Topics
Health services administration
Drug treatment for melanoma: progress, but who pays?
In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension — something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by ...
Richard F Kefford
Appropriateness of healthdirect referrals to the emergency department compared with self-referrals and GP referrals
GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.
Joseph Y Ng MB BS, FANZCA · Daniel M Fatovich MB BS, FACEM, PhD · Valendar F Turner MB BS, FRACS, FACEM · Jennifer A Wurmel RN · Sally A Skevington BWS(Hons) · Michael R Phillips BSc(Hons), MMedSci
A meta-analysis of “hospital in the home”
Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012.Study selection: Randomised controlled trials (RCTs) comparing HITH care with ...
Gideon A Caplan MB BS, MD, FRACP · Nur S Sulaiman MB BS · Dee A Mangin MB ChB · Nicoletta Aimonino Ricauda MD · Andrew D Wilson MD, FRCGP · Louise Barclay BN
This pioneering spirit
Next year, it will be 200 years since Blaxland, Lawson and Wentworth crossed Australia’s Great Dividing Range, opening up the lands beyond to European exploration and settlement. Last century, other pioneering Australians cleared the way towards better health with discoveries and developments as diverse as penicillin (Florey), lithium (Cade) and Helicobacter pylori (Marshall and Warren), and as courageous as life-saving heart surgery (Chang) and our bold ...
Ann Gregory · Ruth Armstrong
Setting up international medical graduates to succeed
Overseas-trained doctors need guidance through the labyrinth of providing medical care in a new countryAustralia, like many other developed countries, depends on international medical graduates (IMGs) to fill workforce shortages. About one in every three to four members of our medical workforce are trained overseas,1 and this dependency is likely to continue for many more years. IMGs are a heterogeneous group with varied skills and ...
Balakrishnan R Nair AM, MD, FRACP, FRCPE · Mulavana S Parvathy MB BS, FRACGP
CareTrack: assessing the appropriateness of health care delivery in Australia
We support the recommendation of Runciman and colleagues for national agreement on clinical standards of health care, and highlight the importance of including routine health promotion activities as a core part of quality care in clinical practice. The indicators used by Runciman et al fail to consider core aspects of preventive care, such as screening and evidence-based behavioural interventions for lifestyle risk ...
Annemarie Wright · Bruce Bolam
Exploring practitioner colour blindness in everyday practice
To the Editor: Most of us in the medical profession would have had encounters with colour blind doctors at some stage, perhaps unknowingly. Colour blindness, more formally known as congenital colour vision deficiency (CVD), affects 8% of males and 0.4% of females.1 For those of us who perceive the world in a different spectrum, tasks involving colour in the workplace may provoke anxiety.2 One could argue ...
Navin I Dadlani
Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the ...
Katie Elkin LLB, BSc · Matthew J Spittal PhD, MBio · David M Studdert LLB, ScD, MPH
Arthroscopy to treat osteoarthritis of the knee?
Changing clinician beliefs and behaviour in response to credible evidence of lack of treatment efficacy remains highly challengingArthroscopy is commonly used to treat people with knee pain due to osteoarthritis. However, data collected from randomised controlled trials over the past two decades have provided compelling evidence that, in general, arthroscopic treatment comprising debridement and lavage is no more effective than placebo surgery or non-operative alternatives,1,2 ...
Rachelle Buchbinder MB BS(Hons), MSc, PhD · Ian A Harris MB BS, MMed(Clin Epi), PhD
Australian general practice: primed for the “patient-centred medical home”?
The central role for Australian general practice in providing high-quality affordable health care for all Australians has been underlined repeatedly by national health bodies including the National Health and Hospitals Reform Commission (NHHRC), the Council of Australian Governments Reform Council, the National Primary Health Care Strategy, the National E-Health Transition Authority and Health Workforce Australia. The Australian Health Practitioner Regulation Agency has recognised general practice ...
Claire L Jackson MB BS, MD, FRACGP
Trends in elective knee arthroscopies in a population-based cohort, 2000–2009
Objective: To assess the use of elective knee arthroscopy procedures for all adults 20 years and older, and for adults with a concomitant diagnosis of osteoarthritis (OA) in Victoria.Design, setting and patients: Retrospective, longitudinal cohort study of 807 030 elective orthopaedic admissions using routinely collected public and private hospital data from 1 July 2000 to 30 June 2009.Main outcome measure: Trends in rates of elective ...
Megan A Bohensky PhD, MPH, BA · Vijaya Sundararajan MD, MPH · Nick Andrianopoulos MB BS, MBiostat · Richard N de Steiger MB BS, FRACS, FAOrthA · Andrew Bucknill MSc, MB BS, FRACS · Christos M Kondogiannis MB BS, FRACS · Geoffrey McColl MB BS, PhD, MEd · Caroline A Brand MB BS, MPH
Correction: Disciplinary notations on the Medical Register of Australia
CorrectionIncorrect article title: The title of the article “Disciplinary notations on the Medical Register of Australia” published in the 4 June issue of the Journal (Med J Aust 2012; 196: 612-613) was incorrect. The title should read: “Disciplinary notations on the Australian Register of Medical Practitioners”.
Ian R Freckelton
Designing incentives for good-quality hospital care
To the Editor: In response to Duckett’s question, “is now the time to send a signal that poor-quality care should not be rewarded in activity-based funding?”,1 Queensland Health answers with a resounding “yes”. In addition to activity-based funding (ABF), Queensland Health applies a purchasing framework model with the aim of improving health care safety and quality, leading to better-quality outcomes for the same or lower cost. ...
Kirstine M Sketcher-Baker · John G Wakefield · Jane V Partridge
The need for data beyond primary diagnosis
To the Editor: A recent editorial in the Journal1 is another in a long line of articles arguing that national linkage of routine care-delivery data will enable us to improve the health care provided to Australian patients.2 However, over the past three decades, progress on national data linkage has been painfully slow. Anyone who has ventured down the path of obtaining national linked data can ...
Michael D Coory
The comparability of emergency department waiting time performance data
One of the key goals of health reform is to drive hospital quality improvement by creating greater transparency in health services performance. With the launch of the MyHospitals website in December 2010, quality indicators for individual hospitals across Australia were publicly ...
Jessica Greene PhD · Jane Hall PhD
Do available predictions of future medical workforce requirements provide a sensible basis for planning? Yes
Professor Peter Brooks advocates increasing productivity and reducing demand to prepare for what lies aheadIf future increased health care demand in Australia is simply met by increasing medical workforce capacity by the year 2025, our country will go bankrupt. However, recently released modelling shows us how we can meet this demand in other ways. The most recent Health Workforce Australia report provides an interesting model of ...
Peter M Brooks MD, FRACP, FAFPHM
Do available predictions of future medical workforce requirements provide a sensible basis for planning? No
Professor Richard Murray explains why action on generalism, regional training and service reform is a national policy emergencyIt might surprise some to know that among wealthy Organisation for Economic Co-operation and Development (OECD) countries, Australia has an average number of doctors for its population.1 Australia has more doctors per capita than ever before, more than New Zealand, Canada, the United States and the United Kingdom. With ...
Richard B Murray MB BS, MPHTM, FACRRM
New money for chronic diseases: can clinicians and entrepreneurs deliver outcomes eluding governments?
Could savings for governments from objective reductions in preventable hospitalisations create long-term incentives for evidence-based health care? It is to our collective shame that those with chronic conditions in Australia suffer “a miserable existence in trying to organise their health care and prevent further deterioration”. With more than 1 million adults with cardiovascular disease and at least 800 000 with diabetes, we are ill equipped for the looming “tsunami ...
Jeanette E Ward PhD, FAFPHM, FACHSM
Australian national birthweight percentiles by sex and gestational age, 1998–2007
Objective: To present updated national birthweight percentiles by gestational age for male and female singleton infants born in Australia.Design and setting: Cross-sectional population-based study of 2.53 million singleton live births in Australia between 1998 and 2007.Main outcome measures: Birthweight percentiles by gestational age and sex.Results: Between 1998 and 2007, women in Australia gave birth to 2 539 237 live singleton infants. Of these, ...
Timothy A Dobbins BMath, PhD · Elizabeth A Sullivan MD, MPH, FAFPHM · Christine L Roberts MB BS, DrPH, FAFPHM · Judy M Simpson BSc(Hons), PhD
Individualising type 2 diabetes management: new treatment options and models of care
Better outcomes require tailored strategiesThe past 15 years has seen the advent of many new classes of antidiabetic agents. We now have biguanides, sulfonylureas, thiazolidinediones, dipeptidyl-peptidase IV inhibitors, glucagon-like peptide 1 receptor agonists, a variety of insulins and a-glucosidase inhibitors. This has resulted in a surfeit of choice, but has also increased the complexity of decision making as there is no simple algorithm for escalation of treatment ...
N Wah Cheung MB BS, FRACP, PhD
A limb lost every 3 hours: can Australia reduce amputations in people with diabetes?
Increased foot problems due to diabetes means a national focus on coordinated foot care is essential. Data from the Australian Institute of Health and Welfare (AIHW) suggest that one Australian loses a lower limb every 3 hours as a direct result of diabetes-related foot disease (DRFD). Further data suggest there has been a 30% increase in diabetes-related amputations in Australia over the past decade, with 8% of ...
Shan M Bergin BAppSci(Pod), PhD · Jan B Alford RN, MEd(AdEd), CDE · Bernard P Allard MB BS, FRACS(Vasc) · Joel M Gurr BSc(Pod), MBA · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Paul R Wraight MB BS, FRACP, PhD
Drug treatment for melanoma: progress, but who pays?
Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...
Richard F Kefford AM, PhD, FRACP
A multicentre evaluation of two intensive care unit triage protocols for use in an influenza pandemic
Objective: To determine the increase in intensive care unit (ICU) bed availability that would result from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols.Design, setting and patients: Prospective evaluation study conducted in eight Australian, adult, general ICUs, between September 2009 and May 2010. All patients who were admitted to the ICU, excluding ...
on behalf of the Influenza Pandemic ICU Triage (iPIT) Study Investigators
Beyond reporting: the MJA takes an active role in improving health care
In this issue, we report a significant study by Runciman and colleagues that was designed to measure how well we deliver “appropriate care” to patients in Australia (doi: 10.5694/mja12.10510). The researchers were aiming to reproduce a landmark 2003 study that found that only 55% of patients in the United States received “recommended care”. While the methods used by the American and Australian studies were slightly different, ...
Annette Katelaris MB BS, MPH, FRACGP
A dog walking on its hind legs? Implications of the CareTrack study
Despite its limitations, this important study highlights a genuine need for systematised performance monitoring[It] is like a dog’s walking on his hinder legs. It is not done well; but you are surprised to find it done at all. Samuel Johnson1 The results of the CareTrack study, reported by Runciman and colleagues in this issue of the Journal,2 and the accompanying commentary by the study authors3 represent an ...
Ian A Scott MB BS, MHA, FRACP · Christopher B Del Mar MD, MB BChir, FRACGP