Surgery in Modern Models of Care

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, to the RACS Annual Scientific Congress 4 May 2010

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Surgery in Modern Models of Care

  1. 1. “ Surgery in Modern Models of Care ” Royal Australasian College of Surgeons Annual Scientific Congress Tuesday 4 May 2010 Professor Jim Bishop AO Chief Medical Officer Australian Government Department of Health and Ageing
  2. 2. Australia compares well among OECD
  3. 3. Broad cause mortality trends Australia
  4. 4. NSW Population Age Distributions, Males (1977-2036)
  5. 5. Burden of major disease groups, 2003
  6. 6. Cancers with reducing death rates 1997 to 2006 – all ages
  7. 7. All Cancer- Mort ality/Incidence ratios 2002 for selected countries
  8. 8. CANCER Milestones in Survival Improvement <ul><ul><ul><li>Preventions – Tobacco control </li></ul></ul></ul><ul><ul><ul><li>Early detection </li></ul></ul></ul><ul><ul><ul><ul><li>Screening </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Interventions </li></ul></ul></ul></ul><ul><ul><ul><li>Better treatments – medical research </li></ul></ul></ul><ul><ul><ul><li>Clinical trials of better approaches </li></ul></ul></ul><ul><ul><ul><li>Evidence based standard practice </li></ul></ul></ul>
  9. 9. Breast cancer mortality NEJM 2005 SOURCE: N.ENGL. J MED: 353:17
  10. 10. WHAT IS THE SURGEON’S ROLE ? <ul><li>Well oriented to patient needs and unmet needs </li></ul><ul><li>Diagnosis/first advice following diagnosis </li></ul><ul><li>Multi-disciplinary team leader/member </li></ul><ul><li>Disease expert/International models of care </li></ul><ul><li>Teacher, mentor to new wave of graduates </li></ul><ul><li>Advocate for prevention and early detection </li></ul>
  11. 11. <ul><li>NSW CANCER PATIENT </li></ul><ul><li>SATISFACTION SURVEY 2008 </li></ul><ul><li>Courtesy of Doctors 95.5% </li></ul><ul><li>Risks benefits explained by Surgeons 90.0% </li></ul><ul><li>Patients received right amount of pain </li></ul><ul><li>medicine 89.6% </li></ul><ul><li>Cancer Institute NSW Patient Satisfaction Survey (8,800 cancer patients participated) </li></ul>
  12. 12. <ul><li>LOW LEVELS OF PATIENT SATISFACTION </li></ul><ul><li>Choice of Admission dates 28.9% </li></ul><ul><li>Patients having enough say about treatment 57.3% </li></ul><ul><li>Patients being given enough information 58.6% </li></ul><ul><li>Patients given enough emotional support 61.1% </li></ul><ul><li>Source: Cancer Institute NSW 2008 </li></ul>
  13. 13. <ul><li>BETTER INFORMED PATIENTS </li></ul><ul><li>NSW Patient satisfaction survey: </li></ul><ul><li>Comfortable asking medical staff questions about their condition or treatment (73.1% satisfaction) </li></ul><ul><li>Evidence based questions given to the patient increases understanding, retention and reduces anxiety </li></ul><ul><li>Medical Psychology Unit: Butow, Tattersall et al </li></ul>
  14. 14. The difference between localised and regional extent of disease at diagnosis
  15. 16. Base: 2006 – n=14, 2008 – n=16
  16. 17. <ul><li>OPPORTUNITIES FOR TRAINING AND </li></ul><ul><li>MENTORING – HEALTH REFORM 2010 </li></ul><ul><li>COAG AGREEMENT </li></ul><ul><li>60% Australian Government funding for Hospitals including teaching and research </li></ul><ul><li>100% funding for primary care </li></ul><ul><li>Local Hospital Networks including Lead Clinician Groups </li></ul><ul><li>Three new National Agencies including Australian Commission of Quality and Safety </li></ul>
  17. 18. <ul><li>HEALTH REFORM: SPECIFIC MEASURES IN WORKFORCE </li></ul><ul><li>Over all immediate COAG package $5.4 billion from 1 July 2010 </li></ul><ul><li>Additional $632m – 5,500 places for GPs </li></ul><ul><li>- 5,400 pre-vocational GP Places </li></ul><ul><li>- 680 Specialist places </li></ul><ul><li>Health Workforce Australia established </li></ul><ul><li>Initial emphasis on Clinical training places </li></ul>
  18. 19. CONCLUSIONS <ul><li>Understanding our patient’s unmet needs </li></ul><ul><li>Training – in areas of future burden </li></ul><ul><li>Treatment – role in prevention, screening early intervention, initial counselling </li></ul><ul><li>Leadership –work with multi-disciplinary teams to develop and implement best practice </li></ul><ul><li>Review and promote high standards of care in areas of expertise </li></ul>FUTURE ROLE OF SURGEONS

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