I could not but help notice your other lectures especially to the Fabians. Disclosure of your interests as a ratbag or "a well known trouble maker".
It was interesting that when Macquarie Pathology was accused of inappropriate practice when distributing computers to GPs in NSW it was simply a commercial decision that electronic distribution was cheaper than courier-delivered reports. Those of us who are a bit older remember the phrase "review recommended in three to six months". This no longer happens perhaps because there is CT, MRI and Ultrasound not to mention radiographically guided tests etc. We are now increasingly told that BNP is an accurate way to diagnose congestive cardiac failure rather than rely on clinical symptoms and signs. Of course if it is positive you are then into Chest X-rays, Ultrasound, and sometimes more invasive testing. Times change. When cimetidine was presented to us it was the cleanest drug to ever hit the market. Now it is the classical case for drug interactions. Perhaps we could now advise our patient who need anticoagulation to go to Sizzlers and get discount while they are fed and anticoagulated at the same time? David de Bhal Virtual Practice -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ken Harvey Sent: Tuesday, March 07, 2006 7:27 AM To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] Increase in Pathology / Radiology ordering Peter MacIsaac wrote: >> ... there has been a steady increase in the cost of radiology >> services over recent years. A related increase in pathology testing has attracted considerable attention in the Melbourne Age newspaper over the last few days, see: http://tinyurl.com/fxq2t http://tinyurl.com/mekc4 http://tinyurl.com/zbtew The editorial (The Age 6/3) mentioned that the Federal government had commissioned a report to investigate why test volumes are increasing. Ironically, many such reports have been commissioned in the past and the reasons for increasing test volumes are well known. Some of these are justified, for example genuine advances in diagnostic testing, greater use of tests to appropriately monitor potentially dangerous treatment and an aging (and increasingly obese) population with more chronic disease. Other causes are more dubious such as "defensive" ordering for perceived medico-legal reasons, thoughtless ordering encouraged by computerised "tick-box" forms (the paper version of which used to be banned) and "vertical integration" of companies owning pathology, radiology, GP clinic and hospital businesses (which may stimulate over-ordering to increase profit). However, a major problem identified by previous reports is enormous variation in how pathology tests are currently used and lack of clear guidance for clinicians as to which tests are most cost-effective for investigating or managing particular clinical problems (and how frequently monitoring tests should be repeated). To date, the Federal government has focused on supply-side interventions in an attempt to contain escalating test volumes, reducing pathology fees if test target volumes were exceeded. However, clinicians, not pathologists, order the tests. Many reports have suggested that the Royal Australian College of Pathologist's, "Manual of Use and Interpretation of Pathology Tests" (funded by the Federal Government) needs much more material on what tests are cost-effective for investigating common clinical problems in addition to how much blood or urine to collect. Furthermore, targeted education and incentives are needed if GPs are to order tests appropriately. Such programs in New Zealand are said to have virtually flat-lined "growth" in pathology testing (see below). For those interested, I have reviewed the history of pathology policy in a lecture available at: http://www.medreach.com.au/downloads.htm#Pathology What do others think about how best to achieve, "best-practice" pathology ordering? Cheers Ken -- Dr. Ken Harvey Adjunct Senior Research Fellow School of Public Health, La Trobe University http://www.medreach.com.au VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910 -------- Original Message -------- Subject: Re: [Haianz] Doctors to be queried over surge in lab tests Date: Mon, 06 Mar 2006 06:33:55 +1100 From: Ken Harvey <[EMAIL PROTECTED]> To: HAIANZ <[EMAIL PROTECTED]> Les Toop wrote: > Without wishing to brag the 200 GTPs in CHCH have held lab expenditure > flat for a decade with huge effort into evidence based education.. [snip] Les, can you tell us more about how you "flat-lined" lab expenditure in N.Z.? Cheers Ken _______________________________________________ Haianz mailing list [EMAIL PROTECTED] https://secure.healthyskepticism.org:8443/mailman/listinfo/haianz -------- Original Message -------- Subject: CHCH programme Date: Mon, 06 Mar 2006 11:44:54 +1300 From: Les Toop <[EMAIL PROTECTED]> To: Ken Harvey <[EMAIL PROTECTED]> Same way we did with drugs, a mixture of small group peer led education programmes, practice visits, case studies, distributing summarised evidence, utilisation feedback, changed the lab form and importantly incentivised the GPs by allowing them to decide how the savings are spent on other patient services (eg subsidised smoking cessation, subsidised palliative care at home, extended care at home, special situation benefits, free contraceptive care for under 20s mammograms prior to the national programme etc etc. It really isn't rocket science, but persuading the funders to allow that level of autonomy is difficult with those who stand to lose undermine the process at every opportunity. Les Les Toop Professor of General Practice Head of Department of Public Health and General Practice Christchurch School of Medicine and Health Sciences PO Box 4345 Christchurch, New Zealand Tel 0064 (0)3 3643604 Fax 0064 (0)3 3643637 _______________________________________________ _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.2/274 - Release Date: 3/3/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.2/274 - Release Date: 3/3/2006 _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
