4 NEWS
Pharmacist owners no good for GPs
4 NEWS
7 SEPTEMBER 2018 australiandoctor . com . au
Concern over gene test reading
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Kemal Atlay GENETIC specialists are concerned
that MBS funding for genetic tests for
patients at high risk of breast and ovarian
cancer may lead to patients being
falsely reassured by negative results .
Associate Professor Judy Kirk ,
head of the Familial Cancer Service at
Sydney ’ s Westmead Hospital is worried
that specialists who do not have
appropriate training or genetic counselling
experience are able to order
genetic tests for BRCA1 and BRCA2
mutations .
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The tests have been MBS-funded since last November .
Genetic testing was conventionally offered through family cancer clinics and genetics services that were wellequipped to provide expert counselling and test interpretation , Professor Kirk and colleagues wrote in the Medical Journal of Australia .
“[ These ] tests are now being mainstreamed and they can be ordered for selected patients , with a new Medicare benefit , by non-genetic specialists in either public or private practice .”
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They said the Medicare-funded test item 73296 was only appropriate if the person being tested had at least a 10 % chance of a pathogenic mutation being i d e n t i fi e d .
A positive result indicated that other adult at-risk relatives could be tested for the family-specific BRCA1 or BRCA2 mutation .
However , a negative result or a result of “ no mutation found ” could lead to problems because it did not necessarily mean there was no risk . “ When a mutation is not found
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using the initial mutation search in
an affected family member , this negative
result is not truly negative , but
rather is uninformative ,” they wrote .
Careful counselling was crucial
so that families , as well as their clinicians
, were not “ falsely reassured ”
by such a result .
The authors recommended that
non-genetic specialists “ receive
appropriate education and support
to enable safe , evidence-based
practice ”. MJA 2018 ; 209:193-96 .
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Pharmacist owners no good for GPs
Antony Scholefield PHARMACISTS who own GP clinics risk undermining patient care by contracting doctors who write more scripts so they can generate bigger dispensing profits , a federal productivity commissioner says .
There has been longstanding bewilderment that pharmacists can own GP clinics , while GPs are effectively banned from owning pharmacies .
Dr Stephen King ( PhD ), who led the Federal Government ’ s review of pharmacy regulation , says it ’ s wrong for dispensers to unduly profit from prescribers .
“ As an economist , my immediate reaction is that if you can stop poor incentives from existing , then it is probably a good idea to do that , rather than allow there to be poor incentives and just hope professionalism avoids people following that path ,” Dr King told a Queensland parliamentary inquiry last month .
Dr King stressed that the ban on anyone but pharmacists owning pharmacies had merit , but the rules were failing in practice , because many pharmacists own businesses they never attended .
“ At a large number of chemists , I would often ask , ‘ Who are the proprietors ? How often do you see them ?’
“ An answer of ‘ never ’ or ‘ perhaps once every three months ’ was fairly common .”
While compiling his review of the pharmacy industry , Dr King said he met a pharmacist in Melbourne who owned pharmacies across Queensland and WA , which he visited once a year on a “ road trip ”.
“ I will not call it gaming of the pharmacy ownership rules , but certainly playing the rules as best as possible for the owner .”