Grassroots Team from UCRH

Aboriginal health priorities project Northern Rivers, NSW

Aboriginal staff at the University Centre for Rural Health (UCRH) in Lismore are leading the Health from the Grassroots Project aimed at giving voice to local mobs (from the Tweed to Clarence Valley) to talk about their priorities for community health and wellbeing and perspectives on what’s working well and what needs improvement to support community health and happiness.

We aim to collate the many comments and feedback received into actions to inform service provision and research.

Elderly patients are frequently admitted to hospital as the result of polypharmacy. Medications are reviewed and many are able to be stopped. 

The list of medications that can cause problems is long. Anticholinergics, antispasmodics, antidepressants and anti-parkinonsian medications are frequent offenders. So too are sedatives and narcotics.

Unfortunately for the GP when patients return after hospital discharge they reportedly find life intolerable due to pain and/or severe insomnia. Despite the warnings medication is often restarted and the cycle begins again.

Dr Tien Khoo, staff physician at Ballina District Hospital, sees this cycle all too frequently. In this article he recommends the "7 step medication review" plan to break or at least slow the cycle.

Concurrent with the evolution of modern medicine practitioners are increasingly caught up in a career that is rife with guidelines and recommendations. Though well-meaning, many of theses are led by specialist groups and institutions that focus (understandably) on a particular condition. Things are then left to the astute clinician involved in the decision-making process of clinical management, often followed by safe prescribing.

The commencement and continuation of medication on the basis of primum non nocere (‘first do no harm’) requires careful consideration of the information at hand. Ideally, information that feeds into our clinical reasoning processes should involve core components of the clinical history, examination, investigation results, intended benefit and most importantly, patient preferences. In addition, I suggest reflecting on the available evidence and the patient’s time horizon.

The Northern Rivers Medical Exchange (NRMX) has closed due to the rising cost of insuring medical data transportation. 

The Exchange started five years ago as a free service from the Northern Rivers General Practice Network for North Coast health practitioners. The Exchange used secure email to send documents between NRMX users. 

The service underwent extensive penetration testing by the Brisbane security firm YellIT prior to its general release and no major vulnerabilities were uncovered. 

Associate Professor Tom Shakespeare, Radiation Oncologist with North Coast Cancer Institute Lismore, has introduced 10,000 international colleagues to the ground-breaking work in prostate cancer treatment being undertaken in local facilities operated by the Northern NSW Local Health District (NNSWLHD).

A/Prof Shakespeare presented two papers at the American Society for Radiation Oncology’s (ASTRO) recent annual meeting in Chicago.

The gathering heard A/Prof Shakespeare speak on world-first programs that are improving healthcare for regional patients.

 Keeping a person healthy is no small charge. Keeping a nation healthy is a near Herculean task. Yet that is exactly what general practitioners (GPs) do.”

So begins the introduction by RACGP President Dr Harry Nespolon to General Practice: Health of the Nation, the latest annual report on the state of general practice in Australia. 

The College, which represents 90 per cent of the general practice profession, commissioned research involving more than 1100 RACGP Fellows (of 37,000 in 6500 accredited practices in Australia) as well as drawing on information in the MABEL (Medicine in Australia: Balancing Employment and Life) Survey and a range of government publications.

Each year the release of the report generates media interest but this year’s has been something of a blockbuster, attracting widespread coverage for the statistic that 65% of patients raise psychological issues with their GP.