Tasmania was unable to return the request for information in time for the completion of this report. Information in this section is derived from semi-structured interview.
Although DHS Tasmania is aware of the National Service Improvement Framework, planning for chronic disease management is focussed around the Tasmania Health Plan, rather than the NSIF. Tasmania DHS is planning for system reform that supports service delivery across a range of chronic conditions including CVD. This relates to the National Chronic disease Framework and will look similar to the Queensland chronic disease strategy. There is however, synergy with the NSIF, particularly in relation to the focus on:
- Person centred care
- Integration of services
- Reduction of variations in clinical care.
DHS Tasmania supports GP-centric models of care, which are generalisable across the range of chronic disease.
DHS Tasmania notes that there are difficulties in monitoring and surveillance for CVD as there is no national review of survey in place and no national risk factor monitoring. For example, there is no routine national monitoring that will allow us to assess how we are going with reducing obesity through the use of regular and objective measures.
DHS Tasmania considers the uptake of clinical guidelines is generally poor unless associated with incentives, measures and/or routine audits. DHS Tasmania discussed the use of the Map of Medicine to improve access for clinicians to clinical pathways. This system takes a pathway and translates it into a series of steps and instructions and is a communication tool to clinicians, provides referral advice and is a tool for audit. DHS Tasmania believes this model could be applied nationally as part of a national approach and national leadership for CVD. Guidelines would need to be NHMRC endorsed.
DHS Tasmania considers there needs to be less downstream investment and better utilisation of GPs to improve early intervention and prevention in CVD programs.
CVD Rehabilitation is delivered through nursing services from within the budget for cardio and cardiothoracic units; a state-wide approach is not feasible.
DHS Tasmania advises that, due to the size of the jurisdiction and the ongoing workforce shortages; the state looks for alternative models of care that will deliver the required patient outcomes. For example, where they are delivering mainstream care they seek to incorporate the elements of a stroke unit, through transitional care, rehabilitation units and aged care.