Australian rheumatology could be a leading force in the Asia-Pacific region but it needs to first correct the problems in its own backyard, say Eric Morand and Michelle Leech in Nature Reviews.

Despite Australia’s many advantages including universal healthcare, subsidized medication access, adequate numbers of highly trained specialists and a strong research culture outcomes are sub-optimal, the rheumatologists from Monash Health write in their article which is part of an APLAR series.

A disconnected and complex healthcare system are partly to blame, but the lack of a national health record is also a big issue, they said.

“In many states records from one hospital are invisible to practitioners in others, despite being part of the same government system,” they write.

This lack of sharing information also affects medication, they say.

In a perverse bureaucratic twist for rheumatologists and their patients Commonwealth funding of initial treatment with biologics is predicated on reporting dates, doses and responses to past DMARD treatment.

“The irony of a system that requires reporting of serial drug exposure information on the one hand, and fails to provide access to such data on the other, is obvious”.

But collaborative action was possible they said, and was illustrated by the OPAL (Optimising Patient Outcomes in Australian RheumatoLogy) consortium, a collaborative network of Australian private-practice rheumatologists who share a clinical record system.

Another issue flagged by the authors was the lack of access to rheumatologists practicing outside of the main cities and the absence of effective workforce planning for the future.

While Australian rheumatology research had much to be proud of funding for research was disproportionately low when compared to the burden of disease, they said.

Grant submission was highly inefficient and there was not a strong tradition of philanthropic support for medical research.

Acknowledgement of the opportunities for improvement is a vital first step in correcting the problems “in our own back yard,”they said.

“Now the will to collectively address these opportunities is required,” they concluded.