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Primary Health Services Toolkit Aboriginal and Torres Strait Islander Initiatives January 2019 Central and Eastern Sydney PHN

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Primary Health Services Toolkit Aboriginal and Torres Strait Islander Initiatives January 2019 Central and Eastern Sydney PHN Primary Health Services Toolkit Aboriginal and Torres Strait Islander Initiatives January 2019 Central and Eastern Sydney PHN Disclaimer The information in this kit is not a substitute for independent professional advice, and expert or legal advice should be sought from competent professional persons as appropriate. Central and Eastern Sydney PHN does not accept liability for any injury or loss or damage incurred by the use of or reliance on the information in this kit. Source: • Practice Incentives Program Indigenous Health Incentive Guidelines – February 2014 • Closing the Gap within your service for Aboriginal and Torres Strait Islander Patients – Practice Guidelines Sept 2013 – Eastern Sydney Medicare Local • Sutherland Division of General Practice – Practice Training July 2011 2 | P a g e Table of Contents Topic Title Page 1 Background NSW Statistics and Local Health 4 Issues 2 The General Practice Environment Customer Service 5 - 6 Asking Patients about Cultural 7 Status Recording cultural background 7 How to ask the question on cultural 8 - 9 status Additional information about asking 10 patient on Indigenous status 3 Patient Records Medical Director 11 Best Practice Non – computerised practices 4 Health Assessment for Aboriginal and Torres Components, Eligible practitioners, 12 Strait Islander People (MBS Item 715) Restrictions 5 Supporting Primary Care Providers to Coordinate Chronic Disease Management Practice Incentives Program (PIP) Indigenous Health Incentive (IHI) 13 - 15 Applying for the PIP Indigenous 16 Health Incentive Patient Registration and Re- 17 registration Requirements for the Indigenous 18 Health Incentive PBS Co-payment – Access to 19 - 20 cheaper or FREE Medicines 6 Frequently Asked Questions 21 7 CESPHN Programs Care Coordination and 22 - 23 Supplementary Services (CCSS) Program Outreach Worker Program 24 HealthPathways – Sydney 25 8 Appendices 26 3 | P a g e 1. BACKGROUND NSW There are an estimated 216,176 (Census 2016) Aboriginal and Torres Strait Islander people living in NSW, comprising one third (33.3%) of the total Aboriginal and Torres Strait Islander population of 649,171 within Australia. The Central and Eastern Sydney PHN (CESPHN) region has five Aboriginal communities, all part of the Eora Nation. These are: Bidjigal (Bediagal); Gadigal; Wangal; Gweagal; Dharawal (language) In the CESPHN region an estimated 13,479 Indigenous Australians reside in the area. The Indigenous population as a proportion of the total population is concentrated in the Local Government Areas (LGAs) of: • Botany Bay: n=819; • Marrickville: n=1,178; • Randwick: n=1,700; In absolute numbers, the largest Indigenous population resides in the LGA Sydney: n=2,180 and the smallest in Strathfield LGA: n=103. Local health issues identified: Health care access such as: • Affordability • Availability • Appropriateness / responsiveness • Utilisation Chronic conditions such as: • Cardiovascular disease • Kidney disease • Diabetes • Cancer • COPD • Asthma 4 | P a g e 2. THE GENERAL PRACTICE ENVIRONMENT Making your service inviting to Indigenous Australian community members and acknowledging different health needs will increase health service accessibility opportunities and help to close the gap for patients who identify as being of Aboriginal or Torres Strait Islander decent. What does a patient look at before entering a service? They consider whether the service appeals to them and whether they will feel welcome there. The practice reception desk and waiting area are where patients obtain their first impression of your practice. Aboriginal and Torres Strait Islander Australians often have different concepts of health and illness from those of the general population. Recognising that there are cultural differences is important in providing good quality care for the indigenous community. It is essential to provide an environment that is welcoming to the Aboriginal community to aid in making these patients feel safe and secure. This will assist in encouraging patients to identify their cultural status and disclose health concerns, which in turn will increase access to health services. There are some simple ways of communicating to Aboriginal and Torres Strait Islander people that they are welcomed and within a safe environment: • Display Aboriginal and / or Torres Strait Islander artwork or icons (e.g. Aboriginal flag) in visible locations within the practice such at or around the reception desk. • A sign at your front desk acknowledging the traditional owners of the land in which you are working. • A sticker for your front window saying: “Our service is proud to support Closing the Gap initiatives for Aboriginal and Torres Strait Islander people” These stickers are available from the Central and Eastern Sydney PHN • Provide a child friendly environment e.g. toys and books • Provide drinking water to patients who may have had a long walk and no transport available to them. • Offer assistance with any follow up appointments that may need to be made or referrals to other primary or allied health service providers • Obtain health promotion information appropriate for Aboriginal and Torres Strait Islander patients. The PHN can assist with this, and there is also a plethora of information available online 5 | P a g e Customer Service Reception staff maintain the front line for each general practice and thus they are integral to providing a good first impression on patients attending the practice. Because of this, it is important for these staff members to be aware of specific cultural issues and barriers that limit Aboriginal and / or Torres Strait Islander patients from attending mainstream health services such as general practice. Following are some tips to assist reception staff in providing culturally appropriate customer service to Aboriginal and Torres Strait Islander patients: • Ask all patients of their cultural status and record in medical software • Allow the patient to have family members present if desired. When inviting family or community members to accompany a patient, ensure the patient fully consents to their attendance and that the community/family members are fully aware of the need for confidentiality • Provide gender appropriate staff where possible, for both male and female patients, especially regarding pap smears, sexual health checks, pregnancy checks, antenatal care and postnatal care • All reception staff should be aware of the services provided to Aboriginal and Torres Strait Islander patients including vaccinations, Aboriginal Health Assessments, the Indigenous PIP, PBS program, Coordinated Care Supplementary Services Program and Outreach Worker Program • All reception staff should be aware of the billing protocol provided to Aboriginal and Torres Strait Islander patients such as bulk billing and Indigenous Health Incentive item number • The practice may need to assist some patients with completing forms • If you have a Practice Nurse, they can complete the clinical information with advice from the patient in an interview style. Or, a family or support person may be present and can assist with the forms • When the patient contacts the practice for their first appointment, remind them to bring their Medicare Card with them • Encourage all staff in the practice to attend Aboriginal and Torres Strait Islander Cultural Awareness programs Given the known access barriers to health services, by patients of Aboriginal and Torres Strait Islander descent (including transport and any past negative or judgmental experiences), if a patient calls in looking for an opportunistic appointment it may well be for something urgent or of a sensitive (shame) nature. If you are pre-booking an appointment for Aboriginal or Torres Strait Islander patients, it may be appropriate to reserve a long appointment to see the doctor as assistance with filling out forms (e.g. housing, Centrelink) may be needed or advice or education for more than one health reason. Extra time should be allowed for first appointments to allow the doctor time to build rapport and trust with the patient. As with all patients, prospective costs should be explained to the patient before they see the GP or any treatment is commenced. If possible, follow up appointments and referrals should be made before the patients leave the practice. 6 | P a g e Asking patients about cultural status Research evidence shows that where general practices take action to improve their identification processes, there is a corresponding increase in the numbers of correctly identified patients. There are sensitivities and concerns in some areas about the issue of identification and that ‘asking the question’ and recording the answer may require IT and procedural support. Reasons for under identification of Aboriginal and Torres Strait Islander patients: • Lack of awareness and training of staff • Staff reluctance to ask the question • Client refusal to answer the question • Staff perceptions about Aboriginal and Torres Strait Islander clients not wanting to disclose their status • Lack of privacy when answering the question • Minimal checking/validating of data and follow up of missing information • Inadequate data management systems At practice level, identifying Aboriginal and Torres Strait Islander status is a necessary condition for participation in the Closing the Gap initiative. Without practice awareness, a patient who is of Aboriginal or Torres Strait Islander origin cannot benefit from various measures in the Australian Government’s Indigenous Chronic Disease Package.
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