ORCID Profile
0000-0003-4901-4182
Current Organisation
UNSW Sydney
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: Springer Science and Business Media LLC
Date: 05-06-2021
DOI: 10.1186/S12913-021-06593-Z
Abstract: MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. It is one of the largest and most widely used primary health care EHR databases in Australia. This study examined the validity of algorithms that use information from various fields in the MedicineInsight data to indicate whether patients have specific health conditions. This study examined the validity of MedicineInsight algorithms for five common chronic conditions: anxiety, asthma, depression, osteoporosis and type 2 diabetes. Patients’ disease status according to MedicineInsight algorithms was benchmarked against the recording of diagnoses in the original EHRs. Fifty general practices contributing data to MedicineInsight met the eligibility criteria regarding patient load and location. Five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected from the MedicineInsight database. Trained staff reviewed the original EHR for as many of the selected patients as possible within the time available for data collection in each practice. A total of 475 patients were included in the analysis. All the evaluated MedicineInsight algorithms had excellent specificity, positive predictive value, and negative predictive value (above 0.9) when benchmarked against the recording of diagnoses in the original EHR. The asthma and osteoporosis algorithms also had excellent sensitivity, while the algorithms for anxiety, depression and type 2 diabetes yielded sensitivities of 0.85, 0.89 and 0.89 respectively. The MedicineInsight algorithms for asthma and osteoporosis have excellent accuracy and the algorithms for anxiety, depression and type 2 diabetes have good accuracy. This study provides support for the use of these algorithms when using MedicineInsight data for primary health care quality improvement activities, research and health system policymaking and planning.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2018
Publisher: Wiley
Date: 16-11-2022
DOI: 10.1111/JVH.13629
Abstract: The availability of direct‐acting antivirals (DAAs) sparked efforts to eliminate hepatitis C virus (HCV) in Australia. We evaluated whether an educational intervention of a 1‐h discussion among staff using audit and feedback data from the MedicineInsight GP programme would improve DAA uptake. Of 296 eligible general practices in MedicineInsight, 11% opted out. Randomization stratified by practice caseload allocated 130 practices to the intervention arm and 129 to control. The primary outcome was the number of patients started on DAAs over 6 months using the negative binomial regression model adjusted for DAA prescription history and clustering by practice. Data for analysis were available for 78% of practices, which included 101 practices and 2469 DAA‐naive patients with confirmed ossible HCV in the intervention arm, and 100 practices and 2466 patients in the control arm. At baseline, 49.5% of practices had prescribed ≥1 DAA in the past year 18.9% of HCV patients had already been treated with DAAs the mean age of DAA‐naive HCV patients was 43 years old, and 57% were men. Over 6 months, 43 patients in the intervention arm and 36 in the control arm started DAAs (adjusted IRR 1.19 95% CI 0.67–2.11, p = 0.55). In the first 3 months, 27 vs 16 patients started DAAs (adjusted IRR 1.77, 0.88–3.58 p = 0.111). Few patients were started on DAAs, and a facilitated discussion in HCV management did not lead to a significant increase. Alternative measures, such as incentivizing GP initiations or patients, are suggested to address remaining barriers to DAA uptake in Australian primary care. Australian New Zealand Clinical Trial Registry (ANZCTR) Registration Number: ACTRN12619000508178p.
Publisher: Wiley
Date: 15-03-2020
DOI: 10.1111/AJD.13268
Publisher: Wiley
Date: 18-06-2021
DOI: 10.1002/JGH3.12593
Abstract: The primary objective of this study was to determine whether the characteristics of patients prescribed direct acting antiviral (DAA) medicines have changed since initial listing of the medicines on the Australian Pharmaceutical Benefits Scheme (PBS). A cross‐sectional study was conducted using data from MedicineInsight, an Australian database of general practice electronic health records, from March 2016 to August 2018. We compared sociodemographic, comorbidity, and clinical characteristics of patients aged at least 18 years who were prescribed at least one DAA in the first 4 months of PBS listing in 2016 with those prescribed at least one DAA in 2018. There were 2251 eligible adult patients prescribed a DAA during the study period, 62% were men and 59% were aged 50 years and older. Patients prescribed DAA medicines initially were older (aged ≥50 years: 67.9% vs 49.3% P 0.001), and more likely to have liver cirrhosis (14.2% vs 8.4% P = 0.01) and an aminotransferase to platelet ratio index (APRI) score (20.4% vs 8.9% P 0.001) than those prescribed DAA medicines in 2018. A greater proportion of patients in regional/remote (46.5% vs 35.6% P 0.001) and socioeconomically disadvantaged areas (44.4% vs 34.5% P = 0.003) accessed treatment in 2018 compared with 2016. Despite evidence of decreasing uptake of DAA medicines across Australia, this study indicates broadened uptake among younger age groups and those residing in regional/remote and socioeconomically disadvantaged areas since 2016. While uptake of DAA medicines in some population subgroups appears to have improved, continuous efforts to improve uptake across the Australian population are essential.
Publisher: Royal College of General Practitioners
Date: 10-11-2020
DOI: 10.3399/BJGPOPEN20X101120
Abstract: In 2013 pregabalin was subsidised by Australia’s Pharmaceutical Benefits Scheme (PBS) for neuropathic pain. Since the subsidy, pregabalin prescribing has been increasing in Australia and so has related harm. There are concerns it is being prescribed for indications other than neuropathic pain, which have little evidence of efficacy. To describe pregabalin prescribing in Australian general practice. A cross-sectional study of patients attending 445 general practice sites in the national MedicineInsight database from March 2012–February 2018. The following aspects were calculated: the proportion of prescriptions that were for pregabalin per year the prevalence of pain conditions in patients prescribed pregabalin and same-day prescribing of pregabalin with opioids or benzodiazepines. Prescribing increased from 13 per 10 000 to 104 per 10 000 prescriptions between 2012–2013 and 2017–2018. A total of 1 891 623 patients were identified of whom 114 123 (6.0%) were prescribed pregabalin 49.7% ( n = 56 772) had a recorded diagnosis of neuropathic pain. Among people prescribed pregabalin without a recorded diagnosis of neuropathic pain, 43.5% ( n = 24 927) had a diagnosis of back problems, 8.8% ( n = 5073) chronic pain, and 26.4% ( n = 30 146) had no pain diagnosis. Pregabalin was prescribed the same day as an opioid to 38.1% of patients (95% confidence interval [CI] = 37.1% to 39.1%) and a benzodiazepine to 13.1% of patients (95% CI = 12.5% to 13.7%). Patients with a diagnosis of chronic pain had the highest rate of same-day prescribing of pregabalin with an opioid (70.4%, 95% CI = 68.9% to 71.9%) or a benzodiazepine (25.8%, 95% CI = 24.2% to 27.4%) Substantial increases in pregabalin prescribing were identified in Australian general practice, but only half of patients had a neuropathic pain diagnosis recorded, the only approved indication for subsidy. High rates of same-day prescribing with opioids and benzodiazepines may put patients at increased risk of harm.
Publisher: Swansea University
Date: 29-06-2022
Abstract: IntroductionMedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. Previous research validated algorithms used to derive medical condition flags in MedicineInsight, but the accuracy of data fields following EHR extractions from clinical practices and data warehouse transformation processes have not been formally validated. ObjectivesTo examine the accuracy of the extraction and transformation of EHR fields for selected demographics, observations, diagnoses, prescriptions, and tests into MedicineInsight. MethodsWe benchmarked MedicineInsight values against those recorded in original EHRs. Forty-six general practices contributing data to MedicineInsight met our eligibility criteria, eight were randomly selected, and four agreed to participate. We randomly selected 200 patients ≥ 18 years of age within each participating practice from MedicineInsight. Trained staff reviewed the original EHRs for the selected patients and recorded data from the relevant fields. We calculated the percentage of agreement (POA) between MedicineInsight and EHR data for all fields Cohen's Kappa for categorical and intra-class correlation (ICC) for continuous measures and sensitivity, specificity, and positive and negative predictive values (PPV/NPV) for diagnoses. ResultsA total of 796 patients were included in our analysis. All demographic characteristics, observations, diagnoses, prescriptions and random pathology test results had excellent ( 90%) POA, Kappa, and ICC. POA for most recent pathology/imaging test was moderate (81%, [95% CI: 78% to 84%]). Sensitivity, specificity, PPV, and NPV were excellent ( 90%) for all but one of the examined diagnoses which had a poor PPV. ConclusionsOverall, our study shows good agreement between the majority of MedicineInsight data and those from original EHRs, suggesting MedicineInsight data extraction and warehousing procedures accurately conserve the data in these key fields. Discrepancies between test data may have arisen due to how data from pathology, radiology and other imaging providers are stored in EHRs and MedicineInsight and this requires further investigation.
Publisher: Oxford University Press (OUP)
Date: 10-07-2019
DOI: 10.1093/IJE/DYZ147
Publisher: CSIRO Publishing
Date: 28-02-2022
DOI: 10.1071/AH21129
Abstract: Objective To support improving participation in the National Bowel Cancer Screening Program (NBCSP), we aimed to identify Medicare-subsidised test requests for immunochemical faecal occult blood tests (FOBT) in Australian general practice for patients aged 50–74 years, eligible for the NBCSP, and describe sociodemographics, risk factors, indications and outcomes. Methods A cross-sectional study was conducted using de-identified data from 441 Australian general practice sites in the MedicineInsight database, recorded from 1 January 2018 to 31 December 2019. Results Of the 683 625 eligible patients, 45 771 (6.7%) had a record of a general practitioner (GP)-requested FOBT, either to aid diagnosis in symptomatic patients, or for screening 144 986 (21.2%) patients had only an NBCSP FOBT. A diagnosis of polyps, gastrointestinal inflammatory condition or haemorrhoids, or a referral to a gastroenterologist or general surgeon, was more commonly recorded in the 6 months after a GP-requested FOBT than after an NBCSP FOBT. Uptake of NBCSP FOBTs was lower among those with obesity, high alcohol consumption and current smokers, who are at higher risk of bowel cancer. Conclusions This study describes the patient characteristics, reasons and outcomes associated with GP-requested FOBTs, identifies under-screened population sub-groups, and suggests involvement of GPs to improve participation in the NBCSP.
Publisher: CSIRO Publishing
Date: 26-04-2022
DOI: 10.1071/SH21207
Abstract: Background Pre-exposure prophylaxis (PrEP) became available through the Australian Pharmaceutical Benefits Scheme (PBS) on 1 April 2018 for HIV infection prevention in patients ≥18 years at medium-to-high HIV risk. The aims were to investigate PrEP utilisation in general practice since PBS listing, and factors associated with discontinuation. Methods This longitudinal study included patients aged 18–74 years attending general practices participating in MedicineInsight, a large-scale national primary care database of deidentified electronic health records, between October 2017 and September 2019. Results PrEP utilisation increased 10-fold following PBS listing. On average, patients had 9.7 PrEP prescriptions per year a medication possession ratio of 80.8%. Of 1552 patients prescribed PrEP from April 2018, most were male (98.3%), aged 18–39 years (59.3%), resided in major cities (86.7%) and in the two most socioeconomically advantaged quintiles (70.0%). Almost half (49.1%) of the patients were identified as new to PrEP. At study end, 65.1% were on active PrEP (16.5%, of whom had non-continuous use), 19.2% had discontinued PrEP and 15.7% were lost to follow up. Patients who discontinued were more likely to attend low rather than high PrEP caseload practices (adjusted odds ratio [aOR] 1.7 95% CI: 1.0–2.8 P = 0.047). The odds of non-continuous therapy was 2.9-fold higher in patients with bipolar disorder (aOR 2.89 95% CI: 1.10–7.6 P = 0.045). Conclusions Following PBS listing, PrEP utilisation increased and stopping therapy was associated with attending low caseload practices. General practice education, particularly among low caseload practices, could help address these disparities.
Publisher: Informa UK Limited
Date: 28-05-2021
Publisher: Informa UK Limited
Date: 06-2014
DOI: 10.2147/PPA.S58046
Publisher: Elsevier BV
Date: 05-2020
Publisher: Springer Science and Business Media LLC
Date: 22-10-2018
Publisher: The Royal Australian College of General Practitioners
Date: 12-2021
Publisher: Public Library of Science (PLoS)
Date: 27-05-2021
DOI: 10.1371/JOURNAL.PONE.0252458
Abstract: The burden of inflammatory bowel disease (IBD) in Australia is increasing but national data about the current prevalence are limited. We aimed to estimate the prevalence of IBD (including Crohn’s disease, ulcerative colitis and unspecified IBD) as well as Crohn’s disease and ulcerative colitis separately in a general practice population in Australia. We also assessed risk factors associated with Crohn’s disease and ulcerative colitis. We conducted a cross-sectional study using data from MedicineInsight, a national database of general practice electronic health records, from 1 July 2017 to 30 June 2019. The prevalence of IBD was calculated and stratified by sociodemographic characteristics. Logistic regression analysis was conducted to assess risk factors associated with Crohn’s disease and ulcerative colitis. The study comprised 2,428,461 regular patients from 481 practices. The estimated crude prevalence of IBD was 653 per 100,000 patients Crohn’s disease was 306 per 100,000 and ulcerative colitis was 334 per 100,000. Males were independently associated with a lower risk of Crohn’s disease (OR: 0.86 95% CI: 0.81, 0.90) but a greater risk of ulcerative colitis (OR: 1.12 95% CI: 1.06, 1.17) than females. Compared to non-smokers, patients who were current smokers were associated with a greater risk of Crohn’s disease (OR: 1.13 95% CI: 1.04, 1.23) but a lower risk of ulcerative colitis (OR: 0.52 95% CI: 0.47, 0.57). Other factors positively associated with both Crohn’s disease and ulcerative colitis were age (≥ 25 years), non-Indigenous status and socioeconomic advantage. Our findings provide a current estimate of the prevalence of IBD, Crohn’s disease and ulcerative colitis in a large national general practice population in Australia and an assessment of the factors associated with Crohn’s disease and ulcerative colitis. These data can assist in estimating the health burden and costs, and planning for health services.
Publisher: CSIRO Publishing
Date: 15-09-2021
DOI: 10.1071/PY20270
Abstract: Little is known about private-market opioid prescribing and how Australian opioid policies impact prescribing across public and private markets in Australia. We aimed to investigate publicly subsidised and private-market opioid prescribing from 2013 to 2018. We used prescribing records from MedicineInsight, an Australian primary care database, to examine trends in prescriptions for non-injectable opioid formulations from October 2013 to September 2018. We examined annual opioid prescribing trends overall, by opioid agent, and by market (public and private). We further examined patterns of fentanyl patch prescribing focusing on co-prescribed medicines and use in opioid-naïve patients. Opioids accounted for 8% of all prescriptions over the study period and 468 893 patients were prescribed at least one opioid of interest. Prescribing rates for oxycodone/naloxone and tapentadol increased, whereas those for fentanyl patches, morphine and single-agent oxycodone decreased over the study period. Private-market prescribing rates of codeine (schedule 4) increased notably following its up-scheduling to prescription-only status. Among patients prescribed fentanyl patches, 29% were potentially opioid-naïve and 49% were prescribed another opioid on the same day. The private-medicines market is a small but growing component of opioid use in Australia and one way in which prescribers and patients can avoid access restrictions in the public market for these medicines. Although fentanyl patch prescribing declined, there is room for improvement in prescribing fentanyl patches among opioid-naïve patients, and co-prescribing of fentanyl patches with other sedatives.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Kendal Chidwick.