CURRENT PROGRAMS AND PROJECTS

Mental Health (Anxiety Disorders and Depression Programs)

The Division aims to improve GPs' knowledge and skills relating to the diagnosis and management of anxiety and depression, and to provide GPs with relevant resources required for optimal care of anxious and depressed patients. Also, to improve patients' access to effective treatments for anxiety and depression, and to improve the working relationship between the Division and mental health, in particular, to enhance continuity of treatment for those patients requiring services of both divisions.

The Division and the Sutherland Division of Mental Health have jointly developed programs that focus on improving GP skills in the management of anxiety disorders and depression.

Anxiety Disorders Program

This program seeks to facilitate access to psychological treatment - Cognitive Behavioural Therapy (CBT) - for patients with anxiety. GPs were upskilled in the diagnosis and management of anxiety and trained in providing patients with a structured self-help manual based on CBT techniques and supervising them through the program.

Achievements of the program have been that relevant and effective training programs were provided to GPs and a database using MS ACCESS has been developed to record program data. Also a total of 21 GPs have enrolled 132 patients in the Anxiety Program; 80 used the Generalised Anxiety Disorder Manual and 52 the Panic Disorder Manual.

'Fear' and 'DASS21' patient questionnaires were used to assess patients' pre and post program clinical status. Those who completed both pre and post test questionnaires showed statistically significant improvement in all measures. GPs' detection and management skills were assessed using the SPHERE GP patient questionnaire with follow up feedback. Results are not yet available. A GPs' Satisfaction Questionnaire showed that GPs overwhelmingly found the program appropriate for their patients and that the program had improved their knowledge, skills and confidence in treating anxiety disorders.

Depression Program

This program, currently in its pilot phase, involves upskilling GPs in the diagnosis and management of depression.

GPs are provided with a resource kit containing CBT handouts for patients. All patients in the program should be treated with CBT material and medication is optional. Patient support materials (video/audiotape/book/leaflet) are also provided.

This program has just embarked on its pilot phase with nine participating GPs. The 'DASS 21' patient questionnaire is being used as a pre and post test measure and also as a progress indicator. GPs' pre and post test detection and management skills are being assessed by practice audit.

Services provided by the Division include:

• GP education in diagnosis and management of anxiety and depression (CME points allocated)
• GPs provided with resource kits/manuals on anxiety and depression
• GPs provided with patient treatment manuals on anxiety
• GPs provided with CBT modules to give to patients in Depression program
• GPs provided with patient support materials for patients in Depression program
• CME session for GPs and local mental health service's assessment service (the "Access Team")

Both programs use PRIME MD as a diagnostic tool and are the result of close collaboration with the local mental health team. Consumer representatives and Area MHS personnel have also been involved.

Data collection has been a necessary part of the program to date but has proved to be a time-consuming process for GPs whose primary concern and focus is the well-being of their patients. Case supervision has been raised as  another issue for GPs in primary mental health care. The Division plans to develop an activity to address this.

Diabetes/Cardiovascular Disease

The Diabetes/Cardiovascular Disease (CVD) Program seeks to provide resources for patients and GP education and the development of a Diabetes resource kit adapted for local use to assist GPs recognise, advise and manage their patients with or at risk of diabetes. The resource kit has been developed in consultation with GPs, the Sutherland Hospital's Diabetes Centre, endocrinologists and diabetes educators.

GP education on dietary management of diabetes was conducted and further CME activities, ie. workshops and audit, are planned. There are also plans to introduce a patient recall system.

The CVD segment of this program is in the needs assessment stage involving consultations with representatives from the Sutherland Hospital, Health Promotion Unit, consumers, Heart Foundation and other NGOs, GPs and private cardiologists. Likely strategies will include resource development and GP education.

Objectives of the program are to improve the management and health outcomes of people with Type 2 diabetes in the Sutherland Shire, and to improve the management of CVD related risk factors.

Achievements include:

• Improved referral from GPs to the Diabetes Education Centre.
• Completion of CVD needs assessment.
• High GP attendance at the CME session - where 30% of GPs in the Shire attended a Diabetes education session.
• Establishment of a diabetes/CVD Advisory Committee involving GPs,
• Endocrinologists and representatives from SESAHS.
• A seminar on the dietary management of Type 2 diabetes.
• Diabetes referral form developed.
• GPs Diabetes Resource Kit developed.
• Investigation of local services and patient education material completed.
• Investigation of database systems for recall of diabetes and CVD patients.
• Collaboration with local health services including the Diabetes Education Centre, the Cardiac Rehabilitation Department and the Health Promotion Unit at the Sutherland Hospital, the SESAHS Public Health Unit and the Sutherland Shire Council.

Services provided by the Division include: Diabetes resource kit, CME, and facilitation of communication between Diabetes Centre and GPs. Barriers have been encountered with data collection issues.

GP Support - Practice Accreditation and Enhanced Primary Care

As of May 2000, of the Division's 81 practices, 33 (41%) have registered for accreditation and seven (9%) have achieved full accreditation. This indicates that within the next 12 months, practices will increasingly require advice and support. Similarly, GP education on the Enhanced Primary Care (EPC) items introduced on 1 November 1999, is a priority area for support. Aims of the Division include promoting quality in general practice through practice accreditation, and to promote the uptake of EPC MBS items in the Sutherland Shire.

Achievements of the program include;

• Provision of AGPAL approved resources to GPs including guide to accreditation, checklist, practice manual, patient feedback survey, infection control manual and
• various AGPAL information sheets.
• Conducted Sterilisation and Infection Control seminar for practice staff, 42-practice managers/staff attended the event, this represents approximately 50% of practices in the Shire.
• Conducted CME night on "Accreditation Information Evening" for GPs.
•  Survey conducted in February 2000 to ascertain GPs and practice staff support needs relating to practice accreditation.
• Organised CPR training for Practice Staff.
• Established Advisory Committee involving two practice managers (whose practice has been accredited), two GPs and a Division Programs Coordinator.
• Conducted EPC information evening for GPs involving Alliance of NSW EPC coordinator and EPC Academic Detailer for the Shire.
• Provided ongoing information on EPC to GPs through a monthly Division newsletter.

Services provided by the Division include academic detailing of GPs (by EPC facilitator, and support through data collection).

Adolescent Services

The Adolescent Health program provides GPs with education on youth health issues and collaboration with key stakeholders (Shire Youth Network and Sutherland Shire Suicide Safety Network). Youth health issues identified in a recent 'Youth Health Survey' will be addressed in consumer forums.

Aims of the Division are to improve GP services to adolescents in the Sutherland Shire, and to raise GPs awareness of issues surrounding adolescent access to health services.

Achievements have included the distribution of the Shire Youth Services directory to all GPs in the Shire and a Youth Health Survey conducted in ten practices in the Shire. Active involvement in the Shire Youth Network resulting in participation in 'Suicide Partnership Forum" held at Sutherland Shire Council and in Youth Week activities. Also, a GP CME workshop was conducted. Issues covered included adolescent developmental psychology, medico-legal issues, communication skills, health risk assessment and drug and alcohol issues.

The Division has found that youth issues are broad and complex. Therefore, the program focuses on access, and many GPs are unaware of young people's perspectives and concerns.

Shared Antenatal Care

The Shared Antenatal Care Program has 85 accredited GP members responsible for sharing the care of 51.9% of the patients at the Sutherland Hospital's Antenatal Clinic. The program seeks to offer consumers the option of sharing the care of pregnant women between GPs and the antenatal clinic through enhancing the skills of GPs and collaboration with the clinic and local obstetricians.

The aim of the program is to improve access to, and standard of, antenatal care by GPs in the Sutherland Shire.

Achievements of the program include the review and update of the existing protocol (November 1998). This has been done to reflect current management conventions for shared antenatal care. The Division has been involved with collaborative activities occurring on three levels: GPs/Division, GPs/Obstetricians/ Clinic staff, and peer review by two GP representatives and two obstetric representatives.

Services provided by the Division include; Shared Antenatal Care kit including protocol, referral pads and patient brochures, and Continuing Medical Education (CME). Barriers have been cross accreditation issues between hospitals.

Information Management and Information Technology

The Division is committed to assisting GPs acquire and use computers for clinical purposes through training and tailored support. The Division aims to promote the use of appropriate information technology and information management systems to local GPs, to assist GPs to select and install information technology and informationmanagement systems that meet appropriate standards, and to provide GPs with hands-on experience in the use of computers and appropriate applications.

Achievements of the program have been the establishment of an Information Management/Information Technology (IT/IM) committee involving three GPs and two IT/IM Consultants from Cronulla Computer Training and the Divisions Programs Coordinator. The Division has provided training opportunities in Information Technology and Management (IT/IM), Help-Desk support and the "Support Plus" program. To date, 117 of GPs have been trained in one or more computer programs accounting for 69% of GP members in the Shire. Courses offered were Introductory Windows & PC, internet, email, Word, Excel, Access and General Practice software (Medical Director) training. A total of 348 doctor interactions have occurred. Sixty practices have contacted the help desk and 22 practices have been computerised and upgraded by Cronulla Computer Training (CCT) under the Support Plus Program. Results from the June 2000 computer survey showed that 80% have computers in the practice and 66.4% have computers on the GPs' desk. Of the GPs that have computers on their desk, 81% used their computer for electronic prescribing. Of the practices that are computerised, 49% used their computers for patient demographics, 75% for patient billing, 40% for clinical record keeping and 48% for email as defined in the PIP guidelines.

Another achievement by this program is the development of the Sutherland Division of General Practice Website.

Free computing training in MIMS Script and MIMS MediDesk computer training have been organized. Services provided by the Division include IT/IM consultancy services such as advice to GPs on appropriate hardware and clinical and non-clinical software, on-site hardware and LAN support, helpdesk facility support as well as PC and General Practice software training. Barriers encountered have been the level of GP commitment to IT/IM - a factor related to workloads and time constraints.

Immunisation

The Division is committed to the ongoing promotion and facilitation of immunisation in the community. The aim of the program is to improve immunisation coverage in the Sutherland Shire to reach the national immunisation target of 90%. Currently the Sutherland Division is in position 26 nationally with an overall coverage rate of 83.6%. As a result of the program 59 practices were visited, issues including ACIR/GPII, opportunistic immunisation and cold chain maintenance were discussed with GPs and/or practice staff. Immunisation resources were offered such as electronic max/min thermometers, temperature monitoring charts, posters, parent information leaflets and "Myths and Realities" booklet.

The Division also held two workshops on improving ACIR reporting and coverage rates attended by five practices.

Other achievements have been the various articles on immunisation published in a local newspaper - "The Leader" - as well as in a monthly GP newsletter. The Division has also been networking with other Divisions, the Public Health Unit, NSW Health, Sutherland Shire Council and vaccine manufacturers.

Services provided by the Division include; education on new schedule, ACIR reporting, maintenance of cold chain, and improving coverage rates. The Division aims to inform not only GPs, but also practice staff who are often responsible for various aspects of their practice's vaccination service.

Continuing Medical Education

The Division aims to provide a relevant, effective and quality Continuing Medical Education (CME) program within the Division as well as maintaining Vocational Registration for GPs. The Division conducts monthly continuing medical education for GPs. These monthly educational activities are allocated CME points. The Education Committee, consisting of seven GPs, meet regularly to coordinate monthly CME programs. The committee plans and discusses CME structure such as topics, objectives of event speakers, sponsorships and any relevant education issues for GPs.

Achievements have been that the CME program is well coordinated and relevant to general practice as evidenced by high GP attendance. CME activities are also integrated into Division programs.

PREVIOUS PROGRAMS AND PROJECTS

• Skin Cancer Awareness Program
• Falls & Injury