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RACGP questions smoking cessation MBS items


Matt Woodley


31/05/2021 4:24:04 PM

The proposed temporary Medicare item numbers risk fragmentation at the expense of comprehensive primary care, the college has warned.

Man butting out cigarette
New Australian research has shown that the risk of cancer increases with the number of cigarettes smoked per day.

The Department of Health (DoH) has put forward the temporary MBS items as a way of generating awareness about new guidelines and regulations relating to liquid nicotine, including the prescribing of e-cigarettes.
 
While the development of MBS items for these services is intended to complement updates to clinical guidelines, a college submission relays membership concerns that they would represent ‘fragmentation of MBS funding rather than comprehensive primary care’.
 
‘The RACGP generally does not support the introduction of single disease focused MBS items, as they are not consistent with the generalist approach to care GPs are trained to provide,’ the submission states.
 
‘A greater priority for allocation of health funding should be supporting patient access to comprehensive, continuous general practice care, where a patient and their GP can determine which assessments and interventions are required to support the patient to remain well.’
 
Should the DoH proceed with the new MBS items, it expects that GPs will eventually incorporate the new treatment strategies into their regular consultations, consistent with how support for nicotine cessation is provided now.
 
The college warns it is still unclear how long the new items will be in place for and suggests that while the new items are designed to familiarise practitioners with new guidelines and interventions, they could actually create confusion.
 
‘Rather than basing the new MBS item/s on item 699 [heart health assessment], the RACGP instead recommends they be managed under similar arrangements to items 721 and 732 [General Practitioner Management Plans (GPMPs)], with standard time-based consultations being used for interim follow-up visits either face-to-face or via telehealth,’ the submission states.
 
‘The new services appear similar to GPMPs in scope, as they require consent and a written plan and involve managing nicotine smoking cessation as a standalone issue.’
 
The RACGP submission, published on World No Tobacco Day, comes in the wake of a new Australian-first study, which has shown that the risk of cancer increases with the number of cigarettes smoked per day, and that even ‘light’ smokers of 1–5 cigarettes per day have an almost 10-fold increased risk of lung cancer.
 
‘Some smokers are at the point where they are smoking a few cigarettes a day and don’t realise the cancer risks they are running,’ Dr Marianne Weber, Senior Research Fellow at The Daffodil Centre said.
 
‘Cigarette smoke is directly coating their mouth, throat, oesophagus and lungs with 7000 chemicals, including 69 carcinogens, and the increase in cancer risk even with light smoking is dramatic.
 
‘The good news is that the risk of cancer was significantly reduced among participants who had quit smoking – and the younger they quit, the better. These results demonstrate that quitting smoking is much more effective at reducing disease than “cutting down” the number of cigarettes smoked.’
 
The findings were drawn from more than 250,000 Australians who participated in the Sax Institute’s 45 and Up Study, one of the largest ongoing longitudinal studies of health and ageing in the world.
 
Other findings include: 

  • lung cancer risk increases by 7% with every cigarette per day
  • for current smokers, the lifetime risk of lung cancer ranges from 14% overall to 26% (1 in 4) for those who smoke more than 35 cigarettes per day, compared to 1% risk for never-smokers (1 in 100)
  • tobacco smoking significantly increases the risk for cancers of the lung, larynx, liver, oesophagus, bladder, pancreas, head and neck, stomach, colorectum, kidney, gallbladder, and cancers of unknown primary site.
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MBS Medicare smoking cessation tobacco


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Dr Peter JD Spafford   7/06/2021 9:01:18 PM

Thank you RACGP. Medicare has no need or right to monitor the content of any consultation (and I include mental health here). Each consult has a balance of physical, mental, social and lifestyle well being. If they want to monitor content, bring back the BEACH. Otherwise it is a political points scoring game with GPs as the ball.