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Update: Doctors National Helpline, Australia’s Opioids Crisis and Artificial Intelligence in Radiology

September 3, 2019 0 Comments

We highlight GPs who are helping the homeless in Melbourne, the need for a National Helpline to support Doctors, findings about Australia’s opioids crisis and what implications Artificial Intelligence may have in Radiology.

Doctor National Helpline and Helping the Homeless

What Australia’s Opioids Crisis Means for Pharmacists

The Future of Artificial Intelligence in Radiology

 

Doctor National Helpline and Helping the Homeless

For the past 18 months, Cohealth and Green Cross collaborated in funding The Street Doctor program. It provides free medical services to the homeless every Wednesday.

Operated from a fully equipped minivan, GP Dr Kate Coles and Nurse Vaan Phongsavan have treated more than 200 homeless patients from their mobile surgery. Some of their homeless patients have problems with transport and difficulties to get to an appointment on time, so by being mobile and there for them, a lot of barriers have been removed.

The homeless, according to Dr Coles, have dealt with various complex problems and not just colds and flus. Some of these include skin infections or mental impairment and drug addiction. Through interacting with them, they have found that the lack of available affordable housing, unemployment and family violence are other common factors besides mental illness that leads to some of her patients becoming homeless.

In order to support the program, the Wednesday clinic and the City of Melbourne have recently committed to helping the service to also operate on Mondays in the CBD.

Dr Coles encourages other GPs and medical practitioners to get involved with similar programs in an ABC release. “It’s just wonderful to meet all these people and be part of the very big team that are trying to do something good,”

But she does admit to feeling frustrated by what she sees while working as the street doctor.

“Often people don’t have much of a safety net and so then they find themselves on the street, and it’s those sorts of things that really get me riled up.”

Homeless man sitting on street

The need for a national helpline for doctors in Australia

An updated report this year from a 2013 Beyond Blue study found that more than 12,000 doctors experience high psychological distress, significantly greater (3.4%) than the general population (0.7%).

Additional findings of the study include up to 21% of respondents reporting a history of depression, 6% had an existing diagnosis, approximately 9% of doctors experienced an anxiety disorder (compared to 5.9% of the population) and 3.7% reported a current diagnosis (compared to 2.7% of the population). The most common sources of work-related stress were the need to balance work and personal responsibilities (26.8%), too much to do at work (25%), responsibility at work (20.8%), long work hours (19.5%), and fear of making mistakes (18.7%). Some have resulted in death and are raising alarm for the lack of help doctors themselves get.

Dr Tagg, a long-time advocate for doctor mental health, told newsGP that it is well known that doctors and medical students have disproportionately higher levels of mental distress. None of his junior doctors knew where to turn if they needed help.

According to him, doctors’ health is a national problem. It should receive more national attention and better access to solutions.

There are multiple websites with similar information about this topic and there are lists of individual helplines for each state but there is no single official helpline for the whole country. To tackle this, Dr Jill Gordon, Chair of the ADHN told newsGP she believed a single helpline was a good idea to start with.

Do you agree there should be a single helpline that every Doctor knows they can reach?

Hands holding supporting each other

What Australia’s Opioids Crisis Means for Pharmacists

ABC news recently reported that the number of Australians accidentally overdosing has climbed by almost 40 per cent in the last decade. This exceeds the national road toll by several hundred people each year.

Additionally, the Guardian also posted an update on the same matter with the gripping title: “Drug overdoses kill one Australian every five hours”.

The latest figures released recently, Australia’s 2019 Annual Overdose Report by the Pennington Institute, revealed a dramatic spike in the number of overdose deaths. Especially involving prescribed opioids, heroin and other illicit drugs in the last 5 years. The total number of deaths to unintentional drug overdose in Australia had increased 38% between 2001 and 2017 and was growing by 3.4% yearly. The report also showed that in 2017 alone, 1,612 Australians died from unintentional overdoses.

Of those, 904 involved opioids including illicit drugs and legal pharmaceuticals, such as morphine, oxycodone and fentanyl. It’s the prescription opioids that continue to cause most overdoses; they were involved in 53 per cent of all accidental drug-induced deaths in 2017.

The CEO of the Pennington Institute – not-for-profit public health organisation – John Ryan, calls for Australia to consider these findings a national crisis.

Graph Unintentional Drug Induced Deaths 2001 2017

More on opioids

The report also suggests that while it is possible to overdose on multiple drug types, the class of drug that contributes the most to a fatal overdose is opioids. Opioids are used to treat pain and can include pharmaceutical medicines like codeine, oxycodone and fentanyl. These can slow down the central nervous system, including the respiratory system.

Taking a high dosage of an opioid, taking multiple opioids simultaneously or taking opioids in combination with other depressants like alcohol or benzodiazepines puts a person at serious risk of overdose. Other factors that may also contribute to an overdose include a tolerance risk after a period of abstinence, severe ongoing chronic pain or having had an overdose already within the last 12 months.

Twenty years ago, one of the most common drugs causing accidental deaths was heroin, the illicit opioid. Currently the pharmaceutical opioids are responsible for a majority of the overdose deaths.

Graph Number Of Drug Induced Deaths 2017 By Type

What it means for Pharmacists

As we previously discussed, raising concerns about opioids addiction had resulted in a number of in-depth investigations and repeated warnings on its possible negative effect. In response to the whole situation, several actions were taken across the country.

In 2017, the Federal Government committed $16 million for the rollout of real-time monitoring on prescription drugs, known as SafeScript.

It provides an instant alert to pharmacists and doctors alike if patients have already received multiple supplies of any dangerous prescription-only medicines. Each time a monitored drug is prescribed or dispensed, it will be recorded in the central database of prescription records. The system helps GPs and pharmacists to make safer decisions when it comes to prescribing and dispensing high-risk medicines, and helps to identify patients who are developing signs of dependence.

According to news, from April 2020, every medical practitioner and pharmacist in Victoria will need to access SafeScript before they dispense or prescribe any monitored medicines. There are a couple of requirements for pharmacists in operating the system as well. Currently, Victoria, Tasmania and the ACT have this monitoring program in place. It is possible that there would soon be a national roll-out for the program. It is important to first understand the outcomes of the SafeScript program.

John Ryan of the Pennington Institute also expressed his concern regarding SafeScript in a press post. It should be centred around cutting back the Demand for opioids, not the Supply entirely.

How will SafeScript impact you at work and what issues do you regularly face with opioids in your Pharmacy?

Pills and capsules medication

The Future of Artificial Intelligence in Radiology

A shortage of Rural doctors also includes a shortage of radiologists. From Low Mobility and staff turnover internally for the experienced Radiologists, to limitations on the Locations of the jobs and the Working conditions.

Artificial Intelligence (AI) is now also a factor to consider. It all started for Medical Imaging when potential opportunities were recognized that AI might bring to healthcare, particularly in radiology and pathology. AI works in assisting the imaging diagnosis when a large amounts of past diagnoses is fed into the machine learning algorithms to generate new rules for classifying scans based on previous work. Applying this technique to diagnostic scans is referred to as radiomics.

A number of innovations were recently introduced such as AI being the imaging solution to accelerate critical patient diagnoses, in which it will allow for instant notifications to review critical findings that may accelerate patient diagnosis or its advanced clinical decision support and diagnostics.

AI has been widely seen as a help to radiologists tasked with making informed clinical decisions and choosing effective treatments. With AI and machine learning, the field of imaging analytics could also improve the care delivery and patient outcomes. A number of healthcare institutions in Australia have decided to incorporate artificial intelligence into its work to make a positive impact on patient care, such as the Global Diagnostics Australia.

However, some have raised a question on whether AI would replace or negatively impact some aspects of Radiologist jobs in the future.

X ray scan of two hands

AI and its implication on Radiologists job

There is potential but also challenges from incorporating AI into the healthcare industry, specifically in the medical imaging industry. Concerns have been raised about the lack of secure access to sensitive patient data to develop AI models in the first place. Another could be the public’s general lack of trust of any new methods. Computerised decision-making in healthcare dates as far back as the early 1970s, but the harder challenge is in winning the public opinion. Finally, there is also the problem of evaluating new methods based on real-world data.

In Australia, RANZCR – The Royal Australian and New Zealand College of Radiologists – expressed its concern about the decision-making transparency, data privacy and ethics in the use of AI and machine learning. They have released a first draft Ethical Principles for AI in Medicine report earlier this year, and calls for the “correct use” of AI and machine learning, specifically with regards to clinical radiology and radiation oncology. They included the following guiding principles including Safety, Avoidance of bias, Transparency and explain-ability, Privacy and protection of data, Decision making on diagnosis and treatment, Liability for decisions made, Application of human values and Governance.

RANZCR believes that these guiding principles are necessary. Because the way radiology adapts to AI may have a direct effect for patients and other healthcare professionals. They see AI more as assisting radiologists and other professions to work in a more time-efficient and effective manner.

RANZCR President Dr Lance Lawler mentioned that the hype about radiologists being replaced by machines is merely an assumption. The hype indicates that some roles will change with AI infiltrating the industry, in terms of machines replacing some of the work done by radiologists.

However, they went on to say that it is far more likely that Radiologists and other impacted professions can do with a reapplying of people’s skills into different areas. Some things a machine could do better than a human, but definitely not all things. The perfect balance between the 2 will benefit everyone the most.

RANZCR hopes to get to a point where there is an accepted use of certain AI tools for some clinical circumstances. For radiology, that may be for breast or lung screening, or comparing responses to treatments. High volume, repetitive cases that machines can do easily.

There are still a number of implementation challenges though before AI is fully developed and accepted as a safe medical tool.

X ray scan doctor reading results

Harvard Business Review on the matter

Several published articles including this Harvard Business Review agree with RANZCR in this instance.

According to the Harvard article, radiologists do more than just read and interpret images. They also consult with other physicians on diagnosis and treatment of diseases, they perform image-guided medical interventions, they define the technical parameters of imaging examinations to be performed tailored to a patient’s condition and they relate findings from images to other medical records. They then also discuss procedures and results with patients, and other additional activities.

The clinical processes for adopting AI-based image work are a long way from being ready to use frequently. To create a comprehensive collection of cases will take many years, which also further expands the role for radiologists in the AI world.

Deep learning algorithms for images must be trained on ‘labelled data’ which is mostly owned by vendors, hospitals, imaging facilities, or patients themselves and therefore, collecting them to accumulate a critical mass for AI training will be challenging and time-consuming. Changes will also be required in medical regulation and health insurance for automated image analysis, like what RANZCR is trying to implement.

Rather than refusing to work with AI, Radiologists are encouraged to learn and work with AI.

Are you looking for your next suitable job in the Radiology, Radiography, Sonography fields?

X ray scan of human body

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