CURRENT PROGRAMS AND PROJECTS

Diabetes

This is the Divisions flagship consumer-based program which primarily operates in the towns of Innisfail/Tully, Mareeba/Kuranda, Mossman/Port Douglas. The program represents a model of shared care that targets people with non-insulin dependent diabetes, but also includes insulin dependent diabetes management and gestational diabetes. It employs two diabetes educators to support GPs with their management of diabetes clients. People with diabetes are referred to the educators by the practitioners. Once seen by the educator, a person has access to other allied health personnel including a dietician and a podiatrist. The educators work according to the nationally adopted clinical management guidelines for diabetes and the program encourages GPs to adopt the guidelines. The program has sponsored two indigenous health workers to complete a diabetes educators course and is looking towards repeating this in the next year. The program is part of a regional diabetes strategy and program personnel, including the Program Coordinator and GP manager, are on the Far North Queensland Diabetes Working Party. This sets the direction for diabetes in the region and links the Division's program into the Cairns Diabetes Centre, the Cairns Division of General Practice, Indigenous Health, Queensland Health and other stakeholders. A pilot program running for 12 months,in partnership with Queensland Health, is the Retinopathy Screening Program. This program will screen clientsacross the FNQ region for eye problems associated with diabetes. There has been the introduction of a national database on diabetes, NDOW, which is reliant on diabetes educators completing a pro-forma on each client, and will be used as a tool for epidemiology.

Retinopathy Program

The Retinopathy Screening Program is a pilot project funded by Queensland Health and the Division is managing the project. The aim is to target all people with diabetes in the Tableland Health District and develop and implement care pathways at a community level so that early detection of retinopathy can reduce the progression of visual impairment. Another important goal is to assist GPs in identifying and recalling their patients with diabetes on a regular basis and to involve practice staff in accessing other diabetes heath providers. A mobile clinic is visiting GPs, hospitals and AMS services on the tableland offering a comprehensive retinal screen (via a non-mydriatic camera) in conjunction with a diabetes complications screen and minimum intervention with 2 diabetes educators. The program is also travelling to the remote areas of Georgetown, Croydon and Forsayth. The visiting team includes a retinal camera operator, an administrative person, and two diabetes educators. Nursing updates in diabetes are being held across the Tablelands. Upskilling for GPs in both Diabetes Management systems and Retinal screening is also a part of this program.

Cardiac Rehabilitation

The Division's Cardiac Rehabilitation programs are an innovative partnership with local District Health Authorities. Participants are referred to Phase II and Phase III components by their GP. The six week Phase II cycle is run alternately at the Atherton, Mareeba and more recently Innisfail Hospitals. Six three-hour-per-week sessions are held featuring a selection of presenters including general practitioners, physiotherapists, dieticians, occupational therapists, social workers and pharmacists. As an adjunct to the Phase II component, the Phase III (walking) component operates in Atherton and Mareeba. Like the Phase II component the walking program is based on the Australian Cardiac Rehabilitation Association's recommended model. The walking program has a focus that extends beyond those people who have completed Phase II; it accommodates all people who have an interest in participating in a regular walking program and has the support of the local council. The Division will soon be offering an outreach program for people who are unable, for geographical reasons, to attend a group program.

Health Promotion

The Division's health promotion program involves a multi-strategy approach to promote awareness and information on all aspects of health. GP members include both public and private doctors including the RFDS and therefore a wide range of CME education and professional development is developed and presented across the Division area. Accreditation liaison is a new area for the health promotion program and aims to provide support for GPs in this area. Presently the program is investigating the development of a diverse range of presentation kits to be utilised by GPs in giving community presentations on health promotion. The Health Promotion program has become increasingly integrated across all division programs and links with numerous community programs and agencies. This in turn provides for opportunities to support GPs and clients with education and promotion of health issues - from immunisation, zoonoses, CVD, mental health, injury prevention, first aid, mens health etc. The program targets community areas across Far North Queensland, farmers, their families and farm workers and the wider community. It has events and activities tailored for adults and children on diverse topics promoting health awareness and education. Working in with other organisations such as Workplace Health & Safety and Farmsafe Qld the Division provides ongoing Farm Safety Demonstration Days for primary school students. A range of topics and events are organised for adults. Events include field demonstration days, shed talks and workshops, health promotion days and activities and publication of a regular health promotion newsletter. There have been school visits, healthy heart days, involvement in a number of community groups and organisations and presentations at conferences, schools, forums and membership of the FARM Alliance.

Multicultural Project

The Multicultural Project is funded under the Multicultural Affairs Department, and is managed within the Health Promotion Program. Over 12 months the project is running a series of six workshops in the Mareeba/Dimbulah areas where there is a large multicultural population with a significant proportion being over the age of 65 years. Interepreters are to be available during the workshops to enable clear understanding of the information being presented which will also involve an interactive component to answer queries and assist with problem areas as they are identified. Proposed topics to date are: Diabetes, Farm Safety/Health Promotion, Cardiac Rehabilitation, Continence, Dementia and Suicide.

The Division is facilitating the services of a GP and an allied health worker to be in attendance for each workshop to discuss and educate attendees on the various topics. Also taking part to date are Tableland Aged Care Service, St Johns Community Care, Rural and Remote Home Care Services and the Queensland Council of Carers. As part of the project health service information in the form of posters and leaflets/flyers is being translated from English into six different languages: Croation, Italian, Spanish, German, Fillipino and Albanian to promote available health and allied services that are available in the Far North Queensland area. A quarterly newsletter is being published and translated into the chosen languages and this provides further updated information on aged care services and activities as well as special events.

Immunisation

The Division is engaged in two collaborative immunisation programs. One is acollaborative agreement between the Division, two shire councils and Queensland Healths Tablelands Health District and Tropical Public Health Unit. The other is a collaborative agreement between the Division, Tropical Public Health Unit, Aboriginal Medical Services and Queensland Health. Both programs bridge the traditional divide between public and private immunisation initiatives in Queensland. Through the collaborative programs, immunisation coordinators liaise with GPs and complement the General Practice Immunisation Incentives program. A system of active follow up of defaulters seeks to improve the immunisation status of children especially those two years of age or younger. VIVAS is the Tropical Public Health Unit database that tracks inmmunisation through Far North Queensland to improve immunisation rates. ACIR is the Health Insurance Commission database that tracks immunisation to link with Family Payments. Recently additional funds were provided for an educationprogram for GPs and the public regarding immunisation issues, including the revised immunisation handbook and schedules.

Mental Health

This program is a recent addition having been initiated in early 1999. The Division has been successful in obtaining funding for a Mental Health Integration and Quality Program. A model of integration between GPs and regional mental health services is being developed. This is occurring through the combination of educational and service measures utilising a Program Coordinator who, in consultation with all stakeholders, is establishing protocols for tracking patient care, advocating integrated services and establishing links and networks between GPs, mental health services, clients and support groups.

The Enhanced Primary Care initiative has been actively promoted through the Mental Health Program initially with workshops focusing on GPs, Allied Health, Practice Staff and Consumer Groups/Carers. Further promotion and education on the MBS items will continue to be developed through the Health Promotion Program.

Information Management and Information Technology

A working group for this area has been formed recently and has surveyed GPs regarding their needs and how the division can best support them. A Practice Accreditation workshop was held in early July and further support will be offered in this area in the future in the form of a secure email system, assistance with email establishment.

Indigenous Health

All of the clinical health programs are designed with the indigenous population in mind and the division has undertaken the sponsorship of two indigenous health workers who have now completed their course and qualified as diabetes educators. Currently the division is looking to undertake such a sponsorship again as the two educators continue to work and assist with the diabetes and retinopathy program and Diabetes Centre.

Consumer Advisory Group

Consumer input and feedback is very important to the Division and to its GP membership. In 1993 the Division conducted a widespread and very intensive consumer Needs Assessment. People from all walks of life and from all of the Division's geographical areas were interviewed about their perceptions of all health services offered and their growing needs. As a result of this assessment a detailed report was forwarded to the Minister for Health and distributed widely amongst health service providers. The Consumer Advisory Group continues to provide valuable input and advice to the division through regular meetings and contact and the provision to be involved in management committee meetings as needs or issues arise.