Half of Health Care Homes sites still to sign contracts
GEIR O ’ ROURKE NEARLY 100 GP practices shortlisted for the Health Care Homes trial are yet to sign contracts with the Federal Department of Health .
With another 27 officially pulling out , the health department says it is willing to negotiate to find a payment model that gets shortlisted practices over the line .
IPN , which is the largest participant in the trial , negotiated a revised contract after receiving legal advice that the capitation payments , as described in the standard version , could bring unintended tax and indemnity costs .
IPN CEO Dr Ged Foley says the corporate is fully behind the reforms and will sign up at least half of its 47 shortlisted practices soon .
But despite the passing of two deadlines , as Australian Doctor went to press , only 104 of the 200 practices originally shortlisted by the department had agreed to participate .
With less than two months to go before the start of the trial , 69 shortlisted practices remain uncommitted .
A spokeswoman said the health department was continuing to work with a number of those practices to finalise arrangements .
“ Some level of withdrawal was always anticipated and the high level of initial interest in the trial has enabled further offers to be made to practices ,” she said .
The spokeswoman said the department was “ actively contacting ” the rest to confirm their intentions so it could make further offers to its reserve list of 136 practices .
“ For those practices that have already been in contact with the department , some changes to the package of documents that make up the offer to participate in the Health Care Homes trial to better reflect the relevant business models may occur ,” she said .
“ These changes do not benefit one practice over any other practice or change the requirements for participating in the trial .”
Not every corporate is unhappy with the standard contract . Tristar Medical
‘ Some level of withdrawal was always anticipated .’
— Federal Department of Health spokeswoman
Group head of programs Anne Gardner said the rural corporate had agreed to commit four practices under the normal deal and was in negotiations to add three more .
“ After looking at the model and the advice that we have received from finance experts and the government themselves , we didn ’ t feel the need to request any changes ,” she told Australian Doctor .
See News Review , page 11 .
Pocket-sized ultrasound aids GP diagnosis
MICHAEL WOODHEAD POCKET-sized ultrasound could be introduced to GP clinics to aid the diagnosis of Achilles tendon injuries , primary care researchers say .
Early use of the devices in primary care could help overcome misdiagnosis rates of up to 22 % with clinical examination , according to a report from GPs in Norway .
They described the case of a 36-yearold man who was initially excluded based on weak active plantar flexion . When re-examined by another GP two days later , pocket-sized ultrasound identified a complete rupture at 5-6cm from the calcaneal attachment .
“ Although improved training [ in clinical examination ] should minimise such misinterpretation , we feel that ultrasound offers supportive visual evidence , which adds value to the diagnostic process ,” the authors said .
Dr Horst Herb , a GP in Dorrigo , NSW , said he had been using the technology for some time because it provided quicker diagnosis and repeatable functional assessments . “ I use portable ultrasound the same way I use my stethoscope — all the time ,” he said .
However , the $ 10,000 cost of the devices could be a barrier for some GPs , especially as “ pitiful ” Medicare rebates did not cover the time needed to do ultrasound examinations . BJGP Open 2017 ; online .
No seal of approval in dementia
JOCELYN WRIGHT A MILLION-dollar government trial has left a toy seal project on the rocks when it comes to soothing agitated dementia patients .
Paro , a robotic seal , was tested in 28 Australian nursing homes as a way of managing residents with behavioural symptoms of dementia .
In a randomised trial funded by the NHMRC , the $ 9000 , Japanese-designed gadget was rated only slightly better than a plush toy when it came to measures of engagement .
There was also little impact on mood state or agitation among 400 residents who were given the robotic baby harp seal to handle .
The toy seal responds to touch and moves its tail and flippers , and makes sounds just like a real baby seal . Patients who handled it became more verbally and visually engaged , but also showed signs of anger when other residents tried to handle or take away their ‘ pet ’.
“ These findings raise questions about the initial novelty effect of the Paro approach ,” said researchers from Griffith University in Queensland .
“ Our findings partly support the efficacy of Paro but also suggest that when there are limited resources , a soft toy animal may be used effectively with a person with dementia ,” they concluded .
Meanwhile , other nursing homes are turning to low-tech solutions such as knitted hand muffs with sewn-in fiddle items to help residents with anxiety and dementia .
“ We are finding they are very good for residents suffering with a little bit of anxiety , or scratching their skin , picking themselves , or for residents with dementia ,” said Heather Robertson , an activities co-ordinator at Bonney Lodge in the Riverland region of SA . Journal of Post-acute and Long-term Care Medicine 2017 ; online .
Asthma : Symbicort ® Maintenance And Reliever Therapy ( Symbicort ® SMART ™ )
PBS Information : Restricted benefit . For single maintenance and reliever therapy in patients ≥12 years who have experienced frequent asthma symptoms while receiving treatment with oral or inhaled corticosteroids or a combination of an inhaled corticosteroid and a long acting beta-2-agonist ( Symbicort Turbuhaler 400 / 12 and Symbicort Rapihaler 200 / 6 is not recommended nor PBS subsidised for use in maintenance and reliever therapy ).
Asthma : Symbicort ® Maintenance Therapy
PBS Information : Restricted benefit . Patients ≥12 years who previously had frequent episodes of asthma while receiving treatment with oral corticosteroids or optimal doses of inhaled corticosteroids ( Symbicort Turbuhaler 400 / 12 is indicated in patients ≥18 years ).
BEFORE PRESCRIBING PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR www . astrazeneca . com . au / PI
Symbicort ® Turbuhaler ® ( budesonide and eformoterol fumarate dihydrate ) for oral inhalation . Indications : Asthma : Treatment of asthma where use of a combination ( inhaled corticosteroid and long acting β 2
-agonist ) is appropriate in adults and adolescents . COPD : Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease ( COPD ), ( FEV 1
≤50 % predicted normal ) in adults with frequent symptoms despite long acting bronchodilator use , and / or a history of recurrent exacerbations . Symbicort is not indicated for the initiation of bronchodilator therapy in COPD . Dosage : Asthma : There are two alternative treatment regimens for asthma : Symbicort Maintenance and Reliever Therapy ( SMART TM ) or Symbicort Maintenance Therapy . Refer to Product Information for full details on dosage . Symbicort Maintenance and Reliever Therapy ( SMART TM ) for Asthma : Symbicort 100 / 6 and 200 / 6 : Adults and adolescents > 12 years : 2 inhalations per day given as either 1 inhalation twice daily or 2 inhalations in either the morning or evening . For some patients , a maintenance dose of Symbicort 200 / 6 2 inhalations twice daily may be appropriate . Patients may take an additional inhalation as needed in response to symptoms , up to 6 inhalations at one time . If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose , the patient should be re-assessed . A total daily dose of up to 12 inhalations can be used temporarily . Symbicort 400 / 12 : The 400 / 12 strength should not be used for Symbicort Maintenance and Reliever therapy . Symbicort Maintenance Therapy for Asthma : Symbicort 100 / 6 and 200 / 6 : Adults and adolescents ≥12 years : 1-2 inhalations twice daily . Symbicort 400 / 12 : Adults ≥18 years : 1-2 inhalations twice daily . Dosage : COPD : Symbicort 200 / 6 : 2 inhalations twice daily . Symbicort 400 / 12 : 1 inhalation twice daily . Contraindications : Hypersensitivity to any of the ingredients . Precautions : Symbicort therapy should not be initiated to treat a severe exacerbation . Not for initiation of inhaled steroids in patients transferring from oral steroids ; impaired adrenal function ; infections of the respiratory system ; increased susceptibility to sympathomimetic amines ; severe cardiovascular conditions ; hypokalaemia ; diabetes ; impaired renal and hepatic function ; pregnancy ( category B3 ); lactation ; children < 12 years . Pneumonia : Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap . Pneumonia has been reported following the administration of inhaled corticosteroids *. Interactions : CYP3A4 inhibitors ( eg . ketoconazole ); beta-receptor blockers ; beta-adrenergic stimulants ; sympathomimetic amines ( eg . ephedrine ); MAOIs ; tricyclics antidepressants ; quinidine ; disopyramide ; procainamide ; phenothiazines ; antihistamines associated with QT interval prolongation e . g . terfenadine , astemizole ; if hypokalaemia : xanthine derivatives , mineralocorticoids , diuretics , digoxin . Adverse effects : Common : tremor , palpitations , oropharyngeal candidiasis , headache , throat irritations , coughing , hoarseness ; others , see full PI . Date of first inclusion in the ARTG : 27 May 2002 ( Symbicort Turbuhaler 100 / 6 and 200 / 6 ); 5 May 2004 ( Symbicort Turbuhaler 400 / 12 ). Date of most recent amendment : 28 March 2017 .
Symbicort ® Rapihaler ® ( budesonide and eformoterol fumarate dihydrate ) for oral inhalation . Indications : Asthma : Treatment of asthma where use of a combination ( inhaled corticosteroid and long acting β 2
-agonist ) is appropriate in adults and adolescents . COPD : Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease ( COPD ), ( FEV 1
≤50 % predicted normal ) in adults with frequent symptoms despite long acting bronchodilator use , and / or a history of recurrent exacerbations . Symbicort is not indicated for the initiation of bronchodilator therapy in COPD . Dosage : Asthma : There are two alternative treatment regimens for asthma : Symbicort Maintenance and Reliever Therapy ( SMART TM ) or Symbicort Maintenance Therapy . Refer to Product Information for full details on dosage . Symbicort Maintenance and Reliever Therapy ( SMART TM ) for Asthma : Symbicort 50 / 3 and 100 / 3 : Adults and adolescents > 12 years : 4 inhalations per day given as either 2 inhalations twice daily or 4 inhalations in either the morning or evening . For some patients , a maintenance dose of Symbicort 100 / 3 4 inhalations twice daily may be appropriate . Patients may take 2 additional inhalations as needed in response to symptoms , up to 12 inhalations at one time . If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose , the patient should be reassessed . A total daily dose of up to 24 inhalations can be used temporarily . Symbicort 200 / 6 : The 200 / 6 strength should not be used for Symbicort Maintenance and Reliever Therapy . Symbicort Maintenance Therapy for Asthma : Symbicort 50 / 3 and 100 / 3 : Adults and adolescents ≥12 years : 2 or 4 inhalations twice daily . Symbicort 200 / 6 : Adults ≥12 years : 2 inhalations twice daily . Dosage : COPD : Symbicort 200 / 6 : 2 inhalations twice daily . Contraindications : Hypersensitivity to any of the ingredients . Precautions : Symbicort therapy should not be initiated to treat a severe exacerbation . Not for initiation of inhaled steroids in patients transferring from oral steroids ; impaired adrenal function ; infections of the respiratory system ; increased susceptibility to sympathomimetic amines ; severe cardiovascular conditions ; hypokalaemia ; diabetes ; impaired renal and hepatic function ; pregnancy ( category B3 ); lactation ; children < 12 years . Pneumonia : Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap . Pneumonia has been reported following the administration of inhaled corticosteroids *. Interactions : CYP3A4 inhibitors ( eg . ketoconazole ); beta-receptor blockers ; beta-adrenergic stimulants ; sympathomimetic amines ( eg . ephedrine ); MAOIs ; tricyclics antidepressants ; quinidine ; disopyramide ; procainamide ; phenothiazines ; antihistamines associated with QT interval prolongation e . g . terfenadine , astemizole ; if hypokalaemia : xanthine derivatives , mineralocorticoids , diuretics , digoxin . Adverse effects : Common : tremor , palpitations , oropharyngeal candidiasis , headache , throat irritations , coughing , hoarseness ; others , see full PI . First inclusion in the ARTG : 22 February 2006 ( Symbicort Rapihaler 200 / 6 ), 20 April 2011 ( Symbicort Rapihaler 50 / 3 ), 26 July 2012 ( Symbicort Rapihaler 100 / 3 ). Date of most recent amendment : 28 March 2017 .
* Please note changes to Product Information
References : 1 . Symbicort Turbuhaler Approved Product Information . 2 . Symbicort Rapihaler Approved Product Information . 3 . Watson J Cur Med Res Opin 1990 ; 11:10 , 654 – 660 . Australian approved product name for eformoterol is eformoterol fumarate dihydrate . Symbicort , ® Rapihaler ® and Turbuhaler ® are registered trademarks and SMART™ is a trademark of the AstraZeneca group of companies . Registered user AstraZeneca Pty Ltd . ABN 54 009 682 311 . 66 Talavera Road , Macquarie Park , NSW 2113 . AstraZeneca Medical Information or to report an adverse event : 1800 805 342 . www . astrazeneca . com . au . AU-3078 _ 1 . Date of preparation : July 2017
www . australiandoctor . com . au 18 August 2017 | Australian Doctor | 5