Issues
Volume 222 Issue 9
Cover image credit: Issara/stock.adobe.com
Editor's choice
General practice in the era of funding reform
How we fund our health system to achieve the most effective, efficient and equitable outcomes is high on the political agenda. Australia has just experienced a federal election dubbed “the health election” for one of the largest funding boosts to Medicare promised by both major parties.1 This issue of the MJA is dedicated to general practice — the bedrock of the health system that has arguably been in crisis for several years. A centrepiece of Labor's campaign on health was a pledge to build more bulk‐billing urgent care centres around the country. These centres aim to bridge the gap for urgent illnesses when patients cannot see their general practitioner and reduce pressure on emergency departments (EDs).2 In this issue of the MJA, Savira and colleagues3 conducted a scoping review to examine the effectiveness of urgent care centres. They examined studies conducted in clinics in the UK, Europe and the United States and found that the results with respect to reduction in ED visits were mixed. While some studies reported that the introduction of these clinics was associated with a reduction in ED visits, others often showed no changes or an increase in presentation to ED minor injury units. Importantly, most studies examined showed a reduction in hospital admission rates in places where urgent care clinics had been set up. Although most patients in consumer surveys examined were happy with the service, continuity of care was a concern expressed by both patients and practitioners. Even though the review was limited by the high heterogeneity of methodologies examined, it provides a warning about relying on a model without adequate governance and formal assessment of cost effectiveness. Indeed, a recent interim report by the Department of Health and Aged Care found that although the cost of seeing a doctor in an urgent care clinic is lower than in an emergency department, this cost is at least five times that of seeing a general practitioner for a standard consult.4 Continuity of care has been an ongoing issue in primary health care for several years. Unlike the UK and New Zealand, where patients are often enrolled into their local primary care clinics for care, in Australia most people can visit any general practitioner anywhere for care, which often leads to a significant amount of fragmentation of care and over ordering of investigations.5 The MyMedicare initiative that has been recently rolled out in Australia attempts to correct this. Bates and colleagues6 in their scoping review for this issue examined enrolment models in other countries to elucidate their impacts on continuity of care. They found little evidence that enrolment improved continuity of care; however, study populations had high levels of pre‐existing patient engagement with a usual general practitioner The review provided evidence that enrolment can be used to support other primary care reforms such as preventive care and management of chronic conditions, and demonstrated how other reforms, such as incentives or increased access to services, can affect uptake of enrolment. For MyMedicare to work, practices and patients need to see value in enrolment. This value proposition will be hard to make without more targeted research evaluating, and then demonstrating, the benefits of enrolment, not just for individuals who have a usual general practitioner, but for those who do not. Although the review noted that the MyMedicare scheme currently has limited incentives for patients, there have been proposals to tie in funding for chronic care plans and allied health visits to a patient's nominated general practitioner and practice on MyMedicare.7 This will likely pressure general clinics to enrol patients specifically to their clinics. The overarching problem most general practitioners have with investment in primary care is that often the governments do not seem to want to consult with them with regards to their experiences and opinions on how unprecedented levels of Medicare funding might best suit their patients. Most clinics currently run on the slimmest of margins and the bulk‐billing incentive still does not meet the gap that mixed billing currently provides most clinics.8 Without effective primary care most Australians will be left without adequate health care. A substantial proportion of research needs to be carried out on effective models of care focusing on general practitioners with general practitioners as a core part of the research and assessment team.
Aajuli Shukla
Perspective
What is needed to improve young people's access to sexual health care through primary care?
Strengthening the primary care system will assist health care practitioners with the time and resources to provide good sexual health care to young people
Helen Bittleston · Meredith Temple‐Smith
Antidepressant prescribing in Australian primary care: time to reevaluate
Given limited benefit in mild to moderate mental illness, limited evidence demonstrating benefit and safety with long term antidepressant therapy, and the difficulties that people can experience stopping antidepressants, better decision support and informed consent for starting antidepressants are needed
Katharine A Wallis · Anna King · Joanna Moncrieff
Medical education
Severe hypoglycaemia secondary to chronic opioid‐induced hypothalamic–pituitary–adrenal axis suppression: an under‐recognised phenomenon
A 49-year-old woman with type 2 diabetes mellitus was hospitalised with critical hypoglycaemia
Michael Do · Annabelle G Hayes · Malgorzata M Brzozowska
Erratum
Erratum
Hengel B, Guy RJ, Casey D, et al. Decentralised COVID‐19 molecular point‐of‐care testing: lessons from implementing a primary care‐based network in remote Australian communities. Med J Aust 2025 ; https://doi.org/10.5694/mja2.52589. In this perspective article, the middle initial of the seventh author was incorrect; it should read Tanya L Applegate.
Reflection
I am a Civil War
This is an article written by a doctor about their experience of navigating seronegative immune-mediated necrotising myositis
Jennifer G Mowbray
Editorial
Preventing intimate partner violence in Australia: unlocking the primary prevention potential of general practice
General practice is uniquely positioned to intervene at multiple points across the life course
Georgina Sutherland · Karen Block
Research
The prevalence of intimate partner violence in Australia: a national survey
The lifetime prevalence of experiencing intimate partner violence is high, especially among women
Ben Mathews · Kelsey L Hegarty · Harriet L MacMillan · Monica Madzoska · Holly E Erskine · Rosana Pacella · James G Scott · Hannah Thomas · Franziska Meinck · Daryl Higgins · David M Lawrence · Divna Haslam · Sara Roetman · Eva Malacova · Timothy Cubitt
Scoping review
Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies
Walk-in and after-hours clinics can help reduce the number of ED presentations and reduce health care costs
Feby Savira · Madison Frith · Clarissa J Aditya · Sean Randall · Naomi White · Andrew Giddy · Lauren Spark · Jamie Swann · Suzanne Robinson
The impact of patient enrolment in primary care on continuity and quality of care around the world, 2014–2024, and lessons for Australia: a scoping review
The Australian voluntary patient enrolment scheme should be continuously evaluated to assess levels of engagement by patients and general practices
Shona M Bates · Jialing Lin · Luke Allen · Michael Wright · Michael Kidd
Guideline summary
2024 Royal Australian College of General Practitioners and Healthy Bones Australia guideline for osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age
Poor bone health is highly treatable with appropriate widely available lifestyle and dietary measures and pharmacological agents; the updated guideline is an evidence-based pragmatic tool to assist general practitioners in the day-to-day care of such patients in partnership with bone specialists
Peter Wong · Weiwen Chen · Dan Ewald · Christian Girgis · Morton Rawlin · John Tsingos · Justine Waters
News
New vaccines herald “era-defining advancements” in RSV prevention
A narrative review published in the Medical Journal of Australia examines the current landscape and future directions of respiratory syncytial virus (RSV) preventives in Australia. RSV is a major cause of acute lower respiratory tract infections, and disproportionally impacts children under the age of 4, who represent 50% of RSV hospitalisations. In November 2023, the long-acting monoclonal antibody nirsevimab was registered with the Therapeutic Goods Administration (TGA) for prevention of RSV-related infections in children under two years of age. Shortly after, in March 2024, a maternal RSV vaccine, Abrysvo, was registered with the TGA for prevention of RSV-related infections in infants under 6 months of age. The narrative review authors describe the availability of these vaccines as “an era defining advancement in RSV prevention.” “Both nirsevimab and Abrysvo have demonstrated substantial potential in reducing hospitalisation rates and mitigating long term health care costs associated with RSV infections in infants,” Sam Barnett of Monash University and co-authors wrote. Western Australia leading the charge at home Western Australia was the first Australian jurisdiction to announce a state-wide immunisation program, rolling out a government funded all-infant RSV immunisation program with nirsevimab in April 2024. A research letter published in the Medical Journal of Australia has examined the impact that the immunisation program had on the WA health care system. “From 2 April 2024, all WA infants born during 1 October 2023 – 30 September 2024 were eligible to receive nirsevimab in primary care services and birthing hospitals, as were Aboriginal children and children with conditions associated with severe RSV disease born during 1 October 2022 – 30 September 2023,” Dr Lauren Bloomfield and co-authors wrote. “With 71% of nirsevimab-eligible infants receiving RSV prophylaxis during April–September 2024, the number of RSV-associated hospitalisations in WA was 57% lower than expected during May–December 2024, equivalent to one hospitalisation averted per 43 infants immunised.” “Further, a contemporary case–control study found that nirsevimab was 86.4% effective in averting RSV-associated hospitalisations of infants in WA. As the cost of an infant RSV hospital admission is estimated to be $12 346 to $13 695, averting 505 admissions is likely to have saved $6.2–6.9 million in hospital costs.” The future of RSV prevention In 2025, Australia has a national RSV prevention program with free maternal vaccination with Abrysvo and targeted infant protection with nirsevimab. Analysing the data from this national program will be pivotal in evaluating and refining the national RSV prevention response going forward. “Program monitoring and evaluation, including cost-effectiveness modelling, from the 2025 RSV [Mother and Infant Protection Program] MIPPs will help guide future decisions regarding the optimal combination of maternal vaccination and nirsevimab,” Barnett and co-authors wrote in their narrative review. “These studies, which will incorporate Australian-specific data, will evaluate factors such as cost-effectiveness, timing, geographic variability and logistical considerations in relation to administration.” Successful implementation of RSV prevention programs will depend on maintaining cost effectiveness, addressing parental acceptance and uptake of the vaccines, and ensuring accessibility for groups at increased risk, such as First Nations children. “An evidence-based approach will be essential to ensure appropriate allocation of resources, tailoring programs to the specific needs of higher risk populations while maximising the economic and health benefits across Australia,” Barnett and co-authors wrote. Read the narrative review in the Medical Journal of Australia. Read the research letter in the Medical Journal of Australia.
Annika Howells
Shifting focus to adolescent wellbeing and inclusive participation in the digital age
with the Health Advisory Panel for Youth at the University of Sydney (HAPYUS)
Preparing Australia for future pandemics: strengthening trust, social capital and resilience
Shanti Narayanasamy · Alisa Pedrana · Katherine B Gibney · Lisa Gibbs · Margaret E Hellard
National Framework for Prevocational Medical Training
Brendan Crotty · Nicholas J Glasgow · Jo Burnand · Georga Cooke · Katrina Anderson · Kirsty White · Sarah Vaughan · Madeleine Novak · Andrew H Singer
What's past is prologue
Michael Skilton
The potential of maternal and child health service data in Australia: how lessons from the COVID‐19 pandemic can accelerate data‐informed decision making
Ashleigh Shipton · Meredith O'Connor · Melissa Wake · Sharon Goldfeld · Helen Lees · Catina Adams · Kristina Edvardsson · Leesa Hooker · Jatender Mohal · Rhiannon M Pilkington · Fiona K Mensah
Exploring the role of urine drug screening in opioid agonist therapy
Grace FitzGerald · Sione Crawford · Adrian J Dunlop · Jon Cook · Dean Membrey · Paul MacCartney · Thileepan Naren
Cultural safety, the LGBTQI+ community and international medical graduate training
Cindy Towns · Charlene Rapsey · Rhea Liang