Thursday 5 November 2009
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Crackdown on Team Care items ■ Michael Woodhead
A
n almost three-fold increase in the number of doctors investigated for inappropriate practice has been reported by the Professional Services Review this year. The PSR investigated 136 practitioners, mostly GPs, for inappropriate behavior such as overuse of long consultations, overprescribing of benzodiazepines and ordering of too many CT scans. In its annual report, PSR director Dr Tony Webber says many cases involved GPs being pressured to ‘get the paperwork done’ for Team Care Arrangements (MBS item 723) for allied health services, when the
Team Care Arrangements and spinal CT scans referred to PSR patient’s condition did not warrant the use of the item. He says there is also ongoing concern about overprescribing of benzodiazepines such as alprazolam by some practitioners, given their potential for diversion and abuse. “Tighter restrictions on and surveillance of these drugs may be needed,” he writes.
The PSR also notes that some GPs appear to be using CT scans as a screening tool for patients with back pain, which is of concern because of the radiation risks, especially for younger women of reprodutive age. In its report, the PSR also warns GPs that it is cracking down on the practitioners who use Medicare consultations to provide alternative and non-evidencebased remedies. Last year the PSR took action against 61 doctors, including a GP working for a heart check clinic who was made to repay almost $180,000 for inappropriate ordering of investigations. What do you think? comment@6minutes.com.au
Nurse practitioners feel stymied ■ Michael Woodhead The number of qualified nurse practitioners has doubled in the last two years but most are still underemployed or unemployed, a new study suggests. Without access to PBS prescribing rights or Medicare provider numbers, nurse practitioner report that they are severely limited in their roles, and they eagerly await the changes proposed by health minister Nicola Roxon due to be introduced next year. In a census of all 234 authorised
nurse practitioners in Australia in 2007, researchers found that almost one in three were not employed in nurse practitioner roles and one in five had never actually worked as a nurse practitioners. Among those who were working as nurse practitioners, a third were still awaiting authorisation to prescribe a limited range of medications, and over 70% said the lack of PBS prescribing and Medicare rights was ‘extremely limiting to their practice”. The survey, published in
Australian Health Review (33: 679) found that the average age of nurse practitioners was 47 years old, and they most commonly worked in emergency departments. The authors of the survey, from the James Cook University in Queensland, say that a more recent survey had shown that number had doubled between 2007 and 2009, but there was still considerable under-utilisation of their skills because of the lck of PBS and MBS rights. What do you think? comment@6minutes.com.au
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FREE! Specialist hospitality High cost prescribing medical specialities enjoy the most pharmaceutical company hospitality including oncologists, cardiologists and psychiatrists, a Newcastle study in PLoS Medicine has found.
High IQ beats stroke Stroke patients are likely to have better outcomes if they are younger and have a higher IQ, a one year study of 125 patients by researchers at the School of Psychiatry, University of New South Wales, has found. Aging and Mental Health (13: 693)
No sexual problems after vasectomy Sexual problems are no more common in men who have had a vasectomy, a study of almost 3400 Australian men has found. Journal of Sexual Health (online 29 October)
Case conference shy GPs are reluctant to engage in multidisciplinary case conferencing in residential aged care facilities, a new study finds, because of problems such as role confusion, isolation and a lack of lack of a 'collaborative culture' among other participants. Australian Health Review. 33: 566–571