30/03/2020:  Bulk-billed Telehealth services now available at The Wellness Clinic

Commencing today, patients have the option to switch their upcoming face-to-face medical appointment to a telephone consultation.  Dr Ison has committed to bulk-billing this service during the COVID-19 crisis.  Telehealth is an eminently sensible option for when there is no necessity to have an in-person attendance.  It is particularly suitable for follow up consultations to discuss results and to review health management.  It is also appropriate for patients to be able to remotely access advice or support from their doctor during this worrying time.  

Until further notice, The Wellness Clinic remains open to serve you either in-person or by Telehealth.  Please call 9686 0700 to organise your appointment.  All requests for Telehealth service will be honoured, as promptly as is possible, for existing patients of the clinic.

29/03/2020:  Telehealth services will be available to all patients

                    for the duration of the COVID crisis

A breakthrough agreement brokered by the AMA with the Federal Government for expanded telehealth access to general practitioners and other medical specialists will allow continuation of normal patient care, and reduce the need for scarce Personal Protective Equipment (PPE).

The $669 million breakthrough agreement was announced this morning by Prime Minister Scott Morrison and Health Minister Greg Hunt.

AMA President, Dr Tony Bartone, said the new telehealth arrangements will allow even more patients from this week to have consultations with general practitioners and some other medical specialists without leaving home.

Dr Bartone said that the AMA has been working with the Federal Government for weeks to ensure that telehealth is widely available so that patients can access care without the risk of exposure to or spread of the coronavirus.

“This is vital in ensuring that usual patient care can continue comprehensively despite the increasing threat of COVID-19,” Dr Bartone said.

“The new telehealth arrangements to be implemented in the coming days will support patient consultations, which do not require a physical examination, to be conducted with general practitioners and some other medical specialists by telehealth.

“Patients who still need to visit their doctor can continue to do so.

“This also means that patients can maintain their home isolation.

“Doctors will be able to conduct telehealth consultations from their practices or while they themselves may be in home isolation. And it will reduce public hospital presentations that could have occurred without telehealth access.

“Critically, it will reduce avoidable use of PPE. Doctors at present require PPE for any patient with symptoms suggesting potential COVID-19. Telehealth consultations require no PPE. It will cut down use of PPE, freeing the scarce supply for use elsewhere in the health system.”

Dr Bartone said that, as part of the negotiations with Health Minister Hunt, the AMA raised concerns about the ongoing sustainability of medical practices should they face business disruption or closure following exposure to COVID-19.

“The Prime Minister and Minister Hunt have today made it easier for patients to see their doctors, and for doctors to keep operating their practices as all Australians work to contain the spread of Covid-19 and stay safe and healthy.

“It may take some patients and doctors who are not familiar with telehealth some time to adjust, but the adjustment will be worthwhile,” Dr Bartone said.

Ref: AMA online, 29 March 2020

24/03/2020:  Telehealth to be expanded for all patients 

GPs will be able to bulk bill telehealth services for all Australians from next week.

The Federal Government has heeded the call of thousands of GPs amid the coronavirus pandemic, opening up the telehealth eligibility criteria to all Australians.

GPs will be able to bulk bill phone or video consultations with all patients from next week in a bid to help contain the rapid spread of coronavirus, AAP has reported.

The Federal Government has expanded the eligibility criteria to include all GPs, specialists, and mental health and allied health professionals.

‘This has been one of the most significant changes we’ve seen in Australian general practice in my working lifetime of 35 years,’ Professor Michael Kidd, Principal Medical Adviser to the Department of Health, said.

The reform follows continued advocacy from the RACGP, and other medical and patient groups, who have been working tirelessly with the Federal Government to co-design the response to the pandemic.

As it stood, the eligibility criteria for bulk-billed telehealth only included suspected or confirmed cases of COVID-19 (coronavirus), and particularly vulnerable cohorts. Anyone between the ages of one and 70 (or one and 50 for Aboriginal and Torres Strait Islander people) had been excluded.

‘The RACGP has said from the start, we need telephone and videoconferencing item numbers for all patients. We need them to continue providing quality care so we can protect patients, GPs, and their teams,’ RACGP President Dr Harry Nespolon told newsGP. ‘We have been working closely with Minister Hunt and the Department of Health to achieve this.

‘We thank the minister and the department for listening to our concerns, and addressing them. There is still work to be done, but we think we can get there within the week.’

Telehealth expansion has been seen elsewhere in the world as confirmed cases soar, with GPs in the UK advised to consult patients remotely where possible. Similarly, in the US President Donald Trump has rolled out telehealth accessibility for all Medicare recipients.

Locally, Federal Health Minister Greg Hunt praised the opening up of telehealth to all Australians as ‘an extremely important development’.

‘Very important to stress, however, that a very large proportion of GP services of course require face-to-face treatment,’ he said.

Meanwhile, Private Healthcare Australia chief executive Rachel David said private health funds are working to expand consultations for mental health services. Dr David also called on health funds to give relief to members experiencing financial difficulty as a result of the pandemic.

General practices have been feeling mounting pressure. Rapidly changing medical advice has meant staff members are constantly inundated with requests for information, while personal protection equipment (PPE) shortages have been worsening.

The Federal Government has said it will continue to work with the RACGP and other peak bodies, with the next stages of the response expected to be confirmed by the end of this week.

Ref: NewsGP 24 March 2020

22/03/2020:  Urgent COVID-19 update regarding 'Shutdown' arrangements 

                   and Medical Practices

A letter to AMA members from NSW Branch President, Dr Kean-Seng Lim:

Dear Dr Ison

AMA (NSW) is welcoming the increased physical distancing measures introduced by the National Cabinet managing the COVID-19 crisis that take effect from midday tomorrow.

We wrote to the Premier on Friday to encourage the NSW Government to consider the evidence and to determine if further measures were required.

We have confirmed that medical services are not subject to the shutdown and therefore practices are able to continue to operate.

In addition, while we congratulate the Government for enabling greater access to Telehealth Services for some patients and some providers, we believe there is a need to broaden this to allow doctors to provide their usual care in a safer manner for both providers and patients.

It has been the AMA's position, since it first started campaigning on this issue, that there be broad access to telehealth wherever clinically appropriate.

Our colleagues at Federal AMA are continuing to lobby the Government on your behalf on this issue.

Practices should still be actively implementing social distancing and other risk management arrangements.

We are aware there is potential for a further escalation of these shutdown measures and will continue to engages with the Government in this regard.

AMA (NSW) will be providing more advice for members as soon as it is available.

Contact AMA (NSW)

P: 02 9439 8822

F: 02 9438 3760

[email protected]

PO Box 121, St Leonards NS

12/03/2020:  Coronavirus Alert

Today the WHO has declared a worldwide pandemic for COVID-19.   Please be advised that, in the public health interest of containing transmission of the virus, you should henceforth (until further notice) not attend The Wellness Clinic, or enter The Hills Private Hospital, if you have any respiratory symptoms such as sore throat, runny/blocked nose, and/or cough.   

If you have respiratory symptoms and are a recently returned traveller, 

you should telephone the COVID-19 National Hotline (24/7) on 1800 020 080 for advice about where and how to get a coronavirus test.

If you have respiratory symptoms and have had contact with a confirmed coronavirus case, 

you should telephone the COVID-19 National Hotline (24/7) on 1800 020 080 for advice about where and how to get a coronavirus test.  

If you have respiratory symptoms but are not a recently returned traveller, nor have you been in contact with a confirmed coronavirus case, 

you should self-isolate at home until you recover and/or you should seek medical attention if your condition worsens. 

Coronavirus Update to GPs as of 8/3/2020 from the Chief Medical Officer, Dr Brendan Murphy


Dear Colleagues,

I am writing to update you on the COVID-19 outbreak situation in Australia and internationally, and to outline the Commonwealth’s current and future support for the central role you are playing in our national response.

Communication

There has been a significant amount of advice and information already provided to health professionals. I recognise that the evolving nature of this outbreak has required public health advice to evolve rapidly with the emerging epidemiology. This has made it more challenging for people to keep it up to date, and has led to some confusion and a perception of inconsistency of information/information gaps.

We are addressing this and will enhance communication to primary care, starting with this letter and followed up by twice-weekly newsletters to all GPs in Australia, together with regular GP webinars.

There is the very real possibility that larger scale community outbreaks will occur across Australia, placing a significant burden on the health system, in which you play an absolutely critical frontline role.

Situation as at 8 March 2020

As you will be aware, the international situation has changed materially in the last few weeks. Cases have now been reported in over 90 countries, some with sustained widespread community transmission. Despite our success in containing the initial cases associated with travellers from China, we are now seeing the expected second wave of imported cases from a number of countries (most notably Iran).

We have evidence of limited community transmission in Sydney. New imported cases are being seen every day, some from countries not previously identified as high risk. It is no longer realistic that we will be able to prevent further importation of cases, and further local outbreaks seeded from imported cases are likely.

Disease characteristics

Before I outline to you what we are doing to improve our support of the primary care response to COVID-19, I will share with you our current state of knowledge about COVID-19.

It is clear that a great majority of people with COVID-19 infection (>80%) have mild disease, not requiring any specific health intervention. This mild disease contributes to the high transmissibility of the virus, as many people with infection will continue working and interacting with the community because their symptoms are so mild.

There is very little evidence of significant COVID-19 disease in children. Initially, it was suggested that children were less susceptible to infection, but more recent evidence supports the fact that children may be infected, in many cases without being aware of symptoms. The role children play in transmission is unknown.

The greatest concern remains the relatively small number of cases with severe pulmonary disease, some with a fatal outcome. We still don’t have certainty about the case fatality rate (CFR) for COVID-19, as the estimates from some countries appear to be over-estimated by under ascertainment of mild cases. It seems reasonable to assume a CFR of around 1% in a country like Australia with a strong health system – it may even be lower. We do know that the majority of fatal outcomes have been seen in the elderly, or people with comorbidities.

Current approach to response

At present our response, under the Australian Health Sector Emergency Response Plan for COVID-19, is focused on early identification of cases, isolation, contact tracing and quarantine where indicated – under the supervision and direction of the public health unit in each state or territory.

If more widespread community transmission occurs, the focus will shift to early detection and home isolation of cases to prevent or delay transmission, with less emphasis on identifying contacts who are generally unlikely to be very infectious, unless they themselves also develop symptoms.

We will let you know if and when such a shift in the public health response is indicated. Even in a large-scale outbreak, isolation of as many cases as possible can play a critical role in flattening the epidemic curve.

Testing

Testing for COVID-19 infection is currently focused on those people with respiratory symptoms who have a relevant travel history or who have been in contact with cases. Testing has largely been done so far by public health laboratories, but I am pleased to advise that we are working on further expanding access under Medicare to private pathology laboratories for the SARS CoV2 virus (COVID-19 virus). It is important at this time that all positive results are immediately reported to the state/territory public health unit, whose contacts are provided at the end of this letter.

Reducing exposure in health care settings

It is clear that, with increasing cases of COVID-19, there will be benefit in more sophisticated strategies to prevent the co-mingling of suspect or proven cases with other patients in healthcare settings. We have previously advised members of the community that, if they believe that they could potentially have or be exposed to COVID-19, they should phone their GP or local health service and seek advice before attending. If followed, this practice has allowed the practice or hospital to make arrangements for isolation and testing.

As case numbers increase, there is a need for new strategies. We will shortly be announcing to the community an expansion of the COVID-19 national hotline (1800 020 080). This hotline will operate 24 hours a day, seven days a week. Expansion of the national hotline is part of our strategy to support general practices manage the flow of cases.

People who believe that they may have been exposed to or have COVID-19 will be encouraged to call the national hotline to seek advice. A standard protocol for the call centre operators will be provided. We will share call centre information and the triage protocol with you shortly, as many GP practices have asked to have the same protocol available for their reception staff to ensure consistent messaging and patient disposition.

Respiratory clinics

We are also actively developing across the nation a series of COVID-19 respiratory clinics, dedicated to the assessment of suspected cases and early treatment of patients with mild symptoms. Some of these are being established by state and territory health services and we are looking at complementing these with a limited number of primary care respiratory clinics at volunteer general practices who have the appropriate infrastructure and capability. Additional infection control training and support will be provided.

The Primary Health Networks (PHNs), in collaboration with the GP colleges and other stakeholders, will be rapidly seeking interest from practices who might wish to be involved. A time-limited separate funding model will be developed, cognisant of the nature and costs of this specialised practice, and appropriate personal protective equipment (PPE) will be provided to these clinics. Rural and regional areas will need special consideration and arrangements.

Some patients will continue to contact their usual general practice and want assessment and advice from that trusted source. It will clearly be helpful for clinic reception staff to have the standard triage protocol available. Practices may choose (as per the triage protocol) to refer patients to the dedicated clinics or health services, to undertake a remote telemedicine consultation (see below) or to make safe arrangements to see the patient at the clinic or in their place of residence.

Government is currently considering the time-limited expansion of telemedicine MBS items to enable remote consultation of patients with suspected COVID-19 and at-risk patients who will not want to be exposed to COVID-19 by attending the clinic. More details on these proposed telemedicine items will be announced very soon.

PPE

Some GPs have expressed concern about the availability of PPE, in particular surgical masks, which are the appropriate PPE for use with most patients with respiratory symptoms. A further 260,000 masks from the national medical stockpile were announced this weekend on top of the 750,000 already distributed to PHNs and we will work closely with PHNs to ensure appropriate supply arrangements.

We appreciate that it can be frustrating if only small numbers of masks are distributed at any one time. Masks are in very short supply worldwide and we need to conserve them at this time until our emergency procurement plan delivers a significantly enhanced stockpile in coming weeks. We recognise the need to supply GPs who are assessing potential COVID-19 patients and are focusing our efforts there.

There has been a change to messages about what PPE is required in the clinical assessment of potential COVID-19 cases. All of the evidence currently suggests that droplet spread is the main mode of transmission and that surgical masks are effective for routine care and non-aerosolising procedures (and much easier to appropriately fit than are P2 masks). Only where there is uncontrolled coughing are P2/n95 masks needed, and general practices will generally divert such patients to hospitals at this time. For your reference, the current PPE guidelines endorsed by the expert COVID19 infection control committee are available on the Department of Health website.

Vulnerable groups

In the meeting with primary care stakeholders last week, a commitment was made on a range of initiatives, many outlined above. We are very aware that additional work is needed in the residential aged care sector and for vulnerable groups, including Aboriginal and Torres Strait Islander peoples. These have been the subject of separate planning workshops and will have their own strategies, which will be shared with you, acknowledging the roles of GPs in these areas.

Community campaign

We will also be undertaking a broad community education campaign on COVID-19. One of the important messages will be the value of standard hygiene messages (hand washing, cough etiquette, social distancing) in preventing transmission. I am sure that you will play a role in communicating that message to your patients along with general balanced information about this virus.

Please be on the lookout for our regular twice-weekly communiques where we will be providing information about respiratory clinics, pathology testing, PPE, temporary MBS telemedicine items and the like. You will also be given details of the planned weekly webinars on COVID-19 that we will be conducting.

No-one can accurately predict how the COVID-19 outbreak will develop in Australia. Our collective response has to be flexible and collaborative.

The Australian Government has committed to providing the necessary resources to support the response in whatever form it needs to take. The critical role of primary care in this response is well understood and greatly appreciated.

Finally, can I apologise for this very long letter. We doctors hate reading long correspondence but there is a lot of information to convey. We will endeavour to keep our twice-weekly newsletters on COVID-19 to one page.

Contact details for state and territory public health units

ACT – 02 5124 9213 (or 02 9962 4155 after hours)

SA – 1300 232 272

NSW – 1300 066 055

Tas – 1800 671 738

NT – 08 8922 8044

Vic – 1300 651 160

Qld – 13HEALTH (13 43 25 84)

WA – 08 9328 0553 

News

What your genes can tell you about your addictive potentials

Posted on July 31, 2018 at 8:45 PM

Alcoholism (alcohol cravings)

Alcoholism (alcohol dependence)

Alcoholism (withdrawal seizures)

Cannabis dependence

Cocaine dependence

Cocaine-induced paranoia

Fatty food addiction

Gambling addiction

Heroin addiction

Nicotine dependence (tobacco addiction)

Salty food addiction

Sugar addiction.

For further information go to:

Ref: Viamedex Genetic and Drug Tresting Laboratory; www.geneticaustralia.com

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