ORCID Profile
0000-0002-0018-962X
Current Organisations
University of South Australia
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University of Western Australia
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Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1111/J.1753-6405.2009.00383.X
Abstract: To determine whether a 24% increase in patient co-payments in January 2005 and two related co-payment changes for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) were associated with changes in dispensings in Western Australia (WA). We analysed aggregate monthly prescription counts and defined daily dose per 1,000 population per day (DDD/1,000/day) for atypical antipsychotics, combination asthma medicines, HmgCoA reductase inhibitors (statins) and proton-pump inhibitors (PPIs). Trends pre and post the co-payment increase in January 2005 were compared. In three of the four categories examined, prescription counts were significantly lower following the increase in co-payment thresholds. Compared with dispensings prior to the co-payment increase, prescriptions fell by 8% for combination asthma medicines (p<0.001), 9% for PPIs (p<0.001) and 5% for statins (p<0.001). Following the rise in co-payments, DDD/1,000/day decreased for all four categories. Decreases in dispensings to concessional beneficiaries were between 4% and 5% larger than for general beneficiary patients. The reduction in the both prescription counts and DDD/1,000/day observed for combination asthma medicines, PPIs and statins, which all remained above co-payment thresholds, suggests the increase in PBS co-payments has affected utilisation of these subsidised medicines. The results indicate that increases in patient contributions particularly impact on concessional patients' ability to afford prescription medicines.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10906
Abstract: Objectives. To determine changes in out-of-pocket expenditure on prescription medicines for Australian patients, and how patient expenditure compares with other Organisation for Economic Co-operation and Development (OECD) countries. Methods. We examined out-of-pocket expenditure on prescription medicines by patients in Australia between 1970 and 2007, and between Australia and 15 other OECD countries (Canada, Czech Republic, Denmark, Finland, France, Germany, Japan, Republic of Korea (South Korea), Luxembourg, Poland, Slovak Republic, Spain, Sweden, Switzerland and the United States) in 2005. Findings. Spending on publicly subsidised medicines by Australian patients increased from $16 per person in 1971 to $62 in 2007. Patient expenditure on all prescription medicines had risen to $134 per person in 2007. Out-of-pocket expenditure for Australian patients ranked 4th of 14 OCED countries with universal pharmaceutical subsidies. Australian patients pay 28% of national pharmaceutical expenditure more than patients in South Korea (27%), Slovak Republic (26%), Sweden (22%), France, Luxembourg, Japan and Switzerland (17%), Germany (15%), Czech Republic (11%) and Spain (6%), but less than patients in Finland (36%), Denmark (33%) and Poland (34%). Conclusions. Compared to other OECD countries, Australian out-of-pocket costs are now in the mid to upper range. Further increases have the potential to significantly affect access to care. What is known about the topic? In Australia and internationally, increases in the portion of prescription medicines paid by patients have been associated with falls in utilisation. Despite the pharmaceutical subsidies patients receive under the Australian Pharmaceutical Benefits Scheme, prescription medicine costs are a barrier to access for many low income, elderly and other vulnerable patients. What does this paper add? The findings demonstrate that the prescription medicine expenditure of Australian patients has increased substantially over recent years, and is double that indicated by benefit-paid data alone. Out-of-pocket expenditure in Australia is moderate-to-high by international standards. What are the implications for practitioners? Patient out-of-pocket expenditure for prescription medicines in Australia has increased in recent decades, accounting for higher proportions of household and national medicine expenditure. Lack of patient involvement in treatment decisions is associated with patients forgoing medicines due to costs. Practitioners are encouraged to discuss treatment decisions, cost-barriers and possible strategies to overcome cost-barriers with their patients.
Publisher: The Sax Institute
Date: 2015
DOI: 10.17061/PHRP2541546
Abstract: The Pharmaceutical Benefits Scheme (PBS) dataset provides detailed information about subsidised medicines dispensed in Australia and is increasingly used for pharmacoepidemiological research. Use of the PBS dataset provides unique opportunities for such research, but comes with its own set of challenges that must be considered and addressed. This paper outlines some issues that commonly arise when using PBS data - relating to accurate identification of medicine dispensings and how to define medicine exposure - and suggests some possible approaches for dealing with them. The paper is intended as an introductory resource for researchers.
Publisher: Springer Science and Business Media LLC
Date: 11-02-2013
Publisher: SAGE Publications
Date: 08-11-2020
Abstract: This study examined the association between statin usage (discontinued, reduced or continued) and two-year death following a 21% increase in the Pharmaceutical Benefits Scheme (PBS) consumer co-payment in Western Australia. A retrospective observational study in Western Australia using linked administrative Commonwealth PBS data and State hospital inpatient and death data (n = 207,066) was undertaken. We explored the two-year all-cause and ischemic heart disease(IHD)/stroke-specific-death in in iduals who discontinued, reduced or continued statin medication following the January 2005 PBS co-payment increase, overall, by beneficiary status (general population vs. social security recipients) and by a history of admission for ischemic heart disease or stroke. Non-cardiovascular (CVD)-related death was also considered. In the first six months of 2005, 3.3% discontinued, 12.5% reduced and 84.2% continued statin therapy. We found those who discontinued statins were also likely to discontinue at least two other medicines compared to those who continued therapy. There were 4,607 all-cause deaths. For IHD/stroke-specific death, there were 1,317. For all non-CVD-related death, there were 2,808 deaths during the 2-year follow-up period. Cox regression models, adjusted for demographic and clinical characteristics, showed a 39%-61% increase in the risk of all-cause death for in iduals who reduced or discontinued statin medication compared to those who continued their statin medication (Discontinued: Adj HR = 1.61, 95% CI 1.40–1.85 Reduced: Adj HR = 1.39, 95% CI 1.28–1.51). For IHD/stroke-specific death, there was an increased risk of death by 28–76% (Discontinued: Adj sHR = 1.76, 95% CI 1.37–2.27 Reduced: Adj sHR = 1.28, 95% CI 1.10–1.49), and for non-CVD-related death, there was an increased risk of death by 44–57% (Discontinued: Adj sHR = 1.57, 95% CI 1.31–1.88 Reduced: Adj sHR = 1.44, 95% CI 1.30–1.60), for in iduals who discontinued or reduced their statin medication compared to those who continued. Patients who discontinued their statin therapy had a significantly increased risk of IHD and stroke death. Health professionals should be aware that large co-payment changes may be associated with patients discontinuing or reducing medicines to their health detriment. Factors that lead to such changes in patient medication-taking behaviour need to be considered and addressed at the clinical and policy levels.
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1111/ANAE.15500
Abstract: Extended‐release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long‐term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended‐release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended‐release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended‐release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11‐month before‐and‐after study and time‐series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended‐release opioid. For surgical patients prescribed any opioid (n = 16,284), extended‐release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p 0.001), primarily driven by a reduction in extended‐release oxycodone (31.1% before vs. 14.1% after, p 0.001). There was a 23% immediate decline in extended‐release opioid prescribing after the position statement release (p 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended‐release opioid prescribing (OR 0.54, 95%CI 0.50–0.58). Extended‐release opioid prescribing was also associated with increased incidence of opioid‐related adverse events (OR 1.52, 95%CI 1.35–1.71) length of stay (RR 1.44, 95%CI 1.39–1.51) and 28‐day re‐admission (OR 1.26, 95%CI 1.12–1.41). Overall, a reduction in extended‐release opioid prescribing was observed in surgical inpatients following position statement release.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2016
Publisher: AMPCo
Date: 07-2017
DOI: 10.5694/MJA16.00841
Abstract: To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters. Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010) their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups. Rates of general practice attendance by former prisoners during the 2 years following their release from prison. In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04 95% CI, 2.00-2.07) as other Queenslanders 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82 95% CI, 1.58-2.10). Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care.
Publisher: Wiley
Date: 11-2008
DOI: 10.1002/PDS.1670
Abstract: Patient co-payments for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) increased by 24% in January 2005. We investigated whether this increase and two related co-payment changes were associated with changes in dispensings of selected subsidised medicines in Australia. We analysed national aggregate monthly prescription dispensings for 17 medicine categories, selected to represent a range of treatments (e.g. for diabetes, cardiovascular diseases, gout). Trends in medication dispensings from January 2000 to December 2004 were compared with those from January 2005 to September 2007 using segmented regression analysis. Following the January 2005 increase in PBS co-payments, significant decrease in dispensing volumes were observed in 12 of the 17 medicine categories (range: 3.2-10.9%), namely anti-epileptics, anti-Parkinson's treatments, combination asthma medicines, eye-drops, glaucoma treatments, HmgCoA reductase inhibitors, insulin, muscle relaxants, non-aspirin antiplatelets, osteoporosis treatments, proton-pump inhibitors (PPIs) and thyroxine. The largest decrease was observed for medicines used in treating asymptomatic conditions or those with over-the-counter (OTC) substitutes. Decrease in dispensings to social security beneficiaries was consistently greater than for general beneficiaries following the co-payment changes (range: 1.8-9.4% greater, p = 0.028). The study findings suggest that recent increase in Australian PBS co-payments have had a significant effect on dispensings of prescription medicines. The results suggest large increase in co-payments impact on patients' ability to afford essential medicines. Of major concern is that, despite special subsidies for social security beneficiaries in the Australian system, the recent co-payment increase has particularly impacted on utilisation for this group.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.FERTNSTERT.2015.06.042
Abstract: To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization. Population-based retrospective cohort study. Hospitals in Western Australia. All women aged 20-44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898). Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment. First live-delivery rates. There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18-23) within the first year after reversal, 40% (95% CI 38-42) at 2 years, 51% (95% CI 48-53) at 5 years, and 52% (95% CI 50-55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40-44 years (26%) compared with younger women (aged 20-29, 30-34, and 35-39 years) (50%, 56%, and 51%, respectively). Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.
Publisher: S. Karger AG
Date: 19-10-2012
DOI: 10.1159/000342375
Abstract: b i Background/Aims: /i /b Chronic kidney disease (CKD) is a major health issue worldwide. The aim of this study was to explore factors associated with CKD progression in Australian nephrology practices. b i Methods: /i /b This was a retrospective study utilising an electronic medical record (EMR), Audit4 (Software for Specialists, Australia). The baseline visit was defined as the first entry into the EMR. The primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). b i Results: /i /b 1,328 patients were included with a mean eGFR at baseline of 37.4 ± 0.7 ml/min/1.73 m sup /sup , a mean follow-up of 17.7 months and a mean annual rate of change in eGFR of –0.84 ± 0.26 ml/min/1.73 m sup /sup . Univariate analysis demonstrated that women, smokers, and patients prescribed erythropoiesis-stimulating agents (ESA) had a significantly more rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gender, age, prescription of ESA and phosphate binders, and baseline eGFR were significantly associated with CKD progression (p = 0.003, 0.004, .001, 0.029, and .001, respectively). b i Conclusions: /i /b This study identifies potential factors associated with CKD progression in a population referred to nephrologists, but current data quality may result in bias. Implementation of changes in the format of data collection is required so that busy clinicians record essential information to enable this to become a more accurate and reliable research tool.
Publisher: The Sax Institute
Date: 28-01-2016
DOI: 10.17061/PHRP2611607
Abstract: It is important for consumers, clinicians and health service planners to know the risk of recurrence of primary breast cancer after initial treatment. At present, none of Australia's state or territory cancer registries routinely report this information. We aimed to determine the incidence of recurrence in New South Wales (NSW) clinical practice for the period 18 months to 6 years after diagnosis of primary breast cancer. Retrospective cohort study using population-based linked health data. We identified 2416 women in the 45 and Up Study who were diagnosed with primary invasive breast cancer between 2003 and 2008 in NSW, and who had not had a recurrence 18 months after diagnosis. Unit-level hospital, pharmacy and outpatient medical claims were used to identify treatment for recurrence. Incidence of recurrence was calculated using in idual person-time at risk (18 months to 6 years postdiagnosis), with follow-up censored for death or end of study period (median follow-up 3 years). Time to recurrence was calculated, and Cox proportional regression was used to identify women's baseline and active treatment characteristics that were predictive of recurrence up to 6 years postdiagnosis. 217 women (9%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence. Overall annual incidence of recurrence was 3.3%. Recurrence rates were significantly higher for women with node-positive (4.8% vs 2.5% annually hazard ratio [HR] = 1.7 95% confidence interval [95% CI] 1.3, 2.3) or hormone receptor-negative tumours (3.8% vs 3.1% annually HR = 1.3 95% CI 1.0, 1.7). Women with tumours >2 cm at diagnosis were more likely to experience recurrence than women with smaller/unknown tumours (4.8% vs 2.7% annually HR = 1.5 95% CI 1.1, 2.0). A combination of routinely collected administrative health datasets can be used to determine recurrence rates, allowing future assessment of population-level changes over time and investigations of the real-world impact of specific treatments on outcomes.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2014
Publisher: BMJ
Date: 04-08-2017
DOI: 10.1136/TOBACCOCONTROL-2017-053715
Abstract: This study examined the impact of antismoking activities targeting the general population and an advertising c aign targeting smoking during pregnancy on the prevalence of smoking during pregnancy in New South Wales (NSW), Australia. Monthly prevalence of smoking during pregnancy was calculated using linked health records for all pregnancies resulting in a birth (800 619) in NSW from 2003 to 2011. Segmented regression of interrupted time series data assessed the effects of the extension of the ban on smoking in enclosed public places to include licensed premises (evaluated in combination with the mandating of graphic warnings on cigarette packs), television advertisements targeting smoking in the general population, print and online magazine advertisements targeting smoking during pregnancy and increased tobacco tax. Analyses were conducted for all pregnancies, and for the population stratified by maternal age, parity and socioeconomic status. Further analyses adjusted for the effect of the Baby Bonus maternity payment. Prevalence of smoking during pregnancy decreased from 2003 to 2011 overall (0.39% per month), and for all strata examined. For pregnancies overall, none of the evaluated initiatives was associated with a change in the trend of smoking during pregnancy. Significant changes associated with increased tobacco tax and the extension of the smoking ban (in combination with graphic warnings) were found in some strata. The declining prevalence of smoking during pregnancy between 2003 and 2011, while encouraging, does not appear to be directly related to general population antismoking activities or a pregnancy-specific c aign undertaken in this period.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2019
DOI: 10.1007/S40258-018-0440-4
Abstract: To describe how post-market utilisation analysis in Australia informs cost-effectiveness assessment and pricing decisions, using aflibercept and ranibizumab as case studies. Pharmaceutical claims were used to identify initiators of aflibercept and ranibizumab in the year after aflibercept-listing (December 2012), and ranibizumab initiators in the year before aflibercept listing. The dispensing rates for each cohort were calculated, and their demographic and clinical characteristics compared using Kruskal-Wallis tests. Aflibercept and ranibizumab each accounted for half the age-related macular degeneration market following aflibercept listing. Aflibercept initiators had similar dispensing rates to ranibizumab initiators in the pre- and post-aflibercept era (~ three scripts during the first 90 days, and eight to nine scripts during the following 12 months). All cohorts were similar in terms of their age, sex, residential aged-care status and geographic remoteness, and no differences were observed in their overall co-morbidity scores and history of thromboembolic events. Contrary to clinical trial protocols, post-market utilisation research for ranibizumab and aflibercept demonstrates equivalent use in practice in terms of dose frequency, and the demographic and clinical characteristics of initiators. This supports Australia's decision to pay the same price for each rather than giving a premium to aflibercept. Many other countries are likely overpaying for aflibercept if their utilization patterns are similar to Australia's, and could benefit from incorporating routine utilisation assessment.
Publisher: Medknow
Date: 2018
Abstract: Little is known about how the different policies available to promote use of generic medicines affect the price per unit supplied or sold. This study compares the influence of pricing policies for generic medicines on atorvastatin prices in Australia, New Zealand, the Republic of Korea and Singapore, after market entry of generic atorvastatin. The annual price of atorvastatin per defined daily dose supplied (price/DDD) was examined for each country from 2006 to 2015 (≥2 years before and ≥4 years after generic market entry). Prices were converted to international dollars and cumulative percentage price reductions were calculated for the first 4 years following generic entry. Prior to market entry of generic atorvastatin, New Zealand had the lowest price ($0.10/DDD), and the Republic of Korea the highest ($2.89/DDD). The price/DDD fell immediately after generic entry in all countries except New Zealand, which already had low prices. The largest immediate decrease was observed in Singapore (46%, year 1). By the fourth year after generic entry, the price had fallen by 46-80% in all countries however, large price differences between countries remained. New Zealand's tendering system and use of preferred medicines resulted in very low atorvastatin prices well before patent expiry. Pricing policies in the other three countries were effective in reducing atorvastatin prices, with reductions of between 46% and 80% within 4 years of generic entry. Where tendering and use of preferred medicines were the mechanisms for atorvastatin procurement (New Zealand), prices were lowest before and after generic entry. Mandatory price cuts, combined with price-disclosure policies (Australia), produced similar relative price reductions to tendering systems (New Zealand, Singapore) at 4 years. By comparison, mandatory price cuts upon generic entry as the sole measure, while initially effective, were associated with the smallest relative reduction in price after 4 years (Republic of Korea).
Publisher: The Sax Institute
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 19-04-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: BMJ
Date: 20-01-2022
DOI: 10.1136/BMJQS-2021-013910
Abstract: To evaluate the association between regulatory drug safety advisories and changes in drug utilisation. We conducted controlled, interrupted times series analyses with administrative prescription claims data to estimate changes in drug utilisation following advisories. We used random-effects meta-analysis with inverse-variance weighting to estimate the average postadvisory change in drug utilisation across advisories. We included advisories issued in Canada, Denmark, the UK and the USA during 2009–2015, mainly concerning drugs in common use in primary care. We excluded advisories related to over-the-counter drugs, drug-drug interactions, vaccines, drugs used primarily in hospital and advisories with co-interventions within ±6 months. Change in drug utilisation, defined as actual versus predicted percentage change in the number of prescriptions (for advisories without dose-related advice), or in the number of defined daily doses (for dose-related advisories), per 100 000 population. Among advisories without dose-related advice (n=20), the average change in drug utilisation was −5.83% (95% CI −10.93 to –0.73 p=0.03). Advisories with dose-related advice (n=4) were not associated with a statistically significant change in drug utilisation (−1.93% 95% CI −17.10 to 13.23 p=0.80). In a post hoc subgroup analysis of advisories without dose-related advice, we observed no statistically significant difference between the change in drug utilisation following advisories with explicit prescribing advice, such as a recommendation to consider the risk of a drug when prescribing, and the change in drug utilisation following advisories without such advice. Among safety advisories issued on a wide range of drugs during 2009–2015 in 4 countries (Canada, Denmark, the UK and the USA), the association of advisories with changes in drug utilisation was variable, and the average association was modest.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2020
DOI: 10.1186/S12916-019-1472-9
Abstract: Varenicline, bupropion and nicotine replacement therapy (NRT) are three effective pharmacotherapies for smoking cessation, but data about their safety in pregnancy are limited. We assessed the risk of adverse perinatal outcomes and major congenital anomalies associated with the use of these therapies in pregnancy in Australia. Perinatal data for 1,017,731 deliveries (2004 to 2012) in New South Wales and Western Australia were linked to pharmaceutical dispensing, hospital admission and death records. We identified 97,875 women who smoked during pregnancy of those, 233, 330 and 1057 were exposed to bupropion, NRT and varenicline in pregnancy, respectively. Propensity scores were used to match exposed women to those who were unexposed to any smoking therapy (1:10 ratio). Propensity scores and gestational age at exposure were used to match varenicline-exposed to NRT-exposed women (1:1 ratio). Time-dependent Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (95% CI) for any adverse perinatal event (a composite of 10 unfavourable maternal and neonatal outcomes) and any major congenital anomaly. The risk of any adverse perinatal event was not significantly different between bupropion-exposed and unexposed women (39.2% versus 39.3%, HR 0.93, 95% CI 0.73–1.19) and between NRT-exposed and unexposed women (44.8% vs 46.3%, HR 1.02, 95% CI 0.84–1.23), but it was significantly lower in women exposed to varenicline (36.9% vs 40.1%, HR 0.86, 95% CI 0.77–0.97). Varenicline-exposed infants were less likely than unexposed infants to be born premature (6.5% vs 8.9%, HR 0.72, 95% CI 0.56–0.92), be small for gestational age (11.4% vs 15.4%, HR 0.68, 95% CI 0.56–0.83) and have severe neonatal complications (6.6% vs 8.2%, HR 0.74, 95% CI 0.57–0.96). Among infants exposed to varenicline in the first trimester, 2.9% had a major congenital anomaly (3.5% in unexposed infants, HR 0.91, 95% CI 0.72–1.15). Varenicline-exposed women were less likely than NRT-exposed women to have an adverse perinatal event (38.7% vs 51.4%, HR 0.58, 95% CI 0.33–1.05). Pregnancy exposure to smoking cessation pharmacotherapies does not appear to be associated with an increased risk of adverse birth outcomes. Lower risk of adverse birth outcomes in varenicline-exposed pregnancies is inconsistent with recommendations that NRT be used in preference to varenicline.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2012
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH11129
Abstract: Aim. To determine whether the national declines in prescription medicine use occurring after the 2005 21% increase in co-payments affected all areas of Australia or were specific to remote and disadvantaged areas. Methods. Observed dispensing of proton pump inhibitors (PPIs) and statins were obtained for 1392 statistical local areas (SLA) of Australia in 2004 and 2006. Expected dispensing was based on national dispensing rates and was age standardised to each SLA. Expected dispensing for 2006 was based on pre-2005 prescription trends. Ratios of observed to expected dispensing (dispensing ratios) for each SLA were calculated. Mean dispensing ratios for each medicine and year were calculated for all remoteness and disadvantage groups. Generalised regression models compared the percentage change in dispensing ratios from 2004 to 2006. Results. Between 2004 and 2006 PPI dispensing fell significantly in major cities (−13.7%, 95% CI = –17.3–−9.8), inner regional (−14.0, 95%CI = −19.5–−8.2), outer regional (−14.6%, 95%CI = −19.9–−9.0) and remote areas (−9.4%, 95%CI = −16.4–−1.8). Statin dispensing fell in all groups but the most remote (range 6–7%). When focussing on disadvantage, PPI dispensing fell significantly in all groups (range 12–15%). Statins dispensing did not fall significantly in the most disadvantaged areas (−2.9%, 95%CI = −8.6–3.2) but did in the least (−6.5%, −11.3–−1.5) and second-least (−5.8, −10.5–−0.9) disadvantaged areas. Dispensing of PPIs and statins in the most remote and disadvantaged areas remained substantially below levels expected for Australia after the 21% co-payments increase. Conclusions. The findings suggest that the 2005 21% in patient co-payments adversely affected prescription medicine use in all areas of Australia and was not specific to remote or disadvantaged areas. Indeed, dispensing of statins fell significantly in all but the most remote and disadvantaged areas, and the existing gap in dispensing of PPIs and statins was not widened by the co-payments increase. PPIs, which are used at above-prevalence rates in Australia and have cheaper over-the-counter substitutes available, were more sensitive to co-payment increases than were statins. What is known about the topic? Despite high levels of chronic illness in geographically remote and socially disadvantaged areas of Australia, prescription medicine use is generally lowest in these areas. In 2005, co-payments for publically subsidised medicines increased by 21%. After this increase, utilisation of many medicines fell at the national level. It is not known whether these falls in utilisation were specific to remote or disadvantaged areas or if decreases occurred across all areas of Australia. What does this paper add? Between 2004 and 2006 PPI dispensing decreased significantly across all remoteness groups (major cities, inner regional, outer regional and remote areas) and statin dispensing fell significantly in all but remote areas. When focusing on disadvantage groups, dispensing of PPIs fell across Australia, and statins fell significantly in all but the most disadvantaged areas. What are the implications for practitioners? The effect of the 2005 21% increase in co-payments was not specific to remote or disadvantaged areas and was associated with decreases in dispensing across Australia.
Publisher: Elsevier BV
Date: 10-2021
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH19069
Abstract: ObjectiveThis study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. MethodsThe study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, in iduals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. ResultsIn December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. In iduals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. ConclusionsPatients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?Following the 21% increase in medication copayment in 2005, in iduals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.
Publisher: Public Library of Science (PLoS)
Date: 02-01-2014
Publisher: BMJ
Date: 04-2018
Publisher: Wiley
Date: 14-10-2017
DOI: 10.1111/AJCO.12600
Abstract: To determine the frequency, timing and patterns of endocrine therapy switching in Australian practice for postmenopausal women with primary breast cancer. We identified postmenopausal women in a population-based cohort commencing endocrine therapy for invasive primary breast cancer between December 2005 and December 2008 (n = 645). In idual-level administrative health records and self-report data were used to determine women's demographic and clinical characteristics, including preexisting and newly-treated comorbidities, and switches in endocrine therapy. Time to therapy switching was calculated. Chi-square tests compared the characteristics of women who did and did not switch, and those switching within 2 years or after 2 years of commencing therapy. Twenty-eight percent of women switched from their initial endocrine therapy, most commonly from tamoxifen to anastrozole, or the converse. A small number of anastrozole-to-exemestane and letrozole-to-exemestane switches were observed (n = 19). Most women (>80%) who switched therapies did not have newly-treated comorbidities. Few women (<5%) switched before completing 2 years of therapy, but these women were significantly more likely to have preexisting antidepressant use than women switching later (43% vs 23%, P = 0.048) and remained on the subsequent therapy for less time (6 months vs 2.7 years, P < 0.001). Approximately one-quarter of postmenopausal women with primary breast cancer switched endocrine therapies. The findings suggest that the majority of switching in Australian practice was planned occurring after 2-3 years of, not precipitated by comorbidity, and in a sequence supported by trial evidence. Early switching, however, was associated with preexisting depression and appeared to be a marker of poor persistence.
Publisher: Public Library of Science (PLoS)
Date: 23-07-2012
Publisher: JMIR Publications Inc.
Date: 05-2023
Abstract: enetic heart diseases such as hypertrophic cardiomyopathy can cause significant morbidity and mortality, ranging from syncope, chest pain and palpitations to heart failure and sudden cardiac death. These diseases are inherited in an autosomal dominant fashion, meaning family members of affected in iduals have a one in two chance of also inheriting the disease (‘at-risk relatives’). The healthcare utilisation patterns of in iduals with a genetic heart disease including emergency department presentations and hospital admissions, are poorly understood. By linking genetic heart disease registry data to routinely collected health data we aim to provide a more comprehensive clinical dataset to examine the burden of disease on in iduals, families and healthcare systems. he objective of this study is to link the Australian Genetic Heart Disease (AGHD) Registry with routinely collected whole-population health datasets to investigate the healthcare utilisation of in iduals with a genetic heart disease and their at-risk relatives. This linked dataset will allow for investigation of differences in outcomes and healthcare utilisation due to disease, sex, socioeconomic status and other factors. he AGHD Registry is a nationwide dataset which began in 2007 and aims to recruit in iduals with a genetic heart disease and their family members. In this study, demographic, clinical, and genetic data (available 2007-2019) for AGHD Registry participants and at-risk relatives residing in New South Wales (NSW) Australia, were linked to routinely collected health data. These data included NSW based datasets covering hospitalisations (2001-2019) and emergency department presentations (2005-2019), and both state-wide and national mortality registries (2007-2019). The linkage was performed by the Centre for Health Record Linkage (CHeReL). Investigations stratifying by diagnosis, age, sex, socioeconomic status and gene status will be undertaken and reported using descriptive statistics. SW AGHD Registry participants were linked to routinely collected health datasets using probabilistic matching (November 2019). Of 1720 AGHD Registry participants, 1384 had linkages with 11,610 hospital records, 7032 emergency department records and 60 death records. Data assessment and harmonisation were performed, and descriptive data analysis is underway. e intend to provide insights into the healthcare utilisation patterns of in iduals with a genetic heart disease and their at-risk relatives, including frequency of hospital admissions and differences due to factors such as disease, sex and socioeconomic status. Identifying disparities and potential barriers to care may highlight specific healthcare needs (e.g. between sexes) and factors impacting healthcare access and utilisation. > ERR1-10.2196/48636
Publisher: The Sax Institute
Date: 2017
DOI: 10.17061/PHRP2731726
Abstract: Although clinical trials recommend that women with hormone-dependent primary breast cancer remain on endocrine therapy for at least 5 years, up to 60% discontinue treatment early. We determined whether these women had consulted with clinicians or had investigations for cancer recurrence or metastasis around the time they discontinued endocrine therapy, and whether clinical contact continued after discontinuation. We performed case-control and cohort studies of women from the 45 and Up Study who were diagnosed with invasive primary breast cancer between January 2003 and December 2008, and who had ≥12 months of anastrozole, exemestane, letrozole or tamoxifen subsequently dispensed. Women who consulted general practitioners and surgeons/oncologists, and women who had breast ultrasound/mammogram were just as likely to discontinue endocrine therapy within 30 days as those who did not consult these clinicians or have this investigation. In the 6 months after early discontinuation, women who discontinued endocrine therapy were less likely to consult general practitioners (adjusted risk ratio [RRadj] 0.80 95% confidence interval [CI] 0.75, 0.86) and surgeons/oncologists (RRadj 0.62 95% CI 0.54, 0.72) than those who remained on therapy. For most women, endocrine therapy discontinuation did not appear to follow consultation with doctors managing their breast cancer treatment or investigations for recurrence or metastasis. However, women who discontinued endocrine therapy were less likely to consult their general practitioner or surgeon/oncologist in the 6 months following discontinuation than those who remained on therapy. Of the clinician groups studied, general practitioners are best placed to engage and support women to continue pharmacotherapy. However, mechanisms are needed to prompt clinicians to do this at every visit.
Publisher: Elsevier BV
Date: 03-2014
Publisher: Swansea University
Date: 21-08-2018
Abstract: IntroductionStudies in the general population suggest that varenicline is more effective than nicotine replacement therapy (NRT) for smoking cessation. However, clinical guidelines recommend against the use of varenicline during pregnancy and suggest NRT be used when the expected benefits outweigh the potential risks. Objectives and ApproachWe evaluated whether varenicline was more effective than NRT for smoking cessation when used during pregnancy. Routinely-collected records of all births (01/01/2011-12/31/2012) in New South Wales and Western Australia were used to identify a cohort of women who smoked during the first 20 weeks of pregnancy. Pharmaceutical dispensing data were then linked to identify varenicline or NRT dispensing in the first 20 weeks of pregnancy. Smoking cessation was defined as women reported not smoking after the first 20 weeks of pregnancy. Inverse probability of treatment weighting with propensity scores were used to account for differences between the two treatment groups. ResultsOverall, 117 women used varenicline and 135 NRT in the first 20 weeks of pregnancy. In the unweighted s le, more women who used varenicline quit smoking after the first 20 weeks than women using NRT (28.2% vs. 11.1%, crude rate difference:17.1%, 95% confidence intervals[CI]:7.4-26.8%). In the weighted s le, quitting rate was 12.7% (95%CI:0.8-24.6%) higher in pregnant smokers who used varenicline (27.4% vs. 14.7%) when compared to those who used NRT. Conclusion/ImplicationsPregnant smokers using varenicline were more likely to quit smoking than those using NRT. This information will assist healthcare providers to make informed recommendations, but data regarding safety of varenicline in pregnancy are also urgently needed. Future studies with greater statistical power are required to confirm our results.
Publisher: JMIR Publications Inc.
Date: 20-09-2023
DOI: 10.2196/48636
Publisher: SAGE Publications
Date: 10-2015
Abstract: Antidepressant use is widespread. While weight gain is a commonly reported side-effect of antidepressant use and has the potential to affect population health, there is little large-scale population-based evidence on the issue, particularly for long-term use (⩾12 months). The aim of this study is to investigate the association between antidepressant use and weight change, including whether this relationship varies according to antidepressant class, recency of use, duration of use and dose. Annual percentage weight change was calculated from self-reported weight at two time-points from 20,751 participants aged ⩾45 years from the 45 and Up Study – a population-based cohort study from New South Wales, Australia. Antidepressant use, ascertained from linked pharmaceutical data, from 19 months before baseline until end of follow-up (mean = 3.3 years of follow-up), was categorised as current, past-only, non-persistent or non-use. The association between antidepressant use and weight change was modelled using linear and multinomial logistic regressions and according to antidepressant class, recency, duration and dose. Antidepressants were dispensed to 23% of participants ( n = 4748) during the study period. Current antidepressant users were significantly more likely to gain % of their body weight annually than non-users (adjusted relative risk ratio = 1.19 95% confidence interval: [1.03, 1.38]) the risk increased with increasing dose among current users ( p[trend] = 0.003). Risk of weight gain did not vary significantly according to antidepressant class, recency or duration of use however, statistical power was limited. No significant associations were found between antidepressant use and weight loss. Current antidepressant use was associated with modest but statistically significant annual gains in weight, with similar effects observed across the different classes of antidepressants used.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.FERTNSTERT.2016.04.035
Abstract: To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. Population-based retrospective descriptive study. Not applicable. All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). Records from statutory statewide data collections of hospitals separations and births were extracted and linked. Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89 95% CI, 0.82-0.97) and Mirena (RR = 0.81 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70 95% CI, 0.61-0.81). Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.
Publisher: BMJ
Date: 06-2017
Publisher: Elsevier BV
Date: 07-2020
Publisher: SAGE Publications
Date: 04-2010
DOI: 10.1258/JHSRP.2009.009059
Abstract: To compare the predictors of self-reported medicine underuse due to cost across countries with different pharmaceutical subsidy systems and co-payments. We analysed data from a 2007 survey of adults in Australia, Canada, Germany, the Netherlands, New Zealand (NZ), the United Kingdom (UK) and the United States (US). The predictors of underuse were calculated separately for each country using multivariate poisson regression. Reports of underuse due to cost varied from 3% in the Netherlands to 20% in the US. In Australia, Canada, NZ, the UK and the US, cost-related underuse was predicted by high out-of-pocket costs (RR range 2.0-4.6), below average income (RR range 1.9-3.1), and younger age (RR range 3.9-16.4). In all countries except Australia and the UK, history of depression was associated with cost-related underuse (RR range 1.2- 4.1). In Australia, Canada, Germany, the UK and the US lack of patient involvement in treatment decisions was associated with cost-related underuse (RR range 1.2-1.4). In Australia, Canada and NZ, indigenous persons more commonly reported underuse due to cost (RR range 2.1-2.9). Cost-related underuse of medicines was least commonly reported in countries with the lowest out-of-pocket costs, the Netherlands and the UK. Countries with reduced co-payments or cost ceilings for low income patients showed the least disparity in rates of underuse between income groups. Despite differences in health insurance systems in these countries, age, ethnicity, depression, and involvement with treatment decisions were consistently predictive of underuse. There are opportunities for policy makers and clinicians to support medicine use in vulnerable groups.
Publisher: Swansea University
Date: 18-04-2017
Abstract: ABSTRACTObjectivesAlthough outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90%, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources. ApproachWe performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis. ResultsA total of 217 women (9.0%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3%. Recurrence was significantly higher for women with node-positive (4.8% vs. 2.5% annually, adjHR=1.7, 95%CI=1.3-2.3) or hormone receptor-negative (3.8% vs. 3.1% annually, adjHR=1.3, 95%CI=1.0-1.7) tumours. Women with tumours cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8% vs. 2.7 annually, adjHR=1.5 95%CI=1.1-2.0). ConclusionsWomen with breast cancer in this Australian cohort experienced recurrence at 3.3%pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.
Publisher: Elsevier BV
Date: 2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.FERTNSTERT.2013.11.127
Abstract: To evaluate the risk of ectopic pregnancy (EP) associated with different methods of tubal sterilization. Population-based retrospective cohort study. Hospitals in Western Australia. All women aged 18-44 years undergoing tubal sterilization between 1990 and 2010 at Western Australian hospitals (n = 44,829). Data on tubal sterilization were extracted from hospital records. Long-term risk of EP. There were 89 EPs recorded during the observation period in women previously sterilized. The 10-year and 15-year cumulative probability of EP for all methods of tubal sterilization were 2.4/1,000 and 2.9/1,000 procedures, respectively. The 10-year cumulative probability of EP was 3.5 times higher in women sterilized before the age of 28 years than in those sterilized after the age of 33 years. An increased risk of EP existed in women who received laparoscopic partial salpingectomy (adjusted hazard ratio = 14.57, 95% confidence interval 3.50-60.60) and electrodestruction (adjusted hazard ratio = 5.65, 95% confidence interval 2.38-13.40), compared with those who had laparoscopic unspecified destruction of fallopian tubes. Women undergoing tubal sterilization at a young age are at particular risk for subsequent EP. The risk among younger women doubled between 5 and 15 years after sterilization. Laparoscopic electrodestruction and partial salpingectomy carried the highest risk of EP.
Publisher: SAGE Publications
Date: 2013
DOI: 10.1258/JHSRP.2012.011184
Abstract: To determine the cost of medicines for selected chronic illnesses and the proportion of discretionary income this would potentially displace for households with different pharmaceutical subsidy entitlements and incomes. We analysed household income and expenditure data for 9,774 households participating in two Australian surveys in 2009-10. The amount of ‘discretionary’ income available to households after basic living and health care expenditure was modelled for households with high pharmaceutical subsidies: pensioner and non-pensioner concessional (social security entitlements) and households with general pharmaceutical subsidies and low, middle or high incomes. We calculated the proportion of discretionary income that would be needed for medicines if one household member had diabetes or acute coronary syndrome, or if one member also had two co-existing illnesses (gastro-oesophageal reflux disease and depression, or asthma and osteoarthritis). Pensioner and low income households had little discretionary income after basic living and health care expenditure (AUD$92 and $164/week, respectively). Medicines for the specified illnesses ranged from $11-$42/month for high subsidy households and $34-$186/month for low subsidy households. Costs reduced substantially once patients reached the annual pharmaceutical cap (safety net), prior to which medicine costs would displace the equivalent of 1%-10% of discretionary income for most household types. However, low income households would have to forego the equivalent of between 5%-26% of their discretionary income for between 7 and 9 months of the year before receiving additional subsidies. Prescription medicines for chronic conditions pose a substantial financial burden to many households, particularly those with low incomes and general pharmaceutical subsidies. Policies are needed to minimize the cost burden of prescription medicines, particularly for low-income working households.
Publisher: Wiley
Date: 27-07-2022
DOI: 10.1002/PDS.5508
Abstract: National regulators in Australia and the United Kingdom issued safety advisories on the association between pioglitazone use and bladder cancer in July 2011. The Australian advisory noted that males were at higher risk of bladder cancer than females, while the UK advisory highlighted a new recommendation, suggest careful consideration in the elderly due to increasing risk with age. This study examined whether these differences in the advisories had different age‐ and sex‐based impacts in each country. Interrupted time series analysis was used to compare pioglitazone use (prescriptions/100000 population) in Australia and the United Kingdom for the 24 months before and 11 months after the July 2011 safety advisories (study period July 2009–June 2012). Separate models were used to compare use by sex and age group (≥65 years vs. years) in each country. Pioglitazone use fell in Australia (17%) and the United Kingdom (24%) following the safety advisories. Use of pioglitazone fell more for males (18%) than females (16%) in Australia, and more for females (25%) than males (23%) in the United Kingdom however, neither difference was statistically significant (Australia p = 0.445, United Kingdom p = 0.462). Pioglitazone use fell to a similar extent among older people than younger people in the United Kingdom (23% vs. 26%, p = 0.354), and did not differ between age groups in Australia (both 18%, p = 0.772). The results indicate that differences in the Australian and UK safety advisories resulted in substantial reductions in pioglitazone use at the population level in both countries, however, differences by sub‐groups were not observed.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1086/444510
Publisher: IEEE
Date: 11-2017
Publisher: SAGE Publications
Date: 23-10-2015
Abstract: Australia has a growing number of graduate-entry medical courses. It is known that undergraduate medical students have high levels of psychological distress however, little is known about graduate-entry medical students. We examined whether graduate-entry medical students had higher levels of psychological distress than the same-age general population. Psychological distress was assessed in 122 graduate-entry medical students in an Australian graduate-entry medical school using the 21-item Depression Anxiety and Stress Scale. Mean scores and the proportion of students with scores in the highly distressed range were compared with non-clinical population norms. Scores were also compared across demographic characteristics. Medical students reported higher mean depression, anxiety and stress scores than the general population and were more likely to score in the moderate to extremely high range for anxiety (45% vs. 13% p .001) and stress (17% vs. 13% p=0.003). Anxiety and stress were higher in students aged ≥30 years than in younger students. Despite their maturity, graduate-entry students experienced high psychological distress. Anxiety and stress were higher, not lower, with increasing age. Our results suggest that graduate-entry medical students warrant the same level of concern as their school-leaving counterparts. Further interventions to support these students during medical school are warranted.
Publisher: Public Library of Science (PLoS)
Date: 02-12-2013
Publisher: Wiley
Date: 02-06-2017
DOI: 10.1111/DME.13148
Abstract: To examine the appropriateness of medicine use and potentially high-risk prescribing before and after hospitalization for diabetes. A retrospective cohort study of patients hospitalized for diabetes was conducted using administrative data from the Australian Government Department of Veterans' Affairs for the period between 1 January 2012 and 31 December 2012. The appropriateness of medicine use and potentially high-risk prescribing, including hyper-polypharmacy and associated treatment conflicts, were examined for the 120-day periods before and after hospitalization. A total of 876 patients were hospitalized for a diabetes-related complication. Of these, 25% were not dispensed an antidiabetic medicine 4 months before hospitalization and 25% had not had their HbA This study has identified poor medication-related care and, in particular, high-risk-prescribing in people subsequently hospitalized for diabetes. While diabetes medicine use improved after hospitalization, there was little change in potentially inappropriate medicine use, which suggests that an opportunity to improve medication use in this older vulnerable population has been missed.
Publisher: Medknow
Date: 2019
Publisher: BMJ
Date: 08-04-2017
DOI: 10.1136/BJOPHTHALMOL-2016-310070
Abstract: To determine the background incidence rate of retinal detachment (RD) in Western Australia (WA) between 2000 and 2013, identify sociodemographic features associated with increased risk of incident RD and examine trends in surgical repair technique. A whole-population retrospective observational study of all people in WA was carried out using linked hospital inpatient records. Cases of RD were identified using a combination of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-AM (Australian modification) diagnosis and procedure codes from routinely collected hospital inpatient data provided by the WA Data Linkage Branch. A Poisson regression model was used to examine the influence of age group, gender, season and year of surgery on RD incidence rates. Age-standardised and sex-standardised incidence of first-eye RD and incidence rate ratio (IRR) of first-eye RD associated with age, sex and season. Counts of RD repair according to surgical technique. There were 4376 first-eye RD between 2000 and 2013. Age-standardised incidence ranged between 12.78 and 16.20 cases per 1 00 000 person-years. After adjusting for age, year and season, males had a higher risk than females for incident detachment (IRR 1.82, 95% CI (CI) 1.71 to 1.93), as did those aged 60-79 years (IRR 33.26, 95% CI 27.60 to 40.08) compared with those aged less than 20 years. RD repair with vitrectomy alone increased by 59% over the study period. The incidence of first-eye RD remained stable between 2000 and 2013. The risk was higher in males and with older age.
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.00671
Abstract: To identify factors that contribute to older Australians admitted to hospital with diabetes being re-hospitalised within 30 days of discharge. A retrospective cohort study of Department of Veterans' Affairs administrative data for all patients hospitalised for diabetes and discharged alive during the period 1 January - 31 December 2012. Causes of re-hospitalisation and prevalence of clinical factors associated with re-hospitalisation within 30 days of discharge. Multivariate logistic regression analysis (backward stepwise) was used to identify characteristics predictive of 30-day re-hospitalisation. 848 people were hospitalised for diabetes their median age was 87 years (interquartile range, 77-89 years) and 60% were men. 209 patients (24.6%) were re-hospitalised within 30 days of discharge, of whom 77.5% were re-admitted within 14 days of discharge. 51 re-hospitalisations (24%) were for diabetes-related conditions 41% of those re-admitted within 14 days had not seen their general practitioner between discharge and re-admission. Factors predictive of re-hospitalisation included comorbid heart failure (adjusted odds ratio [aOR], 1.49 95% confidence interval [CI], 1.03-2.17 P = 0.036), numbers of prescribers in previous year (aOR [for each additional prescriber], 1.06 95% CI, 1.01-1.08 P = 0.031), and two or more hospitalisations in the 6 months before the index admission (aOR, 1.79 95% CI 1.15-2.78 P = 0.009). Older people hospitalised for diabetes who have comorbid heart failure, multiple recent hospitalisations, and multiple prescribers involved in their care are at greatest risk of being re-admitted to hospital within 30 days. Targeted follow-up during the initial 14 days after discharge may facilitate appropriate interventions that avert re-admission of these at-risk patients.
No related grants have been discovered for Anna Kemp-Casey.