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Monash researchers part of team to receive $9.5m NHMRC grant

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4 March 2016

Medical testing

A team of Australia’s leading healthcare researchers have been awarded a $9,578,895 program grant from the NHMRC to help reduce unnecessary testing and treatment, particularly in the areas of musculoskeletal diseases, cardiovascular disease and cancer.

The Four Chief Investigators who will lead the study, entitled ‘Using healthcare wisely: Reducing inappropriate use of tests and treatments’, are Professor Rachelle Buchbinder from Monash University and Cabrini Institute, Professor Paul Glasziou from Bond University, Professor Chris Maher from the George Institute for Global Health and Professor Kirsten McCaffery from the University of Sydney.

Professor Buchbinder said she is thrilled to be able to contribute to this important and timely program of research.

“A systematic approach to investigating the problem of over-testing, over-diagnosis, and over-treatment is needed. We know that one off strategies aimed at changing clinician behaviour are ineffective and an all of systems approach involving clinicians, policy makers and consumers is needed to identify and test sustainable multifaceted solutions.”

As a rheumatologist her major interest has been in improving outcomes for people with chronic musculoskeletal conditions such as osteoarthritis and low back pain.  “However a strength of our planned program of research is that it will cross professional boundaries and this means that we can learn from successes in other disciplines.“

Professor Glasziou said the research program was a natural evolution of work the team had done previously in screening and diagnosis.

“While there are many benefits to early detection and treatment of disease, there is increasing evidence of unnecessary testing and treatment resulting in harm to patients, increased health expenditure and the diversion of scarce resources from where they’re most needed,” Professor Glasziou said.

Professor Maher said he was looking forward to working with the other investigators and stakeholders to improve the health of Australians. 

“My interest is in improving healthcare for common musculoskeletal conditions such as low back pain. Back pain affects millions of Australians and it is the leading health reason forcing older Australians to retire prematurely,” Professor Maher said.

“In Australia we spend an extraordinary amount on healthcare for low back pain, $5Billion each year, so it is important that we use this money wisely,” he said.

Chief Investigator Professor Kirsten McCaffery of the University of Sydney said the team was delighted to be supported by NHMRC in this important area of research. 

“Inappropriate use of health care is a growing problem in Australia and internationally causing harm to patients, wasting resources and threatening the sustainability of health services,” Professor McCaffery said.

“As a health psychologist working principally in the areas of cancer and cardiovascular disease - and soon to include musculoskeletal disorders such as low back pain - my interest is how to communicate the problem of inappropriate tests and treatments to patients, the community and clinicians and to develop solutions to the problem which change the way people think, feel and behave towards this problem. At the moment both public and health professionals understanding of the problem is very limited and this needs to change,” Professor McCaffery said.

Professor Glasziou said over-testing and overtreatment was driven by many factors.

“These factors include clinician concern about missing diagnoses, increasingly sophisticated diagnostic tests which detect smaller and smaller abnormalities of uncertain prognosis, and screening programs that save lives but can also detect disease that won’t progress to cause harm. This leads to unnecessary treatment which can result in complications and harm to patients,” Professor Glasziou said.

“In addition, guideline revisions often lower the threshold for diagnosis and expand disease definitions, labelling people who have only mild symptoms or are at very low risk of illness.

“In summary, our focus through this research program will be on using healthcare wisely. The initial work will be in identifying problems and potential solutions in musculoskeletal diseases, cardiovascular disease and cancer, but the issues we address are also a major international problem so we anticipate our findings will be of international significance.

“The crucial changes needed are better guidelines for disease definition, increased shared decision making, and enhanced public input into screening policy.”

The NHMRC grant will fund a series of national research projects across all states, led by the four Chief Investigators, which will be staggered over a five year period from January 2017.

The team will partner with relevant organisations engaged in diagnostic and screening policy making to translate and disseminate its findings.

Program Grants are the NHMRC’s highest version of grants. They are issued annually and are not based on the cost of the proposed research or budget request, but rather a grant amount is awarded based on the cumulative track record of research achievement of each Chief Investigator involved.