Identification: what’s the big deal?

1. Identification:what’s the big deal? Helen Kehoe August 2009

2. Before we begin… • Who am I and how do I fit in? • Definitions & terminology • Acknowledge the good • Who is Aboriginal?

3. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

4. 1. Identification – a 2 sided coin • Individual service delivery • Data collection • Bringing the two together

5. Closing the Gap Targeted interventions Measuring progress Data Collection & reporting Delivering specific interventions Effective GP Identification

6. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

7. Voluntary Indigenous Identification Not visible to provider Held by Medicare Australia Used at aggregate level Population based, not individual Longer term impact Point of service identification Visible to provider Held at practice level Used for GP generated data collection (eg notifiable disease) Individual based, not population Immediate term impact 2. VII

8. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

9. 3. CTG – What’s the gap we’re trying to close? • Source: DoHA estimates based on data from the AIHW National Mortality Database.

10. ‘process gaps’ also need closing • MBS and PBS expenditure • Expenditure rises wt need in non-Aboriginal population • 2 – 3 x morbidity (at least)

11. The basis of ‘gap closing’ • Gap closing – not whole of population • Necessarily specific only to Aboriginal and Torres Strait Islander people

12. CTG: non GP-mediated • Anti-smoking campaigns • ?healthy lifestyle workers • Indigenous Outreach Workers (ACCHS & ?Divisions)

13. CTG: GP-mediated measures • PIP (registration, level of care) • Referrals for care coordination • PBS co-payment relief • Improved access to specialists

14. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

15. 4. Our track record…. • Existing GP-mediated Aboriginal & Torres Strait Islander specific health interventions: • Immunisations • PBS listings • MBS health checks

16. Immunisation uptake • Over 50: 34% in last 5 yrs • 18 – 49:12% in last 5 yrs • Identification ‘critical to improving uptake’

17. PBS uptake - NRT Source: www.medicareaustralia.gov.au/statistics/pbs_item.shtml

18. Health check uptake Source – ABS Population Characteristics, Aboriginal and Torres Strait Islander Australians, 4713.0 2006, and Medicare websitewww.medicareaustralia.gov.au/statistics/mbs_item.shtml

19. Source: M.Kellaher, Centre for Health Policy, Programs and Economics University of Melbourne, work in progress

20. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

21. 5. Why is uptake low? • Lots of reasons…… • Including identification • NOTE: identification necessary but not sufficient

22. What do we know about identification? • BEACH data • ABS survey (usual point of care) AND • QLD immunisation study • NIPII evaluation • ACTDGP study • Anecdotal evidence (Tas & SENSW)

23. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

24. 6. The ACTDGP study • Conducted by ACT Division of General Practice May 2006 - June 2007 • Partnership with Winnunga Nimmityjah Aboriginal Health Service • Department of Health & Ageing funding

25. Research question • To investigate barriers to uptake of MBS-health assessments for Aboriginal and Torres Strait Islander people in mainstream general practice in the ACT region.

26. Method • Cross-sectional questionnaire (n=145, response rate ~ 25%) • Interviews (n=16, 9/24 practices in targeted areas)

27. Questionnaire • identification barriers • ‘Asking all patients whether they are Aboriginal or Torres Strait Islander would offend our non-Indigenous patients’ • need for specialised services • ‘We treat all patients as individuals here so there’s no need to identify sub-groups such as Aboriginal people or Torres Strait Islanders’ • knowledge • ‘Aboriginal people and Torres Strait Islanders in Canberra are generally as healthy as non-Indigenous people’

28. Interviews • Identification processes • Different treatment • Use of health assessments

29. Results (1) • Identification • 30 – 33% apprehension/cause offence • 37% not feasible • Specialised treatment • 61% agreed entitled to specialised health • 69% agreed relevant to GP care • Knowledge levels • 22% Rural/remote issue • 30% access barriers • 11% not in Canberra

30. Results (2) Current situation • Uptake – (0/9) • Awareness – (1/9) • Identification – (?1/9) Barriers to uptake • Process (eg software) • Resources (eg too busy) • Attitudes (eg treating everyone the same)

31. Discussion • Health assessments – important but not used or seen as useful • Low identification processes • Mismatch between current practice and basis of health assessments

32. A vicious cycle….

33. Challenges to increasing identification • GP & staff knowledge, skills, attitudes • Supporting change, removing barriers and raising the bar • Divisions of GP – priority setting • Government fragmentation

34. A conundrum…. • 50 - 60% of Aboriginal people accessing mainstream services • BUT • For most GPs, a tiny percentage of the practice population

35. Outline of presentation • Identification – a 2 sided coin • Voluntary Indigenous Identification (VII) • COAG approaches! • Our track record • Identification as a barrier • The ACTDGP study • Where to from here?

36. 7. Where to from here? • CDNA discussion paper • Is identification hard? (Hospitals/AMSs/mainstream GPs) • Enhancing better practice – all carrots & sticks leading to a shared goal • Governmental fragmentation • Importance of DGPs • COAG tsunami

37. Yes we can! • Links wt ACCHSs (wt a caveat) • Informing ourselves • Integration across all Divisional business • Cross-Divisional coordination • Local knowledge

38. Take home messages • Identification = currently low • Identification a rate limiter to CTG • Divisions are an essential part of moving forward – change can be sector led

39. Helen Kehoe phone 02 6289 2409