Australian drug names to get an overall in keeping with international standards

According to an article published on the GIZMODO website by Rae Johnston the Therapeutic Goods Administration (TGA) is planning to change the name of approximately 200 medications in Australia over a seven year period to better align with the international community. According to the article the TGA determines the approved names for medications, however in some cases the names may deviate from the internationally known name as identified by the World Health Organization. During the transition period the TGA will insist that labels show both the old and new medication names.

There is a website setup by the TGA acknowledging the name changes and listing some of the medications names which will be changed. Most will stay relatively the same with only minor variations due to the differences of spelling. Interestingly enough the TGA website was published in November, 2016 and the article in GIZMODO published yesterday. I wonder if there is a delay in the name-change process?

References

GIZMODO: 200 Australian Medications Are Getting A Name Change

Theraputic Goods Administration: Updating medicine ingredient names – list of affected ingredients

Advertisements

Concerns raised about investigation of premature deaths in aged care facilities.

One day after this and other sites posted about Joseph Ibrahim’s calls to investigate the causes of what a coroner’s report called premature deaths in aged care two other articles have surfaced regarding the same issue.

Falls in residential aged care facilities

In an article in the Medical Journal of Australia Dr. Stephen Judd, chief executive of Hammond care- an aged care provider, discusses potential consequences if nursing home regulation were to be tighten in an attempt to lessen premature deaths from falls.

“If staff think they are going to get rapped over the knuckles if Mary falls over when she goes outside, they’ll lock the door so she can’t get out,” he said.

“All life is about risk; we have to encourage people to enjoy life, not just keep themselves hermetically sealed in a life of boredom,” he said. “Rather than trying to eliminate risks, we must manage risks intelligently.”

Interestingly I wonder if Dr. Judd is aware that most nursing homes do have locks on exterior doors to prevent residents with dementia from travelling outside? From my experience in aged care many, if not most falls, occur in the resident’s bedroom when the patient is found close to their bed. While I have not statistics evidencing this fact, I am sure Dr. Ibrahim’s report would reveal this.

Additionally, I also find it interesting that Dr. Judd stated that ‘staff’ would be responsible for denying freedom for fear of retaliation. Staff of nursing homes answer to the corporate bodies of said homes, so wouldn’t the fear they would be reacting to not come from the disciplinary action from corporate executives should preventable deaths not reduce? The article also reiterates the principles that I discussed in my previous post regarding the role of residential aged care. There exists a conflict between patient safety and freedom of choice. If a resident is unsteady on their feet and a falls risk but fiercely independent and wants to walk around a facility, does that facility have a right to restrain the resident to reduce falls?

Suicide prevention in residential aged care

Yesterday an article in the Australian Ageing Agenda by  Darragh O’Keeffe discusses the federal government’s stalemate on a decision of how to allow residents of Residential Aged Care Facilities (RACFs) to access the Better Access to Mental Health scheme (BAMH). The BAMH scheme, according to the federal Department of Health’s website

” Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.”

However, according to Dr Margot McCarthy, deputy secretary of ageing and aged care, there is still discussion around how the scheme would be made available to residents in care facilities.

If an elderly member of the community was having depressive thoughts surely the GP would jump at the chance of engaging in this service to allow more treatment options for their patients. The same should be true for residents living in aged care facilities. The Medicare funding does change when a person goes into RACF care, however that should not change the available services to them. I hope that in the near future the Department of Health and Department of ageing and aged care can come to an agreement and make this valuable service available for residents in RACF homes, thereby moving towards reducing preventable deaths related to mental health conditions.

What does this mean for nursing staff and residents?

While the powers-at-be continue to struggle with how to research and tackle the issue of ‘premature deaths’ nursing staff in aged care facilities will continue to be in the firing line. Without clear-cut guidelines their actions and assessments will put the responsibility for minimizing the risks sits squarely on them. For residents and families the falls, suicides and choking will continue until the federal government and corporate aged care executives agree on a standard measure along with established preventative measures to minimize, and hopefully, eliminate the term premature deaths in aged care from existence.

References

The Medical Journal of Australia: Aged care falls deaths: a question of balance

The Australian Aged Agenda: No end in sight to aged care’s mental health blockage

The Department of Health: Better access to mental health care: fact sheet for patients

 

Better behaved- new study finds lower rates of smoking, drinking and drug use

The day after World No Tobacco day the Australian Institute for Health and Welfare published statistics from the 2016 National Drug Strategy Household Survey. The results of that survey are encouraging:

  • Young people (under 30) are smoking less with rates dropping significantly from the 2001 survey. However, the decline is much less when compared to the 2013 survey.
  • Rates of smoking for those in their 40s, 50s and 60s have not lessened.
  • Young adults are showing a decrease in weekly alcohol consumption compared with 2013, however binge drinking is still excessively high. Youths under the legal age are also reporting less alcohol consumption and there are less reports of alcohol-viewed violence.
  • Illicit drug use has declined since the 2001 survey, however there is a slight increase since the 2013 survey.
  • Methamphetamine use is seen as the biggest concern regarding illicit drugs with crystal meth the most used variant.

What does this mean for those of us in healthcare?

There is a vast amount of evidence that smoking over a long period of time leads to higher rates of chronic health problems and increases the individual’s need for healthcare services. The lower rates of smoking of young people, although not immediately beneficial, will lessen the future health burden.

Every week our emergency department, along with many others around the country, see patients who have been the victims of over-intoxication and alcohol-fueled violence. While the binge drinking continues the lower violence numbers mean again less use of acute hospital beds, particularly on the key Friday-Sunday nights when parties typically occur.

I can say from my experience that Ice (Methamphetamine) is the most common illicit drug we see in our department. While not as problematic according to reports as drugs such as the Zombie drug it still causes a considerable amount of time and resources on the hospital system to treat.

The Future?

I am a realist. We will never completely eliminate behavioral health problems such as teenage drinking or smoking. Drug use will continue indefinitely. But at least we can see that improvements on a public health scale are being made. This will lead to more healthcare services being available for other unwell patients and can prevent young people from having poor future outcomes due to bad choices being made today.

References

AIHW: National Drug Strategy Household Survey (NDSHS) 2016 key findings

 

Telehealth to combat Australia’s growing demand for healthcare?

An article in IT Brief tackles the topic of how Australia is going to tackle the increased need for healthcare moving forward. According to a report in the Newcastle Herald Australian men are ranked in the top three countries worldwide in life expectancy, while women are in the top fourth. This is great news for Australians, and can cause sleepless nights for policy makers. The World Health Organization reports that currently Australia as of 2014 spends 9.4% of Gross Domestic Product on healthcare, that equates to approximately $4,357 per person. With the baby boomers expected to reach their senior age this figure is surely going to rise.

The IT Brief discussed several

items relating to IT and healthcare. One such discussion was over the My Health Record program by the federal government. I have previously discussed the My Health Record in another post. I believe it is a vital and important forward step in advancing the Australian healthcare system.

Another item discussed was the use of smartphone apps and other personal IT devices to aid in chronic disease management. This is a field that is sure to improve as our tech-savy population ages.

But the item discussed that interested me was that of individuals being able to visit with a doctor via an online medium. This was described in the article as a potential way for people to access medical care without needing to wait in a doctor’s office and would allow access in rural areas. In Australia we have a similar system in place in rural areas. However, looking to rely on this as a measure to markedly decrease the reliance on in-person healthcare is suspect.

While visual clues and interviews are important in assessing health concerns palpation, auscultation and the ability to have the patient in front of you make up much of both doctors’ and nurses’ assessments. Additionally, many presentations we see in hospital that have come from GPs requires further acute assessment not available in a doctor’s surgery: ultrasounds, CT scans, and urgent blood tests. These items would not be available to a patient sitting in their lounge room speaking with a doctor over the internet.

If there are chronic and stable conditions which only call for simple follow-up then online medical consultation would be fine. However, I wonder if that is not being done already? My concern is that moving forward the need for acute in-person healthcare will only increase. And with that increase will be the need for more acute beds in hospitals and more healthcare facilities to deal with demand.

Your thoughts?

References

IT Brief: Digital tech – the answer to Aussie healthcare’s biggest ailments?

Newcastle Herald: Australia about to lose top spot in this world health ranking

WHO: Australia

Australia, better healthcare than America- absolutely!

stethoscope-840125_1280

 

I came across this article and had to write about it. Marie Shieh, a doctor trained in America and now practices in Australia, has written a piece for the The Telegraph. In it she states emphatically that Australia’s health care is better than Americas. Full stop, no qualifiers. And as a former consumer and provider of America’s healthcare system I can agree.

Confession: my road to becoming a registered nurse started because of poor quality healthcare that my father received before his death. We were poor, not living on the streets poor, but we did not have a lot of money. My parents owned a printing business, and we did not have health insurance. When I was young my father was diagnosed with diabetes, then cancer and finally a heart condition. Because we did not have health insurance all of these medical conditions were treated very conservatively and without extensive examination. I believe, as a consequence of that, he suffered a major heart attack and died prematurely.

Now I know that he contributed to his condition with smoking and being overweight. But a lack of medical care significantly contributed to his death. From that moment on I was destined to be in healthcare, despite my attempts to move away from it. I have worked in palliative (hospice in America) care in the U.S. and now work in the Australian hospital system.

We have an amazing healthcare system. Yes, it is over-budget. Yes, there is over-crowding and never enough beds in our hospitals. Yes, people do (at times) come into emergency departments for things that could just as well be handled at their own doctors. But our system allows for every Australian the chance to have optimal health and to be free of medical issues, or at least have them treated to the best that our medical and nursing care can offer without fear of being unable to pay for such treatment.

I have always said that the Australian healthcare system would not work in America. The current push to repeal ‘Obamacare’ as it is called exemplifies this. Americans feel that they should be self-sufficient. And that is not necessarily a bad thing. Health insurance plans are out there to assist with costs. However, the American attitude of “if you can’t afford it we won’t pay for it” still leads to a class-based healthcare system. If you have money then you have health. As a nurse and believer in healthcare that is not right. Health is part of Maslow’s basic needs, and I feel it should be offered as a right just as security in the form of police and safety with firefighters.

maslow-pyramid

Maslow’s heirachy of needs- image source

Alas I do not feel that America will change their ways. The core beliefs of self-sufficiency go all the way back to revolutionary times. I am proud to say I am an Australian registered nurse. I am proud to say that the healthcare I and the thousands of other dedicated workers allows everyday Australians peace of mind and can allow us to continue to prosper.

 

The Telegraph: Trump is right about Australian health care, an American doctor in Australia says

Premature deaths in aged care facilities, what is really the root cause?

 

A recent article in The Conversation by Joseph Ibrahim discussed recent findings that a large number of residents in residential aged care facilities (most commonly known as nursing homes) died as a result of ‘unnatural causes’. The three most prolific causes identified by a recent report from the coroner’s court was falls (81.5%), choking (4.4%) and suicide (1.9%). The study also stated that while in over 90% of the cases the cause of death was initiated in the nursing home over 67% of the actual deaths occurred in an acute facility, such as a hospital. This is reflected in the patients I see in my emergency department. The report goes on to say that these incidents result in a ‘premature’ death and are in many ways ‘preventable’. I would like to bring up some important factors which may confound such a simple statement.

While I do agree that there are most likely things that can be done within Residential Aged Care Facilities (RACFs) to minimize deaths related to the above items, I do think some moderation of the situation is in order. With the ageing-in-place legislation and current climate allowing elderly people to remain in their own homes longer RACFs are seeing residents coming to them older, and more importantly, more unwell with their disease process advanced. While not an excuse I wonder how much longer RACF residents would be able to functionally thrive in their own home rather than in a facility? From my experience of working in RACFs I can say that most likely a resident is placed in a facility due to either an acute turn in their condition (i.e. fracture or some major medical setback) or commonly due to a decline in mobility and functionality due to dementia which would preclude them from staying at home. Along with the decline in mobility and functionality is an increasing possibility for falls.

A second issue is exactly what is the role of a RACF in the health care continuum? According to the MyAgedCare website in a RACF ” Staff at aged care homes can help you with day-to-day tasks (such as cleaning, cooking, laundry); personal care (such as dressing, grooming, going to the toilet); or 24-hour nursing care (such as wound care, catheter care).” Additionally, the Aged Care Quality Agency standards for RACF homes is very general with standard 2.4 simply stating ” Care recipients receive appropriate clinical care” and standard 2.14 on mobility stating ” Optimum levels of mobility and dexterity are achieved for all care recipients.” These are very broad clinical statements with no specific measurable outcomes. They are also included with other standards such as 4.8 which state ” Hospitality services are provided in a way that enhances care recipients’ quality of life and the staff’s working environment” and 3.7 ” Care recipients are encouraged and supported to participate in a wide range of interests and activities of interest to them.” Therefore, my question again is where does the RACF fit clinically within the healthcare continuum? Is it meant to be a sub-acute residential centre with clinical nursing care as a role on-par with items such as hospitality services and leisure activities?

This case can further be made if Mr. Ibrahim speaks to RACF clinical staff. In most RACF homes the registered nurse is the clinical decision maker for initial diagnosis and guides treatment of patients. However, they have limited assessment and diagnostic tools at their disposal. They have no access to blood tests, CT scanners or even x-rays within a reasonable time frame nor I have found a RACF with a 12 lead ECG machine which is seen as a critical piece of equipment in any hospital emergency department. Additionally, medical services are exclusively provided by general practitioners who can give limited medical support within their clinic hours and an after-hours GP service which does not know the patients and can only provide cursory and event-specific advice. This leaves the registered nurse having to care for a much larger number of patients than any hospital-based nurse would dream of doing with much less equipment and no medical support on-hand.

My worry is with Mr. Ibrahim’s study, as with many previous examinations of care given in RACF homes, will place the burden of responsibility for ‘premature deaths’ at the feet of the registered nurse. I think this is largely unfounded as the RACF system is flawed and needs a truly complete analysis and re-think moving forward. If the RACF is to prevent these events from happening then let us give the registered nurses on the floor appropriate staffing numbers, the right tools and education in assessment using them along with adequate medical support no matter the time of day or night and I think you will see the number of premature deaths decrease rapidly.

References

MyAgedCare: Aged care homes (nursing homes)

The Conversation: Many older people in care die prematurely, and not from natural causes

Aged Care Quality Agency: Accreditation Standards

Coroner asks NSW health privacy rules be relaxed to fight terrorism

A report by SKY news has indicated that the Coroner Michael Burns in investigating the Lindt Cafe siege has found the Personal Information Protection Act and the Health Records Information act were too stringent and did not allow ASIO investigators to have information needed. Coroner Burns has asked the NSW government to review the privacy legislation through his findings. The Sydney Morning Herald, reporting on the findings stated that “Mr Barnes says the government should consider whether NSW Health should more readily share information so that “fixated lone actors”  can be identified and monitored earlier.

However, reviewing the coroner’s report the findings aren’t so clear. Monis did visit several General Practitioners (GPs) who referred him to psychiatrists. Monis did, on one occasion, see a psychiatrist (through a private practice) who diagnosed him with mild depression. He was also seen by the Cantebury mental health team over a period of 16 months. However, according to the coroner’s report Monis was felt to have a personality condtion and not a psychiatric disorder. Additionally, Monis was felt to have manipulated the system to present him as a person with mental instability for some reason.

While the report is obviously a summary of the information gained at the inquest I wonder what good the health information would be in assisting ASIO or any other agency in identifying and removing Monis from the streets prior to the Lindt cafe siege? He appeared to be using the system for his own gains. Monis saw at least 10 GPs within the community, all who I would presume to be in private practice; and therefore not within the confines of the NSW Health system regarding privacy and information sharing. I am wondering how ASIO would be able to know that Monis had seen so many private practitioners and that he failed to follow-up on psychiatric referrals?

I, like many of my countrymen and women, do not want to see terrorist attacks in Australia as occurred in the Lindt cafe siege and in other horrific attacks around the world. And I would be prepared to assist authorities if it was needed. But unless there could be a reasonable explanation as to what benefit would be gained from relaxing the two privacy legislative bills in regards to apprehending potential ‘lone actors’ and preventing terrorist attacks then I fail to see how this would provide benefit over cost to the general public?

NSW Health takes privacy very seriously, and that is a welcome position in my book as a healthcare practitioner and patient. While I am not completely opposed to relaxing privacy legislation I do think we owe it to the general public to have an open discussion regarding what we as that public would be prepared to give up in terms of our privacy for the safety of others. By relaxing privacy legislation, particularly in mental health situations, you risk potential patients staying away from treatment in order to protect their privacy.

Yes, it is a slippery slope. But I am willing to take that slide if there would be real benefit and recognized limits on who the information is shared with and how it will be used. The public has a right to be involved in any discussion.

Your thoughts?

References

Coroner’s report into the Lindt Cafe siege

Sky news report on the findings

Sydney Morning Herald: Lindt inquest: Mistakes cannot be papered over, coroner Michael Barnes finds