We d n e s d a y 7 O c t o b e r 2 0 0 9
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GPs lose joint injection rebate ■ Michael Woodhead
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he Medicare rebate for synovial joint injections will be removed from 1 November, in a move the AMA says will cause financial and physical suffering for thousands of elderly patients. AMA president Dr Andrew Pesce says the government expects the medical profession to absorb this service as part of a standard patient consultation. However, he warns the costcutting move will mean that many older patients will now have
to pay a minimum of $23 per injection for up to 25 injections per patient per year. “This is another example of a random Budget cut made for base economic reasons without any consultation with the medical profession about the cost of providing the service or the health impact on patients,” Dr Pesce says. “To suggest that joint injections can be incorporated into a standard consultation is proof that the government has been poorly advised on this decision." Dr Pesce says the injections are
one of the few effective treatments for older patients with intractable knee or shoulder pain who often spend months on waiting lists for joint replacement surgery. “This latest Medicare rebate cut means that, for many of them, their wait will now be long and painful.” “Our GP members tell us that synovial joint injections are among the most gratifying treatments for patients – they walk in with pain and walk out with a smile,” he says. What do you think? comment@6minutes.com.au
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Back pain patients recover in a year ■ Michael Woodhead Reassuring news for patients with chronic low back pain, with a new Australian study showing that four out of ten patients will recover within a year. The better than expected prognosis was seen in a one year follow up study of more than 900 patients presenting in primary care with a new episode of low back pain. Complete recovery was seen in 35% of patients by nine months and in 41% of patients by one year, says study
author, Dr Luciola da Menezes Costa, from The George Institute at the University of Sydney. His findings, published in the BMJ online today, also show that factors associated with delayed recovery from back pain included taking previous sick leave for low back pain, high disability levels, low levels of education and being born overseas. “Our findings suggest that the prognosis is moderately optimistic for patients with chronic low back pain. Patients with recent onset, non-radicular chronic low back
pain can be reassured that they have a good chance of recovery,” he concludes. Dr Costa says his study may have found a higher than expected rate of recovery because almost all patients were followed up, whereas in other studies many had been lost to follow up. However, other researchers said low back pain was often an episodic and life-long problem and research on what happens to patients over much longer time scales was needed. comment@6minutes.com.au
*Only Symbicort 100/6 and 200/6
doses are approved for use in patients indicated for the SMART regimen.
Pet threats may be key to domestic violence ■ Michael Woodhead Women experiencing domestic violence may be reluctant to speak out or take action because their pets are effectively being held hostage, researchers say. A study by a domestic violence service in NSW has found that abusive partners often threaten to harm or kill a pet, making women reluctant to leave or seek help. Writing in the MJA (191: 409), researchers urge doctors to ask women who are at risk of domestic violence if they have pets, and whether their pets
Women are reluctant to leave pets are at risk of violence. They say women in such situations often become very attached to pets and their partners use this to control and intimidate them. In a survey of women being helped by a domestic violence service, they found that among the pet
owners, one in four partners had threatened to harm or kill their pet. Out of concern for their pets, women delayed leaving home or calling police and pressing charges against a perpetrator of violence. The researchers say the RSPCA provides emergency accommodation for pets of women and children seeking refuge from domestic violence. But women often feel reluctant to speak up and the authors encourage doctors to raise the question of pets and their health. comment@6minutes.com.au
BEFORE PRESCRIBING PLEASE REVIEW THE FULL PRODUCT AND PBS INFORMATION IN THE PRIMARY ADVERTISEMENT OF THIS PUBLICATION Reference: 1. Symbicort Approved Product Information, November 2007. Australian approved product name for eformoterol is eformoterol fumarate dihydrate. Symbicort® and Turbuhaler® are registered trademarks and SMART™ is a trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde, NSW 2113. AZAE0610. H&T AZSY0941/6MIN
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In other news ...
The first men's health policy in a decade is about to be released by Federal government and will see a cultural shift away from blaming men for their poor health to recognising social factors and the need for ''malefriendly'' services, says the Brisbane Times. (read more) Budget cuts at Royal Perth Hospital will slash nearly 500 full-time positions by 2010 and fuel industrial action in coming weeks, reports The West Australian. (read more)
Online therapy programs for depression and anxiety can be twice as effective as seeing a psychologist or psychiatrist in person, studies by Prof Gavin Andrews of St Vincent's Hospital in Sydney show, according to the Sydney Morning Herald. (read more)
A new technique to repair vaginal prolapse that uses synthetic mesh with an adjustable silicon device to support it, improves the success rate of a surgical repair from 66% to 88%, according to a urogynaecologist at Melbourne’s Royal Women's Hospital, reports The Age. (read more)
Monash University researchers have shown how microscopic antennas in the kidney help the repair processes and explain the cause of polycystic kidney disease, says Science Alert. (read more)
Tobacco companies are promoting their goods online to sidestep government restrictions on tobacco advertising, Australian researchers tell The Age. (read more)
A standard medical check up would not have predicted the fatal heart attack of a Queensland man on the Kokoda Track last week, a leading cardiologist says in The Age. (read more)
A team of 22 medical experts has arrived in Indonesia to provide emergency assistance after last week’s earthquake which killed more than 700 people, Sky News reports. (read more)
Researchers from Princess Margaret Hospital are testing whether feeding eggs to infants will prevent common food allergies, The West Australian reports. (read more) Nearly 100 pathology workers who are seeking a pay rise are taking striking action in Victoria today, writes the ABC. (read more) The Royal Darwin Hospital general manager Dr Len Notaras has quit and the NT Health Department is yet to start looking for a replacement, says the NT News. (read more) WorkCover claims have soared in Maribyrnong, Vic, with doctors treating more than 4000 patients, writes Star News Group. (read more)
ONE asthma inhaler for both maintenance and relief?* 1
BEFORE PRESCRIBING PLEASE REVIEW THE FULL PRODUCT AND PBS INFORMATION IN THE PRIMARY ADVERTISEMENT OF THIS PUBLICATION *Only Symbicort 100/6 and 200/6 doses are approved for use in patients indicated for the SMART regimen. Reference: 1. Symbicort Approved Product Information, November 2007. Australian approved product name for eformoterol is eformoterol fumarate dihydrate. Symbicort® and Turbuhaler® are registered trademarks and SMART™ is a trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde, NSW 2113. AZAE0610. H&T AZSY0936/6MIN
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You said it... Ignore GPs at your peril (link)
In the next 10 years we will have a healthcare system that is one of the worst in the developed nations. I believe this is because of current policy, poor leadership, personal agendas and the use of cheap/untrained alternatives. Dr Haikerwal is right, will the government pay attention? Let’s wait and see... Flint I must admit the comments made by the profession are not entirely correct. I am concerned if we are digging in our heels nobody will listen to anybody and we, the patients, miss out. If the government is so arrogant why did Nicola Roxon and the Prime Minister make it a point to drop in on the Geraldton Medical Group a large rural practice last Friday. They did not have to, I
thought this was an incredible gesture and vote of confidence as well as interest in a well run multi-disciplinary clinic. Congratulations GMG in showing what can be done with a compelling vision, leadership and action. I think it is great the little people also have an opportunity to be heard. I will declare my conflict we have been the accountants and business advisers to the group. David Dahm Health & Life Pty Ltd
CT scan risks (link) I agree with the thrust of the article that more careful consultation and changes in access to non-ionising imaging techniques would reduce the radiation exposure to the public. I also believe it prudent to minimise radiation exposure, because the biological effects of low-level radiation are still uncertain. The article, however, states as fact that there are "deaths of several hundred people a year from cancer caused by radiation in CT scans". This stated certainty may make a
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To have your say CLICK HERE sensational argument stronger, but for a medical physicist to state it as fact without considered argument ignores the enormous amount of work that has yet to prove the association. Backextrapolating from proved effects at higher doses is not appropriate for almost any risk. Assoc Prof. Barry Chatterton Senior Director, Nuclear Medicine, Bone Densitometry and PET Royal Adelaide Hospital
BMD at menopause (link) There is an American farm saying - "You don't fatten the hog by putting it on the scales". Genuine prevention is about exercise and eating real food and getting some sunshine for adequate vitamin D. This starts in childhood. Joe Kosterich
Thank you Professor Nordin for your common sense approach to the prevention and management of osteoporosis. I couldn't have said it better myself. Craig Hassed It is also a fact that women in general are often vitamin D deficient and women should take cod liver oil to rectify this so that calcium can be absorbed. The dairy industry pushes its calcium but if the [vitamin] D level is inadequate it won't be absorbed. Gary Roberts Rates of change in BMD are more important than single measurements, and calcium supplements may have little impact on BMD decline. Anon
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GPs told to beware of divorcing patients ■ Louise Durack Beware of the divorcing patient. This was the warning to doctors at the Family Medicine Conference, held today on Queensland’s Gold Coast. With many changes having occurred in Australian family law jurisdiction, lawyer Michael Lynch of Michael Lynch Family Lawyers claimed that he is increasingly seeing doctors frequently on the ‘frontline’ in receiving questions about separation issues from their patients, or having said something to patients then finding themselves unwittingly embroiled in the patient’s legal proceedings. “Patients’ questions and disclosures can come unexpectedly and a doctor’s response can carry serious, long-term legal implications for the practitioner,” said Mr Lynch. “It’s important that we don’t
Doctors' notes may be brought into divorce proceedings. see any more doctors dragged before the wolves in court than we have to.” Alongside advising doctors to make themselves aware of the recent changes to the Family Law Act, Mr Lynch also warned that the confidentiality of doctors’ notes are not protected where legal proceedings are being undertaken, and that patient notes and other documentation are all ‘fair
game’ for legal subpoena. “These notes could be worth gold to a court when related to family law disputes. However, you are entitled to question the scope of the information they are trying to uncover if you feel that it would take an unreasonable amount of time to find and put together.” Mr Lynch also told doctors to be aware of trying to second guess patients when they request written verification such as a compelling medical reason for them to relocate. “Immediately this will make you a witness, if there are legal proceedings involved, and by stepping out you make yourself a player in legal proceedings. Of course, the likelihood of it all coming to a final hearing is small but the potential for crossexamination of your notes is a possibility.” What do you think? comment@6minutes.com.au
Rise in Narcissistic Personality Disorder ■ Louise Durack Narcissistic Personality Disorder (NPD) is on the increase and GPs need to be aware of the characteristics and potential wider family problems associated with it. This was the message from Dr Ranil Gunewardene, consultant psychiatrist and clinical director of Ku-ring-gai Mental Health, Sydney speaking at the Family Medicine Conference on the Gold Coast last week. Seen almost exclusively in men, specialists now believe that 3-5% may have the disorder. Traits listed as being associated with NPD include: having feelings of self grandiosity; having fantasies of power; having significant expectation of power and entitlement; being interpersonally exploitative; and having difficulties in conflict resolution. comment@6minutes.com.au
Symbicort® Maintenance And Reliever Therapy in ONE inhaler*
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*Only Symbicort 100/6 and 200/6 doses are approved for use in patients indicated for the SMART regimen. PBS Information: Restricted benefit. For single maintenance and reliever therapy in a patient who experiences frequent asthma symptoms while receiving treatment with oral corticosteroids or inhaled corticosteroids or a combination of an inhaled corticosteroid and a long acting beta-2-agonist (Symbicort 400/12 is not recommended nor PBS subsidised for use in maintenance and reliever therapy).
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE PRESCRIBING. FULL PRODUCT INFORMATION IS AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342. Symbicort® Turbuhaler® (budesonide and eformoterol fumarate dihydrate) for oral inhalation. Indications: Regular treatment of asthma where use of a combination (inhaled corticosteroid and long-acting ß2-agonist) is appropriate. Dosage: There are two alternative treatment regimens: Symbicort Maintenance And Reliever Therapy or Symbicort maintenance therapy. Symbicort Maintenance And Reliever Therapy: Symbicort 100/6 and 200/6: Adults and adolescents ≥12 years: 2 inhalations per day given as either 1 inhalation twice daily or 2 inhalations in either the morning or evening. For some patients a maintenance dose of Symbicort 200/6 2 inhalations twice daily may be appropriate. Patients may take additional inhalation as needed in response to symptoms, up to 6 inhalations at one time. If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose, the patient should be reassessed. A total daily dose of up to 12 inhalations can be used temporarily. Symbicort 400/12: The 400/12 strength should not be used for Symbicort maintenance and reliever therapy. Symbicort Maintenance Therapy: Symbicort 100/6 and 200/6: Adults and adolescents ≥12 years of age: 1 – 2 inhalations twice daily. Symbicort 400/12: Adults ≥18 years of age: 1 – 2 inhalations twice daily. Contraindications: Hypersensitivity to budesonide, eformoterol or lactose. Precautions: Symbicort therapy should not be initiated to treat a severe exacerbation. Not for initiation of inhaled steroids in patients transferring from oral steroids; impaired adrenal function; infections of the respiratory system; susceptibility to sympathomimetic amines; severe CV conditions; hypokalemia; diabetes; impaired renal and hepatic function; pregnancy; lactation. Interactions: CYP3A4 inhibitors (inc. ketoconazole): beta-receptor blockers; beta-adrenergic stimulants; sympathomimetic amines (inc. ephedrine): MAOIs; TCAs; quinidine; disopyramide; procainamide; phenothiazines; antihistamines associated with QT prolongation e.g. terfenadine, astemizole; L-dopa; L-thyroxine; oxytocin; alcohol; if hypokalaemia: xanthines, mineralocorticoids, diuretics, digoxin. Adverse events: Common: tremor, palpitations, oropharyngeal candidiasis, headache, throat irritations, coughing, hoarseness; others, see full PI. Date of TGA approval: 19 November 2007. PBS dispensed price: Symbicort 100/6 - $54.04 (1+5 repeats); Symbicort 200/6 - $58.34 (1+5 repeats). Reference: 1. Symbicort Approved Product Information, November 2007.
Symbicort® and Turbuhaler® are registered trademarks and SMARTTM is a trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde, NSW 2113. AZAE0610. H&T AZSY0937/6MINS