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CARPA
Newsletter
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go
to:
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the current CARPA Newsletter - Issue 36 March 2004 |
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or
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previous CARPA Newsletter - Issue 35 October 2003 |
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The
current CARPA newsletter is:
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 Issue no 36 - March 2004 |
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The newsletter is a large document and has been divided as follows (Acrobat pdf - please allow time for download) |
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| Contents: | |
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Allied
Health Planning Study Pharmacy
Honours Student Rural Projects
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CARPA
Newsletter, Issue 36-March 2004 Editorial
Committee |
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Divisions of General Practice or Divisions of Primary Health Care? A view from Central Australia by Dr Susan Wearne, Chair, Central Australian Division of Primary Health Care The Commonwealth Department of Health and Ageing first funded Divisions of General Practice in 1992. There are now 122 Divisions in Australia, which general practitioners are eligible to join. This article will consider the role of Divisions, the changes made in the Division in Central Australia and argue that the goals of Divisions cannot be achieved in isolation from other professions. So
what are Divisions for? Divisions exist for the benefit of communities,
and their health, not just for the benefit of general practitioners.
More explicitly "Divisions of General Practice provide the
organisational structure for general practitioners to work together
to improve quality and continuity of care, meet local goals and
targets, promote preventative care and respond more rapidly to changing
community health needs. Divisions also provide general practitioners
with a corporate identity, a method of influencing the organisation
of health care delivery, a chance to utilise a broader range of
skills, knowledge and expertise and an opportunity to work with
other stakeholders on issues of common interest"1. The area covered by the Central Australian Division is half a million square km and has a population of 48,000, a third of whom are Indigenous. Of the 48,000, 18,000 live in remote communities. It is an area of extremes: distances, climate, appalling morbidity and mortality statistics. Providing health services is a challenge because of workforce shortage, high turnover, and high costs. Cultural differences in the meaning of health and illness between professionals and patients add to the complexity. This
environment has required and fostered innovation. Multidisciplinary
teams deliver health services. Aboriginal health workers, remote
area nurses and GPs may provide the first point of contact for people
seeking assistance with health. For years CARPA has provided a forum
for professionals in this area and has created practical clinical
support in the form of the CARPA Standard Treatment Manual. How does a Division of General Practice fit into this environment? The Division of General Practice model fits with private general practice but only a third of Central Australia's GPs work in this setting. An organisation which focuses only on general practitioners cannot improve population health in Central Australia and ignores the strong multidisciplinary focus of remote health care. In
recognition of this in 2000 the Board of the Division proposed to
the Division membership that the name be changed to a Division of
Primary Health Care. Other constitutional changes were the opening
of membership to Primary Health Care organisations. The Aboriginal
Medical Services Alliance of the Northern The
Division Board has formally adopted a position statement of comprehensive
primary health care 2. The organisation strives to work to these
principles. For example, consumers are represented on all new projects,
we collaborate with other organisations As
with any change, there are advocates and dissenters. Some GPs yearn
to have their organisation back; others complain that the changes
are only cosmetic and that there is a long way before we truly become
a Division of Primary Health Care. The
principles of comprehensive primary health care are a useful guide
at Board level when setting the strategic aims, but how does this
translate into a tangible difference to patient care? An obvious
limitation is that the Division is mainly funded for programs for
general practitioners. We risk raising expectations of other professions
and not being able to deliver. Last
year a nationwide review of Divisions took place3. The review recommended
that Divisions consider becoming Divisions of Primary Health Care.
The government has yet to respond to the review but CADPHC is encouraged
that there is recognition that References 2.
Central Australian Division of Primary Health Care 2003, 3.
Department of Health and Ageing 2003, The Future Role of the |
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| Allied Health Services Planning Study in Central Australia by Janine Ramsay, Project Officer, Centre for Remote Health What is it? The Centre for Remote Health has been funded by the Australian Government's Department of Health & Ageing to develop a comprehensive and flexible model of Allied Health service provision to improve the health and well-being of residents of remote communities in Central Australia. Which geographical areas will the planning study cover? The study will cover all communities in the Central Australian region of 5000 people or less, i.e., the communities of the Barkly region including Tennant Creek, the Alice Springs region and the cross-border region of SA, WA and NT (Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara language groups). Why a planning study? This is not another needs analysis or review, rather a planning study to map out what Allied Health services need to be provided in the region, how much service is required, and most significantly, how those services should look and who should run them. This planning study will use the extensive literature already available in regards to health needs, and in particular, Allied Health needs in the region. It will also take into account, and aim to complement, other local initiatives, eg. the Primary Health Care Access Program (PHCAP), the More Allied Health Services (MAHS) Program, any current health planning in communities, and services offered through NPY Women's Council, Nganampa Health and Ngaanyatjarra Health. While this study will consider research from the Allied Health Services Planning Studies being implemented in Katherine and Mt Isa, it is aiming to develop innovative models appropriate for Central Australian needs. This will mean investigating models of service delivery which have had success in remote communities and factor in recruitment and retention strategies. What will the process be? The project has just commenced and will be completed by the end of June this year. Providers and recipients of Allied Health services and other community members will have an opportunity to be involved through consultations with community organisations, government agencies, non-government organisations and individuals. Representatives from the organisations which deliver services in the region are being invited to join a steering committee which will meet monthly. A communication tool will be developed to assist in explaining the roles and functions of the various relevant Allied Health professional services. What will be the Outcomes? o development of a flexible framework for delivery of Allied Health services that allows for differences at a community level; o a fully costed flexible, integrated and robust model(s) of Allied Health service provision for the Central Australian region; and o development of recommended benchmarks for Allied Health service provision for a Central Australian context. Further
information or any feedback for the project: |
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No,
it's not someone's birthday but it may well be reason to celebrate
a promising development in rural/remote workforce recruitment and
retention. Flinders School of Nursing & Midwifery (FSON&M)
in partnership with the Northern Territory Department of Health
& Community Services (DH&CS) took a strategic approach to
attracting undergraduate nurses toward careers in rural and remote
Australia. Since 1998, Flinders nursing students have Although
not specifically the program's aim, Alice Springs Hospital has gained
up to sixteen nursing staff who returned for periods of between
one to five years. Other NT health services have also benefited
from employment of those who gained their clinical experience in
Central Australia, including remote area health Rural and remote areas are most often characterised by high staff turnover and/or staff shortages. This impacts on continuity and quality of care for populations with already compromised health status. The Flinders undergraduate program is able to show students the many positives of rural and remote practice and direct them to work towards developing the skills and knowledge base required for what is undeniably a challenging and rewarding career. By
preparing students at undergraduate level their potential longevity
in rural and remote areas is enhanced. While the average length
of stay for registered nurses in Territory Hospitals is 3-6 months,
the Flinders graduates are moving into their second, or for some,
fifth year of employment at Alice Springs Hospital. Several have
been able to 'fast track' toward remote area employment, having
experienced placements as undergraduates and then again as new graduates. The
Flinders Rural and Remote clinical experiences are achieving results
far exceeding expectations. With a critical mass of Flinders graduates
throughout the region, the program will soon be formally evaluated.
However, anecdotal evidence strongly suggests that the undergraduate
experience of rural and remote nursing has been instrumental in
influencing career choices 1,2. Current informal feedback suggests
that there could be The
key elements of the program include a selection process ensuring
that high calibre students are chosen. Motivation for rural and
remote clinical experience is considered, rather than some current
selection criteria that look at rural/remote background alone, as
it is believed that the potential pool of future recruits should
not be limited to a specific demographic 2,1. Students are encouraged
to complete an Indigenous Health topic and are given a comprehensive
orientation program that usually includes Stage 1 of the Aboriginal
Cultural Awareness Program (ACAP) run by DH&CS. The
Central Australian Clinical experience is a major attraction for
the Flinders' Norwegian students, who are part of a collaborative
venture between the School and several training institutes in Norway.
Controversially, some health professionals have questioned the acceptance
of Norwegian students, suggesting there is little obvious benefit
locally as these students most often return to Norway following
graduation. It has been our experience in Central Australia that
these students provide numerous benefits to local health services.
For example, they effectively become 'global ambassadors', promoting
the Australian nursing experience to th world. They also bring with
them a different worldview and approach to nursing practice that
seems to work well in the cross-cultural context of Central Australia.
Their experience as speakers of English as a second language provides
valuable insights and skill in cross-cultural communication. Many
still maintain relationships with community members, via correspondence.
Several have stayed or returned to Australia for employment References |
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