Value of showing where too much treatment is too bad

A new report showing that high rates of caesareans and infant medication are placing some infants in Australia at risk of avoidable health problems highlights the importance of ensuring treatment and care is based on best available medical evidence, the Consumers Health Forum says.

The Third Australian Atlas of Healthcare Variation released today shows that in some places as many as one in five planned births occurred before 37 weeks gestation, significantly increasing the risk of adverse health and childhood development outcomes.

The Atlas, produced by the Australian Commission on Safety and Quality in Health Care, also reveals Australian children under 9 years of age are frequently being prescribed high rates of unwarranted antibiotic treatment and in some cases reflux medicine. These two medications can expose infants in later years to increased risks of conditions including asthma, gastroenteritis, pneumonia and food allergies.

Australia’s overall rates of antibiotic dispensing for children are triple those in some similar countries.

“It is disturbing that the unjustifiable and excessive use of these treatments exposing children to significant and perhaps lifelong harms is happening in some but not other parts of Australia and points to the necessity for more effective medical and community education,” the CEO of the Consumers Health Forum, Leanne Wells, said.

“Choosing an early caesarean over natural delivery can be the result of anxiety concerning the relatively rare risk of still birth or for other legitimate medical reasons, yet awareness and consideration of the long-term consequences for the infant may not be well-understood.  This dilemma emphasises the necessity of doctor and patient to be aware of the value of informed consent and the benefits of shared decision making.

“While parents, unaware of the risks, may press doctors to prescribe potentially harmful treatments, it should be the unquestionable responsibility of the doctor to act in the best interests of the health of mother and child, both during the peri and post-natal period and the early years of a child’s development.

“The sharp variations in treatment rates between different parts of Australia should alert health consumers to the need to discuss with their doctors the implications of a given treatment or course of action for their children and for themselves.

“As the Commission’s Clinical Director, Professor Anne Duggan says, the wide variations can be a sign that some people are getting health care that they don’t need while others may be missing out on the healthcare they do need.

“Professor Duggan points to the evidence showing the overuse of gastroscopies when the health of the community would be better served by doing more colonoscopies to identify colon cancer.

“The findings of the Third Atlas add to the great benefits of the previous reports in enabling hitherto unavailable scrutiny of variability of healthcare services in Australia. “The Atlas series is in keeping with CHF’s recently released White Paper Shifting Gears – Consumers Transforming Health  where we advocate for greater transparency and wider availability of data to support better policy and give people greater agency to exercise choice and control in health care.     

“The reports combined with the work by such organisations as NPS MedicineWise and Choosing Wisely Australia are having some impact on policies and practices of government health services and the medical profession. The incidence of knee arthroscopy operations for instance shows a steady decline in all states in the past six years since it became more widely known that the operation was not appropriate for most cases of knee osteoarthritis.

“However there still remain wide variations in the use of this procedure and the experience with other treatments, such as antibiotic dispensing, indicate Australia can do much better to ensure the right treatments get to the right people,” Ms Wells said.

“Consumers could be powerful agents for improving the appropriateness of care.  As Professor Duggan says, patient expectations are known to influence prescribing, and greater knowledge among consumers about risks and benefits of antibiotics for children could significantly improve use of these medicines,” Ms Wells said.



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Mark Metherell
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