Osborne Park Hospital (OPH)

GP Newsletter

May 2015 October 2018

Contact for advice: For queries regarding Osborne Park Hospital please call 9346 8000. Contact OPH Liaison GP Dr Clare Matthews on email: clare.matthews@health.wa.gov.au

Welcome to the 2018 edition of the Osborne Park Hospital (OPH) Newsletter.

In this edition I have included an update on the Aged Care Service at OPH and the new National Cervical Screening Test.

We are especially excited to offer you an informative GP Education Day which will be held at the University Club on 10 November 2018. Please see page 2 for information and sign up soon as numbers are limited.

Also included in this edition is a clinical article highlighting the difference between rectocele and rectal prolapse, as the referral pathway for each differs considerably.

If you have any feedback on these articles or would like to suggest topics or information for future editions, please contact me via email: clare.matthews@health.wa.gov.au

Dr Clare Matthews, OPH Liaison GP

In this edition: Geriatrician Residential

Outreach GP Education Event Aged Care Service Update Rectocele Versus Rectal

Prolapse Cervical Screening Update

Geriatrician Residential Outreach (GRO) Geriatricians, Dr Brendan Foo and Dr Chermaine Chua, from Osborne Park Hospital are now able to visit patients in their residential aged care facility (RACF). This service commenced as a pilot project towards the end of 2017 and has been well received. Eight RACFs are currently included, but referrals are welcomed from any facility in the OPH catchment area, with plans to formally expand the service to the whole catchment by the end of the year. Current wait time is 1-2 weeks. A GP referral is required, please send the referral to OPH Aged Care Service via Fax: (08) 9346 8313. Patients will have a comprehensive geriatric assessment and management plan formulated, in their own residential care facility, decreasing their need to attend hospital.

Please see over

Inclusion criteria

Age > 65yr.

Resident of aged care facility within OPH catchment area.

Common issues which can be addressed:

falls

cognitive/ behavioural changes

medication/ polypharmacy review

recurring hospital presentations

optimise medical management

any other aged-care specific queries.

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Aged Care Service

Update Parkinson’s Clinic

OPH offers a high quality multi-disciplinary clinic for patients either with a pre-existing diagnosis of Parkinson’s or with symptoms suggestive of Parkinson’s.

The benefits of a multi-disciplinary team allow the patient to receive OT/speech therapy and physiotherapy with the availability of social work advice as needed.

The experienced team in this clinic is able to arrange for advanced Parkinson’s treatment such as Parkinson’s monitoring systems and Device Assisted Therapy such as continuous treatment pumps (Apo morphine or Duodopa) and deep brain stimulation.

To aid your patient’s journey, please forward a copy of all investigations (including all scans) with your referral. Copies of past neurology letters ARE ESSENTIAL in patient assessment, so please attach copies to your referral.

ACAT referrals

From 1 July 2018 all ACAT referrals are to be sent from GPs through the My

Aged Care site.

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Exclusions | Unable to respond to acute medical deterioration warranting emergent hospital admission or rapid response time.

Referrals | Please send referrals by post or fax to: Dr Chermaine Chua or Dr Brendan Foo Fax: (08) 9346 8313 Rehabilitation and Aged Care Service Osborne Park Hospital, Osborne Place, Stirling 6021.

Dr Chua and Dr Foo can be contacted via OPH switchboard, Ph: 9346 8000 during office hours to discuss referrals.

The tulip is the worldwide symbol for Parkinson’s. * See note on page 3.

An ACAT referral can be made:

1. Online with the e_referral form. https://www.myagedcare.gov.au/referral-form

2. By phone 1800 200 422 (The client can call this number and make their own referral) 3. Fax to 1800 728 174 on the My Aged Care Community Health Professional and GP referral Form-Fax https://agedcare.health.gov.au/community-health-professional-and-gp-fax-referral-form

Rectocele versus Rectal Prolapse

We understand there may be some confusion among some GPs about the difference between rectocele and rectal prolapse. The Gynaecology Clinic at OPH has received a fair number of inappropriate referrals for rectal prolapse.

Rectocele (anterior protrusion of the rectum into the vagina)

The risk factors for pelvic organ prolapse e.g. vaginal childbirth, advancing age, and increasing body mass index, also chronically elevated intra-abdominal pressure and collagen vascular disease.

Symptoms include abdominal muscle splinting, pelvic pressure, constipation, sexual dysfunction, faecal incontinence, and defecatory dysfunction. Of note, increasing severity of prolapse does not necessarily correlate with increased symptomatology. Prolapse-related symptoms may increase when the prolapse extends beyond the hymenal ring

The diagnosis of posterior wall defects is clinical and based on physical examination findings of a posterior vaginal bulge with straining and palpation of breaks in the rectovaginal fascia on rectovaginal examination.

Management

Asymptomatic prolapse does not require treatment. For women whose primary complaint is constipation, dietary modifications, including increased

fluid intake, fibre, and laxatives, are first line. Pelvic floor muscle exercises. Pessary - two main categories of pessaries: supportive/ space-occupying. Surgery - transvaginal rectocele repair- refer to Gynaecology.

Rectal Prolapse (prolapse of rectal tissue out of anus)

Rectal prolapse is a pelvic floor disorder that typically occurs in older adult women but can occur in men and women of all ages. A complete rectal prolapse is the protrusion of all layers of the rectum through the anus, manifesting as concentric rings of rectal mucosa.

Rectal prolapse results in local symptoms (e.g. pain, bleeding, and seepage), bowel dysfunction (e.g. constipation, incontinence), and a diminished quality of life.

Pain is not a typical presenting feature and suggests another diagnosis.

Differential diagnosis — A true rectal prolapse must be differentiated from:

●Prolapsed internal haemorrhoids Grade IV haemorrhoids are prolapsed and cannot be reduced. The clinical features that distinguish rectal procidentia from prolapsed internal haemorrhoids include the presence of circumferential rings of mucosa ‘stacked coins’ and a full-thickness protrusion with rectal prolapse. Prolapsing haemorrhoids result in linear folds.

Management

Treatment of constipation. Pelvic floor muscle exercises. Surgical repair – refer to General Surgery.

Reference:

Up to date https://www.uptodate.com/login

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Osborne Park Hospital GP Newsletter October 2018

From page 2

* The Tulip is a symbol adopted by the Parkinson’s community. The three petals represent the mission of hope through research, education and advocacy. Artwork by Erin Vito, OPH OT

Cervical Screening Test Update

The Gynaecology Clinic has been receiving a substantial increase in referrals for colposcopy since the advent of the new Cervical Screening Test (CST).

It is important to remember that for purely screening specimens (i.e. asymptomatic), if HPV not 16/18 is found and the co-test is either negative or showing a low grade abnormality, the appropriate care is a repeat CST in 12 months and a colposcopy is NOT indicated.

The renewed National Cervical Screening Program (NCSP) is predicted to be both cost saving and life–years saving. Predicted reductions of 31-36% in cervical cancer incidence and mortality in unvaccinated cohorts, and reductions of 24–29% in cohorts offered vaccination.

This is equivalent to 265 fewer cancer cases and 82 fewer deaths annually in unvaccinated cohorts, and 85 fewer cancer cases and 28 fewer deaths annually in cohorts offered vaccination.

October 2018

This document can be made available in alternative formats on request for a person with a disability.

© Sir Charles Gairdner Osborne Park Health Care Group - October 2018.