Monitoring and Evaluation of the Indigenous Chronic Disease Package: Final Report

Australian Government Department of Health

Monitoring and Evaluation of the Indigenous Chronic Disease Package

Final Report Volume 1: Evaluation of the overall package and its individual measuresJune 2014

National Monitoring and Evaluation of the Indigenous Chronic Disease Package Volume 1: Final Report (2013)

Online ISBN: 978-1-76007-165-3

Publications approval number: 11037

Copyright Statement:

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Commonwealth of Australia 2015

This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Communication Branch, Department of Health, GPOBox 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

This report has been independently prepared for the Australian Government Department of Health by KPMG Australia, and does not necessarily represent the views of the Australian Government.

The evaluation of the Indigenous Chronic Disease Package was commissioned by the Department of Health. This evaluation report has been prepared by KPMG Australia.

The reports lead authors were the National Health and Human Services Practice, KPMG.

The other major contributors to the report were: Dr Brita Pekarsky of the Baker IDI Heart & Diabetes Institute; and Winangali.

KPMG wishes to acknowledge the following stakeholders for their contribution to the evaluation through giving their time and sharing their experiences: the Department of Health, state and territory health departments, the National Aboriginal Community Controlled Health Organisation and its Affiliates, peak bodies, Aboriginal Health Services, Divisions of General Practice/Medicare Locals, the Indigenous Health Partnership Forums, ICDP workers and their fund holder representatives, general practice staff and community members.

Citation

National Monitoring and Evaluation of the Indigenous Chronic Disease Package

Final Report

June 2014

KPMG 2014, National Monitoring and Evaluation of the Indigenous Chronic Disease Package: Final Report (2014), Australian Government Department of Health, Canberra.

KPMG is an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.

Table of Contents

Table of Contents2

List of tables4

List of figures9

Glossary12

Indigenous Chronic Disease Package measures14

Key Terms15

Reading this report18

Executive Summary20

Overview of the ICDP20

Context20

Monitoring and Evaluation of the ICDP22

Findings: progress with implementation24

Findings: impacts on the health service system27

Findings: impacts for Aboriginal and Torres Strait Islander people29

Future focus33

1Whole of Indigenous Chronic Disease Package36

1.1Evaluation of the Package36

1.2Contextual influences78

1.3Case study 1: Embedding health promotion in primary health care organisations93

1.4Case study 2: Building individual and community capacity113

1.5Case study 3: Indigenous Chronic Disease Package workforce126

1.6Future focus148

1.7Implementation of future strategies148

1.8Strengthening preventive measures149

1.9Strengthening chronic disease management measures152

1.10Workforce development155

1.11Monitoring and support156

2The Indigenous Chronic Disease Package as a mechanism to tackle chronic disease risk factors159

2.1Regional Tackling Smoking Healthy Lifestyle Teams and other national level support for smoking cessation (A1 and A2 measures)161

2.2Local Community Campaigns (A3 measure)208

3Indigenous Chronic Disease Package as a mechanism to improve chronic disease management and follow up care234

3.1Subsidising PBS medicine Co-payments (B1 measure)238

3.2Increasing utilisation of Pharmaceutical Benefits Scheme and Medicare Benefits Schedule (B2 measure)299

3.3Supporting primary care providers to coordinate chronic disease management through the Practice Incentives Program Indigenous Health Incentive (B3a measure)340

3.4Supporting primary care providers to coordinate chronic disease management through care coordination (B3b measure)375

3.5Improving Indigenous participation in health care through chronic disease self management (B4 measure)407

3.6Increasing access to specialists, allied health and multidisciplinary care through outreach (B5 measure)430

4Intended contribution of the ICDP to the workforce and the health system461

4.1Enhancing the capacity of the AHS sector (AHS workforce, infrastructure and professional development components of C1 and C2 measures)464

4.2Improving community access to primary health care (ATSIOW component of the C1, C2 and C3 measures)516

4.3Improving the accessibility and responsiveness of mainstream primary health care (IHPO component of C3 measure)567

4.4Attracting more people to work in Aboriginal and Torres Strait Islander health (C4 measure)605

4.5Clinical Practice and Decision Support Guidelines (C5measure)620

List of tables

Table 1: Changes made to the ICDP and their implications for different stakeholder groups.40

Table 2: Estimated reach of the ICDP into different cohorts of the Aboriginal and Torres Strait Islander population.43

Table 3: Barriers addressed by the ICDP and assessment of impact of the ICDP measures.48

Table 4: State and territory Closing the Gap (NPA) programs that directly relate to ICDP preventive health measures (the A measures).67

Table 5: State and territory Closing the Gap (NPA) programs that directly relate to ICDP chronic disease management measures (the B measures).68

Table 6: State and territory Closing the Gap (NPA) programs that directly relate to ICDP workforce and resource support measures (the C measures).69

Table 7: Total funding commitment by all jurisdictions to the Closing the Gap NPA over 2009 to 2013 in $millions.70

Table 8: Imputed estimate of the share of CtG funding commitment in each state or Territory that is contributed by the Commonwealth.71

Table 9: ICDP expenditure as a percentage of total expenditure by the government jurisdiction on Aboriginal and Torres Strait Islander health 2010-11.72

Table 10 Contextual factors influencing ICDP measures A measures.90

Table 11 Contextual factors influencing ICDP measures --B measures.91

Table 12 Contextual factors influencing ICDP measures -- C measures.92

Table 13: Summary of Aboriginal and Torres Strait Islander health workforce type by sector.127

Table 14: Summary of ICDP impact on the Aboriginal and Torres Strait Islander Health workforce. 129

Table 15: ICDP workforce role (FTE) by remoteness at 31 December 2012 and 31 March 2013 for ATSIOW and IHPO.131

Table 16: ICDP workforce role by gender proportion from evaluation survey respondents.131

Table 17: ICDP evaluation survey respondents on whether they understand the role (n = 164).134

Table 18: ICDP workforce, FTE recruited by workforce position and time.139

Table 19: ICDP Workforce, funded positions by remoteness.140

Table 20: ICDP workforce, funded positions by organisation type.140

Table 21: Number of full-time equivalent selected health staff employed by Aboriginal and Torres Strait Islander primary health-care services, by Indigenous status, at 30 June 2009, 2010, 2011 and 2012.144

Table 22: Aboriginal and Torres Strait Islander population in 2012 by remoteness and FTE RTSHLT workers as at December 2012.166

Table 23: Aboriginal and Torres Strait Islander population in 2012 by state and territory and FTE RTSHLT workers as at December 2012. Source: former Department of Health and Ageing; Australian Bureau of Statistics.166

Table 24: RTSHLT responses to evaluation survey questions related to training.184

Table 25: RTSHLT responses to evaluation survey questions relating to brief intervention training.185

Table 26: TAW responses (n = 22) to the survey question Approximately how many times have you provided tobacco brief interventions to Aboriginal and Torres Strait Islander people?185

Table 27: RTC responses (n = 13) to the survey question Approximately how many times have you provided tobacco brief interventions to Aboriginal and Torres Strait Islander people?186

Table 28: Comparison of dispensing of CtG, S100 RAAHS and full PBS co-payment smoking cessation medicines supplied per 100 smokers, 2010 to 2012.194

Table 29: Number of LCC grant recipients and LCCs.211

Table 30: Overview of respo