Subscribe
×

Preference: Rehabilitation

1024

AMA supports asylum seeker medical treatment bill

The AMA supports the asylum seeker Urgent Medical Treatment Bill being promoted by Independent MP and former AMA President, Professor Kerryn Phelps.

The AMA has gained assurances on key amendments to the legislation in recent days.

The Phelps bill will allow the temporary removal of children from offshore detention, create a workable system providing proper health care for refugees and asylum seekers under the protection of the Australian Government, and keeps in place deterrents that prevent asylum seekers risking their lives at sea and endangering themselves and others.

AMA President Dr Tony Bartone said that it was vital that all asylum seekers and refugees in the care of the Australian Government have access to quality care.

“There is compelling evidence that the asylum seekers on Nauru, especially the children, are suffering from serious physical and mental health conditions, and they should be brought to Australia for appropriate quality care,” Dr Bartone said.

“This week’s alarming Médecins Sans Frontières report on the health of detainees on Nauru was another signal that urgent action is needed.

“This is a health and human rights issue of the highest order. We must do the right thing.

“The amended Phelps bill is an important measure that will allow the temporary transfer to Australia from Nauru and Manus sooner for those in need of urgent care.

“The AMA has been advocating strongly for better health care for asylum seekers for many years.

“Our 2015 Position Statement, Health Care of Asylum Seekers and Refugees, called for the removal of all children from offshore detention, among other measures.

“We want a new national statutory body of clinical experts, independent of government, with the power to investigate and advise on the health and welfare of asylum seekers and refugees.”

The AMA is pushing for further legislation that incorporates the following reforms:

  • asylum seekers and refugees should have access to the same level of health care as all Australian citizens;
  • asylum seekers and refugees living in the community should have continued access to culturally appropriate health care, including specialist care, to meet their ongoing physical and mental health needs, including rehabilitation;
  • all asylum seekers and refugees, independent of their citizenship or visa status, should have universal access to basic health care, counselling, and educational and training opportunities; and
  • asylum seekers and refugees living in the community should have access to Medicare and the Pharmaceutical Benefits Scheme (PBS), state welfare and employment support, and appropriate settlement services.

Dr Bartone wrote to Prime Minister Morrison in September calling for the children on Nauru to be brought to Australia for appropriate medical care, with similar letters going to all MPs and Senators.

“We have worked closely with the Chief Medical Officer of the Home Affairs Department, and we acknowledge that the Government has since removed some of the children from Nauru,” Dr Bartone said.

“But we need a compassionate and enduring long-term solution that ensures quality appropriate health care for all asylum seekers and refugees in the care of the Australian Government.”

 

 

The opioid epidemic: do we need to rethink pain?

A landmark report has highlighted the link between opioid prescriptions in hospital and the long-term risk of dependence, prompting calls for more collaboration and conversation around pain management.

Released by the Society of Hospital Pharmacists of Australia (SHPA), the report found that more than 70% of hospitals frequently supplied opioids for patients to take home “just in case”, even when they have not required them in the 48 hours prior to discharge.

The paper also noted that pharmacists reported extremely high use of sustained-release opioids in the treatment of acute pain for opioid-naive surgical patients.

Based on data from 135 Australian facilities, the report outlined 33 recommendations to enhance local strategies to improve patient care nationwide.

Opioid prescription in hospitals now routine, increasing risk of dependence

Professor Michael Dooley, president of the SHPA, told doctorportal that the unnecessary use of opioids was particularly pronounced among surgical patients.

“They may come in for knee, hip and other procedures, and they’re in quick and smart. We’re trying to flow them through and they just get written up for a script of 20 Endone, just as routine.”

“The patients may not have needed anything over the last day or two, but we still tend to write them up for a packet of opioids, and they grab them and leave the hospital.”

He said that while the prescription of opioids as a precaution is well intended, there are proven dangers with this.

“There is clear evidence that giving patients opioids to take home, when they don’t need them, puts them at risk of continuing to take them.”

“This can then precipitate some pretty traumatic and tragic paths of dependence.”

Not all pain needs to be eliminated

Professor Dooley described current perceptions of pain as being caught in a pendulum. “We have probably swung too far in thinking that all pain is bad pain, and that we need to eliminate all pain.”

“We need to treat serious pain, but with mild pain, often patients will tolerate it. We actually don’t have a magic bullet for minor pain – it’s probably something that people can cope with.”

“If someone has done in their knee or ankle, the pain is telling them not to stand on it or to push themselves too hard.”

Professor Dooley said Australia’s current relationship with opioids stands in contrast to how it began.

“About 15-20 years ago, we had morphine, and everyone was really concerned about opioids and how to use them. Then we got oxycodone, and now we’ve got 130 opioids and people have become less aware of the potential downstream implications.”

Starting meaningful conversations about opioids is essential

Professor Dooley said that having conversations around opioids was the most important step to take in addressing the problem.

“We need to start having conversations with patients and tell them about their pain and analgesia.”

Professor Dooley added that patients need to be empowered to ask key questions around whether pain medication is needed, how long they should take it, and how long they can reasonably expect their pain to last.

“At the moment, no one really has that conversation with patients. As with all these things, there needs to be multiple people having those conversations with the patient, repeating the same message.”

He said that doctors, pharmacists and nurses all need to be involved in this. “For example, often nurses will approach a patient and ask them if they would like a painkiller, rather than asking how their pain is going, and if they are okay with that level of pain.”

[Perspectives] Reimagining addiction

The Narcotic Farm was established in 1935 in Lexington, KT, USA, by the US Department of Public Health with two aims. First, it was to create a new way of dealing with addiction as an issue of health rather than criminal justice, by offering treatment and rehabilitation instead of punishment and retribution. Second, it aimed to bring together researchers to study addiction in its Addiction Research Center, and to find a cure. “Narco”, as it was commonly known, was a noble idea, designed to support men and women convicted of drug-related offences alongside those who made a voluntary decision to commit to treatment.

Let’s be clear eyed while moving forward on private health insurance

BY ASSOCIATE PROFESSOR JULIAN RAIT, CHAIR, COUNCIL OF PRIVATE SPECIALIST PRACTICE

On October 11, Health Minister Greg Hunt announced the final rules that support the new private health insurance clinical categories and the Gold, Silver, Bronze and Basic classification system. 

CPSP and the AMA have called on these reforms to deliver simplified, better value private health insurance products for consumers. A system that offers more comprehensive coverage, with clear definitions, and less caveats and carve outs. Will the new system deliver total clarity and transparency? Not quite, but it is going to be a lot simpler for consumers than trying to navigate through the current 70,000 policy offerings.

The AMA has always supported, two key aspects of these reforms:

  1. Clarity about what medical conditions are covered in each tier of benefits; and
  2. The use of standard clinical categories across all private health policies. 

The new classification system categorises existing policies into easier to understand tiers. These tiers, in combination with new Private Health Information Statement (which includes mandatory information about what each policy covers), should make it easier for people to compare policies, to shop around and actually see what they are covered for.  

This should enable consumers to know that when they book in for a procedure they are covered now and not have to wait an additional 12 months or try the public system. 

The tiers outline minimum requirements, but they still allow insurers to add additional cover. The legislation clarifies that insurers can move people onto new products, closing old products, but introduces new protections about warning and information for consumers. Additionally, the Minister is on the record stating that “importantly consumers will not be forced to change their policy cover if they are happy with it”. 

There are also some more hidden benefits that will come in with the new system.  

  1. That the system provides full mandatory cover for the medical conditions in each tier; partial cover is not permitted (except in Basic cover and for Psychiatry, Rehabilitation, and Palliative Care – except in Gold cover where there are no exclusions allowed at all); 
  2. The inclusion of gynaecology, breast surgery, cancer treatment, and breast reconstruction in bronze tier products; 
  3. That a clinical category covers the entire episode of hospital care for the investigation or treatment;  
  4. That an episode of hospital treatment covers the miscellaneous services allied to the primary service; and 
  5. Patients with limited cover for psychiatric care can upgrade their cover (once) to access higher benefits for in-hospital treatment without serving a waiting period.  

While these look obvious, they haven’t always been included in policies. From next year they will be. 

The Minister has called for an April 1, 2019 commencement to coincide with the annual announcement of new premiums. However, as with most major changes, not all groups can adapt as quickly as others. So, while the reforms start next year, insurers have a further 12 months to ensure that each of their products is compliant and to move people onto new products if required. This is not ideal, but the transition for the smaller insurers is likely to be very resource intensive. The Minister has stated that his expectation is that the great majority of policies will be ready to go by April 1 next year. He has also stated that these reforms will have an overall neutral to -0.3 per cent impact on premiums compared with current policy settings. 

But we also need to be clear eyed here. This will not solve the wider issue of how to bridge the ongoing premium increases in the 4-5 per cent range, and wages growth at 2 per cent range. That fundamental paradox to a long-term, sustainable private health insurance system remains. These reforms will not address the concerns around private health insurer behavior, nor will they address the variation in rebates. These reforms are about making life a little easier for our patients, and our practices. But the AMA will need the support of all our members going forward – for clearly, the bigger problem is yet to be addressed. 

 

[Editorial] 21st century management and prevention of stroke

Little more than 20 years ago, stroke was widely regarded as an untreatable disease, mostly occurring in older people, with care primarily focused on rehabilitation and support. But over the past two decades, management of ischaemic stroke has been transformed—first with the advent of intravenous thrombolytic or “clot-busting” treatment to restore blood flow to the brain, and more recently with the development of mechanical thrombectomy devices to remove the blood clot responsible for a stroke. Shockingly, this revolution has not been universal.

Doctor Robot  

 

The Guardian reports that robots could soon help hospital patients eat their meals, diagnose serious illnesses, and even help people recover from operations, in an artificial intelligence revolution in the NHS in the UK.

Machines could take over a wide range of tasks currently done by doctors, nurses, health care assistants, and administrative staff, according to a report prepared by the Institute for Public Policy Research (IPPR) and eminent surgeon and former Health Minister, Lord Darzi.

Widespread adoption of artificial intelligence (AI) and ‘full automation’ by the NHS could free up as much as £12.5 billion a year worth of staff time for them to spend interacting with patients, according to the report.

“Given the scale of productivity savings required in health and care – and the shortage of frontline staff – automation presents a significant opportunity to improve both the efficiency and the quality of care in the NHS,” the report says.

“Bedside robots could help patients consume food and drink and move around their ward, and even help with exercises as part of their rehabilitation from surgery.

“In addition, someone arriving at hospital may begin by undergoing digital triage in an automated assessment suite.

“AI-based systems, include machine-learning algorithms, would be used to make more accurate diagnoses of diseases such as pneumonia, breast and skin cancers, eye diseases, and heart conditions.

“Digital technology could also take over the communication of patients’ notes, booking of appointments, and processing of prescriptions.”

The report sought to allay fears of significant job losses, signaling that machines would work alongside human beings, not replace them, so patients would benefit.

Studies spell double trouble for women

There’s been a double whammy of bad health news for women, with one study finding that women with diabetes are more likely to develop cancer, and a second finding that women are twice as likely as men to be under-treated for heart attack.

In the first study, researchers from The George Institute for Global Health reviewed the health outcomes of almost 20 million people involved in 47 studies.

They discovered that having diabetes – type 1 or type 2 – significantly raises the risk of developing cancer, with a significantly higher risk for women.

Women with diabetes were 27 per cent more likely to develop cancer than women without diabetes. For men, the risk was 19 per cent higher.

Overall, women with diabetes were six per cent more likely to develop any form of cancer than men with diabetes.

“The link between diabetes and the risk of developing cancer is now strongly established,” lead author, Dr Toshiaki Ohkuma, said.

“We have also demonstrated, for the first time, that women with diabetes are more likely to develop any form of cancer, and have a significantly higher chance of developing kidney, oral, and stomach cancers, and leukaemia.

“The number of people with diabetes has doubled globally in the past 30 years, but we still have much to learn about the condition.

“It’s vital that we undertake more research into discovering what is driving this, and for both people with diabetes and the medical community to be aware of the heightened cancer risk for women and men with diabetes.”

The George Institute research was published in Diabetologia, the journal of the European Association for the Study of Diabetes.

In the second study, published in the Medical Journal of Australia, University of Sydney researchers found that women admitted to 41 Australian hospitals with ST-Elevation Myocardial Infarction (STEMI) in the past decade were half as likely as men to receive appropriate diagnostic tests and treatment.

They were also less likely to be referred for cardiac rehabilitation, and prescribed preventive medications, at discharge.

Death rates and serious adverse cardiovascular events among these women were more than double the rates seen in men six months after discharge.

“The reasons for the under-treatment and management of women compared to men in Australian hospitals aren’t clear,” lead author and cardiologist, Professor Clara Chow, said.

“It might be due to poor awareness that women with STEMI are generally at higher risk, or by a preference for subjectively assessing risk rather than applying more reliable, objective risk prediction tools.

“Whatever the cause, these differences aren’t justified. We need to do more research to discover why women suffering serious heart attacks are being under-investigated by health services, and urgently identify ways to redress the disparity in treatment and health outcomes.”

Private health insurance reforms – moving ahead

In October last year, Health Minister Greg Hunt announced that the Government would embark on a package of reforms aimed at making private health insurance simpler and more affordable for Australians.  

Private health insurance is one of the most complex forms of insurance and the current complexity of product offerings has led many consumers to report that they do not understand what they are covered for. These reforms aim to simplify private health insurance hospital cover by creating easily understood tiers of cover. There will be four tiers of hospital products Gold, Silver, Bronze and Basic. These new private health insurance products will take effect from April 1, 2019.

When announced, the AMA President welcomed the reforms as a long overdue opportunity to bring much-needed transparency, clarity, and affordability to the private health sector. However, the AMA also noted that the challenge ahead was to clearly define and describe the insurance products on offer – to deliver meaningful and consistent levels of cover in each category.

The reform package has built on the work of the Private Health Ministerial Advisory Committee, which was established to examine all aspects of private health insurance and provide government with advice on reforms. This committee met extensively and set up several working groups to look at specific issues. The AMA has been represented continuously throughout this process. An ad hoc group of members has been working to provide the AMA representatives with advice and support.

As part of this process the AMA recently provided a submission to the Health Department concerning the draft standard clinical definitions that support the new private health insurance categories. More recently, the Government has introduced the legislation required to support the package of reforms into parliament. The legislative package has now been referred to a Senate Committee Inquiry, which is expected to report in mid-August.

On Sunday July 15, the Minister announced the Gold, Silver and Bronze categories again without much further information. However, the next day the Health Department released the draft rules (or subordinate legislation/regulations) that will support the package of reforms. 

Under these new rules, the proposed Gold, Silver and Bronze policies will not contain restrictions or carve outs for included clinical treatments (except hospital psychiatric care, rehabilitation and palliative care). According to Government modelling currently about 25 per cent of people with private hospital insurance purchase cover have restrictions applied to a clinical category other than hospital psychiatric care, rehabilitation and palliative care. In the new system, only the new Basic category can have restrictions (outside hospital psychiatric care, rehabilitation and palliative care), and even then, it must be clearly marked as having a restriction.

The AMA Secretariat is now working with the other Colleges, Associations and Societies to provide the Government with comprehensive advice on the proposed rules, including the critical issue of clinical definitions and MBS item coverage under these definitions.

Extract of a letter to members from AMA President Dr Tony Bartone.

AMA welcomes ice inquiry report

The Joint Parliamentary Committee Inquiry on Law Enforcement has released its Inquiry into Crystal Methamphetamine (ice) Report.

It has recognised drug and alcohol addiction to be a serious illness and should be treated as such.

The AMA has welcomed the findings, which also state that demand for drug and alcohol treatment services often outweighs capacity.

And there is a need to tailor services to suit a variety of needs, including post care services.

The importance of accountability for those bodies who fund alcohol and drug treatment services was also stressed, as was the need to rebalance funding across the National Drug Strategy.

AMA President Dr Michael Gannon said the AMA believes that any substance dependence is a serious health condition, and that those impacted should be treated like other patients with serious illness and be offered the best available treatments and supports to recover.

“We welcome the recommendations that recognise the stigma associated with addiction, and seek to increase compassionate responses, including media reporting,” Dr Gannon said.

“This is essential if we are going to encourage people to seek treatment.”

The release of the report also serves as a timely reminder of the statement made by the Head of the National Ice Taskforce, Ken Ley: “That we cannot arrest our way out of the problem.”

The AMA supports the recommendations to monitor and ultimately reduce the time take for people to access appropriate treatment. It is also great that the importance of pre- and post- care is recognised.

“The AMA is particularly pleased to see the recommendation that the Department of Health work with Primary Health Networks (PHNs) to improve their tender processes for drug and alcohol treatment,” Dr Gannon said.

“We believe that the PHNs must be accountable for the services, wait times and the quality of the drug and alcohol treatment services provided in their jurisdictions.”

The approach (established under the National Ice Action Plan) is new and the capacity of PHNs to oversee the effective and equitable delivery of drug and alcohol treatment services is yet to be fully established.

The report recognises the importance of culturally and linguistically appropriate drug and alcohol treatment for Aboriginal and Torres Strait Islander people. This work should include efforts to increase the Aboriginal and Torres Strait Islander drug and alcohol workforce, it noted.

The report contains a recommendation to collect data on the use of illicit drugs in correctional facilities which will provide some valuable insights, but it is vitally important that rehabilitation and treatment services are available to those people who are in the corrections system noting drug and alcohol addiction is often a key contributor to incarceration.

“We must also recognise the link between mental health and addiction, and the report misses an important opportunity reiterate this and advocate for increased linkages between the sectors,” Dr Gannon said.

“The Inquiry Report is certainly on the right track in many areas relating to drug and alcohol addiction.

“This is in stark contrast to the Government’s current efforts to pass legislation (Social Services Legislation Amendment Drug Testing Trial Bill 2018) that will drug test welfare recipients.

“This punitive measure will increase the stigma associated with drug addiction, and is not supported by evidence. The reality is that it will increase the demand for drug treatment services that are clearly under significant pressure. Throwing money at the trial sites won’t fix the problem.”

The AMA encourages Social Services Minister Dan Tehan to read the Inquiry report to better understand the problems in the sector, and withdraw the random drug testing proposal until such time that we can improve the capacity of the sector to meet demand for drug treatment.

“We must not do anything to increase the delays for those individuals actively seeking treatment,” Dr Gannon said.

“Referring those who test positive under the welfare trial will do this.”

The AMA Submission to the Joint Parliamentary Committee on Law Enforcement Inquiry into crystal methamphetamine can be found at: submission/ama-submission-joint-parliamentary-committee-law-enforcement-%E2%80%93-inquiry-crystal

The AMA Submission to the Senate Community Affairs Legislation Committee’s Inquiry into the Social Services Legislation Amendment (Welfare Reform) Bill 2017 can be found at: submission/ama-submission-senate-community-affairs-legislation-committees-inquiry-social-services

AMA Position Statement on Methamphetamine can be found at: position-statement/methamphetamine-2015

AMA Position Statement on Harmful substance abuse, dependence and behavioural addiction can be found at: position-statement/harmful-substance-use-dependence-and-behavioural-addiction-addiction-2017

CHRIS JOHNSON