Topics

People with existing mental health problems or living in difficult circumstances may be at particular risk

The short and longer term adverse effects of the coronavirus disease 2019 (COVID‐19) pandemic and its economic consequences on the mental health of individuals and communities are under intense scrutiny.1,2 Governments and scientists are anxious about the adequacy of mental health services and the possibility of increased suicide rates.3,4

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1 Orygen, Melbourne, VIC
2 Centre for Youth Mental Health, the University of Melbourne, Melbourne, VIC
3 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
4 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

Correspondence: h.herrman@unimelb.edu.au

Competing interests:

No relevant disclosures.

1. United Nations COVID‐19 and the need for action on mental health [policy brief]. May 2020. https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf (viewed Apr 2021).
2. Pfefferbaum B, North CS. Mental health and the Covid‐19 pandemic. N Engl J Med 2020; 383: 510–512.
3. Atkinson JA, Skinner A, Lawson K, et al; Brain and Mind Centre, University of Sydney. Road to recovery: restoring Australia’s mental wealth. 27 July 2020 https://www.sydney.edu.au/content/dam/corporate/documents/brain-and-mind-centre/youthe/road-to-recovery-v2.pdf (viewed Mar 2021).
4. Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID‐19 pandemic in Japan. Nat Hum Behav 2021; 5: 229–238.
5. Prati G, Mancini AD. The psychological impact of COVID‐19 pandemic lockdowns: a review and meta‐analysis of longitudinal studies and natural experiments. Psychol Med 2021; 51: 201–211.
6. Robinson E, Sutin AR, Daly M, Jones A. A systematic review and meta‐analysis of longitudinal cohort studies comparing mental health before versus during the COVID‐19 pandemic [preprint]. medRxiv 8 Mar 2021; https://doi.org/10.1101/2021.03.04.21252921 (viewed Mar 2021).
7. Beyond Blue. Bushfires and mental health [web page]. 2020. https://www.beyondblue.org.au/the-facts/bushfires-and-mental-health (viewed Mar 2021).
8. Batterham PJ, Calear AL, McCallum SM, et al. Trajectories of depression and anxiety symptoms during the COVID‐19 pandemic in a representative Australian adult cohort. Med J Aust 2021; 214: 462–468.
9. Daly M, Sutin AR, Robinson E. Longitudinal changes in mental health and the COVID‐19 pandemic: evidence from the UK Household Longitudinal Study. Psychol Med 2020; 13: 1–10.
10. Pan KY, Kok AAL, Eikelenboom M, et al. The mental health impact of the COVID‐19 pandemic on people with and without depressive, anxiety, or obsessive‐compulsive disorders: a longitudinal study of three Dutch case–control cohorts. Lancet Psychiatry 2021; 8: 121–129.
11. Patel V, Burns JK, Dhingra M, et al. Income inequality and depression: a systematic review and meta‐analysis of the association and a scoping review of mechanisms. World Psychiatry 2018; 17: 76–89.
12. Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health Soc Care Community 2017; 25: 799–812.
13. Herrman H, Stewart DE, Diaz‐Granados N, et al. What is resilience? Can J Psychiatry 2011; 56: 258–265.
14. Australian Department of Health. What we’re doing about suicide prevention. Updated 19 Apr 2021. https://www.health.gov.au/health-topics/mental-health-and-suicide-prevention/what-were-doing-about-suicide-prevention#strategies-and-plans (viewed Apr 2021).
15. Leucht S, Cipriani A, Furukawa TA, et al. A living meta‐ecological study of the consequences of the COVID‐19 pandemic on mental health. Eur Arch Psychiatry Clin Neurosci 2021; 271: 219–221.
16. Novins DK, Stoddard J, Althoff RR, et al. Research priorities in child and adolescent mental health emerging from the COVID‐19 pandemic. J Am Acad Child Adolesc Psychiatry 2021; 17: S0890–8567(21)00153–2 [online ahead of print.].

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Perspectives

Improving recruitment to clinical trials for regional and rural cancer patients through a regionally based clinical trials network

Arun Muthusamy, Donna Long and Craig R Underhill

Med J Aust 2021; 214 (10): . || doi: 10.5694/mja2.51078
Published online: 7 June 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Neoplasms

Health services administration

Social determinants of health

A new clinical trials network aims to bridge the gap in cancer outcomes between rural and metropolitan cancer patients in Victoria

In general, regional and rural patients have poorer cancer outcomes compared with their city counterparts.1 Although one‐third of the Australian population live in rural and regional areas, there is ongoing inequity in access to care among regional Australians.2 Over the decade to 2010, the disparity in cancer outcomes between rural and urban patients remained unchanged with 7% excess mortality (equating to about 9000 additional rural deaths).3,4 Until recently, clinical trials were almost exclusively conducted in metropolitan health institutions. Although a gateway to new treatments that can result in improved survival, clinical trials may be out of reach for many regional and rural cancer patients owing to distance.2,5,6,7,8,9,10 In 2016, the rate of cancer trial participation was 6.7% in metropolitan Melbourne, but only 1.2% in regional Victoria.4 In that year, a total of 443 patients from regional Victoria accessed clinical cancer trials, but 343 of those regional patients travelled to Melbourne to access a trial.4 We postulate that low rates of trial participation may be a contributing factor to lower cancer 5‐year survival in regional Victoria (66% compared with 70% in metropolitan Melbourne).4

1 Border Medical Oncology, Albury, NSW
2 Regional Trials Network Victoria, Albury, NSW
3 Rural Clinical School, UNSW, Albury, NSW

Correspondence: craig.underhill@bordermedonc.com.au

Acknowledgements:

The authors and the RTNV thank the Victorian Cancer Council and Victorian Cancer Agency for funding this project. The funding sources played no part in the planning, writing or publication of the work. We also acknowledge and thank colleagues from the RTNV sites, Cancer Trials Australia and others who contributed to this project, VCCC colleagues for collaboration on the teletrials component, and the patients and their carers who gave their consent to enrol in a clinical trial.

Competing interests:

Donna Long is employed under the grant from the funders acknowledged above.

1. Crawford‐Williams F, Goodwin B, March S, et al. Cancer care in regional Australia from the health professional’s perspective. Support Care Cancer 2018; 26: 3507–3515.
2. Coory MD, Ho T, Jordan SJ. Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains. Med J Aust 2013; 199: 605–618. https://www.mja.com.au/journal/2013/199/9/australia-continuing-make-progress-against-cancer-regional-and-remote
3. Banks P, Matheson LM, Morrissy K, et al. Characteristics of cancer diagnoses and staging in South Western Victoria: a rural perspective. Aust J Rural Health 2014; 22: 257–263.
4. Cancer in Victoria: Statistics & Trends 2018. Victorian Cancer Registry. Cancer Council Victoria, Melbourne, Nov 2019. https://www.cancervic.org.au/downloads/cec/cancer-in-vic/Cancer-in-Victoria-2018.pdf (viewed Oct 2020).
5. Chow CJ, Habermann EB, Abraham A, et al. Does enrollment in cancer trials improve survival? J Am Coll Surg 2013; 216: 774–780.
6. Sabesan S, Burgher B, Buettner P, et al. Attitudes, knowledge and barriers to participation in cancer clinical trials among rural and remote patients. Asia Pac J Clin Oncol 2011; 7: 27–33.
7. Donnelly CB, Wotherspoon AC, Morris M, et al. A population‐level investigation of cancer clinical trials participation in a UK region. Eur J Cancer Prev 2017; 26: S229–S235.
8. Emery JD, Gray V, Walter FM, et al. The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster‐randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol. BMJ Open 2014; 4: e006156.
9. Queensland Health. An analysis of health and medical research conducted in Queensland public hospitals (January 2011 to December 2016). Brisbane: State of Queensland (Queensland Health), 2017. https://www.health.qld.gov.au/__data/assets/pdf_file/0026/667322/analysis-of-queensland-health-medical-research-2011-2016-June2017.pdf (viewed Oct 2020).
10. Sabesan S, Zalcberg J. Telehealth models could be extended to conducting clinical trials‐a teletrial approach. Eur J Cancer Care 2018; 27: e12587.
11. Cancer Trials Australia. CTA announces partnership in delivering coordinated Electronic Document Management for Victorian study sites. 22 Nov 2018. https://www.cancertrialsaustralia.com/2018/11/22/edm/ (viewed Oct 2020).
12. Velos. Velos partners with Cancer Trials Australia for largest international deployment of Velos eResearch. 16 Feb 2012. https://velos.com/velos-partners-cancer-trials-australia-largest-international-deployment-velos-eresearch-20120216 (viewed Oct 2020).
13. Clinical Oncology Society of Australia. Australasian Tele‐Trial Model: access to clinical trials closer to home using tele‐health. Sydney: COSA, 2016. https://www.cosa.org.au/media/332325/cosa-teletrial-model-final-19sep16.pdf (viewed Oct 2020).
14. Cross H, Collins IM, Woollett A, et al. Implementation of an investigator initiated teletrial. Asia Pac J Clin Oncol 2018; 14: 171–172.
15. Victorian Comprehensive Cancer Centre. Teletrials. Resources. https://www.viccompcancerctr.org/what-we-do/clinical-trials-expansion/teletrials/resources/ (viewed Oct 2020).

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Perspectives

Artificial intelligence and medical imaging: applications, challenges and solutions

Meng Law, Jarrel Seah and George Shih

Med J Aust 2021; 214 (10): . || doi: 10.5694/mja2.51077
Published online: 7 June 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Information science

AI‐based tools can help with image acquisition, reconstruction and quality; interpretation, diagnosis and decision support; and manual tasks

Artificial intelligence (AI) is having a disruptive impact in many areas, including health care. In medicine, machine learning (ML) techniques have existed for decades but were mostly not adopted. New deep learning techniques, along with copious medical imaging and digital health data, now provide standardised, reproducible, dependable and accurate diagnostic reports. These can only improve patient care and safety, enhancing the practice of clinical medicine. However, a number of challenges have arisen, hindering progress and more widespread application. In this article, we describe current AI/ML tools in medical imaging, discuss the major challenges facing the field, and offer some potential solutions.

1 Alfred Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Alfred Hospital, Melbourne, VIC
4 Weill Cornell Medicine, New York, NY, USA

Correspondence: meng.law@alfred.org.au

Competing interests:

No relevant disclosures.

1. Elshafeey N, Kotrotsou A, Hassan A, et al. Multicenter study demonstrates radiomic features derived from magnetic resonance perfusion images identify pseudoprogression in glioblastoma. Nat Commun 2019; 10: 3170.
2. Pesapane F, Codari M, Sardanelli F. Artificial intelligence in medical imaging: threat or opportunity? Radiologists again at the forefront of innovation in medicine. Eur Radiol Exp 2018; 2: 35.
3. Kim H, Irimia A, Hobel SM, et al. The LONI QC system: a semi‐automated, web‐based and freely‐available environment for the comprehensive quality control of neuroimaging data. Front Neuroinform 2019; 13: 60.
4. Duffy BA, Zhang W, Tang H, et al. Retrospective correction of motion artifact affected structural MRI images using deep learning of simulated motion. Proceedings of 1st Conference on Medical Imaging with Deep Learning; 4‐6 July 2018; Amsterdam. https://openreview.net/pdf?id=H1hWfZnjM (viewed Apr 2021).
5. Hwang TJ, Kesselheim AS, Vokinger KN. Lifecycle regulation of artificial intelligence‐ and machine learning‐based software devices in medicine. JAMA 2019; 322: 2285–2286.
6. US Food and Drug Administration. Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD) Action Plan. January 2021. Silver Spring, MD: FDA. 2021. https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-software-medical-device (viewed Apr 2021).
7. Shih G, Wu CC, Halabi SS, et al. Augmenting the National Institutes of Health Chest Radiograph Dataset with expert annotations of possible pneumonia. Radiol Artif Intell 2019; 1: https://doi.org/10.1148/ryai.2019180041.
8. Chervenak AL, Van Erp TGM, Kesselman C, et al. A system architecture for sharing de‐identified, research‐ready brain scans and health information across clinical imaging centers. Stud Health Technol Inform 2012; 175: 19–28.
9. Prevedello LM, Halabi SS, Shih G, et al. Challenges related to artificial intelligence research in medical imaging and the importance of image analysis competitions. Radiol Artif Intell 2019; 1: https://doi.org/10.1148/ryai.2019180031.
10. Filice R, Stein A, Wu C, et al. Crowdsourcing pneumothorax annotations using machine learning annotations on the NIH chest x‐ray dataset. J Digit Imaging 2020; 33: 490–496.
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12. Xing Y, Ge Z, Zeng R, et al. Adversarial pulmonary pathology translation for pairwise chest x‐ray data augmentation. In: Shen D, Liu T, Peters TM, et al, editors. Proceedings of 22nd International Conference on Medical Image Computing and Computer‐Assisted Intervention 2019. Lecture Notes in Computer Science, Vol. 11769. Cham, Switzerland: Springer, 2019.

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Position statement

National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia

Garry LR Jennings, Ralph Audehm, Warrick Bishop, Clara K Chow, Siaw-Teng Liaw, Danny Liew and Sara M Linton

Med J Aust 2021; 214 (9): . || doi: 10.5694/mja2.51039
Published online: 17 May 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

General medicine

Diagnostic techniques and procedures

Abstract

Introduction: This position statement considers the evolving evidence on the use of coronary artery calcium scoring (CAC) for defining cardiovascular risk in the context of Australian practice and provides advice to health professionals regarding the use of CAC scoring in primary prevention of cardiovascular disease in Australia.

Main recommendations:

CAC scoring could be considered for selected people with moderate absolute cardiovascular risk, as assessed by the National Vascular Disease Prevention Alliance (NVDPA) absolute cardiovascular risk algorithm, and for whom the findings are likely to influence the intensity of risk management. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.)
CAC scoring could be considered for selected people with low absolute cardiovascular risk, as assessed by the NVDPA absolute cardiovascular risk algorithm, and who have additional risk-enhancing factors that may result in the underestimation of risk. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.)
If CAC scoring is undertaken, a CAC score of 0 AU could reclassify a person to a low absolute cardiovascular risk status, with subsequent management to be informed by patient–clinician discussion and follow contemporary recommendations for low absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.)
If CAC scoring is undertaken, a CAC score > 99 AU or ≥ 75th percentile for age and sex could reclassify a person to a high absolute cardiovascular risk status, with subsequent management to be informed by patient–clinician discussion and follow contemporary recommendations for high absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.)

Changes in management as a result of this statement: CAC scoring can have a role in reclassification of absolute cardiovascular risk for selected patients in Australia, in conjunction with traditional absolute risk assessment and as part of a shared decision‐making approach that considers the preferences and values of individual patients.

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1 University of Sydney, Sydney, NSW
2 National Heart Foundation of Australia, Melbourne, VIC
3 General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC
4 Calvary Health Care Tasmania Lenah Valley Campus, Hobart, TAS
5 Westmead Hospital, Sydney, NSW
6 UNSW Sydney, Sydney, NSW
7 Ingham Institute of Applied Medical Research, Sydney, NSW
8 Monash University, Melbourne, VIC
9 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: garry.jennings@sydney.edu.au

Acknowledgements:

Funding and coordination were provided by the National Heart Foundation of Australia. Expert reference group members contributed to the technical content on an advisory basis. The position statement manuscript and GRADE evidence appraisal were prepared by the National Heart Foundation of Australia.

Competing interests:

Warrick Bishop receives consultancy fees to report on coronary artery calcium scoring test results, and has written a book on the subject. He is paid membership fees for his website, which provides information about heart attack prevention. Clara Chow receives consultancy fees to report on coronary artery calcium scoring test results. Danny Liew receives honoraria to conduct cost‐effective analyses for pharmaceutical companies.

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Editorials

Lessons from the United Kingdom’s COVID‐19 vaccination strategy

Anthony Harnden and Andrew Earnshaw

Med J Aust 2021; 214 (9): . || doi: 10.5694/mja2.51042
Published online: 17 May 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

The predominantly age‐based structure of the British vaccination program has enabled a rapid delivery with high vaccine uptake

The United Kingdom has been profoundly affected by the coronavirus disease 2019 (COVID‐19) pandemic. In our population of over 66 million, to date we have had over 4.3 million confirmed infections with over 127 000 deaths (10 April 2021).1 Vaccination has provided an opportunity to limit the impact of COVID‐19 on our population and hopefully reduce the risk of significant mortality in any third wave.

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1 University of Oxford, Oxford, UK
2 United Kingdom Joint Committee on Vaccination and Immunisation, National Immunization Technical Advisory Groups, London, UK

Correspondence: anthony.harnden@phc.ox.ac.uk

Competing interests:

Anthony Harnden is Deputy Chair and Andrew Earnshaw is Head of the UK Joint Committee on Vaccination and Immunisation.

1. Public Health England. Coronavirus (COVID-19) in the UK. https://coronavirus.data.gov.uk/ (viewed Mar 2021).
2. Department of Health and Social Care. Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 30 December 2020. https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020 (viewed Mar 2021).
3. Graham NSN, Junghans C, Downes R, et al. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect 2020; 81: 411–419.
4. Campos-Matos I, Mandal S. Annex A: COVID-19 vaccine and health inequalities: considerations for prioritisation and implementation [updated 6 Jan 2021]. https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020/annex-a-covid-19-vaccine-and-health-inequalities-considerations-for-prioritisation-and-implementation (viewed Mar 2021).
5. Medicines and Healthcare products Regulatory Agency. Regulatory approval of Pfizer/BioNTech vaccine for COVID-19. https://www.gov.uk/government/publications/regulatory-approval-of-pfizer-biontech-vaccine-for-covid-19 (viewed Mar 2021).
6. Voysey M, Costa Clemens SA, Madhi SA, et al. Oxford COVID Vaccine Trial Group. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials. Lancet 2021; 397: 881-891. Erratum in: Lancet 2021; 397: 880.
7. Public Health England. Annex A: report to JCVI on estimated efficacy of a single dose of Pfizer BioNTech (BNT162b2 mRNA) vaccine and of a single dose of ChAdOx1 vaccine (AZD1222). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/949505/annex-a-phe-report-to-jcvi-on-estimated-efficacy-of-single-vaccine-dose.pdf (viewed Mar 2021).
8. Department of Health and Social Care. Prioritising the first COVID-19 vaccine dose: JCVI statement. https://www.gov.uk/government/publications/prioritising-the-first-covid-19-vaccine-dose-jcvi-statement (viewed Mar 2021).
9. Department of Health and Social Care. Priority groups for phase 2 of the coronavirus (COVID-19) vaccination programme: advice from the JCVI. https://www.gov.uk/government/publications/priority-groups-for-phase-2-of-the-coronavirus-covid-19-vaccination-programme-advice-from-the-jcvi (viewed Mar 2021).
10. Public Health England. COVID-19: review of disparities in risks and outcomes. https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes (viewed Mar 2021).
11. NHS England. COVID-19 vaccinations. https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/ (viewed Mar 2021).
12. OpenSAFELY. NHS COVID-19 vaccine coverage. https://opensafely.org/research/2021/covid-vaccine-coverage/ (viewed Mar 2021).
13. Lopez Bernal J, Andrews N, Gower C, et al. Early effectiveness of COVID-19 vaccination with BNT162b2 mRNA vaccine and ChAdOx1 adenovirus vector vaccine on symptomatic disease, hospitalisations and mortality in older adults in England [preprint]. medRxiv 2021.03.01.21252652. 2 Mar 2021. https://doi.org/10.1101/2021.03.01.21252652 (viewed Mar 2021).
14. Public Health England. PHE monitoring of the effectiveness of COVID-19 vaccination. https://www.gov.uk/government/publications/phe-monitoring-of-the-effectiveness-of-covid-19-vaccination (viewed Mar 2021).
15. Greinacher A, Thiele T, Warkentin TE, et al. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021; https://doi.org/10.1056/NEJMoa2104840. [Epub ahead of print].
16. Department of Health and Social Care. Independent report: JCVI statement on use of the AstraZeneca COVID-19 vaccine: 7 April 2021. https://www.gov.uk/government/publications/use-of-the-astrazeneca-covid-19-vaccine-jcvi-statement/jcvi-statement-on-use-of-the-astrazeneca-covid-19-vaccine-7-april-2021 (viewed Apr 2021).
17. Australian Government, Department of Health. Joint statement on COVID-19 AstraZeneca vaccine advice from ATAGI. https://www.health.gov.au/news/joint-statement-on-covid-19-astrazeneca-vaccine-advice-from-atagi (viewed Apr 2021).

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Editorials

The challenges of managing both chronic pain and opioid use in general practice

Hester Wilson

Med J Aust 2021; 214 (9): . || doi: 10.5694/mja2.51041
Published online: 17 May 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Anesthesia, analgesia and pain

Substance-related disorders

The safety and value of reducing opioid use are recognised, but difficult conversations and less accessible alternatives are barriers

Chronic pain affects about 20% of adults in Australia and New Zealand,1,2 and opioids have been enthusiastically embraced for treating it. Unfortunately, this has led to significant harm,3,4,5 and evidence of the long term effectiveness of opioids for relieving chronic pain is limited.3,6

1 The Langton Centre, Sydney, NSW
2 University of New South Wales, Sydney, NSW
3 Alice St General Practice, Sydney, NSW

Correspondence: Hester.Wilson@health.nsw.gov.au

Competing interests:

I have no connections with the tobacco, alcohol or gaming industries. I have received funding for consultancies or for serving on expert advisory panels from Indivior, Lundbeck, Seqirus, Mundipharma, and Pfizer.

1. Australian Institute of Health and Welfare. Chronic pain in Australia (AIHW Cat. no. PHE 26). May 2020. https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx?inline=true (viewed Feb 2021).
2. New Zealand Ministry of Health. New Zealand Health Survey: annual data explorer 2019/20. Adults/topic: other health conditions. Nov 2020. https://minhealthnz.shinyapps.io/nz-health-survey-2019-20-annual-data-explorer/_w_15f47ab5/#!/explore-topics (viewed Feb 2021).
3. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med 2015; 162: 276–286.
4. Shipton EE, Shipton AJ, Williman JA, Shipton EA. Deaths from opioid overdosing: implications of coroners’ inquest reports 2008–2012 and annual rise in opioid prescription rates: a population-based cohort study. Pain Ther 2017; 6: 203–215.
5. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. (AIHW Cat. no. HSE 210). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true (viewed Feb 2021).
6. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the space randomized clinical trial. JAMA 2018; 319: 872–882.
7. Tardif H, Hayes C, Allingham SF. Opioid cessation is associated with reduced pain and improved function in people attending specialist chronic pain services. Med J Aust 2021; 214: 430–432.
8. Matthias MS, Johnson NL, Shields CG, et al. “I’m not gonna pull the rug out from under you”: patient-provider communication about opioid tapering. J Pain 2017; 18: 1365–1373.
9. Webster F, Rice K, Katz J, et al. An ethnography of chronic pain management in primary care: the social organization of physicians’ work in the midst of the opioid crisis. PLoS One 2019; 14: e0215148.
10. Matthias MS, Krebs EE, Collins LA, et al. “I’m not abusing or anything”: patient–physician communication about opioid treatment in chronic pain. Patient Educ Couns 2013; 93: 197–202.
11. Prathivadi P, Barton C, Mazza D. Qualitative insights into the opioid prescribing practices of Australian GP. Fam Pract 2020; 37: 412–417.
12. Dunn E. Breaking the pain barrier. Medical Observer [online], 1 June 2018. https://www.apsoc.org.au/PDF/Other_Pain_Resources/20180601_Medical_Observer_Breaking-Pain-Barrier_JUN18.pdf (viewed Mar 2021).
13. Australian Department of Health. Chronic disease management: allied health individual services. Updated 10 Apr 2014. https://www1.health.gov.au/internet/main/publishing.nsf/Content/Chronic+Disease+Allied+Health+Individual+Services (viewed Mar 2021).
14. Bennett C. The impact of pain on rural and regional Australia: problems and solutions [abstract]. National Rural Health Conference, Hobart, Tasmania, 24–27 March 2019. https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf (viewed Mar 2021).

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Perspectives

Introducing general practice enrolment in Australia: the devil is in the detail

Michael Wright and Roald Versteeg

Med J Aust 2021; 214 (9): . || doi: 10.5694/mja2.51027
Published online: 17 May 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Health services administration

Enrolment may strengthen the link between patients and their preferred primary care providers and needs to support flexible provision of high quality care

In the 2019–20 federal budget, $448 million was allocated to introduce a system of voluntary general practice enrolment for Indigenous people over 50 years of age and all Australians over 70 years of age from July 2020.1 Enrolment, also known as nomination or empanelment, allows patients to register with a specified general practitioner at their preferred general practice. At the end of June 2020, the federal government announced that the introduction of voluntary general practice enrolment would be delayed and that models to support universal enrolment would be explored as part of the development of a 10‐year primary health care plan.2 The exploration of population‐wide enrolment was prompted by Australia’s coronavirus disease 2019 (COVID‐19) response, most notably the introduction of Medicare‐funded telehealth (both telephone and video consultations) — a long‐advocated reform currently available until 30 June 2021. In this article, we outline Australian and international experience with enrolment and suggest ways for Australia to introduce a system that benefits patients, health system funders and providers of comprehensive holistic general practice care.

1 Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW
2 Royal Australian College of General Practitioners, Melbourne, VIC

Correspondence: michael.wright@chere.uts.edu.au

Competing interests:

Michael Wright chairs the Royal Australian College of General Practitioners (RACGP) Expert Committee on Funding and Health System Reform, chairs the Board of the Central and Eastern Sydney Primary Health Network, was a member of the Primary Health Care Advisory Group and has advisory roles with the Australian Institute of Health and Welfare. Roald Versteeg is employed by the RACGP.

1. Budget 2019–20. Budget Paper No. 2: Budget Measures 2019–20. Canberra: Commonwealth of Australia, 2019. https://budget.gov.au/2019-20/content/bp2/index.htm (viewed Apr 2021).
2. Australian Government Department of Health. Voluntary patient enrolment. Updated 18 March 2021. https://www1.health.gov.au/internet/main/publishing.nsf/Content/voluntary-patient-enrolment-for-older-australians (viewed Apr 2021).
3. Wright M, Hall J, van Gool K, et al. How common is multiple general practice attendance? Aust J Gen Pract 2018; 47: 289–296.
4. Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions. Canberra: Commonwealth of Australia, 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf (viewed Mar 2020).
5. Medicare Benefits Schedule Review Taskforce. Taskforce findings: General Practice and Primary Care Clinical Committee Report. Canberra: Commonwealth of Australia, 2020. https://www.health.gov.au/resources/publications/taskforce-findings-general-practice-and-primary-care-clinical-committee-report (viewed Apr 2021).
6. Australian Government Department of Health. Evaluation report of the Diabetes Care Project. Canberra: Commonwealth of Australia, 2015. https://www.health.gov.au/sites/default/files/documents/2019/09/evaluation-of-the-diabetes-care-project-evaluation-report-of-the-diabetes-care-project.pdf (viewed Apr 2021).
7. Australian Government Department of Health and Ageing. The national evaluation of the second round of Coordinated Care Trials: final report. Canberra: Commonwealth of Australia, 2007. https://apo.org.au/sites/default/files/resource-files/2008-04/apo-nid8664.pdf (viewed Apr 2021).
8. Kalucy L, Katterl R, Jackson‐Bowers E, et al. Models of patient enrolment (PHC RIS Policy Issue Review). Adelaide: Primary Health Care Research and Information Service, 2009. https://dspace2.flinders.edu.au/xmlui/bitstream/handle/2328/26593/PIR%20May%2009.pdf?sequence=1&isAllowed=y (viewed Mar 2021).
9. Taylor CJ, Wright M, Jackson CL, et al. Grass is greener? General practice in England and Australia. Br J Gen Pract 2016; 66: 428–429.
10. van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract 2010; 16: 947–956.
11. Pereira Gray DJ, Sidaway‐Lee K, White E, et al. Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8: e021161.
12. Adler R, Vasiliadis A, Bickell N. The relationship between continuity and patient satisfaction: a systematic review. Fam Pract 2010; 27: 171–178.
13. Hueston WJ. Does having a personal physician improve quality of care in diabetes? J Am Board Fam Med 2010; 23: 82–87.
14. Blewett LA, Johnson PJ, Lee B, et al. When a usual source of care and usual provider matter: adult prevention and screening services. J Gen Intern Med 2008; 23: 1354–1360.
15. Wetmore S, Boisvert L, Graham E, et al. Patient satisfaction with access and continuity of care in a multidisciplinary academic family medicine clinic. Can Fam Physician 2014; 60: e230–e236.
16. Cheng SH, Chen CC. Effects of continuity of care on medication duplication among the elderly. Med Care 2014; 52: 149–156.
17. Mainous AG 3rd, Koopman RJ, Gill JM, et al. Relationship between continuity of care and diabetes control: evidence from the third national health and nutrition examination survey. Am J Public Health 2004; 94: 66–70.
18. Wright M, Versteeg R, Hall J. General practice’s early response to the COVID‐19 pandemic. Aust Health Rev 2020; 44: 733–736.
19. Tiagi R, Chechulin Y. The effect of rostering with a patient enrolment model on emergency department utilization. Healthc Policy 2014; 9: 105–121.
20. Singh J, Dahrouge S, Green ME. The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada. BMC Fam Pract 2019; 20: 52.
21. Glazier RH, Kopp A, Schultz SE, et al. All the right intentions but few of the desired results: lessons on access to primary care from ontario’s patient enrolment models. Healthc Q 2012; 15: 17–21.
22. Wensing M, Kolle PK, Szecsenyi J, et al. Effects of a program to strengthen general practice care on hospitalisation rates: a comparative observational study. Scand J Prim Health Care 2018; 36: 109–114.
23. Tammes P, Payne RA, Salisbury C, et al. The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016. BMJ Open 2019; 9: e029103.

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Editorials

Health for all by 2030 is within our grasp: we must act now

Sandro Demaio

Med J Aust 2021; 214 (8): . || doi: 10.5694/mja2.51018
Published online: 3 May 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Health services administration

Australia has a once‐in‐a-lifetime opportunity to create a healthy, sustainable, equitable and prosperous future by taking bold action to build back better, fairer and greener after the coronavirus pandemic

Australia is considered a coronavirus disease 2019 (COVID‐19) success story by international standards,1 notwithstanding the significant health and economic impacts experienced across the country. The level of pandemic‐induced disruption has been profound, with COVID‐19 catapulting us all, as individuals and communities, into new ways of being.

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1 Victorian Health Promotion Foundation, Melbourne
2 University of Melbourne, Melbourne

Correspondence: sdemaio@vichealth.vic.gov.au

Competing interests:

No relevant disclosures.

1. Margo J. WHO expert explains Australia’s pandemic success. Australian Financial Review 2021; 15 Jan. https://www.afr.com/policy/health-and-education/who-expert-explains-australia-s-pandemic-success-20210114-p56u8w (viewed Mar 2021).
2. World Health Organization. WHO Director‐General’s opening remarks at the media briefing on. COVID‐19 – 11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (viewed Mar 2021).
3. Klapdor M. COVID‐19 economic response – free child care. Parliament of Australia, 6 Apr 2020; amended 19 May 2020. https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2020/April/Coronavirus_response-Free_child_care (viewed Mar 2021).
4. Parsell C, Clarke A, Kuskoff E. Understanding responses to homelessness during COVID‐19: an examination of Australia. Housing Stud 2020; https://doi.org/10.1080/02673037.2020.1829564.
5. Arthur D. COVID‐19 economic response – wage subsidies aim to put workplaces into hibernation. Parliament of Australia, 6 Apr 2020. https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2020/April/Coronavirus-Response-Wage-Subsidies (viewed Mar 2021).
6. Victorian Health Promotion Foundation. VicHealth coronavirus wellbeing impact study: follow‐up survey. Melbourne: VHPF, 2020. https://www.vichealth.vic.gov.au/media-and-resources/publications/vichealth-coronavirus-victorian-wellbeing-impact-study-follow-up-survey#; (viewed Mar 2021).
7. Australian Government Department of Health. COVID‐19 National Health Plan – Primary Care – MBS telehealth items staged rollout [fact sheet]. 24 Mar 2020. https://www.health.gov.au/resources/publications/covid-19-national-health-plan-primary-care-mbs-telehealth-items-staged-rollout (viewed Mar 2021).
8. Bendle S. Around the traps: 15 things to note for a new crisis, Croakey 2020; 4 June. https://www.croakey.org/around-the-traps-15-things-to-note-for-a-new-crisis/ (viewed Mar 2021).
9. Russell L. Australia’s health care after coronavirus – is there a silver lining to the pandemic? Pearls and Irritations: John Menadue’s Public Policy Journal; 3 July 2020. https://johnmenadue.com/lesley-russell-australias-health-care-after-coronavirus-is-there-a-silver-lining-to-the-pandemic/ (viewed Mar 2021).
10. Australian Institute of Health and Welfare. Indigenous Australians. https://www.aihw.gov.au/reports-data/population-groups/indigenous-australians/overview (viewed Mar 2021).
11. Horne R, Willand N, Dorignon L, Middha B. The lived experience of COVID‐19: housing and household resilience (AHURI Final Report No. 345). Melbourne: Australian Housing and Urban Research Institute, 2020. https://www.ahuri.edu.au/research/final-reports/345 (viewed Mar 2021).
12. Backholer K, Baum F, Finlay S, et al. Australia in 2030: what is our path to health for all? Med J Aust 2021; 214 (8 Suppl): S1‐S40.

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Symptoms of depression and anxiety during the COVID‐19 pandemic: implications for mental health

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National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia

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Lessons from the United Kingdom’s COVID‐19 vaccination strategy

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The challenges of managing both chronic pain and opioid use in general practice

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Introducing general practice enrolment in Australia: the devil is in the detail

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Health for all by 2030 is within our grasp: we must act now

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The increasing burden of inflammatory bowel disease

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Lack of efficacy of cannabidiol for relieving back pain: time to re‐set expectations?

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Symptoms of depression and anxiety during the COVID‐19 pandemic: implications for mental health

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Improving recruitment to clinical trials for regional and rural cancer patients through a regionally based clinical trials network

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Artificial intelligence and medical imaging: applications, challenges and solutions

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National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia

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Lessons from the United Kingdom’s COVID‐19 vaccination strategy

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The challenges of managing both chronic pain and opioid use in general practice

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Introducing general practice enrolment in Australia: the devil is in the detail

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Health for all by 2030 is within our grasp: we must act now

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The increasing burden of inflammatory bowel disease

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Lack of efficacy of cannabidiol for relieving back pain: time to re‐set expectations?

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