www.mdbriefcase.com.au

Early last year we looked at the Canadian flagship mdBriefCase website. Coincidentally, soon after that review I had an interesting chat with the team from mdBriefCase Australia while at the 2009 Sydney GPCE Conference.

While the Australian version is conceptually similar to its parent site (as a free provider of primary care CME rather than medical news), the Australian version is still a little different. Established in January 2006, it uses only local Australasian modules produced by specialist contributors (mostly from the western side of the ditch). And, it would seem that perhaps the repertoire of topics and management guidelines should better reflect our similar trans-Tasman approaches to primary care medicine than the North American site.

The website claims to have a base of 15,000 subscribers, mostly presumably in Australia and New Zealand.

Fortuitously, mdBriefCase Australia did catch my eye again this week with the promotion of a new module on the site titled "Diagnosing and Managing Bipolar Depression in General Practice". Coincidentally, my interest in the intriguing nature of the bipolar disorders had been stimulated after an excellent presentation at the same Sydney conference last year and also following the tragic death of a friend by suicide some weeks before.

There now appears to be significant acknowledgement at a global primary care level of the diagnostic constraints of the DSM-IV which have perhaps substantially handicapped the accurate diagnosis and the optimal and timely management of the various types of bipolar depression for possibly decades. Indeed, some commentators have noted that up to 40 per cent of patients with an intrusive bipolar disorder are not diagnosed for at least 10 years and that 69 per cent of those patients eventually diagnosed with a bipolar disorder had been previously misdiagnosed on an average of three to four times before appropriate therapy was able to be established.

So, with at least 40 in every 1000 of our patients having a likely covert background of either BP I, BP II, cyclothymia or other forms of bipolar disorder, and more mental health funding slowly flowing into primary care here in New Zealand, there is now an evolving opportunity for our primary care teams to better manage this seriously neglected segment of the mental health community.

The module itself was excellent and, as with our own Goodfellow Unit website, really exemplifies the importance of having locally based CME articles. In this case, the detailed resource materials were from the 2004 Australian and New Zealand Clinical Practice Guidelines for the Treatment of Bipolar Disorder (sponsored in part by our own ministry-directed health funding organisations).

As with the Canadian parent site, it is also notable, however, that there is a limited number of topics available for the CME modules. It is accepted - and our Goodfellow Unit would surely agree - that designing and preparing such modules for web-based access is time-consuming and thus each module requires a sponsor. While in New Zealand we have tended to move more away from industry affiliated sponsorships for CME - with the possible exception of ACC - to more of a hands-off involvement, this does not quite seem to be the case in Australia and all modules appear to be sponsored by a company with a major product in that field. The site does, however, emphasise that it "adheres to a strict transparency policy on physician-sponsor roles".

The other negative feature of mdBriefCase Australia is it seems to be a little clandestine in its pedigree. There is no advertised board oversight and all the specialist prepared articles appear to be reviewed by a single one-man band, GP Damian Flanagan.

There are only 13 modules available at the moment and it might be perceived as a little bit of a hotch-potch with topics such as macular degeneration, malaria and NSAID-gastritis, plus all that perpetual "same old stuff" viz acne, cardiovascular risk, osteoporosis, hepatitis A and B, allergic rhinitis, asthma, HPV, depression, COPD and psoriasis.

The modules are said to expire and be taken off the site every 12 months, perhaps having less to do with currency and more to do with time-limited financial support. The modules are also undated which is a little disconcerting, though one can get a reasonable idea of currency with the dates of comments posted in the individual module discussion groups.

It is well worth having a look at mdBriefCase Australia if only to update ourselves on the bipolar disorders, and it would also be worth having another look at the parent Canadian site at mdBriefCase.com for comparison.