Key findings
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
2a. 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.
2b. 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.
2c. The Australian Government Department of Health continues to use educational materials related to the National Bowel Cancer Screening Program to promote key health messages, in particular among lower socioeconomic and rural and remote populations, about faecal occult blood testing and the substantial benefits of early diagnosis on patient outcomes.
2d. The Commission hosts a roundtable of clinical, consumer, and Australian, state and territory government representatives to support specialty-led strategies to improve adherence to the relevant NHMRC guidelines for surveillance colonoscopy in bowel cancer screening.
Prostate Biopsy 40 years and over
2e. Clinicians follow the clinical practice guidelines for prostate-specific antigen testing and early management of test-detected prostate cancer from the Prostate Cancer Foundation of Australia and Cancer Council Australia, and the Royal Australian College of General Practitioners’ Guidelines for preventive activities in general practice (the red book).
2f. Clinicians use the prostate cancer screening decision aid produced by the Royal Australian College of General Practitioners for patients who request screening.
2g. NPS MedicineWise, as part of its Choosing Wisely campaign, monitors effective implementation of the Royal College of Pathologists of Australasia recommendations on prostate-sensitive antigen testing.
Computed tomography of the lumbar spine
2h. The Commission reviews the need for updating the NHMRC guidelines on lumbar imaging in acute non-specific low back pain as part of the ongoing national guideline prioritisation processes.
2i. Relevant clinical colleges review the availability and quality of education and training materials, and continuing professional development courses, to improve clinicians’ knowledge and skills in referring patients or using CT imaging of the lumbar spine.
2j. NPS MedicineWise, as part of its Choosing Wisely campaign, monitors effective implementation of the Royal Australian and New Zealand College of Radiologists recommendation that imaging should not be performed in patients with non-specific acute low back pain.
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