CURRENT PROGRAMS AND PROJECTS

Information Management and Information Technology

The program started February 1999, and centralises around the promotion of Information Management and Information Technology (IM/IT) in General Practice. The program also aims to assist GPs in the uptake of IM/IT, and liaison with GPs with regards to IM/IT related matters. The program is an independent avenue for GP's to ulitilise to further the advantages of the implementation of IM/IT.

The aim of the Division is to increase computerisation implementation levels of GPs and practice staff, to continue IM/IT education, to continue liaison with health services and other health professionals to increase the electronic communication levels between themselves and GPs, and continued medical software evaluation service.

Achievements of the program include:

• Establishment of a GP IM/IT education plan.
• Establishment of a Division website.
• Increased level of practice computerisation (current rate 65%, 15% increase).
• Establishment of an internet and email access solution for GPs.
• Establishment of a IM/IT consulting service for GPs.
• Ongoing GP IM/IT promotion via the distribution of email, brochures, website etc..

Barriers and perspectives are funding, time constraints, equity of services, and the lack of willingness to uptake IM/IT.

Immunisation Project

Funded through the GPII, this project recognises the central role GPs play in providing childhood immunisation. It promotes financial incentives for GPs to monitor, promote and provide age appropriate immunisation. Immunisation project strategies include practice visits detailing statements and calculations from the ACIR, promoting best practice and cold chain maintenance, assisting GPs with ACIR report interpretation, developing resources and disseminating information and education. The aim of the program is to increase age appropriate Childhood Immunisation rates. Achievements include:

• Current rate 77.5% (increase of 8.5%).
• Established online access to the ACIR.
• Monitor and disseminate local GP's rates.
• GP's registered with GPII 90% (increase of 28%).
• Established support and disseminate resources to GP's 100%.
• Cold Chain monitoring 32%.
• Production of television commercial and community announcement aired in the local area.
• Ongoing media promotion in local print media and radio.
• Immunisation update conducted to coincide with the new ASVS.

A barrier to the success of the project has been that there is significant number of 'alternate' population that does not ascribe to traditional immunisation. There is also the need to improve communication and focus on Informed Consent as well as maintaining a positive media profile.

Enhanced Primary Care

The 1999-2000 Federal Budget included a major package of initiatives to Enhance Primary Care (EPC), particularly for older Australians, people with chronic illnesses, and people who require a range of different services to support them in the community.

Aims of the program include trying to achieve better health care and health outcomes for the elderly, older indigenous Australians and those with complex care needs. To ensure that by the Year 2002, every GP will have the opportunity to undertake education associated with the new EPC Medicare items. The program has seen an increased uptake of EPC Medicare items and has raised awareness of new item numbers.

The Division provides education and information to GPs, Local Area Health Services and other health Professionals. The program has experienced difficulty in the program with the geographical size of the Division and the time constraints on GPs.

Attention Deficit Hyperactivity Disorder

The MNCDGP recognised a varied understanding of Attention Deficit Hyperactivity Disorder (ADHD/ADD) amongst GPS and school teachers. It was hypothesized that a collaborative case conference model would allow health and education professionals to meet with parents to jointly coordinate management of the ADHD child. GPs interested in ADHD nominated schools invite parents of children diagnosed with ADHD to participate. A reference team consisting of a GP, speech pathologist and project officer meet with the parent(s) and class teacher of the child. An audit of previous investigations occurs at the first case conference and recommendations of management result.

The main goal of the program was the implementation of a case conference model promoting a collaborative and multidisciplinary approach to the treatment of ADHD. As a result, 52 children with ADHD have been discussed.

44% displayed speech/language disorders, 26% needed interventions not previously identified, and 80% of parents reported social skills deficits. Services provided by the Division include; multisciplinary team services provided including GPs, teachers, speech pathologists and psychologists.

GPs have much to contribute to the active management of ADHD,but are often excluded. Teachers and GPs are ideally placed to identify children out of step with their peers. GPs need to be aware of the increasing role of speech pathology in the identification and management of learning difficulties. Increased understanding of the diagnosis sometimes leads to further diagnosis within the family. The importance of a multidisciplinary team approach is highlighted.

Melanoma

This project is designed to identify people with melanomas at an early stage. Early detection represents over a 99% cure rate. The program is designed to engage in limited population screening programs during the summer season and involve as many of the Divisional GPs as possible. It has an agenda which is concerned with GP Upskilling in both diagnosis and treatment of melanoma. It also looks to educate the community to adopt solar protective behaviours and the early detection of melanoma in the community by promoting screening of patients by GPs and community skin cancer screening campaigns.

The main aim of the project is to reduce the incidence of melanoma on the Mid North Coast of NSW. As a result of the project, approximately 1 000 people are screened each year with two to three people detected and treated with melanomas.

The Division provides community screening campaigns, CME events for GPs focusing on dermatology, Community Education, and the education of Health and Beauty workers in melanoma identification and referral. The only barrier is that the project sustainability is dependent on funding and GP interest.

Quit for CATS (Chronically Addicted Tobacco Smokers)

Quit for CATS is a local GP initiative to help people minimize the harm done by their tobacco habit. The program consists of three sessions of three hours each, held over one month. A GP facilitator and assistant lead each session, which involves group and individual activities. A three month follow up meeting and questionnaire and six month questionnaire complete the program. The activities aim to provide people with knowledge and skills they can use when they reach the right stage to quit smoking.

The Division aims to promote the hazards of tobacco consumption and to assist addicted smokers to reduce tobacco intake, as well as promote GP involvement in the project through patient referral and follow up. As a result of the incentive, 40% of persons completing the Quit for CATS program report they have quit smoking, and approximately 90% report secondary gains in self esteem and control relating to general life management. There has also been significant involvement of Division GPs in Anti-Smoking CME activities.

Adolescent Health Asthma Project

The project has adopted the Triple AAA program developed by the NSW Primary Health Research Unit and has been modified to suit local needs. The project is designed to engage GPs in educating senior school children to become peer reference support for other students to promote effective Asthma Management.

The aims of the Division are to increase the knowledge and understanding of asthma issues amongst adolescents, increase compliance with treatment regimes among adolescents, enhance the relationship between GPs and adolescents, and update GPS in recent asthma management through CME activities.

The main achievements of the program have been the involvement of schools within the Division in promoting effective asthma management amongst adolescents. Also, the development and implementation of a Pilot Program, and the education of senior school students and school staff in providing peer support for students to effectively manage asthma.

A program such as this helps those adolescents who do not comply with asthma treatment programs. However the Division has found that the co-peration of schools and large student groups has proven difficult

Post Natal Depression Support

The project targets support for women with babies who may be experiencing post-natal distress/depression. The project promotes close liaison with Division GPs in the management of their patients experiencing post-natal depression, as well as working with other health professionals. The project also facilitates education sessions with

GPs in identifying and caring for this group of patients.

The project aims to improve the quality of care to patients at risk of, or already experiencing, depression. A Post Natal Support Group has been formed and facilitated by a project officer on a fortnightly basis. The Division also provides support services to women at risk, or experiencing, Post Natal Depression (PND), and their families.

Farm Safety

The aim of the Farm Saftey project is to reduce the incidence of farm accidents. The project introduces safety measures to primary school children. The project takes primary school children through a number of training units delivered by Division GPs and other professionals related to farm safety. The project is implemented by conducting demonstration field days. There have been nine schools involved in the project.

Education, community and GP partnerships have been developed in providing farm safety education to children.

The only barrier is being able to sustain the project through funding, as well as sustaining interest and involvement of stakeholders.

Cervical Screening

This project is designed to encourage women who have not had a screen pap test in the last year to come forward and attend a screening test. Incentives have been utilised to encourage women presenting for screening. The program promotes GP involvement to refer eligible patients for screening. As a result, a significant number of women eligible for cervical screening have accessed the program.

The main aims of the program are for an early detection of preventable cervical cancer, to demonstrate and increase the amount of women presenting for cervical screening, and to promote the availability of screening programs to women in the community.

Cardiovascular Disease

The project is designed to involve the community in activities to reduce Cardiovascular Disease (CVD) risk factors. The project particularly promotes the use of a physical activity prescription pad for GPs to encourage patients to undertake safe physical activity. The project also involves Division GPs in delivering educational activities to the community on smoking and diabetes management. The project involves collaboration with the Mid North Coast Area Health Coronary Care Rehabilitation Unit.

The main aim is to reduce the prevalence of CVD risk factors in the community focusing on obesity, inactivity, smoking and diabetes. Achievements include: Activity Prescription Pads distributed to all Division GPs, Physical Activity and Smoking Cessation programs. The Division provides smoking cessation programs available for GP patients, CME activities and educational events for GPs, as well as a Diabetes Services Directory.

Youth Health

The Youth Health program is designed to elicit from senior school students and teachers specific health issues and concerns. The program utilises this information to educate and prepare GPs to present education to school students on relevant health issues. The project aims to identify barriers for youth to access GP health services, and address these issues with young people.

All schools in the Division have indicated a willingness to participate in the project and schools serviced by the program have described it as a success. Other achievements include the development of an educational pamphlet for students. Approximately 40 Division GPs have indicated interest in project involvement. The only problem has been with logistical barriers to link GPs with school programs according to designated time frames.

Community Care for People Living with HIV/AIDS

This project involves the promotion of a model of shared care between GPs caring for patients living with HIV/AIDS, visiting specialists and associated health/community and welfare services. The project is designed to facilitate the case management of people living with HIV/AIDS to ensure they are provided with the best standard of care. The Division also strives to support the CME requirements for GPs to remain as prescribers, Project strategies have been utilised in the State Strategy/Model of Care for people living with HIV/AIDS.

Aboriginal Health

The Aboriginal Health project is designed to deliver enhanced primary health services to the local Aboriginal Community. The project involves a collaborative partnership between the MNCDGP, Galambila and Bowraville Aboriginal health Clinics, local Aboriginal communities, OATSIHS, State Health and Mid North Coast Area Health and Yarrawarra Aboriginal Corporation.

As part of the partnership, the Division provides GP services to the Aboriginal Health Clinics within the Division, and GP involvement in Aboriginal Health planning and education of local Aboriginal Communities. The project facilitates improved access to health services by Aboriginal people. Aims are to improve the health and well being of local Aboriginal people, engaging GPs in Aboriginal health issues, and strengthening collaborative partnerships between key stakeholders to improve Aboriginal health.

Achievements include:

• Establishment of the Galambila Aboriginal Health Clinic.
• Promoted the Establishment of the Bowraville Aboriginal Health Clinic.
• Provision of GP services to both Aboriginal Health Clinics.
• Partnership agreements with stakeholders secured.
• Development, approval and funding of an innovative grant proposal for
• implementing 'Enhanced Primary Care for Aboriginal People.'

Continuing Medical Education/LOCUM Support

This project is funded by the NSW Rural Doctors Network to maintain a Divisional locum and Continuing Medical Education (CME) program aimed at providing GPs in small towns within the Division locum relief/support and access to quality continuing medical education. The project aims to support the recruitment and retention of GPs in remote and isolated towns within the Division, as well as greater professional and personal satisfaction for eligible GPs in small towns within the Division.

As a result of the project eligible GPs have been made aware of and supported to undertake Clinical Fellowship and quality CME opportunities. Problems come with meeting increased demand for services through funding.

GP Upskilling in Accident and Emergency

The project provides GPs de-skilled in emergency medicine with appropriate training and support to re-enter the hospital setting. This is achieved by re-integrating GPs into the acute care setting; providing emergency departments with experienced GPs to reduce hospital admissions and unnecessary investigations' to reduce the backlog of primary care patients in hospital emergency departments; strengthening links between GPs, andhospitals and specialists in the acute care setting.

Achievements include: Quality emergency training delivered to Division GPs by A & E specialists, and the reintegration of eight GPs into the acute care setting. Also, the engagement of eight CMOs in the project, and a Memorandum of Understanding signed between the MNCDGP and Mid North Coast Area Health Service to facilitate the reintegration of GPs in the acute care setting.

Media

The MNCDGP media includes the production of a weekly 'GP Focus' message to GPs, 'Monthly Medico' newsletter, magazine and website. The website provides a profile of the Division and its activities.

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