Medicare Locals Needs Assessment Report Summary of Findings 1 - - PDF document

7/19/2013 1

Medicare Locals Needs Assessment Report

Summary of Findings

7/19/2013 2

MRNWM-ML catchment area

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Data Sources

• Victorian Refugee Health Network – data

relating to refugee settlement in the catchment

• Alzheimer's Australia – data on incidence of

dementia in the catchment and projections in the future

• Breast Screen Victoria - data on breast

screening rates in the catchment area

• Diabetes Australia – information based on the

use of NDDS

• Heart Foundation – Heart Foundation map

which provides current data on heart related hospitalisations including standard morbidity data

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Data Sources

• GPV – current data on blood borne viruses
• Department of Health – data relating to use of

drug and alcohol services

• Inner East Melbourne portal data was

compiled on patient flows for ED presentations

• Department of Health produced updated local

government profiles for 2013

• The National Health Performance Authority

provided data reflecting patients experience of general practise

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MRNWM-ML demographics

• Four LGAs ( Macedon Ranges, Brimbank, Maribyrnong and

Melton) and two SLAs (Sunbury and Bacchus Marsh)

• Maribyrnong and Brimbank have high proportions of residents

born overseas and are currently settling refugees and asylum seekers

• Brimbank and Maribyrnong comprise 55.6% of the catchment

population

• Melton is the sixth fastest growing municipality in Victoria
• Bacchus Marsh comprises 63% of the Shire of Moorabool and

is becoming a fringe urban area from a country town

• Sunbury comprises 21% of the city of Hume
• Macedon Ranges is all rural with Kyneton the most

disadvantaged town.

(ABS 2013)

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MRNWM-ML Key socioeconomic characteristics

• MRNWM-ML high proportion of people over 65 on age

pensions (2nd highest in Australia)

• 25% of the population have a concession card
• In Sunshine 37% of the population holds a concession

card

• Unemployment rates higher than Victorian average,

particularly in Sunshine and Braybrook.

• Brimbank 2nd most disadvantaged LGA in Melbourne.
• Braybrook ranks 9th in Victoria for disadvantage & is the

second most disadvantaged LGA in Melbourne

ABS (2013)

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• Median family income of $895 compared to the Victorian

average of $1460 and an employment rate of 12.5%

• In Sunshine 12.6% population do not speak English or do not

speak it well

• Relatively small number of ATSI people. Melton has highest

number (530 people)

• An increasing number of both refugees and asylum seekers.

Over half the refugees were under 25 years of age on arrival and 43% were under 18 years of age

• Of all the Medicare Local’s MRNWM has the third highest

proportion of residents with a profound or severe disability

• People over 18 years of age (10%) live with a restriction on a

core activity

• In Brimbank 63.7% per 1000 eligible are on a disability
• pension. The Victorian average is 55.7% per 1000.

ABS (2013)

MRNWM-ML Key socioeconomic characteristics

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Key Health Needs

BRIMBANK

• In Brimbank 25.5% of the population reported that they

have fair or poor health. The highest proportion in the

• nly Victorian LGA.
• Women are more likely than men to report poor health.

MELTON

• 23.4% reported poor health compared to Victorian

average of 18.3%

ABS (2013)

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2012 Needs Assessment Priorities

1. Mental health 2. Information to community 3. Population health data for all 4. Diabetes 5. Acute/primary interface 6. Infrastructure support 7. ehealth 8. After hours primary care 9. Aboriginal Health

• 10. Health literacy
• 11. Aged care
• 12. Care-planning

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2013 Needs Assessment

• 1. Mental Health/AOD
• 2. Diabetes and Cardiovascular
• 3. Acute/primary care interface/ehealth
• 4. Access to quality services: Refugees

Practices Allied Health Aged Care

• 5. Health Literacy
• 6. Screening & early intervention: Cancer, CKD, Heart
• 7. Musculoskeletal conditions
• 8. Injuries
• 9. Breastfeeding support

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Priority 1: Mental Health/AOD

• MRNWM-ML had 2nd highest rate of very high or high

psychological distress of all MLs (PHIDU 2013)

• Sunshine had 16% of the adult population with very high or

high psychological distress

• Higher levels of psychological distress correlated with higher

levels of socio-economic disadvantage:

Brimbank 16.7% (3rd highest in Victoria) Melton 15.5% Maribyrnong 13.9%

• Incidence of drinking is not correlated with socio-economic

status as it was higher in the outer parts of the catchment; Sunbury, Kyneton, Bacchus Marsh & Melton having higher rates than the Victorian average.

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Priority 1: Mental Health/AOD

• Data showed mental health conditions had

highest prevalence after hypertension

• In addition mental health conditions in people

aged 65 and over was higher than the national average

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Priority 2: Diabetes

• Data from Diabetes Australia suburbs in

western Melbourne have some of the highest prevalence of diabetes in Melbourne.

• LGA’s of Brimbank and Hume are amongst the

top 5 diabetes hotspots

• Nearly one in five people in Brimbank LGA

aged 55 and over has type 2 diabetes

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Priority 2: Diabetes/CVD

(Department Health 2009, Diabetes Victoria 2013)

• Region

Prevalence diabetes Brimbank LGA 6.1% Hume LGA 8.5% Melton LGA 9.3% Maribyrnong LGA 4.5% Macedon Ranges LGA 3.9% Moorabool LGA 5% Victoria 4.5 %

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Priority 2:Heart Disease

• Residents in Brimbank and Melton

hospitalised at much higher rate for heart conditions than Victorian average.

• Brimbank has 1.49 times the rate of heart

failure compared to Victoria

• Macedon Ranges residents experiencing more

than average number of hospitalisations due to heart attacks compared to the rest of Victoria.

(National Heart Foundation 2013)

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Priority 2: Heart Disease

• General Practice data (2012) showed that

hypertension was the disease with the highest prevalence (10.3%)

• Overweight and obese people in Melton

(57.9%), Macedon Ranges (53.4%) and Brimbank (52.3%). Higher than Victorian average of 48.6% (Department Health Victoria 2012).

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Priority 3: Acute/primary care interface

• Major hospitals Sunshine and Western General
• Other hospitals include, Bendigo, Ballarat, RCH.
• Highest demand for category 4s (semi urgent) and 5s

(non urgent) at major hospitals came from Maribyrnong (66%) and Brimbank (59%)

• Macedon Ranges had lowest proportion of 4s and 5s

(only 46% of all ED presentations to 6 major hospitals)

(Department Health Victoria 2013)

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Priority 4: Access to quality Services

a. Refugees/asylum seekers

• Brimbank is third highest settlement area in Victoria
• For 2012/13 anticipated number refugees will increase as quota has

been increased Australia wide from 13,400 to 20,000 a year

(Asylum seekers/refugees, numbers 2001-2011 (DIAC settlement data on Refugee Health Network, 2013)

SLAs in Victoria showing refugee numbers Total Greater Dandenong (C) 7,275 Hume (C) 4,648 Brimbank (C) 4,324 Maribyrnong (C) 1,580 Melton (S) 542 Total 35,191 39,262 for all of Victoria

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Priority 4: Access to quality services

b. General practitioners

• 131 general practices
• 533 GPs
• GP population ratio highest in Melton ( 1FTE GP: 1272

pop) and Bacchus Marsh ( 1FTE GP:1272 pop). Vic mean is 1:872

(MRNWMML survey 2012)

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Priority 4: Access to quality services

• 24% population MRNWM-ML stated that they waited too

long for GP appointment. This was the highest proportion for Metropolitan Medicare Locals in Australia

• 78% had a preferred GP (lowest proportion for MLs in

Australia)

• 83% reported that their GP listened carefully (lowest

proportion nationally)

(National Health Performance Authority 2013)

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Priority 4: Access to quality Services

• c. Allied health

Shortages

• To date have identified 551 AHPs in MRNWM-ML
• Shortage of speech pathologists (paediatric)
• Shortage of dieticians in Brimbank and Bacchus

Marsh

• Shortage of Occupational Therapists in Sunbury

and Bacchus Marsh

(Medicare Local Survey 2013)

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Priority 4: Access to quality Services

Waiting Times

• Long waiting times compared to Victorian average in

Community Health, HACC services in Brimbank, Macedon Ranges, Melton and Bacchus Marsh

• Longest waiting times for After Hours for physiotherapy

are at Brimbank (8-24 weeks) and Maribyrnong (17 weeks)

• Longest waiting times for speech therapy in the ML is

Sunbury (26 weeks)

• Also long waiting times for dietetics and audiology in

Sunbury and audiology in Brimbank.

(Medicare Local survey 2013)

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Priority 4: Access to quality services

• d. Aged Care
• 49 aged care facilities in MRNWM-ML
• Shortage of high care beds in Melton, 38.6

places per 1000 eligible population compared to Victorian average 41.3

• Shortage low care beds in Brimbank, 31.2

places per 1000 eligible population compared to Victorian average of 46

(Department Health Victoria 2012)

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Priority 5: Health literacy

(PHIDU 2013)

• There is a high proportion of people born overseas, with English as their

second language, particularly in the ML which will contribute to poor health literacy

Population of Region Brimbank Keilor Brimbank Sunshine Maribyrnong Melton East Melton Bal Bacchus Marsh Sunbury Macedon Ranges Kyneton Macedon Ranges Romsey Macedon Ranges Bal Macedon Ranges and North Western Melbourne Victoria % Born OS 47.5% 58.1% 47.7% 38.2% 26.7% 17.2% 19.8% 15.9% 15.0% 18.6% 40.2% 31.4%

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Priority 6: Screening & Early Intervention

Health Risk Factors

• Smoking: 5 out of 6 LGAs/SLAs had higher smoking rates than

Victorian average

• Exercise: 4 out of 6 LGAs/SLAs exercise guidelines were not

met by a higher proportion than the Victorian average

• Fruit: The fruit intake guidelines were not met by 2 LGAs/SLAs
• Overweight/Obese: the data was only available for the 4 LGAs

and 3 of those had rates of obesity or overweight at rates higher than the Victorian average

(Department Health Victoria 2012 PHRIS 2013)

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Priority 6: Screening & Early Intervention

Screening

• Cervical: 6 out of 10 SLAs had cervical

screening rates less than the Victorian mean.

• Bowel cancer: 5 SLAs in the ML had rates of

screening at rates below the Victorian mean.

(PHIDU 2013)

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Priority 6: Screening & Early Intervention

Areas of most concern:

• Screening: Melton, Brimbank, Maribyrnong

have low cancer screening rates.

• Risk Factors: Melton has a high proportion of

population not meeting recommended guidelines for exercise, fruit and vegetable consumption, smoking and obesity.

(PHIDU 2013)

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Priority 7: Musculoskeletal Conditions

• Comprises: arthritis, osteoarthritis,
• steoporosis, rheumatoid arthritis
• Prevalence is 29% of adult population, which

is the same as the national mean prevalence

• High levels of comorbidity with other disease

(AIHW 2013)

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Priority 8: Injuries

• Medical certificates issued for TAC and

Worksafe patients in 2011 was 36,065

• MRNW-ML is 3rd highest ML in Victoria for

workplace and traffic injuries (out of 17) for 2010 and 2011

(Transport Accident Commission 2012)

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Priority 9: Breastfeeding Support

• Melton and Brimbank LGAs have lowest levels of

full breastfeeding at 3 months of age in Victoria

• In Melton 39% of babies are fully breast fed until 3

months of age and in Brimbank 40% of babies are fully breastfed until 3 months of age.

• The Victorian average is 51.7%

(Department Health 2012: LGA profiles)

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Where to from here?

• Identify gaps in ML resources (skills, staff,

funding, etc.) to address needs analysis gaps

• Acquire resources needed
• Engage with relevant stakeholders
• Implement targeted programs
• Repeat needs analysis in 2014