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RACGP calls for improved resources for tick-borne diseases
As part of a Senate investigation into the illnesses, the college says GPs must be equipped with clear and evidence-based information.
The RACGP says the Therapeutic Goods Administration should consider ways to reduce access to low-value or harmful treatments.
Improving support and resources for GPs in the diagnosis and ongoing care of people with tick-borne diseases will ultimately improve the quality of care that patients receive, the RACGP has told a Parliamentary committee.
The Senate Inquiry is investigating the initiatives and resources developed to improve awareness, diagnosis, treatment and management of tick-borne diseases in Australia, as well as current clinical pathways for patients.
In a submission to the Inquiry, RACGP President Dr Michael Wright has called for clear evidence-based guidelines and resources.
Dr Wright said GPs are one of the first points of contact for people with rare diseases, such as tick-borne illnesses, so need to be alert and aware of when to investigate for rare causes when a patient present with symptoms and signs that could be difficult to pinpoint.
‘GPs will also be aware these illnesses could affect a patient psychologically as well as physically and are well placed to coordinate multidisciplinary care,’ he said in the submission.
Dr Wright highlighted figures from a 2016 Parliamentary report into an emerging tick-borne disease that he said illustrated that ‘misdirected care can lead to underdiagnosis of overlapping conditions and expensive diversion of patient and clinical resources’.
The 2016 report found that, of people presenting with a Lyme-like illness:
- 80–90% had undergone substantial financial hardship paying for investigations from unaccredited laboratories and, in some cases, prolonged antibiotic treatment that had no (or minimal) objective evidence of benefit
- 30–50% had potentially serious medical conditions that had either been previously undiagnosed, diagnosed but inappropriately treated, or diagnosed but denied by the patient such that no treatment was sought
- 10–20% had a serious defined psychiatric illness that required specialist care.
‘We need to be mindful that unnecessary medications, testing or procedures are low-value care and can cause more harm than benefit,’ Dr Wright said.
He also suggested the Therapeutic Goods Administration should consider ways to reduce access to low-value or harmful treatments.
‘As there is currently little or no evidence to support specific treatments for tick-borne diseases, it is important that all patients have access to and are provided with safe and high-quality care,’ he said.
Dr Wright noted from 2020–23,
a suite of educational materials was released to support health professionals on Australian tick-borne illnesses.
However, he said, there was still a need for GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) level evidence-based guidelines and patient information, and quality, evidence-based resources for clinicians and patients to combat existing misinformation.
Dr Wright said key areas where GPs needed clear information and evidence-based resources include:
- effective prevention strategies
- Q fever vaccination
- first aid strategies for tick bite
- information about post-exposure prophylaxis
- the range of symptoms and signs associated with tick-borne subacute and chronic infections
- effective, affordable and accessible diagnostic tests
- evidence-based treatment algorithms
- information to provide returned travellers with suspected Lyme disease and similar conditions.
The RACGP has also called for adequate funding for Australian-specific research and research synthesis to be directed to the recently established Australian Centre for Disease Control, to advance the management of complex inflammatory diseases, and for an alignment of guidance from the veterinarian, agricultural and human health sectors.
However, with GPs at the coalface of patient care they are ‘well placed’ to provide care and support for those presenting with medically unexplained symptoms, Dr Wright said.
‘As highlighted in the
National Strategic Action Plan for Rare Diseases, GPs are one of the key initial points of contact for people with rare diseases,’ he said.
‘Recognition and support for the role of general practice in the diagnosis and ongoing care of people with tick-borne diseases will ultimately improve the quality of care that patients receive.’
RACGP Expert Committee – Quality Care member Dr Gary Deed will front the Parliamentary committee on Wednesday to share more of the college’s advocacy on the topic.
A final report is due to be handed down on 26 March.
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