Australian Doctor Australian Doctor 27th October 2017

AUSTRALIA’S LEADING INDEPENDENT MEDICAL PUBLICATION I www.australiandoctor.com.au
27 OCTOBER 2017
EYE-CATCHING STORM WARNING CHRONIC COST
How a sleep disorder
caused this lesion
Grand Rounds
page 16 Lessons from last
spring’s asthma event
Therapy Update,
page 27 ‘Health Care Homes
won’t solve it all’
Editorial
page 30
Pregnant
pause for
blood risks
MICHAEL WOODHEAD
MEN have a higher risk of
death if they receive a blood
transfusion from a female
donor who has previously been
pregnant, research shows.
Haematologists have
suggested an immunological
mechanism may explain the
higher mortality rates seen
in a retrospective analysis
of outcomes among 31,118
patients who had blood
transfusions in the Netherlands
between 2005 and 2015.
For male recipients of
red blood cell transfusions,
all-cause mortality rates
after a transfusion from an
ever-pregnant female donor
compared with a male donor
were 101 deaths vs 80 deaths
per 1000 person-years.
This translated into a
statistically significant 13%
higher risk of mortality for men
under 50 having a transfusion
from a female donor who had
ever been pregnant.
Women showed no increase
in mortality risk with blood
transfusions from other female
donors, regardless of pregnancy
status, and there was no
increase in mortality rates in
men with blood transfusions
from females who had not been
pregnant.
The researchers said this
increased mortality risk endured
for years and so was unlikely to
be related to lower iron levels
or other pregnancy-related
physiological effects on red
blood cells.
‘Urgent’ items ban looms
MBS Review hammers home after-hours restrictions
GEIR O’ROURKE
ALL after-hours doctors, including
vocationally registered GPs work-
ing for deputising services, should be
banned from claiming ‘urgent’ items
for home visits, the MBS Review Task-
force has concluded.
Its recommendations — which are
expected to be adopted by federal
Minister for Health Greg Hunt by
Christmas — will see items 597-600
restricted to GPs who ordinarily work
during the day.
“When the items were introduced,
they were intended to be used by GPs
who worked during the day and then
got called out at night,” said taskforce
chair Professor Bruce Robinson.
“It was in recognition that it was
over and above their normal work-
‘When the items were
introduced, they were
intended to be used
by GPs who worked
during the day and
then got called out at
night.’
— Professor Bruce Robinson
chair of the MBS Review
Taskforce
ing hours and not intended simply for
people to man after-hours rosters and
then work only after hours,” he said.
Government spending on the items,
which attract rebates of up to $153
for attendances in “unsociable” hours,
has grown more than 150% in the
past five years.
That growth, the review concludes,
is not driven by increased clinical need,
but by “the entry of new businesses ...
with models that promote these ser-
vices to consumers, emphasising con-
venience and no out-of-pocket costs”.
It has also come at the expense of
continuity of GP care, with after-hours
visits swelling to more than 10% of
total GP attendances in some areas.
In response, the taskforce recom-
mends:
No changes to non-urgent after-
• 
hours items, currently worth $75 for
a home visit.
• Only GPs working in daytime gen-
eral practice should be allowed to
claim ‘urgent’ after-hours Medicare
rebates.
• Patients should only be allowed to
book after-hours appointments out-
side of normal working hours.
• The definition of ‘urgent’ should be
tightened to ensure the items are only
claimed when a patient’s assessment
cannot be delayed until the next day.
The recommendations are expected
to save the government at least $75
million a year if implemented.
Mr Hunt has indicated that he is
“very, very drawn” to the proposals.
cont’d page 6
SUICIDE
WATCH
The Netflix series
13 Reasons Why
was popular. But
was it harmful?
News Review,
page 11
cont’d page 6
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