Telehealth services for patients : Submissions sought.

The Gillard Governmen has released a discussion paper seeking views on the most effective delivery of telehealth services for patients. The discussion paper asks for views on the clinical situations and medical specialties in which telehealth would be most helpful and how it will work in practice. The paper also seeks comment on the remuneration models that could be employed, the financial incentives to ensure uptake and ongoing participation in the model, the training and support required, as well as technical issues. The Department of Health will also be consulting stakeholders on telehealth issues through a new Advisory Group which will include professional medical colleges, peak medical and nursing bodies and consumer and aboriginal health representatives.

Submissions close on 27 January 2011

Commentary from " The Australia" on telehealth plan. Rural patients having remote video consultations with city-based medical specialists will not necessarily be in their GP's surgery. The first Medicare rebates for telehealth will become available from July next year

AMA's Public Hospital Report Card 2010

Australian Medical Association (AMA) President, Dr Andrew Pesce, said that there had been little improvement in public hospital capacity and performance despite significant extra Commonwealth funding as part of the National Healthcare Agreement and specific funding for an elective surgery "blitz".

The AMA Public Hospital Report Card 2010 is an analysis of the most recent publicly available national data on public hospital performance plus more recent feedback from doctors working in public hospitals in all States and Territories. Dr Pesce said the most telling finding of the report card is that there were only 11 new hospital beds opened across Australia during the 2008-09 reporting period which falls well short of the AMA's estimate that 3,870 additional beds are needed for the public hospital system to operate at a safe 85 per cent average bed occupancy rate

Media release

Thousand of kids living with problem drinkers

New research from the National Drug and Alcohol Research Centre shows more than 700,000 children live with parents who drink heavily. The study, presented at a drug and alcohol conference in Canberra today, reveals 24 per cent of parents reported heavy drinking behaviour. The report's co-author, Dr Lucy Burns, says children often pick up negative drinking patterns from their parents.

Study probes links between cannabis and schizophrenia (Uni of Wollongong)

The University of Wollongong is heading up new research into the links between cannabis use and drug induced schizophrenia. Researcher Doctor Nadia Solowji says the study will use volunteers to assess the impacts of long-term and recreational use.

Cognitive behaviour therapy used to combat psychosis (UTS study)

For most people with illnesses like psychosis the standard treatment is medication, rather than counselling. But researchers at the Health Psychology Unit at the University of Technology, Sydney say cognitive behaviour therapy (CBT) can help, and are running a study to gauge the effectiveness of CBT in patients with early psychosis.

Yael Perry is leading the study and says there is evidence that CBT can help patients with early psychosis. "There is good evidence across a number of studies to suggest that CBT is effective in reducing core symptoms of psychosis, especially symptoms such as hallucinations and delusions," she said. This article examines the positive benefits of using CBT.

Indigenous health checks : a failed policy in need of scrutiny (Lesley Russell)

As the evidence mounts that efforts to "close the gap" on Indigenous disadvantage are faltering, and with the recognition that much more is needed to address the health care needs across all Indigenous communities, we are confronted with a situation where a key mechanism for uncovering and addressing health problems is ineffectual.

Health assessment or health check items under which Medicare will reimburse for preventive health services to Indigenous patients, were introduced in 1999. In comparison to other MBS preventive services, these items were well reimbursed, generally offering a GP between $175 and $200. Nevertheless, the uptake of these items, has been very low.

Every year over 400,000 Indigenous Australians are entitled to receive a Medicare heath check. In 2009-10 less than 12% of the eligible population got such a check. Despite the emphasis placed on children's health and the ongoing Northern Territory Emergency Response(NTER), in the Northern Territory in 2009-10 only 12.7% of children aged under 15 received a health check.

An additional issue is that there is nothing in place to ensure that health problems uncovered in the course of health checks are addressed in a timely fashion. Published data suggests that about 80% of health checks show health problems that need follow-up treatment or referrals. Even in the NTER communities, with allocated funding for the purpose, the delivery of follow-up care has lagged.

To address these issues and ensure that Indigenous people get access to the health care services they need,Dr. Russell proposes that immediate action should be taken to:

1. Understand and address the barriers for GPs and their Indigenous patients to the effective and widespread utilisation of Medicare Benefits Schedule item 715.

2. Consult with Indigenous health providers and communities about the way they would prefer to see these services delivered, where and by whom.

3. Implement and fund an improved program for health assessments across all age groups.

4. Put in a place a system to ensure that all health problems found as a consequence of a health check are appropriately addressed and resolved.

5. Provide for independent and transparent monitoring and evaluation of this new program.

Euthanasia in Australia: Raising a disability voice

Euthanasia in Australia: Raising a disability voice by Erik Leipoldt of the Curtin University of Technology Western Australia reviews the current state of the euthanasia debate.

Euthanasia legislation is currently being pursued in many State jurisdictions and a Federal Parliamentary debate on restoring Territorial rights to legislate in this area is imminent. Its consequences will reflect on what kind of society we want to have. Whatever we decide won't be easy to unwind once we have made that choice. The Australian euthanasia debate is inviting us to conclude that lives lived with disability are often not worth living, while actual disability experience points to a contrary reality. Disability voices and perspective are seldom heard but are essential ingredients of a fully informed debate. Their experience shows that there is a social context within which requests for euthanasia arise, which calls for the best possible care and support. Set in that context, it is not possible to build any effective safeguards against euthanasia. Some information on the Dutch euthanasia experience is included in arguing against adopting euthanasia laws and for using disability experience of interdependence as an ethically responsible framework for dealing with suffering.

Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times (AIHW)

Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2009 to 30 June 2010. In 2009-10: almost 6 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 610,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days.

Media release

Weight loss surgery in Australia (AIHW)

This report shows that there was a substantial increase in weight loss surgery in Australia, from approximately 500 separations in 1998-99 to 17,000 in 2007-08. In 2007-08, 90% of separations for weight loss surgery were in private hospitals, with private health insurance funding 82% of separations. In 2007-08, the estimated cost of hospital care for weight loss surgery was $108 million-approximately $15.2 million in benefits was paid through the Medicare Benefits Schedule for weight loss surgery-related procedures.

Media release )

Health of Australians with disability: health status and risk factors (AIHW)

Almost half of Australians with severe or profound disability are not in good health, according to a report released by the Australian Institute of Health and Welfare. Health of Australians with disability: health status and risk factors, found that 46% of Australians aged 15-64 years with a severe or profound disability reported poor or fair health, compared to only 5% of those without disability. People in this group had higher rates of all types of long-term health conditions than those without a disability. People with severe or profound disability were more likely to have acquired a long-term health condition earlier in life than those without disability. Some of these conditions were diabetes/high blood sugar level before the age of 25, arthritis before the age of 25 years and osteoporosis before the age of 45 years.

Media release

Health of the people of NSW 2010

The health of the people of NSW - Report of the Chief Health Officer. Summary Report, 2010 is the latest report in a series produced every two years since 1996 to provide key information on the status of the health of N.S.W. It also plays the role of providing information on the effectiveness of public health programs and on factors critical to maintaining a healthy life.

A child born in NSW in 2007 would now expect to live 79.8 years if male and 84.4 years if female, an increase of 3.3 years for males and 2 years for females since 1998. Death rates from major causes of disease and injury have significantly fallen in the last 10 years and there have been improving trends for some risky behaviours such as smoking, sedentary behaviour and inadequate fruit and vegetable consumption, which lead to disease.

However, overweight and obesity rates have increased by more than 3% in women and by 2% in men in the last five years. The consumption of vegetables, while improving, has remained too low in both men and women, with fewer than 15% of men and women eating the recommended amount of vegetables in 2009.

The report also highlights the poor health outcomesof the Aboriginal population of NSW. Rates of avoidable deaths and hospitalisations, infant mortality and premature or low birth weight babies are unacceptably higher in Aboriginal compared with non-Aboriginal people in NSW. Reducing inequities in health outcomes remains a major challenge in NSW.

The Superguide: a handbook for supervising doctors in training

A new practical guide for supervisors of junior medical officers is now available. The guide has been developed in consultation with clinicians across the State by CETI's Medical Division (The Institute of Medical
Education and Training.

"There is good evidence about what makes good clinical supervision, but the literature is diffuse and not readily accessible to busy supervisors. We wanted to publish a short guide based on the evidence that was practical and motivating." author Roslyn Crampton said. "Successful supervision uses the necessities of clinical oversight as the opportunity for training and education, so that safe supervision today becomes the foundation for safe independent practice by the trainee in the future."

The Superguide covers a wide range of topics in the areas of clinical oversight, clinical teaching (with many practical teaching tips), keeping trainees safe and well, and term supervision. A resources section includes references, forms and checklists.

Australia's mothers and babies 2008 (AIHW)

Australia's mothers and babies 2008 is the 18th report providing information on births in Australia from perinatal data collections for each state and territory.

In 2008, 292,156 women gave birth to 296,925 babies in Australia. The increase in births continued, with 2,720 more births (0.9%) than reported in 2007. This is the second year that the rate of caesarean section has not significantly increased with a 0.2% rise from 30.9% in 2007 to 31.1% in 2008.

Media release

Self-injury in Australia

The prevalence of self-injury in Australia is substantial and self-injury may begin at older ages than previously reported, according to an article in the Medical Journal of Australia.

Graham Martin, Professor and Director of Child and Adolescent Psychiatry at the University of Queensland, and co-authors conducted a cross-sectional study to gain an accurate understanding of self-injury and its correlates in the Australian population. A sample of 12,006 Australians, from randomly selected households, participated in the study.

In the four weeks before the survey, 1.1 per cent of the sample self-injured. Six-month prevalence was 1.8 per cent. Lifetime prevalence was 8.1 per cent. For females, self-injury peaked between 15 and 24 years of age. For males, it peaked between 10 and 19 years of age. The average age of onset was 17 years, but the oldest was 44 for males and 60 for females.

Urgent action required on mental health hot-spots

The Federal Government should urgently provide more effective support for people in remote areas where there are clusters of self-harming behaviours. Evidence has recently come to light of high local rates of self-harm and suicide in parts of the Northern Territory and central Queensland.

"There are some good suicide prevention programs in Central Australia, including some run with flexible funding by Aboriginal community controlled health services," said Dr Jenny May, Chair of the Alliance. "However recent evidence from other parts of remote Australia shows there are still very serious unmet needs. Someone has to be accountable for the duty of care in such matters, including in remote Indigenous communities.

Collective apathy: alcohol and child abuse in the NT

The NT Government’s recent report on child protection, ‘Growing them Strong,Together ‘blames the three 'G's' - grog, ganga and gambling for the tsunami of child neglect and abuse in Indigenous communities in the Territory.But according to this ABC report, equally to blame is collective apathy. What has been tolerated in Aboriginal communities would never have been tolerated in the major cities and towns of Australia.

Outreach choir (Aboriginal Mental Health Program)

Queensland's Aboriginal and Islander Health Council has set up five community choirs to attack the symptoms of mental illness and bring sufferers into contact with health professionals.

Indigenous Australians are five times more likely to experience mental illness than the rest of the population - a problem often exacerbated by their reluctance to seek help. Now a new program's been developed to tackle mental health issues through song. Queensland's Aboriginal and Islander Health Council has set up five community choirs to attack the symptoms of mental illness and bring sufferers into contact with health professionals. The scheme has been given a helping hand by Indigenous country and western star Roger Knox, who himself overcame crippling depression and an addiction to painkillers.

WHO releases recommendations on rural workforce retention

Increasing access to health workers in remote and rural areas through improved retention : Global policy recommendations

Globally, approximately one half of the population lives in rural areas, but less than 38% of the nurses and less than 25% of the physicians work there. While getting and keeping health workers in rural and remote areas is a challenge for all countries, the situation is worse in the 57 countries that have an absolute shortage of health workers.

After a year-long consultative effort, this document proposes sixteen evidence-based recommendations on how to improve the recruitment and retention of health workers in underserved areas. It also offers a guide for policy makers to choose the most appropriate interventions, and to implement, monitor and evaluate their impact over time.

The report has important recommendations for all those involved in education & training of rural health staff, and all those struggling with the problem of persuading staff to remain and work in a rural community.

Australian commentary

Injury of Aboriginal and Torres Strait Islander people due to transport, 2003-04 to 2007-08 (AIHW)

Land transport accidents accounted for 20% of fatal injury cases and 8% of all injury hospitalisations for Aboriginal and Torres Strait Islander people. Based on age-standardised rates, there were 2.7 times more fatalities and 20% more serious injury among Aboriginal and Torres Strait Islander people compared to other Australians.

Australians missing out on new medicines: report

A new report looking at patient access and public coverage of new medicines in industrialised countries shows that Australia ranks in the bottom third by many measures.

The Rx&D International Report on Access to Medicines 2009-10 ranks Australia 23rd out of 31 OECD countries in terms of expenditure on medicines as a proportion of GDP.

Medicines Australia chief executive Dr Brendan Shaw said: "In essence this report measures the willingness of governments to pay for new innovative pharmaceuticals and Australia doesn't stack up too well."

Key findings in the report include:

* Australia ranks 24th out of 30 countries for government's share of national healthcare expenditure.
* Australia ranks 19th out of 29 in terms of willingness to reimburse new medicines. Of the 150 medicines reviewed in he study, Australia reimburses 60 per cent, compared with the OECD average of 64 per cent.
* The proportion of first-in class medicines included in the study that were subsidised in Australia is 52 per cent compared with an OECD average of 65 per cent, ranking Australia 20th out of 29.
* In terms of oncology medicines, Australia ranks 20th out of 29 countries when looking at the number of medicines that are subsidised.

The Rx&D International Report on Access to Medicines 2009-10 was commissioned by Rx&D, the Canadian research-based medicines industry association.

Births Australia 2009 (ABS)

Births, Australia 2009 contains statistics for births and fertility in Australia, states and territories, and sub-state regions, based on calendar year of registration data. It also has information on characteristics of the child including place of usual residence, sex, Indigenous status, and age, martial status and country of birth of parents.

A total of 295,700 births were registered in Australia in 2009. Of these, 15,800 births were registered where at least one parent was an Aboriginal and Torres Strait Islander Australian.

New Search engine for PDFs

PubGet is a search engine which specialises in retrieving PDFs. It indexes full-text journals in the life sciences including medicine. Search results go directly to the PDFs. Although not totally comprehensive, it can save considerable time when searching for journal articles on clinical topics. Pubget can be easily configured to a particular university or other major library to enable direct access to a library e-journal collection.

Medicare Locals - Discussion Paper - Submissions by 15th November

The Australian Government has committed to establishing a national network of primary health care organisations, known as Medicare Locals. Medicare Locals - Discussion Paper on Governance and Functions specifically addresses the following areas:

* What will Medicare Locals do?

* What will Medicare Locals look like?

* How will Medicare Locals interact with patients and providers?

The paper outlines five key objectives for Medicare Locals:

1. Identification of the health needs of local areas and development of locally focused and responsive services including a stronger focus on prevention and early intervention

2. Improving the patient journey through developing integrated and coordinated services

3. Providing support to clinicians and service providers to improve patient care, particularly the better prevention and management of chronic disease

4. Facilitating the implementation and successful performance of primary healthcare initiatives and programs

5. Being efficient and accountable with strong governance and effective management

The Government's discussion paper and information on how to respond to the discussion paper is available at the link above.Submissions must be received by 15 November 2010.

The Mental Health of Doctors

The mental and physical health of medical students and doctors in Australia is an ongoing concern within the medical profession and community. Recent research and media reports have highlighted the high rates of suicide, depression, anxiety disorders, substance use and self-medication throughout the profession.

To address these issues, beyondblue has developed a national Doctors' Mental Health Program, in consultation with key stakeholders from the mental health and medical sectors.

The Advisory Committee's first activity was to oversee "The Mental Health of Doctors - A systematic literature review:" (Download from bottom of page) which investigated issues associated with the mental health of medical students and doctors. The review investigated the following 10 topic areas:

1) prevalence of anxiety and depression

2) prevalence of substance misuse and self-medication

3) suicide rates

4) risk factors for anxiety and depression

5) help-seeking rates for anxiety and depression

6) barriers to help-seeking for mental health care

7) interventions for anxiety and depression

8) attitudes of medical colleagues

9) impact on patient care

10) impact on work and family life.