Improve Prevention, Diagnosis and Management of Chronic Diseases

It is known that Aboriginal Victorians are:

• Much more likely to suffer from chronic diseases in comparison to non-Aboriginal Victorians
• Much less likely to be free from long term conditions
• More likely to suffer from multiple conditions ⁽¹⁾

The current poor health outcomes can make the future appear bleak in Aboriginal communities.  It is estimated that Aboriginal people are diagnosed with diabetes at 3.4 times the  rate of non-Aboriginal Australians⁽²⁾, and there are indications that the rates of diabetes amongst Aboriginal and Torres Strait Islanders is increasing.⁽³⁾ However, there is room for optimism that improvements can be made.

A recent analysis of the Aboriginal death rates from chronic diseases, other than cancer in the Northern Territory 1977 – 2001 found that …[m]ortality rates from IHD [Ischaemic Heart Disease] and DM [Diabetes Mellitus] have been increasing since 1977, but there is evidence of a slower rise (or even a fall) in death rates in 1990s.⁽⁴⁾

It is a widely held belief that Aboriginal communities may be resistant to tobacco control initiatives, because smoking rates have remained much higher than amongst non-Aboriginal Australians.   But again, there is evidence that smoking rates have fallen in non-remote Aboriginal communities, and that remote Aboriginal communities are at an earlier stage of the tobacco epidemic and given appropriate intervention similar decreases can be anticipated.  ⁽⁵⁾

Improving chronic disease outcomes within Aboriginal communities is no easy task.  Research about diabetes control within Aboriginal primary health care services demonstrate that there is value in

• screening
• “systematic primary health care approaches to diabetes control, including electronic health information systems, screening, management protocols, recall systems, improved specialist access, quality improvement activities, and staff support and training”  ⁽³⁾

The Indigenous Chronic Disease Package (Department Health & Ageing) has introduced the following incentives to promote improvements in chronic disease outcomes for Aboriginal & Torres Strait Islanders

1. Aboriginal & Torres Strait Islander Health Checks: MBS Item 715
2. PIP Indigenous Health Incentive forms and guidelines
3. Subsidising PBS Co-Payments

Aboriginal & Torres Strait Islander Health Checks: MBS Item 715

The Aboriginal & Torres Strait Islander Health Checks are comprehensive annual health checks.  It involves an assessment of the patient’s health, including physical, psychological and social well-being.  The health check also assesses what preventive health care, education and other assistance should be offered to the patient to improve their health and wellbeing.

The Aboriginal & Torres Strait Islander adult health check has been found to be a … “viable vehicle for evaluating health status, identifying chronic disease risk factors and for implementing preventive health care” in a study undertaken at the Inala Indigenous Health Service, Queensland. _{(Spurling G et al, MJA 2009; 190: 562–564)}.

Aboriginal and Torres Strait Islanders health checks items were first made available in 1999.   A study into the low uptake of the Aboriginal and Torres Strait Islanders health checks in mainstream general practices in the ACT found these barriers:

• low levels of routine identification of Aboriginal and Torres Strait Islander patients
• little awareness of Aboriginal and Torres Strait Islander specific GP mediated health interventions
• lack of support for preventive health interventions targeted on the basis of Aboriginal and or Torres Strait Islander status. (6)

_{Download links:}

• Aboriginal and or Torres Strait Islander Health Assessment – 715 doc
• Hot link MBS item 715 Explanatory notes
  http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=715
• National Guide to preventive health assessment in Aboriginal and Torres Strait Islander peoples doc

PIP Indigenous Health Incentive forms and guidelines

This Medicare incentive supports GPs and Aboriginal Community Controlled Health Services to improve health care for Aboriginal & Torres Strait Islanders (15 years+) with chronic disease by encouraging best practice for the management of chronic disease.  Approximately half the general practices in East Gippsland and Wellington have registered for the Indigenous Health Incentive.

What does our practice need to do to participate in the PIP Indigenous Health Incentive?

• Register as PIP Practice
• Seek consent to register Aboriginal & Torres Strait Islander clients at risk of chronic disease
• Establish & use a reminder system to ensure follow up of patients aged 15 years and over with chronic disease are followed up
• Agree to undertake cultural awareness training
• Agree to annotate PBS scripts for PBS Co-payment measure for participating Aboriginal & Torres Strait Islander patients

Hot link: PIP Indigenous Health Incentive forms and guidelines www.medicareaustralia.gov.au/provider/incentives/pip/forms-guides.jsp

An excel template for managing Indigenous Health - PIP patient registrations and payments is available.  Please contact Michelle for more details.

Subsidising PBS Co-Payments

This provides lower cost PBS medicines for eligible Aboriginal & Torres Strait Islander patients with chronic disease via annotated PBS prescriptions.

“The cost of medicines has been identified as a significant barrier to improved access to medicines for Aboriginal and Torres Strait Islander people.  Access to PBS medicines is an important aspect of preventing and treating illnesses.  Despite two to three times higher levels of illness, PBS expenditure for Aboriginal and Torres Strait Islander people is about half that of the non-Indigenous average.” _{(DoHA website, Subsidising PBS Medicines Co Payments,)}

What does our practice need to do to participate?

• Register for PIP Indigenous Health Incentive
• Aboriginal Community Controlled Health Services (whether PIP registered or not)

Downloads

• PBS Co-payment GP Factsheet.doc

(back to overview)

References:

^{(1)    (The health of Aboriginal Victorians, 2009, VACCHO)
(2)    Health summary Australian Indigenous Health Infonet
(3)    Diabetes in Indigenous Australians: possible ways forward
(4)    (Thomas D et al, Long term trends in Indigenous deaths from chronic diseases in Northern Territory, a foot on the brake,  a foot on accelerator, MJA 185 -3, 2006)
(5)    (Smoking prevalence trends in Indigenous Australians, a typical rather than exceptional epidemic, Thomas D,)
(6)   (Kehoe H. Manuka R., Aboriginal & or Torres Strait Islander Health Assessments, Barriers to improving uptake, Aust Family Physician Vol 37-12, 2008)}