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Orientation

Facilitator Manual

Part 4—Primary Health Care

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Orientation Handbook part 4 - Facilitators Version 1( 5/10)

Orientation Handbook part 4 - Facilitators Version 1( 5/10)

Table of Contents

 - Part PaRROT Orientation Handbook 

• Unit 14 Aboriginal and Torres Strait Islander Health Click on the relevant section for an immediate link
  • SESSION PLAN ..............................................................................................................................................
  • Session 1 ........................................................................................................................................................
  • Presentation ...................................................................................................................................................
  • Learning Activity – Facilitator .....................................................................................................................
  • Questions .....................................................................................................................................................
  • Learning Activity - Participant ....................................................................................................................
  • Questions .....................................................................................................................................................
  • Session 2 ......................................................................................................................................................
  • Quiz – Facilitators ........................................................................................................................................
  • Questions .....................................................................................................................................................
  • Quiz – Participants.......................................................................................................................................
  • Questions .....................................................................................................................................................
  • BIBLIOGRAPHY ...........................................................................................................................................
• Unit 15 Comprehensive Primary Health..................................................................................................................
  • SESSION PLAN...............................................................................................................................................
  • SESSION 1......................................................................................................................................................
  • Presentation .................................................................................................................................................
  • Learning Activity – Facilitator......................................................................................................................
  • Questions......................................................................................................................................................
  • Learning Activity – Participant ....................................................................................................................
  • Questions......................................................................................................................................................
  • SESSION 2......................................................................................................................................................
  • Quiz – Facilitator ..........................................................................................................................................
  • Questions......................................................................................................................................................
  • Quiz – Participant.........................................................................................................................................
  • Questions......................................................................................................................................................
  • BIBLIOGRAPHY..............................................................................................................................................
• Unit 16 Selective Primary Health Care....................................................................................................................
  • SESSION PLAN ............................................................................................................................................
  • Session 1 ......................................................................................................................................................
  • Presentation .................................................................................................................................................
  • Learning Activity – Facilitator .....................................................................................................................
  • Question .......................................................................................................................................................
  • Learning Activity – Participant....................................................................................................................
  • Question .......................................................................................................................................................
  • Session 2 ......................................................................................................................................................
  • Quiz – Facilitator ..........................................................................................................................................
  • Questions .....................................................................................................................................................
  • Quiz – Participant.........................................................................................................................................
  • Questions .....................................................................................................................................................
  • BIBLIOGRAPHY ...........................................................................................................................................
• Unit 17 Introduction to Health Checks.....................................................................................................................
• SESSION PLAN ............................................................................................................................................ Orientation Handbook part 4 - Facilitators Version 1( 5/10)
• Session 1 ......................................................................................................................................................
• Presentation ...............................................................................................................................................
• Learning Activity - Facilitator....................................................................................................................
• Questions ...................................................................................................................................................
• Learning Activity - Participant ..................................................................................................................
• Questions ...................................................................................................................................................
• Session 2 ....................................................................................................................................................
• Quiz - Facilitator.........................................................................................................................................
• Questions ...................................................................................................................................................
• Quiz - Participant .......................................................................................................................................
• Questions ...................................................................................................................................................
• BIBLIOGRAPHY .........................................................................................................................................

Orientation

Unit 14

Aboriginal and

Torres Strait

Islander Health

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Orientation Handbook part 4 - Facilitator Version 1(5/10)

SESSION PLAN ..............................................................................................................................................

Session : Aboriginal and Torres Strait Islander Health

Location

Overall Session Time: 1 Hour

Synopsis Performance outcomes, skills and knowledge required to understand what impacts on Aboriginal and Torres Strait Islander health, and what strategies are recommended to ensure they have effective health care services.

Learning outcomes Be aware of Aboriginal and Torres Strait Islander Health Issues Be aware of factors contributing to poor Aboriginal and Torres Strait Islander Health Understand what is required to deliver effective Aboriginal and Torres Strait Islander chronic disease care

Time allocated

How will session run Delivery method & resources equipment

Assessment

10 minutes

Introduction

1. INTROA
2. Learning Objectives

Session 1 notes Presentation

25 minutes Content (See detailed notes) Presentation

10 minutes Activity Case study Activity sheet

5 minutes Wrap up (^) Session 2 notes

10 minutes Assessment Complete quiz – self mark using answer sheet.

Quiz Quiz – self mark

Close

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Detailed Session Notes

Slide Slide Title Notes 1 Session title Aboriginal and Torres Strait Islander Chronic Disease

Session 1 notes

Interest (Create Interest)

Need (Explain why they need to know)

According to the Australian Institute of Health and Welfare 2008, Aboriginal and Torres Strait Islander peoples experience significantly more ill health, an earlier onset on chronic disease, and higher mortality and morbidity associated with a variety of chronic diseases than their non-Indigenous counterparts. It is for this reason primary health care practitioners need to understand the factors that impact on the problem and the recommendations for responding to these factors.

Session 1 notes

Introduction: Topic (What the session is about) Range (What will be covered)

This unit looks at the findings of research on Aboriginal and Torres Strait Islander health, particularly in reference to chronic disease and the development of systems to support a holistic approach to chronic disease care. These systems are currently being implemented across the state in line with increased funding and resource allocation for Aboriginal and Torres Strait Islander health care.

2 Learning Objectives Outcomes (What they will achieve)

Assessment (How they will be assessed)

Be aware of Aboriginal and Torres Strait Islander Health Issues Be aware of factors contributing to poor Aboriginal and Torres Strait Islander Health Understand what is required to deliver effective Aboriginal and Torres Strait Islander chronic disease care Learners will complete a learning activity and self-marking quiz.

3 Health Status When compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander Australians have a lower life expectancy and carry a greater burden of chronic disease, they also have greater difficulty accessing health care and are more likely to be hospitalised.

4 Inequalities in Health Although the burden of chronic disease in Queensland is great, Aboriginal and Torres Strait Islander people carry an even greater burden. Their life expectancy is on average 10 years less than non-Indigenous people and 90% of presentations to rural and remote health services are the related to chronic disease. A large number of Aboriginal and Torres Strait Islander Australians live in rural and remote areas.

5 Contributing Factors There are a number of factors contributing to poor Aboriginal and Torres Strait Islander health – these factors fall under the key determinants of health and include

• Social, economic & environmental factors e.g. living conditions, working environments,
• Education, income, food quality, water & air quality, social support, age, geographic location, Aboriginal and Torres Strait Islander & ethnic status

6 Review of health status In response to the concerns about Aboriginal and Torres Strait Islander Health Status, a review of the health services in the Cape and Torres Strait was conducted by Queensland Health. The areas of concern identified in the review included high levels of health related problems such as, injury, chronic disease and sexually transmitted infections, high levels of substance abuse, poor nutrition and continued high rates of preventable infectious diseases as a result of inadequate housing, overcrowding & poor hygiene. These findings have been supported by research done in the Northern Territory and are reflected in current data released by the Australian Institute for Health and Welfare 2008.

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Detailed Session Notes

Slide Slide Title Notes 7 Recommendations Recommendations made by the review panel included the need for a ‘whole person’ approach and the need to implement evidence-based medicine and standard protocols, including individual and population based care plans for prevention, early detection and management of Chronic Disease. This supported similar findings found in the Northern Territory in studies done by Weeramanthri.

8 Recommendations Further recommendations include the need for the development and implementation of population-based information and reporting systems, a highly skilled generalist health workforce in communities, supported by a regional workforce strategy and effective communication of health –related information and communities.

9 Outcome The enhanced model of health care preceded the development of the Queensland Strategy for Chronic Disease. This is the systems based framework supporting the implementation of Chronic Disease Care in North Queensland.

10 Outcome In response to the development of the Chronic Disease Strategy, a lot of work has been done on developing and implementing clinical support systems including

• Development of the Chronic Disease Guidelines, Rural and Remote Pathology Handbook and the Primary Clinical Care Manual
• Ferret enhancements including the addition of standardised care plans and health checks
• Implementation of the ABCD quality assurance framework
• Workforce development strategies including the addition of chronic care coordinators, specialist Health Worker positions and training programs
• Partnership development notably the Connecting Health in Communities (CHIC), Regional and Local Health Forums, Health Action Teams and Health Councils.

Activity Sheet

Case study Learners are asked to read a case study and answer 2 questions.

Session 2 notes

Wrap up This unit has discussed the issues of Aboriginal and Torres Strait Islander chronic disease. It reinforces the fact that Aboriginal and Torres Strait Islander people experience inequality in health status and have a number of factors contributing to poor health.

Health practitioners working in the area need to be aware of the link between chronic disease, Aboriginal and Torres Strait Islander chronic disease and the systems approach. The next two units in this module look at comprehensive and selective primary health care which are essential elements in this approach, with the comprehensive primary health care focus on the prevention, early detection and management of chronic disease arguably the approach of choice

Quiz Complete and self mark Give learners 10 minutes to complete the quiz for this unit. Learners can self mark, or swap with another learner, make corrections and hand the quiz in for data collection.

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Session 1 ........................................................................................................................................................

According to the Australian Institute of Health and Welfare (AIHW) 2008, Aboriginal and

Torres Strait Islander peoples experience significantly more ill health than other Australians and that a number of socioeconomic and health related data indicates the population is

disadvantaged. Other data shows that risk behaviours associated with the development of chronic disease, including poor nutrition, smoking and alcohol consumption, overweight and

obesity and physical inactivity is more common in the Aboriginal and Torres Strait Islander population [1].

A number of publications have also identified the social determinants of Aboriginal and

Torres Strait Islander Health, and have reported at the length the importance of health professionals not only acknowledging these factors, but providing services that respond to

the needs [2, 3].

Social factors impacting on health include  History of the Aboriginal and Torres Strait Islander population,  Racism,  Poverty and social class,  Income and social capital,  Education,  Employment and welfare,  Relationship to country,  Housing,  Policy processes and  Human rights issues [4]

The AIHW report on the health of Aboriginal and Torres Strait Islander Peoples 2008 identifies a

trend for an earlier onset on chronic disease, and higher mortality and morbidity associated with a variety of chronic diseases[5]. Research conducted in the Northern Territory and

Queensland supports the data findings [6, 7].

At Federal and State levels of government a number of strategies most notable “Close the Gap” campaign have also been implemented and strategic documents such as the

Queensland Strategy for Chronic disease, identify Aboriginal and Torres Strait Islanders and people from rural and remote areas as target populations for intervention as they carry a

higher burden of disease and experience other systems issues which impact on their health status [8].

This unit looks at the findings of research on Aboriginal and Torres Strait Islander health,

particularly in reference to chronic disease and the development of systems to support a holistic approach to chronic disease care. These systems are currently being implemented

across the state in line with increased funding and resource allocation for Aboriginal and Torres Strait Islander health care.

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Orientation Handbook part 4 - Facilitator

Presentation ...................................................................................................................................................

Aboriginal and

Torres Strait Islander

Health

Version 1(5/10)

Orientation Handbook part 4 - Facilitator

Slide 1

Aboriginal and Torres Strait

Islander Health

Aboriginal and

Torres Strait Islander

Health

Notes:

Slide 2

Learning

objectives Learning objectives  Be aware of Aboriginal and Torres Strait Islander health issues  Be aware of factors contributing to poor Aboriginal and Torres Strait Islander health  Understand the Close the Gap priorities and how these can be addressed in PHC

Notes:

Slide 3

Health status Health status Aboriginal and Torres Strait Islanders:  die on average 10 yrs earlier than non Indigenous Australians  are more likely to die as a baby  have less access to health care  have a higher burden of disease  are 2-4 times more likely to be hospitalised

Kennedy 2009:AIHW 2008

Notes: When compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander Australians have a lower life expectancy and carry a greater burden of chronic disease, they also have greater difficulty accessing health care and are more likely to be hospitalised.

Slide 4

Inequalities in

health Inequalities in health In disadvantaged and under-served groups: 





The health of Aboriginal and Torres Strait Islander Australians in general has not improved in the last decade Slow improvements have been made due to the impact of primarily immunisation programs 90% presentations to rural and remote health centres are caused by chronic ongoing illness AIHW 2008 ) (Couzos & Murray 2008)

Notes: Although the burden of chronic disease in Queensland is great, Aboriginal and Torres Strait Islander people carry an even greater burden. Their life expectancy is on average 10 years less than non-Indigenous people and 90% of presentations to rural and remote health services are the related to chronic disease. A large number of Aboriginal and Torres Strait Islander Australians live in rural and remote areas.

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Orientation Handbook part 4 - Facilitator

Some jurisdictions have shown slight reductions in mortality in recent years along with declines in infant mortality. While mortality rate has improved, birth weights still remain ~200g less than birth weights of babies born to non-Indigenous mothers.

Slide 5

Contributing

factors Contributing factors

Socioeconomic factors contributing to poor Aboriginal and Torres Strait Islander health are: housing and the physical environment education employment and income distance

   

Notes: Slightly more than 50% of Aboriginal and Torres Strait Islander people live in cities and towns, with around 25% living in areas classified as ‘remote’ or ‘very remote’. The poor health status of Aboriginal and Torres Strait Islander people is impacted by social, environmental and economic factors, made worse by a lack of access to health care services. (The following is based on the 2001 Census) Housing and physical environment Substandard living conditions are characterised by overcrowding, inadequate water and washing facilities, poor sanitation and sewage disposal, limited food storage, and poor food preparation facilities

2. Education Aboriginal and Torres Strait Islander people reported: 17% completed year 12 or equivalent compared to 38% of non-Indigenous <15% had a post-secondary school qualification compared to 35% of the non-Indigenous population
3. Employment and income Unemployment rate for Indigenous males was 22% and for females 18%, compared to non-Indigenous rates of 7.7% and 6.5%. Excluding those employed under Community Development Employment Program (CDEP) this rate would increase to around 34% The median weekly family income for Aboriginal and Torres Strait Islanders was $630 compared to $1188 for non-Indigenous (Couzos & Murray 2008)

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Orientation Handbook part 4 - Facilitator

Slide 6

Areas of health

concern Areas of health concern Leading causes of disease burden:  Cardiovascular disease 18%  Mental disorders 16%  Intentional and unintentional injuries 13%  Chronic respiratory disease 9%  Diabetes 9%

65% reported at least one long term condition

AIHW 2008

Notes:

Slide 7

Health beliefs Health beliefs

 Importance of:   

family community connection to land, past and culture

May be limitations in ‘lifestyle’ model and placing responsibility on the individual for change without consideration of whole person

Notes: Health beliefs form the basis for what we think cause ill health and the impacts ill health has on our lives. These beliefs are embedded within social and cultural contexts. Family, extended kinship, community, and connections to land, past and culture are prominent within Aboriginal and Torres Strait Islander health beliefs (Thompson and Gifford 2000).

Socioeconomic disadvantage alone cannot be used as an indicator for increased risk for a chronic illness. A community in the Northern Territory that is connected to culture, family and land and that has the opportunity for self determination is able to demonstrate significantly lower risk factor prevalence, including reduced impaired glucose tolerance, smoking in men and hypercholesterolemia (Rowley, O’Dea et al 2008)

Individual, family and community systems need to be considered when addressing individual risk factors, such as diet and exercise. Having an understanding of the meaning of what is being recommended is important.

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Orientation Handbook part 4 - Facilitator

For example, exercise based interventions could focus on sport and everyday activity rather than individual based activities.

Slide 8

Closing the

Gap Closing the Gap The National Partnership Agreement on Closing the Gap (CTG) on Indigenous Health Outcomes

1. child and maternal health
2. address chronic disease factors through adult health checks;
3. improve chronic disease management and follow up care;
4. workforce expansion and support
5. address smoking rates

Notes:

Slide 9

Addressing

CTG priorities

in rural and

remote Queensland

Addressing CTG priorities in rural and remote Queensland

1. Maternal health, child health checks, and immunisation
2. Early detection through screening – adult health checks
3. Chronic disease management – Chronic disease Guidelines, ABCD, outreach and visiting teams
4. Workforce support – PaRROT orientation and training
5. Brief interventions – SNAP

Notes: The Chronic Disease Strategy in rural and remote Queensland addresses the CTG priorities across the lifespan: Maternal health and antenatal care is an important component of a program to address the health of Aboriginal and Torres Strait Islanders. Ideally antenatal care will start in the first trimester and involve at least four visits. Child health checks are recommended at each immunisation visit and health check forms are available for each check at 1-6 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 3 years, 4 years and 5-14 years. Adult health checks provide evidence based screening and are available for 15-54 years and 55+ years. The screening tests and age for screening are based on population level risk. This with increased risk, for example a family history of diabetes, may need to be screened earlier or more frequently. The aim of primary health care is to keep people well. By identifying risk factors for chronic disease early, they can be addressed early, hopefully

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Orientation Handbook part 4 - Facilitator Version 1(5/10)

preventing progression or cause of a chronic disease. For example, if hyperlipidemia or high blood pressure is treated early, further progression of cardiovascular disease, or renal disease may be prevented. Once a chronic condition has been identified, the Chronic Disease Guidelines (and many other evidence based guidelines) provide management protocols to manage the conditions. This may involve follow up checks e.g. blood pressure, long term medication use and referral to other team members or specialists. The referral to other providers may involve visiting teams in the community, or travel to larger centres. A population register and recall system, such as Ferret, can assist in planning this care and following up on how well patients are managed. One program aimed at improving the quality of care that is provided in the PHC setting is the Audit and Best Practice for Chronic Disease (ABCD) program. This involves auditing clinical records, results interpretation and feedback, and action planning in a twelve month cycle. Workforce development requires significant investment from both the employer and the employee. The PaRROT program is an example of a workforce support program to assist in the orientation and training of those providing services in rural and remote PHC centres. This program can be used in conjunction with other online and District based orientation and clinical education and training. While CTG specifically address smoking as a major risk factor, poor nutrition, alcohol misuse and lack of physical activity are also risk factors for the development of chronic disease. These can be addressed firstly by asking the patient about them, then if required, providing a brief intervention based on the patients stage of change related to the risk factor.

Orientation Handbook part 4 - Facilitator

Slide 10^ Notes:

Learning Activity Learning Activity

Please complete the learning activity

Version 1(5/10)

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Learning Activity – Facilitator......................................................................................................................

Information for facilitators This activity can be conducted as a large group discussion. Participants can either complete this activity prior to or after the brainstorming. Please copy, scan and email it to [email protected] or fax it to 4033 3040 and keep a copy for your records.

Property Setting

Total Number of Questions 2

Total Number of Questions to Ask All

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Questions .....................................................................................................................................................

1. Patrick is an experienced remote area nurse, leading a multidisciplinary outreach team whose main role is managing clients with diagnosed chronic conditions in small Aboriginal communities in Queensland. He feels the approach of the team is not having any impact on clients' health and wants to review the service delivery model. He has spoken to the leaders and health team in one community who are happy to lead discussions and trial a different service model. What things should the team be considering in tackling the issue of poor health in the community?

Choice

History of the Aboriginal and Torres Strait Islander population

Racism

Poverty and social class

Income and social capital

Education

Employment and welfare

Relationship to country

Housing

Policy processes

Human rights issues

Feedback:

The team needs to consider all of the above and to acknowledge and be aware of the factors specific to the community. In consultation with the community they need to look at ways in

which health services should be delivered in order to prevent the ongoing issues of chronic

disease.

2. How could the team change its approach to better manage the poor health of the community? (Essay Question)

Feedback:

The team needs to consider re-orientating their approach from the current reactive service to

one that incorporates prevention, early intervention and management. They also need to

adopt a systematic 'whole person' approach, to implement evidence-based care and

standard protocols and individual and population based care plans. The team needs to be more involved in promoting healthy choices, screening for and managing risk factors such as

poor nutrition, overweight and obesity, smoking, alcohol use, physical inactivity and mental

illness if it is present.

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Learning Activity - Participant ....................................................................................................................

Information for Participants

This activity will be conducted as a large group activity which will be led by your facilitator. Please submit a copy of this to your facilitator who will scan and email it to [email protected] or fax it to 4033 3040 and keep a copy for your records.

Property Setting

Total Number of Questions 2

Total Number of Questions to Ask All

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Questions .....................................................................................................................................................

2. Patrick is an experienced remote area nurse, leading a multidisciplinary outreach team whose main role is managing clients with diagnosed chronic conditions in small Aboriginal communities in Queensland. He feels the approach of the team is not having any impact on clients' health and wants to review the service delivery model. He has spoken to the leaders and health team in one community who are happy to lead discussions and trial a different service model. What things should the team be considering in tackling the issue of poor health in the community?

Choice

History of the Aboriginal and Torres Strait Islander population

Racism

Poverty and social class

Income and social capital

Education

Employment and welfare

Relationship to country

Housing

Policy processes

Human rights issues

2. How could the team change its approach to better manage the poor health of the

community? (Essay Question)

Orientation Handbook part 4 - Facilitator Version 1(5/10)

Session 2 ......................................................................................................................................................

This unit has discussed the issues of Aboriginal and Torres Strait Islander health. It

reinforces the fact that Aboriginal and Torres Strait Islander people experience

inequality in health status and have a number of factors contributing to poor health

including:

 Poor living conditions including overcrowding  Lower economical status as a result of higher unemployment and lower education levels  Social isolation  Cultural diversity and  Distance which impacts on their ability to access health services.

These facts, plus research evidence and the acknowledgement at government

levels, that Aboriginal and Torres Strait Islanders do carry a high burden of chronic

disease reinforces the need for any health service provided to Aboriginal and Torres

Strait Islander communities, to provide a systems approach to service provision which

is currently being implemented in some areas in Queensland [1-3]

Health practitioners working in the area need to be aware of the link between

chronic disease, Aboriginal and Torres Strait Islander chronic disease and the systems

approach. The next two units in this module look at comprehensive and selective

primary health care which are essential elements in this approach, with the

comprehensive primary health care focus on the prevention, early detection and

management of chronic disease arguably the approach of choice [4-6]