Wednesday, July 26, 2017

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Situational analysis

Within Australia there are currently 47 centres designated (DC) to prescribe PAH specific medication funded by the Pharmaceutical Benefits Scheme (PBS) (, all with different levels of expertise and diverse levels of dedicated PHT clinical time and resources. Some centres manage PAH within a multidisciplinary Team as per best practice whilst others are run by a single practitioner with far less resources and support 15. The DC’s are spread throughout Australia as follows:

·in Victoria  ·in N.S.W  ·in QLD  ·in ACT   ·in S.A   ·in W.A  ·in Tasmania  ·in N.T

Within New Zealand, all 30 Hospitals across NZ are able to prescribe PAH specific medication.  Each application for drug must be reviewed by the PHARMAC (Pharmaceutical Management Agency of New Zealand) PAH drugs panel.

On a case by case basis, each patient will be approved by the panel of experts for therapy based on a specific application form and a specific set of criteria (ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY).

A Cardiologist, a Respiratory physician or a Rheumatologist / Immunologist may prescribe a PAH specific medication in a centre designated under the above criteria. This means that Pulmonary Hypertension management may be shared over as many as four different types of Physicians.

Currently there are 5 PAH specific medications funded by the PBS within Australia and 4 in New Zealand under the funded pharmacy review process. Therapies are only funded one at a time and no combination (dual or triple treatment) is funded to date. This represents an area of focus for the society as combination treatment as a strategy has recently shown improvements in survival beyond that expected from mono therapy 16.

PHT is a difficult disease to diagnose with idiopathic PAH representing the culmination of exclusion of all other forms of PHT! PHT crosses at least 26 different diseases and the many subcategories of those diseases makes specialising in PHT demanding, requiring extensive training and experience diagnosing and treating this group of chronic and complex diseases 8.

Diagnosis remains a challenge! – the average delay in diagnosis form Symptom onset is 3.85 yrs 13. Patients see an average of 5 General Practitioners (GP) and 3 specialists before being referred to a centre specialising in PH diagnosis and management.

PHT management in ANZ is evolving and expanding across a diverse group of clinical expertise. Education, Research, Lobbying and Education become more important the more diverse the group of clinicians involved in the care of PHT becomes. National programs specifically and independently run are critical in establishing a sustainable ‘model of care’ for patients needed the service of a skilled PHT clinician.

Australia and New Zealand currently have no national database, no current independent scientific education programmes and no formal independent network of Pulmonary Hypertensive specialists. Having said that, Australian Clinicians are recognised on a world stage as being true leaders in the Pulmonary hypertension field, collectively publishing some of the largest datasets on improved Survival and QoL with Mono therapy, Combination therapy, screening programmes and registry’s to name a few.

Collectively, we believe the Pulmonary Hypertension Society ANZ has the ability to promote a collegial environment that advances the service provision for patients and provides a real opportunity for new doctors to become independent experts in Pulmonary hypertension management maintaining the leading light Australia has shown over the past decade of evolution in PH management.

Copyright 2011 by PHSANZ