Help is on the way for regional allergy sufferers
In a win for rural healthcare, allergy sufferers in regional areas, where a lack of specialists can delay diagnosis and treatment, will receive immediate management and improved referrals.
Imagine feeling constantly exhausted and so nauseated that you have to take regular days off work, all because of allergies.
That’s a reality of Sharon Harley, who has lived with severe allergic rhinitis for 30 years. Her condition is triggered by grass and dust mites, causing severe sneezing, nasal congestion and itching, a full feeling in her head and exhaustion as a result of her immune system having to constantly fight off the allergens.
“I feel foggy and I sound a bit hoarse,” she says. “I have constant sinus headaches, so you’re constantly popping pills. I’m foggy, fatigued, have nausea, so I have a lot of days off work. My social life’s affected because on the weekend I’m just recovering to be able to get through the next week. It’s actually very debilitating.”
The ongoing effect of her allergies prompted Harley to get more help beyond traditional antihistamines. After investigating, her GP eventually said there was nothing more she could do and instead referred her to a visiting specialist.
It took six months for Harley to be seen by the specialist and then, just before she was to begin immunotherapy, the specialist stopped visiting the town. It meant Harley had to find a new specialist in another town, fork out for yet another expensive initial consultation fee, and then travel several hours for the appointment. And all that came with no guarantee she would actually be helped.
Allergic diseases affect more than five million Australians and are growing in prevalence. For sufferers, they are more than just an annoyance; they can cause anxiety, severe illness and, in some cases, be deadly. Getting a diagnosis also can be expensive and time-consuming, and often involves misdiagnosis.
There also is a severe lack of allergists or immunologists nationally, which means patients often face long waiting lists just to see a specialist. It’s a problem amplified for patients in regional and rural areas who also have to contend with long distances to seek help.
Now, a pilot program is seeking to help relieve some of that pressure by providing GPs and rural generalists with a new online support program. The program, called Allergy Assist, has been developed by the National Allergy Council and the Australian College of Rural and Remote Medicine with federal government funding. It is in response to the parliamentary inquiry into allergies and anaphylaxis.
The online platform connects doctors with specialists who will provide general allergy advice as well as individualised case advice within 48 hours.
Katie Frith is a pediatric clinical immunology and allergy specialist who helped to develop the program. She also is the co-chairwoman of the National Allergy Council’s Shared Care for Allergy Project and chairwoman of the Australasian Society of Clinical Immunology and Allergy’s anaphylaxis committee.
“It has the potential to really alter allergy management,” she says.
“I think it’ll provide significant benefit, not only in providing the patient with better immediate management but also may help to improve referrals.
“Sometimes people are travelling long distances to see a specialist, (when) maybe they didn’t actually need to see an immunologist – another specialist may have been more appropriate. So it may help in reducing the burden on waiting lists in tertiary hospitals, but also the impact of that will flow on to rural patients.”
To use the platform, a GP inputs de-identified patient data that is then fed back to four immunologists. Their advice and treatment plans are then sent back to the doctor and uploaded to the platform, along with additional information about clinical tools and other diagnostic and treatment resources, so any GP with access to the program can learn from it.
The 12-month pilot is available to doctors who are part of the ACRRM, though about 200 other GPs who are part of other colleges, such as the Royal Australian College of General Practitioners, also will be eligible to sign up to it for free.
If successful, the program could be rolled out nationally.
“As a nurse I saw just how debilitating and common allergies can be,” federal Health and Aged Care Assistant Minister Ged Kearney says.
“All Australians deserve the best possible healthcare, including those living rurally or remotely. Allergy Assist is a major step forward in achieving that, empowering local doctors to provide timely specialist care.”
The program builds on a similar one that catered specifically to skin allergies.
Rod Martin is the ACRRM’s president and a rural generalist based in the regional NSW city of Armidale. He says the Allergy Assist program is a win for rural healthcare.
“Sometimes it’s a matter of finding out what’s going on,” he says of using the program. “Sometimes it’s really just confirming that the plan that you may have used previously, or the plan that you’ve effectively worked out for yourself, is a reasonable plan and you’re making sure that you are doing all of the right investigations and not increasing the risks for patients.
“I’m in a city of 25,000 people and there’s just not a lot of allergists and immunologists around. Our nearest allergist is 350km away, and that’s an adult allergist; a pediatric one is even harder to access.”
Despite the growing prevalence of people with allergies, the lack of allergists and immunologists has remained. Frith believes it is the result of several factors including a lack of government funding for specialised positions in public hospitals but also because of limited positions at a consultant or even training level. It means there is no quick fix to resolving the problem. Instead, it is hoped programs such as Allergy Assist will help to bridge that gap.
It’s a program Harley wishes her GP had access to earlier because she says she thinks it could have saved time and expense and helped them both understand more about her treatment options.
“It is a long and expensive road to go down to find out whether you want to pursue the treatment or not,” Harley says.
She now has found another specialist and hopes to begin a more tailored treatment in March. But she sees the worth in the new program.
“Our rural GPs are under a lot of pressure and they’re under-resourced. My medical practice entirely shut its doors two years ago, so all the patients were forced to find other doctors. So this is going to be a benefit to the GPs who will have a tool handy for them and maybe it will even ease some of that pressure on them.”
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