Pilot to look at home based palliative care

Taxpayers will fund a trial to provide palliative care services aimed at delivering the right care at the right time while also aiming to reduce hospitalisations.

The $8.3 million pilot program will support people nearing the end of their lives so they can receive better care and treatment at home.

The Greater Choice for At Home Palliative Care program will use the government money to roll out in ten locations around Australia.

The program looks at coordinating patient supported services including: local GP treatment, palliative, hospital and specialist care support, and community and social services.

People will receive the right care at home, tailored to their own need, which will hopefully mean less trips to the hospital to access these services.

Australians who are coming to the end of their life deserve to have the best care possible.

The program will be administered through Primary Health Networks (PHNs) across Australia, and will be coordinated with local and state services, as well as aged care providers.

The ten PHNs which will take part in the trial include: Brisbane South; Central QLD, Wide Bay and Sunshine Coast; Gold Coast; South Western Sydney; Murrumbidgee; Western NSW; North Western Melbourne; Eastern Melbourne; Adelaide, and Country WA.

The trial runs until June 2020 and interested people and their families, in the trial areas, should contact their GP to discuss joining the program.

Palliative Care Australia estimates that as many as 120,000 Australians may need to access palliative care each year.

MEREDITH HORNE

[Correspondence] Germany’s expanding role in global health – Authors’ reply

Germany’s role in global health is expanding, as we outlined in our contribution to the recent Series on Germany and health.1 Manfred Wildner and colleagues rightly argue that this expansion requires a strong domestic public health sector, yet Germany’s public health infrastructure is fragmented2 and in need of domestic investment.1 The kind of investment required remains an issue of debate. Wildner and colleagues call for a reconciliation of public health services focusing on infectious disease control, and revived academic public health focusing inter alia on health promotion.

[Articles] Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data

Traditionally, efforts to improve mental health outcomes have largely focused on the development of new and more effective treatments. Our analyses show that the way psychological therapy services are implemented could be similarly important. Mental health services elsewhere in the UK and in other countries might benefit from adopting IAPT’s approach to recording and publicly reporting clinical outcomes.

Six keys to apologising for medical error

If you practise medicine for any length of time, you’ll inevitably end up being involved in a situation where a patient has been harmed due to medical error. Open disclosure to the patient is not only expected, it’s often mandated by the healthcare provider. And a key element of open disclosure is an apology to the patient or their family, using the words “I’m sorry” or “we are sorry”.

It’s by no means easy to do. Saying sorry in a medical context is so much more difficult than in other situations, according to a new interview-based study on apology in medicine, because the stakes are so high.

“As a doctor, the problem is much more serious than anything you encounter in everyday life,” one of the doctors interviewed for the study said. “When it concerns more important problems, it costs me more to make the effort to go and apologise, I say to myself, I have to through with this.”

Another barrier to apologising for medical error, the study suggests, is the fear of being blamed and fear of a demand of compensation by the patient affected. But actually, research shows that in medicine, as in other fields, apologies help resolve conflicts and litigation and are associated with fewer malpractice suits.

All Australian jurisdictions have so-called “apology laws” that protect doctors who apologise for adverse events from liability before the law. The aim of such legislation is to create an environment where doctors can express regret without it being used against them in any future litigation.

An effective apology is critical to allowing the doctor-patient relationship to continue despite what has happened, and minimises the chances of a complaint against the healthcare provider. Getting the wording right is also crucial, and should include the word “sorry”, using formulations such as “I’m sorry this has happened”, or “I’m sorry this hasn’t turned out as expected”.

Here are some tips on how to say sorry after medical error.

Acknowledge that the error has occurred;
Apologise and/or express regret for what happened;
Be careful about wording. Make sure you use the word ‘sorry’, but avoid saying you personally are liable or speculating on what staff members were at fault;
Go through the facts as you know them, and what you expect will happen next;
Listen to what your patient has to say on the matter;
Let your patient know what is being done to ensure a similar event won’t happen again.

For more information on open disclosure, click here.

Source: Avant

Interested in learning more? Professor Stewart Dunn will be moderating workshops in Sydney on complex communication in health care. The workshops will cover open disclosure, breaking bad news, end-of-life conversations and dealing with conflict in the workplace. Read more about the workshops and sign up here.

[Correspondence] Health equity in Israel

In the first paper in The Lancet’s Series on Health in Israel, A Mark Clarfield and colleagues1 praised the development of health-care services before the establishment of Israel, highlighting health-care needs among Jewish immigrants while ignoring the substantial health consequences2 of the 1948 Nakba (The Palestinian Catastrophe), when nearly 1 million Palestinians were expelled from their lands. Some were internally displaced; others became refugees who were denied basic rights. Israel missed the opportunity to create an egalitarian health-care system when the activities of Medical Services for Minorities—previously a division of the Ministry of Health— were done in collaboration with, and by the orders of, the military administration.

New test to help seniors keep independence

A major study has been released by Aged Care Minister Ken Wyatt designed to uncover frailty and spark simple interventions to help older Australians maintain their independence.

It comes with a new online test to help detect the signs of frailty while action can be taken.

The Frailty in Community Dwelling Older People – Using Frailty Screening as the Canary in the Coal Mine is a landmark report, which surveyed 3000 Australians aged over 65 and found six per cent were frail and 38 per cent were considered pre-frail.

Women were found to be more likely to be frail than men.

Mr Wyatt said he believed the simple FRAIL five-point online test was an important start to people have the opportunity to detect frailty before it hits, allowing them to take action to live better lives, remain in their own homes for longer and avoid potential hospitalisation.

The Minister encouraged older Australians to do the test and follow up with their GP as necessary.

“People classed as frail are more at risk from fall injuries, deteriorating health and premature death,” Mr Wyatt said.

“Importantly, the study recommends that with the right support at the right time, frailty can be halted or even reversed by consulting with health professionals for safe, simple, inexpensive, practical interventions.”

The study was produced by aged care provider Benetas, a large not-for-profit aged care provider based in Victoria and part of Anglicare Australia.

The aim was to validate and implement a simple self-completed tool that can accurately identify frailty. Older people who are at risk of increased dependency and/or mortality can then be identified and provided with appropriate services to keep them well.

The study found 56 per cent of elderly Australians were considered to be robust, with 41 per cent of women classed as pre-frail compared to 34 per cent of men.

Authors of the report believe frailty is generally considered to be a consequence of ageing but not all elderly people are frail.

Frailty describes any person, regardless of age, who is at heightened risk to illness or injury from relatively minor external stresses.

Frailty should be considered a syndrome rather than a disease in itself and can be defined by a number of components — unintentional weight loss, self-reported fatigue, diminished physical activity, and measured impairment (comparative to age-standardised norms) of gait speed.

The study also recommends that, with the right support at the right time, frailty can be halted or even reversed by consulting with health professionals for safe, simple, inexpensive, practical interventions.

These positive changes to decrease frailty risks include taking steps to modifying diet to include more proteins as well as taking vitamin D supplements. Increasing activity, including light resistance exercises and walking, as well as evaluating prescription medication intake, in consultation with your GP, were also recommended by the authors.

Benetas project leader Stephen Burgess said frailty was the “canary in the coal mine” which could help detect a rapid health decline before it happened.

“Frailty, including pre-frailty, is an invisible condition. Many who are frail appear to function reasonably well in the community. As a result, individuals and family members are often unaware frailty is present,” he said.

The FRAIL test is available through the Positive Ageing Resource Centre website. (www.parc.net.au). At the conclusion of the brief questionnaire, users can print off a personal summary to present to their health professional.

The PARC website is funded by an Aged Care Service Improvement and Healthy Ageing Grant from the Federal Department of Health http://www.health.gov.au/ and is developed by researchers from Monash University’s School of Primary Health Care http://www.med.monash.edu.au/sphc/ and Benetas.

MEREDITH HORNE

AMA shines in Australia Day Honours

Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).

He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.

The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.

AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).

A host of other members honoured in the awards are listed below.

AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.

“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.

“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.

“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.

“Doctors from many diverse backgrounds have been recognised and honoured again this year.

“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.

“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.

“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”

Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment.

“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.

“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”

CHRIS JOHNSON

AMA MEMBERS IN RECEIPT OF HONOURS

COMPANION (AC) IN THE GENERAL DIVISION

Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.

Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members.

Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations.

OFFICER (AO) IN THE GENERAL DIVISION

Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies.

Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards.

Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.

Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations.

Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner.

Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations.

Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.

MEMBER (AM) IN THE GENERAL DIVISION

Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies.

Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies.

Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education.

Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups.

Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste.

Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.

Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies.

Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic.

Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.

MEDAL (OAM) IN THE GENERAL DIVISION

Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health.

Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas.

Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery.

Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations.

Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.

Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.

Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.

Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.

Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.

Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.

Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations.

Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.

PUBLIC SERVICE MEDAL (PSM)

Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.

Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.

Medicare Benefits Schedule Review update

The MBS Review Taskforce continues its work into 2018, with the next round of public consultations expected for release in February.

In the meantime, a number of clinical committees have yet to begin. The Department of Health’s MBS Review team is currently accepting nominations from medical practitioners with the relevant background to participate on the following reviews:

Aboriginal and Torres Strait Islander Health, Neurology, Pain Management, Urology, Allied Health, Colorectal Surgery, Consultation Services, General Surgery, Mental Health Services, Nurse Practitioner & Participating Midwife, Ophthalmology, Optometry, Oral & Maxillofacial Surgery, Paediatric Surgery, Plastic & Reconstructive Surgery, Thoracic Surgery, Vascular Surgery

The MBS Review Taskforce also has an interest in participants (both specialists and consultant physicians) for the review of specialist consultation items.

The success of the MBS reviews is contingent on the reviews being clinician-led and the AMA encourages medical practitioners with the relevant skillset to consider nominating to the clinical committees. Follow the online links to learn more about the individual items under review by each committee.

For more information or to submit a nomination, contact the MBS Review team.

The AMA’s approach has always been to defer recommendations relating to specialty items to the relevant Colleges, Associations and Societies (CAS) and comment on the broader policy. As such, the AMA does not have direct representation on individual clinical committees but supports the commitment made by members who do contribute their expertise to the review.

Through feedback mechanisms involving the CAS, a member-based AMA Working Group and the Medical Practice Committee, the AMA has responded to every single MBS review consultation – raising issues from across our membership, while stressing where systematic improvements need to be made. The AMA Secretariat and the President have done this through direct representations with the Health Minister, the Department of Health and in writing to the Chair of MBS Review Taskforce.

Recent submissions highlighted a number clear deficiencies and significant variations in the MBS review process, signalling a need for absolute transparency from the Taskforce and leadership on the clinical committees through early engagement of the relevant CAS.

This year, the AMA will continue to press Government to ensure the reviews result in sensible reinvestment into the MBS while protecting clinical decision making. It is therefore crucial that each committee has the input of practicing clinicians and consistent, practical advice from the CAS.

The AMA continues to monitor the reviews with interest and update members along the way. The profession and the wider CAS are encouraged to do the same by engaging early with the clinical committees and public consultations. The full schedule of MBS reviews can be found on the Department of Health website: http://www.health.gov.au/internet/main/publishing.nsf/content/MBSR-about

For more information on AMA’s advocacy with the MBS reviews, contact Eliisa Fok
Senior Policy Adviser, Medical Practice efok@ama.com.au

Eliisa Fok
AMA Senior Policy Adviser

GPs highly efficient – Productivity Commission

Medical patients across Australia are highly satisfied with their GPs, according to the latest Productivity Commission report, which also found general practice to be the most efficient component of the health system.

The Productivity Commission Report on Government Services 2018 has found Australia’s general practice sector to be both cost effective and highly efficient.

But the report also shows that Australian Government total expenditure on GP services per person only grew by 80 cents between 2015-16 and 2016-17 – from $370.60 to $371.40

AMA President Dr Michael Gannon said the report highlights the funding pressure that general practice continues to operate under, and the pressing need for the Government to deliver new real investment in general practice in this year’s Budget.

“A well-resourced general practice sector can help keep patients out of hospital and save the health system money,” Dr Gannon said.

“GPs are providing more services for patients as the population gets older and, despite this pressure, satisfaction with these services remains high.

“The next Budget is a genuine opportunity to recognise and reward quality general practice.”

Dr Gannon said the Productivity Commission confirmed that the quality and productivity of Australia’s GPs is up with the best in the world.

Its report, he said, offered compelling evidence that the Government must provide greater support for general practice.

The number of GP services in 2016-17 was 6.5 per annum per head of population, which is up from 5.9 services per head of population in 2011-12.

“This reflects growing demand for GP services in the community due to the impact of complex and chronic disease, as well as an increase in GP numbers,” Dr Gannon said.

“There were 105.9 full service equivalent GPs per 100,000 population in 2016-17, compared to 82.9 per 100,000 population in 2011-12.

“Around 75 per cent of patients could get a GP appointment within 24 hours in 2016-17, which is consistent with previous years.

“Significantly, cost does not appear to be a significant barrier for patients who need to see a GP, with only 4.1 per cent of patients saying that they deferred accessing GP services due to cost.”

The Productivity Commission found that patients were highly satisfied with their GPs on a number of measures, including:

91.6 per cent said the GP always or often listened carefully to them;
94.1 per cent said the GP always or often showed respect; and
90.6 per cent said the GP always or often spent enough time with them.

CHRIS JOHNSON

Is your practice ready for the new privacy laws?

According to a recent survey, the overwhelming majority of Australian doctors are unaware or unprepared for new privacy laws which will directly affect their medical practices, and which come into force on 22nd February. These laws introduce a mandatory data breach notification requirement, meaning that doctors and medical practices will have a legal obligation to notify both the people affected by any data breach as well as the Office of the Australian Information Commissioner.

The requirement applies to breaches where “a reasonable person would conclude that there is a likely risk of serious harm to any of the affected individuals as a result of the unauthorised access or unauthorised disclosure”.

Each notification must contain a description of the breach, the type of information involved, and how the patients should deal with the data breach. Failing to notify patients of the breach can lead to fines of up to $360,000 for individual doctors and up to $1.8 million for organisations.

It’s important to note that data breaches can come in many forms and aren’t limited to criminal cyber attacks. They could also be the result of a stolen laptop containing patient information, for example, or accidental disclosure of patient records to a third party.

But it’s also true that healthcare providers have been the particular target of ransomware attacks, which encrypt a computer’s information and then ask for a ransom fee to unlock it. In the United States, around 88% of ransomware attacks have targeted healthcare providers, according to recent research. And Australian institutions have not been spared: just last year, a Queensland hospital suffered a massive loss of patient data due to a ransomware attack.

But do not assume that just because you are a small practice you are immune from cyber attack. Patient records including names, birthdates, Medicare numbers and billing information can provide a rich source of data for criminals and are readily sold on the black market.

Here are some tips for mitigating exposure to unintended data breaches in your practice:

Ensure that you properly understand your obligations under the newly amended legislation;
Check with your insurer that you are adequately covered for any unintentional privacy breaches in relation to your provision of healthcare;
Review your IT systems for collecting, storing and backing up patient information and document where the information is stored and who has access to it;
Ensure your software is up to date and that cyberscurity software is installed;
Ensure you have an emergency response plan to deal with any data breach and that you and your staff are fully aware of what to do in case of such an emergency.
Make sure you document your plan and regularly test it.

Source: Avant