4 NEWS
4 NEWS
19 APRIL 2024 ausdoc . com . au
Is the ‘ noctors ’ battle now lost ?
Dr Bruce Willett . |
Sarah Simpkins HIGH-profile GP Dr Bruce Willett has warned that governments seem set on allowing pharmacists and nurse practitioners to “ virtually operate as GPs in the very near future ”.
“ I do not think the majority of our GPs have a clear sense of how likely this is ,” said the former RACGP vice-president .
“ My personal opinion is the decision has already been made .”
His comments come as the Federal Government pushes legislation
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through Parliament to end the requirement under Medicare for nurse practitioners to have a collaborative arrangement in place with doctors . Dr Willett told a webinar last month : “ You can take it to the bank that [ the Queensland ] Government will allow nurse practitioners and pharmacists to virtually operate as GPs in the very near future .”
He went on to warn that GP practices would need to adapt to the rise of non-doctor diagnosis and prescribing and figure out how to take
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charge of patients ’ care .
Queensland Health has recently confirmed that around 350 pharmacists are completing their training under the state ’ s pharmacy prescribing pilot , with the first pharmacists anticipated to start prescribing at the end of the month .
Under the trial , pharmacists will be able to diagnose and prescribe independently for 17 conditions — including impetigo , herpes zoster and dermatitis — after completing the training .
Queensland has also pledged $ 46
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million to set up free nurse-led clinics offering “ women-focused healthcare ”, including contraception , maternal health , STI treatment and period and menopause advice .
Victoria and NSW have introduced their own trials for pharmacists to prescribe antibiotics for UTIs , renew contraceptive pill scripts and diagnose skin conditions .
There is also the Federal Government review of scope of practice underway , which is due to report later in the year .
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‘ 240 slices ’: A doubleedged scan
PAGE 2 a difference to someone , and all I have probably done is irritate them because they have had to go somewhere else .”
A perspective in the Medical Journal of Australia by physician Professor Ian Scott and evidence-based expert Professor Paul Glasziou , published late last year , acknowledged there remained little understanding or research on the natural history and prognostic features of many incidentalomas .
Artificial intelligence has failed to help so far .
Adding to the problem was that guidelines for managing incidentalomas do not exist for many organs , and the few that do are often inadequate in how they described the likelihood of malignancy .
Australia-specific guidelines could be a big step forward .
LAGEVRIO ® is an effective * treatment for your patients with mild to moderate COVID-19 , with comorbidities on multiple medications , who cannot be prescribed nirmatrelvir-ritonavir 1 , 2
* Demonstrated efficacy 1
*
In MOVe-OUT , LAGEVRIO reduced the risk for hospitalisation or death vs . placebo through Day 29 by 30 % ( ARRR ) 1 ( 95 % CI : 1 %, 51 %; 6.8 % ( 48 / 709 ] vs 9.7 % ( 68 / 699 ). Adjusted risk difference -3.0% ( 95 % CI -5.9%, -0.1%), p-value not available ). Based on a planned interim analysis of LAGEVRIO vs placebo : The adjusted risk difference was -6.8% ( 95 % CI : -11.3%, -2.4; 7.3 % ( 53 / 377 ) vs 14.1 % ( 28 / 385 ); p = 0.0024 ). ARRR = Adjusted relative risk reduction .
Real-world studies , 3-6 including the local Victorian study published in 2023 , 6 also support the use of LAGEVRIO in treating older vaccinated patients with mild to moderate COVID-19 .
Comparable side effect profile : LAGEVRIO vs placebo 1
Scan this QR code to access study designs for the MOVe-OUT registration trial and the Victorian real-world observational study .
The pair also added that , in most reports written by radiologists , the language would often be no more informative than ‘ likely benign ’, ‘ suspicious ’ or ‘ highly suspicious ’.
Professor Sutherland accepts the criticism .
He said Australia-specific guidelines could be a big step forward but required both resources and time from volunteers at medical colleges .
For him , a better solution was to fund general practice properly so that GPs had time for “ the conversations the rest of us cannot do ”.
“ That will make a massive difference ,” he said .
“ For governments , it is not as exciting as funding new drugs , but it will probably help more people .”
On the need for some radiologists to improve their written communications with GPs , he urged both parties to pick up the phone and talk .
“ One of the major ways we can fight incidental findings , given that the government is not going to put in more money , is for GPs and radiologists to have a much closer working relationship ,” he said .
“ Personally , I love when GPs phone up questioning a report or wanting some more information .”
Treatment-related adverse events ≥ 1 %: Diarrhoea ( 2 % vs 2 %), nausea ( 1 % vs 1 %), dizziness ( 1 % vs 1 %) 1
A simple † treatment for appropriate patients 1 , 2
known drug interactions based on limited data available 1
†
No †
No
Before prescribing , please review the full Product Information available at www . msdinfo . com . au / lagevriopi or by scanning the QR code . dose adjustments required in patients with renal and / or hepatic impairment 1
PBS information : Authority required ( STREAMLINED ): LAGEVRIO must be for use when nirmatrelvir (&) ritonavir is contraindicated . 2 The contraindications to nirmatrelvir (&) ritonavir can be found using the Liverpool COVID-19 Drug interaction checker or the TGA-approved Product Information for nirmatrelvir (&) ritonavir . 2 , 7 , 8 Visit www . pbs . gov . au for more information .
▼This medicine is subject to additional monitoring in Australia . This will allow quick identification of new safety information . Healthcare professionals are asked to report any suspected adverse events at www . tga . gov . au / reporting-problems .
Selected Safety Information 1
INDICATION : LAGEVRIO has provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen due to COVID-19 and who are at increased risk for hospitalisation or death . The decision to approve this indication was based on efficacy and safety data from a Phase 3 trial . Continued approval of this indication depends on additional data .
CONTRAINDICATIONS : Hypersensitivity to the active substance or any of the excipients . Hypersensitivity reactions have been reported with LAGEVRIO . If signs or symptoms of a clinically significant hypersensitivity reaction occur , immediately discontinue LAGEVRIO and initiate appropriate medications and / or supportive care .
PRECAUTIONS : Pregnancy Category D : The use of LAGEVRIO is not recommended during pregnancy . In women of childbearing potential , health care providers should discuss the chance that they may be pregnant and consider the need for a pregnancy test . Contraception : Advise women of childbearing potential to use effective contraception for the duration of treatment and for 4 days after the last dose of LAGEVRIO . Sexually active men with a partner of childbearing potential should use contraception during and for 3 months after treatment . Based on animal data , LAGEVRIO may cause foetal harm when administered to pregnant women . Breastfeeding : Based on the potential for adverse reactions on the infant from LAGEVRIO , breastfeeding is not recommended during treatment and for 4 days after the last dose of LAGEVRIO . Paediatric patients : Use in patients under the age of 18 years is not recommended .
ADVERSE REACTIONS : Common : nausea , diarrhoea , dizziness . The following have been reported in post-marketing experience : hypersensitivity , angioedema , erythema , pruritus , rash , urticaria , vomiting .
Copyright © 2024 Merck & Co ., Inc ., Rahway , NJ , USA and its affiliates . All rights reserved . Merck Sharp & Dohme ( Australia ) Pty Limited . Level 1 – Building A , 26 Talavera Road , Macquarie Park NSW 2113 .
MSDA0123 . AU-ANV-00544 . Issued March 2024 .
Med J Aust 2023 ; 18 Dec .