CURRENT PROGRAMS AND PROJECTS

Governance, management, administration and planning

This program includes ongoing monitoring of the Division's governance and management, staff needs and performance and regular financial reporting to ensure an effective and efficient Division. The aim is to operate an effective and efficient Division. The Division was one of the pilot Divisions for Outcomes Based Funding. They have established the Macarthur Division of General Practice Agreement 1999 based on the Private Hospital Nurses Award, and developed a Corporate and Management Manual.

Barriers to the success to the program are mainly a lack of resources in the Divisional area. For example:

• Lack of publicly provided diabetes services; and
• public and private mental health services
• Poor cardiovascular services
• High proportion of GPs bulk billing making it harder to obtain GP time
• Low level of GP computerisation

Continuing Medical Education

The Division organises the Continuing Medical Education (CME) program for Campbelltown and provides support for the Camden CME program that is organised by the local GPs. Other services to GPs are also provided as needs arise. Currently, this includes a practice staff training program. The aim is to increase GP knowledge and skills and to provide relevant services to GPs

There have been two monthly CME programs for GPs in Camden and Campbelltown, the Division has also developed and implemented a practice staff training program. However there have been problems with many GPs not using CME provided by the Division. The Division feels they need to look at the preferred ways GPs gain their CME points.

Information Technology

The Division implements a multi-strategic approach that includes education, assistance and technical advice to practices, a mentor program and ongoing development of information technology solutions at the local level. The aim of the program is to increase the use of information technology in general practice. Achievements have included;

• Collected baseline data on GP use of computers and practice computerisation: 43% of GPs responded they used computers for clinical purposes. However, only 18% used computerised medical records many times daily.
• The provision of technical advice and support for practice computerisation and a help desk facility.
• The Division provides, through TAFE, computer training in basic computer skills and internet and email.
• The Division has developed its own web site at www.acenet.com.au/~macdivgp

Services provided:

• Technical advice, installation, support and maintenance of computers, networks and software etc., provided by a contractor
• Mentor service provided by GPs from computerised practices
• Computer education in basic skills and internet and email through TAFE
• Monthly education sessions on clinical software

Several issues have arisen relating to the program, it seems the technical advice and help desk facility provided by the Division to GPs through a contractor is not well used by practices. One of the barriers to GP uptake of information technology is that there are often more efficient ways to do a task without computers.

Over the next year the Division intends to establish a secure internet link between GPs, the Division, the South West Sydney AHS, specialists, pathologists and other diagnostic services. The Division will also be investigating electronic transfer of clinical information for diabetes, CVD and antenatal care between GPs and the Division for diabetes and between GPs and the hospital for the others.

Special Projects 1

This program is composed of a variety of short term projects

Cardiovascular Disease (CVD): The Division has been involved in a review of CVD secondary risk prevention services. It is hoped that this will lead to the Macarthur Health Service improving these services. Once improved, the Division will implement a CVD program. The Division wants to improve CVD care in general practice. The Division has completed a needs assessment of secondary CVD services and presented it to the Macarthur Health Service (MHS). A number of recommendations were made and are being addressed by the Health Service.

GP/hospital communication: The Division has been working with the Macarthur Health Service to implement timely and appropriate patient transfer reports. By the end of this year a priority system for transfer reports will be in place.

In the short term it is expected that DOCFAX will be implemented. Through the program the Division wishes to improve communication between the hospital and GPs. Much of this has been achieved by an ongoing partnership with the Macarthur Health Service.

Indigenous Primary Health Care: This innovative funded project is a partnership between the Division, Tharawal Aboriginal Corporation and the Macarthur Health Service. The project will determine if there are barriers to Aboriginal people accessing GP services. Strategies will then be implemented along with a service agreement to better meet indigenous primary health care needs. The aim of the program is to increase access to appropriate primary health care services by the urban indigenous community.

Funding for this was achieved through the Innovative Funding pool in 1999. A study of practice receptionists to determine the service provided to Aboriginals has been completed as part of the project. Four other studies are planned. Information on this project and results can be accessed via the internet at http://fohweb.macarthur.uws.edu.au/choir/Tharawal.htm

Chronic Care: A proposal to the Commonwealth for chronic care is planned.

Disadvantaged Community Project: The Division is supporting this pilot project being administered by the Academic General Practice Unit (UNSW) that involves a community nurse based at a practice in the suburb of Claymore. The aim is to improve the health care of a disadvantaged community.

Special Projects 2

This program is composed of a variety of short term projects:

Immunisation: This program is designed to support GPs with a number of issues related to immunisation, particularly the Schedule, cold chain monitoring, ACIR data and new vaccines. Academic visits are part of the program. A clinical audit has also been developed. The aim is to increase the rate of age appropriately immunised children. The program has seen the Division's rate of immunisation increase by 7% since the program began in 1998. As of February 2000 it was 79.6%. Solid partnerships have also been established with the Public Health Unit and Macarthur Health Service, and all practices have had academic visits. The Division has experienced problems with the reliability and validity of ACIR data. However, this issue is gradually reducing. Another barrier is parental understanding of immunisation.

Domestic violence: The Division is working with the Benevolent Society to develop strategies that build on the flip chart that was previously produced to assist GPs with the management of patients suffering domestic violence. The aim is to improve GP management of women suffering domestic violence

Smoking reduction: A program aimed at reducing the rate of smoking, particularly in females. The Division will develop a health promotion strategy targeting smoking reduction in the next financial year.

QA and practice accreditation: The Division supports practice accreditation, assists practices in their understanding of the entry standards and provides resources and forums. The main aim of the program is to foster achievable levels of accreditation. About 33% of practices are registered for accreditation. Three practices have been accredited. The Division provides information and practice visits to assist with accreditation.

Sterile Supply Service: The Division has established an agreement with the Macarthur Health Service to provide a Sterile Supply Service to practices.

Asthma: The Division will develop a plan to address the management of asthma patients in the next financial year.

The main aim will be to improve the management of asthma patients particularly those 0 to14 years.

Enhanced Primary Care (EPC): This is in the planning stage. The Division and the Academic General Practice Unit are conducting a survey of GPs to identify resource that may be required to support case conferencing and care planning. The primary aim will be to educate GPs on the EPC package

Antenatal Shared Care

The Division works closely with GPs, the Macarthur Health Service and other Antenatal Shared Care Programs in SWS to provide effective antenatal shared care. A partnership with the Tharawal Aboriginal Corporation and the Macarthur Health Service has also been established to improve indigenous antenatal care. The main aim of the program is to improve antenatal shared care, so far 48 GPs have been accredited.

The Division will implement a database to improve communication and monitor antenatal care - similar to that implemented by the Illawarra DGP.

Healthy Eating and Activity

This health promotion initiative, that GPs refer patients to, involves Healthy Eating and Activity Groups that focus on behaviour modification and encourage participants to make long-term lifestyle changes to eating behaviours and activity levels. Four two hour sessions combine nutrition, physical activity and psychology. A one hour medical lecture is facilitated by a GP. The program takes a "no diet" approach to long term weight management. Clients are reviewed at three months by the Program Coordinator and then by the GP at nine months. The CARDIAB database is used to monitor clients. Education and information is also provided to GPs.

The aim of the program is to reduce overweight and obesity and increase physical activity, particularly in patients who are at risk of CVD, have had a CVD episode or have diabetes. As of May 2000, 117 patients were registered by 31 GPs. The Division provided a group education program for patients, as well as education and information for GPs.

Barriers to the program are that the clients involved come from a long history of dieting and possess many misconceptions regarding weight loss and healthy eating principles. They often come to the group with unrealistic weight goals and expectations that need to be addressed early.

Attendance at the three-month review session has also been poor, the Division is currently looking at ways to improve this. The Division is investigating ways for greater GP involvement and supervision of client progress and weight loss. They are also investigating strategies to address childhood obesity.

Mental Health

This program is in its development stage. Currently, the main focus is on developing a stronger partnership with the Mental Health Service. A GP mental health program is also to be developed. The aim of the program is to improve the management of mental health patients with a particular focus on depression, suicide prevention, anxiety disorders and drug and alcohol addiction. As well as improving the mental health of GPs.

Achievements have been; establishing some communication with the Mental Health Service and the establishment of a partnership with the Drug and Alcohol Service

The Division has found that GPs are dissatisfied with the Mental Health Service. Overcoming this barrier will require a strong partnership with the Mental Health Service.

Diabetes Education and Management

This program provides ongoing monitoring and review of GP diabetes management and targeted support for high risk cases through the CARDIAB database. It provides education and support to GPs and patient assessment and group education. The Division works closely with the Macarthur Health Service to implement a more shared approach to diabetes care. It also supports the Tharawal Aboriginal Corporation in providing diabetes screening and care to the indigenous community.

The aim is to improve the management of patients with diabetes, there are 1249 patients registered in the program and 77 GPs are participating. The data collected has shown an improving trend in guideline observance by GPs.

The Division has also established a diabetes screening program for the Aboriginal community in partnership with Tharawal Aboriginal Corporation, and developed the CARDIAB database with Intouch Consultancy, The Heart Foundation, the Integration SERU and the Pharmaceutical Alliance. This is now used by many Divisions across Australia to monitor diabetes and CVD care.

Services provided by the Division include; Diabetes education and assessment, targeted support for high risk cases, diabetes education and information to GPs, support to Tharawal Aboriginal Corporation, and advice to Macarthur Health Service on diabetes care.

The program helps GPs and patients referred to the program. The Division is having difficulty employing a full-time Diabetes Educator to coordinate the program. The program has been without a full-time coordinator since November 1999. Also the Division has taken a step back in its involvement at Tharawal in order for them to take the leading role. This is working very well.

Musculo-skeletal program

A needs assessment identified that chronic musculo-skeletal conditions were the second most commonly identified condition for patients consulting GPs and that the management of patients with a musculo-skeletal condition was a priority for GPs.

This program was established to assist patients with a chronic musculo-skeletal condition to better manage their daily activities, to assist GPs to better manage this patient group, to link GPs with local services/ agencies and to provide group education on pain management, focussing on the principles of self management.

Other aims include improving the management of patients with chronic and disabling musculo-skeletal conditions, and trying to increase access to driver assessment and retraining for disabled persons.

Achievements of the program:

• Effective partnerships established with allied health, community health, Campbelltown Hospital, community groups and the University of Western Sydney
• 134 patients referred to the program by 34 GPs
• 54 people have attended groups
• 7 groups have been implemented.
• Only a small number of patients have been reviewed after three months. Those who have been reviewed show encouraging results. as shown below:

Services provided by the Division include Occupational Therapy and Physiotherapy assessment and case conferencing with the GP. A group education program of five sessions addressing stress management & relaxation, pain management and communication, exercise, problem solving, work simplification, energy conservation, community resources and nutrition & medication. As well as education and information to GPs. The program has help patients with a chronic musculo-skeletal condition.

The Division has found that it is difficult to collect post program data (todate: 28 patients contacted, 16 returned data) and information returned is often incomplete. Results are subjective, and data collection relies heavily on good literacy skills, thereby potentially eliminating patients from NESB and poor literacy backgrounds. It is also time

 consuming and often a low priority to complete. We are reviewing the information we collect and the way it is collected. The division is considering establishing a database to monitor patient outcomes and to recall patients.

Aged Care

This program is based on the Southern Highlands Division of General Practice's Aged Care Program. It includes the provision of education and resources to GPs, patients and the community. The aim is to reduce the incidence and risk of falls in older people.

Achievements of the Division have been, the development of a falls prevention management flip chart, which will soon be distributed to all GPs. Partnerships have also been established with Rehabilitation and Aged Care Services, a local nursing home and GPs to address issues of aged care in Macarthur. The Division provides GP resources for falls prevention, as well as a forum to discuss aged care issues in Macarthur. The Division has found that a lack of resources in Aged Care Services to implement a community based Falls Prevention Education Program is a barrier.

GP After Hours Service

The Division is providing support to this service operated through a separate company. The service began operation in May, 2000 The aim is to have a successful GP After Hours Service. It is now operating at the Campbelltown Hospital. So far the utilisation of the service has been low.

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