2024

8 DECEMBER 2023 ausdoc . com . au

Rachel Carter A SYSTEM for GPs to send formal advice requests to other specialists and receive a typed response within three days is expanding after a “ really positive ” response .

The eConsultant system currently lets GPs request clinical advice from dermatologists , endocrinologists and cardiologists .

But next year , it will include respiratory , renal , neurology , obstetrics and infectious diseases specialists .

Former RACGP president Professor

Claire Jackson says the Australian-first asynchronous advice model has been developed by the University of Queensland — where she is professor in general practice and primary care reform research — in partnership with the Mater Hospital Brisbane .

“ The premise that we took was that this has got to be as easy as possible for the GPs to send the request and as easy as possible for the consultants to send it ,” Professor Jackson said .

With the patient ’ s consent , the GP sends their questions via secure

messaging , with Best Practice or MedicalDirector GP software autofilling the patient ’ s medical , social and family history , plus medications and allergies .

The specialist at the Mater Hospital then either provides advice , asks for more information or recommends a face-to-face appointment .

The research has been funded by Queensland Health and the primary health networks , but from next year , Queensland Health will pay specialists $ 111 per request for advice .

Dr Jenny Job , research director of the University of Queensland ’ s Centre for Health System Reform and Integration , said almost half of requests ended with specialists reassuring GPs they were on the right track .

“ In about 50 % of cases , it was advice for a new course of action , and for about 45 %, it confirmed what they thought already , so they might then go on to do a workup with the patient .

“ It gives a documented record of advice at the GP end , as well as the hospital end ,” Dr Job said .

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Kemal Atlay ROSUVASTATIN and atorvastatin are equally effective in cutting the risk of death and cardiac events despite greater LDL cholesterol lowering with rosuvastatin , show results from a head-to-head trial .

But rosuvastatin carries a higher risk of new-onset diabetes and cataract surgery compared with atorvastatin , said the researchers from Yonsei University in South Korea .

The team compared threeyear efficacy and safety outcomes in 4400 adults ( mean age 65 ) with coronary artery disease treated with either statin . The primary outcome — a composite of all-cause death , MI , stroke or any coronary revascularisation — occurred in 8.7 % and 8.2 % of participants in the rosuvastatin and atorvastatin groups respectively , with no significant between-group difference .

Average LDL cholesterol levels “ were consistently lower ” with rosuvastatin ( 1.8mmol / L vs 1.9mmol / L ), but this did not translate into superior efficacy , the authors reported in The BMJ .

This could be explained by the drugs ’ pharmacological properties and greater ezetimibe use in the atorvastatin group , they added .

In terms of safety , patients given rosuvastatin had a 39 % higher incidence of new-onset diabetes mellitus requiring treatment initiation and a 66 % elevated risk of cataract surgery .

Although the antioxidative and anti-inflammatory effects of statin treatment were “ expected to slow the ageing ” of the lens , the researchers said these could also interrupt processes crucial to maintaining lens structure and transparency .

“ The greater LDL cholesterol – lowering capacity of rosuvastatin might have prevented epithelial cell development within the crystalline lens ,” they wrote . BMJ 2023 ; 18 Oct .