Accessibility and Affordability of Healthcare for Aboriginal and Torres Strait Islander Peoples

Improving Community Access to Mental Health Services

Daniel Jopp

Daniel JoppPresenter Biography: Daniel Jopp is a Dunghutti man from Kempsey but grew up in Newcastle. He is currently in his third year of a Bachelor of Health Science (Mental Health) at Charles Sturt University. Daniel has been working in health in mainstream and Aboriginal community controlled organisations for the past 15 years in numerous communities throughout NSW, QLD and WA. Currently Daniel works for Central Coast Local Health District as an Aboriginal Drug & Alcohol Consultant.

Abstract: On the Central coast there are approximately 10,000 Aboriginal and/or Torres Strait Islander people as of the last census which was 2006. The Aboriginal population is spread out and come under two shire councils – Wyong and Gosford. The Aboriginal Medical Service (AMS) is based in Wyong and can be difficult to access due to transport infrastructure. Therefore, Aboriginal people often use local doctors in their area whom work closely with Medicare local and other health services.

This presentation will explore the experience of an Aboriginal Drug & Alcohol Consultant within this region, who is currently studying a degree in mental health. The consultant’s role exists to engage Aboriginal clients, improve access and facilitate pathways for them to receive treatment whether it be through AMS or mainstream services. Through comprehensive assessment the treatment pathway is determined by the client’s needs and this includes all access to treatment types from both a Drug and Alcohol and Mental Health perspective. The consultant works with multiple services within the local health district and local non-government sector. Once again this collaboration is determined by the needs of the client.

The consultant gives Aboriginal clients a voice in deciding appropriate treatment and support for their needs, as well as an Aboriginal voice within the service to educate other workers on how to work better with Aboriginal clients. Many of the clients accessing drug and alcohol services also have underlying mental health issues and the consultant will often perform a dual diagnosis. This involves accessing General Practice to place clients on a Mental Health Plan, which allows improved access to lower cost allied health services. The consultant will then work in with psychologists, psychiatrist, counsellors and other health professionals to focus on mental health whilst also tackling the underlying alcohol and/or other drug issues.

The role of the consultant was developed in response to community need. It provides essential education and support to clients, their family and community members on issues around mental health and alcohol and other drugs, working with individual and groups as required. It is essential that Aboriginal people have access to the care they need in order to lead full and productive lives. The role of the Aboriginal Drug & Alcohol Consultant exists to make this a reality.

Closing the Gap – The challenges of Managing Medications in remote communities

Brendan Hooper

Biography: Brendan Hooper heads up Webstercare’s Professional Services with significant experience in the project and change management required to implement medication management systems.  This role has taken Brendan across Australia from large aged care facilities in metropolitan areas to remote communities with completely different challenges.  Brendan has worked closely with the founder and Managing Director of Webstercare, Gerard Stevens AM, to help revolutionise medication management in Australia.  Brendan and his team of pharmacists, nurses and clinical pharmacists, develop and implement a patient centred clinical approach to a wide variety of environments.  Webstercare is dedicated to technology and system development to achieve best practice within each individual environment and Mirrijini is the result of this dedication.

Abstract: The management of medications in remote communities was ineffective and problematic resulting in either under-medicating or risk of medication misadventure. Medication dispensing and stock management systems in remote primary health care clinics (PHCC) were inefficient, time intensive, badly labelled and recorded, costly and did not promote or capture compliance to medication regime. This took up significant resource for the Aboriginal Health teams and adversely impacted on patient health outcomes placing them at a significant disadvantage.

Goal: The heavy reliance on manual process within this system created many of the problems. It was identified that an electronic solution was needed, which would be user friendly specifically developed for the remote indigenous environment. The system needed to be effective and standardised to enable legible medication labelling, accurate supply records and efficient stock control. The ultimate outcome needed to be improved health care and services for patients in remote and isolated communities while contributing to improved staff satisfaction.

Solution: Mirrijini (Tiwi-Aboriginal for “medicine”) Dispense System was developed in collaboration with Queensland Health, Cairns and Weipa Hospitals and 12 PHCCs, Webstercare and a private pharmacy provider. Webstercare already had extensive experience in developing sophisticated software based medication management systems used within the community and aged care environment. Webstercare created a ‘kiosk’ facilitated system incorporating barcode scanning, labelling, identification, stock control and recording of supply and administration of medications. The software interface was carefully developed to ensure an easy to use and intuitive process flow on the screen, given that many users had little or no prior experience with technology based systems, right down to the location of the icons on the touch screen.

Outcome: Mirrijini is now operating in 19 sites across far north and central Queensland, and The Northern Territory. Registered Nurses and Aboriginal Health Workers are the primary users of the Mirrijini. Using the inbuilt scanner to read the medicine barcodes and the touch screen, labels are printed and the medication is dispensed. Data feeds directly into the stock management system and automatically determines stock reconciliation activity required for that item. The real benefit though is that patients receive clearly labelled medications with administration directions designed to optimise compliance and to record it – this has a clear health outcome. Health professionals in the PHCC or the base hospital/outreach pharmacy can review a patient’s complete medication profile and adherence. Pharmacists can also log in remotely allowing them to quickly see the medications previously supplied to a patient and provide professional support as required.

Mirrijini enables efficient stock control as all medications dispensed are automatically accounted for thus reducing the incidence of out of stock medications. Reliable stock control also means the hospitals/outreach pharmacies can project future medication needs and plan ahead accordingly reducing the reliability on costly emergency supply.

Summary: Mirrijini is an efficient and accurate tool for safe dispensing of medications to patients in remote communities. It also manages inventory of medications and other consumable stock. Staff using Mirrijini have reported a significant reduction in time spent dispensing medications, improved reporting functionality, better availability of medicines through stock management and improved health outcomes for the whole Indigenous communities where Mirrijini is used. This has been achieved because patients get the medication they need when they need it and understand how take it in the right way so they achieve the desired effect. Mirrijini is a unique solution for medication management in remote primary health care clinics.


Spreading the word about communication difficulties after stroke and traumatic brain injury in Indigenous Australians: an introduction to the Missing Voices research

Deborah Hersh

Deborah HershPresenter Biography:     Deborah Hersh, PhD, has over 20 years of clinical and research experience in Speech Language Pathology in the UK and Australia. She has presented and published in the area of acquired communication disorders (ACDs) after stroke, particularly around how people experience being discharged from therapy, professional-client relationships, group work, goal setting in therapy and experiences of Aboriginal Australians with ACD. Deborah is a Fellow of Speech Pathology Australia and Associate Professor in Speech Pathology at Edith Cowan University in Perth. She is a member of the research team on the Missing Voices project.

Abstract – Acquired Communication Disorder (ACD) is a common consequence of stroke and traumatic brain injury (TBI). These both occur at a higher rate and a much younger age in Indigenous compared to non-Indigenous Australians. ACD has a devastating impact on individuals and their families in the general population, and yet virtually nothing is known about Indigenous people’s experiences of this disorder. Their uptake of speech pathology services is minimal, and to date, short and long-term outcomes are unknown. This study will provide the first comprehensive and significant information on adult Indigenous Australians’ experiences of ACD, and one of the first in the world on Indigenous issues related to such disorders. This is also the first study to address the lack of uptake of Speech Pathology services by Indigenous Australian adults, in relation to both rural and urban Indigenous communities.

The proposed research, entitled Missing Voices, builds on a pilot study reported at IAHA in 2012, and is funded for three years (2013-2015) by the NH&MRC. It is a multi-centred study with data collection anticipated across six sites in Western Australia: Perth, Geraldton, Albany, Kalgoorlie, and two sites in the Kimberley.  Both WA Health facilities and Aboriginal Medical Services will participate in data collection, with an Aboriginal liaison person appointed at each site. This person will lead participant recruitment at their site, assist in data collection and liaise with the local Aboriginal community in order to facilitate strong two-way communication between the research team and the local community.

The project aims to: investigate the extent and impact of ACD in urban and rural Western Australian Indigenous populations following stroke or TBI, to develop and validate a culturally appropriate assessment tool for use by health professionals working with this population, to explore how Indigenous people post-stroke or TBI, their family members and health professionals feel about ACDs and rehabilitation services, and to develop potential alternative service delivery models that are accessible and culturally appropriate.

This presentation seeks to spread the word about this important project, to raise awareness of acquired communication disorders following stroke or TBI, and to start discussions about how the project can inform speech pathology services, making them more accessible, tailored to meet the needs of Indigenous people and their families, and integrated into both Indigenous allied health services and communities. Our approach is underpinned by capacity building of Aboriginal researchers and services, and fostering knowledge exchange.

Building Allied Health Capacity in Far West NSW

Bob Davis & Justin Files

Presenter: Bob Davis
Bob Davis is the Chief Executive Officer of Maari Ma Health, an Aboriginal community controlled health organisation dedicated to improving health outcomes for communities in the far west region of New South Wales with a special focus on Aboriginal health. He has over 25 years’ experience at Chief Executive Officer/Executive Director level in Aboriginal health in Government and non-Government organisations in NSW and Cape York, Queensland. He specialises in the management of innovative complex community based Aboriginal health models that are flexible, sustainable whole of community approaches to care. His previous appointments include Chief Executive Officer of the Biripi Aboriginal Health Corporation, the Cape York Health Council and the Partnership for Care Aboriginal Coordinated Care Trial and held senior positions with the former National Aboriginal and Islander Health Organisation, the Aboriginal Health Research Council of NSW, Director Of Aboriginal Health in the Mid North Coast Area Health Service and more recently Chief of Staff at the Redfern Aboriginal Medical Service. In 2007 he joined the NSW Aboriginal Land Council and became Director of Land Policy and Research prior to being appointed as Chief Executive Officer of Maari Ma Health. He is a Dhungutti man from the north coast of NSW.

Presenter: Justin Files
Justin Files is a Barkindji man from the Darling River and is number 16 of 99 descendants of his Barkindji Elder grandmother. He was raised in Menindee, a small community situated in remote New South Wales Australia. He is the second eldest of five siblings and the uncle to 2 nephews and 7 nieces. Justin graduated from Charles Sturt University with a Bachelor of Health Science Mental Health, and is currently the Manager, Maari Ma Primary Health Care Service. Justin currently resides in Broken Hill known as the Silver City (population of approximately 20 000 people). Justin loves living in rural Australia, as long as he visits the major cities “now and then”. He is passionate about his Indigenous culture, and enjoys learning about his family’s history and genealogy. In addition to learning about his culture, Justin appreciates and embraces the diversity of cultures around the world.

 

Abstract:  The Outback Vascular Health Service (OVHS) is an outreach service which delivers a vascular health speciality service to communities of Far West New South Wales (NSW). It represents a collaborative program between Maari Ma Health Aboriginal Corporation (Maari Ma) and The George Institute for Global Health (the George Institute) that has sought institutional support through partnership with Royal Prince Alfred Hospital (RPAH). The OVHS has been funded by the Scully Fund and through the Commonwealth Government’s Medical Specialist Outreach Assistance Program. It aimed to build the capacity of local primary care providers and in particular to support GPs and allied health staff in the management of vascular disease related chronic and complex illness.

Maari Ma Health, established in 1995, is an Aboriginal community controlled regional health service. The corporation’s directors represent six communities in the region: Broken Hill, Ivanhoe, Menindee, Wilcannia, Balranald, and Tibooburra. The corporation covers a vast area, approximately 200,000 square kilometres or just under one third of the state of NSW. The population is approximately 30,000 of whom 20,000 people reside in Broken Hill. The region has a high proportion of Aboriginal Australians and the OVHS primarily services the Aboriginal community in Broken Hill and the towns in the area surrounding Broken Hill within the Central Darling Shire, namely the towns of Wilcannia, Menindee and Ivanhoe.

Maari Ma developed its Chronic Disease Strategy in 2005 in response to the vision and direction of Maari Ma’s Board of Directors at the time, which identified the prevention and management of chronic diseases as one of its major priorities. This strategy aimed to create systems to support self-care, link community health services with hospital services and link medical care with a public health approach. The OVHS was seen as one of the key features to support successful implementation of the Chronic Disease Strategy.

An evaluation of the OVHS was commissioned by Maari Ma and conducted by the George Institute for Global Health between Feb 2012 and October 2012. This evaluation assessed the performance of the OVHS model of care, its processes of implementation and determine the quality of care delivered to OVHS clients. The evaluation represents a snapshot of the service; however, due to the dynamic nature of the service, there have undoubtedly been further developments and changes.