MBS Primary Care Items – Health Assessments August 2010

1. ISO 9001 Lic QEC22546 SAI Global MBS Primary Care Items – Health Assessments August 2010

2. Health Assessment Items

3. Target groups & Claiming Periods

4. Purpose of a Health Assessment • Identification of a broad range of factors that influence a person’s physical, psychological and social function • Inform the GP of risk factors and hazards in eligible patients which may require further health management. • Enable early intervention strategies

5. Before Health assessment • Patient’s ‘usual’ doctor decides whether patient should have health assessment • Patient must be given an explanation about what will happen in health assessment, and how it is likely to help them • Patient is informed of any charges for service • Patient must provide consent • can be verbal • must be documented

6. Risk factors to could be considered • Lifestyle • Smoking, inactivity, poor nutrition • Biomedical risk factors • High BP, excess weight, Impaired glucose metabolism • Relevant recent diagnostic test results • Family history of chronic disease

7. A Health assessment must include • Information collection including taking/updating the patient’s history and undertaking or arranging examinations and investigations as required; • Making an overall assessment of the patient; • Recommending appropriate interventions; • Providing advice and information to the patient; • Keeping a record of the health assessment, and offering the patient a written report with recommendations about matters covered by the assessment.

8. Role of the GP • Review and analyse information collected • Make an overall assessment of the patient • Arrange investigations • Make necessary referrals • Identify appropriate follow-up • Provide advice

9. Role of the Practice Nurse / AHW • Assist with identifying eligible patients • Collection of information from Patient • Provide Patients with information re useful resources & services • Recall for follow up activity

10. Healthy Kids Check • For children aged at least 3 years and less than 5 years who have received, or are receiving, their 4 year old immunisations • An assessment of child’s physical health, general well being and development with the purpose of initiating medical interventions as appropriate • Provided by GP – Time based item number • Provided by PN / AHW – Item number 10986

11. Components of a Healthy Kids Check • The health check must include: • information collection, patient history • the basic physical examinations and assessments; • initiating interventions and/or referrals as indicated; and • providing health advice and information to the patient's parents/guardian utilising • the Department's publication 'Get Set 4 Life - habits for healthy kids' • parent/guardian-held child health record.

12. Type 2 Diabetes Risk Evaluation • Patient eligibility: • Aged 40 – 49 years at ‘high risk’ of developing Type 2 Diabetes • Aim: • To review factors underlying the “high risk” score identified by the Australian Type 2 diabetes Risk Assessment (AUSDRISK) Tool • To instigate early interventions • To assist with the prevention of type 2 diabetes

13. Components of Diabetes Risk Evaluation • Review risk factors underlying the ‘high risk’ score • Update patient’s history, • Undertaking examinations and investigations as required • Make overall assessment of patients with information collected • Provide advice and information to encourage patient to address lifestyle risks (e.g. Lifescripts) • Consider referral to a subsidised Lifestyle Modification Program (LMP) – contact your local GP Division/Network • The Australian Diabetes Risk Assessment Tool to have been used within 3 months of this review.

14. 45- 49 yr old at Risk of Chronic Disease • Must have at least one risk factor for a chronic disease • Factors that the GP may consider include, but are not limited to: • lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol misuse; • biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; or • family history of a chronic disease.

15. People 75 Years or older • An assessment of a patient’s health and physical, psychological and social function • Includes: • BP, Pulse rate and rhythm • Medication • Continence • Immunisation status • Physical function- activities of daily living, falls • Psychological function – cognition, mood • Social function – availability & adequacy of help, whether pt is caring for another

16. Permanent Resident of RACF • Assessment of the resident’s health and physical and psychological function. • Must include: • A written summary of CMA • A list of diagnoses and medical problems based on medical history and examinations • Providing a copy of the summary to RACF • Offering a copy of summary to the resident

17. People with intellectual disability • A person is considered to have an intellectual disability if they have significantly sub average general intellectual functioning • To confirm status seek verification from Paediatrician or Government provided or funded disability service that has assessed intellectual Function • Aim of Assessment: • Assess physical, psychological and social function • Identify medical interventions and preventative health care required

18. Refugee or Other Humanitarian Entrant Purpose: To introduce refugees / other humanitarian entrants to Australian Primary Health Care as soon as possible (within 12 months of arrival) In addition to the general requirements of a health assessment, must include the development of a management plan addressing pts health care needs, health problems and relevant conditions

19. Aboriginal and Torres Strait Islander Health Assessment • An Aboriginal and Torres Strait Islanders Health Assessment gives the opportunity for early detection, diagnosis and intervention for common and treatable conditions that cause considerable morbidity and early mortality. • Available to all Aboriginal persons under the following age categories: • Aboriginal people <15 yrs • Aboriginal people 15yrs - 54yrs • Aboriginal people Aged 55+ • NB: Indigenous status is accepted on basis of self identification

20. Item 10987 • Follow up service for an indigenous person who has received a health assessment (Item 715) • Provided by a Practice Nurse or Registered AHW, on behalf of a GP • Maximum of 10 services per calendar year • Used to provide: • Check on progress and service access • Interventions, education, monitoring, counselling & lifestyle advice, as indicated by the health check

21. Tanya - Case study • Tanya has moved to your area with her 4 children to be near her mother who now lives with her. She identifies as an Aboriginal woman. Tanya is 44 years old, diabetic and her children are: • Sharon 17 years old – unemployed, lives at home • Thomas 14 years old – sometimes goes to school • Sharnee 8 years old • Elvis who is 4 ½ years old • Tanya and her children were attending their local AMS for their health care prior to coming to Dubbo but she never attended or took the children regularly – only when they were sick. • Tanya is coming today because Sharnee is very wheezy with her asthma and she has heard that Elvis needs a needle before he starts school. • What MBS items are available to Tanya and/or her family? • What types of assessments would you recommend?

22. Resources RACGP publications : "SNAP - a population health guide to behavioural risk factors in general practice"; "Putting Prevention into Practice" (the Green Book); and"Guidelines for Preventive Activities in General Practice" (the Red Book).RACGP website – 45-49 year old Health Checkwww.racgp.org.au/clinicalresources/45NHMRC publication:"Overweight and Obesity in Adults: A Guide for General Practitioners”Lifescripts guidelines and resourceswww.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-lifescripts-index.htm

23. Further information Department of Health & Ageing: www.health.gov.au/mbsprimarycareitems MBS online: www.mbsonline.gov.au/ Electronic templates: www.monashdivision.com.au/resources/templates.htm www.nevdgp.org.au (IM Resources) Medical software systems

24. Any questions? General Practice NSW 76-80 Clarence Street, Sydney Ph: (02) 9239 2900 Fx: (02) 9239 2999 Web: www.gpnsw.com.au Email: jerrybacich@gpnsw.com.au