Rural Palliative Care Project 6 August 2009 Deborah Bampton Principal Network Adviser The Divisions Network acknowledges the financial support of the Australian Government Department of Health and Ageing

Contents:  Brief overview of the RPC Project  Phase 1 data collection results Funded by the Australian Government Department of Health and Ageing

RPC Project: Aim The broad aim of the project to increase the capacity of primary health care providers, in partnership with other services, to provide quality palliative care to rural and remote Australians and in doing so will: 1.overcome the barriers of remoteness and isolation, and the siloing effect between multi-disciplinary service providers 2.engage service providers in a shared effort to address the need for culturally appropriate palliative care 3.support evidenced based best palliative care services 4.enhance the agency of the palliative patient and their carer/s; and 5.strengthen the links between specialist palliative care services and mainstream health service delivery.

RPC Project: the elements The Rural Palliative Care Project has eight (8) core elements within the model. The elements are:  Governance (mandatory)  Sustainability (mandatory)  Specialist Palliative Care Services (mandatory)  Data collection (mandatory)  Link Nurses (elective)  Patient held records (elective)  Education (elective)  Multidisciplinary team meetings (elective)

RPC Project: GP data requirements Data collection requirements:  GP Services billed through MBS Specifically: —GPMP & Review —TCA & Review —Case conferencing —Care planning  After hours services  Service referrals Central Highlands GPN multidisciplinary team meeting group

RPC Project: Phase 1 GP data results Response Rates No. GPNsNo. of GPs No. of Patients NSW QLD48129 VIC WA21598 SA NT000 TAS* * Tasmania did not commence in the RPC Project until after the first data collection phase

RPC Project: Phase 1 Patient Demographics Results

RPC Project: Phase 1 GP Data Claiming

Community Patients Diagnosis Cancer & Melanoma 40.5% End stage cardiac 9.5% COPD13% Neurological5.5% Dementia15.5% Cystic Fibrosis0.6% HIV / AIDS0.2% End stage renal5.0% Endocrine9.0% Other1.3%

RACF Patients Diagnosis Cancer & Melanoma 22.5% End stage cardiac 8% COPD9% Neurological9% Dementia45% Cystic Fibrosis3% HIV / AIDS0% End stage renal 4% Endocrine0.6% Other2%

Patient Referral Data No. of patients referred to local services?466 What service types have you referred to? (Please identify number of referrals to each category) Domiciliary Services (meals on wheels, homecare, community transport) 271 Primary Palliative Care (community / district nursing, allied health) 239 Specialist Palliative Care (hospice, specialist nursing and / or medical services) 230 Specific condition support groups (e.g. Alzheimer's Australia) 40 Others: Occupational therapist Speech pathologist Clinical nurse consultant Pharmacist Palliative care cancer nurse 13

After hours services to palliative patients After hours dataYesNo Do you provide after hours services to palliative patients?12017 Does your practice provide after hours services to palliative patients?10334 What services do you provide after hours? Telephone patient and family support11123 Home visits11023 Practice Nurse support3662 Other (list) RACFs2 Local Palliative Care Unit1 Hospital/visits on call2 Local Hospital1 On average how many after hours services would you provide in a month to palliative patients?

So what’s the GP data telling us?  Collecting data on GP billing for palliative patients is difficult  The method devised for collecting data on GP billing and practices for the RPC Project is cumbersome and time consuming and results in poor uptake  GPs tend to classify palliative patients as those living: —in the community —with a diagnosis of Cancer  For those GPs who identify RACF patients diagnoses are generally for: —Dementias —Cancers

So what’s the GP data telling us? cont  GPs are treating more people for conditions more prominently seen in older people such as Dementia’s. Dementia is seen as a condition by GPs that could benefit from a palliative approach.  Less than a quarter of palliative patients seen by a GP were referred to other services.  Approximately 8.5% of the patients referred to other services were referred to a specific condition support group.

Questions to consider  Do PHC providers understand palliative care?  Do PHC providers fully comprehend the benefits of a palliative approach and early referral to specialist services and disease specific support groups?  What role do general practice networks have in addressing these questions and those discussed in this presentation?