Integrated Team Care

There has been a decline (61%) in deaths from circulatory diseases between 1998 and 2018 for First Nations Peoples. However, heart disease is still a major contributor to the gap in life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.

The Heart Foundation wants to improve the heart health of all Australians by providing information and resources to reduce risk of heart disease, so we have developed new and updated web content on Aboriginal and Torres Strait Islander health for health professionals and consumers.

New pages for consumers

• Aboriginal and Torres Strait Islander peoples: Heart health information and resources
• Aboriginal and Torres Strait Islander peoples: Are you at risk of heart disease?
• Aboriginal and Torres Strait Islander peoples: Lower your risk of heart disease
• What is acute rheumatic fever and rheumatic heart disease?

New pages for health professionals

• For Professionals: Aboriginal and Torres Strait Islander peoples information and resources

Updated pages for health professionals

• Aboriginal and Torres Strait Islander peoples: Heart Health Projects
• For professionals: Guidelines for acute rheumatic fever and rheumatic heart disease
• For professionals: Aboriginal and Torres Strait Islander peoples identification training
• For professionals: Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults
• For professionals: Online education and training

An assistive tool was created by Western Queensland PHN and modified by the CSAPHN to support Integrated Team Care Service Providers in their Supplementary Services Funding monitoring and tracking. First released in 2018, we have a webinar to assist service providers in implementing the tool should they need it. The tool, the webinar and activity package is available in our resources library for you to work with.

In order to play the Webinar, it is recommended to download it. You can do this by going to the File tab on the top left hand corner and then choosing 'save as' and save it to your device.

If you have any feedback to modify/ improve, the tool or the webinar and activity, please don't hesitate to contact us.

The South Australian Aboriginal Chronic Disease Consortium have developed a series of video resources, featuring members of rural and remote Aboriginal communities, to capture diabetes stories that highlight challenges and successes in managing diabetes and diabetes risks and complications.

Overall, 24 Aboriginal community members from nine locations across South Australia participated in these resources.

The videos also feature health professionals (including Aboriginal health professionals) who provide background information and explanations about the disease and management strategies in language that is appropriate for Aboriginal people with diabetes and entry-level health professionals.

• Aboriginal Diabetes Video Resources 1- Project Overview
• Aboriginal Diabetes Video Resources 2- Understanding Diabetes
• Aboriginal Diabetes Video Resources 3- Understanding Gestational Diabetes
• Aboriginal Diabetes Video Resources 4 - What Helps My Diabetes
• Aboriginal Diabetes Video Resources 5- Safe Use of Medications
• Aboriginal Diabetes Video Resources 6 - Monitoring My Diabetes
• Aboriginal Diabetes Video Resources 7- Its getting complicated
• Aboriginal Diabetes Video Resources 8 - I Can't Deal With That: Diabetes & Mental Healt
• Aboriginal Diabetes Video Resources 9 - Diabetes Is Preventable

The End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE) was established in 2014 to address the urgent need for a comprehensive, evidence-based plan to eliminate rheumatic heart disease (RHD).

The RHD Endgame

The RHD Endgame Strategy: The blueprint to eliminate rheumatic heart disease in Australia by 2031 is the culmination of work bringing together the collective experience of communities, clinicians, Aboriginal Community Controlled Health Organisations, government and non-government organisations, in addition to more than 25 years of research, means the knowledge and evidence base now exists to eliminate rheumatic heart disease (RHD) in Australia.

The Endgame Strategy brings together this experience, knowledge and evidence for the first time, presenting an opportunity for Australia to implement a comprehensive, long-term strategy to end rheumatic heart disease.

We are excited to let you know about two upcoming webinars on supporting Indigenous wellbeing through digital resources.

The webinars will showcase theWellMobwebsite https://wellmob.org.au/ launched in July by the Australian Indigenous HealthInfoNet. WellMob brings together over 200 digital social and emotional wellbeing resources made by and for our mob.

The focus of the webinars will be to hear our deadly webinar panellists’ yarn about how healthcare workers can use digital wellbeing tools to help keep our mob strong in mind, body and culture.

The webinars and associated podcast that will follow are being prepared with the Black Dog Institute under the national eMHPrac program.

A big shout out to our Indigenous workforce reference groups, workers and communities who helped develop the WellMob website and made it possible to yarn about it in these webinars.

WEBINAR 2: Supporting Indigenous wellbeing through digital resources: an introduction for frontline wellbeing workers

• Who’s it for: Frontline wellbeing & community workers
• Time & Date: Thursday 29^th October at 1 pm
• What’s it about: A webinar yarning about digital wellbeing resources for our mob and tips to use them with your clients and community
• Register at: https://medcast.com.au/courses/367

The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition) was released on 28 February. Available at https://www.rhdaustralia.org.au/arf-rhd-guideline, it is the definitive guide to current ARF and RHD diagnosis and management in Australia.

There are a number of important clinical changes in this new version that will impact on the management of the patients on the SA RHD register. These include changes to:

• The diagnostic criteria for ARF in low risk populations and recurrent episodes
• Recommendations for the duration of secondary prophylaxis
• Priority definitions and timing of follow-up in the ‘priority classification system’ for presence and severity of RHD

The 2020 version also has some new chapters including culture and workforce where a socio-ecological model stresses the importance of focusing on the individual and their culture in all clinical interactions. Check out the five minute video (found at the above address) outlining the changes from the 2012 version

Rheumatic Fever and Rheumatic Heart Disease e Learning modules provide basic to advanced education for all health professionals. The modules are endorsed by the Australian College of Nursing and accredited by the Australian College of Rural and Remote Medicine. A certificate is issued upon completion of the modules for evidence of CPD or CME. Points or education hours are assigned to individual packages or modules. Participants are required to follow a simple registration process which provides a log-in for continuation of modules at one’s own pace. https://www.rhdaustralia.org.au/clinician-modules

Additionally, medical officers and Nurse Practitioners/ Practice Nurses can download the free phone App with a diagnosis calculator and quick-reference guide to the Australian Guideline for the diagnosis and management of acute rheumatic fever and rheumatic heart disease.https://www.rhdaustralia.org.au/apps

The ITC Staff Forum is being planned for the 13-14 November to be held at Adelaide.

We are currently confirming the venue and some of the details surrounding the agenda

Based on the feedback that was provided at the last ITC Staff Forum, we have changed some of the format and setting of the Forum. This includes:

• This upcoming staff forum will be a 2 Day Event.
• It is being held mid week rather than at the end of the week for those that are travelling great distances.
• In the format, 15 minute 'Work Check In' breaks are being completed in order for staff to deal with client issues immediately after sessions.
• The timing of sessions has changed to a maximum of 1 hour sessions
• More time for networking- both structured and unstructured, including but not limited to Peer Support Meeting time.
• The second day is an activity day in groups of three, based on roles, to work together on Optimal Cancer Pathways.

The SA Aboriginal Chronic Disease Consortium are working on Aboriginal Diabetes Education Resources project to develop a series of video resources featuring members of a variety of rural and remote South Australian Aboriginal communities, to capture diabetes stories that highlight challenges and successes in managing diabetes and diabetes risks and complications, with health professionals (including Aboriginal health professionals) providing background information and explanations about the disease and the necessary measures to manage it, in language that is appropriate for Aboriginal and Torres Strait Islander people (including APY languages).

Having Aboriginal and Torres Strait Islander community members share their diabetes story, with an underlying message that diabetes is avoidable, will help to break down a prevailing sense in Aboriginal communities that getting diabetes is inevitable. We also hope to deliver the message that although you may get diabetes, with the right care and management, including some lifestyle changes, you can still live a happy and fulfilling life.

The Project is set to be finalised in December and is funded by the CSAPHN. In November, Project Manager Doug will be talking with us and potentially give us a preview of the work. This will mean that ITC Staff will have at their disposal video resources in delivering Diabetes Awareness in prevention and management strategies to clients and the community, that have been made by the community in partnership with Diabetes Educators.

More information is available via the Consortium Newsletter.

The Aboriginal Chronic Conditions Network (ACCN) works to improve the experience and delivery of healthcare for Aboriginal people with chronic conditions in NSW. To achieve this, the ACCN will support the process of evidence-based reform by promoting and implementing new initiatives, frameworks and models of care. It will do this by enhancing and supporting the integration of care for Aboriginal communities accessing chronic care services in NSW in accordance with Agency for Clinical Innovation (ACI) values.

This years Conference was recorded and is available online.

If you or the Care Coordinators or Aboriginal Outreach Workers would like to select which recordings to view the agenda is available here.