I Have To Say I Did Not Know eConsults Were A Thing Until Now!

This popped up a few days ago.

EConsults? Show me the time and money

By Laura Woodrow

27 October 2023

Broad structural change is necessary if this model is ever to take off in Australia.

EConsults could increase access to specialist care and improve GP-physician relationships, if implemented well – but structural change is needed to allay concerns over remuneration and time allocation, say Australian specialists.

With a 13% rise in referrals from GPs to non-GP specialist over a decade (2006-07 to 2015-16) and 28% of patients waiting more than four weeks for non-GP specialist care, there is a growing need for easy access to timely specialist advice.

EConsults, in which GPs securely share case information with non-GP specialists for advice and support, rather than referring, have been successfully incorporated internationally as a means of asynchronous health provision.

But while the concept of an efficient platform for GP and non-GP specialist communication may appeal, concerns remain over implementation, according to a study recently published by the Australian Journal of Primary Health

The study investigated what 14 RACP fellows, across a range of specialties, genders and ages, thought of implementing eConsults, with a 72-hour turnaround time, in Australia.

According to the study, specialists generally felt this model would improve access to specialist advice and could be of “considerable benefit” for non-urgent consultations.

“RACP fellows agreed this could improve access to timely specialist advice, place downward pressure on outpatient face-to-face clinic waiting times and reduce unnecessary patient travel.”

The fellows interviewed felt that these asynchronous consultations might provide opportunity for ongoing GP education and reduce the need for future referrals or non-GP specialist advice.

But remuneration and time allocation were a recurring concern among study participants.

“It is clear from our work that Australian physicians require reassurance that they will not be pressured to add this work to existing consultation numbers and demand without support,” the researchers said.

“They also did not see the model as workable if it intruded into out-of-work time.” 

According to the researchers, for primarily public health physicians the concerns centred around time constraints.

“Without dedicated time, participants were concerned that uptake would be low among their colleagues, and that the 72-h turnaround time would not be feasible, which in turn, would reduce the effectiveness of the model,” they said.

But for private physicians, concerns were around matching existing consulting rates to face-to-face consultation rates.

Ultimately, the RACP fellows felt broad structural change would be necessary to make the model viable across Australia.

“All participants viewed the success of a future eConsult model as contingent on the formal structures that would be required to underpin it.

“They were of the opinion that eConsults would represent a fundamental change to the primary–secondary care interface, and as such, would require a proper administrative and governance structure.”

The change would require incorporating suitable and safe technology, ensuring indemnity was addressed with providers and administrative support.

“All participants viewed a formal administrative structure as essential to the success of the eConsult model of care,” said the researchers.

“An informal or haphazard approach would result in low provider satisfactions and low uptake among both GPs and non-GP specialists.”

Speaking to The Medical Republic, dermatology specialist and associate professor at the University of Queensland Jim Muir discussed an educational and resourcing platform, Tele-Derm, that facilitates advice exchange between dermatology specialists and other doctors and is currently up and running in Australia.

Professor Muir is one of four moderators of the Tele-Derm service that is provided through ACRRM, alongside Dr Dan Kennedy, Dr Rachael Foster and Dr John Bingley.

The Tele-Derm online service offers free advice and education, contributing to CPD point, to all rural doctors, whether they are ACRRM members or not, and now has around 4000 doctors registered on the platform.

Tele-Derm combines hundreds of case studies, videos, how-tos with telemedicine platform to bolster specialist advice with educational support, allowing 80% of the cases received to be managed locally by GPs, said Professor Muir.

More here:

https://www.medicalrepublic.com.au/econsults-show-me-the-time-and-money/101370

Now I understand, what we have here is really just a new name for electronically enabled joiunt consultation!

It seems to me there are lots of circumstances where such a care model makes perfect sense and equally some where it my not be appropriate.

I reckon it is up to each clinician how they wish to proceed with remote consultation and to go from there. There are certainly a lot of consults where virtual – especially when video-enabled - consults are totally fine – and to have two doctors involved is hardly a stretch!

What do others think?

David.

 

We Have Lost A Man Who Fundamentally Changed Healthcare in Australia.

 This appeared late yesterday:

Former Governor-General Bill Hayden dies aged 90

Former Governor-General and ALP leader Bill Hayden has died, Prime Minister Anthony Albanese has confirmed.

 Steve Zemek

October 21, 2023 - 6:47PM

NCA NewsWire

Former Labor Party leader and Governor-General Bill Hayden has died, aged 90.

Prime Minister Anthony Albanese confirmed the news via social media on Saturday afternoon.

“Bill Hayden was a humble man but there was nothing modest about his ambition for Labor or Australia,” Mr Albanese said.

“He brought a quiet strength to the cause of progress and through his lifetime of service, he changed our party and our country for the better.

“May he rest in peace.”

Mr Hayden served as a minister in both the Gough Whitlam and Bob Hawke governments.

He served as Leader of the Opposition from 1977 to 1983, before being succeeded by Bob Hawke, who led the ALP to victory at the 1983 election.

During the Hawke government, he served as the Minister for Foreign Affairs.

He was also previously Treasurer during the Whitlam government for a brief five-month period in 1975.

He also served as Whitlam’s Minister for Social Security.

He was born in Brisbane in 1933 and joined the Queensland Police Force in 1953, during which time he joined the ALP.

In 1961, he was elected as the Member for Oxley, which he held until 1988.

He served as Leader of the Opposition, following the 1977 election loss and Whitlam’s retirement.

Following the 1987 election, he took up the post of Governor-General and held the role until 1996.

Mr Albanese said a state funeral would be held to honour Mr Hayden.

The Prime Minister describe him as being instrumental in the introduction of Medicare and an important figure in ALP and Australian history.

More here:

https://www.news.com.au/national/breaking-news/former-governor-general-bill-hayden-dies-aged-90/news-story/11c28e421486dad33e92863dff87118e

Wikipedia makes clear his central role:

“Medibank (1975–1976)

The Whitlam government, elected in 1972, sought to put an end to the three-tier system by extending healthcare coverage to the entire population.^[22] Before the Labor Party came to office, Bill Hayden, the Minister for Social Security, took the main responsibility for developing the preliminary plans to establish a universal health scheme.

According to a speech to Parliament on 29 November 1973 by Mr Hayden, the purpose of Medibank was to establish the "most equitable and efficient means of providing health insurance coverage for all Australians."^[23] “

See https://en.wikipedia.org/wiki/Medicare_(Australia)

I have to say it is not many of us who have made such a fundamental change for our fellow citizens. These sorts of changes are not common, and few have such a huge and lasting impact.

David.

AusHealthIT Poll Number 719 – Results – 22 October, 2023.

Here are the results of the poll.

Will The Loss Of The Voice Referendum Lead To Less Effort / Funding In The Crucial Area Of Aboriginal Health?

Yes                                                                                8 (30%)

No                                                                               17(63%)

I Have no Idea                                                             2 (7%)

Total No. Of Votes: 27

A clear outcome with most feeling that funding levels will not change.

Any insights on the poll are welcome, as a comment, as usual!

A poor number of votes. But also a very clear outcome! 

2 of 27 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.

I Am Having Major Network Issues => Use davidgmore@gmail.com To Contact Me If Needed!

 It is a lovely spring day in Sydney - far away from the horrors of the world!

David.

Monday 10am - Issues seem to be resolved!

D.

It Really Seems Like A Lot Has Happened With ChatGPT In A Year!

Spotted this this week:

Incredibly smart or incredibly stupid? What we learned from using ChatGPT for a year

As the tool becomes less of a curiosity and more a part of daily life, fans are finding clever uses – and discovering limitations

Matthew Cantor

@CantorMatthew

First published on Fri 13 Oct 2023 00.00 AEDT

Next month ChatGPT will celebrate its first birthday – marking a year in which the chatbot, for many, turned AI from a futuristic concept to a daily reality.

Its universal accessibility has led to a host of concerns, from job losses to disinformation to plagiarism. Over the same period, tens of millions of users have been investigating what the platform can do to make their lives just a little bit easier.

Upon its release, users quickly embraced ChatGPT’s potential for silliness, asking it to play 20 questions or write its own songs. As its first anniversary approaches, people are using it for a huge range of tasks. We’ve all heard about uses like crafting emails, writing student essays and penning cover letters. But with the right prompts, it can take on jobs that are more esoteric but equally useful in everyday life. Here are a few that might come in handy.

Jargon demystifier

You’re at a work meeting, and the accountants are talking about GAAP operating income for Q4 of FY22, the design people are panicked about kerning, and the CEO wants you to circle back to drill down on some pain points. On top of that, your British boss says your work is “quite good” but strangely doesn’t seem happy with it, while your US colleague claims everything anyone has ever done is amazing. Users say they’ve turned to ChatGPT for help as an intermediary, employing it to translate workplace jargon so everyone’s on the same page about the concerns you flagged, tnx.

This isn’t limited to the office: people have used ChatGPT to, for instance, translate a sleep study’s medical terminology, or help craft a legal opinion. It can serve as an intergenerational go-between: users have turned it into a gen Z slang translator (sample sentence from a description of a key historical event: “Titanic, flexing as the unsinkable chonk, sets sail with mad swag, a boatload of peeps, and the vibes of a 1912 rave”).

Pitiless critic

Sometimes you want a real critique of your work, a harsh assessment that your friends and family are too nice to provide. For some, ChatGPT is that critic (though whether the word “real” applies here is debatable). “I use ChatGPT to brutally audit where my copy is falling short of the target audience’s expectations,” a copywriter wrote on Reddit. Some have even found it can give decent (if imperfect) criticism of fiction writing, pointing out redundancies, missing characterization or weak imagery.

There are, of course, ethical questions about the use of ChatGPT in work and school settings. In response, some argue that asking it to be your critic, and learning from its feedback, is a way to improve your writing without letting it put words in your mouth.

It’s not always an easy task: what it gives you depends entirely on how you structure the prompt. Some users find it tough to find the language to “convince” it to be harsh enough. And you’ll get more appropriate feedback if you give it a detailed task – “give me feedback” might not help as much as “I’m writing an essay for college – tell me whether it’s well-structured and clear”.

Robot with feelings

Maybe you don’t want ChatGPT to be mean – maybe you want the opposite. Users have asked ChatGPT for help being nicer in their work emails, especially when they’re secretly fuming. “I write to it: please make me sound like less of an asshole,” said one user.

Sous chef

It’s dinnertime and there’s stuff in the kitchen – but you have no idea what to do with a half-eaten yogurt, a leftover chicken leg, a bag of flour and some forgotten tomatoes on the verge of becoming truly upsetting. Users report that ChatGPT has helped them create impressive meals out of what they have, or come up with ideas based on what’s around and a specified grocery budget. Many users report being pleased with the results, though some recipes sound perhaps too creative: garbanzo bean and cheddar cheese soup, a peanut butter and Nutella quesadilla, and a “carrot and grape salad with muesli crunch” (based on what’s in my own kitchen).

ChatGPT invents an odd recipe. Photograph: ChatGPT/Screenshot

Last month, OpenAI, the tool’s developer, added an image-recognition feature that makes this task even easier – instead of having to list ingredients, users can take photos of the food in their cabinets and ChatGPT will come up with recipes.

Results have been mixed. Beyond the fact that the bot has no taste buds, some users have expressed safety concerns, saying ChatGPT may, for example, convince inexperienced chefs to undercook meat.

Whiteboard interpreter

Following the update allowing ChatGPT to “see”, users have found its interpretation skills to be alarmingly impressive. In a clip making the rounds, an AI developer, Mckay Wrigley, shows it a hand-drawn flowchart on a whiteboard, which it’s able to turn into code that Wrigley runs – and it works. The platform can even tell that the green arrows indicate the steps should be reordered. So you can stop beating yourself up for never having learned to code.

Speedy summarizer

ChatGPT can act as your personal SparkNotes, condensing large quantities of information into small ones – whether that information is in the form of articles, meeting notes or book chapters. Combined with the right browser plugin, it can even summarize entire YouTube videos so you don’t have to listen to an insufferable Ted Talker.

Here is the full link text:

https://www.theguardian.com/technology/2023/oct/12/chatgpt-uses-writing-recipes-one-year

Certainly we are seeing all sorts of ideas on how to use this AI. I, for one, would not have expected how fast we have moved!

David.

 

This Looks Like Very Good News Indeed Given How Many Sepsis Kills!

 

This appeared last week:

Sepsis treatment on next stage of clinical trials across hospitals throughout the country

By Nicholas Finch

6:31PM October 12, 2023

Australian scientists are developing a new treatment for deadly sepsis, and are moving onto the next phase of clinical trials across the country.

The Florey Institute of Neuroscience and Mental Health discovered that patients administered with sodium ascorbate showed signs of improved organ functions across the body, and needed less medical assistance in restoring blood pressure.

The results were positive enough for researchers to investigate the effects of sodium ascorbate outside of sepsis treatment. Potential benefits include assisting in open heart surgery, ­treating a subarachnoid haemorrhage or traumatic brain injury, and acting as an immune stimulant for immunocompromised patients.

The Florey Institute successfully tested the chemical on an unresponsive patient in 2020, then trialled it from then until 2022 with 30 patients at Melbourne’s Austin Hospital.

The results of the study have been published in the journal Critical Care, which found that patients administered with the drug showed improved kidney function, reduced requirements for blood pressure-maintaining drugs, and reduced multi-organ dysfunction.

The next phase of clinical trials will involve 300 patients over 1 to 1.5 years.

The World Health Organisation said in 2020 that sepsis was responsible for 11 million deaths every year. Austin Hospital’s director of intensive care research, Rinaldo Bellomo, said that its extremity and speed makes sepsis the biggest killer in intensive care units across the world.

“People may not appreciate how big a problem sepsis is,” Professor Bellomo told The Australian. “Your kidneys don’t work, your lungs don’t work, your circulation malfunctions, your liver malfunctions, and your chance of dying is around 20 per cent. And this is a much bigger risk than having a heart attack, which is the sort of thing that people immediately understand and recognise.”

Lots more here:

https://www.theaustralian.com.au/science/sepsis-treatment-on-next-stage-of-clinical-trials-across-hospitals-throughout-the-country/news-story/83078700609111051f0126d92ff4e160

Given the lethality of sepsis every 1% improvement matters.

We can only hope for more soon!

David.

Ozempic Seems To Be Getting A Lot Of Attention. Care Is Required With On-Line Sales And Marketing At Least!

Fads are a commonly seen manifestation in the health sector.

It could be argued to latest biggie is semaglutide (Ozempic). The drug was introduced as a treatment for Type 2 diabetes but it is the powerful weigh-loss effects that have been noticed in the overweight rich world – which now has a shortage and which has the drug selling in such quantities that it is having a real impact on the Danish GDP! (Yes it is not cheap!)

This is a useful review of what is going on!

Possible Ozempic side effects investigated by Australian drug regulator

By Aisha Dow and Henrietta Cook

October 10, 2023 — 11.22am

Australia’s medicine regulator is investigating several reports of intestinal obstructions in patients using the diabetes turned weight-loss drug Ozempic, in a step that could lead to a change to the drug’s product information.

Ozempic, which has been in short supply since Hollywood stars and influencers boosted its reputation as a quick weight-loss solution, has already been associated with several potential complications, including pancreatitis, diarrhoea, nausea and low blood sugar.

Gary Wittert, an endocrinologist from the University of Adelaide, said these and other possible side effects should serve as a reminder that Ozempic was a medication “intended to treat serious disease”.

“It’s not meant to be thrown around to lose a few kilograms here or there.”

Last month, the US drug regulator, the Food and Drug Administration (FDA), updated Ozempic’s labelling to recognise that cases of a gastrointestinal disorder called ileus have been reported following use of the drug.

Ileus stops the bowel from working normally to move waste out of the body.

Australia’s Therapeutic Good Administration (TGA) confirmed it had also received three reports of intestinal obstructions and one case of “ileus paralytic”, though a spokesman stressed that there may be no link between these events and the medicine.

The TGA is investigating the issue to see if local updates are required to the drug’s product information.

Prescriptions for Ozempic have exploded in recent years in Australia and around the world, in a trend linked to its growing reputation as a fat-burning drug, and off-label prescribing of the medicine designed as a treatment for type 2 diabetes.

A weight-loss version of the drug, called Wegovy, has not yet been made available in Australia.

Wittert said when Ozempic was properly prescribed for type 2 diabetes, it was a life-saving medication for many people. He said it could also be extremely beneficial for patients whose health and quality of life are being harmed by obesity.

“I use it to treat people with diabetes who have got significant obesity and significant obesity-related comorbidities, and it changes their lives completely. And it’s been extremely frustrating, and sometimes distressing for people, to find that they can’t get it… because it’s being used inappropriately,” he said.

Wittert said Ozempic worked on at least three parts of the body. It works on the gut, slowing gastric emptying, which may help explain cases of ileus.

He said it also works on the pancreas and has been linked to rare cases of pancreatitis. Finally, he said it works on the brain to decrease appetite.

Since 2020, 91 cases of pancreatitis following the use of Ozempic, otherwise known as semaglutide, have been reported to the TGA.

“It is important to note that reporting of an adverse event to the TGA or publication in the DAEN does not necessarily mean that a causal link with the medicine is established,” a TGA spokesman said.

Dr Terri-Lynne South, chair of the obesity management group with the Royal Australian College of General Practitioners, said gastrointestinal side effects such as nausea and vomiting were the most common side effects of Ozempic. Other patients reported constipation or diarrhoea, she said.

South said although the class of drugs that Ozempic belongs to had been around for quite a while, they were still learning about the long-term impacts of Ozempic, which was first developed about a decade ago.

A spokesperson for Novo Nordisk, the company behind Ozempic, said patient safety was a top priority for the company and it worked closely with the FDA and TGA “to continuously monitor the safety profile of our medicines”.

More here

https://www.smh.com.au/national/possible-ozempic-side-effects-investigated-by-australian-drug-regulator-20231009-p5easx.html

With popularity comes all sorts of problems and potential misuse.

Amazingly there are even counterfeit injector pens (it is usually a weekly injection).

https://www.novonordisk-us.com/media/news-archive/news-details.html?id=166119

What with some misuse, counterfeit injectors and really significant side-effects my feeling is this is a drug to be used by experts for patients with diabetes and those at risk of developing it! (which leaves out the Hollywood set etc.)

Having an on-line free for all will end badly and as for it being flogged by on-line drug peddlers as is now happening I reckon regulatory intervention is well overdue. Could give telehealth a very bad name unfairly and do some real harm!

David.

Adoption Of The Voice Has Failed But Health System Improvements Must Proceed!

Australia has voted on the Indigenous Voice To Parliament:

‘The Australian people always get it right’: Deputy prime minister

Deputy Prime Minister Richard Marles says the government will continue its work on reconciliation and closing the gap despite the defeat of the Voice to parliament referendum.

“Obviously for those of us who are supporting the Yes campaign, it wasn’t the night we hoped for, and I am disappointed, but the Australian people always get it right, and we absolutely accept this result,” he said on ABC’s Insiders this morning.

“But I don’t take last night as any vote against reconciliation, and I think both sides of the argument made that clear, even in their comments after the result last night, nor do I take this as a vote against a will, on the part of the Australian people, to see a closing of the gap in social disadvantage which affects Indigenous Australians.

“To close the gap, and from the government’s point of view, obviously that is now our focus. The Australian people have asked us to do this in a different way. We hear that and we’ll do that and we will now look at how we can work harder.”

Marles said the government had of course weighed up the issues when it became clear the Coalition decided against supporting the Voice, but they always believed it was best to press on.

“Did we understand that it was more difficult? Of course we did. But we didn’t go to the election saying, ‘We will take this to the Australian people so long as Peter Dutton agrees’,” he said.

Here is the link:

https://www.smh.com.au/politics/federal/voice-referendum-results-live-updates-australia-rejects-constitutional-change-pm-says-government-will-accept-result-20231014-p5ec9o.html?post=p55bgp#p55bgp

In the end it wasn’t even close with the NO vote fining up at close to 60%

It seems clear that despite this overall rejectionist sentiment there are a great number of health related initiatives (including Digital Health development) that need to continue and be further evolved..

The physical and mental health of many of the First Australians is simply unconscionable and an outcome of the failed referendum must surely be to make sure the efforts at consultation with and health support of this population are accelerated and not reduced.

The sad thing is that after a gazillion reports we all know what needs to be done and what resources are required. The time for actual delivery has now arrived, as we put to failed referendum behind us and move forward in a positive way! I wonder will our Governments step up?

David.