New service for managing elderly patients at home

The second recommendation of Neglect, the Interim Report of the Royal Commission into Aged Care Quality and Safety emphasised the importance of reducing sedative medication in the elderly. It is a difficult area for GPs and staff attending patients in Aged Care facilities and the final report will suggest more concrete solutions to the problem.

Managing these patients at home can be an equally difficult issue for GPs. However, local clinicians are now able to get advice via a new service provided by Dr Jedda Schutz.

Dr Schutz consults at the Northern Rivers Psychiatry rooms in Bangalow approximately once per month and now offers one-off psychiatric assessments for patients over 65 year of age.

MBS item number 291 is suitable for patients with any psychiatric condition who can be appropriately managed by GPs without the need for ongoing long term input from a psychiatrist, but would find benefit from a one-off review with a specialist. The referral should come from the patient’s usual GP.

Such opinions are useful for issues such as:

Whether to continue psychotropic medications longer term, reviewing psychotropic medication doses and assessment for possible alternative medications/treatment modalities and reviewing any potential side effects.
In the older population, assessments also take into account increasing physical comorbidity, which can impact on management of psychiatric conditions.

Additionally, it can be useful to undertake a formal psychiatric assessment when the patient is proving treatment resistant or not responding to standard first line treatments. This can be done annually under the regulations since Medicare limits 291 assessments to once per year.

A 291 includes a comprehensive report of the consultation outlining the psychiatric opinion and creates a personalised and detailed management plan for the patient. The management plan covers both short term and long term recommendations to assist with the ongoing care of the patient. The report should get to the GP within two weeks of the consultation.

As with care plans it is important to check that the item has not been claimed in the previous 12 months and the referral should include all the appropriate information for the consultant psychiatrist to form an opinion at the first consultation.

Further caveats are that the patient does not have dementia, is not in an acute crisis situation or delirium, does not have ADHD, is not covered by WorkCover or is a first responder presenting with mental health difficulties relating to military, ambulance service, fire service and/or police employment.