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Chief Medical Officers Review

Reducing antibiotic over-prescription

The global challenge of antimicrobial resistance remains one of the major public health threats facing the world. The overuse of antibiotics is a key contributor to antibiotic resistance and in Australia, we have particularly high rates of antibiotic use in general practice.

In 2017-18, the Department provided feedback to the highest prescribing general practitioners (GPs) prompting them to consider opportunities to reduce prescribing antibiotics where appropriate and safe. In winter 2017, coinciding with the annual spike in antibiotic prescribing, I wrote to 5,300 GPs whose prescribing rates were in the top 30 per cent for their geographic region. As a result of this initiative, an estimated 126,352 fewer antibiotic prescriptions were filled over the following six-month period.

Changing patient access for medicines containing codeine

On 1 February 2018, low-dose codeine medicines became prescription-only, bringing Australia into line with the growing number of countries that have introduced, or are shortly to introduce, stronger regulatory controls over these medicines. The use of low dose codeine medicines is associated with high health risks such as tolerance, physical dependence and even fatal verdoses. The change in regulation was followed by widespread communication and consultation with a focus on directing people with chronic non-cancer pain to alternative forms of more effective and safer pain management. To support this, the Government provided $20 million for a Pain MedsCheck trial to support community pharmacists to evaluate their patients’ medication use.

Continuing to improve immunisation

In 2017, a major national immunisation campaign was launched to provide parents and carers with evidence-based information about immunisation, the diseases it prevents and the importance of vaccinating on time. The campaign encouraged parents to take action and increased parents’ intentions to vaccinate their children, especially in geographic areas with low immunisation coverage rates.

In 2017-18, a number of new vaccines were added to the National Immunisation Program. Pertussis (whooping cough) vaccination is now available for pregnant women. Protection against Human Papillomavirus was also improved with the introduction of a new vaccine protecting against nine types of the infection; a significant increase from the previous four types. A new infant Meningococcal vaccine was also introduced to protect against four (up from one) types of the disease.

New influenza vaccines specifically designed to improve protection amongst those aged 65 years and older were introduced in response to the high number of influenza cases and related deaths reported amongst the elderly during the 2017 season. In addition, Australian Government subsidised residential aged care providers are now required to have in place a free influenza vaccination program for staff and volunteers to ensure strengthened protection of vulnerable people against influenza.

Strengthening our emergency preparedness

During 2017, Australia underwent a rigorous World Health Organization-led evaluation, known as a Joint External Evaluation (JEE) of International Health Regulations (2005), across 19 core capacities. Australia’s health security capacity and our public health system’s ability to prevent, prepare for, detect and respond to all manner of public health threats was independently assessed by a team of international experts. The final JEE Mission Report found that Australia demonstrated a very high capacity to effectively respond to public health emergencies across all the targeted core capacities. However, it is important to continuously improve this system in the face of evolving public health threats. The Mission Report contains 66 recommendations for further strengthening Australia’s health security capacity. The Department is developing a National Action Plan for Health Security to implement the recommendations over a five year period.

Coordinating efforts to address the syphilis outbreak affecting Indigenous communities in northern and central Australia

An outbreak of infectious syphilis predominantly affecting Indigenous communities is ongoing in a number of areas across Australia. Syphilis is a serious infection with complex disease progression and early symptoms can often go unnoticed. If left untreated, it can have significant health effects. To assist jurisdictions to control this outbreak in predominantly young Aboriginal and Torres Strait Islander peoples, a nationally coordinated response was developed and put into action. The response is guided by a National Strategic Approach and Action Plan that focuses on increasing testing and treatment, ensuring effective surveillance and reporting mechanisms, developing community and clinician engagement strategies and preventing cases of congenital syphilis.

Addressing out-of-pocket costs

There is increasing concern about the rise in out-of-pocket medical costs for some consumers requiring private hospital treatments and procedures, and some non-admitted services. The major impact is seen in the exorbitant and unjustifiable fees charged by a minority of specialist practitioners. Some of these fees are hidden, not disclosed to Medicare or the private health insurer. Many consumers are not aware of the fee policy of specialists until their first appointment and feel locked into paying unexpected high fees. A Ministerial Advisory Committee has been established to address the issue of transparency of costs and to ensure consumers are informed of fee charging practices when choosing a recommended specialist.

Building our medical workforce

During 2017-18, the Department completed a significant amount of work in order to deliver the Stronger Rural Health Strategy. This Strategy addresses each and every stage of the medical workforce supply and will result in more fully trained doctors providing services to rural and regional communities in Australia.

The expansion and addition of new Junior Doctor Training Programs will mean that young doctors, after graduation, can stay working in rural and remote regions with the opportunity to enter new streamlined and expanded general practice specialist training programs. The Strategy will support doctors currently working in Australia, without full specialist GP qualifications, to gain these qualifications through completing training over the next five years. Throughout the year ahead we will continue to work with key health stakeholders on one of the most comprehensive workforce reform packages ever produced in Australia.

I look forward to continuing to work collaboratively with state and territory Chief Health Officers, departmental staff, and our diverse range of stakeholders in delivering Australia’s world-class health system into the future.

Professor Brendan Murphy
Chief Medical Officer

September 2018