Australia’s COVID-19 Vaccine Rollout by the Numbers

Covid Vaccine By the Numbers Blog Image

In comparison with other countries, Australia’s COVID-19 vaccine rollout plan was very measured, and the implementation has been somewhat leisurely. With the frequent changes to the guidelines paired with vaccine hesitancy, vaccination hubs and GP clinics around the country have faced many challenges in their quest to immunise the nation.

In theory the government’s plan was considered and robust – vaccinations would be done in phases, where the most vulnerable would be immunized first, and the young and healthy would be immunized last. Millions of doses of the Astra-Zeneca vaccine were ordered, and could be manufactured locally, while fewer of the more expensive Pfizer vaccine was ordered for the most vulnerable.

A central online system was developed that allowed citizens and residents to determine which phase of the rollout they qualified for. Those who qualified for the first phase, aptly titled 1a, would be vaccinated soonest with the Pfizer vaccine at government run vaccine hubs. Those who were 1b or lower in the schedule could book into a participating GP clinic near them to get the Astra-Zeneca vaccine. 

Anyone who was involved with the logistics, patient booking, ordering and administration of COVID-19 vaccines was required to complete a five hour online module developed by the federal government to ensure adequate and uniform training of all personnel involved in the vaccine rollout. This included couriers, receptionists, nurses, doctors, and Practice managers at GP clinics around the country.

The plan also involves recording the vaccination details in a centralized system, the Australian Immunisation Register. A lot of groundwork had to be done by software vendors to enable the seamless uploading of this data. This data would help to accurately determine how many people have been vaccinated, in addition to enabling the safety of vaccine administration to ensure they are administered within appropriate time frames. Reactions to vaccines are also being collected to track trends and monitor for any emerging serious reactions.

Despite Australia’s COVID-19 vaccine rollout plan, four months into the rollout, as of the 3rd of June only 4.6 million vaccine doses have been administered in Australia, with only 2.1% of our population being fully vaccinated against COVID-19. A rough comparison with other countries with a similar GDP per capita and healthcare systems, over a period of five months paints a startling picture:

COVID Vaccination Numbers Infographic

The large vaccination numbers in the above-mentioned countries are mostly likely a reflection of the disastrous effect COVID-19 has had socially and economically in those nations, resulting in a more urgent rollout and vaccine acceptance within the community. Given the low level of infections and community transmission in Australia, the immediate benefit of the vaccine is not overtly obvious to many Australians and so the uptake has been slow.

Now with yet another outbreak in Melbourne, a sense of urgency has re-emerged as the public realise the pandemic is still very much a risk to us and this could happen anywhere in the country. Despite the risks of the vaccine, it is clear now from data overseas that the benefit is still greatly outweighed. One of the most common concerns held by those who are vaccine hesitant is the risk of blood clot from the Astra-Zeneca vaccine. Recent Australian data shows 31 confirmed cases of thrombosis with thrombocytopenia syndrome and 10 probably cases, out of a total of 3.29 million doses administered. At the time of writing, the death rate remains at one. Conversely, for every million people diagnosed with COVID-19, 165,000 of those cases (16.5%) experience blood clots as a symptom of the virus.

On the 1st of June 2021, the UK saw its first day without a COVID-19 death. This is a remarkable feat made possible due to their extraordinary vaccination rollout. Similarly, the USA has also seen a significant reduction in mortality and morbidity. Meanwhile other countries, such as Japan, that initially had a slow rollout and low vaccine uptake, are ramping up their vaccination efforts after recent Covid-19 outbreaks.

As a GP who is involved in vaccination counselling and administering the Astra-Zeneca vaccine, the experience has been interesting. From discussing patient concerns, to ensuring informed consent, appropriate documentation, and counselling on the potential side effects in a very short consult has been challenging. There is an immense amount of paperwork and logistical work that is done by my Practice manager and nursing staff to smoothly run the COVID vaccine clinics. Patients are confirmed multiple times to ensure they attend their appointment to avoid wastage of vaccines. 

From a funding perspective, our clinic is not making money with this enterprise, but rather we are doing it as a service to the community. For patients, it is much more convenient to have the vaccine at their local and familiar health care centre rather than a large vaccination hub with thousands of other people like we have seen overseas. In some of these centres, both local police and the military have been involved with administering vaccinations.

As medical practitioners we are taught to look at the evidence and what can be deduced from large amounts of data. There is a limited role of anecdata in medicine, yet I still do get asked “What did you do doc? What has been your experience? Is your family ok?”.

I had registered myself to get the Astra-Zeneca vaccine. Despite being considerably concerned about the risk of thrombosis with thrombocytopenic syndrome, I felt the risk of the sequalae of COVID-19 was much worse. After all, what is the point of worrying about the long-term effects of vaccine related complications if I didn’t make it through the pandemic itself? I ended up having to cancel my Astra-Zeneca vaccination as the guidelines changed, and I have subsequently received two doses of the Pfizer vaccine. Overseas, I have elderly relations who have had the Astra-Zeneca vaccine and have either, at worst, had a very mild infection or, at best, had escaped infection all together.

To get through this pandemic, no doubt we all must work together as no one is safe, until everyone is safe.

Authored by:

Dr Fabrina Avatar

Dr. Fabrina Hossain
Clinical Advisor at Best Practice Software

Prescribing Medication by Active Ingredient – 8 Weeks On

Prescribing medication by active ingredient article calendar on red background with date marked as 8 weeks with AIP

It’s now been approximately 8 weeks since the Australian government mandated that those prescribing medication needed to include the active ingredient names when preparing a prescription.

The introduction of active ingredient prescribing from the 1st of February 2021 presented many doctors with considerable changes to the way they were prescribing medication. The legislation requires prescriptions to include a medication’s active ingredient first, then optionally followed by the brand name. This means that prescriptions can no longer only have the brand name listed, unless they are included in the “List of Excluded Medicinal Items” (LEMI).

A significant amount of groundwork was required for software vendors to implement the changes. Medical Practices across Australia had to upgrade their prescription generating software to ensure they were meeting their legislative obligations.

Prescribing Medication by Active Ingredient

Prescribing Medication by Active Ingredient - Dr. Fabrina Weighs in 8 Weeks On

 

Most Practice management software solutions provide easy and seamless processes to prescribe new medication and re-prescribe existing medication. The new legislation now requires doctors to add additional steps to their existing workflow when prescribing medication if they want their patient to have a specific brand dispensed by the pharmacist. As with all systemic changes, major or minor, there were significant challenges faced by doctors with the introduction of this change.

In the early days of the changeover, it was common to omit the additional step to check the “Print Brand Name on Script” field and as a result, prescriptions that should have had the brand name listed only had the active ingredient printed. This posed potential dangers especially for medications such as insulin with a narrow therapeutic window, and for the combined oral contraceptive pill with multiple brands with the same active ingredient that are not necessarily interchangeable. While these medications are not in the aforementioned “List of Excluded Medicinal Items” (and therefore software vendors could not automatically print the brand on the script), they are included in the government’s “List of Medications for Brand Consideration” (LMBC). The LMBC is a list of medications the government has deemed that, due to safety reasons, should be prescribed by brand name.

In Bp Premier, when prescribing medication, there is now a warning message that highlights if a brand name should be considered – this is based on the LMBC list mentioned above:

Prescribing medication in Bp Premier brand name warning

This change has obligated doctors to have discussions with their patients about their medication, the active ingredient name and if there is a clinical or non-clinical reason why they should be taking a specific brand. 

Some common clinical reasons why a brand should be prescribed can include, but are not limited to; medications that are not bioequivalent such as Eltroxin and Eutroxig/Oroxine; different medication formulations such as extended release or immediate release; drugs with different dosing frequency, for example, certain oestrogen patches; allergies or intolerances to other additives such as gluten or lactose; and patient specific idiosyncratic reactions. 

Non-clinical reasons why doctors may wish to prescribe by brand name for certain populations such as those with low literacy rates, disabilities or those coming from culturally and linguistically diverse backgrounds who may find it easier to identify their medications by its packaging.  If there are no compelling reasons to continue with a specific brand, we should discuss the option to switch to a generic brand thereby facilitating informed decision making by the patient.

Although generic medications have been available in Australia for many years, some patients still have misconceptions regarding perceived poor quality and therefore reduced efficacy and safety of generic medication. It should be stressed that generic medications are not akin to “home brand” items found in supermarkets as these medications have been approved by the TGA and are deemed to be bioequivalent and just as safe and efficacious as their brand-named counterparts by clinical studies. While these discussions naturally add to our consult time, they are important to aide in patients overall understanding of their condition and treatment plan when prescribing medication.

As predicted by the Department of Health, this change will achieve several benefits to both patients and taxpayers. It is envisaged that active ingredient prescribing will increase consumer health literacy and make communication less ambiguous thereby reducing the risk of patients doubling up on medications or omitting to take them by mistake. There will also be a significant reduction in the cost of medications to patients and improvement in the financial sustainability of the PBS and RPBS with the increased uptake of generic medication.

The use of active ingredient prescribing is already implemented in hospitals nationwide and the extension to primary and community-based care was inevitable. While patients, doctors and pharmacies faced some hurdles initially, for the most part these have been overcome with diligence.

For more information, read our article discussing what active ingredient prescribing means for you.

Authored by:

Dr Fabrina Avatar

Dr. Fabrina Hossain
Clinical Advisor at Best Practice Software

Why is my Baby Irritable? – Six Points to Understanding Infant Sleep

Irritable Baby Article Baby Sleeping next to Clouds

A common problem in primary care is to be asked for guidance on the care of an irritable baby. In this article I describe non-medical problems which, in my experience, actually dominate over medical problems.

As a GP I have focused on the care of mothers and babies for about 40 years and have seen well over 10,000 families. For the rest of this article, let’s assume that the irritable baby in question is less than 12 weeks old.

To oversimplify the situation, my experience is that in this age group two problems dominate – fatigue and hunger.

So, if you are faced with an overtired mother and an irritable baby who seems to cry excessively, a very simple algorithm is as follows. Exclude poor weight gain and take a simple sleep history.

In this article I am going to focus on fatigue, but in terms of ensuring adequate nutrition it is easy to measure weight, to calculate weight gain per day and percentiles.  For children under 12 weeks, I recommend measuring and graphing these three variables at every visit.

Weight or Hunger

Unfortunately, hunger is very common in our culture.  If weight gain per day is less than 30 gm per day, if percentiles are dropping, if the baby is irritable at the end of the feed, if feeding times are prolonged i.e., more than a total of 20-30 minutes then a feeding review is needed.  Do whatever is needed to ensure that the baby finishes all their feeds fully satisfied.  I can address hunger and feeding in more detail in a later article. Today, we are focused on sleep.

Sleep, Fatigue or Over-tiredness

Total sleep volume that is needed to be well in the first few months is almost always more than 16 hours per day. This varies with weight but only a little.  Heavier babies can cope with a little less sleep and light babies need more.  To put that point in its reverse, lighter babies become over-tired more rapidly and need shorter waking times.

I teach six main points which give a useful and practical understanding of infant sleep.

  1. Sleep is Cyclical
  • During a block of sleep it is normal and healthy to awaken and resettle multiple times.
  • For a newborn baby, these cycles are about 45 minutes long. The waking events will last generally 30-90 seconds. The majority should be silent, and you will be unaware that they occur.
  • In overtired babies they may waken at the 45-minute point and have trouble getting back to sleep. Thus, if your baby is calling for assistance every 45 minutes it may be a sign of fatigue.
  • In very overtired babies, sleep cycles can ‘break down’ to 20-minute cat naps.
  • In a block of sleep, a baby awakens and returns to sleep multiple times. What forces drive a return to sleep? To simplify very complex events, I identify two things:  Tiredness and ‘cues of sleep’.
  1. Cues of Sleep
  • It is useful to think of the sleep achievement event as being driven by a combination of tiredness and external cues of sleep i.e., the things which are going on around the baby at the time.
  • Again, to simplify these cues can be divided into parent dependent and parent independent.
  • When a baby or child is put to bed at the beginning of a block of sleep tiredness dominates. Cues of sleep achievement are outweighed by tiredness and they are more likely to achieve sleep efficiently.
  • As a block of sleep progresses tiredness reduces and cues of sleep become more important in achieving a return to sleep.
  • If a baby is put to sleep using parent dependent cues i.e., holding, rocking, patting, feeding then there is an increased chance that the baby will request those cues be repeated later in that block of sleep.
  • Cues of sleep which are parent independent are more useful. I use a term ‘parent-lite settling’.  So, we prepare a baby for sleep, but the final transition is achieved by the baby alone as often as is possible.
  1. Cues of Sleep are Learned
  • To make this point I use adult experience. Learning to sleep with a partner. Moving to a new suburb or street with different noises outside the home. Buying a new bed.  We have all had these experiences.
  • So, cues of sleep can be changed and relearned.
  • Babies actually do this very efficiently.
  1. Sleep Achievement and Sleep Maintenance are Usefully Regarded as Learned Skills
  • By combining two points i.e., sleep is in part cue dependent and cues are learned I develop a very important point.
  • Going to sleep and maintaining sleep are usefully considered learned skills.
  1. Fatigue Interferes With the Learned Skill of Sleep Achievement
  • This point may seem counter-intuitive but almost every single mother that you care for will agree that she has had a personal experience of becoming so tired that while she is desperate to get sleep her mind will not turn off. This is critically important for children.
  • Therefore, it is important to ensure the child does not become over tired.
  • A newborn can become overtired in 10 – 15 minutes.
  • Low weight babies are more prone to fatigue and heavier babies a little more resistant.
  • For the age group under discussion waking times need to be fairly short i.e., 20-30 minutes over-night and something like 45 minutes during day light. This time includes feeding, changing, cuddles and any social time.
  • To put it another way in the first month of life my ambitions for a baby are simply feed, sleep, and grow.
  1. Cues of Sleep Achievement That are Parent Independent are the Most Useful for Family Life
  • A baby who achieves sleep with parental care is preordained to request that care again at some point in the block of sleep. Minimise sleep transitions which involve parental assistance and allow a child to achieve sleep alone.
  • Adopt a ‘parent-lite’ approach to sleep achievement. Be there and be supportive but keep it minimal rather than the reverse. The baby needs to feel parental love and support but when it is time to be asleep leave them alone to finalise the last steps in sleep achievement.
  • A parent has a major and positive role to play when the baby is awake and maybe even when sleepy but once the baby is ready to be finally asleep these events are best managed by the baby alone. This is true from the time of birth.

Conclusion to Assessing an Irritable Baby of Less Than 12 Weeks

  • Take steps to check that a baby is being well fed by whatever technique ensures adequate growth.
  • Avoid over-tiredness and the following points assist understanding.
    • Sleep is cyclical with blocks of sleep which include multiple short episodes of arousal followed by a return to sleep
    • Sleep achievement is in part cue dependent
    • Cues of sleep are learned can be altered and relearned
    • Sleep achievement and sleep maintenance are usefully regarded as learned skills
    • Avoid children becoming over tired as this interferes with the learned skill of sleep achievement
    • Minimise cues of sleep achievement that are parent dependent. Take a ‘parent lite’ approach.
  • It is my experience that ensuring complete feeding and avoiding over-tiredness linked to the learning of parent-lite cues of sleep will resolve that large majority of events where the presentation is an irritable infant aged 12 weeks or below.
Dr Brian Symon
This article was contributed by Dr Brian Symon. He has more than 30 years’ experience working with parents and babies experiencing problems of sleep, feeding, growth and behaviour. You can find out more about Dr Symon’s work at his website – The Babysleep Doctor.

Active Ingredient Prescribing: What Does It Mean For You?

Active Ingredient Prescribing Blog Image

Prescribing medication by its active ingredient will become mandatory from February 2021. This change is part of the government’s 2018-2019 Electronic Prescribing Budget initiative that was legislated in 2019 under the National Health (Pharmaceutical Benefits) Amendment (Active Ingredient Prescribing) Regulations 2019. The aim of this regulation is to improve patient understanding of the medications they take in addition to promoting the uptake of generic and biosimilar medicines that would support a long term viable and sustainable market for these medications in Australia.

The regulation mandates the inclusion of the active ingredients on all PBS and RPBS prescriptions with the exception of:

  • Handwritten prescriptions
  • Paper-based medication charts in residential aged care settings
  • Medications with four or more active ingredients
  • Vaccines
  • Custom preparations and prescriptions generated through a free text function within prescribing software
  • Over the counter items
  • Non-medicinal items such as dressings and food supplements
  • Medications determined by the Secretary for practicality and safety reasons

Brand names can be included in the prescription if it is considered to be clinically necessary by the prescriber; however, the active ingredient must be listed first as per the regulation. Furthermore, software is prohibited from automatically including the brand name by default. It is therefore up to the prescriber to include the brand name on the prescription.

Why is this change being implemented?

There are numerous benefits to prescribing by active ingredient rather than brand name. First, generic prescribing enables patients to identify the pharmaceutically active ingredient (the international nonproprietary name) of their drug and thereby have a better understanding about the medications they take.

Second, it will reduce the risk of patients accidentally taking the same medication as a result of a prescribing or dispensing error due to being unaware that the brand name is not a unique identifier of their medication.

Third, it will allow the dispensation of any suitable equivalent generic should their brand of medication not be available at the pharmacy and subsequently reduce delays in supplying medication to the patient.

It is envisaged this change will increase the uptake of generic and biosimilar products which would reduce the out-of-pocket cost to the patient and the PBS.

How might this change the way I prescribe medications?

From a prescriber’s perspective, there are some changes in our workflow. When prescribing a new medication, we can still search by brand name or the active ingredient.

Prescribing a new medication by brand name

If we wish the patient to have a specific brand, then we have to check the “Print brand name on scripts” check-box and un-check the “Allow brand substitution” check box. This will convey to the pharmacist that the brand name on the script is what should be dispensed and brand substitution is not permitted.

Prescribing a new medication by active ingredient name

If we are satisfied that there is no clinical need for the patient to be on a particular brand of medication then we can search and select the drug by the active ingredient name. The options to “Print brand name on scripts” and “Allow brand substitution” will not be selectable as it is superfluous information since we have chosen to prescribe a generic medication.

Providing a prescription for a patient’s existing medication by brand

During the roll out of the software update for active ingredient prescribing, if a patient’s medication has previously been declared as not allowing brand substitution, then it will be set to “Print brand name on scripts”. This is because a prescriber has previously decided and recorded that the patient must be on the recorded brand of medication. In such cases the brand name will be printed on the script and the workflow for the doctor will not change.

However, if “Allow Brand Substitution” is checked (meaning that a generic brand can be dispensed), then the “Print brand name on scripts” will not be flagged. This is because, it has not previously been declared that the patient must be on that brand of medication. As per the regulation, software vendors cannot default to printing brand name on scripts in such cases. This may potentially become an issue to doctors who have, for example, previously prescribed “Micardis”, but have declared that brand substitution is permitted. In these cases, the brand “Micardis” will not be printed on the script and therefore the patient will be dispensed a generic Telmisartan rather than Micardis.

Providing a prescription for a patient’s existing medication by active ingredient

This scenario should not change the workflow of the doctor as the active ingredient will be printed.

How might this change affect my patients?

It is very important that we have a discussion with our patients regarding the upcoming changes and how it can affect their medications. This is especially if they are taking brand medications and we wish them to continue to do so.

Below are some examples of a typical prescription showing branded medication, and the same prescription showing only the active ingredient.

Active Ingredient Prescribing Sample Prescription

Authored by:

Dr Fabrina Avatar

Dr Fabrina Hossain
Clinical Advisor at Best Practice Software

 

To keep up to date with Active Ingredient Prescribing, and to be notified when further information and training materials are available, please sign up to our Educate Newsletter.

Time to Take Your Blood Pressure Pills!

Blood Pressure Medication

Historically, when single dose blood pressure medications were commenced, patients were advised to take them in the morning. This is because blood pressure follows our natural sleep cycle and dips when we are sleeping and rapidly rises in the morning when we get up. It was thought that taking medication in the morning would provide the most benefit as it would reduce that initial increase in the morning.

At the end of 2019, the results of a large study that looked at bedtime dosing of blood pressure medication were published in the European Journal of Cardiology [1]. The study looked at 19,000 patients in Spain in a primary care setting, and it compared the cardiovascular outcomes between those who took their medication at night and those who took it in the morning, with a mean follow up of just over 6 years. The study found a significant improvement in the outcomes of those who took their medication at bedtime with a reduction in the number of heart attacks, strokes, and heart failure in that group.

The study itself was quite comprehensive and had a good follow up period of 6 years. It is important to note that they only included patients in the study if they did not have any history of pre-existing kidney failure, heart failure, retinopathy, abnormal heart rhythms or alcoholism, and they did not include shift workers. They also did not include pregnant patients or those with secondary hypertension. The authors split the groups in half and had one group take all of their medications in the morning, and the second group take all of their medications before bed. 

Patients’ blood pressure control was monitored during their GP visits in addition to doing an annual 48-hour ambulatory blood pressure test. This test involves wearing a blood pressure monitor for 48 hours with BP check every 20 – 30 minutes to get a good picture of the blood pressure fluctuations over a 48 hour period.

The authors found that those taking their medications at night had overall better control of their blood pressure in addition to needing fewer medications to keep to the recommended targets. The study also found that there was a 45% reduction in cardiovascular events such has heart attacks, angina, strokes and heart failure in the group who took their medications at night. Moreover, they did not find any adverse events to occur in that group.

There have been some other smaller studies that have also looked at morning versus bedtime dosing of blood pressuring lowering medications [2], which showed better blood pressure control without any adverse effects of taking blood pressure medications at night. However, there have been a number of small ophthalmological studies that have shown a detrimental effect for those with certain eye conditions if their night-time blood pressure drops too low [3], or if they take their blood pressure medications at night [4].

To date, there have not been any changes to the current Cardiology or Heart Foundation guidelines to routinely recommend changing patients over to bedtime dosing. However, for some patients the benefits would clearly be substantial.

Before changing over to bed-time blood pressure medication dosing, it would be a good idea to discuss with your GP or Cardiologist if this is suitable for you.

Authored by:

Dr. Fabrina Hossain
Clinical Advisor at Best Practice Software

 

References

[1] https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091949/
[3] https://pubmed.ncbi.nlm.nih.gov/8172267/
[4] https://pubmed.ncbi.nlm.nih.gov/22424547/

Mental Health in the Age of COVID-19

It is 3:00am and I am awake. Again.

This is the third time this week. I reach for my phone and open up my social media app where I scroll through the latest COVID-19 updates in a group of doctors that is 13,000-strong. My eyes frantically try to keep up with numerous graphs, projections, news stories and the impacts of compromised mental health during COVID-19. Scattered in between these are personal stories of frustration, anger or even complete denial of the scale of the problem.

By the time I manage to get to work and see my first patient at 8:00, my mind has already spent 5 hours ruminating about COVID-19. My eyes are dry and my shoulders already feel heavy. Surely this behaviour is unsustainable? A chat in the tearoom with my colleagues, sitting 1.5m away from me, reveal this phenomenon to be common.

As we find ourselves in the midst of a one in 100-year event that has upheaved our daily schedules, it is normal to feel stressed, worried or anxious. With rapidly changing government policies regarding work and play, isolation and uncertainty prevails over consistency, routine and social interactions. Many of us in the healthcare and technology industries, who are still able to work and have a steady income, watch in fear as those in the hospitality, retail and tourism industries lose their jobs and livelihoods. We worry about the future and about the economy.

Is the government doing enough?
Why did they let all those people off the Ruby Princess?
Are we doing enough to look after mental health during COVID-19?
Will there be a global economic recession or a depression on the other side of this pandemic?

Stress occurs when there is a perceived threat that is beyond our ability to control. When we are are stressed, there are physiological changes within our body that cause us to be more alert and vigilant. This is commonly known as the ‘fight or flight’ response. If the threat is continuous or persistent, those physiological changes can affect our emotional health and well-being in the form of anxiety.

Anxiety, much like a chameleon, can manifest in many ways. It can be as subtle as mild irritability and a reduction in concentration, to a more noticeable insomnia, early morning rising or reduced appetite, to full blown panic attacks with physical symptoms. This can be compounded by our current situation of physical and social isolation, that has become an mandated part of life today.

How Can We Deal With the Constant Strain on Mental Health during COVID-19?

The first step to coping is to accept that there are many variables that are completely out of our control, such as the duration of this pandemic; how many people will be affected; how others are responding to the situation and if there is enough toilet paper at the shops.

The second step is focusing on the variables we do have control over – such as our daily routine, finding enjoyable things to do at home, connecting with and supporting our friends, families and colleagues. Practically this may involve simple things like going for daily exercise in the morning, getting ready everyday, going to ‘work’ in a dedicated room and clearing it away when work has finished, having breaks, doing activities with the family, debriefing with friends and colleagues and switching off the news and social media. Some workplaces have created virtual ‘tea rooms’ or ‘water coolers’ in their respective meeting applications where staff can drop in at random times, as they would if in an office, and catch up with other colleagues whom they may not interact with regularly.

Of the above, daily exercise is proven to be the most effective intervention for stress at a population level. This is likely because sunlight and the natural hormones that get released during exercise can elevate the mood. For me personally, limiting social media and the news has also helped significantly as my brain gets a break from the constant negative stimulus after 7pm every night. Re-discovering the myriad of enjoyable things to do at home such as gardening, board games and reading, to finally getting through the decade old to-do list of sorting travel photos and decluttering, these activities have provided a welcome sense of achievement.

The link below is a great resource that explains how our normal worries can become excessive, and it provides some methods on how we can stop ourselves from progressing through a negative chain of thoughts that can lead to heightened risk to our mental health during COVID-19. There are also some practical tools included, such as an Activity Menu to keep occupied and a Decision Tree about how to prevent ourselves from overthinking things which are out of our control.

Click here to download a helpful PDF on managing stress and anxiety during this difficult time.

If these simple measures do not help to improve how you are feeling, then it may be time to check-in with your GP.

Authored by:


Dr. Fabrina Hossain
Clinical Advisor at Best Practice Software

Do You Know What Mental Health Is? View from a Doctor’s Desk – Dr Lisa Surman

World Mental Health Day is today (October 10th) – a chance to look at how we can support our patients’ mental health.

The Do You See What I See? campaign aims to challenge perceptions about mental illness, encouraging everyone to look at mental illness with a more positive light to reduce stigma and make it easier to seek support and help for the one in five Australians affected by mental illness every year.

The campaign has enrolled over 700 organisations asking everyone to make a #MentalHealthPromise and to take a more positive view . The promises that have been made by individuals are at 1010.org.au The website has some suggestions for promises you may like to make and a page to post your own promise and associated image.

Stigma around mental illness remains an issue for Australians, delaying or preventing people from seeking help. The misconceptions and misrepresentations about those who experience mental illness can be damaging, including references about those suffering from mental illness as being incompetent, weak or scary and appear in the media, the arts and conversations at school, work and in the home.

The majority of people affected by mental illness are able to lead contributing and independent lives in the community with treatment and support. The website encourages a different light to look at mental illness, colour and life, resilience, bravery, recovery, hopefulness, courage, contribution and more.

To learn more about mental illness, and provide valuable resources for your patients, there are several organisations with easily accessible online information:

SANE Australia at https://www.sane.org/mental-health-and-illness

Beyondblue at https://www.beyondblue.org.au/the-facts/what-is-mental-health

Headspace at https://www.headspace.org.au/young-people/what-is-mental-health/

World health Organisation at http://www.who.int/features/factfiles/mental_health/en/

To find help: see Mental Health Australia https://1010.org.au/need-help

or mindhealthconnect Guided Search Tool: https://www.mindhealthconnect.org.au/

 

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

Mental Health Remains the Most Common Reason for a GP Visit. View from a Doctor’s Desk – Dr Lisa Surman

With this month being Mental Health Month, the focus is on the importance of the mental health of our patients and the resources we can provide, which was highlighted in the Australian Health of the Nation Report.

The recently released annual Royal Australian College of General Practitioners (RACGP) Health of the Nation Report identified the current health trends and issues for General Practice .

Patients see GPs more than any other health professional and 84% visit their GP multiple times a year. Three in every four patents report that their GP always listens carefully, shows respect and spends enough time with them.

Mental health issues such as depression, mood disorders and anxiety remain the most common health issue managed by GPs and was also identified as the health issue causing GPs the most concern for the future, followed by obesity. Mental health and obesity were the key areas the federal government should prioritise for action.

One in four Australians will face a major mental health problem in their life, mental health being the ability to think, feel and behave in a way that allows us to perform at our best – in our personal lives with family and friends, at university at work and in the community. The most common issues are anxiety and depression.

Learning to manage anxiety and/or depression can make a difference to how your patients react to stresses in life and feel calmer. There are many levels and different techniques and tips on how to achieve this :

  • Exercise regularly
  • Eat well
  • Get enough sleep
  • Practice relaxation exercises
  • Reduce alcohol and drug use
  • Spend time with friends
  • Ensure work/study/life balance
  • Use cognitive strategies to deal with stressful thoughts
  • Practice mindfulness to let go of worries
  • Engage in enjoyable and fun activities

Take the opportunity during Mental Health Month to encourage patients to reach out for further assessment, support and referral if required. There are also a host of great resources you can refer them to on the Australian Government’s Head To Health website.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

How Successful is Australian IVF? View from a Doctor’s Desk – Dr Lisa Surman

As health professionals, it’s important to have the latest information and resources on IVF.

A recent report published by the University of New South Wales announced that 18% of IVF cycles in Australia and New Zealand result in a live birth Of the just over 81 000 initiated IVF cycles in 2016-2017, 82.2% resulted in either a successful embryo transfer or all oocytes/embryos being preserved at subzero temperatures for use in IVF ( cryopreservation) In 2016-2017 the highest annual number of births in Australia and New Zealand IVF’s history were recorded, 15,198 babies. The proportion of IVF cycles resulting in twins and triplets is now one of the lowest rates in the world, 3.8%. The average age of women being treated with IVF is 36 years.

The report was produced after the Victorian Government announced a review into the state’s IVF laws to ensure women were getting accurate information from IVF and fertility doctors about success rates and treatment options. Each cycle is expensive, with IVF Australia figures showing patients are out of pocket as average of $ 4,707 for their first IVF cycle and $4,151 for subsequent cycles.

The IVF success rates published for Australian Fertility Clinics can be misleading The rates are given as live birth per pregnancy or per embryo transfer and do not take into account all those whose cycles did not result in an embryo transfer or those pregnancies that do not go to term. Different countries have differing laws regarding public access to fertility treatment outcomes.

Australia’s IVF success rates are assumed to be similar to those of the UK. According to the UK’s National Health Service, between 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was 29% for women under 35, 23% for women aged 35 to 37, 3% for women aged 43 to 44. The Human Fertilisation & Embryology Authority is the UK Government’s independent regulator overseeing fertility treatment and research. This site provides clear outlines about the different treatments available and the associated options, including risks and results.  The HFEA is a very useful reference for Australian women as the fine details are not easily available and not mandated by laws.

The IVF success rates published for US Clinics are higher than Australian rates possible because there was a much higher rate of multiple births from the US Clinics.

For your patients planning or currently trying to start a family, a valuable resource could be The Fertility Coalition, formed by four organisations in Australia – the Victorian Assisted Reproduction Treatment Authority, Andrology Australia, Jean Hailes Research Unit and The Robinson Research Institute; and funded by the Australian Government Department of Health and the Victorian Government Department of Health and Human Services. The site provides facts about fertility for men, women, trans and gender diverse people to make the best possible decisions about having children for your circumstances, the most up to date scientific information to improve fertility. See yourfertility.org.au

For your patients choosing an IVF Clinic and about to attend the first appointment a useful guide is available here.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

R U OK? Day. View from a Doctor’s Desk – Dr Lisa Surman

For the medical community, the annual R U OK? Day reminds us to stay connected, have meaningful conversations and encourage more people to ask R U OK? at work, school and in the community. The website includes suggestions for simple steps that could save a life :

  1. Ask
  2. Listen
  3. Encourage action
  4. Check in

There are conversations tips, videos of how to ask and resources including how to find professional help if needed if the conversation becomes too big for family and friends.

Lifeline provides a directory of free or low cost health and community services available in Australia for areas such as domestic violence, family and children’s services, financial assistance and mental health services at lifeline.serviceseeker.com.au

The BeyondNow suicide safety plan app helps create a safety plan in crisis and distress for those in need, ideally with support us, as health professionals, or someone they trust, to work through when they are experiencing suicidal thoughts, feelings, distress or crisis. The app is available to download and to read further about the app, see beyondblue.org.au

The Headgear app provides workers with a simple and anonymous way to assess and monitor their mental health. The app was developed by researchers at the University of Sydney and the Black Dog Institute. The app guides the user through a 30 day mental health challenge aiming to increase wellbeing and reduce risk of future mental health problems.

moodGYM is an online self-help program that has been available since 2001, using cognitive behaviour training to develop skills to manage depression and anxiety symptoms. The program allows real-time self monitoring of problem moods, thoughts and behaviours via mobile phone or computer. Those using the programme monitor three symptoms of their choice or three recommended to them by myCompass through answering the profiling questionnaire ( eg stress, depression, confidence, worry, irritability, motivation, diet and medication use) See moodgym.com.au

myCompass is a self-help tool for mental health, providing proven techniques to help manage stress, anxiety and depression.

Here are some of the agencies that offer good support to those in need:

  • Lifeline, 1311 14 for 24/7 crisis support, the Suicide Call Back at 1300 659 467
  • kidshelpline at 1800 55 1800 for counselling to young people under 25 years
  • Griefline on 1300 845 745

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.