Environmental Scan

What is the resource? / Where is it located? / Target Audience / Check Dec 2015
ASSESMENT TOOLS
Canadian Public Health Association - ChronicDiseaseTool / / Health Professionals / ✗ Link not working, use:
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interRAI tool /
/ Health Professionals / ✓Link 1, second link works but not sure how it relates?
Minnesota Complexity Assessment Tool / / Health Professionals / ✗ Link not working, possibly use:
[
NatFrame Reference List for Assessment Tools / / Health Professionals in Residential Care / ✗ Link not working, use:
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PARR Tool / kingsfund.org.uk/health_topics/Consumers_at_risk/index.html. / Health Professionals / ✗ Link not working. PARR is mentioned in:
[ and
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Probability of repeat admissions (Pra) tool / / Health Professionals / ✓
Tools that assess organisational systems
• Assessment of chronic illness care (ACIC)––MacColl Institute for Healthcare
Innovation (USA)
• The audit and best practice for chronic disease: systems assessment tool
(ABCD‑SAT)––Menzies School of Health Research (NT, Australia)
• Organisational skills analysis tool: Chronic disease care––Gill and Willcox(Vic, Australia) /

/ Health Professionals / ✓Link 1
✗ Links 2 & 3 not working
For Link 2, I can find projects using the tool, but not the tool itself:
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For Link 3:
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Tools that assess consumer experience of chronic disease care
• Patient assessment of chronic illness care (PACIC)––MacColl Institute for HealthcareInnovation (USA) /
. / Health Professionals / ✓
Tools that assess specific components of chronic disease care
• Self-management assessment tool for community health organisations––Gill and
Willcox (Vic, Australia)
• Self-management survey––Department of Human Services (Vic, Australia)
• Service coordination and ICDM survey––Department of Health (Vic, Australia) / / Health Professionals / ✗ Link not working
Self-management tool:
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Tools that assess general practice provision of chronic disease care
• PEN clinical audit tool
• Practice health atlas
  • cdmNet
/ / Health Professionals / ✓
Auditing chronic disease management
Another perspective on auditing chronic
disease management, and some concise
comparative tables, can be found in the
publicationNavigating self‑management,
which can be downloaded from
< /
. / Health Professionals / ✗ Link not working
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Partners in Health Scale
Cue and Response Interview
Problem and Goals Assessment / Partners in Health Scale
Cue and Response Interview
Problem and Goals Assessment / Health Professionals / ✗ Links not working – asks ‘Do you want to open the file’, then ‘Cannot connect to the server’?
  • Home Care Packages Veterans Eligibility Supplement
/ Health Professionals
  • Home Care Packages Guidelines
/ Health Professionals[CO1]
CVC RESOURCES / [CO2]
General Information sheet
AML Alliance CVC Program Information Sheet / AML Alliance CVC Program Information Sheet / Health Professionals / References Medicare Locals
Resources:
Preparing your practice
Brochure – Information for GPs and Practice Nurses
Brochure – Information for Veterans
Brochure – Information for Community Nurses
A Guide for General Practice
Nurse Home Visit Guidelines
Assessing the patient in the home
Professional Indemnity – APNA
Professional Indemnity – APNA
preparation check list
CVC Assessment Toolkitfor undertaking a comprehensive Needs Assessment.
  • CVC Business Case
/ Information for GPs and Practice Nurses
Information for Veterans
Information for Community Nurses
A Guide for General Practice
Nurse Home Visit Guidelines
Assessing the patient in the home
Professional Indemnity – APNA
Professional Indemnity – APNA
preparation check list
CVC Assessment Toolkit
Information for GPs and Practice Nurses / Health Professionals
Carers
Consumers
Health Professionals
Health Professionals
Health Professionals / ✗ Link not working
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Enroling the veteran on the program
  • Home Care Packages Veterans Eligibility Supplement
  • Home Care Packages Guidelines
/ Health Professionals
Consent to join the program
Guidelines for consent CVC Program(Word Template) / Guidelines for consent CVC Program(Word Template) / Health Professionals / ✗ Link not working
Social Assistance / CVC Social Assistance / Health Professionals / ✗ Link not working
Care Planning Flinders Program Tools: For care planning
  • Partners in Health Scale
  • Cue and Response Interview
  • Problem and Goals Assessment
/ Partners in Health Scale
Cue and Response Interview
Problem and Goals Assessment / Health Professionals / ✗ Link not working
✗ Link not working
✗ Link not working
Care Plans
Examples
  • Flinders Care Plan adapted for CVC(word) (Meets theCVC minimum requirements for a comprehensiveCare Plan)
  • Flinders Care Plan adapted for CVC (patient-friendly version)(word)(Meets CVC requirements for patient-friendly version Care Plan)
  • Flinders Veterans’ Care Plan template(word)
  • Health Assessment and Management Plans(word) (Templates in medical software)
/ Flinders Care Plan adapted for CVC
Flinders Care Plan adapted for CVC (patient-friendly version)
Flinders Veterans’ Care Plan template
Health Assessment and Management Plans / Health Professionals / ✗ Link not working
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✗ Link not working
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Patient treatment report
Patient Treatment Report User Guide
Patient Treatment Report User Guide FAQ
Patient Treatment Reports are available on HPOS FAQ / Patient Treatment Report User Guide
Patient Treatment Report User Guide FAQ / Health Professionals / ✗ Link not working
✗ Link not working
Claiming
  • CVC Program claiming date ready reckoners(Excel 274KB)- (this reckoner helps you to calculate the date of service and the claiming date for each CVC enrolled patient.
  • CVC Program claiming cycle guide(xls)(allows you to enter patient’s name, dob, Dr’s initials and commencement date. Claiming dates will be auto filled.)
  • CVC Checklist Guide
  • CVC Claiming MBS Guide
/ CVC Program claiming date ready reckoners
CVC Program claiming cycle guide / ✗ Link not working
✗ Link not working
In Home telemonitoring
DVA In-home telemonitoring for veterans / DVA In-home telemonitoring for veterans / Health Professionals / ✗ Link not working
Training FAQs
Training
Technical
Login
CVC Program Training /
  • Training
  • Technical
  • Login
  • CVC Program Training
/ Health Professionals / ✗ Link not working
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DISEASE SPECIFIC Resources
Diabetes
Australian Diabetes Society 2009, Australian Diabetes Society Position Statement:
Individualization of HbA1c targets for adults with diabetes mellitus

Australian Institute of Health and Welfare 2011, Diabetes and poor mental health and wellbeing:
an exploratory analysis, Diabetes series no. 16. Cat. no. CVD 55. Canberra: AIHW

Australian Institute of Health and Welfare 2011, Diabetes prevalence in Australia: detailed
estimates for 2007-08, Diabetes series no. 17. Cat. no. CVD 56. Canberra: AIHW

Baker IDI Heart & Diabetes Institute 2012, Hypoglycaemia fact sheet,
Caughey, GE, Roughead, EE, Vitry, AI, McDermott, RA, Shakib, S, and Gilbert, AL, 2010,
‘Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts’, Diabetes Research and Clinical Practice, vol. 87, no. 3, pp. 385-393.
Coleman, EA, Smith, JD, Frank, JC, Min, SJ, Parry, C, and Kramer, AM, 2004, ‘Preparing
Consumers and caregivers to participate in care delivered across settings: the Care Transitions
Intervention’, Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1817-1825.
.
Diabetes Australia. Eating out with diabetes. Available at

Diabetes Australia & Royal Australian College of General Practitioners 2011, Diabetes
Management in General Practice: Guidelines for Type 2 Diabetes. Seventeenth edition 2011/12
Canberra: DA,
Emblen G and Miller E, 2004, ‘Home medicines review: The how and why for GPs’, Australian
Family Physician, vol. 33, no. 1-2, pp. 49-51.
Australian Diabetes Association 2012, Hypoglycaemia,

18 June 2013 page 2 of 6
The Royal Australian College of General Practitioners 2010, The team approach to diabetes in
general practice: A guide for practice nurses, RACGP,
/



Diabetes Research and Clinical Practice, vol. 87, no. 3, pp. 385-393.
Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1817-1825.



/ Health Professionals / ✗ Link not working
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✗ Link not working, not sure what is being referred to.
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2014-15 guide:
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Link takes you to General practice management of type 2 diabetes 2014-2015
Congestive Heart Failure
Briffa,TG,Maiorana,A,Sheerin, NJ,Stubbs,AG,Oldenburg, BF,Sammel,NL,andAllan,RM2006,'Physicalactivityforpeople withcardiovasculardisease: recommendationsoftheNationalHeartFoundation ofAustralia', MedicalJournalofAustralia,vol.184no. 2,pp.71-75
Coleman, EA, Smith, JD,Frank, JC, Min, SJ, Parry, C, and Kramer, AM, 2004, ‘Preparing Consumers andcaregivers to participate in care delivered across settings: the Care Transitions Intervention’, Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1817-1825.
NationalHeartFoundation ofAustralia2008,Livingwell withchronicheart failure

NationalHeartFoundation ofAustralia2012,Livingeverydaywithmyheart failure,

NationalHeartFoundation ofAustralia2011,Diagnosisandmanagementofchronicheart failure: Quick referenceguideforHealth Professionals.UpdatedOct2011

2011.pdf.
NationalHeartFoundation ofAustraliaandtheCardiac SocietyofAustraliaandNewZealand
2011,Guidelinesfortheprevention,detectionandmanagementofchronicheart failure in
Australia.UpdatedOctober 2011

NationalHeartFoundation ofAustralia2010,Multidisciplinarycareforpeoplewithchronicheart failure: Principlesandrecommendationsforbestpractice,

BriffaTG,MaioranaA,Allan R,etal.onbehalfoftheExecutiveWorkingGroupandNational ForumParticipants2006,NationalHeartFoundation ofAustraliaphysicalactivity recommendationsforpeoplewithcardiovasculardisease,Sydney:NHFA,

NewYorkHeartAssociationClassificationof Functional Capacity and ObjectiveAssessment

Taylor,RS,Ashton,KE,Moxham,T, Hooper,L,andEbrahim,S2011,‘Reduceddietarysaltfor thepreventionofcardiovasculardisease’,CochraneDatabase ofSystematicReview,no.7, CD009217.
Veterans'MedicinesAdviceandTherapeuticsEducation Services June2009, Do yourpartto carefor yourheart:getthebestfromyourmedicines,

Veterans’MedicinesAdviceandTherapeuticsEducation Services June2009, Therapeutic Brief
19-Isittime toreviewyour veteranswithheart failure?
/ NationalHeartFoundation ofAustralia', MedicalJournalofAustralia,vol.184no. 2,pp.71-75
JournaloftheAmericanGeriatricsSociety, vol.52,no.11,pp.1817-1825.







CochraneDatabase ofSystematicReview,no.7, CD009217.

/ Health Professionals / ✗ Link not working:
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Coronary Artery Disease
Aroney,CN,Aylward,P,Kelly, AM, Chew,DPB, andClune,E,onbehalfofthe AcuteCoronary SyndromeGuidelinesWorking Group2006,'NationalHeartFoundation ofAustraliaCardiac SocietyofAustraliaandNewZealandGuidelines forthemanagementofacutecoronary syndromes2006',MedicalJournal ofAustralia,vol. 184no.8,pp.S1-S30.
Aroney,CN,Aylward,P,Chew,DP,Huang,N,Kelly, AM, White,H,andWilson,M2008,'2007 addendum totheNationalHeartFoundation ofAustralia/CardiacSocietyofAustraliaandNew ZealandGuidelines forthemanagementofacutecoronarysyndromes2006',MedicalJournalof Australia,vol.188no.5,pp.302-303.
Australian Institute ofHealthandWelfare2011,Cardiovasculardisease:Australian facts 2011,
Cardiovasculardisease seriesno. 35.Cat.no.CVD53.Canberra:AIHW

Briffa,TG,Maiorana,A,Sheerin, NJ,Stubbs,AG,Oldenburg, BF,Sammel,NL,andAllan,RM2006,'Physicalactivityforpeople withcardiovasculardisease: recommendationsoftheNationalHeartFoundation ofAustralia', MedicalJournalofAustralia,vol.184no. 2,pp.71-75.
BriffaTG,MaioranaA,Allan R,etal.onbehalfoftheExecutiveWorkingGroupandNational ForumParticipants2006,NationalHeartFoundation ofAustraliaphysicalactivity recommendationsforpeoplewithcardiovasculardisease.Sydney:NHFA,

Bunker, SJ, Colquhoun, DM, Esler, MD, Hickie, IB, Hunt,D, Jelinek, VM, Oldenburg, BF, Peach, HG, Ruth, D,Tennant, CC, Tonkin, AM 2003, '"Stress" and coronary heart disease: psychosocial risk factors', Medical Journal of Australia, vol. 178 no. 6, pp. 272-276.
Chew, DP, Aroney, CN, Aylward, PE, Kelly,AM, White, HD,Tideman, PA, Waddell, J, Azadi,L, Wilson, AJ, Ruta, LA 2011,'2011 Addendum to theNational Heart Foundation of Australia/Cardiac Society of Australia andNew Zealand Guidelines for themanagement of acute coronary syndromes (ACS) 2006', Heart, Lung and Circulation, vol. 20 no. 8, pp. 487-502.
Finn,JC,Bett,JH,Shilton, TR,Cunningham,C,andThompson, PL2007,‘Patientdelayin responding tosymptoms ofpossibleheartattack:canwe reducetime tocare?’MedicalJournalof Australia,vol.187no.5,pp.293-298.
Harrex,W, Horsley,K,Jelfs, P,vanderHoek,R,andWilson,E2003,MortalityofKoreanWar veterans:the veteran cohortstudy.Areportof the2002retrospectivecohortstudyofAustralian veteransof theKoreanWar, Canberra:DepartmentofVeterans’Affairs,

Katz,DA,Tang,F,Faseru,B,Horwitz,PA, Jones,P,andSpertus,J2011,'Prevalenceand correlates ofsmoking cessationpharmacotherapyinhospitalizedsmokers withacutemyocardial infarction',AmericanHeartJournal,vol.162no.1,pp.74-80.
Australian GovernmentDepartment ofHealthandAgeing2012,Lifescriptsmethodology cardsmoking assessmenttool

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand2007-2008, Reducing risk in heart disease: Guidelines for preventing cardiovascular events in people with coronary heart disease 2007 (updated 2008).

NationalHeartFoundation ofAustralia2012,Managing MyHeartHealth

NationalHeartFoundation ofAustralia2009-2011,Heart attackwarning signs:Checklistof importantinformationtodiscusswithConsumers,

NationalHeartFoundation ofAustraliaandtheCardiac SocietyofAustraliaandNewZealand
2011,Guidelinesfortheprevention,detectionandmanagementofchronicheart failure in
Australia.UpdatedOctober 2011

NationalHeartFoundation ofAustralia2012,Heartattackwarningsigns:Factsheet about reducingdelaysinpatientresponse

NationalHeartFoundation ofAustralia2012,Heartattackfacts

NationalHeartFoundation ofAustralia2010,Willyou recognize yourheartattack?[actionplan],

NationalHeartFoundation ofAustralia2009-2011,Willyourecogniseyourheartattack?[patientfactsheet]CON-075.v3,

Sim,M,Ikin,J,andMcKenzie, D2005,HealthStudy2005: Australian VeteransoftheKorean
War

Veterans’MedicinesAdviceandTherapeuticsEducation Services Nov 2005,Therapeutic Brief:5Antidepressants:Three Steps TowardsSaferUse

Veterans’MedicinesAdviceandTherapeuticsEducation ServicesSep2010,Therapeutic Brief24:LookingAhead: Useofrecommendedmedicines afteracutecoronarysyndromes

Veterans’MedicinesAdviceandTherapeuticsEducation Services Nov 2011,Therapeutic Brief29:HomeMedicinesReview–Thebenefitsfor you and yourConsumers

Watson,L,Ellis,B,andLeng,GC2008,'Exerciseforintermittentclaudication',CochraneDatabase ofSystematicReviews,no.4,CD000990. / MedicalJournal ofAustralia,vol. 184no.8,pp.S1-S30.
MedicalJournalof Australia,vol.188no.5,pp.302-303.

NationalHeartFoundation ofAustralia', MedicalJournalofAustralia,vol.184no. 2,pp.71-75.

MedicalJournalofAustralia,vol.178no.6,pp.272-276.
Heart, LungandCirculation, vol.20no.8,pp.487-502.
MedicalJournalof Australia,vol.187no.5,pp.293-298.

AmericanHeartJournal,vol.162no.1,pp.74-80.













CochraneDatabase ofSystematicReviews,no.4,CD000990. / Health Professionals / ✗ Link not working, list of AIHW publications on the Cardiovascular disease:
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✗ Link not working:
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✗ Link not working:
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From the website: “All Lifescripts resources have been withdrawn from circulation, as they are no longer consistent with the current evidence and guidelines endorsed by the National Health and Medical Research Council (NHMRC).”
✗ Link not working, updated 2012:
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✗ Link not working, they have a ‘Looking after yourself’ page at
✗ Link not working:
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Chronic Obstructive Pulmonary Disease
Aniwidyaningsih W, Varraso R, Cano N, and Pison C 2008, 'Impact of nutritional status on bodyfunctioning in chronic obstructive pulmonary disease and how to intervene', Current Opinion in
Clinical Nutrition & Metabolic Care, vol. 11 no. 4, pp. 435-442.
Australian Mental Health Outcomes and Classification Network 2005, Kessler-10 Training
Manual, Sydney: NSW Institute of Psychiatry,

Ferreira, IM, Brooks, D, Lacasse, Y, Goldstein, RS, and White, J 2005, 'Nutritional
supplementation for stable chronic obstructive pulmonary disease', Cochrane Database of
Systematic Reviews, no. 2, CD000998.
Hughes, JR, Stead, LF, and Lancaster, T 2000, 'Anxiolytics for smoking cessation', Cochrane
Database of Systematic Reviews, no. 4, CD002849.
Livermore, N, Sharpe, L, and McKenzie, D 2010, 'Panic attacks and panic disorder in chronic
obstructive pulmonary disease: a cognitive behavioral perspective', Respiratory Medicine, vol.104 no. 9, pp. 1246-1253.
McKenzie, D, Abramson, M, Crockett, A, Glasgow, N, Jenkins, S, McDonald, C, Wood-Baker, R,and Frith, PA, on behalf of The Australian Lung Foundation 2011, 'The COPD-X Plan: Australianand New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease',

Mendlowicz, MV & Stein, MB 2000, 'Quality of life in individuals with anxiety disorders', American
Journal of Psychiatry, vol. 157 no. 5, pp. 669-682.
Medical Research Council Dyspnoea Scale 2012,

Morissette, SB, Tull, MT, Gulliver, SB, Kamholz, BW, and Zimering, RT 2007, 'Anxiety, anxiety
disorders, tobacco use, and nicotine: a critical review of interrelationships', Psychological Bulletin,vol. 133 no. 2, pp. 245-272.
Piper, ME, Cook, JW, Schlam, TR, Jorenby, DE, and Baker, TB 2011, 'Anxiety diagnoses in
smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome
and response to treatment', Addiction, vol. 106 no. 2, pp. 418-427.
Puhan, MA, Gimeno-Santos, E, Scharplatz, M, Troosters, T, Walters, EH, and Steurer, J 2011,
'Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease',
Cochrane Database of Systematic Reviews, no. 10, CD005305.
The Australian Lung Foundation. COPD Action Plan,

.
The Australian Lung Foundation 2012, COPD Online,

Veterans’ Medicines Advice and Therapeutics Education Services March 2006, Therapeutic Brief 6 – Inhaled respiratory medicines: optimising use in COPD
.
Veterans’ Medicines Advice and Therapeutics Education Services. March 2008, Therapeutic Brief14 – Simplifying inhaler devices for Chronic Obstructive Pulmonary Disease
Veterans’ Medicines Advice and Therapeutics Education Services Nov 2011, Veterans' Brochure
- 8 reasons for having a Home Medicines Review,
Veterans’ Medicines Advice and Therapeutics Education Services Nov 2011, Therapeutic Brief 29– Home Medicines Review – The benefits for you and your Consumers / Current Opinion in Clinical Nutrition & Metabolic Care, vol. 11 no. 4, pp. 435-442.

Cochrane Database ofSystematic Reviews, no. 2, CD000998
CochraneDatabase of Systematic Reviews, no. 4, CD002849.
Respiratory Medicine, vol.104 no. 9, pp. 1246-1253.


Psychological Bulletin,vol. 133 no. 2, pp. 245-272
Addiction, vol. 106 no. 2, pp. 418-427.
'Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease',
Cochrane Database of Systematic Reviews, no. 10, CD005305.


Therapeutic Brief 6 – Inhaled respiratory medicines: optimising use in COPD
Therapeutic Brief14 – Simplifying inhaler devices for Chronic Obstructive Pulmonary Disease
Therapeutic Brief 29– Home Medicines Review – The benefits for you and your Consumers / Health Professionals / ✗ Link not working:
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Pneumonia
Baker IDI Heart and Diabetes Institute on behalf of the Department of Veteran Affairs October
2011, Community Acquired Pneumonia – Management and best practice and implications for the Veteran population: a review of the literature, Goal Setting, Monitoring and Review January 2012
Lim, WS, Baudouin, SV, George, RC, Hill, AT, Jamieson, C, Le Jeune, I, Macfarlane, JT, Read, RC, Roberts, HJ, Levy, ML, Wani, M, Woodhead, MA 2009, 'BTS guidelines for the management of community acquired pneumonia in adults: update 2009', Thorax, vol. 64 Suppl 3 no., pp. iii1-55
Mandell,LA,Wunderink,RG,Anzueto,A,Bartlett, JG,Campbell,GD, Dean,NC,Dowell,SF, File,TMJr,MusherDM,Niederman,MS,Torres,A,Whitney,CG2007,InfectiousDiseases SocietyofAmerica/AmericanThoracicSocietyconsensusguidelines onthemanagementof community-acquiredpneumonia inadults,ClinicalInfectious Diseases, vol.44Suppl 2,pp.S27-72
/

theVeteranPopulation.pdf.


/ Health Professionals / ✗ Link not working – unable to find the document online
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DVA GENERAL RESOURCES
DVA Treatment Arrangements at a Glance (summary of treatments and entitlements for Gold and White Card holders and how to access): / DVA treatment entitlement cards / Consumers
Carers
Health Professionals / ✗ Link not working:
[
Appliances and aids:
(e.g. wheelchairs, continence products, low vision aids, compression stockings, medical grade footwear): / / Consumers
Carers
Health Professionals / ✗ Link not working:
[
Veterans’ Home Care:
The Veterans' Home Care (VHC) program provides low level home care services to eligible veterans and war widows and widowers. / / Consumers
Carers
Health Professionals / ✗ Link not working:
[
Social and physical activities links and day club locations:
Meeting different people and forming new friendships can help you feel good and improve your health & wellbeing. / / Consumers
Carers
Health Professionals / ✗ Link not working
Day Club info:
[
Transport to treatment:
Fact Sheet July 2013 / / Consumers
Carers
Health Professionals / ✗ Link not working:
[
Respite Care:
Respite care is designed to provide relief for a carer who has the responsibility for a person requiring ongoing care, attention and support. It is defined as an alternative form of care that enables carers to have a break. The Department of Veterans' Affairs (DVA) respite care is accessed through the Veterans' Home Care (VHC) program. / / Consumers
Carers
Health Professionals / ✗ Link not working:
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Homefront – falls prevention:
HomeFront was developed by DVA to reduce the risk of falls and similar hazards by assisting in the provision of minor home modifications and appliances for all Gold and White Card holders who continue to live in their own homes. A free assessment is availableonce every 12 months. See also information about the Rehabilitation Appliances Program. / / Consumers
Carers
Health Professionals / ✗ Link not working:
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Mental health:
DVA has information, advice and useful tools to learn more about mental health and better manage symptoms of mental ill health. Also try the At Ease mental health website first. / / Consumers
Carers
Health Professionals / ✗ Link not working: