We have a number of members who have respiratory conditions that are seriously affected by air quality. Air quality is an important issue for all of us as we can’t avoid breathing in the air around us. Diane Proctor has been looking into how consumers can access information about air quality and has written this post.
For those of us who suffer from respiratory diseases, we often do not understand why we feel so much worse on some days than others. Asthma sufferers, people with COPD, and related illnesses sometimes feel really breathless for no apparent reason. Having two brothers mad about flying and in the air force, I have long been interested in weather forecasting. (I too tried to get my private pilot's license back in my late teens but was thwarted by the cost!) As a result of this, I go to the Bureau of Meteorology's website regularly. In wandering around the site, I discovered that I could get air quality readings (or measurements of pollution in the atmosphere) from the Sydney area and also from most regions in NSW. This aroused my curiosity and I was even more interested when I sensed all was not well with the ACT air quality in Canberra a week or so ago. It was the day of the dust storms! I rang up the Bureau and was eventually connected to a very helpful person in Melbourne who explained to me that BOM does not have the instruments to measure pollution but if State Health Authorities give them the information they will publish it. He advised me to look at my local emergency services website Sure enough, there were pollution warnings published there. By chance, I happened to hear a health alert warning on the ABC regional station (666 here in Canberra) and I talked to the producer of the program. She told me that as part of its mandate, the ABC must broadcast such alerts However, no other broadcasters are obliged to do so.
So what does this mean for us? If you have a respiratory disease, I suggest you check the Emergency Service website regularly, especially if you feel unwell for no apparent reason. I also suggest that support groups for people with respiratory diseases try to encourage their Health Departments to convey such warnings to the BOM as a matter of course so that they are included in the regular weather reports. If we know we should stay indoors and close the windows, we could probably save a lot of visits to the ER rooms at Hospitals and thus save a lot of money. Also, we can watch a good movie and not worry!!!
Sunday, May 10, 2009
Tuesday, May 5, 2009
Budget for 2009 - 2010
Overall, HCCA is pleased to see that the Government has made provisions for services to meet the growing demand, despite the financial crisis. The budget makes provision for further development of the services as set out in Your Health - Our Priority, especially the e-health infrastructure and the design and construction of the community health centre at Belconnen. while we recognise that there is funding to build GP workforce, and funding the in-hours locum service, we are disappointed that there are not more initiatives aimed at improving access to primary health care for older people and will work with the GP Task Force to find ways to overcome this seemingly intractable problem.
We welcome the expenditure for electronic health capacity and infrastructure and consider that it is essential to building a robust and efficient health service for our community.
Enhanced Community Health Centre for Belconnen
HCCA welcomes the Government’s provision of $51.3m for the design and construction of the ECHC at Belconnen. We are very pleased that this has been brought forward, and consider that this offers great potential to develop services for those people in the Belconnen region. We look forward seeing the ACT Government working with the community to identify the services that will best meet the needs of that community. We are also very interested to see how the ECHC will work with the services that will be offered with the West Belconnen Health Cooperative so that they complement each other rather than duplicate services. We also look forward to seeing sufficient flexibility built into the design of the facility to enable other services to be located here over time, such as the ACT Health Equipment Service.
Walk in Centre - The Canberra Hospital
We look forward to working with the Government in the development of the walk in centre for The Canberra Hospital.
Cancer Services
We note the increase in funding for cancer services ($4.2m over four years). Comprehensive cancer services however, need to be provided far sooner than as stated in the documents, to effectively deal with the burden of disease.
Calvary
There is no specific provision for growth in public hospital services on the Bruce campus, while we acknowledge there is uncertainty of who will operate this, we would like to see provision for the development of services to complement those provided across the Territory.
Work Force
There is recognition that people are experiencing difficulty accessing GPs; the budget includes $1.9m to establish an in-hours aged care locum service. we consider that this funding allocation is insufficient in view of the demand we see in residential aged care facilities, older people living independently in the community, people with disabilities and other people with mobility issues.
We are pleased to see the funding of 15 new health assistants. We support the notion of the development of more innovative clinical roles, but we note with some concern there is no specific funding to further increase the role of nurse practitioners. Nurse practitioners have demonstrated their worth as an effective adjunct to traditional roles and we would like to see more funding to increase the number of nurse practitioners in the health workforce.
We welcome the intiatives to build our GP workforce, including the four training positions in general practice for junior doctors and the medical graduate scholarships.
Support for Consumers with Chronic Conditions
We welcome the allocation of $4.2m over 4 years to ensure better support for people with chronic conditions; we call on the government for further support of these programs once they have proven to be effective. We would expect to see considerable increase in funding to enable the roll out to more people in the community.
We welcome the expenditure for electronic health capacity and infrastructure and consider that it is essential to building a robust and efficient health service for our community.
Enhanced Community Health Centre for Belconnen
HCCA welcomes the Government’s provision of $51.3m for the design and construction of the ECHC at Belconnen. We are very pleased that this has been brought forward, and consider that this offers great potential to develop services for those people in the Belconnen region. We look forward seeing the ACT Government working with the community to identify the services that will best meet the needs of that community. We are also very interested to see how the ECHC will work with the services that will be offered with the West Belconnen Health Cooperative so that they complement each other rather than duplicate services. We also look forward to seeing sufficient flexibility built into the design of the facility to enable other services to be located here over time, such as the ACT Health Equipment Service.
Walk in Centre - The Canberra Hospital
We look forward to working with the Government in the development of the walk in centre for The Canberra Hospital.
Cancer Services
We note the increase in funding for cancer services ($4.2m over four years). Comprehensive cancer services however, need to be provided far sooner than as stated in the documents, to effectively deal with the burden of disease.
Calvary
There is no specific provision for growth in public hospital services on the Bruce campus, while we acknowledge there is uncertainty of who will operate this, we would like to see provision for the development of services to complement those provided across the Territory.
Work Force
There is recognition that people are experiencing difficulty accessing GPs; the budget includes $1.9m to establish an in-hours aged care locum service. we consider that this funding allocation is insufficient in view of the demand we see in residential aged care facilities, older people living independently in the community, people with disabilities and other people with mobility issues.
We are pleased to see the funding of 15 new health assistants. We support the notion of the development of more innovative clinical roles, but we note with some concern there is no specific funding to further increase the role of nurse practitioners. Nurse practitioners have demonstrated their worth as an effective adjunct to traditional roles and we would like to see more funding to increase the number of nurse practitioners in the health workforce.
We welcome the intiatives to build our GP workforce, including the four training positions in general practice for junior doctors and the medical graduate scholarships.
Support for Consumers with Chronic Conditions
We welcome the allocation of $4.2m over 4 years to ensure better support for people with chronic conditions; we call on the government for further support of these programs once they have proven to be effective. We would expect to see considerable increase in funding to enable the roll out to more people in the community.
Sunday, May 3, 2009
Consumers, General Practice and General PRactitioners
The GP Task Force is interested in identifying consumer needs and expectations about general practice and general practitioners. Janne Graham is member of the GP Task Force and has written this post based on her considerable experience as a consumer representative and work completed by the Consumers Health Forum.
Consumer Perspectives on General Practice Restructuring, Consumers Health Forum of Australia, undated (1991?)
Building Links with Consumers: The Key to Quality General Practice, Consumers Health Forum of Australia, 1993.
Consumers Expectations of General Practice in Australia, Consumers Health Forum of Australia April 1999
Putting Consumers in the Picture – Consumer Perspectives on Better Integration of General Practice and Other Primary Health Care and Related Services, Consumers Health Forum of Australia, June 1999
Review of Standards of General Practice, Consumers Health Forum of Australia, March 2004
Wade T Engaging Consumers with General Practice in Primary Care Development in The Australian Health Consumer, No 2 2003-4, pp27-8
References
The organized health consumer movement has consulted widely with consumers on their experiences and perceptions of general practice, and their engagement with practitioners.
Generally research on consumer satisfaction highlights differences between the criteria applied by doctors and by consumers to a consultation in general practice.
What people want from their general practices includes:
Structural Issues
- Bulk billing/ affordable access
- Physical access, both locality and building design
- Out-of hours access
- Gender choice
- Good appointment systems – emergency and routine.
Consumers use different medical services for different needs. For conditions perceived to require extended care consumers prefer “traditional” general practices.
Process Issues
- Holistic approach, including knowledge of and referral to other health and community resources
- Improved preventive approach.
Outcome Issues
Providing explanations, diagnosis, outlining expectations of interventions and treatment
GPs as managers/team leaders seen as valuable when done well but not always necessary
Gatekeeper role acknowledged relating to access to health services but problematic (particularly for people with disabilities) when relating to other social resources (e.g. pensions)
“Some consumers place greater emphasis on accessibility of the practice, some on the attributes and qualities of the practitioners and some on the quality of care available. These differences might vary for different consumers, or groups of consumers, including those with special needs.” Review of Standards of General Practice p2
Consumer Perspectives on General Practice Restructuring, Consumers Health Forum of Australia, undated (1991?)
Building Links with Consumers: The Key to Quality General Practice, Consumers Health Forum of Australia, 1993.
Consumers Expectations of General Practice in Australia, Consumers Health Forum of Australia April 1999
Putting Consumers in the Picture – Consumer Perspectives on Better Integration of General Practice and Other Primary Health Care and Related Services, Consumers Health Forum of Australia, June 1999
Review of Standards of General Practice, Consumers Health Forum of Australia, March 2004
Wade T Engaging Consumers with General Practice in Primary Care Development in The Australian Health Consumer, No 2 2003-4, pp27-8
Thursday, April 23, 2009
Competency Based Training in Medical Education
Australian Medical Council - competency based training workshop
Sydney 21 April 2009
This week I participated in a workshop with the Australian Medical Council (AMC) that to consider the degree to which competency based training is currently used and how it could be used to improve medical education across the continuum from undergraduate to continuing professional development for those practicing independently.
There is considerable momentum behind the move toward Competency Based Training (CBT). Consumers have long held the view that medical education needs to focus on the broader notion of what it means to be competent and that consumers have a role in developing the standards.
The AMC is to be commended for bringing together such a variety of professionals who have expertise and interests in developing the education of medical professionals. The participants were described by Ian Frank, CEO of the AMC, to be "everybody who is anybody in medical education". There were around 75 participants as well as AMC staff who made it all happen. They included medical schools, state and commonwealth health departments, medical students association, medical boards, and representatives of Colleges, (including CEOs, Presidents, Past Presidents and Chief Examiners). And one consumer representative (me).
The AMC convened a plenary session during which three speakers focussed on different elements. Professor David Prideaux, Profession of Medical Education at Flinders Medical School, Prof Royce Sadler, Professor of Higher Education at Griffith University and expertise in formative assessment and learning and Peter White, CEO of Royal Australian and New Zealand College of Obstetricians and Gynaecologists. I think there was scope to include the consumer perspective of competence in this section and I know a number of consumer advocates who could have contributed to this session. I would encourage the AMC to be more inclusive of consumers and the consumer perspective in workshops such as this one.
Prof Prideaux referred to Lawrence Stenhouse’s work from the 1970s in which four functions of education were identified: training (skills and procedure); instruction (facts and protocols); induction (thinking and reasoning) and initiation (professional milieu, or the vibe). CBT fits well with the functions of training and instruction. You can define the skills, procedures and facts, then test the level of attainment with a range of reliable and valid assessment tools. CBT does not work well to measure the functions of induction and initiation. An outcomes approach needs to be developed for these.
Professor Sadler reflected on the political and historical roots of CBT and how competence is a word people warm to but is not easy to define. He also spoke about the difficulty in determining the appropriate degree of specificity. If the list of competencies is too atomistic they can lose sight of what you are trying to achieve: competent doctors.
I found that there is a reasonable degree of common ground between doctors and consumers on what competency means: that a doctor is safe to practice independently and that they possess the insight to reflect on their practice and know when they have reached the limit of their expertise and knowledge. The difficulty is in defining the technical aspects of competence in such a way that the explicitly refer to the holistic view of competency. There was emphasis placed on the need to take a holistic view of competence rather than reduce this to the specific elements. These broad attributes and competencies can be articulated but there is significant difficulty in assessing and determining the degree to which competencies have been acquired. Prof Prideaux spoke about the need to get terminology right. Competency based training works best at the macro level and warned against reducing competency to small chunks. While the more specific the skills the more easily they can be measured you run the significant risk of losing the big picture and the degree to which the trainee or practitioner has attained the global competencies. To date undergraduate medical education has managed to fend off the move to the technical competencies with a focus on inquiry learning, case studies, patient centered authentic learning and development of clinical reasoning.
One of the concerns participants expressed strongly was the potential for CMT to reduce the amount of time it takes to complete the training to become a doctor. The push for CBT it seems is from government who see that reduction in the time spent in training may alleviate the workforce shortage issues. There seems to be agreement in the profession that this is not necessarily the best thing for the quality of doctors. Doctors work off pattern recognition and by seeing lots of clinical cases they develop the ability to recognise symptoms. Their concern is that a reduction in the time taken to complete the training may compromise their level of experience.
Take away messages
The debate is an excellent opportunity to look at what medical education is all about. Consumers need to be involved with this and I would encourage Colleges and the AMC to engage with the consumer movement.
Sydney 21 April 2009
This week I participated in a workshop with the Australian Medical Council (AMC) that to consider the degree to which competency based training is currently used and how it could be used to improve medical education across the continuum from undergraduate to continuing professional development for those practicing independently.
There is considerable momentum behind the move toward Competency Based Training (CBT). Consumers have long held the view that medical education needs to focus on the broader notion of what it means to be competent and that consumers have a role in developing the standards.
The AMC is to be commended for bringing together such a variety of professionals who have expertise and interests in developing the education of medical professionals. The participants were described by Ian Frank, CEO of the AMC, to be "everybody who is anybody in medical education". There were around 75 participants as well as AMC staff who made it all happen. They included medical schools, state and commonwealth health departments, medical students association, medical boards, and representatives of Colleges, (including CEOs, Presidents, Past Presidents and Chief Examiners). And one consumer representative (me).
The AMC convened a plenary session during which three speakers focussed on different elements. Professor David Prideaux, Profession of Medical Education at Flinders Medical School, Prof Royce Sadler, Professor of Higher Education at Griffith University and expertise in formative assessment and learning and Peter White, CEO of Royal Australian and New Zealand College of Obstetricians and Gynaecologists. I think there was scope to include the consumer perspective of competence in this section and I know a number of consumer advocates who could have contributed to this session. I would encourage the AMC to be more inclusive of consumers and the consumer perspective in workshops such as this one.
Prof Prideaux referred to Lawrence Stenhouse’s work from the 1970s in which four functions of education were identified: training (skills and procedure); instruction (facts and protocols); induction (thinking and reasoning) and initiation (professional milieu, or the vibe). CBT fits well with the functions of training and instruction. You can define the skills, procedures and facts, then test the level of attainment with a range of reliable and valid assessment tools. CBT does not work well to measure the functions of induction and initiation. An outcomes approach needs to be developed for these.
Professor Sadler reflected on the political and historical roots of CBT and how competence is a word people warm to but is not easy to define. He also spoke about the difficulty in determining the appropriate degree of specificity. If the list of competencies is too atomistic they can lose sight of what you are trying to achieve: competent doctors.
I found that there is a reasonable degree of common ground between doctors and consumers on what competency means: that a doctor is safe to practice independently and that they possess the insight to reflect on their practice and know when they have reached the limit of their expertise and knowledge. The difficulty is in defining the technical aspects of competence in such a way that the explicitly refer to the holistic view of competency. There was emphasis placed on the need to take a holistic view of competence rather than reduce this to the specific elements. These broad attributes and competencies can be articulated but there is significant difficulty in assessing and determining the degree to which competencies have been acquired. Prof Prideaux spoke about the need to get terminology right. Competency based training works best at the macro level and warned against reducing competency to small chunks. While the more specific the skills the more easily they can be measured you run the significant risk of losing the big picture and the degree to which the trainee or practitioner has attained the global competencies. To date undergraduate medical education has managed to fend off the move to the technical competencies with a focus on inquiry learning, case studies, patient centered authentic learning and development of clinical reasoning.
One of the concerns participants expressed strongly was the potential for CMT to reduce the amount of time it takes to complete the training to become a doctor. The push for CBT it seems is from government who see that reduction in the time spent in training may alleviate the workforce shortage issues. There seems to be agreement in the profession that this is not necessarily the best thing for the quality of doctors. Doctors work off pattern recognition and by seeing lots of clinical cases they develop the ability to recognise symptoms. Their concern is that a reduction in the time taken to complete the training may compromise their level of experience.
Take away messages
- There is a need to get the terminology right and to define what is meant by competence, a competent practitioner and competency based training
- There is a preference for a program of assessment rather a number of high stakes tests. This could include progress testing, clinical reasoning, work based assessment and global rating of students by experienced clinicians.
- Educational panaceas come and go. In the enthusiasm (and pressure) to adopt CBT do not lose sight of the big picture: medical education needs to deliver to the profession and the public people who are competent in doing what they are trained for.
The debate is an excellent opportunity to look at what medical education is all about. Consumers need to be involved with this and I would encourage Colleges and the AMC to engage with the consumer movement.
Monday, April 20, 2009
GP Task Force
The GP Taskforce has been charged with the responsibility of investigating options and innovations for improving access to primary health care in the ACT and reporting back to the ACT Legislative Assembly in September 2009 with its recommendations.
The Taskforce is jointly chaired by Ross O'Donoughue, Executive Director, Policy Division, ACT Health and Dr Clare Willington, GP Advisor to ACT Health. Ms Janne Graham is the consumer representative on the Task Force and is being supported by HCCA. Further details of membership is available online.
The Terms of Reference include the review and consolidation of work already undertaken by the ACT and Commonwealth governments on access to primary care services in the ACT and the exploration and recommendation on legislative options to protect the rights of patients and the health workforce. It also includes consideration and recommendations on provisions to improve access to primary care services for vulnerable populations, including the aged, people with mental illness and the isolated.
The GP Taskforce has had reasonable coverage in the Canberra Times, Sydney Morning Herald and the ABC.
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