NACCHO Programs ” What Works ” Aboriginal Health : #FASD , Ear and Hearing , #Safeeyes and #Qumax

fasd

 ” The package of FASD Prevention and Health Promotion resources also include data system resources to facilitate routine screening and monitoring for alcohol and tobacco use in pregnancy, and screening of non-pregnant women of childbearing age, at risk of having a prenatal alcohol exposed pregnancy.”

NACCHO Report 1 below

 “The Safe Eyes trial program relies on the effective facilitation of engagement, ownership and leadership within each community to address hygiene and environmental health factors that lead to the spread of trachoma and other communicable disease.

The Safe Eyes program has been developed and implemented by each community with the success of each program evaluated and owned by those communities.”

NACCHO Report 2 Below

 ” The Ear and Hearing Health Skill Set Training was conducted over a two-week period and provided a pathway for Aboriginal and Torres Strait Islander health workers to specialise in the provision of ear and hearing health.

NACCHO coordinated 100 Aboriginal Health Worker Ear and Hearing Training which were delivered in Brisbane, Darwin, Melbourne, Cairns, Perth, Dubbo, Sydney, Kalgoorlie, Albany and Adelaide.”

NACCHO Report 3 Below

 ” The QUMAX Program aims to improve health outcomes of Aboriginal and Torres Strait Islander people who attend participating Aboriginal Community Controlled Health Organisations (ACCHOs) in major cities, inner and outer regional areas.

QUMAX achieves this through the allocation of funding to participating ACCHOs to reduce barriers experienced by their clients to Quality Use of Medicines.”

NACCHO Report 4 below

Articles are from Page 5,18,19,20 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

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NACCHO Report 1 of 4 :Prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) 

NACCHO partnered with the Menzies School of Health Research and the Telethon Kids Institute (TKI) to develop and implement health promotion resources and interventions to prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) on Aboriginal and Torres Strait Islander families and young children.

FASD is an umbrella term used to describe the range of effects that can occur in individuals whose mother consumed alcohol during pregnancy. These effects may include physical, mental, behavioral, developmental, and or learning disabilities with possible lifelong implications.

Fetal Alcohol Spectrum Disorder Prevention and Health Promotion Resources (FPHPR) were developed for the 85 New Directions: Mothers and Babies Services (NDMBS) across Australia. These resources primarily focused on prevention of FASD, but also provide information about sexual and reproductive health, smoking and substance abuse.

The FASD project was announced by Senator the Hon Fiona Nash in June 2014 and forms part of the National FASD Action Plan to address the harmful impact of FASD on children and families.

The FPHPR Project seeks to achieve the following broad outcomes by 30 June 2017:

  • Reduced alcohol consumption during pregnancy.
  • Reduced tobacco smoking and substance misuse during pregnancy.
  • Reduced unplanned pregnancies.

The Project Partnership and Research team developed and implemented a flexible, modular package of health promotion resources and interventions based on the key components of the approach developed by the Ord Valley Aboriginal Health Services.

This includes a set of discrete FASD education and awareness modules targeting key New Directions: Mothers and Babies Services (NDMBS) client groups, including:

Pregnant women using NDMBS antenatal and other services, including  their partners and families.

  • Aboriginal and Torres Strait Islander women of childbearing age.
  • Aboriginal and Torres Strait Islander grandmothers.
  • NDMBS staff (including but not limited to administrative and clinical staff).
  • Aboriginal and Torres Strait Islander men.

The package of FASD Prevention and Health Promotion resources also include data system resources to facilitate routine screening and monitoring for alcohol and tobacco use in pregnancy, and screening of non-pregnant women of childbearing age, at risk of having a prenatal alcohol exposed pregnancy.

Participating NDMBS use this system to evaluate the impact of the FPHPR on target groups of pregnant women using NDMB antenatal and other services, including their partners and families and Aboriginal and Torres Strait Islander men.

The FPHPR Project team facilitated FASD train-the-trainer workshops with participants from NBMBS in each State and Territory.

Approximately 100 NDMBS staff – a diverse combination of clinical service providers and administrative staff, actively participated.

Workshops included information on FASD and its prevention by content experts; orientation to the FPHPR package; interactive training and rehearsal in the use of each component of the FPHPR package developed for each key NDMBS target groups; networking opportunities and strengthening links with other relevant service providers within each jurisdiction to reduce the impact of FASD.

NACCHO 2 Report : Australian Trachoma Alliance – Safe Eyes Program

In 2014 the Australian Trachoma Alliance (ATA) assembled a forum of Aboriginal Community Controlled Health Organisations ACCHOs) to develop an Aboriginal led, community owned action plan to address hygiene and environmental health factors to reduce the incidence of trachoma and other communicable diseases.

In 2015 three trial community sites were selected with guidance through the NACCHO Board of Directors in agreement with the relevant ACCHO:

  1. Yalata (South Australia) – services provided by Tullawon Health Services Inc.
  2. Kiwirrkurra (Western Australia) – services provided by Ngaanyatjarra Health Service
  3. Utju (Areyonga, Northern Territory) – services provided by Central Australian Aboriginal Congress

The criteria for the selection of each site included trachoma prevalence rate, population and available facilities (e.g. school, health service and sporting activities).

The Model: Engagement, Ownership and Leadership

The Safe Eyes trial program relies on the effective facilitation of engagement, ownership and leadership within each community to address hygiene and environmental health factors that lead to the spread of trachoma and other communicable disease.

The Safe Eyes program has been developed and implemented by each community with the success of each program evaluated and owned by those communities.

Moving from ownership of the problem to leading the development of a solution, empowers each community to drive the change process. Furthermore, owning the problem as well as understanding the benefits of addressing it are both necessary elements to embed behaviour change processes within families, organisations and whole communities.

The Safe Eyes program model continues to require a methodical and principled approach to its ongoing implementation.

The following three program stages demonstrate the programs continuing commitment to community engagement, ownership and enabling Aboriginal Leadership.

  1. The three trial community program sites were selected with the direct guidance of the national Aboriginal health leadership through the NACCHO Board of Directors and then through following the direction and agreement of the relevant Aboriginal Community Controlled Health Organisation (ACCHO).
  2. Following the site selection phase, each trial community program has been developed through the engagement, ownership and leadership from the relevant ACCHO and other key community organisations.
  3. All three trial community sites are developing their own Safe Eyes Action Plan to address the elimination of trachoma and other hygiene-related disease. These action plans will also include locally-developed, owned and led program indicators to ensure each community will measure its own success.

The three trial communities are currently at different stages of the planning process and implementation of their action plans. However, establishing and maintaining engagement with each of the trial communities continues to require a flexible and responsive approach.

Initially, formal and informal meetings occurred across each community to discuss the objective of Safe Eyes and to facilitate discussions about issues relating to hygiene and environmental health factors.

This has led to a broader group discussion about the health benefits to the community in addressing factors to stop the spread of germs and possibilities to address the issues identified.

From this starting point, these discussions developed into action plans in each of the three trial communities which provided answers relating to necessary actions, outcome measures, required resources and identifying those needed to be responsible for the actions.

The key elements of this approach undertaken by the Safe Eyes facilitators involve:

  • Demonstrating an ongoing commitment to reinforce community ownership of the action planning.
  • Respecting traditional knowledge and values.
  • Supporting rather than directing the change process.
  • Allowing time for change to occur.

The Safe Eyes program assumes that each community’s attempt to lead and own the elimination of trachoma and other communicable disease through hygiene and environmental health actions is based on the following principles:

  • Long term investment in, and commitment to change in public health behaviours at the individual, family (home) and broader community levels.
  • Community-led and owned solutions are sustainable because they are embedded in the community itself, since these solutions have actively valued and included local context within their development.

Evaluation

An external consultant has been engaged to evaluate the Safe Eyes model of Aboriginal leadership, community engagement and ownership within the three trial community sites.

This evaluation is essential to understanding and articulating how such a model of engagement, ownership and leadership may be applied and replicated within the 140+ trachoma-at-risk communities throughout remote and regional Australia.[1] The evaluation will document and assess the significant contextual factors at each of the three trial sites that have contributed to the successful development of community engagement, ownership and Aboriginal leadership in regard to the Safe Eyes program.[2]

[1] Australian Trachoma Surveillance Report 2013. Kirby Institute. University of New South Wales: p.10.

[2] The external evaluation of the ATA’s model of engagement, ownership and leadership will be completely distinct from the identification and development of measures of success undertaken within each trial community’s action plan.

NACCHO Report 3 of 4 . Ear and Hearing Health Project

Aboriginal and Torres Strait Islander people experience some of the highest levels of ear disease and hearing loss in the world, with rates up to 10 times more than those for non-Indigenous Australians.

Children and adolescents are particularly vulnerable to ear infections. The most common ear disease among Aboriginal Children is otitis media (OM), which is inflammation or infection of the middle ear, typically caused by bacterial and viralpathogens.

Ear infections are responsible for the bulk of hearing problems with lifelong consequences, many of which are preventable and treatable if diagnosed early.

Overview

NACCHOs Ear and Hearing Project, aimed to coordinate the development and delivery of Ear and Hearing Health Skill Set Training for up to 115 Aboriginal and Torres Strait Islander Health Workers.

The Project was funded under the Commonwealth Governments ‘Improving Eye and Ear Health Services for Indigenous Australians for Better Education and Employment Outcomes’ – a COAG measure, which also supported its implementation. The overall measure aimed to improve the early detection and treatment of eye and ear health conditions in Aboriginal and Torres Strait Islander people, leading to improved education and employment outcomes.

NACCHO received funding for five phases of the project by the Aboriginal and Torres Strait Islander Health Workforce Section of the Department of Health.

Selecting Registered Training Organisations

Registered Training Organisations (RTOs) were selected through a rigorous selection panel process with representatives from NACCHO, Department of Health and Hearing Services Australia.

The selection process was strict and services had to meet the following criteria:

  • Be a registered training provided – preference was be given to Aboriginal and Torres Strait Islander Health Registered Training Organisations (RTOs).
  • Have the capacity and scope to deliver the Ear and Hearing Skill Set for Aboriginal and Torres Strait Islander Primary Health Care training.
  • Provide qualified trainer and assessors to deliver Ear and Hearing Skill Set training.
  • Deliver the training within the required timeframe – April – October 2015.
  • Provide confirmation of training dates.
  • Be willing to take on bursary scheme participant/s as part of the delivery of training.
  • Take on eligible students to complete the training (list supplied by NACCHO).
  • Deliver training within the allocated budget.
  • Supply RTO details and provider number.
  • Lodgement of proposal by the closing date.

Outcomes

Four Registered Training Organistations rated as suitable to deliver training on behalf of NACCHO.

The successful organisations were:

  1. Central Australian Remote Health Development Service Ltd, Alice Springs, Northern Territory.
  2. Aboriginal Health Council of Western Australia, Perth, Western Australia.
  3. The Aboriginal Health College, Sydney, New South Wales.
  4. Nunkuwarrin Yunti of South Australia Inc.

Ear and Hearing Health Training

The Ear and Hearing Health Skill Set Training was conducted over a two-week period and provided a pathway for Aboriginal and Torres Strait Islander health workers to specialise in the provision of ear and hearing health. Additionally, the skill set units provide credit towards Aboriginal and Torres Strait Islander Primary Health Care qualifications at the Certificate IV level or higher.

NACCHO coordinated 100 Aboriginal Health Worker Ear and Hearing Training which were delivered in Brisbane, Darwin, Melbourne, Cairns, Perth, Dubbo, Sydney, Kalgoorlie, Albany and Adelaide.

Due to Sorry Business, minimal trainees participated in Darwin with training in Katherine cancelled all together.

NACCHO Report 4 of 4 Quality use of Medicines Maximised for Aboriginal and Torres Strait Islander People

The Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples (QUMAX) program is a collaboration between NACCHO and the Pharmacy Guild of Australia (PGoA) with funding provided by the Commonwealth Department of Health (DoH) under the Sixth Community Pharmacy Agreement (6CPA). Through the 6CPA, the QUMAX program received 12 months funding.

What is QUMAX?

The QUMAX Program aims to improve health outcomes of Aboriginal and Torres Strait Islander people who attend participating Aboriginal Community Controlled Health Organisations (ACCHOs) in major cities, inner and outer regional areas.

QUMAX achieves this through the allocation of funding to participating ACCHOs to reduce barriers experienced by their clients to Quality Use of Medicines. There are seven support categories specified under the 6CPA:

  1. a) Dose Administration Aids Agreements b) Flexible Funding
  2. Quality Use of Medicine Pharmacy Support
  3. Home Medicine Reviews (HMR) models of support
  4. Quality Use of Medicine Devices
  5. Quality Use of Medicine Education
  6. Cultural Education
  7. Transport

In 2015-2016, QUMAX engaged with over 50 per cent of NACCHO member organisations. This equated to 76 ACCHOs across each State and Territory participating in the program reaching 219,486 Aboriginal and Torres Strait Islander clients.

Challenges

The 2015-2016 QUMAX cycle has been a particularly challenging. The delay in notification of the 6CPA caused significant delays to the time sensitive QUMAX program cycle, placing additional administrative burden on NACCHO from a National Coordination stand point; and also at the ACCHO grassroots service delivery level.

The QUMAX program team supported ACCHOs through the completion and submission of their work plans and reporting requirements for this period. Despite these challenges, all program deliverables were met.

NACCHOs, QUMAX Programme: Quality use of Medicines Maximised for Aboriginal and Torres Strait Islander People report was published in March 2016 highlighting the value and effectiveness of QUMAX for Aboriginal and Torres Strait Islander clients of participating ACCHOs.

Funding for QUMAX is and remains capped at 11 million dollars for the five year (2010-2015) 5CPA agreement. Although funding has increased annually, it has not been sufficient in meeting the ongoing needs of patients requiring support through the program. Coupled with additional financial investment provided by ACCHOs across the 2013-2015 financial years, the report indicated that a higher level of funding is needed.

Key outcomes from the report:

  • 81 organisations participated in the QUMAX program from 2010 to 2015.
  • ACCHOs reported greater uptake of QUMAX supported activities for which funding has not kept pace.
  • Program participants are evenly distributed across major cities and inner and outer regional areas.
  • Across the seven support categories:
  • The highest proportion has been allocated to Dose Administration Aids for complex medications (50 per cent).
  • Asthma masks and spacers, nebulisers and peak flow meters are the most highly used device with over 22,500 being provided.
  • 21 per cent of funds have been used for transport assistance for clients to acquire medications. It was noted that 80 per cent of contracted pharmacies are located over one kilometre away from ACCHO clinics.
  • 508 community pharmacies participated as Dose Administration Aids contracted pharmacies.
  • Community Pharmacies actively participated in improving their own cultural awareness and support for client education on medications.

NACCHO continues to work towards ensuring the QUMAX Program, and quality use of medicine support to ACCHOs continues throughout the 6CPA.

The full report is available on the NACCHO website http://www.naccho.org.au/wp-content/uploads/QUMAX-Report-Final-2016-04-10-hiq.pdf

Learn more about these NACCHO programs  at the  NACCHO Members Conference in Melbourne

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1. NACCHO Interim 3 day Program has been released -Download
2. The dates are fast approaching – so register today
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Opportunity to support a special edition #HealthElection16 NACCHO Aboriginal Health Newspaper PUBLISH DATE June 29

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    Opportunity to send your Aboriginal Health issue message to Canberra for

ChklggxU4AA8zLA

#HealthElection16

Advertising and editorial is invited from

  • All political parties
  • NACCHO 150 Members and Affiliates
  • Stakeholders/ Aboriginal organisations
  • Peak Health bodies

Closing 17 June for publishing election week 29 June

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DOWNLOAD THE A PDF COPY 24 Pages

Response to our NACCHO Aboriginal Health Newspaper from our members, community, stakeholders and Government  has been nothing short of sensational over the past 3 years , with feedback from around the country suggesting we really kicked a few positive goals for Aboriginal health.

NACCHO is the national peak body for Aboriginal health. It is entrusted to represent the needs and interests of Aboriginal health on behalf of its members in the national arena.

NACCHO has and continues to be a living embodiment of the aspirations of Aboriginal people

10 good reasons to advertise in the NACCHO Aboriginal Health Newspaper :

  1. Highly targeted health sector from CEO’s to all staff audience
  2. Quality production and guaranteed national distribution in partnership with the award-winning Koori Mail 14,000 printed copies
  3. Spend any surplus dollars before the end of the financial year
  4. Article space offered with ad bookings
  5. Newspaper also distributed at NACCHO events and workshops
  6. 1500 copies posted to the CEO’s of Australia’s top Aboriginal health organisations and NGO’s and Government departments
  7. Thank you ‘burst’ through NACCHO’s social media network naming all advertisers
  8. Over 100,000 audited readers
  9. Targeted at Aboriginal consumer / clients
  10. Support NACCHO vision to Close the Gap

Our media partner Koori Mail Turns 25 this week

The Koori Mail is an Australian media institution, 100% owned and controlled by Aboriginal people. The fortnightly newspaper circulates all states and covers the issues that matter the most to black Australians. 25 years since its first print, the Indigenous paper is still breaking ground for Indigenous journalism.

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Editorial Proposals  10 June 2016
Final Ads artwork 17 June 2016
Publication date 29 June 2016

Editorial Opportunities

New Microsoft Word Document (2)

We are now looking to all our members, programs and sector stakeholders for advertising, compelling articles, eye-catching images and commentary for inclusion in our next edition.

Maximum 600 words (word file only) with image

Please Note: All submitted advertising and editorial content is subject to space availability and review by the NACCHO Newspaper editorial committee

Advertising opportunities

NEW VERSION A3poster_Aboriginal_2_nocropsExample full Page Ad April and June edition

This 24-page newspaper is produced and distributed as an insert in the Koori Mail, circulating 14,000 full-colour print copies nationally via newsagents and subscriptions.

Our audited readership (Audit Bureau of Circulations) is 100,000 readers!

Our target audience also includes over 1,500 NACCHO member and affiliate health organisations, relevant government departments, subsidiary indigenous health services and suppliers, as well as the end-users of Australian Indigenous health services nationally.

Your advertising support means we can build this newspaper to a cost-neutral endeavour, thereby guaranteeing its future.

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Note: the earlier you book your ad or submit an article for consideration, the better placement we can offer in the printed newspaper. All prices are GST inclusive. Discounts are available to not-for-profits, NACCHO member organisations and industry stakeholders. All prices include artwork if required.

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Email nacchonews@naccho.org.au

Download the April 6th Edition of the NACCHO Aboriginal Health Newspaper – click here!

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NACCHO #HealthElection16 : ­Co-­payment policy for the Pharmaceutical Benefits Scheme, and Aboriginal health

Pharmacy

“Labor’s pledge to scrap a ­proposed fee for subsidised medi­cines has been countered by government claims that patients could miss out on lifesaving new drugs without the measure, worth almost $1 billion.

Arguing that a new charge for prescription medicines would ­adversely affect millions of people, Bill Shorten promised yesterday to reverse the “co-­payment by stealth” announced in the 2014 budget but blocked by the Senate.”

From todays Australian

The PSA Federal Budget Submission 2016-2017 titled “The role of pharmacists in Australian health reform–Improving health outcomes through cost effective primary care” highlights the opportunities for pharmacists to work in Aboriginal Health Services.

The activities that could be provided by pharmacists shadow the proposed roles of pharmacists providing services in general practice.

At a recent meeting with NACCHO, PSA and pharmacists who work in Aboriginal Health the following services were identified as being able to be delivered across Australia by pharmacists.”

In the budget submission PSA recommends “that the Government consider an adaptation of the PGPIP to enable AHSs across Australia to improve medication adherence and reduce the progression of chronic disease, by utilising clinical pharmacists in the AHS service-mix.

This would allow AHSs to access up to $125,000 per year to employ a pharmacist where required, in keeping with the general practice proposal.

The use of culturally responsive clinical pharmacists could improve medication adherence and reduce the progression of chronic disease.”

SEE Press coverage below

Refer to Labor and Industry press releases from NACCHO Election files

Contact Colin Cowell at NACCHO for copies of #HealthElection16 press releases nacchonews@naccho.org.au

40. Pharmacy Guild Welcomes Labor PBS annoucement May 22

42. King Shorten LABOR WILL END MALCOLM TURNBULL’S MEDICINES PRICE HIKE (FED)

46. Pharmaceutical Society of Aust PSA Responds to Labors PBS Policy

“Sick people should not be deterred from going to the doctor because of the price of seeing the GP or the cost of medicine,” the Opposition Leader said of the government’s plan to lift the cost of subsidised prescriptions by $5 for general patients and 80c for concessional patients.

“We do not believe the case has been made out to increase the price of prescription drugs.”

Malcolm Turnbull said the government stood by the ­co-­payment policy for the Pharmaceutical Benefits Scheme, arguing that the Coalition’s management of the health budget had allowed new lifesaving medicines to be subsidised, unlike the previous Labor government that deferred several listings because of cost pressures.

“Because we have been able to manage the health budget well, we have been able to bring onto the pharmaceutical benefits schedule $3bn worth of new medi­cines,” the Prime Minister said, citing listings of melanoma and breast cancer drugs and the addition of a diabetes treatment as examples.

The Australian Medical Assoc­iation and consumer health groups welcomed Labor’s announcemen­t it would scrap the PBS increase, saying if the ­government pushed ahead with it, low-income earners would be discouraged from getting medicine they needed.

“It is welcome news for ­patients that they (Labor) are not going to go ahead with the PBS increases, because we know that for many people these costs all add up for their healthcare,” AMA president Brian Owler said.

Announcing $7 million for new cancer trials, Health Minister Sussan Ley sought to turn around Labor’s pledge on the PBS payment to question Mr Shorten on his plan for new drug listings.

“The Coalition has had to, and will continue to, make tough decis­ions when it comes to the list­ings of medicines,” she said.

“I see no plan (from Labor) for listing medicines at all. “I see increased spending, poorly targeted. I do not see any of the reforms necessary to do what the Coal­ition has been able to do in the medicines listing space.”

Ms Ley said the government’s policy was to approve all drugs recommended by the PBAC “without fear or favour”, with cabinet considering drugs that were expected to cost more than $20m a year to list.

“We are talking about breakthrough cures here. There is no time to wait. There is no way of saying the budget cannot afford it. We know we will list it and the Labor Party will not.”

Labor’s health spokeswoman Catherine King said Labor would continue the policy and principle of requiring recommendations from the Pharmaceutical Benefits Advisory Committee to go to cabinet for approval.

“The government lifted the amount that would go to cabinet and we would keep that,” she said.

On average, drug listings costing $12bn are assessed each year by the PBAC. About $1bn worth are recommended for adoption.

There are many opportunities for pharmacists to help improve the health and wellbeing of Aboriginal and Torres Strait Islander Australians, but it’s a complex area to work in, writes Karalyn Huxhagen

The PSA Federal Budget Submission 2016-2017 titled “The role of pharmacists in Australian health reform–Improving health outcomes through cost effective primary care” highlights the opportunities for pharmacists to work in Aboriginal Health Services.

The activities that could be provided by pharmacists shadow the proposed roles of pharmacists providing services in general practice.

At a recent meeting with NACCHO, PSA and pharmacists who work in Aboriginal Health the following services were identified as being able to be delivered across Australia by pharmacists.

Areas of collaboration and opportunity include:

  • medication management services;
  • quality Use of Medicine services for consumers and health workers;
  • health promotion;
  • disease prevention programs;
  • chronic disease management programs;
  • culturally appropriate education and competency development programs for pharmacists and health workers; and
  • improvement in equitable and timely access to medication services.

This work would assist in:

  • improving adherence;
  • reducing medication misadventure;
  • tailoring medication regimes;
  • providing tools to assist consumers and carers;
  • Identifying areas that require research and data analysis; and
  • Improving the health literacy of the patient, carers and Aboriginal community elders.

The employment of a clinical pharmacist in an AHS may also assist in research and drug utilisation activities.

Programs provided by organisations such as National Prescribing Service could be initiated in the health service under the project management portfolio of the of the clinical practice pharmacist. Issues identified when prescribing, dispensing and administering medication to Aboriginal people require more intense research to be undertaken.

The response to medications by this cohort can differ significantly to other ethnic groups. In my own work in aged care facilities I often encounter major issues with metabolism, distribution and elimination of medications due to advanced kidney diseases and differences in skin penetration kinetics.

For example the use of ‘patch’ therapy e.g. Durogesic, Norspan, Transiderm Nitro, smoking cessation patches is complicated by the hot and humid weather encountered in Aboriginal communities.

The application of large pieces of strapping tape or electrical PVC tape to keep the patch attached to the body can alter the kinetics of the medication. It is very difficult to keep the patches attached.

In the regional and rural areas where I perform medication management services I am often faced with the situation of:

  • limited access to GPs;
  • limited access to allied health professionals;
  • lack of resources to adequately support the health needs of the patient;
  • long distances to travel;
  • poor health literacy; and
  • low income families.

The care of these patients often falls to the community care centre or the domiciliary nursing service as the doctor is only available for short periods of time. Often these communities are without a regular GP.

The employment of a clinical practice pharmacist in the Aboriginal Health Service could provide a significant partner in improving patient health outcomes. The reduction in costs to the Medicare and health system could be measured in areas such as compliance and adherence: improved wound care, chronic disease management and general parameters such as blood pressure and glucose control.

In the budget submission PSA recommends “that the Government consider an adaptation of the PGPIP to enable AHSs across Australia to improve medication adherence and reduce the progression of chronic disease, by utilising clinical pharmacists in the AHS service-mix. This would allow AHSs to access up to $125,000 per year to employ a pharmacist where required, in keeping with the general practice proposal.

The use of culturally responsive clinical pharmacists could improve medication adherence and reduce the progression of chronic disease.”

Areas such as Home Medicine Review, Medscheck and medication adherence programs such as dosage administration aids require different formats when they are being utilised in health programs for Aboriginal people.

There will need to be opportunity within program rules to adapt programs to suit the requirements and needs of the patient cohort. The use of a pharmacist within an AHS who can work with the various members of the health service to develop programs and initiatives to improve the primary health outcomes of the community is paramount to improving the longevity of the patients who use the AHS.

I recommend this document to all Australian pharmacists as it is a blueprint for where the practice of pharmacy could be implemented to gain improvement in patient outcomes while delivering more efficient and cost effective health care.

Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group

NNEWS

Send your Aboriginal Health issue message to Canberra for

#HealthElection16

Advertising and editorial is invited from

All political parties

NACCHO 150 Members and Affiliates

Stakeholders/ Aboriginal organisations

Peak Health bodies

Closing 17 June for publishing election week 29 June

Contact for Advertising rate cards/bookings/editorial

NACCHO Aboriginal Health News: PTP an opportunity for our pharmacies to help improve Aboriginal health and wellbeing

Pharmacy

NACCHO is participating in the Pharmacy Trials Programme (PTP), a $50M initiative of Minister Sussan Ley to sponsor transformative and innovative delivery of pharmacy services.

From our NACCHO Aboriginal Health Newspaper out on 6 April as insert in 14,000 Koori Mails : Photo Danila Dilba Health Service Darwin ACCHO (Aboriginal Community Controlled Health ) pharmacy 

Aboriginal and Torres Strait Islander people are a focus of the PTP.NACCHO is represented on the Trials Advisory Group of the PTP.

The Trials Advisory Group (TAG) beings together national stakeholders to consider Trial proposals.  Approved Trials that are evaluated as cost effective can go on to access another $600M of new pharmacy services funding.

Clearly the PTP initiative has significant potential for strengthening the scope and the quality of pharmacy services within and delivered in collaboration with ACCHOs.

NACCHO is working with the Pharmacy Guild of Australia as well as with the Pharmaceutical Society of Australia to submit Trial proposals.  NACCHO is also consulting with a range of stakeholders, experts and reviewing recent literature.  This ensures that NACCHOs interests are fully represented and that the most relevant and up to date methods and ideas are incorporated into Trial proposals.

The $50M PTP is part of the Australian Government’s Sixth Community Pharmacy Agreement (6CPA) with the Pharmacy Guild of Australia.  It will be interesting to see how transformative and innovative Trial proposals approved by the Trials Advisory Group will be.

NACCHO is especially keen to trial a range of solutions for embedding pharmacy services within ACCHOs with the aim of identifying which solutions deliver the best value for money to clients.

At one end of the spectrum, legislation in the Northern Territory allows ACCHOs to own, set up and operate their own pharmacies. Elsewhere, some ACCHOs have installed a pharmacy in their clinics and they have it stocked and staffed by an outposted pharmacist employed by a Community Pharmacy in town. Some ACCHOs have banded together to employ a full-time pharmacist – as with the Institute for Urban Indigenous Health in south east Queensland.

Occasionally a single ACCHO employs its own full-time pharmacist – as in Galambilla in northern NSW.  Yet another model for pharmacy services is to contract a visiting pharmacist for a set number of hours per week.  About 50% of ACCHOs have no form of in-house or on-site pharmacist.

Minister Ley has also set up an independent Panel to review Pharmacy Remuneration and Regulation.  This is an opportunity for NACCHO to influence current federal laws to improve Quality Use of Medicines and access for ACCHOs and communities across Australia.  The Panel will be publishing a Discussion Paper and inviting submissions in May.

NACCHO has already advocated that the Panel do its best to progress the long-delayed reforms to Section 100 and CTG PBS Co-payment Measures.  A comprehensive set of changes have been agreed to by NACCHO and the Pharmacy Guild of Australia in a Joint Statement co-signed in October 2015. This is available on NACCHO’s web site under About Us – Resources/Downloads – Aboriginal Health.

 Clinical tips: Aboriginal and Torres Strait Islander health

There are many opportunities for pharmacists to help improve the health and wellbeing of Aboriginal and Torres Strait Islander Australians, but it’s a complex area to work in, writes Karalyn Huxhagen

The PSA Federal Budget Submission 2016-2017 titled “The role of pharmacists in Australian health reform–Improving health outcomes through cost effective primary care” highlights the opportunities for pharmacists to work in Aboriginal Health Services.

The activities that could be provided by pharmacists shadow the proposed roles of pharmacists providing services in general practice.

At a recent meeting with NACCHO, PSA and pharmacists who work in Aboriginal Health the following services were identified as being able to be delivered across Australia by pharmacists.

Areas of collaboration and opportunity include:

  • medication management services;
  • quality Use of Medicine services for consumers and health workers;
  • health promotion;
  • disease prevention programs;
  • chronic disease management programs;
  • culturally appropriate education and competency development programs for pharmacists and health workers; and
  • improvement in equitable and timely access to medication services.

This work would assist in:

  • improving adherence;
  • reducing medication misadventure;
  • tailoring medication regimes;
  • providing tools to assist consumers and carers;
  • Identifying areas that require research and data analysis; and
  • Improving the health literacy of the patient, carers and Aboriginal community elders.

The employment of a clinical pharmacist in an AHS may also assist in research and drug utilisation activities.

Programs provided by organisations such as National Prescribing Service could be initiated in the health service under the project management portfolio of the of the clinical practice pharmacist. Issues identified when prescribing, dispensing and administering medication to Aboriginal people require more intense research to be undertaken.

The response to medications by this cohort can differ significantly to other ethnic groups. In my own work in aged care facilities I often encounter major issues with metabolism, distribution and elimination of medications due to advanced kidney diseases and differences in skin penetration kinetics.

For example the use of ‘patch’ therapy e.g. Durogesic, Norspan, Transiderm Nitro, smoking cessation patches is complicated by the hot and humid weather encountered in Aboriginal communities.

The application of large pieces of strapping tape or electrical PVC tape to keep the patch attached to the body can alter the kinetics of the medication. It is very difficult to keep the patches attached.

In the regional and rural areas where I perform medication management services I am often faced with the situation of:

  • limited access to GPs;
  • limited access to allied health professionals;
  • lack of resources to adequately support the health needs of the patient;
  • long distances to travel;
  • poor health literacy; and
  • low income families.

The care of these patients often falls to the community care centre or the domiciliary nursing service as the doctor is only available for short periods of time. Often these communities are without a regular GP.

The employment of a clinical practice pharmacist in the Aboriginal Health Service could provide a significant partner in improving patient health outcomes. The reduction in costs to the Medicare and health system could be measured in areas such as compliance and adherence: improved wound care, chronic disease management and general parameters such as blood pressure and glucose control.

In the budget submission PSA recommends “that the Government consider an adaptation of the PGPIP to enable AHSs across Australia to improve medication adherence and reduce the progression of chronic disease, by utilising clinical pharmacists in the AHS service-mix. This would allow AHSs to access up to $125,000 per year to employ a pharmacist where required, in keeping with the general practice proposal.

The use of culturally responsive clinical pharmacists could improve medication adherence and reduce the progression of chronic disease.”

Areas such as Home Medicine Review, Medscheck and medication adherence programs such as dosage administration aids require different formats when they are being utilised in health programs for Aboriginal people.

There will need to be opportunity within program rules to adapt programs to suit the requirements and needs of the patient cohort. The use of a pharmacist within an AHS who can work with the various members of the health service to develop programs and initiatives to improve the primary health outcomes of the community is paramount to improving the longevity of the patients who use the AHS.

I recommend this document to all Australian pharmacists as it is a blueprint for where the practice of pharmacy could be implemented to gain improvement in patient outcomes while delivering more efficient and cost effective health care.

NACCHO News Alert: Therapeutic drug safety for Indigenous Australians: how do we close the gap?

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A lack of data on the safety of medicines for indigenous Australians is putting their health at risk, experts have told AAP

Writing in the latest Medical Journal of Australia, Dr Tilenka Thynne, from Flinders Medical Centre, and Dr Genevieve Gabb, from the Royal Adelaide Hospital, say the potential for harm is real.

SEE FULL ARTICLE FROM MJA here or below

They say indigenous people can be on therapeutic drugs from a younger age and for longer than the average population.

There are known differences in both drug effectiveness and harm across ethnic groups, say the researchers.

While attention is given to reporting the safety of medications in older people, children, and pregnant and breastfeeding women, there are no specific reporting requirements for ethnic groups, including indigenous Australians.

The median age of the indigenous population is 21.8 years, compared with 37.6 years for non-indigenous Australians.

“A younger group of people are exposed to drugs when starting cardiovascular screening and primary preventive treatment, leading to potentially longer cumulative lifetime exposure,” they write.

Noting the known differences in drug effectiveness and harm across different ethnic groups, they say it may be inappropriate to generalise what little drug safety information is available.

They also noted recent cases of adverse drug reactions in indigenous Australians.

But they acknowledged it would be impractical and expensive to test drugs in indigenous populations before approval by the Therapeutic Goods Administration.

“It is in the post-marketing space that a comprehensive and pro-active approach to addressing drug safety in indigenous Australians is urgently needed,” they said.

“The assessment and management of potential adverse drug reactions should be part of any comprehensive health care program.

“Aboriginal health care workers, like all health care professionals, need training in pharmacovigilance, the principles of drug safety, and the identification and reporting of adverse drug reactions.”

Writing in the latest Medical Journal of Australia, Dr Tilenka Thynne, from Flinders Medical Centre, and Dr Genevieve Gabb, from the Royal Adelaide Hospital, say the potential for harm is real.

Source

In the setting of significant disease burden, lack of data on drug safety for Australia’s Indigenous population is concerning

Indigenous Australians have a high burden of disease and are at increased risk of premature death compared with the general Australian population. Cardiovascular disease accounts for a large proportion of this burden, with high prevalence of type 2 diabetes and chronic renal failure being underlying risk factors.1 Traditional cardiovascular risk calculators underestimate risk in Aboriginals and Torres Strait Islanders. For example, observed numbers of coronary events for Indigenous Australians who live in remote areas are 2.5 times higher than predicted using the Framingham risk calculator, and younger women in this population have 30 times the predicted rate of events.2 While this suggests that solely focusing on management of traditional risk factors may not be the complete answer, this high burden of disease in the Indigenous population can drive recommendations for early and extensive use of medicines.

National guidelines recommend using lower thresholds to screen for and manage cardiovascular risk factors such as hyperlipidaemia in the Aboriginal and Torres Strait Islander population.3 Aggressive primary preventive measures for asymptomatic and young people, including early use of statin therapy, is recommended, despite limited direct evidence regarding efficacy in this population. It is also recognised that there are differences in the lipid profile of Indigenous Australians compared with non-Indigenous Australians, which may influence efficacy of therapies.4

Effective medications have adverse effects. Knowledge regarding drug safety is obtained across the lifecycle of drug use: throughout drug development programs, controlled clinical trials, and post-marketing experience. Drug development programs often do not include Indigenous Australians and few randomised controlled trials have been performed in this population. For many years (since the 1950s), the cornerstone of post-marketing safety has been spontaneously generated reports of adverse drug reactions from health care professionals and consumers. More recently, there has been an increasing focus on proactively investigating drug safety and using risk management plans in the post-marketing phase, rather than simply relying on spontaneously generated reports. Drug sponsors are required to report post-marketing adverse drug events to the Therapeutic Goods Administration (TGA), and certain groups are recognised as requiring special mention and consideration as they are often missing from clinical trials.5 Attention is given to reporting the safety of medications in older people and paediatric populations, and in pregnant and breastfeeding women. However, in Australia, there are no specific reporting requirements for ethnic groups, including Aboriginals and Torres Strait Islanders.

The Australian spontaneous adverse drug reporting system has only included a field to indicate racial status as “ATSI” (on the electronic form, not the paper form) since 2008, but this is not reliably completed (TGA, personal communication, 2013). Risk management plans are generally developed for specific products, rather than specific at-risk populations. Therefore, drug safety in Aboriginals and Torres Strait Islanders does not have a robust evidence base. The potential for harm is real.

In the face of this substantial uncertainty, several things are known.

First, the Australian Indigenous population, while ancient in tradition and culture, is a relatively youthful population in 2015. In 2011, the median age was 21.8 years, compared with 37.6 years for the non-Indigenous population.1 The significance of this is that a younger group of people are exposed to drugs when starting cardiovascular screening and primary preventive treatment, leading to potentially longer cumulative lifetime exposure.

Second, differences in drug response — efficacy and harm — exist in racially and ethnically distinct groups.6 Aboriginals and Torres Strait Islanders are a very diverse population, with over 250 different language groups,2 and it may be inappropriate to generalise what little information we do have with regard to efficacy and safety for the group as a whole. The causes of racial and ethnic differences in drug responses may be multifactorial. Potential intrinsic differences (eg, variation in genetics, metabolism and elimination) and extrinsic factors (eg, diet, environmental exposure and sociocultural factors) may play a role. In cardiovascular medicine, it has been established that African Americans respond poorly to β blockers and angiotensin-converting enzyme (ACE) inhibitors,7,8 and ACE inhibitor-associated angioedema is more prevalent (and possibly more severe) in African Americans than in white people.9 Racial and genetic variation contributes to variation in susceptibility to statin-associated myopathy,10 so lower initial statin drug doses are suggested for patients with Asian ancestry.7

In the past decade, pharmacogenomics has advanced significantly, and moved from an individual candidate gene approach to the use of genome-wide association studies — that is, studies that compare the genomes of those affected by a disorder or drug-induced adverse effect to the genomes of those who are unaffected. Genome-wide association studies have consistently identified common variants in SLCO1B1 (a gene encoding the organic anion-transporting polypeptide OATP1B1, which regulates hepatic uptake of statins) that are strongly associated with an increased risk of statin-induced myopathy.11 The prospective use of genotyping can help avoid adverse pharmacogenomic effects. Genotyping can also prevent classification of whole populations as diverse ethnic groups that are at universally high risk. For example, the Han Chinese have been identified as being at higher risk of Stevens–Johnson syndrome and associated severe toxic epidermal necrolysis when treated with carbamazepine. However, the discovery that HLA-B*1502 carriers are the at-risk group has enabled successful genotype screening and treatment of HLA-B*1502-negative Han Chinese without any instances of Stevens–Johnson syndrome or toxic epidermal necrolysis.12

Third, it is known that harm occurs. In recent years, evidence has emerged from case reports and case series regarding drug safety and adverse drug reactions in Indigenous Australians, and some very significant adverse events from use of marketed medications have been published. Indigenous Australians may be at higher risk of serious, and potentially fatal, statin-associated myotoxicity,1315 particularly in the setting of vitamin D deficiency.14 Recently, three cases of ACE inhibitor-associated angioedema involving airway compromise in Aboriginal Australians were reported.16 A genetic predisposition to a specific adverse drug reaction in the Indigenous population has also been suggested; a shared HLA-B allele was identified in three unrelated Indigenous patients who had severe phenytoin hypersensitivity syndrome, two of whom died.17

The paucity of data on potential adverse drug reactions in the setting of a marked disparity in health standards between Indigenous and non-Indigenous Australians is of great concern. It is time to close the gap in drug safety information for Indigenous Australians. How will this be achieved?

The challenge is made greater by having to carefully balance the significant need for drug safety data while not further disadvantaging Aboriginals and Torres Strait Islanders. It is unrealistic and probably unethical to demand that all drugs be tested in an Aboriginal and Torres Strait Islander population before TGA approval. The financial costs alone would be prohibitive and this would significantly delay the introduction of new medications into the Australian market. This would also place a disproportionate burden on a minority group in terms of drug trial participation.

It is in the post-marketing space that a comprehensive and proactive approach to addressing drug safety in Indigenous Australians is urgently needed. The community as a whole — including health care providers, professional organisations, patients and regulators — needs to recognise the significant lack of drug safety data available for Indigenous Australians and actively participate in promoting safety, including adverse event reporting.

All policies and guidelines promoting the quality use of medicine in the Aboriginal and Torres Strait Islander population must include a robust pharmacovigilance strategy and an acknowledgement of the limitations of drug safety information in this population. The assessment and management of potential adverse drug reactions should be part of any comprehensive health care program. Aboriginal health care workers, like all health care professionals, need training in pharmacovigilance, the principles of drug safety, and the identification and reporting of adverse drug reactions. This should be accompanied by culturally appropriate resources and tools to help them and their patients identify and manage adverse drug reactions. When adverse drug reactions do occur, these should be thoroughly investigated.18 Advances in other industries, typically aviation, have come from engaging with failures and investigating and reviewing bad outcomes.19

The same can be said of drug safety for Aboriginals and Torres Strait Islanders as for pharmacovigilance in general; it is not enough to be “content with an absence of evidence on harms … we need to move to a position where we have evidence of absence of harm”.20

Provenance:
Not commissioned; externally peer reviewed.

NACCHO News Alert : Better access to medicines will help close the gap

 

NACCHO GUILD PBS SIGNING (5)

Chronic diseases are one of the major reasons we still have a gap in life expectancy between Aboriginal and other Australians,” Mr Cooke said.

“Improved access to medicines is critically important if we are to see generational change in the health outcomes of Aboriginal and Torres Strait Islander people.”

NACCHO Chair Matthew Cooke pictured at todays signing with The Pharmacy Guild of Australia National President, George Tambassis.

See copy of signed agreement below

A range of practical changes to Australia’s Pharmaceutical Benefits Scheme will boost the numbers of Aboriginal and Torres Strait Islanders accessing appropriate medicines and help close the health gap between Aboriginal and other Australians.

The National Aboriginal Community Controlled Health Organisation (NACCHO) and the Pharmacy Guild of Australia (The Guild) today released a national Joint Position Paper calling for improvements in the CTG PBS Co-payment measure.

Introduced in 2010, the Closing the Gap Co-Payment measure reduces or removes the patient co-payment for PBS medicines for eligible Aboriginal and Torres Strait Islander patients living with, or at risk of chronic disease.

Some of the key points the position paper raises are the need for the measure to:

  • Link CTG eligibility to the patient’s Medicare Card to improve privacy, and so that the patient is eligible regardless of who the prescriber is or where their medicine is dispensed;
  • Expand the PBS listing to include more common medicines;
  • Include Dose Administration Aids for better management of medicines; and
  • Better communication for patients and health professionals of the CTG Co-payment measure.

NACCHO Chairperson Matthew Cooke said it was important that everything is done to ensure Aboriginal and Torres Strait Islander people have access to appropriate medicines.

“Chronic diseases are one of the major reasons we still have a gap in life expectancy between Aboriginal and other Australians,” Mr Cooke said.

“Improved access to medicines is critically important if we are to see generational change in the health outcomes of Aboriginal and Torres Strait Islander people.”

The Pharmacy Guild of Australia National President, George Tambassis, said it was pleasing that more than 258,000 Aboriginal and Torres Strait Islander patients were accessing the more affordable PBS medicines through the measure but more could be done to ensure greater take up.

“A range of practical enhancements would assist those in remote areas to get better access to the medicines under the scheme and ensure they have access to it wherever they fill their prescriptions. We want this vital scheme to be sufficiently flexible to improve the health of people wherever they live and wherever they travel,” he said.

“These relatively simple improvements will help in the management of chronic disease within the Aboriginal and Torres Strait Islander people.”

The joint position paper can be found at here

Signed Joint Position Paper NACCHO PGOA CTG PBS Co-Payment Measure 28 October 2015

NACCHO Aboriginal Health :Dr Lesley M Russell: Analysis of Indigenous provisions in the 2015-16 Federal Budget

Aboriginal-Mobs

“Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined.  Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs. “

Dr Lesley M Russell Adj Assoc Professor, Menzies Centre for Health Policy University of Sydney

It is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than 3 per cent of its citizens. Research suggests that addressing Aboriginal and Torres Strait Islander health inequality will involve no more than a 1 per cent per annum increase in total health expenditure in Australia over the next ten years. If this funding is committed, then the expenditure required is then likely to decline thereafter.”

Tom Calma, in his role as Aboriginal and Torres Strait Islander Social Justice Commissioner and Race Discrimination Commissioner, pointedly stated in 2008:

Notes

This work does not represent the official views of the Menzies Centre for Health Policy or NACCHO

DOWNLOAD THE FULL REPORT HERE

This analysis looks at the Indigenous provisions in the 2015-16 federal Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where this is possible, by data and information drawn from government agencies, reports and published papers.

Similar analyses from previous budgets are available on the University of Sydney e‐scholarship website.[1]

The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors.

Introduction

The 2015-16 Budget from the Abbott Government has no major announcements on Indigenous issues, and they did not rate a mention in the Treasurer’s budget night speech.

However the Budget is far from benign in its support for Indigenous programs and advocacy groups say   it has failed to undo the damage done  and anxiety caused by funding cuts in last year’s Budget.  Many programs and services must continue to operate with uncertain funding into the future and in the absence of clear strategies and policies from the Abbott Government.

This comes on top of the threat of remote community closures in Western Australia, attempts to weaken protection from racial vilification under the Racial Discrimination Act, and concerns about the implementation of and outcomes from the Indigenous Advancement Strategy (IAS) tendering process.  Indigenous organisations are losing out in the competition for funds to deliver Indigenous programs and services and after last year’s Budget cuts, there is no new funding for key representative groups such as the National Congress of Australia’s First Peoples.

Despite the need and the promises, Commonwealth funding for Indigenous Affairs as a percentage of both total outlays and GDP is in decline. And it is disconcerting to see Indigenous voices and input into decision-making being side-lined.  Indigenous groups and spokespeople have called the government on the absence of real engagement and consultation – something which has long been recognised as the key to failure or success in Indigenous affairs.

In March 2015 the Minister for Indigenous Affairs, Nigel Scullion, took delivery of ‘The Empowered Communities Report’, produced of a group of Indigenous leaders from across Australia brought together by the Jawun Indigenous Partnerships Corporation.  The report outlined ways for Indigenous communities and governments to work together to set priorities and streamline services at a regional level, in line with the Government’s approach. The Minister committed that the Government would consider carefully the report’s recommendations and respond ‘in due course’.  That has yet to happen.

What emerges most strikingly from this year’s Budget analysis is that little has been done over the past twelve months to assess the implications of commissioned reports and reviews, to capitalise on the restructure and realignment of Indigenous programs, to develop promised new policies and to roll them out.  All that has been done to date is to shift responsibility for programs to the Department of Prime Minister and Cabinet and to rebrand programs that may or may not be effective. It’s a policy-free zone, where ad hoc decisions are the norm and budgets continue to be constrained in ways that limit the effectiveness and reach of programs and services.

There are a number of examples where program funding has been provided at the expense of other needed programs – taking $11.5 million from Indigenous Safety and Wellbeing programs to reverse funding cuts to the Indigenous Legal Assistance Program is perhaps the most egregious example.

There are also concerns that proposed changes to mainstream programs such as increased co-payments and safety net threshold in health, reduced Commonwealth funding for public hospitals, increased costs for higher education, and changes to the collection of census data will have a disproportionate impact on Indigenous Australians.

Small wonder then that most Closing the Gap targets remain out of reach and the sector is struggling to keep programs functioning and retain staff.

The inequality gap between Indigenous peoples and other Australians remains wide and has not been progressively reduced. With a significant proportion of Indigenous Australians in younger age groups, and without funded commitments to actions now and into the next several decades to improve their socio-economic status, future demands for services will burgeon.

Implementation of the National Aboriginal and Torres Strait Islander Health Plan

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 was developed to provide an overarching framework which builds links with other major Commonwealth health activities and identifies areas of focus to guide future investment and effort in relation to improving Indigenous health.

On 30 May 2014 the Assistant Minister for Health, Fiona Nash, announced that an Implementation Plan would be developed for this Health Plan.

This was supposed to be available from 1 July 2015 to enable the progressive implementation of the new funding approach for the Indigenous Australian’s Health Program. The new approach will target funds to those regions whose populations experience high health need and population growth. The Budget Papers explicitly mention NACCHO as the nominated community stakeholders along with States/Territories in the development of this mechanism.

At June 2015 Senate Estimates PM&C officials said that the implementation plan was still being developed by DoH in collaboration with the National Health Leadership Forum, AIHW and PM&C. Its release was expected within a ‘short period of time’.

The Close the Gap Campaign Steering Committee believes that the Implementation Plan requires the following essential elements:

  • Set targets to measure progress and outcomes. Target setting is critical to achieving the COAG goals of life expectancy equality and halving the child mortality gap;
  • Develop a model of comprehensive core services across a person’s whole of life including end of life care with a particular focus, but not limited to, maternal and child health, chronic disease, and mental health and social and emotional wellbeing; and which interfaces with other key service sectors including, but not limited to, drug and alcohol, aged care and disability services;
  • Develop workforce, infrastructure, information management and funding strategies based on the core services model;
  • A mapping of regions with relatively poor health outcomes and inadequate services. This will enable the identification of service gaps and the development of capacity building plans, especially for ACCHS, to address these gaps;
  • Identify and eradicate systemic racism within the health system and improve access to and outcomes across primary, secondary and tertiary health care;
  • Ensure that culture is reflected in practical ways throughout Implementation Plan actions as it is central to the health and wellbeing of Aboriginal and Torres Strait Islander people;
  • Include a comprehensive address of the social and cultural determinants of health; and
  • Ensure the development and implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Wellbeing 2014-2019 as a dedicated mental health plan for Aboriginal and Torres Strait Islander peoples, and in coordination with the implementation of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the National Aboriginal and Torres Strait Islander Drug Strategy.
  • Establish partnership arrangements between the Australian Government and state and territory governments and between ACCHS and mainstream services providers at the regional level for the delivery of appropriate health services.

The Health Portfolio Budget Statement says that in n 2015-16, the Government will implement a National Continuous Quality Improvement Framework for Indigenous primary health care through the expansion of the Healthy for Life activity. This will support the delivery of guideline-based primary health care and support improved health outcomes.

Health

There were no specific Indigenous issues included in the Health budget, and there are questions about the future of some programs.

Aboriginal Community Controlled Health Organisations

The Abbott Government has provided $1.4 billion /3 years ($448 million / per year) for Aboriginal Community Controlled Health Organisations (ACCHOs). This will include a 1.5% CPI increase over the 3 year period. NACCHO and Affiliate funding of $18 million is provided for 18 months and in that time DoH will commence a review of NACCHO’s role and function.[2]

NACCHO Budget Analysis HERE

In addition, NACCHO has secured confirmation of an extension of the exemption from Section 19.2  of the Health Insurance Act 1973 which expires on 30 June 2015, which enables ACCHOs to receive financial benefit from Medicare rebates in addition to Government funding.  This extension will be granted until June 2018.

The freeze on MBS rebate indexation will have a significant financial impact on ACCHOs as will any increase in Medicare and PBS co-payments.

Flexible Funds

In combination the 2014-15 and 2015-16 Budgets will cut $500 million / 4 years from 14 of the 16 DoH flexible funds.  There is still no clarity in relation to how these savings are to be achieved, although the Aboriginal and Torres Strait Islander Chronic Disease Fund will not be cut.  However cuts to other funds such as those that support the provision of essential services in rural, regional and remote Australia, that manage responses to communicable diseases and that deliver delivering substance abuse treatment services will affect  Indigenous Australians.

Aboriginal and Torres Strait Islander Chronic Disease Fund

Within the Health portfolio, the Aboriginal and Torres Strait Islander Chronic Disease Fund supports activities to improve the prevention, detection, and management of chronic disease in Indigenous Australians and to contribute to the target of closing the gap in life expectancy. The Fund consolidates 16 existing programs, including the majority of initiatives under the Indigenous Chronic Disease Package, into a single flexible fund. The three priority areas targeted are:

  • Tackling chronic disease risk factors
  • Primary health care services that can deliver
  • Fixing the gaps and improving the patient journey.

The Fund was established in the 2011 Budget and came into operation on 1 July 2011. The funding is $833.27 million / 4 years (from 1 July 2011 to 30 June 2015). The majority of funding has been directly allocated to organisations to support activities under the Fund’s Indigenous Chronic Disease Package programs.

At June 2015 Senate Estimates it was confirmed that most, but not all, of the activities under this fund were continuing.  Local community campaigns and the chronic disease self-management program were named as two programs that were not continued.

Tackling Indigenous Smoking Program

The 2014-15 Budget cut $130 million / 5 years from the Tackling Indigenous Smoking Program, despite the fact that 44% of Indigenous people smoke.    The program was reviewed in 2014 and the DoH website says that this review will “provide the Government with options to ensure the program is being implemented efficiently and in line with the best available evidence. The outcome of the review will inform new funding arrangements from 1 July 2015.” However there were no announcements in the Budget.

The redesigned program was announced on 29 May 2015, but with no increase in funding It is not clear when or if the review of this program, conducted by the University of Canberra, will be released.

Funding in 2014-15 was $46.4 million; this is reduced to $35.3 million in 2015-16.  Staffing levels have also fallen significantly, from 284 FTEs in May 2014 to 194 FTEs in May 2015. There will be further disruption to this important program as current contracts cease at the end of June 2015 and the 49 organisations that deliver the program must go through the IAS Invitation to Apply Process for further funding.  Transitional funding will be available for the next 6 months.

Australian Nurse Family Partnership Program and New Directions: Mothers and Babies Services

In the 2014-15 Budget there was additional funding for a Better Start to Life will improve early childhood outcomes :

  • $54 million expansion, from 2015-16, of New Directions from 85 to 137 sites (52 additional sites overall) to ensure more Indigenous children are able to access effective child and maternal health programs.
  • $40 million expansion, from 2015-16, of the Australian Nurse Family Partnership Program from 3 to 13 sites (10 additional sites overall) to provide targeted support to high needs Indigenous families in areas of identified need.

In 2015 the Australian Nurse Family Partnership Program will grow from three to five sites and New Directions: Mothers and Babies Services will reach an additional 25 services, bringing the total to 110 services, with an enhanced capacity to identify and manage Fetal Alcohol Spectrum Disorder in affected communities

Prevention – Shingles vaccine

The Budget provides for the listing of Zostavax vaccine for the prevention of shingles to be listed on the National Immunisation Program for 70 year olds from 1 November 2016.  This measure includes a 5-years program to provide a catch-up program for people aged 71-79.

There is concern that the 70-79 year old age cohort largely excludes Indigenous people because of their lower life expectancy.

Pharmaceutical Benefits Scheme

Close the Gap PBS Co-payment

This is an ongoing measure and although it was not mentioned in the Budget, it was stated in Senate Estimates that this would continue as currently.

QUMAX Program

The QUMAX program is a quality use of medicines initiative that aims to improve health outcomes for Indigenous people through a range of services provided by participating ACCHO and community pharmacies in rural and urban Australia. It commenced in 2008 as a two year pilot. It was later approved for a transition year outside the 4th Community Pharmacy Agreement and for a further four years under the  5th Community Pharmacy Agreement.

NACCHO and the Pharmacy Guild of Australia have been negotiating 1 year transition funding of QUMAX to enable development of an Implementation Plan under the 6th Community Pharmacy Agreement.  NACCHO will seek to expand QUMAX from 76 services to 134 services.

Medicare

MBS Practice Incentive Program (PIP) Indigenous Health Incentive

This is an ongoing program (although it may be subject to an indexation freeze).  It is expected to be considered as part of the new MBS Review.

Healthy Kids Check

The Budget cut Medicare funding for the Healthy Kids Check, a consultation with a nurse or GP to assess a child’s health and development before they start school, on the basis that this measure is a duplication with existing State and Territory based programs.  NACCHO states that this change will not impact ACCHOs or Indigenous children as ACCHOs can continue to bill health assessments through a separate item (MBS item 715).

Primary care – PHN Funding

The current transition of Medicare Locals (MLs) to Primary Health Networks (PHNs) is proceeding slowly and many details relating to specific programs remain unknown, perhaps even undecided.

To date, 21 of 61 MLs outsource the provision of services for Indigenous Australians directly to ACCHOs. The provision of these services will now move to a competitive commissioning process, leading to concerns about issues such as cultural safety and sensitivity.

The Minister for Health, Sussan Ley,  has advised NACCHO that funding for Complementary Care and Supplementary Services will transition to the PHNs.

Mental Health

The Budget has nothing that responds to the National Mental Health Commission’s review of programs and services. The report describes Indigenous mental health as ‘dire’. It’s a dominant over-arching theme throughout, and there is a recommendation to make Indigenous mental health a national priority and agree an additional COAG Closing the Gap target for mental health.

Despite this, the Government has delayed any action and has established an Expert Reference Group to develop implementation strategies.  There is no Indigenous representation on the Reference Group.

Substance and alcohol abuse  

Alcohol abuse

Alcohol abuse has been identified as a major public health concern among Indigenous people, with serious physical and social consequences. Indigenous Australians between the ages of 35 and 54 are up to eight times more likely to die than their peers, with alcohol abuse the main culprit and alcohol is associated with 40% of male and 30% of female Indigenous suicides.

Fewer Indigenous people drink alcohol than in the wider community, but those who do drink do so at levels harmful to their health. Culturally appropriate intervention approaches are needed and ‘dry zones’ are only seen as stop gap measures.

Cuts made in Flexible Funds affect drug and alcohol programs. Professor Kate Conigrave reports that there are now only 5 dedicated Indigenous drug and alcohol services nationally.

Ice campaign

This Budget commits $20 million / 2 years for a new stage of the National Drugs Campaign primarily aimed at the use of ice. No consultation has been undertaken in the lead up to the announcement of this health promotion campaign.

It almost certainly will not achieve tangible outcomes for Aboriginal people, despite concerns about a growing ice epidemic in remote Indigenous communities.

Opal fuel

There are 123 petrol stations selling Opal fuel in remote parts of Australia but some retailers in the roll-out zones don’t and there are pockets of sniffing near state borders. In December 2014 it was announced that a bulk storage tank for low-aromatic unleaded fuel (LAF or Opal ) is to be installed in northern Australia as part of the  roll-out of OPAL in the fight to curb the problem of petrol sniffing.

DOWNLOAD THE FULL REPORT HERE

REGISTRATIONS FOR 2015 NACCHO AGM and Members meeting NOW OPEN

AGM

 

NACCHO Close the Gap news: AMA and Pharmacy Guild continue to make an important contributions to closing the gap

QUMAX

Community pharmacy continues to make an important contribution to the important national task of closing the gap in life expectancy and health outcomes for Aboriginal and Torres Strait Islander people.

Press release from The Pharmacy Guild

The fact that the Prime Minister, Tony Abbott, reported today that there has been “almost no progress in closing the life expectancy gap” should serve as a call to action to all in the health sector to work towards more effective solutions to this national problem.

DOWNLOAD THE PRIME MINISTERS Closing the GAP report

Community pharmacists have actively implemented the Close the Gap Pharmaceutical Benefits Scheme arrangements since 2010, helping to deliver quality use of medicines to Aboriginal and Torres Strait Islander people. Increased access to the PBS helps improve the prevention and management of chronic disease for Aboriginal and Torres Strait Islander people.

The cost of medicines has been identified as a significant barrier to improved access to medicines for Aboriginal and Torres Strait Islander people. 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.

The Executive Director of the Guild, David Quilty, said: “The Guild has a longstanding and proven history of promoting equal access to pharmacy services that are culturally sensitive and appropriate.

“Additionally, the Guild is committed to the development and application of Quality Use of Medicines strategies to improve the health and health infrastructure for Indigenous people.

“That’s why we joined the ‘Close the Gap’ Campaign Steering Committee, which has called for policy continuity in critical areas of the national effort to close the gap, and also for further steps to build on and strengthen the existing platform,” Mr Quilty said.

For example, the Guild’s pre-Budget submission to the Government highlighted the fact that medication adherence is a particular problem in the Aboriginal and Torres Strait Islander population and a modest, funded medication management program to meet their specific needs would improve health outcomes in a cost effective way.

LEADERSHIP AND PARTNERSHIPS NEEDED TO CLOSE THE GAP : AMA

The AMA today commended the Prime Minister on the personal drive and commitment to improve the lives of Indigenous Australians outlined in his Closing the Gap Report, and welcomed the Government’s new target to end the gap between Indigenous and non-Indigenous school attendance.

The AMA also welcomes today’s release of the Close the Gap Campaign Progress and Priorities Report.

AMA President, Dr Steve Hambleton, said both the PM’s Report and the Close the Gap Campaign Report highlight key areas where there has been success in closing the gap and reflect a shared intent to make a real difference to improving the quality of life and health of Aboriginal peoples and Torres Strait Islanders.

Dr Hambleton said the first priority is for all Australian governments to recommit to the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes for another four years, with current levels of funding.

“The AMA believes that achieving equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples is a national priority,” Dr Hambleton said.

“The Close the Gap Campaign Report provides the Government and stakeholders with independent and informed feedback on how well we as a nation are performing in closing the gap on health inequality.

“The Report makes practical and informed recommendations about what more is needed to achieve health equality.

“These recommendations are made by key Indigenous and non-Indigenous groups, including the AMA, who are directly aware of what is happening or not happening on the ground.

“Importantly, the Report identifies the areas where real needs and real gaps remain to be filled.

“There is evidence of some early successes in closing the gap, particularly reduced smoking rates and maternal and childhood health.

“The AMA welcomes these successes and believes the COAG

National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, with leadership and funding from all governments, can achieve many more successes with the right funding and commitment.

“All government and stakeholders must work together in partnership to achieve these goals.

“As the Prime Minister said today: ‘ Our job is to break the tyranny of low expectations.’”

In order to make a real difference in closing the gap, the AMA believes an implementation framework must be established for the recently-developed National Aboriginal and Torres Strait Islander Health Plan.

This would involve:

  •  the development of a comprehensive set of measurable targets to be achieved over the next 10 years;
  •  the development and implementation of a service model that will effectively and efficiently achieve those targets;
  •  the development and implementation of a national workforce strategy for existing and emerging areas of need in service provision;
  •  the formulation of a funding and resource model commensurate with health care needs and priorities in Aboriginal and Torres Strait Islander populations over the next 10 years; and
  •  clear, measurable requirements for governments to work together in genuine partnership and with the guidance of Indigenous health leaders and Indigenous communities.

Dr Hambleton said the development of this framework should be undertaken by a newly constituted Stakeholder Advisory Group, which would use the experience and expertise of Indigenous and non-Indigenous groups that have first-hand knowledge of what works, what doesn’t work, and what holds promise and is worth pursuing.

“The AMA strongly believes that getting a healthy early start in life is crucial to leading a healthy later life, which will eventually close the gap across generations,” Dr Hambleton said.

“Aboriginal and Torres Strait Islander children are particularly susceptible to risk factors and stressors that can determine poor outcomes later in life and entrench the intergenerational cycle of ill-health.

“Governments need to focus greater funding on evidence-based best-practice programs in early childhood development that are delivering positive outcomes.

“The AMA outlined some of these programs in its recent Report Card on Aboriginal and Torres Strait Islander Health.”

The 2013-14 AMA Report Card on Aboriginal and Torres Strait Islander Health,

The Healthy Early Years – Getting the Right Start in Life, is available at here

NATIONAL CONGRESS Press release

Congress notes the Prime Minister’s focus on school attendance in his first Closing the Gap report and looks forward to the detail of the new Closing the Gap target.
“Congress believes education is a two way relationship – we want to see as much energy and focus on making schools places that our kids want to go and our families trust and genuinely feel a part of,” said Congress Co-Chair Kirstie Parker.
“Local schools and communities need to be supported through good policy at both a state and a national level to help make this happen; attendance will not rise through punitive measures alone.
“The Abbott Government must continue the work done on developing previously announced disability and justice targets in Closing the Gap.
“The over-representation of our peoples in the criminal justice system – at around 12 times the rate of the rest of the Australian population – is both cause and effect for the poor state of health, education and employment of so many of our families and communities.
“Access to disability services is an important determination of outcomes not just in health, but in education, employment justice and housing,” Ms Parker said.
Co-Chair Les Malezer said, “We urge the Government to show leadership in closing the gap by forging a new National Partnership Agreement on Indigenous Health Outcomes with all states and territories on board.
“We also urge it to work in partnership with Aboriginal and Torres Strait Islander community controlled health organisations and others on implementing the National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) and its vision of the Australian health system being free of racism and its recognition of culture as central to the health of our Peoples and communities.
“Racism within the health sector affects access to health services -our members tell us and this was also confirmed in national NATSIHP consultations.
“Now is the time for the Abbott Government to walk the talk to continue the strong bipartisan support to close the Aboriginal and Torres Strait Islander health and life expectancy gap by 2030,” Mr Malezer said

NACCHO Aboriginal health news : Aboriginal’s in more remote areas would like to ‘take their medicine’

QUMAX

” Many Aboriginal people in remote areas access medicines through Section 100 arrangements but there is often insufficient professional pharmacist advice provided in these settings.

Better funding could allow greater access for these vulnerable Australians to professional pharmacy services the rest of us take for granted.”

The National Rural Health Alliance has published a Discussion Paper about the relatively poor access to medicines and pharmaceutical advice available to people in rural and remote areas.

DOWNLOAD THE NRHA 2014 DISCUSSION PAPER HERE

FOR MORE INFO ABOUT NACCHO QUMAX PROGRAM

Tim Kelly, Chairperson of the Alliance, described the situation as an important healthcare deficit which has received insufficient attention – but one that could be resolved with some simple and low-cost changes to programs and regulations.

“The new paper demonstrates the extent to which people in Australia’s rural and remote areas have poorer access to prescribed and non-prescribed medicines, less advice about the use of medicines, and poorer access to professional pharmacy services,” Dr Kelly said.

“As with so many other issues in the rural and remote health sector, there is a gradient of deficit as one moves from major cities through regional areas to remote and very remote places. Our Discussion Paper explores these issues and begins scoping for a project which could advise Australian governments on the best ways to improve the situation.”

The paper describes how and where people access medicines and considers the bottlenecks and inefficiencies that need to be addressed.

Reimbursement through the Pharmaceutical Benefits Scheme (PBS) is the main means by which the Australian Government funds access to medicines and there should be action to bolster the supply of pharmacists (and the services they provide) to rural and remote areas of Australia. For instance there could be scholarships for pharmacy students from rural areas and increased incentives for rural pharmacists to provide training opportunities for pharmacy interns.

The Alliance proposes the investigation of ways to simplify medication prescribing and dispensing legislation and evaluate how such things as pharmacy outposts and telepharmacy can allow more equitable access. Small rural hospitals often do not have the capacity to employ a pharmacist, but they could if the role also provided professional support to local Aboriginal Health Services and professional medicines reviews in the community.

People living outside major cities also have poorer access to advice related to medicines, and this has implications for both the safety of patients and for the effectiveness of their medications. There should be better integration of various programs already in place for the provision of medicines and pharmaceutical advice. By prioritising Quality Use of Medicine initiatives, the government could better manage and reduce chronic disease in rural and remote areas.

Many Aboriginal people in remote areas access medicines through Section 100 arrangements but there is often insufficient professional pharmacist advice provided in these settings. Better funding could allow greater access for these vulnerable Australians to professional pharmacy services the rest of us take for granted.

The Alliance is calling for action on this issue and for further investigation of potential solutions. It is time to ensure that people in rural and remote Australia receive the same level of health care as those in the major cities, including access to medicines.

NACCHO health conference alert: Health Workforce National Conference to discuss Close the Gap initiatives and supporting workforce

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National initiatives to close the gap in Aboriginal and Torres Strait Islander life expectancy and to build the supporting health workforce will be discussed and debated at Health Workforce Australia’s (HWA) 2013 national conference in November.

Information and registrations here

The life expectancy of Aboriginal and Torres Strait Islander people is more than 10 years less than other Australians. In 2008, the Council of Australian Governments (COAG) agreed to close the gap in life expectancy within a generation by 2031.

This commitment affects all health professionals and the way care is provided.

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Greg Craven, Deputy Chair of the COAG Reform Council and Adrian Carson (pictured above ), Chief Executive Officer of the Institute for Urban Indigenous Health, will take part in a panel discussion at HWA’s conference, Skilled and Flexible – The health workforce for Australia’s future.

The session will feature a discussion on the progress made to improve health outcomes to close this gap and how Australia is tracking against its commitment. Mr Craven will also focus on flexible service delivery and funding.

“Any effort to close the gap must acknowledge that Aboriginal and Torres Strait Islander Health Workers make an invaluable contribution,” HWA Acting Chief Executive Ian Crettenden said.

“They are often the first point of contact because Aboriginal and Torres Strait Islander people find it easier to access healthcare services from someone who they can relate to, who understands them and their culture.”

Janine Headshot

Romlie Mokak, Chief Executive of the Australian Indigenous Doctor’s Association, and Janine Milera (pictured above) , Chief Executive of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, will reveal initiatives underway to help increase the numbers of Aboriginal and Torres Strait Islander health professionals in the Australian health workforce.

Murra Mullangari – Pathways Alive and Well is a national Aboriginal and Torres Strait Islander health careers development program, established by the Australian Indigenous Doctors’ Association to encourage Indigenous senior secondary school students to remain in school and pursue health careers.

Ms Milera will describe initiatives to overcome the challenge of many Aboriginal and Torres Strait Islander people being uncomfortable using mainstream healthcare services.

More than 50 local and international speakers will explore the latest ideas on leadership, innovation and workforce reform at the event at the Adelaide Convention Centre from 18 to 20 November.

Registrations are now open for this year’s conference.

Concession tickets cost $350 and full price tickets are $600.

To attend the conference and find out more visit www.hwa.gov.au/2013conference

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