Nurse practitioners ready for a bigger role in health system

http://www.abc.net.au/news/stories/2008/06/18/2277900.htm

By Ged Kearney

(Reuters: Christian Hartmann, file photo)

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Nurse practitioners may well be the answer to Australia’s health concerns.

For Australians to see the benefits of real and sustainable health reform there must be major reform to the way health services are funded and delivered. This means putting nursing and midwifery at the centre of decisions in health and health reform.

Vital to a full and effective utilisation of the nursing and midwifery workforce is the role of nurse practitioner, yet they are unable to operate to their full scope of practice due to current funding barriers.

Nurse practitioners are registered nurses and midwives with advanced educational preparation and experience who are authorised to practice in an expanded nursing role. There are currently around 300 nurse practitioners in Australia who can be found working in illness prevention, chronic disease management, aged care, emergency care, wound care, diabetes education, sexual health and rural health.

These nurses and midwives seek candidacy through the nursing regulatory authority in their state or territory and must undergo rigorous review to be authorised to practice as a nurse practitioner. Most have at least five years in their chosen area of practice post-registration and at least seven to nine years study, inclusive of masters-level university qualification.

Nurse practitioners have been shown to bring immense benefit to areas of need, improving quality of and accessibility to health care services for all Australians whether in rural and remote Australia or in residential aged care facility. The benefits they bring have been well documented across Australia and indeed throughout the world.

Programs like the Walwa Bush Nursing Clinic and the ACT aged care nurse practitioner pilot provide evidence that nurse practitioners offer health care efficiency and improve patient care outcomes.

The Alfred Hospital in Melbourne recently conducted a study that demonstrated nurse practitioners operating out of the emergency department had reduced waiting times, staff stress, and patient returns and improved patient outcomes and satisfaction.

Nurse practitioners bring greater efficiency and quality of patient care to Australia’s health system, but are severely limited in their practice because of outdated funding structures.

While nurse practitioners are authorised to refer patients to other health professionals and prescribe some medications, there is currently no mechanism that allows patients to claim any subsidy from the Pharmaceutical Benefits Scheme (PBS) or Medical Benefits Scheme (MBS), as is the case for medical practitioners.

This is a massive disincentive for patients who can be forced to pay hundreds of dollars more for prescriptions or medical tests when they are ordered by a nurse or midwife practitioner as opposed to a GP. Subsequently they are currently under-utilised and left feeling under-valued.

Unless the Federal Government gives the patients of nurse practitioners access to pharmaceutical rebates they will continue to be under-utilised to the detriment of all Australians.

In addition to the obvious benefits to health care consumers in Australia, the role of nurse practitioner offers experienced nurses greater access to career opportunities in clinical practice. Some nurses do not want to move out of clinical nursing into education or management.

The opportunity to become a nurse practitioner offers an incentive to remain in the profession whilst providing expert nursing care. The regulatory process must be reviewed to facilitate advanced practice by suitably qualified nurses and midwives and improve community access to care.

Now that the Federal Government has put health reform on the agenda the time is right to better utilise the expertise of these skilled practitioners, enabling greater access to and equity within the public health system and offering nurses and midwives greater opportunity for career development, encouraging them to stay or if they have left, to return to the profession.

Ged Kearney is the federal secretary of the Australian Nursing Federation.

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‘Millions more needed’ to stave off dementia crisis

http://www.abc.net.au/news/stories/2008/06/18/2278403.htm

• Audio: Researchers make Alzheimer’s detection breakthrough (The World Today)

A leading scientific researcher says Australia needs to increase funding for dementia now in order to avoid a health care crisis in the future.

A report released today says annual funding for research should be increased to $36 million a year to tackle the growing dementia epidemic.

It also recommends that dementia be included as a national health priority.

Report co-author Professor Henry Brodaty says there are more than 200,000 people with dementia at the moment, but the number could be 730,000 by 2050.

“Australia is ageing, the aged are ageing, so the old are getting older, so we really have to think about the best way to tackle this,” he said.

“For every dollar spent in research, the Australian Society for Medical Research estimated we get a $5 return.

“It makes sense to try to understand how to tackle this better.

“If you compare research for dementia compared to other chronic conditions, it’s well below those,” Professor Brodaty added.

“If we compare it on the disability-adjusted life years which is a measure of disease burden, we have only a fraction of what’s being funded in other conditions.”

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Dementia forcing older Aussies in care for longer: study

http://www.abc.net.au/news/stories/2008/06/12/2272086.htm

The report shows 70 per cent of permanent aged care residents needed a high level of care.

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• Audio: Report sparks call for aged care funds (AM)

A new Australian Institute of Health and Welfare report has found older people are spending longer in aged care facilities and need a higher level of attention, partly because so many of them have dementia.

The report shows 70 per cent of permanent aged care residents needed high-level care last financial year, compared with 58 per cent a decade ago.

Institute spokeswoman Ann Puet says more residents have dementia which means many require care for longer.

“On average people stay for 146 weeks now, whereas 10 years [ago], it was 131 weeks,” she said.

She says there has also been a rise in the number of people aged 90 and over who are being admitted to residential care.

“We are seeing an increasing proportion within the residential aged care sector of very old people, simply because of female longevity,” she said.

“That population its still dominated by women, although as men live longer we may see some change in that.”

Council on the Ageing spokesman Paul Flint says the findings reflect Australia’s ageing population.

“It’s the 80-plus age groups that are increasing at the fastest rate at the moment,” he said.

The report also reveals more high care places were allocated to meet increasing demand.

Catholic Health Australia chief executive officer Martin Laverty says the Government needs to step in.

“I had as recently as last week a senior Labor backbencher acknowledge to me that they were not aware of the pressure on aged care providers in their own electorate,” he said.

“A very genuine question was asked – what can we do as a government to help? Well it can assist with the pressure, relieving the pressure on capital works.”

The Aged Care Industry Council represents 95 per cent of the church, charitable and privately-owned and operated nursing homes in the country.

Spokesman Rod Young says the Government will have to face up to the extra costs associated with an ageing population.

“We’ve actually just started a new funding scheme which has changed the parameters and changed the funding methodology, he said.

“The Government claims that that will fix many of our problems. We don’t believe it will, but only the next couple of years is going to tell.”

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Govt pledges $50m to mental health

http://www.abc.net.au/news/stories/2008/06/12/2273155.htm

The Federal Government has announced a $50 million funding boost for mental health services.

Federal Health Minister Nicola Roxon says $20 million will go to suicide prevention programs.

Ms Roxon has also unveiled the make-up of a new national advisory group on mental health, to be led by former head of the Mental Health Council, John Mendoza.

Ms Roxon says the new council fulfils an election commitment.

“The advisory council is a mechanism to provide the Government with independent, balanced and confidential advice from a wide range of experts to inform national mental health reform efforts, and provide continuing impetus for reform,” she said.

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New controls considered for complementary medicines

http://www.abc.net.au/news/stories/2008/06/10/2270015.htm

Consumer advocates are pushing for new labelling laws for complementary medicines. (ABC News: Giulio Saggin, file photo)

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More than half of Australians have used at least one complementary medicine, ranging from vitamins to treatment drugs for arthritis and weight loss.

But recent studies have raised doubts about the effectiveness of some top-selling remedies.

Consumer group Choice recently found the drug glucosamine, used to treat osteoarthritis, provided little benefit to sufferers.

Choice spokesman Christopher Zinn says the only effect is a placebo one.

“People who purchase it are convinced of its efficacy but in terms of the real science, we are far less convinced of that, and in fact we just advise people, you are much better off moving to lifestyle treatments, losing weight, doing exercise,” he said.

“This is actually going to get you better results than taking glucosamine.”

There are more than 16,000 complementary medicines listed on the Therapeutic Goods Administration.

The national prescribing service is currently reviewing the information provided to consumers about such drugs.

Jan McLucas is the parliamentary secretary to the federal Health Minister and is responsible for complementary medicines

She says she’ll consider the report within the next two months.

“Information provided to consumers can really only be described as patchy,” she said.

“Some producers provide very good websites with information about their products.

“With other products it is quite difficult to find out firstly what is in them and how they will work.”

Senator McLucas says the Federal Government may introduce measures to help consumers make more informed choices about complementary medicines.

She says that may include tougher disclosure rules.

“A range of proposals have been put to the Government including increased labelling on the medications themselves,” she said.

“Another alternative is to look at a Government-run website which consumers would have confidence in.”

Another option being considered is a proposal by Choice for complementary medicines to be given the right to display a green tick – similar to the red tick used by the National Heart Foundation.

Mr Zinn says improvements to the industry are long overdue.

“There is no reason why complementary medicines should not be treated with the same, if not similar, scrutiny as other pharmaceuticals and something else we would like to see is that those medicines who do not choose this opting system with a green tick, have some sort of label on their packaging which says this medicine has not been evaluated by health authorities for efficacy,” he said.

Dr Ken Harvey, from the school of public health at the La Trobe University, has welcomed the Government’s proposals.

“Most complementary medicines are listed, which means they’re not evaluated by the Therapeutic Goods Authority to see if they work,” he said.

“There is no approved product information for them, as there is for other medicines and there is no consumer medicines information either.

“So really there is no independent source of information about these medicines in Australia.”

Nobody from two of the biggest suppliers of complementary medicines, Symbion and Blackmores, was available today to respond to the criticism.

But Dr Wendy Morrow, the executive director of the Complementary Healthcare Council, rejects suggestions the industry doesn’t provide consumers with adequate information.

She says the changes aren’t needed.

“The Complementary Healthcare Council believes that the Australian Therapeutic Goods legislation and regulations already provide consumers with one of the best practice and most scientifically rigorous regulatory frameworks for complementary medicines internationally,” she said.

“There have been two comprehensive government-initiated reviews of this system since 2003 and both of these substantially supported the existed risk-based regulatory framework, subject to minor modifications and that is something that we do support.”

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Qld scientists make Alzheimer’s discovery

http://www.abc.net.au/news/stories/2008/06/10/2270576.htm

Neuroscientists at the Queensland Brain Institute have discovered a protein responsible for the degeneration of brain cells in Alzheimer’s disease.

It is already known a build-up of the neurotoxin amyloid beta, and the breakdown of nerve cells, are common factors in the illness.

Doctor Elizabeth Coulson says her team has discovered a molecule known as the “cell death protein” which sits outside brain cells and tells them to shut down when it detects the neurotoxin.

She says when the protein is removed, cells stop breaking down.

“What happens in the adult brain is that when this amyloid beta is around in sufficiently high quantities – as you might find in Alzheimer’s disease – that the cells are told to shut down,” she said.

“If you get rid of the P-75 protein, the cells can still stay alive.”

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Govt considers ‘tagging’ dementia sufferers

http://www.abc.net.au/news/stories/2008/06/02/2262030.htm

There’s a ‘sense of hopelessness’ for carers when a dementia sufferer goes missing, Glenn Rees says. (Reuters: Christian Hartmann)

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• Audio: Govt considers electronic bracelets to keep tabs on dementia patients (AM)

Alzheimer’s Australia says about one third of people with dementia at some point go missing, causing distress for carers and relatives.

Glenn Rees, the group’s national executive director, says it is very traumatic for family carers when somebody goes missing.

“There’s a sense of hopelessness,” he told AM. “Sometimes the person with dementia will go to a favourite place and the situation can be resolved quickly.

“On other occasions, it can’t be. And sometimes, of course, it ends with fatal consequences.”

The Federal Government has just introduced measures to make it mandatory to for service providers to report to it when people with dementia go missing.

Federal Minister for Ageing Justine Elliot says she’s also considering a tag to make it easier for people to be found.

“First and foremost, it could be an identification bracelet,” she said. “So when a lot of these people with dementia are missing, other people can see and realise they are dementia patients.

“As to where they would be a particular tracking or tagging device in a wristwatch or a bracelet, this is something that I’m looking into in consultation with these other groups.”

Alzheimer’s Australia is keen to see a tag with a symbol indicating people have dementia introduced as soon as possible.

“We’ve encouraged the Government to look at a symbol, a symbol for people with cognitive impairment with something that our consumer stakeholders have asked us to examine,” Mr Rees said.

“What they want is something that’s readily recognisable in emergencies, in hospitals, in residential care and in the community.”

As for an electronic device, Mr Rees says the first thing is to establish whether or not a person needs such a device, and then look at the technological options available.

He concedes some of people will have concerns about such a device and he wouldn’t want anyone to be forced to wear it.

Ms Elliot agrees that a ‘tag’ would not be compulsory.

“This is totally in consultation with older Australians and with their families,” she said.

“I want to make sure that people are safe and it’s really important to be working with all groups right across the country to get the best result.”

Mr Rees says technology should not replace quality care, but it could be a good solution for some people.

“But it’s got its limitations and we would certainly encourage people to think in terms of good quality dementia care first, good design in residential care rather than assume that electronic devices would be the total solution,” he said.

Based on a report by Sara Everingham for AM

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Mixed reaction to living wills laws

http://www.abc.net.au/news/stories/2008/06/04/2264452.htm

By Adam Haynes

Health Minister Jim McGinty says the laws will allow people to die with dignity (file photo) (ABC)

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There has been a mixed reaction to new laws which will allow people to refuse medical treatment if they become terminally ill.

The so-called living wills legislation, which allows people to specify how they wish to be treated in the event of terminal illness, passed the Upper House of State Parliament last night.

The WA Director of the Australian Christian Lobby, Michelle Pearse, says the legislation is flawed because it takes power away from doctors.

“Most of the time the patient isn’t aware what the end of life looks like so they don’t have the ability to make this kind of decision,’ she said.

However, the euthanasia campaigner Philip Nitschke supports the measures.

“It’s not up to the medical profession, it’s up to the individual, the adult rational Australian needs to be able to make these decisions,” he said.

The State Government will launch an advertising campaign to inform the public about living wills.

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‘Genetic barcode’ could help predict and prevent disease

http://www.abc.net.au/news/stories/2008/05/23/2253273.htm

The technology could predict and prevent diseases before symptoms appear. (ABC News: file photo)

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Queensland researchers say they have developed a genetic barcode that could predict and prevent diseases before symptoms appear.

Doctor Krassen Dimitrov from the University of Queensland has created fluorescent barcodes called nanostrings, which are mixed with blood to identify the make-up of different genes.

The glowing mixture is scanned, and computer software is used to identify the molecular pattern in the gene.

Doctor Dimitrov says the technology will be used to identify how diseases, like cancer, form.

“They’re like signature motifs and they have different colours that are spatially separated so you see a sequence of green, red, and blue, and that tells you that is one molecule of a particular gene,” he said.

“If you see a different sequence that’s a molecule of a different gene.”

Dr Dimitrov says the technology could predict and prevent diseases before symptoms appear.

“If we can detect each individual molecule and count them digitally like items in a warehouse, we can inventorise (sic) the gene expression levels for many different genes simultaneously,” he said.

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Study looks at health of Vietnam veterans, families

http://www.abc.net.au/news/stories/2008/05/22/2252607.htm

The Federal Government has launched its most comprehensive survey of veterans’ health.

Up to 200,000 Vietnam veterans and their families are needed for the $11.5 million study.

The Vietnam Veterans Family Study will focus on the health and relationship problems the veterans suffer, but will also canvas the issues facing those who served but were not deployed.

Veteran Affairs Minister Alan Griffin says Australians who fought in the Vietnam War have a higher risk of developing skin and lung cancer, mental health issues, back problems and alcoholism.

The family members of veterans are also relevant to the study.

Mr Griffin says children of Vietnam servicemen have a three times higher suicide rate than the general population and the study is overdue.

He says it will not be finished for about eight years, but it is better late than never.

“The Vietnam veterans’ community has been calling upon the Government to do this study for some time now,” he said.

“Quite a bit of work has been done in the last few years to actually consider the feasibility of doing a study but because it is quite a long time since these events, that’s part of the issue.”

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