Primary Health Network Alcohol and Other Drugs …...Department of Health PRIMARY HEALTH NETWORKS Alcohol and Other Drugs (AOD) Needs Assessment report November 2017 (Updated) Page

Department of Health PRIMARY HEALTH NETWORKS Alcohol and Other Drugs (AOD) Needs Assessment report

November 2017 (Updated)

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Primary Health Network

Alcohol and Other Drugs (AOD) Needs Assessment

November 2017

Name of Primary Health Network

North Coast

When submitting this Needs Assessment Report to the Department of Health, the

PHN must ensure that all internal clearances have been obtained and the Report

has been endorsed by the CEO.



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Section 1 – Narrative

Process North Coast Primary Health Network (NCPHN) has reviewed and extended its March and November

2016 Needs Assessments to arrive at a more detailed understanding of the Alcohol and Other Drug

(AOD) health and service needs on the North Coast of NSW, in preparation for the 2017-18 planning

process.

November 2017 update

The Needs Assessment completed in March 2016 has been reviewed and extended to ensure it includes

the most current and relevant AOD health and service data available. In some instances, evidence has

been removed from the needs assessment where local health statistics now indicate a rate or result

that is better (i.e., healthier) than the state or national result. New data has also been added to most

sections within this Needs Assessment, deepening and expanding on NCPHN’s understanding of health

and service needs.

In early 2018, the results of this Needs Assessment will be published on the NCPHN website alongside

20 updated fact sheets detailing need in the region. In addition, the NCPHN will publish a

Comprehensive Needs Assessment using all available health and service data on our website in mid-

2018. Note, secure data made available from the Department of Health and other organisations will

not be included in this publicly-available publication.

Further developmental work

The March and November 2016 NCPHN Needs Assessment processes identified a range of AOD health

and health system issues to be addressed. We examined health and health system needs through a

triangulation of improved health statistics, service mapping and survey results, which provided a solid

basis for assessing need. We further investigated appropriate approaches to addressing the identified

needs through more in depth consideration of evidence based approaches. However, continued

research, analysis and improved data are required to enable NCPHN to best target each issue and

inform continued co-designing of services, projects and programs that achieve the desired outcomes

rather than focussing solely on outputs. To this end some opportunities, priorities and options reflect

the need to continue developing an evidence-informed approach.

For our next Needs Assessment (2018), we have initiated discussion with Local Health Districts and

other social-sector organisations from the region in order to develop a shared process and product that

can inform more coordinated, needs-driven health planning within the North Coast region



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Overview of March 2016 Needs Assessment

In March 2016 North Coast Primary Health Network (NCPHN) implemented the following processes and

structures to complete the initial assessment of needs:

1. Establishment of an oversight committee

2. Focus groups with community members

3. Interviews with clinicians

4. Community survey (the largest local community needs assessment survey undertaken to date)

5. Service provider survey (the largest local service provider needs assessment undertaken to date)

6. Service mapping and collation of health and service statistics

7. Public presentations and roundtables with key stakeholders

8. Communication of health needs to stakeholders

1. Establishment of an oversight committee The below schema represents the various committees, structures and processes used to consult and

gain input into the March 2016 Needs Assessment.

Stakeholders were invited to join the Needs Assessment Oversight Committee (NAOC) in December

2015. NAOC met three times throughout the Needs Assessment process, and provided advice on the

Needs Assessment process and scope. Membership of NAOC includes senior representatives from each

Local Health District, Aboriginal Health Partnership groups (AMSs), Clinical Councils, Divisions of

General Practice, the North Coast Allied Health Association and community representatives.



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NCPHN’s three clinical councils and two key community advisory groups were significantly engaged in

the March 2016 Needs Assessment process. Members took lead roles and provided advice on NAOC,

focus group, survey and workshop activities.

2. Focus Groups with community members

More than 60 community members participated in focus groups – with one focus group held in each of

the 12 Local Government Areas. Four focus groups were attended by people with experience of mental

health services, four were attended by people aged over 65 years, two were attended by Aboriginal

men, and the remaining two were attended by Aboriginal women. The content of the community focus

groups was used to inform the community survey instrument.

3. Interviews with Clinicians

NCPHN staff conducted focus groups and interviews with more than 60 clinicians. More than half of

these were General Practitioners, and at least two clinicians were interviewed in each Local

Government Area. The content of the interviews was used to inform the content of the service provider

survey.

4. Community Survey

The community survey was disseminated over a two-week period online and in hard copy. Partnerships

were formed with 34 Non-Government Organisations who agreed to offer support to hard-to-reach

groups to complete the survey. Only those over the age of 15 were surveyed. The profile of the 2,420

community members surveyed was as follows:

● 12.8% of respondents identified as Aboriginal and/or Torres Strait Islander (n=306, Aboriginal

population rate >15 years is 3.4%);

● 12.8% of respondents identified as Lesbian, Gay or Bisexual (n=294);

● 19.6% of respondents identified as health care card holders (n=475, population rate is 22%);

● 37.2% of respondents identified as having private health insurance (population rate is 51%);

● 21.7% identified as experiencing mental health challenges (n=526); and

● 6% identified as having challenges with alcohol and other drugs (n=144).

5. Service Provider Survey

The service provider survey was disseminated online over a two-week period. The profile of the 1,250

service providers surveyed was as follows:

● Most respondents were based in a public hospital (n=289), Non-Government Organisation (n=196),

or General Practice (n=172) or in Allied Health private practice (n=94);

● Other respondents were from the disability sector, education, Aboriginal health organisations,

government, and employment agencies; and

● Most respondents were nurses (n=322), Allied Health Professionals (n=289), Service Managers

(n=99), Case Managers (n=96) and General Practitioners (n=86).

6. Service mapping and collation of health and service statistics

In 2016, a desktop service mapping exercise was undertaken focussed on General Practice, Allied

Health, mental health and Alcohol and Other Drug (AOD) services. In addition to this, in 2017 a service

mapping exercise was undertaken that focused entirely on dementia services. All available data sources

were interrogated for local health information.



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The following diagram represents the various data sources used in the NCPHN Needs Assessment.

7. Public presentations and roundtables with key stakeholders

The findings of the health statistics analysis, service mapping and survey results were presented to

community members and service providers at public sessions in Coffs Harbour on 14 March 2016 and

Lismore on 17 March 2016. Following each of these sessions, a roundtable workshop session was held,

each attended by approximately 70 service providers, clinicians and community members. In these

sessions, the identified needs were prioritised and potential solutions generated. Further community

presentations were delivered in May 2016 in Tweed Heads, Goonellabah, Grafton, Coffs Harbour and

Port Macquarie.

8. Communication of health needs to stakeholders

To detail the findings of the needs assessment in a publicly accessible format, a series of 20 fact sheets

and booklets were created. Final versions of these are available on the NCPHN website

(http://ncphn.org.au/needs-assessment-2016/).



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Additional Data Needs and Gaps

While the annual NCPHN Needs Assessment is informed by a wide range of national, state and local

data sources, we are limited in our ability to fully understand the health status and service access of

some populations in our community due to a lack of available AOD data that is released at a local level.

Gaining access from the Commonwealth and State governments to localised, timely data, that is

aggregated by population groups and health issues would enable NCPHN to better identify health needs

and service gaps in our region.

Aboriginal health data

In addition to the data already provided to PHNs from the Department of Health, we request access to OCHRE Streams data. This data would provide PHNs a detailed understanding of local Aboriginal Health issues.

Mapping of AOD services

Due to the complexity of mapping Alcohol and Other Drug (AOD) Services is complex due to the

following:

o Omission of health promotion, harm minimisation and early intervention ‘services’ does not

allow for a full picture of what services and supports are available to the community. The

majority of people with D&A problems do not access specialist D&A services.

o Services being a mix of fixed location, outreach and inreach and providers working across

multiple locations, organisations and service types, a more rigorous and detailed mapping of

D&A services and providers is required to understand service provision.

MBS and PBS data

In addition to the data already provided to PHNs from the Department of Health, we request access to

more detailed Medicare Benefits Scheme and Pharmaceutical Benefits Scheme utilisation including;

● the utilisation rate per item and per group by SA3 with State and National comparison,

● breakdown by Aboriginality and age.

Patterns of illicit drug use in rural/regional areas

The National Drug Strategy Household Survey 2016 report only provides national data. Little is known

about patterns of illicit drug use, associated harms and risk behaviours or the illicit drug markets in

regional Australia where patterns of use and harms experienced by rural areas are greater than

compared to metropolitan drug users. People living in rural and remote regions are more likely to

smoke, drink alcohol at risky levels, use cannabis and use amphetamines, including crystal

methamphetamine (AIHW, 2016). Populations with special needs include young people, women who

are pregnant or planning to become pregnant, elderly people, disadvantaged populations (Latt et al,

2009).

In particular, there is a shortage of information regarding these issues within rural Aboriginal

communities. Although nationally there is evidence of risky alcohol and other drug use and related

harms that are twice as high among Aboriginal Australians than the non-Aboriginal population, there is

a lack of regional and local level data. There is a need for accurate and timely information regarding the



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use of illicit drugs at a local level to ensure that services are appropriately targeting those in need, to

inform improvement to and/or the development of new programs, and so that decisions regarding the

provision and resourcing of services are made on the basis of sound knowledge of the characteristics

and behaviour of clients with specific region.

Workforce and service dynamics

In addition to the allied health workforce data already provided to PHNs from the Department of Health

(Health Workforce Australia data), we request access to comparable specialist data which would assist

in understanding service access. Furthermore, any data sources to assist PHNs on system and service

efficiency and effectiveness would greatly assist in understanding health system capacity and capability

development needs.



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Section 2 – Outcomes of the health needs analysis Outcomes of the health needs analysis

Identified Need

Key Issue Description of Evidence

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AOD_D(a) High rates of alcohol consumption, alcohol

related harm and alcohol attributable

hospitalisations

According to 2015 data, across the NCPHN region 33.4% of residents aged over 16 years consumed alcohol at levels that pose a lifetime risk to health. This was significantly higher than the state average of 29.8%. The rate of alcohol consumption was higher in the Mid North Coast (35.9%), compared to Northern NSW (31.6%) Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol drinking in Adults [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alc_age/beh_alc_phn [Accessed October 2017].

The rate of alcohol-attributable hospitalisations per 100,000 people is higher in the NCPHN region (697.0) than the state average (671.6). When the 12 LGAs that make up the NCPHN region are examined, 7 have a rate of alcohol hospitalisations that is significantly higher than the state average. The LGAs of Kyogle (897.8), Richmond Valley (841.8), Kempsey (783.1), and Clarence Valley (777.3) have a rate of alcohol hospitalisation that is concerning Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol attributable hospitalisations. [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcafhos/beh_alcafhos_lga_trend [Accessed October 2017].

In 2013-14, 2,253 people were hospitalised due to injuries attributable to alcohol across the NCPHN region. This is a rate of 408.8 per 100,000 (NSW rate = 329.0 per 100,000) Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol attributed injury hospitalisations [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcafdth /beh_alcafdth_phn_snap [Accessed October 2017].



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Outcomes of the health needs analysis

Identified Need

Key Issue Description of Evidence A

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AOD_D(a) continued… High rates of alcohol consumption, alcohol


hospitalisations

In 2012-13 across the NCPHN region there were 134 alcohol attributable deaths at a rate of 21.5 per 100,000 (NSW rate = 16.1 per 100,000) Centre for Epidemiology and Evidence, 2014. Health Statistics New South Wales: Alcohol Attributable Deaths. [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcafdth/beh_alcafdth_phn_snap [Accessed October 2017].

Alcohol attributable hospitalisations were 12% higher in Northern NSW (737 admissions per 100,000 people in 2010/11) compared to the NSW average (655 admissions per 100,000 people). In 2011/12 Aboriginal residents of Northern NSW were 3.1 times more likely than non-Aboriginal residents to have an alcohol attributed hospitalisation. From 1998/99 to 2011/12 alcohol attributable hospitalisations in both non-Aboriginal and Aboriginal residents in Northern NSW increased by around 60%. This steady increase over time in Northern NSW is more than double the increase in alcohol-attributable hospitalisations compared to all NSW for the same time period Northern NSW Local Health District, 2015 (Northern NSW Integrated Aboriginal Health and Wellbeing Plan 2015-2020 Vol. 2 [Online]. Available at: http://nnswlhd.health.nsw.gov.au/blog/2015/07/30/northern-nsw-integrated-aboriginal-health-wellbeing-plan-2015-2020/ [Accessed October 2017].



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Identified Need


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hospitalisations

Indigenous Australians are more likely to abstain from drinking alcohol than non-Indigenous Australians (31% compared with 23% respectively). However, among those who did drink, a higher proportion of Indigenous Australians drank at risky levels and placed themselves at harm of an alcohol related injury from single drinking occasion, at least monthly (35% compared with 25% for non-Indigenous). The (rate ratio) gap in drinking rates was even greater when looking at the consumption of 11 or more standard drinks at least monthly. Indigenous Australians were 2.8 times as likely as non-Indigenous Australians to drink 11 or more standard drinks monthly or more often (18.8% compared with 6.8%). Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey 2016: Detailed findings, 2016.

In 2014, the percentage of Aboriginal adults in NSW who consumed more than two standard drinks on a day when consuming alcohol (44.1%) was significantly higher than the 2014 NSW average (29.8%) Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol drinking in Adults [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alc_age/beh_alc_atsi [Accessed October 2017].

In 2014-15, the rate of alcohol attributable hospitalisations among Aboriginal people in NSW was 1,390.1 per 100,000 Aboriginal persons, compared to 639.4 per 100,000 people for the non-Aboriginal population. As with previous years, rates of hospitalisation for males was much higher than for females. Data is not currently available for this measure at a PHN level Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol Attributable Hospitalisations by Aboriginality. [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcafhos/beh_alcafhos_atsi_trend [Accessed October 2017]).



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Identified Need


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hospitalisations

In 2014-15, Northern NSW Local Health District Alcohol and Other Drug Service, Riverlands, provided services to a total of 1,437 clients. For 764 clients, alcohol was their principal drug of concern (53.2%) Farrell, NNSW LHD, 2015 – personal correspondence, data extracted from Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS).

In 2013-14 in NSW, alcohol was the most common principal drug of concern in episodes provided to clients by publically funded alcohol and other drug treatment agencies (42% of clients and 44% of episodes) Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS), 2014).

In NSW during 2015, there were 13,517 presentations to emergency departments for alcohol problems. Males accounted for 63% of presentations. Young people between the ages of 18-24 years made up 19.3% of presentations Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol problems, presentations in Emergency Departments [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcedage/beh_alcedage [Accessed October 2017].

Alcohol generates the highest number of calls to the Alcohol and Drug Information Service (ADIS) Crystal Methamphetamine Background Paper, NSW Ministry of Health, 2015. ISBN 978 1 76000 274 9.



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Identified Need


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hospitalisations

In 2016, NCPHN had the highest rate in NSW of people 14 years and older who on average, had more than 2 standard drinks per day (24.4) compared to the average NSW rate (16.5) and the average Australian rate (18.1) Australian Institute of Health and Welfare, 2017. National Drug Strategy Household Survey 2016: Detailed findings. Supplementary data tables: Chapter 7 State and territory. Table 7.37: Tobacco use, alcohol risk and recent(a)illicit drug use, people aged 14 years or older, by Primary Health Networks, 2016 (per cent) [Online] Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/data. [Accessed November 2017].

AOD_D(b) High rates of opioid

prescription and use.

Kempsey-Nambucca SA3 is currently ranked eighth in Australia for rate of opioids being prescribed. In 2013-14 there were 56,951 prescriptions, equating to an age standardised rate of 94,170 per 100,000 people National Health Performance Authority, 2015. Australian Atlas of Healthcare Variation. [Online] Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/623427 [Accessed 25 February 2016].

In 2011, NCPHN had the second highest rate (13.3 age standardised per 1,000) of mortalities of people using Mental Health Services and Prescription Medications in NSW. The NCPHN rate was third highest in Australia with the Australian rate being 11.4. Australian Bureau of Statistics, 2017. 4329.0.00.006 - Mortality of People Using Mental Health Services and Prescription Medications. [Online] Available at: http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4329.0.00.006Main+Features25Analysis%20of%202011%20data?OpenDocument [Accessed November 2017]



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Identified Need


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AOD_D(b) continued… High rates of opioid

prescription and use.

"The 2013 National Drug Strategy Household Survey (NDSHS) found that 4.8% of Australian adults used pharmaceuticals for non-medical purposes in the past 12 months, an increase from 3.8% in 2004.2 The number of people in needle and syringe programs who reported that the drug they last injected was a prescription opioid increased from 7% in 2000 to 23% in 2015.3 The two most common types of drugs abused were analgesics and sedatives". Monheit, B., Pietrzak, D., and Hocking, S. (2016). Prescription drug abuse – A timely update. Australian Family Physician. Vol. 45, No.12, Pgs 862-866.

"In 2013, more than 27 million packs of codeine were sold; 55.8% of these were over the counter and the rest were prescribed. Most of this codeine is combined with ibuprofen, paracetamol or aspirin, which in high doses can cause multiple medical and surgical problems. Growing numbers of patients with codeine dependence are attending general practices, hospitals, and drug and alcohol clinics seeking treatment. Studies in Australia and overseas have shown that those who misuse codeine often differ in a number of significant ways from users of illicit drugs. They tend to be better educated, more often employed and do not use illicit drugs. They initially use codeine as an analgesic, but then find it helpful as an anxiolytic and mild euphoriant, and eventually become physically and psychologically dependent on it. Treatment for codeine dependence has been poorly researched so far, but a recent study in New South Wales has found that a sublingual buprenorphine maintenance program is a useful treatment option for those who cannot stop using codeine compounds". Monheit, B., Pietrzak, D., and Hocking, S. (2016). Prescription drug abuse – A timely update. Australian Family Physician. Vol. 45, No.12, Pgs 862-866.



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Identified Need


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AOD_D(c) Increasing rates of crystal methamphetamine use

Data concerned with methamphetamine use in Australia is only available at a national level. The highest rates of methamphetamine use were consistently among those aged 25-34 years. Estimates suggest there has been a substantial increase in regular dependent methamphetamine users in the last 5 years. A recent study found a rapid uptake of methamphetamine may still be occurring outside of the largest cities, especially in regional centres where young people without prior experience of methamphetamine may be exposed to it Degenhardt, L., Larney, S., Chan, G., Dobbins, T., Weier, M., Roxburgh, A., Hall, W., McKetin, R., 2016. Estimating the number of regular and dependent methamphetamine users in Australia, 2002-2014. Medical Journal of Australia, 204(4). Pp. 1.e1-1.e5).

In 2016, Indigenous Australians were: 2.2 times as likely to use methamphetamines as non-Indigenous people. Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey detailed report 2016. Supplementary data tables: Chapter 8 Specific population groups. [Online]Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/data#page2. [Accessed November 2017]

In NSW, methamphetamine hospitalisations are seven times higher than those for non-Indigenous Australians. For Aboriginal females it is 11 times higher. Across Australia, Aboriginal people accounted for 17.1% of methamphetamine-related hospitalisations (2015-16) Centre for Epidemiology and Evidence, 2017. Health Statistics New South Wales: Alcohol attributed injury hospitalisations [Online] Available at: http://www.healthstats.nsw.gov.au/Indicator/beh_alcafdth/beh_alcafdth_phn_snap [Accessed October 2017].



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Identified Need


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AOD_D(c) continued… Increasing rates of crystal methamphetamine use

At Riverlands in Lismore, 185 (11.7%) clients identified methamphetamine as their primary drug of concern in 2014-15. The proportion of consumers seeking assistance with methamphetamine use has risen significantly since 2010-11, with 37 (3.1%) reporting that methamphetamine was their principal drug of use Farrell, NNSW LHD, 2015 – personal correspondence, data extracted from Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS), 2014-15.

Of the 153 respondents who completed the Nimbin CDAT survey of drug users, 38 (24%) reported using methamphetamine. Respondents who reported using methamphetamine were likely to use an average of 8.5 other substances Nimbin Community Drug Action Team (CDAT), Community Drug Survey Report, Nimbin CDAT and NNIC, 2015, accessed online February 2016, http://nnic.org.au/pub/index.php/our-services/other-services, not yet published.

Service Provider and Community interviews in 2016 revealed strong concerns regarding crystal methamphetamine in terms of behavioural disturbance and community concern. Some Aboriginal communities on the North Coast report high levels of use and individual, family and community harm NCPHN, Alcohol and Other Drug Service Provider and Community interviews, 2016.

50 representatives from a range of jurisdictions and services attended a one day symposium on Crystal Methamphetamine in Lismore in May, 2015. The Symposium identified community and service needs and gaps relating to Crystal methamphetamine harm. A 12-month Action Plan for Northern NSW was developed as a result of the consultation and will inform the NCPHN response into the future North Coast Primary Health Network, 2015. Northern NSW Crystal Methamphetamine Action Plan, unpublished [Accessed May 2015].



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Identified Need


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AOD_D(c) continued… Increasing rates of crystal methamphetamine use

In 2015-16, the Northern NSW region had a higher rate of Methamphetamine-related Hospitalisations (149.1 per 100,000 people) compared to both the Mid North Coast region (134.1) and the rate for NSW (124.4). This trend has been consistently worsening over the past four reporting years. Centre for Epidemiology and Evidence, 2017. Methamphetamine-related Hospitalisation. [Online] Available at: Methamphetamine-related Hospitalisation [Accessed November 2017].

AOD_D(d) Higher rates of illicit drug

use

In 2016, the NCPHN had the second highest rate in Australia for people 14 years or older who used at least one of 16 illicit drugs in the previous 12 months (22.8) compared to the NSW rate (14.0) and the Australian rate (15.6) Australian Institute of Health and Welfare, 2017. National Drug Strategy Household Survey 2016: Detailed findings. Supplementary data tables: Chapter 7 State and territory. Table 7.37: Tobacco use, alcohol risk and recent(a)illicit drug use, people aged 14 years or older, by Primary Health Networks, 2016 (per cent) [Online] Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/data. [Accessed November 2017].

Data from 2016 show that across Australia, the most commonly used illegal drugs used by people aged 14 years or older at least once in the previous 12 months were Cannabis (10.9%), followed by cocaine (2.7%), ecstasy (2.3%) and methamphetamines (1.5%). NSW had the highest percentage (3.6%) for cocaine use in Australia. Australian Institute of Health and Welfare, 2017. National Drug Strategy Household Survey 2016: Detailed findings. Supplementary data tables: Chapter 7 State and territory. Table 7.37: Tobacco use, alcohol risk and recent(a)illicit drug use, people aged 14 years or older, by Primary Health Networks, 2016 (per cent) [Online] Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/data. [Accessed November 2017].



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Identified Need


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AOD_D(e) Higher rates of Alcohol consumption, smoking,

illicit drug use and misuse of pharmaceuticals

amongst the LGBTIQ community

After adjusting for differences in age, people who were homosexual or bisexual were still far more likely than others to smoke daily, consume alcohol in risky quantities, use illicit drugs and misuse pharmaceuticals. Australian Institute for Health and Welfare (AIHW), 2013. National Drug Strategy Household Survey detailed report 2013 [Online] Available at: htp://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848 [Accessed February 2017].



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Section 3 – Outcomes of the service needs analysis

Outcomes of the service needs analysis

Identified Need


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AOD_S(a) Poor access to residential

rehabilitation

43.8% of community respondents who had tried to access residential rehabilitation (n=386) reported it as difficult or very difficult to access.

North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.

Interviews with Service Providers and the community supported the community perception that access to residential rehabilitation was difficult. One residential rehabilitation service in the area has a waiting list of up to 6 months. Most are around 4-6 weeks. Local service providers more often than not go out of area to access Residential Rehab – many of which are in Queensland NCPHN, Alcohol and Other Drug Service Provider and Community interviews, 2016.

Rates of hospitalisation per 100,000 people in the Richmond Valley Coastal and Hinterland regions for drug and alcohol use is more than 110% higher than in Australia, and the number of bed days per 100,000 people in the Richmond Valley Coastal region is more than 120% higher than in Australia Australian Institute of Health and Welfare, 2016. Healthy Communities, 2016. Hospitalisations for mental health conditions and intentional self-harm in 2013–14. [Online] Available at: http://www.myhealthycommunities.gov.au/Content/publications/downloads/AIHW_HC_Report_Mental_Health_September_2016.pdf?t=1475111127719, [Accessed September 2016]).



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Identified Need


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AOD_S(b) Poor access to early

intervention drug and alcohol services

49.1% of service providers rated early intervention drug and alcohol services as hard to access (n=711) North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.

Early intervention drug and alcohol services are limited across NCPHN. There is one Adolescent Drug and Alcohol worker in Northern NSW LHD and one in Mid North Coast LHD. NCPHN, Alcohol and Other Drug Service Provider and Community interviews, 2016.

Headspace provides limited early intervention drug and alcohol services. Limited reach of headspace (headspace National Youth Mental Health Foundation, 2016 Centre Activity Overview reports Financial Year 2015/16) services to youth in the 5 NCPHN LGAs with the lowest quintile on the CSE index: o Postcode 2440, includes Kempsey: 2.2% of total clients at Port Macquarie headspace o Postcode 2474, includes Kyogle: 3.0% of total clients at Lismore headspace o Postcode 2460, includes Grafton (Clarence Valley LGA): 4.2% of total clients at Coffs Harbor headspace o Postcode 2448, includes Nambucca Heads: 4.2% of total clients at Coffs Harbor headspace o Postcode 2470, includes Casino (Richmond Valley LGA): 10.6% of total clients at Lismore headspace.

AOD_S(c) Poor coordination

between drug and alcohol and mental health

services

See 2017 NCPHN Mental Health Needs Assessment MH_S(g) 52.3% of service providers rated coordinated mental health and drug and alcohol services as hard to access (n=866), and 37% of service providers rated coordination of mental health and drug and alcohol services as needing improvement (n=916), making it more frequently identified than any other area of coordination North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.



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Identified Need


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AOD_S(d) Poor access to drug and

alcohol counselling

47.4% of community respondents who had tried to access drug and alcohol counselling (n=386) reported it as difficult or very difficult to access North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.

AOD_S(e) Poor access to GPs with

drug and alcohol knowledge

34.7% of community respondents who had tried to access a GP with knowledge of alcohol and other drugs (n=386) reported it as difficult or very difficult to access North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished).

There is a strong perception that GPs are not interested in working with D&A clients (with exceptions). In 2015 a D&A Symposium was organized for GPs with high level Australian and International experts speaking on current topics (e.g. medicinal cannabis, Ice). Only 7 GPs across the NCPHN registered NCPHN, Alcohol and Other Drug Service Provider and Community interviews, 2016.



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Identified Need


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AOD_S(f) Limited Aboriginal and/or

Torres Strait Islander identified drug and alcohol positions,

impacting on access to culturally appropriate

D&A treatment for Aboriginal and Torres Strait Islander people

Many service providers identify a limited pool from which to employ trained Aboriginal drug and alcohol workers as a major barrier to providing culturally appropriate drug and alcohol services NCPHN, Alcohol and Other Drug Service Provider and Community interviews, 2016.

Across the NCPHN region, there are 6 identified positions for drug and alcohol counselling. Two in Local Health Districts and 4 in Aboriginal Medical Services. NCPHN Alcohol and Other Drug Mapping Project, 2016, unpublished data.

AOD_S(g) Poor access to community drug and alcohol support

groups

28.8% of community respondents who had tried to access a community drug and alcohol support groups (n=386) reported it as difficult or very difficult to access North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.



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AOD_S(h) Poor access to detox

47.2% of community respondents who had tried to access inpatient detox (n=386) reported it as difficult or very difficult to access North Coast Primary Health Network, 2016. Primary Health Needs Survey, unpublished.

Due to the poor access to detox/withdrawal management experienced by Aboriginal and Torres Strait Islander people, some Aboriginal community members have established unsupervised “ice detox houses” within their local communities as they feel local detox and rehab are either inaccessible, inappropriate or feared. Provision of ambulatory withdrawal management is limited throughout the NCPHN footprint North Coast Primary Health Network, 2016. Alcohol and Other Drug Service Provider and Community interviews, unpublished.

AOD_S(i) Lack of awareness of Drug

and Alcohol services

28.8% of community respondents who had tried to access drug and alcohol services (n=386) identified that they were unsure of what is available. North Coast Primary Health Network, 2016. Alcohol and Other Drug Service Provider and Community interviews, unpublished

AOD_S(i) continued… Lack of awareness of Drug

and Alcohol services

Service providers frequently report lack of knowledge regarding availability of drug and alcohol services. North Coast Primary Health Network, 2016. Alcohol and Other Drug Service Provider and Community interviews, unpublished

The National AOD Service Directory database is limited in that only tertiary services are listed and many have out of date information. North Coast Primary Health Network, 2016. Alcohol and Other Drug Service Provider and Community interviews, unpublished



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AOD_S(j) Higher rates of closed treatment episodes

Data cannot be published.

Australian Institute of Health and Welfare, 2017. Data request: AODTS NMDS closed treatment episodes by PHN - North Coast NSW, 2012–13 to 2015–16. Data request provided directly to NCPHN. Data not publicly available.

AOD_S(k) Higher rates of

pharmacotherapy

Data cannot be published. Australian Institute of Health and Welfare, 2017. Data request: AODTS NMDS closed treatment episodes by PHN - North Coast NSW, 2012–13 to 2015–16. Data request provided directly to NCPHN. Data not publicly available.

AOD_S(l) LGBTIQ people rate

Stigma and Shame and Cost as barriers to

accessing Alcohol and Other Drug services

The percentage of LGBTIQ respondents who rated Stigma and Shame as a barrier to accessing Alcohol and Other Drug services (35.5%) was higher than the rate for Non LGBTIQ respondents (25.1%)

The percentage of LGBTIQ respondents who rated Cost as a barrier to accessing Alcohol and Other Drug services (32.3%) was higher than the rate for Non LGBTIQ respondents (28.2%).

North Coast Primary Health Network, 2016. Results from the 2016 NCPHN Primary Health Needs Community Member Survey, document in preparation.

Primary Health Network Alcohol and Other Drugs …...Department of Health PRIMARY HEALTH NETWORKS Alcohol and Other Drugs (AOD) Needs Assessment report November 2017 (Updated) Page

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