Pot-pourri eBulletin 14 December 2018

President's Message

As the year ends I would like to thank our members for their continuous efforts and contributions to the College. Your dedication to the Division, education, training, research and policy & advocacy is what drives change within our profession and the wider community. The Paediatric voice is strong and this is evident through the numerous policy and advocacy campaigns we have led this year.

A recent example of what we can achieve as a Division and College is the successful advocacy campaign of the Inequities in Child Health Position Statement. In October, the RACP held a roundtable at Parliament House in Canberra with the Australian Government announcing the development of a Child Health Action Plan. The Action Plan will build on Healthy, Safe and Thriving, the National Strategic Framework for Child and Youth Health. To further support this, the RACP hosted a roundtable at the Sydney office on 28 November to identify what is required to improve health outcomes for children and young people and provide a framework for action.  I would like to thank Sue Woolfenden and Sharon Goldfeld for their key involvement and look forward to seeing the Framework rolled out.

With 2019 around the corner, the PCHD Council has developed their workplan for the next two years with the below high level key areas of key focus:

  • Mental health and wellbeing of physicians.
  • Models of Care and service re-design.
  • Improved access and communication of resources for PCHD members.
  • Advocacy for the first 2000 days.
  • Education in the Asia Pacific region.

I am excited to see what we can achieve as a Division and look forward to working collaboratively with you to further strengthen our voice and explore new opportunities.

I wish you all a safe and happy holiday.

Professor Paul Colditz
President, Paediatrics & Child Health Division

National Action Plan for Children’s Health for 2020 – 2030 Roundtable

This month, the RACP hosted a round table discussion in partnership with the Commonwealth Department of Health and the Australian Research Alliance for Children and Youth (ARACY), where leading child health stakeholders discussed the development of the National Action Plan for Children’s Health for 2020 – 2030, which was announced by Health Minister Greg Hunt at the RACP’s August forum in Canberra.

The group discussed specific actions and activities that could be introduced to improve current systems, mapped against the five strategic priorities outlined in Healthy Safe and Thriving: National Strategic framework for Child and Youth Health (AHMAC 2015). RACP Fellows Associate Professor Susan Woolfenden and Professor Sharon Goldfeld gave brief opening and closing remarks, and the event was attended by key federal government officials, advocacy and service-providing NGOs, and peak body representatives.

Chapter Satellite Day: Trainee presentations

If you’re a trainee who has completed research in Community Child Health, or a Fellow with research undertaken as a trainee in the last five years, the Chapter Satellite Day is a great opportunity to showcase your research and presentation skills.

The Chapter of Community Child Health Committee is seeking abstracts from interested trainees and new Fellows to present at the Chapter Satellite Day on Sunday, 5 May 2019 at the Aotea Centre, Auckland. This is not a competition but an opportunity to share your findings and receive feedback from senior Community Child Health Fellows.

Abstracts must align with Community Child Health and be on work:

  • undertaken in Australia and/or New Zealand
  • relating to children with special needs, or population paediatrics in one of the following categories:
    • Child development and behaviour
    • Child disability
    • Child protection
    • Child health surveillance and screening
    • Health promotion
    • Health protection and disease control.

As this is not an award, there will be no winner on the day, however presenters will receive a certificate. Rue Wright Memorial Award presentations (to be formally held on Monday, 6 May 2019) may be also submitted for this session; as above, no prize applies for the Satellite Day presentation. 

There will be time for four presentations and the format will be 12 minutes for the presentation and up to three minutes of questions.

Abstracts must be submitted to Paed@racp.edu.au by no later than Thursday, 31 January 2019.

RACP becoming a supporter of the Global Initiative to End All Corporal Punishment of Children

The RACP and its Paediatrics & Child Health Division (PCHD) accepted an invitation from the Global Initiative to End All Corporal Punishment of Children to be listed as supporters on the Global Initiative’s website. The Global Initiative campaigns around the world to end corporal punishment of children. It generally seeks to partner with organisations in many countries and has collaborated with the College previously. Its campaign is strongly aligned with established College positions on child protection and physical punishment of children.

Corporal punishment has been illegal in all settings in New Zealand since 2005, but as the RACP is a trans-tasman College, it is now listed as supporting organisation in Australia as well as New Zealand on an interactive map on the Global initiative’s website.

Other supporter organisations in Australia and New Zealand to date are:

Australia

  • Australian Human Rights Commission
  • Bega Valley Sanctuary Refugee Group
  • Commissioner for Children Tasmania
  • National Children’s and Youth Law Centre

NZ

  • NZ Human Rights Commission
  • Brainwave Trust Aotearoa
  • Action for Children & Youth Aotearoa
  • Youthlaw Tino rangatiratanga Taitamariki

While being a supporter does not entail any financial or other obligations, the College might be listed as supporting organisation in future Global Initiative publications.

PCHD presentation awards at RACP Congress 2019

Abstract submissions are now open for the following opportunities to present and be recognised at 2019 RACP Congress:

Best Poster Prize in Paediatrics & Child Health
Paediatrics and Child Health Fellows or Advanced Trainees are invited to submit an abstract for the opportunity to present at the Best Poster Prize in Paediatrics & Child Health to be held during the RACP Congress.

The best presenter will receive $1500 and a certificate and recognised at the Gala Dinner.

Abstract submissions are now accepted via the RACP Congress website.

Applications close on Thursday, 31 January 2019.

Rue Wright Memorial Award
The Rue Wright Memorial Award is awarded to a Fellow or trainee who demonstrates excellence in hypothesis, scientific merit and relevance to Community Child Health in an oral presentation at RACP Congress.

The Rue Wright will receive $1500 and a certificate and recognised at RACP Congress.

Abstract submissions are now accepted via the RACP Congress website.

Applications close on Thursday, 31 January 2019.

Opinion article: Referral letters are a nuisance more than a necessity

Parents caring for children with complex and rare diseases are heavily burdened by many issues. Attending several appointments a week, and sometimes a day, comes at the expense of sleep and time dedicated to other children or family members. Their mental health suffers negatively, as they feel they have been given a life sentence of hard labour.

A five-minute-appointment for a referral letter, which usually carries no relevant clinical information, can waste hours of their precious time. The painful stretch needed to transport a disabled child, drive in traffic, find parking, and manage an irritable child in a busy waiting room, steals away value from more important daily tasks and adds to their stress levels.  The need for referral letters to access paediatricians is becoming a nuisance rather than necessity. It is adding to low-value care with money and time wasted. It is also becoming a barrier to quality multidisciplinary management.  

Advocating for better healthcare for children should consider the operational costs and the challenges of accessing treatment. The aim is to simplify the system for the increasingly complex cases. Many children with difficult disorders are managed primarily by general paediatricians, rather than general practitioners, as they have the training and capacity to do so. 

Yet, paediatricians continue to be restricted to carry out coordinated care. Their referral letter has a validity of three months. This makes no clinical sense, as most chronic diseases will last for a lifetime. It is an embarrassingly poor policy, and is annoying doctors, nurses, parents, and administration staff alike. It may also be the reason for many missed appointments.

In times of modern medicine, our health system has failed to update its past policies that are now considered poorly designed. What may work in adult medicine does not necessarily translate into paediatric practice. The RACP should advocate for a change of the referral system that has no clinical value or common sense. It is causing frustration and demeaning professional communication, and is an added burden. It is in most cases, not just low-value care, but no-value care.

Dr Joseph Khouri, FRACP

RACP Congress 2019

Join colleagues from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand, for RACP Congress 2019.

Register now to attend the joint Paediatrics & Child Heath (PCHD) and Adult Medicine Divisions (AMD) session on transitioning a patient from paediatric care to adult care and how it can be a complex undertaking. PCHD and AMD are combining to bring expert presentations from the paediatric and adult medicine spheres to seek solutions on how to smooth the process for patients, their carers and their medical teams.

RACP Congress 2019 key topics include:

  • Life course theory ‘How do we impact health along the life course?’
  • Obesity: rising to the challenge
  • First 1000 days and non-communicable diseases
  • Medically unexplained symptoms master class
  • Mental health and addiction of patients
  • Chronic disease and integrated care

Early bird registration closes 22 February 2019.

Visit the Congress website to register and view the program.

Professional Online Communities 

The RACP is researching ways we can help you connect with other members online.

For us to deliver the best solution it's important we understand your needs. The below survey has been created to capture your needs as members of the College.

The survey is short and anonymous – it will take no longer than five minutes.

We strongly urge you to take the time to complete this, the more data we have on what it is members would like and use, the better we can plan ahead.

Click here to take the survey. 

Child Protection Course 2019 - Forensic Medical Assessment in Physical and Sexual Assault

Sydney Children’s Hospital, Randwick
25 – 28 February 2019

Join the child protection team in Randwick for a four-day child protection course.

Topics covered include common medical presentations of physical abuse and neglect, forensic specimen collection in child sexual assault and report writing for court as well as navigating common pitfalls encountered in the legal process.

This course is aimed at paediatric trainees or paediatricians who would like an update on child protection.

Any queries or to register your interest, please contact: Child Protection Secretary Anna Hatzipavlis or Dr Dimitra Tzioumi

Survey of Clinician Researchers – Invitation to participate

The National Health and Medical Research Council (NHMRC) would like to invite all clinician researchers to participate in the 2018 Survey of Clinician Researchers. The survey is being conducted on behalf of NHMRC by ORIMA Research, an independent market and social research company.

By participating in this survey, you will contribute to research that will inform the NHMRC about:

  • whether there are appropriately clear and supported career pathways available to clinician researchers in Australia;
  • factors that enable some clinicians to enter research;
  • factors that enable some clinicians to maintain a career in research;
  • factors that cause some clinicians to choose not to enter research;
  • major support mechanisms and enablers for clinician researchers; and
  • major barriers and current issues for clinician researchers.

Participation in the project will assist NHMRC in building a better understanding of the clinician researcher population in Australia. The RACP encourage you to participate in this important research as the project will benefit researchers from medical, nursing and allied health disciplines and in the longer term will aid the integration and translation of research into health policy and practice.

Ethics approval was granted for this project by the ORIMA Research Human Research Ethics Committee.

For more information, or to participate:

  1. read the Participant Information Sheet
  2. go to the survey website  

If you have further questions regarding the Survey of Clinician Researchers, please do not hesitate to contact:

Workshops to promote participation from Aboriginal and/or Torres Strait Islander women in the National Cervical Screening Program 

Around 55 workshops (free of charge to workshop participants) will be delivered across Australia in 2018 and 2019. The workshops aim to support healthcare providers and other relevant groups to promote cervical screening and the benefits of regular cervical screening to Aboriginal and/or Torres Strait Islander women, in accordance with the Renewal changes. 

To register, or for more information on the workshops, please contact The Benchmarque Group on telephone 1300 855 568 or by email at courses@benchmarquegroup.com.au

Newly released report on reducing opioid-related harm for surgical patients

The Society of Hospital Pharmacists of Australia's (SHPA) newly released report, Reducing opioid-related harm: A hospital pharmacy landscape, exposes national inconsistencies in the provision of pharmacy services to reduce risk of opioid misuse, extremely high use of sustained release opioids and poor handover of discharge information for use by General Practitioners.

According to SHPA, this is the "first Australian study to comprehensively analyse current hospital pharmacy practices around opioids has shone a light on the link between the prescribing and supply of opioids to patients after surgery in public and private hospitals nationally and heightened risk of long-term misuse and dependence, highlighting the urgent need for a coordinated, multidisciplinary response." 

Medical Board of Australia’s updated sexual boundaries guidelines

The Medical Board of Australia’s updated Guidelines: Sexual boundaries in the doctor-patient relationship come into effect on 12 December 2018.

The updated guidelines complement the Board’s Good medical practice: A code of conduct for doctors in Australia and do not change the ethical and professional conduct expected of doctors by their peers, the community and the Board.

The updated guidelines were finalised following wide-ranging stakeholder consultation. The Board appreciates the contribution of stakeholders to the review of the guidelines.

The key changes to the guidelines include:

  • A change in the title to make the scope of the guidelines clearer.
  • Editorial updates that re-order the content, make it easier to read and clarify terms and definitions.
  • A new section on social media that complements the Board’s Social media policy.
  • A requirement for patient consent if medical students or anyone else is to be present during an examination or consultation.
  • Advice that an unwarranted physical examination may constitute sexual assault. This includes conducting or allowing others, such as students, to conduct examinations on anaesthetised patients, when the patient has not given explicit consent.
  • Replacing the term ‘chaperone’ with the term ‘observer’. The revised section on the use of observers reflects the advice and principles in Professor Ron Paterson’s report of the Independent review of the use of chaperones to protect patients in Australia, February 2017.

Lead Fellow reminder

Expressions of interest are sought from Fellows interested in nominating for the RACP Congress Lead Fellow role for 2020, with the possibility of extending to 2021.

The Lead Fellow and the Congress Planning Committee work with key stakeholders to implement the Board’s strategic vision for Congress.

Find out more

Strengthening CPD

Following the recent release of the Medical Board of Australia’s Professional Performance Framework, a new 2019 MyCPD Framework comes into effect in November 2018.

The simplified Framework strengthens CPD by engaging Fellows in a range of CPD activities from three categories:

  • Educational activities.
  • Reviewing performance.
  • Measuring outcomes.

It is likely you are already completing formal or informal activities that can be claimed in these categories.

To help you understand the changes, we’ve put together a list of common questions and answers, that explain what the changes mean for you and why they’ve been made. You can also download the 2019 Framework online.

Read more

PHARMAC audit findings – Special Authority Audit of Funded Melatonin

The Pharmaceutical Management Agency (PHARMAC) undertakes regular audits of Special Authorities (SA) applications and has recently completed an audit of Melatonin SA applications.

The audit revealed that a number of SA applications for funding were submitted where the criteria were not met, with a 28 per cent non-compliance rate overall. Non-compliance was found in two areas of applications reviewed:

  • patients who did not meet the criterion of having a neurodevelopmental disorder. E.g. applications submitted for patients with depression and/or anxiety (54 per cent),
  • patients’ notes did not record that behavioural or environmental approaches had been tried (46 per cent).

The audit findings underscore the importance of clinicians documenting in the patient notes when and how the relevant criteria are met.

Inappropriate use of SA criteria can lead to inequities in both access to treatments and in health outcomes from within the limited health budget, as the funds used for patients who did not meet the relevant melatonin SA criteria are then not available for investment in other treatments.

PHARMAC can take actions against clinicians submitting non-compliant applications including removing the ability to submit SA applications, requiring oversight by another clinician, and/or notifying the clinician’s College, DHB and the Medical Council.

There are options available if a patient does not meet the funding criteria but the clinician considers a treatment or medicine is in the patient’s best interest. For more information contact Jayne.Watkins@pharmac.govt.nz

PHARMAC is continuing to monitor melatonin prescription numbers and may re-audit melatonin SA applications in the future.

Pot-Pourri submissions welcome

To submit an article for publishing in Pot-pourri, please email paed@racp.edu.au. The article should be no more than 350 words. If you would like to submit an image with your article, it would be assumed that you have received appropriate permission to use the photo and it needs to be of high resolution, above 300 dpi. Please note that articles may need to be edited by the RACP Communications Team.

Update your details with the College

Did you know that you can now update your address details online? Simply Login to MyRACP and go to “Edit my details”.

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