Aboriginal and Torres Strait Islander Health

Overview

Closing the Gap

Indigenous Health Project Officer Measure

Aboriginal and Torres Strait Islander Outreach Worker Measure

Health Checks for Aboriginal and Torrest Strait Islanders

PIP Indigenous Health Incentive

PBS Co-payment Measure

Care Coordination and Supplementary Services Program

Resources and Links

Contact Officers

Overview

In Australia Aboriginal and Torres Strait Islander people experience higher mortality rates than non-Aboriginal Australians in every age group. Death rates are around five times higher among adults aged 35-54 years.

Chronic disease is responsible for two thirds of the premature deaths among Aboriginal people. Conditions such as diabetes, circulatory disease, kidney disease, respiratory infections are more common in the Aboriginal population than in the wider community.

In the broader population people are living longer with chronic conditions whilst among the Aboriginal population they are dying earlier with the same lifestyle risk factors. Tobacco smoking alone is responsible for 20% of all deaths for Aboriginal people and the occurrence of smoking is twice a likely than in the non-indigenous population.

Aboriginal communities in parts of Australia have an infant mortality ten times higher than those among the non-Aboriginal population.

Closing the Gap

Indigenous and non-Indigenous Australians across urban, rural and remote areas:

1. to close the gap in life expectancy within a generation
2. to halve the gap in mortality rates for Indigenous children under five within a decade
3. to ensure all Indigenous four year olds in remote communities have access to early childhood education within five years
4. to halve the gap in reading, writing and numeracy achievements for Indigenous children within a decade
5. to halve the gap for Indigenous students in year 12 attainment or equivalent rates by 2020; and
6. to halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade.

In support of this on 29 November 2008 the Council of Australian Governments agreed to a $1.6 billion partnership agreement to address the target of closing the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation. The Closing the Gap (CTG) Indigenous Chronic Disease Package (ICDP) is the Australian Government’s contribution to the Indigenous Health Partnership Agreement and provides $805.5 million over 4 years.

The partnership adopts a genuine, national approach with all level of governments working together with health and medical professionals, and Aboriginal and Torres Strait Islander communities.

The Indigenous Chronic Disease Package provides:

• significant new funding for preventive health focusing on Aboriginal and Torres Strait Islander individuals, families and communities
• support and funding for more coordinated and patient-focused primary health care for Aboriginal and Torres Strait Islander people in both Aboriginal Community Controlled health services and mainstream general practice; and
• an expanded Indigenous health workforce.

The package will:

• promote and support good health by involving local communities and delivering healthy lifestyle programs
• support accredited Indigenous health services and general practices by providing financial incentives to deliver better health care for Indigenous Australians with chronic disease
• remove barriers so that patients can better access essential follow-up services such as allied health, specialist care and Pharmaceutical Benefits Scheme (PBS) medicines; and
• build the capacity of the primary health care system to care for patients by growing the number and skills of the Indigenous health workforce.

General Practice Tasmania and the Tasmanian Divisions of General Practice have received funding through the COAG Closing the Gap initiative to address access to mainstream primary care for Aboriginal and Torres Strait Islander people in Tasmania.

Indigenous Health Project Officer Measure

As part of the Indigenous Chronic Disease Package, Indigenous Health Project Officers are employed in all Divisions , as well as GPT, to encourage greater use and improved cultural safety of mainstream primary care services for Aboriginal people.

Objectives of the Indigenous Health Project Officers include:

• Increasing access to mainstream primary care services by Aboriginal people
• Improving the capacity of general practice to deliver culturally sensitive primary care services
• Increasing the uptake of Aboriginal specific Medicare Benefit Scheme (MBS) items including Health Checks and follow up items
• Supporting mainstream primary care services to encourage Aboriginal people to self identify
• Increasing awareness and understanding of the Closing the Gap measure relevant to mainstream primary care
• Fostering collaboration and support between the mainstream primary care and Aboriginal Community Controlled Health Organisations.

Aboriginal and Torres Strait Islander Outreach Worker Measure

As part of the Indigenous Chronic Disease Package, Aboriginal and Torres Strait Islander Outreach Workers are employed in numerous Tasmanian Divisions of general practice to assist Aboriginal and Torres Strait Islanders to make better use of the available health care services.

Objectives of the Aboriginal and Torres Strait Islander Outreach Workers include:

• Provide community liaison and establish links with local Aboriginal communities to encourage and support the increased use of health services
• Support the Indigenous Health Project Officers to identify barriers that may impact on access to health services by Aboriginal people
• Provide practical assistance to Aboriginal people to attend primary health care services
• Provide feedback regarding problems encountered that may be restricting Aboriginal peoples’ access to health or related services.

Health Checks for Aboriginal and Torres Strait Islanders

A Health Check is available for all Aboriginal and Torres Strait Islander people (MBS Item 715). The Health Check aims to ensure that Aboriginal and Torres Strait Islander people receive primary health care that matches their needs by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early mortality.

PIP Indigenous Health Incentive

As part of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, a new Practice Incentive Payment is available to support eligible general practices and Aboriginal Community Controlled Health Services to provide better health care to Aboriginal and Torres Strait Islander people, including best practice management of chronic disease. To participate in the incentive, practices will need to be participating in the PIP and meet the sign-on requirements, which include:

• Agree to seek consent to register their Aboriginal and/or Torres Strait Islander patients who have, or are at risk of, chronic disease with Medicare Australia in order to access support through the Indigenous Health Incentive and the Pharmaceutical Benefits Scheme (PBS) Co-payment Measure
• Establish and use a mechanism to ensure their Aboriginal and/or Torres Strait Islander patients aged 15 years and over with a chronic disease are followed up (e.g. through use of a recall and reminder system, or staff actively seeking out their patients) to ensure they return for ongoing care
• Agree that at least two staff members (one of whom must be a General Practitioner) will undertake appropriate cultural awareness training within 12 months of joining the incentive
• Agree to annotate PBS prescriptions for eligible Aboriginal and/or Torres Strait Islander patients for the purposes of the PBS Co-payment Measure.

PBS Co-payment Measure

As part of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, cheaper Pharmaceutical Benefits Scheme (PBS) medications are available to eligible patients receiving care at a general practice participating in the Indigenous Health Incentive PIP, as well as metropolitan and regional Aboriginal Medical Services.

To be eligible, patients must identify as Aboriginal or Torres Strait Islander, have a chronic disease or chronic disease risk factor, and in the opinion of the doctor:

• Would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine
• Are unlikely to adhere to their medicine regimen without assistance through the Measure.

Care Coordination and Supplementary Services Program

As part of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, GPT has been funded to implement the Care Coordination and Supplementary Services Program across Tasmania.

The CCSS Program has two components:

1. Care Coordination – provided by qualified healthcare workers to Aboriginal and Torres Strait Islander patients with a chronic disease. Patients must be registered under the Practice Incentives Program Indigenous Health Incentive ( PIP IHI) and be referred by a GP in general practices or Indigenous Health Services participating in the PIP IHI
2. Supplementary Services – a flexible pool of funds that can be used to assist patients receiving care coordination under the CCSS Program. The funds can be used to access medical specialist and allied health services that are in accordance with the patient’s management plan developed by their GP. The funds may also be used to assist with the cost of local transport to health care appointments.

Under the program, ‘care coordination’ means working collaboratively with patients, general practices and Aboriginal and Torres Strait Islander health services to assist in the provision of care and services that facilitate a person with a chronic condition to manage their health in a way that will result in the optimal health outcome for them.

Care coordinators will provide practical help including arranging required services for the patient, helping them access specialist care by providing transport and accompanying the patient to the appointment. They may also help the patient understand their chronic condition, and how to self manage their health and wellbeing. The care coordinator will support the patient and their family to work with the care team including the GP, AMS, Specialist services and social care services.

Contact Officer(s)