New item number for child health check

The Aboriginal and Torres Strait Islander (ATSI) child health check (Item 708), was released by Medicare on May 1.

The new item number assesses children’s health from birth to fourteen years inclusive, and adds to the already existing ATSI adult health check for 15 to 54 year olds (Item 710) and the ATSI health assessment for the over 55 years (Item 702 & 706).

The health check is seen to complement rather than replace existing services provided by a range of care providers, and although seen as an annual assessment, the flexibility of the nine month minimum claiming period allows for more frequent assessments in the first few years of a child’s life.

It is hoped that the combination of these three ATSI health assessments will go a long way to addressing the gap between the health of indigenous and non-indigenous Australians.

ASTI children are twice as likely to have a low birth weight than non-indigenous Australian children, while the indigenous infant mortality rate is 2.5 times higher than the non-indigenous rate. Although respiratory infections are the leading cause of child death, other common yet serious health issues include otitis media, skin infections, gastroenteritis and malnutrition.

The new child health check encourages early detection and treatment of these common, treatable conditions, and assists in the prevention and reduction of chronic disease and serious illnesses.

Health assessment process
As with other Enhanced Primary Care (EPC) item numbers, a full explanation of the health check process and its benefits must be provided to the parent or carer, and consent must be obtained and noted in the patient’s medical record.

The patient’s past history needs to then be collected and past medical records reviewed. Along with a medical history, comprehensive information as appropriate for the patient’s age needs to include information such as the mother’s pregnancy, the birth and neo-natal period, immunisation status, physical activity, developmental and educational progress, family and social history, living conditions and environmental factors, mood and stressful life events, substance use, and sexual activity.

This information can either be collected by the patient’s ‘usual’ GP, or they may wish to delegate this process to a practice nurse or Aboriginal health worker who is working under their supervision, and then review the collected history before the physical examination.

The physical examination is also dependent on age appropriateness, and the Medicare Benefits Schedule provides a helpful table as a guide. However, all ages require height and weight; ear, skin, cardiac and respiratory examination; an assessment of age appropriate milestones and the interaction between the parent and child; and investigations as required, such as audiometry before starting school.

Once the examination and assessment is complete, the findings and recommendations need to be discussed with the parent or carer, a copy of the health check offered, and intervention initiated.

Following up on recommendations
Completing the child health check also requires discussion of any risk factors, preventative health advice, and referral to an activity or service provided by other local care providers, as required.

Coordinating and following up on these generated recommendations can be quite complex, and so it is worth considering whether the patient meets the criteria for a GP Management Plan and Team Care Arrangement (GPMP and TCA). The patient would need to have a chronic and complex condition - that is a condition that has or will likely last for six months or more, and requires at least the GP and two other providers to manage their care. The recommendations, goals, tasks and provider information fit neatly into a GPMP and TCA template, and this allows for ease of follow up by using the GPMP and TCA review item numbers. Of course completing a GPMP and TCA will also allow the patient access to five allied health Medicare rebates a calendar year. Whether or not the patient fits the criteria, it is always easier to provide follow-up through the use of your practice recall and reminder system.

For further information, please refer to the Medicare Benefits Schedule May 2006 Supplement, which can be viewed on-line at www.health.gov.au/internet/wcms/publishing.nsf/Content/mbsonline-downloads or call your friendly practice liaison team on 6622 4453.

Health assessment for refugees
Another item number released on May 1 was the health assessment for refugees and other humanitarian entrants (Item 714 for surgery and 716 for home visits). The item number is claimable only on one occasion for each patient within 12 months of either arriving in Australia or being granted residency (whichever is the later), and GPs can call Medicare Australia (ph: 132 011), with the patient present to check their eligibility.

Many of these patients have experienced war, famine, repression, or extreme poverty, while some patients may have complex health conditions as a result of their prior living conditions. This assessment will introduce them to the Australian healthcare system, including preventative healthcare programs such as childhood immunisations, and provide immediate and long term health care goals. Follow-up of health care issues documented during the assessment may include arranging referrals, such as to specialist trauma professionals, or to allied health workers for dietary and preventative health advice.

Further information can be found in the RACGP’s desktop guide, Caring for Refugee Patients (www.racgp.org.au/guidelines/refugeehealth/) which provides advice on such matters as collecting medical and psychological histories, engaging an interpreter, and the services available to refugees and asylum seekers.

Therese Greenlees is one of the division’s practice liaison officers. tgreenlees@nrdgp.org.au