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Annual Report 2011
Acknowledgement
The Chronic Conditions Strategy Unit is grateful to the many people who have assisted in the production of this report including colleagues from within the Department of Health, other Government Departments, non-Government and Aboriginal Community Controlled Health Services; without your support the task of writing, compiling and extrapolating data would not have been possible.
Suggested citation:
NT Department of Health. Annual Report 2011. The Northern Territory Chronic Conditions Prevention and Management Strategy 2010-2020. Darwin, 2011
An electronic version is available at
www.health.nt.gov.au/Chronic_Conditions/Publications/index.aspx
General enquiries about this publication should be directed to:
Program Leader, Chronic Conditions Strategy Unit Health Development Branch
Department of Health
PO Box 40596, Casuarina, NT 0811 Phone: (08) 8985 8171
Fax: (08) 8985 8177
email: [email protected]
3
TABLE OF CONTENTS
Acknowledgement ... 2
Summary of Chronic Conditions Profile ... 4
Progress against the CCPMS Implementation Plan ... 6
Key Action Area 1 – Increase the focus on the Social Determinants of Health ... 6
Key action area 2 - Increase the focus on primary prevention to prevent and reduce risk factors ... 7
Key action area 3 – Early detection and secondary prevention ... 8
Key action area 4 – Self Management ... 8
Key action area 5 - Care for people with chronic conditions ... 9
Key action area 6 – Workforce planning and development ... 10
Key action area 7 – Information, communication and disease management systems ... 10
Key action area 8 – Continuous quality improvement ... 11
4
The year 2011 marked the second year implementation of the NT Chronic Conditions Prevention and Management Strategy 2010-2020, also known as the NT CCPMS. The NT CCPMS was developed to encourage a consistent approach across all NT health services to reducing the incidence and impact of chronic conditions, in both planning and implementation of services. .
The second CCPMS Annual Report 2011 is not intended to provide detailed report of chronic conditions in the Northern Territory, rather it has been written in the same fashion as 1st Annual Report, where readers can find an overview of the health status of Territorians and progress against each of the eight key action areas outlined in the CCPMS Implementation Plan.
This Report is a summary of the CCPMS Annual Report 2011 and has been published as a separate document to the Annual Report for ease of reading.
Summary of Chronic Conditions Profile
Life expectancy:
Over the last 40 years to 2006, life expectancy at birth has improved significantly across the population: Aboriginal males increased by 7.7 years and non-
Aboriginal males by 16.5 years resulting in a ‘widening of the gap’ in life
expectancy between these two cohorts1. Non-Aboriginal female life expectancy showed a trend towards closing of the gap with Aboriginal females living 15.9 years longer, compared to the non-Aboriginal females living 12.4 years longer.
Deaths:
In a report prepared by the Council of Australian Governments (COAG) Reform Council in 2012 the NT was shown to significantly decrease death rates from 1998 to 2010 by an annual rate of 45.9 deaths per 100,000 (26% overall) from 1998 to 20102. Of the states and territories with reliable data, the Northern
Territory is the only jurisdiction currently on track to close the life expectancy gap by 2031, if the current trend continues.[1]
Mortality rates for specific conditions:
The Northern Territory has significantly higher death rates in Indigenous people compared to non-Indigenous people for many different causes of death. Specifically in the Northern Territory in 2009, Indigenous people were
1 Tay E, Li SQ, Guthridge S. Mortality in the Northern Territory, 1967–2006. Department of Health, Darwin, 2012 2COAG Reform Council, Indigenous reform 2010-11: Comparing performance across Australia, Sydney, 2012
5
twice as likely to die from circulatory diseases compared to non-Indigenous people, 1.7 times more likely to die from cancer, 2.2 times more likely to die from external causes including accidents, assaults and suicide and 7 times more likely to die from endocrine and related disorders.3[1]
Alcohol consumption:
Alcohol consumption across the NT decreased between 2002 and 2011 from a per-capita pure alcohol consumption of 14.36 litres per year in 2002/03 to 13.55 litres in 2010/11.4[2] A reduction in alcohol consumption was not observed across the rest of Australia which remains below the NT at 10.3 litres pure alcohol consumed per-capita per year. Pure alcohol consumption (PAC) is calculated to adjust for the alcohol content in different alcoholic drinks such as beer, wine and spirits.
Alcohol-attributable hospitalisations:
Alcohol-attributable hospitalisations are the number of hospitalisations
determined to be caused by alcohol. These include direct hospitalisations (e.g.
alcohol-related injuries) and indirect hospitalisations (e.g. colon cancer).
Between 2005/06 and 2010/11 the number of alcohol-attributable hospitalisations increased in the NT from 129 to 146 per 10 000.5 The level is dramatically higher in the Aboriginal population (399 per 10 000) than the non-Aboriginal population (146 per 10 000), particularly in Central Australia (757 per 10 000) and
demonstrates the need for a sustained effort to reduce harmful alcohol consumption in the Aboriginal population.
Smoking:
The prevalence of smoking in the NT is high in comparison to the rest of
Australia. The most recent estimates of smoking in the NT come from the 2007 National Drug Strategy Household Survey6 and the 2008 National Aboriginal and Torres Strait Islander Social Survey7 which found that 60% of Aboriginal males and 50% of Aboriginal females smoke. Among the non-Aboriginal population 31% of males smoke and 25% of females smoke compared to 21% of males and 18% of females nationally.
Nutrition:
Each year the DoH Nutrition and Physical Activity Strategy Unit conduct a Market Basket survey of food costs in rural and remote stores.8 The cost of a standard
3COAG Reform Council, Indigenous reform 2010-11: Comparing performance across Australia, Sydney, 2012
42010-11 Report to the Minister for Racing, Gaming and Licensing, NT Department of Justice, Darwin, 2012
5 Alcohol-attributable hospitalisations, Health Gains Planning, 2012, unpublished data
6Australian Institute of Health and Welfare, 2007 National Drug Strategy Household Survey: State and Territory Supplement, Canberra, 2008
7 Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Social Survey, Canberra, 2008, Catalogue No. 4714.0
8 Northern Territory Market Basket Survey 2011. NT Department of Health, Darwin, 2011.
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basket of food that would be expected to feed a family of 6 for a fortnight is
compared to the regional centres. In 2011, a remote community food basket was on average 45% more expensive than in the Darwin supermarket and had
increased by 12% compared to 2010. The proportion of income required to purchase this basket was 38% in remote stores compared with 26% in Darwin, with no significant differences in this proportion since 2000.
Cancer:
Cancer remains an important health issue in the NT. A recent report on women’s cancers in the NT showed there was a 104% increase in the number of women diagnosed with any cancer from 1991 to 2008, during which time there was a 33% increase in the female population.9 The most common cancer in women, regardless of Indigenous status, is breast cancer. Despite this, lung cancer in women has the highest mortality due to poorer survival rates.
Progress against the CCPMS Implementation Plan
Key Action Area 1 – Increase the focus on the Social Determinants of Health
Awareness of the importance of the Social Determinants of Health (SDOH) is increasing and a range of educational opportunities for health professionals have became available. Professor Sir Michael Marmot, Chair of the Commission on SDOH established by the World Health Organisation delivered a lecture in Darwin in July 2011 titled Fair Society, Healthy Lives. Strategic and systematic approaches need to be developed to incorporate SDOH into future activities for the prevention and management of clients with chronic conditions.
The NT Early Childhood Plan has been developed in partnership with a range of government and non-government organisations including the Department of Education and Training, Department of Health, Department of Children and Families. It was developed in consultation with communities across the NT in 2011 and offers increased opportunities for effective brain development for disadvantaged children and is likely to have a significant impact on improving SDOH.
The number and proportion of Aboriginal staff employed within DoH remains unchanged at approximately 370 (6%). This is considerably lower than the
9Zhang X, Condon J, Douglas F et. al. Women’s cancers and cancer screening in the Northern Territory.
Department of Health, Darwin, 2012.
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proportion of Aboriginal people living in the NT of approximately 30%. Consistent and long-term strategies to improve recruitment and retention of Aboriginal staff are required.
Key action area 2 - Increase the focus on primary prevention to prevent and reduce risk factors
There are numerous activities taking place across the NT that focus on primary prevention. Amongst these programs there is a focus on tobacco control, alcohol control, nutrition, physical activity and emotional health.
With tobacco control in 2011, three reforms to the Tobacco Control Act 2002 commenced resulting in a ban on smoking in all public outdoor eating and
drinking areas (with exempt areas for licensed venues), prohibition on the display of tobacco products at the point of sale and introduction of an annual licence fee.
A further amendment of the Tobacco Control Act through a partnership between DoH and the Department of Justice (DoJ) resulted in mandatory reporting of monthly sales data by tobacco retailers from 1st January 2011. This data will be used in future years to provide accurate monitoring of tobacco consumption throughout the NT.
Alcohol reform measures commenced on the 1st July 2011. These reforms targeted problem drinkers who cause alcohol-related crime and anti-social behaviour in the community by issuing drinking bans and introducing mandatory rehabilitation treatment from problem drinkers. Alcohol treatment services and training were expanded to cater for the increased demand for services.
An array of programs targeting Aboriginal people to improve their understanding of and skills in preventative health behaviours are available. Examples of these programs include:
No Germs on Me, a hand washing campaign using social marketing, developed by DoH Environmental Health Branch
NT Oral Health Promotion Plan, launched in March 2011
Swap It Campaign, a national health promotion campaign encouraging young people to swap to healthy nutrition choices and increase physical activity. This campaign has developed resources specifically for
Aboriginal and Torres Strait Islander persons.
Several major partnerships between agencies were established to support the creation of healthy environments. The NT DoH and the South Australian DoH formed a partnership to establish and implement the Childhood Obesity and Lifestyle (COPAL) Program, in the Palmerston community.
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Key action area 3 – Early detection and secondary prevention
Educational opportunities for health professionals to increase knowledge, understanding and action on early detection and risk factors are now widely available. The Chronic Conditions Strategy Unit conducts regular courses targeting all health professionals, including Aboriginal Health Practitioners and remote health workers. Course topics include: preventable chronic conditions, diabetes, respiratory care, renal care coordination, well women’s health
screening, child health and practical paediatrics. The 3-day preventable chronic disease courses, which cover health promotion, early detection, brief intervention, motivational interviewing and self-management approach were all well-attended and received positive evaluation.
Systematic approaches to early detection and management of disease markers have been implemented into all of the Aboriginal primary health care centres, including government-run and community-controlled. These systems use templates for recording risk factors such as smoking, nutrition, alcohol, physical activity and emotional wellbeing (SNAPE) and cardiovascular risk. In the future, data on risk factors will be available for monitoring and analysis.
The proportion of the eligible Aboriginal people aged 15 years and over who underwent an Adult Health Check remains low however there has been a significant increase since 2005. Data from government-run clinics show that in 2011, 7.6% (1454) of the eligible Indigenous population aged 15-55 received an Adult Health Check.10
In 2011, the number of non-Aboriginal people who received a Medicare- subsidised health assessment in the NT was 1379, a 65% increase from 892 in 2010.11 Eligible groups include 4 year old children, 40-49 year olds at high risk for diabetes, 45-49 year olds at risk of a chronic disease and people ≥75 years.
Key action area 4 – Self Management
The NT Chronic Conditions Self Management Framework 2012-2020 has been finalised and a detailed Implementation Plan has been developed. The
Framework will assist health services to promote and support self management by empowering individuals with chronic conditions to actively participate in their own health care. Organisations involved in implementation of the Framework
10 Department of Health Sites Health Centre Report: Modified AHKPI report, NT Department of Health, 2012 (unpublished)
11Audit of Medicare item numbers 701, 703, 705, 707 for the 2011 calender year. Available from:
www.medicareaustralia.gov.au/statistics/mbs_item.shtml. [accessed 8th October 2012]
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include DoH, NGOs and ACCHSs. The Framework will be used to guide and inform at all levels of health organisations including the following:
Policy makers, on how to structure health services to support health staff to provide self-management initiatives to clients, and to create appropriate environments conducive to client’s participation in self management
Service providers, about how a self management approach can be integrated into current practice
Health staff, to deliver evidence based self management initiatives
Self management for clients are provided in various forms in the NT. The majority are disease specific and held in urban areas. Targeted chronic conditions include cardiovascular disease, rheumatic heart disease, type 2 diabetes, chronic kidney disease, chronic airways disease and cancer. Further work needs to be done to expand programs, preferably to address chronic conditions (non-disease specific) to remote areas and evaluate their effectiveness.
There were a number of training opportunities on self management for health professionals. DoH incorporated self management into several short courses across the NT including the preventable chronic conditions, respiratory and renal care coordination short courses. Online learning packages to provide flexibility in training are being assessed for use in the NT. Other organisations incorporating self management into their health professional training include the Asthma Foundations, Healthy Living NT, GPNNT and the Lung Foundation.
Key action area 5 - Care for people with chronic conditions
The number of care plans prepared by GPs for clients with diabetes continues to increase. In 2011, 66% of patients with type 2 diabetes and/or coronary heart disease were on a GP Management Plan and, of these clients, 51% were also on a Team Care Arrangement involving allied health professionals. The proportion increased from 2010 where 36% of patients had a GPMP and 24% of these had a TCA in place. In addition the number of people with diabetes having an HbA1c measured also increased from 55% in 2010 to 62% in 2011.
Specialist outreach services NT (SONT) provided 1101 specialist outreach visits through the Medical Specialist Outreach Assistance Program (MSOAP) in 2011 with the most frequent visits for ophthalmology, paediatrics and general physician services.
Twelve new Indigenous Care Coordinator positions across the NT have been created under the ‘Closing the Gap’ funding. Some of these positions have
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enabled disease-specific care coordinators to be appointed in Aboriginal Medical Services. At the time of this Report writing all 12 positions have been filled:
Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation (WDNWPT – Purple House) – 1 position
Central Australian Aboriginal Congress – 4 positions Katherine West Health Board – 1 position
Danila Dilba Health Service– 4 positions Miwatj Health – 2 positions
Key action area 6 – Workforce planning and development
The NT Medical School commenced in 2011 with 24 students enrolled in the first year including 10 Aboriginal students. The program runs in conjunction with Flinders University and students are subsidised by the NT Bonded Medical Scheme (NTBMS). The medical school is expected to have a significant improvement on retention of the medical workforce in future years.
A number of people took up new roles related to Chronic Conditions in 2011.
Federal funding as part of the Indigenous Chronic Disease Package (ICDP). This increase was most evident in the ACCHSs where the number of tobacco control positions increased from 1 to 9 and 12 new care coordinators were employed.
Other new roles funded through the ICDP in 2011 included 3 regional tobacco coordinators, 3 tobacco action workers and 6 healthy lifestyle workers.
Hospital appointments to increase staff in chronic conditions included a gastroenterology coordinator at RDH and a cardiac coordinator, respiratory educator, diabetes educator and preventable chronic disease clinical nurse consultant at ASH.
Key action area 7 – Information, communication and disease management systems
All Aboriginal primary health care clinics in the NT including government and ACCHS now use electronic patient information and recall systems. Electronic systems facilitate chronic conditions management activities by providing uniform, consistent and reliable systems. They also enable more accurate data collection for audits and analysis.
My Electronic Health Record (MyeHR) is a shared electronic health record which can be used by multiple different providers across different health care settings in
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the NT. It is now available in all public hospitals, ACCHSs, remote health centres and some private general practices in the NT. Since becoming available in 2010 the number of individual registrations have steadily increased to 55 000 by mid- 2012.
The Chronic Diseases Network (CDN), established in 1997, brings together individuals and organisations committed to reducing the impact of chronic conditions and their complications in the Northern Territory. By the end of 2011 there were 900 members. The main activities of CDN include the annual CDN conference, quarterly newsletters, fortnightly e-CDN news and the sharing of information through the CDN website and Combined Network Meetings. In 2011, the Combined Network Meetings were hosted by CDN, Palliative Care NT, Cancer Council, GPNNT and held in Darwin, Alice Springs, Katherine, Gove and Tennant Creek. The annual conference in 2011 focused on mental health and the relationship with chronic physical illness. The conference was well attended with 252 delegates from across Australia.
Key action area 8 – Continuous quality improvement
Continuous Quality Improvement (CQI) is now embedded into Aboriginal primary health care services. The NT CQI program had 2 coordinators and
approximately 16 dedicated CQI facilitators across the NT in 2011. The
facilitators work with local health professionals within DoH and ACCHSs to audit practices according to NT AHKPIs and One21Seventy processes.
The Audit of Best Practices in Chronic Disease (ABCD) National Partnership Project aims to improve the quality of primary health care available to Aboriginal and Torres Strait Islander peoples. Partners from NT, WA, SA and QLD are involved, with participating territories and states being represented by their ACCHS peak bodies, Government Health Departments and a lead research institution. The Northern Territory is represented by the Menzies School of Health research, the Northern Territory Department of Health and AMSANT. The group meets twice yearly.
In partnership with the Flinders Rural Clinical School, DoH undertook quality management for the NT Point of Care Testing (POCT) program. This provides quality assurance for DCA analysers (for HbA1c and ACR) and the i-STAT analyser (INR). The program has expanded since its commencement in 2008 with 41 health centres participating in 2011. Over the three years, 368 remote health centre staff members have been trained in POCT.
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