CURRENT PROGRAMS AND PROJECTS

Chronic Disease Management

Effective management of chronic disease requires a multi-discipline approach. However, access to allied health and some specialist services are limited within the NQRDGP, particularly in the western sector. A gap analysis will be undertaken in each Health Service District, to assess the capacity of the public and private primary health care sector to meet chronic health needs. This information will be vital for future health services planning, program development and implementation. The chronic disease program will build upon work undertaken in the Diabetes, Mental Health and Cardiac rehabilitation - secondary prevention programs. The model developed within the mental health case conferences will be extended to other chronic diseases and will underpin the roll-out of enhanced primary care initiative. The GP-based primary care cardiac rehabilitation - secondary prevention program will continue, with a focus on self-management. The Division is undertaking a trial to evaluate the primary care model of cardiac rehabilitation against the conventional facility-based group program, and against usual care.

Within 2000 - 2001, the NQRDGP will continue to upskill practice staff to support GPs in the management of diabetes and cardiovascular disease. The diabetes audits identified the need for effective information management to support best practice management of chronic disease. Division staff will continue to work with GPs and practice staff to develop practice based registers, recall systems and audit processes. Cardiovascular disease and diabetes continue to be major causes of morbidity and mortality in indigenous communities. The NQRDGP is seeking to extend the cardiovascular disease (CVD) secondary prevention program to indigenous people. During 1998 - 1999 adaptations of the program commenced, including training Indigenous health workers in secondary prevention management, and reviewing patient education materials to be more culturally appropriate. However, barriers to health worker involvement with indigenous patients, and barriers to indigenous people participating in rehabilitation exist. Within the Indigenous health program, these barriers will be identified and strategies developed to ensure rehabilitation is available to Indigenous people.

The prevalence of diabetes in the indigenous communities within the NQRDGP is unknown. The Division will work with the communities, District Health Services and Aboriginal Community Controlled Health Service in Mt Isa (Yapatjara), to assess prevalence, current health status, management status and availability of resources and services. This information will be used to develop program strategies in 2001 - 2002.

In the longer term, the NQRDGP is seeking to assist GPs develop a population health/preventive medicine framework within their practice. In the first year, 2000 - 2001, the Division will promote the new childhood immunisation schedule, and continue to promote best practice vaccine management and storage. A re-audit of vaccine management, including the refrigerator temperature logger trial will be conducted. As part of the longer term strategy, priority preventive medicine areas will be identified. These will form the basis for the development of continuing education, building on the Public Health Education for Clinicians curriculum.

Workforce Development, Recruitment and Retention

Turnover of doctors within the Northern Queensland Rural Division of General Practice continues to impact on the provision of general practice services and continuity of patient care. In 1998/99 there was a 50% turnover of doctors, with the more isolated one doctor towns the main concern. The NQRDGP seeks to collaborate with other rural organisations and training institutions to develop and implement recruitment and retention strategies in a coordinated and targeted manner. The major elements for 2000 - 2001 are:

• A communication strategy with our partner organisations to promote rural general practice.
• Spouse support network.
• Development of an induction package for new doctors into communities.
• Strategies to ensure GPs have opportunities to maintain procedural skills.
• Access to local continuing medical education.
• Development of a mentorship program for isolated GPs.
• Support alternative pathways for GPs to achieve fellowship status.

The Practice Support strategy focuses on the development of Information Management and Information Technology (IM/IT) capacity and capability within practices, business capability and practice management support. The IM/IT strategy over the previous 18 months has seen a marked increase in both the number of practices computerised, and the sophistication of software use. The IM/IT component of the practice support business plan will continue to promote capacity and capability building, particularly toward electronic data management, training for GPs and practice staff, and Helpdesk functions. The practice management component will continue to provide training for GPs and practice staff in business skills and practice management. Accreditation will be promoted to practices, and practices will be actively assisted in preparation for accreditation. Many new doctors to this Division are overseas trained. The practice support officer will assist them in establishing practice management systems, and provide the opportunity to network with other doctors in similar situations.

PREVIOUS PROGRAMS AND PROJECTS

• Prevention of Cardiaovascular Disease
• Mental Health Program
• Diabetes Program
• IM/IT
• Specialist support services for diabetes
• Interface between rural GPs and allied health professionals
• A GP referred dietetic service for low income earners
• Needs assessment for education on skin cancer
• Charters Towers dietitian service
• Telemedicine trial
• Mental Health Service seeding grant project
• Consumer Liaison Officer
• Community/consumer liaison and needs assessment project
• Cardiac rehabilitation for the Atherton Tablelands