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Long Term Intensive Psychiatric Treatment: The Impact of Medicare Item 319 and Associated Restrictions on Patients, Psychiatrists and the Community.

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Executive Summary - May 2002

• The rationale for review/repeal of Item 319 (and all associated Items, eg 316 ) is outlined - it rests primarily on the lack of evidence that its introduction has produced any specific advantages for patients, it has actually disadvantaged adult patients that don't neatly fit the Item 319 criteria; access to psychiatrists has decreased rather than increased; and there is an economic case for review.

• The document outlines the need for long term, intensive psychiatric treatment, which is seen as a necessary treatment for a wide group of patients which span the whole spectrum of psychiatric morbidity. The skills involved offer economic synergies with other treatments and should not be constrained by Item 319 criteria as it reduces the capacity of psychiatrists to offer efficiencies within "best practice".

• Patient characteristics (for those accessing this mode of treatment) are outlined, demonstrating their high level of previous trauma (sexual/physical abuse or bereavement), and the frequency of this group having failed prior attempts at briefer treatments – but failing the GAF criteria highlights that these same patients often fall well outside the current Item 319 criteria for eligibility.

• Australian and international research to support the validity of long term intensive treatment is presented - included are studies that demonstrate efficacy, studies demonstrating the need for high frequency of consultations, and demonstrations of cost effectiveness, as well as comparison studies. Supporting biological and general research is also presented. Such treatment is generally seen as safe.

• Actual details of patients who are clinically disadvantaged by Item 319 regulations are outlined case by case - these are subdivided into (a) patients who are ineligible to access treatment under Item 319, and (b) patients who are adversely affected despite having access to treatment under Item 319 regulations.

• The conclusion outlines broader detrimental impact on issues such as the disincentive Item 319 provides for future training in psychiatry (which goes against recent AMWAC recommendations), the detrimental impact on treatment which the WHO outlines as necessary to deal with an impending epidemic of Depressive Disorders, as well as the disincentive for useful partnerships to emerge in dealing with maldistribution (eg rural) problems.

• A revised consultation descriptor is proposed, with an appropriate fee.

• Consultations with associated organisations, and consumer views are outlined.

• Remedial policy options are outlined.


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© - National Association of Practising Psychiatrists 2004