Traveling Medical Home Team Brings Multi-Disciplinary Services to Remote Tasmania
Tasmania, Australia’s only island state, encompasses an area of 26,262 square miles – an area roughly the size of West Virginia – and is home to just over half a million Australians, most of them low income. According to Tasmania Medicare Local CEO Phil Edmondson, “We are the oldest and sickest and most poorly educated population in the country. We have the highest rates of chronic disease and highest age demographic in terms of skewed towards the elderly.”
Integrated Care Chronic Disease Teams, initially focused on those with diabetes, now operate with the goal of delivering comprehensive, integrated services including mental health, diabetes education, exercise physiology, nutritional counseling, among others in a state where short distances can take hours to navigate. These services enable primary care clinicians to serve as medical homes to their patients living in remote and rural mountainous regions and in small island communities.
Funding for the team came from a flexible funding stream to the Medicare Local from the federal government as well as the Tasmania Department of Health and Human Services. With federal grant funds, a few years later, the Medicare Local expanded the scope and reach of services. Describing the service delivery, Aitor Baonza, Manager of Allied & Refugee Health Services at the Tasmania Medicare Local explained, “The services are integrated in the way we work and the way we fund our services.” The multi-disciplinary team members including mental health therapists, exercise physiologists, diabetes educators, and dieticians also deliver Medicare based services (Australia’s national health insurance) to augment funding streams when referred by the primary care physician. The primary care physician gets a payment by Medicare to oversee members of the team through the formulation of a chronic disease management plan.
The Tasmania Medicare Local hires members of the teams when local commissioning or subcontracting is not possible and manages the referral and appointment process. The teams travel together sharing a van to remote or rural settings or a small plane to islands including Flinders and King islands. Patients in these areas generally receive services on a monthly basis, but for those with mental health needs, services may be delivered weekly. The team meets the patients on site at the primary care practice, but if space does not allow, patients are then seen at community health centers. The team has been well received by both the patients and the practices. Patients are reported to be better educated about their disease processes and their self-management of their disease.
Aussie Habits, Part I
One habit that Aussies are keen to kick is smoking. Like many Western countries, tobacco rates are falling in Australia. Daily smoking rates for Aussies aged 14 years or older are at 12.8% (AIHW 2013). Picking up a couple of empty cigarette boxes littered on a street reveals one part of Australia’s multi-prong tobacco strategy. Since December 2012, all tobacco products sold, offered for sale, or otherwise supplied in Australia must be in plain packaging. As you can see, the packaging is hardly plain—it’s actually quite startling and leaves no question about the deleterious health effects of smoking.