Alcohol and ‘health halos’: a risky mix

Alcohol marketing strategies are being scrutinised again as new research highlights the misleading health claims being placed on alcohol products.

Lead researcher Ms Julia Stafford, Executive Officer of Curtin University’s McCusker Centre for Action on Alcohol and Youth, told doctorportal that there has been a shift among consumers towards health and wellness. The alcohol industry has responded to this threat by advertising products labelled as low carb, low sugar, natural or preservative free.

“We’re seeing alcohol marketing often picking out very minor points about their products, like highlighting that it’s infused with electrolytes or purified water.”

“Using these health claims, which really don’t mean much to your health, creates this health halo over these products which still contain similar alcohol to other products”

The study, published in Public Health Research and Practice, analysed examples of new product developments and monitored alcohol industry publications for information on key trends and comments from alcohol company executives.

The researchers said that existing regulations do not appear to be sufficient in restricting health-related claims made by alcohol marketers as alcohol products continue to be advertised in association with health. They added that this can have significant implications for the way consumers view these alcohol products.

The problem with health halos

Ms Stafford said the main danger with alcohol products making these claims is that although the drinks aren’t genuinely healthier, “people might think they are. They have this health halo over them and pretty packaging with a fruit on it so they might consume them differently.”

“We’ve seen with low carb beer that people think it’s healthier and therefore might be more inclined to drink more of it on occasions.”

However, the label does not change the fact it is still a full-strength alcohol product, with all the same health risks associated with it.

She said the key focus of alcohol labelling should be the alcohol content, “not all these other claims about it being fresh, pure, natural or preservative free, which is misleading consumers about the health impact of the product.”

Regulation of alcohol marketing is still lacking

In Australia, alcohol marketing is self-regulated by the alcohol and advertising industries.

“That has all sorts of problems with it – those regulations are incredibly weak in lots of different ways,” Ms Stafford said.

Current marketing regulations do not cover the kind of health-related claims that are now being made on alcohol product packaging.

“The industry knows what they can do to get around existing regulations and still give consumers a strong suggestion these products are healthier and make health-related claims without breaching any of the regulations.”

The evidence base is strong – now it is time for action

Ms Stafford said there is already a strong evidence base to support the need for industry reform. Governments need to step in and take self-regulation away from the alcohol and advertising industries, and implement legislated and independent controls.

“Our research looking at the health claims is really just adding one extra part to that already existing, strong rationale for why governments should be regulating alcohol marketing much better than what is currently happening.”

[Perspectives] Now we’re talking: bringing a voice to digital medicine

Communication—respectful, honest, accurate, and individualised—is the cornerstone of effective health care. But such communication can be near impossible to receive in a location convenient for the individual, and even after travelling to a primary care visit it will typically last less than 5 min for half of the world’s population. Consequently, communication with health-care providers is too often relegated to sickness care in response to one consultation rather than to overall health management.

Coalition’s own goal on health policy

Scott Morrison is the new Prime Minister, Peter Dutton’s ambitions have been put on hold (for now), Malcolm Turnbull will leave politics, and it is highly unlikely that Greg Hunt will be back as Health Minister (having run as Deputy to Peter Dutton).

Over the coming hours, days, and weeks, there will be resignations, recriminations, a new front bench, and a new direction for the Coalition Government under Scott Morrison.

But through the murkiness of the Government’s leadership crisis this week one thing is starkly clear – the Coalition has scored a massive own goal on health policy with a Federal election just months away.

To continue the football analogy, the Government has gone into a penalty shootout to decide the World Cup final without a goalkeeper.

Come election day, Labor could well have free shots at goal on public hospital funding, private health insurance, the MBS review, primary care reform, and prevention – just for starters. And that is before Mediscare Mark 2 kicks in.

Yes, Labor is well prepared to repeat the tactics of 2016 to undermine the Coalition’s credibility on health. And the polls provide further ammunition.

With Greg Hunt’s resignation ahead of the leadership spill, the Government lost its third Health Minister since its election win in 2013.

After the co-payment disaster under Peter Dutton and the loss of Sussan Ley after her promising start in the key but complex health portfolio, things were looking pretty good for the Government and the sector with Greg Hunt at the helm.

Minister Hunt had won the trust and confidence of the profession, and had quickly developed a solid knowledge across the breadth and depth of health policy and the major players in the sector.

He was also a master at the PR side of health – lots of new drug announcements, photo ops with kids in hospitals, and a Ministerial office with an open door for advocates, lobbyists, and campaigners, including successive AMA Presidents.

He oversaw the gradual lifting of the Medicare freeze.

He was managing the MBS Review and the PHI Review with end dates in sight for reporting and implementing outcomes.

There was even talk of the Coalition matching Labor’s promise on public hospital funding.

He was fixing the My Health Record legislation to give greater confidence on security and confidentiality – and pledging a big education campaign to convince the Australian people to stay opted-in.

And he was working with the AMA and others to develop a bold new vision for general practice and primary care.

Greg Hunt was across his brief and had strong and friendly working relationships with most of the major health sector players.

The failed Health Care Homes trial and the botched launch of the My Health Record opt-out phase are negatives, however.

Now he is gone, and with him a lot of the hope that genuine meaningful health reform was within reach.

With the Federal election due in the first half of 2019 – but now possibly much earlier – the Coalition must go back to square one to rebuild its health policy credentials.

Sure, the bureaucratic machinery will continue behind the scenes with the various reviews, but there is no longer a credible messenger or an experienced tactician to craft the strategic political health messages that are needed to win votes in the limited time available.

With no obvious strong candidate on the horizon to take over Health, there is an outside chance that new PM Scott Morrison might try to make peace with the warring factions and keep Hunt in the portfolio. We will see.

You need a good spinner to be a winner. It is indeed an own goal.

Falls prevention should start in middle age: research

Falls prevention begins at 40, experts say, as new research challenges the assumption that falls are a problem of old age only.

Researchers studied the prevalence of self-reported falls among more than 19,000 men and women aged 40-64 in Australia, Ireland, Great Britain and the Netherlands, using longitudinal survey data.

Writing in the journal PLOS ONE this month, they warned: “While the prevalence of falls is lower in middle-aged adults than in older adults, the current findings show that the prevalence is not low.”

Women more at risk of falls

Falls in middle-age were more common among women than men (27% versus 15%) and the prevalence rose sharply over the mid-life period. The rate of falls in women was 9% at 40-44 years old, 19% at 45-49 years old, 21% at 50-54 years old, 27% at 55-59 years old and 30% at 60-64 years old.

The study concluded: “The sharp increase in prevalence of falls in middle-age, particularly among women, supports the notion that falls are not just a problem of old age, and that middle-age may be a critical life stage for preventative interventions.”

Overall, Australia had the highest falls rate, although the Australian cohort was older and included women only (10,556 women from the Australian Longitudinal Study on Women’s Health).

The authors suggested that the greater increase in prevalence of falls among women than men may be explained by the concurrent stronger increase in prevalence of risk factors such as arthritis, cardiovascular disease and post-menopause.

Lead study author, Dr Geeske Peeters (PhD) of the Global Brain Health Institute at Trinity College Dublin, told doctorportal the findings highlighted a need to intervene in mid-life to reduce falls risks.

“It is obvious that falls require attention not only after the age of 65 but also before the age of 65,” she said.

Balance and strength training needed earlier for falls prevention

“We know that balance and strength training is important in older adults,” she said. “As balance starts to decline from age 40, and poor mobility seems to be an important predictor of falls, it is reasonable to expect that balance training may also be beneficial in middle-aged adults.”

An earlier study by Dr Peeters and colleagues identified several factors that increased the risk of falls in middle-aged Australian women, including obesity, impaired vision, depression, joint stiffness, fatigue and osteoporosis. Hormone replacement therapy (HRT) was found to be protective.

However, the study failed to identify a clear trend with age in the number and types of significant predictors, with the authors reporting a “complex interplay of risk factors”.

Professor Susan Davis, director of the Women’s Health Research Program at Monash University noted previous research showed middle-aged and older women were at greater risk of falls if they were more physically active.

“Perhaps the kind of physical activity they do does not always take into account the need for multi-modal activity, such as balance exercises in addition to walking,” she said.

Menopause also a risk factor

She explained how menopause could also influence falls risk.

“Menopause is associated with increased tendinopathy, which the physiotherapists report all the time,” she said. “So there is possibly a hormonal effect on soft tissue that affects musculoskeletal integrity, and therefore the potential to fall.”

“Women also gain central fat at midlife and increase total body fat even if they do not increase total body weight; more fat with less muscle adds to less musculoskeletal integrity.”

Professor Davis said the study’s finding of a protective effect of HRT on falls risk may reflect a “healthy user” bias. In other words, women might be less likely to use HRT if they have impaired vision, poor physical functioning or other illness causing tiredness.

HRT might also have an independent protective effect by reducing the incidence of bone loss and lowered mood, she said.

The study authors said their findings were potentially limited by recall bias, and by slight differences in the measurement of falls between cohorts.

What use is the high moral ground when you are being eaten alive?

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA

GPs’ livelihood and ability to practise are being attacked on many fronts. Dubious role substitution creep from usurper health care practitioners must stop. Does the fight need to come to their doorstep instead of doctors always being in defence?

The Acting President of the Pharmacy Guild recently likened the AMA to a “salivating and barking dog,” following a perceived “onslaught of abuse and derision,” in a response to broader scope of practice for pharmacists. The hyperbole was rousing!

It was suggested that prescribing medications, being able to capably understand and diagnose a patient’s medical problems without appropriate training or ability to garner a full history and examine, and to provide health prevention advice is within the scope of pharmacy training? Clearly not true. The aircraft engineer doesn’t pilot the plane, serve the drinks, or unload the luggage. Being able to work a sphygmomanometer and having a basic understanding of physiology does not make you a doctor or capable of giving medical advice while standing in the middle of a retail pharmacy. The benefits of an enduring, familiar family doctor who knows you well and can provide wide-ranging advice and treatment is well evidenced and the appropriate cornerstone of our health care system. Pharmacists are not required to do any part of this job.

It was also asserted that self-defined broader scope of practice for pharmacists will also save money and time for patients. Not really if outcomes are inferior. Where is the evidence that pharmacists behaving as quasi-doctors achieves anything? Regular interactions with general practitioners is crucially important in developing an enduring bond, discussing risk factor modification, and so on. Government cannot ‘de-fund’ general practice, then attempt to remove the more simple work, and expect the system will still work given growing patient complexity and potential risk.

If you want to be a doctor – go to medical school. Australia is graduating just under 4000 doctors this year – there’s no lack of space! Please, do not abandon doing the job you are actually trained to do. Patients need direction in how to use their inhalers every few months (or their technique degrades), explain the purpose of medications (both prescribed and over the counter), clarify dosing regimens for patients, make sure warfarin interactions with diet are understood by patients, sort out pill boxes or Webster packs to reduce medication errors, and so on. This unequivocal in-scope pharmacy activity is performed far less than it should. If it was done frequently and properly, it would be far more useful to patients and contribute more robustly to the safety and quality of the system, compared to the constant attempts to do a doctor’s job in a rudimentary and inferior way.

The AMA has always decided it is morally and ethically more appropriate for doctors to not dispense medications as a system- wide policy (bearing in mind it has usefully occurred in rural areas for a long time). It would actually be very convenient to patients if doctors did dispense medications (to use one of the Guild’s main arguments for role substitution), and we could make it cheaper to the system as a whole if the costs reflected the dispensing fees only, without profit being generated, and/or any profit being retained within the practice for other patients’ services. If doctor dispensing of medications became a reality, individuals would not have to do it, if they didn’t want to. If patient convenience and cost are paramount in the system, whereas training, evidence, and professionalism do not matter as much to decision-makers, then we perhaps need to recognise this.

Offence might serve us better than defence. Is the AMA position due for a re-think?

Shared Responsibility

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

New amendments to the Health Insurance Act 1973, strengthening the Government’s debt recovery powers and seeking to tackle the role of corporate entities in billing under Medicare, have recently been passed by Parliament.

Practitioners may have a debt to the Commonwealth raised against them due to receipt of incorrectly, inappropriately, or fraudulently claimed Medicare benefits. However, according to the Government, a large proportion of these debts has proven difficult to collect. New powers will allow the Department of Human Services to off set a portion of future bulk billed claims against debts. If the practitioner doesn’t bulk bill, the new arrangements will allow garnisheeing of other funds owed to them.

So, more than ever, it is in practitioners’ interests to get their claiming right from the outset.

The problem, as many of you have no doubt found, is trying to get clarity when you are unsure of how to interpret an item or an applicable rule. The Department of Human Services ‘ask MBS’ email for billing enquiries was supposed to provide this. However, the answers are often very unclear or non-committal.

What you are likely to get today, at best, is the regurgitation of either the item descriptor, rules, or legislation back in response to a query. At worst, you will get a misinterpretation and advice that is contrary to the rules. The incorrect advice recently provided to a GP Registrar that GPs could not claim a consultation when providing a vaccination, where the vaccine is funded under the National Immunisation Program, is a prime example.

This is not good enough and must be addressed! The AMA Council of General Practice recently made this point to the head of compliance at the Department of Health. If the Department hopes to increase compliance through education, it needs to have on staff medical advisers who understand the legislative requirements and have experience in their application. The Department of Health should also consider bringing ‘ask MBS’ within its realm of responsibility.

The other legislative change, which will take effect on 1 July 2019, is provision for a Shared Debt Recovery Scheme. To date, all the liability for a Medicare debt has been with the individual practitioner, except in cases where another party has engaged in fraud. The new change provides that, where contractual or other arrangements exist between a practitioner and an employer or corporate entity, both may be held responsible for the repayment of the debt.

What the percentage split of the liability between the employing/ contracting organisation and the individual practitioner is, is still to be finalised. Although it is likely it will be similar to the average of current billing splits. Both sides will have the opportunity, where a shared debt determination is made, to make a case for a review of assigned liability.

The objective of this measure is for a fairer assignment of liability and to facilitate greater billing assurance from a practice level as well as from the practitioner level. This is a proposal that the AMA strongly supported as part of improving debt recovery arrangements.

We are still to see how these new compliance arrangements will play out in practice. Most GPs seek to do the right thing, and the AMA be watching the implementation of these measures with interest to ensure its fairness and appropriate application

Super Saturday for health

The big message from the Super Saturday by-elections is that health remains one of the biggest, if not the biggest, issue on the minds of voters, and will once again be a critical factor in the next Federal election, expected in the first half of 2019.

Labor, which retained the seats of Perth, Fremantle, Longman, and Braddon, – with Mayo being retained by the Centre Alliance’s Rebekah Sharkie – campaigned hard with a local focus on public hospital funding and access to health services.

There is a strong theory in Canberra circles that the controversy around the My Health Record further undermined the Coalition’s health policy credentials.

Writing in The New Daily, political commentator, Paula Matthewson, a former adviser to PM John Howard, said that “… the lesson is that health is more important to more voters than almost any other issue, including the economy. Get health policy wrong and you risk throwing away the election”.

Matthewson said that Labor’s ‘Hospitals, not Banks’ slogan ranked in effectiveness with Labor’s 2016 Mediscare campaign to focus voters’ minds on health policy.

The Federal AMA is already putting together its health policy manifesto for the next election. General practice reform, public hospital funding, private health insurance, the MBS Review, the My Health Record, and medical workforce will feature prominently.

Australian Patients Association wants chronic pain coordinators in every GP clinic

MELBOURNE: With one in three Australians over the age of 65 suffering from chronic pain, The Australian Patients Association is calling for coordinators trained in pain management to be a standard feature of primary care medical practices. The role would coordinate care in a highly complex medical system in which patients struggle with medication compliance, access to specialists, and financial management.

To address confusion around medication misuse The Australian Patients Association is holding a forum exploring the impact of prescription medications entitled Medication Myths, Mistakes and Misuse, at Melbourne Town Hall on Sunday 5^th August 2018.

The Australian Institute of Health and Welfare National Drug Strategy Household survey 2016 found that 2.5 million (or 12.8%) people in Australia misused a pharmaceutical drug at some point in their lifetime. 1 in 20 (4.8%) Australians misused a pharmaceutical in the last 12 months with pain-killers/analgesics and opioids the most commonly misused class of pharmaceutical (3.6%)¹.

Pain is one of the most common reasons people seek medical assistance. One in five Australians live with chronic pain and the prevalence of chronic pain is projected to increase as Australia’s population ages – from around 3.2 million in 2007 to 5 million by 2050².

Thirty-eight-year-old Alana Jordan is a Melbourne-based manager who has coped with chronic pain since the age of 16. Despite years of experience and a high level of health literacy, she struggles through the existing delivery care model.

“Chronic pain is invisible for most people – you don’t look sick! You have to coordinate with a lot of Specialists: Neurologists; Pain; Rehabilitation; Physiotherapists; Psychologists; Pharmacists; and General Practitioners. A lack of coordinated services and prohibitive healthcare costs for patients suffering complex or rare illnesses, results in patients advocating and coordinating their own healthcare. These issues lead to many patients using online forums to communicate and discuss issues. There is a clear lack of knowledge in the community about chronic pain and complex rare illnesses, treatment options, medication side-effects and potential drug interactions.

Medically trained, trusted advisors/advocates to coordinate the patients journey is desperately needed, along with affordable integrated pain management services 24/7 to improve the quality of life for sufferers. The impact to society is far reaching both economically and psychology, as every patient has carers, family and friends taking on the roles that a modern democratic healthcare system should be providing.”

The Australian Patients Association believes the complexity of the day to day management means that patients should be able to access an advocate to assist in treatment.

National Strategy Director of the Australian Patients Association, Michael Riley says,

“Chronic pain is a complex condition marked by unpredictable and potentially debilitating flare-ups. This can wreak havoc on a person’s ability to sleep, work, care for their families and has a strong association with mental illness, including depression. Reponses to pain medication vary drastically between individuals. Many patients have to manage their care directly which can be suboptimal.

“GP clinics are accessible locations for advanced practice nurses trained specifically in pain cases who can negotiate, manage and coordinate between specialists, and advise patients on medication and track results. They would not take the role of a pain specialist but they would be in a patient’s corner providing support.”

The Australian Patients Association is dedicated to championing and protecting the rights and interests of patients and improving overall patient care and health outcomes. The forum will explore appropriate use of prescription medications, discuss pain management and how patients, the pharmaceutical industry, doctors and pharmacists can work together to educate the public on the appropriate use of medications and harm prevention strategies.

Australian Patients Association Hotline 03 9274 0788 helps thousands of patients and relatives every year in answering their queries about any aspect of the healthcare system.

Diabetes apps: regulation concerns grow

PATIENTS with diabetes should be warned about the potential for insulin dosing errors with glycaemic control smartphone apps, experts warn, as regulators struggle to oversee the rapidly growing sector.

There are over 1500 diabetes apps available online – a number growing faster than any other health care sector, according to Dr Rahul Barmanray and Dr Esther Briganti, Melbourne endocrinologists writing in this week’s MJA.

“Although apps increasingly advise on insulin doses, there is minimal published information on safety and efficacy, despite these apps effectively providing drug treatment recommendations without health care professional oversight,” they wrote.

Most diabetes apps are not listed with the Therapeutic Goods Administration (TGA), but even those that are have not been required to undergo third-party assessment as they are only Class I devices. Dr Barmanray and Dr Briganti wrote that as a result, the Australian public were not receiving the health and safety protection they ought to reasonably expect from the regulator.

A spokesperson for the TGA told MJA InSight it was considering stricter regulation of the sector, consistent with reforms in Europe.

“The new rules [in Europe] capture decision making software like dosage calculators … [These] apps will now be a higher classification requiring third-party certification. Australia is preparing to undertake consultation for similar regulatory reforms,” the spokesperson said.

The new rules align with the categories proposed by an international working group, which included the TGA.

However, the TGA has previously highlighted challenges with regulating the fast-moving medical software sector. In a recent presentation, TGA Medical Officer Dr David Hau highlighted the problem of “feature creep”, in which therapeutic functions are added to new updates without regulatory oversight.

The most popular diabetes apps in Australia are the companion apps to diabetes pumps, which are regulated as part of the entire glucose monitoring or insulin delivery system, Dr Barmanray noted. However, many apps are developed by home-tinkerers.

Simon Carter is a lead software engineer. He has also lived with type 1 diabetes for 29 years. He developed an Australian app when his daughter was diagnosed with the disease. He told MJA InSight that he would not welcome greater regulation of medical apps.

“It is already too costly, and existing regulation is too outdated to capture the nuances offered by apps,” he said.

Mr Carter said that some patients were using the app to guide multiple daily insulin injections, others were using it in conjunction with an insulin pump.

Mr Carter argued that it was “absurd to imply that only doctors or diabetes educators can provide insulin dose advice”.

“My practical experience and self-education far outstrips the content of the 1-year part-time diabetes educator course.

“Diabetes is probably the only disease where the doctor provides a suggested dose and the patient has to tailor that multiple times per day based on food intake, activity level, blood sugar results and other factors,” he said.

“The doctor is not there to provide round-the-clock guidance, and this is why these apps are so important.”

Dr Barmanray and Dr Briganti urged health care professionals to “remain circumspect” about recommending diabetes apps – especially those with therapeutic functions – in the absence of adequate regulatory safeguards.

They cited the largest review of insulin dose calculation apps to date, which found that of 46 apps, only one was without a safety concern.

Some apps had design flaws that made them more prone than others to patients incorrectly entering data, the study found.

Others had fundamental problems with the underlying software, with two-thirds carrying the risk of generating incorrect and hypoglycaemia-inducing outputs despite data being correctly entered.

Dr Barmanray and Dr Briganti warned: “It is unclear who, if anyone, is medico-legally responsible for adverse effects related to app-derived therapeutic recommendations”.

Mr Carter commented: “We take total responsibility for both preventing patients receiving flawed advice from the app, as well as promptly correcting any issues that might occur.”

Professor Jane Speight, Foundation Director of the Australian Centre for Behavioural Research in Diabetes at Deakin University told MJA InSight that patients should treat diabetes apps as “tools with limitations”.

“The very use of the term ‘[dose] calculator’ implies a level of accuracy that may not be appropriate or realistic,” she said. “That said, many people are making such decisions every day based on guesswork or informed by education undertaken at diagnosis. So, I think we need to be realistic that people will try these apps.”

Professor Speight said that there were promising examples of industry and academia now working together to carefully develop diabetes apps with appropriate regulatory considerations.

“The opportunity to reduce the cognitive and psychological burden of managing diabetes is quite considerable,” she said. “However, we do need the reassurance that industry will go through appropriate steps to ensure the safety and effectiveness of these apps before we can recommend them wholesale.”

The TGA encourages users of medical device software, including apps, to report any issues encountered, even if they may be considered “user errors” or fixable by a reboot.

Between 2016 and 2018 the TGA recalled four diabetes apps – three by Roche (Accu-Check) and one by Medtronic (Guardian). Errors in the apps could have led to incorrect bolus insulin advice or to patients not receiving alerts associated with hypoglycaemic or hyperglycaemic events, the TGA warned.

Professor Speight recommended the T1 Resources website, which provides advice and recommendations about apps and other resources for type 1 diabetes.

This article was first published by MJA InSight. Read the original version here.

Poor and elderly Australians let down by ailing primary health system

Primary care services are usually our first point of contact with the health system. Each year, about A$50 billion – nearly a third of all health expenditure – is spent on more than 400 million primary care services delivered by more than 90,000 providers. This includes GPs, pharmacists, dentists, podiatrists and maternal and child health nurses.

Although by world standards Australia has an extensive set of primary care services, the Grattan Institute’s new report, Mapping Primary Care, finds too many poorer Australians still can’t afford to go to a GP when they need to, or a dentist when they should.

Beyond the cost issues, Australia’s primary care system is fragmented and poorly coordinated, and is ripe for reform.

High out-of-pocket costs

About 4% of Australians delay seeing a GP because of cost. About 7% delay or do not fill their prescriptions.

About one-third of patients pay for GP services at least once a year, with an average out-of-pocket cost of around A$34. If a GP prescribes medication, non-concessional patients pay up to A$39.50. Together with the GP consultation, this quickly adds up to A$75 or more for those who are not bulk billed.

Out-of-pocket costs are higher again for allied health and specialist medical practitioners. On average, allied health practitioners charge A$40 to the patient and specialists A$75. About 8% of people delay seeing a specialist because of cost.

Cost is an even bigger problem for dental services. Around 18% of Australians delay seeing a dentist because of this. More than half of six-year-olds and one-third of adults have tooth decay.

Not surprisingly, out-of-pocket costs are a bigger problem for people on low incomes. One-quarter of those on the lowest incomes delay or do not see a dentist because of cost.

Rural shortages

People who need to see a GP, allied health practitioner, dentist or specialist medical practitioner are less likely to do so if they live in a rural location, due to workforce shortages.

There are half as many GPs, 25% as many allied health services and 20% as many specialist medical services per person in remote rural areas as in major cities.

Compounding the problem, state government-funded primary care and specialist community services (including alcohol and drug, mental health and public dental services) often have capped budgets. When the budget runs out, people have to wait for services. People who need public dental services, for example, often wait a year or more.

Poor coordination

About 20% of Australians have ongoing complex care needs and need services from GPs, specialists, pharmacists, nurses, allied health and home support.

GPs are often seen as the gatekeepers and coordinators of care, particularly for people with greater needs, such as a combination of chronic diseases like diabetes, arthritis, depression, cancer and heart disease.

People with late-stage diabetes, for example, often have heart disease, kidney disease and poor circulation in their hands and feet. They may need a combination of ongoing medication, dialysis, wound management and support at home.

Coordination should help people with complex needs navigate the healthcare system to get the right care at the right time. But only 60% of this group see GPs as their main care coordinator. Nearly one-third of people who saw three or more health professionals say they have no care coordinator.

Lack of coordination can lead to difficulties in communication and frustrating experiences for patients. If treatment for people with advanced diabetes is not well managed, for instance, they are more likely to have kidney failure, a heart attack or lose a foot or a leg through amputation.

Poor coordination often reduces the quality of care patients get and leads to treatment, including hospitalisation, that could be avoided.

Fragmented care

Much of primary care is delivered by small, privately owned professional practices working independently of one another. They operate next to a range of relatively small non-government and state-run agencies providing primary care and specialist community services.

The Commonwealth government is meant to be responsible for managing primary care, but the states continue to have responsibility for a range of primary care and specialist community services.

The result is that responsibility for policy, planning, funding, data collection, organisation and management is fragmented, ineffective and inefficient.

Access and the integration and coordination of services for patients suffer as a result. In rural areas, poor policy and planning means patients have to travel long distances to see allied health professionals like physiotherapists or psychologists, or to see specialist medical practitioners like psychiatrists and dermatologists.

It’s time for the Commonwealth and state governments to negotiate a comprehensive national primary care policy framework to address the funding and organisational shortfalls.

We need a plan to provide better long-term care for the increasing number of older Australians who live with complex and chronic conditions, and to help keep populations healthy in the first place.

This article was published by The Conversation. Read the original version here.