Outcome 10: Health System Capacity and Quality > Outcome Performance Report

Major Achievements

• Supported people with a terminal illness, their families and carers by providing a one-stop shop of palliative care information and practical resources through the CareSearch: Palliative Care Knowledge Network.
• Contributed to a raised awareness of best practice care in diabetes management, through the finalisation of the Guidelines for the Management of Diabetic Retinopathy. The Department also helped improve the community’s knowledge and understanding of diabetes by supporting the development and publication of the Australian Institute of Health and Welfare report: Diabetes: Australian Facts 2008.
• Advanced the development of the first phase of electronic prescribing through initial deployments in aged care and community settings.
• Facilitated, through joint funding with the Northern Territory Government, a Shared Electronic Health Record now available for 25,000 residents of the Northern Territory.

Key Strategic Directions for 2007–08 – Major Activities

Better Access to, and Quality of, Palliative Care for People with a Terminal Illness

Improving Palliative Care and Support in the Community

It has been estimated that terminal illness affects around half a million Australians as patients, carers, family members or friends every year. Palliatve care maintains quality of life for these people, by addressing their distinctly different physical, psychological and spiritural needs. Community involvement helps improve the choice of services available. The Department has worked to implement and support a number of initiatives through the National Palliative Care Program, to improve palliative care and support in the community.

A major achievement in 2007–08 was the launch of the new look CareSearch: Palliative Care Knowledge Network. Accessible at <www.caresearch.com.au>, the website provides a one-stop shop of information for the terminally ill, carers and families, as well as health professionals and researchers. It contains links to other resources and covers sensitive issues, such as what to say to someone who has found out they are dying, and what to do after a death.

Working closely with State and Territory Governments, which provide most palliative care, the Department continued to manage the National Palliative Care Program, to improve access to quality palliative care and to ensure that Australian Government activities were complementary. Funding was provided to 58 applicants for fit outs, equipment and transition to home support under the Local Palliative Care Grants Program. This initiative helps local groups, church and charitable hospices and aged care providers to provide better support to people requiring palliative care and their families.

The Department also provided patients with a method for discussing and recording their choices about their health care. The Respecting Patient Choices model of advance care planning encourages people to appoint a guardian or enduring power of attorney, and to record an advance oral or written instruction about their future medical care in the event that they become unable to communicate.

Collaborative Palliative Care Initiatives

The Department continued to fund a consortium of four universities (led by the Centre for Health Services Development, University of Wollongong) to form the Palliative Care Outcomes Collaboration. The collaboration worked with palliative care services to develop measures that will allow them to assess and compare the quality of services provided, and the outcomes achieved. The project operated with the cooperation of state and territory health departments. Since its inception in 2005, the Palliative Care Outcomes Collaboration has gained the strong support of palliative care services, with 50 per cent of specialist palliative care services having committed to join the collaboration.

The coming year will see the Department support the Flinders University of South Australia to establish the Palliative Care Clinical Studies Collaborative. The data collected from these trials may allow relevant medicines used in palliative care to be registered on the Australian Register of Therapeutic Goods and ultimately result in the medicines being listed through the Pharmaceutical Benefits Scheme. The project will build the research capacity of the palliative care sector, subjecting medicines to randomised controlled trials.

Support for Health Professionals

The Department supported the Program of Experience in the Palliative Approach to provide palliative care workplace training and workshops for health care professionals, including nurses, allied health professionals, Aboriginal health workers, general practitioners and other medical practitioners. The program specifically encouraged health care professionals in rural and remote areas to apply. Between July 2007 and June 2008, 61 workshops were completed involving 1,773 participants. A total of 2,611 participants were trained in 119 workshops between 2003 and 2008.

Table 2.3.10.1: Number of Health Care Professionals Undertaking Palliative Care Workplace Training 2003–08

Jurisdiction	Workshops Delivered	Total Number of Workshop Participants
Australian Capital Territory	9	219
New South Wales	11	489
Northern Territory	15	250
Queensland	3	115
South Australia	17	217
Tasmania	28	288
Victoria	27	887
Western Australia	9	146
Total	119	2,611

Source: Program of Experience in the Palliative Approach. Information and Application Kit 2007–2010. Department of Health and Ageing, 2007.

Improved Management and Self-Management of Chronic Disease

Asthma Awareness and Support

A focus was on implementing initiatives to reduce the impact of asthma and to improve health professionals’ knowledge and practical skills, through the Asthma Management Program 2005–06 to 2008–09. A partnership between the Department and the National Asthma Council Australia saw the training of up to 5,600 health professionals via education workshops and a satellite broadcast.

Collaboration between the Department and the Asthma Foundations supported the training of more than 30,000 teachers nationally, and the recognition of more than 3,500 schools as Asthma Friendly. Teachers learned to develop safe, healthy and supportive environments for students with asthma, and trained in responding to an asthma incident. They were also provided with the tools to increase students and parents’ awareness of asthma, and to help students with asthma to improve their self-management skills.

The effect of these and other initiatives will be considered in an evaluation of the Asthma Management Program in 2008–09, with the findings to inform future directions in national asthma programs from 2009–10.

Management of Acute Stroke Diabetes and Type 1 Diabetes

The Department undertook several initiatives during the year to improve the detection and management of prominent chronic diseases, and to raise awareness of best practice care. A major achievement was the revision and updating of clinical guidelines for the management of diabetic retinopathy and acute stroke. Support was provided to the Australian Institute of Health and Welfare to produce Diabetes: Australian Facts 2008, a concise summary of the latest data and trends relating to diabetes in Australia. The Department also managed funding agreements with the National Stroke Foundation to consult with stroke survivors and carers to develop a stroke support strategy.

In addition, the Department continued to fund research to improve the prevention and treatment of diabetes. Research focused on Islet Cell Transplantation in an effort to better treat type 1 diabetes.

Reduced Burden of Cancer, and Support for Australians Living with Cancer

The Department worked collaboratively with Cancer Australia on initiatives to reduce the burden of cancer and improve support for Australians living with cancer. The Department also administered funding to the National Breast and Ovarian Cancer Centre to improve approaches to the early detection and management of breast and ovarian cancer, and to Breast Cancer Network Australia, to produce and distribute resources for women diagnosed with breast cancer.

The National Breast and Ovarian Cancer Centre also received funding to review and monitor evidence of best practice in breast and ovarian cancer control and management of lymphoedema. The centre also produced and disseminated information for consumers, including Cancer – how are you travelling?: understanding the emotional and social impact of cancer and Lymphoedema: what you need to know booklets.

In 2008–09, the Department will support research into better ways of detecting prostate cancer, and contribute to the establishment of a range of cancer centres and networks throughout Australia to improve care for patients and their families. The Department will also administer funding for the recruitment, training and employment of 30 new breast cancer nurses nationwide.

Promotion of Improved Patient Safety

While Australia’s health care system provides high quality services, health care is becoming more complex, with increased knowledge and new technologies. As a result, occasionally, something goes wrong, and a patient is unexpectedly harmed.

In 2007–08, the Department sought to improve the safety and quality of the nation’s health services by working with the Australian Commission on Safety and Quality in Health Care (of which the Secretary of the Department, Ms Jane Halton PSM, is a Commissioner). The commission is responsible for providing robust advice to Commonwealth, state and territory health ministers, to inform the collaborative development of national safety and quality strategies.

The Department supported the commission through representation on a number of committees, as well as by providing input to its work program. The Department also identified issues, recommended policy directions and provided strategic advice to the Minister for Health and Ageing in relation to the national safety and quality initiatives that the commission is leading. This included the endorsement of recommendations for the implementation of reforms to safety and quality accreditation health care services. The Department will be working with the commission in the first stage of implementation of accreditation reforms which will be reported to Health Ministers at the end of 2009.

The Department also endorsed the commission’s implementation of an Open Disclosure standard which provides a framework for open discussion of incidents that result in harm to patients while receiving health care. The commission will be conducting ongoing monitoring of the effectiveness of implementation of the standard and reporting on this to Health Ministers at the end of 2009.

The Department will work with State and Territory Governments and other stakeholders in 2008–09, to develop a more strategic approach to maternity services. The Department will also review Medicare benefits arrangements for midwives.

Supported Improvements in Clinical Practice and Decision-making through e-Health

Electronic health information (e-Health) systems that securely and efficiently exchange clinical and administrative information can have many benefits for both health care providers and patients. For example, e-Health can provide a clinician with access to the most up-to-date clinical information, as well as a consenting patient’s shared health records. This in turn facilitates sound decision-making and better care for the patient. e-Health can also allow for speedy electronic referrals, which can be of real benefit to patients, particularly for those living in rural areas where distance may be an issue.

National Standards and the National e-Health Strategy

During 2007–08, the Department oversaw the development of national standards to ensure compatibility of e-Health systems across the broader health system. In part, this was achieved by providing funding for 50 per cent of the operating and project costs of the National e-Health Transition Authority – a not-for-profit company established by the Australian and State and Territory Governments to develop safe ways of electronically collecting and exchanging health information.

The Department saw success in the development of individual and provider identifiers, standardised clinical terminologies and secure messaging standards. In addition, the Department worked closely with the National e-Health Transition Authority on the development of targeted packages to support the implementation of electronic discharge, specialist referral and pathology clinical services.

Furthermore, the Department contributed to the development of the National e-Health Strategy through the National e-Health Information Principal Committee. When the strategy is implemented it will allow significantly greater inter-jurisdictional and national coordination of e-Health policy direction.

Electronic Prescribing

The Department collaborated with state and territory health departments to harmonise regulations that will enable electronic prescribing (ePrescribing); and undertook extensive stakeholder consultation to develop implementation options for ePrescribing and the dispensing of medicines. A major achievement was an ePrescribing trial in the Northern Territory, in a community pharmacy and aged care setting, which will see prescriptions generated by a general practitioner sent securely in electronic form to a local pharmacist. This should relieve problems for patients and general practitioners in an aged care facility caused by misplaced prescriptions and delays in mailing or faxing scripts. Results from phase one of the trial are expected in October 2008. Future phases may be rolled out in stages depending on trial outcomes following evaluation.

Shared Health Records

Another highlight of the year was a collaborative effort with the Northern Territory Government, which resulted in a Shared Electronic Health Record becoming available for 25,000 residents of the Northern Territory. With patient consent, a Shared Electronic Health Record allows information about a patient’s medication, test results, diagnoses and allergies to be available to participating health care providers such as hospitals, health centres, general practitioners and Aboriginal Medical Services. This can improve patient outcomes, particularly in emergency situations for individuals who change general practitioners or use multiple health services, as it allows secure access to up-to-date medical information.

The Department will continue to work with the states and territories, professional groups and consumers to address the aspects of e-Health requiring national leadership and coordination. The challenges facing this activity relate to the complexity and pace of technology development, and the willingness of the health sector to embrace it. The Department will manage these issues through consultation strategies and the ongoing involvement of stakeholders.