The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present regarding the after-hours healthcare that support the data. These issues include: improving the coverage of after-hours GP services in more regional parts of the PHN region improving coverage of after-hours GP services to residential aged care facilities to prevent avoidable hospitalisations help develop out of hours or urgent GP services in priority areas Section 4 – Opportunities, priorities and options These table reflect the opportunities, priorities and options that the PHN is pursuing as part of the annual activity work plans for 2017-19. Opportunities, priorities and options Priority Activity Expected Outcome Possible Performance Measurement Potential Lead Improved access to health & community care in Moreton Bay North (right care, right time, right place) Outreach healthcare to vulnerable children in Moreton Bay North. Work in partnership with Act4Kids to improve access for children to allied health services in high need areas. Improved access to allied health services in high needs areas. Improved knowledge and awareness of emotional regulation techniques and improvements in behaviour regulation. number of clients receiving counselling referrals to services and supports number of schools with an allied health professional embedded and providing counselling services change over time in proportion of developmentally vulnerable children in the region Brisbane North PHN to lead service delivery through a commissioning process.
Opportunities, priorities and options Priority Activity Expected Outcome Possible Performance Measurement Potential Lead Better support for those with chronic and complex conditions across the care continuum Health Workforce Innovation to enhance the skills of administrative staff in general practice to enable practice nurses and GPs to use their higher-level skills in complex patient care. Improved access for patients to appropriately trained staff, by offering the right staff with the right training at the right time number of students enrolled /graduated percentage of students who are employed in general practice upon graduation change in skills/ knowledge post implementation Brisbane North PHN will lead this activity. Service Navigation to enhance awareness and access to health service information that will lead to people receiving the right care in the right place at the right time. Improved access and awareness of appropriate healthcare service for the Brisbane North PHN region. number of calls from service providers, HHS, community and politicians percentage of calls actioned within a day or less Brisbane North PHN will lead this activity is partnership with Metro North HHS. Health Data Project to support general practices to make use of their practice data to better manage patient populations leading to more appropriate use of hospital services. Improved collection and use of primary care data through general practices and PHN systems. number and percent of participating practices level of engagement by practice data quality completeness for active patients of participating practices Brisbane North PHN will lead this activity. Remain Home Program to integrate a clinical pharmacist into participating general practices to work with patients who are at risk of readmission to hospital Reduced readmissions to hospitals due to medicine complications. number of GP practices recruited/maintained pharmacists recruited and appointed to work with the practices reduced documented adverse drug events and medicine related problems The University of Queensland in partnership with Brisbane North PHN.
Better support for those with chronic and complex conditions across the care continuum Work in partnership to improve access to primary healthcare for refugee populations Improved access to primary healthcare for refugee populations number of referrals by month rate seen within 28 days of arrival by a nurse or doctor Mater Health Services in partnership with Brisbane North PHN. Pathways Program to improve the continuity of patient care through patient care maps for a range of priority clinical areas and services within the North Brisbane region. Provides health practitioners with ready access to evidence based decision support and referral information. Improved continuity of patient care by encouraging the uptake of patient care maps. awareness and utilisation of health pathways number of health pathways pages developed number of pathways with clinical prioritisation criteria embedded Brisbane North PHN will lead this activity in partnership with the Metro North HHS.
healthcare system for Aboriginal and Torres Strait Islander children Torres Strait Islander children reported satisfaction with referral pathways Opportunities, priorities and options Priority Possible Options Expected Outcome Possible Performance Measurement Potential Lead After-hours Service Delivery Commission outreach services catered to homeless and vulnerable groups, to connect in with mainstream primary care services, particularly during the after- hours period. Immediate clinical needs are met, increased links to primary healthcare for vulnerable groups and reduced after-hours presentations and use of Queensland Ambulance Service. number of clients provided services after hours number of referrals ambulance usage client case studies Brisbane North PHN to lead planning and deliver activity through commissioning processes. Work with key local stakeholders to manage frequent presenters to Emergency Departments by providing viable and sustainable alternatives Improved patient outcomes, reduced presentations to Emergency Departments, identified pathways for appropriate care and treatment for frequent presenters. referrals to services and supports number of presentations to ED for cohort pre and post implementation Brisbane North PHN to lead planning and deliver activity through commissioning processes. Training for after-hours doctors to improve service delivery in aged care facilities and palliative care situations. Reduced presentations to hospital for patients who could be managed at RACFs or other community environments. number of education sessions delivered reported change in knowledge referrals to service and supports change over time in hospital presentations Brisbane North PHN to lead planning and delivery activity through commissioning process.
Deliver an integrated community education campaign to improve awareness of the options for accessing after-hours health services and help people make informed choices when accessing services. Reduction in inappropriate Emergency Department presentations. Patients are empowered to make informed decisions about after-hours healthcare. increased awareness of after-hours healthcare options reduction in inappropriate emergency department presentations Brisbane North to lead planning and delivery activities through commissioning processes.
Contact with the justice system Prisoners continue to have high rates of mental health related issues and in 2012, 46 per cent of people discharged from prison nationally reported having ever been told they have a mental health issue (including alcohol and drug use issues). It is also known that those who identify as Aboriginal and Torres Strait Islander and have been in contact with the justice system are more likely to have mental health issues and are less likely to access resources. Outcomes of health needs analysis Identified Need Key Issue Description of Evidence Aboriginal and Torres Strait Islanders The significant disparities in the health of Indigenous and other Australians have been well documented but the overall picture is one that consistently shows gaps in health outcomes across the life course. Social and emotional wellbeing is often used to describe issues of ‘mental health’ but it has broader scope as the Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community and how these connections have been shaped across generations and the processes by which they affect individual wellbeing. Studies report though that approximately 10 per cent of the health gap between Indigenous and the The Australian Aboriginal and Torres Strait Islander Health Survey reported that 12 per cent of Indigenous Australians had reported feeling depressed or having depression as a long-term condition which was significantly higher than the corresponding proportion for all Australians (9.6 per cent). Nearly one third of Indigenous adults report high or very high levels of psychological distress in their lives, which is nearly three times the rate reported by other Australians. There were significant differences in the proportions of men and women who had experienced high/very high levels of psychological distress (24 per cent compared with 36 per cent). Rates of high/very high psychological distress were significantly higher for women than men in every age group, apart from those aged 45 to 54 years. In the PHN region, it is estimated that 3140 Aboriginal and Torres Strait Islander people aged 15 years and over have high or very high psychological distress and almost two in five live in the Moreton Bay North subregion (1210 people). This is supported by locally collected data from general practice which highlights 1283 Aboriginal and Torres Strait Islander people have a mental health condition (1.8 per cent of the practice population). Aboriginal and Torres Strait Islander people are over-represented in emergency department presentations for mental health related conditions in the PHN region. A total of 5.2 per cent of emergency department presentations for mental health related conditions in 2013-15 identified
Severe mental illness People with a severe mental illness are also more likely to have higher rates of: social isolation family breakdown stigma discrimination and the need for acute care hospital admissions Bribie – Beachmere. An estimated 6 per cent of the population commenced a GP mental health plan in the Brisbane Inner and Strathpine areas. Despite an inequitable distribution of services, high severe mental health needs are also evident in the Caboolture area service use data. Analysis of the Mental Health Nurse Incentive Program between 2011-12 and 2014-15 indicate that the most common residence of patients was Caboolture (811 patients), followed by the Hills District (625 patients) and Strathpine (552 patients). While the number of patients requiring mental health nurse services was high in Caboolture, the number of services delivered in this area was low, indicating a gap. Age-standardised rates of overnight hospitalisations related to Schizophrenia and delusional disorders are 185 per 100,000 people in the PHN compared to the national rate of 160 per 100,000 people (2013-14). While hospitalisation rates remained consistent between 2013-14 and 2014-15, the number of bed days increased across the PHN region. Across the country when grouped by local area (SA3s) remoteness and socioeconomic status the Brisbane Inner SA3 region featured at the top for schizophrenia and delusional disorders in major cities where the status was medium. Section 3 – Outcomes of the service needs analysis Outcomes of service needs analysis Identified Need Key Issue Description of Evidence Low intensity mental illness Inadequate coverage of low intensity services in the PHN region. Existing services are not fully integrated into existing stepped care models of primary healthcare. The PHN completed a service map of low intensity services in July 2016, which aims to provide a comprehensive overview of the range and type of low intensity mental health services delivered in the PHN region. The service map is currently used to inform further needs assessment and commissioning activity of the PHN for low intensity mental illness. In early 2017, the PHN held a series of community workshops to discuss key issues in the mental health, suicide prevention and AOD treatment services system. The results of the workshop, and subsequent stakeholder engagement indicated that low intensity services, and psychological
provide a time-limited service deliver services via one or more of the identified modalities, group sessions, telephone, online services and face to face. provide services that are supported by an appropriate workforce These services will focus on identified priority populations including hard to reach, vulnerable and socially disadvantaged groups and people experiencing a significant life event or transition. population receiving low intensity mental health services average cost per low intensity mental health service clinical outcomes for people receiving low intensity mental health services. providers to deliver activities: Hello Sunday Morning Mental Illness Fellowship Qld Multicultural Development Associations Change Futures Peach Tree Perinatal Wellness Program Area Expected approach Expected Outcome Possible Performance Measurement Potential Lead Suicide Prevention Continue to deliver a systems based integrated suicide prevention plan in partnership with service providers and consumers. Activities will focus on: ensuring continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn Implementation of locally appropriate and sustainable suicide prevention services which support consumers to receive timely and appropriate care. Improved coordination and responsiveness of services to meet the needs of consumers. referrals to services and supports number and type of activities monitoring and evaluation plan for each activity change over time in suicide rates and presentations to hospital Brisbane North PHN has commissioned the following service providers to deliver activities: Mental Illness Fellowship Qld Institute for Urban commissioned
Program Area Expected approach Expected Outcome Possible Performance Measurement Potential Lead Psychological therapy for under serviced groups Commission a range of suitable providers to deliver structured, time limited, evidence based psychological therapies to under serviced groups while making optimal use of the available resource infrastructure and workforce. Increased service provision to under serviced groups and decrease in levels of need across the identified population groups and areas. proportion of regional population receiving mental health services average cost per mental health service clinical outcomes for people receiving PHN‐commissioned services Brisbane North PHN has commissioned a panel of providers to deliver activity. Severe Mental Illness – Coordinated Clinical Care packages Continue to commission innovative clinical primary mental healthcare services to people with severe mental illness through best practice clinical care coordination and treatment services Provision of mental health nursing in primary healthcare to support general practice and improve service coordination. Development of coordinated clinical care packages to support people living with severe mental illness. Improved support and service accessibility for people experiencing mental health issues. Improved support and service accessibility for people experiencing mental health issues. Greater coordination of mental healthcare within the primary care sector. proportion of regional population receiving mental health services - Clinical care coordination for people with severe and complex mental illness (including clinical care coordination by mental health nurses) average cost per mental health service – Clinical care coordination for people with severe and complex mental illness Brisbane North PHN will deliver in line with Department of Health guidelines for lead site in this activity. Brisbane North PHN has commissioned the following service providers to deliver activities: Footprints Inc. Toowong Private Hospital Morayfield Psychology commissioned commissioned
Mental Health Harmful use of alcohol and other drugs among Aboriginal and Torres Strait Islander populations Young people aged 25 and under Continue to commission AOD treatment services to increase availability of AOD treatment services. Particular focus for these services will be the identified priority populations and service groups: Aboriginal and Torres Strait Islander people young people people with mental health issues people living in Moreton Bay North. Manage the contracts of four services transferred to the PHN from 1 July 2017, focusing on treatments services. The PHN will continue to work with current service providers to maintain current services including: counselling post-rehabilitation support and relapse prevention case management, care planning and coordination and early intervention (for Aboriginal and Torres Strait Islander services) Delivery of services and support for priority populations to access appropriate and sustainable AOD treatment services in the Brisbane North PHN region. Increase in the episodes of treatment for AODs, related to specified treatment types. Brisbane North PHN led the planning and has the following service providers to deliver services: Lives Lived Well Institute for Urban Indigenous Health Brisbane Youth Service. Queensland Aboriginal and Islander Corp (QAIAS) Treatment needs Service capacity Regional equity of access System design Continue to enhance service capacity, improve service integration and increase system efficiency to address equity of access across the PHN region. The activity targets all AOD agencies, the AOD workforce and all agencies involved in referral to AOD treatment services funded under this initiative. The following sub-activities will continue: Development of an in-depth map of Brisbane North AOD services, including NGO, government and private providers and development of tools to support the workforce delivering AOD services through activities that promote joined up assessment processes and referral pathways and Increase in referrals from a range of sources, consistent with services commissioned by Brisbane North PHN Brisbane North PHN led planning and has commissioned the following service providers to deliver services: Queensland Injectors Health