Health and Wellbeing Notes

Health and Wellbeing

Week 11 and 12

• CEDS 3001 Madison Shakespeare 2025
• Madison Shakespeare 2020

Acknowledgement of Country

• Acknowledgement of the Darug, Tharawal, Gandangarra, and Wiradjuri peoples.
• Recognition of Western Sydney University Campuses being built on First Nations land.
• Respectful learning from Traditional Owners.
• Responsibility as Custodian of Country.

Disclaimers

• Spoken and written disclaimers regarding deceased persons.
• Copyright Madison Shakespeare ©2020.
• Some content may disturb viewers due to sensitive topics like family dislocation from Stolen Generation issues and trans-generational trauma.
• References may be made to Aboriginal and Torres Strait Islander people who may be deceased.

Health and Welfare Services: Key Points

• Focus on population health programs.
• Antenatal Care (2011):
  • 50% of Indigenous mothers attended at least one antenatal visit in the first trimester.
  • Indigenous mothers were less likely to do so compared to non-Indigenous mothers (age-standardised rates of 51% and 66%, respectively).
• Childhood Vaccinations (2013):
  • Similar vaccination rates between Indigenous and non-Indigenous children at ages 2 and 5.
  • 86% of Indigenous children aged 1 were fully vaccinated, compared to 90% of other children.
• Cervical Screening (2012-13):
  • 57% of Indigenous women aged 18 and over reported having a Pap test at least every 2 years.
• BreastScreen Program (2011-2012):
  • 38% of Indigenous women aged 50-69 participated, compared with 54% of non-Indigenous women.

National Key Performance Indicators (nKPI) for Aboriginal and Torres Strait Islander Primary Health Care (2017)

• Series No. 5: Monitoring progress against high-level policy initiatives.
• Data Collection:
  • Quality, completeness, and timeliness are crucial for effective service delivery and better policies.
  • Continuous quality improvement strategies at the health service level.
• Indicators:
  • 11 indicators initially, with approximately 100 Indigenous-specific primary health organizations participating.
  • Expanded to a full set of 24 indicators from 240 organizations.
• Data Collection Frequency:
  • Every 6 months (30 June and 31 December yearly).
  • In 2017, only 10 reporting periods due to technical issues (no data in December 2016).
• Data Extraction Methods:
  • Pre-June 2016: nKPI data extracted from health organizations’ CISs, mainly via PenCAT tool (compatible with Medical Director, Best Practice, PractiX, Communicare, and a version of Medinet).
  • Some organizations submitted data manually.
  • Organizations using MMEx software submitted data directly to OCHREStreams.
  • From June 2017: New direct load reporting process, enabling direct data transmission to OCHREStreams portal from Communicare, Medical Director, and PCIS clinical software systems.

Data Quality Issues and Time-Trend Analysis

• Increased AIHW assistance needed for data correction in June 2017.
  • Resubmission rate: Approximately 83% of organizations (189) received at least one exception report, compared to 24% (58) in June 2016.
  • Total exception reports: 286 in June 2017, compared to 92 in June 2016.
  • Possible cause: Limited testing of the new direct load process.
• Participation:
  • 228 organizations provided nKPI data for the June 2017 collection, nearly 5% lower than in June 2016 (241 organizations).
  • Exemptions: Three organizations were exempt due to ongoing technical issues.
  • Missing data: 10 organizations did not submit data in June 2017 for unknown reasons.
• Time-Trend Issues:
  • Parallel testing was not possible to assess impacts of changes in data extraction/reporting methods.
  • Time-trend analysis was used but distinguishing between real-world changes and extraction tool artefacts was difficult.
  • Problematic variations in the data at the service level.
  • June 2017 collection: Time trend issues obscured by internal validation errors and lack of comparable data for December 2015, with no data for December 2016.
  • Inclusion criteria: Only organizations reporting valid data in all five annual June reporting periods since June 2013 were included (ranging from 157 to 225 organizations per indicator).
  • Time-series anomalies: Change in extraction method constitutes a break in series.
  • June 2017 collection: New baseline for collection moving forward for 19 of the 24 indicators.
  • Reporting: Only presents data for 2 collection periods—June and December 2017.
  • Unusual time-trend issues in PI13 (First antenatal visit), PI18 (Kidney function test recorded), and PI19 (Kidney function test result), suggesting potential extraction errors.

Considerations for nKPI Data

• nKPIs are useful but imperfect measures of system characteristics.
• Data users need to understand potential departures from reality.
• Other considerations:
  • “Regular clients” vs. “transient clients”.
  • Geographical location: remote/region/urban.
  • Different organizations reporting on different indicators.
  • Same clients using different organizations within similar areas, with organizations reporting on different data.
• Statistical issues and considerations.
• Implications of algorithm/denominator issues.
• Calibration issues with measurement of weights.
  • Birthweight indicators: Results might be underestimated for Northern Territory Government services in June and December 2017 because data from the Northern Territory Government Midwifery Group Practice was not entered as occurring at the client’s usual health center.

Respiratory Diseases

• Prevalence (2012-13):
  • Approximately 31% of Indigenous people reported some form of long-term respiratory disease.
  • Indigenous people were 1.2 times as likely as non-Indigenous people to report this condition (age-standardised rates).
• Hospitalisations (2012-13):
  • Respiratory diseases accounted for 5.4% of hospitalisations of Indigenous people.
  • Indigenous people were hospitalised for such diseases at 2.4 times the rate of non-Indigenous people (age-standardised rates).

Cancer

• Cases (2005-2009):
  • Indigenous people accounted for 1% of cancer cases diagnosed in the 4 jurisdictions with adequate Indigenous identification.
  • Most common cancers: lung cancer (average of 130 cases per year) and breast cancer in females (95 cases per year).
• Mortality (2008-2012):
  • Cancer death rate for Indigenous people was 1.2 times that of non-Indigenous people (age-standardised rates).
  • 16% increase in cancer death rate for Indigenous people between 1998 and 2012, while the rate for non-Indigenous people decreased by 10%.

Cardiovascular Disease

• Prevalence (2012-13):
  • About 1 in 8 (13%) Indigenous Australians aged 2 and over reported having cardiovascular disease as a long-term condition.
  • Indigenous people were 1.2 times as likely as non-Indigenous people to report having cardiovascular disease (age-standardised rates).
• Healthcare Utilisation (2012-13):
  • Cardiovascular disease accounted for 3.0% of all hospitalisations of Indigenous people.
  • 8.1% of all problems managed by GPs for Indigenous patients in 2008-13.

Injury and Poisoning

• Hospitalisations (2012-13):
  • Second leading cause of hospitalisation for Indigenous Australians, accounting for 27,653 (7.2%) hospitalisations.
  • Causes:
    • Assault: 23%.
    • Accidental falls: 19%.
• Mortality (2008-2012):
  • External causes of injury and poisoning accounted for 15% of deaths of Indigenous people, compared with 6.1% of deaths of non-Indigenous people.
  • Most common external causes of death:
    • Suicide: 4.8% of all deaths.
    • Transport accidents: 3.9%.

Diabetes

• Prevalence (2012-13):
  • 11% of Indigenous adults had diabetes, while a further 4.7% were at risk of developing diabetes.
  • Indigenous adults were 3.3 times as likely to have diabetes as non-Indigenous adults (based on age-standardised rates).

Chronic Kidney Disease

• Prevalence (2012-13):
  • 1.8% of Indigenous people aged 2 and over reported having long-term kidney disease.
  • The proportion having long-term kidney disease was 3.7 times as high as the proportion of non-Indigenous people (based on age-standardised rates).
• Hospitalisations (2012-13):
  • Chronic kidney disease accounted for 173,423 (45%) hospitalisations of Indigenous Australians.
  • Almost all (99%) of these hospitalisations were for same-day care involving dialysis.
  • Indigenous people were 10 times as likely as non-Indigenous people to be hospitalised for chronic kidney disease (based on age-standardised rates).
• Mortality (2008-2012):
  • Chronic kidney disease was either an underlying or associated cause of death for 16% of Indigenous deaths.

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