Primary Health Network Needs Assessment Reporting Template This template must be used to submit the Primary Health Network s (PHN s) Needs Assessment report to the Department of Health (the Department) by 30 March 2016 as required under Item E.5 of the Standard Funding Agreement with the Commonwealth. Name of Primary Health Network Western Victoria Primary Health Network
Section 1 Narrative This section provides PHNs with the opportunity to provide brief narratives on the process and key issues relating to the Needs Assessment. Needs Assessment process and issues (500-600 words) in this section the PHN can provide a summary of the process undertaken; expand on any issues that may not be fully captured in the reporting tables; and identify areas where further Western Victoria Primary Health Network Needs Assessment has been a comprehensive undertaking to identify the key health and service needs in the region. This process has utilised an extensive range of data sources and rigorous comparison of these, along with consultations. The Needs Assessment process has resulted in the development of a document that can be utilised across the organisation to inform planning, commissioning and quality improvement activities The health and service needs outlined in the Needs Assessment are based on data gathered via the following four methods: 1. A review of statistical datasets made available primarily through various Victorian and Australian Government departments and agencies. The review was organised around 12 areas of focus. These focus areas were the six priorities for PHNs (Aboriginal and Torres Strait Islander health; mental health; population health; health workforce; digital health; and aged care) and the four national performance indicators (mental health treatment rates; preventable hospitalisations; childhood immunisation; and cancer screening rates [breast, bowel, and cervical]). The other two areas of focus included vulnerable groups and health service availability and coordination. The statistical review is an ongoing process we will conduct to continually build on our evidence base. 2. 25 interviews with rural allied health administrators primarily servicing communities outside the major population centres in the Western Victoria PHN region. Interviews were conducted by staff members and provided insights into the major health needs in local communities as well as insight into health workforce issues. Staff analysed the data collected in these interviews for key themes. 3. Consultations with a broad range of health service providers were conducted in Ballarat, Geelong, Horsham and Warrnambool. These sessions were attended by 122 persons in total. The workshops helped to fill gaps in knowledge which had been identified from the statistical review and interviews with rural allied health administrators. The workshops were facilitated by consultants who provided reports of the key findings. 4. A survey of 61 General Practices was conducted by PHN staff, the number of responses varied depending on which questions were answered for each survey. A content analysis was completed on the extracted data. The survey sought information about the use of digital health systems, the main health issues of patients, resources practices found useful in their work, and issues with workforce recruitment and retention. In addition to the above, community consultation sessions were organised to take place in Ballarat, Geelong, Horsham and Warrnambool in February. Community members were invited to participate in these sessions via advertisements placed in local newspapers, on social media, and letters of invitation to consumer support groups in each region. However, these sessions were cancelled due to a lack of registrations. The lack of brand awareness of
PHNs in the wider community so early in the establishment phase is a likely cause of this issue. Health service and workforce mapping was completed through extracting data from the National Health Services Directory; Victorian Department of Health and Human Services health services lists; an internal list of health service providers (including general practices).. Additional workforce data was extracted from AIHW National Health Workforce Data Set [NHWDS] (2014). To determine the health and service need priorities the identified issues were rated based on the following criteria; The strength of the evidence for each particular issue. (i.e. the quality of the quantitative evidence and whether it was verified by the qualitative evidence) The impact of the issue - whether it was consistent across the region. The impact of the issue for particular populations/areas within the PHN. The impact of the issue for those at risk of poor health outcomes. Whether addressing the issue will contribute to improved population health within the region. The levers the PHN has to impact the health need or service issue positively. The options, outcomes, performance measurements, and potential leads were determined based on the prioritised needs and the capacity and capability of the PHN to utilise resources to address these needs in collaboration with key stakeholders and through the commissioning process. The main area where additional development work is needed is with persons from culturally and linguistically diverse backgrounds, and persons with a disability and their carers. For these groups, high quality data at the local level is very limited. More intensive research will be needed to understand the health and service needs relevant to persons in these groups. Additional Data Needs and Gaps (max 400 words) in this section the PHN can outline any issues experienced in obtaining and using data for the needs assessment. In particular, the PHN can outline any gaps in the data available on the PHN website, and identify any additional data required. The PHN may also provide comment on data accessibility on the PHN website, including the secure access areas. (Expand field as necessary). A particular challenge we have encountered in analysing publicly available health and socioeconomic/demographic statistics is that data has not consistently been aggregated to the same geographic areas. For example, the Needs Assessment Guide asked PHNs to analyse demographic data at the Statistical Area 2 (SA2) level. However, much publicly available data we have used to inform the Needs Assessment is aggregated to larger geographic units than an SA2 (e.g. local government areas or PHNs). Furthermore, the units various departments and agencies aggregate data to vary. This is an issue as it has limited our capacity to develop a comprehensive understanding of conditions in small geographies by linking all the relevant available data together. The capacity to do this is particularly important in the Western Victoria PHN as the region includes many diverse local communities. It would be beneficial to have data available at the SA2 level from the Survey of Disability Ageing and Carers for all age groups on the PHN website as it is a better indicator of
disability than the census data which is self-report and has a very high response to the not stated category. It would be beneficial if the PHN website included a release schedule for data which is to be uploaded to the PHN data page. Such a tool would assist the Western Victoria PHN to better allocate our human resources as staff members expended considerable time analysing and reanalysing data which was released on the PHN website relatively late in the needs assessment process with little pre notification. We also suggest the PHN website include an RSS feed or similar tool to alert visitors to new content. Service mapping is a labour intensive undertaking. As the National Health Service Directory develops, it is anticipated that this will provide a resource that will allow for ease in mapping of services and provide clarity around service gaps and changes over time. Additional comments or feedback (max 500 words) in this section the PHN can provide any other comments or feedback on the needs assessment process, including any suggestions that may improve the needs assessment process, outputs, or outcomes in future (expand field as necessary). The Needs Assessment process provides the PHN with a comprehensive understanding of the health and service needs across the PHN. The large document that results from the detailed analysis of the available quantitative and qualitative data collected and collated provides a solid basis for the ongoing development of a more refined understanding of the health and service needs across the region. However the lack of available health data at the local level hinders understanding of health issues locally. Western Victoria PHN will look to work with service providers to identify what data they have available that can be used to further enhance our understanding of health issues and their impact at the local level on individuals and service providers. Service user and community representative groups engagement in the Needs Assessment has been limited. With the impending development of four Community Councils across the region and the development of relationships over time it is anticipated this will be developed as a major component of our engagement process to inform the ongoing development of our Needs Assessment into the future.
Section 2 Outcomes of the health needs analysis This section summarises the findings of the health needs analysis in the table below. For more information refer to Table 1 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Outcomes of the health needs analysis Chronic conditions Prevalence of chronic conditions such as diabetes, cardiovascular disease, musculoskeletal conditions, asthma and chronic obstructive pulmonary disease. Data on the prevalence of major chronic conditions was sourced from the National Diabetes Services Scheme (December 2015); Australian Bureau of Statistics (ABS) Australian Health Survey (AHS) 2011-12 (Core component) (e.g. circulatory system disease and diabetes); Victorian Population Health Survey (VPHS) 2011-12 (e.g. arthritis and asthma); and data compiled by the Public Health Information Development Unit (PHIDU) based on modelled estimates from the 2011-13 AHS, ABS (unpublished) and the average of the ABS Estimated Resident Population (ERP) at June 2011 and June 2012, based on the Australian standard (e.g. chronic obstructive pulmonary disease and musculoskeletal system diseases). Chronic disease was also identified as a key health issue in the service provider consultations. Modifiable health behaviours Prevalence of behavioural risk factors. Data on a range of health behavioural risk factors was sourced from the 2011-12 ABS AHS (Core component) and the VPHS 2011-12. Concerns about behavioural risk factors were also raised in consultations with service providers. There is some variation in health behaviours between local areas but certain issues are common across the Western Victoria PHN. For example, a large proportion of the population do not consume
Outcomes of the health needs analysis enough fruits and vegetables or engage in adequate amounts of physical activity (VPHS 2011-12). In some local government areas in the Western Victoria PHN region the smoking rate exceeds the Victorian rate (VPHS 2011-12). The proportion of persons consuming alcohol at levels which place them at short-term risk of harm is also above the Victorian rate in certain localities (VPHS 2011-12). Social determinants There are a number of localities within the Western Victoria PHN which fare poorly on a series of indicators related to the social determinants of health. These determinants influence the health experiences of individuals, population health outcomes, and important equity issues such as access to health care. A range of indicators were assessed based on the ten categories of social determinants outlined in The Solid Facts (2nd edn.) report of 2003 from the World Health Organization (R. Wilkinson and M. Marmot [eds.]). These sources included (but were not limited to) the ABS Index of Relative Socioeconomic Disadvantage (2011); VPHS 2011-12 (e.g. food insecurity); ABS 2011 Census of Population and Housing (e.g. household income and level of education data); Department of Employment Small Area Labour Markets data (unemployment figures); Australian Early Development Census 2012 (proportion of children who are developmentally vulnerable); Crime Statistics Agency Victoria (e.g. family incidents [2010-11 to 2014-15] and drug use and possession statistics [2011 to 2015]); and the VicHealth Indicators Survey 2011 (e.g. adequate work-life balance and time for friends and family items). The impact of the social determinants of health on the wellbeing of local communities was also highlighted in the service provider consultations. Of particular concern was access to health care for rural and/or low income households. There is often considerable variation in
Outcomes of the health needs analysis indicators related to the social determinants of health both within and between localities across the Western Victoria PHN catchment. Ageing population Oral health Overweight/obesity A large proportion of the population in the Western Victoria PHN region is aged 65 years or over. This group is projected to grow both in terms of total numbers and as a proportion of the population over the next decade. Prevalence of fair or poor self-rated dental health and infrequent visits made to dental health professionals in certain localities. Dental conditions are a leading cause of Ambulatory Care Sensitive Conditions (ACSCs). A substantial proportion of the population is overweight or obese. This has implications for the development and management of a range of health Data on people aged 65 years or over as a percentage of the population was obtained from the ABS 2011 Census of Population and Housing. Population projections were sourced from the National Aged Care Data Clearing House (NACDC): Population projections, 2012 (base) to 2027 for all states and territories at the Statistical Area Level 2 (SA2) by sex and age (customised projections prepared for the Australian Government Department of Social Services by the ABS). As the population ages it might be expected that health conditions often associated with ageing (e.g. dementia and cancer) will become more common and demand for certain health services will increase (AIHW 2014. Australia s Health 2014. Australia s health series No. 14. Cat. No. AU 178. Canberra: AIHW). VPHS 2011-12 (e.g. self-rated dental health and time since last visit to a dental professional) and 2011-12, 2012-13, and 2013-14 ACSC reports from the Victorian Health Information Surveillance System (VHISS). 2011-12 ABS AHS (Core component), VPHS 2011-12, and the 2012-13 ABS Australian Aboriginal and Torres Strait Islander Health Survey (Core component). The prevalence of overweight/obese persons was also identified as a key health
Outcomes of the health needs analysis Cancer screening Colorectal and prostate cancer conditions. Screening rates for bowel, breast, and cervical cancer in the Western Victoria PHN region as a whole exceeded national rates in 2013-14. However, available data for smaller areas shows that screening rates (by location and cancer) vary markedly across the Western Victoria PHN region. High incidence of colorectal and prostate cancers relative to most PHNs and the national incidence issue in the service provider consultations. Australian Institute of Health and Welfare (AIHW) analysis of the Australian Cancer Database 2011 and data from the National Bowel Cancer Screening Program Register (as at 30 June 2015), BreastScreen Australia, and AIHW analysis of state and territory cervical screening register data for screening programs carried out in 2013 and 2014. This data is provided at the PHN level. Local-level data for cervical screening rates for the same period (Victorian Cervical Cytology Registry Statistical Report 2014) and bowel (compiled by PHIDU based on data provided by the Department of Health from the National Bowel Cancer Screening Program, 2011/12) 1 and breast cancer screening data (compiled by PHIDU based on data from BreastScreen Victoria [2010/11] and the average of the ABS ERP, 30 June 2010 and 30 June 2011) from earlier periods show that screening rates vary markedly across localities within the Western Victoria PHN region. AIHW Australian Cancer Database (2011). It should be noted that the data pertains to the period 2005 to 2009 inclusive. 1 The PHIDU notes that the Department of Health is the original source of data on the National Bowel Cancer Screening Program (NBCSP) and that: 1. Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health. NBCSP data included in this report provided by the Department of Health is not part of the formal publication and reporting process for NBCSP data. 2. Cautionary note about small numbers - Due to a larger degree of statistical fluctuation in small numbers, great care should be taken when assessing apparent differences involving small numbers and measures based on small numbers.
Outcomes of the health needs analysis rate. Mental health Aboriginal and Torres Strait Islander health Prevalence of mental health conditions in a number of local areas. A large proportion of Aboriginal and Torres Strait Islander people in the Western Victoria PHN region report having at least one long-term health condition. VPHS 2011-12 (e.g. lifetime prevalence of depression and anxiety) and data compiled by PHIDU based on modelled estimates from the 2011 13 Australian Health Survey, ABS (unpublished); and the average of the ABS ERP, 30 June 2011 and 30 June 2012, based on the Australian standard. The prevalence of mental health conditions was also a common issue raised in the service provider consultations. 2012-13 ABS Australian Aboriginal and Torres Strait Islander Health Survey (NATSIHS components). The same survey (Core component) indicates a considerable proportion of Aboriginal and Torres Strait Islander people within the Western Victoria PHN region have poor or fair self-rated health. Aboriginal and Torres Strait Islander health (2) Aboriginal and Torres Strait Islander health (3) High prevalence of smoking amongst Aboriginal and Torres Strait Islander people in the Western Victoria PHN region. Aboriginal and Torres Strait Islander people and/or households with Indigenous person(s) fare poorly on For the Aboriginal and Torres Strait Islander population there is limited local-level health data available. Due to small numbers there are often issues with data quality or data is suppressed in accordance with data quality frameworks. 2012-13 ABS Australian Aboriginal and Torres Strait Islander Health Survey (Core component). Relevant data was sourced primarily from the ABS 2011 Census of Population and Housing (e.g. unemployment rates and
Outcomes of the health needs analysis Childhood immunisation rates HPV immunisation rates a number of indicators related to the social determinants of health. Immunisation rates have consistently or occasionally been below the national rate in a small number of Statistical Area Level 3 (SA3) regions in recent years. HPV immunisation rates in certain regions are below the Victorian rate. household income). There is considerable variation in indicators related to the social determinants of health across localities and regions (such as Indigenous Areas) within the Western Victoria PHN catchment (ABS 2011 Census of Population and Housing and Centre for Aboriginal Economic Policy Research 2011 Indigenous Relative Socioeconomic Outcomes [IRSEO] index data). NHPA analysis of Department of Human Services Australian Childhood Immunisation Register statistics for 2012-13, 2013-14 and 2014-15. NHPA analysis of data from the National HPV Vaccination Program Register (2013). Health literacy Low health literacy within the general population. The issue of health literacy was a prominent theme in the service provider consultations. For example, there were concerns some community members may have limited understanding of positive health behaviours and experience difficulties navigating the healthcare system. Persons with a disability High prevalence of disability in a number of localities. Data on people with a severe or profound disability compiled by PHIDU based on unpublished data from the ABS 2011 Census of Population and Housing. Information on Disability Support Pension recipients at the SA2 level sourced from Department of Social Services Payment Demographic Data reports.
Section 3 Outcomes of the service needs analysis This section summarises the findings of the service needs analysis in the table below. For more information refer to Table 2 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Outcomes of the service needs analysis Chronic conditions Communication and service coordination Health literacy Access to services to support health consumers with chronic conditions. Current communication practices do not always support optimal service coordination. Health providers and consumers may have limited knowledge of the health services available in their communities and how to access them. (Proxy) evidence of scope to improve access to primary health care for persons with chronic conditions: 2013-14 Ambulatory Care Sensitive Conditions (ACSC) Victorian Health Information Surveillance System (VHISS) reports and National Health Performance Authority (NHPA) analysis of Admitted Patient Care National Minimum Data Set 2013-14 and Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) 30 June 2013. (Proxy) evidence of coordination issues obtained from 2013-14 ACSC (VHISS) reports and NHPA analysis of Admitted Patient Care National Minimum Data Set 2013 14 and ABS ERP 30 June 2013. Evidence of issues with service coordination and communication practices between service providers was also obtained through service provider consultations. Particular issues included the provision of discharge summaries through to providers having limited knowledge of the full complement of health services available in their communities. This was a prominent theme in the service provider consultations. Digital health Service providers identified a number of barriers to the This issue was a prominent theme in the service provider consultations. Particular barriers to the implementation of digital
Outcomes of the service needs analysis General Practitioner workforce Specialist workforce Ageing health workforce in certain disciplines and locations Attracting and retaining health professionals Transportation implementation and use of digital health systems. There is an uneven distribution of General Practitioners (GPs) in the Western Victoria PHN region. There is a shortage of specialists in a range of disciplines (e.g. anaesthetics, diagnostic radiology, psychiatry, and obstetrics and gynaecology) in most areas outside of Ballarat and Geelong. In certain localities and professional disciplines the health workforce is ageing. Health providers have reported difficulties recruiting and retaining health professionals in a range of disciplines (e.g. physiotherapy and podiatry). Access to health services is often hindered due to limited public and private transport options. health systems included financial costs and issues with software compatibility. Department of Health District of Workforce Shortage (DWS) data (2016 update) and AIHW National Health Workforce Data Set (NHWDS) (2014). The latter reveals a wide divergence in the number of full-time-equivalent GPs on a per capita basis across Statistical Area Level 3 (SA3) regions in the Western Victoria PHN. The shortage of GPs in certain localities was confirmed via service provider consultations. Department of Health DWS data (2016 update). Data from the AIHW NHWDS (2014) indicates specialist medical practitioners (as a collective) are distributed unevenly across the Western Victoria PHN region. AIHW NHWDS (2014) (proportion of practitioners aged 55 years and over) and service provider consultations. Of particular concern are the number of GPs aged 55 years and over in most SA3s within the Western Victoria PHN. Challenges associated with the recruitment and retention of staff in certain disciplines and localities were evident in the service provider consultations. Issues with transportation were a prominent concern in the service provider consultations. Transport is a particular issue in rural communities when residents need to access health services in the larger regional centres. Data which lends support to these concerns was sourced from the Victorian Department of Health 2013 Local government area profiles (based on data prepared by the Modelling, GIS and Planning Products Unit using ArcGIS, data from the ABS 2012 ERP, and 2013 transport location data from
Outcomes of the service needs analysis Access to dental care Aged care Aged care (2) Cultural safety and security Alcohol and other drug services The Western Victoria PHN region has fewer dentists on a full-time-equivalent per capita basis than Victoria and Australia and a pattern of uneven distribution similar to that seen with the General Practitioner workforce. Access to affordable dental care in specific localities was identified as an issue in the service provider consultations. Access to residential aged care and home care packages is limited in some localities. There is a need to model the impact of an ageing population upon the primary health care system. There is a need to ensure that health services are culturally safe and secure. Limited access to alcohol and other drug services is an issue in certain localities. the then Department of Transport) and the ABS 2011 Census of Population and Housing (dwellings without a motor vehicle). AIHW NHWDS (2014); VPHS 2011-12 (avoided or delayed visiting a dental professional due to cost); and service provider consultations. Data on residential aged care and home care packages from the Department of Health (unpublished) Aged Care Data Warehouse. The issue of access to home care and residential aged care services in particular localities was also raised by service providers. This need is grounded in population projections for older persons from the National Aged Care Data Clearing House (NACDC): Population projections, 2012 (base) to 2027 for all states and territories at Statistical Area Level 2 (SA2) by sex and age (customised projections prepared for the Australian Government Department of Social Services by the ABS) and the knowledge that health conditions often associated with ageing (e.g. arthritis and cancer) are likely to become more prevalent as the population ages (AIHW 2014. Australia s Health 2014. Australia s health series No. 14. Cat. No. AU 178. Canberra: AIHW). Service provider consultations. Service provider consultations.
Outcomes of the service needs analysis Mental health Access to GP services (including the after-hours period) Aboriginal and Torres Strait Islander health Persons with unmet need for formal assistance There is limited access to certain mental health services in specific localities. There is evidence of limited access to GP services. This includes access to after-hours services in particular localities. We have limited insight into health service gaps for the Aboriginal and Torres Strait Islander population. Access to GP services were identified as a service gap by the majority of ACCHOs in Western Victoria PHN. There is a high proportion of unmet need for formal assistance for persons with a disability in the 50-64 years age group and amongst persons aged 65 years and over regardless of their disability status in a number of SA3s. Gaps in service provision were identified through service provider consultations. Specific examples include dementia services and outreach mental health services in the Barwon region. Evidence of scope to improve access to GP services obtained from the ABS 2013-14 PES (e.g. the proportion of persons who needed to see a GP after hours but didn t in the last 12 months and items concerning the time people waited to see a GP for urgent care) and NHPA analysis of the ABS 2013-14 PES. Limited after-hours access in certain localities was highlighted as an issue in the service provider consultations. Consultations with the eight ACCHOs in Western Victoria PHN. Other gaps identified included chronic disease management and maternity services. ABS Survey of Disability, Ageing and Carers 2012.