health outcomes (assessed with the European Community Respiratory Health Survey) from baseline to 12 months, or any significant differences between groups. Abramson et al (2010) also reported that there were no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation. The LFA/TSANZ (2015) lists several possible explanations for the negative results, including limited power, few events and inclusion of doctor-diagnosed as opposed to spirometry-defined patients. Abramson (2014) The Concise Guide by Abramson et al (2014) suggests that severity of COPD should be monitored on a regular basis after initial diagnosis. The relevant recommendation is shown in Table 36. Table Abramson (2014): Recommendation relating to lung function and long-term monitoring Recommendation Grading of recommendation To guide ongoing management, assess COPD severity based on lung function and a careful assessment of symptoms and signs, and review the history of exacerbations at least annually. Strong recommendation; moderate-quality evidence Abbreviations: COPD, chronic obstructive pulmonary disease. While the guideline recommends ongoing lung function testing (spirometry), it notes that symptom severity may not correlate with spirometry criteria for severity (see Table 37). Furthermore, a history of previous exacerbations was identified as the best predictor of future exacerbations and possible decline in lung function. Table Abramson (2014): Guide to the severity of COPD Severity FEV1 (% predicted) Symptoms History of exacerbations Comorbid conditions Mild 60-80 Breathlessness on moderate exertion Recurrent chest infections Little or no effect on daily activities Frequency may increase with severity Present across all severity groups Moderate 40-59 Increasing dyspnoea Breathlessness walking on level ground Increasing limitation of daily activities Cough and sputum production Exacerbations requiring corticosteroids and/or antibiotics Frequency may increase with severity Present across all severity groups Severe < 40 Dyspnoea on minimal exertion Daily activities severely curtailed Experiencing regular sputum production Chronic cough Frequency may increase with severity Present across all severity groups Source: Abramson et al (2014); Table 1, p. 6. Note: Common comorbid conditions include cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, anxiety or depression, lung cancer, peripheral vascular disease and sleep apnoea.
75-79 21,400 8% 80-84 12,916 5% >=85 6,533 2% Unpublished data (Department of Health) Note: Total number of services is 270,258. Public data (Department of Human Services website) Figure D2: Number of services by state, 2009-10 to 2014-15, item 11503 Table D4: Top same day item combinations - item 11506 with other MBS items, 2014-15 Item combination Number of Episodes Number of services % of total episodes Description of episodes 11506 292,504 292,941 54% Measurement of respiratory function after bronchodilator only 11506, 00023 85,177 170,865 16% Measurement of respiratory function after bronchodilator & Level B GP consultation 11506, 00036 46,525 93,217 9% Measurement of respiratory function after bronchodilator & Level C GP consultation 11506, 00116 21,222 42,455 4% Measurement of respiratory function after bronchodilator & subsequent consultant physician consultation 11506, 00110 10,697 21,395 2% Measurement of respiratory function after bronchodilator & initial consultant physician consultation 11700, 11506 10,111 20,251 2% Measurement of respiratory function after bronchodilator & 12 lead ECG 11700, 11506, 00036 9,803 29,436 2% Measurement of respiratory function after bronchodilator, 12 lead ECG & Level C GP consultation 11506, 00721 9,226 18,476 2% Measurement of respiratory function after bronchodilator & Chronic Disease Management plan 11700, 11506, 00023 8,194 24,655 2% Measurement of respiratory function after bronchodilator, 12 lead ECG & Level B GP consultation 11506, 00732 7,800 19,573 1% Measurement of respiratory function after bronchodilator & review Chronic Disease Management plan Unpublished data (Department of Health)
MBS Data on Item 11512 – Spirometry laboratory based Table D5: Number of services by age group – 11512, 2014-15 Age Group Number of Services % provided to the age group 0-4 277 0% 5-9 5,263 6% 10-14 5,393 7% 15-19 3,118 4% 20-24 1,739 2% 25-29 1,864 2% 30-34 2,208 3% 35-39 2,456 3% 40-44 3,232 4% 45-49 3,816 5% 50-54 4,888 6% 55-59 6,397 8% 60-64 8,141 10% 65-69 9,617 12% 70-74 9,129 11% 75-79 7,393 9% 80-84 4,984 6% >=85 2,790 3% Unpublished data (Department of Health) Note: Total number of services is 82,705. Public data (Department of Human Services website) Figure D3: Number of services by state, 2009-10 to 2014-15, item 11512 Table D6: Top 10 same day item combinations - item 11512 with other MBS items, 2014-15 Item combination Number of Episodes Number of services % of total episodes Description of episodes 11512 36466 36480 44% Continuous measurement of flow and volume only 11512, 00116 25563 51201 31% Continuous measurement of flow and volume & subsequent consultant physician consultation 11512, 00110 8440 16880 10% Continuous measurement of flow and volume & initial consultant physician consultation 11512, 00132 4432 8864 5% Continuous measurement of flow and volume & consultant physician treatment and management plan 11512, 00133 2085 4170 3% Continuous measurement of flow and volume & review of consultant physician treatment and management plan
based adult treatment initiation study the nose via mask that keeps the airway open to ensure unobstructed breathing. A treatment initiation test occurs in a sleep centre following diagnosis of a sleep disorder and the recommending of PAP therapy. be claimed once in a 12 month period. initiation studies are billed under MBS 12203. These services will transfer to the new item. that is needed to ensure the patient’s airway stays open. New item – Laboratory based adult treatment effectiveness study This test is used when a patient has been diagnosed with a sleep disorder and received treatment but symptoms recur or there is a significant change in weight or other medical conditions. A new MBS item specifically for treatment effectiveness which may be claimed once in a 12 month period. At present, there are no items for this service. However, some effectiveness studies may be being billed under MBS 12203. These services are expected to transfer to the new item. A change in symptoms, weight or other medical conditions may affect how well the PAP treatment works for a patient. An effectiveness study is used to check whether the air pressure needs to be changed. New item – Home based adult automatic positive airway pressure (APAP) titration study Titration is a process used with PAP treatment where the air pressure is adjusted until the right pressure to keep the airway open is identified. This item will allow patients who are diagnosed with uncomplicated sleep apnoea to undergo titration at home. The Committee noted that this proposal should be placed on hold for 2-3 years until the impact of the changes to items 12203 and 12250 is known. Not applicable at this stage. Not applicable at this stage. New item – Laboratory based adult vigilance testing This study involves an assessment of excessive daytime sleepiness or the ability to stay alert using several tests. The Committee recommend that vigilance testing be evaluated by the Medical Services Advisory Committee as this service is not currently funded. Not applicable at this stage. Not applicable at this stage.