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Welcome to gp connect

Welcome to February's edition of gp connect, your monthly update covering Hospital Liaison GP updates, HealthPathways WA and other relevant information to your role in primary health care.

For older editions of this newsletter or to sign up to receive the newsletter direct to your email address visit the WAPHA website.

In this month's edition;

Hospital Liaison update

In this update:

  • Fiona Stanley Fremantle Hospitals Group
  • FSH - Maternal and Gynaecological Services and Shared Antenatal Care
  • PMH – Notification and Clinical Summary and GP information
  • OPH – Rehabilitation and Aged Care
  • KEMH - 2016 O&G Update Event
  • RPH – GP Notify, New Rapid Access Chest Pain Clinic

Fiona Stanley Fremantle Hospital Group


February 1 saw the start of the Fiona Stanley Fremantle Hospitals Group (FSFHG) with a unified leadership and governance structure. I have been the Liaison GP at Fremantle Hospital for several years and I have now been appointed to the liaison role for the FSFHG through to the end of July.

I welcome your feedback about communications and systems affecting the care of our patients as they move between the primary and tertiary healthcare systems, particularly at FSH and FH. Please send your feedback to Monica.Lacey@health.wa.gov.au 

Queries or concerns about clinical patient care should be directed to the relevant medical teams or departments. The hospital websites remain the primary source of information about services and this regular e-newsletter will contain more dynamic and detailed updates.


Dr Monica Lacey, Hospital Liaison GP FH
Email: Monica.Lacey@health.wa.gov.au
Available: Monday and Thursday mornings
 

Fiona Stanley Hospital 


Maternity and Gynaecological Services and Shared Care

The maternity service at Fiona Stanley Hospital opened on 2 December 2014. It is a level 5 service, with a Neonatal Unit that accepts babies from 32 weeks. Being the only maternity service in WA where care is provided in a multispecialty tertiary hospital, the department is capable of looking after moderate to high risk women needing multidisciplinary involvement including medical, surgical, psychiatric, interventional radiology and ICU services. FSH accepts transfers of high risk women from other hospitals in the South Metropolitan region.


The specialist antenatal clinics include:

  • Diabetes in Pregnancy for gestational diabetes and
  • Maternal Medical Disorders in Pregnancy.  
Water birth facilities are available.
Continuity of care is maintained in the postnatal period by the Visiting Midwifery Service.

The GP antenatal shared care and Midwifery Group Practice model is under development and will be rolled out in 2016.
Dr Sunanda, Head of Service and Peta Skuthorp, Maternity Manager Ambulatory Services, will provide an overview of the current maternity service, and the proposed Shared Care model on Monday 29 February, from 13.00 - 14.00, Education Building, Seminar Room 1.5, Fiona Stanley Hospital. There will be an opportunity to discuss the model, ask questions and provide feedback. RSVP to Kate Hendry via email kate.Hendry@health.wa.gov.au. Download the flyer here.


The Gynaecological service provides both elective and emergency care.  Emergency Gynaecology is provided via the Emergency Department and Acute Gynaecology Clinic which is a one-stop service with scan facilities for acute gynaecological problems including early pregnancy.  Elective gynaecological clinics and surgery is provided throughout week.

Contacts:
  • Obstetrics and Gynaecology Registrar via Helpdesk 6152 2222 Available: 24 hours / 7 days
  • Direct referral for early pregnancy problems and other gynaecological emergencies that are not life threatening (Acute Gynaecology Clinic) Phone: 6152 4052 Available: 0800 – 1300 / Mon-Fri
Documents to support urgent referrals can be faxed to:
  • Emergency Gynaecology: 6152 4319
  • Emergency Obstetrics: 6152 4320

Obstetrics/Gynaecology registrar to be contacted prior to sending fax.
Gynaecology referrals should be through Central Referral Service.

Princess Margaret Hospital Liaison update 

Notifications and Clinical Summaries (NaCS)

PMH is switching systems for patient discharge summaries from TEDS to NaCS. The format of the summaries you receive will be changing at this time. The system will be rolled out from Monday February 8 and will take a few weeks. If you are receiving electronic discharge summaries you will no longer receive a hardcopy. Patients will receive a hard copy.


Princess Margaret Hospital GP Information
The Princess Margaret Hospital website has a section for GPs under the Health Professionals tab.
Here you will find:

  • Drug Information
  • Poisons Centre Information and
  • Dental Emergencies.
  • Contact details for Emergency Department
  • ED guidelines (these include handy paediatric drug dose calculator) and
  • Pre-referral guidelines with useful management advice for headaches, constipation, urinary tract infections, chronic fatigue, failure to thrive, enuresis and chronic abdominal pain.

Dr Maree Creighton, Hospital Liaison GP PMH
Email:
Maree.Creighton@health.wa.gov.au
Available: Tuesday 9am-12pm and Wednesday 12pm-5pm
Phone: 9340 7994

Osborne Park Hospital Liaison update 

Rehabilitation and Aged Care at OPH

Osborne Park Hospital has a very active Rehabilitation and Aged Care department that is able to offer excellent in-patient care, community assessment (ACAT), outpatient clinics and emergency community assessment and management through the Rehabilitation and Aged Care intervention Liaison Service (RAILS). These services are available to patients over the age of 65 years.


There is a consultant Geriatrician on call 24 hours a day who is happy to assist with clinical advice, arranging of day hospital review or to facilitate admission. Timely discussion of a case with the consultant is often able to avoid an emergency department admission. There may be the opportunity for your patient to be admitted directly to the OPH Rehabilitation and Aged Care ward. Telephone 9346 8000 and request to be put through to the on call geriatrician.

  • Rehabilitation and Aged Care Intervention Liaison Service (RAILS)
  • Urgent home visiting service
  • Tel 9346 8315   
  • Fax 9346 8263
  • Mobile: 0404 803 569. This number is intended to assist health professionals in referring and accessing information. Please do not give it out to patients.

Referral forms for RAILS are available at www.oph.health.wa.gov.au/Clinicians/GP_Referral_Forms.html 

OPH is fortunate to be able to offer a fantastic service that aims to help avoid emergency admissions of elderly patients. The RAILS team (nurses, OT, physio, social worker) are able to respond within 48 hours to an acute situation. The patient can be visited at home and prompt arrangements put in place to assist caring for them at home.

Services available:

  • review and comprehensive care planning for patients at home
  • Social work advice on urgent residential accommodation or respite
  • Able to  facilitate direct admissions and day hospital reviews and
  •  increase support for patients after discharge.

A GP referral is required. Please refer either by telephone or fax.

King Edward Memorial Hospital Liaison update 

Obstetrics and Antenatal GP update

General Practitioners are invited to the 2016 O & G GP Update, part of King Edward Memorial Hospital’s ongoing commitment to support General Practitioners in providing antenatal care as well as assessment and management of women with gynaecological problems. Junior doctors and other doctors working in women’s health are also welcome.

Full day attendance qualifies as a Certificate of Women’s Health (CWH) workshop for the DRANZCOG.


Topics Covered Include:

  • Shared Antenatal Care: Principles and Pitfalls
  • Screening tests in pregnancy including Non-invasive Pre-natal Testing
  • WA Preterm Birth Initiative and the role of GPs in preventing preterm birth
  • Managing Polycystic ovarian syndrome & infertility in General Practice
  • Urinary incontinence and prolapse in adult women
  • Menopause
  • Office Gynaecology problems including menstrual problems and STIs
  • Cervical Cancer screening and new guidelines

RACGP QI & CPD points have been applied for as per below:
Category 1 (40 Women’s Health points) for full day attendance and completion of required activities Category  2  (2 points per hour of education) Activity Number TBC.

Numbers are limited and registration closes 25 March.

  • Early Bird (by 29/02/16): Full Day $120/Half Day $60 morning or afternoon
  • Standard: Full Day $150/Half Day $75 morning or afternoon
  • Enquiries phone (08) 9340 1388 or email kemh.postgrad@health.wa.gov.au
  • To download registration form click here  


Dr Vicki Westoby, KEMH Liaison GP
Email:
victoria.westoby@health.wa.gov.au 
Phone:
934015611 (Mondays and Tuesdays)

Royal Perth Hospital Liaison update 


RPH GP Notify Problems
Unexpected problems with GP Notify resulted in a number of fax and electronic RPH notifications of admission, discharge or death not being sent to GPs between Wednesday 6th January 2016 and Friday 5th February 2016 or being delayed. This problem has been rectified however some notifications from that period will not be sent. We apologise for any inconvenience and thank you for your patience over this period.

Rapid Access Chest Pain Clinic (RACPC) Now Open

This service, which is now open at Royal Perth Hospital, aims to offer GPs direct and timely access to WA’s first state-of-the-art public, tertiary centre rapid access chest pain clinic (RACPC). Referrals can be made via a single point of contact (direct dial number) for patients who would normally be referred to RPH with new onset (<3/12) chest pain, suggestive of angina, who are not having an acute coronary syndrome (ACS). The service offers:

1 Rapid access (<1 week) to expert clinical assessment.

2 Rapid individually tailored investigation; including exercise stress test, CT coronary angiography, myocardial perfusion imaging, stress echo or conventional coronary angiography as appropriate.

3 An individualised management plan, developed in consultation with a consultant cardiologist

For further info on how to refer, inclusion and exclusion criteria view the flyer here

Dr Jacquie Garton-Smith, Hospital Liaison GP, RPH
Email: Jacquie.Garton-Smith@health.wa.gov.au
 

HealthPathways WA  

In this update

  • New Pathways
  • Zika Virus Pathway
  • Clinical Stream Working Groups
  • HealthPathways Country Engagement



New Pathways
Launched 17 February:
1. Pertussis (whooping Cough)
2. Pertussis vaccine for pregnant and post partum women.

Zika Virus Pathway
A Zika virus pathway is in draft awaiting final Federal Government recommendations. This pathway will contain up-to-date assessment and management information as well as information for patients. Check the HealthPathways WA home page to check when this pathway goes live.

Clinical Stream Working Groups
HealthPathways are recruiting for GPs to participate in the following working groups:

  • Child Mental Health (ADHD, Autism Spectrum Disorder and FASD) – 1, 2 or 3 March
  • Pain Management – 15, 16 or 17 March
  • Chest Pain – 29, 30 or 31 March
  • Diabetes – 12, 13 or 14 April

Please email healthpathways@wapha.org.au if you wish to be involved in any of the above working groups.

HealthPathways Country Engagement
HealthPathways is on the road! The Clinical Leadership team will be visiting GP practices and country health staff across the South West, Goldfields, Midwest and Great Southern between now and April. Contact healthpathways@wapha.org.au for more information.

Clinical update 

In this update:

  • Zika Virus
  • Hepatitis C Drugs Q&A
  • 2016 Seasonal Influenza Immunisation Program
  • Approval for Yellow Fever Vaccination Clinics
  • Women Want to Know – Talking Alcohol Intake with Expectant Mothers
  • New diabetes society to be the voice of primary care professionals

Zika Virus

On 1 February 2016 the WHO announced a Public Health Emergency of International Concern in relation to the Zika virus. The Department of Foreign Affairs and Trade has released a travel advice bulletin warning pregnant women to reconsider the need to travel to regions where Zika virus outbreaks are occurring.

A list of countries with current or recent Zika Virus activity can be found on the Australian Department of Health website. Click here. For the most up to date information for Australian clinicians and public health practitioners can click here.

 
Western Australian specific information
There are no Aedes mosquito vectors in WA so there is no recognised risk of Zika transmission in this state. PathWest can undertake serological testing for Zika virus if indicated for illness in travellers returning from countries experiencing Zika outbreaks. Zika Virus is a notifiable under the “Arboviral encephalitis (MVE, Kunjin, JE, other)” designation, as Zika virus is a related flavivirus and hence captured by the “other” – irrespective of the clinical presentation.

Pregnant women with exposure to Zika Virus
The Communicable Disease Network Australia (CDNA) have a working group that should have some Asutralian guidelines out shortly to help practitioners who are seeing pregnant women with possible Zika exposure. Until these guidelines are available CDCD recommends practitioners use the following information from the UK or USA. The WA CDCD team or Public Health Units can also be contacted for specific advice.
UK:     https://www.gov.uk/guidance/zika-virus has good guidance for Primary Care and algorithm for assessing pregnant women
USA:      http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html


Hepatitis C Drugs

PBS listings for the new drugs are now online. A FAQ for prescribers has been prepared. Click here to view.
 


2016 seasonal influenza immunisation program

  • All government-funded influenza vaccines provided in WA in 2016 will be quadrivalent influenza vaccines.
  • It is anticipated that government-funded influenza vaccines will be available to order by early April 2016.
  • WA Health will alert providers by fax and email once influenza vaccines are available to order.
  • Eligibility for government-funded vaccines remains unchanged from 2015


 
Composition of the 2016 government-funded influenza vaccines
All influenza vaccines provided through the National Immunisation Program and WA Health programs in 2016 will be quadrivalent influenza vaccines (QIVs). The 2016 QIVs will contain the following strains:

  • A/California/7/2009 (H1N1)pdm09-like virus – unchanged from 2015
  • A/Hong Kong/4801/2014 (H3N2)-like virus - changed from 2015
  • B/Brisbane/60/2008-like virus, Victoria lineage – unchanged from 2015 QIV; not included in 2015 trivalent influenza vaccine (TIV)
  • B/Phuket/3073/2013-like virus, Yamagata lineage – unchanged from 2015.

The Government-funded influenza vaccine brands for 2016 are detailed in the table below.

Brand and dose ≥ 6mths <3yrs ≥ 3yrs
FluarixTM Tetra 0.5 mL (GSK) Not registered Use 0.5 mL dose
 
FluQuadriTM Junior 0.25 mL (Sanofi Pasteur) Use 0.25 mL dose
 
Not applicable

 
Although Fluvax® will not be distributed through government-funded programs in 2106, Fluvax® may be available for private purchase. Fluvax® is not registered by the Therapeutic Goods Administration (TGA) for use in children under the age of 5 years, and not recommended for children aged 5 to 9 years.


Approval for Yellow Fever Vaccination Clinics or Providers
In Australia, yellow fever vaccination clinics or providers are approved by state and territory health authorities. In WA the Communicable Disease Control Directorate approves clinics and providers to administer yellow fever vaccines. To apply for approval phone 9388 4835 or email vaccineorders@health.wa.gov.au.

For further information can be found on the Department of Health website including:

  • Guidelines for accreditation of yellow fever vaccination centres,
  • Requirements International Certificate of Vaccination or Prophylaxis,
  • Where to purchase International Certificate of Vaccination or Prophylaxis Booklets,
  • Requirements for Stamps of Accredited Vaccination Centres.

 


Women Want to Know – Talking Alcohol Intake with Expectant Mothers

Women Want to Know is a national campaign funded by the Commonwealth Health Department to encourage health professionals – primarily GPs, midwives and OBGYNs – to discuss alcohol consumption during pregnancy with pregnant women or women planning pregnancy, highlighting the change to the NHMRC guidelines in 2009.  Women Want to Know was developed by FARE in collaboration with leading health professional bodies including the Royal Australian College of RACGP,  RANZCOG, the AMA, the Australian College of Midwives (ACM), the former Australian Medicare Locals Alliance and Maternity Choices (formerly Maternity Coalition).

 
Australian research has shown that 97% of women want to be asked about alcohol during pregnancy however there are barriers to health professionals meaningfully engaging with women on this topic. These include not wanting to stigmatise women or make them feel judged or guilty. National data shows that:

  • 20% of Australian women continue drinking during their pregnancies.
  • older women with higher incomes and higher levels of education are more likely to keep drinking during pregnancy than younger women, especially women under the age of 25.
There are a number of Women Want to Know resources to support health professionals and women.

Free online CPD courses through:
  • Australian College of Midwives
  • Royal Australian and New Zealand College of Obstetricians and Gynaecologists; and
  • Royal Australian College of General Practitioners
If you are not a member of any of these colleges the course is available to non-members Short YouTube videos with women and with health professionals having conversations about alcohol in pregnancy with women
https://www.youtube.com/user/healthgovau/playlists

Resources for Practices
  • Women Want to Know Project Brochure (red) - Information about the project itself
  • Women Want to Know Alcohol & Pregnancy information card (A4).
  • AUDIT-C Screening Tool card (A4) AUDIT-C is an adapted alcohol screening tool that includes three questions (the full AUDIT tool has 10).
  • Women Want to Know Information Brochure for Women (blue) - This brochure is designed to be given to women following a conversation with them in a consultation to provide them with some take away information (it was not designed with the intention of being left in waiting rooms for patients to read in isolation from a conversation with their health professional)

All of these resources can be ordered for free here.
The link to the recent Four Corners episode focused on FASD can be viewed here.


Primary Care Diabetes Society of Australia

In December 2015 The University of Melbourne announced the formation of the Primary Care Diabetes Society of Australia (PCDSA). The not-for-profit society has been established to support primary health care professionals to deliver high quality clinically effective care, in order to improve the lives of people living with diabetes.

 
The PCDSA aims to:

  • Share best practice in delivering quality diabetes care.
  • Provide high-quality education tailored to health professional needs.
  • Promote and participate in high quality research in diabetes.
  • Disseminate up-to-date, evidence-based information to health professionals.
  • Form partnerships and collaborate with other diabetes related, high level professional organisations committed to the care of people with diabetes.
  • Promote co-ordinated and timely interdisciplinary care.

 
Primary health care professionals can join the PCDSA and access the quarterly online journal and PCDSA at the website:  www.pcdsa.com.au. Membership of the PCDSA is free for Australian primary healthcare professionals who manage diabetes.
 
Membership requires an AHPRA registration number. Registration is by registering for the journal. If you encounter problems registering email mark.kennedy@pcdsa.com.au.

Registrations are now open for the PCDSA Inaugural Conference to be held in Melbourne on Saturday 30 April at the University of Melbourne, Parkville Victoria, Australia
 
The conference program includes a panel of highly regarded Australian speakers and the keynote speaker will be Sir Michael Hirst from Scotland who just stepped down after 3 years as President of the International Diabetes Federation.
 
For registration and further information visit: www.eventful.com.au/pcdsa
 

Aboriginal health 

In this update:

  • CtG PBS CoPayment Measure
  • PBS listing for Aboriginal people
  • Remote area Aboriginal health services PBS items (S100)
  • Care co-ordination and supplementary Services – Webster packs


 
There are a number of measures that have been put in place by the government in recognition of the greater burden of disease experienced by Aboriginal and Torres Strait Islander peoples, as well as of the morbidity almost exclusively seen in this population­1. The measures discussed in this update are designed to improve access to care and treatment for those who would be otherwise disadvantaged – either economically, geographically, or with chronic conditions or co-morbidities.

CtG PBS CoPayment Measure
CtG script annotation is a component of the PIP Indigenous Health Incentive (IHI) and allows an Aboriginal patient either with, or at risk of, a chronic disease to access PBS medications at a reduced cost. A patient must register once with a PIP Indigenous Health Incentive (IHI) registered practice. Any Prescriber within any PIP IHI registered practice can then annotate scripts for the patient with ‘CtG’, initials, and a signature. Medication can then be dispensed from most pharmacies with CoPayment relief2.
Specialists in either primary or tertiary care are also able to annotate scripts with CtG for a patient. However, in order to do so:

  1. They must have received a referral from a GP
  2. The GP must state on the referral that the practice is PIP IHI registered
  3. The GP must also state on the referral that the patient has registered for CtG
Please see the link for a summary and comparison (including patient and practice benefits) of PIP IHI and CtG PBS CoPayment.

Specific listings on the PBS for Aboriginal and Torres Strait Islander people
Several PBS medications have been recognised as being particularly essential for addressing Aboriginal and Torres Strait Islander health needs and have become part of a specific PBS list.
 
Prescribers must be brand specific when prescribing medications from this List.
  • Examples of medications and/or the most commonly prescribed brand available include: Antifungals, numerous brands; Magnesium tablets, brand ‘MagMin’; Aspirin, brand ‘Spren 100’; Folic acid, brand ‘Megafol’;
  • Recently added: Hydroxocoblalmin, brand ‘Vita-B12’ or ‘Neo-B12’; Paracetamol, brand ‘Panamax’ or ‘Osteomol’
  • Also of note: a patient accessing Nicotine treatments via the ATSI specific PBS List is eligible for two courses of treatment, as opposed to the standard one course – Nicabate P, Nicotinell Step 1, Nicorette Invisipatch.
The full list can be found here

S100 Remote Area Aboriginal Health Services (RAAHS)
Clients of eligible remote area Aboriginal Health Services who may or may not identify as Aboriginal are able to receive PBS medications directly from the service under S100 arrangements3. Medicines on the S100 PBS list are supplied in bulk to RAAHS by community and hospital pharmacies. S100 RAAHS medications are not available outside of eligible services, which means that patients visiting metropolitan areas will need to access ongoing supplies under the regular system. This can lead to misunderstandings. Patients who are not already registered for the CtG PBS CoPayment can be registered by metropolitan GPs in order to access subsidised medications while ‘off Country’.

For further information or queries please contact: Dr Marianne Wood, Liaison GP (Aboriginal Health), Royal Perth Hospital. Marianne.wood@health.wa.gov.au
  • Support for the cost of “webster packs” may be available through the Care Co-ordination and Supplementary Services (CCSS) program under Closing the Gap.  These programs are GP referral only. For more information please see CCSS program contact details within HealthPathways: https://wa.healthpathways.org.au Username, connected; Password, healthcare.

References:

1 .Prescribing Medicines – Information for PBS Prescribers
2. Closing the Gap - PBS Co-payment Measure
3. Supply of PBS Medicines to remote area Aboriginal Health Services under the provisions of section 100 of the National Health Act 1953  

Feedback 

We want to know what you want to read more of and what is relevant to you and your practice. Submit your feedback to communications@wapha.org.au.

Learn more about WAPHA at our website.

Copyright © 2016 WA Primary Health Alliance, All rights reserved.


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