Health in Focus Report 2017

Health in Focus Report 2017

1 Contents Introduction and Background... 3 Respondents... 4 Geographical Distribution... 4 General Practitioners... 5 Demographics... 5 National Disability Insurance Scheme (NDIS): Knowledge... 6 Referrals... 8 GP referral knowledge... 8 Transfer of Care Documents... 9 Public Health Alerts... 10 ehealth Adoption (My Health Record)... 10 Telehealth Use... 10 Sponsor Spotlight: Focus on Digital Health... 11 After Hours Care... 12 Health Service Directories... 12 The One Big Idea... 13 Allied Health... 14 Demographics... 14 National Disability Insurance Scheme (NDIS)... 15 Knowledge... 15 Knowledge about becoming a provider... 15 ehealth Utilisation (My Health Record)... 16 Telehealth Use... 16 Sponsor Spotlight: Focus on Digital Health... 17 Satisfaction with GP referrals... 17 Sending electronic medical reports to GPs... 18 The One Big Idea... 19 Nurses... 20 Demographics... 20 National Disability Insurance Scheme (NDIS) Knowledge... 21 Prevention... 21

2 Sponsor spotlight... 22 Health Service Directories... 22 Telehealth Use... 23 The One Big Idea... 24 Practice/Service Manager... 25 Demographics... 25 National Disability Insurance Scheme (NDIS): Knowledge... 26 Clinical Software Use... 26 Secure Messaging Use... 27 ehealth knowledge (My Health Record)... 27 Health Service Directories... 28 The One Big Idea... 28 Medical Specialists... 30 Demographics... 30 National Disability Insurance Scheme: Knowledge... 30 The One Big Idea... 32 General Public... 33 Demographics... 33 Health Status (self-reported)... 34 Telehealth Consultations... 34 National Disability Insurance Scheme (NDIS): Knowledge... 35 People with a disability and the NDIS... 35 Prevention... 36 ehealth Adoption (My Health Record)... 36 Engagement with the health care system... 37 Confidence in health providers... 38 Barriers to Accessing Health Care... 38 The One Big Idea... 39

3 Introduction and Background The annual CheckUP survey, Health in Focus, aims to investigate issues faced by primary health care practitioners and the general public in Queensland focusing on a range of topics including workforce models, care coordination, preventative health, digital health and interface between different sectors. CheckUP uses the results of the survey to: inform discussions with stakeholders. inform internal planning. identify areas of need. identify and celebrate initiatives that have been successful. increase the profile of primary health care in Queensland. The survey began in 2009 to gather information from General Practitioners (GPs). Over the years the focus has been broadened to include other health professionals and the general public. Bringing information from these different stakeholders together has enabled CheckUP to continue to collate longitudinal data while seeking new information to inform improvements in primary health care across the state. The table below outlines the evolution of CheckUP s annual survey over the past nine years. 2009 GP Census 2010 GP Census 2011 GP Census 2012 CheckUP Census 2013 CheckUP Census 2014 Health in Focus 2015 Health in Focus 2016 Health in Focus 2017 Health in Focus GPs Practice Managers Allied Health Practice Nurses Medical Specialists General Public Responses 1636 1630 1177 949 1171 1160 1316 1137 1328 In 2017, CheckUP invited Health in Focus sponsors from the health sector to contribute survey questions. The information gathered through these questions is incorporated into this report and featured in sponsor spotlights.

4 Respondents In 2017, the Health in Focus survey received 1,328 responses comprised of 69% from the general public with the remaining 31% from health professionals across five categories. Allied Health Professional 13% 2% General Practitioner 7% Nurse 69% 7% 2% Practice Manager/Service Manager Medical Specialist Member of the public Geographical Distribution = Health Professionals 21 1 = General Public 2 37 11 8 37 21 21 8 16 18 2 11 17 13 18 45 25 25 401 144 60 27 52 52

5 General Practitioners Demographics Most common age groups 35-44 29% 55-64 26% Qualification obtained 71% 61% 39% Average years as a GP 19 29% Sessions worked 75% worked an average of 8 or more sessions per week Plan on changing sessions worked 6% 29% 55% 10% No change Decrease sessions Increase sessions Leaving General Practice Health in Focus 2017 General Practitioners

6 National Disability Insurance Scheme (NDIS): Knowledge The percentage of GPs reporting moderate to high levels if knowledge about the NDIS since 2013 has continued to increase. 36% 41% 25% 16% 9% 2013 2014 2015 2016 2017 Sponsor spotlight Most common neurodegenerative conditions identified by GPs and practice nurses 1. Parkinson s 2. Restless leg Syndrome 3. Essential Tremor *Question supplied by Parkinson s Queensland Health in Focus 2017 General Practitioners

7 Prevention GPs who offer routine prevention or lifestyle advice to patients 97% Preventative areas most commonly targeted by GPs: 97% smoking 86% alcohol /drugs 90% overweight/ obesity 86% physical activity 97% immunisation 70% diet/ nutrition 80% mental health 63% maternal health 70% Sexual health 76% Contraception Sponsor spotlights Most popular structured lifestyle modification programs GPs refer patients to: 63% 20% 17% *Question supplied by the Heart Foundation GPs recognised the value of Motivational Interviewing in helping patients make positive change to improve their health 33% had undertaken training in Motivational Interviewing 61% were interested to do so *Question supplied by Veriti Health in Focus 2017 General Practitioners

8 Referrals Perceived change in waiting times for patients to see a medical specialist at public hospital out-patient clinics. The percentage of GPs indicating longer waiting time has continued to decline 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 47% 47% 44% 43% 46% 40% 33% 31% 20% 10% 7% 4% 2014 2015 2016 2017 Shorter waiting times Longer waiting times No change 69% of GPs send referrals to public hospitals electronically some of the time and/or all the time GP referral knowledge 83% had good pre-referral knowledge (where to send referrals and relevant guidelines) 90% had good referral knowledge (including clinical information required) 54% had good post-referral knowledge (waiting times and managing patients while waiting) Sponsor spotlight 97% of GPs reported moderate to high knowledge of reproductive and sexual health 60% of GPs had undertaken specific training in reproductive and sexual health Health in Focus 2017 General Practitioners

9 Transfer of Care Documents The percentage of GPs that receive transfer of care documents from public hospitals remains steady. The decline in 2015 may have been attributed to a sampling issue. 93% 93% 93% 83% 86% 73% 2012 2013 2014 2015 2016 2017 GPs were asked to rate their satisfaction with transfer of care documents on a 5-point Likert scale. GPs were most satisfied with the clinical relevance (mean = 3.19) and comprehensive (mean = 2.93) of transfer of care documents. Health in Focus 2017 General Practitioners

10 Public Health Alerts 45% of GPs recall receiving Queensland Health s Public Health Alerts from CheckUP 93% were satisfied or very satisfied with the information contained in the Public Health Alerts ehealth Adoption (My Health Record) In 2017, the number of GPs using My Health Record continues to increase with 80% reporting participation and further 7% indicating participation in the future. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2012 2013 2014 2015 2016 2017 MHR participation now MHR participation in the future Telehealth Use More than half of the GPs (55%) surveyed indicated that they had undertaken a telehealth consultation in the past 12 months. 55% 41% 36% 34% 42% 31% 2012 2013 2014 2015 2016 2017 Health in Focus 2017 General Practitioners

11 Telehealth Challenges Most common challenges GPs face when delivering healthcare via telehealth 61% organisational capacity and processes 58% IT functions and systems 42% funding models Sponsor Spotlight: Focus on Digital Health GPs were asked how important it was for them to learn about how digital health could help with general practice 50% very important 40% somewhat important 10% not important Digital health topics most GPs want to know more about: 55% Patient Portals *Questions supplied by HISA 52% Wearables technology 52% Interoperability (exchange of information between systems) 45% Telehealth 45% Data analytics Health in Focus 2017 General Practitioners

12 After Hours Care Most GPs provide direct or indirect access to after-hours care. 16% 84% Yes, provide after-hours care or use an external after-hours service No, do not provide after-hours care Health Service Directories There has been a steady increase in the number of GPs reporting the use of health service directories, in particular Health Engine. 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 39% 24% 15% 21% 16% 13% 10% 13% 10% 4% 3% 4% 2013 2014 2015 2016 2017 Health Engine My Community Directory/CheckUp diary National Health Services Directory Health in Focus 2017 General Practitioners

13 The One Big Idea GPs were asked to identify in free text their one big idea for a needed change that will improve the health system for providers or patients. The three most common themes were: Better Integration and Communication supported by digital health This was the most popular theme with GPs highlighting the need for better shared patient information through electronic health records and more information on wait times. Workforce improvements GPs highlighted the need for education and training as well as better use of allied health staff. Improve access to specialists Including new ways to manage wait lists for medicine specialties. Health in Focus 2017 General Practitioners

14 Allied Health Demographics Most common age groups 45-54 21% 35-44 27% 23% 77% Average years experience 16 Work status 79% of allied health professionals surveyed belong to a professional association 28% 72% Part-time Full-time Plan on changing work capacity 5% 5% 17% 72% No change Increase sessions Decrease sessions Leaving Health in Focus 2017 Allied Health Professionals

15 National Disability Insurance Scheme (NDIS) Allied health providers are becoming better informed about the NDIS. Knowledge The percentage of allied health professionals reporting moderate to high levels of knowledge about the NDIS since 2013 has continued to increase. 57% 41% 45% 32% 19% 2013 2014 2015 2016 2017 Knowledge about becoming a provider The percentage of allied health professionals reporting moderate to high knowledge about becoming an NDIS provider has continued to increase. 56% 33% 14% 19% 2014 2015 2016 2017 Health in Focus 2017 Allied Health Professionals

16 ehealth Utilisation (My Health Record) The adoption of My Health Record has increased, and more allied health professionals anticipate adoption in the future. 35% 30% 30% 28% 33% 25% 20% 15% 20% 20% 19% 15% 10% 5% 5% 6% 9% 6% 0% 2012 2013 2014 2015 2016 2017 MHR participation now MHR participation in the future Telehealth Use The rate of telehealth use amongst allied health professionals remains steady. 31% 30% 25% 17% 20% 12% 2012 2013 2014 2015 2016 2017 Health in Focus 2017 Allied Health Professionals

17 Sponsor Spotlight: Focus on Digital Health Allied health professionals were asked how important it was for them to learn about how digital health could help them provide care 50% very important 38% somewhat important 9% haven t given it much thought 3% not important Digital health topics most allied health professionals want to know more about: 60% Telehealth 50% Patient Portals 31% Wearables technology 31% Data analytics *Questions supplied by HISA Health in Focus 2017 Allied Health Professionals

18 Satisfaction with GP referrals The mean satisfaction (Likert scale) for appropriateness and comprehensiveness of referrals received from GPs to allied health professionals has remained relatively consistent over the past few years. 4.5 4.2 4 3.5 3 3.6 3.1 3.5 3 3.8 3.8 3.4 3.2 3.5 3.8 3.3 2.5 2 2012 2013 2014 2015 2016 2017 Appropriateness Comprehensiveness Sending electronic medical reports to GPs There has been a significant increase in the percentage of allied health professionals sending medical reports back to GPs electronically. 100% 90% 92% 80% 70% 60% 50% 49% 57% 66% 56% 40% 30% 20% 32% 2012 2013 2014 2015 2016 2017 Health in Focus 2017 Allied Health Professionals

19 The One Big Idea Allied health professionals were asked to identify in free text their one big idea for a needed change that will improve the health system for providers or patients. The three most common themes were: Better Integration and Communication supported by digital health This was the most popular theme with Allied health providers highlighting the need for shared patient information and integrated referral processes and systems Better use of the allied health workforce.with capacity boosted through education and training Improve funding allocation h h Increase flexibility of funding models including Medicare funded telehealth sessions Health in Focus 2017 Allied Health Professionals

20 Nurses Demographics 2% 98% Most common age groups 45-54 29% 55-64 34% Average years experience Qualification obtained 92% 8% Nurse type Registered 89% Enrolled 9% Nurse Practitioner 2% 16 Work status Part-time 33% Full-time 67% Plan on changing work capacity 3% 9% 10% 77% No change Increase Decrease Leaving Health in Focus 2017 Nurses

21 National Disability Insurance Scheme (NDIS) Knowledge Nurses are becoming significantly better informed about the NDIS. The percentage of nurses reporting moderate to high levels if knowledge about the NDIS since 2014 has continued to increase. 50% 23% 29% 17% 13% 2013 2014 2015 2016 2017 Prevention Nurses have reported more involvement in preventative health. 95% of Nurses routinely offer prevention or lifestyle advice to patients. Preventative areas most commonly targeted by nurses: 62% diet/ nutrition 63% smoking 60% physical activity 57% overweight/ obesity 51% alcohol /drugs 60% immunisation 51% mental health 46% Falls Health in Focus 2017 Nurses

22 Sponsor spotlight Most popular structured lifestyle modification programs Nurses referred patients to 61% 26% 19% *Question supplied by Heart Foundation Health Service Directories There has been no significant change over the past four years in the percentage of nurses reporting the use of Health Engine, or the National Health Services Directory. Use of My Community Directory/ CheckUP Diary has also remained steady since first asked about in 2016. 30% 25% 21% 24% 20% 17% 16% 18% 16% 18% 15% 13% 12% 12% 10% 10% 5% 0% 2013 2014 2015 2016 2017 Health Engine National Health Services Directory My Community Directory/CheckUP diary

23 Telehealth Use The percentage of nurses reporting participation in telehealth consultations decreased slightly in 2017. 65% 47% 52% 34% 2014 2015 2016 2017 Health in Focus 2017 Nurses

24 The One Big Idea Nurses were asked to identify in free text their one big idea for a needed change that will improve the health system for providers or patients. The three most common themes were: Better Integration and Communication supported by digital health Nurses identified the need to share patient information and improve service delivery through streamlined communication and use of digital heath systems such as telehealth Better use of the nursing workforce.with capacity boosted through education and training. Many suggested a bigger role for nurses including providing chronic disease management services and nurse led clinics Funding models that focus on prevention and long wait areas Including special programs for chronic conditions and partnerships with the private sector Health in Focus 2017 Nurses

25 Practice/Service Manager Demographics 11% 89% Most common age groups 45-54 42% 55-64 24% Work status 79% 21% Highest Qualification 20% 6% 39% 36% Part-time Full-time Diploma/Advanced Diploma Degree/Post Graduate High School Other Health in Focus 2017 Practice/Service Manager

26 National Disability Insurance Scheme (NDIS): Knowledge Practice/Service Managers are becoming better informed about the NDIS. The percentage of practice/service managers reporting moderate to high levels if knowledge about the NDIS since 2014 has continued to increase each year with now over half reporting moderate to high knowledge. 56% 21% 30% 39% 2014 2015 2016 2017 Clinical Software Use Best Practice and Medical Director 3 continue to be the most used clinical software in practices. However, 37% reported using a range of other software programs. 60% 50% 40% 30% 20% 53% 17% 52% 23% 46% 31% 37% 30% 39% 35% 27% 40% 37% 23% 31% 28% 10% 0% 2010 2011 2012 2013 2014 2015 2016 2017 Best Practice Medical Director 3 Health in Focus 2017 Practice/Service Manager

27 Secure Messaging Use In 2017, 94% of services reported having a secure electronic software package installed. The adoption of secure electronic messaging has remained high over the past 6 years. 90% 87% 91% 78% 85% 94% 2012 2013 2014 2015 2016 2017 ehealth knowledge (My Health Record) In 2017, practice/service managers continued to feel well informed about My Health Record. The trend line from 2012 shows an overall increase in knowledge over the last six years with a slight decline in 2015 which could be attributed to a sampling issue. 69% 69% 64% 53% 42% 43% 2012 2013 2014 2015 2016 2017 Health in Focus 2017 Practice/Service Manager

28 Health Service Directories The National Health Services Directory and Health Engine have been the most commonly used health service directories by practice/service managers over the past five years with use of My Community Directory/CheckUP Diary continuing to grow since first asked about in 2016. 50% 45% 43% 42% 40% 38% 42% 42% 35% 30% 25% 20% 30% 25% 23% 17% 32% 25% 28% 15% 10% 5% 0% N/A N/A N/A 2013 2014 2015 2016 2017 Health Engine My Community Directory/CheckUP diary National Health Services Directory Health in Focus 2017 Practice/Service Manager

29 The One Big Idea Practice/service managers were asked to identify in free text their one big idea for a needed change that will improve the health system for providers or patients. The three most common themes were: Better Integration and Communication supported by digital health Managers expressed a need for effective integration of services with streamline communication that interfaces with all clinical software Better allocation of funding Many managers identified the need for increased funding for disadvantaged areas and more flexible funding to include additional nursing and allied health support Improve access to services Manages highlighted the need for new service delivery models to support culturally appropriate care and address areas of need such as mental health Health in Focus 2017 Practice/Service Manager

30 Medical Specialists Demographics 81% 19% Most common age groups 35-44 24% 45-54 38% 65+ 24% Average years in current speciality 16 National Disability Insurance Scheme: Knowledge The percentage of specialists reporting moderate to high levels if knowledge about the NDIS this year has decreased, which could be attributed to a sampling issue. 33% 36% 25% 17% 20% 2013 2014 2015 2016 2017 Health in Focus 2017 Medical Specialist

31 Telehealth Use The percentage of specialists reporting participation in telehealth consultations since 2014 has remained steady. 48% 50% 59% 55% 2014 2015 2016 2017 Secure Electronic Messaging The percentage of specialists using secure electronic messaging has increased by 40% since 2013. 79% 64% 56% 52% 39% 2013 2014 2016 2016 2017 Health in Focus 2017 Medical Specialist

32 Satisfaction with GP referrals The percentage of specialists reporting satisfaction with the comprehensiveness of GP referrals has increased. 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 76% 70% 72% 55% 62% 56% 45% 33% 2013 2014 2015 2016 Appropriateness Comprehensiveness The One Big Idea Specialists were asked to identify in free text their one big idea for a needed change that will improve the health system for providers or patients. The three most common themes were: Better Integration and Communication supported by digital health Specialists highlighted the need for shared patient information and improved communication with primary health providers. Less administration and bureaucracy Specialists identified the need for less administrative requirements and bureaucracy in the delivery of effective healthcare. Improve access to specialist services in rural areas Ideas included rural visiting specialist hubs and more resources for areas of need Health in Focus 2017 Medical Specialist

33 General Public Demographics 24% 76% Age distribution 65+ years, 26.0% 0-34 years, 18.1% 35-44 years, 18.3% 55-64 years, 16.7% 45-54 years, 20.7% 6% of the general public identified as Aboriginal and/or Torres Strait Islander. 11% of the general public indicated they have a disability. Health in Focus 2017 General Public

34 Health Status (self-reported) The self-related health status of respondents has remained consistent over the past four years with three-quarters rating their health as good or very good in 2017. 90% 80% 74% 77% 75% 75% 70% 60% 50% 40% 30% 20% 10% 7% 6% 5% 5% 19% 17% 20% 20% 0% Poor or Very Poor Fair Good or Very Good 2014 2015 2016 2017 Telehealth Consultations Support for telehealth is strong with 7% of respondents reporting participation in a consultation and a further 79% indicating willingness to participate. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4% 79% 73% 74% 75% 13% 7% 7% 2014 2015 2016 2017 Telehealth participation Willingness to participate Health in Focus 2017 General Public

35 National Disability Insurance Scheme (NDIS): Knowledge The general public have reported an increase in their level of knowledge about the National Disability Insurance Scheme since 2015. 80% 70% 60% 69% 69% 67% 60% 50% 40% 30% 31% 31% 33% 40% 20% 10% 0% 2014 2015 2016 2017 Little/no knowledge Moderate/high knowledge People with a disability and the NDIS Of the 11% of respondents who indicated they had a disability: 65% knew where to find information about the NDIS 36% knew how to find information about their eligibility 30% knew when the NDIS would commence in their region 15% had attended information sessions about the NDIS 16% knew what the NDIS will provide for them While most people with a disability knew where to find information about the NDIS the level of knowledge on detail is still quite low, particularly in relation to exactly what the NDIS will provide for them. Health in Focus 2017 General Public

36 Prevention Visiting a health service: 64% of the general public visit a health service for preventative health 36% visit a health service only when they are unwell Only visit when unwell, 36% Visit for preventative health checks and screening, 64% ehealth Adoption (My Health Record) General public support for and/or adoption of the My Health Record continues to increase with just over two-thirds now supporting and/or adopting a My Health Record. 80% 70% 60% 57% 63% 67% 69% 50% 40% 30% 20% 10% 32% 27% 24% 22% 11% 10% 9% 9% 0% 2014 2015 2016 2017 Yes, already have one or will in the future Unsure No Health in Focus 2017 General Public

37 Engagement with the health care system The general public were asked to rate their level of agreement with a range of statements relating to engagement with the health system. Over 80% of people agreed or strongly agreed with the following: Can rely on at leave one healthcare provider to understand and support them Can easily find and understand health information Involved in decision-making about their health Can easily work out which type of healthcare provide they need to see Compared with 2016, there has been a 9% increase in the number of people indicating they would be comfortable allowing their health data to be stored on a mobile phone application. 92% 82% 82% 82% 60% Rely on at least one healthcare provider Find and understand health information Involved in decisionmaking Can select the right provider Comfortable using a mobile phone app Health in Focus 2017 General Public

38 Confidence in health providers Confidence levels for health providers is overall very high, particularly for an individual s regular GP and specialists. % Rated Reasonably and Very Confident 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 89% 87% 85% 86% 78% 47% Specialists GPs (regular) Pharmacists Allied Health Nurses GPs (Locum) Barriers to Accessing Health Care The general public identified a number of key barriers to accessing health services in their local area. Cost Waiting times Distance particularly for those in a rural or remote areas Access to specialists particularly for those in rural and remote areas Health in Focus 2017 General Public

39 The One Big Idea The general public were asked to identify in free text their one big idea for a needed change that will improve health services to meet health care needs. The most common themes with example quotes were: Better Integration and Communication supported by digital health An online system like "My Health Record" could really streamline healthcare so that no matter which doctor, specialist or hospital you go to the information is readily available. I have multiple illnesses and need to see various medical professionals. It would be ideal if they could all see my health record and communicate with each other on the best care for me. Reduce the cost of health care Bulk billing for ongoing health issues. Or a call and collect for update of scripts. Reduce costs for routine/preventative visits Improve access to specialist services particularly in rural areas more coordinated visiting specialist services like the heart bus, but with other specialists Greater focus on preventative health make preventative health checks cheaper/bulk billed for everyone more investment in preventative health measures in primary care More focus on preventive health - asking me the hard questions about diet, physical activity, alcohol intake, mental health, etc. Measuring height, weight and waist circumference Improve access to appointments less travel and waiting More appointment times - I work during the day and cannot get to doctor even when I feel unwell Encourage doctors to practice in outer suburbs and country areas. I live 35KMs from Brisbane and it s hard to get an appointment more video consultations (not just specialist telehealth session) should be available for people living in rural and remote locations Health in Focus 2017 General Public

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41 CheckUP would like to thank our 2017 Health in Focus sponsors: General Practice Queensland Ltd. ABN 56 123 426 111 trading as CheckUP Australia Level 2 / 55 Russell Street (Cnr Edmondstone Street) South Brisbane Q 4101 07 3105 8300 info@checkup.org.au www.checkup.org.au