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Evidence-based advocacy
Marcus Dripps

The APA is determined to advocate for funding to be made available for physiotherapy services in order to address conditions where there is: a demonstrable burden of disease; effectiveness of physiotherapy management; and cost effectiveness of our preferred approach.

As has been flagged in several areas of APA communications over the past few months, continence is an issue the APA has selected as requiring a stronger focus in 2013. According to Continence Foundation of Australia, 4.6 million Australians live with incontinence (either urinary and/or faecal incontinence), 80 per cent of which are women due to the effects of childbirth. The prevalence of incontinence increases dramatically with age; considering Australia’s well-documented ageing population, it means this issue is increasing at a very high rate.

The APA believes in focusing our advocacy efforts on evidence-based management in all areas, and the evidence for the efficacy of physiotherapy intervention in people with incontinence is strong and plenty. It is also great example of an area of physiotherapy practice that is supported by excellent cost effectiveness data. This was outlined in our recent pre-budget submission to the federal government.

With the government announcing funding for several large initiatives recently, not least of which the National Disability Insurance Scheme (NDIS), the APA thought it prudent to focus our pre-budget submission on one single issue where the evidence is overwhelming rather than a series of issues with less strong evidence.

This year’s submission outlined the statistics and the enormous financial burden of this condition. The solutions, research and staggering difference in cost between surgery and physiotherapy are laid out clearly and honestly—there is no mistaking the positive impact physiotherapy treatment can have on this population, or on the government’s purse.

The pre-budget submission highlighted the lack of a Medicare item for the funding of physiotherapy treatment for those with incontinence. In comparison, there are six available for continence surgery. The absence of Medicare funding means that some patients who have a good chance of becoming continent through physiotherapy, are prohibited by the costs involved.

We look forward to 14 May and hopefully a positive budgetary outcome for those with incontinence. Alongside the pre-budget submission, the APA continues to spread this consistent message about continence in other forums and in other submissions.

Last year, the Department of Veterans’ Affairs (DVA) removed prior approval for lymphoedema treatments, something the APA welcomed. Similarly, the APA is now advocating to the DVA for prior approval to treat continence patients to be removed.

Evidence has been presented to the DVA to demonstrate the efficacy of physiotherapy treatment on female stress urinary incontinence, and the cost-effectiveness when compared with surgery, like that displayed in the pre-budget submission.

In September last year, the APA also made a submission to the ACCC called ‘Feedback on ACCC Senate Report on Private Health Insurance’. The evidence of the efficacy of physiotherapy treatment on female stress urinary incontinence was again presented.

The unfairness of preferred provider contracts was also highlighted in terms of continence and women’s health physiotherapists with extended training. Women’s health physiotherapists provide specialised treatment for stress incontinence, which requires longer consultations with senior practitioners. They cannot and generally will not provide this treatment at the maximum price required under many health insurance contracts. As these physiotherapists are unable to provide effective treatment within the constraints of the contract, they are locked out of preferred provider arrangements, something patients are often not aware of until they seek treatment.

Our message to the government and government organisations is clear: continence is a debilitating and growing problem in Australia, and physiotherapy treatment is the most cost-effective and least invasive treatment for people with incontinence. Greater access to physiotherapy needs to be provided, so that these patients can become continent and get their quality of life back.

The APA will be working hard on advocacy and awareness efforts on this very treatable issue this year.

APA National President

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