focusSUMMER 2014 | EDITION 11

focusLOOKING FORWARD:The future of connected care

BROADER HORIZONS:Meeting the challenge of a growing region

PATH TO INTEGRATION:

HealthPathways Melbourne

approaching 100

Contents03 News

11 A growing region

14 Towards a PHN

17 Member profile

19 Focus On

PRIMARY NOTESPRIMARY FOCUS

2

The year may be drawing to a close, but it remains a busy time for us as we continue to deliver services and support through our health partners while preparing for the big changes ahead.As I’m sure you are all aware by now, from the beginning of July next year Medicare Locals across Australia will be replaced by Primary Health Networks based on larger areas. These networks will bring together initiatives aimed at supporting general practice and primary care, and improving outcomes for health practitioners and the people they serve.We are participating in the development of a bid for the North Western Melbourne Primary Health Network (PHN), and I am pleased to confirm that key partners in this bid are leaders in public health, finance, health insurance, and health analytics and planning. We believe that the consortium will demonstrate the far reaching benefits of better planning and coordination in the sector.Key to the development of this bid, as has always been key to our work, is strong engagement and involvement of GPs and other health professionals. These relationships have helped us develop a platform for a range of programs and services – all aimed at supporting primary health care partnership and delivery.The success of HealthPathways Melbourne demonstrates the critical importance of streamlining clinical pathways to better connect patients and GPs to the services they need. The team has localised nearly 100 pathways for GPs and a further 120 are due for release in the coming months – a magnificent effort in a relatively small timeframe. As well as better connecting services, we are committed to better health service planning through shared data resources and consultation processes. The eHealth support that we’ve provided to practices includes installation of clinical quality improvement software to any practice wanting to improve their practice data and billing.Over the past year, our practice engagement and support team has delivered 500+ quality improvement visits to practices. The team has responded to 4,500+ phone calls and email requests for support. Two-thousand GPs and their practice staff have attended 50 education events. GPs and practice nurses in our current region have told us that they value our support and that they hope to see many of the functions we provide transition to a PHN. We’ve also asked GPs and practice nurses and managers throughout the North Western Melbourne region to tell us what they value, because we want to be as connected to the new region as we are to our current health community.We’re ready for the challenge and we look forward to helping partners make a difference in the communities of the north western metropolitan region.

ASSOCIATE PROFESSOR CHRISTOPHER CARTERCHIEF EXECUTIVE

Time to look forward.

PRIMARY FOCUS3

NEWSAOD CONFERENCE THE START OF SOMETHING BIGA hugely successful Alcohol and Other Drug (AoD) conference held in November has put AoD treatment and response firmly on the health agenda in the inner north west of Melbourne. The Inner North West Melbourne Best Practice Management of Alcohol and Other Drugs Primary Care Conference brought together AoD researchers, workers and experts with health professionals to discuss the latest ways to manage this key health issue for our region.More than 100 delegates attended the day long program, discussing topics as diverse as opioid replacement therapy, dual diagnosis and drug issues in ageing populations.INWMML general manager of Primary Care Services Julie Borninkhof said it was also a great opportunity to step up the conversation about recent Victorian AoD reforms with the service providers who have been tasked with delivering care to this vulnerable population. “It also gave GPs the opportunity to access service providers from a range of areas that interact with AoD treatment and management, such as pain management, aged care and mental health,” Ms Borninkhof said.The conference has already forged closer connections in the AoD sector, and further consolidated the partnership between INWMML and cohealth to work more closely together on the provision of pharmacotherapy in general practice.“This is exactly the sort of result we were hoping for when we began organising the conference and we look forward to seeing more collaborations across the AoD and health sectors in the near future.”

NEW PATHWAY PROVIDES BOOST TO EBOLA PROTECTIONDoctors in inner Melbourne will be better equipped to handle suspected cases of Ebola following the release of a clinical pathway for Ebola Virus Disease (EVD) as part of HealthPathways Melbourne.The pathway focuses on appropriate procedures for suspected EVD patients, including isolation and quarantine, application of infection control measures and who to contact if a suspected case is found.The pathway advises clinicians to suspect EVD in patients that have recently travelled to EVD affected countries, and who present with a sudden onset of fever and a range of other potential symptoms including weakness, headache, abdominal pain and unexplained haemorrhage.Clinicians are advised to ask patients reporting these symptoms by phone to stay in their homes and await advice from the Department of Health. Patients that present to a practice should be isolated from other patients to reduce the risk of infection while the Department is contacted to organise transfer to hospital.Inner North West Melbourne Medicare Local chief executive Associate Professor Christopher Carter said the pathway is important because it provides EVD response information that is appropriate for doctors in Australia.“A lot of the information available online is written for doctors treating patients in EVD affected countries in West Africa, with advice focusing on how to safely test for and treat EVD,” A/Prof Carter said. “This isn’t relevant and could even be dangerous for GPs in Australia, where the best advice is to isolate suspected cases, not to conduct testing and to keep patient contact to an absolute minimum.”EVD is spread by contact with infected bodily fluids and has killed around 5,000 people in West Africa since an outbreak there began earlier in the year. There have been no confirmed cases in Australia.“While we hope there will continue to be no cases of EVD in our region, we are confident that Victoria’s EVD response plan, which this pathway supplements, will be able to handle any suspected or confirmed cases of EVD and prevent it spreading further.” The full EVD clinical pathway covering all necessary actions is available at the HealthPathways Melbourne website http://melbourne.healthpathways.org.au

Dr Stephen Bright from Peninsula Health presents to the audience

at the conference.

PRIMARY FOCUS4

FIRST DIABETES FORUM A HIT WITH THE COMMUNITYPeople living with diabetes in our region have declared the first INWMML Diabetes Information Forum a great success.More than 70 community members attended the forum in October, learning about what causes diabetes, how it’s treated, as well as how they can manage their condition through diet, exercise and regular monitoring.Many of the attendees came to learn more about how to manage their diabetes and information for motivation and support, including a number of people who had been recently diagnosed or who had a family history of diabetes.Evaluation showed they got what they came for and more – with all survey participants saying they’d learnt things that would help them with their diabetes and that would make changes to their lifestyle.One participant said the forum had inspired her take charge of her life and her condition.“I want to take more control and responsibility for my own health,” the participant said. “I’m only 60 – I need to make some changes to enjoy good health for the next 40 plus years!”Based on the success of the forum other consumer events and activities are being planned, and ongoing consumer engagement is being stepped up through INWMML’s People Bank initiative.More information on diabetes for clinicians and consumers is available at www.inwmml.org.au/diabetes and the latest People Bank news is at www.inwmml.org.au/peoplebank

TAKING THE HEADACHE OUT OF COMMON NEUROLOGICAL CONDITIONSManaging migraines and other headache related conditions will soon be less of a pain for general practitioners in inner Melbourne, thanks to a new assessment, treatment and referral pathway as part of the HealthPathways Melbourne project.St Vincent’s Hospital Melbourne (SVHM) Director of Neurosciences Professor Mark Cook played a key role in the development of the pathway, driven by a desire to empower general practitioners to manage more common neurological conditions.“A lot of the misunderstandings around headache generally relate to concerns that there is some serious cause for it,” Prof Cook said. “Now there are a few red flags, but they’re not complicated to understand and the investigations that are appropriate to exclude those are pretty straightforward.“There are always rare instances that people bring up, but the reality is that 999 times out of a 1000 there’s not going be a serious cause, but inevitably these patients are referred urgently to clinics, which causes an enormous amount of anxiety to them and it’s a demand that’s very difficult for hospitals to cope with.”Looking for a way to reduce this strain, Prof Cook was introduced to the HealthPathways Melbourne project by GP Dr David Isaac. Dr Isaac had been involved in the development of the new project, which aims to provide general practitioners in inner Melbourne with best practice information on managing a range of common health conditions.Backed by SVHM, Melbourne Health, Eastern Health and the Royal Women’s Hospital along with Inner East and Inner North West Melbourne Medicare Locals, the project proved to be the perfect vehicle to provide best practice information, while engaging GPs in the process to ensure it was fit for purpose.“I think the end result of the HealthPathways process is going to be fantastic, and it’ll change the way practitioners go about dealing with hospitals in a general sense and in managing patients. It has the capacity to fill the sort of gaps that we’ve been talking about.“I think as importantly though it’s already brought us together with a lot of GPs and groups in general practice to share ideas and get a bit more of a feel for what we’re trying to do and as much as anything that’s been important and we need to see more of that.“I’ve been to speak at one of the GP events about this and everyone’s got valuable thoughts and often of course we don’t have the right perspective on it either. We’ve got a particular view relating to hospital practice that might not reflect well what’s actually being seen out there at ground level.”Having GPs involved in the pathway development means information is designed from the start to be brief enough to be practical for a busy general practice setting, while still being detailed enough to provide useful information. “And I think we’ve done that, I think it gives people some useful points – it’s not a dogmatic routine that must be instituted but I think it gives some useful and practical tips for managing people with recurring headache.” Prof Cook hopes to work on more HealthPathways in the future, to further de-mystify the neuroscience field and give GPs the confidence to know when they can take the lead and when referrals are required.“There are lots of other neurological complaints, common ones, which I think could be very well dealt with by general practitioners,” Prof Cook said.“It’s been impressed on people that a lot of these conditions are very complex and serious and can only be managed by a specialist, but 90% of neurological problems can be managed by a local doctor and managed extremely well.”

Prof Cook wants GPs to feel more confident with neurological conditions.

PRIMARY FOCUS5

IMMUNISATION CAMPAIGN TO PROTECT WHOLE COMMUNITYA new campaign aims to boost child immunisation rates in inner Melbourne by tackling myths about immunisation and sharing stories of local people who immunise their kids.Backed by Inner North West Melbourne Medicare Local (INWMML), the Immunise Melbourne campaign looks to reverse a small but increasing trend of non-immunisation within the greater Melbourne area.Immunise Melbourne showcases the stories of real people in the local government areas of Moonee Valley, Moreland, Melbourne and Yarra about why they chose to immunise their children, based on the highly successful ‘I Immunise’ campaign from the WA Immunisation Alliance.And while some people may see immunisation as a personal choice, the story of Laura, a local mother of two, is a perfect example of how these choices can affect the whole community.“When my daughter was a baby, she caught rubella,” Laura said. “At just seven months old, she was too young to have had her 12 month measles, mumps and rubella immunisation, so she wasn’t protected. It was terrible and frightening to see her suffering like that.” “Even worse, I had been in contact with three pregnant friends who had held her and given her plenty of cuddles. Rubella in pregnancy can cause congenital rubella, which can lead to miscarriage and has potentially devastating lifelong repercussions for the foetus such as deafness, blindness, learning disabilities and heart problems”.“I had to call each of my pregnant friends and tell them that they could possibly have contracted this devastating disease. It was awful. I still have a knot in my stomach every time I think about those conversations”. Laura said the experience has made her more passionate than ever about immunisation. “Just one infection put so many people at risk: my daughter, my friends, and their unborn children. If everyone in our community was fully immunised, the chances of my daughter contracting the disease would have been much lower and we would all have been safer.”INWMML chief executive Associate Professor Christopher Carter said stories like Laura’s show the importance of striving for full immunisation for everyone in our community.“We need a minimum of 90% full immunisation for herd immunity to be effective, which is crucial to protect people like Laura’s baby who can’t be fully immunised themselves,” A/Prof Carter said.“While 90.2% of five-year-olds in our region are fully immunised, the figure varies significantly from suburb to suburb, meaning there’s plenty of work to be done. And the higher the figure, the better the protection for our families and our children.” Immunise Melbourne has now launched and you can find all the campaign resources at our new website – www.immunisemelbourne.org.au

INWMML SECURE MESSAGING PROJECTProgressing eHealth functionality across the catchment remains an important part of our work at INWMML. One of the many activities our eHealth team will be undertaking in 2015 is secure messaging. Secure Messaging is a key component of eHealth and allows for the secure exchange of clinical information in a confidential and timely manner. An expression of interest for health service providers will be released in early December. In addition, INWMML will be holding a secure messaging event in February 2015.For more information, please contact Gary Morris on 9347 1188.

INWMML AGM EMBRACES THE FUTURE OF PRIMARY HEALTHInner North West Melbourne Medicare Local has held its third Annual General Meeting, ahead of the change to Primary Health Networks(PHNs) in July 2015.INWMML Chair Dr Ines Rio reflected on the significant achievements of the organisation over the last 12 months. These include funding a primary care outreach program for those living rough in the CBD, providing more than 10,000 service contacts across mental and physical health programs, and localising nearly 100 health pathways.“All of this and so much more has relied on productive collaboration and partnerships across all levels of government and the health care and other care sectors,” Dr Rio said.And while acknowledging the uncertainty ahead with the change to PHNs, Dr Rio said she was confident INWMML had a key role to play in the primary health care system of the future.“It is a gauntlet that has been thrown to us, one which we are facing head on. Yet with our history, partnerships and staff I am confident that this organisation is well positioned to contribute to this evolving landscape,” she said. “Thank you all for coming on this journey with us.”

Laura’s support for immunisation is stronger than ever.

PRIMARY FOCUS6

HEALTHPATHWAYS MELBOURNE CLOSING IN ON A CENTURYThe HealthPathways Melbourne (HPM) project is well ahead of schedule as it approaches 100 pathways localised and available for GPs in our region.The joint project between Inner North West and Inner East Melbourne Medicare Locals, along with major hospital networks The Royal Melbourne Hospital, Eastern Health, St Vincent’s Hospital Melbourne and The Royal Women’s Hospital, had targeted mid-2015 for the milestone.However with 91 pathways already available and over 100 more in development, HPM is likely to pass 100 localised pathways before the end of the year.HPM supports local GPs through the assessment, management and referral processes for a range of common conditions, with existing pathways covering a wide range of fields including cardiology, diabetes, gastroenterology, allied health and much more.Pathways soon to be released include new specialties such as neurology and gynaecology, as well as building on the information available in existing areas.

BETTER HEALTH LITERACY STARTS AT HOME – OR IN THE WORKPLACEINWMML staff have boosted their health literacy knowledge and skills at a half day workshop presented by health literacy expert Dr Helen Keleher.Low health literacy is a serious issue which can lead to poorer health outcomes such as increased hospital use and premature mortality, and has been highlighted as one of the five key health priorities for our region in our most recent population health needs assessment.The workshop was one step in a broader health literacy action plan which includes a number of initiatives and resources to address health literacy in targeted populations and the broader region. These include our consumer newsletter My Health My Voice, The Hepatitis B Story and information for consumers on After Hours services, translated into six languages. To learn more about health literacy and access resources, including toolkits to address health literacy in clinical practice, visit www.inwmml.org.au/HL

Want to share your ideas? Please contact Michelle Ferrari on (03) 9347 1188 or michelle.ferrari@inwmml.org.au

FAMILY VIOLENCE HELP FOR GPSHelp is available for general practitioners confronting the difficult and potentially dangerous issue of family violence, which is the leading contributor to preventable death, illness and disability for Victorian women aged 15-44 years.Local research has indicated that women experiencing fear of a partner are unlikely to seek help from primary health care providers regarding this issue.To help GPs identify potential family violence among their patients and respond appropriately, the Royal Australian College of General Practitioners (RACGP) have updated guidelines on patients experiencing abuse and violence.Abuse and violence: working with our patients in general practice, 4th edition, also known as the White Book, helps define family violence, covers identification and validation, counselling strategies, and dealing with perpetrators within the practice.It also covers key issues for different ages, genders and community groups, as well as providing an overview of the relevant laws around family violence.As the nation marked White Ribbon Day, Inner North West Melbourne Medicare Local chief executive Associate Professor Christopher Carter said it is crucial GPs have the resources they need to play their role in stopping violence against women.“Women may often not feel safe reporting family violence to their doctor, or not realise that their doctor can help in the situation,” A/Prof Carter said.“That’s why resources like the White Book are so important, so GPs have the tools to be able to identify family violence and take appropriate steps to put an end to it.” Get the White Book at www.racgp.org.au/your-practice/guidelines/whitebook

The INWMML team hears from health literacy expert

Dr Helen Keleher.

PRIMARY FOCUS7

CLEAR INFORMATION AND SUPPORT KEY FOR PEOPLE WITH DIABETESA new study from INWMML and Victoria University has highlighted the emotional, physical and organisational burdens faced by people living with Type 2 Diabetes (T2D).The study, authored by Professor Mary Carolan-Olah and published in the Journal of Clinical Nursing, reinforced the importance of clear, simple instruction provided immediately post-diagnosis, supplemented with additional information once the patient gained some understanding of their condition.The development of appropriately targeted diabetes related information was also identified as a way to improve the patient experience and self-management outcomes, as was taking into account differing levels of health literacy among people with T2D. Based on a focus group of 22 people living with T2D in Moonee Valley and Moreland, the study showed the demands of managing the condition and its symptoms often made patients feel isolated and overwhelmed.Managing their diet was a particular issue for a number of participants. Receiving consistent information about what food to eat, managing cravings and the impact of their new diet on social and family interaction were mentioned as concerns.“You have to keep thinking or preparing for in advance, so you don’t eat crap,” said one focus group participant. “And that’s the hardest thing, you need to keep yourself disciplined.”This may be an issue for patients with low health literacy, who can struggle to understand complex information about diabetes management and treatment.“When you’re first diagnosed, you get so much information,” said focus group participant Terrie. “It’s just, I know it’s all good [but] it does your head in. You just think, it’s all new to you, this big book and this book. You read through it once and you go ‘Oh God’.But while the study supported modifications to information provision and design, it also found most participants were generally satisfied with their care, especially where they have been able to take ownership of managing their condition.“You cant actually change the (disease),” said another participant. “You can change the story. It’s one of the few diseases where you can change the ending to your story by doing something about it.”INWMML would like to thank the participants of the focus groups along with our partners – The Health Issues Centre, Victoria University, Merri Community Health Service, Doutta Galla Community Health (now cohealth) and Melbourne Health.

CHRONIC DISEASE CONCERNS BUT LIFE EXPECTANCY ON THE UPThere’s both good and bad news in the latest reports from the Australian Institute of Health and Welfare (AIHW), with one revealing 29% of adult Australians have cardiovascular disease, diabetes, or chronic kidney disease, while another showed life expectancy is on the rise.The Cardiovascular disease, diabetes and chronic kidney disease: Australian facts: Prevalence and incidence report shows a high level of crossover between the three diseases, with most people living with either diabetes or chronic kidney disease also having cardiovascular disease.The report also showed a significant amount of people are unaware they have these disease, particularly chronic kidney disease.Around 10% of adults (1.7 million) showed signs of chronic kidney disease, although only 1% of adults self-reported having the disease.“This reflects the fact that chronic kidney disease remains a highly under-diagnosed condition, largely because by the time any symptoms appear, around 90% of kidney function can be lost,” AIHW spokesperson Sushma Mathur said.Meanwhile another report showed that children born today can expect to live significantly longer lives with more years free of disability than those born just 16 years ago.The report, Healthy life expectancy in Australia: patterns and trends 1998 to 2012, shows increasing longevity combined with falling rates of disability for both men and women.“Between 1998 and 2012, male life expectancy at birth rose from 75.9 years to 79.9 years-a gain of 4 extra years. For females it rose from 81.5 years to 84.3 years-an extra 2.8 years,” said AIHW spokesperson Mark Cooper-Stanbury.Australians can also expect to live more of these extra years free of disability and severe or profound core activity limitation (that is, sometimes or always needing personal help with activities of self-care, mobility or communication).Disability-free life expectancy at birth rose by 4.4 years for males and 2.4 years for females between 1998 and 2012.

Three generations came together to learn about diabetes at our community forum.

Collaboration was on the agenda for INWMML chief executive Associate

Professor Christopher Carter and cohealth CEO Lyn Morgain.

PRIMARY FOCUS8

FORUM CONFIRMS PARTNERSHIP IMPORTANCEInner North West Melbourne Medicare Local, cohealth, Merri Community Health Services and Melbourne Health have reaffirmed their commitment to improve patient care, outcomes and pathways for their shared community, following the third Inner North West Melbourne Health Collaborative Forum which was held on Tuesday 18th November 2014.The Forum brought together key clinical staff from each of the organisations to discuss the aims, achievements and future plans of the Collaborative.INWMML General Manager of Primary Care Reform and Development Sean Lynch said the Collaborative had already delivered excellent results in diabetes and chronic kidney disease care, as well as promoting eHealth adoption and general collaboration between the organisations.“The next step is to spread the word about the Collaborative among the clinical staff at the organisations involved, to really unlock the full potential of the partnership,” Mr Lynch said.The organisations have longstanding engagement through initiatives such as Hospital Admission Risk Program (HARP) and Health Workforce Australia Clinical Placements Project, as well as representation on the Melbourne Health Primary Care and Population Health Advisory Committee and Inner North West Primary Care Partnership. Building on ongoing executive level consultations, the organisations came together in 2012 to form the Inner North West Melbourne Health Collaborative, aimed at coordinating and reforming health services to meet the growing health challenges facing our region.Over the last year the partnership has developed further, with a range of programs launched or expanded throughout 2013/14 in areas such as Diabetes Demonstration Projects (INWMML), Chronic Kidney Disease Projects (Merri Community Health Service), ICT interface and eHealth (cohealth) and Low Back Pain (Melbourne Health). At the forum, an additional priority project was agreed on – Advance Care Planning.

Some of the key achievements include:• Piloting of the Coordinated Care for

Diabetes (CCC4D) project. This has two distinct elements. The first is a trial of insulin initiation among a select group of general practices. The second element is investigating improved models of community-based diabetes care with a focus in 2013 on a comprehensive needs analysis and the development of clinician-led patient pathways.

• Chronic Kidney Disease – development of a Chronic Kidney Disease (CKD) Working Party, Terms of Reference and Project Plan. The Project is trialling a CKD screening tool that can be used by health practitioners in Community Health. A range of resources and tools to provide information and support the use of the screening tool are also being developed.

• A joint commitment to increasing the take up of the Personally Controlled E Health Record (PCEHR) across the catchment, including eHealth readiness of providers, exploring Secure messaging applications and trialling uploads and meaningful use of the PCEHR amongst the collaborative partners.

• Development of the INWH Collaborative Strategic Directions 2014-17.

• Development of an Evaluation Framework to determine the success of the partnership and the projects we have committed to.

CARE COORDINATION PROVIDES LOCAL SOLUTION FOR NATIONAL ISSUEA program that provides direct support for Aboriginal and Torres Strait Islander (ATSI) people managing complex health issues is helping to close the gap in health in our region.ATSI people suffer more chronic diseases – like heart disease and diabetes – at a younger age than the general population, which is the major factor in ATSI people having significantly lower life expectancy.To help close this gap INWMML supports the Care Coordination and Supplementary Services (CCSS) program, which delivers care coordination, provided by qualified healthcare workers, to ATSI people with one or more chronic diseases. One person being helped by the program is Collingwood resident Brenda, who suffers from multiple complex health problems, including depression and anxiety. She has also experienced cancer, stomach problems and low weight. GPs like Dr Simon Wilding from North Yarra Community Health Centre can refer patients like Brenda to the CCSS. Dr Wilding said that having the care coordination team available changes the way he thinks about the next step after prescribing or recommending treatment. “[Brenda’s] treatment plan might have community barriers, there could be cultural difficulties to putting it into place,” Dr Wilding said.

“Brenda or I can take those issues back to the care coordination program, and say ‘These are the sorts of things we’d like, do you know what services or programs are in place to help us achieve that?’” Brenda’s Care Coordinator, Gill Lowe, makes sure that the care plan is written by a doctor or by nurses working as a team in consultation with the client, to ensure that the finished product is something that the client can understand and is happy with.Registered nurse Gill is based in the North Yarra Community Health Centre in Fitzroy, in a position funded by INWMML. “Basically my day is making appointments, building rapport with the clients, talking with their other health workers, helping people with the difficult paperwork and doing things that are just too hard for the client to manage themselves,” Ms Lowe said.Brenda has dyslexia and finds it hard to know exactly what a written prescription says or to follow written instructions, so working out how to manage communication was a key concern.“I’d tried and tried to get doctors and chemists to [communicate] and it just was not happening,” Brenda said.Ms Lowe worked with Brenda to identify the issues and come up with a workable solution. “Brenda has trouble remembering. Dr Wilding might write a script but she might put it in her bag and forget for a couple of weeks. So Brenda asked if Dr Wilding could send them directly to the pharmacy. Then they can fill them and Brenda or I can pick them up – whatever Brenda wants.”Ms Lowe finds that the CCSS program gives her a crucial edge when it comes to improving outcomes. “It’s a unique position because you can take a holistic view, you can look at everything and then work out what the client might need and who can help them.”For Dr Wilding, INWMML’s support for care coordination improves his efficiency as a doctor. “I can offer better treatments because I know she’ll be able to access other services …we can effectively get a lot more done out of one consultation,” he said.For Brenda, the benefits of the program are obvious. “It’s a good idea – not just for myself but for other people as well.”

PRIMARY FOCUS9

Care Coordinator Gill Lowe, Collingwood resident Brenda and GP Dr Simon Wilding at the North Yarra Community Health Centre.

PRIMARY FOCUS10

Dr Munoz thinks HealthPathways Melbourne has great potential to help GPs.

Dr Anita MunozWe sit down with new HealthPathways Melbourne Clinical Editor Dr Anita Munoz to discuss her role and the potential of the program for GPs.WHAT DOES YOUR ROLE INVOLVE AS A HEALTHPATHWAYS MELBOURNE (HPM) CLINICAL EDITOR?The first thing that occurs is the selection of a pathway to be localised. That selection is usually based on perceived demand for change and improvement. For example if a particular medical or surgical condition is identified by one of our four hospitals as clogging up the public health system or which could be managed better in general practice it will be put forward to be localised, Similarly, it may be general practitioners themselves requesting information on better managing a condition, that results in a pathway being selected.Then the first thing I do in localising a pathway is to look at what already exists – often there’s a pathway that’s been written by New Zealand or by another Medicare Local around Australia. I look at the existing clinical content and then I scope the pathway’s links and referral pages and decide how much needs to be edited. Then I get in contact with subject matter experts from each of our participating hospitals to introduce myself and present them with the clinical content for comment and revision. In addition to liaising with subject matter experts, I also seek input from allied health practitioners, GPs and General Practice Liaison Officers who represent the hospitals.We meet several times, either in one-on-one meetings or by running clinical working groups to agree on the clinical content and how we want GPs to be assessing, investigating and managing conditions. We then also have a discussion about the best way to approach the referral process, which hopefully can be agreed upon by all the major stakeholders including the main four hospitals – Royal Melbourne, St Vincent’s, Royal Women’s and Eastern Health.

I work closely with a project coordinator on all of the pathways. The HealthPathways coordinator’s job is to essentially map what services are available publically and privately and summarise that within the pathway referral pages. This aims to enable GPs quick and efficient access to the services available in our catchment, being both in the public and private arena.WHAT ARE THE POTENTIAL BENEFITS FOR GPS AND THE HEALTH SYSTEM FROM HPM?It will enable GPs to access up to date information, advice on best management, and also serve as a reminder for managing and assessing conditions that the GP may not have seen as frequently as perhaps they’ve seen other conditions. The pathway is designed to be used at the point of care when the GP is in a consultation with their patient.I think there are quite a number of conditions that could be managed a little more optimally in general practice and I think there are probably several reasons why that’s not necessarily happening at the moment. I think rapid access to up to date clinical information at the point of care may give GPs a greater sense of confidence in their assessment and their management and may make them feel more able to manage those conditions in the primary care setting without deferring to advice from specialists and from public health services. I also think that GPs need to know what services are available in their community, and the most appropriate way to utilise those services. Having a portal that summarises these services and makes the referral process easier to understand and execute is likely to result in greater use of community resources, and hopefully ease the demand on our public health system. WHAT ARE SOME OF THE NEW PATHWAYS COMING OUT SOON?Soon to be completed will be a cache of neurological pathways, including headache, migraine, epilepsy and associated conditions. Carpal tunnel syndrome is about to be finished, as is giant cell arteritis and iron deficiency anaemia. There’s a collection of women’s health pathways in final draft stage, and COPD is due to be finalised in the coming months.Advanced care planning has just been released and aged care and wound management will be out soon.

HEALTHPATHWAYS PROFILE

PRIMARY FOCUS11

If there are three words that hold the key to success for any health organisation, they are probably these: know your community.Whether you’re a solo GP practice or a multi-disciplinary community health network, knowing the health needs and preferences of the people who use your services is crucial to providing the right care at the right time. That’s why population health research and analysis has always been a priority for Inner North West Melbourne Medicare Local, highlighted by two Comprehensive Needs Assessments (CNAs) which have helped shape and target our program activities over the past two years.But there’s a bigger challenge coming – indeed it’s already here. The geographic boundaries of the North Western Melbourne Primary Health Network stretch from coastal Cocoroc in the south past the wineries of Lancefield in the north, from the western plains around Pentland Hills to the north-eastern suburb of Watsonia. And the health needs and challenges across this region of around 1.5 million people are just as diverse. In the most recent Our region, our people report released in August this year five health priorities were highlighted for the inner north west: prevention and

management of chronic disease; coordinating care across systems; health literacy; mental and emotional health and wellbeing; and alcohol and other drugs.While all of these are also priorities across the larger region, there are also many new priorities that are of particular concern in some parts and not in others: Aboriginal health, disability care, care for older adults and maternal and child health services among them.These needs are being revealed thanks to the work of the INWMML research and analysis team, who were also responsible for collecting and analysing the data used in the Our region, our people reports.Population Health Planning and Data Analysis officer Natalie Rinehart said the data collection for the broader north western region began well before the announcement of the Primary Health Network (PHN) boundaries in late October.“We’ve been looking at this general region for some time, and we’re certainly finding that while some issues like chronic disease and mental health are universal, there are marked differences in the severity and range of health issues across the North Western Melbourne PHN area,” Ms Rinehart said.“Refugee health and culturally and linguistically diverse communities are showing up as key priorities in both the north and south-western areas, while in the north and northwest health service access and child and maternal health are major issues.”Research and analysis is being supplemented by numerous discussions with the key health organisations already working in the region, to ensure that the areas of concern suggested by the data also reflect the ‘lived experience’ of health workers on the ground.INWMML chief executive Associate Professor Christopher Carter said that as well as helping to shape the initial priorities of the new PHN, these meetings have been crucial in building the partnerships which will allow the new organisation to be connected and effective from day one.“We’re here to support the existing health providers to deliver better health outcomes, so it’s really important that we build these connections and get on the same page as early as possible,” A/Prof Carter said.“The work we’ve done so far shows there’s a number of issues and challenges in the new region, but it’s also shown that we couldn’t have better partners available to help us meet those challenges.”

The Royal Melbourne Hospital remains a key health provider in our expanded region.

A GROWING REGION

TOWARDS A PRIMARY HEALTH NETWORK

PRIMARY FOCUS14

Responsive, coordinated primary health care can keep people out of hospital and in the community, improving the patient experience while also reining in burgeoning health costs.But to take advantage of these opportunities the new organisations will need to be able to hit the ground running; quickly adapting to the kaleidoscope of health challenges presented by much larger and more diverse areas as the current 61 Medicare Local regions are reduced to 30 PHNs.In consultation with our stakeholders we’ve focussed on eight key areas that we and our partners believe should form the base of an effective PHN. These areas are driving our thinking as we move forward with our participation in a bid to operate the North Western Melbourne Primary Health Network.

Knowing the communityA health organisation can’t operate at its best if it doesn’t have a solid understanding of the major health issues facing its community, especially one that is specifically mandated to coordinate care services within a region.Since 2012 we’ve been committed to researching and analysing the health priorities of the inner north west of Melbourne. The Our region, our people reports and related material that have resulted from these efforts have given us the evidence base to support successful activities in areas such as mental health, care coordination and alcohol and other drug treatment.Well before the announcement of the PHN boundaries we began to focus on the broader north western region, gathering information and making partnerships to inform our program delivery and coordination activities.

The launch of Primary Health Networks (PHNs) in the middle of next year is a real opportunity for the development of primary health care as the most crucial part of our health system.

INWMML Chair Dr Ines Rio at the HealthPathways Melbourne launch.

PRIMARY FOCUS15

This work has already proven its worth by revealing the diversity of health priorities across the North Western Melbourne PHN area, challenges we are already developing responses to thanks to a commitment to thorough population health research and analysis.

Engaging and supporting general practice

The needs and experiences of general practitioners have always been central to our work. During the last year alone our practice support team conducted more than 500 practice visits and responded to over 4,500 requests for assistance via phone, email and fax, while thousands of GPs and other health professionals attended more than 50 educational events organised by INWMML.Visits, assistance and events are all provided as part of supporting practices undertake continuous quality improvement, which was highlighted in our recent GP survey as being one of two most important Medicare Local activities that should be continued in PHNs.The other was continued work to improve coordination and communication with local hospital networks, so GPs are able to adequately monitor and guide their patient’s care across all health services.Both of these elements will central to a PHN that is truly representative of the general practice community, helping to create responsive, demand based primary care access models that support GPs as the cornerstone of health care.

Driving innovation through technology

While not without their challenges in development and implementation, eHealth technologies remain crucial to enable better communication within the sector and improved safety and quality of patient care.Supporting the PCEHR through increased membership and usage has been a major focus for all Medicare Locals, and recent signs are good that the system is moving beyond its initial issues. We have broadened our focus to include bringing practitioners and patients together through the National Health Services Directory, as well as helping practices reap the benefits of clean and comprehensive patient data with PEN Clinical Audit Tool support. As we move into the Primary Health Network environment, partnerships with innovative and health focused technology partners will play an increasingly important role in delivering better health outcomes.

Bringing the primary health community togetherTo deliver the responsive, integrated and patient-centred primary health care needed, PHNs will need to innovate not only in terms of technology and services but also in the partners they bring into the system.Leaders in information technology, education and research, preventative health and even financial systems can all play a role in creating this system, facilitated by a strong and engaged coordinating network.We’ve been working to become that network in north western Melbourne, developing partnerships with business, academic institutions and both public and private health organisations to create the best care models for our practitioners and our community.These partnerships will only become more important to improve service delivery and address gaps as expectations grow in line with our geographical boundaries.

Connecting and coordinating CareBringing new players into the system will of course increase the need for care coordination, which as well as being one of the top concerns highlighted by GPs is also one of the areas with the most potential to improve patient care and provide substantial cost savings.An ageing population and an increasing chronic disease burden are the other driving forces for change, necessitating a focus shift away from episodic care to GP and patient directed ongoing care relationships. Our Care Coordination and Supplementary Services program, which provides a care coordinator to vulnerable patients to assist them to navigate the various health services they need, is one way we’ve been doing this, along with a focus on improving the acute-primary interface for people with chronic disease through HARP and other programs.This facilitation role will become even more central as PHNs step back from direct service provision to focus on commissioning and coordination, working to integrate services across the continuum to provide seamless patient care.

The Inner North West Melbourne Health Collaborative is one way we’re connecting our health community.

Developing best practice patient pathwaysAs mentioned, generating better health outcomes while improving the efficient use of resources – doing more with less – is one of the key overarching goals which will drive all successful PHNs. The HealthPathways Melbourne project encompasses both of these goals, providing GPs with best practice tools to assist them in managing a range of common conditions within the community, avoiding potentially expensive hospitalisations where possible and improving continuity of care.More than 90 localised pathways are now available and hundreds more are in development, the product of ongoing partnerships between local GPs, specialists and hospital networks facilitated by Inner North West and Inner East Melbourne Medicare Locals.This project and associated collaboration, which focuses on matching local solutions and services to local health issues, will be one of the most important ways we’ll be able to keep in touch with each of our many local areas as the region expands.

Commissioning services to address gapsPHNs will play less of a role in providing direct services than the Medicare Locals they replace, shifting to a service commissioning and funding model that will support existing health services and organisations to develop localised solutions.

Successfully managing this shift will require evidence based commissioning and clinical governance models, to ensure that the best and most needed services are supported and that service providers are selected in a transparent and equitable manner.The ISO:9001 accreditation achieved by INWMML in addition to the Medicare Local Accreditation Standards provides a strong governance structure that can be built on to take into account the additional scope and responsibility of the new PHN organisation.This strength in governance is complemented by experience in service commissioning, exemplified by the success of the contracted elements of the CAREinMINDTM mental health counselling program.This is an area where the local Clinical Councils and Community Advisory Groups will play a key role, ensuring the services commissioned are those that are truly needed and supported by the community they will serve.

Creating and strengthening the patient-centred medical home

By bringing all these elements together we aim to provide the resources, support, coordination and structure to allow general practice and other primary health care providers to operate effectively as patient centred medical homes. This means putting general practice at the heart of comprehensive and coordinated care for all patients in our community, and integrating models of care across the specialist/generalist spectrum so managing patient care is seamless rather than onerous. The north western region boasts some of the best and hardest working GPs, local hospital networks, community health organisations and health professionals in our state if not the whole country. They, as well as the people they care for, deserve to be part of the best primary health care system possible, and we believe that with a clear focus on the areas outlined it can be delivered. We’re already seeing success as the programs outlined and others start to have an impact in our local region. With the drive and support of our broader health community, we’re confident that the North Western Melbourne Primary Health Network can amplify that success on a larger scale and become a national leader in primary health excellence.

Dr Geoff Markov MBBS, FRACP Rheumatologist

Dr Markov is pleased to announce his return from sabbatical leave in Galway, Ireland. He has resumed

consulting at:

Suite 502, 100 Victoria ParadeEast Melbourne 3002

(opposite St Vincent’s Hospital)

A short stroll from the CBD. Easy access with trams, buses and Parliament Station. On street and high rise parking available.

Also consulting at Williamstown and Hoppers Crossing.

For all appointments:

Tel: 9639 6128 Fax: 9639 0465

PRIMARY FOCUS16

Elise Boyar Each issue we profile one of our members, who form the heart of our organisation. This time we talk to Melbourne based Traditional Chinese Medicine practitioner Elise Boyar.TELL US SOMETHING ABOUT YOURSELF AND YOUR PRACTICE?Having trained in China, Australia and the US, I now run a Traditional Chinese Medical practice in Melbourne, Facing East Chinese Medicine. I also run educational seminars, alongside medical and allied health specialists, addressing areas such as chronic pain, fertility, digestive disorders, mental health, as well as general well-being. There is therefore a focus on preventative care and education equipping individuals with the right tools necessary to make a change to their health as well as clinical care in the practice. I am also engaged by RMIT, as a clinical educator.I have designed my practice to be a retreat for my patients, giving them the ability to take some time out of their busy stressful lives to just be able to focus on themselves and their own wellbeing. All treatment forms I undertake (including acupuncture, remedies and diet and lifestyle education) are customised to the individual.WHAT DO YOU MOST ENJOY ABOUT YOUR WORK?I feel fortunate to be part of a modality, which rears powerful results. The ability for traditional Chinese medicine to support the body to heal itself is phenomenal and I embrace all opportunities which help to educate people about their health. Similarly I really value industry discussions, which help profile how TCM can complement other modalities, to achieve greater patient outcomes, which last. I love that no matter how experienced I become, I am constantly evolving and growing as a practitioner.I help many people with chronic pain and mental illness and as all health practitioners will appreciate, the ability to alleviate such suffering is what motivates me to continue within traditional Chinese medicine.WHAT AREA OF WORK ARE YOU MOST INTERESTED IN AT THE MOMENT?At the moment I am most interested in the parasympathetic nervous system, the endocrine system and how hormones affect the body – for example how stress hormones, namely cortisol and adrenaline can affect ones moods e.g. depression and anxiety as well as digestive health. Also in women’s health how oestrogen and progesterone imbalances can cause all sorts of menstrual irregularities, mood swings, weight gain and infertility.WHAT WOULD YOU LIKE TO CHANGE IN THE HEALTH SECTOR?I would like to see an increase in preventative care and education within the Australian health sector, so to intervene at earlier stages, and so to allow patients to heal as efficiently as possible.The body has an amazing ability to heal itself, especially if a health issue is identified and treated proactively. By adopting a preventative care model we can much more easily move Australians along the health spectrum.

As a huge supporter of evidence based treatments and conventional medicine, I have found through traditional Chinese medicine that I am able to treat a range of issues addressing the root cause of why my patients become ill in the first place. This approach to health allows for better recovery, and works well to offset any potential disease in my patients.Traditional Chinese Medicine can work very effectively within the existing medical system, as well as incredibly well for preventative health. This is particularly important given the rise in lifestyle diseases such as diabetes, cancers, infertility and heart disease. My ambition is to help patients as early along the disease curve as I can.IS THERE ANYTHING INWMML HAVE DONE THAT HAS IMPROVED / ADDED VALUE TO YOUR WORK / PATIENT OUTCOMES?The opportunity to connect with different members of the health community and medical sector is really critical to patient care. I really do believe in a full health system.An integrated health approach is something I really value and opportunities to illustrate how TCM can work within the system, only strengthens our community, knowledge and patient care.If you would like to be profiled in a future edition of Primary Focus, please contact Julie Sucksmith on (03) 9347 1188.

PRIMARY FOCUS17

FOCAL POINT: FACING EAST CHINESE MEDICINE

www.lakeimaging.com.au

North Melbourne: (03) 9321 4900 Melton: (03) 9747 4800 Sunbury: (03) 9744 5344

Lake Imaging is a privately owned radiology company established in 2002 with the primary

philosophies of providing:

A state of the art service

Optimal quality diagnostic imaging and patient care

Over 12 years on these philosophies are unchanged.

The North Melbourne practice, located at 55 Flemington Rd, provides minimal waiting time and

fast report turn around time for the following:

Low Dose CT

Ultrasound

Echocardiography

OPG/Dental Imaging

Bone Densitometry/DEXA

General Radiography

Interventional Radiology

Mammography

A Radiologist is available on site 5 days per week to answer any questions, queries or concerns

you may have.

Heading up the team at North Melbourne is Clinical Director for the Western Region, Dr Ross

Breadmore. Ross has a wealth of experience with a particular interest in musculoskeletal imaging

and neuroradiology. He completed his fellowship at Nuttfield Orthopaedic Centre in Oxford, and

has been with Lake Imaging since inception.

Dr Breadmores interest is in education with a focus on

maintaining and improving the quality of diagnostic imaging.

CT SCANS BULK BILLED

HELPING ANSWER YOUR CLINICAL QUESTIONS

Each issue we profile a condition, treatment or practice management tool. This issue we look at diabetes care in the community, looking at the positive impact Diabetes Nurse Educators like Rebecca Comer can have on patient health outcomes. A COMMUNITY THAT CARES83-year old Italian-born Elio has lived in Brunswick for 55 years. He’s managed his diabetes for two decades, but it’s been getting harder as he gets older. His neighbours of 20 years come from the same part of Italy. Their daughter has been his daily carer – taking him to appointments, for example, and helping to pick up his prescription medicines. INWMML Diabetes Nurse Educator, Rebecca Comer, is now working with Elio and his carer linking them to supports and services, making a difference to his life and the standard of care he receives. The carer is finally accessing a carer’s pension after years of support for her elderly neighbour due to Rebecca’s efforts.

MAKING A DIFFERENCERebecca said that in the six months she has been visiting Elio, he has avoided multiple hospitalisations and potential serious illness because she picked up that he had cellulitis and provided the right treatment. Through Rebecca’s efforts, Elio is now receiving a variety of services including cleaning, shopping and gardening. And Benetas provides a care manager who helps to organise any home maintenance issues. These steps have greatly improved both Elio’s life and that of his carer.

“Elio is now linked into health and community networks in a way that works for him and helps him manage his condition,” Rebecca said. “His GP has become more engaged in his diabetes care.”Rebecca said there has been a significant improvement in Elio’s diabetes control which has given him more energy and reduced his susceptibility to infections and complications.

EMPHASISING THE POSITIVEAs a Diabetes Nurse Educator, Rebecca also advises her patient about diet. He was eating too much of some things, like fruit, and not enough of other things. With regular support he’s been able to make some beneficial changes.But Rebecca said that he hasn’t had to stop one lifetime habit.“I make sure that we share a coffee from his favourite coffee shop each time I visit.”

Diabetes Nurse Educator Rebecca Comer is helping Elio

get the most out of life.

FOCUS ON: DIABETES CARE

PRIMARY FOCUS20

All the happenings around the INWMML office and beyond over the last few months.

BY THE WAY… 1 Health Literacy Training and Plain WritingA two-session plain writing course in October was a great reminder of how to write clearly and with purpose, while a health literacy workshop held in November gave 26 staff members an update on what it means to be health literate. Both workshops were a great opportunity to discuss strategies and brush up on skills.

2 Mental Health Week – Morning TeaOn Thursday 9 October we celebrated the great work done in our organisation and beyond community to address the mental health needs of our community. There was (too much) food and (some questionable) entertainment and all money raised was donated for The Clown Doctors.

3 10 years of serviceIn November we congratulated Gillian Cass on her 10-year anniversary with the organisation and thanked her for all her work toward improving health care in the community!

4 New starters and farewells In October we welcomed Carlene Miller to the Care Coordination and Supplementary Services Program and Dr Paul McCauley to the mental health team, both located at cohealth in Fitzroy. Jen Thompson and Piru Soma joined us as the newest members of the HealthPathways team.Kim Gordon started in November in a knowledge management role within the Business services team and Kathryn Griffin will be starting as NPS Facilitator in December.Thank you and farewell to Norman Carson who has decide to retire. Norman has been our biostatistician and provided great support to our population health team and efforts and will be very hard to be replaced. Farewell and good luck also to Denise Clarke, who worked within many teams and brightened all of our lives.

5 September eventsIn September we held our first information session on LGBTIQ issues in aged care, our annual travel medicine update, and a terrific session on Bipolar disorder as part of our GP Mental Health series.The Diabetes Symposium, also held in September brought together a range of health practitioners to further develop their diabetes management skills. This was a very successful event with 73 engaged practitioners.

6 October eventsThe highlight of October was the Type 2 Diabetes Community Forum, held in October at Moonee Valley Racecourse. More than 70 people attended and connected with each other and to local services and support groups, as well as getting active, motivated and keen for another session!

3

2

1

PRIMARY FOCUS21

7 Inner North West Melbourne Drug and Alcohol ConferenceThe Best Practice Management of Alcohol and Other Drugs conference was a truly successful day with over 100 people attending and very positive evaluations. The event, funded by INWMML and FARE brought together GPs, welfare and mental health workers, researchers and other health professionals to discuss the treatment and management of AOD issues within our region.

8 November events The Infection control update was a large event, with timely information about Ebola management. Other events in November included our first Contraceptives Counselling session, the third annual Collaborative forum (with cohealth, Merri Community Health Services and Melbourne Health) as well as our last session for the GP Mental Health Series – Addiction to Recovery.

9 Immunisation launchINWMML launched the consumer awareness campaign – Immunise Melbourne – at the Boyd Assembly Hall in Southbank on the 28 November. All four local councils were there to support this great initiative to boost immunisation rates within our catchment. Watch out for the posters and help us to support the campaign by displaying them in your practice. For more info go to www.immunisemelbourne.org.au

5

7

5

8

6

5

7

6

Merrilyn, 30 Coburg local

I study and workI’m involved in our

local communityand I

immunise.

immunisemelbourne.org.au

Find out why @

INWMML would like to acknowledge the Immunisation Alliance WA, which has granted approval for use of their I Immunise concept for this campaign.© MPCN 2014 All rights reserved

Merrilyn.indd 1 31/10/2014 11:37:34 AM

PRIMARY FOCUS23

IN ONE EAR twitter.com/inwmml

Standard advertising rates for the magazine (excluding GST):

NON- INWMML MEMBER MEMBER

• Quarter page $450 $225 • Half page $800 $400 • Full page $1,500 $750

All material is subject to editorial review.

Please contact Julie Sucksmith on (03) 93471188 for more information.

YOUR PRACTICEKeep up to date with Your Practice, our fortnightly newsletter covering all our upcoming events as well as the latest news and information from across the primary health care sector.

Subscribe to Your Practice through events@inwmml.org.au or read it online at www.inwmml.org.au

ACKNOWLEDGEMENTSWe acknowledge the Wurundjeri people and other peoples of the Kulin nation as the Traditional Owners of the land on which our work in the community takes place. We pay our respects to their Elders past and present.

Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health.

DISCLAIMERThis magazine is provided for information only. Although every effort is made to ensure accuracy of information, it is presented without warranty of any kind either expressed or implied. The reader assumes the entire risk as to the use of the magazine and the material in it. The views expressed in this magazine are those of the authors and do not necessarily reflect the official position of Inner North West Melbourne Medicare Local.

INNER NORTH WEST MELBOURNE MEDICARE LOCALABN 95 153 323 436

Telephone: (03) 9347 1188 Fax: (03) 9347 7433

Street address: Level 1, 369 Royal Parade, Parkville, Victoria 3052

Postal address: PO Box 139, Parkville, Victoria 3052

Email enquiries: inwmml@inwmml.org.au

ADVERTISE WITH US

Missed out on the big tips? Here’s our news in 140 characters or less.Make sure you catch everything next time by following us at twitter.com/inwmml

INWMELBMEDICARELOCAL @INWMML · NOV 26Our new initiative Immunise #Melbourne – find out more at http://www.immunisemelbourne.org.au or like us on FB http://www.facebook.com/immunisemelbourne … or @immunisemelb

INWMELBMEDICARELOCAL RETWEETED MOONEE VALLEY @MOONEEVALLEYCC · NOV 25Today’s @WhiteRibbonAust Day – say no to violence towards women. Sign a #MooneeValley pledge board. Find out where: http://mvcc.vic.gov.au/whiteribbon

INWMELBMEDICARELOCAL RETWEETED CHRISTOPHER CARTER @CARTERCHRISJ · NOV 18 Thanks to @TheRMH, @cohealth_au, Merri CHS for another great collaborative forum. Advance Care Planning now on the agenda for serious work.

INWMELBMEDICARELOCAL @INWMML · NOV 14 Great support from @cohealth_au at the INWM #AoD conference last weekend – full story here http://inwmml.org.au/news/fx-news.cfm?loadref=6&id=108 …

INWMELBMEDICARELOCAL @INWMML · OCT 30 Just a few days to mo...#Movember that is! Check out http://au.movember.com/ for ways to raise awareness of men’s health @MovemberAUS

INWMELBMEDICARELOCAL @INWMML · OCT 20 #MooneeValley LGA: Healthy lifestyles, higher income/higher #diabetes, poorer youth #mentalhealth @mooneevalleycc Need help to #eathealthy? http://eatforhealth.gov.au has meal plans for women, men and children to help you stay on track http://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day …

INWMELBMEDICARELOCAL @INWMML · OCT 10 Mental health begins with me...and you! Make a mental health promise to yourself #WMHD14 #MentalAs @AUMentalHealth https://1010.org.au/promise/add

INWMELBMEDICARELOCAL @INWMML · SEP 24 Important story in @melbtimes on #speechtherapy & #language needs in inner north west of #Melbourne http://www.theweeklyreviewmelbournetimes.com.au/story/1811060/inner-north-children-s-speech-problems-tackled/ …

The Dementia Consultancy Services range has been built on evidence based research. We provide a range of dementia specific services and easy to use products, widely used by professional care facilities and also available to family care providers for people living with dementia.

Real Solutions for Dementia Family Care Providers

For more information, visit us at:www.dementiaconsult.com.au

Our Services• Music Therapy Services-

CDs and handbooks

• Dementia Education

• Behaviour Management

• Personalised Care Plans

• Dementia Specific Gardens

When applied properly at the right time, these strategies can help manage difficult behaviours.

Contact us for more information on 1300 202 120 or info@dementiaconsult.com.au

Season’s greetingsfrom INWMML

Thank you for all your support over the past year.Best wishes for the holiday season and the new year.

PRIMARY FOCUS24