16 OPINION
PBS listed for COPD † & severe asthma ‡ 1
16 OPINION
8 MARCH 2024 ausdoc . com . au
Insight
Should allied health
refer to specialists ?
PBS listed for COPD † & severe asthma ‡ 1
†
Trimbow 100 is indicated for the maintenance treatment of patients with moderate to severe COPD who are not adequately treated by a combination of an ICS + LABA or a LABA + LAMA . 2
‡
Trimbow 200 is indicated for the maintenance treatment of asthma , in adults not adequately controlled with a maintenance combination of a high dose of ICS / LABA , and who experienced ≥1 exacerbations in the previous year . 2
PBS
LISTED FOR COPD 1 †
Paul Smith Editor of Australian Doctor .
The government ’ s scope of practice review is for it .
TRACKING the embrace of mass antibiotic prescribing by pharmacists for UTIs over the last three years has been a realworld object lesson for anyone wanting to understand how health policy works . We ’ ve covered it in some detail . Yes , it lacks the laughs you find in Yes Minister , but the cynicism of the process running through both narratives remains the same .
Powerful lobby groups with cash to pay for contacts , the pollies eyeing ways to look all-action for the voters , the questionable academic research purportedly proving the reform will harm no-one , before being pushed into mainstream primary care aided and abetted by gaping loopholes in the regulatory system .
The spectacle of pharmacists as diagnosers-cum-prescribers-cum-S4 dispensers backed with taxpayers ’ cash for the consults remains an impressive achievement .
The Federal Government ’ s decision last year to announce a scope of practice review across allied health is a belated attempt to bring surface rationality to the process .
It is being led by Professor Mark Cormack , a former civil servant and now an academic at the National Centre for Health Workforce Studies at ANU in Canberra .
It already seems to be raising red flags .
The issues paper released in January is saturated with a remarkably breezy rhetoric about what can result amid the promise of some glorious future .
It carries the mildly dramatic title Unleashing the potential of our health workforce .
Health reform nerds , those of us who probably need to find other hobbies , can guess at its contents .
But it touches on one key idea overshadowed by the debate on extending prescribing rights .
It ’ s the push for opening up the MBS to allow allied health practitioners to start making referrals directly to specialists .
According to the paper , the expert group ’ s first consultation already found that it has the “ potential to improve consumer outcomes ”.
That word “ consumer ” is bad enough — like it ’ s all about giving punters easy access to medicine ’ s version of the posh shops .
But it continues : “ Opening up access beyond the medical profession to referrals for certain MBS subsidised specialist services addresses a widely discussed gap in the primary healthcare system and over-reliance on GPs to manage all referrals .
“ By enabling consumers to access referrals to specialist and some diagnostic services through the relevant health professional , not only via their GP ,” could result in “ reduced time and cost burden along the care pathway ”. The wording seems to betray a
disturbing ignorance of what it is actually saying .
The alternate world whose existence the issues paper fails to envisage is the real one , where patients are placed on a diagnostic merry-go-round , referred to specialists unfamiliar with their history , whose scope of practice doesn ’ t always match their actual ailments and whose care carries serious out-ofpocket costs .
Some patients , unaware of what awaits them , can be spun around on this high-cost fairground ride for prolonged periods unless someone pushes them back to their GP .
The medical profession is frequently accused of self-interest . And yes it has significant social and political power . But to its credit , it has long recognised the menace to patients of ‘ too much ’
That word ‘ consumer ’ is bad enough — like it ’ s all about giving punters easy access to medicine ’ s version of the posh shops .
care when they are pulled into the system with no co-ordination .
The Choosing Wisely campaign launched back in 2015 led to the specialist medical colleges drawing up lists of interventions and tests doctors should avoid without obvious clinical need .
The revolution could still go much further , but it ’ s a revolution that has bypassed certain allied health professions who want to expand their scope under Medicare .
On the Choosing Wisely website , pharmacists are advised by the Pharmaceutical Society of Australia , the profession ’ s education and standards body , not to provide or promote PAGE 18
PBS Information : Authority required ( STREAMLINED ). Severe Asthma ( 200 / 6 / 10 mcg presentation only ). Chronic Obstructive Pulmonary Disease ( 100 / 6 / 10 mcg presentation only ). Criteria Apply . Refer to PBS for full information .
Please review Product Information before prescribing . Product Information can be accessed by calling Chiesi Australia Medical Information on 1800 943 587 or scanning the QR code .
References : 1 . Pharmaceutical Benefits Scheme ( PBS ). Available at : www . pbs . gov . au . 2 . Approved Trimbow Product Information . Chiesi Australia Pty Ltd , Hawthorn East , VIC . 3123 . Tel : + 61 3 9077 4486 ; Email : medinfo . au @ chiesi . com ; Website : www . chiesi . com . au . Copyright © Chiesi 2024 . All rights reserved . Date of preparation : February 2024 . AU-TRI-2400014 . CHIE00168 .