more_vertThis cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing.
Preference: Emergency Medicine
202
More resources, faster internet the key for rural health
Rural doctors have overwhelmingly identified the need for improved public hospital funding and better internet access as the most important solutions for rural health care.
In the first AMA survey of rural doctors since 2007, GPs, other specialists, salaried doctors and doctors in training were asked to rank in importance 20 proposed solutions to improve the health of rural Australians.
Almost 600 doctors took part in the 2016 AMA Rural Health Issues Survey in April.
And, as they did in 2007, they nominated “provide extra funding and resources to support improved staffing levels, including core visiting medical officers, to allow workable rosters” as their top priority.
In a sign of the growing use of internet-based communications and data, access to high-speed broadband was not a survey option nine years ago, but was ranked as second-most important in this year’s survey.
Ensuring that rural hospitals have modern facilities and equipment rose one space to third, and encouraging medical colleges to include rotations for trainees to rural areas rose from sixth to fourth.
Related: Rural doctors want support
AMA President Dr Michael Gannon said the survey results showed that rural Australia needs more resources to recruit and retain doctors and other health professionals.
“We have record numbers of medical school places and, with sufficient numbers of medical graduates coming through, the focus must now be in how we can get them to work in the places they are needed the most,” Dr Gannon said.
As one respondent said: “I cannot stress enough the importance of rotating specialist/vocational trainees into rural posts. The RACS and RACP have done so for years with great exposure and training of prospective doctors for a rural practice. Other colleges must follow suit, especially psychiatry, radiology, pathology, O&G, and emergency medicine, to name a few key deficiencies in rural placement or training.”
The survey found that rural doctors enjoy their careers but struggle with the workload and lack of support.
Related: MJA – Providing a lifeline for rural doctors
“It’s very hard to find locum support to take holidays/attend conferences, and as the only specialist in my field in all rural WA, extra support to maintain CPD and be able to go on holidays would be nice,” one respondent said.
But the response from the community makes the job rewarding, doctors said.
“Small towns often appreciate what little I could do for them,” one doctor said.
The survey results build on the AMA’s Plan for Better Health Care for Regional, Remote, and Rural Australia, released in May.
The Plan proposes a focus on four key areas – rebuilding country hospital infrastructure; supporting recruitment and retention of doctors; encouraging more young doctors to work in rural areas; and supporting rural practices.
“Addressing and investing in these measures will make a long-term difference to the health of Australians living in rural communities,” Dr Gannon said.
Maria Hawthorne
Photo credit: Nils Versemann / Shutterstock.com
Latest news:
Baggoley steps down
The former Deputy Chair of Health Workforce Australia has been appointed to replace Professor Chris Baggoley, who has retired as the nation’s Chief Medical Officer.
Professor Brendan Murphy, who served on the now-defunct HWA and has been Chief Executive Officer of Austin Health in Victoria since 2005, has been selected by Health Department Secretary Martin Bowles to succeed Professor Baggoley in the frontline role.
Mr Bowles announced Professor Baggoley’s departure last week, and praised the leadership he had shown in the CMO role in the past five years, particularly in advancing the nation’s response to mounting global antibiotic resistance, the threat of communicable diseases, and improved detection of non-communicable illnesses such as cancer.
The Health Department head singled out Professor Baggoley’s significant contribution to the international response to epidemics including Ebola, Middle East Respiratory Syndrome (MERS) and, most recently, the Zika virus.
In addition to his work on the World Health Organisation’s International Health Regulations Emergency Committee – which played a central advisory role during the Ebola, MERS and Zika outbreaks – Mr Bowles said Professor Baggoley had also been instrumental in work to improve the nation’s defences against, and response to, international health emergencies.
Professor Murphy will take up the CMO position on 4 October. In the interim, the position will be filled by Dr Tony Hobbs, who has been appointed Deputy CMO.
Adrian Rollins
Family doctors: invaluable to health
As the new Chair of the AMA Council of General Practice, I am honoured to follow on from my predecessor, Dr Brian Morton, and wish to acknowledge him for his six years of leadership and service to the Council and to general practitioners.
It is certain that as a profession we will have some interesting times ahead of us as the dust from the Federal Election settles. If there is one thing we know for sure from the last few weeks, it is that putting health on the backburner is risky business. The Government must be in no doubt now that health is a priority, and that it will have to do more than it has to date to ensure vulnerable patients do not have to worry about whether or not they can afford to see their GP when required, and to have pathology and radiology investigations when requested.
Next week we will be celebrating general practice and the primary role played by Australia’s GPs, our family doctors, as frontline and holistic health care providers. Throughout Family Doctor Week (24-30 July), the AMA will be highlighting how invaluable the family doctor is to patient health, and to the health system more broadly.
We know from international comparisons that countries with a strong GP-led primary care system have lower rates of ill health, better access to care, reduced rates of hospital admissions, fewer referrals to other specialists, less use of emergency services, and better detection of adverse effects of medication.
The comprehensive care provided by our nation’s family doctors needs to be seen by Government as an investment rather than as an expense. With only 6 per cent of Australia’s total health expenditure on general practice, our family doctors have proven the value of their care. Ending the freeze on Medicare rebates, raising the rebates and lifting rates of indexation to cover the true costs of care must be at the top of the Government’s to-do list.
For most patients, our general practices are their medical home. If appropriately funded, rather than struggling for viability, we know we can do more to help our patients live the healthiest life they can. We can do this though appropriate health screening and life-stage assessments, through structured care that is patient-centred and planned, through greater use of innovative technology that not only empowers patients in managing their conditions, but enables us to monitor their progress, through better use of medicines, and through care that is streamlined and coordinated within our multidisciplinary health care team.
Family Doctor Week will highlight that, properly funded, the medical home has the potential to both improve the care patients receive, and to save on more costly downstream health costs.
Supporting general practices to bring non-dispensing pharmacists into the health care team is but one way Government can invest to deliver better patient outcomes and minimise avoidable hospital admissions. The AMA’s Pharmacist in General Practice Program would deliver $1.56 in savings for every $1 invested by ensuring the quality use of medicines, medication optimisation and increased medication compliance, reducing adverse drug events and hospitalisations as a result.
In rural and remote areas, Government needs to assist general practices with appropriately designed and implemented infrastructure grants to expand their facilities to better meet the complex health needs of people in these communities.
You can support us in supporting you by visiting the website family-doctor-week-2016 and downloading and displaying the poster and your Family Doctor Logo, and by using #amafdw16 if tweeting or sharing FDW content on social media.
[Correspondence] Medical response to 2016 earthquake in Taiwan
An earthquake with a moment magnitude of 6·4 struck southern Taiwan at 0357 h on Feb 6, 2016. The earthquake caused 513 injuries (in people aged 0·5–92·0 years, mean 40·8 [SD 20·5] years; 245 [48%] of whom were men) and 117 deaths (in people aged 0·5–75·0 years, mean 32·0 [SD 19·1] years; 62 [53%] of whom were men; figure). This earthquake was the deadliest to have occurred in Taiwan since the 921 earthquake in 1999. Of the 513 people who were injured, 501 (98%) were sent to emergency departments in the first 72 h after the earthquake; 146 (28%) were transferred to emergency departments by ambulance; 67 (13%) were triaged as severe, 371 (72%) intermediate, and 75 (15%) mild.
Victoria on measles alert as infections mount
Victorian health authorities have issued a statewide measles alert to GPs and hospitals amid fears there are “multiple” undiagnosed people who are unwittingly spreading the highly infectious disease in the community.
Warning that the number of cases are likely to mount, Victoria’s Acting Chief Health Officer Dr Finn Romanes said investigations were “strongly indicating there were now multiple undetected cases in the community potentially spreading the infection”.
There are already four confirmed cases, including a young woman who had been in Shepparton, Melbourne’s CBD, Melbourne Airport and Brisbane while infectious with the illness.
Authorities have revealed that three of the cases involved people aged between 18 to 30 years, all of whom became infected in early to mid-June, and none of whom had recently travelled overseas – the usual route by which measles is introduced to Australia.
“Because of this, our concern is that there was a person or persons who probably had travelled overseas, and have since unknowingly passed on measles to these three people in the western suburbs and Barwon area – and there may be more,” Dr Romanes said.
“There is now the potential for these three people and anyone else was has been infected to pass on the disease and create a significant outbreak.”
Dr Romanes said it was likely that the three had been infected while in Melbourne’s CBD between 10 and 13 June.
But he admitted the source of the infection had yet to be determined, and it was likely that people in outer metropolitan Melbourne, as well as in some Victorian regional areas and interstate had been exposed – one of those infected travelled to Brisbane on 1 July.
“There are many other areas across metropolitan Melbourne where infections may have been acquired, and individuals have attended a range of public settings across Melbourne and in regional Victoria whilst infectious, including Shepparton,” Dr Romanes said.
He said the infection may also have been acquired in Geelong and the Surf Coast, and warned that “it is likely there will be more cases related to this outbreak”.
Family doctors and hospital emergency department staff have been put on alert for measles in patients who present fever at rash onset, particularly if they are not fully immunised or are unaware of their vaccination status.
While measles is uncommon in Australia because of widespread vaccination, it is still prevalent in many areas overseas, and local outbreaks were usually linked to returning travellers.
Nationwide, between 90 and 92 per cent of children are vaccinated against measles, but some adults – particularly those born after 1966 – are not immunised.
Dr Romanes recommended those unsure of their vaccination status to be immunised as soon as possible, and for parents to ensure their child’s vaccinations are up-to-date.
He asked anyone unwell with a fever and rash who was not fully vaccinated for measles to ring ahead to their doctor or hospital and alert them that they may have measles.
“The doctor or hospital will then be able to immediately isolate them whilst assessing for measles, which will minimise spread to others,” he said.
Adrian Rollins
[Comment] The French experience of the threat posed by Zika virus
On Feb 1, 2016, a public health emergency of international concern was declared by WHO1 as the possible association between Zika virus and clusters of microcephaly raised international awareness. France was in a unique position to evaluate and respond to the situation for a number of reasons. First, the 2013–14 French Polynesian outbreak was the initial report of neurological and congenital complications in people infected by Zika virus, with an increase in incidence of Guillain-Barré syndrome and eight reported cases of neurological congenital malformations.
News
AMA award winners presented at national conference
At the recent AMA National Conference the following awards were presented: AMA President’s Award in recognition of outstanding contributions to the care of their fellow Australians — Dr Paul Bauert, who for 30 years has fought for better care for Indigenous Australians and, more recently, children in immigration detention, and Vietnam War veteran Dr Graeme Killer, who has devoted his life to improve the care of current and retired Defence Force personnel; Doctor in Training of the Year Award for outstanding leadership, advocacy, and accomplishments of a doctor in training — Dr Ruth Mitchell, a neurosurgery trainee currently in her second year of her PhD at the University of Melbourne, and a neurosurgery registrar at the Royal Melbourne Hospital, and chair of the Royal Australasian College of Surgeons’ Trainee Association; Woman in Medicine Award, presented to a woman who has made a major contribution to the medical profession by showing ongoing commitment to quality care, or through her contribution to medical research, public health projects or improving the availability and accessibility of medical education and medical training for women — Associate Professor Diana Egerton-Warburton, in recognition of her exceptional contribution to the development of emergency medicine, and her passion for public health; Excellence in Healthcare Award recognises ongoing commitment to quality health and medical care, policy, and research, and is awarded to an individual or individuals who have made a significant contribution to improving health or healthcare in Australia — Associate Professor John Boffa and Ms Donna Ah Chee, who have made an enormous contribution to reducing harms of alcohol and improving early childhood outcomes for Aboriginal children.
Global emergency call on yellow fever outbreak
The World Health Organisation has been urged to take emergency action over a rapidly spreading yellow fever epidemic that has so far infected more than 2000 people in Africa and Asia.
Health experts at Georgetown University’s Institute for National and Global Health Law, writing in the Journal of the American Medical Association, have warned that “quick and effective action” is needed to halt the spread of the disease, which has already killed more than 250 people in Angola and has appeared in Congo, Kenya and China.
The experts, Dr Daniel Lucey and Professor Lawrence Gostin, said that shortages in the supply of the yellow fever vaccine raised the risk of a “health security crisis” if the disease spreads through Africa and reaches Asia (which has never experienced a yellow fever epidemic) or the Americas (where the mosquito that can transmit yellow fever is endemic).
“The WHO should urgently convene an emergency committee to mobilise funds, coordinate an international response, and spearhead a surge in vaccine production,” they said.
Dr Lucey and Professor Gostin said delays in the international community’s response to the 2014 Ebola outbreak that eventually infected 28,646 people and claimed 11,323 lives should serve as a salutary lesson of the costs of a tardy response.
“Prior delays by the WHO in convening emergency committees for the Ebola virus, and possibly the ongoing Zika epidemic, cost lives and should not be repeated,” they said. “Acting proactively to address the evolving yellow fever epidemic is imperative.”
Yellow fever kills around 30,000 people a year, mostly in Africa, and the latest outbreak has added impetus to mass vaccination programs. More than 7 million Angolans have been immunised against yellow fever, and in May the Democratic Republic of Congo Government announced plans to vaccinate 2 million of its citizens.
Dr Lucey and Professor Gostin warned that these mass immunisation campaigns “could be a tipping point in exhausting global vaccine supplies”.
Medical experts have already advised that just one-fifth of normal vaccine dose be administered to avert the risk of an acute shortage if the disease spreads, but Dr Lucey and Professor Gostin said it was time for the WHO to step in.
They said the world health body should invoke procedures similar to those used during the Ebola epidemic to safeguard vaccine supplies.
“Stewardship of scarce vaccine supplies is essential, but requires the WHO’s Director-General to declare a public health emergency of international concern,” they wrote. “[But] it is only by convening an emergency committee that the Director-General could declare a public health emergency of international concern.
“Given the world’s vital health security interest, the WHO’s Director-General should use [the procedures] to authorise a reduced vaccine dose to control the epidemic in Angola.”
Dr Lucey and Professor Gostin said the yellow fever outbreak, combined with the experiences of the Ebola and Zika epidemics, showed that the WHO needed to have a standing emergency meeting that met regularly, rather than having to be formed each time a serious global health threat arose.
“The complexities and apparent increased frequency of emerging infectious disease threats, and the catastrophic consequences of delays in the international response, make it no longer tenable to place the sole responsibility and authority with the WHO’s Director-General to convene currently ad hoc emergency committees,” they said.
Adrian Rollins
[Comment] Platelets after intracerebral haemorrhage: more is not better
Spontaneous intracerebral haemorrhage has a disproportionally high burden of mortality and disability compared with other subtypes of stroke.1,2 As a clinician, when faced with a condition as devastating as intracerebral haemorrhage, one feels compelled to use any and all therapies available, even though at times evidence of effectiveness of those therapies is not yet established.1 This is particularly the case for many health-care providers on the front lines of emergency diagnosis and treatment for patients who have had an intracerebral haemorrhage while taking antiplatelet therapy.