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general practice

Mar 30, 2012

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A Canadian study investigating the factors that help and hinder GPs in providing care to patients with mental disorders also rings many bells locally.

Facilitators included being paid a salary or hourly fees, having longer time slots for consultations, having psychosocial mental health care teams based on site, and having access to multidisciplinary assessment, meetings and trainings.

Other enabling features were knowing mental healthcare resources and professionals, formal referral procedures, good communication between practitioners, and being informed about patients’ treatment following referral.

The study – profiled below in the latest update from the Primary Health Care Research and Information Service (better known as PHC RIS) – also suggests (indirectly) the qualities that patients might look for in a doctor.

These include GPs who are more confident or enthusiastic about treating patients with mental disorders, who have undergone more continuing medical education in mental healthcare, who favour multidisciplinary care and who are empathetic and good listeners.

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The factors that help and hinder GPs when it comes to managing patients with mental disorders

Petra Bywood writes:

Mental health problems are one of the leading causes of morbidity and comorbidity worldwide. Approximately 20% of Australians experience a mental health problem each year and for most of those who seek health services, their GP is the primary point of contact (AIHW).

Given the prevalence of mental health problems, and the demand for treatment through primary care, GPs’ skills in this area are being challenged beyond their training and a large proportion of patients’ mental health problems are going undetected or inadequately treated.

This study investigated GPs’ management of mental disorders in Quebec – the strategies they employed, the impact on their practices and the barriers and enablers to mental health management. Continue reading “What helps GPs provide better care to patients with mental disorders? And what doesn’t?”

general practice

Mar 29, 2012

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Attending recent conferences, I was struck by two comments which, in their own ways, say much about the silos and divisions within the health sector.

During a session where GP registrars were brainstorming ideas for improving the image of general practice, someone suggested that specialists should be re-named “partialists”, as a way of highlighting the value of the generalist.

(As a by-the-by, I’ve never quite understood why general practice has been so desperate to be viewed as a specialty given the many merits of a generalist workforce and the acknowledged downsides of a specialist-based health system. Maybe, just maybe, it’s something to do with the skewiff remuneration system…)

The other comment came during an informal conversation at an Australasian College of Health Service Management conference, where one battle-weary state health bureaucrat suggested that taking the states out of healthcare (ie having a federal/regional system) would, amongst other things, “remove one layer of hate” from the system. Some of the context to the discussion was the fierce tribalism and competition that goes on, whether between professions, services or bureaucracies.

No doubt many different interpretations could be drawn from these comments but for me a linking thread is the need for systematic efforts to build more cooperative, collaborative relationships between the many tribes of health.

One of the more interesting presentations at the Association of Health Care Journalists conference in Philadelphia last year was by Associate Professor Christine Arenson from the Thomas Jefferson University in Philadelphia, which has pioneered interprofessional education.

This has been defined as: “The collaborative process by which teams of health professionals develop curricula and courses, coordinate and plan practical experiences jointly, and team teach groups of interdisciplinary health professional students to provide holistic care throughout the lifespan.”

Arenson, Co-Director of the Jefferson InterProfessional Education Center, said the historic silos in health professional education have had profound implications for patient safety, as the various professions have not learnt from the outset about each others’ competencies, scope of practice, or how to work effectively together.

“We have a health care system which has been driven by professionals in competition with each other for scope of practice and perceived increasingly scarce dollars,” she told the conference. “One of the first things many industries do is train them to work in teams. We’ve never done that, we have just assumed they will figure it out.”

Her university brings together students from medicine, nursing, physical therapy, pharmacy, couples and family therapy, and occupational therapy. Arenson described some of the difficulties of the long journey to introduce interprofessional education, which included breaking down some of the barriers between faculties.

“We had to bring people to the table together to get to know each other and to develop trust,” she said. “It takes a lot of time and resources. Our experience shows that it requires a tremendous amount of leadership at most senior levels of the organisation.”

All of which is a long-winded introduction to the piece below by Professor Peter Brooks – a longstanding, vocal advocate of the need for health workforce and education reform, and Director of the Australian Health Workforce Institute at the University of Melbourne.

In the column below, first published earlier this month by Medical Observer, he suggests that every health professional should rise each morning and ask themselves ‘what did you do yesterday that could have been done by someone else?’ Continue reading “Tackling some of the tribal divisions within health”

adverse events

Mar 29, 2012

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The Federal Government needs to do a much better job of explaining the reasons for its reluctance to introduce a no fault compensation scheme for vaccine-related injuries, according to Associate Professor Heath Kelly.  To date, the responses to calls for such a scheme have not been helpful, he suggests.

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Why won’t the Government support such a scheme?

Heath Kelly writes:

A seminar at Sydney University held on Monday 26 March explored ethical issues in immunisation.

One of the questions asked on the day was, why does Australia not have a no-fault scheme for the serious and rare adverse events that on “the balance of probabilities” were caused by a vaccine?

Such schemes exist in 19 countries and the fist scheme was established in Germany more than 50 years ago (1). The scheme in the United States, which is funded by an excise on vaccine doses distributed, is billions of dollars in surplus (2).

In addition to Germany and the US, no fault compensation schemes operate in the UK, Japan and New Zealand, countries with which we would happily compare ourselves. Compensation occurs when the adverse event is shown to be caused by a vaccine and is assessed as being through no fault of the vaccine manufacturer, regulator or administrator. Continue reading “Why won’t the Federal Government support a no fault compo scheme for vaccine-related injuries?”

Twitter celebrated its sixth birthday last week, and this week it is the turn of The Conversation to be marking its first anniversary.

According to the site’s co-founder, Andrew Jaspan, The Conversation has had more than 2.5 million unique visitors in its first year, almost 4 million total visits, and 8 million page views. Over 300 websites and newspapers have republished its content, which is free under a creative commons licence.

Jaspan says around 40 per cent of the academics and researchers who write for The Conversation report receiving follow up requests from other media outlets.

From Croakey’s perspective, The Conversation has quickly become a useful source of health and medical news and debate.

By contrast, another new online publication, The Global Mail, does not appear to rate health as a priority – its listing of story categories includes arts & culture, business and economics, environment, people, politics, religion, science and technology, and sport.

Of course health stories could slot into any of these categories but the fact health does not rate a category in its own right (given that it is one of the country’s major policy/reform challenges, a large industry, and is an ever-expanding soak of public and private funding) is noteworthy. Health is such a huge and complex area that it requires a systematic approach to investigation and analysis. (It should be acknowledged though that TGM has done some worthwhile and innovative work in the health space).

It would be nice to see some wider innovation in health journalism (The Health Reporter, as recently covered on Croakey, didn’t last long, and has been taken offline.  One of the founders told Croakey today that they hope to resurrect it down the track if financial backing can be found).

As I tweeted this morning, I am quite jealous of US health journalists for the range of philanthropic support for public interest health journalism there, as per these fellowships.  They seem more likely to make a constructive contribution than the proliferation of health journalism prizes that we have, funded by single interest groups (eg this one from the pathologists).

Meanwhile, in the article below, Fron Jackson-Webb, Health and Medicine Editor of The Conversation, tells us about some of the highlights of her year.

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Health + Medicine: reflections on our first year

By Fron Jackson-Webb, Health and Medicine Editor, The Conversation

In The Conversation’s first editorial meeting editor Andrew Jaspan explained what he wanted to achieve with the site: a more informed level of debate, based on evidence, research and expert opinion.

It was frustrating, he said, that scientists and other experts were often pitted against non-experts in news stories. And because they were given the same amount of space and were quoted alongside each other, readers might consider the two voices equally informed on a topic.

And so, The Conversation was born. From March 2011, experts had another platform from which to share evidence-based research, information and opinion with a general but curious audience. Perhaps most importantly, readers could join the discussion, share their insights and even interrogate the evidence. Continue reading “Health & medical celebrations at The Conversation, plus a wrap of other health media news”

As previously mentioned, an interesting research project has been exploring the nexus between research and policy making.

In the article below, Abby Haynes, research officer at the Sax Institute, reports on some of the implications of the findings for researchers and policy makers.

And at the bottom of the post is a link to a resource that may be useful for those with an interest in knowledge translation or communications more broadly.

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For research to make a difference…

Abby Haynes writes:

When the worlds of policy and research collide, great things can happen in public health. The trouble is, such productive collisions don’t happen nearly enough.

As many as 50% of academic papers are never read by anyone other than their authors, referees and journal editors.

The vast majority of research publications, even those in applied fields such as public health, have no influence on health policies or health services practice.

So if we want to achieve health policy in Australia that is informed by the best available research – something I’m pretty sure most people would agree is worth striving for – then how do we bridge this gulf?

An important step is better understanding the mechanics of what happens when researchers do produce and present research that resonates in policy circles. What are these researchers doing differently? Continue reading “Ensuring that research makes a difference: some practical advice”

global health

Mar 23, 2012

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On the eve of World TB Day, governments, international donors and drug companies are being urged to step up their commitment to fighting a “health emergency”.

In the article below, Dr Marianne Gale, a TB and HIV Advisor for Médecins Sans Frontières, describes the terrible toll that this disease is taking upon people around the world.

(Update, 26 March: And more on related themes from other MSF doctors in this PLoS blog, Zero MDR-TB deaths in children in my lifetime?)

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An urgent plea for help on World TB Day

Dr Marianne Gale writes:

As we mark another World TB Day and the 130th anniversary of the discovery of the tubercle bacillus by German physician Robert Koch, there is little reason to celebrate.

The global crisis of tuberculosis sadly continues, its scale only expanding as most governments and donors sit idly by.  This emergency is only exacerbated by the increase in the deadlier form of the disease, the strain of TB that does not respond to the regular drug regimen, multidrug resistant TB (MDR-TB).

In light of new data collected by Médecins Sans Frontières, it is alarming to note that there is little being done to avert a health emergency.

We are finding MDR TB in shocking numbers, notably in new patients, suggesting the crisis is much larger than had been thought. In South Africa for example, our teams have seen a 211 percent increase of TB diagnosis per month in our clinic in KwaZulu Natal following the introduction of a new rapid diagnostic test. Of those patients confirmed, 13.2 percent were resistant to the drug rifampicin, one of the most effective drugs for treating TB.

As my colleagues from Médecins Sans Frontières and I see on a daily basis, MDR-TB takes a horrific toll on a patient. A persistent cough, fever, weight loss, chest pain and breathlessness will ultimately lead to death if the right treatment is not administered.

There are currently an estimated 650,000 people living with MDR-TB worldwide. Shockingly however, around 90 percent of these patients have absolutely no access to treatment. Continue reading “Marking World TB Day with a call for urgent action on an international “health emergency””

aged care

Mar 23, 2012

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More than 130 aged care campaigners descended on Parliament House last week as part of the Australians Deserve to Age Well campaign, which is calling for the Federal Government to commit to aged care reform in the forthcoming Budget.

Claire Maskell from Palliative Care Australia, a member of the National Aged Care Alliance that organised the campaign, provided this summary.

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Australians speak up: we deserve to age well

Claire Maskell writes:

The message is clear: We can’t afford to wait any longer for aged care reform.

The facts are well known. Our population is ageing and by 2050, over 3.5 million Australians are expected to use aged care services each year –that’s three times the number that currently use the system, and it’s already buckling under pressure.

Trying to access aged care services is like navigating a minefield, it’s hard to know where to start, it’s inconsistent, and very complicated. Continue reading “Hearing from the people about the need for aged care reform”

chronic diseases

Mar 23, 2012

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There is so much rhetoric in the health sector about the importance of collaboration, multidisciplinary approaches and teamwork. But there are many barriers to translating the rhetoric into reality.

In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a study that makes timely and relevant reading for Medicare Locals’ staffers and others involved in primary health care reform. No doubt the results will also be of interest to patients, particularly those with diabetes or other chronic conditions requiring long-term, multidisciplinary management.

University of NSW researchers interviewed 45 health service providers from 19 organisations in a rural city (including fee-for-service practices and block funded public sector services) and eight patients, with the aim of exploring the influence of power dynamics and trust on collaboration between health professionals involved in managing diabetes.

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The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus

Olga Anikeeva writes:

The primary health care sector is critically important in diabetes care, as diabetes is the second most frequent chronic condition managed in general practice and the most frequent reason behind referrals to other health care providers in Australia.

In order to effectively manage type 2 diabetes, patients require access to well coordinated care from health professionals including GPs, specialists, educators, dieticians, optometrists and podiatrists.

The authors used a qualitative case study approach to explore the experiences and perceptions of participants involved in providing or receiving care for type 2 diabetes. Data were collected through semi-structured interviews that were audio recorded, transcribed and thematically analysed.

Three themes emerged that related to power dynamics between health professionals. The first of these was the use of power by health professionals to protect their autonomy.

GPs maintained their autonomy by engaging in a low level of collaboration with allied health professionals. They rarely consulted and collaborated with other providers, with little two-way communication. Continue reading “Unpicking some of the barriers to better collaboration between health professionals involved in diabetes care”

health reform

Mar 21, 2012

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A major challenge for the next Queensland Government will be to address systemic problems within the health sector, says Professor Andrew Wilson, Executive Dean of the Faculty of Health at Queensland University of Technology (and who has previously held senior positions within the Queensland and NSW health departments).

In the article below (cross-posted from The Conversation), Wilson outlines some areas requiring the attention of the incoming government, including the need for more out-of-hospital care, a regional focus, and new approaches to governance and management.

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The five priorities in health for the next Queensland Government

Andrew Wilson writes:

No matter who wins the Queensland election this Saturday, the next premier of Queensland will have to face up to some serious challenges within the state’s health system.

There were improvements made under the Bligh government, including major improvements in hospital infrastructure. But without addressing issues of governance, skills, and quality access to care in regional areas all these gains will come to nothing.

The following are the top five priorities for the winner of the election and their next government.

1. Accountability

Queensland Health, the state government department responsible for public health services, has been a key vulnerability for the Bligh Labor government for its whole term of office. The Labor government did make gains here, but it is more likely to be remembered for the safety failures at Bundaberg Hospital and the mess of its failed payroll system.

Both of these are clear examples of a failure of governance and accountability. The decision to proceed with a new payroll system with Queensland Health was high risk given its complexity and size. Responsibility was split between two departments. Continue reading “The next Queensland Government has some heavy lifting to do in health”

aged care

Mar 21, 2012

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In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a new trial focused on improving management of patients with dementia in general practice.

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Early diagnosis of dementia offers a window of control in a disintegrating world

Christina Hagger writes:

Dementia carries many burdens. There is the lost productivity for people living with dementia, as well as their carers; the need for costly support services and the emotional costs suffered both by people with the disease as well as the impact on their families and friends.

GPs are often reluctant to diagnose a disease that causes such immense suffering and also lacks a known cure.

Yet, there are some positive outcomes to be gained from an early diagnosis. It allows people to plan ahead and, importantly, even retain some sense of control.

Early recognition of symptoms can allow reversible causes of cognitive decline to be addressed as well as identification and management of co-morbidities such as depression. Continue reading “Improving the management of dementia in general practice”