SWSLHD and Bowral's Health - 74

SSRIs do not increase teen suicide risk: study - ■ Gemma Collins  - 6Minutes

Antidepressants do not increase the risk of suicide among adolescents, a study suggests.

An analysis of data from 41 clinical trials involving more than 9,000 adults and adolescents found that there was no evidence of an increased suicide risk in young people taking fluoxetine.

The study published in the Archives of General Psychiatry also found that the adults who were taking either fluoxetine or venlafaxine had a decreased risk of suicidal thoughts and behaviours.

And in all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behaviour, according to the government-funded study.

The authors found that among the 700 young patients receiving SSRIs, there was a 50% decrease in the probability of suicidal thoughts or behaviour after eight weeks, compared to 61% among control patients.

Young patients receiving fluoxitine decreased their depressive symptoms more quickly than patients receiving placebo.

“Despite a strong association between depression severity and suicide risk in youths, treatment with fluoxetine was not found to be related to suicide risk when compared with placebo”, the authors conclude.

However the authors do point out that their findings are limited to fluoxetine only.

SWSLHD and Bowral's Health - 53

Patients complain of long GP waiting times

• By Gemma Collins on  28 November 2011 - 6Minutes

The majority of patients are happy with the time that their GP spends with them but some feel they are waiting too long for an appointment, according to new figures.

More than 14.5 million Australians – 82%- visited a GP in the past 12 months, making it the most common health service accessed, according to the latest Patients' Experience Survey 2010-2011 by the Australian Bureau of Statistics (link).

Around 88% of patients said they felt their GP had always or often spent enough time with them.

However, just over 15% who had seen a GP in the past 12 months said they felt they had waited longer than acceptable to get an appointment.

And around 8% admitted that they had delayed or put off seeing a GP because of the cost of the consultation.

Nearly a third of patients managed to see their GP for urgent medical care within four hours of making an appointment, 13% had to wait until the next day and 9% had to wait two or more days.  

While only 3% had to travel more than an hour to see one, according to the figures.

Most people who saw a GP last year did so two or more times, with a higher proportion of women than men visiting a doctor and more than three quarters of patients over-75 seeing a doctor more than four times a year. 

Meanwhile the figures show more than a quarter of Australians who needed to see a dentist had put it off because of the cost and 12% of patients needing to see a specialist had done the same.
 

SWSLHD and Bowral's Health - 51

Government "committed" to mental health cuts

• By Gemma Collins on  3 November 2011 6Minutes

Doctors have pledged to continue their fight against cuts to mental health services as the government said today it was still “committed” to its original Budget plans.  

Following the release of the long-awaited Senate report into mental health services (link) President of the RACGP Professor Claire Jackson said it had “opened the door to ongoing constructive discussion” with the government. 

But her assurance came as Minister for Mental Health Mark Butler said the government would be considering the enquiry’s recommendations but was “committed to the measures in our budget”.

“We’ll consider the recommendations of the enquiry, just like we would with any other Senate enquiry,” a spokesperson told 6minutes.  

“However, we're committed to the measures in our budget which together deliver the single largest investment in new mental health measures in Australian history.”

The report released on Tuesday recommended that the cuts to the Better Access scheme, which will see GP mental health services slashed by nearly half, be delayed until there is an “adequately equipped” alternative program for patients.

“Overall, the final Senate report leaves much open for interpretation due to its failure to provide clear recommendations,” Professor Jackson said. 

“It is the opinion of the College that a strong case has been made to justify greater reward and recognition in relation to providing mental healthcare plans – an issue the College will continue to fiercely advocate for”.

She said she would be urging the government to take on the recommendation “to revise its scheduling for the 2011-12 Federal Budget changes to ensure continuity of care”, in order “to allow for a final consensus to be formed, agreeable to the vast majority of health professionals desiring the best mental health outcomes for their patients and communities.”

SWSLHD and Bowral's Health - 41

Mental health nurses improve access

• By Gemma Collins on  24 October 2011 - 6Minutes

Incorporating mental health nurses into general practice can lead to better outcomes for patients and GPs, but a shortage of these specialist nurses could make it difficult to expand the program, a pilot scheme has found.

A four-year program, which involved mental health nurses working with GPs and private psychiatrists in five states, was found to have “significantly improved” access to appropriate mental health services, a report has revealed (link).

More than 40,500 people received a service through the $191.6m Mental Health Nurse Incentive Program (MHNIP) from 2007-2011, in a range of areas which ranged from one nurse supporting one practice to seven nurses supporting 29 practices, according to the recently released report.

The authors say the program led to earlier intervention, shorter admissions and better follow-up with patients receiving mental health services in “convenient and non-stigmatising settings”.

GPs said they felt better supported in their work with mentally ill patients and said their knowledge and confidence had improved. 

Out of the 57 patients who were surveyed, 80% reported improvements in their mental health and almost half reported improvements in their social relationships. 

The government has since announced it will allocate a further $13m over two years to employ an additional 136 mental health nurses.     

But the limited availability of ‘credentialed’ nurses, particularly in rural areas, could make it difficult for the program to expand, the authors say.  

The funding which was based around a fixed payment per half day session was also found to be a deterrent, as it did not allow for any additional costs including computers or professional development and for the extra time needed to get around rural areas.

Now here is an interesting tale! I'm told that the Southern Highlands still has only one Credentialed Mental Health Nurse who provides this service. Other's have tried to enter the SH area to also provide the service but have not been supported by .... you guessed it !... the CEO of the Southern Highlands Division of General Practice..... who suggests it may be due instead to the others not being able to market themselves to the GPs. I guess it does not help if the CEO informs the GPs who are interested that they would be more open to being audited and other bits of misinformation guaranteed to turn off even the most ardent advocate for the program. The fact remains that since the failure of their own staff member in achieving credentialed mental health nurse status, the Southern Highlands Division of General Practice has taken their bat and ball and left the MHNIP field of play.

SWSLHD and Bowral's Health - 37

Smokers not quitting after cancer diagnosis

• By Gemma Collins on  19 October 2011 - 6Minutes

 
A cancer diagnosis is not motivating smokers to quit, suggesting the need for a smoking cessation intervention, an Australian study has found.

A survey of 100 patients who were newly diagnosed with cancer and receiving radiotherapy, found that half of the smokers made no reduction in their smoking habits and only two out of the 14 quit altogether, according to the study (link) in the Journal of Medical Imaging and Radiation Oncology (online Oct 18).

The researchers in Victoria and Queensland found one current smoker even increased their smoking after being diagnosed with melanoma while another breast cancer patient took-up the habit.

Any changes in smoking habits occurred within the first 30 days of diagnosis.

Around 79% of the smokers believed that the radiation oncologist should discuss smoking cessation with them and they thought that the first consultation would be the ideal time.

“…the diagnosis of cancer alone is not sufficient to obtain the benefits from smoking cessation by radiotherapy patients and some form of intervention may be appropriate,” the researchers say.  

“The results relating to the receptiveness of the patients to intervention seem to support the concept of radiotherapy providing a ‘teachable moment’ for accepting smoking cessation and perhaps other lifestyle changes.”

They do suggest that the patients are screened for symptoms of depression and anxiety as well as smoking cessation as part of standard cancer care. 

SWSLHD and Bowral's Health - 34

E-health record failure blamed on top-down approach

• By Gemma Collins on  18 October 2011

The failure of the UK’s e-health program has been blamed on rushed implementation, failure to engage clinicians and a top-down government-driven partnership with private contractors. 

A review of the UK’s program, similar to the $500 million PCEHR planned in Australia, concluded that it was “time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients.”

Researchers who reviewed five areas where the IT system was implemented through partners such as Cerner and iSoft, blamed the program’s ‘top down’ approach which led to an “unrealistic, politically driven timeline from the outset”, with “multiple tensions” between the creators and NHS staff.

In their review (link) the authors suggest there needs to be a clear vision and realistic timescale from the start with more “user involvement” of local clinicians and health staff in decision making.

They say a key lesson is the need to “move away from technology driven models of implementation,” and to “consider the merits of participating in the development of open source systems as opposed to the purchase of commercially developed systems.”

Large scale procurement projects were used in an effort to save money, but these often resulted in the ‘tail wagging the dog’ and programs being influenced by the particular type of software implemented.

 

  Comments

Yet another monumental waste of taxpayer funds. With all the privacy restrictions placed on the EHR by well-meaning but misguided people, it will only serve those who don't cause problems within the health system but would potentially generate a lot of wasted time and effort - if doctors had the time to actually do what is being asked. The drug dependent patients and doctor-shoppers where this initiative could be useful will just restrict their EHR access. What's the point of such a system? As in the UK, no benefits, just cost and effort. Why can't we learn from the experiences of others but be doomed to repeat them? Count me out. I'll give my patients a one-page summary where necessary.

Dr. Igor Jakubowicz | 18 October 2011 at 15:43

SWSLHD and Bowral's Health - 29

Quitters need support to try and try again

• By Gemma Collins on  14 October 2011

Smokers make many failed attempts to quit, suggesting more needs to be done to reduce long-term relapse, Australian researchers have found. 

Using data involving more than 21,000 smokers, researchers from Cancer Council Victoria found that the majority of quitters succeeded in staying smoke-free for more than a month, with one third having stopped for more than six months.

And the average 40-year-old smoker who started in their teens will have made over 20 failed quit attempts, according to the study (link) published in Addiction (online 12 Oct).

The review of the data from the International Tobacco Control 4-Country survey that involved smokers from Australia, Canada, UK and the US, also revealed that it was very common for smokers to think about quitting but never attempting to do it.

The researchers suggest “smoking cessation is clearly on the minds of most smokers” but the “key challenge” is helping smokers stay quit long term.

And they recommend there needs to be different interventions for those who think about quitting, those who attempt to quit and fail and those who are able to stay smoke-free for a longer amount of time.

“There is a huge amount of unsuccessful quitting activity going on among smokers.,” they say.

“We need to review what we consider to be success when around one third of current smokers have achieved that milestone (six months abstinence) in the past.”
 

SSWAHS = SWSLHD + SLHD and the GP Super Clinics

Super Clinic funding ‘wasted’ says MP

• By Gemma Collins on  24 May 2011

Every practice in the country could have had a $91,000 infrastructure grant if the funding for GP Super Clinics had been spent on existing practices instead, according to an Opposition MP.

Liberal MP Dr Andrew Southcott made the claim (see link) in Parliament yesterday as he lashed out at the $650 million GP Super Clinic program, calling it “another area of government waste”.

He said the GP Super Clinic funding would have been better spent on improvements to existing general practices.

“This approach would have provided much better value for the taxpayer and much better value for money and would have seen more results than the paltry 10 clinics around Australia that we have now,” he said. 

“Instead, the government has provided grants of up to $15 million each to a select 64 clinics in a select 64 locations, through a process with no accountability, to compete against the age-old family practices who got where they are because of a lot of hard work.”

He added that with only 10 clinics open since the government announced its plans three years ago, it could take another 23 years before all of the 64 clinics are fully operational.

Data obtained by Dr Southcott shows that almost 40% of the 64 Super Clinics are being built in districts not classed as areas of workforce shortages.

However, the government insists workforce shortage is not the only criteria that determines their locations. And Health Minister Nicola Roxon said the Super Clinics are being built in areas of need or where the clinics can help to relieve the pressure from local hospitals. 


The data does show that nearly half of the GP infrastructure grants have been allocated to regional areas

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 30

AGPN calls for more Medicare Locals to start in July

• By Gemma Collins on 15 April 2011

The AGPN is urging the Federal government to fast-track its plans for Medicare Locals after the first round was inundated with applications.

AGPN Chair Dr Emil Djakic is calling for more than the planned 15 Medicare Locals to be implemented in July after 58 bids were submitted from across the Divisions of General Practice.

Dr Djakic said that the high response rate proved the network was “willing to transform primary health care services”, although five Medicare Local areas did not attract any applications.

“The AGPN is urging the Federal government to support the commencement of as many as possible in this first round if more than 15 applications meet the eligibility requirements,” he said.

“The sooner these organisations can be established in communities across the country, the sooner the benefits to the local health system will flow to those communities.”

As reported in 6minutes, the application process has triggered disputes among some of the divisions who have been unhappy with the government’s planned boundaries for the Medicare Locals.

An independent mediator had to be called in to help resolve a row between the Sydney consortiums - the South West Health Coalition (SWSHC) and the Macarthur and Southern Highlands Divisions - who both submitted bids for a Medicare Local in the south west."

Socrates wishes good luck to the SWS Health Coalition in achieving the outcome they seek. Their preparation and community consultation places them poles apart from the secretive "Boards only" process adopted by their competitors. I hope that if the SWS Health Coalition is the successful applicant for the SWS Medicare Local, they will aim to expand their network to include the Wollondilly and Wingecarribee LGAs.

If the SWS Health Coalition can't extend their reach to the Southern Highlands area then perhaps they can give some good advice to the Macarthur and Southern Highlands Division about how they can improve their game. That is, of course, if those Divisions of General Practice retain their current funding. After all, the Medicare Locals are meant to replace the Divisions, are they not? And in the context of the proposed Budget constraints and cuts, perhaps a cut to the funding for Divisions of General Practice would be helpful.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 28

GP-type patient burden on EDs is overestimated

• By Gemma Collins on 12 April 2011
• 2 comments

"The Federal government has overestimated the burden of ‘GP-type’ patients on emergency departments which has led to “misguided” strategies including GP super clinics that are “doomed to fail”, according to doctors.

"Five senior emergency specialists have accused the Australian Institute of Health and Welfare of using a “flawed” method to calculate the number of patients in EDs who potentially require only GP services.

"The AIHW reported that 41% of patients at EDs were potentially GP cases last year.

"But in an editorial published in the Emergency Medicine Australasia, (see link), the specialists say the true figure is about 15%.

"And the inaccurate estimate has led to “unhelpful strategies” to reduce ED overcrowding, the authors say, including the $650 million GP Super Clinics, after-hours general practices being located close to EDs, and after-hours telephone consultations that are planned for Medicare Locals.

“Patients attend EDs for multiple reasons and the literature clearly shows that after-hours general practice clinics, super clinics and polyclinics fill a gap in medical services, but do not take any pressure off EDs,” they say.

"According to the editorial, the definition used by the AIHW was “made up” by NSW Department of Health Consultants, without significant clinical input.

"And it is based on GP cases being category 4 and 5 patients attending EDs, who are not admitted or conveyed to the ED by ambulance or police.

"But the triage category reflects urgency, not complexity, the authors say, and the real problem lies in the inability to move admitted patients to the ward in a timely manner, and which causes overcrowding and long waiting times."

Comments:

1.
So what has Minister Roxon have to say? Ignoring the issues as usual I see. Glad to see my tax payer dollars not at work!

John Jackson | 12 April 2011 at 19:24

2.
Our local ED medical director has been saying this for years - that 'GP style' patients are not a significant burden on the ED. This is despite the fact that the north of Tasmania has had a critical GP shortage for years - I must conclude that those of us who are there are doing a good job in limiting patients going to the ED. It must also be remembered that 'GP style' patients when presenting to the ED are easy work for the hospital. The problem is often relatively simple and, most importantly, they can be sent home not requiring an inpatient bed to see their GP for follow-up. So not only are they limited in number (15% not 41%), the ED resources that such patients consume are low. The critical issue for our ED as with others is 'Bed Block'. Successive governments have failed to provide sufficient inpatient beds to allow sick patients to be efficiently transferred out of the Department. It was thus clear to working doctors from the get-go that 'super' and 'nurse-lead' clinics as a solution to ED overcrowding were doomed to fail all at massive taxpayer expense.

Dr. Andrew Jackson, Launceston | 12 April 2011 at 15:15