Chapter 2 Diagnostic interventions At a glance Almost 600,000 Medicare Benefits Schedule radiation. More than 314,000 MBS-funded (MBS) funded fibre optic colonoscopies were computed tomography (CT) scans of the performed in Australia in 2013–14, and the lumbar spine were performed in 2013–14, number of services is likely to rise as the with marked variation around Australia, National Bowel Cancer Screening Program suggesting overuse of this investigation. increases its coverage. Very large variations Recommendations were seen in colonoscopy rates across the country the highest rate was 30 times that of – the lowest. Even when highest and lowest rates Fibre optic colonoscopy were removed, the rate was more than four The MBS Review Taskforce reviews relevant times higher in one local area compared with MBS item(s) to align reimbursement with another. Rates were higher in high adherence to the existing National Health and socioeconomic populations in metropolitan Medical Research Council (NHMRC) clinical areas and decreased with distance from major practice guidelines for surveillance colonoscopy. cities. Participation in the National Bowel Cancer Screening Program follows similar trends, with Primary health networks work with general higher participation in metropolitan areas. practitioners to ensure colonoscopy referral Approaches to screening and initial practices align with applicable NHMRC treatment for prostate cancer are guidelines and the Royal Australian College of controversial. More than 25,000 MBS-funded General Practitioners’ guidelines for preventive prostate biopsies were performed in Australia activities in general practice (the red book). In in 2013–14, with considerable variation addition, general practitioners recommend faecal occult blood test screening to age-appropriate across the country. patients. Low back pain is a frequent reason for presentation to general practitioners, who may refer patients for diagnostic imaging. However, inappropriate use of diagnostic imaging exposes patients to unnecessary
Chapter 2 Diagnostic interventions At a glance Almost 600,000 Medicare Benefits Schedule (MBS) funded fibre optic colonoscopies were performed in Australia in 2013–14, and the number of services is likely to rise as the National Bowel Cancer Screening Program increases its coverage. Very large variations were seen in colonoscopy rates across the country – the highest rate was 30 times that of the lowest. Even when highest and lowest rates were removed, the rate was more than four times higher in one local area compared with another. Rates were higher in high socioeconomic populations in metropolitan areas and decreased with distance from major cities. Participation in the National Bowel Cancer Screening Program follows similar trends, with higher participation in metropolitan areas. Approaches to screening and initial treatment for prostate cancer are controversial. More than 25,000 MBS-funded prostate biopsies were performed in Australia in 2013–14, with considerable variation across the country. Low back pain is a frequent reason for presentation to general practitioners, who may refer patients for diagnostic imaging. However, inappropriate use of diagnostic imaging exposes patients to unnecessary radiation. More than 314,000 MBS-funded computed tomography (CT) scans of the lumbar spine were performed in 2013–14, with marked variation around Australia, suggesting overuse of this investigation. Recommendations Fibre optic colonoscopy The MBS Review Taskforce reviews relevant MBS item(s) to align reimbursement with adherence to the existing National Health and Medical Research Council (NHMRC) clinical practice guidelines for surveillance colonoscopy. Primary health networks work with general practitioners to ensure colonoscopy referral practices align with applicable NHMRC guidelines and the Royal Australian College of General Practitioners’ guidelines for preventive activities in general practice (the red book). In addition, general practitioners recommend faecal occult blood test screening to age-appropriate patients.