ORCID Profile
0000-0003-3974-3437
Current Organisation
University of Tasmania
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Publisher: Informa UK Limited
Date: 10-2017
DOI: 10.2147/CIA.S146613
Publisher: Springer Science and Business Media LLC
Date: 02-04-2012
Publisher: Elsevier BV
Date: 09-2015
Publisher: SAGE Publications
Date: 15-04-2018
Abstract: The aim of this study was to investigate the proportion of patients who have suboptimal adherence to oral anticoagulant (OAC), identify the predictors of adherence, and determine whether patient-related factors vary across adherence levels in Australia. Respondents were recruited for an online survey using Facebook. Survey instruments included the Morisky Medication Adherence Scale, the Anticoagulation Knowledge Tool, the Perception of Anticoagulant Treatment Questionnaires, and a modified Cancer Information Overload scale. Predictors of medication adherence were identified using ordinal regression analysis. Of the 386 responses eligible for analysis, only 54.9% reported a high level of adherence. Participants aged 65 years or younger were less likely to have high adherence compared to older participants (odds ratio [OR], 0.54 95% confidence interval [CI], 0.33-0.88 P = .013), while females were more likely to be highly adherent compared to males (OR, 1.69 95% CI, 1.08-2.64 P = .023). The analyses showed that age, gender, treatment satisfaction, information overload, concerns about making mistake when taking OACs, and cost of medication were significant predictors of adherence. Self-reported suboptimal adherence to OAC is common among patients with atrial fibrillation. A focus on supporting people who are at higher risk of suboptimal adherence is needed to maximize the benefit of OAC therapy in this population.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2016
DOI: 10.1007/S40264-016-0444-7
Abstract: Adverse drug reactions (ADRs) are one of the leading causes of hospital admissions and morbidity in developed countries and represent a substantial burden on healthcare delivery systems. However, there is little data available from low- and middle-income countries. This review compares the prevalence and characteristics of ADR-related hospitalisations in adults in developed and developing countries, including the mortality, severity and preventability associated with these events, commonly implicated drugs and contributing factors. A literature search was conducted via PubMed, Scopus, Web of Science, Embase, ProQuest and Google Scholar to find articles published in English from 2000 to 2015. Relevant observational studies were included. The median (with interquartile range [IQR]) prevalence of ADR-related hospitalisation in developed and developing countries was 6.3 % (3.3-11.0) and 5.5 % (1.1-16.9), respectively. The median proportions of preventable ADRs in developed and developing countries were 71.7 % (62.3-80.0) and 59.6 % (51.5-79.6), respectively. Similarly, the median proportions of ADRs resulting in mortality in developed and developing countries were 1.7 % (0.7-4.8) and 1.8 % (0.8-8.0), respectively. Commonly implicated drugs in both settings were antithrombotic, non-steroidal anti-inflammatory and cardiovascular drugs. Older age, female gender, number of medications, renal impairment and heart failure were reported to be associated with an increased risk for ADR-related hospitalisation in both settings while HIV/AIDS was implicated in developing countries only. The majority of ADRs were preventable in both settings, highlighting the importance of improving medication use, particularly in vulnerable patient groups such as the elderly, patients with multiple comorbidities and, in developing countries, patients with HIV/AIDS.
Publisher: BMJ
Date: 08-2022
DOI: 10.1136/EMERMED-2021-211660
Abstract: Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised. This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED. A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses. Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI −0.42 to −0.23, I 2 =51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I 2 =85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I 2 =95%) and quicker initiation of time-critical medications. The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams. CRD42020165234.
Publisher: Wiley
Date: 13-10-2022
DOI: 10.1111/BCP.15021
Abstract: Approval of direct‐acting oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation (AF) was an important milestone, providing a wider range of treatment options and creating the possibility for drug switching after initiation. In addition to improved utilisation of oral anticoagulants (OACs) for stroke prevention, reports of switching among OACs are growing in the literature switching may influence clinical outcomes, healthcare costs and patient satisfaction. This review aimed to summarise the current literature on the pattern of OAC switching in patients with AF, including reasons for switching and clinical consequences following switching. A literature search was conducted in PubMed, Scopus and Embase on 27 June 2020. We included 39 articles published after 2013, following the introduction of apixaban. The review found that switching among OACs was common in clinical practice, significantly varying with the type of OAC. Studies reporting the reason for switching and clinical outcomes were comparatively limited. The decision to switch was often related to safety issues (usually bleeding), poor anticoagulation control and ease of use. Patient characteristics, clinical conditions and drug interactions were found to be associated with switching from OACs. Findings regarding bleeding outcomes following switching were inconsistent, possibly confounded by the rationale for switching and the switching protocol. Noting the limited number of studies included and their relatively short follow‐up periods, switching did not have a significant impact on the risk of stroke and other thrombotic outcomes. Further prospective studies are needed to understand better potential rationales for switching and the clinical outcomes.
Publisher: Springer Science and Business Media LLC
Date: 11-07-2010
DOI: 10.1007/S11096-010-9416-7
Abstract: To describe the development, implementation and outcomes of an anticoagulation education program for pharmacists participating in a community-based post-discharge warfarin management service. Australian community pharmacy practice. Three education modules were developed in collaboration with medical experts and delivered electronically and via hands-on training sessions to pharmacists in three Australian states. Educational outcomes were assessed via a short answer assignment and evaluation of their warfarin dosing recommendations for five hypothetical scenarios. Consumer and pharmacist perceptions of the adequacy of the training were surveyed using a structured postal questionnaire. Pharmacists' score in the short answer assignment and evaluation of their responses to the hypothetical warfarin dosing scenarios. Sixty-two pharmacists successfully completed the training program with a mean score for the short answer assignment of 14.3 out of 15 (95.3% 95% CI 13.8-14.7). The pharmacists' warfarin management recommendations were very similar to those of two experienced medical specialists. Pharmacists and consumers expressed confidence in the adequacy of the training program. This education program successfully up-skilled a cohort of pharmacists for involvement in a post-discharge warfarin management service. These findings support formalization and further development of the program to facilitate widespread implementation of home-based post-discharge warfarin care.
Publisher: Springer Science and Business Media LLC
Date: 13-11-2017
Publisher: Hindawi Limited
Date: 19-02-2018
DOI: 10.1111/IJCP.13072
Abstract: Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia in clinical practice, and is associated with a significant medical and economic burden. Anticoagulants reduce the risk of stroke and systemic embolism by approximately two-thirds compared with no therapy. Knowledge regarding anticoagulant therapy can influence treatment outcomes in patients with AF. To measure the level of anticoagulation knowledge in patients with AF taking oral anticoagulants (OACs), investigate the association between patient-related factors and anticoagulation knowledge, and compare these results in patients taking warfarin and direct-acting oral anticoagulant (DOACs). Participants were recruited for an online survey via Facebook. Survey components included the Anticoagulation Knowledge Tool, the Perception of Anticoagulant Treatment Questionnaires (assessing treatment expectations, convenience and satisfaction), a modified Cancer Information Overload scale and the Morisky Medication Adherence Scale. Treatment groups were compared and predictors of OAC knowledge were identified. Participants taking warfarin had a higher knowledge score compared with those taking DOACs (n = 386, 73% ± 13% vs 66% ± 14%, P<.001). Advancing age, type of OAC, health information overload and ease of OAC use (treatment expectation) were significant predictors of knowledge. Treatment expectation, including the belief that OAC treatment would cause bleeding side effects, varied significantly between participants taking warfarin and DOACs (P = .011). The study identified knowledge gaps in patients taking OACs, and these deficiencies appeared to be greater in participants taking DOACs. Knowledge assessment should be integrated into patient counselling sessions to help identify and resolve knowledge deficits.
Publisher: Wiley
Date: 28-09-2018
DOI: 10.1002/PDS.4667
Abstract: To compare prospective identification of adverse drug reaction (ADR)-related hospital admissions in the elderly with administrative coding using the International Classification of Diseases 10 We linked the records of 768 enrolled patients from an earlier study, where clinical pharmacists identified ADRs using prospective data collection, to hospital administrative data. We identified patients in the study whose admissions were coded as ADRs using ICD-10-AM codes. We then compared the prevalence and characteristics of ADR-related hospital admissions identified by the two approaches. According to ICD-10-AM coding, 2.7% of patients were admitted due to ADRs, while 15.0% of patients were deemed to have been admitted due to ADRs based on prospective identification by clinical pharmacists. Most (85.7%) patients coded as having an ADR-related hospital admission were also identified as such prospectively. Hematological (23.1%) and metabolic reactions (23.1%) were frequent causes of ADRs identified by coding, whereas cardiovascular ADRs (27.8%) were more common causes of ADRs identified prospectively by pharmacists. Antidepressants (16.7%) and cardiac glycosides (16.7%) were the most commonly implicated drug groups in ADRs identified by coding, whereas diuretics (28.8%) and renin-angiotensin system inhibitors (17.0%) were frequently implicated as causes of ADRs identified prospectively by pharmacists. Reliance on administrative coding potentially underestimates the extent of the problem of ADRs as a cause of hospitalization in the elderly, and more detailed prospective analysis of admissions provides additional targets for strategies to prevent ADRs. The types of ADRs identified also differ between the two approaches.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Hindawi Limited
Date: 07-07-2009
DOI: 10.1111/J.1365-2710.2009.01089.X
Abstract: Antiplatelet therapy with aspirin and clopidogrel is an important component of the management of acute coronary syndrome, but it also increases the risk of bleeding. There are no formal guidelines about the use of a proton pump inhibitor (PPI) for gastroprotection in patients on clopidogrel. This study assessed how many patients in the Royal Darwin Hospital (RDH) and the Royal Hobart Hospital (RHH) prescribed clopidogrel and at risk of bleeding were co-prescribed PPIs. We conducted a retrospective cohort study using a pharmacy database to select all patients commenced on clopidogrel in a 1-year period. We identified all patients newly prescribed clopidogrel and determined the proportion that had a risk factor for bleeding and also received a PPI. We also assessed the effect of the use of PPIs on the number of reported bleeds. The final study cohort consisted of 385 patients who had been newly prescribed clopidogrel. Of all patients discharged on clopidogrel, 95.6% (368/385) had >or=1 risk factor for bleeding. One hundred and twenty-eight of these patients [128/368, (34.8%)] were discharged on a PPI. Patients on dual antiplatelet therapy with an additional risk factor for bleeding and not discharged on a PPI were more likely to develop a major bleed than patients on dual antiplatelet therapy without a risk factor for bleeding not discharged on a PPI (11.1% vs. 1.8% P < 0.01). Patients on dual antiplatelet therapy with an additional risk factor for bleeding not discharged on a PPI had a higher probability (borderline significance) of major bleeding, compared with patients on dual antiplatelet therapy with an additional risk factor for bleeding discharged on a PPI [PPI: 1/60, (1.7%) vs. no PPI: 6/54, (11.1%) P = 0.05]. Our results indicate that PPIs may only lower the probability of major bleeding in patients treated with dual antiplatelet therapy, who possess additional risk factor(s) for bleeding.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2022
Abstract: We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation. We performed a retrospective study using an Australia‐wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.9±12.6 years, 47.1% women) 11 419 had a recorded OAC prescription for at least 80% of their follow‐up time. During the mean follow‐up time of 3.7±2.0 years, 425 patients (2.3% 95% CI, 2.1%–2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59 95% CI, 0.44–0.80 P .001) compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49 95% CI, 0.33–0.73 P .001) or warfarin users (HR, 0.46 95% CI, 0.28–0.74 P =0.002). No significant difference was seen between warfarin users and non‐OAC users (HR, 1.08 95% CI, 0.70–1.70 P =0.723). In patients with atrial fibrillation, direct‐acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.
Publisher: Informa Healthcare
Date: 15-08-2006
Publisher: AMPCo
Date: 04-2014
DOI: 10.5694/MJA13.00061
Publisher: Informa UK Limited
Date: 02-06-2022
DOI: 10.1080/14740338.2022.2084071
Abstract: Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods. The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms. The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between in idual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.
Publisher: MDPI AG
Date: 13-03-2020
DOI: 10.3390/JCM9030783
Abstract: Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.
Publisher: Springer Science and Business Media LLC
Date: 08-2018
DOI: 10.1007/S11096-018-0700-2
Abstract: Background Under-reporting of adverse drug reactions (ADRs) by healthcare professionals is prevalent worldwide. Community pharmacists are the most frequently visited healthcare professional and are well placed to document ADRs as a part of their routine practice. Objective To measure community pharmacists’ knowledge and perspectives towards ADR reporting and their reporting practices. Setting Community pharmacists in the New South Wales, Queensland, Victoria and Tasmania, Australia. Method A survey tool consisting of 28 items was developed, piloted and validated by a panel of expert reviewers. The final anonymised survey was distributed online to community pharmacists. Exploratory factor analysis and Cronbach’s alpha were used to measure the validity and reliability of the tool, respectively. Non-parametric statistical tests were used to analyse knowledge, perspectives and ADR reporting practices. Main outcome measures : Knowledge, perceived importance, enablers and barriers to reporting ADRs. Results The survey tool showed acceptable validity and reliability. A total of 232 respondents completed the survey. The median knowledge score was 5 out of 10 (interquartile range, 2). Less than a third of respondents (31.0%) reported sufficient knowledge and training on ADR reporting. Only 35.3% of pharmacists reported at least one ADR in the previous 12 months. Non-reporting pharmacists were more likely to report lack of time as a barrier ( P 0.001), conversely they were more likely to report if the practice was remunerated ( P = 0.007). Conclusion Under-reporting of ADRs by community pharmacists is highly prevalent. Initiatives to educate and train them on ADR reporting and simplifying the reporting process may improve reporting practices.
Publisher: University of Buckingham Press
Date: 15-07-2014
Abstract: Rationale, aims and objectives: To develop and evaluate a person-centered online education package to facilitate the delivery of a Home Medicines Review system following acute coronary syndromes (ACS).Methods: An education package of 5 online lectures, an assessment quiz and an evaluation questionnaire was developed to increase the skills and capacity of pharmacists. Course material was generated from a targeted appraisal of literature and reviewed by expert pharmacists. Kirkpatrick’s 4-level model for evaluating training programs was applied as an international standard for measuring the quality of the material developed. The evaluation questionnaire measured the dimension of reactions to the material and the assessment quiz measured the dimension of learning.Results: From a pool of 91 accredited pharmacists, 36 registered an interest in the education package and completed the online enrolment. Of those who enrolled, 27 completed the package. Twenty-two pharmacists passed the quiz on their first attempt and 3 passed on their second attempt. Analysis of the evaluation questionnaire consistently showed pharmacists’ reactions to the material were positive.Conclusion: In Australia, Home Medicines Reviews are endorsed by policy and reimbursed. Providing resources to increase the knowledge and confidence of pharmacists will potentially improve their ability to address specific issues with adherence and medication use following ACS.
Publisher: Springer Science and Business Media LLC
Date: 28-12-2021
DOI: 10.1007/S40256-020-00457-3
Abstract: Atrial fibrillation is the most common arrhythmia. It increases the risk of thromboembolism by up to fivefold. Guidelines provide evidence-based recommendations to effectively mitigate thromboembolic events using oral anticoagulants while minimizing the risk of bleeding. This review focuses on non-adherence to contemporary guidelines and the factors associated with guideline non-adherence. The extent of guideline non-adherence differs according to geographic region, healthcare setting, and risk stratification tools used. Guideline adherence has gradually improved over recent years, but a significant proportion of patients are still not receiving guideline-recommended therapy. Physician-related and patient-related factors (such as patient refusals, bleeding risk, older age, and recurrent falls) also contribute to guideline non-adherence, especially to undertreatment. Quality improvement initiatives that focus on undertreatment, especially in the primary healthcare setting, may help to improve guideline adherence.
Publisher: Wiley
Date: 09-2005
Publisher: SAGE Publications
Date: 30-04-2200
Abstract: The relationship between the medication regimen complexity index (MRCI) and adverse drug reaction (ADR)-related hospital admissions has not yet specifically been investigated. To evaluate the MRCI and compare with medication count for prediction of ADR-related hospital admissions in older patients. This was a retrospective analysis of a prospectively collected convenience s le of 768 unplanned medical admissions of Australians aged 65 years old and older. The s le consisted of 115 (15.0%) ADR-related unplanned hospital admissions and 653 (85.0%) non–ADR-related unplanned medical admissions. The MRCI score was calculated from the medical records and analyzed to predict ADR-related hospital admissions. The cohort had a median age of 81 years, 5 comorbidities, and 11 medications, with a slight majority of women. The MRCI score was not significantly different in patients who had ADR-related admissions compared with other medical admissions—38.5 versus 34.0, respectively Wilcoxon Rank Sum test W = 33 522 P = 0.067. The medication count was significantly different between the ADR-related admissions compared with other medical admissions: 12 versus 10 W = 32 508 P = 0.021. However, the medication count was not a strong predictor of ADR-related admissions unadjusted odds ratio = 1.044 95% CI = 1.006-1.084. The MRCI score did not discriminate between ADR-related admissions and other medical admissions despite taking time to calculate with potential for inconsistent application. Medication count is more readily applicable with marginally greater relevance in this cohort however, both measures do not appear to be useful when used alone for clinicians to identify patients at risk of ADRs.
Publisher: American Medical Association (AMA)
Date: 10-2014
Publisher: Wiley
Date: 09-06-2013
DOI: 10.1111/JPC.12267
Abstract: To review the supply of medications to children with asthma and parent-reported management of childhood asthma in Tasmania and highlight evidence-practice gaps for future interventions. Participating pharmacies ran a software application that extracted data from dispensing records and helped to identify children with asthma. Parents of identified children were mailed a survey evaluating components of asthma management. Dispensing and survey data were analysed. A total of 939 children from 23 pharmacies were identified by the software and deemed eligible for inclusion. Surveys were received from 353 (37.6%) parents. In the past year, short-acting beta-2 agonists were supplied to 56.1% of the cohort, preventers to 76.5% (inhaled corticosteroids 52.3% leukotriene receptor antagonists 31.3% inhaled cromones 0.6%), long-acting beta-2 agonists (LABAs) to 25.7% and oral corticosteroids to 21.5%. Approximately half of the children receiving inhaled corticosteroids were concurrently receiving a LABA. Among children with indicators of inadequately controlled asthma, up to 73.7% of their parents reported that their asthma was adequately controlled, up to 38.2% did not possess an Asthma Action Plan, up to 36.8% were not regularly using a spacer and up to 22.8% had not received a preventer. These results indicate gaps in childhood asthma management, in particular, undersupply of preventers in high-risk patient groups, high supply of LABAs and insufficient spacer and asthma action plan usage. These areas should be targeted for interventions to improve childhood asthma management.
Publisher: MDPI AG
Date: 13-01-2023
Abstract: Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies’ clinical significance, with ‘unintentional’ discrepancies deemed ‘errors’. Fewer patients in the PPMC group had at least one error (3.5% 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4% 95% CI: 42.5% to 56.3%) and usual care group (61.4% 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.
Publisher: Public Library of Science (PLoS)
Date: 16-10-2017
Publisher: Informa UK Limited
Date: 18-11-2016
DOI: 10.1080/02770903.2016.1226899
Abstract: To investigate actual and perceived disease control in Australians with asthma, and identify factors associated with overestimation of asthma control. This was a cross-sectional study of Australian adults with asthma, who were recruited via Facebook to complete an online survey. The survey included basic demographic questions, and validated tools assessing asthma knowledge, medication adherence, medicine beliefs, illness perception and asthma control. Items that measured symptoms and frequency of reliever medication use were compared to respondents' self-rating of their own asthma control. Predictors of overestimation of asthma control were determined using multivariate logistic regression. Of 2971 survey responses, 1950 (65.6%) were complete and eligible for inclusion. Overestimation of control was apparent in 45.9% of respondents. Factors independently associated with overestimation of asthma control included education level (OR = 0.755, 95% CI: 0.612-0.931, P = 0.009), asthma knowledge (OR = 0.942, 95% CI: 0.892-0.994, P = 0.029), total asthma control, (OR = 0.842, 95% CI: 0.818-0.867, P < 0.001), agreement that most medications are addictive (OR = 1.144, 95% CI: 1.017-1.287, P = 0.025), and increased feelings of control over asthma (OR = 1.261, 95% CI: 1.191-1.335), P < 0.001). Overestimation of asthma control remains a significant issue in Australians with asthma. The study highlights the importance of encouraging patients to express their feelings about asthma control and beliefs about medicines, and to be more forthcoming with their asthma symptoms. This would help to reveal any discrepancies between perceived and actual asthma control.
Publisher: Hindawi Limited
Date: 29-04-2015
DOI: 10.1111/JCPT.12274
Abstract: Ischaemic heart disease (IHD) is a major cause of death in developed countries. Patients with IHD are at greater risk of subsequent myocardial infarction (MI). International studies suggest that guideline recommended therapies proven to reduce this risk are underutilised. The objectives of this study were to review the use of guideline-recommended medications for the secondary prevention of IHD in Australians and identify patient characteristics influencing use of these medications. The medication regimens of community dwelling Australians with documented IHD who received a Home Medicines Review (HMR) between January 2010 and September 2012 were extracted from a pharmacist decision support software database and retrospectively reviewed. Each patient's use of antithrombotics angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) statins and β-blockers (BBs) or non-dihydropyridine calcium channel blockers (CCBs) was evaluated in conjunction with documented contraindications. Guideline concordance in all four categories was classified as 'Optimal Medical Therapy' (OMT). Univariate and multivariate analyses identified patient characteristics influencing OMT use. Of the 5396 patient medication regimens reviewed, 24·3% demonstrated OMT. Guideline concordance was observed in 91·6%, 75·6%, 74·8%, and 42·4% of patients for antithrombotics, statins, ACEI/ARBs, and BB/CCBs, respectively. The independent predictors of not receiving OMT were age 75 years or over (adjusted odds ratio [AOR] 0·76 95% confidence interval [CI] 0·67-0·87), asthma (AOR 0·69 95% CI 0·57-0·84), and depression or anxiety (AOR 0·84 95% CI 0·71-0·99). Diabetes (AOR 1·20 95% CI 1·04-1·38), hypertension (AOR 1·56 95% CI 1·36-1·79) and a high Charlson Comorbidity Index score (AOR 1·37 95% CI 1·15-1·64) independently predicted receipt of OMT. Only one quarter of community dwelling Australian patients with IHD receive antithrombotics, ACEI/ARBs, BB/CCBs and statins. The potential consequences of these evidence-to-practice gaps are exacerbated by Australia's increasing prevalence of IHD. Healthcare professionals must work to ensure that recommended therapies are prescribed and adhered to long-term, especially in the elderly and patients with asthma and mental health problems, to reduce IHD-related mortality and morbidity and the consequent healthcare and financial impact.
Publisher: Hindawi Limited
Date: 23-06-2019
DOI: 10.1111/JCPT.13000
Abstract: Fever, one of the most common symptoms of illness experienced by children, often creates undue parental anxiety about the consequences of fever, which can lead to overtreatment. The full extent of this problem in Australia is not known. This study aimed to describe parents' knowledge, beliefs and perceptions about childhood fever and its management, and identify any predictors of the burden on parents when children are febrile. This was a cross-sectional web-based survey of parents living in Australia. Parents with at least 1 child <6 years were recruited via Facebook. Demographic information, parental fever knowledge and beliefs and responses to the Parent Fever Management Scale, a measure of parental burden, were collected and analysed. Of the 12 179 parents who completed the survey, 42.0% knew that a temperature above 38°C constitutes a fever, with 33.4% underestimating the temperature of a fever. Parents believed that there were many harms associated with untreated fever, namely seizures (71.8%), dehydration (63.6%), serious illness (43.0%) and brain damage (36.8%). Phobic beliefs were more common among parents who underestimated the temperature of a fever. Identification of health professionals as a main information source about fever did not significantly improve knowledge or reduce fears. Up to 65.0% of respondents indicated that they practice non-evidence-based strategies to reduce temperature. The belief that 'every child with a fever should be treated with medication to lower temperature' was the strongest predictor of parental burden (ß = 0.245, P < 0.001). Poor parental knowledge and misconceptions surrounding fever and its management are still common among parents throughout Australia. Large-scale, sustainable educational interventions are needed to dispel misconceptions and concerns about fever, encourage appropriate and safe care of febrile children.
Publisher: SAGE Publications
Date: 07-2006
DOI: 10.1345/APH.1G407A
Publisher: Wiley
Date: 24-04-2013
DOI: 10.1111/ANS.12119
Publisher: Frontiers Media SA
Date: 25-03-2022
DOI: 10.3389/FPHAR.2022.869162
Abstract: Background: Accurate clinical assessment of patient adherence using reliable and valid measures is essential in establishing the presence of adherence issues and support practices for pharmacists. Objective: This investigation aims to conduct a novel assessment of patient adherence to asthma controller therapy by combining 1) patient-specific dosage data found in pharmacy dispensing data with 2) centrally collected administrative claims records, to determine the added value of using both sources of data. Methods: A total of 381 clinically uncontrolled asthma patients, from 95 community pharmacies across three Australian States were recruited and provided consent for the retrieval of their claims records and pharmacy dispensing data. Patients were stratified as multiple or single pharmacy users and adherence scores were calculated via the proportion of days covered (PDC) method using 1) patient claims records, 2) patient pharmacy dispensing data, and 3) combined claims records and pharmacy dispensing data. Cohort and subgroup adherence estimates were then compared. Results: Low levels of adherence were evident amongst the cohort irrespective of the data source used. PDC estimates based on claims records alone or combined claims records and pharmacy dispensing data were significantly higher than estimates based on pharmacy dispensing data for the total cohort (56%, 52%, 42% respectively, p & 0.001) and more noticeably for multiple pharmacy users (67%, 64%, 35% respectively, p & 0.001). PDC estimates based on combined claims records and pharmacy dispensing data were significantly lower than estimates based on claims records alone, indicating that perhaps standard daily dose is not a robust proxy for prescribed dosage to inhaled respiratory devices in adherence approximations. Poorer adherence was found amongst single pharmacy users than multiple pharmacy users when combined claims records and pharmacy dispensing data (46% compared to 64% respectively, p & 0.001) or claims records alone (51% compared to 67% respectively, p & 0.001) were compared. Conclusion: Access to routine collected data increases clinical acuity over patient adherence to asthma controller medications and is a valuable resource for health care professionals. A policy of secure accessibility of such data at the patient-pharmacist or patient-GP interface may allow real-time intervention and assist in decision making across numerous therapeutic areas.
Publisher: Hindawi Limited
Date: 02-05-2018
DOI: 10.1111/JCPT.12702
Abstract: Adverse drug reactions (ADRs) are an important cause of mortality during medical care. To our knowledge, no Ethiopian studies have reported on mortality due to ADRs in patients presenting to hospital from the community setting. The aim of this study was to determine the mortality rate attributable to ADRs in patients presenting to hospital, identify drugs implicated in the ADR-related deaths and identify factors contributing to ADR-related mortality at Jimma University Specialised Hospital (JUSH), south-west Ethiopia METHODS: This cross-sectional study included 1001 patients aged ≥18 years consecutively admitted to medical wards from May 2015 to August 2016. ADR-related mortality was determined through detailed review of medical records, laboratory tests and patient interviews followed by causality assessment by the Naranjo algorithm and expert consensus. Of 1001 patients, 15, 1.5% (95% confidence interval [CI]: 0.80%-2.30%) died with an ADR. The primary suspected causes of death were drug-induced hepatotoxicity (7, 43.8%) followed by acute kidney injury (4, 25.0%). Isoniazid (6, 33.3%), pyrazinamide (3, 16.7%), efavirenz (2, 11.1%) and tenofovir (2, 11.1%) were commonly implicated drugs. The majority of ADRs (14, 93.8%) were preventable. Unadjusted bivariate comparisons suggested patients who died with ADRs were more likely to have pre-existing liver disease (40.0% vs 7.0% 95% confidence interval [CI]: 8.1%-57.8%), a history of ADRs (40% vs 1.4% 95% CI: 13.8%-63.4%), a lower mean (±SD) body mass index (BMI, 17.6 ± 2.1 vs 20.0 ± 2.9 kg/m Fatal ADRs were common in patients presenting to hospital. The drugs implicated were mostly antitubercular and antiretroviral therapies, reflecting the high burden of HIV and tuberculosis in the study population. ADR-related deaths were significantly associated with poor nutritional status. The majority of ADR-related deaths were preventable, highlighting the need to develop a multidisciplinary approach to closely monitor patients who are prescribed antitubercular and antiretroviral therapies, particularly in patients with hepatic disease, a history of ADRs, who are malnourished and who are exposed to multiple medications.
Publisher: John Wiley & Sons, Ltd
Date: 31-01-2013
Publisher: Oxford University Press (OUP)
Date: 05-2018
Publisher: Elsevier BV
Date: 03-2021
Publisher: Oxford University Press (OUP)
Date: 15-04-2013
DOI: 10.1111/IJPP.12035
Abstract: In aged-care facilities (ACFs) monitoring of warfarin can be logistically challenging and International Normalised Ratio (INR control) is often suboptimal. We aimed to determine whether an integrated information and communications technology system and the use of point-of-care (POC) monitors by nursing staff could improve the INR control of aged-care facility residents who take warfarin. Nursing staff identified residents who were prescribed warfarin in participating ACFs. A computer program (MedePOC) was developed to store and transmit INR results from the ACFs to general practitioners (GPs) for dosage adjustment. Nursing staff received training in the use of the CoaguChek XS point-of-care INR monitor and the MedePOC software. Following a run-in phase, eligible patients were monitored weekly for up to 12 weeks. The primary outcome was the change in the time in therapeutic range (TTR) in the intervention phase compared to the TTR in the 12 months preceding the study. All GPs, nursing staff and patients were surveyed for their experiences and opinions of the project. Twenty-four patients and 19 GPs completed the trial across six ACFs. The mean TTR for all patients improved non-significantly from 58.9 to 60.6% (P = 0.79) and the proportion of INR tests in range improved non-significantly from 57.1 to 64.1% (P = 0.21). The mean TTR improved in 14 patients (58%) and in these patients the mean absolute improvement in TTR was 23.1%. A post hoc analysis of the INR data using modified therapeutic INR ranges to reflect the dosage adjustment practices of GPs suggested that the intervention did lead to improved INR control. The MedePOC program and POC monitoring was well received by nursing staff. Weekly POC INR monitoring conducted in ACFs and electronic communication of the results and warfarin doses resulted in non-significant improvements in INR control in a small cohort of elderly residents. Further research involving modification to the communication strategy and a longer follow-up period is warranted to investigate whether this strategy can improve INR control and clinical outcomes in this vulnerable population.
Publisher: Mary Ann Liebert Inc
Date: 03-2019
Abstract: To determine whether a fucoidan extract reduced insulin resistance and/or altered other cardiometabolic markers in an obese, nondiabetic population. Single-site, double-blinded, placebo-controlled, randomized controlled trial. Hobart, Tasmania, Australia. Eligible subjects were obese, with no history of diabetes, and ages between 18 and 65 years. Subjects were randomly assigned, in even blocks of 10, to either active fucoidan 500 mg or placebo capsules twice daily for 90 days, with identical measurements performed at baseline and follow-up. The primary outcome was insulin resistance, defined by the homeostasis model of assessment (HOMA) values. Secondary outcomes were lipid profile, glycosylated hemoglobin, urea electrolytes and creatinine, liver function tests, full/complete blood count, fasting insulin, fasting glucose, quantitative insulin sensitivity check index, glucose area under the curve, weight, body mass index, waist circumference, and systolic and diastolic blood pressure. The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12614000495628) and the Therapeutic Goods Administration (2014/0348), and was funded by Marinova Pty. Ltd. There were no differences in the 90-day outcome measures between placebo and active treatment in the intention-to-treat-analysis (n = 35 for active, n = 37 for placebo). The mean change in HOMA scores was 0 for the placebo and -0.1 for the active groups (p = 0.73). Self-reported adherence was high, consistent with capsule counting at the conclusion of the trial. Fucoidan taken twice daily for a period of 90 days did not markedly affect insulin resistance or other measured parameters of cardiometabolic health in an obese, nondiabetic cohort. This could be due to an intrinsic lack of efficacy, lower than measured adherence, or because longer therapy and/or higher baseline insulin resistance are required to exert a significant effect.
Publisher: Elsevier BV
Date: 07-2017
Publisher: SAGE Publications
Date: 30-08-2201
DOI: 10.1345/APH.1Q138
Publisher: Springer Science and Business Media LLC
Date: 04-06-2016
DOI: 10.1007/S40256-016-0171-6
Abstract: Atrial fibrillation (AF) is a growing public health concern and remains an independent risk factor for ischemic stroke. Warfarin, a commonly used oral anticoagulant, is associated with a 60-70 % relative reduction in stroke risk and a reduction in mortality of 26 %. However, warfarin has several limitations, including a narrow therapeutic window, variable dose response, multiple interactions with other drugs and concurrent illnesses, and the need for frequent laboratory monitoring. In recent years, the direct acting oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban and edoxaban, have been developed to overcome the limitations of warfarin therapy. These treatment strategies are either comparable or superior to warfarin in stroke prevention in AF. Despite the documented effectiveness of oral anticoagulants in AF, patients may not derive optimal benefit if they fail to adhere or fail to continue with their medication. This may lead to treatment failure, increased hospitalization and mortality. This review summarizes the literature regarding adherence and persistence (or discontinuation) rates with oral anticoagulants in the management of AF the impact of non-adherence and non-persistence on treatment outcomes and the effectiveness of strategies to improve adherence and persistence with oral anticoagulant therapy.
Publisher: SAGE Publications
Date: 10-01-2018
Abstract: Oral anticoagulants are essential drugs for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Anticoagulants are, however, commonly withheld in older people due to the risk and fear of hemorrhage. Although the underutilization of anticoagulants in patients with AF has been demonstrated internationally, few studies have been conducted among aged care residents. The aim of this study was to determine the utilization of anticoagulants among people with AF residing in aged care facilities. We performed a non-experimental, retrospective analysis designed to evaluate antithrombotic usage in patients with AF in Australia residing in aged care facilities, using data collected by pharmacists while performing Residential Medication Management Reviews (RMMRs). The utilization of antithrombotic therapy and the appropriateness of therapy were determined based on the CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED risk stratification schemes in consideration of documented contraindications to treatment. Predictors of anticoagulant use were determined using multivariate logistic regression. A total of 1952 RMMR patients with AF were identified. Only 35.6% of eligible patients (CHADS 2 score ≥2 and no contraindications to anticoagulants) received an anticoagulant. As age increased, the likelihood of receiving an anticoagulant decreased and the likelihood of receiving an antiplatelet or no therapy increased. In patients at high risk of stroke (CHADS score ≥2), utilization of anticoagulants dropped by 19.7% when the HAS-BLED score increased from 2 to 3, suggesting that physicians placed a heavier weighting on bleeding risk rather than stroke risk. Prescribing of anticoagulants was influenced to a greater extent by bleeding risk than it was by the risk of stroke. Further research investigating whether the growing availability of direct oral anticoagulants influences practice in this patient population is needed.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.JAPH.2022.02.009
Abstract: Evaluating pharmacy services from the perspective of the end user-patients-is imperative for ensuring the sustainability of services. This study evaluated patient feedback regarding an evidence-based community pharmacist-delivered Pharmacy Asthma Service (PAS), in terms of overall satisfaction, satisfaction with PAS delivery, and perceived impact, and explored determinates of satisfaction. All patients who received the 12-month PAS (n = 143) were invited to provide feedback via a project-specific patient evaluation survey upon completion of the final consultation. The survey included a mix of 5-point Likert-type scale items, multiple-choice questions, and free-text response questions. Overall satisfaction was determined by a single 5-point Likert-type scale question. Satisfaction with service delivery and overall impact were assessed using a 4-item and 8-item Likert-type scale, respectively, and a summative score computed for each section. Patient PAS data including demographics and management outcomes were then cross tabulated against overall satisfaction, satisfaction with PAS delivery, and impact. Feedback was received from 71% (n = 101) of patients who completed the PAS. The results indicated high overall patient satisfaction, with 86% of respondents very satisfied with the service. Patients identified positive impacts of the PAS including improved understanding and management of asthma and allergic rhinitis. Similarly, almost all patients were satisfied with service delivery including the pharmacist's knowledge and their ability to assist (98%) and the privacy of the pharmacy setting (91%). Patients who had controlled asthma at the end of the trial had higher levels of overall satisfaction (χ The diffusion of health services within community pharmacy practice is dependent upon patient receptivity and how the services align with patient needs. The positive satisfaction received indicates that the PAS would be welcomed by patients with asthma in future.
Publisher: AMPCo
Date: 11-2009
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.AMJCARD.2017.06.055
Abstract: Suboptimal guideline adherence and underuse of anticoagulants in patients with atrial fibrillation (AF) have been reported worldwide. This study aimed to compare anticoagulation practice in Australia during the pre- and postdirect oral anticoagulant (DOAC) eras. Between January 2011 and July 2015, patients with nonvalvular AF (NVAF) admitted to the Royal Hobart Hospital, Tasmania, Australia, were retrospectively reviewed. The pre- and post-DOAC era cohorts included admissions from January 2011 to July 2013 and August 2013 to July 2015, respectively. Overall, 2,118 patients met our inclusion criteria. The overall rate of anticoagulation increased from 52.5% in the pre-DOAC era to 60.7% in the post-DOAC era (p <0.001). Moreover, prescribing of OACs among high-risk patients improved significantly (63.1% vs 55.2%, p = 0.001). OAC overprescribing in low-risk patients did not change significantly between the 2 cohorts (35.0% vs 42.9% in the pre- and post-DOAC eras, respectively, p = 0.59). In multivariate analysis, DOAC era (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.17 to 1.68 and CHA
Publisher: Informa UK Limited
Date: 04-03-2022
DOI: 10.1080/17512433.2022.2070151
Abstract: We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs). We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 January 2013 and 31 December 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared. Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68-0.81, p < 0.001 for ≥30% decline in eGFR HR 0.28, 95% CI 0.20-0.41, p < 0.001 for eGFR decline to ≤30 mL/min/1.73 m The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.
Publisher: Wiley
Date: 19-09-2012
DOI: 10.1111/J.1445-2197.2012.06203.X
Abstract: To identify enablers and barriers to thromboprophylaxis prescribing following hip and knee arthroplasty, from the perspective of orthopaedic surgeons. An invitation to participate in an online survey was distributed electronically to Arthroplasty Society of Australia members (n = 103). The survey collected demographic details, thromboprophylaxis attitudes and clinical practice of the orthopaedic surgeons, and explored their familiarity with contemporary national and international guidelines. Twenty-five surgeons (24%) completed the survey, all male with a median of 20 years of practice as orthopaedic surgeons (range: 8-27 years). Most surgeons (92%) practised predominantly in the private sector, and conducted both hip and knee arthroplasties each month. While all surgeons prescribed chemoprophylaxis following arthroplasty, most surgeons (64%) were uncertain to what extent it would prevent fatal pulmonary embolism (PE). The pharmacological agents of choice were low molecular weight heparin (48%) and aspirin (44%). One-third of surgeons were not familiar with the National Health and Medical Research Council recommendations for thromboprophylaxis in hip and knee arthroplasty patients. After reviewing a summary of the recommendations, most surgeons (80%) indicated they were inappropriate, commonly citing that they were grounded on an insufficient evidence base and should include aspirin as a sole chemoprophylaxis option. There are clearly strong barriers to the translation of current thromboprophylaxis guidelines into practice. Many surgeons doubt the effectiveness of chemoprophylaxis to prevent fatal PE, perceive the risk of venous thromboembolism following surgery to be low, are unfamiliar with current national guidelines or believe the guidelines are grounded on inappropriate evidence.
Publisher: Frontiers Media SA
Date: 27-12-2021
DOI: 10.3389/FPHAR.2021.798263
Abstract: Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice. Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes. Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data. Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p & .0001) and comparator (MD in ACQ from baseline = −0.94, p & .0001) arms at the trial end however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079). Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.5688/AJPE8633
Publisher: Wiley
Date: 22-01-2021
DOI: 10.1111/ECI.13489
Abstract: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA 2 DS 2 ‐VASc (CHA 2 DS 2 ‐VA) score. Overall, the CHA 2 DS 2 ‐VA score increased by a mean of 1.34 (95% confidence interval, 1.29‐1.39) points over the study period. Nearly two‐thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. Nearly one‐third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.
Publisher: Wiley
Date: 14-12-2020
Abstract: To identify the prevalence of oxycodone immediate release (IR) prescribed during an ED admission and the persistence of Schedule 8 (S8) opioids following an ED admission. A retrospective cross-sectional audit was undertaken reviewing all admission at the ED of the Royal Hobart Hospital, Tasmania, between 1 August and 30 September 2016. The admissions lists for ED were cross matched with the narcotic registers for oxycodone IR (the most commonly supplied S8 in ED) to identify how many patients received IR oxycodone during their ED admissions. Determination of the persistence of opioid use in opioid naïve patients was then undertaken using the Tasmanian real time reporting database of all S8 opioid dispensed in Tasmania (DAPIS). There were 8432 ED admissions for 7065 patients aged over 13 years. IR oxycodone was prescribed during 1049 of these admissions (12.4%). Of the patients who were not taking regularly prescribed S8 opioids prior to their ED admission (n = 853), 48 patients (5.6%) were taking S8 opioids at both 2 and 6 months following their ED admission. Thirty patients (2.8%) were approved for authorities for long-term opioids for non-cancer pain. These findings suggest that prescribing of IR oxycodone within ED is lower than previous studies. Additionally, the progression to regular chronic opioid use following an ED admission where IR oxycodone was given was relatively low with 3.0% of opioid naïve patients being approved for indications related to chronic non-cancer pain in the following 6 months.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2017
DOI: 10.1007/S00228-017-2337-9
Abstract: Limited data are available from the Australian setting regarding bleeding in patients with atrial fibrillation (AF) receiving antithrombotic therapy. We aimed to investigate the incidence of hospital admissions due to bleeding and factors associated with bleeding in patients with AF who received antithrombotic therapy. A retrospective cohort study was conducted involving all patients with AF admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015. Bleeding rates were calculated per 100 patient-years (PY) of follow-up, and multivariable modelling was used to identify predictors of bleeding. Of 2202 patients receiving antithrombotic therapy, 113 presented to the hospital with a major or minor bleeding event. These patients were older, had higher stroke and bleeding risk scores and were more often treated with warfarin and multiple antithrombotic therapies than patients who did not experience bleeding. The combined incidence of major and minor bleeding was significantly higher in warfarin- versus direct-acting oral anticoagulants (DOAC)- and antiplatelet-treated patients (4.1 vs 3.0 vs 1.2 per 100 PY, respectively p = 0.002). Similarly, the rate of major bleeding was higher in patients who received warfarin than in the DOAC and antiplatelet cohorts (2.4 vs 0.4 vs 0.6 per 100 PY, respectively p = 0.001). In multivariate analysis, increasing age, prior bleeding, warfarin and multiple antithrombotic therapies were independently associated with bleeding. The overall rate of bleeding in this cohort was low relative to similar observational studies. The rate of major bleeding was higher in patients prescribed warfarin compared to DOACs, with a similar rate of major bleeding for DOACs and antiplatelet agents. Our findings suggest potential to strategies to reduce bleeding include using DOACs in preference to warfarin, and avoiding multiple antithrombotic therapies in patients with AF.
Publisher: Public Library of Science (PLoS)
Date: 28-06-2016
Publisher: Therapeutic Guidelines Limited
Date: 12-2010
Publisher: MDPI AG
Date: 04-05-2022
Abstract: This retrospective cohort study analyzed the administrative hospital records of 91,500 patients with the aim of assessing adverse drug reaction (ADR)-related hospital admission risk after discharge from ADR and non-ADR-related admission. Patients aged ≥18 years with an acute admission to public hospitals in Tasmania, Australia between 2011 and 2015 were followed until May 2017. The index admissions (n = 91,550) were stratified based on whether they were ADR-related (n = 2843, 3.1%) or non-ADR-related (n = 88,707, 96.9%). Survival analysis assessed the post-index ADR-related admission risk using (1) the full dataset, and (2) a matched subset of patients using a propensity score analysis. Logistic regression was used to identify the risk factors for ADR-related admissions within 90 days of post-index discharge. The patients with an ADR-related index admission were almost five times more likely to experience another ADR-related admission within 90 days (p 0.001). An increased risk persisted for at least 5 years (p 0.001), which was substantially longer than previously reported. From the matched subset of patients, the risk of ADR-related admission within 90 and 365 days more than doubled in the patients with an ADR-related index admission (p 0.0001). These admissions were often attributed to the same drug class as the patients’ index ADR-related admission. Cancer was a major risk factor for ADR-related re-hospitalization within 90 days other factors included heart failure and increasing age.
Publisher: SAGE Publications
Date: 03-2011
DOI: 10.1345/APH.1P617
Abstract: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy al 8 and 90 days postdischarge. The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7% p = 0.03) and day 8 (0.9% vs 7.2% p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0% p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6% p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence In patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care. KEY WORDS: adverse drug events, community pharmacy services, international normalized ratio, patient discharge, warfarin.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20420986221080796
Abstract: Trends in the incidence of adverse drug reaction (ADR)–related hospitalizations have been studied in the general population, but not specifically in people with dementia. This study aimed to investigate trends in the incidence of ADR-related hospitalizations among people with dementia, and identify the most commonly implicated drugs and diagnoses in these admissions. This study utilized the administrative data of all adults admitted to the four major public hospitals of Tasmania, Australia, with a primary or secondary diagnosis of dementia from July 2010 to December 2019. ADR-related hospitalizations were identified by using diagnosis-based and external cause codes. The Cochran–Armitage test was used to examine trends in the incidence of ADR-related hospitalizations. Of the 7552 people with dementia admitted to the hospital at least once within the study period, 1775 (23.5%) experienced at least one ADR-related hospitalization. The estimated annual incidence of ADR-related hospitalizations increased 18% (1484–1760 per 100,000 population with dementia, p for trend .05) from 2010 to 2019. For those ADR-related admissions with a drug code recorded, 19.3% were due to antithrombotics and 11.5% to antihypertensives. The most frequent ADR-related admission diagnoses were renal diseases (72.9%). Length of hospital stay and in-hospital mortality were both significantly greater for ADR-related, relative to non-ADR-related, admissions (median 7 versus 5 days and 11% versus 6.7%, respectively p 0.001). The annual incidence of ADR-related hospitalizations in people with dementia increased between 2010 and 2019. Antithrombotics were the most commonly implicated drug class. The ADR-related hospitalizations were associated with increased length of stay and greater mortality. Adverse drug reaction–related hospitalizations among people with dementia This study aimed to investigate trends in hospitalizations associated with medication problems among people with dementia, and identify the most commonly implicated drugs and diagnoses in these admissions. This study utilized the administrative data of all adults admitted to the four major public hospitals of Tasmania, Australia, with dementia from July 2010 to December 2019. The annual incidence of hospitalizations associated with medication problems among people with dementia increased nearly 20% over 10 years. The length of hospital stay and in-hospital mortality were significantly greater for hospitalizations related to medication problems. The incidence of hospitalizations associated with medication problems in people with dementia increased between 2010 and 2019.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.SAPHARM.2022.03.017
Abstract: An evidence-based randomized controlled trial for a novel Pharmacy Asthma Service was tested in 3 Australian states. Positive asthma outcomes were achieved after the 12-month intervention, albeit in both the intervention and comparator arms. The current investigation uses a mixed methods approach to 1) qualitatively explore how comparator arm pharmacists implemented the trial protocol and 2) quantitatively examine how this may have impacted patient outcomes in this trial. Post-intervention semi-structured qualitative interviews were conducted with 20 pharmacists, representing 21 of 37 (57%) comparator arm pharmacies that completed the trial. Based on these interviews, pharmacies were classified as 'adherent' to the trial protocol (reporting no interventions other than general practitioner referral) or 'non-adherent' (reporting at least one extra intervention to the trial protocol), or 'inconclusive'. These subgroups were compared descriptively in relation to patient outcomes. Overall, 33% (n = 8/24) of the comparator pharmacies who were interviewed (n = 21) or determined to have monitoring by a project officer to ensure adherence to the protocol (n = 3) were classified as adherent), 58% (n = 14/24) as non-adherent, 8% inconclusive (n = 2/24). While all patients commenced with uncontrolled asthma (Asthma Control Questionnaire score (ACQ) > 1.5), after 12 months the mean ACQ score for patients from adherent comparator pharmacies ('true control') was 1.8 (still uncontrolled asthma) compared to a score of 1.4 (controlled asthma) in the non-adherent comparator group. Quality of life significantly improved in the non-adherent comparator group over the 12 months of the trial. The majority of pharmacists in the comparator arm who were interviewed, introduced their own interventions, which may have influenced the outcomes of the trial. The naturalistic setting of the study was not protective against these confounders. These findings question the feasibility of comparator arms within primary care settings and that alternative study designs should be considered when designing future intervention studies in pharmacy practice.
Publisher: Royal College of General Practitioners
Date: 05-03-2019
DOI: 10.3399/BJGPOPEN18X101629
Abstract: The management of pain by GPs for residents of aged care facilities (ACFs) is very common. To measure the prevalence and assess the management of pain in ACF residents, particularly those with dementia. A retrospective review of ACF residents’ medical records was undertaken at five southern Tasmanian (Australia) ACFs. Data extracted included results of the most recent assessment of pain and its management, frequency and treatment of pain incidents in the previous 7 days, demographics, and medical and medication history. Univariate analysis was used to identify variables associated with increased frequency of pain episodes. The final analysis included 477 residents. At least one episode of pain in the preceding 7 days was documented in 25.6% ( n = 122) of residents' notes. Pain episodes were most commonly managed by analgesics (45.5%), massage (40.7%), and heatpacks (13.8%). Residents with dementia were not less likely to have pain identified during the past week (14% versus 20% P = 0.09), but they were much less likely to have pain identified on their most recent pain assessment ( P = 0.03). GPs should carefully consider the suitability of using ‘as required’ analgesics. Furthermore, on admission to an ACF, GPs need to ensure a patient’s medical history includes all pain or potentially pain-causing conditions, to ensure that a resident’s pain assessment is complete. This is especially necessary for those with dementia, to ensure that staff remain vigilant about the possibility of the resident experiencing pain.
Publisher: SAGE Publications
Date: 04-02-2020
Abstract: Background: There are limited Australian data on sex differences in oral anticoagulant (OAC) prescribing in atrial fibrillation (AF) and ongoing debate regarding the optimal approach to stroke risk assessment and OAC prescribing in female patients with AF. Objective: The purpose of this study was to investigate sex differences in the prescribing of OACs in patients with AF stratified by stroke risk and in the rate of adverse outcomes. Methods: A retrospective analysis of patients admitted to the Royal Hobart Hospital (Tasmania, Australia) with nonvalvular AF between January 2011 and July 2015 was conducted. Rates of antithrombotic prescribing according to sex and stroke risk were assessed along with a multivariate analysis for predictors of OAC prescribing. Rates of thromboembolism, bleeding, and all-cause mortality were assessed according to sex. Results: A total of 2090 patients were included (44.7% female). Women with a CHA 2 DS 2 -VA score ≥2 were less likely to receive an OAC compared with men (56.7% vs 62.2%, P = 0.023). Female sex was an independent negative predictor of OAC prescribing (adjusted odds ratio = 0.83 95% CI = 0.69-0.99 P = 0.041). There were no sex differences in the incidence rates of thromboembolism, bleeding, or all-cause mortality in patients newly commenced on antithrombotic therapy. Conclusion and Relevance: Female patients with a high stroke risk were less likely to receive guideline-recommended treatment. This study provides new information on prescribing trends within the Australian setting and highlights the opportunity to improve the management of female patients with AF and 1 or more additional stroke risk factors.
Publisher: Wiley
Date: 03-2016
DOI: 10.1111/IMJ.12964
Abstract: The clinical outcomes of warfarin are largely dependent on the international normalised ratio (INR) control achieved, and strategies to improve the time in therapeutic range (TTR) should be identified and widely implemented in practice. To investigate the influence of pharmacist-led medication reviews on INR control and observe the quality of INR control in Australian veterans who take warfarin. We undertook a retrospective cohort study using administrative claims data for Australian veterans and war-widows identified by the Department of Veterans' Affairs who were regularly dispensed warfarin and invited them to contact the research team. Pathology providers were subsequently contacted to provide INR results. INR data were available for 344 of 818 (42.1%) veterans who consented to participate in the study 64.4% were male and the median age was 83 years. The overall TTR for the veteran cohort during the study period was 64.0%. There was no difference in the TTR in the 6 months following home medicines review (HMR) compared with the control group (63.0% vs 67.0%, P = 0.27), with the TTR in patients with INR data available in the 6 months prior to, and the 6 months following HMR, remaining high (67.9% vs 69.6% P = 0.63). Approximately, one-third of veterans in this study had a percentage TTR below 60%. INR was well-controlled in this elderly cohort, comparable to that achieved in recent randomised trials involving warfarin. Pharmacist-led medication reviews were not associated with a change in INR control.
Publisher: Elsevier BV
Date: 09-2021
Publisher: AMPCo
Date: 04-2013
DOI: 10.5694/MJA12.11370
Publisher: JMIR Publications Inc.
Date: 12-07-2013
DOI: 10.2196/JMIR.2255
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.TIM.2021.02.008
Abstract: Phylodynamic methods have been essential to understand the interplay between the evolution and epidemiology of infectious diseases. To date, the field has centered on viruses. Bacterial pathogens are seldom analyzed under such phylodynamic frameworks, due to their complex genome evolution and, until recently, a paucity of whole-genome sequence data sets with rich associated metadata. We posit that the increasing availability of bacterial genomes and epidemiological data means that the field is now ripe to lay the foundations for applying phylodynamics to bacterial pathogens. The development of new methods that integrate more complex genomic and ecological data will help to inform public heath surveillance and control strategies for bacterial pathogens that represent serious threats to human health.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.CPTL.2022.09.024
Abstract: Although pharmacists are first and foremost medication specialists and suppliers, in Australia they are also ideally positioned within the healthcare setting to encourage and support positive lifestyle choices in the community. Little has been done to assess their nutrition knowledge in over 20 years. We aimed to explore pharmacists' nutrition knowledge and associated practice and to subsequently develop and evaluate a short course to fill identified gaps. The General Nutrition Knowledge Questionnaire was revised for testing nutrition knowledge in the pharmacy setting. Once validated, the questionnaire was distributed to pharmacists using social rofessional media advertising. A short course was then developed, and its effectiveness assessed on final-year pharmacy students. Pharmacists' (N = 258) mean score was 89.9 out of 121 (SD = 10.6) with significant variation. Nutrition education provision in practice was provided inconsistently and was associated with how strongly participants rated their own knowledge. Most pharmacists (95.7%) agreed they are well-placed to assist in disease burden reduction through nutrition education however, most (98.4%) felt their knowledge needed improvement. The short course was well received by participants, deemed to be appropriate in context, and resulted in a median improvement in matched scores of 14.7% (P < .001) with no significant decline in knowledge when reassessed three weeks later (P = .383). Pharmacists' nutrition knowledge and practice was variable. Further education can improve knowledge without significant time outlay and is likely to improve associated counselling practices.
Publisher: Wiley
Date: 07-2017
DOI: 10.1111/IMJ.13418
Abstract: Early diagnosis and management can mitigate the long-term morbidity and mortality of chronic obstructive pulmonary disease (COPD). To gain insights into the initial diagnostic process and early management of COPD by Australian general practitioners (GP). A random s le of Australian GP was invited to complete a postal survey, which assessed familiarity with and use of contemporary practice guidelines, diagnostic criteria and management preferences for COPD. A total of 233 GP completed the survey. While most GP based a COPD diagnosis on smoking history (94.4%), symptoms (91.0%) and spirometry (88.8%), only 39.9% of respondents recorded a formal diagnosis of COPD after the patient's first symptomatic presentation. Tiotropium was the preferred treatment in 77.3% of GP for the initial management of COPD, while only 27.5% routinely recommended pulmonary rehabilitation. GP routinely recorded patients' smoking status and offered smoking cessation advice, but the timing of this advice varied. Less than half of the respondents routinely used COPD management guidelines or tools and resources provided by the Australian Lung Foundation. There is scope for major improvement in GP familiarity with and use of COPD management guidelines and readily available tools and resources. Some systematic issues were highlighted in the Australian primary care setting, such as a reactive and relatively passive and delayed approach to diagnosis, potentially delayed smoking cessation advice and underutilisation of pulmonary rehabilitation. There is an urgent need to devise strategies for improving patient outcomes in COPD using resources that are readily available.
Publisher: SAGE Publications
Date: 23-12-2017
Abstract: Limited data are available on atrial fibrillation (AF) and its clinical management and outcomes from an Australian perspective. This study was designed to examine the patient characteristics and antithrombotic treatment patterns among patients with AF in Tasmania, Australia. This retrospective observational study reviewed and followed patients with AF admitted to Tasmania’s 3 major hospitals between January 2011 and June 2012. Patients were excluded if they had only 1 episode of AF that reverted spontaneously or upon cardioversion without any documented recurrences. We reviewed the records of 2502 patients (≥18 years), and1469 were subsequently included in the study. The mean (±standard deviation [SD]) age of the patients was 76 (±12.3) years. The mean (± SD) CHADS 2 score was 2.1 (±1.3), and 65.7% had a score ≥2. In total, only 55.6% of patients with CHADS 2 score ≥2 were receiving anticoagulation and 9.9% were not receiving any antithrombotic treatment, whereas 85.4% of those at low risk (score 0) were on antithrombotic therapy. Hospitalization was associated with a significant increase in the rate of combination (antiplatelet plus anticoagulant) therapy ( P .001). Suboptimal use of antithrombotic therapy highlights the need to improve AF management in our jurisdiction.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2015
Publisher: Wiley
Date: 20-04-2021
DOI: 10.1111/BCP.14824
Abstract: We aimed to investigate the efficacy and effectiveness of pharmacist‐led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs). We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi‐experimental studies conducted in RACFs. We screened 3826 records and included 23 studies. We found seven single‐component and 16 multicomponent pharmacist‐led interventions to reduce ADEs in older people living in RACFs. The most frequent single‐component pharmacist‐led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist‐led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist‐led interventions either as a sole intervention or as a part of a multi‐component intervention. Many interventions focused on reducing the incidence of falls (39%). This systematic review suggests that pharmacist‐led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug‐related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist‐led interventions are required to reduce ADEs in older people in RACFs.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2016
DOI: 10.1007/S11096-016-0330-5
Abstract: Background Community pharmacists' role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1-3. Therefore, a web-based training program was developed to enhance pharmacists' knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists' knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists' satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists' satisfaction with the training program. Main outcome measure Pharmacists' knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the in idual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p < 0.001) and skills scores (p < 0.001) at pre- and post-training. Cronbach's alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1-100 %) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists' knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.
Publisher: Springer Science and Business Media LLC
Date: 17-11-2022
DOI: 10.1038/S41533-022-00315-6
Abstract: Uptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers ( consulted their GP on pharmacist’s advice) or action avoiders ( did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients ( n = 148) received a GP referral, of whom 78% ( n = 115) were action takers , and 44% ( n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers . Action takers were more likely to have an asthma action plan ( P = 0.001) at month 12, and had significantly more GP visits during the trial period ( P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.
Publisher: Oxford University Press (OUP)
Date: 06-01-2016
DOI: 10.1093/PM/PNV066
Abstract: To document pain levels, functionality, and analgesic use in the 12 months following a sternotomy to identify factors associated with the development of persistent post-sternotomy pain. Prospective observational study. Royal Hobart Hospital, Australia. Patients undergoing a sternotomy between January and November 2013. One hundred and ten patients were recruited and followed for 12 months, with telephone calls at 10 days, 6 weeks, 3 months, and 12 months. An initial survey was completed at the point of recruitment including patient history, depression and anxiety scales, self-rated health, and pain catastrophizing scale. The mean age of participants was 69.6 years, with the majority of participants being male (84.5%). The proportion of patients reporting pain in the early post-discharge period was high, with 30% of patients experiencing on average moderate-severe pain in the 10 days following discharge and 11% experiencing on average moderate-severe pain at 6 weeks. At 12 months, 15.5% of participants reported on average mild pain and 0.9% an average of moderate-severe pain in the preceding week at their sternotomy site. Pain of neuropathic origin was reported by 41.2% of those with on average daily pain at 12 months. This study highlights the need for further research to investigate whether more intensive pain management in the post-discharge period following sternotomy as well as the early identification of patients with neuropathic pain symptoms can reduce the incidence of persistent post-operative pain at 12 months.
Publisher: Informa UK Limited
Date: 05-2016
DOI: 10.2147/PPA.S99803
Publisher: Oxford University Press (OUP)
Date: 08-2015
DOI: 10.1111/PME.12720
Abstract: To identify potential medication management issues associated with opioid use in older Australians. Retrospective cross-sectional review of the utilization of analgesics in 19,581 people who underwent a medication review in Australia between 2010 and 2012. Australian residents living in the community deemed at risk for adverse medication outcomes or any resident living fulltime in an aged care facility. Patient characteristics in those taking regularly dosed opioids and not and those taking opioid doses >120 mg and ≤120 mg MEQ/day were compared. Multivariable binary logistic regression was used to analyze the association between regular opioid and high dose opioid usage and key variables. Additionally, medication management issues associated with opioids were identified. Opioids were taken by 31.8% of patients, with 22.1% taking them regularly. Several major medication management issues were identified. There was suboptimal use of multimodal analgesia, particularly a low use of non-opioid analgesics, in patients taking regular opioids. There was extensive use (45%) of concurrent anxiolytics/hypnotics among those taking regular opioid analgesics. Laxative use in those prescribed opioids regularly was low (60%). Additionally, almost 12% of patients were taking doses of opioid that exceeded Australian recommendations. A significant evidence to practice gap exists regarding the use of opioids amongst older Australians. These findings highlight the need for a quick reference guide to support prescribers in making appropriate decisions regarding pain management in older patients with persistent pain. This should also be combined with patient and caregiver education about the importance of regular acetaminophen to manage persistent pain.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 12-2007
DOI: 10.1002/J.2055-2335.2007.TB00769.X
Abstract: Studies have demonstrated that the risk of warfarin‐related complications is highest in the first 90 days of treatment, while quality audits suggest that warfarin initiation protocols are not always adhered to. To improve the quality of anticoagulation for hospital patients initiated on warfarin. A warfarin drug chart, incorporating the hospital's warfarin initiation protocol, was implemented on four target medical and cardiothoracic wards. The chart was used to record international normalised ratios (INRs) and prescribe warfarin, and was faxed to the patient's GP on discharge. Warfarin initiations on the target wards immediately post‐introduction of the warfarin drug chart were reviewed and compared to the pre‐intervention data collected over a 17‐month period. The pre‐intervention and post‐intervention groups included 271 and 183 patients initiated on warfarin, respectively. The intervention was associated with fewer warfarin‐related complications (thromboembolism, major bleeding) occurring within a 90‐day follow‐up period (2.1% vs 11% adjusted OR 0.24 95%CI 0.07–0.85 p = 0.03), largely driven by a reduction in the incidence of major bleeding (0.7% vs 7.1% adjusted OR 0.17 95%CI 0.02–1.45 p = 0.05). Adherence to the warfarin initiation protocol improved significantly from 36% to 71% (p 0.01) in the pre‐ and post‐intervention data collection periods, respectively. Post‐intervention, the proportion of patients with an INR 4 and the proportion of patients who required a warfarin dose to be withheld was reduced from 8.5% and 13%, to 3.8% (p 0.05) and 6.6% (p = 0.02), respectively. Adherence to an age and disease based warfarin initiation protocol, and improving the quality of discharge information for patients initiated on warfarin, significantly improved patient outcomes.
Publisher: Hindawi Limited
Date: 02-07-2018
DOI: 10.1111/JCPT.12584
Abstract: Up to 80% of patients experience acute pain following surgery. This study aimed to improve the current understanding about the strategies in iduals use to self-manage pain following discharge after surgery, stratified by pain intensity. A prospective observational study conducted at the Royal Hobart Hospital, Australia, between November 2014 and March 2015. Eligible participants were 18 years or older and had undergone surgery requiring an incision. Patients who had undergone surgery related to cancer, childbirth or multitrauma or those with dementia were excluded. Participants were identified through hospital records and mailed a survey within 1 week of discharge. This survey asked about post-discharge pain, management strategies utilized and advice on self-management of pain provided during their inpatient stay. Five hundred surveys were mailed, with 169 (33.8%) being returned. The median age of the respondents was 57 years (range: 18-92 years) 53% were female. The majority (89.3%) of participants recalled receiving information about pain self-management. Analgesic use was reported by 95.4% of participants in the week following discharge. Moderate-severe pain was reported by 80 participants (47.3%) 63.7% and 11.3% of patients reported underuse and overuse of analgesics compared to what was recommended, respectively. A high proportion of patients underused analgesics despite experiencing moderate-severe pain. Although the vast majority of participants reported receiving advice regarding pain self-management, this did not appear to translate into optimal pain management after discharge. Different approaches to the provision of advice appear to be required.
Publisher: Hindawi Limited
Date: 08-2005
DOI: 10.1111/J.1365-2710.2005.00656.X
Abstract: The aim of this project was to assess whether rural pharmacist involvement in the management of patients receiving warfarin has the potential to lead to safer and more effective anticoagulation, and is valued and welcomed by patients and their general practitioners (GPs). A convenience s le of rural pharmacists was trained in the use of the CoaguChek S International Normalized Ratio (INR) monitor and then conducted pharmacy-based testing for approximately 3 months. Two types of testing were performed in the pharmacy: (i) comparison testing was defined as pharmacy-based tests taken within 4 h of conventional laboratory testing or (ii) additional testing, which was a pharmacy-based test with no direct comparison laboratory test taken. Pharmacists, GPs and patients completed anonymous satisfaction surveys after the completion of the pharmacy-based testing. Pharmacists from 16 rural pharmacies were trained to use the CoaguChek S monitor. During the trial period, 518 INR tests were performed in the pharmacies on 137 different patients. A total of 120 tests were evaluated against results from laboratory testing. The pharmacy-based INR values were significantly correlated with the laboratory INR values (mean of 2.32+/-0.77 and 2.32+/-0.59 respectively r=0.88, P<0.0001). A total of 398 additional pharmacy-based tests were conducted in the pharmacy and 8.5% of the additional tests resulted in a subsequent dosage change. The monitoring was well received by pharmacists, GPs and patients. The results of the trial were very positive. The CoaguChek S monitor in pharmacy-based testing performed accurately compared with conventional laboratory testing. Further research needs to be conducted on the impact of community pharmacy-conducted INR monitoring on patient care and outcomes.
Publisher: Hindawi Limited
Date: 19-06-2014
DOI: 10.1111/JCPT.12185
Abstract: About half of all patients taking antihypertensives discontinue treatment by 12 months. There is potential for substantial health gains at both in idual and population levels through improved treatment adherence. The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure (BP) control. prospective, non-blinded, cluster-randomized, controlled trial. adults with primary hypertension who obtained antihypertensives in the previous 6 months. Patients with poor refill adherence were preferentially identified with the help of a purpose-built software application. package comprising BP monitor training on BP self-monitoring motivational interviewing medication use review prescription refill reminders. six months. change in proportion self-reporting medication adherence. Secondary outcome: BP changes. Participants (n = 395 intervention - 207 control - 188) had a mean age of 66.7 years 51.1% were males. The proportion of adherent participants increased in both groups but was not significantly different between groups [57·2% to 63·6% (control) vs. 60·0% to 73·5% (intervention), P = 0·23]. The mean reduction in systolic BP was significantly greater in the intervention group (10·0 mmHg vs. 4·6 mmHg P = 0·05). The proportion of patients who were non-adherent at baseline and adherent at 6 months was 22·6% (95%CI 5·1-40·0%) higher in the intervention group (61·8% vs. 39·2%, P = 0·007). Among participants with baseline BP above target, reduction of systolic BP was significantly greater in the intervention group [by 7·2 mmHg (95%CI 1·6-12·8 mmHg) (P = 0·01)]. Among participants non-adherent at baseline and above target BP, the proportion reporting adherence at 6 months was significantly greater in the intervention group [56·8% vs. 35·9%, P = 0·039). This community pharmacist intervention resulted in improved adherence to antihypertensive medication and reduced systolic BP.
Publisher: Frontiers Media SA
Date: 23-03-2021
DOI: 10.3389/FPHAR.2021.586370
Abstract: Objective: Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke in patients with atrial fibrillation (AF). The study characterized the prescribing of OACs in people with AF in the Australian primary care setting over 10 years. Design: Retrospective population study. Setting and Participants: We performed 10 sequential cross-sectional analyses of patients with a recorded diagnosis of AF between 2009 and 2018 using national general practice data. The proportion of patients with AF who were prescribed an OAC based on their stroke risk was examined. Primary and secondary outcomes: The primary outcome was the proportion of high stroke risk patients who were prescribed an OAC over a decade. The secondary outcome was variation in OAC prescribing among general practices. Results: The s le size of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The proportion who were prescribed an OAC increased from 39.5% (95% CI 38.6–40.5%) in 2009 to 52.0% (95% CI 51.5–52.4%) in 2018 ( p for trend & 0.001). During this time, the proportion of patients with AF and high stroke risk who were prescribed an OAC rose from 41.7% (95% CI 40.7–42.8%) to 55.2% (95% CI 54.7–55.8% p for trend & 0.001) with the direct-acting oral anticoagulants accounting for over three-quarters of usage by 2018. There was substantial variation in OAC prescribing between general practices. In 2018, the proportion of moderate to high stroke risk patients who were prescribed an OAC was 38.6% (95% CI 37.2–40.1%) in the lowest practice site quintiles and 65.6% (95% CI 64.5–66.7%) in the highest practice site quintiles. Conclusions: Over the 10 years, OAC prescribing in high stroke risk patients with AF increased by one-third. There was considerable variation in OAC prescribing between general practices.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.PMN.2017.10.002
Abstract: Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16141
Publisher: Elsevier BV
Date: 2005
Publisher: Springer Science and Business Media LLC
Date: 11-05-2014
DOI: 10.1007/S00228-014-1693-Y
Abstract: Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries' health care systems. A literature search was conducted via PubMed and Google Scholar to find articles published in English between the years 2000 to 2014. Search terms used were "atrial fibrillation", "oral anticoagulants", "warfarin", "NOACs", "dabigatran", "rivaroxaban", "apixaban", "edoxaban", "time in therapeutic range", "International Normalized Ratio" "cost-effectiveness", "stroke", "adverse-drug reactions" and "drug-drug interactions", together with the in idual names of developing countries as listed by the World Bank. We reviewed the results of randomized clinical trials, relevant retrospective and prospective studies, case-studies and review articles. Many developing countries lack or have sporadic data on the quality of AF management, making it difficult to anticipate the potential impact of NOACs in these settings. The utilisation of anticoagulants for AF appears highly variable in developing countries. Given the issues associated with VKA therapy in many developing countries, NOACs offer some potential advantages however, there is insufficient evidence to advocate the widespread replacement of warfarin at present. VKAs may continue to have a role in selected patients or countries, especially if alternative monitoring strategies can be utilised. The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2015
Publisher: Oxford University Press (OUP)
Date: 10-06-2012
DOI: 10.1111/J.2042-7174.2012.00217.X
Abstract: Good warfarin knowledge is important for optimal patient outcomes, but barriers exist to effective education and warfarin knowledge is often poor. This study aimed to explore the educational outcomes of home-based warfarin education provided by trained pharmacists. In a prospective, non-randomised, controlled cohort trial, patients received either usual community-based post-discharge care or a post-discharge warfarin management service, including warfarin education by trained pharmacists during two or three home visits. Patients’ warfarin knowledge was assessed at 8 and 90 days post-discharge using the Oral Anticoagulation Knowledge test. One hundred and thirty-nine patients were recruited into the usual care group between November 2008 and August 2009, and 129 into the intervention group between May and December 2009. Pharmacist-delivered warfarin education was associated with a significant difference between the intervention patients’ baseline and day 8 mean warfarin knowledge scores of 64.5% (95% confidence interval (CI) 61.0–68.5%) and 78.0% (95% CI 74.5–81.5% P & 0.001), respectively. The intervention patients also scored significantly higher than the usual care patients at day 8 (65.0%, 95% CI 61.5–68.0% P & 0.001), but not at day 90. Use of an existing healthcare framework overcame several systemic barriers by facilitating warfarin education in patients’ homes. While the intervention was associated with better short-term warfarin knowledge, follow-up may be required to optimise its benefits. Widespread implementation of home-based warfarin education by pharmacists has the potential to contribute significantly to improved outcomes from warfarin therapy.
Publisher: BMJ
Date: 10-2013
Publisher: MDPI AG
Date: 03-06-2022
Abstract: A community-based opportunistic screening program was implemented to (i) improve atrial fibrillation (AF) awareness and detection and (ii) assess the performance of the Microlife WatchBP Home A for detecting AF when used in community screening. Screening sessions were conducted among people aged ≥ 65 years with no history of AF at public events across Tasmania, Australia. Participants with positive screening results were referred to their general medical practitioner for assessment. The device’s performance was assessed using the positive predictive value. A total of 1704 eligible participants were screened at 79 sessions. Of these people, 50 (2.9%) had a positive screening result. The device correctly identified AF in 22 (46.8%) participants with positive results. Among those with subsequently confirmed AF, 6 (27.3%) had a history of AF but were not aware of the diagnosis, and 16 (72.7%) were identified to have previously undiagnosed AF, with an overall prevalence of 0.9% (95% CI, 0.58 to 1.52). Oral anticoagulation therapy was initiated in 12 (87.5%) eligible participants. The positive predictive value of the device was 46.8% (95% CI, 33.3 to 60.7). Given the relatively low performance of the device, its application in community-based opportunistic screening programs for AF is unlikely to be cost-effective.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2016
DOI: 10.1007/S40256-016-0161-8
Abstract: Atrial fibrillation (AF) and the associated risk of stroke are emerging epidemics throughout the world. Suboptimal use of oral anticoagulants for stroke prevention has been widely reported from observational studies. In recent years, direct oral anticoagulants (DOACs) have been introduced for thromboprophylaxis. We conducted a systematic literature review to evaluate current practices of anticoagulation in AF, pharmacologic features and adoption patterns of DOACs, their impacts on proportion of eligible patients with AF who receive oral anticoagulants, persisting challenges and future prospects for optimal anticoagulation. In conducting this review, we considered the results of relevant prospective and retrospective observational studies from real-world practice settings. PubMed (MEDLINE), Scopus (RIS), Google Scholar, EMBASE and Web of Science were used to source relevant literature. There were no date limitations, while language was limited to English. Selection was limited to articles from peer reviewed journals and related to our topic. Most studies identified in this review indicated suboptimal use of anticoagulants is a persisting challenge despite the availability of DOACs. Underuse of oral anticoagulants is apparent particularly in patients with a high risk of stroke. DOAC adoption trends are quite variable, with slow integration into clinical practice reported in most countries there has been limited impact to date on prescribing practice. Available data from clinical practice suggest that suboptimal oral anticoagulant use in patients with AF and poor compliance with guidelines still remain commonplace despite transition to a new era of anticoagulation featuring DOACs.
Publisher: Informa UK Limited
Date: 25-02-2022
DOI: 10.1080/17512433.2022.2044793
Abstract: We assessed switching patterns of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) in the period following widespread availability of the direct-acting oral anticoagulants (DOACs). A retrospective cohort study was conducted using NPS MedicineWise's MedicineInsight dataset, collected from Australian general practices. Patients with AF who newly commenced an OAC between 1 January 2013 and 30 September 2017 were included. The switching rate was calculated within 12 months post-initiation. Switching rates between OACs were compared, and predictors of switching were identified. We included 15,020 patients who were recorded as having been commenced on warfarin or a DOAC. Overall, 5.7% of patients switched their OAC within 12 months. The switching rates from warfarin, apixaban, dabigatran and rivaroxaban were 9.4%, 2.6%, 8.9% and 4.0%, respectively. Compared to apixaban, commencement on warfarin, dabigatran or rivaroxaban was associated with a higher risk of switching to another OAC. Patients with an estimated glomerular filtration rate (eGFR) 60 mL/min. There was a low switching rate between OACs in Australian general practice patients with AF. A key determinant of switching appeared to be kidney disease.
Publisher: Public Library of Science (PLoS)
Date: 31-10-2016
Publisher: MDPI AG
Date: 06-03-2020
Abstract: Assessing and improving public knowledge of atrial fibrillation (AF) could increase its detection rate and the subsequent use of stroke prevention therapies. However, there is no validated AF knowledge assessment tool applicable to the general population, including those at risk of AF. Therefore, we aimed to develop and validate such a tool. The tool was developed from a literature review and discussion with subject matter experts. Content validity was ensured by a ten-member panel of experts comprising cardiologists and pharmacists. An online validation survey was conducted and reported based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The survey evaluated the tool performance by construct validity, internal consistency reliability, item discrimination, difficulty index and ease of readability. The survey participants included 14 general medical specialists, 20 fourth-year and 33 second-year undergraduate pharmacy students, and 122 members of the general public. The tool had satisfactory content validity, with a scale content validity index of 0.8. The mean percentage knowledge scores for general medical specialists and fourth-year pharmacy students were higher than second-year pharmacy students, followed by the general public (92.9%, 87.6%, 68.5% and 53.4%, respectively p-value 0.001), supporting construct validity. The tool had good internal consistency reliability (Cronbach’s alpha = 0.91). The item-total correlation was in the preferred range of 0.23 to 0.71. The Atrial Fibrillation Knowledge Assessment Tool is a valid instrument and can be used to investigate AF knowledge of the general population.
Publisher: Hindawi Limited
Date: 03-2011
DOI: 10.1111/J.1365-2710.2010.01167.X
Abstract: Warfarin is an important drug for the prevention of thromboembolic events such as stroke in patients with atrial fibrillation (AF). However, it is commonly implicated in major adverse drug events, which may result in reluctance to prescribe warfarin, especially in the institutionalised elderly population. This study aimed to assess the current trends in the antithrombotic management of AF in aged care facilities (ACFs) in Tasmania, Australia, and to compare this with current recommendations. We performed a non-experimental, retrospective cohort study designed to evaluate antithrombotic usage for AF in ACF residents in Tasmania. Residents with AF were identified on a patient-by-patient basis from residential case-note summaries collected from 29 of the 64 ACFs in Tasmania. The CHADS-2 score and the presence or absence of documented contraindications were used to determine the appropriateness of the current antithrombotic therapy prescribed. Fifteen per cent (262/1737) of the ACF residents were diagnosed with AF. Nine per cent of the residents with AF had a contraindication to antithrombotic therapy (either warfarin or antiplatelet therapy). Eighty-one per cent of residents were eligible for treatment with warfarin according to the CHADS-2 score and did not appear to have a contraindication to warfarin. Of these, only 38% were prescribed warfarin 16% (40/255) did not receive any antithrombotic treatment, despite being eligible for treatment with warfarin or antiplatelet therapy. Residents who did not receive any antithrombotic treatment or who received antiplatelet treatment were significantly older than those treated with anticoagulants. Our results indicate that antithrombotic therapy, particularly warfarin, is underused in ACF-dwelling elderly patients who are eligible for treatment.
Publisher: AMPCo
Date: 03-2005
Publisher: Springer Science and Business Media LLC
Date: 19-05-2011
DOI: 10.1007/S11096-011-9515-0
Abstract: To characterise the nature of the drug-related problems with warfarin therapy identified in pharmacist-conducted medication reviews during a collaborative post-discharge warfarin management service, with a focus on potentially serious drug interactions. Australian community pharmacy practice. Medication review reports submitted by pharmacists to patients' general practitioners as part of the service were reviewed and the type and clinical significance of the warfarin-associated drug-related problems, and the pharmacists' recommendations were classified. The prevalence of prescribing of 'potentially hazardous' warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports. The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of 'potentially hazardous' warfarin drug interactions in the reports from pharmacist-conducted medication reviews. A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports (mean 1.4 per patient, 95% CI 1.3-1.6, range 0-5). Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems most drug-related problems were of moderate clinical significance. Eight of 23 potentially serious warfarin drug interactions (34.8%) were identified in the medication review reports. Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.
Publisher: SAGE Publications
Date: 12-04-2017
Abstract: Discordance between international guideline recommendations and anticoagulant prescribing patterns among patients with nonvalvular atrial fibrillation (NVAF) has been frequently reported. This study was designed to compare the anticoagulant utilization pattern to earlier data in the same population and identify predictors of anticoagulant prescribing among patients with NVAF. We reviewed patients with NVAF admitted to Tasmania’s 3 major hospitals between January 2011 and June 2012 and compared the anticoagulant utilization pattern to earlier data. Patients were excluded if they had only 1 episode of NVAF that reverted spontaneously or upon cardioversion. Multivariate logistic regression analysis was used to identify predictors of anticoagulant prescribing. Overall, 53.8% of patients received anticoagulant treatment compared to 40.4% 15 years ago. Among eligible patients at high-risk of stroke, 52.5% were receiving anticoagulant therapy (vs 42.1% 15 years ago). Approximately 10% of patients with a CHADS 2 score ≥2 were not receiving any antithrombotic treatment, reduced from 18.2% in the earlier cohort, whereas anticoagulant use increased among those at low risk (score 0) to 48.5% from 14.2%. Younger age (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.97-1.0 P = .04) CHADS 2 = 1, relative to 0 (OR 1.68, 95% CI 1.07-2.63 P = .02) CHF (OR 1.56, 95% CI 1.12-2.15 P = .008) and embolic disease history (OR 1.77, 95% CI 1.09-2.86 P = .02) were significant predictors of anticoagulant prescribing. While there has been improvement over the past 15 years, suboptimal use of anticoagulant therapy among high-risk patients with NVAF remains common. There is significant potential for improvement in the quality of stroke prophylaxis in patients with NVAF.
Publisher: SAGE Publications
Date: 07-2018
Abstract: Limited data are available on the clinical management of atrial fibrillation (AF) and its outcomes from an Australian perspective. To describe the appropriateness of antithrombotic prescribing for patients who presented with a diagnosis of AF to the Hawkesbury St John of God Hospital, New South Wales, Australia. This retrospective observational study reviewed patients admitted to St John of God Hawkesbury Hospital with AF between June 2016 and June 2017. We calculated stroke risk using the CHA2DS2-VASc score based on medical records and reviewed the appropriateness of oral anticoagulant (OAC) prescribing compared to the 2016 European Society of Cardiology guidelines. Patients were excluded if they had only 1 episode of AF that reverted either spontaneously or upon cardioversion without any documented recurrences. A total of 200 patients (18 years) were included, with 180 (90%) deemed eligible for anticoagulation. Of these 72.8% (n = 131) were prescribed an OAC. A total of 40.0% of patients at low risk of stroke and 68.4% at intermediate risk were prescribed an OAC, respectively. Apixaban was the direct OAC of choice with 36.6% of patients prescribed an OAC receiving apixaban. Warfarin was prescribed for 25.1% of the patients who were prescribed an OAC. The underutilization of anticoagulant medication in high-risk groups and over utilization in low-risk groups remains an ongoing issue in contemporary AF management, and it highlights the need to improve AF-related stroke prevention in our jurisdiction.
Publisher: Wiley
Date: 23-03-2016
DOI: 10.1111/RESP.12755
Publisher: SAGE Publications
Date: 09-07-2016
Abstract: Oral anticoagulants are essential drugs for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Anticoagulants are, however, commonly withheld due to a perceived risk of severe adverse events. The underutilization of anticoagulants in patients with AF has been demonstrated internationally, but to date, there are limited data available in the Australian context. The aim of this study was to determine the utilization patterns of anticoagulants (including novel oral anticoagulants) with respect to stroke and bleeding risk among patients with AF within the community. We performed a nonexperimental, retrospective analysis designed to evaluate antithrombotic usage for AF in Australia. The utilization of antithrombotic therapy and the appropriateness of therapy were determined based on CHADS2, CHA2DS2-VASc and HAS-BLED risk stratification schemes. The presence of documented contraindications was used to determine the appropriateness of antithrombotic therapy. Anticoagulants were overutilized in patients at low risk of stroke and underutilized in patients at higher risk of stroke. As the HAS-BLED score increased, the likelihood of patients receiving an anticoagulant decreased regardless of CHADS 2 or CHA 2 DS 2 -VASc scores.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.5688/AJPE789168
Publisher: MDPI AG
Date: 05-11-2020
DOI: 10.3390/JCM9113568
Abstract: Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The s le size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%–47.4%) in 2014 to 39.9% (95% CI 39.2%–40.6%) in 2018, p for trend 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2019
DOI: 10.1007/S00228-019-02795-X
Abstract: The purpose of the study is to conduct a systematic review of studies examining the association between anticholinergic burden and mortality in older in iduals. A literature search was performed to identify relevant studies, using MEDLINE, EMBASE, PsycINFO and CENTRAL, from January 1990 to December 2018. We included studies of patients with a mean age of 65 years or older where the anticholinergic burden was estimated using anticholinergic risk assessment tools, and associations between anticholinergic load and mortality were investigated. The primary outcome of interest was the association between anticholinergic burden and mortality. Twenty-seven studies were included. These were three cross-sectional, one nested case-control and 23 prospective or retrospective cohort studies. Most studies were determined to be of good quality. A total of 15 studies reported a positive correlation between anticholinergic burden and mortality, while the remaining 10 studies did not report a significant association. Eighteen out of 27 studies (80%) had a short follow-up period of 1 year or less. Among the five high-quality studies that met all the domains of the quality assessment criteria, four showed a positive association. The variation in results could relate to the quality of the studies, follow-up period, anticholinergic risk assessment tool used and the study setting. Sixty-three percent (n = 17) of all the included studies, but almost all of the high-quality studies with an extended follow-up, reported a positive correlation between anticholinergic burden and mortality. Further high-quality research, using standardized measures and with adequate follow-up periods, is required to confirm the relationship between anticholinergic burden and mortality.
Publisher: Wiley
Date: 03-12-2020
DOI: 10.1111/ECI.13457
Abstract: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF. Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice. A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two‐thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 ( P .001). High risk of stroke (CHA 2 DS 2 ‐VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99‐4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72‐2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65‐1.98]) and male sex (AOR, 1.29 [95% CI, 1.22‐1.35]) were independently associated with OAC initiation. Direct‐acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 ( P .001). The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and in iduals with dementia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
DOI: 10.1007/S40264-015-0295-7
Abstract: In Ethiopia, the use of antiretroviral therapy (ART) has been scaled up for HIV/AIDS over the past decade. Adverse drug reactions (ADRs) associated with ART pose a unique challenge in the treatment of the infection in this resource-limited setting. The aims of this study were to examine the incidence and nature of ADRs, identify the risk factors associated with the development of ADRs, and assess their impact on treatment outcomes. A prospective cohort study was conducted in adult patients (≥18 years of age) with HIV/AIDS who commenced ART. All ADRs in the first 12 months of therapy were recorded, and the severity, causality, and preventability assessed. The impact of severe ADRs on self-reported adherence, immunological, and body mass index (BMI) outcomes were assessed. Of the 211 patients included in the analysis, 181 (85.7 %) experienced at least one ADR and 66 (31.3 %) experienced at least one severe ADR within 12 months of commencing ART (incidence rates for any ADR and severe ADR of 14.8 and 3.2 per 100 person-months, respectively). Logistic regression analysis indicated that taking zidovudine-containing regimens (odds ratio [OR] 4.2, 95 % confidence interval [CI] 2.1-8.4) or being unemployed (OR 2.2, 95 % CI 1.1-4.3) were independent predictors of experiencing severe ADRs. Patients who experienced a severe ADR were less likely (OR 0.4, 95 % CI 0.2-0.9) to be ≥90 % adherent to ART. The mean gain in BMI was significantly lower in patients with severe ADRs after 3 and 12 months of therapy. ADRs were common within the first 3 months in patients initiated on ART. Severe ADRs were negatively associated with self-reported adherence and gain in BMI. Measures need to be implemented to routinely monitor for severe ADRs to improve ART adherence and treatment outcomes.
Publisher: Wiley
Date: 02-2013
DOI: 10.1111/J.1445-5994.2013.02864.X
Abstract: To determine local thromboprophylaxis prescribing practices following arthroplasty. A retrospective review was performed of 300 consecutive hip and knee arthroplasty patients (150 each) over a 2-year period at Tasmania's major public hospital. The provision of thromboprophylaxis, the presence of bleeding/thrombotic risk factors and the prevalence of symptomatic venous thromboembolism (VTE) and major bleeding occurring within 90 days postoperatively were documented. The mean age of the 300 patients (169 females, 131 males) was 68.7 years (standard deviation 10.4). Only 11.3% of knee arthroplasty and 16.7% of hip arthroplasty inpatients had mechanical thromboprophylaxis documented during their stay. All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants (98.4%). Only 36.5% continued to receive pharmacological thromboprophylaxis following discharge, predominantly an antiplatelet agent (55.5%). The 90-day incidence of symptomatic VTE was 2.7% (95% confidence interval: 1.0-5.0%) 4.0% (95% confidence interval: 1.0-8.0%) for knees and 1.3% (95% confidence interval: 0-5.0%) for hips. The in-hospital and post-discharge VTE incidence was 0.7% and 2.0% respectively. All readmissions for VTE occurred within 1 month of surgery. While inpatient thromboprophylaxis was routine, it generally was not continued on discharge, potentially leaving many patients exposed to a higher risk of VTE. Most cases of symptomatic VTE occurred after discharge, with the majority requiring readmission to hospital under medical units.Within the limitations of a retrospective study, these findings suggest a need for further research and discussion regarding what constitutes appropriate thromboprophylaxis (type, agent and duration) following hip or knee arthroplasty.
Publisher: MDPI AG
Date: 03-09-2020
Abstract: Pharmacists report being less confident in their knowledge of direct acting oral anticoagulants (DOACs) than of vitamin K antagonists, which may influence their ability to detect and manage complications arising from DOAC use. In a mystery shopper study, patient agents were sent into community pharmacies with symptom or product-related requests related to common complications that might arise during treatment with oral anticoagulants, with each visit being assessed for the preferred outcome. Only 10/41 (24.4%) visits resulted in the preferred outcome. A complete history-taking process, obtaining a medical history, patient characteristics and pharmacist involvement were strong predictors of the preferred outcome being achieved. The preferred outcome was not consistently achieved without pharmacist involvement. The potential for strategies that support comprehensive pharmacist involvement in over-the-counter requests should be considered to ensure the provision of optimal care to patients taking high-risk medications such as DOACs.
Publisher: Authorea, Inc.
Date: 22-05-2020
Publisher: Springer Science and Business Media LLC
Date: 28-09-2019
DOI: 10.1007/S11096-019-00908-1
Abstract: Background Adverse drug reactions are common in Australian general practice and can be a cause of, or contribute to, preventable hospital admissions. Developing practical tools to assist in identifying patients who are at high risk of serious adverse drug reactions is an important step in preventing these hospitalisations. Objective The aims of the study were to apply the Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (PADR-EC) Score to assess the risk of medication-related hospitalisation among patients aged ≥ 65 years attending a rural general practice, and to investigate general practitioners' acceptance of the PADR-EC Score. Setting The project was based in a multicentre rural general practice in southern Tasmania, Australia. Method We conducted a cross-sectional study wherein the PADR-EC score was administered to patients aged ≥ 65 years attending a general practice. A focus group of general practice doctors was conducted and thematic analysis of the transcript used to explore their views regarding the utility of the PADR-EC score. Main Outcome Measures Successful application of the PADR-EC Score and an evaluation of general practitioners' acceptance of the PADR-EC Score are the two outcome measures of the project. Results The PADR-EC score was applied by the practice pharmacist and reported to GPs for 428 patients aged ≥ 65 years, with 24.8% classified as high-risk. The focus group found the PADR-EC score helped raise awareness of the risk of adverse drug reactions in the general practice setting. Doctors demonstrated good understanding of the PADR-EC Score and there were no negative reactions to the delivery model used. No changes to prescribing were implemented directly as a result of the PADR-EC Score, but more caution was used when doctors provided their usual clinical care. Conclusion Doctors used the PADR-EC score to complement their decision making. The PADR-EC Score was used as a reminder to review existing medication lists, follow-up on pathology results that may impact drug treatment and assess patients for prevalent ADRs. Further research is needed to validate the PADR-EC score in this setting.
Publisher: Public Library of Science (PLoS)
Date: 14-05-2014
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 08-2004
Publisher: Informa UK Limited
Date: 02-2016
DOI: 10.1080/09540121.2016.1139039
Abstract: Developing appropriate strategies to sustain optimal medication adherence among the increasing number of HIV-positive patients taking antiretroviral therapy (ART) in sub-Saharan Africa is a major challenge. The objective of this study was to determine patient, regimen, disease, patient-provider, and healthcare-related factors associated with adherence with ART over a one-year period, and assess the impact of adherence on treatment outcomes. We performed a prospective, observational study among 246 patients who were initiated on ART in Ethiopia. Of 172 who completed follow-up, 130 (75.6%) had ≥95% adherence. In the multivariate analyses, a higher baseline BMI (OR, 1.2 95% CI 1.0, 1.4) and use of reminder devices (OR, 9.1 95% CI 2.0, 41.6) remained positively associated with adherence, while a higher HIV symptom and adverse drug reaction distress score was an independent negative predictor of adherence (OR, 0.90 95% CI 0.9, 1.0) CD4 count increase was significantly higher in the adherent patients compared to non-adherent patients at 12 months (159 cells/µL [interquartile range (IQR), 72-324 cells/µL] vs. 132 cells/µL [IQR, 43-190 cells/µL] p = 0.026). Our findings indicate that interventions aimed at improving adherence and thereby treatment outcomes in patients initiated on ART should promote the use of reminder devices, and monitor HIV symptoms and adverse reaction distress and nutritional status.
Publisher: Elsevier BV
Date: 09-2015
Publisher: Elsevier BV
Date: 09-2015
Publisher: Wiley
Date: 12-05-2017
Abstract: Contemporary Australian data regarding antithrombotic prescribing patterns following approval of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) are limited. The aim of this study was to assess antithrombotic prescribing patterns before, during, and after the clinical introduction of DOACs. Using digital medical records, this retrospective cohort study included all patients with AF as a primary or secondary diagnosis who were admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015. Antithrombotic agents were prescribed for 2078 (91.9%) of 2261 patients without documented contraindication to therapy. Higher rates of OAC prescribing were observed following government subsidization of DOACs in Quarter 3 (Q3) 2013 than anticoagulation rates in the prior quarters (54.4% in Q3, 2013, to 68.1% in Q2, 2015, P<.001), with the prescribing of warfarin and antiplatelet agents declining. DOACs, as a class, accounted for 18.4% of patients on antithrombotic therapy in 2011-2015 the proportion of patients receiving a DOAC steadily increased from 3.9% among OAC users in Q3, 2011, to 67.6% in Q2, 2015 (P<.001). In a subset of patients with newly diagnosed AF, patients commenced on DOACs were younger (70.4 vs 73.8 years, P=.04) and had lower stroke and bleeding risk scores (CHA2DS2-VASc 2.8 vs 3.3, P=.03, HAS-BLED 2 vs 3, P=.04) than patients who were newly prescribed warfarin. Direct oral anticoagulants rapidly became the most commonly prescribed class of antithrombotic medications in patients with AF soon after they became widely available. Warfarin and antiplatelet prescribing declined significantly, although a substantial proportion of patients continued to be prescribed antiplatelet therapy. Patients who were initiated on DOACs were typically younger with fewer comorbid conditions compared with those initiated on warfarin therapy.
Publisher: Wiley
Date: 12-2009
DOI: 10.1002/J.2055-2335.2009.TB00471.X
Abstract: Clopidogrel is used for the secondary prevention of cerebrovascular and cardiovascular events. Clopidogrel has a similar safety profile to low‐dose aspirin but is considerably more expensive. Clopidogrel is subsidised for restricted indications via the Pharmaceutical Benefits Scheme (PBS). To examine clopidogrel prescribing in hospital and to identify patients discharged on clopidogrel according to PBS criteria. Cross‐sectional evaluation of patients started on clopidogrel (July 2006 to June 2007) at the Royal Darwin and Royal Hobart Hospitals. Clopidogrel prescribing was examined and the indication for discharge on clopidogrel was documented. The primary outcome was concordance between clopidogrel use and PBS criteria. Data were collected for 385 patients. 54% of patients from the Royal Darwin Hospital and 39% of patients from the Royal Hobart Hospital discharged on clopidogrel met PBS criteria. The main reason for noncompliance with the PBS was absence of a history of cardiovascular or cerebrovascular events while on low‐dose aspirin and an absence of contraindications to aspirin at the time of clopidogrel prescribing. Although clopidogrel prescribing at the hospitals was often not in accordance with PBS criteria, in most cases prescribing was based on the available evidence.
Publisher: Wiley
Date: 04-09-2015
Publisher: SAGE Publications
Date: 10-08-2020
Abstract: To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36 95%CI=0.79-2.35) or hospitalization (OR=1.02 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. In iduals with cognitive impairment or dementia are at increased risk of medication misadventure based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2015
DOI: 10.1007/S40256-015-0149-9
Abstract: Guideline-based management of acute coronary syndrome (ACS) is well established, yet some may challenge that strict implementation of guideline recommendations can limit the in idualization of therapy. The use of all recommended medications following ACS places a high burden of responsibility and cost on patients, particularly when these medications have not been previously prescribed. Without close attention to avoiding non-adherence to these medications, the full benefits of the guideline recommendations will not be realized in many patients. Using a case ex le, we discuss how the recognition of adherence barriers can be an effective and efficient process for identifying patients at risk of non-adherence following ACS. For those identified as at risk, the World Health Organization's model of adherence barriers is explored as a potentially useful tool to assist with in idualization of therapy and promotion of adherence.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2018
DOI: 10.1007/S40620-017-0375-0
Abstract: Targeted screening interventions for chronic kidney disease (CKD) are increasingly being implemented in various community settings. However, the overall success of these programs is uncertain. Therefore, the aim of this review is to determine whether targeted screening is effective in detecting people with undiagnosed CKD. We performed a systematic literature review, and included studies of targeted screening intervention implemented in any community-based setting. Studies were required to have targeted people aged ≥18 years, and multiple CKD risk factors from the following: diabetes, hypertension, cardiovascular disease and family history of kidney disease. The outcome measures were percentages of participants with positive screening test results and diagnosed with CKD at follow-up. Nine studies met the inclusion criteria. Eight studies reported the percentage of participants with positive screening test results, which ranged from 7 to 60.3%. Only two studies repeated the diagnostic tests to detect CKD, and confirmed the chronicity of CKD in 20.5 and 17.1% of screened participants. The most commonly used screening tests were albumin creatinine ratio (≥3.4 mg/mmol), and estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m This systematic review found significant variation in the methods that were used to detect CKD, with the majority of studies reporting results based on only single albuminuria or eGFR values. Future targeted screening programs should appropriately use the 2012 KDIGO guidelines in order to detect CKD, which is necessary to determine the benefit of these programs when implemented in community-settings.
Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-032851
Abstract: Many medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia. The reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants’ general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial. Ethics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health. Australian and New Zealand Trials Registry ACTRN12618000766213.
Publisher: Oxford University Press (OUP)
Date: 04-2022
Abstract: To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions. Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities. Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine. Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months. Usual care (Residential Medication Management Review) provided by accredited pharmacists. Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life. 248 persons (median age 87 years) completed the study 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength. The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.SAPHARM.2021.09.007
Abstract: Adverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs. This trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12-24 months following hospital discharge. The study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression. It is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.
Publisher: Public Library of Science (PLoS)
Date: 05-01-2023
DOI: 10.1371/JOURNAL.PONE.0279748
Abstract: Asthma has substantial and increasing health and economic burden worldwide. This study aimed to estimate healthcare expenditure and determine the factors that increase expenditure in Australians with poorly controlled asthma. In iduals ≥18 years of age with poorly controlled asthma, as determined by a score ≥1.5 on the Asthma Control Questionnaire, were included in the study. Healthcare utilization costs from medical services and medications were estimated over an average follow-up of 12 months from administratively linked data: the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. A generalized linear model with gamma distribution and log link was used to predict participants’ key baseline characteristics associated with variations in healthcare costs. A total of 341 participants recruited through community pharmacies were included. The mean (standard deviation, SD) age of participants was 56.6 (SD 17.6) years, and approximately 71% were females. The adjusted average monthly healthcare expenditure per participant was $AU386 (95% CI: 336, 436). On top of the average monthly costs, an incremental expenditure was found for each year increase in age ($AU4 95% CI: 0.78, 7), being unemployed ($AU201 95% CI: 91, 311), one unit change in worsening quality of life ($AU35 95% CI: 9, 61) and being diagnosed with depression and anxiety ($AU171 95% CI: 36, 306). In a cohort of Australian patients, characterized by poor asthma control and co-morbidities in iduals impose substantial economic burden in terms of Medicare funded medical services and medications. Programs addressing strategies to improve the quality of life and manage co-morbid anxiety and depression and encourage asthma patients’ engagement in clinically tolerable jobs, may result in significant cost savings to the health system.
Publisher: Springer Science and Business Media LLC
Date: 19-04-2023
Publisher: Research Square Platform LLC
Date: 06-11-2019
Abstract: Background: Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice from February 01, 2016 and June 01, 2016, using validated indicators. Methods: We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients using clinical and sociodemographic factors. Results: Among 44,259 patients with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5% P .001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions: We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Australian programs working to improve quality use of medication need to focus on improving the appropriate prescribing of recommended preventive medications in patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy. Keywords: chronic kidney disease, drug therapy, quality indicators, inappropriate prescribing, general practice, quality use of medicine, primary care
Publisher: BMJ
Date: 26-05-2006
Publisher: SAGE Publications
Date: 2019
Abstract: The primary objective of this study is to use the Capability, Opportunity, and Motivation Behaviour (COM-B) model to identify potential strategies aimed at improving the early detection of atrial fibrillation (AF) in the general population. We undertook a review of the literature to identify factors associated with participation in community-based screening for AF, followed by mapping of the factors generated into the components of the COM-B model, and validation of the model by an expert panel. The Behaviour Change Wheel (BCW) was used to nominate potential intervention strategies and steps to guide the design and implementation of community-based screening for AF. A total of 28 factors from 21 studies were mapped into the COM-B model. Based on the BCW approach, 24 intervention strategies and 7 steps that could guide the design and implementation of community-based screening for AF were recommended. The application of the COM-B model demonstrated how factors influencing the participation of in iduals with undiagnosed AF in community-based screening could be identified. The model could also serve as a guide for the design and implementation of interventions for improving AF detection in the general population.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2019
Publisher: Research Square Platform LLC
Date: 27-06-2019
Abstract: Background Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice, using validated indicators. Methods We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients with and without concomitant diabetes. Results Among 44,259 patients aged 18 years or older with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5% P .001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Targets for intervention studies in Australian general practice could include the appropriate prescribing of recommended preventive medications of patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy.
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/IMJ.15514
Abstract: Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta‐blockers and flecainide increased.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2021
Publisher: Hindawi Limited
Date: 20-10-2011
DOI: 10.1111/J.1365-2710.2011.01308.X
Abstract: Warfarin is recognized as a high-risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient's discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post-discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post-discharge warfarin management service. Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion-based s ling within two Australian states. Semi-structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach. Forty-seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home-delivered services are valuable to both patients and healthcare professionals. Although high-quality warfarin education and effective communication at the hospital-community interface were identified as important in post-discharge warfarin management, deficiencies were perceived within current systems. The role of home-delivered services in ensuring timely follow-up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post-discharge management should therefore focus on providing patients with a solid foundation to minimize future problems. Addressing the three identified facets of care within a new, collaborative post-discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short- and longer-term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.
Publisher: Oxford University Press (OUP)
Date: 13-06-2014
Abstract: up to 80% of residents in aged care facilities (ACFs) experience pain, and previous studies have found that older patients with pain are often undertreated. Few studies have been conducted in Australia evaluating the use of analgesic therapy in ACF residents. to explore the use of analgesics among ACF residents, including independent predictors of analgesic use, evaluate analgesic use against pain management guidelines and identify potential medication management issues. a retrospective analysis of 7,309 medicines reviews conducted on Australian ACF residents was undertaken. Medication use was compared with published guidelines relating to the management of pain in elderly patients or ACF residents. Multiple variable logistic regression was used to identify independent predictors of analgesic use. nearly 91% of residents were prescribed analgesics. Of those, 2,057 residents were taking regular opioids (28.1%). Only 50% of those taking regular opioids received regular paracetamol at doses of 3-4 g/day. The concurrent use of sedatives was high, with 48.4% of those taking regular opioids also taking an anxiolytic/hypnotic. there is a need to optimise the prescribing and administration of regular paracetamol as a first line and continuing therapy for pain management in ACF residents, to potentially improve pain management and reduce opioid requirements. Furthermore, with the risk of falls and fractures increased by concurrent use of opioids and sedatives, the widespread use of these drugs in a population already at high risk was concerning, indicating a need for better education of health professionals in this area.
Publisher: Wiley
Date: 02-2004
DOI: 10.1111/J.0141-9854.2003.00578.X
Abstract: The accuracy and reproducibility of the CoaguChek S, and its clinical agreement with conventional laboratory international normalized ratio (INR) determination, were evaluated in an outpatient anticoagulation clinic setting. Forty-three patients provided 248 paired INR measurements for analysis. The paired results were highly correlated (r = 0.90). The mean coefficient of variation for the CoaguChek S for a random s le of 21 patients with three repeated tests each, was 4%. Clinical applicability was also measured by discrepant INR values, as defined in the literature by expanded and narrow agreement, and by INR values resulting in a different clinical decision by a blinded haematology registrar. Expanded agreement and narrow agreement between the two INR values occurred 90 and 88% of the time, respectively. The stricter criteria set down by the clinician resulted in 73% of paired results producing the same dosage decision. The CoaguChek S displayed good correlation with laboratory determination of INR and compared relatively well with expanded and narrow clinical agreement criteria.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2023
The Persistence of Opioid Use Following Surgical Admission: An Australian Single-Site Retrospective Cohort Study
Publisher: Informa UK Limited
Date: 04-2020
DOI: 10.2147/JPR.S235764
Publisher: Wiley
Date: 06-06-2018
DOI: 10.1111/JPC.14071
Abstract: We investigated the presentations of children with unspecified fever to an Australian emergency department (ED): (i) to determine the proportion of these presentations that could be classified as potentially avoidable and (ii) to identify factors associated with an increased risk of hospital admission. This study retrospectively identified and described children aged <6 years who presented to the Royal Hobart Hospital (Tasmania, Australia) ED with unspecified fever (ICD-10-AM code R50.9) between January 2013 and December 2015, using data from the ED information system and digital medical records. The Australian Institute of Health and Welfare method was used to estimate the number of potentially avoidable general practitioner-type presentations. Predictors of hospital admission were determined using multivariate logistic regression. A total of 459 patients aged <6 years presented to the ED with a primary diagnosis description of unspecified fever. Of these, 30.7% were classed as potentially avoidable general practitioner-type presentations. Overall, 26.1% of presentations resulted in admission to hospital. Administration of intravenous fluids in the ED and a longer treat time were identified as significant predictors of a child with non-specific fever being admitted to hospital. Older age, administration of antipyretics in the ED and presentations triaged as semi-urgent and non-urgent significantly reduced the probability of admission. To our knowledge, this is the first Australian study that has assessed the impact of unspecified childhood fever on an Australian ED. Further investigation of presentations classified as potentially avoidable is warranted to investigate whether these could be managed in the primary care setting.
Publisher: Elsevier BV
Date: 2010
Publisher: SAGE Publications
Date: 11-04-2018
Abstract: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC mid-2013 to 2015). Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY] P .001) and IS/TIA (2.1 vs 1.3 per 100 PY P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers. Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.
Publisher: Wiley
Date: 25-09-2017
Abstract: Patients' knowledge regarding their oral anticoagulant (OAC) treatment for stroke prevention in atrial fibrillation (AF), their level of medication adherence, and health literacy are known to affect treatment outcomes. However, contemporary data regarding the relationships between these variables are lacking. To investigate the relationships between anticoagulant knowledge, health literacy, and self-reported adherence in patients taking warfarin and the directly acting oral anticoagulants. A cross-sectional survey was conducted in 48 patients with AF identified from general practices. The Anticoagulation Knowledge Tool (AKT) was used to assess anticoagulation knowledge the Short Test of Functional Health Literacy in Adults (s-TOFHLA) for health literacy and the 8-item Morisky Medication Adherence Scale (MMAS) for medication adherence. Participants had mean scores of 61.6 ± 15.8, 7.2 ± 1.1, and 24.7 ± 9.5 for the AKT, MMAS-8 and s-TOFHLA, respectively. Significant correlations were observed between anticoagulation knowledge and health literacy with medication adherence (0.37, P < .01 and .30, P < .05, respectively). Participants with inadequate health literacy had a significantly lower mean knowledge score than those with adequate health literacy (55.8 ± 15.9 vs 66.1 ± 14.4, P < .05). Participants who self-reported adherence to their OAC had significantly higher knowledge scores than those who did not (67.5 ± 13.3 vs 56.1 ± 16.2, P < .05). Significant correlations between health literacy, OAC knowledge, and adherence were observed, and these relationships should to be considered by health professionals responsible for monitoring patients who are prescribed anticoagulants. We also observed serious gaps in OAC knowledge. Interventions designed to optimize the outcomes of anticoagulant treatment need to address these factors.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2011
Publisher: Informa Healthcare
Date: 13-04-2006
Abstract: The use of warfarin in the elderly, particularly for stroke prevention in chronic atrial fibrillation, is steadily increasing. Although the benefits of warfarin are greatest in the elderly, so are the risk of adverse outcomes and the difficulties of anticoagulant management. Clinical systems need to improve to counter this therapeutic dilemma, as warfarin is likely to remain the only widely available oral anticoagulant for the foreseeable future. Aspects that require attention are: the careful selection of patients in whom treatment with warfarin is appropriate initiating therapy in a low dose (e.g., 2.5-5 mg/day) thorough education of patients and carers close monitoring, especially with any change in the patient's regular drug therapy involving patients more in the management of their warfarin therapy (self-monitoring/management in suitable patients) and ongoing review of the appropriateness of therapy as circumstances change.
Publisher: Wiley
Date: 14-07-2010
DOI: 10.1111/J.1755-5922.2010.00209.X
Abstract: Atrial fibrillation (AF) is the most commonly occurring arrhythmia, and is a condition of both significant clinical and economic importance. An antithrombotic agent is considered mandatory as part of the management in most patients with AF. It has been conclusively demonstrated that long-term anticoagulation therapy can significantly reduce the risk of stroke in patients with nonvalvular AF. While vitamin K antagonists (VKAs) such as warfarin are highly effective, they possess numerous limitations that curtail their use, or make their use challenging for clinicians and patients. A new generation of anticoagulants are being investigated in phase III clinical trials in patients with AF. One or more of these agents have the potential to either replace or act as alternatives to VKA therapy in AF. This group includes the direct thrombin inhibitor, dabigatran, the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, and finally, the vitamin K analogue, tecarfarin. Additional agents are being developed in phase I or II clinical trials. The direct thrombin and factor Xa inhibitors are generally small, synthetic molecules with predictable pharmacokinetics, a predictable pharmacodynamic effect, few drug interactions and do not require routine therapeutic drug monitoring. These new anticoagulants may well represent a new era in anticoagulation. However, they do possess their own limitations and will present new challenges for clinicians.
No related grants have been discovered for Luke Bereznicki.