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Monash Minute is a collection of short articles and headlines about Monash Health which may be useful for primary health providers. 
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March/April 2021 Update from Monash Health GP Liaison

Please forward this newsletter to GPs in your practice or email us at GPLiaison@monashhealth.org to subscribe to this newsletter.
NEW General Practitioner in the GP Liaison Team
Welcome Dr Alan Andrews 

Dr Andrews has worked as a general practitioner in Melbourne for the last 15 years, having previously trained and worked in north Queensland.  Primary health care practitioners, and Dr Andrews, understand that their ability to deliver optimal patient care relies on effective communication between health services. In this capacity, Dr Andrews recognised the potential to improve communication channels, and the quality of information, between general practitioners, secondary and tertiary healthcare organisations.  In addition to managing general queries from general practitioners, Dr Andrews is also involved with the following initatives:
  • timely and concise discharge summaries which are vital for the safe clinical handover of clients
  • discharge summary optimisation
  • specialist referral pathways
  • COVID-19 vaccination rollout
  • clinical incident reviews
  • communicating for safety and
  • service delivery planning.

Dr Andrews is excited by the opportunity and challenges that the Monash Health Community GP Liaison role presents and he looks forward to corresponding and meeting with local GPs in coming months.

To further information on the GP Liaison Unit please contact: 
P: 9554 9374
E: GPliaison@monashhealth.org
 

Monash Health Cancer Support Nurse Telehealth Clinic  

 
This new clinic provides rapid access to experienced cancer nurses who can discuss symptom management and urgent clinical reviews for patients receiving systemic cancer therapies at Monash Health.  


GPs and practice nurses might find this service useful when patients present with toxicities related to their cancer therapies

 
The clinic is staffed Monday to Friday from 9 am until 4 pm, excluding public holidays.

 
The clinic can be accessed  here https://videocall.direct/vsurc
 

For further information regarding  this clinic please contact:
T: 03 99288161
E: cancersupportnurse@monashhealth.org
GP eReferrals – efficient, cost saving and secure 
Specialist Consulting Services
 
Monash Health and Monash Children’s Hospital invite you to use our completely free eReferrals system via HealthLink! More than 250 GP practices are using eReferrals with overwhelmingly positive feedback from 6500 successful referrals received in the past 6 months.

Our first specialised Maternity eReferral form was successfully launched in mid-January and we are currently developing forms for a number of other Specialties. This will help guide you through the information required for a successful referral, linking state-wide referral criteria and Monash Health guidelines. 

To continually improve the referral experience, we value your ongoing feedback, involvement and expertise in the development and refining of eReferral.

How do I make a referral?
Refer to the GP eReferral website here for further information on how to make a referral:
 
 
To register for HealthLink please contact HealthLink Technical Support:
E:  helpdesk@healthlink.net
P: 1800 125 036
W: https://monashhealth.org/health-professionals/referrals/gp-ereferrals/
 
Movement Disorders Clinic

The Monash Health Movement Disorder Program provides specialist outpatient services for people with Parkinson’s disease and other neurological disorders and is a recognized Centre of Excellence through Parkinson’s Foundation (USA).

To access our service, patients must have a suspected or confirmed movement disorder diagnosis, Parkinson's, Parkinson’s Plus syndromes (e.g. MSA, PSP etc.) or Parkinson's-like symptoms such as cog wheeling, tremors, shuffly gait etc.

The Movement Disorders Clinic aims to:
  • Provide specialised treatment for, and management of Parkinson’s disease and other neurological movement disorders.
  • Work collaboratively with patients and family/carers to develop a therapy plan to address individual needs relating to a specific movement disorder.
  • Provide education about specific movement disorders.
  • Provide counselling for patients, carers and/or family.
  • Assist with arranging referrals to appropriate community support services.
  • Facilitate a carer support program including a monthly carer’s group.
  • Assist patients who live in residential care facilities by providing education to facility staff to help them manage movement disorders.
  • Provide a safe environment for patients, carers and/or families.
The Movement Disorders Clinic team comprises:
  • Medical Specialists (Neurologists, Geriatricians and Registrars)
  • Community Health Nurse
  • Dietitian
  • Neuropsychologist
  • Physiotherapists
  • Occupational Therapists
  • Social Workers
  • Speech Pathologists
  • Allied Health Assistant
For more information contact the Movement Disorders Clinic:
P: 9265 1411
F: 9265 1576
Mental Health: GP Psychiatrist Advisory Service (GPAS) 

Psychiatrists supporting GPs 

The GP Psychiatrist Advisory Service (GPAS) Mental Health Program at Monash Health was launched in January in collaboration with the South Eastern Melbourne Public Health Network (SEMPHN).

The GPAS is aimed at supporting primary care providers so they can address the mental health needs of their patients more confidently. If GPs have a question that can reasonably be answered through a telephone conversation they can make use of this service so, give us a call.

Key features of this service include:
  • GPs access to a free, 30 minute phone consultation with a psychiatrist
  • General advice for de-identified patients will be provided
  • There are no age restrictions or exclusions
  • Specialist advice can be organised if needed e.g. for a perinatal patient, or a person with intellectual disability, an eating disorder or gender-related issues
  • This is a non-urgent service.  (For all urgent matters, please contact the Psychiatric Triage Service on 1300 369 012)
  • Clinical responsibility for the patient remains with the GP.
Click HERE to read the letter sent to GPs by Prof David Clarke (Program Director, Mental Health) about the GPAS.

More information can be found on the SEMPHN website
P:    SEMPHN Access & Referral   1800 862 363     8.30am-4.30pm weekdays                                                                  
New Project Offers Diversion from CLAYTON Emergency Department to GPs

The ‘Monash Health Diversion of Emergency Consumers to Community Based Treatment (ED Diversion Project)’ aims to facilitate timely and safe access to primary health care as an alternative for eligible adult consumers who present to Monash Health Clayton ED with low acuity health complaints.

On arrival at Clayton ED, adult patients triaged as either semi-urgent or non-urgent are screened for eligibility against inclusion and exclusion criteria. Eligible patients will be offered the option of same-day GP care which is arranged by the Triage Nurse at either a participating General Practice or their regular GP.

This project runs until 30th June 2021, with project evaluation proposed through consumer, ED staff and GP staff surveys, in addition to
key outcome measures.

Potential patient benefits:
Safe and timely access to primary health care.
Improved awareness of local primary health care providers.
Improved interconnection across the health care system.

Potential GP benefits:
Six General Practices are participating in the pilot project.
Opportunity for GPs to receive further information about the project or future participation opportunities.

This project receives financial support from the Australian Government Department of Health through the Eastern Melbourne Primary Health Network and is modelled on the Eastern Health project, ‘Rapid Access to Community Based Primary Treatment.

For further information about the Clayton ED Diversion Project please contact:
E: James.Fordyce@monashhealth.org
P: 03 9594 2707
GEM@Home (Geriatric Evaluation and Management)

A pilot for home-based GEM care

An exciting 8-bed pilot commenced in December 2020, based at the Kingston Centre. The Geriatric Evaluation and Management (GEM) program enables us to provide care in patient’s homes, rather than in a traditional ward-based setting. . Patients receive daily care from Medical, Nursing and/or Allied Health via a face-to-face visit or telehealth consultations.

The GEM@Home program aligns with the new state government’s ‘Better at Home’ initiative, providing more patients with the opportunity to receive care in a familiar home environment.

Eligible patients can be referred to GEM@Home from ward-based GEM or acute hospital wards. Future models may also include referrals from general practice and the community

Early evaluation of the pilot has shown promising results, including
•  Clinical outcomes comparable with bed based GEM
•   Low rates of adverse events
•   High rates of patient satisfaction

This pilot is scheduled to end in March 2021, and planning is underway to expand the program to provide GEM@Home as an ongoing service.
 
For further information regarding the GEM@Home program, please contact the program coordinator on:
P:  0438 139 189
E:  GEMatHome@monashhealth.org
Osteoporosis – Feedback on care during COVID-19
Seeking GP Feedback 
 
The COVID-19 pandemic has resulted in the rapid growth of telehealth within medicine. The extensive and ongoing use of telemedicine provides a unique opportunity to assess this model of care, and consider the ongoing preferences and needs of patients and clinicians.

An evaluation of telemedicine investigating models of care for osteoporosis.is being conducted as part of a Monash University PhD research project and requires feedback from  GPs.

This project has been approved by Monash Health Human Research Ethics Committee. Please note, participation and/or withdrawal from this research will not affect your relationship with Monash Health.

What will it involve?
  • An anonymous online questionnaire lasting approximately 10 minutes assessing your osteoporosis care practices and knowledge, needs and preferences
  • If interested, a telephone interview lasting 20-30 minutes at a time convenient to you
How do I get involved?
  • Access  the online questionnaire here  or use the QR code below!
  • Complete the survey
  • if you are interested in participating in the telephone interview stage, please provide your email. Following this, a researcher will contact you to provide further information regarding the interview


For further information please contact us on:
E: osteoimprove1@monash.edu
P: 0474 249 967
Community Hospitals Update

Cranbourne
The Cranbourne Community Hospital service plan is now complete. Developed in partnership with Monash Health, the plan will provide a framework for how services will be delivered.

A parcel of land at 65 Berwick-Cranbourne Road, Cranbourne East has been identified as the preferred site for the Cranbourne Community Hospital.

The Victorian Health Building Authority continues to work closely with Monash Health to progress planning for the Cranbourne Community Hospital.

For the latest information please visit the project website:
https://www.vhhsba.vic.gov.au/cranbourne-community-hospital

Pakenham
The Victorian Health Building Authority and Monash Health have partnered to finalise the service plan for the Pakenham Community Hospital. Based on local population characteristics and insights from our Community Consultative Committee (CCC), this plan will form the basis for how services will be delivered at the community hospital.

Work is continuing to identify a preferred site for the Pakenham Community Hospital. Further due diligence is being completed on a number of shortlisted sites to ensure the most suitable site is selected for the community hospital.

For the latest information please visit the project website: https://www.vhhsba.vic.gov.au/pakenham-community-hospital
Vitamin D Deficiency Rickets Increasing
Update from the Refugee Team 
 
Over the past 12 months there has been an increase in children of migrant families presenting  to our Refugee Health team. with symptoms of Rickets.

Background:
Severe, prolonged vitamin D deficiency can cause impaired bone mineralisation, which in children can manifest as Rickets. 
Most cases of Rickets in Australia are seen in migrant populations, where vitamin D deficiency is common, and multiple other risk factors may be present. Identification of those patients that require specialist referral for possible Rickets is critical.

Clinical Manifestations:
  • Angulation of long bones
  • Varus or valgus deformity of the knees (note: it is normal to have some bowing in toddlers, and a degree of knock-knees in early school years). 
  • Splaying or swelling of wrists and ankles
  • Frontal bossing
  • Delayed fontanel closure (anterior fontanelle usually closes by 18 months - 2 years)
  • Craniotabes (softening of occipital bones) - in infancy 
Investigations:
 
Initial blood tests should include Vitamin D level , renal function, serum calcium, serum phosphate, alkaline phosphatase (ALP) and parathyroid hormone (PTH).
Radiology investigations are guided by clinical presentation and may include anteroposterior x-rays of the wrist or knee showing widening or fraying of distal metaphyses, x-rays of long bones showing angular deformities, x-rays of ribs showing widening of anterior rib ends (rachitic rosary), x-rays of shafts of bones showing osteopenia. Severe Rickets may result in pathological fractures.
 
If clinical or laboratory findings are clinically suspicious for Rickets, urgent paediatric referral and treatment is warranted.

For further information regarding managing Rickets -
https://www.rch.org.au/immigranthealth/clinical/Low_Vitamin_D/

Monash health Refugee team discussion paper “ Vitamin D Deficiency Rickets” can be found HERE.
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