WA News Doctor Polls
Poll Results
Reporting Adverse Drug Reactions - June 2014

In the July 2014 edition we explored the issue of the underreporting of adverse drug reactions. We asked doctors their reporting habits and 165 GPs responded. .

Which of the following statements most closely aligns with what you do in reporting a possible Adverse Drug Reaction (ADR) to the TGA?

Rarely report, as very few adverse reactions encountered.        27%

Mostly forget to do it, despite encountering adverse reactions.    12%

Limit my reports to those I consider most serious                          39%

I report the majority of possible reactions                                        8%

Other                                                                                                 7%

Doesn’t apply                                                                                    7%

 
 

If you had to put a figure on it, what proportion of possible adverse drug reactions do you report to the TGA??

0%           23%

1-25%      43%

26-50%    5%

51-75%    3%

76-99%    5%

100%       4%

Doesn’t apply  8%,

Uncertain    8%

ED. 39% of respondents to question 1 said they limited their reports to those they considered most serious (and another 12% said they mostly forgot to do this). In question 2, a similar proportion of GPs (43%) said their reporting to the TGA amounted to a quarter or less of ADR possibilities encountered, and another 23% said they did not report any ADRs.

 

How aware are you of the TGA’s Adverse Drug Reaction reporting methods??

I know of the ‘Blue Card’ paper form.                                     33%

I know of the online reporting system at www.tga.gov.au    33%

I subscribe to emailed TGA safety alerts for products.           4%

None of the above                                                                 12%

Doesn’t apply                                                                           5%

Uncertain                                                                                13%

ED. Only a third of our surveyed GPs knew of a method to report an ADR to the TGA.

 

 
Doctors vs the Pace of Change - April 2014

124 GPs (56%), Specialists (36%) and Doctors in Training (7%) responded to questions fashioned following discussion at the Doctors Drum, where “The Pace of Change” was centre stage, so responses are an extension of that breakfast’s lively discussion and ED notes reflect that.

Given the ‘health information overload’ online, is it a good idea for doctors to offer expert advice on the usefulness of some of this information?

Yes   80%

No   5%

Uncertain   13%

There is no overload   2%

ED. Surveyed doctors and those at the breakfast agreed – patients are in information overload and only a few want us to agree with their Internet expert opinion, while most want guidance on where to get good information.

 

Will health professionals outside hospitals find time to adopt worthwhile technology if there is no financial incentive?

Yes   45%

No   31%

Uncertain   22%

Doesn’t apply   2%

ED. For whatever reason, ‘money speaks’ in a large section of the profession. Are those doctors greedy, needy or just business minded? See responses to the next question…maybe we missed mentioning investing in better patient outcomes.

This requires deep thought! Does a litigious society make medical innovation safer by slowing the pace of change?

No   56%

Yes   26%

Undecided   19%

ED. The lawyer panellist at the breakfast disagreed with our surveyed doctors. The panellist said wariness fuels better learning and more cautious adoption of innovations, whereas market forces or money can speed things to the health consumers’ detriment.

What’s the most important driving force for innovation in medicine [choose one]?

9%   Making money (market forces).  

23%  Better patient outcomes.  

62%  Both the above.   

3%   None of the above.  

2%   Uncertain   

Who has the most power for bringing about innovative change in medicine [multiple choice]?

35%  Commercial interests

27%  Doctors

24%  Organised groups

11%  Patients

3%   Other

ED. Interestingly the Doctors Drum breakfast talked little of money whereas surveyed doctors feel commercial interests, presumably other than doctors, were the biggest drivers of change. Certainly, there seems no shortage of people jostling for top spot in the technology stakes.

Survey comments

The big-end of town – pharma and medical technology companies – with the profit motive and the organisation to make it happen (with the danger of monopolising) drew most comment. There was regret that doctors weren’t in a position to lead the innovation charge, with one suggesting non-doctor innovation has been harmful to best outcomes. Some blamed an embarrassingly slow pace of change on government, and slow uptake of technology by doctors to some extent. Safe, effective change takes great care, forethought and research, said one. “Now we have the technology to form groups with special interests beyond geographical and time restrictions. The support, shared workload and feedback should make us vastly more effective in driving change. But does it happen?” one doctor commented.

Which of the following do you think will encourage medical innovation that has broader community interests in mind [multiple choice]?

53%  Greater transparency in costs/pricing.

14%  Online consumer forums.

15%  Patients having say over a personalised health budget. 

18%  Other.  

ED. Maybe people are tired of cost blowouts and surprises and treating taxpayer funds like they are a gift from a political party or suchlike? There is a sense that soon the honeymoon will be over.

Survey comments

Personalised health budgets were treated warily by those who commented but there was a strong agreement that if the consumer knew the cost of some treatments and had to bear some of the brunt, they would keep themselves healthier. Several thought consumer and community input vital to efficient health systems. One doctor suggesting community controlled health services. However, another view was for greater uptake of doctor-directed innovations and as technology is embraced more widely, costs would come down.

If you believe state or federal governments allocate some health funds inappropriately, what are the most important factors, in your view [multiple choice]?

25%  Political influence 

23%  Vested interests interfering with good decisions

18%  Following poor advice

14%  Lack of integration of changes

11%  Not enough consideration for the end user 

7%   Inappropriate influence from doctor groups

1%   Other 

1%   I don’t believe govts allocate funds inappropriately.


 

 
Sport, Research & Health Insurers - March 2014

158 responses from General Practitioners (42%), Specialists (42%), Doctor in Training (8%) and Other (8%). GP-Specialist differences in responses are outlined as footnotes. 

Take promotions out of sport and Australians would be healthier.

Strongly Disagree                    5%

Disagree                                 32%

Neutral                                    32%

Agree                                      25%

Strongly Agree                         6%

ED: The 158 respondents largely reflect the split community attitudes to commercial promotions in sport. With 37% of doctors unconvinced that promotions for fast food and alcohol at sporting events lead to unhealthy life choices and 31% thinking they do, it leaves the final third for the public health campaigners to convince.

Q: WA taxpayer investment in medical research should be increased.

Strongly Disagree     2%

Disagree                   7%

Neutral                     27%

Agree                      51%

Strongly Agree        13%

ED: It looks like the campaign for more research dollars gets a big thumbs up from more than two thirds of the 158 respondents to our e-Poll.

Q. As health cost pressures increase, private health insurers are contracting with corporate GP practices to give preferential treatment to their insured clients. Stated aims are to promote the benefits of health insurance or reduce the payout for treatment to those with chronic health problems, both through improved care. Please respond to these statements…

Statement

Strongly
Disagree

Disagree

Neutral

Agree

Strongly
Agree

These two things should be targeted in those with health insurance.

 9%

 22%

 41%

 23%

 5%

If costs end up controlling clinical decisions this is a necessary step.

 23%

 33%

 14%

 23%

 6%

Insurers might dictate clinical care in particular situations.

 4%

 13%

 11%

 46%

 25%

This is no different, in essence, to ‘no-gap’ products for specialist services.

 9%

 22%

 33%

 30%

 6%

Clinical independence can no longer be justified at all cost. (1)

 18%

 27%

 12%

 34%

 8%

Government could benefit under this arrangement from fewer hospital admissions.

 6%

 26%

 35%

 28%

 4%

This is the most appropriate way to reduce the cost burden of private health insurance “frequent flyers”. (2)

 13%

 34%

 37%

 14%

 2%

ED. (1) Although viewpoints seemed polarised on this statement, specialists were in strongest disagreement (25% ‘strongly disagree’ vs 13% of GPs). (2) GPs were more strongly against this idea (52% said ‘disagree’ or ‘strongly disagree’ vs 38% of specialists).

 
GP Accreditation – How Valued? - January 2014

Medical Forum published a guest column by Mr Tim Spokes a co-practice principal in Kalgoorlie about accreditation standards not keeping up with the demands of modern general practice. We wanted to get a broader reader view and asked GPs in an e-Poll what they thought. N = 147.

Without general practice accreditation, do you believe the quality of health care delivered in general practice would decrease, overall??

Yes                                                                                 26%

Maybe                                                                             31%

No                                                                                   37%

Unsure                                                                             6%

 

Do you believe that the majority of things required of general practices undergoing accreditation are appropriately targeted to improve the quality of patient care?

Yes                                                                                  31%

No                                                                                    53%

Uncertain                                                                         16%

ED: The strong reaction that accreditation was less focused on patient care is reflected in some of the comments below.

 

In your practice, are you asked to comply with anything to meet accreditation requirements that you regard as not helpful to quality patient care?

Yes                                                                                  52%

No                                                                                    28%

Uncertain                                                                         20%

Amongst 41 commenting GPs, most were negative. Of the positive comments, one doctor was adamant in support of accreditation: “It should be mandatory with or without benefits attached.” Another said the process helped keep small practices up to date, while another acknowledged that it was good in theory but in practice the process took a lot of time and effort for negligible gain.

One doctor believed accreditation had lifted standards enormously over time and it was important to have them spelt out. However, “patient feedback is too costly an exercise in current Fourth standards. Empires are created for firms marketing these tools!”

Another supporter believed accreditation had improved their practice though added “it can become overdone.”

One doctor thought the process was reasonable but bemoaned the necessity. “Unfortunately, it is too easy to cut corners on health care delivery in general practice without some form of accreditation.”

The critics decried the time and money spent, not to mention the stress on staff, with no apparent evidence that it improved patient care, in fact one said it encroached on their core business – patients. One doctor wrote: “The patient has no awareness whatsoever if a practice is accredited or not.”

The moving goalposts were a frustration for a number of doctors: “Once you jump through the current hoops, they add more the next time. Where is the evidence to show it improves patient care?” Another shed some light on demands: “Inevitably more expense for less benefit – we need an electric bed now next time around? Every bed??”

Small practices are disadvantaged in the process said one: “Regular staff meetings are silly in a small practice where the staff interaction is already regular, eg one doctor, one receptionist.”

Several doctors believed accreditation was more about creating a bureaucracy than standards. “Some basic standards would be fine but has now gone way too far just to justify the whole industry. I hate the way it stresses our staff and we have found some of the referees downright rude.”

A couple of respondents said accreditation should be used as guidelines for quality General Practice, not as income sources. “Comparative data against peer groups on patient management would be a more useful guide to quality general practice (some of these used to be done through Medicare and prescribing data),” wrote one. Another believed there should be a system such as yearly appraisals to identify poor performing GPs.

The last word goes to Dr X who wrote: “The [current] system measures process and administration and should be much more outcomes focused. Give me a good conscientious doctor rather than a crap one with good admin and process any day!!

 

 
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