AFRM eBulletin – 9 March 2018

Ambulatory Rehabilitation – key to the future of rehabilitation, but of unproved value

The major objective of Australasian Rehabilitation Outcomes Centre (AROC), auspiced by AFRM, is to improve the quality of rehabilitation and patient outcomes. AROC has developed a national benchmarking system to improve clinical rehabilitation outcomes for patients in both the public and private sectors and is initially focused on inpatient rehabilitation. Currently almost 100 per cent of inpatient rehabilitation services are members of AROC and participate in benchmarking.  

Since inception in 2002, the collection and analysis of outcome information has been shown to assist in the development of clinical protocols for rehabilitation, help the interpretation of outcome and service utilisation data, assist in the development of quality improvement initiatives, and in the interpretation of variations between service providers. 

As part of its remit AROC continually scans the health (and specifically rehabilitation) environment to identify trends and potential upcoming disruptions. The increasing focus on the provision of ambulatory models of rehabilitation care is clearly one of the very important trends. It is critical in the current value based purchasing environment, that ambulatory rehabilitation services are able to demonstrate the outcomes they achieve for their clients. 

AROC has had an ambulatory benchmarking system in place for quite a few years, however it has been an uphill battle to recruit ambulatory rehabilitation services to join AROC, submit data and participate in benchmarking. 

While we know that ambulatory rehabilitation services tend to be time and resource challenged and the models of care varied, the assessment of function and achieving functional outcomes for clients is the fundamental raison d’etre of rehabilitation. Given the funding environment and the need to prove value for money, participating in collecting outcome data and benchmarking outcomes makes perfect sense, and one would think would be an attractive proposition for services.

So if you oversee an ambulatory rehabilitation service, and you are not already participating in AROC, please consider doing so. Contact AROC to discuss and/or get more information via aroc@uow.edu.au

Frances Simmonds
Director, AROC

A message from your President

Although rehabilitation specialist physicians have worked in both hospital and community settings for more than 40 years now, it is only in the last decade that home-based programs have really started to develop.

To see how far we have come – in my Fellowship graduation year, 1985, there were four newly-minted rehabilitation specialists in NSW. Three went into inpatient rehabilitation practice, and I went to work in the new St George Community Rehabilitation & Geriatrics Services. 

This comprised two community nurses, a physiotherapist, an occupational therapist (OT), a social worker, a secretary and myself, and we shared two large rooms in a sprawling Federation-era house (since demolished) with 54 bath-boards, and various walking frames, wheelchairs etc. Two small Holden Astras afforded us mobility around the district, and there were no aged care nor psychogeriatrics beds in the adjacent St George Hospital. With the development of the Aged Care Assessment Team (ACAT) precursor services, the team ​grew to about 20 individuals over the next five years, but it was only from the end of the 1980s that proper inpatient rehabilitation and geriatric care services with dedicated beds started at St George, with the disappearance of general physicians and the rise of geriatrics services in their place.

In the 20 years after that, hospital-based services for rehabilitation and aged care have increased considerably, and the whole treatment outcomes system of reporting was put in place for acute and subacute inpatient care systems. Colleagues may remember the early AN-SNAP trials that started more than 20 years ago now? It is interesting that whilst there is still no one agreed system for measuring the outcomes of ambulatory rehabilitation care, there has been development of accelerated discharge schemes for diagnoses like stroke, with community-based therapy programs, on the basis of ‘saved’ inpatient care costs. As more than one health bureaucrat has observed, of course you never actually save on bed costs, as other individuals appear to occupy the vacated beds, but it does mean that you can allow more patients to use the same corpus of beds, to a point.

Both your Faculty and the College are very interested in advancing the cause of community-based specialist care programs. The Faculty’s Policy & Advocacy Committee has done a lot of work on the role of rehabilitation specialists in community settings, and is working to publishing a policy paper in this area in the near future. While specific diagnoses like strokes occupy most attention at present, the ageing of our population means that musculoskeletal frailty is becoming a major issue that will be eminently suited to ‘prehabilitation’, before these folks ever get to the stage of having a fall with fractures, or another marker of the approaching end of life.

More specifically, we need to work on development of agreed outcomes measures in community and ambulatory rehabilitation, and the Faculty will be working on this with AROC in 2018, as part of our Faculty’s annual workplan.

Most patients prefer to be at home than in hospital anyway, so community care makes very good sense for all sorts of reasons.

Associate Professor Andrew Cole
President, Faculty of Rehabilitation Medicine

Examination applications open

Examination applications for eligible AFRM trainees opened on Thursday, 1 March and close on 16 March 2018.

Trainees can apply for the following exams, at their training level:

Examination  Examination date
 Module 1  Tuesday, 24 April 2018
 Fellowship Written Examination – paediatrics and general  Tuesday, 29 May 2018
 Module 2  Sunday, 24 June 2018
 Fellowship Clinical Examination – general  Saturday, 11 August 2018
 Fellowship Clinical Examination – paediatrics  Saturday, 25 August 2018

To check your eligibility email rehab@racp.edu.au

All eligible applicants can access the application forms on the examinations section of the RACP website. Please complete one application form for each examination you will attempt.

Applications close at 5pm on Friday, 16 March 2018 (AEST). 
No late applications will be accepted.

Further information can be found in the Instructions to Candidates, for each examination in the examinations section of the RACP website.

For further information regarding the examination application process please email examinations@racp.edu.au or phone 1300 69 7227 (Australia) or 0508 69 7227 (New Zealand).

Program available for 2018 Australasian Faculty of Rehabilitation Medicine Annual Training Meeting – much more than an educational meeting

The full program is now available for the 2018 Australasian Faculty of Rehabilitation Medicine (AFRM) Annual Training Meeting (ATM) being held on Saturday, 21 to Sunday, 22 April 2018 at the RACP Office, Sydney. 

Join us for an educational experience with practical workshops and lectures. Connect with your peers and Rehabilitation Specialists, streamlining your knowledge to leave more confident and energised, preparing you for your future as a physician.

We look forward to seeing you there, register at www.afrmatm.com.au. If you have any questions regarding the ATM, please contact afrm@racp.edu.au.

Voting now open for College elections

College elections are a terrific opportunity to consider the ideas being put forward by College Members and cast your vote for the leaders of tomorrow.

Voting is now open and in accordance with the College’s Constitution and By-laws, ​voting will close at 5pm AEST, Tuesday, 3 April 2018.

Read more

RACP C​ongress 2018 – ​program update

RACP Congress 2018 will take place at the International Convention Centre, Sydney, from 14 to 16 May 2018.

The AFRM George Burniston Oration will be presented by Associate Professor Michael Pollack, Senior Staff Specialist in Rehabilitation Medicine at John Hunter Hospital. Professor Pollack will present on the shifting definitions of health and illness and the role of rehabilitation. 

For more information on the RACP Congress program and speakers visit the Congress website www.racpcongress.com.au

Call for nominations

The call for nominations for various elected positions or, if applicable, expressions of interest for appointment, to Division, Faculty, Chapter, New Zealand and Australian Regional Councils or Committees is now open.

Learn more

Spinal Cord Damage Special Interest Group 

The AFRM Spinal Cord Damage (SCD) Special Interest Group (SIG) wants to reactivate after ‘being in hibernation’ for a few years. 

The focus of the SCD SIG is on rehabilitation of people with both traumatic SCI and non-traumatic spinal cord dysfunction. This includes both paediatric and adult rehabilitation, and the important issue of transition between these services.

The SIG acts as a forum for trainees and Fellows to share knowledge, discuss issues, and contribute to the College or Faculty in matters regarding SCD.  As with all SIGs, there is no joining fee – membership ‘costs’ simply entails participation and contribution to the activities of the SIG.

Potential activities include teleconference discussion around events and conferences related to SCD, the opportunity to discuss interesting journal articles, and a space to discuss challenging cases. Other potential projects include the development of a web-space for sharing articles and resources, and perhaps allowing online discussion as an adjuvant to teleconferences.  There may also be a future opportunity for reviewing the AFRM training program curriculum to ensure it remains relevant and focused to spinal specific rehabilitation concerns.

As the Interim Chair of the SCD SIG, Associate Professor Peter New, and the Interim Secretary, Dr Emma-Leigh Synnott, we ask anyone interested in joining the SCD SIG to email Emma-Leigh and raise their hand to be involved.  The intention is to then survey those who have expressed an interest to assess availability for a teleconference early in 2018, at which time we aim to discuss ideas regarding the activities and focus of the SCD SIG over the coming year. 

Anyone with expertise or interest in spinal cord rehabilitation medicine is welcome – we want you, so come and join the club.

Associate Professor Peter New and Dr Emma-Leigh Synnott

South Australia Election Statement 

The College has released a South Australian Election Statement prior to the election on 17 March.

It calls on the incoming government to focus on key priorities and makes specific policy recommendations on matters including vaccination, disability services, integrated care, digital health and telehealth, Indigenous health, and high-value care.

AMA Public Health Awards 2018 – call for nominations 

The AMA is seeking nominations of people or groups who have made an extraordinary contribution to health care and public health. Recipients will be invited to attend the 2018 AMA National Conference in Canberra in May 2018, where the awards will be presented. In the year following the presentation of the awards, recipients will have the opportunity to participate in interviews with interested media, and engage in AMA supported activities promoting their work in their field of expertise. 

Nominations are sought in the following categories: 

  • AMA Excellence in Healthcare Award
  • AMA Woman in Medicine Award.

More information regarding the awards and the nomination process may be found on the AMA website. Nominations close COB Monday, 23 April 2018.

How is immigration control impacting the health care sector?

A researcher from Monash University is asking Australian health care professionals and health justice advocates to help investigate how immigration controls impact on the provision of health care within the Australian community.

Complete an online survey covering topics including: access to health services by visa holders, information exchange between health care providers and immigration authorities, visits to health care providers by immigration officials, and actions taken by health professionals to support patients experiencing immigration problems. 

It is not necessary to have knowledge or experience of these topics to take part in the survey

No identifying information is being collected and participants are invited to complete the questionnaire based on their own professional experience.

New initiative introduced for Indigenous communities to participate in 2018 conferences

Indigenous Conference Services (ICS) Australia is proud to announce the launch of its 2018 Indigenous Conferences which takes you to Cairns, Canberra and Brisbane with a broad range of topics in Indigenous affairs.  

2018 sees an exciting new initiative introduced to encourage and help Indigenous communities participate in 2018 conferences, they have allocated up to 70 per cent of the conference proceedings to community groups and partnerships between community and government organisations in an attempt to promote the positives being achieved. We hear time and time again throughout the media how Closing the Gap initiatives are not being achieved where in real terms, many successful leap forwards are taking place.  ​ICS invites you to submit-a-paper and be part of the positive movement in Indigenous Australia. 

For more information, please visit the conference website at www.icsconferences.org or contact them by email at adminics@bigpond.com.

Voting is now open for the Medical Council election

The Medical Council of New Zealand election opened on Tuesday, 20 February 2018. ​Twenty one candidates are standing for four positions. 

Voting closes on Friday, 23 March 2018. 

Read more

Claiming initial attendance items – education campaign from the Department of Health

The Department of Health will be conducting an education campaign in March 2018 on the use of Medicare Benefit Scheme (MBS) initial attendance items 104 and 110. The campaign will involve the department writing to specialists and consultant physicians who appear to be claiming multiple initial attendance items for a patient’s single course of treatment.

This is a good opportunity for all specialists and consultant physicians to review their billing protocols for these items. To assist providers, the department has developed a checklist for initial attendance items 104 and 110 that is available for download.

Initial attendance items must only be claimed for the first attendance of a single course of treatment. Any subsequent attendance that relates to the continuing management or review of the referred condition, up to the stage where the patient is referred back to the care of the referring practitioner, is to be billed as a subsequent attendance item (e.g. 105, 116 or 119). The department will be continuing to monitor MBS items 104 and 110 in the future.

AFRM ​training resources

Bi-National Training Program (BNTP) 

The AFRM conducts the BNTP on the last Wednesday of every month from February to November. These training sessions are broadcast across Australia and New Zealand. The BNTP sessions use Zoom conferencing to provide trainees with Rehabilitation Medicine knowledge and information. These sessions are not intended to prepare trainees for the AFRM Fellowship Examinations. 

View session dates

To join the video conference on the day, follow this link to the Zoom Software.

The meeting ID: 389 913 1497 

Email the RACP events team at events@racp.edu.au or call +61 2 8247 6240 to arrange equipment testing. Ensure you do this as soon as possible to avoid any last-minute disruptions.

Important note: Please ensure that you turn your webcam off before you join the session. Due to the nature of the recordings if you connect to the videoconference with your webcam on you will appear on the screen. If you join the session late, the videoconference room will indicate that it is locked and will not allow you to connect, in this instance please call RACP events team +61 2 8247 6240.
 
This information will also be available on the AFRM Training Resources Page

AFRM contact details

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM Education and Training enquiries:
Name: Kathleen Walker, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Oral Examination enquiries:
Name: Irene Atsiaris, Examination Coordinator 
Phone: +61 2 9256 5422
Email: examinations@racp.edu.au  

AFRM training site accreditation inquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
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