Closing the Gap - The Indigenous Chronic Disease Package in 2009-10 - Annual Progress Report on the Australian Government’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes - November 2010
Improving Chronic Disease Follow-Up Care
The Package is encouraging better management of chronic disease, with more coordinated care and better access to specialist and allied health services for Aboriginal and Torres Strait Islander people with chronic disease.
2009-10 activity overview and key achievements
Access to ongoing care, including specialist care provided by members of a multidisciplinary team, is important to good chronic disease management. Many Aboriginal and Torres Strait Islander people cannot afford the specialist and allied health services they need to ensure their chronic diseases are well managed. Workforce shortages, lack of transport and cost mean clients often have difficulty accessing specialist care.Aboriginal and Torres Strait Islander people who receive a health assessment are now eligible for more comprehensive follow-up and preventative care. In 2009-10, the maximum number of MBS-funded follow-up services provided by a practice nurse or registered Aboriginal Health Worker increased from five to 10 services per year following a health assessment. Early data already suggests there has been a significant increase in the number of health checks completed in 2009-10 compared to previous years.
In addition, new specialist outreach programs developed in 2009-10 are now connecting Aboriginal and Torres Strait Islander peoples at risk of or living with a chronic disease with the specialist and allied health care they need, wherever they live.
Urban and Regional Australia
The first Urban Specialist Outreach Assistance Program (USOAP) services were provided in Armidale, NSW in May 2010. This initiative supports outreach services by specialists focusing on chronic disease for Aboriginal and Torres Strait Islander peoples living in urban areas.Rural and remote Australia
An expanded Medical Specialist Outreach Assistance Program (MSOAP) was also launched in 2009-10, with 148 services provided in Western Australia, New South Wales and Queensland by 30 June 2010. This initiative provides outreach services by multidisciplinary health teams in rural and remote Indigenous communities. The composition of the teams varies depending on the specific health and treatment needs of each community, and can include specialists, general practitioners and allied health professionals.Next Steps: Looking forward to 2010-11
Planning has begun for further MSOAP services in 2010-11, including consultations with local Aboriginal and Torres Strait Islander communities, health services and the Indigenous Health Partnership Forums in each jurisdiction.Support will be available to general practices and Indigenous health services participating in the PIP Indigenous Health Incentive to help in providing their Aboriginal and Torres Strait Islander clients with more proactive follow-up care through the new Care Coordination and Supplementary Services Program. This will improve the quality of care provided to Aboriginal and Torres Strait Islander people with a chronic disease by addressing the barriers people face in accessing the full range of care set out in their care plan.
Expanded MSOAP Services in Western Australia
Aboriginal and Torres Strait Islander people living in the Kimberley region of Western Australia now have increased access to specialist and multidisciplinary team follow-up care through the expanded MSOAP measure. Starting in June 2010, a multidisciplinary renal team comprising a renal physician, nurse and Aboriginal health worker, have provided 15 consultation services to this community.This initiative has enabled specialist services to expand their reach, and support the growing Kimberley Renal Support Service to extend complementary multidisciplinary team care targeting chronic renal disease across the region. The main regional centres in the Kimberley, including Broome, Derby, Fitzroy Crossing, Halls Creek and Kununurra, are serving as hubs and drawing in patients from small nearby communities.
Through the expanded MSOAP, 11 very remote communities in the Ngaanyatjarra Lands are also receiving much needed additional health care by a dedicated multidisciplinary team comprising a general physician, chronic disease nurse and Aboriginal health worker. This has increased services for these communities by 50%. With ongoing up-skilling also provided to the health staff at the various communities, funding provided through this initiative will in turn increase the capacity of Indigenous health organisations to provide better continuity of care for Aboriginal and Torres Strait Islander people with chronic and complex health conditions.