WA News Have You Heard?
Have You Heard
October 2017
Print E-mail

Have You Heard?

Complex care, simpler?

We were interested to watch the WA Department of Health video describing the roles of the new Diabetics Complex Care Clinics, which aim to reduce patient wait times and fragmentation for those with complex type 2 diabetes. The DCCC shtick is that they provide timely care closer to home and reduce the need for care in a tertiary hospital outpatient clinic. We asked a DoH spokesman to fill in the gaps. The pilot clinics are being run at Kwinana Medical Centre and Cockburn Integrated Health by the Health Networks, South Metropolitan Health Service (providing endocrinology support and program evaluation) and 360 Health + Community, which is coordinating the clinics. Specialist care is being delivered by advanced skills GPs (ASGPs) with the support of an endocrinologist. Patients at the DCCC receive support from a diabetes educator for each session, and an exercise physiologist and dietitian if appropriate. DCCC GPs are required to complete the ‘Advanced Diabetes Care in General Practice’ course run by the University of Queensland. Once the course is completed, the ASGPs manage patient care under the supervision of an endocrinologist (from Fiona Stanley Hospital) for three months. The WA pilot has engaged and recruited GPs within the catchment areas, and services began in November 2015. The latest statistics for the 18 months to July 2017: a total of 503 referrals have been received and over 2100 occasions of service provided.

GPs take on hep C

The WA Department of Health has released a report on hepatitis C treatment uptake, to September 2016, after new treatments were listed on the PBS in March of that year. In that time 1827 people initiated Direct Acting Antiviral (DAA) treatment for chronic HCV, representing 8.9% of West Australians living with the condition. About equal numbers were prescribed treatment by a GP (51%) or a specialist (49%) and the proportion of those treated by a GP increased from 43% to 54%. Of the 201 DAA prescribers, 66% are GPs. Full report and information about free online training on hepatitis C management and clinical guidelines visit www.health.wa.gov.au

GPs and kids

Former Geraldton, now Queensland, GP Dr Edwin Kruys blogged a timely response to an idiosyncratic piece of research published in the Journal of Paediatrics and Child Health last month. While it showed that around 90% of parents are mostly or completely confident in GPs to provide general care to their children and 93% reported they would take their child to see a GP in the event of a minor illness, instead of visiting an ED, the academic paediatric researchers concluded that “confidence with GPs is an issue for parents of many walks of life”. Edwin writes that the authors conveniently omitted the “mostly confident” category (45%) and only reported the “completely confident” category (44%) as their main result, stating that “fewer than half of parents were completely confident” in a GP. Of course it went viral. We have searched for a response from the journal and/or the authors but found none. The AMA and the RACGP have hit back but Edwin smells a rat. He thinks the report is a softener for more training “similar to the certificate for GP provision of antenatal care”. As Edwin points out, GPs’ core business is child health. What a waste of time!

Pocket costs rocket

As reported last month, the Senate Community Affairs References Committee will be reporting their findings on the value and affordability of private health insurance and out-of-pocket medical costs, mainly from specialist care, on November 27. Peter Sivey, writing in The Conversation last year, said about 50% of Australians had private health insurance, and Australians pay too much to see a specialist. About 30% of specialist services are bulk billed (compared with 85% of GP services). For many, bulk billing is now so entrenched, many doctors know nothing else. Health consumers’ out-of-pocket costs are not going to go away and there have been mounting calls for greater transparency of charges before a patient signs the consent form. Websites comparing specialist costs are springing up like mushrooms, even one started by a frustrated Sydney GP who started his own price comparison website so he could inform his own patients. While his methodology by his own admission is crude and the results incomplete mostly due to receptionists being unforthcoming, it speaks volumes of just how difficult it is to get accurate pricing information. And even when you do, how is a consumer to work out relative values without outcome data. While these types of websites are fraught with all sorts of inconsistences, are they better than nothing? For example, while 18% of urology surgeons charged no out-of-pocket fees, data released by Medibank and the RACS showed NSW surgeons charged $7049 in out-of-pocket fees on average, compared to $4110 among Victorian surgeons, and $1579 in Tasmania. The RACS is said to be fully committed to full disclosure and fee transparency for patients after it released data in 2015, showing that a small number of surgeons were charging extremely high fees and it was recognised that “patients may feel compelled to accept the procedure and attendant cost in the understandable hope for cure or relief of suffering” One in five cancer patients say finances impact their treatment decision-making. With 27% of initial bladder cancer resections requiring re-operation within six months, and out-of-pocket expenses varying by about 400%, urologists may wish to explain things.

Making hospitals happy places

We’re not sure that the horse hasn’t bolted on this one in WA given that we may not see a new hospital built here for quite some time, but it was interesting nonetheless to take part in a sustainable healthcare architecture webinar organised by the Green Building Council of Australia. It was led by US architect Gail Vittori whose firm has done a lot of work around integrating health into design decisions, with the Austin health complex in Texas a standout example. There is no dispute that environment affects health outcomes, so the greener and cleaner the environment it stands to reason that patient outcomes will improve. Gail goes as far as to suggest that hospitals will become ‘wellness centres’ but that may be an activated almond too far. Perhaps the most interesting take home point is that health campuses can participate at any level – from a visual and physical connection to nature, energy conservation, renewables and even their own food production. If something needs replacing, consider a green alternative. It makes sense. Another message is that health practitioners should be chief design consultants. They are the experts in understanding how environment affects function as well as health.

ED staff need space

Speaking of doctors being consulted on design issues, another report has been launched from the Melbourne, Monash and Deakin universities looking at the design of EDs to minimise error as a result of miscommunication between staff. Government funds went into a survey of ED staff to determine what spaces they needed to have safe, ethical and effective conversations with patients and colleagues. Researchers found staff talked briefly and frequently in all areas of the ED – central workstations, dedicated rooms, transit areas, communal and patient spaces – and made difficult trade-offs to accommodate their work and their need for occasional refuge from a stressful environment. The most notable finding is that the current trend to de-institutionalise the hospital environment (by creating more hotel-like spaces and fewer barriers) is not necessarily what ED staff want or need, which was a sense of control over when and how they interacted and communicated with patients. “Staff preference for more enclosed and protected spaces that communicate hierarchy and separation from patients suggest that EDs needed to find a balance between a clinical aesthetic for staff and a calming environment for patients,” the report found.

Overtaking trial in WA29092017-accident-car-bike-trauma

Cyclists were the only road users to increase (by 8% per year) the number of seriously injured and hospitalised road accidents from 2007 to 2015. MVA occupants, pedestrians, and motorcyclists had no change in incidence over that time. Moreover, disability-adjusted life-years (DALYs) – years of life lost and years lived with disability – increased by 56% over that period for cyclists, whereas it declined for the other road users. Most of those injured were male (87%) and average age was 46 years. While this increase was partially put down to increased cycling participation rates, also mentioned were speed, road rage, and congestion. Wearing helmets and dedicated cycle paths reduce the incidence and severity of injury according to European and Australian research. In April, the new WA Labor Government announced a two-year trial of the 1m rule, which means motorists must leave a 1m clearance between their car and a cyclist when overtaking at 60km/h – faster than that, the distance is 1.5m. NSW, Queensland, ACT, South Australia and Tasmania have all introduced safe passing laws. In the Netherlands, we understand, the onus of proof is on the motorist should cycle and motorcar collide. Health costs in Victoria alone from cyclist injuries were about $1.4b during the nine-year period of one study. But it may need more than legislation. With the number of road users of all types, cycling and motoring peak bodies are calling for education of the road rules and more tolerance. Stephen Moir from the Motor Trade Association was reported at the time of the 1m trial announcement: "My fear is that motorists won't comply. We need to take a much stronger approach to people who deliberately set out to harm another person on the road, whether on a bicycle or in a car." There are indications from those states with the 1m rule is it is having an impact on cyclist injury numbers.

29092017-Alan-Green---low-res

Kindness and hard work show

Radiation oncologist Prof David Johnson met artist Alan Green in 2010 under not so-happy circumstances when Alan was referred for treatment at Sir Charles Gairdner Hospital. While time has passed and both men have moved on with their lives, Alan has created an indelible reminder of the link they shared. He’s painted David’s portrait, which has been named among the 40 finalists in the Black Swan Prize for Portraiture. David told Medical Forum that the process of ‘sitting’ for his portrait included several sessions with Alan, who took numerous photos. “I have yet to see the portrait in the flesh but I have seen pictures. My wife thinks I need a shave but Alan would come after a long clinic and that’s how I look!” he said. Alan said of David in his submission: “I was especially impressed at how generous he was with his time to explain everything in detail and with kindness, as he was aware of where I was heading.” Alan’s work and that of other finalists will be on display at the Art Gallery of WA from November 1 for a month and portraits will go on tour around the St John of God Hospitals at Murdoch, Midland and Subiaco in December.

By the Numbers: Musculoskeletal Conditions

44.6%...

...is the proportion of disease burden attributed to overweight and obesity for those with osteoarthritis

(For those with gout, the proportion of burden attributed to weight was 38.5%. Occupational exposures and hazards were risk factors for 17.2% of back pain)

  • Musculoskeletal conditions were the fourth leading contributor to total burden
  • Back pain, osteoarthritis and rheumatoid arthritis made the great contribution of musculoskeletal burden
  • 39.5% of those with osteoarthritis (n=33,606) were classified as severe; 34% (n=27,586) of those with rheumatoid arthritis were severe; 41.2% (n=66,925) of those with ‘back pain and problems’ were severe
  • 66% of those with osteoarthritis were female; 64% of those with rheumatoid arthritis were female; 84% of those with gout were male
  • Accounting for population increase and ageing there was a 15% reduction in the total burden due to musculoskeletal conditions between 2003 and 2011, from 26 to 22 disability-adjusted life years (DALY) per 1000 people
  • There was no change in the DALY rate for osteoarthritis (3.5 per 1000 people)
  • Total burden for rheumatoid arthritis decreased from 4.4 to 3.5 DALY per 1000

 
<< Start < Prev 1 2 3 4 5 6 7 8 9 10 Next > End >>

Page 1 of 118