General Practice Flashcards
What history and examination should the GP perform, and what investigations would you order for this man? Refer to the RACGP Red Book to guide your answers.
What Medicare billing options are available for this consult?
- There are standard time-based consult fees – 23 (5-20 minutes) or 36 (20-40 minutes)
- There is also the Heart Health Assessment – item 699, or 177 (heart health assessment lasting at least 20 minutes)
- These can be bulk billed, where the patient pays no fee and the practice receives money directly from Medicare, or they can be privately billed – in this case the patient pays the whole fee, and receives a rebate from Medicare directly back into their bank account
Calculate his CV risk.
Advise him on management, based on his risk.
Using the CVD check calculator – his cardiovascular risk is 18%, i.e. high risk.
What Medicare items are there that could support your management of this patient? What are the requirements for these items?
How do you assess his readiness to change, and what is an intervention strategy you could use?
It is worth asking simple questions in a non-judgemental manner such as ‘how do you feel about your smoking’. From their answer, you can generally ascertain a sense of where they are in the Stages of Change Model: precontemplation, contemplation, preparation, maintenance, or relapse. Once you are aware of this, you can tailor appropriate questioning and advice.
How do you assess a person’s dependence to nicotine?
- 3 key questions?
What are 3 non-pharmacological options for smoking cessation?
What are 5 pharmacological options for smoking cessation?
Smoking cessation treatment algorithm?
How would his experience change if he was living in a rural location?
Read the following articles and compare and contrast the patient’s experience in Australia to the examples in the UK and China.
- 4 Similarities?
- 5 Differences?
How does the Australian healthcare system work in terms of government funding for public and private health care?
Specific target groups meet criteria for health assessments. List 9 of them.
How do you test for osteoporosis?
What are the recommendations for osteoporosis checks?
- For those at average risk?
- For those at increased risk?
Depending on the indication for scanning, different MBS billing codes will be used. See two examples summarising billing codes here. Compare and contrast each summary.
Discuss practice software recall and reminder systems, and what you would recommend for this patient.
Does she qualify for an MBS subsidized BMD scan? Consider reasons why she may not have had a BMD before.
Discuss how an Aboriginal Health Assessment differs from other health assessments.
Does she qualify for PBS subsidised medical treatment? If she had not had the minimal trauma fractures, would her options change? Comment on discrepancy between the MBS and PBS guidelines for screening and management of osteoporosis.
What are 8 evidence based falls prevention strategies that you could implement for this patient?
Refer to the resources below to inform yourself about the options available to this patient. How would you counsel this man in answer to his question about the PSA test? It is a good idea to practice this conversation with your peers as well as non-medically trained friends or family.
Look at this consult from the view point of a GP and of a urologist? How would it differ? Why do recommendations of the Cochrane Database, NHMRC and RACGP differ from those of the Urological Society of Australia and New Zealand?
What are the levels of evidence and strengths of recommendations used to classify research outcomes?
Why are levels of evidence and strengths of recommendations used to classify research outcomes?
Grades of recommendation are provided to assist users of the clinical practice guideline in making clinical judgments. Grade A and B recommendations are generally based on a body of evidence which can be trusted to guide clinical practice, whereas Grade C and D recommendations must be applied carefully to individual clinical and organisational circumstances and should be followed with care.
Is there a national screening program for prostate cancer in Australia?
Why is a PSA test not used?
There is no national screening program for prostate cancer in Australia.
Who is eligible to participate in the National Bowel Cancer Screening Program (NBCSP)?
All Australians aged 50 and above are recommended to participate in the NBCSP. It is offered as a free program where kits are mailed to eligible participants – they usually arrive within six months of the person’s birthday. The two samples are collected at home, and participants drop them to a pathology collection centre.
What happens with the results? Does it change if the person lives rurally?
Is there an inequity in cancer screening between Aboriginal and non-Aboriginal people?
Does the National Bowel Cancer Screening Program (NBCSP) meet the WHO criteria for a screening program?
Evaluation of the Bowel Cancer Screening Program has been found to be both effective, by reducing bowel cancer mortality, and cost-effective in Australia (i.e. falls within accepted thresholds). (Cost-effectiveness may nonetheless vary according to factors such as compliance rates and quality of follow-up.
What are the potential harms of the National Bowel Cancer Screening Program?
Harms of the screening program are related to the risks of procedures that are conducted because of true or false positive FOBT, or harms as a result of false negatives and subsequent reassurance that may lead to people not presenting for investigation of symptoms.
What are 2 possible implementation problems the National Bowel Cancer Screening program might face in Australia?
What are the opportunity costs of the multimillion dollar NBCSP program?
Opportunity cost is the cost of any activity measured in terms of the value of alternatives forgone. Opportunity costs play a crucial part in ensuring that limited resources (for example money, doctors’ time, theatre space) are used efficiently. The opportunity costs associated with spending health resources on this program and allocation of resources for the FOBT and follow up of patients, rather than in another area, also must be considered.
Is there a national skin cancer screening program?
There is no national screening skin cancer program – there is insufficient evidence to demonstrate mortality reduction. It is important rather to provide education on early signs of skin cancer.
Who should receive opportunistic checking for skin cancer?
- medium or increased risk (4)
- high risk (3)
How common is skin cancer in Australia?
What advice should she be given by the GP regarding skin cancer prevention? (7)
For breast cancer screening:
a. What are important characteristics of diagnostic tests?
b. What is a likelihood ratio?
List 8 harms related to breast cancer screening.
What is the ARR associated with screening when considering the outcome of mortality from breast cancer at 13 years in a) adequately and b) sub-optimally, randomised
studies?
What is overdiagnosis?
After an independent inquiry into the mammography screening program in France, two options were presented, both of which offered ending the screening program. Has Australia done a similar inquiry to re-think our breast cancer screening program? If not, should we?
Outline how the Australian health care system works and how funding is allocated?
- The Australian health system is a hybrid system with a universal, mandatory health insurance system funded through taxation and a private sector funded directly by patients or through a regulated, voluntary private health insurance system.
- The federal government funds Medicare, which is responsible for primary care, as well as aged care. It also funds pharmaceuticals through the Pharmaceutical Benefits Scheme. State governments fund and manage the public hospitals.
- Fee-for-service model, as occurs in primary health care, means that each service is paid for separately. Most of the time this is one payment per patient. Activity based funding, as occurs in public hospitals, means that for each activity the hospital receives payment – there may be many payments for one patient.
- Value based health care, capitation and bundled payments are all alternative funding models.
Primary health care in Australia is largely funded via a fee-for-service model and hospitals via an activity-based funding model. Outline these models of funding.
Outline alternative funding models, value-based health care, capitation and bundled payments as described in Koff’s paper and the AIHW report?
Why do you think there is a movement towards alternative models of care not based on volume of activity/service provision? (6 reasons)
Name 8 key health areas that require attention within the WA offender population.
Identify factors that contribute to hepatitis C being a problem in prisons. (4)
List 3 health conditions that more commonly affect Aboriginal prisoners than non-Aboriginal prisoners.
List 6 health conditions that more commonly affect female prisoners than male prisoners.
What additional factors would you need to consider as a GP and incorporate into your clinical management given that this patient has been recently released from prison?
What are 6 factors would you have to consider when treating prisoners?
