department of health | welcome to the department …€¦ · web viewmiles mb, & huberman am...

KPMGNational Monitoring and Evaluation of the Indigenous Chronic Disease PackageFirst Monitoring Report2010-11Appendices

Paper-based publications© Commonwealth of Australia 2013This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected]. Internet sites© Commonwealth of Australia 2013This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to [email protected].

This report has been independently prepared for the Australian Government Department of Health by KPMG Australia, and does not necessarily represent the views of the Australian Government.

National Monitoring and Evaluation of the Indigenous Chronic Disease Package

First Monitoring Report2010-11

Appendices

Table of ContentsDisclaimer vAppendix A. Overview of the ICDP 1Appendix B. Overview of the evaluation 4Appendix C. Methodology 6Appendix D. Regional Forum summary 18Appendix E. Whole of ICDP evaluation table 23Appendix F. Subsidising PBS Medicine Co-payment measure data

appendix 44Appendix G. Higher utilisation of MBS and PBS data appendix 71Appendix H. PIP Indigenous Health Incentive data appendix 108Appendix I. Evaluation Framework tables 121

iKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG

and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.



Appendices

List of Figures and TablesFigure 1: Number of patients dispensed at least one CtG script, by quarter, by age group, Australia.................................................................................................55Figure 2: Number of CtG Scripts dispensed, by quarter, by age group, Australia...................................................................................................................57Figure 3: Number of CtG scripts dispensed per patient in first and fourth quarter of the measure............................................................................................58Figure 4: CtG Scripts dispensed in May quarter 2011, by Broad ATC, by age group, Australia.......................................................................................................59Figure 5: Share of total CtG scripts dispensed within each broad ATC, by age group, Australia, May quarter 2011..........................................................................60Figure 6: Share of CtG scripts dispensed within each age group, by broad ATC, Australia, May quarter 2011.....................................................................................61Figure 7: Patients dispensed at least one CtG script in each quarter, by remoteness, Australia..............................................................................................62Figure 8: Number of CtG scripts dispensed for each quarter, by remoteness, Australia...................................................................................................................63Figure 9: CtG scripts per patient for first and fourth quarter of measure, by remoteness, Australia..............................................................................................64Figure 10: Share of CtG scripts dispensed in May quarter 2011 within remoteness areas, by broad ATC, Australia.............................................................65Figure 11: CtG scripts dispensed per patient for first and fourth quarters of measure, by patient category, Australia..................................................................66Figure 12: Share of CtG scripts dispensed within patient category, by broad ATC, May quarter 2011 Australia.............................................................................67Figure 13: Patients dispensed at least one CtG script, by quarter, by jurisdiction...............................................................................................................68Figure 14: CtG scripts dispensed per patient for first and fourth quarter of measure, by jurisdiction...........................................................................................68Figure 15: Share of CtG scripts dispensed within jurisdictions, by broad ATC,May quarter 2011, Australia.............................................................................69Figure 16: Australia..................................................................................................70Figure 17: Share of CtG scripts dispensed in first and fourth quarters of measure, by broad ACT, Australia............................................................................71Figure 18: Numbers of CtG scripts dispensed and S100 RAAHS items supplied, by jurisdiction, May quarter 2011............................................................................72Figure 19: Share of items within S100 RAAHS and CtG, by broad ATC, Australia, May quarter 2011. ...................................................................................73Figure 20: Total utilisation by quarter - Australia: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.....................................................................77Figure 21: Per 100 capita utilisation by quarter - Australia: Selected MBS items (services); and CtG scripts. Source: KPMG...............................................................78Figure 22: Total utilisation by quarter - NSW Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................80Figure 23: Per 100 capita utilisation by quarter – NSW: Selected MBS items; and CtG scripts. Source: KPMG.................................................................................81Figure 24: Total utilisation by quarter – Qld: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................83

iiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Figure 25: Per 100 capita utilisation by quarter – Qld: Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................83Figure 26: Total utilisation by quarter – WA: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................85Figure 27: Per 100 capita utilisation by quarter – WA. Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................86Figure 28: Total utilisation by quarter – NT: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................88Figure 29: Per 100 capita utilisation by quarter – NT: Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................89Figure 30: Total utilisation by quarter – Vic: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................91Figure 31: Per 100 capita utilisation by quarter – Vic: Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................92Figure 32: Total utilisation by quarter – SA: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................94Figure 33: Per 100 capita utilisation by quarter – SA. Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................95Figure 34: Total utilisation by quarter – Tas: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG.............................................................................97Figure 35: Per 100 capita utilisation by quarter – Tas. Selected MBS items; and CtG scripts. Source: KPMG.......................................................................................98Figure 36: Total utilisation by quarter – NT: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG...........................................................................100Figure 37: Per 100 capita utilisation by quarter – ACT. Selected MBS items; and CtG scripts. Source: KPMG.....................................................................................101Figure 38: Total utilisation by quarter – Major Cities: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG...................................................................103Figure 39: Per 100 capita utilisation by quarter – Major Cities. Selected MBS items; and CtG scripts. Source: KPMG....................................................................104Figure 40: Total utilisation by quarter – Inner and Outer Regional: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG............................................106Figure 41: Per 100 capita utilisation by quarter – Inner and Outer Regional. Selected MBS items; and CtG scripts. Source: KPMG.............................................107Figure 42: Total utilisation by quarter – Remote and Very Remote: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG............................................109Figure 43: Per 100 capita utilisation by quarter – Remote and Very Remote. Selected MBS items; and CtG scripts. Source: KPMG.............................................110Figure 44: Aboriginal Health Assessments by gender. Source: KPMG....................112Figure 45: Aboriginal Health Assessments by age group. Source: KPMG................113Figure 46: Unique providers of health assessments at the national level by quarter. Source: KPMG...........................................................................................114Figure 47: Average health assessments per unique provider for Australia. Source: KPMG.........................................................................................................115

iiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Table 1: Whole of ICDP evaluation medium-term results table. Source: KPMG24

Table 2: Whole of ICDP evaluation early results table. Source: KPMG......................31Table 3: Whole of ICDP evaluation outputs table. Source: KPMG.............................42Table 4: CtG scripts and other PBS scripts dispensed by ATC for May quarter 2011.................................................................................................................................72Table 5: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Australia..................................................................................................................76Table 6: Selected MBS and PBS utilisation, total and per 100 capita by quarter - NSW.........................................................................................................................78Table 7: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Qld.................................................................................................................................80Table 8: Selected MBS and PBS utilisation, total and per 100 capita by quarter - WA.................................................................................................................................83Table 9: Selected MBS and PBS utilisation, total and per 100 capita by quarter - NT.................................................................................................................................85Table 10: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Vic............................................................................................................................88Table 11: Selected MBS and PBS utilisation, total and per 100 capita by quarter - SA.................................................................................................................................91Table 12: Selected MBS and PBS utilisation, total and per 100 capita by quarter -Tas...........................................................................................................................94Table 13: Selected MBS and PBS utilisation, total and per 100 capita by quarter – ACT..........................................................................................................................97Table 14: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Major Cities............................................................................................................100Table 15: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Inner and Outer Regional.......................................................................................103Table 16: Selected MBS and PBS utilisation, total and per 100 capita by quarter – Remote and Very Remote......................................................................................106Table 17: Practice registrations by jurisdiction and Medicare quarter....................111Table 18: Practice registrations by remoteness and Medicare quarter. ................112Table 19: Practice registrations by Medicare quarter and practice type................112Table 20: Patient registrations in 2010 by jurisdiction...........................................113Table 21: Patient registrations in 2010 by remoteness..........................................113Table 22: Patients registered in 2010 by practice type..........................................113Table 23: Patients re-registered and registered in 2011 and 2010 by jurisdiction. 114Table 24: Patients re-registered and registered in 2011 and 2010 by remoteness 115Table 25: Patients re-registered and registered in 2011 and 2010 by practice type..............................................................................................................................115Table 26: Patients registered and the type of payment those patients triggered in 2010 by jurisdiction...............................................................................................116Table 27: Patients registered and the type of payment those patients triggered in 2010 by remoteness..............................................................................................116Table 28: Patients registered and the type of payment those patients triggered in 2010 by practice type............................................................................................116Table 29: Patients and practices registered by type of practices...........................117Table 30: PIP Indigenous Health Incentive payment statistics May 2010 and May 2011......................................................................................................................118Table 31: Practice reach of PIP Indigenous Health Incentive by jurisdiction at May 2011. ....................................................................................................................119Table 32: Persons with one or more chronic conditions.........................................120Table 33: Estimates of PIP Indigenous Health Incentive reach for the Aboriginal and Torres Strait Islander population aged 15 years and over by jurisdiction, 2010 ...121

ivKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Table 34: Estimates of PIP Indigenous Health Incentive reach for the Aboriginal and Torres Strait Islander population aged 15 years and over by remoteness, 2010 . 121Table 35: Evaluation Framework Table for National Action to Reduce Indigenous Smoking Rates (A1)...............................................................................................123Table 36: Evaluation Framework Table for Helping Indigenous Australians Reduce Their Risk of Chronic Disease (A2).........................................................................126Table 37: Evaluation Framework Table for Local Indigenous Community Campaigns to Promote Better Health (A3)...............................................................................127Table 38: Evaluation Framework Table for Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3b)....................................................129Table 39: Evaluation Framework Table for Improving Indigenous Participation in Health Care through Chronic Disease Self Management (B4)................................131Table 40: Evaluation Framework Table for Increasing Access to Specialist and Multidisciplinary Team Care (B5a).........................................................................131Table 41: Evaluation Framework Table for Increasing Access to Specialist and Multidisciplinary Team Care (B5b).........................................................................133Table 42: Evaluation Framework Table for Workforce Support, Education and Training (C1)..........................................................................................................135Table 43: Evaluation Framework Table for Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care (C3)...............................135Table 44: Evaluation Framework Table for Attracting More People to Work in Indigenous Health (C4)..........................................................................................137Table 45: Framework Evaluation Table for Clinical Practice and Decision Support Resources (C5).......................................................................................................138

vKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Disclaimer

Inherent LimitationsThis report has been prepared as outlined in the scope section. The services provided in connection with this engagement comprise an advisory engagement which is not subject to Australian Auditing Standards or Australian Standards on Review or Assurance Engagements, and consequently no opinions or conclusions intended to convey assurance have been expressed.

This report has not been prepared on KPMG letterhead and does not contain the KPMG logo, but is presented in an editable format to support web accessibility for the vision impaired. We confirm that the definitive version of this report is that which bears the KPMG logo.

The findings in this report are based on consultation with stakeholders.

No warranty of completeness, accuracy or reliability is given in relation to the statements and representations made by, and the information and documentation provided by the Department of Health personnel and stakeholders consulted as part of the process.

Where appropriate KPMG have indicated within this report the sources of the information provided. We have not sought to independently verify those sources unless otherwise noted within the report.

KPMG is under no obligation in any circumstance to update this report, in either oral or written form, for events occurring after the report has been issued in final form.

The findings in this report have been formed on the above basis.

Third Party RelianceThis report is solely for the purpose set out in the scope section and for the information of the Department of Health, and is not to be used for any other purpose or distributed to any other party without KPMG’s prior written consent.

This report has been prepared at the request of the Department of Health in accordance with the terms of KPMG’s contract. Other than our responsibility to the Department of Health neither KPMG nor any member or employee of KPMG undertakes responsibility arising in any way from reliance placed by a third party on this report. Any reliance placed is that party’s sole responsibility.

viKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Appendix A. Overview of the ICDP

This Appendix presents an overview of the ICDP.The ICDP is the Australian Government’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (the NPA). The Package comprises a set of 14 interrelated measures that include a range of health promotion and social marketing activities, reforms to existing programs, and new initiatives and funding to increase the size and capacity of health care services to deliver effective care to Aboriginal and Torres Strait Islander people. The ICDP includes funding to monitor and evaluate the Package under the B6 measure.The National Closing the Gap Initiative involves two targets for Closing the Gap in health outcomes. These targets are: to close the gap in life expectancy within a generation; and to halve the gap in mortality rates for Indigenous children under five

years of age within a decade. On 29 November 2008, the Council of Australian Governments (COAG) agreed to a $1.6 billion National Partnership Agreement (NPA) to specifically address the first of the COAG Closing the Gap targets – to close the gap in life expectancy within a generation. In order to achieve these targets, five priority areas have been established in the NPA:1. tackling smoking;2. providing a healthy transition to adulthood;3. making Indigenous health everyone’s business;4. delivering effective primary health care services; and 5. better coordinating the patient journey through the health system. The National Closing the Gap Initiative aims to support change for all Aboriginal and Torres Strait Islander people across Australia, regardless of health and wellbeing status or geographical location. The ICDP is the Australian Government’s contribution to the NPA. A.1 Aims, objectives and principles underpinning the ICDP The three key priority areas identified for the ICDP are: Tackling chronic disease risk factors – such as smoking, poor nutrition

and lack of exercise. This outcome will be achieved through community education initiatives, new chronic disease prevention and health promotion workers, and implementation of healthy lifestyle and smoking cessation programs provided by Aboriginal and Torres Strait Islander people.

viiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Improving chronic disease management and follow up care – through a comprehensive approach that seeks to encourage greater uptake of health checks and the provision of follow-up care in a coordinated, accessible and systematic manner. It is intended that this will be achieved through provision of incentives, training and support to health professionals to deliver best practice chronic disease care, improving access to medicines, specialists and primary health care services, and supporting Aboriginal and Torres Strait Islander people to self manage their chronic conditions.

Workforce expansion and support – for the Aboriginal and Torres Strait Islander health workforce. It is intended this will be achieved through marketing activity to attract more people to work in the Indigenous health services sector (IHSs), recruitment of Aboriginal and Torres Strait Islander health workers and provision of training and support to the health workforce, such as access to culturally appropriate clinical guidelines.

The Package comprises a set of 14 interrelated measures that include a range of health promotion and social marketing activities, reforms to existing programs, and new initiatives and funding to increase the size and capacity of health care services to deliver effective care to Aboriginal and Torres Strait Islander people. The department has affirmed that the ICDP will: promote and support good health by involving local communities and

delivering healthy lifestyle programs; support accredited IHSs and mainstream general practices by providing

financial incentives to deliver better health care for Aboriginal and Torres Strait Islander people with chronic disease;

remove barriers so that patients can better access essential follow up services such as allied health, specialist care and PBS medicines; and

build the capacity of the primary health care system to care for patients by growing the number and skills of the Aboriginal and Torres Strait Islander health workforce.1

A.2 Policy rationale The incidence of chronic disease is having a significant impact on the health and well being of Australians and is higher amongst Aboriginal and Torres Strait Islander Australians than other Australians. The broad rationale for the ICDP is that the impact of chronic diseases can be reduced by earlier identification, and improved management of risk factors and the disease itself.2

1 Department of Health and Ageing 2011, Indigenous Chronic Disease Package fact sheet, Commonwealth of Australia, Canberra. 2 Department of Health and Ageing 2011, Indigenous Chronic Disease Package fact sheet, Commonwealth of Australia, Canberra.

viiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

The ICDP responds to the recognition that a holistic life stage approach is required to overcome Aboriginal and Torres Strait Islander people disadvantage, to build sustainable social change and to embed system reform. It recognises the need for a coordinated effort by all jurisdictions, and the importance of involving Aboriginal and Torres Strait Islander people and communities in directing and delivering primary health care services. The ICDP is supporting a holistic and sustainable approach to Closing the Gap by putting in place strategies to address chronic disease risk factors and manage chronic disease, while also considering contextual factors influencing Aboriginal and Torres Strait Islander health outcomes. By improving the basic health and wellbeing of all Aboriginal and Torres Strait Islander people, the ICDP will build stronger, healthier communities.

ixKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Appendix B. Overview of the evaluation

This Appendix presents an overview of the evaluation of the ICDP. The ICDP includes funding to monitor and evaluate the Package. The ICDP Monitoring and Evaluation Strategy (B6 measure) includes three main elements: The development of a monitoring and evaluation framework (referred to

as the Evaluation Framework). The Sentinel Sites Evaluation (SSE). National Monitoring and Evaluation (this project). The Evaluation Framework was developed to guide the SSE and the National Monitoring and Evaluation. 3 The Evaluation Framework4 provides an overview of the whole of Package and individual measure program logics which underpin the evaluation. The Framework uses a program logic structure for the Package and for the individual measures that clearly links program inputs and activities to expected outcomes. The Framework stipulates key results that could be expected to be achieved over different periods of implementation of the Package – early results, medium-term results, long-term results and ultimate outcomes. It sets out – for each identified result – key evaluation questions, indicators, data sources and timing of data collection.In July 2011, the Department of Health and Ageing (DoHA) engaged a consortium of independent consultants to conduct the National Monitoring and Evaluation of the ICDP (referred to hereafter as the evaluation). The consortium includes: KPMG, as the lead evaluator; Winangali, an Indigenous communications firm, which will support the

conduct of community consultations for the evaluation; Baker IDI, which will lead the health economics components of the

evaluation; and Ipsos-Eureka (now Ipsos Social Research Institute, referred to hereafter

as Ipsos SRI), which will be involved in the evaluation of social marketing and community campaign components of the ICDP.

The purpose of the evaluation is to undertake ongoing monitoring and evaluation of the implementation and impact of the ICDP, and the individual

3 Department of Health and Ageing 2011, Indigenous Chronic Disease Package fact sheet, Commonwealth of Australia, Canberra.4 Urbis Pty Ltd 2010, Indigenous Chronic Disease Package Monitoring and Evaluation Framework, September 2010, Volumes 1, 2 and 3, Department of Health and Ageing, Canberra

xKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG


http://www.health.gov.au/internet/ctg/publishing.nsf/Content/icdp-eval-framework-vol1-toc~3

http://www.health.gov.au/internet/ctg/publishing.nsf/Content/icdp-eval-framework-vol1-toc~3



Appendices

measures which make up the Package. The evaluation will involve consideration of: consistency of the implementation of individual measures/Package with

the original plans, as identified in the Framework under ‘Aims’, ‘Activities’ and ‘Outputs’ for each measure and the Package;

synergies among the measures: the extent to which the Package and individual measures are consistent and coordinated with, and complementary to, each other and the Package aims;

effectiveness of individual measures and the Package as a whole in delivering the results/outcomes (early, medium and long-term) identified in the Framework at various stages of implementation, including:- success of the individual measures/Package in achieving early results;- progress of the individual measures/Package in achieving medium-

term results; and- contribution of the individual measures/Package in progressing

towards long-term outcomes. This will involve assessment of the extent to which the early and medium-term activities and outcomes of the measures and the Package as a whole represent progress towards long-term outcomes of the Package; and

appropriateness of individual measures and the Package as a whole to the target population and stakeholder needs including awareness, appreciation and satisfaction with the activities undertaken under individual measures/Package.

A more focused, measure specific evaluation of the Local Indigenous Community Campaigns to Promote Better Health (the A3 measure) will also be undertaken. While this report contains an overview of the A3 measure in 2010-11, the A3 Interim Evaluation report, currently under finalisation, provides more detailed information relevant to that measure.

xiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Appendix C. MethodologyThis Appendix presents a summary of the evaluation methodology – qualitative and quantitative methods.C.1 Qualitative methodsC.1.1 Stakeholder consultations Individual semi-structured interviews and focus groups were undertaken with a range of government and other stakeholders. Consultations commenced in September 2011 and are ongoing. Consultations were generally conducted as semi-structured interviews, guided by a consultation guide which was provided to stakeholders prior to the meetings. For many stakeholder groups two rounds of consultations will be conducted. The second round of consultations will be conducted in the later stages of the evaluation, in late 2012-early 2013. The following national and state/territory stakeholders were consulted during the first round of consultations:NACCHO affiliates Tasmanian Aboriginal Centre Victorian Aboriginal Community Controlled Health Organisation Aboriginal Health Council of Western Australia Aboriginal Health and Medical Research Council Aboriginal Health Council of South Australia Aboriginal Medical Services Alliance NTState based organisations Tasmanian Medicare Local General Practice Victoria WA GP Network GP New South Wales GP Queensland General Practice South Australia Northern Territory GP NetworkOpportunistic consultations A1 / A2 National Networking and Training Workshop Tasmanian Aboriginal Health Reference Group Wellington Aboriginal Medical Service

xiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

B1 consultations Pharmacy Guild - Victoria Individual community pharmacists (invited to participate through the

Pharmacy Guild)National consultations National Aboriginal Community Controlled Health Organisation Tom Calma, National Coordinator - Tackling Indigenous Smoking Menzies School of Health Research – initial consultation, further

discussions to follow Australian General Practice Network Health Workforce Australia Pharmaceutical Society of Australia Royal Australian College of General PractitionersPharmacy Guild Australian College of NursesDepartmental consultations The Australian Government Department of Health and Ageing Other consultations Ipsos EurekaC.1.2 Community site visits Eight community site visits were conducted to inform this report. Six of these communities were the focus of Patient Journey Mapping and service mapping (baseline activities) as well as general activities designed to inform this report. All communities will be visited again in late 2012 or early 2013. The following sites were involved in the community visits: North Melbourne, Victoria; Perth, Western Australia; Griffith, New South Wales; North West Tasmania; Charleville, Queensland; Western Sydney, New South Wales; Murray Bridge, South Australia; and Darwin and Alice Springs, Northern Territory.

xiiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

The communities were selected in consultation with the department. Selection of the communities for the first round was based on the following criteria: a mix of remote, rural, regional, and metropolitan sites with

consideration to the spread of the Aboriginal and Torres Strait Islander population across these areas;

sites spread across all states/territories; the location of Indigenous health services, mainstream general practices,

and availability of other health providers; and a range of ICDP measures being accessed (for instance MSOAP, USOAP,

various ICDP-funded workers).Similar criteria will be applied to selection of the additional seven communities to be visited in 2012.Evaluation activities undertaken during community site visits included: semi-structured interviews with a range of service providers,

representatives and community members relevant to the measures in place; and

focus group discussions with community representatives.The stakeholders at each site were identified by key community stakeholders/ representatives as part of the initial contact with communities. The focus of these visits was primarily on implementation of the particular ICDP activity in place within each community. Specifically, the visits sought to understand, at a detailed level: the structures and processes that have been implemented at sites to

support implementation of the ICDP, and the effectiveness of these; the progress of implementation to date, and the reasons behind the level

of progress; and local contexts for implementation of ICDP (i.e., the presence of specific

ICDP measures, the remoteness-status of the area), including factors impacting on the success of implementation.

KPMG and Winangali evaluators spent between two to three days at each site and consulted with a range of stakeholders including local community members, local IHSs, local general practices, other local health services, pharmacists, DoGP/Medicare Locals, and local ICDP workforce. A full list of stakeholders consulted during the community site visits is provided below. Stakeholders engaged through community site visits Northern Melbourne- Victorian Aboriginal Health Service (VAHS)- North Metro Division of General Practice staff

xivKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

North West Tasmania- North West Division of General Practice staff

Charleville - RHealth staff - Charleville and Western Areas Aboriginal and Torres Strait Islanders

Corporation for Health (CWAATSICH) Perth- Rural Health West staff - Derbal Yerrigan AMS staff - Primary Care Network staff

Griffith - Murrumbidgee Medicare Local staff- Griffith community members (held at AMS)- Griffith AMS staff - Griffith health professionals

Western Sydney- Western Sydney Medicare Local - AMS Western Sydney

Murray Bridge- Murray Mallee General Practice Network - Murray Bridge health professionals- Raukkan Aboriginal Community Co-op- Country Health SA

Darwin / Alice Springs - Danila Dilba - General Practice Network NT (Darwin)- Pharmacy Guild, NT- Darwin local health providers - Central Australian Congress- Alice Springs Hospital - GPNNT (Alice Springs) - Local health provider (Alice Springs)

xvKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Staff consulted: 2 Regional Tobacco Coordinators (RTCs) 3 Tobacco Action workers (TAWs) 4 Healthy Lifestyle workers (HLWs) 13 ATSIOWs 9 IHPOs 6 ICDP Care coordinators, 1 Chronic Disease Care Coordinator and 1 Care

Coordinator Purple House 1 Manager USOAP/MSOAP-ICD 8 CEOs and Deputy CEOs/Branch Managers (2) 4 GPs and 1 Medical officer 18 managerial staff (including Clinical manager, Program coordinator,

Operations manager, Public Health Manager, General Manager Primary Care, Manager Primary Health Care Services, Manager GP Services, Operations Manager, Program Manager, Executive Officer, Management staff - Aboriginal and Torres Strait Islander Health (2), 5 Practice Managers

4 Nursing staff 6 other allied health staff (including 2 Local Pharmacists, 2 AHWs,

Diabetes educator, Dietician) Several other staff (including practice staff, Policy Officer,

Business/finance staff, Practice support staff)Community focus groups held during site visits North Melbourne community members (held at VAHS):- One extended focus group incorporating patient journey mapping and

other evaluation activity: Seven females, age range 25 to 70 years North West Tasmania community members (held at 6 Rivers

organisation)- Group one: Seven participants, five females and two males, age range

26-63 years- Group two: Six participants, three males, three females, age range 23-

60 years Charleville community members- Group one: Nine participants, three males, six females, age range 20-

70 years- Group two: Eight participants, six females, two males, age range 20-

70 years

xviKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Perth community members (held at Ashfield street doctor site (2) and Derbal Yerrigan AMS (1))- Group one: Eight participants, five female, three male, age range 25-

70 years- Group two: Six participants, four female, four male, age range 25-70

years- Group three: 10 participants, seven female, three male, age range 40-

70 years For Griffith site visit, focus groups held with various communities

included: - Leeton community members (held at Land Council): 11 people, seven

female, four male, age range 20-65 years- Griffith community members (held at AMS): Three participants, two

female, one male, age range 45-60 years- Darlington Point community members (held at Aunty Jean's program):

Three participants, all female, age range 65-70 years- Narrandera community members (held at Aunty Jean's program): Five

participants, all male, age range 28-75 years Western Sydney community members (held at Marrin Weejali)- Group one: 10 participants, seven female, three male, age range 18-

70 years- Group two: 11 participants, six female, five male, age range 30-75

years- Group three: Five participants, one female, four male, age 18-72 years

Murray Bridge community members- One group. Three participants, all female, age range 65-70 years

Darwin community focus groups - Group one: Five participants, four female and one male age range 50-

70 years- Group two: Five female participants age range 50-70 years

Community focus groups (Alice Springs) - Group one: Seven participants, five females and one two males, age

range 22-70 years- Group two: One male and one female participant, age range 19-20

yearsCommunity focus groups contained between three and 11 participants. Groups were mixed gender, according to the wishes of the community, other than two female only groups.

xviiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

C.1.3 Regional Forums Regional forums are being conducted at two points in time across each state and territory, bringing together organisations involved in the delivery of ICDP in the ‘region’. A ‘region’ represents a locality rather than a formal governance region. A range of organisations were invited to participate in the first round of Regional Forums, namely: Aboriginal Community Controlled Health Services; Divisions of General Practice/Medicare Locals; state health regional offices (where they exist); state health departments (central office); rural workforce agencies; jurisdictional NACCHO affiliates; Pharmacy Guild; and other local organisations that have an ICDP role.The Regional Forums collect information about the implementation and ongoing operation of the ICDP across different locations. The first round of 10 Regional Forums was conducted in November and December 2011. The purpose of these Regional Forums was to gain an understanding of the current status of ICDP activities in each locality and the issues which have arisen in the first two years of the ICDP. This includes challenges encountered during implementation, enablers and barriers which have facilitated or inhibited any achievements to date, and any lessons which have been learned from local or regional implementation of the ICDP. Forums were conducted at the following locations: Adelaide, South Australia; Brisbane, Queensland; Cairns, Queensland; Bendigo, Victoria; Perth, Western Australia; Broome, Western Australia; Sydney, New South Wales; Dubbo, New South Wales; Alice Springs, Northern Territory; and Launceston, Tasmania5.The second round of Regional Forums will be follow up forums at locations where the first round forums were conducted. They will be held in late 2012. 5 This was not strictly speaking a Regional Forum; rather it is an example of utilising an existing event or forum to undertake evaluation activities.

xviiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

The purpose of these forums will be to assess achievements to date, map and analyse service improvements and outcomes, gather evidence of lessons learnt, explore implications for collaboration and coordination across services, assess impacts on workforce development and consider ways forward for future programs targeting chronic disease morbidity and management for Aboriginal and Torres Strait Islander people. ParticipantsThe number of organisations able to participate in the Regional Forums was less than planned. The key constraints were the limited lead time given to organisations and the time of the year (just prior to the festive break). In some cases, individual organisations had been involved in multiple other events (some related to ICDP and others related to a range of other government and local initiatives) and were suffering “consultation fatigue”.While the duration of the forums (all day events in urban areas and evening events for rural areas) were an issue for some organisations, there was not a universally held view of what would have been the optimum timing or time duration. The number of organisations varied from 3 to 11. C.1.4 Sentinel Sites reports The 2011 Evaluation Report from the Sentinel Sites project was reviewed and findings incorporated into each of the chapters relating to ICDP measures (chapters 4-17) of this report. C.2 Quantitative methodsC.2.1 Analysis of secondary dataThe analysis of secondary data to be undertaken in the ICDP evaluation aims to, where possible, quantify the impact of the ICDP. That is, assess whether individual measures and the overall Package are achieving early results, medium-term results and long-term outcomes. The analytical work to date for establishing the impact of ICDP has been exploratory in nature. A number of data requests have also been developed throughout this phase, and while some data has been made available, more is expected. Some of the data that is not yet available will be used to answer key evaluation questions. The key data sources were the PIP Indigenous Health Incentive data, MBS Data and S100 RAAHS data. Analysis focused on understanding trends and distributions in these data sources. For example, PIP Indigenous Health Incentive allowed for analysis by state, remoteness and type of practice. It was the type of practice (i.e., IHS or mainstream general practice) analysis which showed the most interesting differences for the practice and patient registration statistics.MBS services data allowed for breakdowns by age, gender, state and remoteness. Analysis could focus on trends (e.g., increase in health assessments, Item 715) and distribution (e.g., provision of allied health services by jurisdiction). Future analysis will look at movement throughout

xixKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

the health system (e.g., are patients receiving GP Management Plans) and whether registered patients are receiving more services post registration. While the S100 RAAHS Program is not part of the ICDP, this data source is of use to understand prescribing, dispensing and utilisation of medicines, which is of interest to the evaluation of measures focused on reducing smoking as a chronic disease risk factor and the PBS co-payment. For example, if a region receives a large number of medicines through S100 RAAHS. Analysis of data has been primarily exploratory and aimed to establish the most recent level in a relevant indicator and the trend that exists for that indicator within those sources. For example, the trend for health assessments is an increasing one and the time series displays seasonal effects (e.g., drop in services between November to February quarters). One question that this observation raises is whether this increase is a consequence of reducing the administration involved in these health assessments (by combining four items into one item) or is it a result of the ICDP? This will be explored in the attribution analysis.Data sources used throughout the report include:Key data sources Data Request: Remote Area Aboriginal Health Services Program Data for

2008-09 to 2010 11, Department of Human Services, Medicare provided by the Department of Health and Ageing (aka S100 RAAHS Data).

Data Request: Practice Incentives Program – Indigenous Health Incentive data for May 2010, Department of Human Services, Medicare, provided by the Department of Health and Ageing (aka PIP Indigenous Health Incentive data).

Data Request: Medicare Benefits Schedule Aboriginal and Torres Strait Islander specific items. For August 2008 to May 2010, Department of Health and Ageing, Medical Benefits Division, Medicare Information and Analysis Section provided by the Department of Health and Ageing (aka MBS Data).

Australian Bureau of Statistics 2006a, National Aboriginal and Torres Strait Islander Health Survey 2004–05, ABS cat. no. 4715.0, ABS, Canberra.

Other data sources Australian Bureau of Statistics 2009, National Aboriginal and Torres Strait

Islander Social Survey 2008, ABS cat. no. 4714.0, ABS, Canberra. Australian Bureau of Statistics 2008, 3238055001DO004_200606

Experimental Estimates of Aboriginal and Torres Strait Islander Australians, Jun 2006, ABS cat. no. 3238.0.55.001, Canberra.

Australian Institute of Health and Welfare 2011, Aboriginal and Torres Strait Islander health services report 2009–10: OATSIH Services

xxKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Reporting key results, Cat. no. IHW 56, AIHW, Canberra. Australian Institute of Health and Welfare & Australian Government

Department of Health and Ageing 2009, National Bowel Cancer Screening Program: annual monitoring report 2009, Cancer series no. 49, Cat. no. CAN 45, AIHW, Canberra.

Australian Institute of Health and Welfare 2010, BreastScreen Australia monitoring report 2006–2007 and 2007–2008, Cancer series no. 55, Cat. no. CAN 51, AIHW, Canberra.

Australian Institute of Health and Welfare 2010, Cervical screening in Australia 2007–2008: data report, Cancer series no. 54, Cat. no. CAN 50, AIHW, Canberra.

Laws PJ, Li Z & Sullivan EA 2010, Australia’s mothers and babies 2008, Perinatal statistics series no. 24, Cat. no. PER 50, AIHW, Canberra.

Australian Institute of Health and Welfare 2011, Aboriginal and Torres Strait Islander Health Performance Framework 2010: detailed analyses, cat. no. IHW 53, AIHW, Canberra.

Data Request: National Centre for Vocational Education and Research 2011, Australian vocational education and training statistics.

Australian Health Ministers’ Advisory Council 2011, Aboriginal and Torres Strait Islander Health Performance Framework Report 2010, AHMAC, Canberra.

Data Request: Department of Education, Employment and Workplace Relations 2011, Australian tertiary education statistics.

C.3 Case studies C.3.1 IntroductionThe department has identified the use of case studies as a feature of the ICDP national monitoring and evaluation project. In addition to two case studies prepared for the First Monitoring Report (this document), two case studies will be prepared for the Second Monitoring Report, and three case studies will be included in the Final Report. The A3 evaluation also includes case studies specific to that measure. The following case study topics have been selected for inclusion in this Report: the impact of the PIP Indigenous Health Incentive (B3a measure) on the

standard of care provided to Aboriginal and Torres Strait Islander patients; and

factors impacting access to the Care Coordination and Supplementary Services Program (B3b measure)

These two case studies were considered for in-depth inquiry based on feedback to the department and preliminary evaluation findings which suggested varying implementation approaches within these two measures.

xxiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

The department and the evaluation team worked together to develop sub-questions or lines of inquiry for each case study. These are addressed at the end of each case study. The purpose of the case studies is to provide the opportunity to closely examine specific topics.

C.3.2 Case study approachAs a research and evaluation methodology, case studies offer the opportunity to develop a holistic understanding of a situation where the context is complex and the impact of the context on outcomes is not clearly evident.6 Case studies allow investigators to capture a full picture of the situation while recognising unique variations from one setting to another. The case study method is particularly relevant to the ICDP, given the widely varying contexts in which the ICDP measures are implemented – for example, diversity in primary health care practices, recipient population characteristics and needs, workforce characteristics, etc. While it will not be possible to fully account for the impact of context on ICDP measures, case studies allow for a more sophisticated portrayal of the interaction between context and program implementation. The present case studies are largely based on information provided by a selection of stakeholders. While the case studies cannot claim to represent the full range of findings at all locations where ICDP measures are implemented, they do offer the ability to draw certain generalisations about the topics of interest. These include generalisations about constructs and their relationships7 and small-scale generalisations that cautiously contribute to grand generalisations.8 One of the benefits of case studies is the ‘vicarious experience’ offered in the presentation of findings, which can assist program managers to engage with the content, come to new understandings, and apply insights to program improvements.9 Accordingly, case studies are presented here in a narrative format. Care has been taken to ensure that findings are well supported by evidence. C.3.3 MethodsThe selected case studies are related to the two components of the Supporting Primary Care Providers to Coordinate Chronic Disease Management measure – PIP Indigenous Health Incentive and the CCSS program. These two components are interrelated, as registration as a PIP

6 Yin RK 1989, Case study research: Design and methods (Revised ed.), Sage Publications, Newbury Park.7 Miles MB, & Huberman AM 1994, Qualitative data analysis: An expanded sourcebook (2nd ed.), Sage Publications, Thousand Oaks.8 Stake RE 1994, ‘Case studies’ in Denzin NK & Lincoln YS (Eds.), Handbook of qualitative research, Sage Publications, Thousand Oaks, pp. 236-2479 Stake RE & Trumbull DJ 1982, ‘Naturalistic Generalizations’, Review Journal of Philosophy and Social Science, 7, pp. 1-12.

xxiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Indigenous Health Incentive practice is generally required to make referrals to the CCSS Program. Likewise, the set of stakeholders involved in the two measures is overlapping. Naturally the two case studies presented here are based on similar sets of data. These case studies have been developed by harnessing a broad range of relevant data collected during the course of the national evaluation up to the First Monitoring Report. This includes the following qualitative and quantitative information sources: consultations with national peak bodies; consultations with AGPN State Based Organisations and NACCHO

affiliates in the jurisdictions; community site visits; regional Forums; and MBS data. Additional data collection was conducted specifically to inform the case studies. Data collection was largely focused on two Divisions of General Practice (Division/s) one in outer regional Victoria, and one in inner regional New South Wales.10 This involved: semi-structured interviews with a key contact at GP Victoria and GPNSW; semi-structured interviews with a key contact at each Division; semi-structured interviews with GPs and Practice Managers at six primary

health care practices registered with the PIP Indigenous Health Incentive; written submissions provided by Practice Managers at two primary health

care practices; and semi-structured interviews with six Care Coordinators employed at the

Division. Care Coordinators were asked questions related to the CCSS Program case study, while other stakeholders were asked questions about both case studies. Outside of these two sites, semi-structured telephone interviews were conducted with four additional Care Coordinators located in major cities, regional and remote locations in Queensland, Western Australia, Northern Territory and Australian Capital Territory. A semi-structured interview was also conducted with the National Coordinator of the CCSS Program, a position funded with the Australian General Practice Network. Interview questions for all of these stakeholders related primarily to the CCSS Program. Interview guides were prepared for stakeholder interviews. These interview guides were based on the evaluation framework questions and sub-10 The classification as ‘rural’ and ‘urban’ is as identified on the Australian General Practice Network website.

xxiiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

questions and were agreed upon with the department.Participant selection occurred through a multi-step process that was initiated through a request to SBO contacts11 for a full list of Care Coordinator locations in that state or territory. Based on the received lists, one major city and one outer regional Division were selected. SBO key contacts for the selected jurisdictions were contacted to provide their advice on the suitability of the selections, and the appropriate protocol for soliciting participation within the Division. The selected Divisions were contacted through their CEOs, as suggested by SBO contacts. CEOs confirmed their interest in participating, and recruitment of other stakeholders proceeded with the assistance of a key contact identified at the Division. Based on the preferences of key contacts at the Division, interviews were conducted in person in Victoria and by telephone and written submission in New South Wales. Interview notes were transcribed and were subject to thematic analysis which revealed a number of key themes. It became evident through analysis that the experience of the measures varied considerably between practice types (general practice and Indigenous health services); in addition, experience of the CCSS program was further delineated by the model of service delivery in operation. C.3.4 Presentation of findingsVarying experiences of implementation are reflected in case study vignettes. These are composite ‘stories’ that reflect common findings across numerous stakeholders. The vignettes are presented in narrative format to provide insight into the lived experiences of stakeholders involved in implementation.

11 These contacts were identified through KPMG participation at a Care Coordinator conference held in Canberra on 10 February 2012.

xxivKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Appendix D. Regional Forum summary

This Appendix summarises the findings from the ten Regional Forums undertaken in late 2011. A description of the methodology, sites and participants is provided in Appendix Appendix C. The findings are arranged under the three key areas of investigation explored during each of the Regional Forums: Expectations – reporting on what participants expect to change as a

result of the implementation of the ICDP in their region. Assessment of the current state – exploring the extent to which

participants believe the various components of the ICDP have progressed to date.

Challenges and opportunities – a summary of the challenges and opportunities which were raised with some consistency across the Forums. Many of these are also discussed in the individual measure chapters.

D.1 Expectations There was a high degree of consistency across the forums in the expectations participants had of the ICDP, although their emphasis differed somewhat regionally and amongst individual organisations. In general terms, participants considered ICDP to be sufficiently comprehensive that it should benefit individual clients, communities and health service providers in an inter-related manner. While the range of expected benefits was considerably varied (reflecting the wide range of measures that comprise ICDP), the expectations that were consistently emphasised across the forums were that ICDP would: improve the capacity of both the community controlled sector and the

mainstream primary health care sector to respond to the needs of individual patients;

improve identification of Aboriginal and Torres Strait Islander status by health services;

increase engagement and coordination between mainstream and Aboriginal and Torres Strait Islander health service sectors, and that this would support increased patient access and better patient care;

increase the cultural competency of mainstream health services in terms of their interaction with and treatment of patients (more strongly associated with the employment of IHPOs and ATSIOWs than cultural awareness training);

improve patient access to health services directly through initiatives such as CtG scripts and indirectly through the new ICDP workforce (such as ATSIOWs);

xxvKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

improve coordination of care for people with a chronic condition; and raise the awareness of chronic disease risk factors amongst individuals

and the community. In particular, participants hoped ICDP would decrease smoking amongst community members and amongst Aboriginal Torres Strait Islander health workers.

D.2 Assessment of current state of ICDP There was a consistent theme running through all Regional Forums regarding the implementation challenges for all stakeholders. However, notwithstanding these challenges, participants consistently reported that ICDP has led to a greater level of collaboration between the sectors (state, community controlled and mainstream primary health care Divisions) which in itself was important to getting the various ICDP initiatives off the ground and in part a consequence of these organisations having to deal with local implementation challenges. While some aspects of ICDP have considerable traction, participants generally considered that ICDP is still in its early days and much more needs to be done before core ICDP activities and initiatives are consolidated locally. The main components of ICDP that have advanced the most from an operational perspective are: CtG scripts, participants reported that the uptake of the B1 measure had

been strong and consistent, and had resulted in increased access to medications;

uptake of the B3a measure (PIP Indigenous Health Incentive) was strong, but not as consistent as CtG scripts, with some practices that have a considerable Aboriginal and Torres Strait Islander client population yet to register;

the use of outreach services – both in terms of the number and range of services, had progressed substantially (MSOAP-ICD and USOAP programs); and

the ‘ICDP workforce’ is largely in place and working well with and accepted by the community.

While participants acknowledged that all aspects of ICDP are progressing, they generally considered that substantially more work needs to be done to consolidate some of the core elements of ICDP. While ATSIOWs, IHPOs and Care Coordinators are engaging with other parts of ICDP including making referrals to the PIP Indigenous Health Incentive, informing patients about the PBS Co-payment measure and cross referring to each other, their roles are still evolving as are their networks, organisational relationships and referral mechanisms. Many of the organisations employing these types of workers seem to be working through the operational elements of their role and working through how they will interact with other parts of the existing service system and in some cases within their own organisational service system. Participants made similar comments with respect to the TAWs and

xxviKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

HLWs although there was less knowledge of these measures amongst the forum participants.D.3 Challenges and opportunitiesD.3.1 General challengesA range of challenges and associated opportunities for improvement were put forward at the Regional Forums. In general terms, participants considered that considerable effort was required to ensure that the nationally designed Package was relevant to local needs and that in some cases, the drive for national consistency created constraints for local application, such as those listed below. Insufficient information was available during implementation period

regarding the roles of new workforce types funded by ICDP such as TAWs and ATSIOWs and related to this either delay in or insufficient access to training opportunities for newly recruited staff.

Difficulty in accessing information on which primary health care services were PIP Indigenous Health Incentive registered (a pre-requisite for a patient to obtain a CtG script).

Variable knowledge and understanding amongst relevant stakeholders of how core components of ICDP were to operate such as patient eligibility for CtG scripts and in some cases, the fact that this initiative existed.

The decision to create prescribed new workforce roles such as Tobacco Action Workers rather than allocated funding for organisations to use to enhance their own workforce capacity to focus on smoking cessation.

The rules governing the use of care coordination supplementary funding that were designed to prevent funding substitution that appears to have made it difficult for health workers to use the funds to respond to patient needs in a timely manner.

In more general terms, the two consistent themes running through all forums were the lack of consultation regarding local needs and the lack of flexibility in the use of ICDP funding. These findings simply reflect that the aim to have a nationally consistent program has the consequence of creating constraints for local application. Striving for a balance between national consistency and local flexibility is always a challenge for national program design. All forums agreed with the broad strategy underpinning ICDP but that the allocation of ICDP workforce has not been optimum. Examples cited were allocation of ICDP workforce has duplicated other program investments or were not located where there was the greatest need. All forums raised a similar alternative strategy which was for the department to allocate funds to address ICDP priorities and to allow local organisations to determine how to best use those funds to meet ICDP targets.

xxviiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

D.3.2 Specific challengesParticipants commonly felt that the PIP Indigenous Health Incentive created an administrative burden for mainstream general practices and IHSs, leading to reluctance to register and re-register patients. Participants indicated that to make the measure more attractive to GPs, particularly in small practices, the registration and re-registration process should be simplified. One suggestion in South Australia was to make eligibility criteria across the PBS Co-payment measure and the PIP Indigenous Health Incentive consistent. Participants also noted that the requirements for cultural awareness training under the B3a measure, that two staff only must complete training, and that training can be online, were not adequate to support increased cultural appropriateness in many cases. Access to CCSS funding was considered to be difficult, largely due to the guidelines which are very prescriptive. Participants suggested re-development of these guidelines to allow for more flexibility in the use of this fund. Regional Forum participants said that initially there was poor understanding of the B1 measure, particularly amongst pharmacists but also amongst GPs. Although this has reportedly improved with time, participants felt there were opportunities for explicit, targeted and ongoing information dissemination about the measure, for example, information about which medications are included in the CtG scripts arrangements. Some participants thought more could be done to ‘make the most’ of the success of the measure, such as including home medication review as an additional component. Participants also raised issues about sustainability of the ICDP, both in terms of measures and staff. Participants said there have been difficulties recruiting staff to positions that are time limited, due to a lack of job security. There were also reportedly issues in attracting staff to some locations, such as Alice Springs. Participants also discussed reluctance amongst ICDP staff to ‘sell’ what are perceived to be ‘time limited’ programs to community members. Participants thought there were opportunities to improve the training available for staff through the ICDP. Participants reported that the training is currently poorly coordinated, and varies in its accessibility. Participants suggested conducting needs analyses to understand what training is required across locations and provision of more targeted, accessible training. At many Regional Forums, participants indicated there was a lack of common understanding about different measures amongst stakeholders (i.e., health services, funded organisations), and limited coordination across and between the measures, and between measures and other non-ICDP programs. Participants highlighted examples such as community members being eligible for some measures and not others, and health services not understanding which measures community members would be eligible for.

xxviiiKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

To address these issues, participants suggested provision of information clarifying the aims and eligibility requirements for measures, education for GPs about programs and services that could be referred to, and clear referral pathways between measures. Participants also suggested better integration of ICDP within other programs, for example, formalising the engagement between Care Coordinators and the state funded Connecting Care Program. More broadly, a number of participants indicated some difficulties were occurring in coordinating and sharing information between services, particularly Aboriginal and Torres Strait Islander and mainstream services. Participants identified opportunities for better coordination between Divisions of General Practice and Medicare Locals with ACCHSs and AMSs. This includes support for sharing of patient information.Some Regional Forum participants said the delivery of ICDP measures, particularly the B5 measure (MSOAP and USOAP), was not always based on an understanding of needs and good planning processes. Participants in Queensland suggested tools could be developed to support IHPOs to undertake needs assessments. Other participants indicated flexibility was required about implementation of the ICDP at the local level to account for geographic variation.D.3.3 Opportunities The measure specific chapters discuss opportunities that are specific to the individual measures. The following opportunities were raised during Regional Forums, and relate to the Package as a whole. Collaboration: Medicare Locals will have a core role in population health

planning, and workforce development across the entire primary health care sector and have a strengthened focus on Aboriginal and Torres Strait Islander health. The department should promote the potential benefits of including Medicare Locals in the IHPFs at the national and jurisdictional level as a way of supporting ongoing cross-sector collaboration of ICDP activities and Aboriginal and Torres Strait Islander health more broadly.

Workforce development: The ICDP workforce values the networking opportunities that have been organised as part of the ICDP initiative. All ICDP workforce groups expressed a desire for more networking opportunities as an important workforce development activity. Although individual measures have training and networking opportunities in place, development of a strategic approach to promote networking for all workforce components may be warranted. The strategy should consider options to provide more networking opportunities, ways of sharing local innovations that could have relevance for other regions and options for integrating ICDP workforce groups into the broader Aboriginal and Torres Strait Islander workforce.

Intra-ICDP connections: There have already been enhanced linkages between different ICDP measures, with the most notable one being

xxixKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

linking A1 and A2. There are other examples such as promoting the web-site resource (C5) to all ICDP workforce and the complementary roles of ATSIOWs and Care Coordinators. The department should ensure that all potential linkages between the measures are explored and optimised.

xxxKPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Appendix E. Whole of ICDP evaluation table This Appendix presents an update on the data collection and analysis against the medium-term results, early results and outputs for the whole of ICDP evaluation. Table 1: Whole of ICDP evaluation medium-term results table. Source: KPMG

ICDP Outcomes Hierarchy

Evaluation Questions

Indicators Potential Data Sources

Data Collection Timing or Frequency

Update

More health care providers are accessed by and provide quality care to Aboriginal and Torres Strait Islander people with or at risk of chronic disease

How have individual Aboriginal and Torres Strait Islander people made use of the primary health care services? What impact has there been on the local community of the enhanced service provision?

Experiences and perceptions of Aboriginal and Torres Strait Islander people who have used primary health care services

Community members consultation

Year 4 There has been a substantial increase in the number of Aboriginal Health Assessments. In May 2011 there were 20,599 assessments. This equates to 53% more assessments than the May quarter 2010.

More health care providers are accessed by and provide quality care to Aboriginal and Torres Strait

To what extent has access to allied health and specialists been increased?

Number and occasions of services provided by CCSS and USOAP

Program documentation

Annually There has been a substantial increase in the number of allied health services accessed in the

31KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.

All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.



Appendices





Update

Islander people with or at risk of chronic disease

last 12 months. In May 2010 there were 345 allied health services accessed and by May 2011 there were 1,353 allied health services accessed. For further discussion see chapters 9 and 11.


To what extent has the uptake of MBS items related to health assessments and early detection by Aboriginal and Torres Strait Islander people increased?

Early detection and early treatment: MBS Health Assessment and follow-up items for Aboriginal and Torres Strait Islander People (15-54 years) and Chronic Disease Management Plans (CDMP) and follow-up services

MBS Year 4 There has been a substantial increase in the number of Aboriginal Health Assessments. In May 2011 there were 20,599 services. However, there is no data available to date on Item 721 (GP management plans) or Item





Appendices





Update

723. For further discussion see chapter 8.


To what extent has the PIP Indigenous Health Incentive increased the number of Aboriginal and Torres Strait Islander people receiving the target level of care?

Number of registered Aboriginal and Torres Strait Islander people receiving target level of care (# of annual PIP Indigenous Health Incentive payments) (by service type, geography, age, gender)

MBS/PIP Indigenous Health Incentive

Annually Between May 2010 and May 2011 there have been49,741 patient registrations 2,046 patients triggered a tier 1 payment; and 24,796 patients triggered a tier 2 Payment. Data available to date only allows for analysis by state, remoteness and practice type. For further discussion see chapter 8.

More health care providers are accessed by and provide quality

To what extent has the PIP Indigenous Health Incentive

Annual increase in the number of follow-up allied health services

MBS Annually There has been a substantial increase in the number of allied





Appendices





Update

care to Aboriginal and Torres Strait Islander people with or at risk of chronic disease

increased the number of Aboriginal and Torres Strait Islander people receiving the target level of care?

for people of Aboriginal and Torres Strait Islander descent (MBS 81300-81360) provided

health services accessed in the last 12 months. In May 2010 there were 345 allied health services accessed and by May 2011 there were 1,353 allied health services accessed.


To what extent has the PIP Indigenous Health Incentive increased the number of Aboriginal and Torres Strait Islander people receiving the target level of care?

Annual increase in the number of Aboriginal and Torres Strait Islander Health Assessments provided

MBS Annually There has been a substantial increase in the number of Aboriginal Health Assessments. In May 2011 there were 20,599 services. This equates to 53 per cent more assessments than the May quarter 2010. For further discussion see chapter 8.





Appendices





Update

ICDP-funded health care services deliver a comprehensive and coordinated approach to chronic disease management, including increased and earlier access to primary health care, specialist and allied health services, affordable care and medicines

To what extent has the uptake of MBS items related to health assessments and early detection by Aboriginal and Torres Strait Islander people increased?

Early detection and early treatment: MBS Health Assessment and follow-up items for Aboriginal and Torres Strait Islander People (15-54 years) and Chronic Disease Management Plans (CDMP) and follow-up services

MBS Year 4 There has been a substantial increase in the number of Aboriginal Health Assessments. In May 2011 there were 20,599 services. However, there is no data available to date on Item 721 (GP management plans) or Item 723. For further discussion see chapter 9.

ICDP-funded health care services deliver a comprehensive and coordinated approach to chronic disease management, including

To what extent has the ICDP increased utilisation of PBS by Aboriginal and Torres Strait Islander people?

PBS utilisation of participants (before and after measure, vs. S100 RAAHS, vs. all Australians)

PBS Annually There were 859,370 CtG scripts dispensed over the 12 months to 31 May 2011. These were dispensed to 79,076 Aboriginal and Torres Strait





Appendices





Update

increased and earlier access to primary health care, specialist and allied health services, affordable care and medicines

Islander people

ICDP-funded health care services deliver a comprehensive and coordinated approach to chronic disease management, including increased and earlier access to primary health care, specialist and allied health services, affordable care and medicines


PBS utilisation of Aboriginal and Torres Strait Islander people before and after measure (using all VII PBS dispense records)

PBS Annually The number of CtG scripts dispensed has increased each quarter: with an increase of 38% from the February quarter 2011 to May quarter 2011.The following will be assessed upon receipt of data that facilitates this analysis. (See PBS Co-payment Subsidy (B1) Data Appendix)Comparisons of





Appendices





Update

PBS (including CtG) utilisation between CtG registered Aboriginal and Torres Strait Islander people and all Australians.PBS utilisation by Aboriginal and Torres Strait Islander people who are registered for CtG scripts before and after the introduction of CtG scripts.

ICDP-funded health care services deliver a comprehensive and coordinated approach to chronic disease management,


Medication adherence (CtG prescription repeats)

PBS Annually In the May quarter 2011, 347,938 CtG scripts were dispensed to patients and 365,683 items were supplied to





Appendices





Update

including increased and earlier access to primary health care, specialist and allied health services, affordable care and medicines

IHSs through the S100 RAAHS Program.





Appendices

Table 2: Whole of ICDP evaluation early results table. Source: KPMG





Update

The ICDP workforce is retained and developed within funded services

To what extent has the recruited ICDP workforce been retained within funded services?

Extent of retention

Organisational survey

Year 4 Data available to date shows the number of IHPOs and ATSIOW positions funded by organisations and recruitment into those positions. Available data cannot be used to answer the question of retention. For further discussion see chapters 13-15.

There is an increase in the workforce providing primary health care and other health services to Aboriginal and Torres Strait

How are ATSIOWs, RTCs, TAWs, HLWs, IHPOs deployed? To what extent do they complement existing services?

Roles played by new workers, perceived value and effectiveness of these roles

Health workforce survey

Year 4 For 2010-2011 the distribution of total funded positions (i.e., ATSIOWs, RTCs, TAWs, HLWs and IHPOs) align with the Aboriginal and Torres Strait





Appendices





Update

Islander people Islander population distribution, e.g., NSW has most funded positions in 2010-2011 and the highest population. Most (116.5 of 130.5 FTE) funded positions have been to either Divisions of General Practice or to IHSs. For further discussion see chapters 4, 13, 14 and 15.

There is an increase in the workforce providing primary health care and other health services to Aboriginal and Torres Strait

To what extent has the ICDP increased the overall size of the health workforce serving Aboriginal and Torres Strait Islander people?

Increase in workforce in Divisions of General Practice focused on Aboriginal and Torres Strait Islander chronic disease

AGPN/Australian Medicare Local Network surveys

As available For 2010-2011 there have been 45 FTE Funded positions to Divisions of General Practice (i.e., ATSIOWs, RTCs, TAWs, HLWs and IHPOs).





Appendices





Update

Islander people The majority of these were ATSIOWs. For further discussion see chapters 4, 13, 14 and 15.

There is an increase in the workforce providing primary health care and other health services to Aboriginal and Torres Strait Islander people


Number of people employed through the ICDP


Annually In 2010-2011 there were 44.5 ATSIOWs, 21 RTCs, 22 TAWs, 43 HLWs and 94.5 IHPOs FTE positions funded across Australia. Most organisations were able to recruit people into these positions. For further discussion see chapters 4, 13, 14 and 15.

There is an increase in the workforce providing primary

To what extent has the ICDP increased the overall size of the

Total size of IHS workforce

HPF #3.20 Year 4 As at 30 June 2010 Aboriginal and Torres Strait Islander primary





Appendices





Update

health care and other health services to Aboriginal and Torres Strait Islander people

health workforce serving Aboriginal and Torres Strait Islander people?

health care services employed about 4,841 FTE staff across various health (3,115 FTE), managerial, administrative, support and other roles (1,727 FTE). OATSIH Services Report data for 2010-2011 will be released in September 2012 and will provide further insight regarding this outcome.

There is an increase in the workforce providing primary health care and other health services to Aboriginal and


Enrolments (Aboriginal and Torres Strait Islander people) in health-related higher education courses/VET courses

HPF #3.18 Year 4 Data for 2011 on higher education and VET enrolments for health courses will become available in August 2012.





Appendices





Update

Torres Strait Islander peopleThere is an increase in the workforce providing primary health care and other health services to Aboriginal and Torres Strait Islander people

To what extent has the increase in workforce in general practice lead to an increase in delivery of care to Aboriginal and Torres Strait Islander people?

Evidence of increased use of general practice by Aboriginal and Torres Strait Islander people

APCC Year 4 Between May 2010 and February 2011 IHSs registered more patients than mainstream general practices. In May 2011 mainstream general practices registered 6,659 patients, which was 395 more than IHSs. MBS statistics on Health Assessments (or follow ups or allied health services) are not available by practice type. For further discussion see chapters 8-15.





Appendices





Update

Care coordination within ICDP-funded services is improved for Aboriginal and Torres Strait Islander people with or at risk of chronic disease

To what extent has care coordination been improved? What changes have occurred?

Number and type of Medicare services provided pre and post the measure (for PIP registered participants) (IHS and general practice

MBS Year 4 Data has been requested which will enable the analysis of the number of Medicare services provided pre- and post-registration. This data has not yet been received.

Financial and other barriers to accessing health care and medicines are reduced

To what extent do participating General Practices and Aboriginal and Torres Strait Islander health services facilitate access to co-payment relief for PBS medicines?

Number of PIP Indigenous Health Incentive registered practices facilitating co-payment relief

PIP Indigenous Health Incentive

Annually Between May 2010 and May 2011 there have been 2,128 practice registrations. In the May quarter 2011, 180 practices received tier 1 payments. To date a total of 1,092 practices have received tier 2 payments. For further discussion





Appendices





Update

see chapter 8.Financial and other barriers to accessing health care and medicines are reduced

To what extent do participating General Practices and Aboriginal and Torres Strait Islander health services facilitate access to co-payment relief for PBS medicines?

Number of Aboriginal and Torres Strait Islander people recruited (consented) for PBS co-payment relief

PBS Annually Data is not available on this outcome area


Has there been an increase in health professionals working in Aboriginal and Torres Strait Islander primary health care and other services?

Total size of HIS workforce

HPF #3.20 Year 4 As at the 30 June 2010 Aboriginal and Torres Strait Islander primary health care services employed about 4,841 FTE staff across various health (3,115 FTE), managerial, administrative, support and other roles (1,727 FTE). OATSIH Services





Appendices





Update

Report data for 2010-2011 will be released in September 2012.


Has there been an increase in health professionals working in Aboriginal and Torres Strait Islander primary health care and other services?

Number of Aboriginal and Torres Strait Islander people in health workforce (noting that they will not all be serving Aboriginal and Torres Strait Islander people and that there are non- Aboriginal and Torres Strait Islander people working in Aboriginal and Torres Strait Islander health)

HPF #3.10 Year 4 Australian Bureau of Statistics 2011 Census data is due to be released on June 21 2012. This outcome will thus be explored further in the Second Monitoring Report.

ICDP-funded health system supports, incentives and

To what extent do the available incentives and supports

Uptake of PIP Indigenous Health Incentive by Aboriginal and


Annually Between May 2010 and May 2011 there have been 2,128





Appendices





Update

subsidies are operating to facilitate the provision of quality primary health care for Aboriginal and Torres Strait Islander people with chronic disease

encourage participation?

Torres Strait Islander health services and general practice

practice registrations. In the May quarter 2011, 180 practices received tier 1 payments. To date a total of 1,092 practices have received tier 2 payments. Of the 2,128 practices registered, 116 have been IHSs while 2,012 have been mainstream general practices. For further discussion see chapter 8.

ICDP-funded health system supports, incentives and subsidies are operating to

To what extent do the available incentives and supports encourage participation?

Number of chronic disease patients recruited to PIP Indigenous Health Incentive by Aboriginal and


Annually Between May 2010 and May 2011 there have been49,741 patient registrations,





Appendices





Update

facilitate the provision of quality primary health care for Aboriginal and Torres Strait Islander people with chronic disease

Torres Strait Islander health services and general practice

2,046 patients triggered a tier 1 payment and 24,796 patients triggered a tier 2 Payment. Data available to date only allows for analysis by state/territory, remoteness and practice type. For further discussion see chapter 8.

ICDP-funded health system supports, incentives and subsidies are operating to facilitate the provision of quality primary health care for Aboriginal and Torres Strait

To what extent do the available incentives and supports encourage participation?

Number of registered clients receiving target level of care (# of annual PIP payments) (by service type, geography, age, gender)


Annually Between May 2010 and May 2011 there have been49,741 patient registrations, 2,046 patients triggered a tier 1 payment and 24,796 patients triggered a tier 2 Payment. For





Appendices





Update

Islander people with chronic disease

further discussion on PIP Indigenous Health Incentive payments see chapter 8. Data available to date only allows for analysis by state/territory, remoteness and practice type.

Aboriginal and Torres Strait Islander people who have had contact with the ICDP are more aware of and utilise (according to their need) the expanded range of health services and supports available to them to adopt healthy lifestyle choices and reduce

What types of services are being accessed?

Number and type of Medicare services provided pre and post the measure (for PIP registered participants and for VII patients)


Annually Relevant MBS and PIP Indigenous Health Incentive registered data is the subject of a current data request. The evaluators are awaiting receipt of data. This will be presented (if available) in the Second Monitoring Report.





Appendices





Update

smokingAboriginal and Torres Strait Islander people(s) who have had contact with the ICDP are more aware of and utilise (according to their need) the expanded range of health services and supports available to them to adopt healthy lifestyle choices and reduce smoking

What types of services are being accessed?

Number of Aboriginal and Torres Strait Islander people accessing relevant MBS items including for allied health services (see logic model for B3a)

MBS Annually There has been a substantial increase in the number of allied health services accessed in the last 12 months. In May 2010 there were 345 allied health services accessed and by May 2011 there were 1,353 allied health services accessed.





Appendices

Table 3: Whole of ICDP evaluation outputs table. Source: KPMG





Update

The workforce required to implement the ICDP is recruited, oriented and trained

Are the necessary workers/health professionals/organisations recruited as required for each measure?

Extent of recruitment of Regional Tobacco Workers (57), Tobacco Workers (170), Healthy Lifestyle Workers (105), Chronic Disease Care Coordinators, Aboriginal and Torres Strait Islander Outreach Workers (166), IHS practice managers (43), IHS health professionals (33), Indigenous Health Project Officers (80)


Annually Of the total FTE positions (i.e., ATSIOWs, RTCs, TAWs, HLWs and IHPOs) funded between 2009-10 and 2010-2011 (308) there have been 275 FTE recruited. Further discussion is provided in chapters 4, 13, 14 and 15.

The workforce required to implement the ICDP is recruited, oriented and

What are the occupancy rates for the ICDP funded positions?

Number of positions filled

Consultation with health care and other relevant services

Six monthly/annually

Of the total FTE positions (i.e., ATSIOW, RTCs, TAWs, HLWs and IHPOs) funded





Appendices





Update

trained between 2009-10 and 2010-2011 (308) there have been 275 FTE recruited. Further discussion is provided in chapters 4, 13, 14 and 15.

The workforce required to implement the ICDP is recruited, oriented and trained

What are the occupancy rates for the ICDP funded positions?

Length of time positions remained filled

Consultation with health care and other relevant services

Six monthly/annually

Of the total FTE positions (i.e., ATSIOW, RTCs, TAWs, HLWs and IHPOs) funded between 2009-10 and 2010-2011 (308) there have been 275 FTE recruited. Further discussion is provided in chapters 4, 13, 14 and 15.

Package measures are implemented in

What regional variations are there in the

Extent of consistent uptake of the ICDP

Program documentation and

Annually There is geographical variation in the





Appendices





Update

accordance with agreed guidelines and timelines

uptake of the universal ICDP measures?

services across regions

administrative data sets

distribution of particular measures. For example, almost all Aboriginal and Torres Strait Islander health services (Item 81300) have been provided in NSW, QLD and Victoria. There have been a very small number of these services in the remaining jurisdictions.

Monitoring and reporting requirements are met

Has the implementation of the ICDP resulted in the anticipated MBS and PBS utilisation rates?

Level of uptake of funding allocated for the utilisation of MBS and PBS items, compared to initial forecast

MBS Annually PIP Indigenous Health Incentive payments between May 2010 and May 2011 include:Practice Registrations: $2,128,000Patient





Appendices





Update

Registrations: $12,435,250Tier 1 payments: $204,600Tier 2 payments: $3,719,400

Monitoring and reporting requirements are met

Has the implementation of the ICDP resulted in the anticipated MBS and PBS utilisation rates?

Level of uptake of funding allocated for the utilisation of MBS and PBS items, compared to initial forecast

PBS There were 54,700 patients that were dispensed a CtG script in the May quarter 2011. This was an increase of 27% from the previous quarter.





Appendices

Appendix F. Subsidising PBS Medicine Co-payment measure data appendix

This Appendix presents a complete list of the PBS Co-payment evaluation questions for which the following data sources are specified: PIP, PBS, S100 RAAHS or Medicare (excluding the previous). Three issues relating to these questions and the associated data are presented: some general considerations about this area of data and the measure; status of each individual evaluation question – what can be reported at

this stage, limitations in interpretation, what might be reported at a future stage, what is unlikely to be addressed at any stage and alternative options for exploration; and

detailed results generated from the available data, with some discussion.F.1 Some general considerationsF.1.1 Incremental effect of measure vs. absolute take-up of CtG

scriptsIn relation to the evaluation of the PBS Co-payment subsidy, the term “incremental effect” refers to the additional PBS items dispensed as a consequence of the reduced financial barriers to utilising PBS listed medicines. The absolute take-up of CtG scripts is the total number of CtG scripts dispensed. The former is an indicator of the success of the measure in achieving improved access to PBS medicines. The latter is an indicator of the acceptance of the measure by providers and Aboriginal and Torres Strait Islander people.Some CtG scripts would otherwise (in absence of the PBS Co-payment measure) have been dispensed; hence, the total number of CtG scripts dispensed over-estimates the additional utilisation of PBS listed medicines as a consequence of the measure. With currently available data it is not possible to estimate the incremental effect of the measure. Hence, care should be taken in interpreting the available data (CtG scripts dispensed); it is evidence of the uptake of the measure rather than the impact of PBS Co-payment measure in improving access to PBS medicines. This question is expected to be explored in future evaluation reporting.F.1.2 PBS Co-payment Subsidy, Safety-Net Co-payment Subsidy

and PBS Price SubsidyThe PBS Price Subsidy is available to all patients with a Medicare card. “The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment. From 1 January 2012, you pay up to $35.40 for most PBS

55KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

medicines or $5.80 if you have a concession card. The Australian Government pays the remaining cost.”12

The Safety Net Co-payment subsidy is available to patients and households who have reached a threshold level of expenditure on PBS listed medicines. “After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form.”13

The PBS Co-payment subsidy provided through this measure is available on CtG annotated scripts prescribed by an authorised prescriber to an eligible patient. The incremental effect of the PBS Co-payment measure is the additional medicines dispensed as a consequence of the measure. CtG annotated scripts that would otherwise have been dispensed with a Safety Net subsidy are in most cases unlikely to be part of the incremental effect; they would otherwise have been available at a subsidised co-payment.CtG annotated scripts that would otherwise have been dispensed as conventional PBS scripts would have attracted a PBS price subsidy and, hence, the PBS price subsidy on these scripts does not represent an incremental cost to the PBS scheme; that expenditure would otherwise have occurred.Additional PBS items that would otherwise not have been dispensed do represent an incremental effect and cost to the PBS.F.1.3 “EverCtG”Identification of the cohort of patients who have been dispensed at least one CtG script is critical for the analysis of the impact of those aspects of the Package that influence prescribing and utilisation of medicines. These aspects and their expected impact on the use of medicines are: improved management of patients with chronic disease, which will in

turn impact on improved prescribing of medicines, including PBS (CtG and non-CTG scripts) and medicines supplied through the S100 RAAHS program;

the National Action to Reduce Indigenous Smoking Rates measure (A1), one element of which is intended to increase use of smoking cessation pharmacotherapy; and

the subsidy of the PBS Co-payment, which is expected to reduce financial barriers to accessing PBS medicines.

12 Department of Health and Ageing 2012, Pharmaceutical benefits scheme , Commonwealth of Australia, Canberra 13 ibid.



http://www.PBS.gov.au/



Appendices

The “EverCtG” term is used in the data requests provided to the department by the evaluators. It identifies Aboriginal and Torres Strait Islander people who have been dispensed at least one CtG script at a given point in time. Both CtG and non-CtG annotated PBS scripts dispensed to the “EverCtG” group can be compared to pre-measure dispensing of PBS scripts and the question of impact of the measure on PBS medicine use can then be analysed.Critically for the analyses required for the First Monitoring Report, it is not possible to identify this group from the data currently available, hence, a number of evaluation questions relating to the impact on access by Aboriginal and Torres Strait Islander people to PBS medicines cannot be assessed at this stage. However, this appendix refers to this cohort of patients in a number of places for two reasons: to clarify the limitations of available data in addressing key indicators and to indicate how such limitations will be addressed in future evaluation reports. F.1.4 Factors that influence capacity to evaluate the impact of

the PBS Co-payment measure on management on chronic conditions

A number of indicators in the Evaluation Framework refer to the impact for Aboriginal and Torres Strait Islander people in terms of improved management of chronic conditions. At this stage the data is not available to address this question. Firstly, the use of PBS medicines in the absence of the measure (and hence improvement in use post measure) cannot be estimated without the identification of the “EverCtG” group of patients (see above). Secondly, at this stage it is not possible to assess whether increase in use of medicines for chronic disease (for example, ATC A10 - Drugs for diabetes) relates to more frequent use by the same number of patients or more use by a larger number of patients.And finally, not all patients who are dispensed CtG scripts have a chronic condition. Others qualify because they are at risk of a chronic disease. Furthermore, not all scripts dispensed to patients with a chronic condition relate to that condition, or to acute exacerbations of that chronic condition. Hence, it is difficult to identify the proportion of utilisation of medicines for depression (for example) that relates to people with, rather than at risk of, a chronic disease. F.1.5 Time PeriodsThe following two practices are used throughout this Appendix: Where a 12 month period is referred to, it is the 12 months ending May

2011 unless otherwise stated. quarters are: February, May, August and November.





Appendices

When the number of unique patients dispensed a CtG script is referred to, in the case of the data extractions from the data custodians, this is for specific quarters. These cannot be summed to obtain a total for the year because most patients will be counted in more than one quarter. When percentage distribution of medicines across patient category, geography or medicine type is referred to, on most occasions, if the data extractions are used, only the final quarter is referred to. The reason is that results from the first three quarters of the measure are assumed to be less likely to be representative of ongoing utilisation.When comparisons are made with S100 RAAHS medicines and general PBS, only the May 2011 quarter is used, for reasons given above. F.1.6 Anatomical Therapeutic Chemical (ATC) classificationsFor the monitoring report, the following groups of medicines (Anatomical Therapeutic Chemical classifications ATCs) were used to report the data: the only ATC level 2 is for medicines used for diabetes (A10); the level one ATCs reported separately are: for Cardiovascular system

(C), Respiratory system (R), Anti-infectives for systemic use (J), Alimentary tract and metabolism other than diabetes (Other A), Nervous system (N), Musculo-skeletal system (M) and Other;

when medicines used to treat chronic diseases are reported as a group, they include all diabetes (A10), cardiovascular (S) and respiratory (R) medicines; and

medicines used to treat conditions are reported in addition to those relating to the three chronic diseases above because in May quarter 2011 less than 50 per cent of CtG scripts dispensed were for these ATCs.

F.1.7 Section 100 RAAHS ProgramAn S100 RAAHS medicines data extraction, which was specified by the department, was supplied to the evaluators. It is included in the evaluation framework as a data source. It is relevant to the evaluation for five reasons: to explain variation in the uptake of CtG scripts – e.g., remote Northern

Territory v. remote Western Australia v. inner regional NSW; to address evaluation questions such as: How many Aboriginal and

Torres Strait Islander Australians with or at risk of a chronic disease have access to co-payment relief?;

to monitor the effectiveness of the activities under the National Action to Reduce Indigenous Smoking Rates measure (A1) that promote the use of smoking cessation pharmacotherapy;

to monitor the effectiveness of initiatives to improved management of chronic disease at IHSs that are supplied through S100 RAAHS; and





Appendices

to ensure that uptake of CtG scripts can be disaggregated into incremental increase and use that would otherwise have occurred. To the extent that there is substitution between PBS scripts and S100 RAAHS supply as a consequence of the co-payment subsidy, some increases in CtG will be offset by reductions in S100 RAAHS.

F.2 Specific evaluation questions: Status, caveats, availability and technical issues

There are 15 evaluation questions that pertain to six broad outcomes relating to this measure and each of these are discussed below in terms of the key data issues and where available, results. Some results are only reported in the main body of the report.F.2.1 Participating patients have reduced financial barriers to

purchasing pharmaceuticals for chronic disease management

1) How many Aboriginal and Torres Strait Islander Australians with or at risk of a chronic disease have access to co-payment relief?

This evaluation question addresses the PBS Co-payment subsidy measure’s reach in the intended population, Aboriginal and Torres Strait Islander people at risk or with a chronic disease. The following considerations apply to this evaluation question: currently there is no estimate of the number of Aboriginal and Torres

Strait Islander people with or at risk of chronic disease available, hence, the capacity to assess “reach” of this measure within this group of people is limited;14

the proportion of Aboriginal and Torres Strait Islander patients registered with the PBS Co-payment subsidy who have a chronic disease is not known and is unlikely to be available;

some Aboriginal and Torres Strait Islander people living in remote and very remote locations have access to PBS listed items free of charge through the S100 RAAHS and hence estimates of the number of Aboriginal and Torres Strait Islander patients who have the PBS co-payment fully or partly subsidised needs to consider this group; and

some CtG scripts that would otherwise have been dispensed as conventional PBS have a co-payment subsidy as a consequence of the Safety Net threshold; the CTG co-payment subsidy on these scripts would otherwise have occurred (that is, without the measure).

14 There are estimates of Aboriginal and Torres Strait Islander people with at least one chronic disease and also Aboriginal and Torres Strait Islander people with at least one risk factor. However the sum of these two estimates is not the group of people with or at risk of chronic disease; some, not all, people with risk factor also have a chronic disease. A range of estimates of the number of Aboriginal and Torres Strait Islander people with or at risk of chronic disease will be developed from a range of data sources and the assumptions underlying each estimate will be documented for the evaluation Final Report.





Appendices

The status for each indicator is summarised below.Number of consenting participants by service typeThe total number of consenting participants of CtG is not available at this stage. The number of patients dispensed at least one script in the 12 months to May 31st 2010 is 79,076 and represents a lower bound of the number registered. Proportion of PIP IHI (B3) registered participants to access PBS Co-payment subsidy (B1) under new arrangementsThe number of PIP Indigenous Health Initiative registered patients at May 2011 who are also registered for CtG also is not available at this stage. However, 49,741 Aboriginal and Torres Strait Islander people were registered as part of the PIP Indigenous Health Incentive.Number of individual patients to have co-payments reduced/removed (as a proportion of all consenting patients)This indicator is the proportion of registered patients who have at least one CtG script in a given period. At this stage, the denominator that allows this proportion to be calculated is not available. 2) How much access is there by concession card holders/non-

concession patients?Both concession and non-concession card holders are eligible for this measure.Volume of Closing the Gap concession prescriptions and non-concession prescriptionsThis data is available and reported in the main body of the report. For the entire 12 month period: The information sourced from the measure manager is presented in the main report section. For each quarter: The information sourced from the data custodians related to activity in each quarter. It is not correct to sum across the four quarters to provide a 12 month estimate of these unique individuals because of the potential for double counting. F.2.2 Participating patients increase their utilisation of PBS

medicines for the management of chronic disease, in accordance with care plans

3) How many medicines are dispensed under the measure?Number of Closing the Gap medicines dispensedData available and reported in main body of report.





Appendices

4) Is utilisation of PBS medicines by participants increased?As discussed above, the number of PBS medicines dispensed to participants prior to the measure is not available at this stage. The number of CtG scripts overestimates the incremental effect of the measure on the PBS scripts dispensed to participants.Numbers and locations of people accessing medicines through the programGiven the caveats above regarding increased access to PBS medicines (with and without CtG annotated scripts, pre and post the measure), it is only possible to present the variation in the utilisation of CtG scripts. Some summary indicators of variation are presented in the main body of the report and the remainder are provided below in the section on detailed results.5) Is overall utilisation of PBS medicines by Aboriginal and Torres

Strait Islander Australians increased?Currently, there is no information available to the evaluators on the pre-ICDP use of PBS medicines (see discussion above in general issues).PBS utilisation of participants (before and after measure, vs. S100, vs. all Australians)The caveats regarding increased access to PBS medicines (with and without CtG annotated Scripts, pre and post the measure) are discussed above.The caveats regarding comparisons with S100 RAAHS include: no data on patients dispensed these medicines, only data on supply to IHSs; inclusion of people with acute conditions only and no risk factors (e.g., children); and the S100 RAAHS program supplies all PBS medicines to a group of patients identified by their location. The main caveat regarding comparisons with the general population is: the Aboriginal and Torres Strait Islander people registered with the measure are not representative of the general population. For these reasons, these comparisons, while presented to ensure consistency with the Evaluation Framework, are not presented in the main body of the report. Instead they are presented in the final section of this Data Appendix.6) What types of medicines are dispensed under the measure?PBS utilisation of participants by Anatomical Therapeutic Classification (ATC)This data is summarised in the main body of the report and presented in more detail in the final section of this Data Appendix. The broad classifications used are described above in “General Issues”.





Appendices

7) Has utilisation of medicines for management of different chronic diseases increased?

PBS utilisation of Aboriginal and Torres Strait Islander Australians (by ATC) before and after measure (using all VII PBS dispense records)This information is not currently available. The VII (Voluntary Indigenous Identifier which relates to MBS data) is not allowed to be used for analysis of PBS data, due to legislative constraints. Nor can PIP Indigenous Health Incentive registration of patients be used to identify a cohort of patients in the PBS data. While the “EverCtG” identifier proposed above will provide some insight into pre/post use for patients who are registered, it is unclear whether it will be possible to address the utilisation of PBS items by Aboriginal and Torres Strait Islander people more generally. 8) What is the cost to the PBS?This question, which is in the Evaluation Framework, does not currently require a response from the evaluators. The caveats regarding the incremental increase in use of CtG scripts v. the absolute use of CtG scripts, discussed previously, apply here.F.2.3 Participating prescribers and approved suppliers utilising

CtG enabled software products

9) Do health services and pharmacies update prescribing/dispensing software in a timely way?

Proportion of electronic vs. manual annotation of prescriptionsThis data was provided by the data custodians and reported in the main body of the report.F.2.4 Patients registered for the PBS co-payment through

participating primary health care practices

10) Do individuals provide their consent?Number of patient registrations receivedAt this stage this data is not available.11) What are the reasons for not participating?Patient registration coverage (service type, state/territory, age)At this stage this data is not available.





Appendices

F.2.5 CtG scripts written by GPs in participating primary health care practices

12) What is the rate of participation in the program by sector? (Practice participation - registration and commence obtaining patient consent)

Number of Indigenous health services participating in the programAt this stage the data is not available, as PBS data cannot be separated by IHS and mainstream practices.Number of practices participating in the programAt this stage the data is not available, as PBS data cannot be separated by IHS and mainstream practices.Approximate volume of Closing the Gap prescriptions produced by service typeData is not available by the type of service that the prescriber was located. Analysis by prescriber type (specialist, nurse, vocationally registered GP and non-vocationally registered medical officer) is an alternative currently being explored.13) Do all PIP IHI registered practices participate in the program? Proportion of PIP IHI registered practices which participate in the program As PBS data cannot be separated by IHS and mainstream practices, these estimates are not available.14) Are there any locational or other patterns to participation of

primary health care practices?Urban v. rural v. remote and practice sizeAt this stage this data is not available.F.2.6 Medicines dispensed by approved suppliers

15) How many community pharmacies participate in the program? Number of community pharmacies participating in the programData was provided by the data custodians.At this stage KPMG does not have data that would allow it to derive the distribution of scripts across the community pharmacies. For example, the proportion of registered pharmacies that dispensed less than 5 scripts a week and the proportion dispensed by the top ten in each state.F.3 Detailed results All the analyses presented in the following tables and charts are derived from data extractions specified by and provided by the department, with the





Appendices

exception of the data on PBS use for the whole of Australia, which was extracted from Medicare Australia online statistical reports.15 These graphics represent a sample of the detailed descriptive analysis performed on the data provided to the evaluators. At this early stage, the results are mainly descriptive and interpretation of the examples of variation across age, jurisdiction, ATC and remoteness is necessarily limited. However, the results are presented to illustrate some of the opportunities for more detailed analyses in the future.F.3.1 Variation by ageThe PBS Co-payment measure includes patients who are under the age of 15 and have, or are at risk of, a chronic disease. Three age groups were specified: under 15, 15 to 54 and 55 plus. Some of the variations across these groups are presented in the following figures.

3,075

10,906

5,213

10,124

31,648

12,856

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

0 to 14 15 to 54 55+Num

ber o

f pat

ient

s disp

ense

d at

leas

t on

e Ct

G sc

ript

Age group (years)

Aug-10Nov-10Feb-11May-11

Figure 1: Number of patients dispensed at least one CtG script, by quarter, by age group, Australia.16

The rate of increase in the number of patients dispensed CtG scripts between the first and fourth quarters was greatest for under 15 year olds (230 per cent) and the highest growth between the third and fourth quarters was also for under 15 year olds (42 per cent.In the May quarter 2011: 81 per cent of under 15 year olds were concessional patients, compared

to 69 per cent of 15 to 54 year olds and 80 per cent of over 55 year olds.

15 Department of Human Services 2013, PBS Statistics, Commonwealth of Australia, Canberra16 PBS data, provided by the Department of Health and Ageing, 2012.



http://www.medicareaustralia.gov.au/provider/pbs/stats.jsp



Appendices

The geographic distribution is consistent across age groups, for example: 28 per cent of under 15 year olds came from major cities compared to 31

percent of 15 to 54 year olds; and 46 per cent of under 15 year olds came from NSW compared to 42 per

cent of 15 to 54 year olds.The following graph (Figure 2) presents the growth in CtG scripts dispensed per quarter by age group.

5,115

36,41824,93620,453

182,113

145,372

020,00040,00060,00080,000

100,000120,000140,000160,000180,000200,000

0 to 14 15 to 54 55+

Num

ber o

f CtG

scrip

ts d

ispen

sed

Age group (years)


Figure 2: Number of CtG Scripts dispensed, by quarter, by age group, Australia.17

Some descriptive results of CtG use by age group include: scripts per quarter dispensed to under 15 year olds increased three-fold

over the four quarters compared to 4 and 4.8 fold for 15 to 54 and over 55 year olds respectively;

83 per cent of scripts dispensed to under 15 year olds were concessional compared to 75 per cent for 15 to 54 year olds; and

42 per cent of scripts dispensed in NSW were for over 55 year olds compared to 34 per cent in Victoria.

17 PBS data, provided by the Department of Health and Ageing, 2012.65

KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG




Appendices

Growth in number of scripts dispensed was faster than growth in number of Aboriginal and Torres Strait Islander people dispensed at least one script, consequently, the scripts per patient increased over each quarter. At 132 per cent, this increase was most noticeable for over 55 year olds (Figure 3).

1.7

3.34.8

3.52.0

5.8

11.3

6.4

0

2

4

6

8

10

12

0 to 14 15 to 54 55+ Australia

Num

ber o

f CtG

scrip

ts

disp

ense

d

Age group (years)

Aug-10May-11

Figure 3: Number of CtG scripts dispensed per patient in first and fourth quarter of the measure.18

The following graphic (Figure 4) illustrates the profile of drugs dispensed across ATC and within each ATC by age group. It shows that the majority of dispensing is for cardiovascular medicines, with nervous system medicines the second largest group of medicines. Under 15 year olds form only a small proportion of all prescribing for CtG scripts. The groups of medicines indicated on the graph represent broad ATCs described under “General Issues” and the details are provided in the main report.






Appendices

-

20,000

40,000

60,000

80,000

100,000

120,000Nu

mbe

r of C

tG S

crip

ts d

ispen

sed

ATC

55+15 to 540 to 14

Figure 4: CtG Scripts dispensed in May quarter 2011, by Broad ATC, by age group, Australia.19

The following graphic (Figure 5) illustrates how a prescriber might see differences by age group in broad categories of conditions. There were some significant differences in the distribution of scripts within each ATC by age group. The two main results are the high proportion of anti-infectives dispensed to under 15 year olds and the higher proportion of nervous system drugs that are dispensed to 15 to 54 year olds.






Appendices

0%10%20%30%40%50%60%70%80%90%

100%Sh

are

of to

tal C

tG sc

ripts

disp

ense

d

ATC

55+15 to 540 to 14

Figure 5: Share of total CtG scripts dispensed within each broad ATC, by age group, Australia, May quarter 2011.20

The following graphic (Figure 6) illustrates how a prescriber might see the profile of medicines prescribed within each age group. The main differences in the distribution of dispensed medicines between age groups include anti-infectives for under 15 year olds, nervous system medicines for 15 to 54 year old and cardiovascular medicines for over 55 year olds.6






Appendices

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 to 14 15 to 54 55+

Shar

e of

CtG

scrip

ts d

ispen

sed

Age group (years)

Other

AT and M - other

Respiratory system

Nervous system

Musculo-skeletalsystemDrugs used in Diabetes

Cardiovascular system

Antiinfectives forsystemic use

Figure 6: Share of CtG scripts dispensed within each age group, by broad ATC, Australia, May quarter 2011.21

F.3.2 Variation by remotenessFactors that influence variations by remoteness include the availability of medicines supplied through the S100 RAAHS program and population. The following graphic, Figure 7, illustrates the small number of Aboriginal and Torres Strait Islander people dispensed at least one CtG scripts in remote and very remote locations. The rate of growth between the third and fourth quarter is high for all regions. This theme is repeated in the number of CtG scripts dispensed (Figure 8). The number of CtG scripts dispensed per patient dispensed at least one script increased substantially in all regions (Figure 9), and the remote and major city regions have a slightly higher than average count of scripts per person. CtG scripts dispensed are more likely to be for nervous system medicines as the degree of remoteness is reduced and the reverse is the case for the cardiovascular medicines (Figure 10).






Appendices

5,419 5,5406,527

1,162 546

16,219 15,684

17,351

3,692

1,681

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Major Cities Inner Regional Outer Regional Remote Very Remote

Patie

nts d

ispen

sed

at le

ast o

ne C

tG sc

ript

Remoteness area


Figure 7: Patients dispensed at least one CtG script in each quarter, by remoteness, Australia.22

20,609 18,099 21,830

3,980 1,951

108,651

95,876106,734

26,027

10,650

0

20,000

40,000

60,000

80,000

100,000

120,000

MajorCities

InnerRegional

OuterRegional

Remote VeryRemote

Num

ber o

f CtG

scrip

ts d

ispen

sed

Remoteness area







Appendices

Figure 8: Number of CtG scripts dispensed for each quarter, by remoteness, Australia.23

3.8 3.3 3.3 3.4 3.6

6.76.1 6.2

7.06.3

012345678

MajorCities

InnerRegional

OuterRegional

Remote VeryRemote

CtG

scrip

ts p

er p

atie

nt

Remoteness area

Aug-10May-11

Figure 9: CtG scripts per patient for first and fourth quarter of measure, by remoteness, Australia.24

23 PBS data, provided by the Department of Health and Ageing, 2012.24 PBS data, provided by the Department of Health and Ageing, 2012.





Appendices

0%10%20%30%40%50%60%70%80%90%

100%Sh

are

of C

tG sc

ripts

disp

ense

d

Remoteness area

Other

AT and M - other

Respiratory system

Nervous system

Musculo-skeletal system

Drugs used in Diabetes


Antiinfectives for systemicuse

Figure 10: Share of CtG scripts dispensed in May quarter 2011 within remoteness areas, by broad ATC, Australia.25

F.3.3 Variation by patient categoryThe following graph (Figure 11) presents the scripts dispensed per patient-by-patient category. The higher numbers of scripts dispensed for concessional compared to general categories reflect the higher representation of older (over 55) patients in the concessional category, however, this effect is somewhat mitigated by a high proportion of under 15 year olds being in the concessional category. There were small numbers only of RPBS patients and these patients, who tend to be older, have a higher per capita rate of prescribing than other Aboriginal and Torres Strait Islander patients.






Appendices

3.6 2.94.1 3.5

6.9

4.8

11.8

6.4

02468

101214

Concessional General RPBS Total

CtG

scrip

ts d

ispen

sed

per

patie

nt

Type of CtG script

Aug-10May-11

Figure 11: CtG scripts dispensed per patient for first and fourth quarters of measure, by patient category, Australia.26

The following graph (Figure 12) presents the distribution of medicines by ATC across patient categories. The main result is that Cardiovascular and diabetes medicines represent a higher proportion of total medicines dispensed for general compared to concessional patients, and nervous system drugs are over represented for concessional patients.






Appendices

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Concessional General RPBS

Shar

e of

CtG

scrip

ts d

ispen

sed

Patient category

Other

AT and M - other

Respiratory system

Nervous system





Figure 12: Share of CtG scripts dispensed within patient category, by broad ATC, May quarter 2011 Australia.27

F.3.4 Variation by stateThe numbers of patients dispensed at least one script increased most significantly in absolute and relative terms in NSW. The number of scripts dispensed in Northern Territory remains low due to the reach of the S100 RAAHS scheme (Figure 13).






Appendices

8,031

5,250

1,276186

2,6491,262 308 233

23,645

14,333

5,221

907

4,682 4,245

1,080 5140

5,000

10,000

15,000

20,000

25,000

NSW QLD WA NT VIC SA TAS ACT

Patie

nts d

ispen

sed

at le

ast o

ne C

tG

scrip

t

J urisdiction


Figure 13: Patients dispensed at least one CtG script, by quarter, by jurisdiction.28

The scripts dispensed per patient increased in all jurisdictions and were highest in Western Australia (Figure 14).

3.3 3.6 3.7 3.5 3.3 3.6 3.62.6

6.2 6.37.0

5.0

6.8 6.6 6.25.2

0

2

4

6

8

NSW QLD WA NT VIC SA TAS ACTCtG

scrip

ts d

ispen

sed

per p

atie

nt

J urisdiction

Aug-10May-11

Figure 14: CtG scripts dispensed per patient for first and fourth quarter of measure, by jurisdiction.29

Differences in the types of medicines dispensed across jurisdiction (Figure15) include: nervous system medicines are more likely to be prescribed than

cardiovascular medicines in some jurisdictions (Victoria, Tasmania and ACT); and

28 PBS data, provided by the Department of Health and Ageing, 2012.29 PBS data, provided by the Department of Health and Ageing, 2012.





Appendices

medicines used in diabetes are more highly represented in dispensing in WA, NT Queensland and South Australia compared to other jurisdictions.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Shar

e of

CtG

scrip

ts d

ispen

sed

J urisdiction

Other

AT and M - other

Respiratory system

Nervous system





Figure 15: Share of CtG scripts dispensed within jurisdictions, by broad ATC,May quarter 2011, Australia.30

F.3.5 Variation by ATCThe rate of growth in scripts from the August 2010 to May 2011 quarter ranged from 84 per cent for cardiovascular drugs to 71 per cent for the anti-infectives.






Appendices

10,46516,763

5,2171,759

14,302

5,479 4,1598,325

36,851

104,852

29,188

8,855

78,587

26,070 25,513

38,021

0

20,000

40,000

60,000

80,000

100,000

120,000Ct

G sc

ripts

disp

ense

d

ATC


Figure 16: CtG scripts dispensed, by quarter, by broad ATC, Australia.31

The share in total CtG scripts in the Anti-infective ATC decreased slightly over the 12 months, possibly as a result of under 15 year olds forming a smaller proportion of patients dispensed at least one CtG script.






Appendices

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aug-10 May-11

% o

f CtG

scrip

ts

Quarter ending

Other

AT and M - other

Respiratory system

Nervous system

Musculo-skeletalsystemDrugs used in Diabetes


Antiinfectives forsystemic use

Figure 17: Share of CtG scripts dispensed in first and fourth quarters of measure, by broad ACT, Australia.32

F.4 Comparisons with general population and S100 RAAHSAt this stage, given the available data, only simple comparisons are possible and substitutions between PBS and CtG scripts and S100 and CtG scripts, cannot be analysed.When the ever-CtG scripts are available, more detailed analyses about the changes in almost all scripts known to be dispensed to Aboriginal and Torres Strait Islander people will be possible. Therefore information will be available to inform estimates of impact of ICDP as a whole on chronic disease management.






Appendices

F.4.1 S100 RAAHS items supplied and CtG items dispensed

-20,00040,00060,00080,000

100,000120,000140,000160,000180,000200,000


Scrip

ts

J urisdiction

S100 RAAHSCtG

Figure 18: Numbers of CtG scripts dispensed and S100 RAAHS items supplied, by jurisdiction, May quarter 2011.33

In the May quarter 2011, the S100 RAAHS program represented the main way that PBS listed medicines were made available free of charge to Aboriginal and Torres Strait Islander people in Northern Territory and Western Australia. The main factor influencing this result is the large remote populations of Aboriginal and Torres Strait Islanders in those jurisdictions, together with the low availability of pharmacies in remote locations (Figure18).






Appendices

-

5%

10%

15%

20%

25%

30%

35%%

of s

crip

ts

ATC

CtGS100 RAAHS

Figure 19: Share of items within S100 RAAHS and CtG, by broad ATC, Australia, May quarter 2011. 34

S100 RAAHS medicines are more likely to be anti-infectives compared to CtG scripts, probably as a consequence of the high use of this group of medicines to treat acute conditions, particularly in younger people. Nervous system medicines are comparatively more highly represented in CtG scripts. This is consistent with the difference observed between remote and very remote compared to inner regional and major cities for CtG scripts. (See Figure 10).






Appendices

0%10%20%30%40%50%60%70%80%90%

100%Sh

are

of C

tG sc

ripts

disp

ense

d

Remoteness area

Other

AT and M - other

Respiratory system

Nervous system





Figure 20: Share of CtG scripts dispensed in May quarter 2011 within remoteness areas, by broad ATC, Australia.35

F.4.2 CtG scripts dispensed compared to all PBS scripts dispensed.

CtG scripts dispensed in the May quarter 2011 represent 0.7 per cent of all PBS items dispensed in Australia through pharmacies in that quarter and 3 per cent of all PBS items dispensed in Northern Territory. The only ATCs for which CtG scripts represented more than 1 per cent of total PBS scripts dispensed in Australia were anti-infectives (1.2 per cent) and anti-parasitics (8.2 per cent) The breakdown across ATC for CtG scripts and PBS scripts (excluding CtG scripts) is presented in the following table. Despite the focus on chronic disease, cardiovascular system medicines represent proportionally less (30 per cent compared to 35 per cent) of CtG scripts compared to general PBS medicines. Factors that could contribute to this result include: i) non CtG medicines that are dispensed at less than the co-payment do not appear in this PBS online data but all CtG medicines dispensed are recoded; 35 PBS data, provided by the Department of Health and Ageing, 2012.





Appendices

ii) a higher rate of prescribing of anti-infectives in the Aboriginal and Torres Strait Islander population will dilute the proportion of all CtG scripts that are for cardiovascular disease; andiii) the high proportion of non-Aboriginal and Torres Strait Islander people who have cardiovascular disease. Table 4: CtG scripts and other PBS scripts dispensed by ATC for May quarter 2011.36

ATC CtG scripts in ATC as a % of total CtG scripts

PBS scripts in ATC as a % of total PBS scripts (ex CtG scripts)

Alimentary Tract and Metabolism 16% 14%Blood and Blood Forming Organs 4% 4%Cardiovascular System 30% 35%Dermatologicals 2% 1%Genito Urinary System and Sex Hormones 1% 1%Systemic Hormonal Preparations, excl. Sex Hormones 1% 1%General Anti-Infectives for Systemic Use 11% 7%Anti-Neoplastic and Immunomodulating Agents <0.5% 1%Musculo-Skeletal System 3% 5%Nervous System 23% 21%Anti-Parasitic Products <0.5% <0.5%Respiratory System 7% 5%Sensory Organs 1% 4%Various + <0.5% <0.5%Other ++ <0.5% <0.5%






Appendices

Appendix G. Higher utilisation of MBS and PBS data appendix

This Appendix presents data relating to the Higher utilisation of MBS and PBS data (B2) measure.G.1 IntroductionIn relation to this measure, the department has expressed an interest in utilisation of MBS and PBS items by jurisdiction, remoteness, age and gender. The main body of the report provides data and analysis, and interpretation of trends, by these key variables. This Data Appendix complements the main body of the report by providing graphs and tables presenting data on relevant MBS and PBS utilisation for Australia and by key variables where available including jurisdiction, remoteness classification, age, and gender between 2009 and the May quarter 2011. G.2 Higher utilisation of MBS and PBS data – summaries by

jurisdiction and remotenessThe 14 summaries below each comprise two graphs and one table. The two graphs are:

1. Total utilisation by quartera. Selected MBS items use (715, 10987, 81300 to 81360) as total

servicesb. Selected PBS items use (CtG scripts) as a total.

2. Per 100 capita utilisation by quartera. Selected MBS items (services per 100)b. CtG scripts (scripts per 100).

Throughout this section the population that has been used for Australia, the jurisdictions and remoteness categories is the Aboriginal and Torres Strait Islander projected population for 2010 based on Series A.37 The population projection for 2010 is used to calculate per capita figures for data from August 2009 quarter through to May 2011 quarter. In each of the 14 summaries, the trend of the total services/scripts and per capita services/scripts in each graph is the same because the line is simply the first set divided by a constant, i.e., Aboriginal and Torres Strait Islander projected population for 2010. Despite this common characteristic, the two graphs are presented to indicate the range of total utilisation and change in per capita utilisation for each quarter for both MBS and CtG scripts. 37 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.





Appendices

The summary table presents a set of summary statistics for eight quarters up to May quarter 2011. These statistics include population and numbers of Aboriginal and Torres Strait Islander people participating in the PBS Co-payment measure. They also include a range of utilisation statistics for each quarter. Section G.3 presents data on MBS item 715 utilisation by gender, age and unique provider. G.2.1 Australia

050,000100,000150,000200,000250,000300,000350,000400,000

0

5,000

10,000

15,000

20,000

25,000

30,000

CtG Scripts

MBS

Item

s

MBS Items CtG Scripts

Figure 21: Total utilisation by quarter - Australia: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG38

38 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.84





Appendices

010203040506070

0

1

2

3

4

5

CtG items per capitaM

BS it

ems

per c

apita

MBS items per 100 capita per quarterCtG items per 100 capita per quarter

Figure 22: Per 100 capita utilisation by quarter - Australia: Selected MBS items (services); and CtG scripts. Source: KPMG39

39 Based on MBS and PBS, data provided by the Department of Health and Ageing, 2012.85





Appendices

Table 5: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Australia.40

Australia Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1

1Aboriginal and Torres Strait Islander people - - - - - - - - -

Total population (est.) 41 550,818

550,818

562,681

562,681

562,681

562,681

574,874

574,874

568,778

People dispensed at least one CtG script - - - - 19,194 38,177 42,833 54,628 n/aPBS Utilisation42 - - - - - - - - -

CtG scripts dispensed - - - - 66,469 194,040

250,902

347,938

859,349

MBS Utilisation - - - - - - - - -Item 715 10,979 11,063 10,142 13,378 16,286 17,818 15,136 20,599 69,839Item 10987 470 568 911 1,483 1,966 2,640 3,090 4,293 11,989Total items 81300 to 81360 271 395 482 575 663 1,114 908 1,353 4,038Total selected MBS items 11,720 12,026 11,535 15,436 18,915 21,572 19,134 26,245 85,866Per 100 capita per quarter utilisation - - - - - - - - -MBS items 2.1 2.2 2.1 2.7 3.4 3.8 3.3 4.6 15.1CtG scripts - - - - 11.8 34.5 43.6 60.5 151.1

40MBS and PBS data, provided by the Department of Health and Ageing, 2012.41 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.42 For patients dispensed at least one CtG script before 31 May 2011

86KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss

entity. All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.



Appendices

G.2.2 New South Wales

020,00040,00060,00080,000100,000120,000140,000160,000

01,0002,0003,0004,0005,0006,0007,0008,0009,000

CtG ScriptsM

BS It

ems


Figure 23: Total utilisation by quarter - NSW Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG43

0102030405060708090100

0

1

2

3

4

5 CtG scripts per 100 capitaMBS

item

s pe

r 100

capi

ta

MBS items per 100 per quarterCtG scripts per 100 per quarter

Figure 24: Per 100 capita utilisation by quarter – NSW: Selected MBS items; and CtG scripts. Source: KPMG44

43 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.44 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.

87KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved

under Professional Standards Legislation.



Appendices

Table 6: Selected MBS and PBS utilisation, total and per 100 capita by quarter - NSW.45

New South Wales Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1



165,190

165,190

165,190

165,190

165,190

165,190

165,190

165,190


CtG scripts dispensed - - - - 26,819 81,252 104,183

147,092

359,346

MBS Utilisation - - - - - - - - -Item 715 2,655 2,481 2,398 3,512 4,184 5,197 4,552 5,938 19,871Item 10987 88 96 310 546 669 913 984 1,398 3,964Total items 81300 to 81360 116 153 153 193 230 348 337 529 1,444Total selected MBS items 2,859 2,730 2,861 4,251 5,083 6,458 5,873 7,865 25,279Per 100 capita per quarter utilisation - - - - - - - - -MBS items 1.7 1.7 1.7 2.6 3.1 3.9 3.6 4.8 15.3CtG scripts - - - - 16.2 49.2 63.1 89.0 217.5

45 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.46 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.47 For patients dispensed at least one CtG script before 31 May 2011





Appendices

G.2.3 Queensland

010,00020,00030,00040,00050,00060,00070,00080,00090,000100,000

01,0002,0003,0004,0005,0006,0007,0008,0009,000

CtG ScriptsM

BS It

ems


Figure 25: Total utilisation by quarter – Qld: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG48

0102030405060

0123456 CtG scripts per 100 capitaM

BS it

ems p

er 1

00 ca

pita


Figure 26: Per 100 capita utilisation by quarter – Qld: Selected MBS items; and CtG scripts. Source: KPMG49

48 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.49 Based on MBS and PBS data, provided by the Department of Health and Ageing, 2012.





Appendices

Table 7: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Qld.50

Queensland Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1



160,514

160,514

160,514

160,514

160,514

160,514

160,514

160,514


CtG scripts dispensed - - - - 19,135 52,650 65,717 90,534 228,036

MBS Utilisation - - - - - - - - -Item 715 3,543 3,750 3,327 4,397 5,816 5,559 5,097 6,979 23,451Item 10987 95 55 107 170 198 233 345 727 1,503Total items 81300 to 81360 75 164 199 155 152 292 237 267 948Total selected MBS items 3,713 3,969 3,633 4,722 6,166 6,084 5,679 7,973 25,902Per 100 capita per quarter utilisation - - - - - - - - -MBS items 2.3 2.5 2.3 2.9 3.8 3.8 3.5 5.0 16.1CtG scripts - - - - 11.9 32.8 40.9 56.4 142.1

50 Based on MBS and PBS, data provided by the Department of Health and Ageing, 2012.51 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.52 For patients dispensed at least one CtG script before 31 May 2011





Appendices

G.2.4 Western Australia

05,00010,00015,00020,00025,00030,00035,00040,000

0500

1,0001,5002,0002,5003,0003,5004,000

CtG Scripts

MBS

Item

s


Figure 27: Total utilisation by quarter – WA: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG53


KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved




Appendices

0102030405060

0

1

2

3

4


item

s pe

r 100

capi

ta


Figure 28: Per 100 capita utilisation by quarter – WA. Selected MBS items; and CtG scripts. Source: KPMG54






Appendices

Table 8: Selected MBS and PBS utilisation, total and per 100 capita by quarter - WA.55

Western Australia Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 56 76,218 76,218 76,218 76,218 76,218 76,218 76,218 76,218 76,218People dispensed at least one CtG script - - - - 1,276 3,167 4,238 5,221 n/aPBS Utilisation57 - - - - - - - - -CtG scripts dispensed - - - - 4,772 18,051 27,255 36,618 86,696MBS Utilisation - - - - - - - - -Item 715 1,693 1,718 1,674 1,942 2,189 2,544 1,933 2,565 9,231Item 10987 NR* 238 204 207 245 398 276 635 1,554Total items 81300 to 81360 NR* 13 27 108 91 147 233 279 750Total selected MBS items 1,806 1,969 1,905 2,257 2,525 3,089 2,442 3,479 11,535Per 100 capita per quarter utilisation - - - - - - - - -MBS items 2.4 2.6 2.5 3.0 3.3 4.1 3.2 4.6 15.1CtG scripts - - - - 6.3 23.7 35.8 48.0 113.7

* For confidentiality reasons, this number is not reported.






Appendices

G.2.5 Northern Territory

05001,0001,5002,0002,5003,0003,5004,0004,5005,000

0500

1,0001,5002,0002,5003,0003,5004,0004,5005,000

CtG ScriptsM

BS It

ems


Figure 29: Total utilisation by quarter – NT: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG58

01234567

01234567 CtG scripts per 100 capitaM

BS it

ems p

er 1

00 ca

pita


Figure 30: Per 100 capita utilisation by quarter – NT: Selected MBS items; and CtG scripts. Source: KPMG59

58 Based on MBS and PBS, data provided by the Department of Health and Ageing, 2012.59 Based on MBS and PBS, data provided by the Department of Health and Ageing, 2012.





Appendices

Table 9: Selected MBS and PBS utilisation, total and per 100 capita by quarter - NT.60

Northern Territory Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 61 68,599 68,599 68,599 68,599 68,599 68,599 68,599 68,599 68,599People dispensed at least one CtG script - - - - 186 456 618 907 n/aPBS Utilisation62 - - - - - - - - -CtG scripts dispensed - - - - 641 2,228 2,846 4,533 10,248MBS Utilisation - - - - - - - - -Item 715 2,295 1,959 1,835 2,415 2,854 3,134 2,148 3,325 11,461Item 10987 127 105 198 332 450 577 949 1,050 3,026Total items 81300 to 81360 29 34 38 54 45 41 36 69 191Total selected MBS items 2,451 2,098 2,071 2,801 3,349 3,752 3,133 4,444 14,678Per 100 capita per quarter utilisation - - - - - - - - -MBS items 3.6 3.1 3.0 4.1 4.9 5.5 4.6 6.5 21.4CtG scripts - - - - 0.9 3.2 4.1 6.6 14.9






Appendices

G.2.6 Victoria

05,00010,00015,00020,00025,00030,00035,000

0

200

400

600

800

1,000

1,200

CtG Scripts

MBS

Item

s


Figure 31: Total utilisation by quarter – Vic: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG63






Appendices

0102030405060708090100

0

1

2

3


item

s pe

r 100

capi

ta


Figure 32: Per 100 capita utilisation by quarter – Vic: Selected MBS items; and CtG scripts. Source: KPMG64






Appendices

Table 10: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Vic.65

Victoria Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 66 36,734 36,734 36,734 36,734 36,734 36,734 36,734 36,734 36,734People dispensed at least one CtG script - - - - 2,649 4,177 3,988 4,682 n/aPBS Utilisation67 - - - - - - - - -CtG scripts dispensed - - - - 8,861 20,568 23,829 31,914 85,172MBS Utilisation - - - - - - - - -Item 715 379 707 621 618 652 648 646 825 2,771Item 10987 12 33 33 27 67 63 55 35 220Total items 81300 to 81360 42 21 56 55 110 274 59 199 642Total selected MBS items 433 761 710 700 829 985 760 1,059 3,633Per 100 capita per quarter utilisation - - - - - - - - -MBS items 1.2 2.1 1.9 1.9 2.3 2.7 2.1 2.9 9.9CtG scripts - - - - 24.1 56.0 64.9 86.9 231.9






Appendices

G.2.7 South Australia

0

5,000

10,000

15,000

20,000

25,000

30,000

0

200

400

600

800

1,000

1,200

CtG Scripts

MBS

Item

s


Figure 33: Total utilisation by quarter – SA: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG68






Appendices

0102030405060708090100

0

1

2

3


item

s pe

r 100

capi

ta


Figure 34: Per 100 capita utilisation by quarter – SA. Selected MBS items; and CtG scripts. Source: KPMG69






Appendices

Table 11: Selected MBS and PBS utilisation, total and per 100 capita by quarter - SA.70

South Australia Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 71 30,382 30,382 30,382 30,382 30,382 30,382 30,382 30,382 30,382People dispensed at least one CtG script - - - - 1,262 2,733 3,314 4,245 n/aPBS Utilisation72 - - - - - - - - -CtG scripts dispensed - - - - 4,525 14,562 20,628 27,885 67,600MBS Utilisation - - - - - - - - -Item 715 347 323 217 348 493 601 511 705 2,310Item 10987 NR* NR* NR* NR* NR* NR* NR* NR* 1,672Total items 81300 to 81360 NR* NR* NR* NR* NR* NR* NR* NR* 26Total selected MBS items 390 370 284 552 833 1,054 985 1,136 4,008Per 100 capita per quarter utilisation - - - - - - - - -MBS items 1.3 1.2 0.9 1.8 2.7 3.5 3.2 3.7 13.2CtG scripts - - - - 14.9 47.9 67.9 91.8 222.5







Appendices

G.2.8 Tasmania

01,0002,0003,0004,0005,0006,0007,0008,000

0

50

100

150

200

250

CtG Scripts

MBS

Item

s


Figure 35: Total utilisation by quarter – Tas: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG73






Appendices

05101520253035

0

1


item

s pe

r 100

capi

ta


Figure 36: Per 100 capita utilisation by quarter – Tas. Selected MBS items; and CtG scripts. Source: KPMG74






Appendices

Table 12: Selected MBS and PBS utilisation, total and per 100 capita by quarter -Tas.75

Tasmania Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 76 20,086 20,086 20,086 20,086 20,086 20,086 20,086 20,086 20,086People dispensed at least one CtG script - - - - 308 610 781 1,080 n/aPBS Utilisation77 - - - - - - - - -CtG scripts dispensed - - - - 1,106 3,062 4,457 6,683 15,308MBS Utilisation - - - - - - - - -Item 715 37 61 19 57 53 72 182 184 491Item 10987 NR* NR* NR* NR* NR* NR* NR* NR* 43Total items 81300 to 81360 NR* NR* NR* NR* NR* NR* NR* NR* 0Total selected MBS items 37 62 20 57 57 75 193 209 534Per 100 capita per quarter utilisation - - - - - - - - -MBS items 0.2 0.3 0.1 0.3 0.3 0.4 1.0 1.0 2.7CtG scripts - - - - 5.5 15.2 22.2 33.3 76.2







Appendices

G.2.9 Australia Capital Territory

0

500

1,000

1,500

2,000

2,500

3,000

0

20

40

60

80

100

120

CtG Scripts

MBS

Item

s


Figure 37: Total utilisation by quarter – NT: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG78






Appendices

0102030405060

0

1

2


item

s per

100

capi

ta


Figure 38: Per 100 capita utilisation by quarter – ACT. Selected MBS items; and CtG scripts. Source: KPMG79






Appendices

Table 13: Selected MBS and PBS utilisation, total and per 100 capita by quarter – ACT.80

Australian Capital Territory Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1


Total population (est.) 81 4,709 4,709 4,709 4,709 4,709 4,709 4,709 4,709 4,709People dispensed at least one CtG script - - - - 233 391 448 514 n/aPBS Utilisation82 - - - - - - - - -CtG scripts dispensed - - - - 611 1,678 1,997 2,680 6,966MBS Utilisation - - - - - - - - -Item 715 30 64 51 89 45 63 67 78 253Item 10987 NR* NR* NR* NR* NR* NR* NR* NR* 7Total items 81300 to 81360 NR* NR* NR* NR* NR* NR* NR* NR* 37Total selected MBS items 31 67 51 96 73 75 69 80 297Per 100 capita per quarter utilisation - - - - - - - - -MBS items 0.7 1.4 1.1 2.0 1.6 1.6 1.5 1.7 6.3CtG scripts - - - - 13.0 35.6 42.4 56.9 147.9







Appendices

G.2.10 Major Cities

0

20,000

40,000

60,000

80,000

100,000

120,000

0500

1,0001,5002,0002,5003,0003,5004,0004,500

CtG Scripts

MBS

Item

s


Figure 39: Total utilisation by quarter – Major Cities: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG83






Appendices

010203040506070

0

1

2


item

s pe

r 100

capi

ta


Figure 40: Per 100 capita utilisation by quarter – Major Cities. Selected MBS items; and CtG scripts. Source: KPMG84






Appendices

Table 14: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Major Cities.85

Major Cities Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1



184,148

184,148

184,148

184,148

184,148

184,148

184,148

184,148


CtG scripts dispensed - - - - 20,609 58,231 77,836 108,651

265,327

MBS Utilisation - - - - - - - - -Item 715 2,102 2,244 1,916 2,462 3,473 3,524 2,947 3,670 13,614Item 10987 24 47 31 32 42 196 276 312 826Total items 81300 to 81360 87 111 100 177 191 251 220 289 951Total selected MBS items 2,213 2,402 2,047 2,671 3,706 3,971 3,443 4,271 15,391Per 100 capita per quarter utilisation - - - - - - - - -MBS items 1.2 1.3 1.1 1.5 2.0 2.2 1.9 2.3 8.4CtG scripts - - - - 11.2 31.6 42.3 59.0 144.1






Appendices

G.2.11 Inner Regional and Outer Regional

0

50,000

100,000

150,000

200,000

250,000

02,0004,0006,0008,000

10,00012,00014,00016,000

CtG Scripts

MBS

item

s


Figure 41: Total utilisation by quarter – Inner and Outer Regional: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG88






Appendices

0102030405060708090

0123456 CtG item

s per 100 capita

MBS

item

s pe

r 100

capi

ta


Figure 42: Per 100 capita utilisation by quarter – Inner and Outer Regional. Selected MBS items; and CtG scripts. Source: KPMG89






Appendices

Table 15: Selected MBS and PBS utilisation, total and per 100 capita by quarter - Inner and Outer Regional.90

Inner and Outer Regional Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1



246,859

246,859

246,859

246,859

246,859

246,859

246,859

246,859


CtG scripts dispensed - - - - 39,929 117,158

147,057

202,610

506,754

MBS Utilisation - - - - - - - - -Item 715 4,701 4,983 4,673 5,834 7,269 8,283 7,905 10,477 33,934Item 10987 185 151 393 665 882 970 1,093 1,883 4,828Total items 81300 to 81360 182 277 374 377 459 831 674 1,024 2,988Total selected MBS items 5,068 5,411 5,440 6,876 8,610 10,084 9,672 13,384 41,750Per 100 capita per quarter utilisation - - - - - - - - -MBS items 2.1 2.2 2.2 2.8 3.5 4.1 3.9 5.4 16.9CtG scripts - - - - 16.2 47.5 59.6 82.1 205.3






Appendices

G.2.12 Remote and Very Remote

05,00010,00015,00020,00025,00030,00035,00040,000

01,0002,0003,0004,0005,0006,0007,0008,0009,000

10,000

CtG Items

MBS

Item

s


Figure 43: Total utilisation by quarter – Remote and Very Remote: Selected MBS items use (715, 10987, 81300 to 81360) as total services; and Selected PBS items use (CtG scripts) as a total. Source: KPMG93






Appendices

051015202530

01234567 CtG item

s per 100 capita

MBS

item

s pe

r 100

capi

ta


Figure 44: Per 100 capita utilisation by quarter – Remote and Very Remote. Selected MBS items; and CtG scripts. Source: KPMG94






Appendices

Table 16: Selected MBS and PBS utilisation, total and per 100 capita by quarter – Remote and Very Remote.95

Remote and Very Remote Aug-09

Nov-09 Feb-10 May-

10Aug-10

Nov-10 Feb-11 May-

112010/1



131,674

131,674

131,674

131,674

131,674

131,674

131,674

131,674

People dispensed at least one CtG script - - - - 1,708 3,570 4,352 5,373 n/aPBS Utilisation97 - - - - - - - - -CtG scripts dispensed - - - - 5,931 18,651 26,009 36,677 87,268MBS Utilisation - - - - - - - - -Item 715 4,176 3,836 3,553 5,082 5,544 6,011 4,284 6,452 22,291Item 10987 NR* NR* NR* NR* NR* 1,474 1,721 2,098 6,335Total items 81300 to 81360 NR* NR* NR* NR* NR* 32 14 40 99Total selected MBS items 4,439 4,213 4,048 5,889 6,599 7,517 6,019 8,590 28,725Per 100 capita per quarter utilisation - - - - - - - - -MBS items 3.4 3.2 3.1 4.5 5.0 5.7 4.6 6.5 21.8CtG scripts - - - - 4.5 14.2 19.8 27.9 66.3







Appendices

G.3 MBS item 715This section presents data on MBS item 715 utilisation by gender, age and unique provider.G.3.1 Aboriginal and Torres Strait Islander Health Assessments by

genderWithin Australia females are generally more likely than males to see a general practitioner.98 As seen in Figure 45 below the number of Aboriginal and Torres Strait Islander females receiving Health Assessments has always been greater than males. Interestingly though, since the introduction of Item 715 the gap appears to have increased. In August 2008, of the 8,731 Health Assessments, the proportion that were for females was 52.6 per cent. This proportion had increased slightly by the May quarter 2011 with 55.0 per cent of health assessments being for females. This difference is generally consistent across jurisdictions and remoteness areas.

02,0004,0006,0008,000

10,00012,000

Heal

th a

sses

smen

ts

Female Male

Items 704, 706, 708 and 710 Item 715

Figure 45: Aboriginal Health Assessments by gender. Source: KPMG99

G.3.2 Aboriginal and Torres Strait Islander Health Assessments by age

The growth in Health Assessments was not evenly distributed across age groups. The 0-14 year old age group saw a growth in Health Assessments

98 Royal Australian College of General Practitioners, Engaging men in primary care settings, RACGP Victoria. 99 Based on MBS data, provided by the Department of Health and Ageing, 2012.





Appendices

but not to the degree that has been seen in the 15-54 and 55+ age groups. This is demonstrated in Figure 46 below.

02,0004,0006,0008,000

10,00012,000

Heal

th a

sses

smen

ts

0-14 15-54 >=55

Items 704, 706, 708 and 710 Item 715

Figure 46: Aboriginal Health Assessments by age group. Source: KPMG100

G.3.3 Aboriginal and Torres Strait Islander Health Assessments – unique providers

The unique number of providers of Health Assessments also increased over the last twelve months. For example, in May 2010 there were 1,514 unique providers of Health Assessments. In May 2011 there were 2,193 providers. This is an increase of 44.8 per cent. This is shown in Figure 47 below.

100 Based on MBS data, provided by the Department of Health and Ageing, 2012.118





Appendices

Figure 47: Unique providers of health assessments at the national level by quarter. Source: KPMG101

It is possible to combine the service and provider statistics. This gives an indication as to the average number of Health Assessments per provider by quarter. At the national level this has shown a steady increase since August 2008 to May 2011, as the below figure shows.






Appendices

7

7.5

8

8.5

9

9.5

10

Aug-08 Nov-08 Feb-09 May-09Aug-09 Nov-09 Feb-10 May-10Aug-10 Nov-10 Feb-11 May-11

Heal

th a

ssse

ssm

ents

Average health assessments per provider

Linear (Average health assessments per provider)

Figure 48: Average health assessments per unique provider for Australia. Source: KPMG102






Appendices

Appendix H. PIP Indigenous Health Incentive data appendix

This Appendix presents the result areas as specified within the Evaluation Framework, and corresponding data for the PIP Indigenous Health Incentive (B3a) measure.H.1 IntroductionIn relation to this measure, the department has expressed an interest in utilisation by jurisdiction and by remoteness. The main body of the report provides a comparison across each jurisdiction, and by remoteness, for a range of key indicators for PIP Indigenous Health Initiative and MBS service data. This Data Appendix complements the main body of the report by providing a summary of change in PIP Indigenous Health Incentive registration and payment statistics and MBS statistics for: Australia; each jurisdiction; and each remoteness classification (14 sets of summaries). H.1.1 Some general considerationsEver IHIIdentification of patients who have been PIP Indigenous Health Incentive registered is critical for the analysis of the impact of those aspects of the Package that influence service utilisation. The “Ever IHI” term is used in the data requests provided to the department by the evaluators. Importantly use of this concept enables the evaluators to compare pre and post registration service utilisation. In addition it allows for comparisons between number of health assessments for patients that are registered versus those that are not registered. Critically for the analyses required for the First Monitoring Report, it is not possible to identify this group from the data currently available, hence a number of evaluation questions relating to the impact on access by Aboriginal and Torres Strait Islander people to MBS services cannot be assessed at this stage.H.1.2 Early Results (2 – 4 years)Data is not available to answer the following evaluation framework questions: Do participating patients receive more ‘better practice’ services than

non-participating Aboriginal and Torres Strait Islander patients? What additional and complementary services are offered? How does this

differ from what has been previously available?The following evaluation framework questions are addressed with PIP Indigenous Health Incentive data and MBS item data.





Appendices

To what extent is Tier 1 care implemented for registered patients? To what extent is Tier 2 care implemented for registered patients?H.1.3 Key Outputs (year 1 and ongoing)Data is not available to answer the following evaluation framework question. How many people consent? What is the rate of patient registration over

time?The following evaluation framework questions are addressed with PIP Indigenous Health Incentive data. How many patients are re-registered annually? How many Indigenous Health Services register for the incentive? How

many general practices register for the measure? What is the pattern of uptake over time? Is participation linked to

particular geographical areas or types of service? How many practices are registering patients? What is the level of expenditure for the IHI payments? How many patients are registered by different types of health services?H.1.4 PIP Indigenous Health Incentive data There were fewer than expected practices registered for the PIP Indigenous Health Incentive in 2010-11. While 2,000 practices were projected to receive sign on payments, only 1,275 sign on payments were provided between August 2010 and May 2011 quarters. If sign on payments from May 2010 quarter were included then the number of practices registered, 2,128, exceeded the projection. The number of practices registering for PIP Indigenous Health Incentive has steadily declined since May 2010 (See ). This was the quarter in which practices commenced registering after the Department of Human Services wrote to practices in March 2010 and invited them to join the PIP Indigenous Health Incentive. This decline is consistent geographically i.e., by jurisdictions and remoteness. Practice registrations by type show that registrations appear to have ceased for IHSs. This is not unexpected as there are only 235 IHSs in Australia.103 Practice registrations may have steadied for general practices and it will be of interest to see the number that register in the next 12 months. Practice registration statistics for the May 2010 to May 2011 quarters are broken down by jurisdiction, remoteness and practice type in the following tables.

103 Australian Institute of Health and Welfare 2011, Aboriginal and Torres Strait Islander health services report 2010–11: OATSIH Services Reporting—key results, Cat. no. IHW 56, AIHW, Canberra.





Appendices

Table 17: Practice registrations by jurisdiction and Medicare quarter.104

Medicare Quarter

NSW

QLD

WA NT VIC SA TAS ACT Total

May-10 292 216 100 13 143 56 NR* NR* 853Aug-10 182 112 55 12 77 19 NR* NR* 472Nov-10 137 74 43 NR* 40 33 NR* NR* 339Feb-11 88 48 22 NR* 44 18 11 NR* 236May-11 81 53 17 NR* 42 22 NR* NR* 228Total 780 503 237 40 346 148 58 16 2,1

28* For confidentiality reasons, this number is not reported.Table 18: Practice registrations by remoteness and Medicare quarter. 105

Medicare Quarter

Major Cities of Australia

Inner Regional Australia

Outer Regional Australia

Remote Australia

Very Remote Australia

Total

May-10 455 196 136 48 18 853Aug-10 268 97 88 NR* NR* 472Nov-10 167 95 56 NR* NR* 339Feb-11 131 63 30 NR* NR* 236May-11 126 68 29 NR* NR* 228Total 1,147 519 339 81 42 2,12

8* For confidentiality reasons, this number is not reported.Table 19: Practice registrations by Medicare quarter and practice type.106

Medicare quarter

IHS General Practice

Total

May-10 86 767 853Aug-10 24 448 472Nov-10 14 325 339104 Ibid.105 Ibid.106 MBS PIP Indigenous Health Incentive data, provided by the Department of Health and Ageing, 2012.





Appendices

Medicare quarter

IHS General Practice

Total

Feb-11 8 228 236May-11 1 227 228Total 133 1,995 2,128

The patient registration process is based on a calendar year. A payment of $250 is made to practices for each Aboriginal and Torres Strait Islander patient aged 15 years and over, registered with the practice for chronic disease management. In 2010 there were 31,646 patient registrations. The number of patient registrations in a jurisdiction generally mirrors the size of the Aboriginal and Torres Strait Islander population in that jurisdiction. Table 20: Patient registrations in 2010 by jurisdiction.107

Jurisdiction Patient RegistrationsNew South Wales 11,224Queensland 8,460Western Australia 5,017Northern Territory 1,518Victoria 2,659South Australia 2,164Tasmania 208Australian Capital Territory 376Total 31,646

Table 21: Patient registrations in 2010 by remoteness.108

Remoteness Patient RegistrationsMajor Cities of Australia 8,706Inner Regional Australia 7,724Outer Regional Australia 10,166Remote Australia 3,606Very Remote Australia 1,444

107 MBS PIP Indigenous Health Incentive data, provided by the Department of Health and Ageing, 2012.108 MBS PIP Indigenous Health Incentive data, provided by the Department of Health and Ageing, 2012.





Appendices

Remoteness Patient RegistrationsTotal 31,646

Table 22: Patients registered in 2010 by practice type.109

Practice Type Patient RegistrationsIHS 20,966General Practice 10,680Total 31,646

2010 was the first year in which practices could register patients for the PIP Indigenous Health Incentive. In 2011 practices could register new patients and re-register those patients that registered in 2010. Data for the February and May 2011 quarters provide an insight into the level of registration and re-registration that has occurred. In February and May 2011 there had been 15,308 patient registrations. Of these 5,517 were re-registrations from 2010 (i.e., 28.3 per cent). It is difficult to interpret the differences in patient registration proportions across jurisdictions, remoteness and practice types. This is primarily due to the following reasons: the requirement of patient registration is that the Aboriginal and Torres

Strait Islander patient has a chronic disease, which by definition is managed rather than cured, and therefore a high proportion of patients are eligible for re-registration;

if the proportion of patients re-registered in 2011 is low this may be due to more new patients being registered in 2011, rather than patients in 2010 not re-registering; and

a full calendar year of registrations and re-registrations was not available at the time of writing this report

The tables below outline the number and proportion of patient re-registrations in 2011 and the proportion of re-registrations compared to 2010. The tables consist of breakdowns by jurisdiction, remoteness and practice type.Table 23: Patients re-registered and registered in 2011 and 2010 by jurisdiction110

Statistic NSW QLD WA NT VIC SA TAS ACT TotalRe-registrations till May 2011

1,702 1,781 845 184 450 395 106 54 5,517

109 MBS PIP Indigenous Health Incentive data, provided by the Department of Health and Ageing, 2012.110 PIP data, provided by the Department of Health and Ageing, 2012.





Appendices

Statistic NSW QLD WA NT VIC SA TAS ACT TotalTotal registrations till May 2011

5,362 4,169 2,384 762 1,082 1,121 281 147 15,308

Re-registration proportion in 2011

31.7%

42.7%

35.4%

24.1%

41.6%

35.2%

37.7%

36.7%

36.0%

Patient registrations in 2010

11,244

8,460 5,017 1,518 2,659 2,164 208 376 31,646

Re-registrations in 2011 as proportion of 2010 registrations

15.1%

21.1%

16.8%

12.1%

16.9%

18.3%

51.0%

14.4%

17.4%





Appendices

Table 24: Patients re-registered and registered in 2011 and 2010 by remoteness111

Statistic Major Cities of Australia



Remote Australia


Total

Re-registrations till May 2011

1,357 1,356 2,074 581 149 5,517

Total registrations till May 2011

4,366 4,104 4,849 1,546 443 15,308

Re-registration proportion in 2011

31.1% 33.0% 42.8% 37.6% 33.6% 36.0%

Patient registrations in 2010

8,706 7,724 10,166 3,606 1,444 31,646

Re-registrations in 2011 as proportion of 2010 registrations

15.6% 17.6% 20.4% 16.1% 10.3% 17.4%

Table 25: Patients re-registered and registered in 2011 and 2010 by practice type112

Statistic IHS General Practice

Total

Re-registrations till May 2011 3,496 2,021 5,517Total registrations till May 2011 8,019 7,289 15,308Re-registration proportion in 2011 43.6% 27.7% 36.0%Patient registrations in 2010 20,966 10,680 31,646Re-registrations in 2011 as proportion of 2010 registrations

16.7% 18.9% 17.4%

A Tier 1 outcomes payment of $100 is paid in the quarter following the provision of services based on entries against the MBS schedule. A Tier 2 outcomes payment of $150 is made to the practice that provides the majority of eligible MBS services for a registered patient (with a minimum of five eligible MBS services) in a calendar year in February of the following year.111 PIP data, provided by the Department of Health and Ageing, 2012.112 PIP data, provided by the Department of Health and Ageing, 2012.





Appendices

In 2010, seven out of ten PIP Indigenous Health Incentive registered patients triggered a payment. This proportion was fairly consistent across jurisdictions and remoteness categories. The jurisdiction and remoteness categories with the highest proportion of registered patients triggering a payment were Queensland with 73 per cent and very remote Australia with 76 per cent. General practices registered fewer patients than IHSs in 2010; however, general practices had a lower proportion of patients that did not trigger a payment.Table 26: Patients registered and the type of payment those patients triggered in 2010 by jurisdiction113

Statistic NSW QLD WA NT VIC SA TAS TotalIHI Registrants - no payment

3,517 (30%)

2,284 (27%)

1,441 (29%)

445 (29%)

NR* 683 (32%)

NR* 9,404 (30%)

IHI Registrants - Tier 2 only

7,578 (65%)

5,687 (67%)

3,247 (65%)

905 (60%)

1,636 (62%)

1,417 (65%)

128 (62%)

20,598

(65%)

IHI Registrants - Tier 1 & 2 (includes Tier 1 only)

525 (5%)

489 (6%)

329 (7%)

168 (11%)

NR* 64 (3%)

NR* 1,644 (5%)

Total IHI Registrants

11,620

(100%)

8,460 (100%

)

5,017 (100%

)

1,518 (100%

)

2,659 (100%

)

2,164 (100%

)

208 (100%

)

31,646

(100%)

* For confidentiality reasons, this number is not reported.Table 27: Patients registered and the type of payment those patients triggered in 2010 by remoteness114




Remote Australia


Total

IHI Registrants - no payment

2,578 (30%)

2,335 (30%)

2,906 (29%)

1,229 (34%)

356 (25%)

9,404 (30%)

113 PIP data, provided by the Department of Health and Ageing, 2012.114 PIP data, provided by the Department of Health and Ageing, 2012.





Appendices




Remote Australia


Total

IHI Registrants - Tier 2 only

5,776 (66%)

5,089 (66%)

6,732 (66%)

2,098 (58%)

903 (63%)

20,598

(65%)IHI Registrants - Tier 1 & 2 (includes Tier 1 only)

352(4%)

300(4%)

528(5%)

279(8%)

185 (13%)

1,644 (5%)

Total IHI Registrants

8,706 (100%)

7,724 (100%)

10,166 (100%)

3,606 (100%)

1,444 (100%)

31,646

(100%)





Appendices

Table 28: Patients registered and the type of payment those patients triggered in 2010 by practice type115

Medicare quarter IHS General Practice

Total

IHI Registrants - no payment 6,764(32%)

2,640(25%)

9,404 (30%)

IHI Registrants - Tier 2 only 13,352 (64%)

7,246(68%)

20,598 (65%)

IHI Registrants - Tier 1 & 2 (includes Tier 1 only)

850(4%)

794(7%)

1,644(5%)

Total IHI Registrants 20,966 (100%)

10,680 (100%)

31,646 (100%)

In 2010 an IHS registered, on average, 169 patients while a general practice registered, on average, seven patients. Table 29: Patients and practices registered by type of practices.116

Statistic IHS General Practice

Practices registered in 2010 124 1,540Patients Registered in 2010 20,966 10,680Average patients registered 169 7For calculating the level of expenditure it is possible to add all patient registrations (and outcome payments) between the May 2010 and May 2011 quarters. The largest expenditure component of the PIP Indigenous Health Incentive to date has been patient registrations, which at $12.4 million accounts for over two thirds of the expenditure to May 2011.

115 PIP data, provided by the Department of Health and Ageing, 2012.116 MBS PIP Indigenous Health Incentive data, provided by the Department of Health and Ageing, 2012.





Appendices

Table 30: PIP Indigenous Health Incentive payment statistics May 2010 and May 2011.117

PIP Indigenous Health Incentive statistics from May 2010 to May 2011

Number Payment

Expenditure

Total Practice registration payments 2,128 $1,000 $2,128,000Total Patient registration payments 49,741 $250 $12,435,25

0Patients triggering tier 1 payments 2,046 $100 $204,600Patients triggering tier 2 payments 24,796 $150 $3,719,400Total n/a n/a $18,487,25

0

H.1.5 Estimating the reach of the PIP Indigenous Health Incentive It is estimated that there were 7,035 general practices in Australia in 2010-11.118 In 2010-11 there were an estimated 235 IHSs.119 To assess the “reach”120 of the practice sign on payments at a jurisdiction and practice level, the practice registrations were compared to the total number of practices by jurisdiction. The three steps for estimating the “practice reach” of the PIP Indigenous Health Incentive are outlined below. Step 1: Obtain AIHW OATSIH Services report total numbers of Indigenous

Health Services and PHCRIS estimate of total numbers of general practices by jurisdiction.

Step 2: Obtain PIP Indigenous Health Incentive practice registration statistics for Indigenous Health Services and general practices by jurisdiction.

Step 3: Calculate reach by dividing the number of PIP Indigenous Health Incentive registered practices by the total number of practices (by practice type and jurisdiction).

Table 31 below provides an indication of the reach, at the practice level, of the PIP Indigenous Health Incentive. There is substantial variation in the proportion of general practices and IHSs registered by jurisdiction. At a national level, the proportion of IHSs registered (56.6 per cent) is substantially higher than the proportion of general practices that have registered (28.4 per cent). Within jurisdictions there is also interesting 117 PIP data, provided by the Department of Health and Ageing, 2012.118 Primary Health Care Research Information Services (PHCRIS) 2011, SBO Key Division of General Practice characteristics 2010-2011, PHCRIS.119 Australian Institute of Health and Welfare 2011, Aboriginal and Torres Strait Islander health services report 2010–11: OATSIH Services Reporting—key results, Cat. no. IHW 56, AIHW, Canberra 120 Reach is broadly defined as the number of participating practices divided by the total number of practices.





Appendices

variation in the reach by practice type. For example, in New South Wales three out of every four IHSs have registered but only one in four general practices registered. In contrast within Western Australia the proportion of IHSs and general practices that have registered is similar at approximately two out of five primary health care services. Table 31: Practice reach of PIP Indigenous Health Incentive by jurisdiction at May 2011.121 122 123

StatisticNSW/ACT

QLD WA NT

VIC124 SA TAS

AUS

Mainstream general practices

2,796 1,179

573 105 1,687

537 158 7,035

General practices registered

753 478 223 18 328 140 55 1,995

Proportion Total Registered

26.9% 40.5%

38.9%

17.1%

19.4%

26.1%

34.8%

28.4%

Total IHSs 57 37 35 55 25 15 11 235Total IHSs Registered *

43 25 14 22 NR* NR* NR* 133

Proportion IHSs Registered

75.4% 67.6%

40.0%

40.0%

NR* NR* NR* 56.6%

* For confidentiality reasons, this number is not reported.While the above data show the level of penetration or reach of this measure in terms of practice participation, it is also important to consider whether the measure is operating in areas that will benefit Aboriginal and Torres Strait Islander people. While there are estimates of the number of Aboriginal and Torres Strait Islanders with specific chronic disease such as diabetes, cardiovascular disease and many other chronic diseases, there is no available estimate on the number or proportion of Aboriginal and Torres Strait Islanders with any chronic disease. However, lower and upper bound estimate can be derived through consideration of data held by the AIHW and the ABS data, and consideration of PIP Indigenous Health Incentive patient registration numbers in 2010. The approach to calculating patient reach involves the following steps.

121 Primary Health Care Research Information Services (PHCRIS) 2011, SBO Key Division of General Practice characteristics 2010-2011, PHCRIS.122 Australian Institute of Health and Welfare 2011, Aboriginal and Torres Strait Islander health services report 2009–10: OATSIH Services Reporting—key results, Cat. no. IHW 56, AIHW, Canberra123 PIP data, provided by the Department of Health and Ageing, 2012.124 The number of IHSs in Victoria not registered can be deduced to be less than ten based on the number of IHSs registered, hence the number registered is reported as <20.





Appendices

Step 1: Obtain AIHW estimates of number of persons with one or more chronic diseases (see Table 25 below) and ABS estimates of Aboriginal and Torres Strait

Islander population distribution. Step 2: Calculate Aboriginal and Torres Strait Islander population

estimates by age group, jurisdiction and remoteness (note: jurisdiction and remoteness calculated separately) from ABS. ABS data is in five year age groups, therefore, need to sum number of persons to match AIHW age group categories, i.e., number of persons aged 25-44 years comprises the age groups 25-29, 30-34, 35-39 and 40-44 years in ABS publication.

Step 3: Multiply AIHW proportion of persons with one or more chronic diseases (e.g., 26.0 per cent of persons aged 25-44 years have one or more chronic diseases) by the number of Aboriginal and Torres Strait Islander persons in the same age group for that region, e.g., 40,840 Aboriginal and Torres Strait Islander persons in NSW aged 25-44 years (40,840 * 0.26). Sum the estimates of persons with chronic disease by age group and relevant geography together.

Step 4: Calculate reach by dividing the number of PIP Indigenous Health Incentive registered patients by the estimated number Aboriginal and Torres Strait Islander persons with a chronic disease (by jurisdiction and then by remoteness).

Table 32: Persons with one or more chronic conditions.125

Number of chronic conditions

0-14 years

15-24 years

25-44 years

45-64 years

65+ years

None 86.9% 80.8% 74.0% 47.0% 18.4%One 12.3% 17.0% 21.0% 32.0% 32.0%Two or more 0.8% 2.2% 5.0% 21.0% 49.6%

The estimates presented in Table 32 provide a guide to patient reach by state. At the national level it is estimated that 26.5 per cent (31,646 / 119,456126) of eligible patients registered for PIP Indigenous Health Incentive in 2010. As evidenced in below there is substantial variation in the reach of the initiative across jurisdictions.The four jurisdictions with the largest Aboriginal and Torres Strait Islander population, i.e., New South Wales, Queensland, Western Australia and

125 Australian Institute of Health and Welfare 2012, Chronic diseases (website ) , AIHW, Canberra, viewed March 2012126 ABS population projections



http://www.aihw.gov.au/chronic-diseases/




Appendices

Northern Territory have substantially different estimates of PIP Indigenous Health Incentive reach. In New South Wales it is estimated that 31.7 per cent of Aboriginal and Torres Strait Islanders with a chronic disease have registered. While in the Northern Territory only 10.3 per cent of Aboriginal and Torres Strait Islanders with a chronic disease have registered. In terms of remoteness it is the inner and outer regional combined area that has registered the highest proportion of patients. Further statistics on patient reach are presented in and Table 34 below.





Appendices

Table 33: Estimates of PIP Indigenous Health Incentive reach for the Aboriginal and Torres Strait Islander population aged 15 years and over by jurisdiction, 2010127 128 129

Population (aged 15 years and over)


Population with one or more chronic diseases

35,491

32,926

16,379

14,714

8,022 6,485 4,407 968

PIP Indigenous Health Incentive Registered patients in 2010

11,244

8,460 5,017 1,518 2,659 2,164 208 376

Percentage of population that is registered

31.7%

25.7%

30.6%

10.3%

33.1%

33.4%

4.7% 38.8%

Note, the period of time this data is relevant to (2010) reflects only the first six months of measure implementation.

Table 34: Estimates of PIP Indigenous Health Incentive reach for the Aboriginal and Torres Strait Islander population aged 15 years and over by remoteness, 2010130 131 132

Population (aged 15 years and over)

Major Cities

Inner and Outer Regional combined

Remote and Very Remote combined

Australia

Population with one or more chronic diseases

38,635 51,895 28,926 119,456

PIP Indigenous Health Incentive Registered patients in 2010

8,706 17,890 5,050 31,646

Percentage of population that is registered

22.5% 34.5% 17.5% 26.5%

127 Australian Institute of Health and Welfare 2012, Chronic diseases (website) , AIHW, Canberra, viewed March 2012128 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.129 Based on PIP data, provided by the Department of Health and Ageing, 2012.130 Australian Institute of Health and Welfare 2012, Chronic diseases (website) , AIHW, Canberra, viewed March 2012131 Australian Bureau of Statistics 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021, ABS cat. no. 3238, Canberra.132 Based on PIP data, provided by the Department of Health and Ageing, 2012.







Appendices

Note, the period of time this data is relevant to (2010) reflects only the first six months of measure implementation.





Appendices

The true proportion of eligible patients who are enrolled would be lower than the estimates presented in and Table 34 because even though the estimates of numbers enrolled are reliable, the denominator, the proportion of the population that is eligible, may be an underestimate for the following reasons: AIHW estimates are from 2004-05 National Health Survey and are for all

people with one or more chronic diseases, whereas the PIP Indigenous Health Initiative is for patients aged 15 and over, with a chronic disease; and

Aboriginal and Torres Strait Islander people experience higher levels of chronic disease133.

133 Australian Health Ministers’ Advisory Council 2011, Aboriginal and Torres Strait Islander Health Performance Framework Report 2010, AHMAC, Canberra.





Appendices

Appendix I. Evaluation Framework tables This appendix presents the Evaluation Framework tables for each measure and provides information about indicators relevant to 2010-11 (‘Year 2’) including whether they were able to be addressed in the this report; why they may not have been addressed; and identification of future data collection activities for those indicators which could not be addressed. I.1 National Action to Reduce Indigenous Smoking Rates (A1)Table 35: Evaluation Framework Table for National Action to Reduce Indigenous Smoking Rates (A1)

Year two indicators Addressed / reason not addressed

Future data collection

Fund ‘Break the Chain’ campaign

Yes -

Train up to 1,000 community workers in brief interventions

No – data not available on the number of workers trained in brief intervention for 2010-11

Survey results, and additional program documentation from the department

Establish National Coordinator for Tackling Indigenous Smoking

Yes -

Develop and disseminate resource kits to the workforce

Yes -

Deliver smoking prevention and cessation activities to groups and communities

Yes -

Provide Regional Tackling Smoking project funding

Yes -

Work with communities to develop smoking prevention and cessation activities

Yes* Future consultation activities and surveys

Identify community needs

Yes* Future consultation activities and surveys

Network the workforce Yes -





Appendices



through meeting opportunitiesConduct research to inform smoking prevention and cessation

Yes -

Recruit Regional Tobacco Coordinators

Yes -

Recruit Tobacco Action Workers

Yes -

Trained workers for delivery of tobacco brief interventions

No - data not available on the number of workers trained in brief intervention for 2010-11

Survey results, and additional program documentation from the department

National Coordinator leadership provided to the A1 workforce and host organisations

Yes -

Delivered smoking prevention and cessation communications and activities

Yes -

Implemented community projects designed to reduce smoking

Yes -

Delivered training that is well received by the workforceProvided networking opportunities

Yes -

Research products that inform Measure design and implementation

Yes -

Participants increasingly seek assistance and utilise services in their

Yes* Future consultation activities, surveys and secondary data analysis





Appendices



quit attemptsRTCs and TAWs have the knowledge and skills to provide smoking prevention and cessation activities and communications

No – not enough information about the knowledge and skills of RTCs and TAWs due to lack of information about training participated in and skills gained across RTSHLTs

Future consultation activities and surveys

Primary health care practices have increased and sustainable capacity to provide smoking prevention and cessation activities and communications

No – not enough information about the impact of RTSHLTs on primary health care practices**


*Addressed but with limited evidence ** RTSHLTs new and unlikely to have had such impacts at this stage.I.2 Helping Indigenous Australians Reduce Their Risk of Chronic

Disease (A2)Table 36: Evaluation Framework Table for Helping Indigenous Australians Reduce Their Risk of Chronic Disease (A2)



Deliver healthy lifestyle activities to individuals, groups and communities, including promotion of Health Checks

Yes* -

Identify community needs

Yes* -

Health checks conducted at primary health care practices

Yes* - need further information to identify links between HLW activities and

-





Appendices



Healthy lifestyle activities provided to community members

Yes* -

Annual regional plans that are based on community needs assessment

No – no Annual Regional Plans available to the evaluation for 2010-11 reporting period

Analysis of available plans

Opportunities provided that enhance HLW networking

Yes -

Trained HLWs Yes -

Recruited and retained HLW workforce

Yes -

HLWs have the knowledge and skills to provide healthy lifestyle activities

No- not enough information about the knowledge and skills HLWs due to lack of information about training participated in and skills gained across RTSHLTs


Increased and sustained community engagement in healthy lifestyle activities

Yes** -

*Addressed but with limited evidence ** RTSHLTs new and unlikely to have had such impacts at this stage.I.3 Local Indigenous Community Campaigns to Promote Better

Health (A3)Table 37: Evaluation Framework Table for Local Indigenous Community Campaigns to Promote Better Health (A3)



Develop and distribute Community Health Action Packs

Yes -





Appendices



Organise and facilitate information sharing, e.g., forums

Yes -

Develop website Yes -

Expressions of interest assessed and funded provided (for healthy community events) across Australia according to service delivery principles

Yes -

Community participates in the design of local projects

Yes* -

Grant applications assessed and funded across Australia according to service delivery principles

Yes -

Conduct literature research on better practices in social marketing in Aboriginal and Torres Strait Islander communities

Yes -

Consult Aboriginal and Torres Strait Islander communities on appropriate practices for local social marketing

Yes -

Community Health Action Packs

Yes -

Level and nature of participation in forums

No – at the time of drafting, LCCs only just being established.

Future consultation activities and analysis of program documentation

Functional and resourced website that is maintained

Yes -





Appendices



Healthy Community Day events delivered

Not applicable – no longer relevant to LCC measure


Implemented community campaigns



Local Aboriginal and Torres Strait Islander media organisations and/or community groups involved in local or regional campaigns

Yes -

Research report that enables improved program design and enhances knowledge base of chronic disease strategy options

Yes -

Sustained participation of community members in community campaign activities



Enhanced community capacity to initiate local campaigns



Community Health Action Packs are beneficial to the design and implementation of community campaigns



Enhanced networking across communities



Local organisations share knowledge about campaigns and actively


Future consultation activities and analysis of program





Appendices



participate in forums documentationFunds for grants and events are spent efficiently



Enhanced community understanding of health risks and benefits associated with lifestyle choices



Local community campaigns are evidence based

Yes -

Communities have increased and sustainable capacity to undertake community level campaigns



Participants increase their use of primary health care services



Increased evidence base to inform future investments in communications that promote chronic disease prevention and management in Aboriginal and Torres Strait Islander communities

Yes -

I.4 PBS Co-payment measure (B1)PBS Co-payment measure (B1) – See Appendix F for details on the relevant indicators in the evaluation framework.I.5 PIP Indigenous Health Incentive (B3a)PIP Indigenous Health Incentive (B3a) – See Appendix H for details on the relevant indicators in the evaluation framework.





Appendices

I.6 Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3b)

Table 38: Evaluation Framework Table for Supporting Primary Care Providers to Coordinate Chronic Disease Management (B3b)



Promote the CCSS to health care providers

Yes -

Provide program guidelines to fund holders for local implementation of the CCSS

Yes -

Establish National Coordinator in the Australian General Practice Network

Yes -

Expedite patient access to services in accordance with care plans

Yes -

Build care coordination structures and referral pathways

Yes -

Established local arrangements to implement guidelines

Yes -

National Coordinator support provided to Care Coordinator workforce

Yes -

Purchased services that meet patient care needs

Yes -

Appropriately referred patients

Yes -

Established effective referral systems

Yes -

Recruited Care Coordinator workforce adequately prepared for

Yes -





Appendices



their rolesParticipating patients have increased access to coordinated multidisciplinary care as recommended in care plans

Yes -

Measure B3b is implemented in accordance with program guidelines

Yes -

I.7 Improving Indigenous Participation in Health Care through Chronic Disease Self Management (B4)

Table 39: Evaluation Framework Table for Improving Indigenous Participation in Health Care through Chronic Disease Self Management (B4)



CDSM sessions delivered by trained health care professionals

No – data not made available to evaluation.

Future analysis of program documentation.

Health care professionals have the knowledge and skills to effectively deliver CDSM sessions to Aboriginal and Torres Strait Islander patients with an established chronic disease

Yes* -

*Addressed but with limited evidence





Appendices

I.8 Increasing Access to Specialist and Multidisciplinary Team Care (B5a)

Table 40: Evaluation Framework Table for Increasing Access to Specialist and Multidisciplinary Team Care (B5a)



Provide program guidelines to fund-holders for local implementation of USOAP

Yes -

Run Program Advisory Committees to guide design and delivery of the Measure

No – information not provided on establishment or operation of Program Advisory Committees in 2010-11


Promote outreach specialist services to patients

Yes -

Participating specialists undertake cultural awareness training

Yes* -

Establish effective fund-holding and host organisation arrangement in priority locations

Yes -

Developed and distributed guidelines which inform local implementation

Yes -

Identification of community service needs

Yes -

Promotional channels and materials utilised to promote specialist outreach to patients

Yes -

Delivered specialist outreach services which

Yes -





Appendices



are accessible and culturally sensitiveTrained, culturally aware specialists

No – data not available Future consultation activities and analysis of program documentation

Identified specialists for delivery of outreach services

Yes -

Established arrangements with fund-holders and host organisations

Yes* -

Aboriginal and Torres Strait Islander people in urban locations have increased access to a wider range of specialist services

Yes -

Aboriginal and Torres Strait Islander people receive culturally appropriate care from specialist outreach service providers

Yes -

Specialist service provision reflects community health

Yes* -

Health care system has increased and sustainable capacity to deliver appropriate specialist services to Aboriginal and Torres Strait Islander people in accessible urban locations

Yes* -






Appendices

I.9 Increasing Access to Specialist and Multidisciplinary Team Care (B5b)

Table 41: Evaluation Framework Table for Increasing Access to Specialist and Multidisciplinary Team Care (B5b)



Run Program Advisory Committees, including representation from allied and Aboriginal and Torres Strait Islander health to guide design and delivery of the Measure

Yes -

Deliver specialist and allied health outreach medical services in accessible rural / remote host settings

Yes -

Promote outreach services to Aboriginal and Torres Strait Islander patients

Yes -

Health care professionals participate in cultural awareness training

Yes* -

Identify medical specialists and other health care professionals to deliver outreach services

Yes -

Establish effective fund holding and host organisation arrangements in each State and the Northern Territory

Yes -

Identification of community service needs

Yes* -

Outreach services Yes -149





Appendices



delivered by providers in accessible rural/remote host organisationsChannels and materials utilised to promote outreach services to patients

Yes -

Trained, culturally aware outreach service providers

Yes* -

Identified health care providers (specialists and other disciplines) to provide outreach services

Yes -

Established arrangements with fund holders and host organisations

Yes -

Patients receive more coordinated care through outreach services

Yes -

Providers have increased participation in outreach service delivery

Yes -

Specialist and allied health service provision reflects community needs

Yes* -

Measure is implemented in accordance with program guidelines

Yes -

Health care system has increased and sustainable capacity to deliver appropriate

Yes* -





Appendices



specialist and allied health outreach medical services to Aboriginal and Torres Strait Islander patients in rural and remote locations*Addressed but with limited evidence I.10 Workforce Support, Education and Training (C1)Table 42: Evaluation Framework Table for Workforce Support, Education and Training (C1)

I.11 Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care (C3)

Table 43: Evaluation Framework Table for Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care (C3)

Year two indicators Reason not addressed


Provide program guidelines to stakeholders

Yes -

Establish a National Coordinator IHPO in the AGPNEstablish State Coordinator IHPOs in State Based Organisations and NACCHO affiliates

Yes -

Develop and implement activities and initiatives to address access barriers and promote culturally sensitive service delivery

Yes -

Recruit over 80 FTE ATSIOW positions in Divisions of General PracticeRecruit IHPO positions in

Yes -





Appendices



DivisionsGuidelines distributed to fund holders to inform local implementation of workforce

Yes -

State level coordination activities undertaken

Yes -

National coordinator supports provided to C3 workforce

Yes -

Supports provided by IHPOs to ATSIOWs

Yes -

Recruited and retained IHPO positions in Divisions

Yes -

Recruited and retained ATSIOWs in Divisions

Yes -

Improved collaboration among participating general practices / networks and the IHSs sector

Yes -

Participating practices deliver increased amount of MBS items specific to Aboriginal and Torres Strait Islander people, including the Health Checks

Yes -

Aboriginal and Torres Strait Islander people increase their utilisation of primary health care services

Yes* -

Primary care providers have greater understanding of health needs and culture of

Yes -





Appendices



Aboriginal and Torres Strait Islander peopleImplementation of the Measure complies with program guidelines

Yes -

Mainstream primary health care providers have increased and sustainable capability and capacity to meet the needs of Aboriginal and Torres Strait Islander people

Yes* -






Appendices

I.12 Attracting More People to Work in Indigenous Health (C4)Table 44: Evaluation Framework Table for Attracting More People to Work in Indigenous Health (C4)



Develop and run public relations activities targeted to health care professionals and health care students to encourage work in the Indigenous Health Services sector

Yes -

Develop and deliver media campaign targeted to Aboriginal and Torres Strait Islander secondary school students and their key influencers through television, radio, print advertisements and internet

Yes -

Conduct research to explore motivators and barriers for health sector career choices by Aboriginal and Torres Strait Islander secondary students

Yes -

Delivered promotions that encourage health workforce participation in the Indigenous Health services sectorFunctional and maintained website for Do Something Real campaign

Yes -

Consultation report that enables improved design of Do Something Real Campaign

Yes -





Appendices



Delivered promotions that encourage health sector career choicesFunctional and maintained website that promotes health sector career choicesResource kits delivered to school careers advisorsCompleted community engagement activities

Yes -

C4 Health Heroes campaign is informed by evidence from research and key stakeholder consultation

Yes -

I.13 Clinical Practice and Decision Support Resources (C5)Table 45: Framework Evaluation Table for Clinical Practice and Decision Support Resources (C5)



Web traffic and use of primary health care resource website

No – no data available for 2010-11, due to resource still being in pilot stage.

Future consultation activities and Web-user survey

Functional and maintained web pages and software toolbar



Primary health care providers have increased their application of clinical practice guidelines, tools and patient education materials to chronic disease management for Aboriginal and Torres







Appendices



Strait Islander patients



department of health | welcome to the department …€¦ · web viewmiles mb, & huberman am...

Documents