CURRENT PROGRAMS AND PROJECTS

Women's Health

The Ante-natal Shared Care Program was the main focus of the Women's Health Program. Over the last year the Division has broadened its attention to deal with the major women's health issues that challenge the Division's GPs. These include parenting issues, neonatology, infectious diseases in pregnancy, medical problems in pregnancy, perinatal mental health, cervical cancer, menopause, breast disease and, in the near future, domestic violence.

The program's aims are to provide an Ante-natal Shared Care Program, to improve GP awareness and management of women's health issues, to improve cervical screening rates of women in Divisional area, to improve mental health of mothers in the Divisional area and to decrease the risk to infants of abuse and neglect.

Achievements of the program include:

• Two Women's Health Public Education Forums, the last of which had 500 women attend.
• Two GP O & G Updates per year, each attended by 100 GPs.
• Workshops held to update GPs clinical skills.
• Regular Continuing Medical Education on relevant current issues.

The Division provides GP shared care for ante-natal women attending the Royal Hospital for Women, Continuing Medical Education on Women's Health Issues for local GPs, public education for local women, and liaison with RHW and community women's health and early childhood health providers. Barriers have been communication problems between the hospital and GPs which provide an ongoing challenge.

Shared Care for Older People Program

The Shared Care for Older People Project began in August 1996 as a joint project between South Eastern Sydney Division of General Practice (SESDGP) and Eastern Sydney Division of General Practice (ESDGP). The program aims to promote continuity of care of the elderly patient, and to establish the GP as the primary care coordinator of the aged in the area. The Division is also working to improve communication between GPs and other health care providers to the elderly, and to improve the health status of the elderly.

Achievements have been:

• Aged Care Service Directory for South Eastern Area.
• Contracted with Community Health that GPs could fax referrals to Intake.
• Bridging the GAP Forum between SESDGP, ESDGP and Community Health resulted in agreed feedback
• communication form, to improve communication and coordination between home-based services.
• Attendance and registration at relevant meetings in the community, hospital and stroke prevention strategy.
• EPC Items: Academic detailing to all willing members of SESDGP.
• CME activities in Aged Care with increasing attendance.
• Active involvement in aged care hospital/community committees.

Services provided by the Division include SCOPP 'Aged Care Services Directory, current referral and service information on aged care, GP education, improving relationships and patient information exchange with local hospitals.

Budget cuts over the last three year period have resulted in a limitation of the program. Our focus has changed from evaluating patients' needs of community services to enabling GPs to understand and access available services. Liaison activities have become more prominent. Based on the program achievement, our focus is to fulfil the program's objectives and implement its strategies.

Diabetes Shared Care/Cardiovascular Disease

Diabetes Shared Care program commenced in February 1994. In July 1999 Cardiovascular Disease (CVD) became a part of the program. There are currently 120 members of the combined program.

As a result of the program, GPs have been kept updated with the latest advances in the field of diabetes and heart disease. The pilot screening program screened more than 1 850 people attending GP surgeries for a high risk for diabetes and heart disease and identified more than 400 patients at a high risk for each disease, identified 69 people with diabetes or impaired glucose tolerance and 305 people with heart disease.

Services provided by the Division include:

• Provision of educational and upskilling workshops and seminars.
• Encouraging GPs to use protocols to document the management of patients with diabetes/CVD.
• Provision of recall system for patients with diabetes/CVD.
• Provision of lifestyle factors intervention programs.
• Helping implement diabetes/CVD risk factor questionnaire.

The program targets GPs within the Division's geographical area. Through the GP's the program benefits people with diabetes and heart disease, and people who are at a high risk for developing these conditions.

Problems have been encountered with financial constraints, and the Division not having the ability to be able to pay GPs adequately for their involvement in the program, and not being able to employ a podiatrist who could visit surgeries and benefit patients with diabetes.

Immunisation

The program is designed to keep GPs abreast with issues in immunisation as they arise. GPs now are the main immunisation providers to the childhood population. Therefore, a main focus of the program rests with ensuring that practices meet all criteria so that immunisations given to children remain effective and safe.

This program aims to improve the Division's immunisation coverage rate from 71.9% to at least 90% overall. The program has seen the development of a good rapport with local GPs and office staff. Other achievements include the assessment of vaccine fridges and several practices, and the collection of vaccine fridge data. Explanation of the ACIR reporting system and GPII payments at educational sessions and at practice visits has also occurred.

Services provided by the Division include practice visits, educational sessions and immunisation resources such as minimum/maximum thermometer, protocols for cold chain maintenance the recording of vaccine fridge temperatures with the use of computerised data loggers and ACIR data cleaning.

Infection Control

The program was introduced in October 1999. The overall aim of the project is to offer a strategy to gain and maintain consistent quality assurance interventions in infection control, provide public confidence in General Practice procedures and ensure a safe working environment for all General Practice personnel.

The program aims to assist the General Practice environment through practice visits. The program provides General Practice with the necessary resources to improve infection control, sterilisation, cold-chain storage and waste disposal procedures, and to encourage GP/staff vaccination.

Achievements of the program have been the establishment of a good rapport with GPs and office staff, assessment of several practices with regard to practices and policies in infection control, sterilisation and contaminated waste and data collected.

The Division provides an assessment of existing infection control standards, sterilisation, cold-chain storage and waste disposal practices is conducted initially by conducting a questionnaire. It is then followed up with the assistance required to bring the practice to RACGP standards.

Barriers have been the financial costs required to make the necessary changes to Infection Control so that it is of accreditable standard, and the inability for the Project Officer to go to all practices.

Quality Use of Medicines/National Prescribing Service program

This program commenced in July 2000. In preparation for this a needs survey has gone out to all Divisional GPs. This is to assess the level of interest in the program and the type of activities GPs would be interested in if they were to be involved. The program is designed to facilitate the various means by which a GP can have access to the information and support needed to make good prescribing decisions.

The activities used to provide information are clinical audits, case conferencing, CME activities and practice visits. The aim, once an activity is completed, is that the best and most cost - effective medications are prescribed to patients.

Prevention and Management of Osteoporosis in General Practice

The program began on 30 March 1999 with the recruitment of 17 Divisional GPs. Because the program is an evaluation of treatment strategies, there is a maximum number of GPs that can participate in the first (pilot) year of the program. In order to participate and qualify for the 20 PA points attached to the program, each GP should have at least five eligible patients on file that they could enroll in the program.

The aim of the program is to improve GP skills in identifying, treating and managing osteoporosis, increasing the capture rate of osteoporosis, encouraging osteoporosis management following the clinical guidelines, increasing the rate of referrals to Falls Prevention and exercise programs, and improving the coordination of care between all stakeholders. Achievements have been a successful Public Forum held conjointly with Women's Health Program attended by 500 women.

Services provided by the Division include a Series of eight workshops, a practice assessment activity and a maximum of five hours clinical attachment sessions at the Prince of Wales Hospitals Endocrinology Unit. A Prevention and Management of Osteoporosis Manual based on the Clinical Management Guidelines locally adapted for relevance is also available.

Information Management and Information Technology

Information Management and Information Technology (IM/IT) is one of the highest priorities to be addressed. Good communication and timely information transfer is essential in the contemporary environment. The Division's IM/IT program specifically focuses on assisting GPs to improve their computer literacy and to use modern technology in their practices.The Division's aim is to improve healthcare and GP communication by making use of information technology within the settings of General Practice.

Workshops (Divisional and external based) covering introduction to PC usage, Windows, MS Word, email and internet and Medical Director have been conducted. These workshops had 104 participants (46 individual GPs or 24.6% of membership). A Divisional Help Line is also in operation.

Services provided by the Division include GP IM/IT needs determined via a needs analysis and focus group, IM/IT practice audits and advice on the best strategy to get the most benefit from IM/IT. The Division also provides on and off-site training to GPs and practice staff. The Division is also negotiating with local suppliers to provide GPs with hardware and software at discounted rates.

Barriers to the program's success have been that certain older GP members are not keen on computerisation, and that due to a wide variety of different clinical and practice software programs, it is difficult to provide comprehensive advice to GP members. However, the Division has found that they are now linking GPs from South Eastern Sydney Area Health Service and the Prince of Wales group of hospitals via the internet.

Mental Health Shared Care

The South Eastern and Eastern Sydney area has a high prevalence of psychiatric disorders. The main aim of shared care is to provide 'seamless service' by appointing the GP as the primary carer. The GP is responsible for coordinating services with other mental health professionals and as such establishes reciprocal communication.

The objective of this program is to provide quality mental and physical health care to people suffering from a mental illness in South Eastern and Eastern Sydney, by educating GPs and integrating this form of care into the surrounding community health system.

The program is one of the longest running and most rigorously evaluated programs in Australia, and the Division is perceived as leaders in Mental Health Divisional Projects. Services provided by the Division include bi-monthly educational lectures, monthly supervision groups with a consultant psychiatrist, workshops on interviewing techniques, GP Manager liaising with community health, liaising and organising clinics at Jarrah House, and a GP Coordinator liaising with SES AHS.

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