National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

The National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people was conceived and started by NACCHO in 2001 and went on to be supported by the RACGP from 2002. The first edition was published in 2005 and has proven to be widely used by health services and health policy makers to inform best practice in preventing disease in Aboriginal and Torres Strait Islander populations. This second edition has been significantly updated and improved, with appraisal and endorsement from peak bodies across Australia. The National Guide is a practical resource intended for all health professionals delivering primary healthcare to Aboriginal and/or Torres Strait Islander people. Its purpose is to provide GPs and other health professionals with an accessible, user-friendly guide to best practice in preventive healthcare for Aboriginal and Torres Strait Islander patients. This second edition of the National Guide comprises: • the National Guide, which contains evidence statements, recommendations, risk calculation tables and an outline of the development of the guide • the evidence base: the collection of evidence underpinning the guide and recommendations (electronic only) (see the Methodology section ‘Searching the evidence base and drafting recommendations’) • a child and adult lifecycle summary chart listing activities recommended at each age group. The National Guide is available on the NACCHO and the RACGP websites at www. naccho.org.au and at www.racgp.org.au/aboriginalhealth/nationalguide. The National Guide is being integrated into clinical software over time to support primary healthcare professionals to implement best practice by providing them with accessible, accurate and up-to-date preventive health information relevant to Aboriginal and Torres Strait Islander people. For further information contact the RACGP National Faculty of Aboriginal and Torres Strait Islander Health on 03 8699 0499 or email [email protected]. Purpose: The National Guide is intended for all health professionals delivering primary healthcare to the Aboriginal and Torres Strait Islander population. This includes general practitioners (GPs), Aboriginal and Torres Strait Islander health workers, nurses and those specialists with a role in delivering primary healthcare. The National Guide makes specific recommendations regarding the elements of a preventive health assessment across the lifecycle of the Aboriginal and Torres Strait Islander population. The aim of the National Guide is to provide an up-to-date, evidence-based national resource that can help inform health providers and policy makers on a defined set of activities that are of particular relevance to Aboriginal and Torres Strait Islander people. These activities may prevent disease, detect early and unrecognised disease, and promote health in the Aboriginal and Torres Strait Islander population while allowing for variations based on regional and local circumstances. The health status of Torres Strait Islander people is very similar to that of the Aboriginal population, and the information in the National Guide can be applied to both population groups

Community based, multicenter, double-blind, randomised controlled trial comparing the effectiveness of topical ciprofloxacin and Sofradex as treatments for chronic suppurative otitis media in Aboriginal children

Many Aboriginal conmmunities in rural and remote western Australia have rates of chronic suppurative otitis media (CSOM) 10 times the rate that the World Health Organization deemed as a massive public health problem in the child population. The recognition by Aboriginal leaders that the treatment of CSOM is a priority area has led to this issue being highlighted in Australia's National Aboriginal Health Strategy. In Aboriginal children, the disease usually commences in infancy within a few weeks of birth, causes hearing loss, is recurrent, can persist into adulthood, and may impact adversely on child development. Our trial aimed to compare the effectiveness of topical ciprofloxacin (0.3%) and framycetin (0.5%), gramicidin, dexamethasone (FGD, Sofradex) as treatments for CSOM in Aboriginal children. The trial was the first conmmunity controlled, multicenter, double-blind, randomized, controlled trial in Aboriginal children across the north of Australia

Community based, multicenter, double-blind, randomised controlled trial comparing the effectiveness of topical ciprofloxacin and Sofradex as treatments for chronic suppurative otitis media in Aboriginal children

Many Aboriginal conmmunities in rural and remote western Australia have rates of chronic suppurative otitis media (CSOM) 10 times the rate that the World Health Organization deemed as a massive public health problem in the child population. The recognition by Aboriginal leaders that the treatment of CSOM is a priority area has led to this issue being highlighted in Australia's National Aboriginal Health Strategy. In Aboriginal children, the disease usually commences in infancy within a few weeks of birth, causes hearing loss, is recurrent, can persist into adulthood, and may impact adversely on child development. Our trial aimed to compare the effectiveness of topical ciprofloxacin (0.3%) and framycetin (0.5%), gramicidin, dexamethasone (FGD, Sofradex) as treatments for CSOM in Aboriginal children. The trial was the first conmmunity controlled, multicenter, double-blind, randomized, controlled trial in Aboriginal children across the north of Australia

Aboriginal health

[Extract] There is good evidence to show that the strengthening of preventive health services that are relevant and accessible to Aboriginal people, will reduce hospitalisation, and ultimately reduce health costs. Health policy analysts and Aboriginal community representatives have taken this evidence and have scoped what needs to be done, but the political commitment towards taking these initiatives to the next stage and implementing them remains weak. [...] In 2004, the International Decade of the Worlds Indigenous Peoples will be at an end. Thus, it is a prime opportunity for Australian leaders to take heed of the scientific and economic evidence and demonstrate unequivocal commitment, of sufficient scale, to substantially reduce health inequalities between Aboriginal and non-Aboriginal Australians. The evidence shows us that such a commitment would first be manifested in improved Aboriginal child health. Reduced health disparities could potentially be evident by the end of the next decade

Hearing Loss

The National Guide provides recommendations on the primary prevention of otitis media as a cause of hearing loss, and the early detection of hearing loss predominantly for children aged less than 15 years with some recommendations pertaining to Aboriginal and Torres Strait Islander adults. The diagnosis and management of otitis media and hearing loss is outside the scope of this guide, as other sources of advice are available

Hearing Loss

The National Guide provides recommendations on the primary prevention of otitis media as a cause of hearing loss, and the early detection of hearing loss predominantly for children aged less than 15 years with some recommendations pertaining to Aboriginal and Torres Strait Islander adults. The diagnosis and management of otitis media and hearing loss is outside the scope of this guide, as other sources of advice are available

Medicare rebate for the 'health assessment of Aboriginal and Torres Strait Islander persons': proposal to benefit Aboriginal health (2001)

[Extract] EXECUTIVE SUMMARY In this paper, the National Aboriginal Community Controlled Health Organisation(NACCHO), the peak Aboriginal health body in Australia, has described the importance of primary health care activity incorporating all types of preventive interventions, not just tertiary prevention for Aboriginal populations. Efforts by the Federal Government to enhance the effectiveness of Medicare to reward preventive health activity have been welcomed by NACCHO. The new Enhanced Primary Care (EPC) items offer service providers more appropriately structured remuneration for several aspects of work commonly undertaken in Aboriginal primary health care services. However, only a limited number of Aboriginal people can benefit from these Medicare rebates, as they are currently structured. Firstly, these new Medicare items reward health assessments or health checks for the elderly. The elderly were defined as people over the age of 75 years or over the age of 55 years if Aboriginal or Torres Strait Islander. Secondly, the Care Plan items are valid for all regardless of age, but are an investment in tertiary prevention only. They aim to reward practice that will prevent worsening of chronic disease and hospitalisation for those who are already known to have chronic disease. There is no financial incentive of any kind, which rewards primary and secondary prevention of chronic disease. There is a need for an incentive to encourage and reward broad GP involvement in best practice pertaining to Aboriginal health. This is especially urgent given that there is a high burden of unidentified chronic illness in the Aboriginal population, and this illness is preventable based on good evidence, and interventions to high-risk populations is costeffective. NACCHO, with the support of the Australian Medical Association, Divisions of General Practice, the General Practice Partnership Advisory Council and the EPC Taskforce recommends a Medicare Rebate for a health check in an Aboriginal adult (regardless of age) which should be available for any doctor to claim. This is otherwise known as a 'well persons health check'. Any Aboriginal person should have a right to expect and receive such a comprehensive service. Such a Rebate has the potential to generate savings over and above the foregone fee-for-service activity. It would provide for streamlined, cost-effective administration of investments in prevention for Aboriginal health, compared with current or alternative mechanisms. Early identification and intervention for chronic disease in the primary care setting will reduce the need for care in the acute hospital sector, with a concomitant reduction in downstream costs. As a result of increased primary and secondary prevention of disease in Aboriginal populations, investments in tertiary prevention (Care Plans) would yield better returns. In 1995-7 there were over 51,000 years of potential Aboriginal life lost before age 65 years due to premature deaths. The excess burden of chronic disease and the high rate of premature deaths in the Aboriginal population require urgent investments in preventive activity at the primary health care level. There are a number of levers the Federal Government could introduce to foster improvements in clinical practice, discourage inappropriate practice and enhance health outcomes for the Aboriginal community. This paper compares and contrasts current Federal Government initiatives aimed at fostering improvements in immunisation activity with the relative lack of initiatives fostering primary and secondary prevention of chronic disease in Aboriginal populations. Aboriginal people carry the excess burden of disease and consequent financial and health costs fall on those that are least able to afford it. A health system that perpetuates the free market provision of preventive health care ('laissez faire' approach) perpetuates inequity. The health profession needs to enable preventive health interventions to those who are least able to ask for it. This underlies the need for interventionist options A number of options are presented to assist the Commonwealth Department of Health and Aged Care in planning for future activity to foster improvements in Aboriginal health. Underpinning all these options is the development of a Medicare Rebate for the health assessment for Aboriginal adults (of any age) as an investment in primary and secondary prevention at the practice level

Submission to senate inquiry into hearing health in Australia with reference to the Aboriginal and Torres Strait Islander population

This submission is made to the Senate Inquiry in order to inform on issues that are relevant with regard to the provision of hearing support services to Aboriginal peoples. Accompanying this submission is research which has recently examined access to hearing services, which was endorsed by the National Aboriginal Community Controlled Health Organisation

Medicare rebate for the 'health assessment of Aboriginal and Torres Strait Islander persons': proposal to benefit Aboriginal health (2001)

[Extract] EXECUTIVE SUMMARY\ud In this paper, the National Aboriginal Community Controlled Health Organisation(NACCHO), the peak Aboriginal health body in Australia, has described the importance of primary health care activity incorporating all types of preventive interventions, not just tertiary prevention for Aboriginal populations.\ud \ud Efforts by the Federal Government to enhance the effectiveness of Medicare to reward preventive health activity have been welcomed by NACCHO. The new Enhanced Primary Care (EPC) items offer service providers more appropriately structured remuneration for several aspects of work commonly undertaken in Aboriginal primary health care services.\ud \ud However, only a limited number of Aboriginal people can benefit from these Medicare rebates, as they are currently structured. Firstly, these new Medicare items reward health assessments or health checks for the elderly. The elderly were defined as people over the age of 75 years or over the age of 55 years if Aboriginal or Torres Strait Islander. Secondly, the Care Plan items are valid for all regardless of age, but are an investment in tertiary prevention only. They aim to reward practice that will prevent worsening of chronic disease and hospitalisation for those who are already known to have chronic disease. There is no financial incentive of any kind, which rewards primary and secondary prevention of chronic disease.\ud \ud There is a need for an incentive to encourage and reward broad GP involvement in best practice pertaining to Aboriginal health. This is especially urgent given that there is a high burden of unidentified chronic illness in the Aboriginal population, and this illness is preventable based on good evidence, and interventions to high-risk populations is costeffective.\ud \ud NACCHO, with the support of the Australian Medical Association, Divisions of General Practice, the General Practice Partnership Advisory Council and the EPC Taskforce recommends a Medicare Rebate for a health check in an Aboriginal adult (regardless of age) which should be available for any doctor to claim. This is otherwise known as a 'well persons health check'. Any Aboriginal person should have a right to expect and receive such a comprehensive service.\ud \ud Such a Rebate has the potential to generate savings over and above the foregone fee-for-service activity. It would provide for streamlined, cost-effective administration of investments in prevention for Aboriginal health, compared with current or alternative mechanisms. Early identification and intervention for chronic disease in the primary care setting will reduce the need for care in the acute hospital sector, with a concomitant reduction in downstream costs. As a result of increased primary and secondary prevention of disease in Aboriginal populations, investments in tertiary prevention (Care Plans) would yield better returns.\ud \ud In 1995-7 there were over 51,000 years of potential Aboriginal life lost before age 65 years due to premature deaths. The excess burden of chronic disease and the high rate of premature deaths in the Aboriginal population require urgent investments in preventive activity at the primary health care level.\ud \ud There are a number of levers the Federal Government could introduce to foster improvements in clinical practice, discourage inappropriate practice and enhance health outcomes for the Aboriginal community. This paper compares and contrasts current Federal Government initiatives aimed at fostering improvements in immunisation activity with the relative lack of initiatives fostering primary and secondary prevention of chronic disease in Aboriginal populations.\ud \ud Aboriginal people carry the excess burden of disease and consequent financial and health costs fall on those that are least able to afford it. A health system that perpetuates the free market provision of preventive health care ('laissez faire' approach) perpetuates inequity. The health profession needs to enable preventive health interventions to those who are least able to ask for it. This underlies the need for interventionist options\ud \ud A number of options are presented to assist the Commonwealth Department of Health and Aged Care in planning for future activity to foster improvements in Aboriginal health. Underpinning all these options is the development of a Medicare Rebate for the health assessment for Aboriginal adults (of any age) as an investment in primary and secondary prevention at the practice level

Advocacy and the health professional role

[Extract] Advocacy can extend across all interactions. However, in healthcare it can form an integral part of the care we give to patients or the community. For most healthcare professionals, professional regulations and societal laws bind the scope of practice concerning advocacy. In this chapter, advocacy is defined and applied to individuals and community situations. The role of the health professional regarding advocacy is delineated and challenges to this role are highlighted and discussed. The position of social justice regarding ethical decision-making and policy development is debated. Real-life scenarios allow the reader to examine the various ways in which effective advocacy has been achieved. Finally, the chapter poses questions, encouraging the reader to pause and think about how they would manage various challenges related to healthcare advocacy