- Written by Andrew Binns
In 1979, when I started in GP practice, some 80% of my patients presented with an acute problem. Now I estimate the same quantum has one or more chronic diseases. The Medibank scheme started in 1975 (it became Medicare under Hawke in 1984) and the standard consultation was described and given a monetary value.
The descriptor basically said take a history, examine the patient, investigate as appropriate, implement a management plan, provide appropriate preventive health care and document this record on the one or more presenting health- related issues.
Fair enough for a sore throat or ‘flu like’ presentation but what about the patient with one or more chronic diseases, who is likely to have multiple medications and many complex physical and/or psychological health issues?
Medical bodies including the AMA and the Colleges of General Practitioners and Physicians are putting their weight behind moves to see practical changes in the way Aboriginal and Torres Strait Islander people are treated in the health, child protection and criminal justice systems. Pressure is also being exerted on government to give greater recognition to the views of Indigenous people from around the country.
These issues were featured prominently at the National Indigenous Incarceration Conference (NIIC), held in Kingscliff in June 2018 and attended by a wide range of mainly Aboriginal and Torres Strait Islander speakers and delegates, both national and local.
Australia is heading towards one in two of the prison population comprising Aboriginal prisoners by 2020. In 1992, the ratio was one in seven.
Amongst the alarming statistics was the revelation that since 2004 the number of Aboriginal Australians in custody has increased by 88 per cent, compared to a 2 per cent increase for non-Aboriginal Australians. Moreover, Australia is heading towards one-in-two of the prison population comprising Aboriginal prisoners by 2020. In 1992, the ratio was one in seven.
The federal government has approved the listing of new diabetes and hepatitis C medications on the PBS, helping patients save thousands of dollars a year.
Referring to the hepatitis C drug Maviret, local MP for Page Kevin Hogan said, “Without the listing, patients could pay more than $50,000 per course of treatment for this medicine.
Maviret works by stopping hepatitis C virus from multiplying and infecting new cells. It belongs to a class of new treatments which provide a cure for well over 90 percent of people treated.”
- Written by Dr Dan Ewald.
Following up on the Nordocs unConference, where local medicos presented on things they are passionate about, the following is an introduction to the Handbook of Non-Drug Interventions. I have been part of the editorial/ writing group for HANDI since 2013 and have learned much from it.
Why a handbook of non-drug interventions?
It is estimated that half of the myriad clinical trials conducted each year globally are for non-drug treatments. However, effective non-drug interventions are less well known, less well promoted and less well used than their pharmaceutical counterparts.
The pale, thin, anaemic, vegetarian schoolgirl who gets constipated on iron tablets would benefit from an iron infusion. The tired 40 year old woman with low iron stores will feel a whole lot better with some iron tablets (or a B12 injection). The plethoric smoking, drinking, overweight 50 year old male with a high ferritin should pop down to the Red Cross for some regular blood donations.
These and other myths are debunked in Dr Louise Imlay-Gillespie's talk on modern iron management at the inaugural Nordocs Unconference held on 30 June 2018 at UCRH, Lismore.
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