Primary Health Care Provision

Definition

Primary health care provision focusses on creating supportive environments, strengthening community action, developing personal skills and reorienting health care services (Ottawa Health Charter 1986). Prevention forms a vital focus of care provision represented by primary prevention to maintain health, secondary prevention for treating and limiting advancement of injury / illness and tertiary prevention aimed at rehabilitative or restorative actions.

Question 1

What have you observed or contributed to in the provision of primary health care that works well for your clients?

Robyn's answer

The primary healthcare that's provided in an organization such as Family Planning is mainly preventative such as cervical screening.  We're trying to prevent some of these cancers forming and infections such as chlamydia that can lead to infertility.  It’s nothing is going to kill someone but it will certainly give them problems in 10 or 15 years even 20 years so we're trying to avoid that.

The organization doesn't deal with a lot of chronic diseases such as diabetes or heart disease. We are a specialized service, so we really focusing on the fertility side and the prevention of infection and screenings.  Because there is the great public message in Australia with the cervical screening and we've done well at that to prevent the number of deaths from survival cancer across Australia. 

Clients who come to our clinic end up with a longer appointment time.
It’s a service that actually gives some time to talk about anything they need. If they've got menopause issues, some women will want to have a talk about their relationship problems and their sexual disability or their sexual issues that they're having trouble with. Whether it be themselves or in a relationship.

So the unique thing about the organization is that we give them skilled doctors and nurses to talk to and we've given them time which is often what they don't get in a GP setting or environment.

Catherine's answer

Cancer Council NT provides a range of psychosocial and emotional support services and practical support services. We provide access to nurse counselling from registered nurses, we can also provide our clients with access to a psychologist for brief intervention.

I myself, as a cancer support nurse visit Alan Walker Cancer Care Centre in Darwin and the medical accommodation Barbara James House in the city on a regular basis to provide emotional support to clients. We also link clients with practical services, that can be from other organizations or from ourselves as well, practical services such as wigs and breast prostheses, legal and financial assistance.

Chrissie's answer

In primary health care, things that work well with us, particularly in the urban services is being part of that bigger Primary Health Care Network. Generally speaking the GP’s (general practitioners) are the central area of care we all funnel into and then we have lots of different services that funnel out depending on the client needs themselves.

Part of our role in primary services to actually engage in with that bigger Network and all work together collaboratively to do that.  Communication works well to build that.
It's a similar service but slightly different in the fact of cardiac because often people come here post-acute event, so we've already engaged them through the acute care sector and then we're getting them back into community living and to managing their cardiac condition in the real world.

Simon's answer

Our main focus for a small not-for-profit organization like us here in the Northern Territory, we focus mainly at the workforce that can actually impact and have the greatest impact on client or the population.
We work well with Aboriginal Health Practitioners through the Batchelor Institute
We have some resources there that we supply and educate that workforce to pass on key health messages into the environment.

We also work with the hospital staff through the Cardiac Nurses as well as a Cardiologist to ensure that Clinical Guidelines are up to date and that they're aware of all those Clinical Guidelines. We also work with General Practitioners in that clinical space  as well, through warning signs of heart attack and we've got Absolute Cardiovascular Risk Assessment which looks at the risk of a person having a heart attack within five years That works in the primary healthcare space as well.

Kylie's answer

I suppose we have a range in terms of we have primary health care in terms of early intervention where we are working with the 0 to 18 age group.
They work with a family member as well so that is why we are looking at keeping families well.
If there is risk factor, we want to make sure families are safe and keeping well and that includes a variety of things from early parenting skills to one-on-one sessions on the different factors of keeping a family strong and healthy.
It could be things like cooking skills so there is a range of things that come into that primary health care setting.
Then we do secondary as well, more the acute end of mental illness, so we have a variety of adult based programs where people are unwell when they do come to us, if they have been referred to us.
It might be severe and persistent mental illness that we are dealing with then, and supporting them to try to manage that so that they do live a full and valued life, there is a lot of things that come into that.
There is the child mental health which is the family setting and then with adult mental health we have a lot of outreach, so you might be going and seeing someone on one on one and having a talk about what in their life they practically need in terms of assistance  to help keep them well.
That is things like assisting them to gain employment or to keep employment, relearning new skills and that could be cooking or even just getting out into the community.

Social isolation is often something that you'll find people experience with mental illness and it's participation and sometimes what that means is getting a variety of adults together from across our services and coming together and having a barbecue together or doing some mindfulness practice or doing a yoga or Tai Chi session

Getting them out in communities, participating and just engaging again because sometimes they are just stuck at home and they can't get to where they want to go to in terms of transport logistic wise and sometimes they just become so stuck in their ways of being at home and that’s so rewarding I think seeing them and then you know in their in their happiest moments out just having fun and just engaging in the community.

Then we have the Day-to-Day Living Centre at Rapid Creek and what we do there is a lot of art and music lessons, they cook, the participants there cook together, eat together.
We do things like go on excursions, maybe to the museum or educational places, go for walks on the beach, just everyday stuff that people enjoy doing whether it's an educational focus or just participating in the community

 

Question 2

What are the main challenges in your health care provision and what have you observed that could be done to improve primary health care in your sector?

Kylie's answer

There is a few main challenges that I could touch on, so firstly you have the logistics of being in the Territory, so the broad spaces that we work across because we do go out into communities as well.

Then you have the high turnover, though Northern Territory tends to be a transient place and people do not always come for a long time they come for a set period or for a specific reason often you will find.

I think when you have someone who comes into the organization and has skills and talents to offer we have to think of it as quality not quantity so let us enjoy and embrace what this person has to offer for the time that they are here and get the most out of that period.
One of the other challenges would be the budget constraints that we deal with working in a not-for-profit organization/ non-government organization where our budgets and funding contracts are dictated by the government and the contracts that we get.

They have been one year, two years and if we are lucky three years.
That means that recruitment and being able to put into place sustainable projects, over a period can be difficult because we often do not know when we are getting our funding.
Right now, we're in May, our staffing contracts end on the 30th of June for example and until I've got a new funding contract I can't give those staff surety about their employment until I know what funding is coming my way

That just makes logistics tricky sometimes because people want security, so retaining good people it can be difficult in that sense as well.

Chrissie's answer

Usually communication of health information, that is a biggie. We are not part of the public health system and obviously the level of information that we can give and education and support that we can give is reliant on their level of information and health information that we get. The more we know the better our information and the better our education.

Sometimes that is a challenge to get the right information at the right time.
Because individual people and part of all of this is also reflecting back on to the clients are people that we see in the community, and that their understanding of their own condition is really important when they're traveling around different services. 
Because if they don't know and we don't have the information then nothing can get done, you know we really limit ourselves and how we can be effective.

Catherine's answer

I guess its lack of knowledge of people knowing that there is support services out there and sometimes people wanting to take on board the support is quite difficult, I guess getting people to want to receive support and to understand how beneficial it may be.
We can overcome that only through further education of the wider community that we are a support service and we are available to anyone who needs us. It not a means tested service, it’s for everyone.

Simon's answer

From a Northern Territory perspective some of those main challenges are the turnover of workforce here in the Northern Territory and ensuring that the workforce has the level of understanding of the role of the Heart Foundation and the tools and resources that we have available. That’s probably our greatest challenge here. It’s making sure we're constantly talking to the workforce.

There’s a lot of work being done  in the Primary Health Care sector here in the Northern Territory it's about coordinating that sector.
I know the role of the Primary Health Network is to coordinate that sector but there seems to be a lot of silos work going on within the primary health sector in the Northern Territory which probably could be better coordinator from our perspective in terms of our resources and our messaging going out.

 

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