• 26 Aug 2020
  • 18 min 20
  • 26 Aug 2020
  • 18 min 20

In this episode NPS MedicineWise CEO Steve Morris is joined by Professor Michael Kidd AM, Deputy Chief Medical Officer, Australian Government Department of Health.

They discuss the role of the Department of Health’s National Incident Room and the National COVID-19 Clinical Evidence Taskforce, the challenges of managing chronic disease during this pandemic - particularly in vulnerable populations, and some the ways health professionals are ensuring continuity of care and access to medicines to patients in this rapidly changing environment.

Further reading

National Incident Room: www.health.gov.au/initiatives-and-programs/national-incident-room

National COVID-19 Clinical Evidence Taskforce: covid19evidence.net.au

Transcript

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hi. I'm Steve Morris, CEO of NPS MedicineWise, and welcome to another podcast in our series related to COVID-19 issues. Today I would like to welcome Professor Michael Kidd, Deputy Chief Medical Officer of the Commonwealth Department of Health. Hello, Michael.

Michael Kidd:

Hi there, Steve. Thanks for the opportunity to join you.

Steve Morris:

Thank you. Look, it's fantastic to have you joined us on our podcast today, and many of our listeners would have heard you on the radio and TV over recent months talking about the many challenges of COVID-19 and there are a number of topics we could discuss, but for this podcast we'd just like to focus on a few relating to chronic disease management, continuity of care and quality use of medicines. But to start off with, it would be really interesting to hear from you more about, I suppose, the engine room of the Department of Health response in terms of the National Incident Room- what's it's role and purpose and how it works.

Michael Kidd:

Sure. So the National Incident Room is the Australian Government Department of Health emergency response centre. And it's activated by the Australian Government Chief Medical Officer when we identify a significant event or a threat to the health and wellbeing of the people of Australia. The National Incident Room has actually been activated since November 2019. It was set up at that time for the bushfires, it was involved in the response to the White Island volcano tragedy in New Zealand. And then of course has continued throughout the COVID-19 pandemic from the very beginning when the very first reports were starting to come out. The Incident Room is staffed by people from across our government, our portfolios, including health and home affairs and defence, foreign affairs, and also our links in with the states and territories. And I think that where people have probably seen the most visibility for what's happening with the National Incident Room has been with the deliberations of the Australian Health Protection Principal Committee, which brings together the Chief Medical Officer with the Chief Health Officers of each of the States and territories, which has been meeting daily throughout the pandemic and providing advice to the National Cabinet on the national response to all the health elements in response to COVID-19. Also, the National Medical Stockpile, which has been bringing together, in the case of COVID-19 particularly, our personal protective equipment, but also medications and treatments for COVID-19 and things which are being researched as a possible prevention or treatment for the virus and also issuing the community alerts. So Health.gov.edu, the Australian Government Department of Health website with its huge amount of information, which has been coming out to the general public, but also targeted information. And of course, for many of the listeners, this will be the advice coming out to healthcare providers about all aspects of the health response.

Steve Morris:

Thanks, Michael, that's a really comprehensive insight into the workings of the National Incident Room. Just one further question on that. What's the linkage to the COVID-19 Clinical Evidence Taskforce?

Michael Kidd:

The COVID-19 Clinical Evidence Taskforce was set up with funding from the Australian Government Department of Health and is carrying out the rapid reviews, which many of you, the listeners, will have looked at and which is a great resource for when you're looking for updates on our current knowledge about, particularly about treatments for, or potential treatments, for COVID-19 and response to recommendations and advice from the HPPC, from the Department of Health about topics, which are of particular interest, but of course there's also scoping the world literature and producing its own responses as well.

Steve Morris:

Yeah. Thanks, Michael. And NPS MedicineWise is a partner to the work of the National COVID-19 Clinical Evidence Taskforce, and we've been producing summaries of information for clinicians to help understand this complicated space. Look, I'd just like to move on to maybe talk about managing chronic disease during the pandemic. And I want to say, given that nearly 12 million Australians and approximately 50% of Australians live with one or more chronic diseases and recent data suggested a significant drop in GP and specialist visits alongside a significant drop in pathology testing, what are the concerns that you have for people with chronic disease at this time and what steps should and could be taken?

Michael Kidd:

One of the core principles behind Australia's response to COVID-19 has been to ensure that, as well as having a health system able to respond and manage and care for people infected with COVID-19 that also our regular healthcare system continues, and continues to deliver care for acute conditions, for people with chronic conditions, for people with mental health conditions and all the preventive interventions which are carried out as well. What we know from past evidence of past pandemics and past epidemics in different parts of the world is that often if the health care system becomes overwhelmed in responding to the impact of the infectious agent, a lot of the regular health care falls by the wayside. And you can actually end up with more morbidity and mortality related to neglecting addressing regular health care concerns than may occur from the infectious agents.

So we've been very active, right from the outset of the pandemic, to make sure that the people of Australia can continue to get their regular health care. And of course, when we went into the initial lockdown around Australia, one of the responses was to very rapidly introduce telehealth and the capacity for people to be able to access their GP, their consultant specialist and other healthcare practitioners using telehealth and being able to do that from their homes. And then when necessary to come out and to arrange face-to-face consultations for further assessment in care, and also to arrange for appropriate investigations which may be needed. We have seen of course a lot of the face-to-face consultations replaced by telehealth during the initial lockdown period right around the country. And then this of course has been happening again with the second wave of infection, which we've seen in Victoria and particularly with the stage four lockdowns in Melbourne.

And it's really important to remember that, even with Melbourne under stage four lockdowns, one of the reasons that people are allowed to leave their homes is to receive care, so to attend their GP, to go to their pharmacist to pick up their medications, to attend other specialists, to attend pathology, to have blood tests or other tests done, to attend radiology services, to have investigations. And even though we've seen in Melbourne at this time a dramatic reduction in elective surgery procedures, we still have the capacity of course for operations and other procedures to be carried out which are necessary in order to ensure the health and wellbeing of the population. We are however though concerned that there have been reports about reductions in the number of people presenting with new symptoms. In particular we had reductions during the initial lockdowns of people attending emergency rooms or acute presentations of heart attacks and strokes and other conditions.

We know that many people with chronic health concerns, despite the public messaging, were putting off and delaying receiving the regular care and checkups, which they would have. We know that many people with chronic mental health concerns had been delaying some of their care as well. And we know that initially we had people delaying the cancer screening which they would normally have been having carried out on a regular basis.

Fortunately, around the rest of the country a lot of this, of course, this backlog has been caught up with over the last few months, but we are very concerned obviously about the second wave of restrictions on the people of Melbourne. And we've been very active in encouraging GPs through reaching out to their patients, particularly those with chronic conditions, those who would normally be attending appointments to reach out using telehealth, to assist people and if necessary then to arrange face-to-face consultations. Very keen that people obviously are continuing to get their repeat prescriptions from their pharmacists and very aware of the need for people to continue to be having the pathology tests and other investigations as part of their continuing care.

Steve Morris:

Yeah. Thank you, Michael. And what about specific vulnerable populations, particularly at the moment, those in aged care facilities?

Michael Kidd:

Well we're very concerned about everybody who is at increased risk, if they're infected with COVID-19. And of course this includes older members of our community, both those who are in their own homes and those who, as you mentioned, are in residential aged care facilities, but also people with significant chronic health concerns and also Aboriginal and Torres Strait Islander people with chronic health concerns, who, if they were to be infected with COVID-19, there's an increased risk of more severe disease occurring. And people becoming, at risk of becoming gravely unwell. Really important for those in residential aged care, again, that the ongoing care is continuing.

And of course this has been happening through telehealth once again, with the general practitioners who are providing care to their patients or residents in aged care, are being able to reach out using telehealth to have consultations with their patients and where necessary for people to come into the facilities with appropriate personal protective equipment and in order to carry out assessments and when necessary to carry out treatments as well. It's been really important in particular that our allied health services have been able to continue - our physiotherapists and dietitians, our podiatrists and others who are providing ongoing care and rehabilitation support to people who are maybe in residential aged care, or maybe recovering from stroke, some from other serious concerns, health concerns, really important that care is continuing. And also of course, through telehealth we've had a lot of mental health care services being delivered remotely as well by psychiatrists, by psychologists, by general practitioners, by other people delivering mental health services to their patients.

Steve Morris:

Yeah. Thank you, Michael. And just, obviously you talked quite a bit about telehealth. Do you have any views as to the ongoing sustainability of telehealth, both during the pandemic period and perhaps beyond it?

Michael Kidd:

Well, I think telehealth, as you know, we were planning to roll out telehealth over a 10 year period and we ended up rolling it out over 10 days in response to the urgent emergency healthcare needs of the population of Australia. And it's been working very well for many, many people. We've had millions and millions of consultations between GPs and other health care providers and their patients using telehealth. Both video consultations, but also telephone consultations as well. At the moment, the emergency measures for telehealth are running until the 30th of September, at which point the government will be assessing what, if any of those measures, will continue beyond that time. But I think that as we've seen the pandemic continuing and with the continuing community transmission that we have in Victoria at this time, the importance of telehealth of being able to protect the vulnerable members of our patient populations, but also to protect the vulnerable members of our healthcare worker populations. That need of course continues.

Steve Morris:

Yeah. Michael, and you mentioned previously measures put in place to ensure continuity of medicines. Are there any of the quality use of medicines issues that come to mind in terms of issues you'd like to highlight?

Michael Kidd:

I think the most important issue has been making sure that people have been able to access their medications and obviously continuing to have community pharmacy open, even under the most stringent of restrictions, has been absolutely essential for the population. I think that we had a number of measures which came into place to ensure the continuity of people's access to medicines during the bushfires and a number of those measures have rolled through and continued in order to support the population throughout the pandemic. The protection of people working in community pharmacies has obviously been very important and the provision of personal protective equipment hasn't just happened through the primary health networks to general practitioners and the people working in general practices, has also been applied to people working in community pharmacies as well. And I think we've seen, very quickly, people adapt to new ways of getting prescriptions, of prescriptions being transmitted to the pharmacy of choice, pharmacies arranging delivery to vulnerable people in their homes where people were not wanting to venture out from their homes and risk coming into contact with large numbers of other people.

So I think there's been really, really remarkable and magnificent responses by so many people in the health professions in Australia to make sure that we've been able to continue to deliver the high quality of health care, which the Australian public expects and deserves.

Steve Morris:

Yeah, Michael - there's many health care professionals, obviously, done more than and gone above and beyond to deliver care to patients over the last six months or so. Is there any key message that you'd like to send to them?

Michael Kidd:

Look, I think firstly, a huge thank you to everybody who is working in healthcare in Australia and making sure that the people of Australia are able to continue to receive the care that they need. People have, as I said, responded magnificently, but also have been incredibly adept and nimble in changing the models of care delivery in a very rapid period of time. And making sure that even as we move to more and more virtual care for our patients, that we still have the face-to-face services available when they're needed. And recognising that our telehealth, as good as it is, does not completely replace the need for many face-to-face consultations, and for that further care to be delivered. I think also, I've just been really impressed how people have been reaching out to their patients when the isolation measures have been brought in, to make sure that people are coping well. Especially those of our patients with chronic disease, those that are patients who we know are living on their own and are in isolation, those of our patients we know have significant mental health concerns, to check-up and make sure that people are doing okay.

And that reaching out by trusted health professionals is, I know just so appreciated by so many members of the Australian population.

Steve Morris:

Absolutely right, and thank you for your time to take part in this podcast, Michael. Really appreciate it.

Michael Kidd:

Thanks Steve. And thanks for all the great work that NPS MedicineWise is doing to support us all during this really challenging time.

Steve Morris:

Thank you, Michael. And for our listeners, as always, further information on the work we're doing on COVID-19 is available on our website, NPS.org.au. Thank you for listening.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at NPS.org.au.