WA News Trailblazers Proving that Primary Care Works
Proving that Primary Care Works
Written by Ms Jan Hallam
Wednesday, 01 October 2014


Moyez-Jiwa-Future-Me-app Sep14Prof Moyez JiwaThe CEO of the National Health and Medical Research Council, Prof Warwick Anderson, wrote in The Conversation in July under the headline, With the right kind of research, we can reduce health-care costs, that by culling treatments which didn’t work or replacing expensive medical products for cheaper options without affecting outcomes, millions would be saved.

It’s a statement loaded with significance and prompts big questions about medical practice and research and where common sense fits in.

For one senior primary health researcher and GP, Curtin University Chair of Health Innovation (Chronic) Prof Moyez Jiwa, his work is all about bringing common sense back into the equation.

Cog in the medical wheel
 “I was lucky to have trained at Trinity College Dublin where I came under the influence of James McCormack – a good old-fashioned GP who had a major role in the curriculum of the college.

He told us we would be trained to behave like automatons and we needed to understand the reasons why. He said: ‘You are there to support the industry that’s built up around medicine – the drugs, investigations, tests, surgery – activity that is driven by a biomedical model of healthcare’.”

Moyez for his entire career as GP, first in Scotland, the UK and for the past decade in WA has been trying to show good reason why it is imperative to re-evaluate the way things have always been done.

His work as a primary care researcher is focused on prevention and support of people with chronic diseases at the primary care level but that rarely attracts the competitive funds from bodies like the NHMRC. Such funding is a key measure of success for Universities.

“About 2% of NMHRC money goes into primary care research, which is very translational. We don’t tend to research in the laboratory. Much of what we produce is of more immediate benefit to the community.”

Cure, but in the meantime …
Of course, all those working in the area of primary care research are aware of the bigger picture, where a cure for cancer, for instance, would change the scene dramatically.

“But that is not going to happen, in my view, in the next 10-20 years, so we are left with treatments that may be curative but require on-going support of the patient . We have an ageing population developing complex conditions and becoming increasingly disabled by their condition and sometimes also by their treatment.”

“The short-term solution must be solid evidence-based primary care practice to give the patient an early diagnosis, the right treatment pathway and support through the process.”

“The role we GPs fulfil in society is as much a social role as a technical one. I know that for the majority of patients I see, there is very little I do that makes a technical difference to their health outcomes. But a lot of the interaction between doctor and patient helps them through their day, hopefully through their month and years in a way that has not yet been quantified.”

“That’s why I find it so exciting to be working in this space. It has the potential to do an awful lot of good but also prevent an awful lot of harm.”

Moyez-Jiwa-Prof Sept14.jpg180Commitment for primary care
WA universities are all investing in primary care research. UWA has just appointed Prof Helena Liira as new Chair of General Practice. She comes to Perth from Finland in January and is apparently keen on GP involvement in medical research. Prof Tom

Brett is at Notre Dame focusing on building research capacity amongst health professionals and disease burden from ‘multi-morbidity’. GP Prof Moira Sim is at ECU.

WA Health is also ramping up its presence in the primary care space with the development of the Primary Care Health Network, which is seeking input from GPs later this month at a forum.

The system is so weighed down, it’s time for action.

“We’ve done a lot of research and now we need to apply it in a way that is agile, intuitive, creative and cost effective. The thing that will rescue Australia from the growing prevalence of morbidity is 10 minutes of uninterrupted time from someone who cares enough to give you their undivided attention.”

“What we don’t need to do is to interfere in that 10 minutes by creating payment structures which distract the practitioner and patient. GPs think all the time how they can improve that time with their patients and we need to harness this insight for the greater good so the system improves.”

  Innovations push change
“I’m a great admirer of [Ballajura GP] Dr Alan Leeb, who developed the Smart Vax app [see www.medicalhub.com.au] Alan is likely to find out before anyone else, if there was a bad batch of vaccine. That’s the kind of innovation I am excited about. It allows us to show people what will happen.”

This showing, not lecturing, is the force behind several of Moyez’s own innovations – the smoking software, which aims to show young people what smoking will do to their faces; and the Future Me app, which aims to tackle obesity.

His most recent research is in hospital discharge summaries where he put volunteer GP researchers and technology together in a unique way.

“Time makes it difficult for GPs to be involved in research. Medicare doesn’t recognise research nor are GPs insured for it. So we used simulation, which allowed us to test GP interventions or hypotheses in a safe environment.”

“We have about 200 willing GPs and about 80 took part in this project and they really enjoyed seeing the patients [actors in this scenario] and testing hyoptheses in a safe environment where no de facto patients can be harmed. We focused on both the referral process and discharge process because for GPs those are big ticket items. And the outcomes of the randomised trial may be helpful to the integration of health service providers.”

“Primary care has to wake up to the fact that it’s on the ropes and the only way to get off is to provide evidence that it can make a difference; provide evidence of the interventions that are likely to work and step up to the mark and provide leadership.”