Topics December 2016

Topics December 2016
Chairman's Report

Thank you to all the members who showed their support of our organisation at the Annual General Meeting held in October this year.  Dr Ewen McPhee retired from the board at the AGM, however the remaining board members have committed to another year of setting the strategic directions for the organisation.  The current board members of Central Queensland Rural Division of General Practice (trading as CQ Rural Health) and Rural Health Management Services are; Dr Mike Belonogoff, Dr Mary Dunne, Dr Richard Tan, Louisa Backus, Frank Houlihan, Dr John Evans (appointment by the board) and Dr Ross Woodward (appointment by the board).

The current constitution stipulates that there is to be a minimum of five GP board members and the board is grateful to Dr Evans and Dr Woodward for accepting their appointments until the new constitution can be adopted at an AGM.  A small group has already commenced reviewing the constitution to better reflect the changing nature of the CQ Rural Health circumstances and membership. The review of the constitution will be completed in early 2017. Once the board has fully considered the implications of the constitutional changes, the changes will be presented at an AGM for the members to adopt, change or reject. There is still a lot of work to be done before it is presented to the membership.

I would like to thank Dr Ewen McPhee for his many years of contributions as an active board member. Ewen, your input has helped make our organisation a more robust organisation and helped guide it in the direction of its vision – ‘Excellence and Sustainability in Rural Health’.

 

CQ Rural Health Highlights

The Integrated Allied Health Project in the Banana Shire is progressing.  Ellen Agius and Donna Johnson have been appointed as the project team and have been busy setting up a Steering Committee, Allied Health Committee and Community Members Committee which will support the development of the Allied Health Plan. They have also been working on the service mapping which was part of the foundation of the project and is ongoing.

The project goals are pushing some accepted boundaries. The project outcomes are to be delivered in a sustainable manner. Our partnering with the Central Queensland Hospital and Health Service and the Central Queensland, Wide Bay and Sunshine Coast PHN will ensure the stated outcomes are so delivered.

My understanding is that the Central Highlands region will soon have a similar foundation mapping work done by Central Highlands Health. Our knowledge and experience in the Banana Shire Integrated Allied Health Project could be useful to them.

 

Upcoming Continuing Professional Development

  • Dr Hany Aziz on Oral Health and Human Wellbeing – Emerald February 2017
  • Black Lung Disease (Speaker to be confirmed) – Emerald March 2017
  • Banana Shire Education Day, covering topics such as wound management, allied health services, emergency care and risk management – February 2017
  • North Burnett Education Day, covering topics such as maternity and shared care, chronic disease management and telehealth – April 2017
  • Grow Rural Program, which will showcase medical services in Rural QLD to medical students – July 2017

 

 

Rural Health Management Services Highlights

Negotiations with the Wide Bay, Mackay and Central Queensland Hospital and Health Services have been hard hitting but progressing amicably and all parties are committed to developing extra private based general practice services in a sustainable manner through partnership and collaboration. It is important that smaller rural communities that have traditionally relied on Queensland Health funding only, also have locally based private health services that can be further supported and sustained by the Commonwealth Medicare funding.

Baralaba, Eidsvold and Monto clinics have completed their AGPAL accreditation in 2016 and Clermont and Biggenden will undergo accreditation early in the New Year.  The accreditation process of the RHMS practices demonstrates our organisations commitment to best practice primary healthcare services.

RHMS has seen some staff appointments that will endeavour to support the clinics in a way that is more manageable, sustainable and effective. Sandra and the board were concerned that most of the clinic support previously was provided by Sandra Corfield. Two staff members now have practice support included in their roles. Shannon MacElroy will support the Monto, Biggenden and Eidsvold clinics; while Di Atfield will support the Mt Morgan and Baralaba clinics. Sandra Corfield will continue to have oversight for all clinics; and also be the main support person for Clermont, and Rolleston Clinics. General Practice is a complex operational environment and these positions will help the staff within the practices to ensure they all have the necessary skills, training and confidence to provide patients and their communities with the safest and best primary medical care possible.

 

Thanks for the Support

In conclusion, the 2016 year has been a difficult year in which we have had to look deeply at our sustainability, and have addressed the various issues in consolidating our financial base so that we have a sustainable basis for both organisations. This would not have been possible without the hard work, passion and commitment from all our staff, Sandra Corfield, and the board members.  I am looking forward to 2017 as it promises to be one of consolidation and less excitement for RHMS and CQ Rural Health. The government funding in health areas, continues to be placed under more pressure to provide more for less. Our organisations are well positioned and responsive to deliver quality primary health care in rural areas in a sustainable manner.

Thank you to the members and supporters of CQ Rural Health.  Please feel free to contact me, any board member, or Sandra Corfield; about any feedback or input for new ideas, on the work done by our organisations. I would like to wish everyone a Very Merry Christmas and a Happy, Healthy and Prosperous New Year.

Yours sincerely,

Dr Michael Belonogoff

Chairman

15/12/2016

 

CQRH Happenings

I must admit that I haven’t really been in the office much over the last two months. A lot has changed over that time, including the file-paths to literally everything. Penny has been waging war on anything we don’t need. Lots of information scanned and more archived.

New staff (new desks for some).

  • Di Atfield has started in June and has taken on a lead role in Quality and some systems support. She has also taken up the challenge of being the primary support for Mt Morgan and Baralaba Practices.
  • Shannon MacElroy has spread her wings and is now providing practice support and leadership for the 3 practices in the North Burnett.
  • Ellen Agius and Donna Johnson are back working for the Division. They are the project team working on Integrated Care Innovation Fund Grant. (What does this mean you ask?) It is a project funded through Queensland Health to find ways of working with communities to better plan and deliver Allied Health services that are funded from all the different sources of funding. It’s a two year project that should give those of us who live in the Banana Shire more confidence that we can access the allied health services we need locally. The information and resources will then be available across the State.

 

Finally, CQRH and RHMS have raced into the 21st Century! We now have Websites, Facebook, Online bookings and soon SMS reminders, and all in two short months. I’m a little impressed. A consultant has set up the web platform for RHMS and CQRH and also a website for each practice and we are now adding more and more information to the sites. Log on and check them out!

CQ Rural Health: http://www.cqruralhealth.com.au/

Rural Health Management Services (links to the Practices’ websites here): http://www.rhms.com.au/

Providing education and networking opportunities for rural health professionals is still a big part of what we do. The Mundubbera Health day was a great success, attended by 22 clinicians from across the North Burnett. The day saw a real cross section of attendees who discussed shared care obstetrics, immunisation, wound care, local services and how we can work better in the North Burnett. These days will be held in the North Burnett twice a year in partnership with the PHN. Education days are also planned for Banana on the 18th or February and in March for the Central Highlands so watch this space.

The Office will be officially closed from the 19th of December but some staff will be in and out and (of course) Sandra is available on her mobile over the break if you need help with anything.

 

Wishing you all a great Christmas and the very best for 2017,

Genevieve Corfield

(Very) Casual Administration Officer

 

Allied health project showcased to senior QLD clinicians

A Central Queensland Rural Health (Central Queensland Rural Division of General Practice trading as CQRH) project to improve access to allied health services has been showcased to senior clinicians across Queensland.

The Banana Shire pilot project was promoted at the Queensland Clinical Senate meeting, ‘Our integration – beyond fragmentation’, in Brisbane on 3-4 November 2016.

CQ Rural Health Chief Executive Sandra Corfield said integration was key to the project.

‘Along with integrated service provision, we are also developing the allied health assistant roles across organisations, increasing the use of telehealth and sharing infrastructure,’ she said.

‘This will be achieved in a partnership between service providers and communities as they develop and co-ordinate allied health service planning.

‘Being able to showcase this work to our colleagues across Queensland is a great opportunity to share our experience and outcomes in the early stages.’

Among more than 160 senior Queensland clinicians at the Senate meeting were Sandra Corfield, and Central Queensland Hospital and Health Service’s Sandy Munro.

They were joined by their colleagues from Central Queensland, Wide Bay and Sunshine Coast Primary Health Network including Chief Executive Pattie Hudson, Mason Stevenson, Gaston Boulanger, Peter Dobson and Brad Murphy.

QCS chair Dr David Rosengren said this was the Senate’s second integrated care meeting.

‘Integrated care is critical to the future sustainability of our health system and we need to keep it on the agenda,’ he said.

‘This meeting gave us the opportunity to look at what progress had been made towards shared governance and innovative integrated care programs since we first met on the topic in October 2015, and make recommendations about the next steps for Queensland.’

For more information about the Queensland Clinical Senate visit: https://www.health.qld.gov.au/clinical-practice/engagement/clinical-senate/default.asp

Follow the Senate www.facebook.com/qldclinsenate

Queensland Clinical Senate (November 2016)

Nurses are critical to delivery of health care reforms

Nurses are essential to making Australia’s $71 billion health system more efficient and effective in meeting the health needs of Australians.

The Minister for Health and Aged Care, Sussan Ley, in an address to the National Nursing Forum 2016 in Melbourne today, said that the ageing of the population and the fact that people are living longer is placing ever increasing pressure on health and aged care.

“Health reform is important for the nation’s nursing profession and the nursing profession is important to health reform,” she said.

“Real on-the-ground reform cannot happen without a strong and stable workforce and this includes nurses and midwives.

“Nurses play an increasingly important role in health service delivery. Nurses are there at every stage of a patient’s journey.”

Nurses represent more than 50 per cent of the health workforce.

Ms Ley said nurses would play an enhanced role in the Turnbull Government’s Health Care Homes initiative.

Health Care Homes is a revolutionary new model of delivering Medicare to Australians with chronic illnesses.

It will allow doctors and nurses to deliver quality health care improvements for patients without restrictions of Medicare’s fee-for-service model.

The Government is investing $120 million to roll out the first stage of Health Care Homes.

Ms Ley said nurses would be part of the team working with GPs to design tailored-care plans for patients with chronic or complex conditions.

One in two Australians is living with a chronic condition and one in five is managing two or more.

The Government recognises the vital role of nurses in health care delivery and reform.

Ms Ley said: “I want nurses to be part of a robust health care agenda because nurses are the boots on the ground.

“I am aware that the nursing profession sometimes feels somewhat forgotten in terms of engagement in policy design, development and implementation. I assure you that you have not been forgotten – far from it.

“That is why I want to continue to tap into your knowledge and understanding of quality patient care and our health care systems.

“Big changes are underway that will build a world-class health system and the nurses of Australia will be front and centre of this incredible journey.”

For more information contact Randal Markey 0417 318 620

Press release for the Hon Sussan Ley MP (26 October 2016)

View the original article here

 

Government to assess number of Australia’s student medical places amid shortfall of rural doctors

The Federal Health and Education Departments will carry out a stocktake of the current number and location of student medical places in Australia, with recommendations for change to be presented to Cabinet after April next year.

“We’ve expanded medical undergraduate places by over 100 per cent since 2001, because we had an absolute shortage, but now predictions are that we’ll have 7,000 excess medical practitioners by 2030,” Assistant Minister for Rural Health David Gillespie told AM.

“So we want to look at the distribution of undergraduate training, see what works best, with the aim of addressing the shortage of medical practitioners in rural and regional Australia.”

Dr Gillespie said so many doctors ended up working in Australia’s major cities because they overwhelmingly had to complete their post graduate studies there.

“The baggage one collects in one’s life, partner, mortgages, houses, friends, schools, children, if you’ve been there six or seven years, that’s where you more than likely stay,” he said.

The Federal Government has already announced a $94 million program to build up specialist training capacity in regional areas.

The terms of reference for the departmental assessment include “recommendations for arrangements to consider and assess future expansion, reduction or redistribution of medical places/schools”.

“We’re going to assess the whole box and dice and see what works for rural and regional Australia,” Dr Gillespie said.

The Federal Government said workforce data from the Department of Health and the Institute of Health and Welfare did not support the establishment of new medical school places, despite proposals for a Murray Darling school to be based in regional New South Wales and Victoria, and another on the Sunshine Coast.

New medical schools unnecessary, focus should be on ‘country kids’: RDAA

Doctors groups have welcomed the Government’s plan to assess current student places.

“The last thing we need are more medical schools,” the President of the Australian Medical Association, Michael Gannon, said.

“What we need to see is an expansion of the investment in existing rural clinical schools and a serious look at the process of maybe reallocating numbers to those universities with rural clinical schools, or to schools that are in rural areas themselves.

“Let’s get the numbers right.”

The Rural Doctors Association of Australia also said new medical schools were not necessary.

“We still see people believing that if they turn on a tap in the city that eventually the tsunami of water will flow out into the country and this simply doesn’t work,” RDAA President Ewen McPhee said.

“You’ve got to get the right people and give them the right skills and support them to live and work in the country.”

The AMA and RDAA said there had to be a greater focus on supporting medical students and graduates who chose to work in regional and remote areas.

“We know that if you choose country kids, if you choose people with rural intent, and you give them a training that identifies the need that they require to deliver care to rural communities, those people have the skills and the resilience, to stay, live, thrive and survive in country places,” Dr McPhee said.

Naomi Woodley, ABC News (14 December 2016)

View the original article here 

Innovative ACRRM education program promotes eHealth-enabled management of chronic and complex conditions

The Australian College of Rural and Remote Medicine (ACRRM) has released an online education program which will assist GPs and their practice staff to build an integrated and patient-centred approach to chronic disease management and improve both patient and practice outcomes.

College President, Associate Professor Ruth Stewart, said that the program reflects key priorities for the College and its rural and remote practitioner members in terms of promoting high standards of quality, safety and efficiency in rural and remote medical generalist practice and improving the patient experience.

“This innovative and integrated program is designed to support and encourage a systems approach to understand best clinical practice and improve health and service outcomes,” she said.

“The approach is based within a model of shared care and made viable by eHealth arrangements targeting a priority group-patients in underserved rural and remote regions of Australia.”

Associate Professor Stewart said that benefits of a range of eHealth tools, including the My Health Record; point of care testing; self-monitoring devices and Telehealth; have not yet been fully realised.

“The opportunity and case for the increased use of these tools is most compelling in rural and remote communities where there are often challenges in terms of accessing face-to-face health services and effectively managing a high incidence of chronic disease,” she said.

“The ACRRM program will assist General Practice and Primary Care Teams, including Doctors, Practice Nurses, and Practice managers, to develop local strategies to build integrated care teams around each patient, use technology rationally, and share appropriate information through the National My Health Record System as a routine component of sustainable and quality practice.

“Its development has been led by College Fellows who are ‘working at the coalface’ of rural practice and who are leaders in implementation of Practice Improvement (Quality and Safety) strategies and the adoption and utilisation of the My Health Record and Telehealth in the management of patients with complex chronic diseases.”

The program includes accessible online interactive education module(s), supported by webinars/virtual scheduled workshops. It is based on pragmatic, evidence based strategies which have been successfully applied in busy rural practice.

Practical participant activities will include the guided development of work plans which will include practice based protocols to achieve a number of objectives, including systematic use of the My Health Record for patients with chronic conditions; developing capacity for participation in Health Care Home arrangements; and meeting the requirements of the Practice Incentive Program (eHealth Incentive).

Associate Professor Stewart said that all General Practitioners and practice staff can register for free access to the program website: www.acrrm.org.au/ehealth-enabled

GPs and staff who have registered for access and who complete the pre course survey are eligible for a place in the course proper.

Places are limited in the first November round and priority will be given to early applicants. For more information or comment, please contact Mersija Mujic on 07 3105 8200.

Press Release for the Australian College of Rural and Remote Medicine (16 December 2015)

View the original article here

Digital Health oversold and under-delivered: Kelsey

Australian Digital Health Agency (ADHA) CEO Tim Kelsey has offered a mea culpa for the past mistakes of his agency’s predecessor and promised to try to set things right in eHealth in Australia, accepting that digital health had been “oversold and under-delivered” but urging clinicians and the public not to pull the plug just yet.

Mr Kelsey told Pen Computer Systems’ National PHN Conference in Sydney last week that the ADHA had targeted several priority programs, including the already announced focus on secure messaging interoperability, but also planned to “rapidly enhance” the My Health Record through a three-pronged approach that would make it more attractive to clinicians to use.

This includes a new, comprehensive view of medications, getting private pathology reports uploaded by the end of the financial year, and starting the upload of longitudinal radiology reports.

Mr Kelsey said the new agency had inherited a “pretty tricky legacy” from NEHTA, including what was formerly known as the PCEHR.

“The honest truth is that people’s experience wasn’t good,” he said. “Pretty much around the world and in Australia as well, the digital technology opportunity has been grossly oversold and it has been grossly under-delivered.

“And people look at My Health Record in general practice and go, what is the point of this to me today? The answer is we have a lot of work to do to get it to a point where it’s of use for you today.”

However, Mr Kelsey urged the industry not to throw the baby out with the bathwater, warning that some countries are beginning to pull the plug on the whole digital opportunity. “In the US there is a such a degree of disenchantment among clinical leaders with digital services as in fact the evidence now shows there that it does have the tendency to increase administrative burden,” he said.

“The agency is here to serve and it does so in the context of a very difficult legacy. A lot of people feel underserved and disenchanted with the digital agenda.”

Mr Kelsey said the first step in the agency’s plan to get things right was to agree on what the problem is.

“A couple of weeks ago we launched the new national digital health strategy process,” he said. “I’m sure no one wants another strategy, we are overloaded with strategies, but we really do need to have a conversation about what matters most to every person to make sure we don’t get into the same spot again.

“The second thing the digital health agency is going to do, we have launched a series of priority programs to get some of the basics done as quickly as we can. They [include] secure messaging … so we get to the stage where we remove the fax from the whole process.”

Another focus is the My Health Record, which Mr Kelsey said was grounded in exceptional legal principles and had the best consent model in the world.

However, the system needs some rapid enhancements such as the new medications view, which he said was one of the outstanding requests that has come from general practice.

“We’d also like to start a program around the Health Care Home, because there is an opportunity there,” he said. “It is not crystallised quite yet and the Commonwealth needs to be clear about what exactly it is expecting from a Health Care Home, but it feels like the opportunity has been left for a really entrepreneurial engagement with PHNs in determining just how the digital opportunity can help support people with chronic illness.

“This is everything from risk stratification right through to what
kinds of apps do we feel comfortable are safe to support people in their home with chronic illness.”

Kate McDonald, Pulse+IT (22 November 2016)

View the original article here

Zostavax popularity leaves GPs' stocks dry

Elderly Australians have embraced the shingles vaccine to the point where there’s a shortage in three states, the distributor has confirmed.

At least 190,000 people have been vaccinated since 1 November when Zostavax (Seqirus, MSD) was rolled out for 70- to 79-year-olds under the National Immunisation Program.

GPs in Victoria, South Australia and Queensland have been experiencing shortages but new stock will be distributed this week, according to Dr Lorna Meldrum, Seqirus vice-president commercial operations, Asia Pacific.

The manufacturer, Merck, is giving priority to fulfilling Australian demand, she says.

“Merck … are working to expedite further doses beyond the originally planned shipments,” Dr Meldrum says.

Fifty thousand doses of Zostavax arrived in Australia last night and another 60,000 are due tomorrow.

It’s expected about one-third of the 1.5 million Australians eligible under the NIP will be vaccinated by Christmas, whereas modelling by Seqirus and the federal health department suggested this goal would not be reached until after about eight months.

The health department says there’s been an “unexpected rush” on the vaccine, draining reserve stocks.

“The Department of Health is closely monitoring the company and its progress in supplying more vaccine as a matter of priority,” a department spokesperson says.

Meanwhile, Seqirus has put a planned TV marketing campaign on ice for fear of exacerbating the shortage.

Rada Rouse, Medical Observer (15 November 2016)

view the original article here

Health Care Homes 'will mean 10% funding boost'

The Health Department is batting away concerns that the Health Care Homes trial is being done on the cheap, asserting that participating practices will receive more funding for chronic disease care than they do at present.

In stage one of the trail — due to start in 200 practices in mid-2017 — practices will receive bundled payments of up to $1795 annually to manage enrolled patients with complex chronic conditions.

In a major reengineering of funding, practices will then use the money to bankroll a GP management plan that is not tied to MBS items.

Explainer: Health Care Homes: Your key questions answered

The RACGP, long an advocate of the shift away from fee-for-service, is now worried that the trial will simply move existing money around, and that a lack of investment will doom the project before it gets off the ground.

Presented with these concerns, a Health Department spokeswoman said the trial is more than a simple cash out of existing MBS expenditure.

“There is approximately a 10% increase on current MBS funding for chronic disease care,” the spokeswoman said.

Because the model moves from single-level to tiered funding based on a patient’s level of sickness, it can be misleading to calculate differences on a per-patient level, she said.

“There is not a consistent increase for each patient.”

Under the trial, the government will offer three annual levels of payment:

  • $1,795 for highly complex patients with multiple chronic conditions (1% of the population);
  • $1,267 for those with multiple morbidities and moderate needs (9% of the population); and
  • $591 for largely self-managing patients (10% of the population).

These payments will cover their chronic disease care. Access to allied health care will remain as now and all acute care which continued to be paid through the MBS.

The amount of cash coming to individual practices will be impossible judge because the department is still working on the tools practices will use to identify which tier individual patients will fit into.

Practices have only until 22 December to sign up to the trial.

Rada Rouse, Medical Observer (15 November 2016)

Health Care Homes: Reform of the Primary Health Care System
What is a Health Care Home?

Health Care Homes are a ‘home base’ that will coordinate the comprehensive care that patients with chronic and complex conditions need on an ongoing basis.

General practices and Aboriginal Medical Services can serve as Health Care Homes.
Patients who have been assessed as eligible and likely to benefit from this model will be offered the opportunity to voluntarily ‘enrol’ with a participating Health Care Home.

A tailored care plan will be developed with the patient and implemented by a team of health care providers. This will involve identifying the best local providers to meet each patient’s needs, coordinating care with these providers, and putting in place strategies to better manage their health conditions and improve their quality of life.

Care will be integrated across primary and acute care as required.

Health Care Homes will support enrolled patients and their carers to be active partners in their care. This will involve giving patients the knowledge, skills and support they need to make decisions about their health and keep healthy.
To enable this new model of care, payments for patients enrolled in Health Care Homes will change.

Health Care Homes will be paid regular periodic payments by the Government to provide care related to a patient’s chronic and complex condition. This will enable Health Care Homes to be flexible and innovative in how they deliver care to enrolled patients.

 

Who will benefit?

Health Care Home services will be available to patients assessed as those that would benefit most from the new model, with services specifically aimed at the one in five Australians with multiple chronic and complex conditions.

The Health Care Home model will initially be rolled out in selected geographical regions, based on Primary Health Network boundaries, across the country. Around 200 medical practices or Aboriginal Medical Service’s in these regions will become Health Care Homes and together they will enrol up to 65,000 patients with chronic and complex health conditions who have been assessed as eligible.

 

What funding has the government committed?

The Health Care Home implementation will improve the targeting and alignment of existing health care resources. The Government has announced that $21.3 million will be allocated to develop the infrastructure needed to implement and evaluate the Health Care Home model. Additionally, $93 million in MBS funding is being redirected for clinical service delivery. A core element of this investment is to help businesses, health providers and consumers transition to the new model of care.

 

Governance Structure

To support the introduction of the Health Care Home model during Stage 1, a two tiered governance structure consisting of an overarching Implementation Advisory Group (IAG) and four specialised working groups, has been established.

The role of the IAG is to work collaboratively with the Department to provide advice on issues relevant to the design, implementation and evaluation of the Health Care Home model. The IAG will be supported by time limited working groups, tasked with guiding the development of core elements underpinning the rollout of Stage 1 Health Care Homes, including payment mechanism, patient identification, guidelines and training, and evaluation.

Terms of Reference – Health Care Homes Implementation Advisory Group
Membership of the IAG and working groups

 

What regions have been selected?

Health Care Homes will initially be implemented in ten geographical regions based on Primary Health Network boundaries. These regions include:

  • Perth North PHN
  • Adelaide PHN
  • Country South Australia PHN
  • Brisbane North PHN
  • Western Sydney PHN
  • Hunter New England and Central Coast PHN
  • South Eastern Melbourne PHN
  • Nepean Blue Mountains PHN
  • Northern Territory PHN
  • Tasmania PHN

The process by which practices in these regions can apply to become a Health Care Home is currently being finalised.

 

Which health care providers can offer Health Care Homes services?

General practices and Aboriginal Medical Services are eligible to become Health Care Homes.

An Expression of Interest process will occur in late 2016, asking practices in the stage 1 regions to apply to become a Health Care Home. Further detail on eligibility, timeframes and training will be provided ahead of that time.

 

When will it happen?

Health Care Home services will be delivered in implementation sites from 1 July 2017 to 30 June 2019.

Evaluation of Health Care Homes in these regions will inform refinement of the new model of care and its suitability for broader rollout.

Apply to become a Health Care Home

General practices and Aboriginal Community Controlled Health Services (ACCHS) in selected regions around Australia can now apply for stage one of Health Care Homes.

Health Care Homes will improve the provision of care for people with chronic and complex conditions. Participating general practices and ACCHS will play a vital role in shaping this important reform.

Ten Primary Health Network (PHN) regions have been selected for stage one. They are Perth North; Northern Territory; Adelaide; Country South Australia; Brisbane North; Western Sydney; Nepean Blue Mountains; Hunter, New England and Central Coast; South Eastern Melbourne; and Tasmania.

To apply, a general practice or ACCHS must:

  • Be located in one of these ten PHN regions
  • Meet the eligibility and assessment criteria set out in the application form and guidelines.

Applications close Thursday 22 December 2016.

Refer to the Health Care Homes information booklet , QandA and factsheets

Australian Government Department of Health (09 December 2016)

Research and evaluation findings: My Aged Care

The first wave of research was conducted between January-March 2016 and focussed on evaluating the implementation of stage two of My Aged Care in July 2015.

 

Stage Two Wave 1 Research

Earlier this year the department commissioned research through independent research consultancy, AMR, to evaluate experiences and perceptions of the aged care system and My Aged Care initiative among:

  • clients
  • carers
  • assessors
  • service providers
  • health professionals

Link to Summary of Findings.

 

Key findings

Overall, client satisfaction with the services offered by My Aged Care and the aged care system was strong, participants were positive about information provided by My Aged Care and their experiences with the contact centre.

The key strengths identified include:

  • Awareness of My Aged Care across Australia has doubled since the July 2015 expansion.
  • Clients were positive about the contact centre, with care recipients and carers satisfied with the information provided and their interaction with staff.
  • Clients were positive about the registration and screening process through the contact centre, with more than 80% stating they were satisfied or very satisfied with their experience.
  • Assessors generally felt well equipped to conduct assessments using My Aged Care, and clients were overwhelmingly satisfied with their assessment experience.
  • Clients were also positive about the referral to service process with more than 70% stating they were satisfied or very satisfied with their ability to find services after the assessment.

These results are very encouraging given a key function of My Aged Care is to provide older people with easier access to information, facilitate assessment and support access to services.

There were also some opportunities for improvement identified by service providers, including:

  • The quality and accuracy of information recorded by the contact centre in the central client record.
  • The appropriateness of referrals by the contact centre for both assessment and service provision.

The administrative requirements for service providers when using My Aged Care.

Clients also indicated that access to information on fees and charges could be improved, including additional information on the website.

 

Next steps

Work is already underway to address these areas, in particular, the department has been working closely with the contact centre over recent months to review and implement improvements. The results of this research, as well as the outcomes from the recent co-design workshops will be used to inform key areas of focus moving forward.

Another wave of research is scheduled to take place early next year.

Australian Government Department of Health (28 October 2016)

View the original article here

Bulk billing is finally dropping, official stats show

Official statistics are finally reflecting what GPs have been saying for months and years: the Medicare freeze is denting rates of bulk billing.

New Medicare figures for the three months to September show the official rate of bulk-billed non-referred services has dropped. The figure stands at 85.4% — down half a percentage point on the record high 85.9% of the June quarter.

While the change appears small, it’s the first time since September last year (and since the May budget, which extended the freeze to 2020) that the figure has failed to increase.

It also bucks the long-term upward trend; the rate has risen in all but three of the last 20 quarters.

While the latest statistics could be a blip, it could also be the first sign that GPs are reacting to the extension of the freeze by changing their billing practises.

While the government is confident that competition for patients will keep the rate stable, the RACGP and AMA have both warned that clinics have begun scaling back bulk billing.

Primary Health Care, for example, which has long been a champion of bulk billing, has responded to funding cuts by dipping its toes into private billing.

AMA vice-president Tony Bartone tweeted that the figures show the freeze is “starting to bite”.

“(It) was only a matter of time before (the) tipping point (was) reached,” he wrote. “Practices can’t continually absorb rising costs.”

While the RACGP declined to comment, it has previously stated that the government’s figures are a flawed measure because they indicate the number of services that are bulk billed rather than the number of consults. It therefore skews the measure by including the things for which, anecdotally at least, most patients don’t pay out-of-pocket, such as care plans, spirometry, wound dressings and diabetes reviews.

Based on its own survey of 10,222 patients who booked appointments with clinics using the HealthEngine website between August and September, the college posits that a more accurate bulk billing rate is about 70%, with an average out-of-pocket cost of $40. Yet that research doesn’t have the data to indicate whether the trend is up or down.

Health Minister Sussan Ley attributed the drop to “seasonal variation”, claiming that the rate remains 0.8 percentage points higher than in the equivalent quarter last year.

According to calculations from the now defunct BEACH research group, the freeze will have cost the average full-time GP $109,000 in income by the time indexation returns, as planned, in 2020.

Even after that, the lost years of indexation will mean an ongoing annual hit of about $40,000 compared with an imaginary world where the freeze had never been brought in.

The December Medicare statistics will provide a better indication of whether the latest figures are a temporary blip or indicate a lasting downward trend. The rate hasn’t dropped for two consecutive quarters since 2003.

Health department officials expect the rate to plateau rather than drop significantly.

Medical Observer (15 November 2016)

View the original article here

Latest News from Medical Directions

Chronic Disease Management (CDM) Billing

It is important that the correct item is billed for CDM patients so that your GPs receive the correct amount from Medicare. If an Attendance item and a CDM item are billed for the same patient on the same day, the GP will only be paid for the CDM item. More information about Item 721 and Item 723 can found in the Education Guide – Chronic Disease GP Management Plans and Team Care Arrangements.

 

Better Start for Children with Disability Initiative – MBS Items

MBS items are available for the early diagnosis and treatment of children with an eligible disability. More information can be found in the Education Guide – Medicare items for Better Start for Children with Disability initiative.

 

2014-16 Triennium Ends Soon

A reminder for all your GPs that the 2014-16 triennium ends on 31 December 2016. The following resources may be helpful:

RACGP – QI&CPD Program 2014-16 Triennium Handbook

ACRRM – PDP Triennium Handbook

 

RACGP QI&CPD 2017-19 Program

The RACGP recently launched its new Quality Improvement and Continuing Professional Development (QI&CPD) Program for the 2017-19 triennium. The program will see more focus on reflective learning practices … read more

 

Medical Benefits Schedule (MBS) Online

The 1 November 2016 MBS files (XML, DOC, PDF, ZIP) can be downloaded from the 1 November 2016 downloads page. A summary of changes is available on the November 2016 Latest News page.

 

View their webpage

Senators move for new, stronger inquiry into complaints processes

Senators investigating Australia’s medical complaints process are so concerned by evidence that the system is being used to bully and harass that they’re calling for a fresh inquiry to delve even deeper into the issue.

Several hours of hearings and more than 120 submissions have convinced members of the inquiry into medical complaints processes that the issue of vexatious complaints is “widespread and significant”.

“(We have) received evidence of considerable concern about the way in which medical complaints in Australia are handled, including the use of notifications as a tool of bullying and harassment,” the committee says in its report, released Thursday.

Members say they’re particularly concerned with the number of individual submissions — many made in confidence — from medical practitioners detailing their experiences of notifications allegedly submitted with the aim to bully.

They conclude that the complaint system’s vulnerability to “misuse as a tool of bullying and harassment” warrants further investigation, as does the effectiveness of the notification and investigation process.

A new inquiry should be empowered to look further at the roles of AHPRA, the national boards, specialist colleges, and the National Law itself, the committee recommends.

Community Affairs References Committee chair Rachel Siewert, a Greens senator, moved on Wednesday that a new inquiry be convened with the aim of reporting by May next year.

During public hearings, the committee heard evidence from both AHPRA and the National Health Practitioner Ombudsman that the number of vexatious complaints appears to represent a “very small” fraction of the total.

Ombudsman Samantha Gavel told the inquiry that the small number of notifications about AHPRA’s handling of allegedly vexatious complaints in recent years have been dismissed following comprehensive consideration.

But the committee members say cases highlighted in submissions provide evidence that the system is indeed being misused by some people “for their own purposes”.

The report applauds moves by some specialist colleges, notably the Royal Australasian College of Surgeons, to address allegations of systemic bullying and harassment. But it says a sector-wide change remains to be seen.

It presents the following recommendations:

  1. All parties with responsibility for addressing bullying and harassment in the medical profession, including governments, hospitals, speciality colleges and universities:
  2. acknowledge that bullying and harassment remains prevalent within the profession, to the detriment of individual practitioners and patients alike;
  3. recognise that working together and addressing these issues in a collaborative way is the only solution; and
  4. commit to ongoing and sustained action and resources to eliminate these behaviours.
  5. All universities adopt a curriculum that incorporates compulsory education on bullying and harassment.
  6. All universities accept responsibility for their students while they are on placement and further adopt a procedure for dealing with complaints of bullying and harassment made by their students while on placement.
  7. All hospitals review their codes of conduct to ensure that they contain a provision that specifically states that bullying and harassment in the workplace is strictly not tolerated towards hospital staff, students and volunteers.
  8. All specialist training colleges publicly release an annual report detailing how many complaints of bullying and harassment their members and trainees have been subject to and how many sanctions the college has imposed as a result of those complaints.
  9. A new inquiry be established with terms of reference to address the following matters:
  10. the implementation of the current complaints system under the National Law, including role of AHPRA and the National Boards;
  11. whether the existing regulatory framework, established by the National Law, contains adequate provision for addressing medical complaints;
  12. the roles of AHPRA, the National Boards and professional organisations — such as the various Colleges — in addressing concerns within the medical profession with the complaints process;
  13. the adequacy of the relationships between those bodies responsible for handling complaints;
  14. whether amendments to the National Law in relation to the complaints handling process are required; and
  15. other improvements that could assist in a fairer, quicker and more effective medical complaints process.

 

Medical Observer (1 December 2016)

View the original article here

Doctor ordered to repay $14.4 million as Medicare investigations surge

One Doctor was ordered to return more than $1.1 million to Medicare in a bumper year for the Professional Services Review — the body tasked with peer-reviewing potentially inappropriate billing.

The health department referred 80 cases to the PSR in the year to June, according to the body’s annual report. That’s up 29% on the previous year and represents an 82% increase over three years.

Seven of 49 completed cases resulted in final determinations, including reprimands and Medicare bans. One doctor, whose name is not disclosed, was ordered to repay $1.14 million in Medicare benefits.

About half of the cases resulted in no further action and 18 were settled by negotiated agreements.

Matters are referred to the PSR when they cannot be resolved or explained after investigation by health department staff. While most cases continue to involve GPs, there has been a notable increase in non-hospital specialists.

The report singles out a handful of areas where doctors have been getting into trouble, including:

 

MBS Chronic Disease Management Items

Many GPs who provide lots of CDM plans use computer-generated templates, meaning there’s often little content specific to individual patients. The PSR says that in several cases, CDM plans “appeared contrived to maximise income rather than being based on clinical assessment”.

 

Overseas-trained doctors

Overseas-trained doctors accounted for more than half (~54%) of all those referred to the PSR in 2015–16, raising questions about whether those new to the system need more education on billing. Mandatory tests have recently been flagged by the MBS review taskforce (see story here).

 

The 80/20 rule and the 60/100 rule

Five doctors were referred for breaching the ‘80/20 rule’, that is, that they had billed at least 80 MBS attendance items on at least 20 days. A further 15 were referred having billed more than 60 professional attendances on more than 100 days. The PSR says that a typical 80/20 GP bills up to $1 million a year.

One GP provided 20,000 services, 600 GP management plans, 400 team care arrangements and more than 1000 item 2713 mental health services. One GP billed for more than 80 services on 75 days.

 

Urgent after-hours services

A number of practitioners were referred to the PSR over concerns they were over-using urgent after hours items such as 597, 598, 599 and 600. Some, the PSR says, used urgent items to bill for uncomplicated rashes, reissuing prescriptions and routine completion of medication charts in residential aged care facilities.

 

Medical Director (31 October 2016)

MBS changes for removing skin lesions

GPs undertaking skin excisions will need to be aware of recent changes to MBS item numbers.

In the latest amendments to the MBS, starting from 1 November, there were some significant changes to the skin excision item numbers that will affect all GPs who perform these procedures.

The rationale behind the changes was to restructure the previous 48 skin excision items, which have now been condensed into 21 new skin excision items.

According to the MBS website, there are also two more restricted items for flap repair, and the descriptors for the previous flap repair items (45200-45207) have been amended so that they can no longer be used to repair skin lesion excisions.

The following is a summary of the changes that are going to be of most relevance to GPs who surgically remove skin lesions as part of their clinical practice. In all cases, the excision diameter refers to the defect size that is required to clear the tumour. It does not include ellipse arms or the like.

Histological confirmation of the diagnosis is required to claim any of these items. This can include a previous biopsy result as well as the more common excision biopsy.

View changes here

 

Dr Linda Calabresi, Australian Doctor (17 November 2016)

 

Future changes to cervical screening

Based on new evidence and better technology, the National Cervical Screening Program will change from 1 May 2017 to improve early detection and save more lives.

The National Cervical Screening Program is changing. From 1 May 2017:

  • women will be invited when they are due to participate via the National Cancer Screening Register
  • the Pap smear will be replaced with the more accurate Cervical Screening Test
  • the time between tests will change from two to five years
  • the age at which screening starts will increase from 18 years to 25 years
  • women aged 70 to 74 years will be invited to have an exit test.

 

Women of any age who have symptoms such as unusual bleeding, discharge and pain should see their Health Care Professional immediately.

HPV vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.

A 2015-16 Australian Government Budget commitment provides funding to implement these recommended changes to the National Cervical Screening Program and establish a National Cancer Screening Register to support the new program.

The new program will commence from 1 May 2017 when the new Cervical Screening Test will become available on the Medicare Benefits Schedule. Until this time, women aged between 18 and 69 years who have ever been sexually active, should continue to have Pap test when due.

For answers to frequently asked questions http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/content/future-changes-cervical

 

National Cervical Screening Program, Australian Government of Health (28 October 2016)

CSIRO tests GP-led screening for diabetic retinopathy

The CSIRO is lending its Remote-I low-cost imaging technology to a new trial enabling GPs to screen for diabetic retinopathy (DR) and avoid patients having to be referred unnecessarily to a specialist.

CSIRO is conducting the trial with the GP Superclinic at Midland Railway Workshops in Perth for the next six months, imaging up to 200 patients for the early stages of DR.

Remote-I has been used successfully in trials in three regional and remote locations across Australia, predominantly to screen for eye disease in indigenous and elderly people.

The technology consists of a low-cost camera that takes high-resolution images of the retina and sends them to the cloud, where they can be studied by an ophthalmologist remotely. It has been particularly successful in areas where broadband access is limited to satellite.

The new metro trial, which the CSIRO says is a world first, is aimed at tackling the number of people in the early stages of DR who for whatever reason don’t attend specialist clinics.

CSIRO scientists will also process the retinal images using their Dr.Grader software to grade the images for DR and alert the GP to patients who need referrals.

Australian e-Health Research Centre research director Yogi Kanagasingam said vision loss or blindness caused by diabetes can often be prevented through early detection and timely treatment for the one in three diabetics who will experience it.

“GPs are the frontline in managing chronic disease, such as diabetes,” Professor Kanagasingam said. “This is the first step in developing a DR screening system that will help GPs prioritise patients for treatment and surgery to prevent disease complications.”

GP superclinic director Amitha Preetham said the project would break down barriers in specialist access to services in the community.

“This tool provides a valuable adjunct in the delivery of our comprehensive one-stop diabetes services that already exists on site, which includes GPs upskilled in diabetes working alongside other specialists and a wide array of allied health services to provide whole person, patient-centred healthcare,” Dr Preetham said.

She said the array of services offered in the community would help avoid hospital admissions.

The trial comes at the same time that GPs have access to an MBS item number allowing them to test for DR using a non-mydriatic retinal camera rather than referring them. However, these cameras can cost over $15,000 each.

 

Kate McDonald, Pulse+IT (14 November 2016)

view the original article here

Insuring against racism by doctors is no easy task

I am responsible for the delivery of the Aboriginal and Torres Strait Islander health curriculum at one medical school and have peripheral involvement at two other Queensland universities. Let me tell you—it’s not an easy gig.

Of all areas of medicine, cultural competency presents the hardest compromise between teaching what we want students to know, versus what the students say they want to know. In comparison, teaching about diabetes is a cinch.

One challenge is teaching anti-racism. Yes, I think it can and should be taught, but no, I don’t think that teaching it makes much difference to a minority of future-doctors with entrenched views. There, I’ve said it.

With the rise of Trump and Hanson, both of whom have made racist statements, and the backlash, some of which has been unreasonable, discussing racism among doctors is currently a place where angels fear to tread.

I have sat through cultural training of awful quality, and also some which moved me to tears. For both, feedback reveals some are angry their time has been wasted, and annoyed they learned nothing useful.

A literature review by my peers at the University of Western Sydney doesn’t put it so starkly, but broadly outlines the problem. They analysed 50 studies of cultural competence in general practice, 14 of which were Australian.

They found a strong association between racism and ill-health of minority groups and concluded that “formal training in cultural competence does improve clinicians’ attitudes, knowledge and skills”.

So yes, we must teach this stuff to med students and registrars, and must model it as GP mentors.

Teaching ‘knowledge’ creates a tension between cultural competence and stereotyping. In a short workshop, to ignore teaching about the dire state of Aboriginal or refugee health is incompetence. But overemphasising drug and alcohol use, mental health and parenting issues risks stereotyping. It’s a fine line to tread.

Even harder, the authors describe the task of teaching GPs about attitudes: “to recognise the effect of their own position within the power structures of society and within their own culture … including their deficiencies in practice, their own assumptions, prejudices and non-conscious biases”.

Wow. T
eaching doctors to reflect on their own deficiencies. Deficiencies that, for some, include racist attitudes. Did I me
ntion it’s a hard gig?

Participant feed
back could no doubt be cleaned up by making attendance voluntary, although as the authors point out, “where non-compulsory training exists…[it] was thought to be under-prioritised or overlooked, but where it is compulsory, resistance by health staff attending formal training was perceived to be very difficult to overcome”.

We teach this stuff because it matters, and makes a difference to patients, every bit as much as talking about a new diabetes treatment. But it ain’t easy.

 

Justin Coleman, Medical Observer (17 November 2016)

View original article here

Paediatricians have released a new list of 5 do-not-dos

Another list of low-value clinical interventions has been released as part of the Choosing Wisely Campaign — this time from paediatricians.

The Royal Australian College of Physicians’ Paediatrics and Child Health Division has compiled the list as part of the EVOLVE program, following similar releases from endocrinologists, dermatologists, and several others.

 

Here’s the list:

  1. Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection

“The vast majority of children presenting with fever do not have a bacterial infection and therefore will not benefit from being prescribed oral antibiotics … Given that inappropriate prescribing of antibiotics is a major cause of antibiotic resistance and antibiotics have adverse effects, it is not considered good clinical practice to prescribe antibiotics in children without a specific bacterial infection.”

 

  1. Do not routinely undertake chest radiography for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children

“Chest x-rays for patients with acute lower respiratory tract infections rarely affect clinical treatments and outcomes. Chest x-ray films do not discriminate well between bronchiolitis and other forms of lower respiratory tract infection and in mild cases do not offer information that is likely to affect treatment …

“With the exception of improving clinical scores in infants treated as outpatients, the evidence overwhelmingly shows that bronchodilators, including salbutamol, do not improve oxygen saturation, reduce hospital admissions or shorten the duration of hospitalisation and time to resolution of illness in children with bronchiolitis …

“The majority of randomised controlled trials have not found a clinically relevant, sustained impact of systemic or inhaled glucocorticoids on admissions or length of hospitalisation in children with bronchiolitis or other forms of lower respiratory tract infection.”

 

  1. Do not routinely order chest radiography for the diagnosis of asthma in children

“There is extensive evidence that the majority of x-rays ordered for children admitted for asthma and wheezing disorders do not provide clinically relevant information and therefore do not contribute to their diagnosis and management.”

 

  1. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy

“Numerous randomised controlled trials have concluded that PPIs are no more effective than placebo in treating GORD in infants, though there is some evidence (of moderate quality) of their effectiveness in treating GORD in older children.”

 

  1. Do not routinely order abdominal radiography for the diagnosis of non-specific abdominal pain in children

“In only a very small minority (under 5%) of cases do abdominal x-rays make a difference in patient treatment … There is significant scope for reducing the number of abdominal x-rays performed without sacrificing diagnostic accuracy for children with abdominal pain.”

 

Medical Observer (15 November 2016)

View the original article here

What are GPs duties when it comes to domestic violence?

Statistics on family violence are notoriously difficult to determine, due in part to widespread under-reporting and the fact that there is no consistent definition of family violence.

Surveys of domestic violence data suggest that at a minimum, “one in six women and one in 20 men have experienced at least one incidence of violence from a current or former partner since the age of 15”.

All commentators warn the actual incidence is likely to be much higher. It is estimated that 20% of women experiencing domestic violence will first disclose this to their GP and that full-time GPs may see as many as five women a week who have experienced intimate partner abuse in the past year. Statistically then, it is likely that some of your patients are experiencing violence.

 

How GPs can Help

Australian of the Year Rosie Batty recently called on GPs to ask about patients’ safety if they thought something was wrong. She reminded doctors that people experiencing family or intimate partner violence “may not even think they are worthy of someone like you taking the time to care”.

Asking in a compassionate, non-judgemental way about something you have seen or observed can be the permission a patient needs to disclose their experience of violence.

The issue can come up in various ways. For example, when you are taking a general history and ask about who is at home, or when you notice something during an examination and ask, “Oh, how did you get that?”

It is important to be alert to comments patients make in general conversation and to indicators that a patient may be experiencing violence. The AMA’s Supporting Patients Experiencing Family Violence document includes a section on what to watch for, and how to ask about violence (see Resources below).

 

It’s complicated

The AMA guide also points out questions not to ask, such as “Why don’t you just leave?”

For doctors who want to help with the problem, it can be very frustrating when a patient is not yet ready to go to the police, or to leave the relationship. So it is very important to understand that family violence is complex.

Patients experiencing it are likely to feel powerless, conflicted and fearful. Leaving a violent partner is difficult, and may put your patient and their children at greater risk.

Anything that makes them feel judged, guilty or pressured into acting is unlikely to be helpful. You may just have to sit with your frustration, and offer support and information so they can leave the situation when they are ready.

 

What happens after you have asked the question?

What if a patient does disclose they are experiencing violence but they are not yet able to leave?

Doctors are often unsure whether they should report this to authorities. Apart from the NT, it is not mandatory for doctors to report domestic violence that affects only adults.

You can offer to help patients report an incident, but it is important that you allow them to make the decision themselves and do not try to pressure them into acting before they are ready.

The exception to this is the NT, where you are required to report to the police if you reasonably believe a person has experienced or is likely to suffer serious physical harm.

In other jurisdictions the privacy legislation permits disclosure of information to the police where you reasonably believe a person faces a serious threat to their health or safety, and it is advisable to check with your medical defence organisation if you are unsure whether you should take this step.

 

What are the requirements for reporting risk to children?

In NSW and the NT, it is mandatory for doctors to report when children are exposed to domestic violence, even if they are not direct victims of the physical violence themselves.

In other jurisdictions, the wording of the legislation varies and you should seek advice about your reporting obligations.

Impacts of family violence on children were a focus of the recent Council of Australian Governments summit on reducing violence against women and their children, so legal requirements for reporting family violence may change in the future.

If you feel you do need to make a mandatory report, always discuss this with the parent who may also be experiencing violence. You need to report as soon as is reasonable or practicable, which allows for a reasonable delay so the patient can take steps to ensure their own and the children’s safety if necessary.

Another particularly difficult area can be in family disputes, where a parent may report to you that a child is being abused, but you may be unable to find evidence on which to form a reasonable belief that the child is at risk. You should also discuss this with your medical defence organisation before reporting.

 

Tips for your practice when dealing with domestic violence
  1. Given the likelihood that at some time some of your patients will be experiencing violence, it is important to make sure your practice staff are also aware of these issues.
  2. Sometimes both partners are still patients of the practice and may have joint responsibility for children of the relationship, even if they have separated.
  3. Confidentiality of records is particularly important in this case.
  4. Familiarise yourself with local resources and emergency contact numbers so that you do have something to offer when you identify domestic violence.
  5. Finally, if a patient discloses violence, ensure you document clearly the patient’s report and a description of any injuries.

 

Liana Jacobi, Sydney Morning Herald (31 October 2016)

View the original article here

Legalising marijuana won’t turn us into a nation of pot heads

Cannabis is the most widely used illicit drug in Australia and worldwide. The long-running legalisation debate gained momentum earlier this year when the Federal Government passed new laws to pave the way for the use of medical cannabis.

Despite both recreational and medical use at present being illegal in Australia, the country ranks among the highest in the world for marijuana use. According to the Australian National Drug Strategy Household Surveys (NDSHS), 13 per cent of Australians aged 14 and above used marijuana in the 12 months prior to the survey, with teenagers and young adults in their twenties making up most of the users. Over 40 per cent reported having used it at some point in the past.

In the current “black market” environment, it is difficult to predict the effects of legalising cannabis for recreational use. However, our research, the first of its kind in the world, uses economic modelling to shed some light on the implications of a legal cannabis market. What is clear is that the drug market, like any other, is one of supply and demand, with demand depending on price, quality and such demographic factors as age and gender.

However, unlike a product such as, say, milk, it cannot be bought in the local supermarket. Only about 50 per cent of the NDSHS respondents reported having ready access to marijuana, and, of those, roughly a quarter said they ended up using the drug. Therefore, not everyone with access necessarily uses. Those who are eager to use are more likely to know how to get it. Illegality was deemed a serious hurdle by 16 per cent of the respondents who said it was the main reason for not using marijuana.

Legalisation would make marijuana widely available to be bought like other legal drugs, such as alcohol. Currently marijuana is only available on the black market and from dealers who also often supply more harmful illegal drugs. Suppliers face potentially heavy criminal penalties including prison if caught. And while many states in Australia have decriminalised use to some degree, users still face penalties and possibly a criminal record when caught with a small amount of marijuana for personal use – something that can have a significant impact on a person’s ability to function in society.

For example, it may be more difficult to get a job, secure a rental property, or secure a loan. We find that the fear of legal consequences lowers the use in all age groups in the current environment.

Our findings indicate that while legalisation would increase marijuana use, it would not turn the country into a nation of potheads. Overall use would increase from 13 per cent to 19 per cent in the Australian population aged 14 and older if prices remain unchanged. We also found higher projected use among people who now have access to illegal cannabis than those who don’t.

While use increases among all age groups, the highest increase is among people in their thirties and older. We observe the smallest relative increase among teenagers and young adults, as these groups have the highest access before legalisation.

Our model predicts that Australia could raise a minimum of between $70 million and $220 million in taxes (or far more depending on the tax scheme employed and the demand for legalised marijuana) that could be used, for example, to fund education or other social programs.

The recent legalisation of cannabis in Colorado has provided us with a unique experiment to benchmark the predictions from our model. For a state the size of Colorado, our model predicts tax revenues of US$68.2 million ($A89.6 million) annually — assuming a tax rate of 25 per cent that is reduced to US$61.5 million a year when allowing for losses to the black market. Colorado’s tax office reported that it collected US$56.1 million in taxes from the sale of marijuana (excluding medical use) in 2014, most of which is used for school construction and state programs. With Australia’s population more than well over four times the size of Colorado’s 5.4 million, we would expect it to raise taxes well in excess of $250 million.

Legalisation would provide a safe-sale environment with no judicial risks. However, it would require restricted use for underage individuals similar to alcohol and cigarettes. Whether this would encourage higher numbers of teenagers and young adults to seek supply from alternative sources is yet to be seen. Unfortunately, taxes and higher prices are only a very limited tool to curb use after legalisation.

Our research shows only a very moderate response to higher prices. We find that even with restrictions on access for underage users after legalisation, the average price per gram of marijuana would have to increase four-fold to keep use as low as before legalisation in this vulnerable age group. Such an increase is not feasible as most users would resort to the black market.

By combining a new economic framework that takes into account the role of restricted access to cannabis and the impact of illegal behaviour on the decision to use marijuana, we have provided answers to some of the questions fuelling legalisation debates in Australia and globally – answers that are essential for informed debate and the formulation of effective policy discussion and implementation.

 

Liana Jacobi, Sydney Morning Herald (31 October 2016)

View the original article here

The Bronchiectasis Toolbox: an invaluable resource for patients with bronchiectasis

The Bronchiectasis Toolbox is a multidisciplinary resource for health professionals on the management of people with bronchiectasis. It has been developed by a team of clinicians from the Alfred Hospital in Melbourne, who all have extensive experience in this area. The easily navigated website includes sections on diagnosis, assessment, medical and physiotherapy management, medicines, radiology, lung function, paediatrics, cultural awareness, nutrition and co-morbidities.

The resources section including patient handouts, information on where to purchase equipment and videos of airway clearance techniques is also proving to be invaluable for patients who can review the management strategies that have been prescribed for them. The Indigenous section provides information on cultural awareness and relevant resources for both the Aboriginal and Torres Strait Islander and Maori communities. Importantly, the website will be regularly updated with the latest evidence-based information. The toolbox can be accessed at www.bronchiectasis.com.au and is endorsed and supported by Lung Foundation Australia and the Thoracic Society of Australia and New Zealand.

Lung Foundation Australia, 24 October 2016

Free Advance Project Toolkit gains great response from nurses

The free Advance Project palliative care toolkit and training package for nurses article recently featured in APNA Connect has had a great response.

Suitable for both enrolled and registered nurses working in Australian general practice, the program provides online training and face-to-face workshops with a practical toolkit of screening and assessment tools.

The project aims to provide better care for people in the Australian community who are either older and/or chronically ill, while also supporting nurses to work with GPs to initiate advance care planning and palliative care in everyday general practice.

 

About the Project

Information sourced from the Advance website

What is Advance?

Advance is a free toolkit of screening and assessment tools and a training package, specifically designed to support nurses in Australian general practices to work with general practitioners (GPs) to initiate advance care planning (ACP) and palliative care in everyday general practice.

The Advance Toolkit consists of six screening and assessment tools and a Guide, which indicates how to implement the screening tools in a systematic way in general practice. The toolkit was informed by a literature review of the best available evidence about tools to support palliative care and ACP in general practice, as well as input from our expert advisory group and feedback from general practice nurses, general practitioners and Carers Australia.

 

Who is it for?

Only registered and enrolled nurses who are currently working in Australian general practice are eligible.

What is the aim of Advance?

Advance aims to enable better care outcomes in Australian GP practices through:

▪ enabling earlier consideration and uptake of ACP

▪ enabling more efficient use of GP and nurse time in providing palliative and supportive care

▪ enabling more appropriate and timely referrals to specialist palliative care services if required

▪ increasing confidence and comfort levels for general practice nurses (GPNs) in initiating conversations with patients and their carers about screening for supportive care needs and ACP.

 

Why nurses in general practices?

General practices provide ongoing care for a large number of patients with chronic, debilitating and eventually fatal diseases, both malignant and non-malignant conditions. Thus general practices have an essential role in providing palliative care to patients and their families. GPNs play a key role in patient management within general practices. GPNs are already involved in managing patients who are at risk of deteriorating health and dying. Given their ongoing relationship with patients and carers and the level of trust developed, GPNs may be ideally placed to help such patients identify their most important symptoms, concerns and priorities that they would like addressed by their GP.

General practices are also well placed to undertake ACP because of the ongoing and trusted relationships that develop with their patients. The general practice environment enables planning discussions to start early when a patient is still relatively well. GPNs potentially have an important role in ACP. It is important that GPNs have the appropriate training and education to support whatever role they undertake in delivering ACP in their practice.

 

What are the benefits of Advance for general practice?

The Advance training package will help general practice nurse(s) to work with GPs to initiate ACP and, where appropriate, palliative care for elderly and/or chronically ill patients within the practice.
This will:

▪ Help break down some of the barriers to ACP in general practice

▪ Enable the practice to more efficiently:

* identify patients who might be at risk of deteriorating and dying

* assess and address the supportive care needs of patients who might be at risk of deteriorating and dying

* assess and address the needs of carers of patients who might be at risk of deteriorating and dying

▪ Help identify patients who might benefit from early referral to specialist palliative care services.

  

How is the training funded and delivered?

The program is available FREE of charge for nurses working in Australian general practice. Advance is funded by the Australian Government Department of Health and will be delivered by a national consortium. There is FREE online training, FREE face-to-face workshops, FREE one-to-one tele-mentoring from an experienced palliative care nurse, sponsorship for completing patient assessments, and more.  The training will count towards your GPN’s CPD requirements.

  

How much time will it take a general practice nurse to complete the training and where will the training be delivered?

The online component of the training package will take about two hours in total to complete. There are three modules, covering concepts such as:

▪ Learning to initiate palliative care and ACP in general practice in a routine and sensitive way;

▪ Learning how nurse facilitated screening of patients and their carers will support general practices to more efficiently address patients’ and carers’ needs; and

▪ Developing skills to use the Advance Project screening and assessment tools.

The online learning modules and the Advance Toolkit have been endorsed by the Australian Primary Health Care Nurses Association (APNA) according to approved quality standards criteria.

The FREE practical workshops will be held on weekday evenings in every capital city of Australia for approximately 3 hours. Scholarships will be made available for GPNs from rural/remote settings to assist with their costs to attend the workshops.

  

What other opportunities are available as part of Advance? 

Participants are encouraged to use the Advance screening and assessment tools in their clinical practice. There are opportunities to participate in the evaluation and quality improvement of the Advance program, including reimbursements to take part in a “clinical audit” of the Advance Project patient and carer assessments. Optional in depth ACP workshops will be available for a subset of participants. To enable ongoing implementation train-the-trainer workshops will be delivered in every capital city of Australia.

 

 How will we know if the training is useful?

An important role of the project is evaluating if it is effective. We will be inviting nurses to help us evaluate the project by providing us with feedback and completing surveys.

 

 Would you like to be able to print this information and share it with others?

You can download a pdf (48kb) of this information

  

Like to know more?
For more information please contact the Advance project team.
Email: AdvanceProject@hammond.com.au

  

Want to get involved?

If you are an Australian General Practice Nurse the first step is signing up to do the online modules. Once you have completed the modules you will be able to choose other training options and to carry out patient assessments using the Advance assessment tools in your workplace.  You can register for the online training here.

 

GP Connections Snippets, 15 November 2016

GP saved lives in ‘thunderstorm asthma’ event

GPs have been praised for their role in preventing more deaths from ‘thunderstorm asthma’ that took the lives of four people in Victoria earlier this week.

Emergency medicine specialists say GPs stepped in to treat many patients during the unprecedented event that led hundreds of patients in the Melbourne area to seek emergency treatment for respiratory symptoms.

The large-scale increase in patients with respiratory distress was likely caused by a sudden and massive spike in pollen levels caused by a storm that swept Victoria on Monday, according to respiratory specialists.

Dr Kristin Boyle, an emergency specialist at Geelong Hospital, said GPs played a crucial role in managing critically ill patients.

“There has been much coverage of the overwhelming attendance at emergency departments, but numerous GP practices treated critically ill patients, often for hours, because ambulances were simply unavailable,” she said.

“I know of multiple lives saved in this way and I applaud my GP colleagues for the role they played in responding to this disaster,” she told Fairfax.

Dr Boyle told Australian Doctor that the event was so widespread that many people suddenly found they couldn’t breathe and literally just walked into their nearest GP practice.

“I’m aware of one practice where they had two patients, one who walked in literally with a silent chest, and there were no [ambulance] vehicles available to transport them. The GPs cared for these patients for 3-4 hours.”

“They weren’t just providing first aid, they were providing hospital level care, giving Ventrolin, Atrovent, putting drips in, giving IV steroids.”

An important lesson from the incident was that GPs played an important role in providing critical care backup during major events such as bushfires and heatwaves, Dr Boyle said.

Many of the patients treated for ‘thunderstorm asthma’ had a history of hayfever and wheeze but had never had a formal diagnosis of asthma, said Professor Christine McDonald, director of respiratory medicine at Austin Health in Melbourne.

“It’s really about having an awareness that people who have atopy are at risk of developing severe asthma in these exceptional circumstances,” she told 3AW radio.

 

Michael Woodhead, Australian Doctor (24 November 2016)

View the original article here

What I’ve learnt about how to talk to teenage patients

I enjoy seeing my adolescent patients. They never fail to surprise me and it is exciting being involved with such a formative time of their lives.

Establishing trust is essential if an honest dialogue is to take place. I begin the consultation by explaining my role and I always encourage the young woman to be seen alone for at least part of the consultation.

My advice is to treat her as the patient and direct the conversation to her instead of her parent or caregiver. You need to make it a good experience as you want to encourage openness.

It is vital to reassure the young woman that the consultation is confidential. Information cannot be given to parents or caregivers unless you have her permission. I also explain there are situations where I might need to share information, such as with other medical practitioners or under mandatory reporting.

The most common presentations I see are dysmenorrhoea, menorrhagia and irregular periods. Mostly, these can be managed with simple empirical treatments. Invasive examinations are rarely needed in a young woman who is not sexually active.

If required, a transabdominal ultrasound usually suffices. Often the irregular periods are in younger adolescents as the girl’s body gets into a routine.

I see lots of over-diagnosis of PCOS, which can be difficult to diagnose with certainty in the adolescent years.  Part of the problem is the current ultrasound criteria of more than 12 follicles being visible in one ovary. In many young women this is a normal finding and a sign of adequate ovarian reserve.

A good ultrasound service will report these as multi-follicular, rather than polycystic, ovaries.

A diagnosis of PCOS brings a lot of anxiety. Girls will Google it and arrive at the clinic convinced they are going to become fat, hairy, infertile and will get cancer.

I always use HEADDS (Home, Education, Activities, Diet, Drug use and Sexual activity) screening with adolescents, starting with non-invasive questions about their home life, and moving on to more probing questions, such as partners and sex. To be honest, this is a useful approach with adults too.

Make sure you do ask about sex and inquire specifically what sexual habits they have, as they might have differing views on what sex actually is. For instance, some adolescents consider oral sex to be safer because pregnancy is not a threat, but are unaware the risk of STIs still applies.

I also always ask if they have had any unwanted sexual experiences. Never make assumptions based on cultural background.

I always talk about alcohol use, binge drinking and at-risk behaviours, especially coming up to schoolies week. I ask where they are going and what they think could happen.

This is a good opportunity for preventive medicine and encouraging good habits.

This generation is internet- and social media-savvy. This can work in their favour and be a great, accessible resource. But it can also be a trap and present them with images that are extreme and not necessarily representative of life in general, particularly with regard to sex and body image.

I consider that one of my important roles is to point them in the right direction and work as an advocate for their health.

 

Dr Melissa Cameron, Medical Observer (17 November 2016)

View the original article here

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