The crux of modern health care challenges

IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Journal of Australia Pub Date : 2024-11-03 DOI:10.5694/mja2.52488
Michael Skilton
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Rodda and colleagues (https://doi.org/10.5694/mja2.52471) review current approaches to identifying and managing gambling disorder. Formerly known as pathological gambling, gambling disorder is now classified as a behavioural addiction. Gambling disorder affects only 1% of the population; however, gambling is pervasive in Australian culture with significant costs. Approximately three-quarters of the Australian adult population spent money on gambling in 2022, with total losses of $20–25 billion per year (https://www.aihw.gov.au/reports/australias-welfare/gambling). This does not account for the further social costs of gambling, which are extensive. Of those Australian adults who gamble, almost half are classified as being at risk of harm, with the highest rates in young people and men. The evidence base outlined by Rodda and colleagues provides best practices for identifying gambling disorder and risk thereof, and subsequent treatment.</p><p>Slape and colleagues (https://doi.org/10.5694/mja2.52475) provide a perspective on the establishment of a First Nations custodial dermatology service. This First Nations-led service, established in New South Wales and now extended to the Northern Territory, reflects a commitment to ethical and socially responsible health care services through timely and high quality health care that is culturally safe and meets the complex health care needs of incarcerated people. 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引用次数: 0

Abstract

In rock climbing, the crux is the hardest section, or sections, of a particular climbing route. To solve a crux, the climber must draw on their skill and expertise, problem-solving abilities, perseverance and teamwork, before being able to send it — solve the crux and complete the route. This issue of the MJA covers a broad range of subjects that could be considered some of the most critical challenges in modern health and health care.

Over the past 55 years, the proportion of people in Australia who die from cardiovascular diseases has halved (https://www.abs.gov.au/statistics/health/causes-death/changing-patterns-mortality-australia/latest-release). Nonetheless, cardiovascular diseases remain a leading cause of death and morbidity. In this issue of the MJA, Figtree and colleagues (https://doi.org/10.5694/mja2.52482) describe the Cardiovascular Health Leadership Research Forum. Established in 2022, this initiative unites governments, health service providers, and the research workforce to tackle major cardiovascular health challenges. By accelerating the implementation of new preventive and therapeutic strategies, it seeks to enhance patient outcomes and produce economic benefits.

On a broader scale, Jackson (https://doi.org/10.5694/mja2.52476) discusses the National Health Reform Agreement, and the challenges it faces to remain fit-for-purpose for maintaining a high quality equitable health system. Seven policy barriers are identified that have long undermined health system reform, and will need to be addressed for the next agreement to be successful.

Four further articles discuss key aspects of modern socially responsible health care. Rodda and colleagues (https://doi.org/10.5694/mja2.52471) review current approaches to identifying and managing gambling disorder. Formerly known as pathological gambling, gambling disorder is now classified as a behavioural addiction. Gambling disorder affects only 1% of the population; however, gambling is pervasive in Australian culture with significant costs. Approximately three-quarters of the Australian adult population spent money on gambling in 2022, with total losses of $20–25 billion per year (https://www.aihw.gov.au/reports/australias-welfare/gambling). This does not account for the further social costs of gambling, which are extensive. Of those Australian adults who gamble, almost half are classified as being at risk of harm, with the highest rates in young people and men. The evidence base outlined by Rodda and colleagues provides best practices for identifying gambling disorder and risk thereof, and subsequent treatment.

Slape and colleagues (https://doi.org/10.5694/mja2.52475) provide a perspective on the establishment of a First Nations custodial dermatology service. This First Nations-led service, established in New South Wales and now extended to the Northern Territory, reflects a commitment to ethical and socially responsible health care services through timely and high quality health care that is culturally safe and meets the complex health care needs of incarcerated people. More broadly, the foundational principles of this service highlight the promise of First Nations-led specialty care within the prison system.

In their research letter, Nolan and colleagues (https://doi.org/10.5694/mja2.52471) used deidentified dispensing data from the Pharmaceutical Benefits Scheme (PBS) to demonstrate that about one in five PBS-subsidised testosterone prescriptions are for trans individuals, despite there being no specific PBS indication for gender affirmation. In younger people, this figure is as high as four in five. They argue that a specific PBS authority indication for “gender affirmation” would facilitate equitable access and improve quality of care for trans people.

Finally, Fry and colleagues’ medical education article (https://doi.org/10.5694/mja2.52481), which, in their words, “is intended to serve as a beginner's introduction to the environmental footprinting techniques that can be applied to uncover health care's environmental impacts”, with a clear focus on greenhouse gas emissions. They identify five key areas for action, including improving health care environmental footprinting literacy and incorporating environmental footprinting into existing frameworks for quality improvement, procurement and health system performance. These are practical recommendations that have implications for individual health care worker practices, but also, perhaps more importantly, for system change guided by health and medical leadership and management.

These are some of the most challenging aspects of modern health and health care. Much like climbers working through a crux, these challenges will require the collective efforts of the medical and health care community to achieve the best outcomes for patients and the broader community.

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现代医疗挑战的症结所在。
在攀岩运动中,"十字路口 "是某条攀岩路线中最难的一段或几段。要解决一个难点,攀岩者必须利用他们的技能和专业知识、解决问题的能力、毅力和团队合作精神,然后才能将其送出--解决难点并完成攀岩路线。本期MJA杂志涉及的主题非常广泛,可以说是现代健康和医疗保健领域最严峻的挑战之一。在过去的55年中,澳大利亚死于心血管疾病的人口比例减少了一半 (https://www.abs.gov.au/statistics/health/causes-death/changing-patterns-mortality-australia/latest-release)。然而,心血管疾病仍然是导致死亡和发病的主要原因。在本期的《医学期刊》上,Figtree及其同事(https://doi.org/10.5694/mja2.52482)介绍了心血管健康领导研究论坛(Cardiovascular Health Leadership Research Forum)。该论坛成立于 2022 年,旨在联合各国政府、医疗服务提供商和研究人员,共同应对心血管健康领域的重大挑战。通过加快实施新的预防和治疗策略,该论坛旨在提高患者的治疗效果并产生经济效益。在更广泛的范围内,杰克逊(https://doi.org/10.5694/mja2.52476)讨论了《国家卫生改革协议》,以及该协议在维持高质量的公平医疗体系方面所面临的挑战。文章指出了长期以来阻碍医疗系统改革的七大政策障碍,要使下一份协议取得成功,就必须解决这些障碍。另有四篇文章讨论了现代社会责任医疗保健的主要方面。Rodda 及其同事 (https://doi.org/10.5694/mja2.52471) 回顾了当前识别和管理赌博障碍的方法。赌博障碍以前被称为病态赌博,现在被归类为行为成瘾。赌博障碍只影响到1%的人口;然而,赌博在澳大利亚文化中无处不在,造成了巨大的损失。2022 年,约四分之三的澳大利亚成年人在赌博上花钱,每年的总损失达 200-250 亿澳元(https://www.aihw.gov.au/reports/australias-welfare/gambling)。这还不包括赌博造成的更大社会成本。在参与赌博的澳大利亚成年人中,几乎有一半被归类为面临伤害风险,其中年轻人和男性的比例最高。罗达及其同事概述的证据基础提供了识别赌博障碍及其风险以及后续治疗的最佳做法。斯莱普及其同事(https://doi.org/10.5694/mja2.52475)提供了建立原住民监护皮肤病服务的视角。这项由原住民主导的服务在新南威尔士州建立,现已扩展到北部地区,体现了通过提供及时、优质、文化上安全的医疗保健服务,满足被监禁者复杂的医疗保健需求,提供符合道德规范、对社会负责的医疗保健服务的承诺。更广泛地说,这项服务的基本原则凸显了在监狱系统内由原住民主导的专科医疗服务的前景。诺兰及其同事(https://doi.org/10.5694/mja2.52471)在研究信中使用了药品福利计划(PBS)中的去身份化配药数据,证明尽管药品福利计划中没有明确的性别确认适应症,但每五个药品福利计划补贴的睾酮处方中就有一个是为变性人开的。在年轻人中,这一数字高达五分之四。他们认为,针对 "性别确认 "的特定 PBS 授权指示将有助于变性人公平地获得医疗服务并提高医疗质量。最后,Fry 及其同事的医学教育文章(https://doi.org/10.5694/mja2.52481),用他们的话说,"旨在作为环境足迹技术的入门介绍,可用于揭示医疗服务对环境的影响",并明确将重点放在温室气体排放上。他们指出了五个关键的行动领域,包括提高医疗环境足迹知识,将环境足迹纳入现有的质量改进、采购和医疗系统绩效框架。这些切实可行的建议不仅对医护人员的个人实践有影响,也许更重要的是,对卫生和医疗领导及管理部门引导的系统变革也有影响。这些都是现代卫生和医疗保健领域最具挑战性的一些方面。就像登山者在峭壁上攀登一样,这些挑战需要医疗和卫生保健界的共同努力,才能为患者和更广泛的社区带来最佳结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medical Journal of Australia
Medical Journal of Australia 医学-医学:内科
CiteScore
9.40
自引率
5.30%
发文量
410
审稿时长
3-8 weeks
期刊介绍: The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
期刊最新文献
Inequity of access to voluntary assisted dying for New Zealand citizens residing permanently in Australia. Issue Information Issue Information The crux of modern health care challenges Five decades of debate on burnout.
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