variance to NSW -10%)

Higher Aboriginal admissions for intentional self-harm (rank 29/31, variance to Aust -33%)

Higher Aboriginal admissions for respiratory system disease (rank 24/28, variance to Aust -8%)

Higher admissions for chronic asthma (PPH) (rank 28/31, variance to Aust -32%)

Higher Aboriginal admissions for chronic asthma (PPH) (rank 25/31, variance to Aust -22%)

Higher admissions for chronic obstructive pulmonary disease (PPH) (rank 30/31, variance to Aust -60%)

Higher Aboriginal admissions for chronic obstructive pulmonary disease (PPH) (rank 27/31, variance to Aust16%) Higher admissions for influenza (rank 10/10, variance to NSW -40%)

Higher admissions for influenza over 65 years (rank 10/10, variance to NSW -29%)

Higher admissions for digestive system disease (rank 26/31, variance to Aust -35%)

Higher Aboriginal admissions for digestive system disease (rank 25/31, variance to Aust -9%)

Higher admissions for congenital malformations, deformations and chromosomal abnormalities (rank 31/31, variance to Aust -32%) Higher admissions for Admissions for chronic iron deficiency anaemia (PPH) (rank 27/31, variance to Aust -55%) Higher Aboriginal admissions for admissions for chronic iron deficiency anaemia (PPH) (rank 25/31, variance to Aust -36%) Higher Aboriginal admissions for acute convulsions and epilepsy (PPH) (rank 26/31, variance to Aust -23%)

Lack of Dentists Lower rank for dentists per 100,000 population (rank 26/30, variance to Aust -33%) PHIDU 2017: Table 321: Admissions for infectious and parasitic diseases

NSW Health 2018-19: Table 319: Admissions for same day admission for dialysis for kidney disease

PHIDU 2015: Table 322: Admissions for intentional self-harm

PHIDU 2017: Table 328: Admissions for respiratory system disease

PHIDU 2017: Table 329: Admissions for chronic asthma

PHIDU 2017: Table 330: Admissions for chronic obstructive pulmonary disease

NSW Health 2018-19: Table 332: Admissions for influenza and pneumonia all ages

NSW Health 2018-19: Table 333: Admissions for influenza and pneumonia over 65 years

PHIDU 2017: Table 336: Admissions for digestive system disease

PHIDU 2017: Table 337: Admissions for congenital malformations

PHIDU 2017: Table 340: Admissions for chronic iron deficiency anaemia

PHIDU 2016: Table 344: Aboriginal admissions for acute convulsions and epilepsy (PPH)

PHIDU 2018: Table 367: Dentists