MediSecure

Read more at http://medisecure.com.au/racgp-proposes-changes-to-funding-of-general-practices/

The RACGP has released a Consultation Paper named Vision for a sustainable health system which made several proposals to overhaul current funding arrangements general practice, including:

Immediately ending the freeze on Medicare rebates

Reintroducing annual indexation

Phasing out practice incentive payments PIPs

Ending the service incentive payments SIPs

Replacing these payments with more targeted payments aimed at both GPs and practices

Adding a complexity loading to support GPs in areas of need

Funding to support patients with more complex conditions

Providing a comprehensive payment for providing additional services

Bridging the gap between hospitals and primary healthcare via integration support funding

Establishing a voluntary patient enrolment system as a formal link between the patient and GP

Read more at http://medisecure.com.au/doctors-prefer-alerts-over-look-ups-to-prevent-drug-interactions/

The following post is adapted from an article published on 14 April 2015 by Pulse+IT magazine. 

When a number of drugs are administered to a patient at the same time, there may be interactions between the drugs (termed drug-drug interactions or DDIs) that could result in adverse effects such as low blood pressure, bleeding and kidney damage. Advances in technology can help to identify and prevent DDIs, which make up to 4% of hospital admissions.

There are two main computerised strategies to help doctors identify DDIs. When prescribing, doctors can enter medication names into a reference look-up software to check drug combinations for potential DDIs. Alternatively, automated alerts of potential DDIs can be integrated into electronic prescription systems.

Unexpected results were revealed in research conducted by the University of NSW at Sydney’s St Vincent’s Hospital, which uses CSC’s MedChart electronic medications management system. In an earlier study, MedChart’s generated alerts were largely ignored by doctors on ward rounds as they were not seen as helpful in guiding prescribing decisions.

However, different outcomes were obtained in recent interviews with 18 doctors at the same hospital and 8 drug safety experts.  The participants were asked about their confidence in identifying DDIs and their opinions on computerized strategies to prevent DDIs. Doctors, particularly junior ones, were not confident in their abilities to identify dangerous DDIs. Most preferred automated alerts over look-up tools to prevent DDIs. First the doctors felt they would not use a look-up tool when they are busy or time-constrained, hence compromising their ability to recognize DDIs. Secondly, alerts provide doctors with automated decision support, instead of them having to request information on their own.

In contrast, drug-safety experts were more critical of computerised alerts, warning too many alerts can overload or fatigue users, leading to the alerts being ignored. Doctors may also become over-dependent on alerts such that they could not detect DDIs on their own.

Read more at http://medisecure.com.au/scripts-may-not-be-required-to-buy-oral-contraceptives-from-pharmacies/

In 2014, Green Cross Health (a New Zealand pharmacy banner group) sought approval from the New Zealand Medicines and Medical Devices Safety Authority, Medsafe, to allow pharmacists to sell oral contraceptives over the counter. Medsafe turned down the proposal, saying more input was required from doctors.  Now Green Cross Health and a pharmaceutical company made a second attempt and requested Medsafe to reconsider the proposal at its May meeting.

It argues there is an unmet demand for oral contraceptives, with increasing demand for the morning-after pill at pharmacies. Its proposal includes training pharmacists to ask patients the right questions in a face-to-face consultation and checking for any contraindicating health conditions before selling the drugs over the counter.

Across the Tasman Sea in Australia, a proposal was submitted to the Therapeutic Goods Administration (TGA) in November 2014 to move oral contraceptives to Schedule 3 medicines. This proposal would require patients to fill in a simple questionnaire on any family history of hypertension, heart problems or stroke. The pharmacist would also need to conduct a blood pressure test on the patients to make sure they are suitable for the medication. Each visit is limited to a 3-6 months supply of oral contraceptives.

Dr Brian Morton, chair of the Australian Medical Association (AMA) Council of General Practice, described the proposal as a completely inappropriate expansion of pharmacists’ scope of practice. He questioned whether pharmacies would be an appropriate environment to ask women questions on their suitability for contraception and doubted pharmacists have the training or skills to interpret the relevant information.

“It will lead to fragmentation of care, lack of continuity of care. You will end up with the patient never coming to see the doctor and [missing out on] mammograms, breast self-examination, Pap smears, blood pressure checks, and all those things related to lifestyle won’t be checked,” he says.

Apart from being strongly opposed by the AMA, the proposal also did not have the support of the Pharmacy Guild of Australia, which said as a general rule, this is not something they would support.

TGA is expected to announce the outcome of this proposal on July 23 on its website.

Read more at http://medisecure.com.au/harper-raises-prospect-of-compensation-for-pharmacy-owners-under-deregulation/

Related article(s):

Harper Review and Pharmacy Guild on Deregulation

Speaking at a Committee for Economic Development of Australia event in Melbourne, Professor Ian Harper Professor said that “there’s no doubt that if people have invested in good faith in assets, and then government comes along and reduces value of those assets to zero, it would strike many Australians as unfair“.

He suggested transitional arrangements may be needed for compensating pharmacy owners and taxi drivers if laws are changed to allow new entrants. “When you’re thinking about what may come out of this, don’t think that it’s just a matter for the Commonwealth. It isn’t. Individual jurisdictions may well act and that could conceivably move other jurisdictions to act,” he said.

The review recommended removing restrictions on pharmacy location and ownership. The Abbott government would face hurdles in the Senate as independent senator Nick Xenophon has already vowed to block these pharmacy-related legislations. Professor Harper however, said some of the review’s recommendations would not require approval at the Federal level. The states and territories could still act alone on a number of the recommendations including those pertaining to pharmacies and extended trading hours.

Professor Harper hoped the effects test recommended in section 46 would pass the Federal Parliament. “What is against the law is misusing market power … to take advantage of the market power that you have for the purpose of damaging competition,” he said.

The competition policy review’s 540-page final report, based on 1000 submissions, was handed over to the federal government at the end of March. The government is consulting with stakeholders before it delivers its response before the end of this year.

Read more at http://medisecure.com.au/heath-ledgers-father-on-need-for-prescription-monitoring-to-deter-doctor-shopping/

Another indication of the need for a real-time prescription monitoring system like DrShop, as Heath Ledger’s father Kim Ledger talks on the Sunrise program on Channel 7 about his work as a patron of ScriptWise to raise awareness of the misuse/abuse of legal prescription drugs and how to prevent it.

  Seven year ago, the world was shocked by the death of actor Heath Ledger from an accidental overdose of prescription medications. Now his father Kim Ledger is raising awareness about the misuse of prescriptions. The actor had visited several doctors for help with his chest infections and sleeping issues. It is believed he mixed the drugs without realizing the danger. His father Kim is a patron of ScriptWise, a not-for-profit organization, raising the awareness of prescription misuse, which is incredibly common unfortunately.

Kim said: “It is an extremely significant problem and in very recent times, two coroners’ reports, one in Victoria and one in Western Australia, recommended as a result of their findings, that real-time monitoring should be put in place to capture those people who are misusing or abusing the pharmaceutical drug system.”

The Sunrise program host David Koch asked: “Kim, ScriptWise as you say wants real-time monitoring, GPs want it, health ministers want it, pharmacies want it, how frustrating is it that everyone seems to want it but it is not happening.”

Kim replied: “I know Koch and I was a matter aware of this only in recent times and being involved with some families that had gone through some terribly tragic circumstances with loved ones. There are people who had been trying to run this program from up to 10 years or live their awareness of the requirements for this program for the last 10 years. The other frustrating thing is that there is a system available and it is just simply it hasn’t been adopted.”

David asked: “How come it hasn’t been adopted? Is it too hard or too expensive or what’s the block?”

Kim answered: “Well, from my experience Koch, and learning about it in recent times, it is not an expensive thing to adopt. Maybe there are some doctors out there who don’t like the idea of a slight change in computer technology or whatever to be accepted. But as I understand, it can be blended well straight into existing systems in doctor surgeries so there should not be a problem. And as you say, most doctors want it anyway because they don’t want to compromise themselves in this situation so they’ll love to see it. So I am not sure. If it requires mandating, let’s mandate it. That’s all I say.”

The other Sunrise presenter Samantha said: “It’s not necessarily malicious either. You can be thinking you are doing the right thing and getting proper medications, but you don’t know it shouldn’t be mixed with something else.”

David added: “It seems silly if everyone agrees. We might talk a bit more off air – just see who we need to get on to increase the pressure. It just seems ridiculous if everyone agrees and it is easily there. Let’s get cracking.”

Read more at http://medisecure.com.au/pharmacists-play-key-role-in-promoting-ehealth/

This post was adapted from an article written by Grant Kardachi, president of the Pharmaceutical Society of Australia who is also a member of the Australian Association of Consultant Pharmacy.

  What is eHealth?

Wikipedia describes eHealth as a healthcare practice supported by digital processes and communication, such as the Internet or health apps on mobile phones (referred to as mHealth). It lists 11 forms of eHealth, including services MediSecure is already providing or developing.

Grant Kardachi described four areas of eHealth in his article.

  Electronic Health Record (EHR)

An eHealth record is an electronic summary of a patient’s health information which can be accessed by different health providers, usually through information networks or exchanges.

The eHealth record system was rolled out nationally in July 2012, with the goal of giving healthcare providers access to their patients’ health information, including information such as medical history, medications, hospitalization records, allergies, immunization status, laboratory test results, radiology images, vital signs, etc.

The system aims to ensure data accurately captures the state of the patient at all times, which represents a major step forward in providing better and more consistent care. Unfortunately the system has been plagued with problems, resulting in very low take up rate among the public.

Electronic records and prescriptions greatly reduce errors due to manual input and any consequent hospital readmissions. Pharmacists have a responsibility in helping to establish and widely implement eHealth so that its benefits can flow through to the community. This will help to increase medication compliance and reduce readmissions, leading to a more sustainable health system.

Telemedicine

Telemedicine, often quoted as a key application of the National Broadband Network, is the use of telecommunication and IT in overcoming distance barriers to provide distant rural communities access to medical services. It is also used to save lives in critical emergency situations.  Through telemedicine, pharmacists can provide mediation management for remote patients who may have difficulty accessing health professionals.

mHealth

mHealth is the use of mobile devices (smart phones, tablets, PDAs) for collecting health data, delivering health information , providing healthcare, monitoring patients, etc.

For example, there are apps that track the number of remaining prescription repeats. When medications are running low, they automatically send reminder alerts to patients for filling scripts or booking follow up appointments with doctors. After patients have ordered the repeat through the app, the pharmacist can send them a message to inform them when the prescriptions are ready for collection.

Dose Administrations Aids

Pharmacists can use these aids to help patients in medication compliance. These aids come in a variety of forms and are particularly useful for people who regularly take many different medicines.

The Future

The evolution in eHealth technology means that new ways will constantly be available to pharmacists for incorporating in their professional practice. These technological advances cam better help in informing and advising patients, thereby increasing medication effectiveness and reducing misadventures.

Read more at http://medisecure.com.au/harper-review-and-pharmacy-guild-on-deregulation/

On 4 Dec 2013, PM Tony Abbott and the Minister for Small Business, Bruce Bills, announced a panel to review Australia’s competition policy (Ref). This review is dubbed Harper Review after its chairman Professor Ian Harper, an Emeritus Professor at the University of Melbourne and a director at Deloitte Access Economics (Ref). The Final Report, released on 31 Mar 2015, made 56 recommendations to the Federal government. If implemented, these changes would initiate the biggest shake up in the competition regime in over 22 years, revolutionising the way business is conducted.

The recommendations are designed to dismantle regulations that restrict retail trading hours and operational licenses in certain industries and to usher Australia into the 21st century. Traditional bricks and mortar shop fronts face unprecedented competition from cross-border, online stores utilising disruptive technologies and operating 24/7. The ultimate objective is to promote competition and in turn improve outcomes for consumers with lower prices and better service.

Some of these recommendations are controversial and would have profound consequences for particular industries. These include:

Deregulation of trading hours, leaving Christmas Day, Good Friday and Anzac Day morning, the only three days a year closed for retail.

Removal of restrictions on parallel importing, allowing goods such as second-hand cars, books and software, that could be purchased overseas at much lower prices, to be sold here.

Opening up of the tightly protected taxi industry to ride sharing service providers under the online-based Uber model. The increase in supply may lead to at least a 15-20% drop in taxi fares, making them more affordable to low-income earners.

Introduction of specific “effects test” to assess anti-competitive conduct.

The taxi industry and parts of the small business community, whose interests are affected, are outraged by the review’s recommendations. Small retailers claim it is costly and unprofitable to open longer hours and will struggle to compete with large supermarket chains, which will be handed even more market power. They say this will eventually lead to the demise of the small corner store.

  Proposed Deregulation of the Pharmacy Industry

The strongest response came from the Pharmacy Guild of Australia, whom Fairfax Media described in a recent article as “the most powerful lobby group you have never heard of”.

Currently there are many state and federal restrictions on the operation of pharmacies:

State laws require pharmacies to be owned by registered pharmacists and impose limits on the number of outlets they can own.

Complex federal laws (written in a 56-page handbook) govern where pharmacies can be located. For example, a new pharmacy cannot be opened within 1.5km (metropolitan areas) or 10km (country towns) from an existing pharmacy, effectively closing the door for new entrants. Pharmacies cannot be located either within or directly accessible from a supermarket. A pharmacist has to apply to the Federal Government for approval to open a new pharmacy or to move/expand an existing pharmacy.

The Harper Review recommended the scrapping of pharmacy location and ownership rules, finding these restrictions were imposing costs on consumers, limiting choice and thwarting the ability of providers to meet consumer preferences.

The location rules are part of the 5CPA (Fifth Community Pharmacy Agreement), a 5-year agreement between the Pharmacy Guild and the Federal Government, due to expire on 30th June 2015. The review suggested relaxation of the location rules as part of the 6CPA, the next agreement currently being negotiated, as the first step towards their complete removal.

  Consequences of Deregulation

The likely consequences include:

More pharmacies, particularly in affluent or densely populated areas.

Pharmacies in supermarkets, owned by Coles and Woolworths etc. or by independent pharmacists renting space to take advantage of the foot traffic.

More pharmacies staying open outside standard business hours.

Lower prices for non-PBS medicines and other products, as shown by a 10-30% drop in prices in the UK after supermarkets were allowed to sell medications (Ref).

Limited impact on prices for PBS drugs. Currently, prices are determined mainly by government subsidies. However, for off-patent drugs, retail chains may be able to negotiate better prices with suppliers and pass the savings on to customers.

  The Winners and Losers

The winners would likely be:

Consumers who would benefit from lower prices for some drugs and greater choice on where and when they obtained their medications, though pharmacy groups have suggested the quality of service would deteriorate.

Pharmacy chains such as Chemist Warehouse, which would find it easier to grow without the existing rules that thwart their ambitions for expansion.

Supermarkets, which would gain a new, lucrative and stable revenue stream.

The losers are most likely:

Smaller pharmacies with their margins squeezed by competition.

Pharmaceutical suppliers/wholesalers as the entry of the supermarket giants may use their enormous purchasing power to demand lower prices.

  The Supporters

Adam Stankevicius, CEO of The Consumers Health Forum, says the Government should bring in a new, more flexible system over the next two years. He said the current system is geared towards pharmacies making profits, not the consumers. The location rule protects existing pharmacies from competitors wanting to establish themselves nearby. This in turn keeps young pharmacists out of the industry, as they cannot compete with established businesses. He said even if pharmacies set up next to each other, they could offer different services or specialize in particular areas such as providing services to an aged care home or a disability service. He said a new pharmacy would more likely to remain open longer and attend to after-hours customers (Ref).

The Pharmacy Guild represents 4000 pharmacy owners. Another 20,000 pharmacists, so-called “employee pharmacists“, are locked out of pharmacy ownership. They are represented by Professional Pharmacists Australia, which supports a review of the location rules (Ref a, b).

The Business Council of Australia welcomed many of the report’s recommendations but was concerned about the Effects Test (Ref).

The Australian National Retailers Association (ANRA), which represents big retailers such as Woolworths and Coles, supports removing restrictions on retail trading hours, pharmacy ownership and parallel imports but is against the Effects Test (Ref a, b).

Alan Kirkland from consumer group Choice said the competition law failed to keep up with developments in technology and consumer markets. He is worried that big business will lobby against the recommendations, predicting that there will be very powerful forces opposed to some of these changes. He was concerned about the recommendations in expanding competition in the welfare sector, believing this should require a lot more community consultation (Ref).

The Opponents

The Australian Retailers’ Association called for protection of small businesses against being forced out of business by the two major supermarket chains (Ref). Master Grocers Australia (MGA), which represents the independent supermarket sector, is opposing the deregulation of trading hours as this would deliver even more market share to the Coles and Woolworths duopoly (Ref).

Grant Kardachi, national president of the Pharmaceutical Society of Australia, said the proposed changes could impact the quality of patient care. “The worst case scenario is if pharmacies are owned by non-pharmacists, that profitability could well become the target and consumer needs and outcomes may well be compromised,” he said (Ref).

The Pharmacy Guild argues the current pharmacy model is a tried, tested and trusted model, working well for patients and taxpayers, and continuing to enjoy strong public and bipartisan support. It is underpinned by a multi-billion dollar investment in local pharmacies by pharmacists who have put their livelihoods in these small businesses.

The location rules ensure consumers have timely and equitable access to Pharmaceutical Benefits Scheme medicines no matter where they live, rather than having pharmacies clustered around affluent suburbs. The ownership rules ensure that local pharmacies are owned by registered pharmacists, who are health care professionals, frequently putting their patients before profits.

The Pharmacy Guild president George Tambassis argued against big supermarkets being allowed to open pharmacies. “We don’t believe Coles and Woolies are interested in the health care of the Australian public. They are interested in selling tobacco and alcohol, interested in profit. We are interested in looking after people’s health care.” he said (Ref).  Abolishing the ownership rule would lead to major supermarket chains securing high level of market dominance in the pharmacy sector like what they had already achieved in grocery retailing (Ref).

The Pharmacy Guild commissioned several independent studies. A geospatial analysis of pharmacy distribution in Australia showed pharmacies are more accessible to consumers than banks, supermarkets and general medical practices. For example, 87% of Australians live within 2.5km of at least one pharmacy. Consumer surveys showed 89% of consumers highly trust their local pharmacists and 64% support pharmacists’ ownership of their own business. A cost-benefit analysis showed deregulation of the pharmacy sector would result in a $700 million loss in consumer benefits per year. Hence, these studies demonstrate that pharmacies are delivering high levels of access, choice, competition, equity and quality for consumers (Ref).

The Pharmacy Guild Executive director David Quilty criticised the panel for putting ideology before evidence that shows the current model was superior. “There is no evidence that a deregulated alternative model would deliver superior outcomes for patients or taxpayers,” he said. “On the contrary, all the evidence indicates that the alternative would likely result in worse outcomes both for consumers and taxpayers, and carry significant risk. Australia’s 5450 community pharmacies, currently struggling under the pressures of price disclosure, need certainty and stability – not a constant push to abolish a system that’s working.” (Ref)

  Political Factors

What are the chances the recommendations on pharmacy deregulation will be implemented?

There were various reviews on reform in the pharmacy sector, dating at least as far back as 2000.  The most recent one took place last year when the Commission of Audit recommended removal of the location and ownership rules. So far no government has adopted the measures.

This is probably due to the legendary lobbying power of the Pharmacy Guild. It has demonstrated its ability to make use of the high levels of public trust in pharmacists and to mobilize its thousands of members nationally to fight changes that threaten pharmacist interests (Ref).

Having suffered serious setbacks in the brawl with doctors over a Medicare co-payment, Liberal Party MPs said they do not expect the Abbott Government to support pharmacy deregulation, fiercely opposed by the politically powerful Pharmacy Guild. A Liberal politician said:  “Abbott has absolutely no appetite for this whatsoever. They don’t have to twist Tony’s arm.”

The Pharmacy Guild reminded PM Tony Abbott of what he said at the Guild’s annual dinner in November last year. He said: “I do not want to go for something which is untried and unproven against something which is tried and proven, and I never want to promote theory over practice. How do you know that I respect the place of community pharmacy in our economy and in our society Because the last time there was a serious push to threaten the place of community pharmacy in our society, I stood up against it.” (Ref)

The Pharmacy Guild also has a key ally – independent senator Nick Xenophon who has vowed to block any deregulation of Community Pharmacies to ensure they remain viable and able to meet the increasing health needs of all Australians. He said: “Pharmacists have to run a business with very little price-setting ability for prescription drugs. As many as 10 per cent of Community Pharmacies are known to be only marginally financially viable”. (Ref)

Read more at http://medisecure.com.au/record-level-of-prescription-drug-overdoses-with-gps-unable-to-monitor-doctor-shopping/

Victorian coroner Audrey Jamieson called for urgent action to address the problem of drug overdoses which have reached record levels. She revealed prescription drug overdoses had increased for the sixth year in a row, with 314 cases recorded last year, more than the road toll in 2014.  Among the overdose mortality, 42% were caused solely by prescription drugs, 6% by illicit drugs and the remainder by a combination with alcohol and illicit drugs.  56% of all overdose deaths in 2014 involved benzodiazepines, which include Xanax and Valium.

Victorian Alcohol and Drug Association (VAADA) chief executive Sam Biondo said the figures showed there is a policy blindspot for legal substance abuse. He said: “Many of the answers to reduce this toll are fully acknowledged yet we have faced persistent inaction in addressing this catastrophic situation. We need better linkages between doctors, pharmacists, pain management specialists and the alcohol and drug treatment sector.” He said death or dependence was increasing in new demographic groups, such road trauma victims, WorkCover recipients and patients requiring post-surgery pain management, not traditionally perceived as problematic drug users.

St Kilda GP Dr Mike Birrell, who regularly sees prescription drug addicts, said a prescription monitor could save lives. He said: “You can get caught out even with the best intentions. I had a chap die three or four weeks ago. These people have other medication they take … and they’re not sure what they’re taking.”

Currently, doctors are unable to fully monitor patients’ access to potentially lethal doses of medicines. Hence, a mandatory real-time prescription drug register for Victoria similar to a system currently in place in Tasmania would help doctors catch out “doctor shoppers” – patients who see multiple doctors to obtain excessive levels of legal drugs.

Read more at http://medisecure.com.au/prescription-drug-deaths-trigger-calls-for-the-errcd/

The Royal Australian College of General Practitioners (RACGP) and the Pharmaceutical Society of Australia (PSA) had called upon the federal and state governments to implement a national Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, after a Victorian coroner warned legal drugs were killing more people than illicit drugs or alcohol.

RACGP president Dr Frank Jones said prescription drug overdoses caused more deaths in some states than car accidents and these deaths could be mostly avoided if GPs had access to a drug database. PSA president Grant Kardachi said there is a need to limit the harm associated with drugs such as those containing codeine.

In the National Pharmaceutical Drug Misuse Framework for Action 2012-2015, the ERRCD received the top priority and was backed by all health ministers but has yet to be implemented, due partly to political issues in several states.

A federal Health Department spokeswoman said NSW, ACT, Western and South Australia had advised they were ready to sign up to a national system “in the near future”. A Victorian state government spokeswoman said: “The introduction of real-time prescription monitoring requires consideration and planning, following no progress over the past four years under the Liberals”. A Queensland Health spokeswoman said Queensland is still determining whether the ERRCD would meet its future needs or whether it needs to be modified.

Read more at http://medisecure.com.au/role-of-the-nbn-in-real-time-prescription-monitoring-system/

Anthony Tassone, President of the Victorian Branch of the Pharmacy Guild of Australia, said pharmacies are becoming more dependent on online technology to monitor patients’ drug use. The National Broadband Network (NBN) would become particularly important when a real-time reporting system is set up to combat “doctor shopping” and excessive pseudoephedrine purchases.

He said: “We have quite an inconsistent internet speeds here. There are plans to have a real-time monitoring system implemented and an adequate internet system will be key. Doctor shopping is a significant concern in the community. There have been six coroner’s findings in the last 12 months where people have overdosed on medications that could have been prevented with a real-time monitoring system.”

Mr Tassone said pharmacists are concerned about patients abusing their prescription and over the counter drugs, such as pseudoephedrine, found in cold and flu tablets. He would like to see the State Government making it a priority to set up a real-time prescription reporting system.

New Post has been published on http://medisecure.com.au/prescription-opioid-dependency-patient-treatment/

Prescription Opioid Dependency & Patient Treatment

Prescribing buprenorphine/naloxone (bup/nal) is an effective way to treat patients with opioid dependence, says a senior clinical specialist in addiction medicine.

Professor Robert Batey, a clinical professor of medicine at the University of Sydney and Professorial Fellow at Flinders University, said primary-care doctors have the option of using bup/nal to assist in the ongoing, constructive management of patients dependent on prescription opioids. The most common of these are oxycodone, fentanyl, long-acting morphine products and codeine.

GPs must seek permission from their state or territory health authority to prescribe bup/nal. If this is not possible, the patient should be referred to a local addiction medicine clinic.

GPs have tended to treat patients who say they are in pain but are dependent on opioids in one of two ways, Professor Batey said. They either continue to prescribe opioids despite the clear dangers of dependency or withdraw ongoing treatment.

“Using an agent such as bup/nal allows for a change in thinking about opioid use and provides an opportunity to work with the patient to achieve abstinence from opioids in a systematic and supported way,” Professor Batey said.

Professor Batey, who is also an addiction medicine specialist with NT and NSW Health,, cited the example of “Mr JK”. The 44-year-old man had a persistent knee injury five years ago that led him being prescribed up to 20mg bd of oxycodone for more than three months. After trialling NSAIDs to treat another injury, Mr JK said the new medication wasn’t working and his oxycodone dose was increased to 20mg tds.

“The reality, globally, over the past two decades has been that patients on opioids who develop another painful problem are as likely as not to get an increased dose of opioids because the patient is afraid that other analgesics will be ineffective once they have started on opioids,” Professor Batey said. “This is wrong.”

Finally, after showing clear signs of opioid dependency, Mr JK agreed to start using bup/nal.

“Mr JK received daily dosing of his bup/nal for a month,” Professor Batey said. “He engaged with physiotherapy and pain-management strategies and his life improved overall. After eight months, he asked if he might start reducing his bup/nal dose from 24mg daily.

“[He] decided to reduce his dose slowly with a view to ceasing the program over the next six months. He remains off all opioid medication five years later.”

New Post has been published on http://medisecure.com.au/medtech-set-to-launch-64-bit-version-with-drshop-capability/

Medtech set to launch 64-bit version with DrShop capability

Clinical and practice management software vendor Medtech is set to launch Medtech64, a 64-bit version of its clinical system featuring a native Windows look and feel as well as integration with the DrShop real-time prescription monitoring system.

DrShop, designed by prescription exchange service MediSecure to allow GPs to check through the software to see if a patient has been prescribed Schedule 8 or addictive Schedule 4 medications in the previous 90 days, is also due to be integrated with Best Practice.

Medtech’s general manager for client engagement, Hosi Stankovic, said that as well as committing to a tight integration with DrShop, the company had decided to become a supporter of the new ScriptWise real-time prescription monitoring advocacy group, which has appointed Kim Ledger, father of the late actor Heath, as patron.

“We decided we’d sponsor important events such as the launch of ScriptWise, but clearly our involvement is with the technology component,” Mr Stankovic said. “[ScriptWise is] dealing with the people side – education, promotion and awareness.”

DrShop will be the main new feature of Medtech version 10.0, which has been upgraded from the current 32-bit platform to 64 bit to better reflect users’ requirements for higher performance and more memory, he said.

“We’ve effectively gone to the more native Windows feel – the user interface will look different and work slightly better,” Mr Stankovic said. “It is cleaner and higher performing on the newer machines and servers.

“It will especially help our very large clients as well as smaller ones that use imaging, where the restrictions with memory are getting more and more prevalent. With image resolutions increasing, CDA documents growing in size and the number of users on the rise becoming a real challenge for the memory restrictions of 32 bit, Medtech64 will free these sites up for better performance and clinical service.”

Medtech plans to continue supporting the 32-bit platform and can release a 32-bit compatible version, but will make a decision based on individual customer requirements, he said.

“More and more of our customers already have 64 bit so it is going to be something that we discuss with individual customers. We’ll do the transition in a progressive way. A number of businesses are saying we just want the fastest and the best, we want it hosted, we want cloud. For those customers who want something new and fresh and high performance, we’ll just say here’s the 64-bit version.

“We have hybrid versions – some doctors work at different sites and perhaps have slower connectivity – and there’s nothing preventing them from using 32-bit client technology. However, it would be nice to support one, future-proof platform.”

The new Medtech64 is due for release in May, first as version 10.0 and then with a slightly upgraded v10.1 to follow.

“There will be an immediate and very noticeable difference to the look and feel, but for 10.0 we’ve decided to take a middle road,” he said.

“We don’t want people who are already familiar with the product and are just looking for an upgrade path to not be able to move because of lack of familiarity, so we are giving them something that has refreshed icons, refreshed look and feel combined with higher performance and better controls, but the things they have been used to and they depend upon are still there.

“The 10.1 release will have quite a number of new features and the new platform allows us to introduce a newer user interface as a progressive step. If a site wishes to continue with the classic look they will be able to, with an alternative version more aligned with the familiar Windows look and feel. This also gives users the power to be able to run it on the Windows Surface Pro and similar tablets.”

Medtech is currently in testing for 10.0 with a generally available release due in May, and the company is also now doing clinical testing for DrShop with MediSecure. Mr Stankovic said the integration needed to be thoroughly audited by clinicians as it was a new workflow that had not been seen before.

In time, Medtech will release its Evolution version into the Australian market. The company is by far the market leader in New Zealand, where Evolution has been released to eventually replace Medtech32, but the Australian general practice sector requires far more integrations with third-party systems than does New Zealand, he said.

New Post has been published on http://medisecure.com.au/get-on-your-bike-to-ward-off-cancer/

Get on your bike to ward off cancer

Being a fit middle-aged man comes with some surprising benefits, according to a study of almost 14,000 participants.

For a start, aerobically fit males are at lower risk for lung and colorectal cancer than their sedentary peers.

And if they do happen to get cancer later on – from about 65 onwards – they have improved odds of survival.

“Our data suggest that higher levels of midlife cardiorespiratory fitness provide a mortality benefit into older age even in the setting of a cancer diagnosis,” write the researchers in JAMA Oncology.

Midlife cardiorespiratory fitness (CRF) is a powerful predictor of cardiovascular disease survival among men who have cancer, they say. “Specifically, high CRF was associated with a 68% reduction in CVD death compared with low CRF among men who developed cancer.”

However, the researchers did not find any protective effect for prostate cancer.

The exact reasons for this are not known, but the difference could be related to higher rates of diagnosis among a health conscious group who are more likely to be screened than other men their age.

The authors believe this study is the first to demonstrate that CRF is predictive of site-specific cancer incidence, as well as risk of death from cancer or CVD following a cancer diagnosis.

Read more at http://medisecure.com.au/increased-use-of-electronic-health-records-in-us/

  Interesting findings that almost one third of American physicians have implemented an electronic health record in their clinic. The study follows calls from the American Medical Association the repair of EMR systems to make usability and better patient care a greater priority. MediSecure certainly sees the value of electronic health records in promoting better patient outcomes.

Read more at http://medisecure.com.au/australia-expected-to-be-fastest-growing-ehr-market/

Australia is expected to be the fastest growing market for electronic medical records and electronic health records in the Asia Pacific region in the next five years, according to research firm Frost & Sullivan.

In Australia, the government is actively promoting electronic exchange of health information as part of the National E-Health Strategy, in which MediSecure’s eTP service is important.

In response to this increasingly obvious demand MediSecure is considering the development of an online health record.