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GP psych help may cut CHD deaths
CLARE PAIN PERSISTENT anxiety and depression substantially increase the risk of death in people with cardiovascular disease, suggesting the need for psychological interventions in primary care, Australian cardiologists say.
Mortality rates were found to be four times higher in patients with stable coronary heart disease and persistent moderate-tosevere psychological distress compared with their nondistressed peers over the 12 years of follow-up of the LIPID statin trial.
While anxiety and depression were not unexpected after a major cardiovascular event or diagnosis, this was the first study to use repeated psychological assessments to assess the impact of severity and duration of distress.
The study involved 950 patients at 36 centres in Australia and New Zealand. The
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“ Ultimately, the GP needs to have the care of the patient as their primary concern and... act in a manner which is consistent with competent professional practice.”
If a GP was contacted by a pharmacist or pathologist, the key issue would be to ensure there was agreement about who was responsible for what, Dr Bird said.
The pathology-ordering services, run by Smart Health, a subsidiary of Sonic, were also being sold to naturopaths, chiropractors and homeopaths who wanted to order tests for their patients.
RCPA president Dr Michael Harrison, CEO of Sullivan Nicolaides Pathology, a company owned by Sonic Healthcare, defended the move.
“ They are all valid tests and they can all be done on patients without symptoms or abnormalities in those areas. It’ s just that in this case they are not being triaged by a GP.
“ But these are people who have decided for whatever reason not to go through their GP. I think a fair bit of [ the anger about the scheme ] is related to the turf war between GPs and pharmacists.”
“ There is evidence that a significant cohort in the community have raised cholesterol but don’ t know it. So whatever mechanism we currently have in place, these patients are not getting into the system. The pharmacists are seeing a lot of these people. They are not going to GPs.” data suggested that it was persistent moderate-to-severe distress that did the harm, the study authors said.
“ These findings suggest that in patients with stable [ coronary heart disease ],
‘ Silly’ to let a non-doctor chair the medical board
GEIR O’ ROURKE DOCTORS’ groups are calling for a guarantee that a“ silly” proposal to allow non-doctors to chair the Medical Board of Australia stays buried.
The rule change has been pushed by the COAG Health Council as part of sweeping reforms to medical licensing laws.
Dr Aniello Iannuzzi, from the Australian Doctors Fund( ADF)( pictured), says allowing a layperson to run the medical board is like putting a dentist in charge of engineering.
“ You don’ t have the legal system headed by a nonlawyer; architects regulate architects and engineers regulate engineers. So it seems silly to let anyone but a doctor control the medical board,” he says.
Legislation containing the clause allowing community members to chair the board long-term mortality risk is related to the cumulative burden of psychological distress,” they said.
About 4 % of the patients had persistent moderate distress, and they could be
‘ You don’ t have the legal system headed by a nonlawyer.’
— Dr Aniello Iannuzzi, Australian
Doctors Fund spokesman( pictured)
will have to pass through every state parliament before the change can be introduced.
The clause was removed from a recent Queensland bill after an outcry from the AMA. But some doctors were suitable for interventions for managing anxiety and depression.
“ The patient’ s primary care or usual healthcare providers may be best placed to identify these patients and
fearful it would resurface.
“ The Queensland legislation may not have it for now, but there is a risk it will come back,” said ADF CEO Stephen Milgate.
“ And there is no confirmation that the amendment won’ t go through other state parliaments.”
In 2014, there was an outcry from doctor groups when then Queensland health minister Lawrence Springborg appointed a nurse to chair the state medical board.
At the time, Associate Professor Susan Young, from the University of Queensland’ s school of nursing and midwifery, had already served as chair of the Queensland Nursing Council for six years.
Her appointment followed charges by Mr Springborg that the board had been too lenient on doctors coming before the state medical board.
Professor Colquhoun says the study confirms that the mind does affect the heart.
consider appropriate interventions.”
Study co-author Associate Professor David Colquhoun, a cardiologist at the Wesley Hospital in Brisbane, said the findings confirmed what
GEIR O’ ROURKE CRUISE ship passengers should get their vaccinations shipshape if they want to avoid being confined to their cabin because of disease outbreaks, an infectious diseases expert says.
After dealing with more than 50 shipboard outbreaks of infectious diseases in the past decade, Professor Mark Ferson, director of the Sydney Cruise Ship Health Surveillance, is firing a shot across the bow to passengers who give vaccinations a wide berth.
People embarking on a cruise should prepare as they would for a tour through a developing country, he told a Communicable Diseases conference in Melbourne.
When it comes to disease outbreaks, the main hazards for shipping came from norovirus gastroenteritis but there had also been 18 outbreaks of influenza, he said.
“ People think‘ Okay, I’ m going on a cruise; I’ m not going somewhere I will get cholera or typhoid’. So they probably do forget about the ordinary infections,” Professor Ferson told Australian Doctor.
He urged passengers to see their GP two weeks before weighing anchor to ensure they were vaccinated against influenza.
But he also warned passengers not to turn many patients suspected about distress and cardiovascular prognosis.
“ Persistent moderate-tosevere distress— what you feel— is a major predictor of total mortality. The patients were right. People feel that if [ they’ re ] stressed out, it’ s bad for their health, and we’ ve proven it,” he told Australian Doctor.
“ The mind certainly affects the heart, and a persistent, miserable feeling, stressed about all things in life, does affect the heart.
“ What can we do about it? Well, we can try to minimise the fallout of distress … if patients need appropriate help with psychologists and psychiatrists, we should do that,” he said.
People with persistent distress were more likely to report angina and dyspnoea and also had a higher CRP, the study authors noted. Heart 2017; online.
Batten down vaxes, cruise passengers told
The chief shipboard hazard is gastroenteritis.
a blind eye to personal hygiene.
“ Cruise ships are places where lots of people congregate, bringing in infections from wherever they come from and outbreaks are pretty hard to control,” he said.
Passengers who‘ mutinied’ against visiting the shipboard medical clinics could also set the ship on course for an outbreak, Professor Ferson noted.“ Doctors on ships are quite expensive and passengers know they might be isolated to their cabins if they see them so there are a few disincentives,” he said.
“ A sick passenger ends up back in the buffet and you have the ingredients for an outbreak.”
The old quarantine regulations for ships have been updated with biosecurity rules for 21st century threats such as SARS, he added.
4 | Australian Doctor | 7 July 2017 www. australiandoctor. com. au