Community Needs Analysis Report

Transcription

1 Grampians Medicare Local Community Needs Analysis Report Summary October 2013

2 2 Contents Introduction 3 Snapshot of results 4 Stakeholder feedback 5 Health status of residents 6 Health behaviour of residents 9 Health services in the GML region 12 Health determinants 14

3 3 Introduction The Grampians Medicare Local (GML) Community Needs Analysis Report was undertaken to help identify the health needs of the diverse communities living within the GML region. The report was compiled by Patrice Higgins and Associates between November 2012 and May 2013 through consultation with 115 consumers, 29 key informants and 52 service providers from across the region. Statistical data was also utilised from the Australian Bureau of Statistics, the Victorian Department of Health and the Public Health Information and Development Unit. The report includes information on the health status and behaviour of residents, the factors influencing health and wellbeing and the current issues and future challenges facing both residents and the healthcare sector in the region. Along with an overview of the entire GML region, the report also provides information divided into three sub regions Wimmera, Grampians Pyrenees and Central Highlands. The GML region extends from west of Melbourne (Ballan) to the South Australian border and covers an area of 48,000 square kilometres. The boundaries of the GML are classified into three subregions: Central Highlands, Grampians Pyrenees and Wimmera and includes larger rural centres of Ballarat, Ararat, Maryborough and Horsham and many smaller towns and localities. The GML region had an estimated resident population of approximately 204,455 people at 30 June 2011 (ABS 2013).

4 4 Snapshot of results There are a much higher proportion of people in the GML region with respiratory system diseases. GML has the highest incidence of this disease when compared to 61 Medicare Locals across Australia. There are high rates of babies born in the region with low birth weight. The region has high reported rates of physical inactivity, smoking, risky drinking and poor nutrition. GML is ranked 6 out of 61 Medicare Locals for men with mental health and behavioural problems and 14 out of 61 for women. GML had a much higher proportion of people with musculoskeletal system diseases than state and Australian wide averages. There are high rates of people with at least one of four key health risk factors (smoking, harmful use of alcohol, physical inactivity and obesity) compared with the state average. Parts of the GML region have lower rates of participation in cervical, breast and bowel screening. The GML region has high avoidable death rates from conditions including diabetes, cardiovascular disease, injuries and cancers. The GML is ranked number one compared to other Medicare Locals across Australia for rates of avoidable death due to colorectal cancer. The report found that by 2020 the key health conditions affecting people living in the GML region will be osteoporosis, diabetes, osteoarthritis, asthma, anxiety, depression, chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, ischaemic heart disease and dementia.

5 5 Stakeholder feedback A number of key themes emerged in the report from consultation with residents and health service providers. These include: Widespread concern about the ongoing availability of health services that are reasonably local for people. The inability to retain doctors and allied health professionals in the region is an issue of great concern for residents. The need for coordination of care was mentioned frequently, particularly for those consumers who suffer a chronic illness or have complex care needs. The ability to access up-to-date, comprehensive information regarding the availability of health services and related support programs was repeatedly raised as challenging for consumers. Consumers with chronic health conditions and the elderly were the most likely to describe their relationship with their health professional as an important issue. The lack of appropriate mental health services was raised repeatedly as an issue of concern for community members and health professionals. There was also widespread concern about the current and future demand on mental health services and the growing impact of mental health disorders within local communities. Travel and transport issues continue to contribute substantially to the ability of people in the region to access adequate and timely health care. This was most often the case when it came to accessing specialists for those living in rural and regional communities. Consumer and community understanding of health issues and health promotion is a high priority for many of those consulted across the GML catchment. This relates to both the low health literacy levels as well as a perceived lack of a coordinated approach to health promotion. Concern regarding the increased costs of health care was widespread among the consumers consulted, particularly those living with chronic illness requiring regular specialist care.

6 6 Health status of residents The health status data for the GML region found: High prevalence of chronic diseases including mental health, diabetes, cancers (prostate cancer in particular), respiratory system and musculoskeletal system diseases. High avoidable death rates from conditions including diabetes, cardiovascular disease and cancers. High reported rates of fair or poor health and disability. There is evidence of high prevalence of a range of chronic diseases within the region affecting both men and women. These include: Diabetes GML had a higher proportion of its population (3.6 per 100 persons) with type 2 diabetes than both the Victorian and the national average. GML is ranked 19 out of 61 Medicare Locals on this indicator and falls within the second highest national quintile for all Medicare Locals. High cholesterol The GML catchment had a higher proportion of its population (5.6 per 100 persons) with high cholesterol than the Victorian average (5.4 per 100 persons). GML is ranked 24 out of 61 Medicare Locals on this indicator. Mental Health GML falls within the highest national quintile for all Medicare Local areas for both men and women who have mental and behavioural problems. GML is ranked 6 out of 61 Medicare Locals indicating it has a very high proportion of males who have mental health and behavioural problems when compared to other Medicare Local areas. It has a ranking of 14 out of 61 Medicare Locals for women with mental health and behaviour problems. The rate of men with mental health and behavioural problems (11.5 per 100 men) is higher than both state (9.9 per 100 men) and national averages (10.1 per 100 men). GML also had a much higher proportion of females (12.5 per 100 women) with mental health and behavioural problems than the Victorian (11.6 per 100) and national average (11.8 per 100).

7 7 Health status of residents (continued) Respiratory diseases GML had a much higher proportion of people (31.4 per 100 persons) with respiratory system diseases than the Victorian average (27.3 per 100 persons) and national average (26.6 per 100 persons). For respiratory system diseases, such as asthma and Chronic Obstructive Pulmonary Disease (COPD), the GML region is ranked 1 out of 61 Medicare Locals. Asthma GML had a much higher proportion of people (10.3 per 100 persons) with asthma than the Victorian average (9.1 per 100 persons) and national average (9.7 per 100 persons). Musculoskeletal system diseases GML had a much higher proportion of people (32.1 per 100 persons) with musculoskeletal system diseases, such as osteoarthritis than the Victorian average (29.8 per 100 persons) and national average (30.1 per 100 persons). Arthritis GML had more people (15.9 per 100 persons) with arthritis than the Victorian average (14.6 per 100 persons) and national average (14.9 per 100 persons). GML is ranked 15 out of 61 Medicare Local and falls within the second highest national quintile for all Medicare Locals. COPD (incorporating emphysema, chronic bronchitis and chronic asthma) GML had a higher proportion of people (2.6 per 100 persons) with COPD than the Victorian average (2.2 per 100 persons) and national average (2.3 per 100 persons). Rheumatoid Arthritis The number of people living in the GML region with rheumatoid arthritis was consistent with the Victorian average (1.9 per 100 persons) and lower than the national average (2.0 per 100 persons).

8 8 Health status of residents (continued) Cancers (avoidable) GML has a higher rate of avoidable mortality for both colorectal cancer and lung cancer. GML had a higher rate (65.6 per 100,000) compared to Victoria (61.4 per 100,000) and nationally (62.0 per 100,000) and is ranked 23 out of 61 Medicare Locals for avoidable deaths due to cancer. Lung cancer GML had a higher rate ( 20.7 per 100,000) compared to the rest of Victoria (20.6 per 100,000) and Australia (21.4 per 100,000) and is ranked 42 out of 61 Medicare Locals for avoidable deaths due to lung cancer. GML is in the second lowest quintile nationally when compared to other Medicare Locals on this indicator. Colorectal cancer GML is ranked number one compared to other Medicare Locals for rates of avoidable death due to colorectal cancer. GML had 13.9 per 100,000 compared to state (11.3 per 100,000) and national (10.9 per 100,000) figures.

9 9 Health behaviour of residents Analysis of the health behaviour data for residents living in the GML region found: High rates of people with at least one of four key health risk factors (smoking, harmful use of alcohol, physical inactivity and obesity) compared to the state average. High reported rates of physical inactivity, smoking, risky drinking and poor nutrition. Low rates of immunisation coverage in parts of the region. Low rates of participation in cervical, breast and bowel screening. alcohol at risky levels (5.5 per 100 persons) compared to Victorian (4.6 per 100 persons) and national rates (5.4 per 100 persons). Grampians Medicare Local is ranked 34 out of 61 Medicare Locals on this indicator. Smoking The GML region shows higher rates of smoking for both men and women compared with state and national rates. Smoking rates for men (24.3 per 100) were higher in GML compared to state (21.9 per 100) and national averages (22.4 per 100). Rates were also higher for women who identified as current smokers (21.2 per 100) compared to the rest of the state (17.8 per 100) and across Australia (18.2 per 100). High rate of babies born with low birth weight. Lifestyle Harmful use of alcohol The Grampians Medicare Local region had a higher proportion of adults who consumed Physical Inactivity Fewer people aged 15 years and over living in the GML region had undertaken exercise (33.7 per 100 persons) compared with the Australian rate of 34.3 per 100 persons. However, the GML rate was slightly higher than the Victorian participation rate (32.6 per 100). GML is ranked 40 out of 61 Medicare Locals on this indicator.

10 10 Health behavior of residents (continued) Poor Diet The National Health and Medical Research Council (NHMRC) recommends that adults eat at least two serves of fruit and five serves of vegetables a day. In the GML region, less young children and teenagers met the guidelines (61.1 per 100) compared to state (63.2 per 100) and national averages (61.0 per 100). Grampians Medicare Local is ranked 35 out of 61 Medicare Locals on this indicator. Overweight and Obesity Men The rate of obese men (20.8 per 100) living in the GML region, was higher than the state (18 per 100 men) and national averages (19.6 per 100 men). GML is ranked 26 out of 61 Medicare Locals on this indicator. The rate of overweight men (35.6 per 100) living in the GML region was lower than the state (35.7 per 100) and national averages (36 per 100 men). GML is ranked 45 out of 61 Medicare Locals on this indicator. Women The rate of obese women in the GML region is 17.7 per 100 women, higher than the state (16 per 100) and national averages (16.4 per 100). GML is ranked 22 out of 61 Medicare Locals on this indicator. The GML rate for overweight women was 23 per 100 women which was higher than the state (22.6 per 100) and national averages (22.7 per 100). GML is ranked 8 out of 61 Medicare Locals on this indicator.

11 11 Health behavior of residents (continued) Health Screening Cervical Screening Over half (56.9 per cent) of women aged 20 to 69 years in the region participated in cervical cancer screening. This rate was lower than the state average (63.1 per cent). Immunisation Large differences exist in immunisation coverage across the region of babies fully immunised at 12 to 15 months of age. Overall, GML had a rate of 93.1 per cent which was higher than the state (91.7 per cent) and national average (91.3 per cent). Bowel Cancer Screening Women The participation rate for women in bowel cancer screening in the region of 44.6 per cent was higher than the state (39.8 per cent) and national average (39.2 per cent). However, lower rates of immunisation coverage was reported in areas such as Ballarat South, Central Goldfields Balance, Golden Plains north-west, Hepburn West and Yarriambiack south with significantly lower percentages compared to state and national averages. Men The participation rate for men in bowel cancer screening in the GML region (37.6 per cent) was higher than the state (34.4 per cent) and national average (34.5 per cent). Breast Cancer Screening Overall, there was a higher rate of women in the GML region (56.8 per cent) who participated in breast cancer screening compared with the state average (55.9 per cent). Low birth weight babies The overall proportion of low birth weight babies in the GML was high (7.3 per cent) compared with state and national figures (6.6 per cent and 6.5 per cent). Ten of the 22 Statistical Local Areas in the GML region have higher percentages of low birth weight babies than both state and national averages.

12 12 Health services in the region Analysis of the health services and workforce data for the GML region identified: Workforce shortages and capacity issues Increased demand on public hospital emergency departments, especially from vulnerable groups, and future demand issues particularly from older people with chronic illnesses Inequities in access to primary care and other health services Public hospital use Within the GML catchment, there are 12 public health services (with 23 separate hospital sites/ campuses), four Bush Nursing Hospitals and one private hospital. Across the GML region the total number of hospital separations increased by 5.7 per cent from 64,982 in to 68,658 in (Separation from a health service occurs when a patient is discharged, dies, is signed -out or transferred). The average length of stay decreased over the three-year period by 6.29 per cent from 3.18 days to 2.98 days. Emergency Department presentations for the two designated emergency departments in the GML catchment (Ballarat and Wimmera Base hospitals) totalled 200,783 across the two emergency departments for the three-year period. Presentations for the two hospitals combined increased by 2.59 per cent, from 65,330 in to 67,025 in Primary and community care health workforce Primary and community health services available to residents across the GML region include: 61 general practices 6 palliative care services 3 Aboriginal health services 10 public dental services and 14 dental practices 1 women s health service 15 mental health services 237 medical specialists 50 pharmacy services 41 pathology centres 15 radiology centres 2 community health centres and 12 community health services part of rural public health services

13 13 Health services in the region (continued) General Practice It is estimated that there are 354 GPs working within the GML region. have easy access to transport and/or face transport related barriers to accessing health services. The percentage of adults who had a preferred GP varied across Medicare Locals, ranging from 64 per cent to 95 per cent. The percentage of adults within the GML catchment who had seen a GP for their own health in the preceding 12 months was 81 per cent. Across the GML catchment, 15 per cent of people thought they had waited longer than acceptable to get an appointment to see a GP in the preceding 12 months. The percentage of people who said they did not see, or delayed seeing, a GP due to cost varied across all Medicare Locals, ranging from three per cent to 16 per cent. Eight per cent of adults living within the GML region reported avoiding or delaying seeing a GP due to cost. Many people, particularly older people living in more rural communities within the region do not There are also some households who have no access to private transport options with 6.8 per cent of households in the GML region having no motor vehicle. More than two in five GPs planned to change their workforce participation in the next five years. Nearly half of these GPs (45 per cent) wanted to reduce their working hours and 26 per cent of GPs planned to retire. Sixteen per cent intended to relocate to an urban practice in the coming five years. Aged Care The overall ratio of total residential aged care places in the GML was lower (84.4 per 1,000 people aged 70 years and over) compared with state (87.3 per 1,000) and national averages (87.0 per 1,000) with GML ranking 41 out of 61 Medicare Locals on this indicator.

14 14 Health determinants The socio economic profile of the GML region is characterised by considerable disadvantage whether measured in terms of numbers of low-income earners experiencing mortgage stress, high numbers of welfare recipients, high unemployment rates, educational disadvantage, numbers of children who are developmentally vulnerable, or numbers of sole-parents with young children. There were 20,833 health care card holders (11.9 per cent) which is a higher rate when compared to Victorian (9.1 per cent) and national averages (8.0 per cent). Within the GML region, there were 79.2 per cent of young people (at age 16) in secondary school education. The GML region is ranked 29 out of 61 Medicare Locals on this. The GML region had 27,181 aged care pensioners aged 65 years and over, a higher rate (75.1 per cent) compared to Victoria (71.9 per cent) and national averages (72.7 per cent). Within the GML region, there were 11,220 disability support pensioners. This rate (8.5 per cent) was higher than Victorian (5.0 per cent) and national (5.0 per cent) figures. There were 11.3 per cent of low-income households (households in bottom 40 per cent of income distribution) with mortgage stress, and GML is ranked 19 out of 61 Medicare Locals on this indicator. Eleven Statistical Local Areas within the GML region had rates higher than Victorian (11.4 per cent) and Australian averages (10.5 per cent).

15 15 62 High Street Ararat VIC 3377 PO Box 127 Ararat VIC 3377 t f e ararat@grampiansml.com.au 105 Webster Street Ballarat VIC 3350 PO Box 36W Ballarat VIC 3350 t f e ballarat@grampiansml.com.au 148 Baillie Street Horsham VIC 3400 PO Box 1158 Horsham VIC 3402 t f e horsham@grampiansml.com.au Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health. Grampians Medicare Local Ltd ABN