Thursday 5 November 2009
CLICK HERE to subscribe for of interesting stuff for doctors today.
Crackdown on Team Care items ■ Michael Woodhead
A
n almost three-fold increase in the number of doctors investigated for inappropriate practice has been reported by the Professional Services Review this year. The PSR investigated 136 practitioners, mostly GPs, for inappropriate behavior such as overuse of long consultations, overprescribing of benzodiazepines and ordering of too many CT scans. In its annual report, PSR director Dr Tony Webber says many cases involved GPs being pressured to ‘get the paperwork done’ for Team Care Arrangements (MBS item 723) for allied health services, when the
Team Care Arrangements and spinal CT scans referred to PSR patient’s condition did not warrant the use of the item. He says there is also ongoing concern about overprescribing of benzodiazepines such as alprazolam by some practitioners, given their potential for diversion and abuse. “Tighter restrictions on and surveillance of these drugs may be needed,” he writes.
The PSR also notes that some GPs appear to be using CT scans as a screening tool for patients with back pain, which is of concern because of the radiation risks, especially for younger women of reprodutive age. In its report, the PSR also warns GPs that it is cracking down on the practitioners who use Medicare consultations to provide alternative and non-evidencebased remedies. Last year the PSR took action against 61 doctors, including a GP working for a heart check clinic who was made to repay almost $180,000 for inappropriate ordering of investigations. What do you think? comment@6minutes.com.au
Nurse practitioners feel stymied ■ Michael Woodhead The number of qualified nurse practitioners has doubled in the last two years but most are still underemployed or unemployed, a new study suggests. Without access to PBS prescribing rights or Medicare provider numbers, nurse practitioner report that they are severely limited in their roles, and they eagerly await the changes proposed by health minister Nicola Roxon due to be introduced next year. In a census of all 234 authorised
nurse practitioners in Australia in 2007, researchers found that almost one in three were not employed in nurse practitioner roles and one in five had never actually worked as a nurse practitioners. Among those who were working as nurse practitioners, a third were still awaiting authorisation to prescribe a limited range of medications, and over 70% said the lack of PBS prescribing and Medicare rights was ‘extremely limiting to their practice”. The survey, published in
Australian Health Review (33: 679) found that the average age of nurse practitioners was 47 years old, and they most commonly worked in emergency departments. The authors of the survey, from the James Cook University in Queensland, say that a more recent survey had shown that number had doubled between 2007 and 2009, but there was still considerable under-utilisation of their skills because of the lck of PBS and MBS rights. What do you think? comment@6minutes.com.au
Get ready to celebrate!
AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde NSW 2113. 06/09 NEX000003r AST1943SIXa/CJB AZAE0710
FREE! Specialist hospitality High cost prescribing medical specialities enjoy the most pharmaceutical company hospitality including oncologists, cardiologists and psychiatrists, a Newcastle study in PLoS Medicine has found.
High IQ beats stroke Stroke patients are likely to have better outcomes if they are younger and have a higher IQ, a one year study of 125 patients by researchers at the School of Psychiatry, University of New South Wales, has found. Aging and Mental Health (13: 693)
No sexual problems after vasectomy Sexual problems are no more common in men who have had a vasectomy, a study of almost 3400 Australian men has found. Journal of Sexual Health (online 29 October)
Case conference shy GPs are reluctant to engage in multidisciplinary case conferencing in residential aged care facilities, a new study finds, because of problems such as role confusion, isolation and a lack of lack of a 'collaborative culture' among other participants. Australian Health Review. 33: 566–571
2
In other news ... South Australia is currently experiencing its worst pertussis outbreak on record - and low immunisation rates are to blame, says the Advertiser. (read more)
A GP medical centre collapsed in Brunswick, Melbourne's inner north yesterday, with the secretary having a close escape after fleeing when cracks appeared in the wall, reports The Age. (read more) A Melbourne baby with a rare genetic condition, molybdenum cofactor deficiency, has been cured in a first for neonatologists at Monash Children's Hospital, reports the Herald Sun. (read more)
A medical centre in Ferny Grove in Brisbane's north was hit by an out of control car, reports The Brisbane Times. (read more) Worsening ambulance response times in WA are being blamed on ramping at emergency departments, says the West Australian. (read more)
Reason to celebrate
Drunks should be made to pay the hospital costs of any emergency department treatment they need due to alcohol, says an article in the Courier Mail. (read more)
Women who take folate supplements throughout pregnancy have a 30% higher risk of their child having asthma, an Australian study has shown, according to the Canberra Times. (read more)
Five of Darwin's 15 surgeons have quit over a pay dispute, according to the NT News. (read more)
The bowel cancer screening program is a waste of time for Fraser Coast patients who face up to two years on waiting lists for colonoscopy, says Maryborough GP Dr Paul Cotton, according to the Fraser Coast Chronicle. (read more)
The death of a Melbourne woman after a liposuction procedure is being investigated by the coroner, say WA Today. (read more)
PBS Information: Nexium 40 mg. Restricted Benefit. Healing of gastrooesophageal reflux disease. Nexium 20 mg. Restricted Benefit. Maintenance of healed gastro-oesophageal reflux disease; initial treatment of gastric ulcer. Nexium 10 mg sachets are not listed on the PBS.
Plans to privatise hospital services such as linen, cleaning, catering and waste services at a new WA hospital have caused outrage, says WA Today. (read more)
Undiagnosed chlamydia is a major problem in young people and new cases of syphilis nearly doubled in the Hunter region of NSW, reports the ABC. (read more) Two people have been killed in a stabbing incident at a Melbourne psychiatric hospital, reports The Age. (read more)
†
†Nexium relieves symptoms of erosive oesophagitis and protects from relapse;1 Nexium restores quality of life during treatment of gastro-oesophageal reflux disease (GORD) in adult patients.2,3 §Heartburn and regurgitation symptoms associated with gastro-oesophageal reflux disease.1 Before prescribing, please review Product Information in the primary advertisement in this publication. Full Product Information is available on request from AstraZeneca. References. 1. Nexium Approved Product Information. 2. Johnson DA et al. Am J Gastroenterol 2005;100:1914-1922. 3. Kulig M et al. Aliment Pharmacol Ther 2003;18:767-776. AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde NSW 2113. Trademarks herein are the property of the AstraZeneca Group. 06/09 NEX000003r AST1943SIXb-R/CJB AZAE0710
esomeprazole
3
You said it... Podiatry EPC items blowout (link)
To have your say CLICK HERE
completly removed to rein in the budget blowout. Brad
Unused pandemic vaccine could be given away (link)
As the author of this paper, I have some concern about the uptake of podiatry EPC items being described as a "blowout". Although 1.4 million consultations sounds like a large number for such a small profession, the analysis was undertaken over a five year period. If we assume that there are 1,500 podiatrists in private practice in Australia working 48 weeks per year, the average number of EPCfunded consultations is less than four per week. Relative to the typical caseload of a podiatrist, this figure is actually quite small. Also, the statement in the paper regarding sustainability related to the EPC program as a whole - not specifically to podiatry consultations. Hylton Menz Surprise, surprise. I wonder what percentage of referrals are not clinically needed and made only to tick the "2 allied health providers" box to claim the TCA. Shouldn't be a problem when TCAs are
I believe it would be irresponsible to donate vaccine in multi-dose vials to a developing country where the risk of cross infection with HIV is so high. Dr Umberto Boffa GP, St Kilda, Victoria Good idea. Also send Roxy's newly enrolled nurses to administer the vaccines. Send Roxy to supervise. JJB
Lesions missed without whole body exams (link) Good to see that the wheel continues to be reinvented. I remember being taught as a medical student in the early 80s to do a full skin check whenever a patient presents concerned about their skin. Advice worth following, but now we have a paper to prove it. As to childhood melanoma, when asked I say that if you filled the Telstra Dome stadium with pre-pubescent children and got on the loud speaker and announced 'none of you have melanoma', you'd be right! Jim Muir
Super Clinic protest (link) Dr Sheen appears to be emerging as an exciting and dynamic leader. He is talkiing a lot of common sense and I wouldn't be surprised if a new organisation appears out of this Penrith meeting. Dr James Moxham Superclinics only work when key self employed GP’s have skin in the game - only then will you get socially responsible and sustainable provider and community engagement. Why rent a house when you can own one? More importantly, why take care and invest long term in a rented property? Is this not throwing good money after bad, its counter intuitive. David Dahm CEO, Health & Life Pty, Accountants and Practice Management Consultants
What a waste of money. Maybe a nurse-driven Super Clinic is the go. Maybe also add a vet, free dentist - 'one stop shop'. JJB Labor has already destroyed heath care beyond repair, thanks Roxon, thanks heaps! Mike
Roxon relaxes 10-year rule (link) "International students are given a lower standard of entry to Australian medical universities..." NZ citizens go through the same application process as Australian students. As non Australian citizens we do not qualify for the scholarships (John Flynn, MRBS etc) or Centrelink though, and pay our HECS upfront with no discount. Ex Kiwi Australian grad comment@6minutes.com.au
Short-changed on Super Clinics (link) I've been telling people for nearly 50 years that you NEVER trust a Labor politician's promises as far as medical issues are concerned. Look what Medibank started in the 70s. We are reaping the rewards today. This will be another nail in the already heavy medical coffin !! William Warr
Lipo sp
st i l a eci
Liposuction, Liposculpture, Lipoplasty Experienced GPs who wish to learn & practice techniques that combine medicine with science and art to produce high patient safety and practitioner and patient satisfaction, please apply to lipospecialist@gmail.com by forwarding CV & brief list of reasons for your application
Find your ideal job General Practitioner
GP - Croydon
VR GP’s
General Practitioner
General Practice Registrar
Independent Practitioner Network Limited Manly, NSW
Medi-7 Medical Centres
HealthStaff Recruitment
Melbourne
Brisbane
Independent Practitioner Network Limited Penrith, NSW
Royal Flying Doctor’s Service Broken Hill, NSW
click here for more info
click here for more info
click here for more info
click here for more info
click here for more info
4
From the editor
Never mind the quality… get the points
■ Michael Woodhead
T
he GP divisions are in town today for their annual conference and a guest speaker is the UK’s ‘primary care czar’, Professor David Colin-Thome. He’s been telling GPs at the AGPN conference that patient enrolment is a good thing, because GPs respond well to the performance targets that come with them, “especially when they see that they make
sense and encourage good practice models”. When performance targets were introduced in the UK, the government was somewhat taken aback to find that GPs were already doing their job properly and getting 100% all the time. So they moved the goalposts and gave GPs more difficult targets to achieve. So much for the czar – what do the primary care serfs think? One GP blogger reports that he has now become a full time QOF ‘point chaser’. Never mind that many of the targets are dubious, he writes, he is now continually under pressure to chase up QOF points as his priority. Missed points means missed income. “I’m getting really fed up
with the barrage of emails reminding us of all the QOF points we have missed,” he writes. And QOF now means that there is a tendency – especially among practice partners - to focus exclusively on points. “If it doesn’t bring money into the ‘practice pot’ (partners’ pockets) they are not interested,” he writes. Another effect of the QOF program, he says, is that patients are now seen in light of their point potential. Healthy people don’t score well, but those with chronic diseases are prized – especially if amenable to hitting targets. “You could have some sort of QOF über-patient,” he writes. “…a depressed obese asthmatic
with epilepsy, diabetes and heart disease? Could score a lot of points there! But to be a good patient they would, of course, have to turn up for regular review and take all the medication you throw at them.” But point chasers beware – even if you hit all your clinical targets, the QOF system then requires you to get 90% popularity ratings from your patients in a questionnaire survey. Does this mean all the whingers will quietly find themselves dropped from practice lists? And didn’t the original czar score less than 90% in the 1917 popularity stakes? comment@6minutes.com.au
PBS Information: Nexium 40 mg. Restricted Benefit. Healing of gastro-oesophageal reflux disease. Nexium 20 mg. Restricted Benefit. Maintenance of healed gastrooesophageal reflux disease; initial treatment of gastric ulcer. Nexium 10 mg sachets are not listed on the PBS. §Heartburn and regurgitation symptoms associated with gastro-oesophageal reflux disease.1 Please review Product Information before prescribing. Full Product Information is available on request from AstraZeneca. Nexium® (esomeprazole magnesium trihydrate). Indications and dosage. *Children 1-11 years: Treatment of erosive reflux oesophagitis: weight <20 kg, 10 mg once daily for 8 weeks; weight ≥20 kg, 10 mg or 20 mg once daily for 8 weeks. Long-term management of patients with healed oesophagitis to prevent relapse: 10 mg once daily. Symptomatic treatment of gastro-oesophageal reflux disease (GORD): 10 mg once daily for up to 8 weeks. Children ≥12 years and adults: Treatment of erosive reflux oesophagitis: 40 mg once daily for 4 or 8 weeks. Long-term management of patients with healed oesophagitis to prevent relapse: 20 mg once daily. Symptomatic treatment of gastro-oesophageal reflux disease (GORD) in patients without oesophagitis: 20 mg once daily for 4 weeks. Other indications/dosage in adults: Prevention of gastric and duodenal ulcers associated with NSAID therapy: 20 mg once daily. Short-term treatment of upper GI symptoms associated with NSAID therapy: 20 mg once daily. Healing of gastric ulcers associated with NSAID therapy: 20 mg once daily for 4 to 8 weeks. Healing of duodenal ulcer associated with H. pylori or eradication of H. pylori with active or healed peptic ulceration: Nexium 20 mg used in combination with 1000 mg amoxycillin and 500 mg clarithromycin, twice daily for 7 days. Pathological hypersecretory conditions including Zollinger-Ellison syndrome and idiopathic hypersecretion: 40 mg twice daily initially and may be increased. Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or other constituents of Nexium. Precautions: Hepatic insufficiency; renal impairment; pregnancy; lactation; interactions with other medicines; exclude malignancy. Interactions: Clarithromycin, cisapride, citalopram, clomipramine, imipramine, diazepam, phenytoin, warfarin, antiretroviral drugs (*atazanavir and nelfinavir are not recommended); others see full PI. Adverse Reactions (common): GI upset, headache. For less common adverse reactions see full PI. Presentations: Tablets: 20 mg and 40 mg; *Unit dose sachets containing 10 mg granules for oral suspension. Date of TGA approval: 30 April 2008. Date of most recent amendment: 7 April 2009. *Please note changes in Product Information. PBS dispensed price: 40 mg (30) $58.24; 20 mg (30) $38.11. References. 1. Nexium Approved Product Information. AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde NSW 2113. Trademarks herein are the property of the AstraZeneca Group. 06/09 NEX000003r AST1943SIXc/CJB AZAE0710
esomeprazole