Central Viewpoint : July 2009

Joshua Cringle headspace Central Sydney Youth Reference Group

Josh with Human Rights Commisioner Graham Innes among others

Internet and Privacy workshop

3-14 PROJECT BRIEFS 16 CPD UPDATE 3 UPDATES 15 GP ADVERTISEMENTS

NEWSLETTER FOR THE CENTRAL SYDNEY GP NETWORK Ltd July edition 2009

FOR THE LATEST NEWS AND UPDATES PLEASE VISIT OUR WEBSITE http://www.csgpn.com.au

Looking for staff phone numbers! see page 2MERRY MONTH

OF JULY EDITION

NEW IN STROKEPREVENTION

continued on page 3

Rights here, rights now! forum see page 8

Antiplatelet and anticoagulant therapy in stroke prevention: new NPS program

CSGPN will be participating in a new National Prescrib-

ing Service Limited (NPS) therapeutic education program,

“Antiplatelet and anticoagulant therapy in stroke preven-

tion”.

Stroke is the second leading cause of death in Australia

and often results in significant long-term disability. Al-

though the incidence has declined in recent decades about

40,000 to 48,000 strokes still occur each year, with 70%

of these being first-time events (AIHW 2008). One in five

people having a first-ever stroke die within one month and

one in three die within a year (National Stroke Foundation

2008).

Antiplatelet and anticoagulant therapies have an impor-

tant role in primary and secondary prevention.

Despite evidence that antithrombotics are effective in re-

ducing the risk of stroke in atrial fibrillation (AF), they re-

main widely underused in clinical practice. It is well docu-

mented that warfarin is underutilized in atrial fibrillation,

yet it reduces the relative risk of stroke in patients with

atrial fibrillation by 64%, while aspirin reduces the relative

risk by 22%.

There is also uncertainty for prescribers over the use of

clopidogrel and alternative antiplatelets in secondary pre-

vention of stroke. Our program aims to reiterate the role of

aspirin as first line therapy in stroke prevention, and dispel

some of the myths surrounding the prevalence of aspirin

intolerance, as well as the perceived advantage of clopidog-

rel over aspirin in secondary prevention.

This latest program focuses on:

Assessing absolute cardiovascular risk ( New Australian •absolute cardiovascular risk assessment guidelines) to

establish which patients would benefit from aspirin in

primary prevention of cardiovascular events

Deciphering the evidence behind aspirin, aspirin plus •dipyridamole and clopidogrel to choose the appropri-

ate antiplatelet to prevent recurrent stroke and TIA

Using scoring of risk factors in patients with atrial •fibrillation to stratify stroke risk and decide between

warfarin and aspirin

2

Central Sydney GP Network Ltd

July 2009

StaffMichael MooreCEOPh 8752 4921 Email [email protected]

Peter WoodDeputy CEOPh: 8752 4903 Email [email protected]

Lee Sheppard (Newsletter Editor)Communications OfficerPh 8752 4927 Email [email protected]

Project OfficersMano ArumanayagamCervical ScreeningPh 8752 4926 Email [email protected]

Jerry BacichMental Health / D&APh 8752 4907 Email [email protected]

Christopher Daniel Preventive Health / CollaborativesPh 8752 4918 Email [email protected]

Dianne DeschampsAntenatal Shared Care / Aged CarePh 8752 4923 Email [email protected]

Alex DolezalIT/IMPh 8752 4912 Email [email protected]

Melissa FranklinDiabetes Prevention: Live Life WellPh 8752 4914 Email [email protected]

Karen FrostMental Health - ATAPSPh 8752 4910 Email [email protected]

Michelle Lampis Headspace Youth CoordinatorPh 8752 4931 Email [email protected]

FROM THE CHAIR . . .CSGPN, like all Divisions of General Practice, has been asked to take a leading

role in relation to the H1NI Influenza (Swine Flu). Specifically CSGPN has been

requested to conduct Pandemic Planning and Pandemic control-related matters

training sessions for a senior staff member (GP, Practice Nurse or Practice

Manager) at each practice before 15 July 2009. The training will cover issues

such as: practice pandemic preparedness and response, infection control and

effective use and safe disposal of personal protective equipment. The training

is focused on correctly using personal protective equipment to make sure

that GPs and their staff who we rely on to diagnose and treat swine flu don’t

contract the virus themselves and can continue to do the great job in keeping

the community well.

The training will be conducted in one of three ways: a session at all upcoming

CSGPN CPD events until mid-July; 5 specific workshops in June and July

(details of these were included in a recent fax to all practices) and personal

visits by CSGPN Project Officers. Should you require any further information

please contact Beba Ostrugnaj or any CSGPN Project Officer.

Recently I participated in a Panel Discussion on Diabetes hosted by CSGPN

for GPs and other health providers about the incidence of diabetes in the area

and what this means for health services and families. Experts are quoted as

saying that more than 34,000 people in Sydney’s inner west and south west

have diabetes and 17,500 of those don’t even know it. The Forum heard

about the AUSDRISK (Australian Type 2 Diabetes Risk Assessment) tool, a

simple questionnaire which helps individuals assess their risk of developing

Lara Leibbrandt Aged CarePh 8752 4911 Email [email protected]

Danielle Maloney Headspace Clinical Services ManagerPh 8752 4924 Email [email protected]

Lisa MaudeEnhanced Primary CarePh 8752 4902 Email [email protected]

Julie McLean-MurrayNPS Facilitator / CPD Ph 8752 4905 Email [email protected]

John MulleyDiabetes Prevention: Live Life Well Project CoordinatorPh 8752 4916 Email [email protected]

Beba Ostrugnaj NPS / Home Medicine ReviewPh 8752 4909 Email [email protected]

Vijay RamanathanNPS / Home Medicine ReviewPh 8752 4915 Email [email protected]

Julia ThompsonDiabetes Prevention: Live Life WellPh 8752 4928 Email [email protected]

Helene WalshPractice Management Ph 8752 4906 Email [email protected]

Kerstin WaltherChronic Disease Management / Preventive HealthPh 8752 4904 Email [email protected]

Jo WildImmunisation / Preventive HealthPh 8752 4919 Email [email protected]

Fan YangDiabetes Prevention: Live Life WellPh 8752 4941 Email [email protected]

Sarah YorkDiabetes Prevention: Live Life WellPh 8752 4940 Email [email protected]

AdministrationFrank Calcagno Administration AssistantPh 8752 4901 Email [email protected]

Gabrielle CallaghanFinance OfficerPh 9799 0933 Email [email protected]

Ian Hunter Administration OfficerPh 8752 4922 Email [email protected]

Donna LesterAccounts Co-ordinatorPh 8752 4944 Email [email protected]

Sue Moxon Administration Officer / MembershipPh 8752 4920 Email [email protected]

Dr Janice Colagiuri Dr George Nema

Dr Jeremy Bunker

Dr Linda Mann Jennie Burrows

Dr Anne Sutherland Dr Aline Smith

2009 Board of Directors

CSGPN is an ISO certified system

ISO 9000 is a family of standards

for quality management systems.

ISO 9000 is maintained by ISO,

the International Organisation for

Standardisation and is adminis-

tered by accreditation and certifi-

cation bodies. CSGPN is managed

by SAI Global.

diabetes in the next five years. As part of the Federal Government’s AUSDRISK

program, GPs can refer 40-49 year old high risk patients to a subsidised six

month lifestyle modification program that CSGPN is running in conjunction with

Diabetes Australia-NSW Branch. For further information on this initiative please

contact Jo Wild, CSGPN’s Project Officer.

Of course the other CSGPN Diabetes project is the Prevent Diabetes - Live

Life Well program (PDLLW). This is a pilot program funded by NSW Health and

run in conjunction with Sydney University, SSWAHS and two other divisions

of General Practice (Macarthur and Southern Highlands). The PDLLW program

targets people aged 50-65 years of age and a GP needs to be enrolled in the

program to refer people. For further information contact John Mulley CSGPN’s

Project Coordinator.

Dr Janice Colagiuri, CSGPN Chair.

3


July 2009continued from page 1

The Medical Benevolent Association of NSW

provides assistance for doctors, their families

and other members of the medical family.

It offers a free professional counselling service

through its Social Worker and financial assist-

ance to those in need.

Doctors and their families would find the use

of a sympathetic but confidential ear of much

benefit in times of personal or professional cri-

sis and/or financial distress.

Please contact: Meredith McVey

MBA Social Worker

(02) 9987 0504

www.mbansw.org.au

Donations to the MBA NSW are tax deductible

Prizes for best photograph - GP

Prizes for best photograph - Practice staff

Gift voucher prizes:

$500 (1st prize), $300 (2nd prize), $200 (3rd prize)

More detailed information in the next newsletter.

What are you waiting for? Get clicking!

COMPETITION2009

Assessing risk factors for bleeding in patients with •atrial fibrillation before commencing warfarin therapy

Strategies that will help increase patient concordance •with warfarin and educate patients on the safe use of

warfarin

The importance of maintaining INR within therapeutic •range.

The program includes one-on-one educational visits from

NPS facilitators and small-group, case based peer meet-

ings for GPs and pharmacists. If you wish to participate in

an educational visit or divisional case study at your prac-

tice please contact Beba or Vijay, QUM Facilitators on 9799

0933.

AGED CARE“Round One” of the Aged Care Access

Initiative (ACAI) is now underway.

CSGPN approved forty seven submis-

sions from fourteen Residential Aged

Care Facilities (RACFs) with funding of

$63,000 provided in the first round. The initiatives are var-

ied and fall in the following Allied Health areas:

Physiotherapy/Exercise Physiology (Falls Prevention)•Speech Pathology (Communication and swallowing as-•sessments)

Diversional Therapy/Occupational Therapy (improving •independence and ability to participate in activities,

development of tailored activities)

Dietician (Nutrition: menu reviews, individual assess-•ments staff education)

Specialist Nursing services (pain management, pallia-•tive care)

Psychology (Behaviour and challenging behaviour •management)

In the area of Speech Pathology, CSGPN received ten sub-

missions. The submissions either related to staff educa-

tion or to individual resident assessments in RACFs. Bar-

bara Braithwaite from Braithwaite Speech and Learning

Clinic explains that a common scenario is:

“The resident returns from a hospital admission on thick-

ened fluids and a pureed diet. But how long should they

stay on this regime? Who assesses when and if they are

able to return to a more normal diet, or if they remain safe

For more information contact:Beba Ostrugnajp. 8752 4909 e. [email protected]

4


July 2009

For more information contact:Lara Leibbrandtp. 8752 4911e. [email protected]

on their current regime? RACF staff are reluctant to make

this change themselves.”

This occurred at one RACF recently. The resident was dis-

tressed asking for other food and water, the family was

particularly keen to give them sips of water and did so

resulting in the resident aspirating and ending up back in

hospital. Under the ACAI, a speech pathologist was able

to assess this resident. In this particular case the speech

pathology assessment found the resident was not able to

return to a more normal diet (soft and small cut up piec-

es). However, at least staff could now reassure the family

who will be more willing to accept the decision to stay on

thickened fluids due to professional advice.

Barbara says: “sometimes these residents are fine to re-

turn to a more normal diet, RACF staff are likely to put/or

keep residents on puree diets and thickened fluids (if they

are unsure or the person is coughing/choking) and this is

not always necessary”

Puree and thickened fluid diets look visually unappealing

and can make the resident uncomfortable due to consti-

pation. A formal assessment from speech pathologist will

ensure the right and safest decision is made.

ANSCIt is recognised that any GP may see

women early in pregnancy not just

GPs accredited as part of the Antena-

tal Shared Care Program.

Often there can be lengthy waits be-

fore women can make their booking at one of the Sydney

South West Area Health Service (SSWAHS) Hospitals.

If you see a woman who you consider to be at risk of com-

plications, please refer her for a review early in her preg-

nancy. Do not wait until she is booked into hospital.

Conditions that may require review early in pregnancy in-

clude:

Diabetes•Hypertension•Renal Disease•Thyroid Disease •Haematological disorders•Known uterine anomalies•Previous pregnancy complications•Possible multiple pregnancy.•

It is also important to organise all the necessary blood

tests DO NOT FORGET:

IMPORTANT MESSAGE FOR ALL GENERAL PRACTITION-

ERS WHO SEE WOMEN IN EARLY PREGNANCY.

Many women consult General Practitioners who are part

of the antenatal share care program. However it is recog-

nised that women may also attend a general practitioner

in the area of Royal Prince Alfred Hospital who may not be

involved in the share care program.

You will be aware that women who make their bookings

in at Royal Prince Alfred Hospital may not have their first

visit to the hospital until they are well into the second tri-

mester.

It is important that if you see a woman in the first trimes-

ter who you may consider high risk of a complication of

pregnancy that she be referred for early review and not to

wait for her booking visit. This is called a “consultation in

pregnancy” and these consultations are seen in the various

high risk pregnancy clinics at Royal Prince Alfred Hospital.

The high risk pregnancy clinics have different emphases

depending on the consultant involved and the expertise in

that clinic.

CENTRAL VIEWPOINTUPCOMING SUBMISSION DEADLINES:August Edition - Monday 6 July 2009September Edition - Monday 3 August 2009October Edition - Monday 7 September 2009November Edition - Monday 5 October 2009

JULY CPD EVENTSUpcoming events in July:

Wed 8 CPD Large Group Event: Diabetes•Tue 14 EPC Health Assessments ALM I•Mon 20 CPD Small Group Event: Lymphoedema•Tue 21 EPC Health Assessments ALM II•Thu 23 Practice Staff Event: LabTests Online•

Please refer to the back page for a full listing.

5


July 2009

For more information contact:Dianne Deschampsp. 8752 4923e. [email protected]

The high risk clinics that you should be aware of at the

Royal Prince Alfred Hospital are:

Clinic Women seen Consultant/s

Tue AM Women who have known renal •

disease/renal transplant

Pre existing hypertension•

Previous severe pre eclampsia•

Recurrent urinary tract infection •

in pregnancy

Dr Robert Ogle

Dr Jon Hyett

Tue PM Multiple pregnancies•

Drug and alcohol problems/•

psychiatric disorders

Women who are referred from •

Aboriginal Medical Service

Pregnancies with placenta •

praevia or uterine fibroids

Dr Joanne Ludlow

Dr Sue Jacobs

Thu AM Type I or type II diabetes •

Current gestational diabetes•

Graves disease•

Other endocrine disorders•

Dr Brad de Vries

Dr Warwick Birrell

Dr David Kowalski

Thu PM Women with previous caesarean •

section requesting a trial of

vaginal delivery

Women with known uterine •

fibroids

Women with known placenta •

praevia

Dr Brad de Vries

Fri AM Any medical or genetic disorder •

in pregnancy

Previous stillbirth•

Previous preterm delivery/wom-•

en with uterine anomalies

Previous cervical surgery (eg •

LLETZ or cone biopsy)

Dr Robert Ogle

Dr Jon Hyett

Following this consultation a pregnancy plan will be made

which will involve either follow up in one of the high risk

pregnancy clinics or a joint care with the share care Gener-

al Practitioner. It is ideal that when referring these women

for consultation that the appointment be prior to 12 weeks

so that the necessary early investigations can be done. We

would be happy to organise nuchal translucency screening

and her morphology scan and appropriate other interval

scans depending on the nature of the high risk complica-

tion being assessed.

To arrange for a consultation in early pregnancy in high

risk patients please ring the Royal Prince Alfred Hospital

Women and Babies Ambulatory Care on 9515 7101 or

9515 7102 and specify which high risk clinic you would

like the consultation.

If you are asking your patient to make a phone call for this

consultation please indicate to your patient that it is for

a consultation and that it would be desirable if she could

specify which clinic she is to attend. If there are any diffi-

culties with accessing consultations please feel free to ring

Dr Robert Ogle, Director, RPA Women and Babies through

the Royal Prince Alfred Hospital switchboard or contact

Audrey Lee the SSWAHS GP Liaison Midwife on 0425 230

662.

Also consider the need for Nuchal Translucency Screening

and Genetic Counselling.

For an early clinical review for your patient do not hesitate

to ring Royal Prince Alfred Hospital Women and Babies

Ambulatory Care (Antenatal Clinic) on 9515 7101 or 9515

7102.

Women when phoning must indicate that their GP has

asked for her to be reviewed, or you or your staff can ring

on her behalf.

If you require any further advice or clarification you can

contact Audrey Lee the SSWAHS GP Liaison Midwife on

0425 230 662.

ATAPSATAPS Self Harm

Referrals

Referrals into the ATAPS Self Harm

Prevention and Early Intervention

project were slow to take off in the

2008/09 Financial Year. Following

recent promotional activities, some GP training, and some

further liaison with the Emergency Department at RPA, I

am confident that referrals in the 2009/10 Financial Year

will be much higher.

The ATAPS Self Harm project provides immediate access

to fee-free focussed psychological strategies for individu-

als at risk of or currently undertaking self harming behav-

iours. To be part of this, GPs must first be registered on

the ATAPS GP listing – ring me to organise this – it’s easy.

Under the self harm project self harming behaviours in-

clude self-mutilation and co-occurring self-poisoning, reck-

6


July 2009

For more information contact:Karen Frostp. 8752 4910e. [email protected]

less use of alcohol and/or other substances, high risk

sexual behaviours and behaviours which may be consid-

ered as eating disorders such as bulimia or self starvation.

Prior to activating a referral, the GP MUST ensure their

patient is ready for immediate services, and is willing to be

contacted by the Service Provider to commence treatment.

Patients referred into this project will be contacted by the

ATAPS provider within 24 hours of referral, and seen within

72 hours of referral.

To obtain a unique referral number for their patient, GPs

contact the CSGPN Admin team on 9799 0933. The GP and

patient need to have selected a Service Provider, from the

Self Harm Prevention provider listing (also see below). The

Admin team will provide the GP with the unique patient ID

code, which must be recorded on the ATAPS documenta-

tion for this patient. We recommend the GP also contacts

the Service Provider with the referral details and to engage

a shared care approach for the patient.

Each patient referred under this project is entitled to unlim-

ited access to psychological services (within a two month

period). Each referral will cover twelve sessions to allow

us to monitor the project, and to ensure regular contact is

made between the GP and the Service Provider.

Providers

The providers listed below have all undertaken the man-

datory training to provide services under the ATAPS Self

Harm Prevention project. Their details are included on the

ATAPS provider directory which is available on our website

www.csgpn.org.au

John Carmody – Mental Health Nurse•Stephanie Hurst – Psychologist /Occupational Therapist•Janine Peckham – Clinical Psychologist•Alison Smith – Psychologist •Janina Szyndler – Clinical Psychologist•

The following providers have been recruited to provide

ATAPS Self Harm Prevention services to youth aged 12

– 25 years who are presenting with Self Harming Behav-

iours, as outlined above:

headspace• – South Sydney Youth Services - Juliet Don-

ald & Jessica Swinbourne

The following providers have been recruited to provide

services specifically within the Canterbury area of CSG-

PN’s catchment:

Canterbur• y – Christina Moscovis & Noris Ma

CENTRAL VIEWPOINTUPCOMING SUBMISSION DEADLINES:August Edition - Monday 6 July 2009

CERVICAL SCREENING

BARRIERS IN CERVICAL SCREENING

How can you encourage your patients to

have regular Pap Tests?

Take the initiative and raise the issue of Pap Tests. •One of the easiest ways to introduce the subject is

simply to ask: “while you are here, can we check when

you last had a Pap test?”

Ensure clients are physically and psychologically com-•fortable when taking a Pap Smear

A recall and reminder system is useful for keeping •track of women who are due for a Pap test.

Which patients should I target?

Women who are more likely than the general population to

be significantly unscreened include:

women of lower socioeconomic status•women from culturally and linguistically diverse back-•grounds

indigenous women, and •older women•

Can the NSW Pap Test Register (PTR) give me a list of my pa-

tients who are due for a Pap Test?

Yes, the PTR will gladly issue you with a list on a CD of your

overdue patients – simply go to www.csgpn.com.au, click

on services, and click on cervical screening to download

the form. Complete the form with your provider number

and those who work in your practice and fax it to the NSW

PTR (fax number shown on the form) and a CD will be sent

you.

Just remember the PTR list of patients includes only those

who have had a Pap test under your care (provider no). If

the client has gone elsewhere for a Pap test, then she will

not appear on your list.

7


July 2009

CT Lung Nodule Analysis

CT Nodule analysis involves advanced software where the •volume of the nodule is calculated.

On a 12 week follow-up study the volumetric doubling •time (VDT) can be calculated

Nodules with a >25% increase in volume & a doubling •time of <400 days are suspicious for malignancy

The negative predictive value is around 98%. •If the the VDT is > 400 days at 3 months then a 1 year •follow-up could be performed.

QUIZ

50 year old female presents with weight loss. CT Colonography

- Where is the cancer?

Answer in the next issue of Central Viewpoint. Previously -

How should this nodule be followed up? There is a lung nodule which

may represent an early lung cancer, granuloma or hamartoma.

For further information please contact:

Five Dock Medical Imaging (Five Dock) 8705 8300 www.fivedockmedicalimaging.com.au

Alfred Medical Imaging (Camperdown) 8228 9000www.AlfredMedicalImaging.com.au

Inner West Imaging (Nth Strathfield) 8282 8100 www.InnerWestImaging.com.au

Advertisement

For more information contact:Mano Arumanayagamp. 8752 4926e. [email protected]

The PTR list of your overdue patients could include a •number of women who are no longer attending your

practice

Not all your eligible patients are listed with PTR. You •will still need to check your own database to find the

ones who are not listed with PTR, and follow-up with

them to have their Pap test.

If you need assistance with any aspect of managing and

increasing your practice’s cervical screening rates, please

call Mano Arumanayagam, Project Officer, Cervical Screen-

ing on 8752 4926 or email [email protected].

au

EPC

Bay Run - 2 August

As CSGPN is a corporate sponsor

for the Bay Run, it would be great to

see our local GPs and practice staff

out there living the dream! If your

practice would like to participate or you would like to join

the CSGPN team why not register on our website www.

csgpn.com.au

The Bay Run website has a direct link to the AUSDRISK as-

sessment tool that can be completed online. This is a great

opportunity for people to check their status. If people be-

tween the age of 40-49 years have scored =>15 remember

the steps:

1. Do the AUSDRISK assessment

2. Do a fasting glucose test to eliminate diabetes if their

score is =>15

3. Offer them the opportunity of joining the Diabetes

NSW LMP program

4. Fill out the LMP referral form

5. Call us for a referral number

6. Fax the form to Diabetes NSW

7. MBS Item 713 is the item to bill for the consultation

Australian Cardiovascular RISK CHART

The Heart Foundation (2009) has produced a useful re-

source that was presented at our recent Stroke CPD. All

GPs present thought it was a useful tool hence I have in-

cluded it as a flyer in this newsletter. It could be useful as

a visual indicator to patients, both with and without diabe-

50 year old female with wt loss

CT Colonography - Where is the cancer?

8


July 2009

For more information contact:Lisa Maudep. 8752 4902 e. [email protected]

tes, to identify what their risk of a cardiovascular episode

could be.

For a more comprehensive look at the Quick reference

guide for health professionals absolute cardiovascular dis-

ease risk assessment go to the Stroke Foundation website

which has an interactive Cardiovascular risk calculator tool

that can be downloaded to both windows and mac:

http://www.strokefoundation.com.au/health-professionals

HEADSPACE

Rights Here Rights Now Youth Forum

headspace in partnership with Marrick-

ville Legal Centre

Currently, the Australian Government

wants to hear what all people in Australian think about

human rights and how our rights should be protected in

Australia. Part of this process includes making sure young

people’s views are being heard. As part of the National

Human Rights Consultation, a Youth Forum was held on

Thursday 21 May 2009 at Marrickville Town Hall.

The forum, entitled “Rights Here, Right Now”, provided an

opportunity for young people to be involved in expressing

their views on their rights and providing feedback on how

to protect their rights and address gaps in current laws/

policies. The forum was a huge success and involved the

participation of 100 young people from a variety of differ-

ent schools and youth services from the inner West, Bank-

stown/Canterbury area and the St George region.

The “Rights Here, Rights Now” forum consisted of five

workshops targeting high school aged children in the In-

ner West area. The workshop was facilitated by a young

person and a professional with topics including: police and

young people, debt and fines, public space, education and

Internet privacy.

Josh, a member of the heads together Youth Reference

Group, reports on the success of this event:

My name is Josh Cringle, I am 21 years old and a member

of the headspace youth reference group ‘headstogether’. I co

-facilitated the police and young people workshop with Katrina

For more information contact:Michelle Lampisp. 8752 4931e. [email protected]

Wong a children solicitor from Marrickville legal centre.

I have a background of being in trouble with the law, living on

the streets and drug and alcohol problems. A few years ago I

would have found the information at a forum like this invalu-

able. In the work shop we asked the young people what kind

of interactions they have had with the police, what was nega-

tive in their interactions and what could be improved. Also we

discussed what their obligations are when dealing with the

police.

There was about 90-100 young people at this event. The Hu-

man Rights Commissioner Graeme Innes spoke and had a

photo taken with organisers and young people. I met him and

thought it was an awesome experience. Graeme spoke strong,

generous and kind words. I think it was good of him coming to

an event and speaking where all young people can listen and

be inspired.

It was also good to see young people from all different ages

and all different cultures all having their say. It takes a lot of

courage to stand up and speak about their rights as young peo-

ple. They said they found the forum helpful and good as they

now know the correct procedure and can come up with a lot of

other ideas and are all willing to make a change for all youth

in the future.

Some of the participants commented on how it was good to

have a young person talking about their experiences, someone

that has been where they have and understand them.

I as a young person found it helpful and also learnt a lot from

the forum and was happy to hear that it is going places to help

other youth.

Joshua Cringle headspace Central Sydney Youth Reference Group

Josh with Human Rights Commisioner Graham Innes among others

Internet and Privacy workshop

Josh (2nd from Right) with Human Rights Commissioner Graham Innes (middle).

9


July 2009

HMR

ONLINE EDUCATION

Medicare and You – eLearning for

health care professionals

Medicare now has on online edu-

cation tool (free to anyone) that promotes HMR as part

of Enhanced Primary Care. The tool is aimed at GPs and

practice managers/staff/nurses.

This is a self-paced eLearning program for all (new) health

care professionals that:

make it easier for health professionals to access Medi-•care education

improve confidence in using the Medicare Benefits •Schedule, and

increase awareness of associated rules and regula-•tions.

The program is easy to use, interactive and case based.

There are seven modules – each with multiple topics that

will take between 5 and 20 minutes to complete. To get the

most out of this training you will need to actively partici-

pate in the e-Learning activities.

Go to:

http://medicare.gov.au/provider/business/education

then click on Medicare and You – eLearning for new health

care professional which takes you to the education tool:

http://www.medicareaust.com/medicareandyou/

Follow the prompts by clicking on Begin. Eventually you

will get to a screen that lists all the modules. Module Four

is called Enhanced Primary Care.

This module will provide an overview of the enhanced pri-

mary care program and the range of allied health services

available for patients with chronic conditions and complex

care needs. The first part of this module is Medication

Management Reviews.

In Quarter 1, 2009 (Jan - Mar), 189 HMR services were

completed by 57 GPs. This is a significant increase when

compared to the same quarter last year (142 services by

46 GPs). We, the HMR Facilitators, would like to thank

those GPs who undertake HMRs and request others to con-

sider the benefits of HMR.

HMR Self-evaluation quiz

Please tick the correct response and check with the answers

below:

1. Which of the following is the mandatory criterion to

do HMR?

a. Patient should be taking more than 5 medicines

b. Patient should be aged over 60 years

c. Patient should be residing in the community

d. None of the above

2. Which is/are the risk factor(s) for medication misad-

venture?

a. Taking more than 12 doses a day

b. Confusion or worry about their medicines

c. Seeing more than one GP or specialist

d. All of the above

3. HMR can only be done annually unless there is a

major change to patient’s medication or had a recent

discharge from hospital.

TRUE / FALSE

4. What is the approximate income per year for the

practice for doing 5 HMR/week?

a. $ 5,000

b. $ 10,000

c. $ 20,000

d. $ 35,000

5. Who benefits from a HMR?

a. the patient

b. the patients’ GP

c. the patients’ pharmacy

d. all

Please check your responses with the correct answers. Do

you want to know more about HMR, please contact the

QUM Facilitators (Vijay Ramanathan or Beba Ostrugnaj) at

CSGPN or visit www.csgpn.org.au

Answers: 1 c; 2 d; 3 TRUE; 4 d; 5 d.

For more information contact:Vijay Ramanathanp. 8752 4915e. [email protected]

10


July 2009

IT/IM

Benefits of HL7 pathology format

Downloaded electronic investigations

are convenient and most GPs who

are computerised are now receiving

their pathology electronically. Some

radiology providers also offer their radiology in electronic

format, however this is still less common than with pathol-

ogy providers.

Electronic pathology results are available in two formats.

The default format is called Pathology Information Trans-

fer (PIT) and it is a text file, which after processing goes

into your results. This format now has been superseded by

a more user friendly format called Health Level 7 (HL7).

HL7 format allows the result to auto-populate other sec-

tions of your clinical software, namely diabetes record,

diabetes register and INR calculator. If you receive your re-

sults in HL7 format you do not have to double enter HbA1c,

cholesterol, microalbumin or triglyceride values into your

diabetes record, these values come across automatically.

Same applies for the INR results that go into International

Normalised Ratio Record. If you use the PIT format you

need to re key this data into your diabetes record or your

INR record, which in my experience rarely happens.

Additional benefit is that HL7 pathology format allows cu-

mulative result graphing, which can be used for fast trend

analysis and also as a patient education tool.

Unfortunately your pathology provider will send you the

pathology in PIT format unless you request otherwise. To

receive pathology in HL7 format contact your provider and

request this change. It is usually only a matter of minutes

to enable your pathology to come in HL7 format and there

is hardly any difference in the appearance of the results.

HL7 pathology format is especially useful to those GPs

who wish to concentrate on management of patients with

diabetes. I have worked closely with practices which start-

ed receiving their pathology in HL7 format and within six

to twelve months they can extract meaningful data show-

ing levels of HbA1c and cholesterol for these patients. For

more information about the benefits of HL7 pathology for-

mat please contact me on 9799 0933.

For more information contact:Alex Dolezalp. 8752 4912 e. [email protected]

LIVE LIFE WELL

Field Agent Report 5 to CSGPN-HQ

Codename: Prevent Diabetes – Live

Life Well

The CALD stream…..

The mainstream project is up and running and the team is

now gearing up for the CALD (Culturally and Linguistically

Diverse) stream of the Prevent Diabetes – Live Life Well

program. Diabetes is a growing problem in people from

many different cultures living in Australia, but the same

lifestyle changes can prevent diabetes across the board.

The CALD stream of the Program is targeting Chinese and

Arabic speaking people. Diabetes is very prevalent in these

communities living in Australia and both of these groups

have significant numbers living within CSGPN’s area. There

are definitely other cultural groups that also have a high

prevalence of diabetes within CSGPN’s area and the im-

portant thing to note is that the aim of CALD stream is to

see if the program can be effective across cultures, not

just in the specific cultural groups chosen.

CSGPN aims to see 100 Arabic speaking and 100 Chinese

speaking people through the Program.

The Chinese speaking stream will be conducted in Manda-

rin. One of our current agents, Fan Yang, speaks Mandarin

and will be running this stream of the Program. Thanks

Fan!

CSGPN recently interviewed for an Arabic speaking agent

to run the Arabic stream and we should have someone on

board very soon – we will bring you more on this as it de-

velops.

All the materials used for the program are being translated

into the appropriate language, including the screening tool,

referral form and all the educational material. If anyone

has been involved in translating material before you will

know that this is not necessarily a straight forward process

and may take a little time (the manual has 175 pages).

As soon as we have the materials and the staff on board we

will be starting CALD stream of the Prevent Diabetes – Live

Life Well program. Prior to this we will be signing up GPs

who are interested in being involved.

If you are interested in being part of the Prevent Diabetes

11


July 2009

For more information contact:John Mulleyp. 8752 4916 e. [email protected]

– Live Life Well program, either in the CALD stream or the

mainstream, please contact John Mulley on 8752 4916.

MENTAL HEALTH

CARE for Families is looking for re-

ferrals from GPs and allied mental

health professionals

CARE for Families is an Australian

Government initiative funded by the

Department of Families, Housing, Community Services

and Indigenous Affairs

CARE for Families Clients

CARE for Families provides case management and psycho-

education for people with a mental illness and their family

members and friends for nine months.

8 Weeks Option

If only one family member is able to attend then one per-

son may attend the CARE for Families program for up to 8

weeks on their own.

CARE for Families Program Outcomes:

Enhance well-being and family stability•Improve knowledge and understanding of mental illness•Improve communication and problem solving skills•Increase awareness of knowledge of services.•

The CARE for Families program is offered at the following

Break Thru sites:

Enfield•Rockdale •Bankstown•Blacktown•Liverpool •Maroubra•Parramatta•Penrith•St Marys•

Support Group

Support Group – a fortnightly support group is run at En-

field and Rockdale. The aim of the support group is to

reduce social isolation and offer an opportunity to share

and learn from other people’s experiences.

Enfield - Every 2nd Tuesday from 5:30pm - 7:00pm•Rockdale - Every 2nd Wednesday from 6:00pm - 7:30pm•

If you have any questions about the CARE for Families pro-

gram please see the attached CARE for Families brochure

(Is this a flyer?) or contact the CARE for Families Manager

Hoda Kobeissi on ph 9745 1529.

The Woolcock Insomnia Clinic

Insomnia is a distressing difficulty with going to sleep,

staying asleep or waking too early where the unwanted

wakefulness is greater than 30 minutes; occurs more than

three times per week and has been present for more than

a month.

The Woolcock Insomnia Clinic is part of the Woolcock Insti-

tute of Medical Research and is located at 431 Glebe Point

Road, Sydney. People with insomnia can make appoint-

ments to see psychologists who have specialist training in

behavioural sleep medicine. They have also had additional

training of working in a sleep laboratory, attending sleep

training courses and sleep conferences and can read sleep

studies to diagnose possible ‘other’ sleep disorders.

The patient’s initial consultation is to assess applicabil-

ity for the insomnia program and identify any other sleep

disorders. The Woolcock clinic offers a cognitive behav-

ioural therapy (CBT) program based on international re-

search. CBT “works as well or better than hypnotic medi-

cations to alleviate chronic insomnia and its benefits also

continue after active treatment ends” (Lamberg. JAMA,

2008;300:2474).

A group CBT program was introduced at Royal Prince Al-

fred Hospital in 2002 to reduce the waiting list for insomnia

consultations which at that time extended to five months.

Questionnaire data on sleep quality, fatigue, sleepiness,

depression, anxiety, stress and beliefs and attitudes at the

initial visit, after the four group sessions and at six months

was collected. The data showed that individuals who at-

tended at least three out of the four sessions had signifi-

cantly improved sleep outcomes (increased total sleep

time, reduced sleep onset times, reduced wake times and

increased sleep efficiency) and these were maintained at

six months with mood outcomes further improving. These

positive outcomes were in an unselected population (RPAH

sleep clinic) which had considerable co-morbidity. The

data is presently being evaluated for publication.

At the Woolcock Insomnia Clinic patients attend two edu-

cational or group sessions and two individual consultations

which are after the initial individual consultation. This for-

12


July 2009

mat has been found to be the most useful and will be ex-

amined as a pilot study for future research.

All patients are given a number of booklets relating to

healthy sleep habits (including sleep hygiene), relaxa-

tion, reducing anxiety and worry, monitoring sleep and the

strategies involved in changing behaviours, and increas-

ing awareness about unhelpful thoughts linked with poor

sleep. Patients are expected to complete sleep diaries and

sleep homework scheduling.

The Woolcock Clinic is considered unique because there

are a number of specialists covering a number of medical

areas, all in the one building, which enables the doctors to

treat a range of conditions comprehensively without the

patient having to travel to see various specialists.

Many of the Woolcock doctors are leading edge research-

ers. A range of diagnostic services including overnight

sleep studies, comprehensive respiratory, stress and pul-

monary tests, ECG and EEG tests and a number of at

home portable diagnostics for measuring sleep patterns

are available.

Patients can make appointments for the following special-

ty areas:

Sleep specialists for the treatment of sleep disorders •such as sleep apnea, Restless Legs Syndrome, insom-

nia;

Respiratory physicians for the treatment of diseases •such as asthma, COPD, emphysema and allergies

Ear, Nose and Throat surgeon•Psychiatrist•Endocrinologist and andrologist for the testosterone •deficiency, male infertility and internal referrals diabe-

tes mellitus and metabolic disorders.

Delwyn Bartlett PhD MAPS

Co-ordinator Medical Psychology; Sleep & Circadian Re-

search Group

The Woolcock Clinic,

431 Glebe Point Road, Glebe

Ph: 9114 0000

PRACTICE MANAGEMENT

Provider percentile charts available

on Medicare Australia website

Medicare Australia has launched a

website that enables GPs to com-

pare their billing data with their

peers. The provider percentile charts show the number of

services billed by peer groups for selected MBS items. GPs

can obtain information on their own billing from their prac-

tice management software or by requesting a rendered

items report from Medicare Australia. Find out more here

http://www.medicare.gov.au/about/stats/provider-per-

centile-charts.jsp#N1008F

AGPAL/QIP ACCREDITATION

Earn RACGP QA&CPD points

GPs can now earn RACGP QA&CPD points for participating

in accreditation. However practices must ensure that their

GP(s) have recorded their QA&CPD number(s) in Accredi-

tionPro prior to their accreditation visit.

Medicare and You - enhancing your learning journey

Medicare Australia has recently launched its latest online

eLearning initiative, Medicare and You.

Medicare and You is a series of interactive eLearning mod-

ules and covers topics you need to know when you begin

Medicare billing.

They have designed this new educational tool to help you

better understand the Medicare program and your obliga-

tions when working with the MBS.

Successfully piloted since July, Medicare and You is aimed

at new health professionals, as well as anyone who may

want a refresher.

QIP/AGPAL: ONLINE EDUCATION COMING SOON

QIP/AGPAL has partnered with “ThinkGP”, Australia’s

leading provider of online education solutions for health

care professionals including general practice teams. The

partnership will result in a series of six by one hour online

educational modules on quality improvement and accredi-

tation.

The topics that will be covered are:

quality improvement and accreditation•sterilisation, •infection control, •health information management, •

For more information contact:Jerry Bacichp. 8752 4907 e. [email protected]

13


July 2009

For more information contact:Helene Walshp. 8752 4906 e. [email protected]

practice management, and •practice services.•

For more information visit the ThinkGP website.

Face Masks P2 (N95 equivalent) in stock and ready for

immediate delivery

The US Centre for Disease Control (CDC) recommends N95

NIOSH approved masks to prevent the spread of swine flu.

The P2 mask is the Australian Standards equivalent of the

US N95. Easidirect provide immediate dispatch on respi-

rators via Australian Air Express (AAE). Stock is available

from various locations. Please call CSGPN for further infor-

mation on 9799 0933.

Certificate III in Business Administration

(Ideal for healthcare staff involved in office reception of admin-

istrative tasks)

This workplace program is assed within the workplace, en-

suring that new skills are directly applied to the context of

the practice. Assessors are representatives from the AMA

(NSW).

Traineeships may provide financial funding for eligible em-

ployers and employees gain a nationally accredited quali-

fication. Commonwealth Incentives of up to $4,000 (sub-

ject to eligibility) may be available in NSW. Please contact

Helene for further information.

Medicare health checks reveal hidden suffering

Jim Simpson, NSW Council for Intellectual Disability

GPs around Australia are reporting very positive results

from using the annual health assessments of people with

intellectual disability that are now covered by Medicare.

From July 2007 to December 2008 there were 8,700 peo-

ple with intellectual disability assessed.

Hobart GP Nick Cooling reports often finding up to three

previously untreated conditions when doing the assess-

ment. These include reflux, tooth decay, skin cancers, side

effects from medication interactions, excess ear wax and

various visual problems. Dr Cooling suspects that the as-

sessments will be of greatest use for detecting the less

acute conditions which may have long term consequences

if not treated early.

Dr Bob Davis is Director of the Centre for Developmental

Disability Health in Melbourne. He also works in a general

practice. Even with his expertise in intellectual disability,

Dr Davis is finding that the new assessments are helping

him to pick up important health problems. For example, he

recently found that a patient had an inflamed oesophagus

– the assessment had revealed that the patient often wakes

up quite distressed and then settles with a glass of milk.

An Adelaide woman who was thought to be “uncoopera-

tive” was found to have significant hearing loss. She now

has hearing aids and her first word after they were fitted

was “Birdies!” – it was a long time since she had heard

birds cheeping.

A Canberra woman was found to have a serious malignant

cancer which is now being treated.

It is a promising start that 8,700 assessments occurred in

the first 18 months. However that is only a small propor-

tion of the population of people with intellectual disabil-

ity. Hopefully, the take-up on the assessments will steadily

grow as word spreads about the practical benefits they are

bringing.

GPs can claim on item 718 for an assessment in their

practice ($208.70) and item 719 ($232.15) if the assess-

ment needs to be done at the patient’s home. Someone

who knows the patient well should attend the appointment

to help provide the information the doctor needs.

They should bring the person’s medical records and cur-

rent medications.

In NSW, the Department of Ageing, Disability and Home

Care requires supported accommodation services to en-

sure that each resident has an annual health assessment.

The Department provides the Comprehensive Health As-

sessment Program (CHAP) tool to be used in the Medicare

assessment. The CHAP has a section to be completed by

the person, family and support worker to give the doctor

information about the person’s health situation. The CHAP

is also used by the disability departments in Victoria,

Queensland and Western Australia.

For further information phone NSW Council for Intellectual

Disability on 6296 4400 or email [email protected]

14


July 2009

CONCORD NEUROLOGISTDr PENNY SPRING (MBBS Hons 1, FRACP, PhD)

Has recently returned from leave to:

Suite 100, Ground Floor

Concord Hospital Medical Centre

Hospital Rd, Concord 2139

Ph: 9767 8380 for appointments

All general neurology referrals including migraine

Special interests - peripheral nerve and muscle

disorders, burning feet & restless legs syndrome.

Do you have an interest in Mental Health?

Northside West Clinic in Wentworthville is part of The Northside Group, owned by Ramsay Health Care, Australia’s premier provider of private mental health services.

We are looking for a doctor to join our ECT

(Electroconvulsive Therapy) treatment team, led by Dr

Bill Lyndon, Consultant Psychiatrist, Director of ECT Services, The Northside Group; and Clinical Lecturer

in Dept of Psychological Medicine University of

Sydney.

We have a vacancy on Wednesdays with option of holiday relief cover.

You will participate in an ECT training course, run by Dr Lyndon, which is offered to psychiatrists from all over Australia and New Zealand. You will also have access to ongoing support and consultation.

Attractive remuneration offered.

For further enquiries, please contact Di Hollings, ECT Coordinator on 02 9433 3555 or email [email protected].

www.northsidegroup.com.au

Dr Brindha Shivalingam

Neurosurgeon

MBBS (Syd), FRACS Provider No : 214282CB Practice address : RPAH Medical Centre Suite 208 100 Carillon Avenue Newtown 2042. Phone : 02 9519 4214 Fax : 02 9519 4302 Email : contact@brain‐surgeon.com.au Webste : www.brain‐surgeon.com.au

Hospital Appointments Royal Prince Alfred Hospital Camperdown

Prince Of Wales Private Hospital Randwick

The Mater North Sydney

A physician is obligated to consider more than a

diseased organ, more even than the whole man

– he must view this man in his world

Rene J Dubois

CENTRAL VIEWPOINTUPCOMING SUBMISSION DEADLINES:

August Edition - Monday 6 July 2009September Edition - Monday 3 August 2009October Edition - Monday 7 September 2009November Edition - Monday 5 October 2009December/January Edition - Monday 2 November 2009

15


July 2009

Doctor:Full Time / Part Time

Flexible hours for friendly, accredited group practice in Ashfield. Excellent facilities. Great Conditions.

Phone: 9798 6999Multicare Family Medical Centre

Strathfield, Sydney

VR GP required to join established, busy family friendly practice

in Strathfield. Mentorships available with support from FRACGP

GPs, mentoring since 1992. AGPAL accredited, well-equipped and

fully computerised surgery with good support from reception staff,

experienced colleagues, pathology sister, psychologist, podiatrist and

audiologist. Located next to Strathfield station (parking provided) and

within walking distance to Sydney’s top private, Catholic and selective

schools. No Sunday work or house calls are required. For more

information contact:

Tracy Alexakis 0418 865 013 or email [email protected]

Dr Brian Harrisberg MB BCh FRACS FRANZCO

• Cataract Surgery • Refractive Surgery• Diabetic Eye Disease • General Ophthalmology

Dr Gayatri Banerjee MB BS (Hons) UNSW FRCOphth (London) FRANZCO

• Medical Retina • Uveitis• Diabetic Eye Disease • General Ophthalmology

Dr Valerie Saw MBBS (Hons) PhD (Lond) FRANZCO

• Corneal Surgery • Cataract Surgery• External Eye Disease • General Ophthalmology

Suite 1155 Missenden Road

Newtown

Ph: 9519 3882

Fax: 9550 2839

[email protected]

www.centralsydneyeye.com.au

DISCLAIMER: The views expressed in this newsletter are those of the contributor and do not necessarily reflect those of the Directors or Staff. All

advertisements including employment related articles are paid for. Enquiries can be made by contacting CSGPN.

CSGPN CPD EVENTS JULY ‘09Wed 1 Practice Nurse Event: Legal and Professional issuesVenue: CSGPN, ASHFIELD @ 7:00 pm Thu 2 Personal Protective Equipment workshopVenue: CSGPN, ASHFIELD @ 6:30 pmMon 6 Personal Protective Equipment workshopVenue: CSGPN, ASHFIELD @ 6:30 pmTue 7 Personal Protective Equipment workshopVenue: CSGPN, ASHFIELD @ 6:30 pmWed 8 CPD Large Group Event: DiabetesVenue: Burwood Function Centre, BURWOOD @ 6:30pmThu 9 Personal Protective Equipment workshopVenue: CSGPN, ASHFIELD @ 6:30 pmTue 14 ALM: EPC Health Assessments ALM IVenue: CSGPN, ASHFIELD @ 6:30 pmMon 20 CPD Small Group Event: LymphoedemaVenue: CSGPN, ASHFIELD @ 7:00 pmTue 21 ALM: EPC Health Assessments ALM IIVenue: CSGPN, ASHFIELD @ 6:30 pmThu 23 Practice Staff Event: LabTests OnlineVenue: CSGPN, ASHFIELD @ 6:30 pmThu 30 Practice Staff: Cert III in Business admin Presentation Venue: CSGPN, ASHFIELD @ 6:30 pm

To RSVP or for more information on our events, contact: Frank on 9799 0933, or email [email protected]


July 2009

SHE SEES AN AUSTRALIA THAT TAKES HEALTH FOR GRANTED.SHE LIVES IN AN AUSTRALIA THAT CAN’T.

At birth, she risked a mortality rate 300% higher than for most Australians.

As she grows, her risk of being hospitalised for preventable conditions will be

500% higher, her risk of being hospitalised for care involving dialysis will be

1,400% higher, her risk of falling victim to endocrine, nutritional and metabolic

diseases, including diabetes, will be 300% higher and as an adult, she will be

200% more likely to suffer very high levels of psychological stress.

Finally, statistics say, she will die... fifteen years earlier than most Australians.

To make her future even less certain, the remote NT community where

she lives... has no access to a GP.

If you’re a GP who can help close the gap, you’re needed.

For a comprehensive information pack about current positions in the NT and

the pro-active support you can expect from General Practice Network NT

contact Dani Eveleigh Ph (08) 89821007

or email [email protected]

TO CLOSE THE GAP... FIRST FILL THE GAPS WHERE GPs DON’T EXIST

GPNNTAUST1

Central Viewpoint : July 2009

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