ORCID Profile
0000-0001-6828-1564
Current Organisation
University of South Australia
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-039579
Abstract: To evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears. A prospective cohort intervention. The intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178). An interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms. In the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p .001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups. The intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2022
Publisher: SAGE Publications
Date: 28-08-2020
Abstract: At least half of all residents of Australian residential aged care facilities have dementia. Most residents living with dementia will at some stage experience behavioural and psychological symptoms of dementia (BPSD), which can be challenging to manage and distressing for the resident, their family and carers. This literature review examined the prevalence of antipsychotic use in Australian residential aged care facilities, which may be used to manage BPSD only after non-pharmacological treatments have failed. Sixteen studies assessing care between 2000 and 2017 were identified and reviewed. The proportion of residents prescribed an antipsychotic ranged from 13% to 42%. Evidence from six Australian interventions showed that the antipsychotic use can be reduced, especially when non-pharmacological interventions that are in idualised to the person and the behaviour are implemented. Research has shown that antipsychotics can be tapered and ceased without re-emergence of behavioural symptoms in many instances. Multidisciplinary, multi-strategic approaches have demonstrated effectiveness in reducing antipsychotic use by up to 3% (absolute reduction) in the aged-care setting.
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-038016
Abstract: Educational, and audit and feedback interventions are effective in promoting health professional behaviour change and evidence adoption. However, we lack evidence to pinpoint which particular features make them most effective. Our objective is to identify determinants of quality in professional behaviour change interventions, as perceived by participants. We performed a comparative observational study using data from the Veterans’ Medicines Advice and Therapeutics Education Services program, a nation-wide Australian Government Department of Veterans’ Affairs funded program that provides medicines advice and promotes physician adoption of best practices by use of a multifaceted intervention (educational material and a feedback document containing in idual patient information). Primary care practices providing care to Australian veterans. General practitioners (GPs) targeted by 51 distinct behaviour change interventions, implemented between November 2004 and June 2018. We extracted features related to presentation (number of images, tables and characters), content (polarity and subjectivity using sentiment analysis, number of external links and medicine mentions) and the use of five behaviour change techniques (prompt/cues, goal setting, discrepancy between current behaviour and goal, information about health consequences, feedback on behaviour). The main outcome was perceived usefulness, extracted from postintervention survey. On average, each intervention was delivered to 9667 GPs. Prompt and goal setting strategies in the audit and feedback were independently correlated to perceived usefulness (p=0.030 and p=0.005, respectively). The number of distinct behaviour change techniques in the audit and feedback was correlated with improved usefulness (Pearson’s coefficient 0.45 (0.19, 0.65), p=0.001). No presentation or content features in the educational material were correlated with perceived usefulness. The finding provides additional evidence encouraging the use of behaviour change techniques, in particular prompt and goal setting, in audit and feedback interventions.
Publisher: Weston Medical Publishing
Date: 18-03-2020
Abstract: Introduction and aims: Mental health disorders and substance abuse are risk factors that both precede and follow chronic opioid use. We predicted that incident opioid users would have lower rates of mental health comorbidities than chronic opioid users, but that incident chronic opioid users would have lower rates of mental health comorbidities than prevalent chronic users.Design and methods: We used administrative health claims data to evaluate differences in lifetime mental health and substance abuse comorbidity profiles of people who were prevalent and incident chronic opioid users, as well as those who used opioids acutely. Results were stratified by age.Results: Over 5,188 people were prevalent chronic opioid users at study entry. Of the 10,079 people who initiated opioids, 10.2 percent had a subsequent chronic episode (incident chronic) and the remainder stopped within 90 days (incident acute). In prevalent chronic users compared to incident chronic users, rates of depression and anxiety were higher across all age groups (odds ratio (OR) across age groups range from = 1.60, 95 percent confidence interval (CI) = 1.35,1.89, to OR = 6.66, 95 percent CI = 3.02, 14.69) and prevalence of alcohol abuse was higher in those aged 55 to 74 years (OR = 5.11, 95 percent CI = 1.83, 14.24, p = 0.002). Acute users were less likely than incident chronic users to have depression and anxiety in those aged over 74 years (depression OR = 0.82, 95 percent CI = 0.70, 0.95 anxiety OR = 0.82, 95% CI 0.70, 0.98).Conclusions: Mental health morbidities commonly associated with chronic opioid use increase in prevalence as chronic use continues.
Publisher: Wiley
Date: 08-2018
DOI: 10.1002/PDS.4629
Publisher: BMJ
Date: 2017
Publisher: Informa UK Limited
Date: 24-07-2019
Publisher: Weston Medical Publishing
Date: 2019
Abstract: Objective: Work that has shown a relationship between anxiety and chronic opioid use has not focused on older people specifically, despite the additional risks in older populations. This study aimed to understand whether anxiety prior to opioid initiation increased the likelihood of chronic opioid use over time in persons aged 60 years or older.Design: Administrative claims data were used to calculate time between initiation of opioids and a first chronic episode of opioid use. Patients were classified as having a history of anxiety if they were dispensed medicines in the anxiolytics class or had a hospitalization event for anxiety prior to treatment with an opioid. Proportional hazards models were used to compare the likelihood of experiencing a chronic episode of opioid use between those with and without a history of anxiety.Results: The cohort was 15,000 persons, of which, 5,076 (34 percent) had history of anxiety. Those with anxiety prior to their first opioid dispensing were 30 percent more likely to have an episode of chronic use after adjustment for age, gender, number of comorbidities, and prior surgery (HR = 1.30, 95% CI = 1.16-1.47). The risk of a chronic episode in patients who had surgery prior to initiation of an opioid was 60 percent greater in those with anxiety compared to no anxiety (HR = 1.60, 95% CI = 1.21-2.11) and 24 percent greater in those with anxiety but no prior surgery (HR = 1.24, 95% CI = 1.08-1.42).Conclusions: A significant proportion of older people will have a chronic episode of opioid use. This risk is increased where a history of anxiety is present.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-023990
Abstract: To determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids. Retrospective cohort study using administrative health claims database from the Australian Government Department of Veterans’ Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds. The outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge. In 2014–2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%. Opioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.
Publisher: Wiley
Date: 09-03-2020
DOI: 10.1111/ADJ.12750
Publisher: Springer Science and Business Media LLC
Date: 22-08-2018
DOI: 10.1007/S10803-018-3718-3
Abstract: Based on data from the Longitudinal Study of Australian Children linked with pharmacy dispensing data from the Australian Government's Pharmaceutical Benefits Scheme, we calculated the 1-year prevalence of psychotropic medicine supply in children and adolescents with Autism Spectrum Disorder (ASD) as reported by parents in 2014. The majority of children and adolescents with ASD in Australia were not treated with psychotropic medicine. One-third had claims for at least one psychotropic medication, most commonly medications for attention-deficit/hyperactivity disorder (ADHD), and antidepressants. Antipsychotics were supplied to less than one in twenty children and approximately one in ten adolescents. In line with findings from North America, psychotropic medicine was more often supplied to children and adolescents with ASD and comorbid ADHD.
No related grants have been discovered for Anna Moffat.