In Practice newsletter
7 November 2014
Australia ramps up Ebola response efforts
The RACGP participated in a specially convened meeting of the Department of Health (DoH) GP Round Table this morning in order to gain detailed knowledge on Australia's preparedness activities in relation to Ebola virus disease (EVD). The DoH announced there will be additional screening for all travellers entering Australia who will be required to complete a ‘travel history card’ in addition to the regular ‘incoming passenger card’. The purpose of this card is to collect specific information about time spent in any country on the African continent 21 days prior to arrival in Australia. If a passenger has visited an affected country, they will be referred for additional assessment of any potential symptoms and/or contact with an infected person prior to entering Australia. This process will be implemented in the near future.
If a returned traveller develops symptoms after entry into Australia, they are advised not to contact their GP, but rather to call the dedicated national Ebola hotline, 1800 186 815. Patients will be advised about the actions they should take and where and how they should seek treatment. The DoH has reiterated that general practice is not the appropriate environment to provide assessment or care of patients with EVD. Whilst it is unlikely that an EVD infected patient will present to general practice, GPs should remain alert to the possibility of EVD in unwell travellers and obtain a full travel and exposure history. The DoH is developing advice for GPs on evaluation processes should a patient present to the practice, which will be released in the coming days.
The RACGP advises patients and GPs to continue following directives from the DoH, which is leading control measures. The latest information regarding Ebola for patients, GPs and other clinicians can be found on the DoH website.
Dr Frank R Jones
Patient safety must come first in PCEHR developments
The RACGP was disappointed to read accusations from the Consumers Health Forum (CHF) of Australia claiming the Personally Controlled Electronic Health Records (PCEHR) system is ‘threatened by self-interested doctors who wrongly claim they are putting patients’ interests first’. The CHF asserted the RACGP was seeking to prevent patients from gaining prompt access to pathology results meant for their PHECR. The RACGP has expressed significant concerns in regards to the clinical risks associated with a model in which investigation results have not been reviewed by the requesting physician prior to being uploaded to the patient’s PCEHR.
The DoH has proposed a seven-day delay in releasing the results of the patient, although any healthcare provider with access to the individual’s PCEHR will be able to view the results immediately following upload by the pathology lab or Diagnostic Imaging DI provider, even if it has not been viewed by the referring physician. The DoH’s assumption is that a seven-day delay has provided adequate time for the GP and other test requesters to recall patients and discuss results if required. This places the burden of responsibility on the GP and if a patient is not available, for various reasons, the patient may then be able to access their results in the PCEHR before any discussion occurs with the GP or test requester. This might not always be desirable and could lead to unintended consequences, in particular with clinically significant results. The RACGP stands firm on its position that the referring doctor has the implicit responsibility to review results and action any further healthcare needs with practices well supported to develop systems to ensure this occurs, as outlined in the RACGP Standards for general practices (4th edition).
In addition, results that are just outside the norm may cause unnecessary distress and further GP visits, with results potentially colour-coded by an automated results process. The RACGP will continue to emphasise that it is the ongoing GP–patient relationship that facilitates the provision of contextual advice and ensures the patient understands their test results and is well supported throughout any future necessary healthcare needs. The RACGP has been very clear during its consultations with the DoH that should it continue with the proposal, it is imperative the line of responsibility is fully documented and lies with the document author, or ‘the uploader’ (pathology laboratory or radiology personnel).
The RACGP met with the DoH earlier this week to further discuss the RACGP’s concerns and clarify areas of uncertainty. The proposed e-health pathology and DI results upload model has not examined the impact on clinical flow within the consultation, or the broader impact to patient privacy, in any detail. The DoH has also confirmed it will be possible for GPs to ‘opt-out’ of the proposed model. Should the DoH progress with this model, the RACGP has proposed a 12-month trial with specific measurable key performance indicators (KPIs) as an outcome. The RACGP is awaiting additional information regarding privacy, workflow, clinical safety and medico-legal aspects of the PCEHR from the DoH and, once received, will provide additional feedback and advice after consultation with its National Standing Committee – Health Information Systems. The RACGP will continue its negotiations with the DoH and patients and ensure the general practice profession is kept informed of all future developments on the PCEHR.
Smartvax: a ground-breaking initiative
Smartvax, a ground-breaking general practice initiative pioneered by the RACGP’s Dr Alan Leeb, is a post-vaccination surveillance system strengthening patient safety in Australia. In response to an unexpected spike in adverse reactions in children receiving Fluvax in 2010, Dr Leeb developed the mobile tool to increase immunisation safety surveillance in general practice. Smartvax sends an SMS to patients or parents of children who have received a vaccination to collect feedback on any negative side effects experienced. Monitoring for adverse reactions following immunisation (AEFI) is core general practice and Smartvax encourages a proactive approach to monitoring effectiveness and safety of vaccinations.
Smartvax is the first surveillance tool of its kind in Australia and was trialled in 3000 patients over 19 months, with a response rate of more than 72%. Any patient who responds to the SMS with notification of an adverse reaction is telephoned by practice staff to ascertain the severity of the reaction and ensure appropriate follow-up care and maintenance of patient records. Adverse reaction rates can vary depending on patient age and the vaccine administered and GPs have a recognised duty of care to manage all adverse reactions following immunisation.
This vital initiative, which saw Dr Leeb receive the Peter Mudge Award at the RACGP’s annual conference in Adelaide earlier this year, further supports the notion that immunisation programs must be general practice-led. Despite ongoing discussion surrounding pharmacy-delivered vaccination programs, the RACGP maintains that safety and quality of patient care can only be provided by a qualified healthcare professional. GPs have established relationships with their patients, including knowledge of medical history, and any move to expand pharmacists’ scope of practice in this area poses a serious risk to patient safety.
RACGP feedback poll – Expanding role of pharmacists
In August 2011, the Australian Government, together with states and territories, signed the National Health Reform Agreement (NHRA). The NHRA recognises the need to identify new and expanded roles within the clinical workforce in order to fill gaps in current service delivery and improve system efficiency.
Following the announced agreement, peak organisations representing the pharmacy profession commenced their response, including the launch of the Queensland Pharmacist Immunisation Pilot (QPIP), which has now been broadened to include measles and whooping cough vaccination.1 The Federal Government has also recently flagged interest in discussing the scope of services provided by community pharmacists.2
To help inform its position on the delivery of primary healthcare services at the community pharmacy level, the RACGP would like to invite members to participate in its current poll.