4.3.1 National Leadership for CVDIt should be noted that, while not listed as a recommendation for action, there is strong support across jurisdictional and non-government stakeholders for the formulation of a National Action Plan for CVD. This reflects concerns that the implementation of the NSIF was compromised by the lack of a cohesive implementation plan which clearly committed the different levels of government. The following structures would underpin national leadership in CVD reform:
- Australian Health Minister’s Council, the Australian Health Ministers’ Advisory Council (AHMAC) and AHMAC’s Principal Committees such as Health Workforce, Australian Population Health Development and Health Policy Priorities;
- National Health and Hospital Reform Commission;
- Role of non Government Organisations;
- Australian Government agencies;
- Council of Australian Government (COAG); and
- Individual jurisdictions.
4.3.2 Integrated Clinical InformationIt should also be noted that while there is a strong case for the development of integrated electronic clinical information systems for CVD, this has not been included as a recommendation as this is part of the Australian Government’s broader eHealth strategy.
This review recognises that electronic integrated clinical information is a foundation for good health care across the entire system and disease groups. There is a significant body of literature that describes the importance of linked clinical information in safety, improving health outcomes and reducing inefficiencies in health care. Most key reform documents currently being developed in Australia make reference to the need for integrated electronic health records.
There are international examples of successful integration of clinical records across systems. In the USA Kaiser-Permanente has recently introduced an electronic clinical record to assist in co-coordinating care information for patients across the health delivery system. 65
For co-ordinated care models to work effectively there must be the capacity to share clinical information between service providers. A UK study of the success factors for shifting care from hospital to community settings identifies clinical information and access to clinical guidelines as essential success factors in sustaining the shift. 66
Stakeholders advise that the current inconsistency in collection of data relating to Aboriginal and Torres Strait Islander origin hampers the capacity to effectively research and report on health outcomes for Indigenous Australians. This is an issue that can be imparted to the relevant branch in DoHA and to NEHTA along with specific issues related to improving the integration of clinical information for CVD.
4.3.3 Reducing smoking rates and increasing CVD funding through Tobacco TaxThroughout the review there was considerable discussion regarding the importance of reducing smoking rates. Smoking is a key risk factor for coronary heart disease, stroke and lung cancer and in Australia is the single largest cause of preventable death. Reductions in the use of tobacco reduce healthcare costs. 67 There has been extensive economic research that demonstrates that increasing the price of tobacco products significantly reduces the use of tobacco in the population 68 .
“Evidence shows that a 21% increase in price through excise would prompt 130,000 adults to quit and prevent 35,000 children from taking up smoking, while boosting federal revenue by $ 1.03 billion per annum.” 69 The National Preventative Health Taskforce supports a 2.5% per stick increase in cost. The WHO recommends a 5% annual taxation increase. 70
Increasing the cost of tobacco through increases in taxation would result in decreased consumption of harmful tobacco products and increased revenue that would then be available for investment in public health initiatives. This is consistent with the National Preventative Health Taskforce target to reduce the prevalence of daily smoking to 9% or less 71 and an essential strategy if this target is to be achieved. Ernst & Young strongly suggests that this policy issue be given consideration by the Australian Government.
4.3.4 Addressing workforce shortages in Indigenous health care70% of Indigenous Australians live outside of major cities, but this statistic is not matched by an appropriate health workforce response. Stakeholders have identified serious workforce shortages impacting on the delivery of health care to Indigenous Australians. This problem becomes progressively works as remoteness increases. In 2004 the Australian Medical Association (AMA) identified a shortfall of 250 primary health care practitioners in the workforce delivering health care to Indigenous Australians. 72
Significant recruitment and retention issues have been identified for Remote Area Nurses (RANs), who provide primary health care in many remote Indigenous communities. Issues identified in research on this issue include a sense of being treated as second-class workers within a system that is itself second-class. 73 Strategies to reduce the rate of attrition from the profession include improving managerial practices and staff support (leadership, communication and professional development) and providing better infrastructure (buildings and equipment).
There are strategies in place to try to improve the retention of primary health care providers in remote communities. For example, in the Northern Territory, a comprehensive orientation program has been developed to support registrars planning to work in general practice in remote Indigenous communities. The program includes cultural safety training; clinical skills; population health and strategies for self-care. 74
Organisations such as the Central Australian Rural Practitioners Association (CARPA ) work to support primary health care practice and practitioners in remote areas. 75
Recommendations on workforce issues for Indigenous health are outside the scope of this review. Ernst & Young suggests existing bodies tasked with workforce issues be advised of the impact that rural and remote workforce shortages are having on the system’s capacity to improve CVD outcomes for Indigenous Australians.
65 Kaiser Permanente, www.kaiserpermanente.org
66 Singh D, Making the Shift: Key Success Factors, University of Birmingham/NHS, July 2006
67 Hurley S, Scollo M, Younie S, English D, Swanson M, The Potential for Tobacco Control to Reduce PBS Costs for Smoking related Cardiovascular Disease, MJA, Vol 181, No 5, Sept 2004.
68 , Durkin,S, Spittal,J, Siahpush,M, Scollo,M,Simpson,J, Chapman,S,White,V, Hill,D, Impact of Tobacco Control Policies and Mass Media Campaigns on Monthly Adult Smoking Prevalence, American Journal of Public Health, Aug 2008, Vol 98, No. 8
69 National Heart Foundation, Cancer Council Australia, Taxation reform and tobacco excise: best practice for a sustainable future, Submission to the Australian Tax review.
70 Preventative Health Taskforce, 2008. Available at http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/discussion-healthiest
71 Australian Labor Party media statement Oct 10 2008
72 Arkles R, Hill P, Jackson Pulver L, Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions, MJA 2007, Vol 186, pp528–530
73 Weymouth S, Davey C, Wright J, Nieuwoudt L, Barclay L, Belton S, Svenson S, Bowell L, What are the effects of distance management on the retention of remote area nurses in Australia?, Rural and Remote Health 7: 652 (online) 2007, www.rrh.org.au
74 Morgan S, Orientation for general practice in remote Aboriginal communities: A program for registrars in the Northern Territory, Australian Journal of Rural Health, Vol 14 (5) pp202 - 208
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