Report on Primary Health Care Research Conference 22-25 July 2014

Report on Primary Health Care Research Conference 22-25 July 2014

By Joanne Baumgartner, HCCA Representative. 

I was lucky enough to be able to attend this conference sponsored by HCCA and I thank the organisation for that as it was a very useful and worthwhile conference to attend. Unlike the previous PrimaryHealth Care Conference that I attended in Brisbane a few years ago, this one was definitely aimed at including the consumer perspective in the majority of sessions that I attended. 

I started off the conference by participating in a Higher Degree Workshop where we were given polo shirts to wear with the words “Agents for Change” written on the back as a catalyst for the day’s workshops. The workshops focused on how we could get our research published and how to write for different purposes and it was a very practical and inclusive day. My reason for being able to participate is that I am currently a Masters student at the University of New South Wales. An added bonus is that I have been given a research profile on the Primary Health Care Research and Information Service, ROAR (Registration of Australian Research) website where my published works are available to read at: www.phcris.org.au/roar/profiles/1751 

Some of the workshops that I attended during the following two days included a very interesting workshop on the use of Tibetan Sound Bowls in a nursing home for people with dementia where people were accommodated in separate houses for 6-8 people and the Sound Bowls were played like musical instruments while everyone sat around a large table , placing their hands on the table so that they could feel the vibrations from the music. The results were that there was a significant drop in the agitation and medication required to subdue people as they were calmed down by the sounds coming from the bowls music. The presenters showed a video of the process of playing the Tibetan Sound Bowls and the subsequent reactions from the people residing in the Aged Care Facility. 

The conference as a whole focused on patient or consumer engagement. A very interesting and particularly enlightening speaker right throughout the conference was Professor Nancy Edwards from the University of Ottawa who presented papers on Implementation research which had the focus of being very practical in that all of her research was developed with specific outcomes as an end result and a requirement of her projects. Her main question to all of us was “How are our research methods driving the questions we ask? ”, and  “What types of interventions do we want ?”. Again I was fortunate enough to be able to attend a follow up workshop with Professor Edwards at the Australian National University as an Alumni of the ANU on the following Monday where we had further discussion on Implementation Research and this knowledge will definitely assist me with my postgraduate studies and further research papers that I may think of writing. 

Since the conference and ANU workshop I have submitted another paper for publication with the Operational Research Society in the United Kingdom of which I am a Member, based on the report that I wrote on Infant Mortality in the Australian Capital Territory 2001-2005 when I was HCCA representative on the Maternal and Perinatal Information Network at The Canberra Hospital.

I hope that this report is useful to health care consumers and again thank you to HCCA for sending me to the conference and I was glad to attend the extra two workshops which were free to me as a postgraduate student.

Joanne Baumgartner

Canberra Home Doctor Service

Many of you may be aware of the new after-hours primary health care service the National Home Doctor Service. 

HCCA met with staff from the Home Doctor Service to find out more about what it can offer in-terms of after-hours care and ask about any issues we could possibly see with their model of care and business model.

The National Home Doctor Service is a pre-existing that has been running for over 40 years in other states and territories with the service running in Canberra since August this year.

The Home Doctor Service provides house calls to people living in the ACT and surrounding areas in the after hours period. 

This is a bulk-billed service for those with a medicare card or those who are part of the Global Assistance Program (for example international students) with no out-of-pocket-cost to the consumer. If you do not have a medicare card there is a flat rate of $200 per hour, but they are looking at working with private health insurers to try to potentially cover people without medicare cards.

This ABC news video released at the start of August explains the billing model and explores the notion that this type of billing may not be the most cost- effective way to spend the health dollar. We asked the Home Doctor Service about this, particularly in relation to whether their call centre referred people to other ACT after-hours services like the Walk-in Centres. Essentially their business model relies on medicare after-hours billing code and they do not refer to other services if they can be seen by the house call doctors, however call centre staff do triage callers and refer them to emergency services if needed.

The Home Doctor Service currently works in both private homes and in residential aged care facilities. They provide electronic health care summaries to peoples regular General Practitioners or GP practices by 8 am the day after receiving the house call. They are also currently set up to upload directly to the Personally Controlled Electronic Health Record, however this is not yet active.

As of September this year the service employed eight local Canberra doctors and two experienced Melbourne locums to help guide the new practice. The number of doctors is likely to have gone up due to the high demand for these services.

HCCA asked the the Home Doctor Service about quality and safety assurance and the use of consumer feedback and was informed that they have an 80% approval rating from feedback provided via e-mail from users. They have Clinical Governance through a Canberra based doctor and are developing a Clinical Governance Committee for the ACT. HCCA has asked that they consider having a consumer representative on this committee.

The Home Doctor Service aims to see people within 3 hours of receiving a call, however due to the huge demand in the ACT the wait may be longer. The Home Doctor Service also informed us that those using the service tended to be sicker than usual presentations in other states and territories. HCCA believes this is demand is likely to be due to the history of under service in primary health care and after-hours services to the ACT community.

Have you used this service? We are always interested to hear about your experiences and to feed this important information to service providers to ensure continuous improvement!

Let us know what you think!

We are open to hearing whether this new service meets the needs of consumers in the ACT and provides better access to after-hours primary care.

Eleanor Kerdo
Policy Officer  



    

Medicinal Cannabis and the ACT Clinical Senate

Greetings from the Policy Officer Eleanor Kerdo! This is the first of several blogs I will be uploading on various health policy topics.

The topic of medicinal cannabis is currently of great interest to the community and Australian media. This is can be seen by the recent proposed trail of medicinal cannabis by NSW and ACT. 

As part of my role here at HCCA I am a consumer representative at the ACT Clinical Senate.

The role of the ACT Clinical Senate is to provide a forum for a multidisciplinary group of clinicians, health experts and consumers with diverse perspectives to share their collective knowledge in discussing strategic clinical issues and to make recommendations to the Director-General, ACT Health an

d the Chair of the ACT Medicare Local.

At the last meeting of the Clinical Senate the topic was the use of cannabis for medicinal purposes. 

In the context of the high degree of interest in this issue being expressed in the Australian community and among politicians at both jurisdictional and Federal levels, the topic’s pertinence both to the situations of health consumers and to the practice of health professionals, and the legal and regulatory barriers that currently exist to accessing cannabis for medicinal use, members were asked to consider and respond to questions relating to:

• Possible models to provide access;
• Apparent drivers for making medicinal cannabis available
•   Possible issues to be considered in the context of a proposed national trial.

As part of this discussion I was asked to deliver a ten minute presentation on consumer perspectives on medicinal cannabis. You can read my talk below:

Hello All,

Thank you so much for having me here today. I would like to acknowledge the traditional owners of the land on which we meet, and pay our respects to their elders – past, present and future. My name is Eleanor and I am the Policy Officer at Health Care Consumers Association of the ACT. I've been asked to present a consumer view of medicinal cannabis and I will say I have no personal experience relating to this issue. I think it’s also important to start off by saying that there is not one consumer perspective on this issue or in reality on any health care issue. At HCCA we are yet to establish an organisational position on this issue, however it is one that is of interest to a great number of our individual members as well as organisational members such as bosom buddies – a breast cancer support group, The AIDs Action Council, pain support ACT and Alcohol Tobacco Other Drugs Association a peak body in the ACT which seeks to prevent and reduce harm associated with ATOD, and I would like to especially acknowledge Carrie Fowlie the executive director of ATODA who joins us here today. My talk is informed by input by these individuals and groups.

This evening, I want to talk about why the introduction of legalisation to permit the compassionate approach to the use of medicinal cannabis represents an important increase in choice for consumers that is, what medicinal cannabis can mean to consumers and what are some of the key implementation challenges from a consumer perspective.

Two thirds of the Australian community in a recent ReachTel survey support the use of cannabis for medicinal purposes with highest support between the 51 and 65 year olds. For many consumers the use of medicinal cannabis is about palliating symptoms and suffering for those with terminal or serious health conditions that are not responding to other treatments. So for many it is about compassion and the alleviation of great suffering.

On the 23^rd of September ATODA, AIDS Action Council and the Public Health Association held a public forum at the Legislative Assembly on understanding evidence based options for medicinal cannabis in the ACT, The speakers and audience included academics, politicians, clinicians, consumers carers and the public. All agreed there was strong evidence for the use of medicinal cannabis to relieve great suffering. With an expert clinician stating " this works fantastically for some people who are suffering unbearably". It was an extremely interesting evening.

 For me, outside of learning more about the current scientific evidence on the use of medicinal cannabis I was particularly touched by two members of the public who shared their stories about medicinal cannabis and what these changes in legislation could mean to them. I will share them now noting that they have been made anonymous.

A 50 something man stood up wearing a suit and tie. He told us he has recently lost his wife, one month ago to an aggressive form cancer which took three months from diagnosis to her death. Cannabis was the only thing that seemed to ease her suffering, when they tried to remove it from her treatment regime after a doctor expressed concern, quickly began being unable to cope. Cannabis, he told us was the key for them in allowing his wife to have a beautiful death. It was extremely moving. He counted himself lucky that he knew where to get Cannabis through his uni days, he could make an oil for her, but not having a legal supply – buying from the pimply teenager on the corner presented it’s challenges and he wanted to advocate for a legal and safe supply to allow everyone to access this treatment and he was particularly concerned for the older population

This was echoed by a young professional looking mother her child suffered from extremely severe epilepsy that meant they had seizures almost around the clock. She knew the evidence that cannabis has been shown to help ease some of these symptoms but how to access, grow, identify the most useful strains for treating her child and prepare this for her was not something she knew how to do. A legal supply and education on this meant a possible ease to her daughters suffering.

Again this is not all consumers, we know that some mental health consumers feel and have experience that medicinal cannabis relieves their symptoms with little scientific evidence to support this and in some cases directly contradicting this believe.  We have to acknowledge that there is no one consumer or public perspective on this.

A legal safe supply is essential for many in an ideal scheme as those suffering with serious illness are often conflicted with the hope they can ease their suffering and knowing they need to engaging in illegal activity or not being able to source the drug from drug dealers in a safe or timely manner.    The legislation to allow for the limited use of medicinal cannabis is the first step to allow a choice. A choice to people suffering or watching family suffering to talk openly with their doctors, to get advice and to try a treatment that may offer them some relief. A compassionate staged implementation approach offers those identified as eligible for medicinal cannabis treatment some options now, while we move towards access to cannabis of a known quality through a legal source.

Thank you.

We know this is a topic that is of interest to many of our members and we are keen to hear your thoughts. Let us know what you think!

Eleanor Kerdo

policy Officer

Acronyms and nuns

We find jargon and the use of acronyms very challenging. Recently I was in a meeting with doctors and they were talking about the important role NUMS play in medical education. Only, I thought they said 'nuns' and was terribly confused. It was a useful reminder of the difficulty acronyms pose for consumers in the health system.

Here's a recent collection that has been flying around our committees.

ACTPAS	ACT Patient Administration System
ADON	Assistant Director of Nursing
ANU	Australian National University
APFPM	Asia Pacific Federation of Project Management
ATSI	Aboriginal and Torres Strait Islander
B&I	Business and Infrastructure
CACHS	Cancer, Ambulatory and Community Health
CALD	Culturally and Linguistically Diverse
CC	Critical Care
CHCACT	Calvary Health Care ACT
CHHS	Canberra Hospital and Health Services
CSS	Clinical Support Services
CT	Computed Tomography
DDG	Deputy Director-General
DG	Director-General
DHP	Dental Health Program
DON	Director of Nursing
DRGs	Diagnosis Related Groups system
EC	Executive Council
EDC ED	Executive Directors Council Emergency Department or Executive Director
EHCR	E-Health and Clinical Records
ENT	Ear, Nose and Throat
GP	General Practitioner
HAI	Healthcare Associated Infections
HCCA	Health Care Consumers' Association
HIP	Health Infrastructure Program
IARM	Internal Audit and Risk Management
ICT	Information and Communication Technology
ICU	Intensive Care Unit
IDC	In Dwelling Catheter
IHI	Individual Health Care Identifier (National)
ILC	Independent Living Centre
JMO	Junior Medical Officer
LCMHC	Little Company of Mary Health Care
LHN	Local Hospital Network
MHJHADS	Mental Health, Justice Health & Alcohol & Drug Service
MOSU	Medical Officer Support Unit
MRI	Magnetic Resonance Imaging
MRO	Multi-Resistant Organisms
NATA	National Association of Testing Authority
NBHF	Ngunnawal Bush Healing Farm
NICU	Neonatal Intensive Care Unit
NICUCAM	Neonatal Intensive Care Web Camera Project
NSQHSS	National Safety and Quality Health Service Standards
NSW	New South Wales
PCEHR	Personnally Controlled Electronic Health Record
PET	Positron Emission Tomography
PGR	Policy and Government Relations
PH	Population Health
PIB	Performance Information Branch
PMI	Patient Master Index
PSSB	People, Strategy & Services Branch
QI	Quality Improvement
QSB	Quality and Safety Branch
RACC	Rehabilitation, Aged & Community Care
RCPA	The Royal College of Pathologists of Australia
RISPACS	Radiation Information and Picture Archive and Communication System
SCP	Service and Capital Planning
SDU	Staff Development Unit
SIDS	Sudden Infant Death Syndrome
SOH	Surgery and Oral Health
SOP	Standard Operating Procedure
TCH	Canberra Hospital
WYC	Women’s, Youth and Children

Darlene Cox
Executive Director

Health Literacy for All

This work was completed as part of the consumer-led Health Literacy for All project that ran from June 2011 to June 2014. This project was an initiative of the Health Care Consumers Association (HCCA) of the ACT and was funded by a Health Promotion grant from the ACT Government.

HCCA has more than thirty years of experience in increasing consumer access to information about the health system. With the increasing complexity of our health system, it has become even more important for consumers to have access to opportunities to develop their knowledge of the health system. It is also important that these opportunities are ‘consumer-led’, that is, that they provide access to information that consumers themselves have said they need to know.

The Health Literacy for All project was designed around a community development model. The program particularly sought to provide assistance to disadvantaged and marginalised health consumers. It sought to promote consumer participation in the health system by providing opportunities for consumers to improve their knowledge of support, community and health services. It also sought to increase consumers’ ability to advocate for themselves and family in health contexts. This involved helping consumers to identify their own needs so that they would be able to interact more effectively with health professionals.

The topics for the modules are based on consumer requests, and the content of the modules was developed in consultation with consumers who participated in health literacy workshops. More than 250 consumers and 170 health care professionals participated in 40 workshops over a three year period. 

In the coming weeks the material we developed and use in our community information sessions will be uploaded to the HCCA website.