Needs assessment reporting template - Northern Territory PHN · 2018-09-26 · Department of Health Primary Health Networks Needs Assessment Northern Territory PHN - 30 March 2016

Department of Health Primary Health Networks Needs Assessment

Northern Territory PHN - 30 March 2016

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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

Northern Territory Primary Health Network

When submitting this Needs Assessment Report to the Department of Health, the

PHN must ensure that all internal clearances have been obtained and the Report

has been endorsed by the CEO.



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Section 1 – Narrative All references to Aboriginal people within this document include Aboriginal and Torres Strait Islander peoples.

This Baseline Needs Assessment includes identification of needs relating to mental health, suicide prevention and drugs and alcohol treatment. For a more comprehensive overview of these areas, refer to Attachments B and C. Attached to this document are:

A. Mental Health and Suicide Prevention Needs Assessment Reports

B. Drugs and Alcohol Treatment Needs Assessment Reports

C. After Hours Needs Assessment Summary

Needs Assessment process and issues

Summary of the process undertaken

The Needs Assessment was compiled by the Menzies School of Health Research in close

collaboration with Northern Territory PHN (NT PHN); an Advisory Committee consisting of key

stakeholders; and NT PHN’s Board. A desktop audit utilising existing data was completed, with

an emphasis on the key priority areas and gaps. Input was invited from the Northern Territory

Government (NTG) Department of Health, the Top End Health Service (TEHS), the Central

Australia Health Service (CAHS), Aboriginal Medical Services Alliance of the Northern Territory

(AMSANT) and NT PHN’s Associate Members. Input was also drawn from the Priorities for

Aboriginal Primary Health Care in the Northern Territory (AMSANT 2016).1 Whilst limited given

timeframes, additional consultation and input with general practitioners, dentists,

pharmacists and allied health professionals occurred via consultations undertaken through NT

PHN. Consumers and community consultation took place through NT PHN’s Community

Advisory Council. A draft Needs Assessment Report was reviewed by the Advisory Committee

and NT PHN’s Board, prior to the report being finalised. Priorities were informed by the

Advisory Committee and NT PHN’s Board, prior to CEO approval.

Expand on any issues that may not be fully captured in the reporting tables

NT PHN covers the entire Northern Territory (NT) geographic area. The NT’s demographic

breakdown has a number of key differences to that of Australia as a whole. Approximately

one-third of the NT’s population is Aboriginal, compared to 3 per cent nationally (ABS, 2013)2.

The age and sex distribution of the NT’s Aboriginal population is very different to the non-

Aboriginal population. Aboriginal people in the NT have a higher birth rate, and lower life

expectancy. Half of the NT’s Aboriginal population are aged less than 25 years.

NT-wide data does not always reflect the challenges posed by remoteness, the plethora of

small, isolated communities, the very different demographics of the Aboriginal and non-

Aboriginal populations, and differences in urban versus the rural and remote areas.

1 Aboriginal Medical Services Alliance NT (AMSANT) 2016, Priorities for Aboriginal Primary Health Care in the Northern Territory

(February), AMSANT, Darwin. 2 Australian Bureau of Statistics (ABS) 2013, Estimates of Aboriginal and Torres Strait Islander Australians, 3238.0.55.001 - June

2011, ABS, Canberra.



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There are a number of issues not fully captured by the reporting tables within this template.

This includes:

1) The NT experiences extremely high rates of health workforce turnover and vacancies,

particularly in regional and remote areas, and there are many unfilled Aboriginal and Torres

Strait Islander Health Practitioner (AHP) positions.

2) Compared with other Australian jurisdictions, the NT has a much smaller private health

sector.

3) A significant component of the workforce, especially the social and emotional wellbeing

and the alcohol and other drugs workforce is made up of unregistered, community-based

workers.

4) Many people, particularly in remote areas, see an AHP and/or a nurse/midwife, hence

service utilisation is under reported in Medicare Benefits Schedule (MBS) data.

5) A significant proportion of primary health care services are provided by Aboriginal

Community Controlled Health Services (ACCHS), government primary health care centres and

private general practices which may affect representations across other data sources.3

In particular, the reporting tables do not capture the impact of remoteness in the NT. The

Accessibility Remoteness Index of Australia classifies the majority of the NT as Very Remote,

apart from Darwin (which is classified as Outer Regional) and Alice Springs (classified as

Remote). More than half of the NT’s Aboriginal population (58.3 per cent) live in Very Remote

regions, and only one fifth (20.3 per cent) in the outer regional hubs. The health needs of the

Aboriginal population are such that it has been integrated into every priority area in this

document.

Transience is common in the NT, where interstate arrival and departure flows represent 7.5

per cent and 7.2 per cent of the population respectively ABS Australian Health Survey 2012.4

Unique access challenges, including issues with continuity of care and adequate

transportation need to be constantly addressed.

Areas where further developmental work may be required

Further developmental work may be required in order to assess primary health care needs

where reliable data is not available, and/or community consultation has been limited. For

example, there is limited understanding of the needs of the lesbian, gay, bi-sexual,

transgender, queer and intersex communities (LGBTQI), and barriers they experience in

accessing services.

Further work is also required to gain the perspectives of the private sector workforce, and to

better understand how the NT’s primary health care data systems can best be harmonised or

synthesised, and made accessible to inform planning and impact monitoring.

3 Australian Institute of Health and Welfare 2014. Aboriginal and Torres Strait Islander Health Organisations: Online Services

Report—key results 2012–13, AIHW 139, AIHW, Canberra. 4 Australian Bureau of Statistics (ABS) 2008, National Health Survey 2007-08 (cat. no. 4364.0), ABS, Canberra.



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Additional Data Needs and Gaps

NT PHN needs access to more nuanced population health data, health services utilisation data

and health workforce data to enable it to better identify needs, and commission programs

and projects. This requires ongoing commitment to working in partnership, and real and

regular data sharing between CAHS, TEHS, ACCHS, AMSANT, Menzies School of Health

Research and the NTG Departments of Health, Attorney General and Justice, Children and

Families, the NT’s Children’s and Anti-Discrimination Commissioners, and NT PHN.

There are significant gaps in existing data and areas where data is several years out of date.

This baseline needs assessment has been challenged by the need to rely on multiple national

and local datasets with different timeframes and variable errors (including confidence

intervals) relating to sampling and responses. This necessitates caution in the interpretation

of National Health Performance Authority (NHPA) data, and indeed all other data available.

The NT has particular issues with discrete non-Aboriginal and Aboriginal populations scattered

in regional and remote areas with high population mobility. The data does not always reflect

the two distinct health patterns that exist in the NT (non-Aboriginal and Aboriginal). NT-wide

or regional data that are not disaggregated can be misleading, and much of the data is not

available down to local areas. When data for the whole of the NT, Darwin or Alice Springs is

provided, this data will have limitations. Both non-Aboriginal and Aboriginal data sets, within

their specific geographic distributions need to be considered. Cultural safety concerns or

language barriers may affect Aboriginal responses in data collection (i.e. surveys). The

variation in rates for some diseases across the NT seem to be very high, indicating possible

problems with sample size and sample variability. Biomedical measures are more accurate

reflections of disease prevalence.5 6

The NHPA has collated minimum datasets for all PHNs including immunisation rates,

Aboriginal and non-Aboriginal health experience, and service use (including hospitals, general

practitioners, specialists and nursing and allied health). This is very high-level data, and is often

descriptive. Comparisons with other PHNs across the Rural 2 PHN “peer group” (nationally)

indicate generally acceptable performance for the NT. From one perspective, the sole use of

such peer group comparisons seems to reflect the assumption that rural regions should not

aspire to the national average (or enable the clear identification of real and substantial gaps

in need in Australia’s rural and remote areas). The presentation of data for the whole of the

NT does not reveal major variations within the NT. Importantly however there are high levels

of preventable hospitalisations across all admission categories in excess of the national

average.

In addition, it should be noted that the NHPA minimum datasets draw on some national

datasets i.e. MBS and Pharmaceutical Benefits Scheme (PBS) data. In the NT, primary health

care services are provided through a range of providers including ACCHSs, NTG primary health

services, NT PHN contracted outreach services, ambulance services, the Royal Flying Doctor

Service, other non-government organisations (NGO’s) and private general practice. Not all

5 Australian Bureau of Statistics (ABS), 2008 National Aboriginal and Torres Strait Islander Social Survey, 2008 (cat. no. 4714.0) 6 Australian Bureau of Statistics ABS, 2008 National Health Survey 2007–08 (cat. no. 4364.0).



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types of primary health care service delivery is fully reflected in the current NHPA minimum

dataset collections.

Additional comments or feedback

The NT experiences a high turnover of residents, both seasonally and over longer durations.

According to 2011 Census data7, 33.2 per cent of NT residents stated they had changed

address in the last five years, and 17.2 per cent of residents had changed address within the

last year.

Territorians, particularly Aboriginal people can experience challenges when accessing care

across borders, particularly concerning language and cultural safety issues (Kelly et al. 2015)8.

Some of the national mainstream data assumptions are not relevant to the NT’s population.

For example, with the incidence of premature ageing in an Aboriginal population with

appreciably lower life expectancy, the data on ageing and disability (which generally assumes

an ageing cut-off of 65 years), is not appropriate for the NT’s Aboriginal population.

Development of data systems, derived from multiple sources such as NHPA and Aboriginal Key

Performance Indicators (KPIs), and from longitudinal specific collections such as Aboriginal

child health data is required. This requires new information systems, data sharing and

governance agreements, and data collection to address the gaps including where health

workers are not registered and therefore no MBS or PBS data is available.

There are major issues in regards to workforce availability in the NT which do not appear to

be reflected in comparative national datasets. Compared with feedback provided through

recent NT PHN stakeholder consultations, there are major discrepancies with the NHPA’s NT

workforce indicator data.

7 Australian Bureau of Statistics (ABS) 2011, 2076.0 - Census of Population and Housing: Characteristics of Aboriginal and Torres

Strait Islander Australians. 8 Kelly, J. et al. 2015, managing two worlds together. Stage 3: Improving Aboriginal Patient Journeys – Study Report, The Lowitja

Institute, Melbourne.



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Section 2 – Outcomes of the health needs analysis Outcomes of the health needs analysis

Identified Need Key Issue Description of Evidence

Mental Health – Utilisation, equity of access and continuity of care

Meeting the needs of a dispersed population and in particular, the mental health needs of Aboriginal people. The current health system response is fragmented, not well integrated or coordinated. This impacts negatively on equity of access to services, continuity of care and the patient journey. Mental health disorders are often under diagnosed or under reported. Access to mental health services, particularly for Aboriginal people is limited, and there are can be major cultural safety concerns with mainstream service delivery. There is limited access to health professionals particularly psychiatrists and in-patient facilities. This has a direct effect on patient pathways and continuum of care (not just high complexity presentations). Many frontline services are provided by a community based Aboriginal Workforce. The importance of principals of social and emotional wellbeing (SEWB) should be seen as a cultural concept that varies between language groups and within some

Australian Bureau of Statistics (ABS) 2015, Australian Aboriginal and Torres Strait Islander Health Survey 2012-2013, 4727.0.55.001, ABS, Canberra. Australian Bureau of Statistics (ABS) Australian Health Survey 2011 – 2013, ABS, Canberra. Northern Territory Aids and Hepatitis Council (NTAHC) 2016, unpublished, NTAHC, Darwin. Australian Institute of Health and Welfare (AIHW) 2013, Mental Health Services – In Brief 2013, Cat. No. HSE 141, AIHW, Canberra. National Aboriginal Community Controlled Health Organisation (NACCHO) 2011, Constitution of the National Aboriginal Community Controlled Health Organisation, NACCHO, Canberra, p.5.



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Outcomes of the health needs analysis

communities. Appropriate training, professional supervision and debriefing are essential for this workforce. The mental health, SEWB and Alcohol and Other Drugs (AOD) issues for LGBTQI people are not well understood or addressed.

Northern Territory Aids and Hepatitis Council (NTAHC) 2016, unpublished, NTAHC, Darwin.

Mental Health – Suicide prevention and self-harm

High rates of suicidality and self-harm, particularly among young Aboriginal people aged 15-29 years, compounded by contagion or ‘copycat’ effects. Particular high-risk groups include young Aboriginal males (who experience suicide rates up to four times the rate of the general population); non-Aboriginal males aged 25-49 years; defence force personnel; and young, urban, non-Aboriginal people. Suicide rates for Aboriginal females are higher than non-Aboriginal females. NT suicide rates are declining from a high in the late 2000s, but the rates continue to remain far higher than national rates. The response to ‘outbreaks’ and suicides in remote areas is not optimal, with some communities with high suicide rates having markedly limited access and/or longer waiting periods for access to mental health professionals. The need for more community based supports, including a local Aboriginal workforce, so that communities have access to immediate culturally appropriate supports without long waits has been identified.

Northern Territory PHN 2016, NT PHN Mental Health Needs Assessment Report, NT PHN, Darwin. Northern Territory Medicare Local 2015, 2014-2015 Needs Assessment, Northern Territory Medicare Local, Darwin. People Culture Environment in partnership with Our Generation Media, 2014, The Elders Report into preventing Indigenous self-harm and youth suicide



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Alcohol and Other Drugs

High levels of alcohol related harm across the lifespan are of concern in the NT, among both the Aboriginal and non-Aboriginal populations. The average adult per capita consumption of pure alcohol for the NT is considerably higher than the national average (13.7L compared to 10.4L). In 2010, 11.8 per cent of NT deaths were alcohol attributable deaths compared with 3.9 per cent nationally. 17.2 per cent of the NT’s non-Aboriginal adult population consume alcohol in quantities considered risky or of high risk to health in the long-term (compared with the national average of 10.6 per cent), and Aboriginal drinkers consume more than their non-Aboriginal counterparts. Among adults who consume alcohol, 30.1 per cent reported drinking alcohol at a risky or high-risk level. Men in the age group 45 years and above (40 per cent) and women in the age group 35-44 (39 per cent) are more likely to consume alcohol at risky or high-risk level than other age groups. Of those who consume alcohol, the level of risk differed by gender. In remote areas, Aboriginal women were more likely (22.8 per cent) to consume alcohol at risky levels than Aboriginal men (14.1 per cent). In non-remote areas, the consumption at risky levels is similar for Aboriginal men and women (22.7 per cent and 21.2 per cent, respectively). Annual rates of hospitalisation for alcohol-attributable conditions across the NT increased from 291.3 per 10,000 population to 460.0 per 10,000 (57.9 per cent among Aboriginal

Gao, C et al 2014, Alcohol’s burden of disease in Australia, FARE and Vic Health in collaboration with Turning Point, Canberra. (Estimated from National Drug Strategy Alcohol Survey (2010) Chondur R, Wang Z, 2010, Alcohol use in the Northern Territory. In: Health Gains Planning, NT Department of Health, Darwin. Crundall I. 2006, Northern Territory Alcohol Consumption and Related Attitudes: 2006 Household Survey. Northern Territory, Department of Justice, Darwin. Australian Bureau of Statistics (ABS) 2009, National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2008, ABS, Canberra. Australian Bureau of Statistics (ABS) 2015, National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS), 2012-13. Northern Territory Government 2010, Alcohol use in the Northern Territory. Health Gains Planning Information Sheet, Darwin (http://www.territorystories.nt.gov.au/bitstream/10070/245741/1/Alcohol_use_in_the_Northern_Territory.pdf)



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males) and from 181.8 per 10,000 to 387.4 per 10,000 (113.1 per cent) among Aboriginal females from 1998-99 to 2008-09. Alcohol consumption is a significant factor in domestic and family violence and other violent incidents, motor vehicle accidents, accidental drowning, crime rates and homelessness. Responses to alcohol misuse and dependence often reflect a tension between a health and a policing approach because of frequently changing policy directions and philosophies. Foetal Alcohol Spectrum Disorder (FASD) is an issue for the NT. FASD is an area where prevalence estimates vary and reported rates are likely to be under-estimations. Although there is no national data on the prevalence of FASD in Australia, it is known to occur in both the Aboriginal and non-Aboriginal populations in the NT. Studies have found higher rates among Aboriginal people than non-Aboriginal people. The workforce needs access to information on alcohol and pregnancy and FASD that is culturally appropriate and acceptable, together with training in appropriate interventions during antenatal care. A recent report sets out 26 recommendations for action to reduce FASD related harm in the NT. Recommendations address alcohol management and support services, sexual health, pregnancy support, early childhood support and education services, and FASD prevention, diagnostic and support services.

Li, SQ, Pircher, S and Guthridge, S, 2012 Trends in alcohol-attributable hospitalisation in the Northern Territory, 1998-99 to 2008-09, MJA, 197: 341-344 Select Committee on Action to Prevent Foetal Alcohol Spectrum Disorder, 2015, The Preventable Disability, Darwin AIHW and AIFS 2015, Fetal alcohol spectrum disorders: a review of interventions for prevention and management in Indigenous communities. Resource sheet no. 36 prepared by the Closing the Gap Clearinghouse, Canberra. NT Department of Health 2015, Supplementary Information from the Department of Health in relation to the Northern Territory Needle and Syringe Program, prepared for the Legislative Assembly of the NT “Ice” Select Committee, August, NT Department of Health, Darwin.



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The NT has the highest proportion of smokers in Australia. The rate of smoking amongst Aboriginal people continues to be significantly higher than that of the non-Aboriginal population (32 per cent compared to 12.4 per cent). There are high rates of reported illicit drug use in the NT, with cannabis the most commonly identified consumed drug. Aboriginal people reportedly use cannabis at twice the rate of non-Aboriginal people in the NT. There is an increase in use of amphetamine type substances (ATS) in the NT, particularly use of crystal methamphetamine (ice), among injecting drug users. The NT also has the highest rate of use of ecstasy in Australia. Volatile substances continue to be used at higher rates in the NT than in other jurisdictions. Needle and Syringe Program data provide the source of most information about injecting drug use in the NT. It suggests that injecting drug use is concentrated in the Top End (91.9 per cent) and amongst males (almost 80 per cent). There are different patterns of use, with steroids being the most commonly injected drug for young men; however overall, amphetamines are the most commonly injected drug.



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Aboriginal and Torres Strait Islander Health

Inter-generational trauma through colonisation, dislocation and child removal practices have contributed to poor health outcomes for Aboriginal people. From pregnancy through early childhood, Aboriginal children are disadvantaged compared to non-Aboriginal children with Australian Early Development Census data showing 40-50 per cent of children in remote communities are vulnerable in two or more domains (Silburn et al 2012). Increased holistic child-centered approaches and consistent follow up of risks and problems identified during child health checks and screening is needed. Additionally, programs that have been proven to improve outcomes in key areas such as reducing child injuries and neglect (Nurse Family Partnership – Olds 2007, AMA 2013) or improving educational outcomes (Abecedarian program, AMA 2013) are required. It is important that suitable services are available for children who are developmentally delayed, or who have diagnosed conditions requiring multidisciplinary input such as cerebral palsy or autism (Baile et al, 2008). Reliable health status data for remote communities is difficult to obtain, and has limitations of small population numbers. The National Health Measures Survey (ABS 2011 -2012) found that 19 per cent of Aboriginal people in the NT had diabetes compared to 11 per cent nationally, and 32 per cent had kidney disease compared to 18 per cent nationally.

Australian Bureau of Statistics (ABS) 2015, Australian Aboriginal and Torres Strait Islander Health Survey 2012-2013, 4727.0.55.001, ABS, Canberra. Australian Bureau of Statistics (ABS) 2013, Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12, Cat. No. 4364.0.55.005, ABS, Canberra. Australian Early Development Census 2015, https://www.aedc.gov.au/. Silburn S. et al. 2012, The First Five Years. Starting Early. Topical Papers. The Lowitja Institute, Melbourne. Kelly, J. et al. Managing Two Worlds Together. Stage 3. Improving Aboriginal Patient Journeys – Study Report, The Lowitja Institute, Melbourne, 2015. National Drug Research Institute (NDRI) 2014, National Aboriginal FASD Resources Project Snapshot for Health Professionals, NDRI, Curtin University, Perth. Aboriginal Medical Services Alliance of the Northern Territory (AMSANT) 2011, Core Functions of Primary Health Care: A Framework for the Northern Territory, AMSANT, Darwin.



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ABS 2013, National Health Measures Survey, 2011-2012, ABS, Canberra.



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Aboriginal and Torres Strait Islander Health – Health Outcomes

On all indicators – health status, disease profiles, quality of life and SEWB - Aboriginal people report worse health outcomes than the non-Aboriginal population in the NT, and in some instances as compared to the Australian Aboriginal indicators.

Australian Bureau of Statistics (ABS) 2013, Australian Aboriginal and Torres Strait Islander Health Survey 2011-2012, ABS, Canberra. Australian Bureau of Statistics (ABS) 2013, National Health Measures Survey 2000, 2011-2012, ABS, Canberra. Australian Early Development Census 2015, https://www.aedc.gov.au/ Silburn S. et al. 2012, The First Five Years. Starting Early. Topical Papers. The Lowitja Institute, Melbourne. NT Aboriginal Health Forum, 2011, Core Functions of Primary Health Care: A Framework for the Northern Territory, Darwin.

Aboriginal and Torres Strait Islander Health – Care Journeys

Care journeys can be particularly complex, challenging and costly, not only for the Aboriginal person experiencing them, but also for their carers, family and health system assisting them in accessing various health and support services. Accommodation while accessing services can be difficult to secure, or highly unsuitable (i.e. located at a considerable distance from the treatment centre). There are additional issues with access to accommodation for carers and families, and for expectant mothers from remote communities who may

Kelly, J. et al. Managing Two Worlds Together. Stage 3. Improving Aboriginal Patient Journeys – Study Report, The Lowitja Institute, Melbourne, 2015. Belton, S. 2016, NT Patient Case Studies. Unpublished report. Menzies School of Health Research, Darwin.



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be waiting in regional centres for up to four weeks prior to giving birth. Communication across the primary health care sector and hospitals is a critical area to improve, especially when Aboriginal patient journeys are often complex and long. Patients can fall through the cracks of formal care systems.

Population Health – Initiatives and Health Screening

Participation rates in Adult Health Checks are high, and care planning is routinely undertaken for chronic conditions. However, due to many people experiencing multiple co-morbidities and high burden of chronic disease, population health initiatives in the NT can be particularly challenging to achieve. The NT has a diverse and dispersed population with two large regional population centres, and very highly dispersed rural and remote communities which are culturally and linguistically diverse. However, access to a range of services by Aboriginal people in the NT compares well with national access by Aboriginal people, based on a number of national KPIs. For example, in the NT, 46 per cent of Aboriginal regular clients aged 25 and over received an MBS health assessment in the past 24 months as at December 2014, compared with the national average of 44 per cent. 44 per cent of the NT’s female Aboriginal regular clients had a cervical screening in the previous two years, compared with 31 per cent nationally, as at December 2014. 58 per cent of Aboriginal regular clients aged 50 and over were immunised

Australian Bureau of Statistics (ABS) 2013, Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12, Cat. No. 4364.0.55.005, ABS, Canberra. Australian Bureau of Statistics (ABS) 2014, Aboriginal and TI Health Survey Biomedical Results 2012 – 2103, ABS, Canberra. NTML PHC Atlas 2014 NTML Needs Assessment 2013 AIHW 2015, National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results from December 2014, AIHW, Canberra.



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against influenza, as at December 2014, compared with 40 per cent nationally.

Population Health The NT’s Aboriginal population has multiple and complex health needs, and experiences unique barriers to accessing appropriate services. The NT’s population includes sub groups that have high rates of infectious diseases, accidental and non-accidental injuries and falls, non-communicable diseases, and ageing syndromes (including dementia). This impacts on health needs and service utilization, and compounds the burden of disease. A number of the population biomarkers are worse in the NT, compared with other states.

Australian Institute of Health and Welfare (AIHW) 2011, The Burden of Disease and Injury in Australia, AIHW, Canberra. National Health Performance Authority (NHPA) 2016, Key Performance Indicator Reporting, NHPA, Canberra (http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Performance-Indicator-Reporting). Silburn S. et al. 2012, The First Five Years. Starting Early. Topical Papers. The Lowitja Institute, Melbourne. Australian Bureau of Statistics (ABS) 2013, Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12, Cat. No. 4364.0.55.005, ABS, Canberra.

Chronic Disease Prevention and management of chronic conditions is a key issue for Aboriginal and non-Aboriginal people in the NT. There are high rates of potentially preventable hospitalizations (PPH) and emergency department presentations. Chronic disease contributes towards two thirds of the health gap between Aboriginal and non-Aboriginal people. The rates

Australian Bureau of Statistics (ABS) 2013, Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12, Cat. No. 4364.0.55.005, ABS, Canberra. Menzies School of Health Research 2013, Sentinel Sites Evaluation: A place-based evaluation of the



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for selected chronic condition risk factors and bio-markers in the NT’s Aboriginal population are higher than for Aboriginal people in other states and territories, indicating a potential needs gaps in primary health care in the NT. Whilst there has been significant improvements in recent years related to the prevention and management of chronic conditions - including improvements in recall and registration systems, care planning, follow up and continuous quality improvement (CQI) systems - the rates of PPH remain high. The impact of the advances in care, shared electronic health records, registers and recall systems on health outcomes have not been comprehensively evaluated.

Aboriginal Chronic Disease Package 2010-2012, Menzies School of Health Research, Darwin. Bailie et al. 2014, Primary Health Care for Aboriginal and Torres Strait Islander Children: Final Report. Engaging Stakeholders in Policy Study of the ABCD National Research Partnership, Menzies School of Health Research, Darwin.

Social and Cultural Determinants of Health

Addressing the social and cultural determinants of health including primary prevention through food security and nutrition, participation in education and employment, mobility and exercise, a safe environment, access to appropriate housing, potable water and facilities is critical to improving long term health outcomes. Coordination across the many agencies responsible for these areas (including across all three levels of government and NGOs) is difficult, and places multiple demands on limited community infrastructure. Social determinants such as housing overcrowding, school retention and employment lag behind other states considerably.

Devitt, J., Hall, G. and Tsey, K., 2001 An introduction to the social determinants of health in relation to the Northern Territory Indigenous population, Cooperative Research Centre for Aboriginal and Tropical Health. Occasional Papers Series, Issue No. 6, CRCATH, Darwin.



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Primary prevention addressing the social determinants of health, including housing nutrition, education, employment, exercise and safe environment needs improvement, but is often beyond the mandate of health services. Greater cross-sectoral collaboration and cooperation from those with responsibility for overseeing housing and education provision, land and resource management, mining and pastoral leases as well as environmental protection is needed to address the social and economic determinants of health. Preventative – immunisation, screening, campaigns, health education and improving health literacy require significant resourcing to reach the most at risk and vulnerable, and most difficult to reach.

Health Workforce - Availability

Timely and effective access to health care services is adversely affected by the availability and stability of the workforce. Recruitment and retention of primary health care staff, and the availability of staff housing in remote communities are significant issues. There is a reliance on fly-in, fly-out (FIFO) and drive-in, drive out (DIDO) models of care and specialist’s services. Additionally, staff working in remote areas may be required to provide after-hours care in addition to their duties during the day. This may affect their ability to staff primary

National Health Performance Authority (NHPA) 2016, Key Performance Indicator Reporting, NHPA, Canberra (http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Performance-Indicator-Reporting). Australian Bureau of Statistics (ABS) 2015, Patient experience Survey (2014- 2015), ABS, Canberra.



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health care services the following day, as well as presenting safety risks.

Health Workforce - Access

There are low rates of access to MBS and PBS due to workforce shortages experienced in key positions, funding arrangements and the multidisciplinary nature of many remote primary health care teams.

Australian Institute of Health and Welfare 2014. Aboriginal and Torres Strait Islander Health Organisations: Online Services Report—key results 2012–13, AIHW 139, AIHW, Canberra.

Health Workforce - Aboriginal Health Workforce

There is an under supply of AHPs, and difficulty in accessing local training and retaining AHPs, who often function as key aspects of the multidisciplinary primary health care team. There are multiple challenges associated with AHPs practicing in their own community, with the need for AHPs to be well supported. It is also important for AHPs to ensure that their work responsibilities are aligned with their cultural responsibilities.

Australian Institute of Health and Welfare 2014. Aboriginal and Torres Strait Islander Health Organisations: Online Services Report—key results 2012–13, AIHW 139, AIHW, Canberra.

Health Workforce – Impact of Ageing Population

The projected ageing of the NT’s population is likely to impact on the health workforce. This changing demographic creates the need for workforce reconfiguration to achieve better coverage, earlier detection of ageing syndrome, and better support by strengthening the non-registered health workforce.

Modeling the NT Health workforce til 2022 NT McConville V, Dempsey K, Tew K, Malyon R,Thompson F, Guthridge S, Bhatia B., 2013, Modeling the NT Health Workforce till 2022, The health and wellbeing of older Territorians, Department of Health: Darwin. (http://www.dcm.nt.gov.au/strong_community/seniors/territory_seniors)

eHealth There are many dimensions to the eHealth space, including electronic health records, client databases, practitioner decision-making and information tools, digitally delivered

National e Health Transition Authority (NEHTA) 2015, My eHealth Record to National eHealth Record Transition Impact Evaluation, Phase 1 Evaluation Report (July), NEHTA, Canberra.



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health interventions (assisted and unassisted) and electronic prescribing software. The NT was an early adopter of the electronic health records system, and the benefits of these services are beginning to be realised.

AMSANT website (www.amsant.org.au), accessed 11.03.16. NT E-Health website (www.ehealthnt.nt.gov.au) accessed 11.03.16. NT Department of Health 2015, Evaluation of the Patients Assisted Transport Scheme (PATS) -Telehealth Project, (December) NT Department of Health, Darwin.

eHealth As in other jurisdictions, there are a number of sub-optimally integrated databases used across government, NGOs, ACCHSs and private health services. This results in difficulty in accessing client records, and achieving health planning to enhance delivery of patient centered care. Poor integration leads to wasted resources in investigations and also patient time. A level of duplication of care planning is inevitable, however it may be desirable where the population is highly mobile, and often living between two or more communities. Whilst some patients may need to be “regular clients” at two or more health services, there should be greater sharing of care plans or common care planning across services. There is currently a transition underway from use of the shared NT patient information system for the NT to the national shared patient record system.

Information based on stakeholder feedback provided during 2016 Needs Assessment.



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Aged Health The number of ageing Australians in the NT is anticipated to triple by 2036, with the NT to experience the fastest ageing population in Australia. The NT’s younger age demographic should not overshadow the significant and increasing burden of ageing and multi-morbidity in the NT. Many Aboriginal people aged in their 40s and 50s have disability and morbidity characteristics similar to non-Aboriginal NT people aged 65 years and older. Frailty and geriatric syndromes, dementia and disabilities are particularly prevalent in remote Aboriginal communities in people 50 years and older. The need for a comprehensive strategy, policy and service framework to address future ageing has been identified.

McConville V, Dempsey K, Tew K, Malyon R, Thompson F, Guthridge S, Bhatia B, 2013, The health and wellbeing of older Territorians, Department of Health, Darwin. (http://www.dcm.nt.gov.au/strong_community/seniors/territory_seniors) Hyde Z, Flicker L, Smith K, Atkinson D, Fenner S, Skeaf L, Malay R, Lo Giudice D, 2016, Prevalence and incidence of frailty in Aboriginal Australians, and associations with mortality and disability, Maturitas, DOI: (http://dx.doi.org/10.1016/j.maturitas.2016.02.013)

Aged Care The lifestyles of older Territorians are less healthy than the rest of Australia, with this reflected particularly in the poor health in the Aboriginal population. The NT is reporting increasingly levels of Morbidity Burden (i.e. self-rated health, chronic disease and disability) with age. This indicates considerable health care issues which could be prevented or ameliorated. Other problems experienced as a result of a rapidly ageing population include the caregiving burden and reduced financial, social, housing and environmental resources.

Hyde Z, Flicker L, Smith K, Atkinson D, Fenner S, Skeaf L, Malay R, Lo Giudice D, 2016, Prevalence and incidence of frailty in Aboriginal Australians, and associations with mortality and disability, Maturitas, DOI: (http://dx.doi.org/10.1016/j.maturitas.2016.02.013) McConville V, Dempsey K, Tew K, Malyon R, Thompson F, Guthridge S, Bhatia B, 2013, The health and wellbeing of older Territorians, NT Department of Health, Darwin

http://www.dcm.nt.gov.au/strong_community/seniors/territory_seniors

http://www.dcm.nt.gov.au/strong_community/seniors/territory_seniors



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(http://www.dcm.nt.gov.au/strong_community/seniors/territory_seniors).

Child and Maternal Health

The National Primary Health Care Strategic Framework (2013) recognises the importance of a child’s formative years – including the health and wellbeing of their parents, care during pregnancy, and early childhood development. In the NT, the proportion of children aged 0-14 is 33.2 per cent compared with the national proportion of 35.9 per cent. In the NT (as of 2011), Aboriginal children made up 10 per cent of the total population, and 44 per cent of the NT’s child population. In most other states, Aboriginal children make up between 1 per cent (Victoria) and 7 per cent (Tasmania) of the child population. Compared with their non-Aboriginal counterparts, Aboriginal children in the NT are more likely to be born to younger parents, have lower birth weights, live in socio-economically disadvantaged households, have had involvement with the child protection system, and live in remote communities where basic needs such as housing and nutrition are not always adequately met. Babies born to Aboriginal mothers were almost twice as likely to be of low birth weight (less than 2,500 grams) than babies born to non-Aboriginal mothers. Low birth weight can increase the risk of a child developing health problems.

Australian Government Standing Council on Health 2013, National Primary Health Care Strategic Framework, Canberra. AIHW 2012 A picture of Australia’s children, 2012, AIHW, Canberra. ABS 2011, Census of Population and Housing - Counts of Aboriginal and Torres Strait Islander Australians (Cat. No. 2075.0), ABS, Canberra. Source: Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit National Perinatal Data Collection.



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Low birth weight (LBW) rates are much higher for Aboriginal babies in the NT than the non-Aboriginal population (14.3 per cent compared to 9.1 per cent). LBW rates for the NT overall are much higher than the Australian rate (6.5 per cent). The Tiwi Islands contains the highest proportion of LBW babies at 18.6 per cent, while the urban centres are all below 10 per cent. Only the unincorporated NT region was below the national level (5.2 per cent). Aboriginal children are twice as likely to die before their fifth birthday as other Australian children. Their mothers also have less access to antenatal and postnatal services, and are less likely to use services when they are available. Across the NT the infant mortality rate (0 – 5 years) is high with an average rate of 7.2/1000 live births compared to the national level of 3.9/1000. When broken down by Aboriginal status however the non-Aboriginal rate is below the national level (3.8/1000) while the Aboriginal rate is well above (12.5/1000). Infant mortality was highest in the Roper Gulf region (22.3/1000) and the Tiwi islands (20/1000), both regions with very high Aboriginal populations. Based on the 2012 Australian Early Development Census, the NT had the highest proportion of developmentally vulnerable children (those scoring in the lowest docile) in Australia.

The Lowitja Institute, website: https://www.lowitja.org.au/research-topics/child-and-maternal-health (accessed: 230316). ABS and AIHW analysis of National Mortality Database. Source: Australian Institute of Health and Welfare (AIHW) National Perinatal Statistics Unit National Perinatal Data Collection. Source: Australian Early Development Census, (www.aedc.gov.au) AIHW 2012 A picture of Australia’s children, 2012, AIHW, Canberra.



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Aboriginal children experience higher rates of chronic conditions than non-Aboriginal children, e.g., asthma prevalence (14 per cent compared with 11 per cent: ABS and AIHW 2008). The Australian Government’s response to the Review of Mental Health Programs and Services identifies perinatal and infant and child mental health services as an area of focus to support development of resilience in children and families and to reduce potential for development of mental illness later in life. Aboriginal mothers in the NT reported smoking in pregnancy at a far higher rate (44.7 per cent) than the general NT level (27.3 per cent), and as compared with the national rate of 13.7 per cent. Interestingly, there appears to be a North/South divide with rates below 30 per cent in the south compared to over 40 per cent in the rural Top End. The East Arnhem region suffers the highest load with 55 per cent of expectant mothers reporting smoking in pregnancy.

National Mental Health Commission 2014, The National Review of Mental Health Programs and Services, NMHC, Sydney. Department of Health 2015, Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programs and Services, Department of Health, Canberra. Source: National Perinatal Statistics Collection, AIHW National Perinatal Statistics Unit, Sydney.

Youth Health Young people are particularly vulnerable to experiencing poorer social and emotional wellbeing outcomes than other Australians, and the national mental health reform process has identified an integrated and equitable approach to youth mental health as a priority. There is a two-way association between health and education. People with low educational attainment tend to have poorer

National Mental Health Commission 2014, The National Review of Mental Health Programs and Services, NMHC, Sydney. Department of Health 2015, Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services, Department of Health, Canberra.



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health, fewer opportunities, low incomes and reduced employment prospects (Johnston et al. 2009). In turn, poor health is associated with lower educational attainment (Conti et al. 2010). According to the National Assessment Program (AIHW, 2014), in the NT:

The proportion of Aboriginal students at or above the benchmark for reading was lower than for non-Aboriginal students for Year 3 (34 per cent compared with 89 per cent); Year 5 (32 per cent compared with 92 per cent); Year 7 (37 per cent compared with 94 per cent); and Year 9 (34 per cent compared with 91 per cent) (Table 2.04.1, Figure 2.04.1).

AIHW 2014 Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, Northern Territory, AIHW, Canberra. Johnston V, Lea T, Carapetis J 2009, Joining the dots: the links between education and health and implications for Indigenous children. Journal of Paediatrics and Child Health 45(12):692–697. Conti G, Heckman J, Urzua S 2010, The education-health gradient. American Economic Review 100(2):234–238.

Dental health As a general rule, oral health status declines with increasing remoteness, meaning that people who live in the most remote areas of Australia have the worst oral health of all Australians (especially Aboriginal Australians). Risk factors for poor oral health in remote and rural areas include: poor diet, tobacco use, harmful alcohol use, high stress and low control, poor dental hygiene, poor oral health literacy, reduced access to fluoridated water, limited access to fruit and vegetables and the high cost of dental products. Based on the 2008 ABS National Aboriginal and Torres Strait Islander Social Survey, 30 per cent of the Aboriginal population

Bishop, LM and Laverty, MJ 2015, Filling the Gap. Disparities in oral health access and outcomes between major cities and remote and rural Australia, Royal Flying Doctor Service (RFDS), Canberra. Source: ibid. Source: ABS National Aboriginal and Torres Strait Islander Social Survey, 2008.



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had teeth or gum problems. Lack of access to dental services and water fluoridation are contributing factors to these teeth and gum problems, which may be under reported due to insufficient screening and treatment.

Sexual health There are a number of sub populations at greater risk of poor sexual health in the NT. Aboriginal young people aged 15 – 24 years carry the highest burden of disease. Aboriginal adults, young people in urban centres and men in prisons are also priority groups. The key issues identified by this needs assessment are:

The current (2016) high rates of syphilis , especially among children and young people

Sexually Transmitted Infections among young people aged 15 – 29 years, (Aboriginal and non-Aboriginal) in the Darwin/Palmerston urban area and NT wide

Sexual health of males in prison

Source: NT Department of Health, Sexual Health and Blood Borne Virus Unit (http://health.nt.gov.au/Centre_for_Disease_Control/Sexual_Health_and_Blood_Borne_Viruses).



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Section 3 – Outcomes of the service needs analysis

Outcomes of the service needs analysis

Identified Need Key Issue Description of Evidence

Mental Health – Equity of Access and Continuity of Care

The NT has a low rate of accessing MBS funded mental health services (more than 50 per cent less than national average), but a high incidence of mental health conditions. This indicates a large unmet need, and limitations in access to mental health services. There is limited access to MBS subsidised mental health services, due to MBS and / or other mental health programs being dependent on access via registered health professionals (i.e. psychologists). This workforce is often not available outside the public mental health sector, or has limited availability privately outside Darwin and Alice Springs. In the NT, the use of MBS funded services delivered by psychiatrists has declined by one-third over the last five years, whilst the number of psychiatrists has remained stable. This is the opposite of the national pattern.

NT Department of Health 2015, Mental Health Service Strategic Plan, 2015-2021, NT Department of Health, Darwin. Australian Institute of Health and Welfare (AIHW) 2014, Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people. Closing the Gap Clearinghouse. AIHW, Canberra. NT PHN stakeholder consultations, 2016. NT Department of Health, 2016, Access to Allied Psychological Services (ATAPS) Program Evaluation, NT Department of Health, Darwin.

Mental Health - Integrated and coordinated care

The National Reform of Mental Health Services (Department of Health 2015) has identified access to a “first point of contact” to link people to information, resources advice and treatment options via phone and a web-based portal offering digital health information and approaches as a key element of a stepped care

Department of Health. The National Reform of Mental Health Services, 2015 Australian Government Department of Health 2015, Australian Government Response to Contributing Lives,



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approach. The target for this initiative is people who will benefit from self-help and low intensity telephone and web-based services. There is considerable evidence that these interventions can be as effective as face-to-face treatment particularly for people experiencing anxiety and depression. In a review of the efficacy of these types of applications, (Christensen et al,2011) found that the programs worked well for young people, however there were barriers in both clinician’s confidence and promotion of the programs, and in the willingness of young people to engage with them. Similarly, a randomized control trial (Lindtvedt et al 2013) found internet-delivered programs have the potential to increase the capacity and accessibility of mental health services. The trial also showed that internet-delivered programs could be effective in reducing depressive symptoms. However, there are concerns that there is not a clear framework about how to evaluate mental health applications, and many are unevaluated or poorly evaluated (Powell et al, 2016). There may be a risk of harm when applications are poorly designed, not well aligned with the person’s need or when utilised by patients that have not had a comprehensive assessment and the diagnosis is wrong or incomplete.

Thriving Communities: Review of Mental Health Programs and Services, DoH, Canberra. Lintvedt O, Griffiths K, Sørensen K, Østvik A, Wang C, Eisemann M, Waterloo K. 2013, Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial. Clin Psychol Psychother. 2013 Jan-Feb; 20(1):10-27. doi: 10.1002/cpp.770. Powell AC, Torous J, Chan S, Raynor GS, Shwarts E, Shanahan M, Landman AB. 2016. Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps. JMIR mHealth uHealth; 4(1):e15.



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Whilst the potential of alternate service delivery approaches has been identified, there remain considerable challenges for rural and remote service delivery, and in particular delivery to Aboriginal people. Reliance on digital mental health is problematic for rural and remote communities due to access and infrastructure issues. There are also significant barriers due to computer literacy, attentional issues, cultural fit and language barriers. Further exploration and promotion of these tools is required with practitioners as they will be useful adjunct for current approaches.

Ciaran Pier, Britt Klein, David Austin, Joanna Mitchell, Litza Kiropoulos and Paul Ryan, Reflections on internet therapy: Past present and beyond. By Department of General Practice, Monash University http://www.psychology.org.au/publications/inpsych/internet/

Alcohol and Other Drugs

The NT has the highest rate of alcohol consumption compared with other jurisdictions, highlighting the need for appropriate services to address the range of AOD problems in the NT. The AOD workforce (including ACCHSs, NGO’s and government services), Sobering Up Shelters and Night Patrols provide good examples of how community based workers, with appropriate support and supervision, and access to other mental health clinicians such as psychologists can address community needs. Addictions to tobacco and AOD, and mental health comorbidities are significant issues for NT health services. Alcohol-related violence is implicated in the high-rate of injuries, and is a safety concern for health providers. Alcohol use is a major factor exacerbating chronic conditions.

Gao, C et al. 2014, Alcohol’s burden of disease in Australia, FARE and VicHealth in collaboration with Turning Point, Canberra. Northern Territory Medicare Local 2013, Needs Assessment Report 2013.



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The role of primary health in responding to AOD issues requires further discussion across the NT, including concerns over capacity to respond, and current lack of standardised approaches, whilst recognising the need for cultural appropriateness and local adaption. Limited harm reduction initiatives remain an ongoing issues across the NT. Given that 65 per cent of people receiving treatment in relation to AOD issues are Aboriginal, the need for culturally appropriate services cannot be underestimated.

Aboriginal and Torres Strait Islander Health

Primary health care for Aboriginal people in the NT is provided by ACCHSs, NT Government primary health care centres, NT PHN funded services, and private general practice. There has been a strong emphasis on system development within all sectors. Features include use of common clinical protocols (i.e. Central Australia Rural Practitioners Association [CARPA] suite of manuals); reporting common clinical performance indicators across services; resourcing for CQI; practice accreditation; high uptake of recall and reminder systems; and increasingly sophisticated use of electronic information management systems. There is a need for particular support to primary health care centres where prescribing patterns are outside the usual range of use of specific medications for patients with chronic conditions. A need has been identified for improved adherence to evidence-based current treatment guidelines (e.g. CARPA Guidelines). There is a lack of recording of recommended clinical

Bailie, et al. 2015. Chronic Illness Care for Aboriginal and Torres Strait Islander people: Final Report, ESP Project, Menzies School of Health Research, Darwin. Bailie et al. 2014. Primary Health Care for Aboriginal and Torres Strait Islander Children: Final Report, ESP Project, Menzies School of Health Research, Darwin. Bailie et al. 2016 National Report on Aboriginal and Torres Strait Islander Mental health and Wellbeing Care (2012-2014) with comparative NT data. Phase 1 Report, ESP Project, Menzies School of Health Research, Darwin. Bailie, et al. 2015. National Report on Aboriginal and Torres Strait Islander Preventive Health Care (2012-2014) with comparative NT data). Phase 1 Report, ESP Project, Menzies School of Health Research, Darwin.



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patient information across the range of Aboriginal health condition areas. This is accompanied by the lack of follow up on abnormal findings, risk factors, and review of medication.

Bailie, et al. 2015. National Report on Aboriginal and Torres Strait Islander Maternal Health Care (2012-2014) (with comparative NT data). Phase 1 Report, ESP Project, Menzies School of Health Research, Darwin.

Health Workforce – Multidisciplinary Teams

Due to complexities of a heavy burden of disease and multiple comorbidities, there is a clear requirement for a multidisciplinary approach. This approach is rendered more challenging due to high turnover of staff, and short term FIFO teams such as locums and/or agency staff. Compared with other jurisdictions, the NT has a much smaller private health sector, including fewer pharmacists, dentists and allied health professionals working outside Darwin and Alice Springs. Whilst there may be an ‘over supply’ of GPs in urban Darwin, there are severe shortages in rural and remote communities. The NT experiences extremely high rates of workforce turnover and vacancies particularly in regional and remote areas, and there are many unfilled AHP positions. Anecdotal evidence suggests that where AHP positions are unfilled for a duration, then funding for these positions becomes absorbed into other staffing resources. The workforce, particularly in remote areas of the NT, can be called upon to fulfil a range of roles and functions. As a result,

NT PHN, 2015, Supporting Aboriginal Mental Health Workers: Research into Perspectives on System Change, Aboriginal Resource and Development Services, NT PHN. NTPHN Program data Northern Territory Department of Health, Office of the Chief Medical Officer, 2015 Review of Area of Need. General Practices in Greater Darwin and Alice Springs Information provided from 2016 Needs Assessments stakeholder consultations.



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some staff may be in positions of considerable influence or responsibility despite only limited professional experience in that area. While the willingness of workers to take on additional responsibility is highly valued, there is a need for system supports, decision-making aids, detailed guidelines and support from specialists and experienced staff. The remote workforce is also often constrained by the infrastructure, including ICT systems, the design of clinics, limited housing, lack of clinic space for visiting services, and limited capacity to support multi-disciplinary approaches. The safety of staff working remotely, including in the after-hours period, has also been identified as an issue.

eHealth The NT’s Telehealth program saw significant patient uptake since being rolled out in 2014. An independent evaluation of the NT Telehealth trial (part of the National Telehealth Connection Service) found that it saved time, money (particularly for the NTG Department of Health’s Patient Travel Assistance Scheme) and improved access to care. The evaluation recommended an expansion of the service. The Telehealth NT service network has grown since being launched in 2012, and is currently delivering clinical services including Tele Specialist Clinics, Tele Preadmissions, Tele-Rapid Assessment, and Tele-Critical Care (eHealth NT 2016).

Evaluation of the PATS-Telehealth Project December 2015 Department of Health. The National Reform of Mental Health Services, 2015 Australian Government Department of Health 2015, Australian Government Response to Contributing Lives, Thriving Communities: Review of Mental Health Programs and Services, DoH, Canberra.



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Whilst take-up of this service continues to grow, infrastructure and lack of training remains a problem in some areas. There is room for further expansion to support better use of specialist medical services. Primary health care centres also require support including for administration and patient support.

eHealth There are currently a number of unintegrated databases used across health services in the NT which results in interoperability issues, duplication of client records, and difficulty accessing client records, and epidemiological data.

Aged Health The major identified need is for development of a comprehensive strategy, policy and service framework that addresses ageing in the NT. The NTG Department of Health has recently produced a report outlining the health and welfare of senior Territorians, which could inform the development of a comprehensive strategy and unified approach across primary health care. There are many gaps in the current aged care system which are likely to magnify in the future with an ageing population. This includes poorly integrated services and silos of disability, ageing services and multi-morbidity. The National Disability Insurance Scheme (NDIS) will present challenges in its implementation in the NT, particularly in remote areas. Poor identification and management of functional decline is one of the major causes of preventable population deterioration. Decline is linked to multi-morbidity, ageing or geriatric

Health Workforce Australia http://www.hwa.gov.au/ Kodner DL. 2006, Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons. Health and social care in the community, 14(5):384-90. Freund, T., Peters-Klimm, F., Boyd, C.M., et al. 2016, Medical Assistant–Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial, Ann Intern Med., 164(5):323-330. Ismail SA, Gibbons DC, Gnani S. 2013, Reducing inappropriate accident and emergency department attendances: a systematic review of primary care service interventions, The British Journal of General Practice: ,63(617):e813-20.

http://annals.org/article.aspx?articleid=2484872






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syndromes and disability. The ability to intervene earlier allows older people to remain well in their homes in the community rather than requiring more costly residential and/or acute services. It is instrumental in improving outcomes for older people, especially in rural and remote areas. Older patients account for up to a quarter of all emergency department visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, limited attention to cognitive functioning upon admission to hospital and greater illness severity contribute to a higher risk of adverse outcomes. Increased prevention and support for the ageing needs attention and monitoring via:

Measures of self-rated health and frailty demonstrating improvements from current baseline in NT

Monitoring of culturally appropriate services delivered in the community

Increased use of MBS items e.g. enhanced primary care, aged care, medication management

Monitoring and systematically responding to preventable emergency hospitalisations

Improvements in nutrition and exercise rates, and declining rates of smoking, alcohol and substance use

Australian Government Standing Council on Health 2012, National Strategic Framework for Rural and Remote Health, Department of Health and Ageing, Canberra Health Workforce Australia http://www.hwa.gov.au/ Medical Assistant–Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial Tobias Freund, MD; Frank Peters-Klimm, MD; Cynthia M. Boyd, MD; et al.Ann Intern Med. 2016;164(5):323-330. doi:10.7326/M14-2403






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Healthy ageing strategies across health and other sectors has been demonstrated to improve outcomes. Population based care management for vulnerable aged adults at risk of poor outcomes has been demonstrated to promote appropriate use of hospitalisations and aged care service use and improve quality of life.

Child and Maternal Health

Child and maternal health service needs that have been identified include:

Child health check coverage remains unacceptably incomplete, especially among children not at school

Where checks occur, identified issues may not be followed up

Childhood anaemia rates are improving, but otitis media and other Respiratory Tract Infections remain a major issue, affecting children’s education outcomes etc.

FASD is increasingly recognised as an issue that communities are willing to acknowledge and respond to, and some evidence based or best practice interventions have been identified. However health professionals need to be trained in recognising, diagnosing and responding to FASD both in children, and during pregnancy if risk factors are present

Scabies and other skin sores, are a cause of significant morbidity in Aboriginal populations. Although these conditions are preventable, they lead to serious complications, organ damage etc.

Source: AIHW nKPI reports. Source: ABS Health Measures Survey 2000, 2011-2012. Northern Territory Legislative Assembly, Select Committee on Action to Prevent Foetal Alcohol Spectrum Disorder 2-015, The Preventable Disability, Northern Territory Legislative Assembly, Darwin. Marquardt, T, 2014, Managing skin infections in Aboriginal and Torres Strait Islander children, Australian Family Physician, 43 (1-2): 16-19. AIHW 2012 Dental health of Indigenous children in the Northern Territory, Bulletin 102, AIHW, Canberra



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Access to child dental health services in limited, particularly in remote areas

Youth health There is no youth health strategy available that identifies service needs, and it has been reported that limited consultation has been undertaken in relation to this issue. Nationally, there were 1,977 per 100,000 potentially preventable hospitalisations for young Aboriginal people aged 12-24 years (2008-09), compared with 1,054 per 100,000 for non-Aboriginal youth (rate ratio: 1.9). Additional youth health needs relating to sexual health are addressed above in Section 2.

AIHW 2011, Young Australians. Their Health and Wellbeing 2011, Cat. No PHE 140, AIHW, Canberra.

Dental health There is a general lack of dentists in regional and remote areas across Australia, including the NT. Timely access to oral health services is critical, and facilitates opportunities for preventative dental checks, early diagnosis of oral diseases and conditions, and health promotion and educational awareness regarding oral health (Marino et al., 2014). An analysis of data from the Closing the Gap Child Oral Health Program, delivered to Aboriginal children living in prescribed communities in the NT (August 2007-December 2011), of the 3,223 children who received a dental referral during their health checks:

2,458 (76 per cent) had received a dental service

Bishop, LM and Laverty, MJ 2015, Filling the Gap. Disparities in oral health access and outcomes between major cities and remote and rural Australia, Royal Flying Doctor Service (RFDS), Canberra. Marino, R., Manton, D., Hopcraft, M., McCullough, M., Hallett, K., Clarke, K., & Borda, A. 2014, Paediatric teledentistry: Delivering oral health services to rural and regional children. (http://apo.org.au/node/39755). Crocombe, L. A., Stewart, J. F., Barnard, P. D., Slade, G. D., Roberts-Thomson, K., & Spencer, A. J. (2010). Relative oral health outcome trends between people inside and outside capital city areas of Australia. Australian



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756 (23 per cent) had an outstanding dental referral indicating further need for services; and

9 children (less than 1 per cent) were considered loss-to-follow up.

The average waiting time between referral and service was 18 months. The need for further services was highlighted by the fact that 2,001 children were referred for additional treatment or services for their oral health conditions identified during their dental visits. Oral Health Services NT provides oral health services including pain and trauma management, emergency care, restorative fillings and repairs, endodontics, extractions, oral hygiene, oral health promotion and denture services. Specialist services include orthodontics, oral surgery, and treatment in hospital under general anaesthetic. Adults with a Centrelink Pensioner Concession Card or Health Care Card are eligible for free dental services, however as demand for services is high, waiting lists can apply. Free dental services are provided from birth to 19 years of age, through school-based clinics, community clinics and mobile services. Barriers to accessing oral health services in remote and rural areas include:

Service availability/provision (few permanent services, sporadic provision of temporary services, specialist services unavailable)

Dental Journal, 55(3), 280-284. Crocombe, L. A., Stewart, J. F., Brennan, D. S., Slade, G. D., & Spencer, A. J. (2012). Is poor access to dental carewhy people outside capital cities have poor oral health? Australian Dental Journal, 57(4), 477-485 AIHW 2012 Dental health of Indigenous children in the Northern Territory, Bulletin 102, AIHW, Canberra Source: AIHW, ibid. Source: NT Department of Health website.



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Service access (lack of transport, long travel distances

Cost of dental treatment (high individual out of pocket expenses)

Workforce mal-distribution (few dental services available, where services exist, difficult to retain staff)

Appropriateness of services (person unlikely to visit service if not culturally appropriate)

Lack of investment in oral health

Source: NT Department of Health website. Source: NT Department of Health website. Bishop, LM and Laverty, MJ 2015, Filling the Gap. Disparities in oral health access and outcomes between major cities and remote and rural Australia, Royal Flying Doctor Service (RFDS), Canberra.

Sexual Health The NT Blood Borne Virus Program (focusing on prevention control and treatment of Hepatitis B, Hepatitis C and HIV) is reported to be severely under-resourced in both funding and staffing. Staffing in sexual health services is highly problematic (e.g. staff coverage for leave, and vacancies in sexual health positions for AHP positions).

NT PHN 2016 Needs Assessment.

Sexual Health – Youth

There is a major service gap in relation to youth sexual health, following the cessation of funding in June 2015 of the Adolescent Sexual Health Program by the Australian Government. The need has been identified for a program to target youth health education in a comprehensive format. This could include substance misuse, violence, gender imbalances and gender-based vulnerability and risks, tobacco, and with a contextualised focus on sexual health and safe sexual relationships.

Source: Stakeholder consultations for the NT PHN Health Needs Assessment, 2016



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LGBTQI There has been no consultation or needs assessment in relation to health and wellbeing documented with these communities in recent years. Limited consultation reveals the need for primary health care services that are LGBTQI friendly, and where service providers are able to address the specific health needs for this population, including the treatment needs of transgender people.

NT PHN 2016 Needs Assessment

Documents

Needs assessment reporting template - Northern Territory PHN · 2018-09-26 · Department of Health Primary Health Networks Needs Assessment Northern Territory PHN - 30 March 2016