Carmel Sparke TWO-THIRDS of peripheral intravenous catheters are inserted into areas not recommended by guidelines, an international study led by Australian researchers shows.

In the study, hundreds of health professionals assessed 40,620 peripheral intravenous catheters in 51 countries.

They found that while the forearm was the recommended site in an adult, most catheters were inserted in the hand, wrist or antecubital veins.

One in 10 were unnecessarily painful and a further 10 % had signs of malfunction, said the authors, led by Dr Evan Alexandrou( PhD) from Western Sydney University. Journal of Hospital Medicine 2018; online.

Critics slam the midwives college for awarding a reflexology course CPD points.

Jocelyn Wright THE Australian College of Midwives stands

accused of introducing“ dark age” practices

after awarding CPD points for a training course

promoting burning dried mugwort to correct a

breech birth position.

The ancient Chinese medicine intervention

known as‘ moxibustion’ involves lighting the

mugwort, which is then placed near the woman

’ s fifth toe in the belief that the heat on the

acupressure point releases pregnancy hormones

. These hormones supposedly lead to

uterine contractions that move the baby.

The technique is included in a midwife

reflexology course, accredited with 62 CPD

points, run by midwife and reflexologist Dr

Lyndall Mollart( PhD).

heard of Adelaide University’ s obstetrics and gynaecology unit, has slammed the course.

“ I’ m appalled that midwifery among some practitioners could see a return to the dark ages, by introducing therapies to midwives that are unproven, not audited, and could cause great conflict among hospital clinicians where evidence-based medicine occurs,” says Professor MacLennan.

“ We all want safe birth with minimal surgical and medical intervention. But alternative midwives cannot claim this ground without evidence for their beliefs and nonsensical woo.”

Dr Mollart’ s course also includes the use of acupressure for reducing labour duration and pain, as well as reflexology for increasing the mother’ s milk supply. She denied she was practising“ woo”, saying there were a number of randomised controlled trials that suggested moxibustion could correct a breech position.

“ Of all the studies that have been done on moxibustion, there’ s been no bad side effects

must be a reason,” Dr Mollart said.

“ Personally, I teach midwives reflexology and acupressure. The reason I teach those two is because they’ re not unproven. If medicine believes randomised controlled trials are the golden standard, with those techniques I can show there is evidence behind them.”

She added:“ We can’ t bury our heads in the sand. If 50-80 % of pregnant women are using some type of complementary medicine or therapy, then we’ ve got to make sure the health professionals who work with them at least know what the evidence is on each one.”

The Australian Midwives College also dismissed Professor MacLennan’ s claims, saying the college encouraged midwives to understand complementary medicine techniques rather than adopting them as part of their practice.

A spokesperson stressed alternative therapies were not a substitute for obstetric consultation or referral and that the college also offered its own clinically based professional

Professor Alastair MacLennan, a former

for the baby and if it doesn’ t turn, then there

education courses for midwives.

FROM PAGE 1

Significantly, he says

the company has more than 80 registrars

in training— more than any other

corporate.

By July next year, he insists that

Myhealth will have overtaken Primary

to become the country’ s second-largest

GP corporate and he hopes

to match IPN in scale within the next

5-10 years.

Main GP corporates

Estimated number of doctors

2000

1800

1500 1000 500

1000

400

200

150 150

120 100 85

“ Our success really comes down to

our doctors,” he says.

“ If you pay people big money to

join you, you select a certain type of

doctor, whereas to join Myhealth, you

have to pay money— which means

that people join who are proud of the

brand and want to be part of it.”

Half his business is owned by Crescent

Capital, a healthcare investor

with a stake in a range of businesses

including the National Home Doctor

Service, Australian Clinical Labs, Sun-

Doctors skin cancer clinics and a chain

of dental practices.

Crescent Capital had never before

been involved in“ daytime” general

practice, says Dr Liang, but it saw an

opportunity in Myhealth’ s model

that is as much about keeping its GPs

happy as it is about the patients.

“ Our most important customers

are the GPs themselves,” Dr Liang

says.

But old hands such as Dr Khaled

el-Sheikh, who founded the rural corporate

Tristar Medical Group in 2003,

remain sceptical.

“ These new corporates are not in

the health business for the long term,”

he tells Australian Doctor.

“ Some organisations are promoting

it to get the market hyped up so

they can sell and collect fast cash.”

But along with the hunt for dollars,

are the investors changing corporate medicine? For industry analyst David Low, the fundamentals of the game remain the same: patient convenience.“ From my perspective, what Primary offers and I think what Myhealth offers as well, is what a lot of patients want: a big clinic that is available for long hours, and is easier than going to your local GP and having to wait a couple of weeks and not getting an appointment,” says Mr Low, the executive director of Australian healthcare research at investment bank JP Morgan.

The corporate investors also seem to be interested because of the cash opportunities of the technology revolution.

Myhealth, for instance, is focused on building IT infrastructure to allow electronic booking, airline-style electronic check-in computers and an app for patients.

When Dr Malcolm Parmenter took over as CEO at Primary last year, he was also talking about innovations that you suspect would have made

Dr Bateman blink— such as offering repeat scripts online to regular patients and emailing test results. He was also flagging various ideas that included setting up cubicles with stand-up terminals staffed by doctors to deal with simple presentations.

“ It’ s a bit like casualty and there is quick throughput,” he told Australian Doctor.

But then there is that other attraction for patients— a lasting relationship with a GP. Terry Barnes, a former health policy adviser to former health minister Tony Abbott, says:“ I think there is a convenience factor for large

corporatised practices, particularly

outside standard hours, but I think if

you ask the vast majority of patients,

they like going to the old-fashioned

family practice.

“ Healthcare is still the most intimate

form of professional service and

people like to have an intimate relationship

with their doctor. The big corporates

are realising that.”

While the mass takeover of general

practice by corporates widely

predicted back in the 1990s has not

occurred, some doctors feel that the

only thing wrong with the prediction

is the time frame. Further growth is

Dr Geoffrey Edelsten in his practice waiting room back in 1985.

inevitable in an environment where

governments have been unwilling to

invest.

“ While the Medicare GP financing

structure remains broadly the way it

is, it is hard to escape the conclusion

that the GP corporates will continue

to grow,” says Dr Bill Coote, a former

AMA secretary general and long-time

GP commentator.

“ Corporates can achieve economies

of scale by exploiting opportunities

around access to capital, practice

infrastructure and facilities, opening

hours and administration.

Scepticism remains, of course. At

the National Press Club in July, AMA

president Dr Tony Bartone warned

that GPs see general practice becoming

“ increasingly corporatised, burdened

with more red tape”.

“ This is not the future that GPs

want to see,” Dr Bartone said.

What is clear is that there are

increasing numbers of corporate

voices— backed with big dollars—

who want to persuade GPs to think

otherwise.