Issues
Volume 221 Issue 9
Editor's choice
The crux of modern health care challenges
In rock climbing, the crux is the hardest section, or sections, of a particular climbing route. To solve a crux, the climber must draw on their skill and expertise, problem‐solving abilities, perseverance and teamwork, before being able to send it — solve the crux and complete the route. This issue of the MJA covers a broad range of subjects that could be considered some of the most critical challenges in modern health and health care. Over the past 55 years, the proportion of people in Australia who die from cardiovascular diseases has halved (https://www.abs.gov.au/statistics/health/causes‐death/changing‐patterns‐mortality‐australia/latest‐release). Nonetheless, cardiovascular diseases remain a leading cause of death and morbidity. In this issue of the MJA, Figtree and colleagues (https://doi.org/10.5694/mja2.52482) describe the Cardiovascular Health Leadership Research Forum. Established in 2022, this initiative unites governments, health service providers, and the research workforce to tackle major cardiovascular health challenges. By accelerating the implementation of new preventive and therapeutic strategies, it seeks to enhance patient outcomes and produce economic benefits. On a broader scale, Jackson (https://doi.org/10.5694/mja2.52476) discusses the National Health Reform Agreement, and the challenges it faces to remain fit‐for‐purpose for maintaining a high quality equitable health system. Seven policy barriers are identified that have long undermined health system reform, and will need to be addressed for the next agreement to be successful. Four further articles discuss key aspects of modern socially responsible health care. Rodda and colleagues (https://doi.org/10.5694/mja2.52471) review current approaches to identifying and managing gambling disorder. Formerly known as pathological gambling, gambling disorder is now classified as a behavioural addiction. Gambling disorder affects only 1% of the population; however, gambling is pervasive in Australian culture with significant costs. Approximately three‐quarters of the Australian adult population spent money on gambling in 2022, with total losses of $20–25 billion per year (https://www.aihw.gov.au/reports/australias‐welfare/gambling). This does not account for the further social costs of gambling, which are extensive. Of those Australian adults who gamble, almost half are classified as being at risk of harm, with the highest rates in young people and men. The evidence base outlined by Rodda and colleagues provides best practices for identifying gambling disorder and risk thereof, and subsequent treatment. Slape and colleagues (https://doi.org/10.5694/mja2.52475) provide a perspective on the establishment of a First Nations custodial dermatology service. This First Nations‐led service, established in New South Wales and now extended to the Northern Territory, reflects a commitment to ethical and socially responsible health care services through timely and high quality health care that is culturally safe and meets the complex health care needs of incarcerated people. More broadly, the foundational principles of this service highlight the promise of First Nations‐led specialty care within the prison system. In their research letter, Nolan and colleagues (https://doi.org/10.5694/mja2.52471) used deidentified dispensing data from the Pharmaceutical Benefits Scheme (PBS) to demonstrate that about one in five PBS‐subsidised testosterone prescriptions are for trans individuals, despite there being no specific PBS indication for gender affirmation. In younger people, this figure is as high as four in five. They argue that a specific PBS authority indication for “gender affirmation” would facilitate equitable access and improve quality of care for trans people. Finally, Fry and colleagues’ medical education article (https://doi.org/10.5694/mja2.52481), which, in their words, “is intended to serve as a beginner's introduction to the environmental footprinting techniques that can be applied to uncover health care's environmental impacts”, with a clear focus on greenhouse gas emissions. They identify five key areas for action, including improving health care environmental footprinting literacy and incorporating environmental footprinting into existing frameworks for quality improvement, procurement and health system performance. These are practical recommendations that have implications for individual health care worker practices, but also, perhaps more importantly, for system change guided by health and medical leadership and management. These are some of the most challenging aspects of modern health and health care. Much like climbers working through a crux, these challenges will require the collective efforts of the medical and health care community to achieve the best outcomes for patients and the broader community.
Michael Skilton
Perspective
The national Cardiovascular Health Leadership Research Forum: a new data‐driven model placing research at the centre of improving patient outcomes
Harnessing research resources to tackle key health challenges can accelerate implementation and drive new preventive and therapeutic strategies, positively affecting patient and economic outcomes
For the Cardiovascular National Health Leaders Research Forum Writing Group
Custodial dermatology for First Nations peoples: a niche service caring for incarcerated communities
To address skin health of First Nations children and adults in prison, a First Nations-led dermatology clinic is addressing the right to equitable health care.
Dana RML Slape (Larrakia) · Penelope A Abbott · Kelvin M Kong (Worimi)
Redrawing Australia's next National Health Reform Agreement: confronting the wickedest of wicked problems
Seven major policy barriers to overcome for successful reform of the health system under the next National Health Reform Agreement.
Claire L Jackson
Medical education
Environmental footprinting in health care: a primer
Environmental sustainability should be considered as a dimension of quality, safety and good governance alongside patient and population health outcomes
Jacob Fry · Angie Bone · Keiichiro Kanemoto · Carolynn L Smith · Nick Watts
Melasma in the male: a less well recognised entity
An otherwise healthy man of Southeast-Asian descent aged in his mid-30s presented with non-pruritic hyperpigmented patches involving the face for over 12 months
Tim Aung · Rowland Noakes
Ethics and law
A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector
Residential aged care: proposing a shift to communities within social and ecological communities
Lachlan Green · Bridget Pratt · David Kirchhoffer
Erratum
Erratum
Skinner T, Brown A, Teixeira‐Pinto A, et al. Sensitivity and specificity of Aboriginal‐developed items to supplement the adapted PHQ‐9 screening measure for depression: results from the Getting it Right study. Med J Aust 2024; https://doi.org/10.5694/mja2.52406
Research
Changes in the incidence of type 2 diabetes in Australia, 2005–2019, overall and by socio‐demographic characteristics: a population‐based study
The incidence of type 2 diabetes in Australian adults declined during 2010–2019 across all age, sex, socio-economic disadvantage, and remoteness groups
Dianna J Magliano · Lei Chen · Jedidiah I Morton · Oyunchimeg Buyadaa · Agus Salim · Jonathan E Shaw
Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015–2018: a retrospective population‐based study
High level acute clinical care, provided for about two-thirds of hip fractures, was associated with lower short and longer term mortality
Lara Harvey · Morag E Taylor · Ian A Harris · Rebecca J Mitchell · Ian D Cameron · Pooria Sarrami · Jacqueline Close
Systematic review
Physical activity interventions to prevent and manage type 2 diabetes in Aboriginal and Torres Strait Islander people: a systematic review
Quality research into the impact of physical activity interventions on type 2 diabetes in Indigenous people is sparse
Raymond J Kelly · Rona Macniven · Leonid Churilov · Margaret J Morris · David O'Neal · Elif I Ekinci
Research letter
Gender affirmation testosterone therapy, Australia, 2021–22: a review of PBS dispensing data
Knowing how many people use testosterone for gender affirmation is important for service provision and quality of care
Brendan J Nolan · Sav Zwickl · Jeffrey D Zajac · Ada S Cheung
Notification of acute rheumatic fever and rheumatic heart disease in hospitalised people in the Midwest region of Western Australia, 2012–2022: retrospective administrative data analysis
Clinician awareness of notification requirements and automated technology that facilitates ARF/RHD notifications are needed
Ingrid Stacey · Yolande Knight · Claire MX Ong · Amy Lee · Suresh Karuppannan · Allison Christou · Judith M Katzenellenbogen
Narrative review
Current approaches to the identification and management of gambling disorder: a narrative review to inform clinical practice in Australia and New Zealand
Discussion of recent developments in the identification and management of gambling disorder and the remaining gaps in literature and research
Simone N Rodda · Stephanie S Merkouris · Nicki A Dowling
Letter to the editor
Genetic testing in cardiovascular disease
Andrew C Martin · Ari E Horton · Shubha Srinivasan
Genetic testing in cardiovascular disease
Michael P Gray · Gemma A Figtree
News
The national Cardiovascular Health Leadership Research Forum: a new data-driven model placing research at the centre of improving patient outcomes.
Each year, more than $14 billion is spent by the federal government on the direct health costs of cardiovascular disease, a leading cause of death and disability in Australia. A perspective in the Medical Journal of Australia discusses developing new models to harness Australia’s immense research resources to drive new strategies that can help patient and economic outcomes. “Australia urgently needs a model that connects governments, health service providers and the research workforce to regularly update data on the burden of disease and essential clinical quality indicators,” the authors state. “There is already a wealth of information available for clinical quality improvement, but these data are often fragmented, lack robust metadata and are unable to be accessed in a systematic and timely manner.” The Cardiovascular Health Leadership Research Forum (CV HLRF) connects the health system with Australia’s researchers. It allows funders to invest in, and our health system to implement, prioritised research areas. “Until now, there has been no mechanism that allows for a fully integrated national conversation on CVD [cardiovascular disease] and stroke between the health system, clinicians, researchers, industry partners, state and federal governments, and data and health economics experts.” “It has the potential to accelerate implementation and drive new preventive and therapeutic strategies and foster a vibrant medical technology ecosystem, thereby, positively affecting patient and economic outcomes,” the authors said. The CVHLRF was established in 2022 and was designed and is hosted by the Australian Cardiovascular Alliance (ACvA) — the nation’s peak body for CVD researchers. “Key elements of the CVHLRF include: endorsement by National Health Chief Executive Forum as a valuable model for connecting health, clinical and research leaders to contemporary cardiovascular health data to identify evidence-based research and implementation priorities;commitment of health leaders from all Commonwealth, state and territory health jurisdictions to at least biannual forum meetings;collaborative approach to identifying research and implementation priorities that are deeply relevant to health system needs for CVD;connection to national cardiovascular research workforce through the ACvA for whole-of-pipeline solutions (eg, fundamental mechanisms, new diagnostic and therapeutic tools, bioengineering, clinical trials, and implementation and policy);building of partnerships with health services and industry and moving towards co-commissioned approaches to prioritised areas;commitment to evaluating the clinical and economic impact of interventions prospectively; andsupport for an evolving national data dashboard of standardised cardiovascular outcomes and clinical quality indicators to identify major gaps and inequities.”Read the perspective published by the MJA here.
Sally Block
Supplement
The impact of long COVID in Victoria 2020–2023
Med J Aust 2024; 221 (9 Suppl).
Intergenerational equity and the health of Australia's young people
Elizabeth Zuccala · Michael Skilton
Beyond the silver bullet: closing the equity gap for children within a generation
For the Changing Children's Chances Investigator Group
An Aboriginal and Torres Strait Islander adolescent model of primary health care
Stephen Harfield · Peter Azzopardi · Gita D Mishra · James S Ward
Safeguarding the health and wellbeing of transgender young people
Carmen Pace · Alessandra Chinsen · Ada S Cheung · S. Rachel Skinner · Ken W Knight · Michelle A Tollit · Michelle M Telfer · Ken C Pang
30/60/90 National stroke targets and stroke unit access for all Australians: it's about time
For the 30/60/90 National Stroke Targets Taskforce
Towards evidence‐based skin checks
Linda K Martin · Pascale Guitera · Georgina V Long · Richard A Scolyer · Anne E Cust
Implementability and impact in clinical research and the role of clinical trial networks
Helena J Teede · Karen Best · Frank H Bloomfield · Alan Cass · Paul Cohen · Sue Crengle · Tiffany Harris‐Brown · Stephen Jan · David W Johnson · Samantha Keogh · Anne McKenzie · Philippa Middleton · Sandra Peake · Hashim Periyalil · Paul A Scuffham · Angela Scheppokat · Greg R Sharplin · Steve Webb