News in brief: IBD patients need early referral for ART; HCV on track for elimination in gay men; Nurse practitioner repays $80k after PSR investigation

27 Oct 2021

Assisted reproduction awareness needed for IBD patients

Greater gastroenterologist awareness of Assisted Reproductive Technology (ART) is needed for patients with  Crohn’s Disease and ulcerative colitis, Australian researchers say

A systematic review by Sydney gastroenterologists Dr Robyn Laube, and Professor Rupert Leong, Rupert showed that ART is safe and effective in patients with ulcerative colitis and medically managed Crohn’s disease with pregnancy and live birth rates similar to that of the general population.

However, the data suggested that SART efficacy may reduced in women with CD-related surgery and ileal pouch–anal anastomosis (IPAA) failure, they wrote in the American Journal of Gastroenterology

Their review included eleven studies and showed that compared with the general population, women with CD (with and without previous surgery) had no difference in pregnancy rates (odds ratio [OR] = 0.69) but had reduced live births (OR = 0.67) per cycle of ART. Live birth rates were 49%–71% lower after CD-related surgery. For women with UC, live birth rates were reduced after IPAA failure (hazard ratio = 0.36).

The findings showed that gastroenterologists should be aware of ART “to facilitate timely fertility therapy referral when indicated, particularly in Crohn’s disease,” they concluded.

HCV on track for elimination in gay men

A large decline in hepatitis C virus (HCV) incidence among gay men using HIV preexposure prophylaxis (PrEP) suggests that  Australia is on track to eliminate HCV among gay, bisexual and other men (GBM) who have sex with men before global 2030 targets.

Data from in 6744 GBM with HIV in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance network shows that the rate of HCV declined by 78% in 2019 compared to 2015 (incidence rate ratio [IRR], 0.22).

There was no change in HCV incidence among 20 590 HIV-negative GBM, but there was an 80% decrease in 11 661 HIV-negative GBM prescribed PrEP, (IRR, 0.20).

The study investigators said the government funding of direct acting antivirals and PrEP since 2016 was having a significant impact on HCV and HIV rates in GBM in Australia.

The findings are published in Clinical Infectious Diseases.

Nurse practitioner repays $80k after PSR investigation

Nurse practitioners have not escaped the scrutiny of the Medicare claims watchdog, the Professional Services Review (PSR), with one practitioner receiving a reprimand and agreeing to repay $80,000 to Medicare for inappropriate claims for long consultations.

The PSR’s update for September 2021 reports an investigation it mounted into claims made by an un-named nurse practitioner who was the highest ranked provider nationally of MBS item 82215.

The item covers consultations over 40 minutes for the purposes of taking an extensive history; undertaking clinical examination; arranging necessary investigations; implementing a management plan and providing appropriate preventive health care.

According to the PSR, the investigation revealed concerns that the MBS requirements were not always met, “as the clinical input and complexity of the service was not consistent with at least 40 minutes of clinical input being provided, as required by the MBS item descriptor and the practitioner’s records were not always adequate or contemporaneous.”

The PSR also had concerns that the nurse practitioner’s handwritten records were extremely difficult to read and did not reflect that nursing processes were followed.

“In some cases no record for the date of service could be identified in the patient record,” it noted.

The nurse practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 82215, received a reprimand from the PSR, agreed to repay $80,000 and was disqualified from providing MBS item 82215 for a period of 12 months.

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