Medical Journal of Australia最新文献

{"title":"Human case of diphyllobothriasis in Australia","authors":"Sadid F Khan, Anson V Koehler, Alistair Tinson, Maidhili Chinnappan, Harsha Sheorey, Robin B Gasser","doi":"10.5694/mja2.52579","DOIUrl":"10.5694/mja2.52579","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"122-124"},"PeriodicalIF":6.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of GLP-1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system","authors":"Christopher Kanellis, Kyle Williams, Darcy Q Holt, Jennifer Wong, Rachel David, Ravi Carothers, Suong Le","doi":"10.5694/mja2.52582","DOIUrl":"10.5694/mja2.52582","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"118-121"},"PeriodicalIF":6.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of differences in bulk-billing rates: strategies for greater equity in Medicare","authors":"Sebastian P Rosenberg, Ian B Hickie","doi":"10.5694/mja2.52580","DOIUrl":"10.5694/mja2.52580","url":null,"abstract":"<p>In this issue of the <i>MJA</i>, Saxby and Zhang<span><sup>1</sup></span> provide more evidence about the limits of Medicare as a universal public health insurance scheme, highlighting deep inequities that mean that access to general practice-based Medicare services depends less on your needs than on where you live.</p><p>The authors provide some reassurance in that they report that bulk-billing rates are higher in the most socio-economically disadvantaged regions of Australia (86%) than in the least socio-economically disadvantaged (73%). However, they also identified that mean out-of-pocket costs for general practice services are substantial in many areas, including disadvantaged regions and remote areas. Consequently, people living in remote and socio-economically disadvantaged areas are still likely to be spending larger proportions of their incomes on out-of-pocket fees for primary care health services.<span><sup>1</sup></span></p><p>The federal government has recognised the need for solutions to this problem. It increased the bulk-billing incentives for general practitioners in rural and remote areas in January 2022, and subsequently tripled them in November 2023.<span><sup>2</sup></span> Nevertheless, Saxby and Zhang found that people pay a mean of $43 for non-bulk-billed general practitioner visits, more than the triple bonus, which means that these incentives are unlikely to be sufficient to reduce out-of-pocket costs, particularly for people in metropolitan areas, where the bonus payments are lowest.<span><sup>1</sup></span></p><p>Our own research has found both steep increases and major differences in out-of-pocket costs for health care in Australia.<span><sup>2</sup></span> Our findings and those of Saxby and Zhang are consistent with those regarding other critical areas of health care.<span><sup>3</sup></span> Using bulk-billing rates as a proxy measure of “good care” is inappropriate and misleading. A key limitation of the analysis by Saxby and Zhang is that they could not consider patient needs. In mental health, the paradox of psychological distress and service use has been understood for some time; that is, we know that more services are provided where they are needed least.<span><sup>4</sup></span></p><p>Three key questions must be addressed if we are to reduce growing inequities in Medicare. The first concerns limitations associated with relying on fees for service as our primary payment mechanism, particularly for people with complex needs. Medicare funds teamwork poorly. Sending a young woman with an eating disorder to a psychologist for fifteen (partially subsidised) sessions is unlikely to achieve long term benefits. Instead, in addition to the psychologist, she would probably profit from care provided by a team comprising a general practitioner, a nurse, a dietitian, a psychiatrist and allied health workers, helping her stay connected with school, work, friends, and family.<span><sup>5</sup></span> Australia must divers","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"133-134"},"PeriodicalIF":6.7,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline","authors":"Renuka Shanmugalingam, Angela Makris","doi":"10.5694/mja2.52576","DOIUrl":"10.5694/mja2.52576","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"158-159"},"PeriodicalIF":6.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guidelines","authors":"Cathy Latino, Oyekoya T Ayonrinde","doi":"10.5694/mja2.52575","DOIUrl":"10.5694/mja2.52575","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"158"},"PeriodicalIF":6.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban green space provision: the case for policy-based solutions to support human health","authors":"Craig Williams, Christie Byrne, Shannon Evenden, Veronica Soebarto, Stefan Caddy-Retalic, Carmel Williams, Yonatal Tefera, Xiaoqi Feng, Andrew Lowe","doi":"10.5694/mja2.52569","DOIUrl":"10.5694/mja2.52569","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"110-113"},"PeriodicalIF":6.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic counsellors: facilitating the integration of genomics into health care","authors":"Tatiane Yanes, Eliza Courtney, Mary-Anne Young, Amy Pearn, Aideen McInerney-Leo, Jodie Ingles","doi":"10.5694/mja2.52568","DOIUrl":"10.5694/mja2.52568","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"114-117"},"PeriodicalIF":6.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-thinking kidney function: a new approach to kidney function estimation and the identification of chronic kidney disease","authors":"Jessica Dawson, Meg Jardine","doi":"10.5694/mja2.52560","DOIUrl":"10.5694/mja2.52560","url":null,"abstract":"<p>Each serum creatinine pathology test result in Australia is routinely returned with a report on the estimated glomerular filtration rate (eGFR). The equation for calculating the eGFR has been updated, and Australian practitioners may be curious to know why this might concern them.</p><p>The eGFR equations were derived from multiple studies that used direct measurements of kidney function with accurate but intensive methods that are generally reserved for research, such as the clearance of the exogenous filtration markers inulin, iothalamate, or iohexol.<span><sup>1</sup></span> The Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)<sub>2009</sub> equations included serum creatinine concentration, age, sex, and race (Black or non-Black) as variables.<span><sup>1</sup></span> A new, race-free equation was developed after concerns in the United States regarding the validity, accuracy, and implications of including a binary or non-binary race component.<span><sup>2</sup></span> In 2021 the CKD-EPI published a newly derived and validated race-free equation (CKD-EPI<sub>2021</sub>), and reported that the new equations produced estimates of measured kidney function that were within the accepted 30% margin of error.<span><sup>3</sup></span> The CKD-EPI confirmed that equations based on creatinine and cystatin concentrations consistently produce more accurate estimates than equations based on creatinine alone. It also reconfirmed the clinical relevance of eGFR, reporting a strong inverse linear association with the risk of kidney failure, adverse cardiovascular events, and death. The association of lower eGFR with adverse event risk is the underlying rationale for risk-based categories in the widely used KDIGO classification of chronic kidney disease.<span><sup>4</sup></span> Using the new equation without a race coefficient is now the recommended standard.<span><sup>5</sup></span></p><p>Practitioners may wonder about the implications of the change for Australia. At the individual level, the difference is mostly a minor, one-off change in eGFR that might only be apparent in people who are being frequently monitored at the time of the equation change. At the population level, even small changes in the calculated eGFR could affect how health systems anticipate and plan for chronic kidney disease (CKD)-associated health care.</p><p>CKD has a large impact on community health and on health budgets. It affects an estimated one in ten Australian adults, and one in five Aboriginal and Torres Strait Islander adults.<span><sup>6</sup></span> The association of CKD with adverse outcomes<span><sup>4</sup></span> is reflected by the prediction that CKD-associated death will be the fifth leading cause of years of lost life globally by 2040.<span><sup>7</sup></span> Even now, it has been estimated that CKD costs the Australian economy $9.9 billion each year.<span><sup>8</sup></span></p><p>How the CKD-EPI<s","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"72-73"},"PeriodicalIF":6.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulk-billing rates and out-of-pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data","authors":"Karinna Saxby, Yuting Zhang","doi":"10.5694/mja2.52562","DOIUrl":"10.5694/mja2.52562","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine bulk-billing rates and out-of-pocket costs for non-bulk-billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area-level socio-economic disadvantage and remoteness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Retrospective analysis of administrative data (Medicare claims data).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>All Medicare claims for non-referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Mean proportions of general practitioner services that were bulk-billed and mean patient out-of-pocket costs for non-bulk-billed general practitioner visits by SA3 region, adjusted for area-level age and sex, both overall and by area-level socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During 2022, 82% (95% confidence interval [CI], 80–83%) of general practitioner services in Australia were bulk-billed; the mean out-of-pocket cost for non-bulk-billed visits was $43 (95% CI, $42–44). By SA3, mean bulk-billing rates ranged between 46% and 99%, mean out-of-pocket costs for non-bulk-billed general practitioner visit between $16 and $99. Bulk-billing rates were higher in regions in the most socio-economically disadvantaged quintile (86%; 95% CI, 84–88%) than those in the least disadvantaged quintile (73%; 95% CI, 70–76%); the mean rate was not significantly different for remote (86%; 95% CI, 79–92%) and metropolitan areas (81%; 95% CI, 79–83%). Out-of-pocket costs for non-bulk-billed general practitioner services were higher in remote ($56; 95% CI, $46–66) than in metropolitan areas ($43; 95% CI, $42–44), and lower in areas in the most socio-economically disadvantaged quintile ($42; 95% CI, $40–45) than in those in the least disadvantaged quintile ($47; 95% CI, $45–49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although most general practitioner services are bulk-billed, out-of-pocket costs for non-bulk-billed services are relatively high, particularly for people in remote and socio-economically disadvantaged areas of Australia.","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 3","pages":"144-148"},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of chronic kidney disease in older Australian adults by the CKD-EPI 2009 and 2021 equations: secondary analysis of ASPREE study data","authors":"Elisa K Bongetti, Rory Wolfe, James B Wetmore, Anne M Murray, Robyn L Woods, Michelle A Fravel, Mark R Nelson, Nigel P Stocks, Suzanne G Orchard, Kevan R Polkinghorne","doi":"10.5694/mja2.52559","DOIUrl":"10.5694/mja2.52559","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the clinical impact on generally healthy older Australians of changing from the 2009 CKD-EPI (CKD-EPI<sub>2009</sub>) to the 2021 CKD-EPI (CKD-EPI<sub>2021</sub>) equation for calculating the estimated glomerular filtration rate (eGFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Secondary analysis of data from the prospective ASPirin in Reducing events in the Elderly (ASPREE) cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Australians aged 70 years or older living in the community and without life-limiting medical conditions, recruited 1 March 2010 – 31 December 2014 for the ASPREE trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Baseline characteristics and long term health outcomes for participants classified to different chronic kidney disease (CKD) stages by CKD-EPI<sub>2021</sub> and CKD-EPI<sub>2009</sub>, and for those classified to the same CKD stage by both equations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Complete data were available for 16 244 Australian ASPREE trial participants. At baseline, their mean age was 75.3 years (standard deviation, 4.4 years), and 8938 were women (55%); the median eGFR (CKD-EPI<sub>2009</sub>) was 74 mL/min/1.73 m<sup>2</sup> (interquartile range [IQR], 64–85 mL/min/1.73 m<sup>2</sup>), the median urine albumin-to-creatinine ratio 0.8 mg/mmol (IQR, 0.5–1.4 mg/mmol). eGFR values were higher for most participants with CKD-EPI<sub>2021</sub> than with CKD-EPI<sub>2009</sub> (median difference, 3.8 mL/min/1.73 m<sup>2</sup>; IQR, 3.3–4.4 mL/min/1.73 m<sup>2</sup>), and 3274 participants (20%) were classified to less advanced CKD stages by CKD-EPI<sub>2021</sub>. The proportion of participants with eGFR values below 60 mL/min/1.73 m<sup>2</sup> (clinical CKD) was 17% (2770 participants) with CKD-EPI<sub>2009</sub> and 12% (1994 participants) with CKD-EPI<sub>2021</sub>. Participants were followed up at a median of 6.5 years (IQR, 5.4–7.9 years); the risks of reaching the disability-free survival composite endpoint (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.84–1.05), all-cause mortality (aHR, 0.90; 95% CI, 0.78–1.03), major cardiac events (aHR, 0.94; 95% CI, 0.79–1.13), and hospitalisations with heart failure (aHR, 1.00; 95% CI, 0.67–1.49) were each similar for participants reclassified or not reclassified by CKD-EPI<sub>2021</sub>.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"74-81"},"PeriodicalIF":6.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}