MEDICARE 45- 49 YEAR OLD HEALTH CHECK Train the Trainer

Introduction The Australian Government has introduced a number of health check items to assist in the identification of common health problems and risk factors of disease and illness in specific target populations. Specifically MBS item number 717 targets men and women aged 45-49 years with at least one risk factor for chronic disease. This item was introduced under the Australian Better Health Initiative (ABHI), a joint initiative of the Council of Australian Governments which aims to enhance the capacity of the health system to promote good health and reduce the burden of chronic disease.

What are we going to cover.. Overview of the 45-49 year old Health Check Overview of other Health Check and Health Assessment Items Outline training resources Motivational Interviewing – links to health assessment Overview of Wave 2 funding Provide/demonstrate links to the MPFA PI Launch/baseline uptake Division showcase regarding links with CDM item numbers and health assessments through the ABHI

Aims of the 45-49 year old health check Once only health check Assist with the detection and prevention of chronic disease and enable early intervention strategies in this age group Lifestyle factors (smoking, physical inactivity etc.) Biomedical factors (blood pressure, cholesterol etc.) Family History of chronic disease Focus on preventative care for the first time

Who is eligible for the 45- 49 year old health check? Patients aged 45-49 years who are at risk of developing chronic disease Patients who have at least 1 risk factor for chronic disease

Aim of the 15- 54 year old Adult Health Check for Aboriginal and Torres Strait Islanders Aboriginal and Torres Strait Islander people aged 15-54 years should access the specific Aboriginal and Torres Strait Islander Adult Health Check (Item 710) Aboriginal and Torres Strait Islander people may also access Item 717 if eligible Patients aged 45-49 years who are at risk of developing chronic disease Patients who have at least 1 risk factor for chronic disease

What does the 45-49 year old health check involve? The MBS requires: Information Collection, including taking history and performing examination and investigations as required Making an overall assessment of the patient Interventions as indicated Providing advice and information to the patient

Who can help with a health check? And How? Practice Nurses Aboriginal Health Workers Other Health professionals Identifying eligible patients Through examination of patient records Collection information from patients Such as measuring height, weight, blood pressure (at the direction of the GP) Providing patients with information About recommended interventions (e.g. details of local community resources, support services and referral options)

What happens if you identify a patient with a Chronic Disease? Prepare a GP Management Plan (Item 721) Team Care Arrangement (Item 723)

Other Health Checks and Health Assessments Type Item Number 45-49 Year Old 717 Aboriginal and Torres Strait Islander People 704, 706, 708, 710 Patients aged 75 years and over 700, 702 Humanitarian entrants to Australia 714, 716 People with an intellectual disability 718, 719 Permanent residents of residential aged care facilities 712

Training Resources Division-Specific resources Practice-level Resources For Practice Managers For Health Professionals

Division-Specific Resources PowerPoint Presentation and Facilitators Guide (AGPN) 2 hour Presentation Learning Objectives Increase understanding of who is eligible for the 45-49 year old health check, what assessment entails, and who can help with each step of the assessment Increase awareness of the burden of care that this patient group places on the Australian healthcare system and highlight that this health check can be used to reduce this burden; and Inform participants of the tools, interventions and approaches available to help them bring about behavioual change.

Division-Specific Resources Practice Detailing Cards (AGPN) 6 Practice Detailing Cards Used to raise awareness with GPs and practice staff about the health check item numbers during practice visits What information do they provide? The eligible population for each item number Details of the MBS fee for each item Where and when the health check should be conducted Guide to the health Check Information Resources (AGPN) Overview of Health Check Resources available through AGPN

Division-Specific Resources Rural Health Education Foundation DVD (RHEF) Satellite broadcast of an expert panel discussing the best practice use of the 45 year old health check. Also contains electronic versions of all AGPN resources. A Guide to facilitating Adult learning (RHEF) Adult learning principles for facilitating group learners Provides basic instructional information to facilitate face to face learning. The Learning Guide (RHEF) Provides a framework for facilitating discussion Contains activities to facilitate group discussion and engage with the material covered in the DVD.

Practice-level Resources For Practice Managers and Health Professionals Rural Health Education Foundation DVD (RHEF) Satellite broadcast of an expert panel discussing the best practice use of the 45 year old health check. Included on the DVD: 4 Filmed case studies Quick Reference Guides Business Case Guide to Health Checks Information Resource Practice poster Wall chart (no hard copy available)

Practice-level Resources For Practice Managers Patient Practice prevention survey (RACGP) Taken from “Putting Prevention into Practice” (the Green Book). www.racgp.org.au/guidelines/greenbook Used to identify eligible patients through identification of risk factors Practice Support Templates (RACGP) 2 template letters Used to contact patients who: have a risk factor OR may have a risk factor Medical Director Templates (AGPN) A template for the 45-49 year old health check can be uploaded into Medical Director Available: http:www.adgp.com.au/site/index.cfm?display=21387

Practice-level Resources For Practice Managers Business case for Item 717 (AGPN) Discusses financial and non-financial benefits of conducting the 45-49 year old health check to eligible patients. Practice Poster and Wall Chart (AGPN) PowerPoint presentation (RACGP) Outlines the 45 year health check and the role of GPs and their teams. Available: http://www.racgp.org.au/clinicalresources/45

Practice-level Resources For Health Professionals Quick reference Guides (AGPN) Companion resources to the practice detailing cards To assist GPs in conducting health checks What information do they provide? How to conduct a health check Information on eligibility of patients for each item number What is involved with each health check

Practice-level Resources For Health Professionals Checklist (RACGP) “Guidelines for Preventive Activities in General Practice” (the Red Book). www.racgp.org.au/redbook Provides a checklist on key factors to address during a health check Lifescripts (DoHA) Lifescripts guidelines and evidence cards, assessment tools and prescription pads help GPs and their practice manage lifestyle risk factors. These resources can also assist GPs and practice nurses in conducting the 45-49 year old health check. Another Useful resources (RACGP) “SNAP – a population health guide to behavioural risk factors in general practice”. www.racgp.org.au/guidelines/snap

Practice-level Resources For Health Professionals Motivational Interviewing Techniques Helping patients change behaviour Used to explore patients attitudes to their lifestyle and health risks Assess patients’ willingness to change Help patients identify and overcome barriers to adopting a healthier lifestyle 2nd Session: Stan Steindl – from Psychology consultants Further information on Motivational Interviewing is available from www.agpn.com.au

Case Study 2 – Video Case Study 2 Time: 4 minutes 50 seconds. The role of the practice nurse and other health professional in assisting GP’s in performing the 45-49 year old health Check. Use of Lifescripts Use of motivational interviewing techniques. Time: 4 minutes 50 seconds.

How to order resources? AGPN and RHEF Health Check Kits Send Order Form to resourcekits@health.gov.au www.health.gov.au/epc for downloads Rural Health Education Foundation Resources 45-49 health check http://rhef.com.au/programs/803/803.html Indigenous Health Checks http://www.rhef.com.au/programs/807/807.html Lifescripts Resources DoHA http://www.health.gov.au/lifescripts AGPN http://www.agpm.com.au/site/index.cfm?display=5267 Order form: Fax (02) 6260 2770 or Call (02) 6269 1080 RACGP Resources Available from: http://www.racgp.org.au/clinicalresources/45

Wave 2 Funding for Divisions The Department of Health and Ageing has requested a proposal from General Practice Queensland to act in a fund-holding capacity and conduct a Request for Proposal (RFP) process for Divisions of General Practice $79, 200 (GST inclusive) will be available for disbursement to Divisions in each financial year to the period ending 2009-10. Funding will be awarded on an application basis, outlining educational strategies focussing on health checks

Wave 2 cont. Division funding proposals will be invited under 2 streams: Generic use of the MBS health checks (including one new planned health check item) Specific population cohorts identified with a greater burden of chronic disease and lifestyle risks, such as Aboriginal and Torres Strait Islander people, refugees and people with intellectual disabilities

Evaluation Evaluation will be undertaken at a Division and SBO level to measure the extent and effectiveness of the various approaches to up-skilling general practices in best practice use of health check items for eligible patients. This will be achieved through: Monitoring uptake of Group A14 MBS items 700 – 719 Evaluation of health check resources including the practice detailing cards, satellite broadcast program etc (survey) Identification of additional resource and materials developed by Divisions or practices to support implementation of the items at the practice level

Evaluation cont. Assessing the extent to which the MBS health check items have been integrated with other Division initiatives/ programs Evaluation results of Division educational strategies/ activities to: assess changes in behaviour, attitude, skills and knowledge determine barriers and enablers to general practice health professionals undertaking health checks in the practice setting Identification of successful models for implementing health checks in target populations

Multi Program Funding Agreement 2008-12 National Performance Indicator DGPP Access 2 The number of health checks and health assessments provided to patients of Aboriginal and/or Torres Strait Islander origin by GPs within the Division (compared to the estimated population in the area who could benefit from the health check) Includes items 704, 706, 708 and 710 Data sources – Medicare Australia and ABS

MPFA 2008-12 cont. National Performance Indicator DGPP Prevention 1 The number of 45-49 year old health checks provided to at-risk patients by GPs within the Division (compared to the estimated population who could benefit from the health check) Includes item 717 Data sources – Medicare Australia and ABS

Support in ACTION!! Redcliffe Bribie Caboolture Division of General Practice Project Coordinator: Barbara O’Toole Links with Chronic Disease Management item numbers and health assessments through the Australia Better Health Initiative funding.

Motivational Interviewing Techniques Coming Up….. Session 2: Motivational Interviewing Techniques - Stan Steindl

Thank you