We highlight research into a new Artificial Intelligence tool to help with Heart Attacks, factors for a payment model reflecting Pharmacist Counselling services and the importance of CT Scanning in Lung Diseases.
Machine Learning for Heart Attacks
Pharmacist Counselling Fee
CT Scanning and Risk Detection
Machine Learning for Heart Attacks
There is a new artificial intelligence (AI) tool that helps doctors determine whether a patient is having a heart attack. Find out more about the research and implications.
New research published by the international healthcare company Abbott shows that the algorithm they used could allow hospital emergency departments to identify patients having a cardiac arrest more accurately.
Researchers from the US, Germany, UK, Switzerland, Australia and New Zealand and more than 11,000 patients participated in the study. The test was to determine whether artificial intelligence technology could provide faster and more accurate heart attack diagnosis.
The algorithm in the AI tool analyses extensive data sets and identifies the variables that predict a cardiac event. The variables include age, sex, a patient’s specific troponin levels and blood sample timing.
In such a way, the AI tool has also enabled a more individualised calculation of a person’s heart attack risk.
The research showed that the AI tool could provide doctors with a more comprehensive analysis of the probability that a patient is having a heart attack, faster than the current methods.
Abbott said the algorithm is designed to address two barriers that exist today for doctors when diagnosing heart attacks in individual cases:
- Firstly, the international guidelines for using sensitive troponin tests do not always account for personal factors, which were proven to have an impact on the test results.
- Secondly, while these guidelines recommend doctors to carry out troponin testing at fixed times over a period of up to 12 hours, they do not consider a person’s age or sex and it puts patients into one algorithm, leading to no personalised factors being taken into account.
Researchers found when this information is combined through computation, this algorithm has the potential to give doctors more confidence in the results. It gives them a more comprehensive assessment of the probability that a patient was having a heart attack, especially with those patients who presented within the first three hours of their symptoms.
The research found that the algorithm performed better than the European Society of Cardiology pathway.
The European Society of Cardiology rule-out pathway includes a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling guidelines at different timed intervals to rule out heart attacks.
The algorithm developed by the Abbott team is more versatile than existing algorithms, it neither depends on fixed cardiac troponin thresholds nor require testing to be performed at specific time points.
The study concluded that the algorithm’s individualised assessment of the likelihood for Myocardial Infarction could be used as a tool for identifying both low-risk and high-risk patients, especially to benefit from earlier clinical decisions.
According to Abbott, the algorithm was used for research only and is not yet commercially available. The company has also applied for an international patent for the use of the algorithm.
A senior medical director at Abbott mentioned that the AI technology is able to consider many variables, characteristics and data points and it can combine them into meaningful results in a matter of seconds. Thanks to the advancements in computation and AI applications, Australia’s healthcare can benefit greatly with this approach.
Pharmacist Counselling Fee
According to research published this year, quality-linked dispensing could be a performance-based payment model that will improve the patient outcomes and benefits to the health system.
Dispensing in community pharmacies in Australia is currently remunerated on a fee-for-service basis with little room to create incentives for better performance and quality of care.
Through quality-linked dispensing remuneration, pharmacists could provide enhanced counselling that will improve patient outcomes and bring other benefits to the health care system.
Researchers at the Monash University Faculty of Pharmacy and Pharmaceutical Sciences suggested that instead of fast dispensing, it would be better for patients and the healthcare system if pharmacists were better funded for improving the use of medicines rather than just supplying them.
Thanks to increasing healthcare costs around the world, researchers from the healthcare systems have been experimenting with performance-based payment models that link payments with the quality of care provided. And some countries have started to introduce alternative models that link the level of funding to the quality of services provided by healthcare practitioners.
The United States has experience with performance-based payments to pharmacists, with evidence suggesting lower total costs of care and better medication use from adequately paying pharmacists to proactively address all necessary factors at the time of dispensing a patient’s medication.
In the UK, the government’s Pharmacy Quality Scheme works similarly to the Australian Practice Incentives Program for General Practitioners with the aim to track improved performance in areas such as monitoring drug use and patient safety.
A minor concern about performance-linked payments needs to be considered. Performance targets should not be too onerous and time consuming as this may impact other areas of a pharmacist’s regular job. There is evidence that suggests improved patient outcomes and it should be applied naturally without putting pressure on a pharmacist’s performance.
Under the Pharmaceutical Benefits Scheme (PBS), pharmacies receive a handling fee and mark-up on the cost of the medicine to cover the commercial cost of maintaining the pharmacy.
There is also a dispensing fee for the pharmacist’s professional services. These include reviewing the prescriptions to ensure all necessary factors for the patient have been considered and a record has been created for the dispensing, labelling the medicine, and counselling the patient on the necessary information.
Generally the basic dispensing fee for a pharmacist with Ready-prepared medicine is currently at A$7.39.
Higher dispensing fees are paid for medicines requiring more security (such as controlled substances) and for various medicines a qualified pharmacist has to prepare themselves.
But the dispensing fee to the pharmacy does not currently change in line with the level of counselling given to the patient. This creates the perception that the current funding model does not benefit the pharmacist to spend time with the patient to proactively go over all the factors pertaining to the particular medicine.
If the pharmacist spends more time counselling the patient, the amount of prescriptions they can dispense may be lower and thus also the fees the pharmacy could receive.
The Proposed Model
With the aim of improving patient outcomes, counselling to patients should be an integral part of a pharmacist’s activities. Appropriate remuneration models need to reflect this .
Dispensing fee for a prescription is recommended in the research as a way to encourage the pharmacist to interact with patients and help them with advice on the best use of their medicine.
The proposed changes would require a major restructure to the funding model and dispensing prescriptions. There would also need to be agreements on reliable and valid performance measures and information systems to help with this.
In the end, funding based on a professional services and performance-based model rather than a volume-based model would greatly support pharmacies in Australia with the patient outcomes and improvements to the overall healthcare system.
What do you think about this recommended model? We would love to hear from you.
CT Scanning and Risk Detection
CT Scanning is strongly recommended by The Royal College of Radiologists for the screening of occupational lung diseases such as silicosis instead of the traditional chest X-ray. There are also implications.
The Royal Australian and New Zealand College of Radiologists have recommended the screening of workers for occupational lung diseases such as silicosis should be carried out using CT scans, rather than the currently used X-rays.
X-rays are failing to reliably detect lung disease in all workers, and RANZCR cited a study where 43% of workers with silicosis in particular, were overlooked during the standard X-ray testing.
The study was conducted with workers who were exposed to silica dust. The standard X-ray result showed that 43% of the tested workers had normal or healthy chest X-rays while the CT Scan showed otherwise.
RANZCR worried that X-ray testing for these workers failed to detect lung disease, the CT scans were far more reliable in the testing with greater sensitivity and accuracy.
Silicosis on the Rise
Lung diseases, including silicosis, are considered a danger to Australian’s health and the Morrison Government has committed funds to address them. A final report on this is expected by December 2020.
Silicosis has been called one of Australia’s next public health crisis. It is a lung disease with a particularly high prevalence among young tradies and where silica-containing dust is not controlled. It scars the lungs and causes progressive respiratory problems over time.
An example according to the Royal Australian College of Physicians, whereby one third (34%) of the workers in two Queensland stone masonry businesses were assessed had accelerated or complicated versions of silicosis.
The Work Health report showed that at least 22 workers’ compensation claims for silicosis were lodged in Queensland in the period between August to September 2018. Other cases have also been diagnosed in New South Wales and Victoria. However, figures about accelerated silicosis in Australia and New Zealand have not been captured.
The Australian Cancer Council also reports that more than 580,000+ Australian workers have been exposed to silicosis since 2011. Of those, it is estimated between 5000 to 6000 of those may develop lung cancer over the course of their life.
According to the Council, the occupations with the greatest exposure include Miners, Constructions Workers, Farmers and Engineers. Exposure to silica dust increases with the following work activities:
- Breaking, crushing or grinding material containing silica dust
- Sand blasting and/or casting
- Cement paving, surfacing or finishing
- Road construction
- Manufacturing of glass, ceramics, brick, concrete, tiles or metals
Implications of the Study
Workers with a risk of lung disease from harmful dust have access to free and subsidised X-rays scans with the government’s icare NSW screening clinic and the icare Lung Bus that travels around the state offering mobile screening.
More than 6500 workers in recent years have been screened by icare under the Dust Diseases scheme. The scheme also offer testing for other workplace diseases such as mesothelioma and asbestos.
Manager of the Industrial Relations (including Compensation) portfolio for the NSW Greens, worried the number of workers screened with the standard X-rays instead of CT scans was concerning.
The government is urged to invest in CT Scan technology for icare’s Lung Bus, which will be a comprehensive effort to conduct testing for workers who are already on the system.
A spokeswoman for icare NSW was positive and open to working with peak bodies and industry regulators including SafeWork Australia to act on the findings of the college.
It is strongly recommended that doctors and other medical professionals, especially also occupational nurses, should ask all patients from the building industry about their level of exposure to artificial stones and any silica dust.
If a patient has been exposed, medical professionals are advised to:
- Ask about any respiratory symptoms
- Assess the patient using chest x-ray and full lung function testing
- If the patient has worked in his or her industry for over 3 years, a high-resolution CT chest scan could be considered
- With any concerns, the patient should be referred to an occupational physician or respiratory physician for further assessment
What are your thoughts on the findings of the study? We would love to hear from you.
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