Stigma deters COPD patients from seeking medical care

People living with COPD feel stigmatised by doctors because of the links with smoking and this deters them from seeking help from a GP, Australian research shows.

An online survey that drew responses from 161 patients with COPD found that they reported significantly higher anticipated stigma scores compared to a group of 225 people with other chronic conditions.

Stigma was strongly related to delayed or avoidance in seeking help from a GP when needed, according to Monash University researchers.

Levels of COPD-related stigma were just as high in former smokers as in current smokers, and all patients living with COPD reported poor experience of care in the GP setting compared to people with other chronic illnesses or no chronic illnesses.

The findings are published in the journal Chronic Illness.

Inappropriate prescribing of azithromycin for CAP

Inappropriate prescribing of azithromycin for community-acquired pneumonia is putting patients at risk of QTc interval prolongation and life-threatening cardiac arrhythmias, according to a report from NSW.

A review of 100 patients at St George Hospital, Sydney. who were prescribed the macrolide for CAP found that one third (33%) did not have ECGs documented and of those that did, 15% were prescribed azithromycin despite having prolonged QTc intervals.

For patients with prolonged QTc intervals, the calculated QTc intervals ranged from 446 to 487 ms, with the average QTc interval being 464 ms. The average age of patients with prolonged QTc intervals was 82 years and many had a background of other cardiovascular diseases, including atrial fibrillation, congestive cardiac failure, ischaemic heart disease, valvular abnormalities and previous pacemaker insertion.

Of the 10 patients with prolonged QTc intervals on admission, only two had follow-up ECGs during their admission and three did not have their serum calcium or magnesium checked during their admission.

Of concern was the finding that four of the patients with prolonged QTc intervals were also prescribed other QT prolonging medications while taking azithromycin, the study investigators said.

While there were no cardiac arrhythmias reported in this sample patients, the authors said the findings suggested an unmet need for screening ECG prior to azithromycin administration, monitoring QTc intervals while on azithromycin, and optimisation of other factors which may contribute to prolonged QTc interval, such as monitoring serum electrolytes, as well as avoidance of other QTc prolonging medications when possible.

More information: Internal Medicine Journal

Regional specialist telehealth services hit by Tristar collapse

The collapse of the rural bulk-billing medical centre group Tristar Medical may result in clinic closures and reduced access to specialist telehealth services for people in regional Australia, doctors have been told.

The Mildura-based group went into administration on 24 May due to financial difficulties, with administrators McGrath Nicol saying there is a question mark over which of the 30 clinics would remain open in the long term unless a potential buyer can be found.

Tristar Medical was reported to be reliant on international medical graduates (IMGs) to staff its GP bulk billing clinics, and the AMA said it had concerns about unpaid wages and continuity of employment for doctors currently working at the clinics.

“It’s not an easy process for them to up sticks and go to another job because they also need to apply to the medical board to allow them to move to another employer,” a spokesman told the Ballarat Courier.

According to its website the Tristar Medical Group also promoted specialist telehealth services via its clinics across Victoria, NSW, SA and the NT. It offered GP-mediated  telehealth consultations with cardiologists, dermatologists, endocrinologists, gastroenterologists, haematologists, neurologists, oncologists, rheumatologists and respiratory and sleep specialists, as well as surgeons and other physician specialities.

The demise of Tristar has been blamed on the freeze in Medicare rebates and reduced IMG recruitment during the pandemic.