Hope Alexander MPH

Posts Tagged ‘future’

Hope is attending the Anaesthetists Expert Working Party meeting.

Date
Thursday 15th April 2010

Agenda

10.00  Welcome and overview of meeting objectives – Linda MacPherson

10.10  Summary of results Kirsten Armstrong

10.30  Facilitated discussion:

• Feedback on report

• Identification of recommendations – Lorraine Acheson

12.15  Next steps and close – Linda Macpherson

Hope will be attending the following Clinical Senate meeting on 26 March 2010 in Perth, Western Australia.

Event: 26 March 2010 - Pre-Hospital Assessment - Avoiding the Revolving Door

The Consumers Health Forum-nominated consumer representative on the Medical Services Advisory Committee panel reviewing Vertebroplasty, has asked for comments on consumer issues around treatments such as Vertebroplasty (or injection of bone cement into diseased vertebrae such as osteoporotic fractures).

She is keen to ensure that all consumer issues relating to potential Medicare funding for this procedure are considered in the evaluation.

The Question:
Are we aware of any consumer issues relating to the current treatment and management of painful vertebral compression fracture as a consequence of osteoporosis or vertebral malignant tumours?

In a letter to the editor of the Medical Journal of Australia (MJA 2010; 192 (3): 174-17) Paul J Graziotti states that “Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm”.

Some years earlier Vertebroplasty was described as “a promising but as yet unproven intervention for painful osteoporotic spinal fractures” by Rachelle Buchbinder and Richard H Osborne (MJA 2006; 185 (7): 351-352). It was further claimed that “Medicare funding could jeopardise the research needed to establish the benefits and risks of this procedure”.

I read elsewhere that the “slurry” they inject into the bones, can leak out and cause even more problems. Therefore I would suggest caution to anyone who may be contemplating this procedure … as yet the evidence is not available.

The Response:
I would be very wary of suggesting that this procedure be funded by Medicare until there is some strong evidence that it works, and does not cause further harm. The way I read it, the evidence is just not there, and the possibility of damage and the “potential to cause harm” has already been established.

Further information about treatment for osteoporotic vertebral fractures can be found on The Health Report ABC National Radio web site here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647587.htm

Western Australians will be able to make important decisions regarding their future medical treatment and lifestyle choices, under new legislation which takes effect today.

Ministerial Media Statement from Kim Hames, Deputy Premier; Health; Indigenous Affairs can be viewed here:

http://www.mediastatements.wa.gov.au/Pages/Results.aspx?ItemId=133128

Government of Western Australia Department of Health Advance Health Directives information and forms can be viewed here:

http://www.health.wa.gov.au/advancehealthdirective/home/

The below article is a guest column written by Hope, that was published in the “Medical Forum WA”  magazine, Western Australia’s Independent Monthly for Health Professionals July, 2009 edition. Her article is on Page 10 and the orginal article can be accessed at http://www.medicalhub.com.au/component/option,com_docman/task,doc_download/gid,130/Itemid,228/

With the ageing population, what can the Australian health consumer expect in the way of primary health care, and by whom will it be delivered? One strategy to overcome the shortage of trained health professionals is to utilise the skills and strengths of nurse practitioners.

The article “On solutions to the shortage of doctors in Australia” states that:

• WHO estimates a current global shortage of 4.3 million health workers;

• Australia … compares unfavourably with other OECD countries in respect to doctor numbers;

• The overall shortage of doctors in Australia … is exaggerated by the disciplinary, cultural, and demographic misdistribution of the doctors relative to need and utility;

• Australia … is one of the most reliant of the OECD countries on foreign doctors; and

• An increase in spending on health promotion and disease prevention is essential.

“The majority of health professionals recognise that there is a gap in health service delivery in this country, and that nurse practitioners can contribute to filling that gap” (Cerasa, 2009).

Anecdotal evidence from patient X has a woman attending a GP surgery to have weekly dressings on her leg after day surgery. But can either of the two practice nurses reassure the patient that her wound is healing? No. Can the GP who sees the wound on an irregular basis? No, “It is OK.” What does that mean? So the patient returns to the surgeon to get a definite opinion. “Yes, the leg is healing, everything is proceeding as normal.”

If a consumer consulted a nurse practitioner specifically trained in wound care, the outcome would be much different. The skill and knowledge base would be there. Information would be given to the patient to best manage her condition: how often would dressings need to be done, for how long, and what the patient could do to resume her normal lifestyle. As a consumer, I have faith in the education and training of nurse practitioners. Many consumers have been let down by GPs who do not communicate, who do not share information and/or evidence, and who “do not want to treat old people” or “people with no money”.

As an older consumer with a chronic condition brought about by medical treatment for another condition, I would say “Yes, I am willing to consult a nurse practitioner” for routine checks and most ailments. Part of the nurse practitioner training is to differentiate between serious and minor complaints. I see their role as being similar to triage. Instead of referring a patient to a GP, it may be a referral to an exercise physiologist, a dietician, or a massage therapist.

GPs are trained in the medical model, but many consumers, particularly those with chronic conditions, and older ones, would prefer a non-drug treatment, along the lines of the New Zealand “Green prescription”. In addition, consumers find it difficult to access a GP who is willing to write an Enhanced Care Plan. Excuses given are “it takes too much time” and “we don’t get paid enough”. Consumers may well ask “But what about us?”

Hope Alexander

July 2009

© Copyright Hope Alexander

Submission to the Commonwealth Government Department of Health and Ageing on the new National Women’s Health Policy 1 July 2009

Hope Alexander MPH, Consumer Representative and Health Educator, Perth, Western Australia.

Introduction

In any proposed new National Women’s Health Policy as submitted by the Australian Women’s Health Network there needs to be a balance struck between research, prevention, and treatment and care.

For all those sick women whose treatment is determined not by gender but by class and economic disadvantage where are their voices in this proposed policy?

Where are the recommendations around Foetal Alcohol syndrome so that Indigenous children can have the best start in life?

The emphasis should show balance, not the middle class mantra of prevention education without the recognition of the suffering of the poor and the marginalised in our health system.

Recommendations

• Breast prosthesis – eligible women to be given a voucher for their prosthesis/es similar to that given eligible people for hearing aids

• A voucher for say $350 per year to attend an accredited gym to undergo an exercise program designed by an exercise physiologist for weight loss and/or weight management

• The New Zealand Green Prescription be implemented nationally

• Programs to address the issue of foetal alcohol syndrome, particularly in Indigenous women

The rationale for the recommendations

• Breast prosthesis – eligible women to be given a voucher for their prosthesis/es similar to that given eligible people for hearing aids.Although the Medicare rebate is a welcome innovation, it still leaves some women with a problem. They do not have the cash to pay upfront for their prostheses. These can cost from between $350 up to $550 each and possibly beyond. For a woman requiring two prostheses, (double mastectomy) this could mean anything up to $1000, perhaps more. For a woman whose only income is the aged pension or other form of income support this outlay is not an option.

• A voucher for say $350 per year to attend an accredited gym to undergo an exercise program designed by an exercise physiologist for weight loss and/or weight management.

For those women who have suffered weight gain and body fat gain from cancer treatments (HEAL study, USA, 1996) and possibly other drug treatments some form of assistance is required. Women on pensions and other low incomes are unable to afford gym memberships, and thus are prevented from gaining access to rehabilitation exercise.

It is recognized that chronic conditions (eg cancer and cardiovascular disease) are becoming a greater burden on the public health purse, and will continue to do so. Rather than have the Federal Government spend around $15,000 per obese person on stomach stapling surgery, a more equitable option would be to invest $350 per year per woman, for those meeting the above criteria: weight gain from cancer and other drug treatments. This is a form of rehabilitation, thus returning these women to a more fully functional and hopefully independent lifestyle.

The costs of the consultations with the exercise physiologist can be met by Medicare, under the Enhanced Care Plan (ECP). Many GPs are reluctant or unwilling to put women on an ECP. The complaint is “it takes too much of my time” and “We don’t get paid enough” (personal communications).

• The New Zealand Green Prescription (1, 2) is a program that works, and has been evaluated. Because the populations of Australia and New Zealand are similar (both having Indigenous peoples and a diversity of cultures) there appears to be no reason why the Green Prescription could not work in Australia. More important, it may well be acceptable to Indigenous women in Australia, as was the “One heart many lives”(3) program acceptable to New Zealand Maori males.
• A national program to address the issue of foetal alcohol syndrome particularly in Indigenous women.

References

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1508188

http://www.sparc.org.nz/getting-active/green-prescription/how-it-works

http://www.oneheartmanylives.co.nz/