Lisa Urquhart is an Accredited Practising Dietitian, Accredited Nutritionist and Associate Lecturer in Nutrition and Dietetics at the University of Newcastle’s Department of Rural Health. She graduated from the University of Sydney. Her current academic role involves supporting Nutrition and Dietetic Students on their placements in a rural setting, through a range of activities including teaching, community engagement and service learning. She is also involved in rural health and education research, as well as, providing continuing professional development to regional and rural clinicians. Lisa also works clinically in both private and public settings, particularly in the areas of paediatric feeding and diabetes. She was part of a dynamic allied health team at Coffs Harbour Health Campus involved in a local interdisciplinary paediatric feeding and assessment clinic. Lisa works privately as part of specialist diabetes team including an endocrinologist and diabetes educator, at the Coffs Diabetes Centre in areas of clinical practice, research and education.
Children with feeding difficulties have the potential for social, physical, emotional and developmental delay. Feeding difficulties can intertwine complex sensory, motor and psychological aspects requiring individualised therapy. As rural and regional centres become more responsible for the implementation of specialised paediatric services, there is an increasing need for an interdisciplinary approach to childhood feeding difficulties.
The Feeding Assessment and Management (FAM) Clinic was developed in Coffs Harbour in collaboration with Child Adolescent and Family Health (CAFH) and acute care providers to meet a growing need for specialised paediatric service provision in the local rural area. The area is characterised by communities with low socioeconomic status from geographically isolated areas, including 5% Aboriginal and Torres Strait Islander and 2% refugee population.
The FAM clinic is an interdisciplinary clinic which operates one day per month, involving a CAFH Occupational Therapist and Speech Pathologist, and, an Acute Care Dietitian. This service operates without additional funding or allowance for extra clinical or administration time. Eligibility for FAM clinic includes prior contact with an allied health professional (AHP) for a screening process and service referral, as well as, not being eligible for government disability funding or services. An eligible client requires two areas of clinical concern from the three areas of growth and nutrition, feeding skills and/or sensory concerns. The interdisciplinary sessions last 1.5 hours and, are framed around the Sequential Oral Sensory approach to feeding. A comprehensive report is provided to the GP, Paediatrician, parent/guardian and other relevant parties for each client assessment, outlining findings and recommendations.
The FAM clinic clearly addresses a previously unmet service gap. Client outcomes have included removal of a nasogastric feeding tube secondary to increased oral intake, reduced reliance of oral nutrition supplements, increased food variety and improved communication and play. Parents have reported decreased anxiety around meal times and increased empowerment around food play and meal provision. Enabling families to source services in a rural setting has reduced travel times, associated expenses and stress for families typically incurred when travelling to metropolitan centres. Opportunities for staff upskilling can be achieved within a local health district or via technology to capture additional AHPs and improve rural and remote staff satisfaction. The FAM clinic model of service delivery could be translated to suit a range of rural and remote settings, without additional costs to achieve positive paediatric nutrition and health outcomes.
Tim Usherwood is Professor of General Practice at the University of Sydney; and Professorial Fellow at the George Institute for Global Health. He is Chair of the General Practice and Primary Care Clinical Committee of the MBS Review, Chairperson of the Diagnostics Expert Advisory Panel for NPS MedicineWise, and an Associate of the Menzies Centre for Health Policy. He is Deputy Chair of the Board of WentWest Ltd, the Western Sydney PHN, and chairs its Clinical Governance Committee. Professor Usherwood's research focuses on the development and evaluation of interventions to improve health outcomes in chronic disease and primary care, with a particular focus on access to care, vascular disease, depression and asthma. He has published more than 140 refereed research papers on these and other health-related topics, in addition to many other articles, book chapters and books. He has been a Chief Investigator on ten NHMRC-funded research projects (four current) and a large number of other studies.
Background: The MBS Review Taskforce is undertaking an independent clinician-led review of the Medicare Benefits Schedule (MBS). This is the first comprehensive review in 30 years of the 5,700 items covered in the MBS.
The priority with this Review is to ensure that the items on the MBS are aligned with contemporary clinical evidence and practice and improve health outcomes for all Australians. The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.
The Taskforce is committed to providing recommendations to Government that will allow the MBS to deliver on each of these key goals:
The clinical review of MBS items, ranging from consultations, procedures and diagnostics is carried out by discipline specific clinical committees and working groups.
At the same time the MBS Principles and Rules Committee appointed by the Taskforce are reviewing the enforceable rules and regulations underpinning the MBS so they are up-to-date and support contemporary clinical practice.
To date, more than 300 clinicians and approximately 40 Clinical Committees and working groups have been reviewing the items, line-by-line.
Rural and remote consultation: A key part of the Review is continuing and widespread consultation with rural and remote health professionals and patients.
Our community consultations have highlighted the diversity of needs of patients in urban and rural and remote Australia and the need for different methods of supporting rural and remote clinicians and their patients as they access care.
Rural and remote consultation will continue to be integral to the MBS Review process and feedback on the impact of the recommendations in rural and remote Australia is invited and welcomed. This feedback will be closely considered by the Taskforce Clinical Committees and the Taskforce when final recommendations are delivered to government.
Professor Bruce Robinson, Chair of the Taskforce, has been on the road this year in QLD, NT and Tasmania listening to the unique challenges facing health professionals and patients in rural and remote Australia with further plans for more rural consultations in 2017.
We will report progress of the General Practice and Primary Care Clinical Committee.