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Prime Minister Julia Gillard PCEHR breakthrough Doctors win right to bill for e-health record work, p5 Inside PCEHR: Should I sign up? AMA Guide, p6 Doctors must oversee treatment of asylum seekers, p8 Prime Minister leads tributes to AMA, pp11-14 Abortion drug approved, p20 Men to get the Pill?, p35 Chocolate is good for you, p35 AUSTRALIAN MEDICINE - SEPTEMBER 3 2012 ISSUE 24.16 - SEPTEMBER 3 2012 2 AUSTRALIAN2 MEDICINE - SEPTEMBER 3 2012 AUSTRALIAN Managing Editor: John Flannery Contributing Editor: Dominic Nagle Editor: Adrian Rollins IN THIS ISSUE Production Coordinator: Kirsty Waterford Graphic Design: Streamline Creative, Canberra Advertising enquiries NEWS Streamline Creative Tel: (02) 6260 5100 Fax: (02) 6260 5200 Australian Medicine is the na tion al news publication of the Australian Medical 5-10, 15-25, 37-38 Association Limited. (ACN 008426793) 42 Macquarie St, Barton ACT 2600 Telephone: (02) 6270 5400 Facsimile: (02) 6270 5499 SPECIAL FEATURES Web: www.ama.com.au Email: [email protected] Australian Medicine welcomes diversity of opinion on national health issues. For this reason, published articles reflect the views of the 11 AMA PARLIAMENTARY DINNER authors and do not represent the official policy of the AMA unless stated. Contributions may be edited for clarity and length. 30 AMA: A HISTORY Acceptance of advertising material is at the absolute discretion of the Editor and does not imply endorsement by the magazine or the AMA. All material in Australian Medicine remains the copyright of the AMA or the author and may not be reproduced without permission. The REGULAR FEATURES material in Australian Medicine is for general information and guidance only and is not intended as advice. No warranty is made as to the accuracy or currency of the information. The AMA, its servants and agents will not be liable for any claim, loss or damage arising out of 4 VICE PRESIDENT’S MESSAGE reliance on the information in Australian Medicine. 26 General PRACTICE EXECUTIVE OFFICERS 27 THERAPEUTICS 28 AMSA 29 the ECONOMY President Vice President Dr Steve Hambleton Prof Geoffrey Dobb 32 health ON THE HILL 35 RESEARCH 39 public HEALTH OPNION Chairman of Council Treasurer 40 wine Dr Rod McRae Dr Peter Ford 41 MEMBER SERVICES EXECUTIVE OFFICER EXECUTIVE OFFICER Dr Liz Feeney Dr Iain Dunlop Cover: AMA President Dr Steve Hambleton (2nd from r) with Prime Minister Julia Gillard, Health Minister Tanya Plibersek and AMA Vice President Professor Geoffrey Dobb at the AMA Parliamentary Dinner, Great Hall, Parliament House AUSTRALIAN MEDICINE - SEPTEMBER 3 2012 3 A3USTRALIAN MEDICINE - JUNE 4 2012 AUSTRALIAN MEDICINE - SEPTEMBER 3 2012 3 vice president’s message Where’s the evidence? BY AMA VICE PRESIDENT PROFESSOR GEOFFREY DOBB Modern medicine is evidence based, so new therapies or items are being considered for de-listing. procedures need clear evidence of benefit to be accepted A seasonally suitable example might be the use of vaccines into medical practice. Any new drug seeking a listing on the for preventing influenza in the elderly. This intervention is Pharmaceutical Benefits Schedule (PBS) needs a robust body recommended worldwide for individuals aged 65 years or older of evidence for efficacy and safety supported by pharmaco- as a means of reducing the risk of complications in a vulnerable economic evidence of cost effectiveness. A similar framework population. However, in 2010 a Cochrane review of 75 studies underlies applications for new listings on the Medicare Benefits into influenza vaccination in the elderly found only one Schedule (MBS). randomised clinical trial, and this did not detect any significant Such an approach is consistent with prudent use of the taxpayers’ effect on influenza complications. The other studies were all of healthcare dollar, but where is the evidence to come from? In its poor quality, so the authors were unable to reach any conclusion absence, Australians stand to be deprived of life enhancing or about the efficacy of influenza vaccines in the elderly. This life prolonging drugs and procedures, but calls for evidence can doesn’t mean that influenza vaccines don’t work, just that there easily become a dead weight on progress and innovation. isn’t good evidence that they do. It’s not surprising, therefore, that the authors recommend that, to resolve the uncertainty, an The advent of the Independent Hospital Pricing Authority (IHPA) adequately powered randomised clinical trial is needed. But who has further potential to stifle innovation. If hospital admission is to fund it? for a disease process or procedure is founded on its historic cost there is less incentive to innovate, especially if innovation carries A lot of work would need to be done, in consultation with those higher initial costs even though there is increased patient benefit, running clinical trials and with health consumers, to develop and perhaps future savings to the cost of health care. the necessary ethical framework and research infrastructure. Public education would be another challenge. This is not an easy The history of innovation in health care is positive. Costs option. Nevertheless, public debate about the funding of health associated with research, development, passing regulatory innovation is a debate that perhaps we have to have. hurdles and initial marketing are amortised over time. Benefits associated with reduced hospital length of stay or reduced Australia has many groups with expertise in running pragmatic hospitalisation persist. But innovation needs investment today for clinical trials with patient-centred outcomes, so we should be the dividends to accrue in the future. With funding for research confident there is the capacity to do it well. Providing new and development in short supply, and likely to come under even treatments only within the context of a clinical trial is not a new more pressure, a new approach and new funding sources are concept, but doing it on this scale may be seen as controversial. needed. However, if the alternatives are to either prevent or restrict the access to new treatments in Australia, or fund them on the basis This may be a good time to re-think our approach to these of imperfect evidence, the clinical trial should be preferred. difficult issues and provide a robust evidence base for new treatments. When there is some sound evidence of benefit, but Worldwide, countries are struggling to meet the escalating perhaps not sufficiently robust to justify PBS or MBS listing or costs of health care. As a profession, we advocate for as much funding through the IHPA, the treatment could be provided funding as possible to be devoted to health care, but we also to half of those with agreed indications and the funds saved have a responsibility to ensure the dollars are well spent. The by not treating the other half used to support the clinical trial aging of the baby boomer generation is about to put greater infrastructure needed to assess the efficacy, safety and cost pressure on all health budgets and, in this context, striving for effectiveness of the treatment in an Australian setting. These trials effectiveness - and not just the ‘efficiency’ that is the focus of should have patient-centred outcomes, such as survival or quality bureaucratic attention - will do much to ensure our health system of life. The same approach could also be used if drugs or MBS is sustainable. TO COMMENT CLICK HERE 4 AUSTRALIAN4 MEDICINE - SEPTEMBER 3 2012 NEWS Doctors win recognition for PCEHR work The Federal Government has bowed to something that has been concerning pressure from the AMA and will allow some of you.” doctors to bill for time spent preparing The Minister said “strong representations” and maintaining shared electronic health from the AMA had also convinced her to records as part of Medicare Benefits delay the PCEHR capability requirement Scheme consultations. for the e-PIP to May 2013. In an important change that should help “We believe that these decisions deliver some much-needed momentum acknowledge the central role that GPs to its Personally Controlled Electronic will be playing in an effective e-health Health Records (PCEHR) scheme, the records system,” Ms Plibersek said. Commonwealth has acceded to AMA demands that doctors be compensated for AMA President Dr Steve Hambleton said the extra work involved in supporting the the changes were a welcome and much- system. needed improvement in arrangements for the PCEHR, and would encourage In a further breakthrough, Health doctors to become actively involved in Minister Tanya Plibersek has delayed been at the forefront of criticisms of the the implementation of the scheme. the introduction of requirements that way the Government has devised the practices have PCEHR capability to “The Government has clarified that PCEHR scheme, and the haste with which remain eligible for the Practice Incentive additional time spent by a GP on a shared it has been introduced. Program (PIP) e-health payment. health summary or an event summary The system has been dogged by technical during a consultation will count towards The new rules were originally to come glitches and delays, and in its first six the total consultation time, and that the into effect in February next year but weeks little more than 5000 people relevant time-based GP item can be billed doctors will now have until May 2013 to registered an interest in having a shared accordingly,” Dr Hambleton said. meet the PCEHR requirement. electronic record. “The Minister has fully explained how This new cut-off date, while an In a nationally televised speech soon after doctors can safely and confidently improvement, remains a tight deadline its 1 July launch, Dr Hambleton warned provide new PCEHR clinical services, for doctors to ensure their practices are that the scheme would stall without the such as a shared health summary, under PCEHR-ready. support of GPs.
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