Exam Prep Lecture Notes 1-7,9-10 PDF

lOMoARcPSD|26305708 Exam prep - Lecture notes 1-7,9-10 Health and Health Care in Australia (James Cook University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Contents Week 1 – Health care in Australia..........................................................................................................3 Health............................................................................................................................................3 Health and Population...................................................................................................................4 Health policy..................................................................................................................................4 Conclusion.....................................................................................................................................5 Week 2 – Understanding your community............................................................................................5 Demography..................................................................................................................................5 Transition models..........................................................................................................................6 Population pyramids......................................................................................................................7 Demography of Australia rural areas.............................................................................................7 Health profile of Australia rural areas............................................................................................7 Conclusion.....................................................................................................................................8 Week 3 - Health and disease in our population.....................................................................................8 Epidemiology.................................................................................................................................9 Epidemiology study design..........................................................................................................10 Conclusion...................................................................................................................................10 Week 4 – Looking through a social lens...............................................................................................11 Looking through a social lens.......................................................................................................11 The social model of health...........................................................................................................11 Social determinants of health......................................................................................................11 Social exclusion............................................................................................................................12 Social inclusion............................................................................................................................12 Health risk factors........................................................................................................................13 Rural and remote health..............................................................................................................14 Conclusion...................................................................................................................................14 Week 5 – Primary Health Care in Australia..........................................................................................14 Primary Care................................................................................................................................14 Primary health care.....................................................................................................................15 Alma-Ata Declaration on Primary Health Care.............................................................................15 Common elements of PHC services.............................................................................................15 Requirements for sound PHC.......................................................................................................15 PHC Reform in Australia...............................................................................................................15 National Primary Health Care Strategic Framework (NPHCSF).....................................................16 Aboriginal Community Controlled Health Organisations.............................................................16 1 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Primary Health Networks (PHNs).................................................................................................16 Conclusion...................................................................................................................................17 Week 6 – Hospitals in Australia............................................................................................................17 Public Hospitals............................................................................................................................17 Private hospitals..........................................................................................................................17 Hospital services..........................................................................................................................17 Number of hospitals in Australia..................................................................................................18 National Healthcare Agreements.................................................................................................18 National Safety and Quality Health Service (NSQHS) Standards..................................................18 Challenges for Australian hospitals..............................................................................................19 Ensuring health care worker safety..............................................................................................19 Conclusion...................................................................................................................................19 Week 7 – Health care practitioners......................................................................................................20 Australian health workforce.........................................................................................................20 Health workforce planning..........................................................................................................21 Geographical context...................................................................................................................21 Regional variations within our NQ region....................................................................................21 Challenges around the world.......................................................................................................22 Conclusion...................................................................................................................................22 Week 8 – Paying the bills.....................................................................................................................22 Health funding.............................................................................................................................22 Government health expenditure.................................................................................................22 Non – government expenditure...................................................................................................23 Funding responsibilities...............................................................................................................23 Projected expenditure.................................................................................................................23 Medicare Benefits Schedule........................................................................................................24 Private health insurance..............................................................................................................24 National Disability Insurance Scheme (NDIS)...............................................................................24 Pharmaceutical Benefits Scheme (PBS).......................................................................................25 Oral health care in Australia.........................................................................................................25 Conclusion...................................................................................................................................26 Week 10: The future of health in Australia..........................................................................................26 Technology enabled care (TEC)....................................................................................................26 Benefits of digital health for providers........................................................................................26 Benefits of digital health for consumers......................................................................................26 TEC barriers..................................................................................................................................26 2 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 My health record – Australia.......................................................................................................27 Mobile technology (mHealth)......................................................................................................27 Future challenges in Australia......................................................................................................27 Priority areas for action...............................................................................................................28 Other issues and their trends......................................................................................................28 Conclusion...................................................................................................................................29 Week 1 – Health care in Australia  Healthcare in Australia is evolving o As health care professionals we are exposed to changes in the way we diagnose, treat and manage conditions due to technologies and research o Nowadays health care professionals are linked to colleagues in the wider international community Health ‘A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ - WHO  Health is a state of wellbeing that reflects a person’s: o Genetics o Lifestyle o Environment  Generally depends on determinants (factors that influence health) and interventions (actions to improve health)  We can describe the health or a health system using health indicators o Life expectancy o Mortality rates (Death rates) o Self- assessed health status Health and Population  Important to know populations we treat to ensure o Accurate funding allocations (geographic and workforce) o Accurate workforce allocations o Examine disease trends and employ preventative strategies o Adequately plan for health services including infrastructure  Australian population o Most live in cities o 3.3% are Aboriginal o Around ¼ were born over seas  Population health status o Life expectancy is fifth highest o Death rates have a downward trend o Ppl are living longer free of disease and illness  Indicators that demonstrate Australia’s improving health status include: 3 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o A decrease in notification rates for hepatitis B and C o Heart attack rates have declined for both men and women since 2007 o The death rate for infants aged under 1 and children aged 1–4 has decreased since 2001 o The notification rate of human immunodeficiency virus (HIV) has remained steady (4.2 notifications per 100,000 people in 2016).  Health concerns for Australian population o Chronic disease from poor lifestyle factors o Inequalities in health:  Health in rural and remote areas  Socio economic groups  Aboriginal and Torres Strait Islander People Health policy ‘Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society’ – WHO o Defines a vision for the future o Helps to establish targets and points of reference for the short and medium term o Outlines priorities and the expected roles of different groups while building consensus and informing people o Example: No Smoking Policy JCU  Australian health policy o All policy decisions made from governments emerge from a complex process, involving various stakeholders o Decisions can be influenced by parliamentarians, unions, professional associations, consumer advocacy groups and individuals o Council of Australian Governments (COAG) is the peak intergovernmental forum in Australia  COAG comprises of the Australian Prime Minister, state/ territory leaders and local government leader  its advisory body, the Australian Health Ministers’ Advisory Council (AHMAC), support and advise COAG on health policy, services and programs  Australian Health Performance Framework o National health policies are informed by the new 2017 Australian Health Performance Framework (AHPF) o AHPF was devised to assess the performance of the whole Australian health care system and builds on existing frameworks: National Health Performance Framework (NHPF) and the Performance and Accountability Framework (PAF) o Objective: “to improve health outcomes for all Australians and ensure the sustainability of the Australian health system”  Challenges to Australian health care system o Advances in medical research, science and technology (having to teach people how to use new machines o Health data management (privacy of electronic documents) o Workforce challenges o Demographic changes and the demand for health services 4 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Management of chronic conditions  With increasing life expectancy and improvements in health, people are more likely to remain active for longer  Many health care conditions associated with disability as we age  Demand for health care services for people over 65 years Conclusion  The Australian health care system is constantly evolving  The general health of the Australian population is positive, however some significant challenges still exist  Health policy determines actions to combat significant health issues and involves a collaborative effort of government and industry professionals Week 2 – Understanding your community Demography  Demography is the statistical study of human populations (size, structure and distribution of people and how they change  Census is the most common way to collect demographic data – in Australia this is done every 5 years  Demography (i.e. the distribution of populations) can be defined at multiple levels: o Local/Regional/National/Global o Ascribed  Age/Gender/Ethnicity o Achieved  Educational/Occupation/Family structure  We know that in different places and over time population structures and health change dramatically o Less developed countries:  High levels of fertility.  High levels of infant mortality.  A high prevalence of some diseases such as HIV/AIDS.  High levels of out - migration to more developed countries. o More developed countries:  Low fertility patterns.  Women having babies at later ages.  Some populations with below replacement levels of fertility.  Large numbers of migrants from less developed countries.  Importance of demographic data o Allows health professionals and health planners to understand the characteristics of their community so they can plan health care services. o Ensures health care services match population health care needs. o Can assist health professionals make informed decisions to improve health care delivery. 5 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Allows deeper insight into what is needed to prevent disease and to promote health and wellbeing. o Examining data over a period can help to identify trends in health. Transition models  Stage 1 Pre-industrial o High death rate & high birth rate. o Slow population growth. o All human populations are believed to have had this balance until late 18th century. o This is still seen in Ethiopia  Stage 2 Industrialising o Death rate starts to fall sharply. o Birth rate remains high. o Prior to the mid-20th century. o Improved food handling, water supply, sewage, and personal hygiene  Stage 3 Mature o Birth rate falls sharply. o Fall in death rate begins to level off. o Mainly a response to social changes –e.g. access to contraception, increased incomes, improved education and status of women.  Stage 4 Post industrial o Both birth & death rates level off at low levels. o Birth rates may drop to below replacement level –e.g. in German, Italy, Japan resulting in a “shrinking” population.  Stage 5 Declining (no one has hit this stage yet) o A decline in the overall population as the death rate becomes higher than the birth rate. o Developed countries are experiencing this trend for different reasons. o Economical constraints: cost to raise a large family is increasing in many developed countries. o Societal shift: couples choosing to have children later in life order to pursue careers. o Negative population rate is not an immediate affect and make take a couple of generations. 6 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Population pyramids  Four representations of population age -sex structure provide an overall example of what a pyramid for different levels of population growth would look like o Rapid growth (packed into younger age bracket) o Slow growth (pear shaped) o Zero growth (almost like a column all age brackets are of a similar size) o Negative growth (less individuals in younger generation then in older age brackets Demography of Australia rural areas  Australians living in rural and remote areas face unique challenges due to their geographical location. This is due to accessibility to services  Generally poorer health outcomes influenced by a variety of demographic characteristics: o Disadvantages in education – if so, they have to leave and go to boarding school far from home o Reduced employment opportunities o Hazardous occupations o Less income  Age and sex distribution – 51 % female (major cities) vs 46 % female (very remote areas).  Access to health care services limited however high hospitalisation rates. Health profile of Australia rural areas  Higher obesity rates (68 %) in outer regional / remote areas  o Reduced physical activity o Increased alcohol consumption  Higher occurrence of chronic and other conditions o Asthma o Osteoarthritis o Diabetes  Lower life expectancy 82 years (major cities) vs 67 years (very remote)  Higher rates of suicide  Lower birth weights and higher rates of teenage pregnancy. 7 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Conclusion  Demography is the statistical study of human populations – the size, structure and distribution of populations and how these change over time.  Allows health professionals and health planners to understand the characteristics of their community so they can plan health care services.  Population pyramids indicates the potential for future growth.  The health profile and demography of remote and rural areas varies from that in metropolitan or urban centres.  ABS and AIHW are a great source of demographic data. Week 3 - Health and disease in our population Epidemiology  The study of the distribution and determinants of health-related states in specific populations; and application of this study to try and control problems  Distribution o Epidemiology is concerned with the frequency and pattern of health events in a population:  Frequency: Not only the quantity of health events but how this relates to the wider population  80 cases of influenza “a” in a population of 150 has a different relationship to 80 cases in a population of 1 million.  Pattern: Refers to the occurrence of health-related events by time, place, and person.  May be annual, seasonal, weekly, daily, hourly, weekday versus weekend, or any other breakdown of time that may influence disease or injury occurrence. 8 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Determinants o Factors that influence “health related events” or “health states”:  Biological (Genetic influences)  Behavioural (Risk factors such as smoking)  Social  Cultural (Practices and views of health)  Economic (Income)  Political factors (Policies and regulations influencing health)  Heath related states o A health-related state does not describe illness alone, may describe the absence of disease in a region  helps to create strategies to prevent illnesses o Description of health related “events” and “states”:  Morbidity (The rate of disease)  Injuries  Disability  Mortality of populations (Deaths)  Fertility (Births) Epidemiology study design  British Doctors Study o First large scale prospective study into the effects of smoking o Began in 1951 -Sir Richard Doll and Sir Austin Bradford Hill  Questionnaire on smoking habits -41024 returned (34494 males and 6207 females) o Established the linkage between tobacco smoking and cause-specific mortality  The risk of death from lung cancer (1954)  Myocardial infarction and chronic obstructive pulmonary disease (1956) o Results have influenced decisions about quitting  Half of the smokers died from a tobacco-related disease and half of these deaths occurred in middle age o Stopping smoking at any age is effective in reducing the loss of non-smokers life expectancy  Designs o Descriptive observational studies  Describes the occurrence of a risk factor/exposure/health outcome in a population  Are observational only – the investigator does not change anything  Considers person, place and time variables  Focuses on a population at a point in time, or over time  Examples: Case, Case series or Survey (eg. ABS survey) o Analytical observational studies  Examines the relationship between a risk factor/exposure and a health outcome  Are observational only – the investigator does not change anything  Analytical observational studies aim to identify associations  Cannot demonstrate the “cause” of the health outcome  But can guide further research  Ecological, Cross–sectional, Case–control and Cohort studies 9 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Experimental  Examine the relationship between a risk factor/exposure and a health outcome  Experimental studies aim to identify “cause”  Are experimental- the investigator changes something  Stronger evidence of a “causal association” than an observational study but are still subject to a range of potential errors  Randomised Controlled Trials (RCT’s) and Community trials Conclusion  Epidemiology is the study of the occurrence, distribution and determinants of health-related states and events that impact populations  Epidemiology involves the application of knowledge to solve health problems  In Australia, life expectancies across all age brackets are improving  Epidemiology comprises both observational and experimental study designs Week 4 – Looking through a social lens Looking through a social lens  People actively create the conditions that shape their health experiences in our communities  Illness not only has pathological (biomedical) origins but is impacted by social determinants: o Income o Education o Early life experiences  As health care professionals we must be aware of these social influences o Accurate assessments o Develop rapport o Intention planning The social model of health  Views health, disease and illness as integral products of the person/ environment relationship  Socio-economic influences  Addresses all stages of health/ illness across a lifespan continuum  Aim is to define the influence of external factors on an individual: o Social (Socially excluded groups) o Economic (Income) o Environmental (Access to health care services)  External factors  alongside individual behaviours there are contextual factors that affect a person’s health: o Level of education o Where someone resides o Where/ whether someone is employed o Level of employment  Food quality and security o Lifestyle and recreation behaviours o These considerations form the social determinants of health 10 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Social determinants of health  The conditions in which people are born, live, work as well as their access to health services  These conditions are significantly shaped by economics, social policies and politics  They can detract or contribute to the health of individuals and communities  Good predictor of individual and population health o Important for health planning (workforce planning and health infrastructure)  Ten factors o Social gradient o Stress o Early life o Social exclusion o Working conditions o Unemployment o Social support o Addiction o Food o Transport Social exclusion  Social exclusion is a term that describes social disadvantage and lack of resources, opportunity, participation and skills: o Poverty o Discrimination o Racism o Stigmatization o Hostility o Unemployment  These processes prevent individuals participating in education and gaining access to services/ citizenship activities: o Reduced access to basic health care services 11 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Social exclusion can be driven by unequal power relationships across different levels: o Individual o Households o Community groups o Countries o Globally  Involves denial of resources, rights, goods and services  Inability to participate in the normal activities, relationships in society Social inclusion  Promoting inclusion is about helping people who have previously been excluded from mainstream society by: o Drawing attention to the health needs of a group through awareness campaigns o Advocating for change and community action to promote socially inclusive health care services o Engaging those who are socially excluded with health care interventions that promote a sense of belonging and connectedness:  Group therapy  Multidisciplinary approaches to care  Social inclusion influences our health and wellbeing Health risk factors  A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury  Types of risk factors include: o Behavioural  A person’s health is influenced by health behaviours or risk factors that are part of their individual lifestyles:  Overweight and obesity – 66% adults and 28% children obese in Australia  Insufficient physical activity –Linked to chronic diseases (coronary heart disease and diabetes)  Alcohol and illicit drug use – Leading risk factors for disease/ injury in males aged 14 – 44 years  Tobacco use – Decline from 1991 to 2019 (from 24% to 12%)  Still the leading risk factor for preventable causes of death – (cancer and CVD)  Diet – Most Australians do not consume the recommended servings from the five food groups  Higher rates of behavioural health risk factors in outer regional/ remote areas  People who live in Outer regional/ Remote areas have increased rates of:  Smoking/Risky alcohol consumption/Physical inactivity/Overweight and obesity  As a result, the occurrence of chronic diseases are generally higher in these locations o Biomedical (intrinsic) 12 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Biomedical risk factors are bodily states that have an impact on a person’s risk of disease  High blood pressure –hypertension o 34% of Australian adults with high blood pressure  Abnormal lipids –cholesterol and triglycerides o 65% of Australian adults with abnormal blood lipid levels  Impaired glucose regulation o 3.1% of Australia adults with impaired regulation o Major precursor for Type II Diabetes o Environmental  Most Australians have access to clean water, safe food products and effective sanitation  Factors including population growth/ distribution and extreme weather events place pressure on the natural environment and impact:  Food safety – Gastrointestinal diseases (Salmonellosis)  Air quality – Cardiovascular and respiratory diseases  Water quality – Gastroenteritis  Ultraviolet radiation – Sun exposure, Vitamin D deficiency, and skin cancer Rural and remote health  People in rural and remote communities are “less healthy” than those in metropolitan areas  National health goal: o National Strategic Framework for Rural and Remote Health 2011 o Achieve equality across Australia by 2020  To achieve health equality, we must adequately address: o Social conditions o Economic conditions o Environmental conditions Conclusion  Illness not only has pathological (biomedical) origins but is impacted by social determinants  The social model of health views health, disease and illness as integral products of the person/ environment relationship  The social determinants of health are the conditions in which people are born, live, work as well as their access to health services  People in rural and remote communities are “less healthy” than those in metropolitan areas Week 5 – Primary Health Care in Australia Primary Care  Biomedical model of care that focuses on: o Treatment/Rehabilitation/Medical care  Provided by a range of HCP’s including doctors, allied health practitioners and nurses  Known as a “frontline” service  Gateway to other services 13 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Most commonly used services in the health system  Internationally, the term ‘primary care’ commonly refers to medical care provided by General Practitioner’s (GP’s)  Funded by a “fee for service” model  o Medicare funded: bulk-billing services for GP’s and some other practitioners (eg psychologist) o Gap payment o Out of pocket payments for allied health  New service models currently under investigation in Australia based on a lump-sum payment to manage health needs in General Practice o Eg. Health Care Home for people with chronic conditions Primary health care  Primary health care is a broader term (proactive and reactive)  Community-based services based on the social model of health o Health services delivered to individuals  Includes the services delivered in primary care o Population-level "public health-type" functions  Considers broader determinants of health o Equity o Acceptability o Cultural competence o Affordability o Universalism Alma-Ata Declaration on Primary Health Care Foundations for health are: “Peace, shelter, food, income, stable ecosystem, sustainable resources, education, social justice, equity” Common elements of PHC services  Education  Promotion of food supply and proper nutrition  An adequate supply of safe water and basic sanitation  Maternal and child health care  Immunisation against major infectious diseases  Prevention and control of local endemic diseases  Appropriate treatment of common diseases  Provision of essential drugs Requirements for sound PHC  Appropriateness  Availability  Adequacy  Accessibility  Acceptability  Affordability 14 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Assessability  Accountability  Completeness  Comprehensiveness  Continuity PHC Reform in Australia  Reforms generally reflect a change to population circumstances: o Changing demographics o Maldistribution of services o Ageing populations o Burden of chronic and non-communicable disease o Cost of health technologies o Disasters o Disadvantaged groups e.g. Aboriginal and Torres Strait Islander people National Primary Health Care Strategic Framework (NPHCSF)  NPHCSF builds on the National Primary Health Care Strategy (2010)  Aims to improve health care for all Australians, particularly those who currently experience inequitable health outcomes by: o Preventing illness o Reducing the need for unnecessary hospital presentations o Improving the management of complex and chronic conditions  The framework recognizes the role of GP’s, other health care professionals, individual consumers and specific population groups - Strategic outcomes o Building a consumer focused and integrated primary health care system o Improving access and reducing inequity  PHC addresses service gaps o Increasing the focus on health promotion and prevention, screening and early intervention  Individual and community wellbeing promoted through a multi-tiered approach o Improving quality, safety, performance and accountability  Consumers and providers are engaged and collaborate on a continuous improvement cycle Aboriginal Community Controlled Health Organisations  Focus on the health and wellbeing of Aboriginal and Torres Strait Islander people  A primary health care service initiated and operated by local Aboriginal communities to deliver: o Holistic health care o Comprehensive health care o Culturally appropriate health care  NACCHO is the national peak body representing Aboriginal Community Controlled Health Services (ACCHSs) 15 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Primary Health Networks (PHNs)  In 2012 – 13 Medicare Locals were established -localized population health data for health needs  Replaced in 2015 by Primary Health Networks (PHNs) o Increasing the efficiency and effectiveness of medical services for patients o Improving coordination of care to ensure patients receive the right care in the right place at the right time  PHN’s do not directly deliver health services o PHN’s undertake community health needs assessments o Identify gaps in service o Support and plan for service delivery i.e. Commissioning  Northern Queensland Primary Health Network assists with funding towards several health care services aimed at addressing: o Aged care o Immunizations o Mental health o Chronic disease o Alcohol and other drug services Conclusion  Primary care is a biomedical model of care  Primary health care is a social model of care that includes the services provided in primary care  There are 11 principles to support sound PHC services  The National Primary Health Care Strategic Framework identifies four key strategies to promote PHC in Australia  Aboriginal Community Controlled Health Services (ACCHSs) are primary health care services run by and for Aboriginal and Torres Strait Islander peoples  PHNs aim to increase the efficiency, effectiveness and coordination of primary health care services Week 6 – Hospitals in Australia Public Hospitals  State and territory governments own and manage the public hospital system (microlevel) o Location o Capacity (how many beds) o Service provision (paediatrics) o Closures/ expansion  Funding is shared between state/ territory and federal governments  Hospitals make up the largest component of spending in the health care system Private hospitals  The quantity of private hospitals has expanded considerably in recent decades (due to long wait list in public as well as more funding)  Funded largely by non-government resources: 16 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Non –governmental organisations o Consumers – ‘Fee for service’ o Private health insurance  A majority owned by commercial organisations o Ramsey, Healthscope and Epworth  History of private hospitals being owned by church or charitable groups Hospital services  Typically provide medical and 24-hour nursing services with surgical and obstetric services  Emergency admissions ~ 28 % of hospital related care  Intensive care units (ICU) o Complex and multi-system life support services  Rehabilitation care o Aimed at improving functioning following illness or surgery  Palliative care o Treatment goal is to optimise the quality of life of a patient with an active and advanced life-limiting illness  Larger hospitals in metropolitan areas provide specialist services such as psychiatric inpatient clinics Number of hospitals in Australia  695 public hospitals (compared with 746 in 2012–13) o Decrease due to reclassification of small hospitals (~ n=50) to non-hospital services  Due to reclassification of small hospitals that didn’t have as many services, lower bed counts and were transferred into non-hospitals and now are community health care clinics  630 private hospitals (compared with 592 in 2011–12)  Number of beds? o Public hospitals – increase in beds despite decrease in hospitals  2.5 beds per 1,000 people o Private hospitals – increase by approximately 3.3 % per year  1.4 beds for every 1,000 people National Healthcare Agreements  The National Healthcare Agreement affirms the agreement of all governments about how the Australia's health system should operate o Includes agreements about the operation and joint funding ventures of public hospitals  Governments commit to improving health outcomes for all Australians and to ensure the sustainability of the Australian health system  Key outcomes of the agreement include: o Provision of high quality and affordable health care o That the health system remains sustainable National Safety and Quality Health Service (NSQHS) Standards  The NSQHS standards became mandatory for all hospitals (public/private) in January 2013  The standards provide a quality assurance mechanism to ensure minimum standards of safety and quality are met in Australian hospitals  NSQHS primary aims: 17 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o To protect the public from harm o To improve the quality of health service provision  There are eight standards that target workforce practices across all levels of Australian public and private hospitals 1. Clinical Governance 2. Partnering with Consumers 3. Preventing and Controlling Healthcare-Associated Infection 4. Medication Safety 5. Comprehensive Care 6. Communicating for Safety 7. Blood Management 8. Recognisingand Responding to Acute Deterioration  Standard 2 – Partnering with consumers o Systems that are based on partnering with patients should be used to support the delivery of person-centred care o This standard aims to create a health service that is responsive to patient, carer and consumer needs o Criteria to accomplish this standard:  Governance systems to support partnering with consumers  Partnering with patients in their own care  Enhancing health literacy among consumers  Standard 3: Preventing and Controlling Healthcare-Associated Infection o Systems are in place to support and promote prevention and control of health care associated infections, and improve antimicrobial stewardship  Antimicrobial stewardship is the ongoing effort by a health service organisation to optimise antimicrobial use to improve patient outcomes o Criteria to accomplish this standard include:  Quality improvement controls to prevent and control infection  Infection control systems  Reprocessing of reusable medical devices Challenges for Australian hospitals  Managing digitisation and innovations  Worker safety  Complexities in funding, governance and reporting arrangements o Agreements between commonwealth and state governments  Service planning and delivery within the sector and with other health care, social and welfare sectors  System inadequacies -workforce shortages and maldistributioneg. managing rural/remote services  Staphylococcus aureus bacteremia (SAB) infection control o In 2016–17, about 30 % of all SAB cases occurred in Public hospitals Ensuring health care worker safety  Biological: SARS, TB, Anthrax, HIV, Hepatitis  Chemical: Drugs, disinfectants, sterilant  Ergonomic: Lifting, transfers  Stress/Violence: Staffing shortages, shift rotation 18 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Physical Hazards: Radiation, heat, noise Conclusion  The National Healthcare Agreement affirms the agreement of all governments about how the Australia's health system should operate  The NSQHS are designed to protect the public from harm and increase the quality of care  The hospital system faces a variety of challenges from workforce safety to policy and governance requirements organisation  Various factors influence hospital service delivery including remoteness of facility and resources available Week 7 – Health care practitioners Australian health workforce  Approximately 13% of individuals employed in Australia are working in health  In 2018 there were ~ 702,700 registered health care practitioners employed in Australia  This number excludes Biomedicine, SES and Ex.Phys (Not registered through APHRA)  Nursing and midwifery comprise the largest professional group ~ 50 %  Most health workers have completed some form of tertiary training  The health care industry is a growth industry with marked change in recent years  Reasons behind growth include government incentives to meet consumer demand Nursing and midwifery o Largest health occupation in Australia ~ 398,000 (2018 figure) o RN ~ 294,000, EN ~ 63,000, both EN and RN ~ 7,700, Midwife ~ 5,200, RN and Midwife ~ 27,000 (2018 figures), and AIN ~ 70,000 (uncertain) o Primarily work in acute based settings with some in community health centres o Approximately 25 specialties including mental health nurses and midwifery o A major reform was the change of training from hospitals to universities in 1993  Considered a landmark change to bring nursing into line with other HCP’s Allied health o A range of university educational occupations (physiotherapy, occupational therapy, speech pathology & psychology) o Approximately 15% of all health occupations -Psychology is the highest o Term “allied health” originally meant “allied to medicine” in days when viewed as an inferior profession o Nowadays a greater alliance between allied health professions o Still lacks political power and organisation compared to nursing and medical professions Dentistry o Approximately 23,000 (2018 figure) registered Dental Practitioners in Australia o Majority work in private practice o Dental teams include dental technicians, dental hygienists and dental therapists 19 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 Pharmacy o Approximately 31,000 pharmacists are registered in Australia o A majority employed as retail pharmacists -fewer in hospitals (~ 14%) o Paid by the Australian Govt. to dispense under the PBS o Increased regulation by Govt. to ensure locations of pharmacies remain a viable business Exercise and physiology science o Provide clinical exercise interventions and facilitate behaviour change for individuals to promote health and wellbeing; and to manage chronic disease and injury o A discipline that continues to evolve o Work across a variety of public and private settings o The exercise and sports science workforce is young:  59% of members under 30 years of age and  80% of members being under 40 years of age o Nearly 80% working in a capital city or major metropolitan centres Biomedicine o Most medical scientists work in the health industry, especially in hospitals in tandem with:  Doctors  Pathologists  Scientists  Technicians o Most medical scientists work in the health industry, especially in hospitals o Workforce is predominantly made up of females (66.6 %) o Most of the workforce is aged over 35 years (64.8 %) Health workforce planning “the systematic assessment of future human resource needs and the determinations of the actions required to meet those needs”  The health workforce market is highly complex and influenced by many factors  Poor planning can result in imbalances of a health care system (rural vs metropolitan service gaps)  Traditionally, a widely used and simplified approach to health workforce planning included personnel-to-population ratios  Must consider demographic transitions to accurately forecast workforce allocations  Must consider change in health states – increasing impacts of chronic disease on health workforce  Various influences including new technologies and community expectations Geographical context  The nature of a work force is defined by its geographical context  It is widely recognised that people living in rural and remote areas tend to have much poorer access to allied health professionals  Indigenous communities in remote areas often have very little or no access to health services 20 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Rural areas frequently attract new health graduates  Rural practitioners are often expected to work at a much higher skill level Regional variations within our NQ region Example  Torres and Cape has the highest Primary Health workforce rate for population (690 per 100,000 people) o Half of these are nurses o No physiotherapists, occupational therapists or radiographers o Highest GP rate in the NQ region (134 per 100,000 people)  Small actual number of GPs in Torres (n=13)  Region with the greatest variation, with no GPs in 12 LGAs in the region: Croydon, Etheridge, Wujal Wujal, Hope Vale, Lockhart River, Mapoon, Napranum, Pormpuraaw, Torres Strait Island, Flinders, Palm Island, and Richmond Challenges around the world PNG  An ageing workforce  Low numbers of critical occupations, such as midwives and community health workers  A “de-motivated” workforce due to poor working conditions, including low wages and poor physical infrastructure  Insufficient training capacity to produce the number of health workers to meet population needs  Misdistribution of specialist clinical and technical skills, where 30% of skilled health professionals occupy administrative and management positions Indonesia  Challenges around planning, recruitment, and retention of health workers in the face of increasing demand from neighbouring countries  Quality of care related to lack of oversight and effective licensing, particularly in the private sector Conclusion  The health care workforce is growing in line with population growth and consumer demand  Nurses comprise almost half of our workforce  The quantity of health workers is significantly skewed towards metropolitan locations  North Queensland’s health workforce varies across the region  Similarities in health care challenges exist between developed and developing countries Week 8 – Paying the bills Health funding  Most of the funding for health is from Federal and State government sources  Other funding is provided by non-government sources: o Private health insurance 21 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Workers compensation o Third party insurers o Charitable organisations o Individuals Government health expenditure  Health expenditure is defined as expenditure on health goods and services, including investment in equipment and facilities.  The Australian Government spent $71.6 billion on health in 2016–17 o Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) o Department of Veterans’ Affairs (DVA) ($3.1 billion)  Total health expenditure by state and territory governments in 2016–17 was estimated at $49.6 billion o About two-thirds expenditure ($27.3 billion) was for public hospital services o The next largest area of spending was community healthcare services (E.g. Sexual Health Clinics) Non – government expenditure  Non-government health expenditure was estimated at $56.5 billion in 2016–17.  Expenditure by individuals was $29.8 billion in 2016–17  Private health insurance funded 8.8% ($15.9 billion) of total expenditure in 2016–17  The balance of non-government funding ($10.9 billion) came from other non-government sources: o Payments by compulsory third-party motor vehicle o Workers compensation insurers Funding responsibilities  Federal Government and State and Territory governments –Joint funding initiatives: o Funding for public hospitals o State and Territory governments primarily manage the expenditure that is provided by federal sources  Federal Government: o Most primary healthcare consultations (E.g. GP visit) -Medicare o The Pharmaceutical Benefits Scheme (PBS) o Most health and medical research o Aged care residential and community healthcare services o Department of Veterans Affairs (DVA) o National Disability Insurance Scheme (NDIS)  State/ territory and local governments: o Community health services (E.g. The Child and Youth Community Health Service) o Public health services (Immunization clinics) o Patient transport (ambulance services)   Individuals: o Most dental services - some public dental services; private health insurer covers as part of “extra’s cover” o All the medications not covered by the Pharmaceutical Benefits Scheme (PBS); private health insurance “extra’s cover” o Out of pocket expenses for Medicare 22 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Most allied health services (Occupational Therapy, Speech Pathology, Physiotherapy); private health insurance “extra’s cover” o Most health aids and appliances Projected expenditure  Total health and residential aged care to increase by 189% in the period from 2003 to 2033.  Diabetes is set to have largest increase in expenditure (436 %) followed by dementia (364 %)  Projection in neonatal and maternal services is low in comparison.  Different population needs, have implications for workforce planning: o Less obstetricians required o More HCP’s required to serve older populations - Future expenditure trends Medicare Benefits Schedule  1984: Labor government formed the tax–funded Medicare scheme to ensure “Universal” access to medicaland hospitalcare for all Australians  Healthcare agreements exist between state/ territory and federal government to ensure that people have access to free treatment  Medicare levy: 2 % of an individual’s taxable income  Recent challenges include o Long waiting lists in public hospitals o Medicare freeze (indexing of Medicare rebate, eg. currently standard GP consultation is approx. $37 – frozen 2014-2018, indexed since July 2018 at 1.5%, individuals pay the difference – the gap), Foster & Fleming, 2008 Private health insurance  Private health insurers funded 8.8% ($15.9 billion) of total health expenditure in 2016–17  Covers admission to a private hospital; or admission as a private patient in a public hospital  Private patients have more choice for their care (treating doctor; time of admission)  Additional private health insurance cover is available for ancillary services –“extra’s cover” (allied health, pharmacy etc.)  Since the introduction of Medicare, uptake of private health insurance has decreased  Government has introduced tax incentives to promote uptake o Private health insurance rebates o Medicare levy surcharge on higher income earners (additional 1 to 1.5% of income)  Medibank Private is an example of a large national insurer 23 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 National Disability Insurance Scheme (NDIS)  Provides all Australian’s under 65 years who have a permanent disability with “reasonable” and “necessary” supports  National Disability Insurance Agency (NDIA) is responsible for the implementation.  Assists individuals to obtain their goals  To be eligible the individual must: o Have a disability o Be 65 years or less o Be an Australia citizen o Live in a location where the NDIS is available - Funding NDIS o In order to receive services under the NDIS an individual is assessed based on a written application, current supports in place and degree of disability  Everyone will receive supports and funding relative to their needs  All support plans and funding allocations will vary o Provides the individual with a choice of service provider o 4-year rollout plan (2016-19) with Federal Government funds increasing to $21.6 billion in 2019-20 o Post 2019, Federal, State and Territory Governments to share funding  Federal Government share expected to be around $ 11.2 billion per year Pharmaceutical Benefits Scheme (PBS)  Access for all Australians to affordable medicines  Government subsidises up to 90% of medications available for prescription by medical doctors  Level of co-payment will differ based on the individual  Heavily regulated industry: National Medicines Policy o Timely access to affordable medicines o Medicines meeting standards for quality o Safety and efficiency o Quality use of medicines Oral health care in Australia  Total annual spend on dental care in Australia was $9.9 billion in 2015-16  Individuals contributed to 58% of spend in out-of-pocket costs  Public dental care is limited, with long waiting times  44% of uninsured Australians and 20% of those with insurance delay or avoid going to the dentist  20% of those who do go to the dentist are unable to proceed with recommended treatment because of cost  Oral health conditions can contribute to other health problems, including diabetes and heart disease - Oral Health Outcomes o 1 in 4 children aged 5-10 years have untreated tooth decay o 1 in 25 Australians aged 15 and over have no natural teeth o Poorer outcomes for Indigenous Australians, especially in remote communities o 67,060 preventable hospitalisations for oral health conditions in 2015-16 (10% of all preventable hospitalisations, estimated cost of $230 million) 24 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o Increase in general anaesthesia for children o People in rural areas report the highest levels of complete tooth loss, the lowest levels of dental insurance coverage and the highest levels of dissatisfaction with their dental health - Oral health expenditure - current o Commonwealth and states jointly fund public dental services for people on low incomes  36% of the population iseligible for public dental services  capacity to provide services to only about 20% of this group o Commonwealth currently funds the Child Dental Benefit Schedule  Medicare funded scheme for up to $1000 per year of dental services for eligible children o Ancillary private health insurance provides dental cover o expensive o does not protect against unexpected costs o most people with private health insurance pay out of pocket for dental care Conclusion  A large proportion of federal and state funding is directed towards the health care system.  With a changing population, health needs will change and therefore funding allocations and workforce planning will need to be addressed  Medicare is provided as a method of universal care.  PBS provides subsidised pharmaceuticals based on an individual’s circumstances.  The NDIS is funded by the federal government and can be accessed by those individuals aged < 65 years and who have a permanent disability  A universal dental scheme to provided subsidised oral health care is a topical conversation Week 10: The future of health in Australia Technology enabled care (TEC)  Advances in technology transform the way we deliver health care services  TEC involves health technology, digital media and mobile devices  TEC assists HCP’s and consumers to access health data  Enhances the quality of care and improves health outcomes  May be a cost-effective solution for a health system that is financially constrained  In the future, some interventions currently undertaken by health professionals, may be completed by consumers at home. Benefits of digital health for providers  Decreases paperwork and time  Focuses on preventative health actions  Promotes patient independence: o Empowers patients and carers to have control over care o Increases access to health information o Increases capacity to share experiences and have interconnected support  Potential decrease in hospital admissions 25 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  Anticipated decrease in hospital bed days Benefits of digital health for consumers  HCP communication and connectivity  Education and increased awareness around symptoms or medical conditions  Ease of collating and retrieving medical records  Increase treatment compliance through social support mechanisms TEC barriers  Quality, consistency and validity of applications  Privacy and security of health data  Reluctance of HCP’s to adopt TEC: o Scale and pace of changes o Lack of education and training o Concerns over liability and funding  Access and cost to users  On many occasions, TEC is created without user consultation: Therefore, is irrelevant or widely misunderstood My health record – Australia  My Health Record is the national digital (online) health record system o Allows consumers to share health information with their health care practitioners o Information may include medical imaging, medical test results and patient referral  Not a comprehensive health picture and only contains what the individual or practitioner uploads  Every Australian now has a record unless they have opted out (31 January 2019)  Concerns of safety for personal data o Independent third parties warn it is impossible to make any online database “bulletproof” o Insurers shouldn’t have access to individual’s material Mobile technology (mHealth)  Opportunities to use mobile technology has improved over the years  Growing population of smartphone and tablet use, particularly in older populations  Proliferation of health apps (myfitnesspal, alcohol aware & stress check)  Availability of bio sensing wearables (Digital blood pressure monitors and glucose sensors)  Portable medical imaging devices.  4 levels (or opportunity) 26 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708  mHealth is expected to grow to 21.5 billon by the end of 2018 (value up from 2.4billion in 2013) Future challenges in Australia  An ageing population, together with new discoveries, new technology and new treatments are creating a growing demand for healthcare  Lifestyle choices and behaviours that are contributing to higher levels of chronic disease  Disparities and inequalities in health outcomes for certain population groups  People’s changing needs and expectations  Unprecedented financial constraints that are unlikely to diminish Priority areas for action  Person centred view of health care: o Ensure that health system meets the needs of the people we treat o Empower people through taking ownership of their health o Personalise technology making the individual at the center of care  Preventing and treating chronic disease: o A focus on prevention and early intervention o Education and appropriate use of resources  Better health for people in rural and regional areas: o Establishing pathways between metropolitan and rural/ remote areas o Planning towards ensuring that people have the opportunity to recover at home  Supporting the health workforce: o Enhance safety and wellbeing o Engaging practitioners in decision making processes Other issues and their trends  Cardiovascular disease o Incidence of CV disease expected to fall by 40.4 % over 30 years o Largely due to increased awareness and interest of population regarding healthy eating and exercise practices o Due also to improved medical procedures and technologies  Dementia 27 Downloaded by paul madu ([email protected]) lOMoARcPSD|26305708 o 200% increase in the number of people with dementia over the next 30 years o Due largely to population ageing and population growth  Road traffic injuries o A decrease of 52.1% from 25,381 to 12,166 new cases per year o Primarily due to safe infrastructure and vehicles o Stricter regulations o More awareness and education  Climate change and health o Increasing greenhouse gas concentrations in the Earth’s atmosphere are contributing to climate change o Greenhouse gases include carbon dioxide, methane, nitrous oxide and halocarbons o Produced by:  Fossil fuel combustion for electricity generation  Transport  Mining  Agricultural and land management sectors o Greenhouse gases increase the trapping of heat in the lower atmosphere producing increases in air and sea temperature o Affects health by:  Heatwaves  Floods  Bushfires  Air quality  Changes in the patterns of infectious diseases  Threats to food and water supplies  Effects on mental health  Mental health o Climate change may adversely affect the mental health of many people in Australia o Extreme events such as cyclones, floods, droughts and bushfires cause psychological distress due to trauma, illness, loss of loved ones o Displacement causes significant distress, as does the disruption of goods and services o Depression, anxiety and posttraumatic stress disorders Conclusion  Technology including mHealth devices will influence the way we treat our patients throughout our careers  Ageing populations, the rise of chronic disease and financial constraints are challenging our health care system will face into the future  Climate change will bring with it several health-related effects. As a result, we will have to adapt to treating new diseases or conditions. 28 Downloaded by paul madu ([email protected])

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