Policy rationale The incidence of chronic disease has a significant impact on the health and wellbeing of Australians, and is higher amongst Aboriginal and Torres Strait Islander people than other populations. The broad rationale for the ICDP is that the impact of chronic disease can be reduced by earlier identification, and improved management of risk factors and of the disease itself. A holistic life stage approach is required to overcome Aboriginal and Torres Strait Islander disadvantage, to build sustainable social change and to embed system reform, which the ICDP has recognised and to which it has responded. The ICDP appreciates and supports: the need for a coordinated effort by all jurisdictions; the importance of involving Aboriginal and Torres Strait Islander people and communities in the design and delivery of programs and activities; implementation of strategies that address chronic disease risk factors and manage chronic disease; and the contextual influences on Aboriginal and Torres Strait Islander health outcomes. ICDP measures The ‘measures’ of the ICDP are set out in the following table. These sit under the three priority areas for the ICDP. Table 1: Overview of ICDP measures. Priority area Measure Core components Tackling chronic disease risk factors National Action to Reduce Indigenous Smoking Rates (A1) and Helping Indigenous Australians Reduce Their Risk of Chronic Disease (A2) Regional Tackling Smoking and Healthy Lifestyle Teams (RTSHLTs) and other national tackling smoking supports Local Indigenous Community Campaigns to Promote Better Health (A3) Local Community Campaigns (LCCs) Improving chronic disease management and follow up care Subsidising PBS Medicine (B1) PBS Co-payment (Closing the Gap (CtG) scripts) Higher Utilisation Costs for Medicare Benefits Schedule and PBS (B2) None Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3a) Practice Incentives Program Indigenous Health Incentive (PIP Indigenous Health Incentive) Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3b) Care Coordination and Supplementary Services (CCSS) Program payments
Improving Indigenous Participation in Health Care through Chronic Disease Self Management (B4) Chronic Disease Self Management (CDSM) measure Increasing Access to Specialist Care (B5a) Urban Specialist Outreach Assistance Program (USOAP) measure Increasing Access to Specialist and Multidisciplinary Team Care (B5b) Medical Specialist Outreach Assistance Program – Indigenous Chronic Disease (MSOAP-ICD) measure Workforce expansion and support Workforce Support, Education and Training (C1) Aboriginal and Torres Strait Islander Outreach Worker (ATSIOW) Orientation and Training, General Practitioner (GP) registrar training posts and nurse and midwifery scholarships Expanding the Outreach and Service Capacity of Indigenous Health Organisations (C2) ATSIOWs and Practice Managers Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care (C3) Indigenous Health Project Officers (IHPOs) and ATSIOWs Attracting More People to Work in Indigenous Health (C4) Health Heroes and Do Something Real campaigns Clinical Practice and Decision Support Guidelines (C5) ClinicalInfoNet Source: KPMG.
Reduction in chronic disease risk factors or slowed progression of disease among healthy lifestyle program participants participating in the pre and post health participant survey Partial* – no consistent data is available on this indicator, so it has been addressed through qualitative data collection Note: *Available but with limitations. Source: KPMG. Table 49: Helping Indigenous Australians Reduce Their Risk of Chronic Disease (A2 measure) evaluation framework key outputs (year 1 and ongoing). Indicators Data available / reason not available Number of positions filled Yes Number of healthy lifestyle workers funded and trained (target 105 recruited) Yes Description of training provided to healthy lifestyle workers Number of healthy lifestyle workers funded and trained Yes Level of healthy lifestyle workers’ satisfaction with training provided Yes Type of networking activities Yes Plans based on needs assessment Yes Number of participants in healthy lifestyle sessions and activities Partial* - caveats relevant to this data are explored under section D.3 below. Number of healthy lifestyle sessions and activities conducted Partial* - caveats relevant to this data are explored under section D.3 below. Increased number of Health Checks Yes Note: *Available but with limitations. Source: KPMG. Table 50: Helping Indigenous Australians Reduce Their Risk of Chronic Disease (A2 measure) evaluation framework (Key Activities). Indicators Data available / reason not available Description of recruitment activities Yes Description of training activities Yes Type and nature of meeting opportunities Yes Community needs assessment developed and documented Yes Process used to work with communities in identifying and designing activities Yes Demonstration of evidence base used in development of healthy lifestyle activities Yes Description of healthy lifestyle activities / projects Yes
Table 53: Summary of data reported by Quitline on Number of Aboriginal and Torres Strait Islander people referred to the Quitline, various time periods (as indicated). Jurisdiction Progress Report Indicator reported against Reporting period Number of people referred New South Wales 4th Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline October to December 2011 Not provided 4th Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline January to March 2012 128 Queensland 3rd Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline 1 January 2011 to 30 September 2011 551 4th Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline 201112 650 Western Australia 3rd Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline 1 December 2011 to 31 May 2012 79 4th Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline 1 June 2011 to 30 November 2011 132 Northern Territory 3rd Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline Quarter ending December 2010 to Quarter ending December 2011 165 4th Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline Quarter ending March 2012 and June 2012 62 Victoria 3rd Progress Report Number of Aboriginal and Torres Strait Islander people referred to the Quitline 1 July 2010 – 30 November 2011 143
Table 87: Items in ATC4 class ‘Tests for diabetes’ added to or removed from the PBS, 2010. Date PBS Code PBS item Action February 2010 09297H Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 50 diagnostic strips (Bionime Rightest) Added to PBS 09298J Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 50 diagnostic strips (Bionime Rightest) Added to PBS February 2010 01820T Glucose Indicator Blood Electrode strips, 50 (Glucoboy) Removed from PBS 09260J Glucose Indicator Blood Electrode strips, 50 (Glucoboy) Removed from PBS March 2010 09300L Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 100 diagnostic strips (Accu-Chek Mobile) Added to PBS 09301M Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 100 diagnostic strips (Accu-Chek Mobile) Added to PBS April 2010 09324R GLUCOSE INDICATOR-BLOOD Test strips, 50 (AgaMatrix Jazz) Added to PBS 09325T GLUCOSE INDICATOR-BLOOD Test strips, 50 (AgaMatrix Jazz) Added to PBS May 2010 02926B Glucose Indicator Blood Electrode strips, 100 (Precision Plus) Removed from PBS June 2010 08573F Glucose Indicator Blood Electrode strips, 100 (SofTact) Removed from PBS 09271Y Glucose Indicator Blood Electrode strips, 100 (SofTact) Removed from PBS July 2010 03406G Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 50 diagnostic strips (CareSens N) Added to PBS 03407H Glucose Indicator Blood Glucose Indicator Blood strip: diagnostic, 50 diagnostic strips (CareSens N) Added to PBS July 2010 09063B Glucose Indicator Blood Electrode strips, 50 (Omnitest Plus) Removed from PBS 09266Q Glucose Indicator Blood Electrode strips, 50 (Omnitest Plus) Removed from PBS 09358M Glucose Indicator Blood Removed from
December 2008 93,631 1,020,267 10.9 June 2009 95,725 957,947 10.0 December 2009 99,883 1,120,429 11.2 June 2010 101,386 1,067,871 10.5 December 2010 116,060 1,339,788 11.5 June 2011 124,421 1,356,931 10.9 December 2011 132,575 1,569,451 11.8 June 2012 139,923 1,582,799 11.3 December 2012 145,167 1,733,856 11.9 Table 98: Number of NeverCtG patients to receive at least one PBS script, number of PBS scripts dispensed and number of PBS scripts per patient, by six month period, Australia. Period Patients PBS scripts PBS scripts per patient June 2007 7,261,906 85,010,494 11.7 December 2007 7,541,223 98,936,111 13.1 June 2008 7,370,393 88,277,852 12.0 December 2008 7,732,782 103,337,222 13.4 June 2009 7,594,361 90,866,931 12.0 December 2009 7,869,579 105,360,771 13.4 June 2010 7,725,619 93,320,933 12.1 December 2010 8,000,712 109,142,880 13.6 June 2011 7,839,532 95,960,029 12.2 December 2011 8,064,852 111,373,585 13.8 Multivariate regression was carried out to examine the relationship between number of scripts dispensed and number of patients who were dispensed scripts. Different combinations of variables were included in the regression models to identify factors that influenced the scripts to patients’ relationship over the six years from 2007 to 2012. These regressions were carried out separately for the EverCtG and NeverCtG groups. Factors that were considered for inclusion within the models: age; sex; remoteness;
Changes in prescribing and changes in dispensing cannot be distinguished and the reality may be a mix of both. If accompanied by an increase in patients, differential numbers of scripts per patient for added or removed patients may affect the observed outcome. Table 106: Range of outcomes observed among all pre ICDP and post ICDP comparisons of average scripts per EverCtG patient, with potential causes. Observed outcome Potential causes A post ICDP trend increase: an upwards trend pre ICDP with a larger, upwards trend post ICDP Existing PBS patients dispensed more scripts due to increased prescribing. Existing PBS patients dispensed more scripts due to reduced financial barrier. A post ICDP upward trend: flat pre ICDP with an upwards trend post ICDP Existing PBS patients dispensed more scripts due to increased prescribing. Existing PBS patients dispensed more scripts due to reduced financial barrier. A post ICDP trend reversal: downwards trend pre ICDP with an upwards trend post ICDP Existing PBS patients dispensed more scripts due to increased prescribing. Existing PBS patients dispensed more scripts due to reduced financial barrier. A post ICDP positive levelling: downwards trend pre ICDP and flat post ICDP Existing PBS patients were not filling some scripts pre ICDP, due to growing financial barrier and choose to have them filled post ICDP, when the financial barrier is reduced. No change in pre ICDP trend: upwards trend pre ICDP continuing post ICDP Pre ICDP trend drivers remain unchanged post ICDP. No trend flat pre ICDP and continuing flat post ICDP Patients are mainly concession card holders and most medicines are above the threshold. A post ICDP negative levelling: upwards trend pre ICDP and flat post ICDP No change in average scripts for existing patients and additional patients being dispensed scripts receive fewer scripts per patient. Source: KPMG. Alimentary tract and metabolism Table 107: Summary of changes in annual trends from pre ICDP to post ICDP period, medicines from the ATC1 class of 'Alimentary tract and metabolism', by EverCtG status, age group and indicator. Age Group Indicator EverCtG NeverCtG 0 to 14 Patients dispensed at least one script Post ICDP trend increase +8.8% to +21.3% No trend Average scripts per patient No trend No trend
Table 145: Number of PBS scripts per patient, medicines from the ATC1 class of 'Sensory organs', by EverCtG status, age and six month period, Australia. Age group (years) Status Jun 2007 Dec 2007 Jun 2008 Dec 2008 Jun 2009 Dec 2009 Jun 2010 Dec 2010 Jun 2011 Dec 2011 Jun 2012 Dec 2012 0 to 14 NeverCtG 1.26 1.29 1.26 1.30 1.26 1.28 1.26 1.29 1.27 1.29 1.27 1.29 EverCtG 1.22 1.23 1.21 1.23 1.23 1.22 1.22 1.25 1.26 1.25 1.26 1.28 15 to 54 NeverCtG 1.96 2.09 1.99 2.11 1.96 2.08 1.97 2.09 2.00 2.15 2.04 2.17 EverCtG 1.55 1.62 1.55 1.66 1.54 1.60 1.52 1.59 1.56 1.59 1.58 1.63 55+ NeverCtG 4.41 4.84 4.44 4.87 4.42 4.92 4.46 4.96 4.52 5.03 4.55 5.02 EverCtG 3.36 3.71 3.39 3.81 3.43 3.85 3.52 3.81 3.52 3.81 3.52 3.83 Unknown NeverCtG 3.31 5.85 3.84 5.72 3.59 5.78 3.69 5.72 3.70 5.50 3.43 5.30 EverCtG 1.73 1.80 1.00 1.30 2.63 2.33 1.14 4.29 1.33 2.15 1.27 2.54 Total NeverCtG 5.77 6.08 5.82 6.12 5.81 6.16 5.85 6.19 5.92 6.33 5.99 6.34 EverCtG 3.98 4.13 4.03 4.24 4.06 4.26 4.09 4.18 4.05 4.17 4.08 4.18 All patients 5.75 6.06 5.81 6.10 5.79 6.15 5.83 6.17 5.90 6.31 5.97 6.31
Drugs For Obstructive Airway Diseases Table 188: Summary of changes in annual trends from pre ICDP to post ICDP period, medicines from the ATC2 class of 'Drugs for Obstructive Airway Diseases', by EverCtG status, age group and indicator. Age Group Indicator EverCtG NeverCtG 0 to 14 Patients dispensed at least one script Post ICDP increase +8.0% to +15.9% No change in trend Average scripts per patient Post ICDP increase 0.0% to +2.5% No change in trend 15 to 54 Patients dispensed at least one script Post ICDP increase +7.9% to +15.9% No change in trend Average scripts per patient Post ICDP increase 0.0% to +3.2% Post ICDP positive levelling -1.5% to 0.0% 55+ Patients dispensed at least one script No change in trend No change in trend Average scripts per patient No change in trend Post ICDP positive levelling -1.0% to 0.0% Source: KPMG. * Includes only medicines in this ATC2 class. Figure 142: Index of number of EverCtG patients that received at least one PBS script, Drugs for Obstructive Airway Diseases*, by age and six month period, Australia (January to June 2010 = 100. * Includes only medicines in this ATC2 class. Figure 143 Index of number of NeverCtG patients that received at least one PBS script, Drugs for Obstructive Airway Diseases*, by age and six month period, Australia (January to June 2010 = 100. * Includes only medicines in this ATC2 class. Figure 144: Number of PBS scripts dispensed per EverCtG patient, Drugs for Obstructive Airway Diseases*, by age and six month period, Australia. * Includes only medicines in this ATC2 class. Figure 145 Number of PBS scripts dispensed per NeverCtG patient, Drugs for Obstructive Airway Diseases*, by age and six month period, Australia.
Item 723 TCA As seen in Table 221 below vocationally registered general practitioners provided the majority of TCAs to EverIHI patients. The proportion of GPMPs provided to EverIHI patients by vocationally registered general practitioners increased from 76.7 per cent to 79.9 per cent between 2007 and 2012. Table 222: TCAs for EverIHI patients by peer group provided between 2007 and 2012. Year General Practitioner (VR) services General Practitioner (VR) services percent Other Medical Practitioner (Non-VR GP) Other Medical Practitioner (Non-VR GP) percent Total 2007 3,565 76.7% 1,083 23.3% 4,648 2008 4,690 77.2% 1,382 22.8% 6,072 2009 6,436 77.7% 1,844 22.3% 8,280 2010 9,735 77.5% 2,830 22.5% 12,565 2011 12,965 79.7% 3,305 20.3% 16,270 2012 15,567 79.9% 3,910 20.1% 19,477 Item 732 Review of GPMP/TCA As seen in Table 223 below vocationally registered general practitioners provided the majority of reviews to EverIHI patients. Table 223: Review of GPMP/TCA for EverIHI patients by peer group provided between 2007 and 2012. Year General Practitioner (VR) services General Practitioner (VR) services percent Other Medical Practitioner (Non-VR GP) Other Medical Practitioner (Non-VR GP) percent Total 2007 4,406 81.4% 1,006 18.6% 5,412 2008 5,508 76.8% 1,663 23.2% 7,171 2009 7,396 80.9% 1,744 19.1% 9,140 2010 10,010 82.4% 2,139 17.6% 12,149 2011 14,733 80.5% 3,573 19.5% 18,306 2012 21,950 81.4% 5,021 18.6% 26,971
Table 227: Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3a measure) Evaluation Framework early results (years 2-4). Indicators Available / reason not available Documented processes for ensuring compliance with PIP Indigenous Health Incentive requirements Yes Extent of implementation of Tier 1 care by registered practices Yes – the evaluation reports on patients receiving Tier 1 care and practices providing Tier 1 care Identification of barriers and how have they been overcome (if at all) Yes Extent of implementation of Tier 1 care by registered practices Yes – the evaluation reports on patients receiving Tier 1 care and practices providing Tier 1 care Level of training participants’ satisfaction with training Yes Level of satisfaction of staff and general practice with training Yes Evidence of changed knowledge, cultural awareness and practice as a result of training Yes Change in general practice staff members’ level of understanding of better practice care Yes Comparison of participating patients and Aboriginal and Torres Strait Islander patients in services received for chronic disease management Yes Extent of additional and complementary health services, and evidence of uptake Yes Number of Aboriginal and Torres Strait Islander Health Assessments (pre and post) by service type Yes - the evaluation reports on Aboriginal and Torres Strait Islander Health Assessments pre- and post- Indigenous Chronic Disease Package (ICDP) but not by service type Level of satisfaction with standard of care Yes Perceptions and impact of additional services, including cultural awareness Yes Source: KPMG.
Table 243: Practice registrations and practices receiving outcome payments by state. State Number of practices registered to November 2012 Number of practices receiving a Tier 2 payment in February 2012 Number of practices receiving a Tier 1 payment in November 2012 Proportion of practices receiving Tier 2 in February 2012 Proportion of practices receiving Tier 1 payment in November 2012 New South Wales 1,161 689 266 59.3% 22.9% Queensland 768 484 185 63.0% 24.1% Western Australia 318 195 65 61.3% 20.4% Northern Territory 50 36 23 72.0% 46.0% Victoria 589 190 45 32.3% 7.6% South Australia 231 140 37 60.6% 16.0% Tasmania 93 48 18 51.6% 19.4% Australian Capital Territory 39 17 4 43.6% 10.3% Total 3,249 1,799 643 55.4% 19.8% Table 244: Practice registrations and practices receiving outcome payments by remoteness. Remoteness Practices registered to November 2012 Practices receiving a Tier 2 payment in February 2012 Practices receiving a Tier 1 payment in November 2012 Proportion of practices receiving Tier 2 payment in February 2012 Proportion of practices receiving Tier 1 payment in November 2012 Major Cities of Australia 1,865 870 247 46.6% 13.2% Inner Regional Australia 794 496 207 62.5% 26.1% Outer Regional Australia 436 320 139 73.4% 31.9% Remote Australia 99 72 30 72.7% 30.3%
Very Remote Australia 55 41 20 74.5% 36.4% Table 245: Practice registrations and practices receiving outcome payments by practice type. Practice Type Number of practices registered to November 2012 Number of practices receiving a Tier 2 payment in February 2012 Number of practices receiving a Tier 1 in November 2012 Proportion of practices receiving Tier 2 payment in February 2012 Proportion of practices receiving Tier 1 payment in November 2012 General practice 3,097 1,662 549 53.7% 17.7% AHS 152 137 94 90.1% 61.8% Figure 176: Proportion of patients triggering a Tier 1 by jurisdiction and year. Figure 177: Proportion of patients triggering a Tier 1 payment by remoteness and year. Figure 178: Proportion of patients triggering a Tier 1 payment by practice type and year. Table 246: Patients by outcome payment triggered by state and year. State Payment triggered 2010 2011 2012 New South Wales Neither payment 3,400 4,315 5,089 Tier 1 only and Tier 1 and 2 524 1,845 2,835 Tier 2 only 7,320 8,825 9,868 Queensland Neither payment 2,284 3,140 4,389 Tier 1 only and Tier 1 and 2 payment 489 1,641 2,929 Tier 2 only payment 5,687 6,903 8,268 Western Australia Neither payment 1,441 2,343 2,864 Tier 1 only and Tier 1 and 2 payment 329 562 772 Tier 2 only 3,247 3,574 3,889
Table 263 below shows the number of Flinders CDSM trainees by occupation and organisation type. Most trainees were either Aboriginal Health Workers (AHWs) or practice nurses, or worked within an Aboriginal health service (AHS). Few General Practitioners were engaged in the measure. Table 263: Flinders University CDSM trainees, by occupation and organisation type. Occupation Aboriginal Health Service Medicare Local/Division of General Practice Other Private Practice State Based Health Service Total Aboriginal Health Worker 108 28 23 7 46 212 Nurse 74 20 13 32 81 220 Allied Health Professional 12 1 11 5 53 82 Non-Clinical staff 15 18 7 3 26 69 Chronic Condition Worker 10 20 4 0 21 55 General Practitioner 21 0 5 13 1 40 Health Educator 9 0 2 1 6 18 Other/not specified 10 2 5 2 3 22 Total 259 89 63 237 718 Table 264 below, shows the number of Flinders CDSM trainees who achieved formal competency certification. Table 264: CDSM trainee competence rates by occupation. Occupation Achieved Certification (proportion %) Other/undisclosed 11 (45%) Allied Health Professional 35 (43%) Aboriginal Health Worker 88 (42%) Nursing 87 (40%) Health Educator 7 (39%) Chronic Condition Worker 20 (36%) Non-clinical staff 25 (36%) General Practitioner 8 (20%) Total 281 (39%)
occurring* A1_4 Participating community members have improved understanding of resources available for smoking cessation Excluded from evidence map due to insufficient data on early results Activities external to the ICDP are likely to influence this outcome Perceptions about level of service awareness*; Demonstrated awareness of health risks and increased inclination to address risk factors among Aboriginal and Torres Strait Islander people as a result of A1 activities*; and Perceptions of Aboriginal and Torres Strait Islander people regarding A1 activities and identification of reasons some may choose not to participate A1_5 Health care professionals have better access to smoking cessation resources to support their own cessation attempts Excluded from evidence map. There was evidence that some workplaces implementing smoke free policies but no data available on indicators Include in the analysis of Influencing factors Activities external to the ICDP are likely to influence this outcome Proportion of Aboriginal and Torres Strait Islander health care professionals intending to quit, attempting to quit, or successfully quitting as a result of ICDP-funded activities* A1_6 Participants increasingly seek assistance and utilise services in their quit attempts Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Activities external to the ICDP are likely to have influenced the observed result Increased delivery of tobacco cessation servicesc; Access to Quitline services*; Number of prescriptions for drugs listed on the PBS (e.g. Champix)b; and Program/service utilisation figuresc A1_7 Participants reduce their level of smoking Excluded from evidence map due to insufficient data at this early stage. Included in analysis of other influencing factors Activities external to the Smoking rates among adults*; and Smoking rates during pregnancy*
Participating community members have improved understanding of health risks and benefits associated with healthy lifestyle choices map Included in analysis of other influencing factors. Activities external to the ICDP are likely to influence this outcome knowledge, planning and behaviour in relation to their health condition* A2_3 Participating community members have improved understanding of the resources available to support healthy lifestyle choices Excluded from evidence map due to insufficient data Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Perceptions regarding level of understanding of resources* A2_4 Participants have increased utilisation of primary healthcare services to support healthy lifestyle choices Included in evidence map Moderate evidence of the indicator but no data relating specifically the outcome Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Referrals to Health Assessments, allied health care providers and other health care providersc A2_5 Participating community members have strong and sustained participation in healthy lifestyle interventions Excluded due to insufficient data. Number of participating health services that report an increased number of Aboriginal and Torres Strait Islander Australians participating in healthy lifestyle activities*
Table 347: A3 Early outcomes – description, inclusion or exclusion in analyses and Evaluation Framework data expectations for June 2013. A3 early outcomes Inclusion in analyses Evaluation framework data expectations on specific indicators A3_1 LCCs are evidence based Included in the assessment of the plausibility of the measure having an effect Refer to measure chapter in the main report A3_2 Enhanced community understanding of health risks and benefits associated with lifestyle choices Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Extent to which healthy lifestyle messages have been understood by intended audiencea A3_3 Participants increasingly make more healthy lifestyle choices Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Uptake of healthy lifestyle choices relevant to the local campaignc A3_4 Participants have increased awareness of importance of accessing primary health care Exclude from evidence map due to insufficient data. Data that one third of LCCs included health checks is noted Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Perceptions of Aboriginal and Torres Strait Islander community members where A3 activities have taken place* A3_5 Funds for grants and events are spent efficiently Excluded because this early result does not refer to a change in an outcome n/a A3_6 Local organisations share knowledge about campaigns and actively participate in forums Excluded because this early result refers to a process not a change in an outcome. n/a
RTSHLTs (refer to the respective measure chapters in the main report), and the activities of similar projects and programs funded by jurisdictions. (Refer the Policy Map for details of these projects). There was strong evidence of networking and partnerships with other projects and programs in the regions, including organisations that contributed funding and other resources (refer to the A3 measure chapter in the main report). There is evidence that the measure strengthened the capacity of sites to develop local initiatives. Subsidising PBS Medicine Co-payments (B1) measure Table 348: B1 Early outcomes – description, inclusion or exclusion in analyses and Evaluation Framework data expectations for June 2013. B1 early outcomes Inclusion in analyses Evaluation framework data expectations on specific indicators B1_1 Participating patients have reduced financial barriers to purchasing pharmaceuticals for chronic disease management Included in evidence map Included in analysis of other influencing factors Included in evidence map Included in analysis of other influencing factors Number of patients dispensed at least one Closing the Gap (CtG) scriptb; Proportion of PIP Indigenous Health Incentive (B3) registered participants who access PBS Proportion of CtG scripts dispensed by Anatomical Therapeutic Chemical (ATC) classesb Number of patients dispensed medicines through S100 RAAHS* Access barriers identified by prescribers and dispensersb; Barriers identified by community membersb; Responses to access barriers identified (local, state and national level)b; Volume of CtG concession scripts and scriptsb; and Perceived impact of co-payment relief on reduced financial barriersb B1_2 Participating patients increase their utilisation of PBS medicines for the management of chronic disease, in accordance with Care Plans Included in evidence map Activities external to the ICDP are likely to influence this outcome Number of CtG scripts dispensedb; Numbers and locations of people accessing medicines through the program – (i.e., number of patients receiving at least one CtG script by remoteness area and jurisdiction)b; Number of CtG scripts dispensed per patientb PBS utilisation of participants before and after the measure compared to S100 and compared to all Australiansb; Proportion of CtG scripts dispensed by ATC classesc PBS utilisation of Aboriginal and Torres Strait
B3a_2 Tier 1 care is implemented for registered patients Included in the assessment of the plausibility of the measure having an effect Refer to measure chapter in the main report B3a_3 Tier 2 care is implemented for registered patients Included in the assessment of the plausibility of the measure having an effect Refer to measure chapter in the main report B3a_4 Health care providers in registered practices have enhanced cultural awareness of Aboriginal and Torres Strait Islander people Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Level of training participants’ satisfaction with training*; Level of staff and general practice satisfaction with training*; and Evidence of changed knowledge, cultural awareness and practice as a result of training* B3a_5 Health care providers in registered practices have increased understanding of better practice care for Aboriginal and Torres Strait Islander people with chronic disease Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Change in general practice staff members level of understanding of better practice care* B3a_6 Registered practices provide better practice care to Aboriginal and Torres Strait Islander patients Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Comparison of participating patients and non-participating Aboriginal and Torres Strait Islander patients in services received for chronic disease management* B3a_7 Aboriginal and Torres Strait Islander patients have improved access to relevant primary health care Included in evidence map Included in analysis of other influencing factors Activities external to Extent of additional and complementary health services, and evidence of uptake*; Number of Aboriginal and Torres Strait Islander Health Assessmentsb (pre and post) by service type (Not
ATSIOW workforce is better equipped to carry out their required duties Activities external to the ICDP are likely to influence this outcome with the orientation, and training and support provided* C1_2 ATSIOWs are more likely to continue working in primary health care assisting Aboriginal and Torres Strait Islander people Included in evidence map Activities external to the ICDP are likely to influence this outcome Self-reported intentions to continue working in primary health care and other services assisting Aboriginal and Torres Strait Islander people* C1_3 Aboriginal Health Services have increased capacity to provide GP services; Patients served by participating Aboriginal Health Services have increased access to GP services Included in evidence map Activities external to the ICDP are likely to influence this outcome Increase in service capacity of participating Aboriginal Health Services to provide GP services (GP training posts)* C1_4 ATSIOWs, GP registrars and nurses / midwives , and nursing / midwifery scholarship students have increased understanding of the health needs of Aboriginal and Torres Strait Islander people Included in evidence map Included in analysis of influencing factors Activities external to the ICDP are likely to influence this outcome Level of confidence with skills as reported by participants in C1 activities to provide quality care to Aboriginal and Torres Strait Islander people*b C1_5 Increased numbers of participating GP registrars and nurses / midwives , and nursing / midwifery scholarship students elect to work in Aboriginal Health Services upon completion of training/schooling Included in evidence map Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Self-reported intentions to continue working in Aboriginal Health Services and other services assisting Aboriginal and Torres Strait Islander people*b; and future intentions as reported by participating GP registrars and recipients of nursing scholarships under the measure*
Islander people increase their utilisation of primary health care services Limitation is that the sectoral share of MBS funded services is not known Included in analysis of other influencing factors Activities external to the ICDP are likely to influence this outcome Activities external to the ICDP are likely to have influenced the observed result Islander community members on their use of primary health care services*; C3_5 Patients in contact with participating practices value the enhanced services Excluded because this early result does not refer to a change in an outcome Not applicable C3_6 Enhanced implementation through effective national and state level leadership, coordination, supports and resources Included in the assessment of the plausibility of the measure having an effect Refer to measure chapter in the main report C3_7 Improved collaboration among participating general practices / networks and the AHS sector Included in evidence map Included in analysis of influencing factors Activities external to the ICDP are likely to influence this outcome Evidence of improved collaboration, such as shared planning, priority setting etc., between the mainstream and Aboriginal health sectors, including the National Aboriginal Community Controlled Health Organisation (NACCHO) Affiliates, and impact of collaboration* Perceptions of community members* * indicators were expected only to be exploratory in Year 2 and/or 3 or not assessable until Year 4 a some (not all) data was expected to be available to assess the indicator at Year 3. b sufficient data both expected and actually available to draw a conclusion. c sufficient data expected to be available but was not. ‘Not applicable’ indicates that this outcome did not relate to a change and hence is not amenable to analysis of influencing factors.
Jurisdiction based activities are likely to have contributed to the uptake of Health Assessments, for example, the South Australian ‘Aboriginal Well Health Checks Program’. (Refer the Policy Map for further examples.) It is certain that the measure contribute to this increase and that it is likely to be moderate relative to the contribution from other ICDP measures and small relative to other external influences. The contribution of this measure to the capacity of the health care system to improve the capacity of the health care system to respond to the needs of Aboriginal and Torres Strait Islander people with chronic disease is likely to be significant. One example is that the ICDP workforce can improve the rate of uptake of further Aboriginal and Torres Strait Islander primary care initiatives by mainstream general practice.
the number of Aboriginal and Torres Strait Islander people accessing cancer services within southern New South Wales. The program also provides training and support to both Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander staff in the health workforce. team was continuing to work with the area’s Aboriginal Health manager and local health care workers to deliver ‘consultation, outreach, training and educational initiatives’ in order to provide a ‘more collaborative and united approach to improving cancer outcomes in Aboriginal or Torres Strait Islander communities’. In 2011, the program’s team was awarded the New South Wales Cancer Services Award for Excellence in the Provision of Cancer Services. Social marketing and community-level strategies Development of a state-wide health promotion project to raise awareness of chronic diseases and encourage accessing primary care services for treatment. No publicly available information. A2, A3, B3, B4, C4 Delivery of lifestyle risk reduction sessions to individuals and families targeting those at high risk of developing a chronic disease. No publicly available information. A2, A3, B3, B4, C4 Partnership with communities to develop local-level information and communication activities including media placement. No publicly available information. A2, A3, B3, B4, C4 Source: KPMG.
Other New South Wales Aboriginal and Torres Strait Islander-specific health programs targeting chronic disease and healthy lifestyle choices Table 367: Other New South Wales Aboriginal and Torres Strait Islander-specific health programs and their alignment with the ICDP. Program, strategy or initiative Overview Alignment with ICDP Know Your Heart Training Manual The Know Your Heart training manual is a resource to assist Health Workers in delivering training, health education and health promotion to other AHWs and their communities. The manual contains information on cardiovascular disease and teaching strategies which can be used by AHWs who look after cardiovascular disease. It also contains information about the provision of health promotion and education to Aboriginal and Torres Strait Islander communities. The manual supports the increased capacity of Aboriginal and Torres Strait Islander health workers employed in chronic disease management through the provision of information and education, aligning with the C1 measure of the ICDP. The community teaching and health promotion components of the manual mean it also aligns with the A3 and B4 measures of the ICDP. SmokeCheck program The New South Wales SmokeCheck program involves a one day training course in brief intervention smoking cessation activities for health workers providing services to Aboriginal clients. Evidence-based resources are also made available to participants including DVDs, desktop cards and brochures. The SmokeCheck program involves educating Aboriginal and Torres Strait Islander health professionals in the provision of smoking cessation programs, and thus aligns with the A1/A2 and C1 measures of the ICDP.
New South Wales (mainstream) health programs, strategies and initiatives targeting chronic disease and healthy lifestyles Table 368: New South Wales (mainstream) health programs and initiatives and their alignment with the ICDP. Program, strategy or initiative Overview Alignment with ICDP Get Healthy Information and Coaching service The Get Healthy Information and Coaching Service is a free and confidential telephone service run by New South Wales Health. It helps people make lifestyle changes in relation to: healthy eating; being physically active; and achieving and maintaining a healthy weight. The Get Healthy Information and Coaching service provides coaching directly to consumers to get healthy in regards to their diet, physical activity and weight. While health professionals can make referrals to the service, it is provided directly to consumers and as such is aligned with the A2 measure of the ICDP. Healthy kids is a New South Wales Government initiative focused on promoting good food habits and daily physical activity for children. The website provides a range of information about healthy lifestyles for kids, teens, parents, carers, teachers and childcare. It encompasses a range of programs for healthy living, including Go for 2&5 and Play for Life. As such, it aligns with the A measures of the ICDP. Live Life Well is a New South Wales Government initiative focused on promoting healthy living including good food habits and daily physical activity for adults. The website provides a range of information about healthy living, including smoking, eating, alcohol, weight, stress and physical activity. As such, it aligns with the A1 and A2 measures of the ICDP. Western Australian policy map Western Australia – Closing the Gap There are currently 99 Aboriginal and Torres Strait Islander-specific services and 317 positions (69 per cent Aboriginal) being delivered by the government, non-government organisations and Aboriginal community controlled sectors across the five priority areas in the agreement: Tackling smoking – 13 programs. A healthy transition to adulthood – 24 programs including the Statewide Specialist Aboriginal Mental Health Service.
Moorditj djena - Moorditj djena (meaning ‘Strong Feet’) is a podiatry and diabetes education service that was launched in early 2011 in partnership with North Metropolitan Area Health Service (NMAHS), South Metropolitan Area Health Service (SMAHS) and Derbal Yerrigan Health Service. The program aims to increase access to culturally sensitive care for Aboriginal and Torres Strait Islander people. The program covers the entire Perth metropolitan area with teams in both the southern and northern metropolitan areas managing over 500 regular clients. The clinics provide the following services: foot and diabetes screening and assessment, clinical management for high risk clients, prevention and risk reduction, healthy lifestyle promotion and education, self management support, facilitation of referrals and follow up, patient support and advocacy, and care coordination. A mobile clinic has also since become operation in 2012. B3, B4, B5 The Western Desert Kidney Health project - The Western Desert Kidney Health project commenced in October 2010 in Kalgoorlie. Its objective is to reduce kidney disease by 20 per cent in 10 targeted communities through the use of arts and health education programs. One of the project’s key messages is the importance of drinking water, and eating ‘2 and 5’ fruits and vegetables. A multidisciplinary team of AHWs, and community development, medical and arts practitioners visit communities in two vehicles, one which operates as a mobile health clinic and the other which runs as an arts vehicle. A survey and testing was conducted on dietary habits upon commencement of the project. Further evaluation conducted by the team after 12 months reported ‘one third of people in the project had reduced cholesterol and a quarter had lost weight’. The project featured in the eleventh National Rural Health Conference in 2011. It has continued to visit local communities and schools (e.g., Leonora District High School in August 2012), in order to facilitate early detection and management of chronic diseases, and education about kidney health. B3, B4, B5 Fixing the gaps and improving the patient Employment of additional ALOs and AHWs in hospitals and AHSs Development and launch of Aboriginal Cultural Framework and Western Australian Health Aboriginal C2
Tasmania (mainstream) health programs, strategies and initiatives targeting chronic disease and healthy lifestyles Table 380: Tasmania (mainstream) health program and initiatives and their alignment with the ICDP. Program, strategy or initiative Overview Alignment with ICDP Eat well Tasmania Eat Well Tasmania is a state-wide program which provides support and assistance for activities or projects that promote enjoyable healthy eating. The program aims to improve the nutritional wellbeing of all Tasmanians by promoting increased awareness of the importance of healthy food choices; increasing the level of inter-sectoral action in nutrition promotion; and coordinating and raising the profile of projects, activities and campaigns consistent with the Dietary Guidelines for Australians. It therefore aligns with the A measures of the ICDP. Plan for Physical Activity 2011-2012 The objective of Tasmania’s Plan for Physical Activity 2011-2021 is to ‘set a unifying direction and framework for action’ when it comes to engaging Tasmanians in physical activity. The plan has the following goals: become a community that values and supports physical activity; create built and natural environments that enable and encourage physical activity; develop partnerships that build and share knowledge and resources; and increase opportunities for all Tasmanians to be physically active where they live, work and play. It therefore aligns with the A measures of the ICDP. Other common relevant policies, programs and initiatives – state and territory level In addition to state/territory Closing the Gap initiatives above, there are other common initiatives and strategies across the states and territories that link with the ICDP. These, and their alignment with the ICDP measures, are detailed below. Note – many existing state/territory Aboriginal and Torres Strait Islander health programs have been rolled into state/territory Closing the Gap initiatives. These are separated into: state/territory Aboriginal and Torres Strait Islander-specific health programs, strategies and initiatives targeting chronic disease and healthy lifestyle choices’; state/territory mainstream health programs, strategies and initiatives targeting chronic disease and healthy lifestyle choices; and
State and territory Aboriginal and Torres Strait Islander health workforce programs, strategies and initiatives The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011-2015) – The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011-2015) has the objective of increasing representation of Aboriginal and Torres Strait Islander people in the health workforce. It was developed to guide jurisdictional health workforce action plans in the states and territories. The Aboriginal and Torres Strait Islander Workforce Working Group (ATSIHWWG) also provides a forum for states and territories to discuss their strategies. The Framework has an aspiration target of Aboriginal and Torres Strait Islander people occupying 2.6 per cent of the Australian health workforce. The Closing Gap initiative has been launched since the initial inception of the Framework. The focuses on enhanced recruitment and retention, and the improved delivery of education and training align with the C1 and C4 measures of the ICDP. New South Wales Health Aboriginal Workforce Strategic Framework 20112015 Queensland Health Indigenous Workforce Strategy SA Health Aboriginal workforce reform strategy 2009-2013 Western Australian Aboriginal and Torres Strait Islander Employment Framework Victorian Aboriginal Health Workforce Plan New South Wales Health Aboriginal Workforce Strategic Framework 2011 – aims to increase the representation of Aboriginal and Torres Strait Islander employees in health professions (thus aligning with the C4 measure of the ICDP) as well as providing culturally safe and competent health services (thus aligning with the C1 measure of the ICDP) Queensland Health Indigenous Workforce Strategy – focuses on encouraging Aboriginal and Torres Strait Islander people to work in health careers (thus aligning with the C4 measure of the ICDP). The strategy also aligns with the C1 measure of the ICDP through its activities to support and develop Aboriginal and Torres Strait Islander staff. SA Health Aboriginal workforce reform strategy 2009-2013 – focuses on