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Assessing Fitness for Return to Work Jun 16th, 2015
'Worklessness' has profound negative effects on the injuried individual and their family. People who are unemployed suffer from poorer general health and they are more likely to participate in risk-taking behaviours such as alcohol and drug abuse, sexual promiscuity and smoking.

Unemployment also leads to wider social inequalities, and economic stress can impact on families with implications played out over decades. Importantly, regaining work may reverse these adverse health effects, and re-entry into work leads to an improvement in health.

There are several principles that health-care professionals need to take into account when assessing an individual's fitness for work.

Safety

It is important to consider not only if the person is likely to be able to perform their duties effectively, without harm to themselves, but also if the patient's return to work may lead to risk to others.

Inclusive approach

Individuals do not need to be symptom free to work. Many medical conditions, and virtually all minor health problems, have minimal implications for work and should not prevent employment.

The majority of people who are off work due to MSDs return to work within 4 weeks without vocational rehab advice or intervention. The priority at this stage is to support and encourage restoration of function and to avoid exacerbating disability, as there is evidence that occupational outcomes for most people with MSDs are improved by early return to some work.

Once an individual has been off work with an MSD for 4 weeks, an intervention to assist return to work is more likely to be required. By 26 weeks of absence, incapacity is likely to have become entrenched and rehabilitation becomes much more difficult. Therefore, the period of 4-26 weeks is often referred to as the ‘window of opportunity’ for effective return-to-work management.

Medical fitness should be assessed in relation to the particular demands of the work, such as hours; shiftwork; exposure to physical, chemical, biological and psychosocial hazards; work relationships; physical work environment; and requirement to travel.

An in-depth knowledge of the workplace and the duties of the job invaluable when assessing a employees fitness for work. Another reason this process should be done by the workplace injury management co-ordinator or injury management provider.  OH service. If such a person is not available majority descisions regards fitness to work are therefore undertaken by general practitioners (GPs) or hospital-based health professionals. These individuals often have limited knowledge of an employees workplace and roles.


Assessment of work capability is complex, and despite its importance, there is very limited scientific evidence to base RTW decisions on in part as there is no standard or valid methodology for assessing suitability for RTW used over all professions.

Outcomes from fitness for work assessments may range from ‘fit’ to ‘unfit’, with intermediate categories such as ‘fit subject to work modifications’, ‘fit with restrictions’ or ‘conditionally fit (temporarily, permanently)’. Workplace modifications to improve or adjust working conditions should always be considered.

Suitable Duties

Adjustments to work may be temporary or permanent, and they may take many forms. They may include shorter working hours, different shift patterns, avoidance of manual handling or transferring someone from a physical to a sedentary post.

For example, an employee with arthritis may benefit from starting work slightly later in the morning to allow time for the medication to take effect and early morning stiffness to reduce.

It is important to consider how individuals travel to work. Employers may be able to provide workers with a parking space to facilitate their access to work. Individuals who use public transport may temporarily or permanently benefit from travelling before or after the rush hour, so as to ensure that they get a seat.

Return to Work

Patients should be forewarned that they are likely to experience disproportionate fatigue on return to work. This symptom is likely to be more prominent in individuals with inflammatory MSDs. This can be mitigated in some cases by simple strategies such as returning to work on alternate days for the first week; returning in the middle rather than the beginning of the working week; and, if possible, working shortened hours, gradually increasing to usual working hours over a period of a few weeks.

Next - Pre-employment Physical Assessments



Physical Assessment and Return to Work Jun 16th, 2015
Work health and safety laws in Australia and other jurisdictions also require employers to provide a "safe system of work". For example, section 19 of the Work Health and Safety Act 2011 states that the "primary duty of care" is to "ensure, so far as is reasonably practicable, the health and safety of workers" by, among other things, "provision and maintenance of safe systems of work".

Pre-employment physical assessments provide vital information for such decisions, and will find more and more value as our workforce gradually ages over the coming 2-3 decades. Information gained form Physical Assessments can also be helpful in establishing pre-existing physical capacity, whch asssits in establishing return to work goals.

It is important for recruiting employers to make clear to applicants the reason why health-related questions are asked pre-employment and the purposes for which the information will be used. 

Once a job has been offered, and accepted employers may, if they wish, ask additional medical questions. If a condition is revealed that might cause the candidate problems in performing the job, then adjustments must be considered. If no adjustments are possible, or the adjustment is not considered to be reasonable by the employer, then the job offer may need to be withdrawn.

It is important that an organisation ask the advice of medical/health professionals before turning down an individual for work on health grounds.

Summary

RTW is most successful if a clear return to work plan is agreed upon; the employer is willing to make adjustments to the person's job or working environment and all health-care workers involved with the patient communicate with each other .

Main Points


  • Be inclusive in your RTW process, by considering what injuried employees can or may be able to do, rather than what they cannot do.

  • It is important an employer can entertain reasonable adjustments recommended by an employees treating GP. Alternatively an employer must be ready to provide suitable alternatives to enable employees with MSDs to return to work, stay in work or access work.

  • There is strong evidence that return to work is most successful if it involves a partnership and understanding between employers, the worker and health-care professionals.

  • There is strong evidence that temporarily modified work can facilitate early return to work.



Diabetes Support Group Jun 15th, 2015



Centrals - Physical Activity Readiness Questionnaire Jun 11th, 2015
The following is a standardised Physical Activity Readiness Questionnaire. If you answer yes to any of the following questions it is strongly recommended you discuss your answers with your Doctor or a suitable health professional. 

Once completed you will be provided a link to continue the gym use process.



Centrals - After Hours Gym Safety Questionnaire Jun 11th, 2015

To confirm you have completed our gym safety induction please answer the following questions. 




Gym Program - Beginner 1 Jun 8th, 2015

Lunge



Half Pushup



Lat Pulldown



Seated Row



Bicep Curl



Tricep Pushdown



Lateral Dumbell Raise



Sidge Bridge



Bird Dog



 



Gym Program - Beginner 2 Jun 8th, 2015

Leg Press



Bench Press



Lat Pulldown



One Arm Row



Bicep Curl



Tricep Pushdown



Lateral Dumbell Raise



Sidge Bridge



Bird Dog



 



Medical Observer - Pharmacy’s $19b deal a ‘political’ move May 29th, 2015


This article was written by Flynn Murphy

DOCTORS and consumer groups say the government has folded to the pharmacy sector with a new $19 billion agreement that puts politics above patient care.

As general practice shoulders the burden of an MBS rebate freeze, the massive funding boost for pharmacies includes a doubling of the allocation for pharmacy-delivered primary care to $1.26 billion.

Health Minister Sussan Ley introduced the legislation on Wednesday, telling parliament the Sixth Community Pharmacy Agreement would let the sector “innovate and transition from a focus on medicines supply to medicines management and pharmacy services”.

As previously revealed by Medical Observer, wound care programs, staged supply of medicine for mental health, and basic arthritis checks are likely beneficiaries of $600 million in new and expanded pharmacy services.

No specifics have yet been announced. A $50 million Pharmacy Trial Program will be established to decide which of the services meet the cut, and new and existing programs will need to be approved by the Medical Services Advisory Committee (MSAC) to be funded.

Existing services like medication adherence and medication management programs, including clinical interventions, have been allocated $613 million.

That’s despite what RACGP head Dr Frank Jones says is a lack of evidence such programs have worked.

“We wrote a strongly worded letter to the minister [in March] suggesting that there was little evidence provided – at least publicly – that what pharmacists were doing was improving patient care,” Dr Jones said.

“After that there was not really much feedback; negotiations continued between the department, the minister and the pharmacists.”

Dr Jones said the government had “given in” to the pharmacy sector.

“Our views were very plain right from the start – we really wanted to know where these dollars were going to improve patient care.”

A Pharmacy Guild of Australia spokesman said pharmacy-delivered programs were evidence-based and he did not expect any of the current programs to be knocked out by the MSAC.

He ruled vaccination programs out of the process, saying they were paid for by patients rather than the government.

Dr Brian Morton, AMA chair of general practice, said it was “amazingly short-sighted and hypocritical to give such a massive handout to the pharmacists – specifically the massive handout for expanding their scope of practice and doing primary care”.

“It’s not the way to design a healthcare system. If you’re treating a minor wound, a pharmacist would have a direct conflict of interest – are they going to sell them the cheapest dressing? Or a particularly expensive one? An ointment that could be complementary?”

Dr Morton said the money should be spent on establishing a Practice Incentives Programme payment for GPs to employ non-dispensing pharmacists in their clinics.

“That’s where there will be significant returns to quality prescribing,” he said.

Dr Jones said the agreement was a “political decision” and questioned whether it was good scientific practice to hand out the money before a two-year pharmacy review had been carried out, particularly in light of a scathing audit report about the previous agreement.

“Why didn’t we look retrospectively at what’s happening to see whether we’re spending money sensibly, as opposed to doing it prospectively when the money’s actually been given to them?”

The Sixth Community Pharmacy Agreement is one plank of the government’s five year Pharmaceutical Benefits Scheme Access and Sustainability Package, which also includes an agreement with the Generic Medicines Industry Association.

An agreement with Medicines Australia will see drug manufacturers absorb around $6.6 billion in PBS cuts.

Medicines Australia CEO Tim James said: “In response to the government’s budgetary challenges, we have agreed to meet all of the government’s savings targets… Our members have been given a number of undertakings and concessions regarding any future price-related savings throughout the life of the agreement.”

Medicines Australia and the Pharmacy Guild had both rattled their sabres in the lead-up to the federal budget, but observers say the guild came out on top while the medicines body bore the brunt of the government’s quest for budget savings.

Consumers Health Forum head Leanne Wells welcomed the measures to bring down the prices of some drugs, to announce the listing of new drugs and the introduction of an optional $1 discount on prescription medicines – which is still being fought by the guild.

But she called the pharmacy agreement a “lost opportunity to drive reforms to loosen the grip of pharmacy owners on the anti-competition rules and provision of patient services”.


Australian Doctor - Diabetes Care Project fails on cost May 25th, 2015
This article was written by 

A three-year trial of capitation and pay-for-performance funding for GP diabetes care has shown they are much more expensive than the existing MBS items.  

The $34 million Diabetes Care Project program involved 184 general practices and 7781 patients with type 1 or type 2 diabetes and was meant to test alternatives to the current MBS items for chronic disease management.

While the trial - one of the biggest in Australian general practice - showed that new funding models improved HbA1c and other clinical outcomes, there was a higher overall cost of $203 per patient than existing Medicare item-based care.

The cost was so large that researchers said the funding model used in the trial would not be value for money.

The pilot of an enrolment-based ‘healthcare home' model replaced GP Medicare payments and care plans with a flexible funding model that included lump-sum payments per patient and funding for care co-ordinators.

When adopted by practices in Victoria, Queensland and SA, patients had a statistically significant 0.2% improvement in HbA1c compared with a control group.

Improvements were also seen in outcomes such as blood pressure, lipids and waist circumference, as well as for aspects of diabetes care such as care-plan take-up, completion of recommended ‘annual cycles of care,' and allied health practitioner visits.

However, the program that offered general practices flexible payments of $200-300 per diabetes patient would not be cost-effective if implemented on a wider scale, the evaluation report concluded.

Despite reducing hospitalisation costs by $461 per patient, the Diabetes Care Project had an estimated cost per QALY of $100,000 to $250,000, well below the threshold of $50,000 deemed necessary for cost-effectiveness.

The report authors said a diabetes co-ordinated care program might be cost-effective if funding was targeted more at the highest-risk patients.

Their analysis showed that more than 60% of costs were incurred by 5% of patients with complex needs.

They therefore recommended a ‘re-calibrated' program with funding of up to $700 for high-risk diabetes patients and $100 for low-risk patients.

Dr Gary Deed (pictured), a GP with a special interest in diabetes, said the modest changes in clinical outcomes were achieved at a high cost, and one of the main lessons from the Diabetes Care Project was the need to focus on the highest-risk patients with diabetes.

"The project didn't really address the frequent flyers, the highly complex patients and their risk stratification. So really, the study may be telling us that we need more evidence before we implement broad changes to funding models in diabetes care," he told Australian Doctor.

The evaluation report also showed that when implemented without the flexible funding component, the use of IT tools for care planning and Continuous Quality Improvement processes did not improve outcomes.

Federal Health Minister Sussan Ley said the findings from the Diabetes Care Project report would be considered by the Primary Health Care Advisory Group, whose remit was to develop innovative care and funding models for people with complex and chronic illness.

It would also be used to inform the National Diabetes Strategy, with the consultation period for the advisory group extended to 31 May to allow time for feedback on the Diabetes Care Project report.


Couch to 2k Initial Questions - HBF Geraldton RunFest Program May 21st, 2015
The following is a standardised Physical Activity Readiness Questionnaire. If you answer yes to any of the following questions it is strongly recommended you discuss your answers with your Doctor or a suitable health professional. 

On clicking the 'submit' button you will be provided a link to your running program and a brief clip on running technique. We are collecting a name and email address in the event that some form of correspondence is required.

Enjoy!



Do Patients Return to Sports and Work After Total Shoulder Replacement Surgery? May 21st, 2015

Total shoulder arthroplasty (TSA) is a well-established treatment option for degenerative pathologic abnormalities of the shoulder joint and has shown satisfactory long-term functional outcomes.

As life expectancy increases and shoulder replacement surgery is routinely performed in young and active patients with degenerative conditions as well as in the elderly population, new goals of shoulder joint replacement are becoming more important, such as the ability to resume sports and return to work.


The above study demonstrated a good rate of successful return to sports in patients undergoing TSA with primary glenohumeral arthritis. Overall, 57% of patients who had ever participated in sports in their lives were doing so at final follow-up. All patients that participated in sports right before surgery were successfully able to return.

The results for return to work were far less encouraging; however, it is important to note most of the study participants were retired at the time of follow-up.

While only 14% of patients were able to return to work after shoulder replacement surgery. Using statistical assumptions, the authors suggest the majority of participants (61%) did not retire or stop their work because of TSA.

30 patients (20%) had to change their work because of shoulder replacement surgery. Six patients (3.9%) of the entire cohort were not pursuing their work at the time of recent follow-up because of problems with the affected shoulders.

It is encouraging that a large proportion of patients did progress back to normal recreational activities following TSA, which would suggest that the RTW outcomes may also be more favourable in a younger, currently working population.


Couch to 2k - HBF Geraldton RunFest Program May 20th, 2015


Next Dietitian Talk Monday 25th May 2015 at 12 noon. May 18th, 2015

Temika Lee's next Dietitian Talk is on Monday 25th May, 12 noon at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.


This talk covers:



  • Healthy Eating Habits

  • Glycemic Index

  • Fat Types and Cholesterol

  • Recipe Modification Label Reading



Lumbar compression forces while lifting and carrying May 12th, 2015
In the construction industry, lifting loads is a frequent occurrence. Manual material handling (MMH), in terms of lifting is associated with an increased incidence of work-related back disorders.

To prevent work-related back disorders as a result of lifting, the maximum load mass to be lifted by one worker has been set at 25 kg in the Netherlands, and the maximum load for manually lifting is set at 50 kg when lifted by two workers. Loads above 50 kg should always be lifted mechanically (Visser et al, 2015). However, mechanical transportation is not always feasible and when not available the loads should be lifted by more workers (team lifting), while not exceeding 25 kg per worker.


The above study examined the lumbar compression forces of handling loads, which occurs daily at construction sites. It was found that a 50-kg two-worker lift resulted in higher mean and maximum peak lumbar compression forces compared with a 100-kg four-worker lift.

Carrying a load while stepping over an obstacle resulted in higher mean and maximum peak lumbar compression forces compared with carrying on level ground. The variability of the peak lumbar compression forces during the carrying tasks was higher while stepping over an obstacle compared to carrying on level ground for carrying 50-kg and 100-kg loads.

Compared to lifting, carrying a 100-kg load while stepping over an obstacle or up a platform led to a higher variability. Carrying a load up a platform resulted in the highest compression forces.

To reduce peak lumbar compression forces, lifting a fixed load mass with additional workers is advised. However, the benefits of additional workers are task-dependent (e.g., carrying vs. lifting). Additionally, the question remains whether the use of an additional worker is feasible in practice.

Two overall recommendations were made:


  1. Efforts should be made to prevent manual lifting and carrying of objects to reduce exposure of high compression forces during lifting and carrying.

  2. When mechanical transportation is not possible and loads are handled manually, carrying routes should be free of any obstacles to be overcome.




Australian Doctor - Diabetes Strategy urges GP payment overhaul Apr 15th, 2015
This appeared in todays Australian Doctor written by Michael Woodhead.

Pay-for-performance incentives that would see GPs paid on the basis of how many patients they screen and treat for diabetes form a central plank of a new national diabetes strategy.

The National Diabetes Strategy consultation paper states that fee-for-service payments are not working for diabetes and should be supplemented by payments based on quality and outcomes measures.

The Federal Government's paper, released on Wednesday, lays out five key target areas for change, which include:

- increasing the number of people who are screened and diagnosed early with diabetes

- boosting the number of patients with diabetes receiving structured management programs in primary care

It notes that currently only 18% of patients with diabetes had an annual cycle of care completed by a GP, and suggested that this could be improved by linking performance benchmarks to reimbursement

"The fee-for-service model does not incentivise long-term follow-up or the proactive care of people with chronic conditions. As such, more innovative funding models are needed that combine fee-for-service reimbursement with other payment types, such as population-based payments and quality-based payments," the consultation paper said.

"The government could consider exploring (potentially through demonstration projects) an innovative combination of payment models, such as pooled funds, ‘medical homes,' capitation payments, pay for performance, and pay for quality and outcomes based on performance indicators."

The paper also suggests new funding models for allied health professionals.

Among the other proposals are a national program for detecting prediabetes and early diabetes based on the AUSDRISK tools, and programs based in Primary Health Networks to encourage annual screening for complications

The National Diabetes Strategy should also include measures to improve access to medications and devices such as insulin pumps, and encourage uptake of the PCEHR by people with diabetes, the consultation paper suggests.

The proposals have been released by the National Diabetes Strategy Advisory group, set up by former health minister Peter Dutton in 2013, which is led by endocrinologist Professor Paul Zimmet and former MP Judi Moylan.

It is accepting feedback on the proposals until 17 May and will release a final National Diabetes Strategy in late 2015.

The proposals have been backed by RACGP resident Dr Frank Jones, who said they were in line with the college's newly released new primary healthcare funding model that proposes a move away from fee-for service funding.

"[The Diabetes Strategy proposal] basically reinforces our viewpoint that you can't look after patients with chronic disease with the Medicare model that we have," he told Australian Doctor.

Dr Jones said the RACGP model would retain fee for service for acute episodic care, but would introduce patient enrolment and replace PIP and SIP incentives with practitioner and practice-directed loading payments based on "comprehensiveness" and complexity of care.

The new reimbursement would recognise the ongoing work that GPs did with patients such as those with chronic and complex diseases, according to Dr Jones.

"We really believe that GPs who provide quality care ought to be recognised," he said.


Pacing your Lifestyle and Exercise Apr 14th, 2015
“Pacing is an active self-management strategy whereby individuals develop self-efficacy through learning to balance time spent on activity and rest for the purpose of achieving increased function.”

Jamieson-Lega et al (2013)


Pacing involves learning to balance your time spent on exercise and activities, to avoid overactivity or underactivity. It is about being able to manage your chronic pain more effectively, to achieve a balance between rest and activity. This enables you to perform meaningful activities with less pain interference.

When you start an exercise program, you may struggle to adopt the right pace and technique in developing your fitness training. As a result, exercise can feel like a struggle. If you’ve experienced difficulty sticking with your exercise regime, the problem is likely to be one of pacing judgment and intensity:

a) Starting your exercise too quickly and paying the price later on

b) Completing sessions too conservatively and feeling you’ve got a lot more left in the tank

The solution is learning how to evaluate your training intensity and match it to your session so that you get maximum training benefits — and importantly, enjoy your training sessions.

“After having a serious illness a few years ago, and not being able to exercise without pain, I was unsure of how to begin an exercise plan without making my symptoms worse. I then realized that if I paced myself, I might be able to exercise successfully without the symptoms getting worse. I changed my thought processes from trying to lose weight and getting fit, to relieving the symptoms of my chronic pain. I started at a very slow pace, not pushing myself at all, a pace that I could do on my worst days, and then as it became easier, with no pain I increased the pace of my exercise program” Anonymous

Rhianne Turner Physiotherapist

Next- Pacing Your Lifestyle

 


 



Pacing your Lifestyle Apr 14th, 2015
“Pacing and balancing tasks become skills that can assist with managing chronic pain”

It is important to prioritise activities so that the most important tasks get done first. This way if you are unable to finish every task, then at least the most important tasks are done. Also, try to leave yourself plenty of time to complete each task. Pacing your lifestyle will provide you with an effective means of achieving your goal, provided you are realistic in choosing the priorities in your life.

Performing one major task in small steps each day can lead to feelings of achievement and build your coping strategies. This will take time and patience. Try not to compare yourself to what you used to be able to achieve before the onset of chronic pain, this may not be realistic initially.

Following a routine of less pleasurable activities/chores followed by enjoyable activities can also assist in the pacing process, rewarding yourself for your achievements.

WHAT TO AVOID

Chronic pain commonly leads to ‘Good days and Bad days’. It is important not to use good days for going hard at physical activity – as you will surely feel those bad days and need some time to rest and recover.

An increase in muscle pain is to be expected as you are using muscles and joints in new ways, known as Exercise Induced Muscle Soreness (EIMS).

Boom – Bust Approach is when a person does too much all at once, crashes, rests, starts to feel better and does too much once again. If activities or exercises are not spread out, a boom-bust cycle will occur. At times this may be inevitable; however when Boom-Bust approaches become habitual it can result in exhaustion, sleep disturbances, insomnia, appetite and weight changes, or mood swings. You should learn to recognise contributors such as fear avoidance, attitudes and beliefs.

Watch out for Boom-Bust signs as they can significantly increase pain levels, such as:

a) being highly motivated to achieve your goal that you significantly increase pain levels

b) being apprehensive about what may happen if things don’t get done

c) having a high number of commitments or responsibilities to meet


10 TIPS FOR SUCCESSFUL PACING

  1. Be consistent. Be persistent. Be patient with yourself.

  2. Choose something you enjoy

  3. Have a realistic timeframe, gradually making the activity harder and changing the environment (from walking on level ground to walking uphill or on the beach)

  4. Pace your activities, even on bad days (avoid good day, bad day behaviour)

  5. Have rest periods

  6. Listen to your Body: The body sends us signs and signals when it is being overworked, so it is important to balance rest and activity

  7. Stick to your designated time limit: use a timer and be disciplined in starting and stopping activities

  8. Use a diary to record your progress so you can pace accordingly and measure your achievements

  9. Avoid too large of an increase in activity to avoid a ‘Boom-Bust’ approach to exercise

  10. To improve your pacing, undertake a little more each week, gradually building up physical activity over time. It is important to set SMART goals to pace yourself so that these realistic goals can be met




Rhianne Turner Physiotherapist



Infographic- SMART Goals Apr 14th, 2015



Insurers won’t run PHNs Apr 13th, 2015
This article appeared in Medical Observer written by Julie Lambert

PRIVATE health insurers will not take roles in running new Primary Health Networks despite reports describing them as partners in successful PHN consortiums.

Health Minister Sussan Ley (pictured) on Saturday announced the successful tenderers for 28 of the 31 PHNs, which are to replace Labor’s 60 Medicare Locals as of 1 July.

Ms Ley’s media release said many of the successful PHNs were “consortiums harnessing the best skills and knowledge from a range of sources, including allied health providers, universities, private health insurers and some of the more successful former Medicare Locals”.

Adding to the impression that the insurers had managed something of a coup, a weekend news report said the Abbott government had “handed control” to a range of groups including the two major health insurers HCF and Bupa.

Giving a specific example, the News Ltd report said the North Brisbane PHN would be “run” by Metro North Brisbane Medicare Local (MNBML), together with Metro North Hospital and Health Service, Children’s Health Queensland Hospital and Health Service, Telstra Health, AMA Queensland, UnitingCare Health, and the two insurers.

However, Medical Observer has confirmed that only four of the 28 successful bids had any involvement with private health insurers, and their roles are strictly as support players.

MNBML CEO Abbe Anderson said HCF and BUPA were just two of many groups that had backed the successful application from her organisation.

“While MNBML has the support of a wide range of key participants – including those listed – I think we had over 30 organisations that provided us with letters of support and endorsement in our application,” Ms Anderson toldMedical Observer.

“But the PHN itself will be governed and managed by the same organisation that has been running the ML since its inception.

That organisation – Partners 4 Health, the registered trading name of MNBML – has been in place for four years and is very much a “grassroots” outfit, she said.  

“It has a local membership structure of over 20 organisations, all of which represent local clinicians and community groups, and that will be complemented by the formation of new clinical councils and community adviser groups,” Ms Anderson said.

She said private insurers shared the same imperatives as hospitals and primary care groups - trying to keeping people well and out of hospitals - adding they were in conversation “about the types or program we want to see".

“In our experience, private health insurers are very willing to look at chronic disease programs that benefit everyone, that aren’t just aimed at their members,” she said.

But Ms Anderson did not see any risk of a push for preferential treatment of private health fund members.

“I honestly see everyone working very collaboratively together, and I guess that’s one of the key reasons why we need the voices of GPs and other clinicians in the planning of these models, to ensure we don’t end up with systems that somebody will lose out on.”

Dr Marcus Tan, a director of WA Primary Health Alliance, which has landed contracts for three WA PHNs, said his organisation saw a similar need to take “a very collaborative approach” including input from the same two insurers.

“This is recognition of the need for an integrated healthcare system to have government, non-government and private involvement,” he said.

“The private health insurers have signalled their interest in chronic care, for example – but they are not formally part of the organisation.”

The Alliance was formed from Perth Central & East Metro ML, Goldfields-Midwest ML, Perth South Coastal ML and Fremantle ML, with endorsement from Bupa and HCF among others.

Dr Tan said he thought the Perth North, Perth South and Country WA PHNs would make the 1 July start date because much of the established resources and infrastructure of the Medicare Locals would be transitioned into the new networks.

In Victoria, the Grampians and Barwon South West PHN was also named as having a private health-fund partner aboard.  

But Jason Trethowan, CEO of Barwon Medicare Local, which will manage the new PHN covering western Victoria, said the association with locally based private health insurer GMHBA was entirely without conflict.

“Our Medicare Local is the company that will change its name and constitution to establish the PHN for western Victoria,” Mr Trethowan said, adding GMHBA and the four local hospital networks would all be critical in the rollout.

“But there’s no deals, no role in governance, no seats on boards, no interference with the running of the PHN,” he said.

“Where there are areas where [GMHBA] can support us or work with us, then we would do so.

“It was important in our submission to show we had a strong buy-on from Deakin University, four major hospital networks and also a health fund that has most of its members in our footprint.”

South Eastern NSW PHN is the fourth new entity identified by the minister’s office as having private-insurer backing.

The managing organisation is Coordinare Limited, formed by the Illawarra Shoalhaven ML, supported by the University of Wollongong and Peoplecare, a member-owned, not-for-profit health fund based in Wollongong. 


Australian Doctor - Axed preventive health program showed promise Apr 2nd, 2015
This appeared in todays Australian Doctor written by 

Australia’s national preventive health program was showing promising results before it was scrapped in last year’s budget, according to a belatedly released Department of Health report.

The National Partnership Agreement on Preventative Health (NPAPH) was introduced as a COAG initiative under Labor in 2008 with programs to reduce smoking rates, combat excess alcohol intake, boost physical activity and improve diet.

The Coalition axed the program in the 2014 federal budget and diverted the savings of $368 million over four years to the Medical Research Future Fund.

However, an independent evaluation report released under a Freedom of Information request showed that six months before the partnership agreement was abandoned, the government was told the program "appears to be a sound, evidence-based and highly appropriate investment in preventive health".

"Overall, approaches have been based on effective health promotion principles and best-available evidence, and there is a judicious mix of innovative and evidence-based strategy," the report authors said.

"Available evidence indicates that implementation is on track, and that some states and territories are achieving a good level of reach into target groups."

The programs funded by the NPAPH included the Healthy Children Initiative, the Healthy Workers initiative, the Measure Up campaign, the National Tobacco campaign, and the Healthy Communities Initiative.

The report was finalised in January 2014, when the future of the NPAPH still looked bright.

"While it is too early to reach conclusions on the likely extent that the NPAPH will achieve its longer term outcomes ... the current evidence of reasonably effective partnership processes and successful implementation of initiatives indicates that considerable progress is being made in the right direction," it concluded.

This week, 11 peak health groups raised concerns about the axing of a wide range of preventive health programs.

"We are particularly concerned about the future of the Close the Gap Indigenous Chronic Disease package, which aims to prevent chronic disease including GP services, medications and tackling smoking. The new Primary Health Networks will not be able to pick these critical programs up as they have barely been established yet," said Lisa Briggs, CEO of the National Aboriginal Community Controlled Health Organisation.

Federal Minister for Health Sussan Ley could not be reached for comment.


Realising the Health Benefits of Work for all Australians Mar 31st, 2015
Realising the health benefits of work for all Australians requires a paradigm shift in thinking and practice. It necessitates cooperation between many stakeholders, including government, employers, unions, insurance companies, legal practitioners, advocacy groups, and the medical, nursing and allied health professions.

The family doctor is best placed to advise and educate patients that, in most cases, a focus on return to work is in the best interest of the patient – for both their future and quality of life and that of their family.

Return to work is not possible for everyone, but certifying time off work – particularly when absence is long term – can have significant side effects, including increased rates of overall mortality, poorer physical health and poorer mental health and psychological wellbeing.

The following document is a consensus statement from the Australian Faculty of Occupational and Environmental Medicine. It highlights the importance of a trusted GP in assisting employee's to return to work.


Despite all of the above, research continues to show that many GPs are unlikely to recommend alternate duties for injured workers, and many GP’s who suggest a ‘special interest’ don’t always follow these best practice guidelines.

I hope that the above highlights the significant benefits to be gained from offering employees a 'trusted' GP and Injury Management Service.

 



Reassuring Employees About Low Back Pain Mar 28th, 2015
Back pain is one of the most commonly encountered conditions in Australian workplaces.

In the 2012-2013 Australian Workers Compensation Statistics 22% of serious claims were due to back pain and some 33% of serious claims were caused by muscular strain while lifting or handling objects.

Despite trends showing increasing use of advanced imaging tests, opioids, and invasive surgical and interventional procedures, with attendant increases in costs, the prevalence and burdens associated with back pain appear to be on the rise.

In fact, there is growing evidence that those who suggest a ‘special interest’ in managing back pain often provide less appropriate treatment recommendations. These providers often hold alternative beliefs regarding the association of pain and activity that influence their practice behaviour.

For example, the presence of common degenerative findings on spinal imaging poorly correlates with the presence of and severity of back pain or the likelihood of developing chronic disabling symptoms. Rather, predictors of chronicity are primarily psychosocial.

For this reason back pain is best understood as a complex biopsychosocial condition. Many other factors besides the employee's medical condition (e.g. acute back pain) affect outcomes– e.g. organizational, work-environmental, and social.

Most acute back pain improves substantially within the first 4 weeks. However, a small proportion of patients with acute back pain go on to develop chronic disabling symptoms. Such patients often are refractory to treatments and account for the majority of the costs associated with back pain. Preventing the transition from acute to chronic low back pain is therefore an important goal of current evaluation and management strategies.


The above paper provides a 2 page summary of evidence regards how best to approach the employee with acute back pain to alleviate patient worries and fears. This along with evidence based acute injury management assist in preventing the transition from acute to chronic low back pain.



Medical Observer - Better use of healthcare professionals is vital for a sustainable Medicare Mar 28th, 2015
WHILE welcoming the Abbott government’s abandonment of the GP co-payment, to ensure a sustainable Medicare system the Australian Physiotherapy Association (APA) would like to see an improvement to the use and scope of practice of existing healthcare professionals.

Removing barriers to physiotherapists referring patients directly to medical specialists with a Medicare rebate, instead of requiring a GP referral, would achieve better patient-centred care, as well as over $13 million in savings to Medicare each year. This would also reduce out-of-pocket payments for patients by more than $2 million per year.

Other sustainable measures that would improve healthcare for patients and save money include: 



  • Physiotherapists leading screening clinics to triage surgery patients. 

  • Better supporting advanced scope physiotherapists in emergency departments to deal with patients with simple but urgent musculoskeletal injuries that are currently contributing to the burden on ED doctors. This has been shown to reduce patient waits, and helps move patients out of hospital more quickly.

  • Enabling physiotherapists with additional qualifications and endorsement to prescribe medications within their scope of practice. The Medicare co-payment would have made access to primary care even more difficult for people who could least afford it.



The APA’s solution to improve the use of physiotherapists who are highly qualified and experienced primary health professionals to undertake these practices will ensure better patient-centred care and relieve pressure on the healthcare system.

The APA’s pre-budget submission for 2015–16 details APA’s recommendations on the referral to specialist issue. It is available online Click here.

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation.

Cris Massis is CEO of the Australian Physiotherapy Association.

Click here to read other ideas submitted so far


Many Reap Rewards in Wellness at Work! Mar 27th, 2015
Australia’s working population is becoming sedentary and workers are being asked to put off retirement and work longer hours.

TWO out of every three Australian adults have at least three or more risk factors for cardiovascular disease, diabetes and chronic kidney disease, according to a new AIHW report.

Employees with a cluster of seven heart disease risk factors have an average annual cost of ~$2640.00 more than employees with no modifiable risk factors.

Employers have a choice, proactively promote health promotion programs or expect to pay more in direct and indirect health related costs.

Workers spend a large proportion of their waking lives at the workplace and are a captive audience for any health promotion intervention.

We recognise that you, the employer, have extensive experience in ensuring the wellbeing and health of your staff. However there are times when it could be helpful to access the insight and expertise of a trusted partner to tailor services to your organisation and employee's needs.


Click to download copy

Our team of allied health professionals from a wide range of backgrounds give the perfect know-how and skills base to provide such an intervention in a proficient and energetic manner.


Medical Observer - Nine reasons why Australia needs to improve preventive health! Mar 25th, 2015
This appeared in today's Medical Observer, Written by Ruby Prosser Scully

TWO out of every three Australian adults have at least three or more risk factors for cardiovascular disease, diabetes and chronic kidney disease, according to a new AIHW report.

Multiple risk factors were also prevalent among Australians who already had one of the conditions. 

“For people with diabetes, nearly all adults (94%) had three or more risk factors, and for CVD and CKD, 84% and 77%, respectively, had three or more risk factors,” AIHW spokesperson Sushma Mathur said.

NINE FACTORS FOR ILL HEALTH

1. Just under a third of all adults have hypertension (including 22% with uncontrolled hypertension).

2. Almost two-thirds are overweight or obese, and 3% have impaired fasting glucose. 

3. Over half the population is not active at all or insufficiently active. 

4. One in six people smoke daily and one in five surpass guidelines for lifetime alcohol risk. 

5. A third of Australian adults have high LDL-cholesterol, and 63% have dyslipidaemia.

6. People with cardiovascular disease are more likely to have uncontrolled hypertension (2.1 times), be overweight or obese (1.3 times), have dyslipidaemia (1.3 times) and be inactive or insufficiently active (1.2 times) than those without CVD.

7. Almost all adults (95%) do not eat the daily recommended two serves of fruit and five serves of vegetables.

8. People with type 2 diabetes are twice as likely to have uncontrolled hypertension, be overweight or obese (1.5 times), and have uncontrolled dyslipidaemia (1.2 times) than adults without the disease.

9. People with CKD are more likely to have uncontrolled hypertension (1.9 times), or have blood glucose levels ≥6.1 mmol/L (2.8 times) than adults without CKD.

 

Source: Australian Institute of Health and Welfare report, Cardiovascular Disease, Diabetes and Chronic Kidney Disease