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A Patient's Perspective on Oxygen Therapy

Ms Anne Cahill Lambert, formerly Chief Executive Officer of Women's Hospitals Australasia and Children's Hospitals Australasia, is a patient awaiting a lung transplant. She needs domiciliary oxygen therapy 24 hours a day.

In the latest issue of the Medical Journal of Australia, Cahill Lambert comments on a recent position statement on domiciliary oxygen therapy by the Thoracic Society of Australia and New Zealand. She says the statement is good, as far as it goes, but does not consider the patient's point of view.

Four major issues not discussed are access to and equity of oxygen supplies, portability and comfort of oxygen cylinders, assessment and review of patients needing oxygen therapy, and patients' quality of life.

Not all Australians who need oxygen therapy have access to free or subsidised oxygen, and rules on eligibility for oxygen therapy vary from state to state. For example, Victoria, Tasmania, South Australia, Western Australia and the ACT provide free oxygen, based on clinical need, irrespective of the patient's financial position. Queensland provides the service only to patients on a lung transplant waiting list, and in NSW, patients must hold a government health care card to be eligible.

Furthermore, some patients who need to travel interstate for treatment have to pay for their own oxygen supplies while travelling or staying in another state.

"Everyone pays their taxes and their Medicare levies — yet, at the whim of a postcode, some people do not have access to a basic supply such as oxygen," Cahill Lambert said.

On the issue of portability and comfort, Cahill Lambert says that available oxygen cylinders (weighing about 4 kg when full) are too heavy for an independent lifestyle. She calls on Australian suppliers to provide light-weight liquid oxygen, currently available in the UK and USA.

Cahill Lambert also criticises the practice of patient reviews being undertaken by oxygen suppliers. She says this represents a significant conflict of interest and raises questions about clinical governance. All patients being prescribed oxygen should be reviewed by appropriate thoracic or respiratory physicians.

In reply to Cahill Lambert's article, the authors of the position statement, Associate Professor Christine McDonald and colleagues, welcomed her comments. They said informal consultation with consumers had been made through the Australian Lung Foundation's COPD Consultative Group, but no funding had been available to seek broader community comment.

The authors said that liquid oxygen is not widely available in Australia because it is yet to be demonstrated that the extra cost involved is balanced by greater portability and comfort and better quality of life.

The authors agree with Cahill Lambert that there is a potential conflict of interest in the review being conducted by the oxygen supplier and they support her call for more advocacy in this area, if the review is being conducted by the oxygen supplier.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT Anne CAHILL LAMBERT 0400 127 211 / 02 6257 3893

Ass Prof Christine McDONALD 0413 703 533 / 03 9496 5739 / 03 9496 5760

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471

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