ORCID Profile
0000-0002-5751-0488
Current Organisations
University of Tasmania
,
West Tamar Health
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Publisher: JMIR Publications Inc.
Date: 17-09-2020
DOI: 10.2196/20160
Abstract: Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In iduals with 2 measures of eGFR mL/min/1.73 m2, at least 90 days apart, were identified as having CKD and were included in the CKD cohort. In iduals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. DERR1-10.2196/20160
Publisher: Wiley
Date: 26-05-2020
DOI: 10.1111/TCT.13168
Publisher: University of Otago Library
Date: 29-07-2015
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PYV25N3ABS
Publisher: MDPI AG
Date: 30-10-2022
DOI: 10.3390/JCM11216438
Abstract: Background: Studies investigating the association between the use of oral anticoagulants (OACs) and osteoporosis are limited. We aimed to determine the risk of osteoporosis in patients with atrial fibrillation (AF) and receiving different OACs. Methods: We performed a population-based cohort study using a nationwide primary care dataset, MedicineInsight. Patients aged between 18 and 111 years with AF and newly recorded OAC prescriptions between 1 January 2013 and 31 December 2017 were included and followed until 31 December 2018. We applied propensity score matching to control for patients’ baseline characteristic differences before calculating adjusted hazard ratios (aHRs) for a new diagnosis of osteoporosis, using Cox proportional hazard models. Results: A total of 18,454 patients (1714 prescribed dabigatran, 5871 rivaroxaban, 5248 apixaban and 5621 warfarin) were included. Of these, 39.5% were females, and the overall mean age (standard deviation [SD] was 73.2(10.3) years. Over a mean follow-up of 841 days, 1627 patients (1028 receiving direct-acting oral anticoagulants (DOACs) and 599 warfarin) had a newly recorded diagnosis of osteoporosis. The weighted incidence rates (95% confidence interval CI) per 100 person-years of treatment were 5.0 (4.7–5.2) for warfarin, 4.3 (3.8–4.8) for dabigatran, 3.6 (3.3–3.8) for rivaroxaban, and 4.4 (4.0–4.7) for apixaban. Overall, DOAC use was associated with a significantly lower risk of a new diagnosis of osteoporosis than warfarin use (aHR, 0.79, 95% confidence interval (CI) 0.74–0.85 p 0.001). Use of each in idual DOAC was associated with a significantly lower risk of osteoporosis compared with warfarin (aHRs, 0.75, 95% CI 0.69–0.82 for rivaroxaban 0.78, 95% CI 0.71–0.86 for apixaban 0.88, 95% CI 0.77–0.99 for dabigatran). Conclusion: Compared with warfarin, the use of DOACs was associated with a significantly lower risk of developing osteoporosis in patients with AF. This association remained significant when in idual DOACs were compared with warfarin.
Publisher: Kaplan Higher Education Academy Pte Ltd
Date: 22-05-2020
Publisher: Springer Science and Business Media LLC
Date: 19-04-2016
Publisher: MDPI AG
Date: 10-05-2023
DOI: 10.3390/JCM12103389
Abstract: Objective: Little research has evaluated trends in psychotropic prescribing and polypharmacy in primary care patients, especially those with dementia. We sought to examine this in Australia from 2011 to 2020 using the primary care dataset, MedicineInsight. Methods: Ten consecutive serial cross-sectional analyses were performed to evaluate the proportion of patients aged 65 years or more, with a recorded diagnosis of dementia, who were prescribed psychotropic medications within the first six months of each year from 2011 to 2020. This proportion was compared with propensity score-matched control patients without dementia. Results: Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. In 2011, 42% (95% confidence interval [CI] 40.5–43.5%) of patients in the dementia group had at least one recorded prescription of a psychotropic medication, which declined to 34.2% (95% CI 33.3–35.1% p for trend 0.001) by 2020. However, it remained unchanged for matched controls (36% [95% CI 34.6–37.5%] in 2011 and 36.7% [95% CI 35.7–37.6%] in 2020). The greatest decline in the dementia groups by medication class was for antipsychotics (from 15.9% [95% CI 14.8–17.0%] to 8.8% [95% CI 8.2–9.4%] p for trend 0.001). During this period, the prevalence of psychotropic polypharmacy (use of two or more in idual psychotropics) also decreased from 21.7% (95% CI 20.5–22.9%) to 18.1% (95% CI 17.4–18.9%) in the dementia groups, and slightly increased from 15.2% (95% CI 14.1–16.3%) to 16.6% (95% CI 15.9–17.3%) in the matched controls. Conclusions: The decline in psychotropic prescribing, particularly antipsychotics, in Australian primary care patients with dementia is encouraging. However, psychotropic polypharmacy still occurred in almost one in five patients with dementia at the end of the study period. Programs focused on encouraging further reductions in the use of multiple psychotropic drugs in patients with dementia are recommended, particularly in rural and remote regions.
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: F1000 Research Ltd
Date: 2014
Publisher: The Royal Australian College of General Practitioners
Date: 03-2019
Publisher: University of Otago Library
Date: 31-03-2023
Abstract: A core value of the Australian and New Zealand Association for Health Professional Educators (ANZAHPE) is to be a nurturing organisation that enshrines the value of mentorship. In this paper we explore the roles of mentors and coaches and how these might adapt over the next 50 years towards assisting a novice to understand the culture within their own workplace, to enable them to function, survive, and thrive within this context. We further propose that the respective roles of mentors and coaches will become increasingly distinct from each other, to optimise the support that is available for new health professionals, educators, and researchers as they enter the workforce and prepare for lifelong learning and scholarship.
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: JMIR Publications Inc.
Date: 12-05-2020
Abstract: hronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. o examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. his is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In iduals with 2 measures of eGFR& mL/min/1.73 m sup /sup , at least 90 days apart, were identified as having CKD and were included in the CKD cohort. In iduals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. he study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. hole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. ERR1-10.2196/20160
Publisher: The Royal Australian College of General Practitioners
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 05-06-2020
DOI: 10.1186/S12882-020-01862-1
Abstract: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016 collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values 60 mL/min/1.73m 2 , and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% ( n = 9926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.
Publisher: SAGE Publications
Date: 2019
Abstract: Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected in iduals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016 collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.
Publisher: Wiley
Date: 16-09-2020
DOI: 10.1002/HPJA.403
Abstract: Men in the Northern Suburbs of Launceston, Tasmania, experience substantially poorer health outcomes and socio‐economic disadvantage than most Australians. They are often described as “hard‐to‐reach,” meaning difficult to engage in research, health promotion, policy and planning. This paper summarises the OPHELIA process to combine health literacy profiling with engagement of local men in health promotion, and their experience of the process and outcomes. Interviews were conducted to explore the experiences of middle‐aged men with the OPHELIA process and subsequent interventions. Local data and health literacy profiling revealed experiences of isolation, lack of trust in the system, medication non‐adherence, mental illness and chronic pain, which formed the basis for generation of ideas to improve their well‐being and understanding of health. Tailored interventions were implemented, including suicide prevention, “Numeracy for Life” and “Healthy Sheds” courses. Interviews with six participants revealed that the process contributed to a sense of worth, social support and ability to break “old habits.” Prioritising the lived experience of “hard‐to‐reach” men through the OPHELIA process resulted in co‐design of interventions that were valued by participants. Health literacy profiling and genuine community engagement can empower vulnerable, under‐represented communities to co‐design, and engage in, health promotion.
Publisher: CSIRO Publishing
Date: 19-11-2020
DOI: 10.1071/AH19290
Abstract: Objective Clinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the ‘right care’, in the ‘right place’, at the ‘right time’ and ‘tailored to the needs of communities’. This ideal is being h ered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC. Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of complexity into policy, subsequent service planning and development of models of care. Methods The WHO components of health policy were used as the basis for the framework. Literature was drawn on to develop a policy framework that integrates complexity into health policy. Results Within the framework, complexity is juxtaposed between the WHO components of ‘vision’, ‘priorities’ and ‘roles’. Conclusion This framework, supported by the literature, provides a means for policy makers and health planners to conduct analyses of and for policy. Further work is required to better model complexity in a manner that integrates consumer needs and provider capabilities. What is known about the topic? There is a growing body of evidence regarding patient complexity and its impact on the delivery of health services, but there is little consideration of patient complexity in policy, which is an important consideration for service provision. What does this paper add? This paper presents an argument for the inclusion of patient complexity in health policy and provides a framework for how that might occur. What are the implications for practitioners? The inclusion of patient complexity in policy could provide a means for policy makers to consider the factors that contribute to patient complexity in service provision decisions.
Publisher: University of Otago Library
Date: 04-08-2017
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: SAGE Publications
Date: 08-09-2015
Abstract: This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students’ attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus.
Publisher: Research Square Platform LLC
Date: 15-12-2020
DOI: 10.21203/RS.3.RS-127873/V1
Abstract: Background: Residential aged care facilities (RACFs), also known as nursing or aged care homes are infrequently used to deliver experience-based learning to medical students. Methods: This is a realist evaluation of senior medical students’ perspective of a one-week clerkship delivered in RACFs seeking to find what aspects of their clerkship worked for whom and why as part of the evaluation of the clerkship. This is a qualitative study using written and focus group data. Results: The highly structured curriculum delivered many positive learning outcomes for students such as practice in improving management of end-of-life and dementia care, an understanding of how RACFs functioned, and a chance to participate in interprofessional practice. The context also challenged some students who struggled to see the relevance of the clerkship in relation to their personal and/or professional identities. Conclusions: The realist evaluation builds on a previous theory of experience-based learning adding a student intrain idual aspect to the theory to better define the mechanisms involved. The resulting realist theory of experience-based learning may prove useful to other studies of experience-based learning.
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: Springer Science and Business Media LLC
Date: 29-07-2019
Publisher: Wiley
Date: 13-12-2018
DOI: 10.1111/NEP.13537
Publisher: The Royal Australian College of General Practitioners
Date: 05-2019
Publisher: MDPI AG
Date: 23-09-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/CIRCGEN.122.003842
Abstract: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia. We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised in iduals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective. Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested. An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.
Publisher: MDPI AG
Date: 08-09-2017
DOI: 10.3390/INFORMATICS4030030
Abstract: Connectivity is intrinsic to all aspects of our life today, be it political, economic, technological, scientific, or personal. Higher education is also transcending the previous paradigm of technology enabled content delivery and e-learning, with a new emphasis on connectivity, enabling participants to exchange knowledge and collaborate to meet educational goals. In this study, a social media technology supported website—digiMe—was developed and evaluated at the School of Medicine of one Australian university. Connectivity to other medical learners and health professionals is intrinsic to digiMe. This paper reports the functionalities of this website, results of a post-intervention evaluative survey, and statistics of website usage generated from Google Analytics. The results revealed more active adoptions and a more positive attitude towards digiMe from Year 4 students compared to Year 5 students. The participants showed a desire for access to a recommended collection of apps, such as those offered through digiMe. However, many participants did not use digiMe beyond initial introduction to it. digiMe demonstrated its potential in raising awareness of web and mobile apps useful for enhancing connectivity, although it needs to be introduced to students in earlier years of their medical education to achieve a higher impact on their learning.
Location: No location found
Location: Australia
No related grants have been discovered for Jan Radford.