9 results on '"Wesselingh, Steve L."'
Search Results
2. Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
- Author
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Sluggett, Janet K., Caughey, Gillian E., Air, Tracy, Moldovan, Max, Lang, Catherine, Martin, Grant, Carter, Stephen R., Jackson, Shane, Stafford, Andrew C., Wesselingh, Steve L., and Inacio, Maria C.
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- 2022
- Full Text
- View/download PDF
3. Predictors of mortality shortly after entering a long-term care facility.
- Author
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Jorissen, Robert N, Wesselingh, Steve L, Whitehead, Craig, Maddison, John, Forward, John, Bourke, Alice, Harvey, Gillian, Crotty, Maria, Collaborators, STAAR-SA Study, and Inacio, Maria C
- Subjects
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RISK assessment , *PREDICTION models , *AUSTRALIANS , *RESEARCH funding , *HEALTH status indicators , *LONG-term health care , *SEX distribution , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *LONGITUDINAL method , *NURSING care facilities , *CONFIDENCE intervals , *DRUGS , *PROPORTIONAL hazards models , *ACTIVITIES of daily living ,MORTALITY risk factors - Abstract
Objective Moving into a long-term care facility (LTCF) requires substantial personal, societal and financial investment. Identifying those at high risk of short-term mortality after LTCF entry can help with care planning and risk factor management. This study aimed to: (i) examine individual-, facility-, medication-, system- and healthcare-related predictors for 90-day mortality at entry into an LTCF and (ii) create risk profiles for this outcome. Design Retrospective cohort study using data from the Registry of Senior Australians. Subjects Individuals aged ≥ 65 years old with first-time permanent entry into an LTCF in three Australian states between 01 January 2013 and 31 December 2016. Methods A prediction model for 90-day mortality was developed using Cox regression with the purposeful variable selection approach. Individual-, medication-, system- and healthcare-related factors known at entry into an LTCF were examined as predictors. Harrell's C-index assessed the predictive ability of our risk models. Results 116,192 individuals who entered 1,967 facilities, of which 9.4% (N = 10,910) died within 90 days, were studied. We identified 51 predictors of mortality, five of which were effect modifiers. The strongest predictors included activities of daily living category (hazard ratio [HR] = 5.41, 95% confidence interval [CI] = 4.99–5.88 for high vs low), high level of complex health conditions (HR = 1.67, 95% CI = 1.58–1.77 for high vs low), several medication classes and male sex (HR = 1.59, 95% CI = 1.53–1.65). The model out-of-sample Harrell's C-index was 0.773. Conclusions Our mortality prediction model, which includes several strongly associated factors, can moderately well identify individuals at high risk of mortality upon LTCF entry. [ABSTRACT FROM AUTHOR]
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- 2024
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4. National Trends in Antibiotic Use in Australian Residential Aged Care Facilities, 2005–2016.
- Author
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Sluggett, Janet K, Moldovan, Max, Lynn, David J, Papanicolas, Lito E, Crotty, Maria, Whitehead, Craig, Wesselingh, Steve L, Rogers, Geraint B, and Inacio, Maria C
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ANTIBIOTICS ,CONFIDENCE intervals ,CROSS-sectional method ,REGRESSION analysis ,NURSING care facilities ,RESIDENTIAL care ,DRUG utilization ,ELDER care ,LONG-term health care - Abstract
Background Understanding current patterns of antibiotic use in residential aged care facilities (RACFs) is essential to inform stewardship activities, but limited utilization data exist. This study examined changes in prevalence and consumption of antibiotics in Australian RACFs between 2005–2006 and 2015–2016. Methods This population-based, repeated cross-sectional analysis included all long-term permanent residents of Australian RACFs between July 2005 and June 2016 who were aged ≥ 65 years. The yearly prevalence rate of antibiotic use and number of defined daily doses (DDDs) of systemic antibiotics per 1000 resident-days were determined annually from linked pharmaceutical claims data. Trends were assessed using ordinary least squares regression. Results This study included 502 752 residents from 3218 RACFs, with 424.9 million resident-days analyzed. Antibiotics were dispensed on 5 608 126 occasions during the study period, of which 88% were for oral use. Cefalexin, amoxicillin-clavulanic acid, and trimethoprim were the most commonly dispensed antibiotics. The annual prevalence of antibiotic use increased from 63.8% (95% confidence interval [CI], 63.3%–64.4%) to 70.3% (95% CI, 69.9%–70.7%) between 2005–2006 and 2015–2016 (0.8% average annual increase, P < .001). There was a 39% relative increase in total consumption of systemic antibiotics, with utilization increasing from 67.6 to 93.8 DDDs/1000 resident-days during the study period (average annual increase of 2.8 DDDs/1000 resident-days, P < .001). Conclusions This nationwide study showed substantial increases in both prevalence of use and total consumption of antibiotics in Australian RACFs between 2005 and 2016. The increasingly widespread use of antibiotics in Australian RACFs is concerning and points to a need for enhanced efforts to optimize antibiotic use in this setting. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
5. Provision of a comprehensive medicines review is associated with lower mortality risk for residents of aged care facilities: a retrospective cohort study
- Author
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Janet K Sluggett, Gillian E Caughey, Tracy Air, Max Moldovan, Catherine Lang, Grant Martin, Stephen R Carter, Shane Jackson, Andrew C Stafford, Steve L Wesselingh, Maria C Inacio, Sluggett, Janet K, Caughey, Gillian E, Air, Tracy, Moldovan, Max, Lang, Catherine, Martin, Grant, Carter, Stephen R, Jackson, Shane, Stafford, Andrew C, Wesselingh, Steve L, and Inacio, Maria C
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Aging ,homes for the aged ,hospitalisation ,pharmacists ,Australia ,residential facilities ,General Medicine ,nursing homes ,mortality ,medication therapy management ,Hospitalization ,older people ,aged ,pharmaceutical services ,residential aged care ,treatment outcome ,Homes for the Aged ,Humans ,long-term care ,Accidental Falls ,medication review ,Geriatrics and Gerontology ,Aged ,Retrospective Studies - Abstract
Background no studies have examined the impact of residential medication management review (RMMR, a 24-year government subsidised comprehensive medicines review program) in Australian residential aged care facilities (RACFs) on hospitalisation or mortality. Objective to examine associations between RMMR provision in the 6–12 months after RACF entry and the 12-month risk of hospitalisation and mortality among older Australians in RACFs. Design retrospective cohort study. Subjects individuals aged 65–105 years taking at least one medicine, who entered an RACF in three Australian states between 1 January 2012 and 31 December 2015 and spent at least 6 months in the RACF (n = 57,719). Methods Cox regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for associations between RMMR provision and mortality. Adjusted subdistribution hazard ratios were estimated for associations between RMMR provision and next (i) emergency department (ED) presentation or unplanned hospitalisation or (ii) fall-related ED presentation or hospitalisation. Results there were 12,603 (21.8%) individuals who received an RMMR within 6–12 months of RACF entry, of whom 22.2% (95%CI 21.4–22.9) died during follow-up, compared with 23.3% (95%CI 22.9–23.7) of unexposed individuals. RMMR provision was associated with a lower risk of death due to any cause over 12-months (aHR 0.96, 95%CI 0.91–0.99), but was not associated with ED presentations or hospitalisations for unplanned events or falls. Conclusions provision of an RMMR in the 6–12 months after RACF entry is associated with a 4.4% lower mortality risk over 12-months but was not associated with changes in hospitalisations for unplanned events or falls.
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- 2022
6. Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
- Author
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Janet K. Sluggett, Gillian E. Caughey, Tracy Air, Max Moldovan, Catherine Lang, Grant Martin, Stephen R. Carter, Shane Jackson, Andrew C. Stafford, Steve L. Wesselingh, Maria C. Inacio, Sluggett, Janet K., Caughey, Gillian E., Air, Tracy, Moldovan, Max, Lang, Catherine, Martin, Grant, Carter, Stephen R., Jackson, Shane, Stafford, Andrew C., Wesselingh, Steve L., and Inacio, Maria C.
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Victoria ,Assisted Living Facilities ,Homes for the Aged ,Humans ,Geriatrics and Gerontology ,medication review ,nursing homes ,drug utilization ,Long-Term Care ,Aged ,Retrospective Studies ,medication therapy management - Abstract
Background Residential Medication Management Review (RMMR) is a subsidized comprehensive medicines review program for individuals in Australian residential aged care facilities (RACFs). This study examined weekly trends in medicines use in the four months before and after an RMMR and among a comparison group of residents who did not receive an RMMR. Methods This retrospective cohort study included individuals aged 65 to 105 years who first entered permanent care between 1/1/2012 and 31/12/2016 in South Australia, Victoria, or New South Wales, and were taking at least one medicine. Individuals with an RMMR within 12 months of RACF entry were classified into one of three groups: (i) RMMR within 0 to 3 months, (ii) 3 to 6 months, or (iii) within 6 to 12 months of RACF entry. Individuals without RMMRs were included in the comparison group. Weekly trends in the number of defined daily doses per 1000 days were determined in the four months before and after the RMMR (or assigned index date in the comparison group) for 14 medicine classes. Results 113909 individuals from 1979 RACFs were included, of whom 55021 received an RMMR. Across all three periods examined, decreased use of statins and proton pump inhibitors was observed post-RMMR in comparison to those without RMMRs. Decreases in calcium channel blockers, benzodiazepines/zopiclone, and antidepressants were observed following RMMR provision in the 3–6 and 6–12 months after RACF entry. Negligible changes in antipsychotic use were also observed following an RMMR in the 6–12 months after RACF entry by comparison to those without RMMRs. No changes in use of opioids, ACE inhibitors/sartans, beta blockers, loop diuretics, oral anticoagulants, or medicines for osteoporosis, diabetes or the cognitive symptoms of dementia were observed post-RMMR. Conclusions For six of the 14 medicine classes investigated, modest changes in weekly trends in use were observed after the provision of an RMMR in the 6–12 months after RACF entry compared to those without RMMRs. Findings suggest that activities such as medicines reconciliation may be prioritized when an RMMR is provided on RACF entry, with deprescribing more likely after an RMMR the longer a resident has been in the RACF.
- Published
- 2022
7. National Trends in Antibiotic Use in Australian Residential Aged Care Facilities, 2005–2016
- Author
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Lito E. Papanicolas, Maria C.S. Inacio, Maria Crotty, Janet K. Sluggett, Steven Lodewyk Wesselingh, Craig Whitehead, Geraint B. Rogers, Max Moldovan, David J. Lynn, Sluggett, Janet K, Moldovan, Max, Lynn, David J, Papanicolas, Lito E, Crotty, Maria, Whitehead, Craig, Wesselingh, Steve L, Rogers, Geraint B, and Inacio, Maria C
- Subjects
0301 basic medicine ,Microbiology (medical) ,Drug Utilization ,medicine.medical_specialty ,030106 microbiology ,nursing homes ,03 medical and health sciences ,0302 clinical medicine ,Homes for the Aged ,Humans ,Medicine ,030212 general & internal medicine ,National trends ,Aged care ,Antibiotic use ,Aged ,business.industry ,Australia ,Anti-Bacterial Agents ,Long-term care ,Cross-Sectional Studies ,Infectious Diseases ,Family medicine ,antimicrobial ,long-term care ,drug utilization ,business ,Nursing homes - Abstract
Background Understanding current patterns of antibiotic use in residential aged care facilities (RACFs) is essential to inform stewardship activities, but limited utilization data exist. This study examined changes in prevalence and consumption of antibiotics in Australian RACFs between 2005–2006 and 2015–2016. Methods This population-based, repeated cross-sectional analysis included all long-term permanent residents of Australian RACFs between July 2005 and June 2016 who were aged ≥ 65 years. The yearly prevalence rate of antibiotic use and number of defined daily doses (DDDs) of systemic antibiotics per 1000 resident-days were determined annually from linked pharmaceutical claims data. Trends were assessed using ordinary least squares regression. Results This study included 502 752 residents from 3218 RACFs, with 424.9 million resident-days analyzed. Antibiotics were dispensed on 5 608 126 occasions during the study period, of which 88% were for oral use. Cefalexin, amoxicillin-clavulanic acid, and trimethoprim were the most commonly dispensed antibiotics. The annual prevalence of antibiotic use increased from 63.8% (95% confidence interval [CI], 63.3%–64.4%) to 70.3% (95% CI, 69.9%–70.7%) between 2005–2006 and 2015–2016 (0.8% average annual increase, P Conclusions This nationwide study showed substantial increases in both prevalence of use and total consumption of antibiotics in Australian RACFs between 2005 and 2016. The increasingly widespread use of antibiotics in Australian RACFs is concerning and points to a need for enhanced efforts to optimize antibiotic use in this setting.
- Published
- 2020
8. National trends and policy impacts on provision of home medicines reviews and residential medication management reviews in older Australians, 2009-2019
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Janet K. Sluggett, Luke R. Collier, Jonathan Bartholomaeus, Maria C.S. Inacio, Steven Lodewyk Wesselingh, Gillian E. Caughey, Sluggett, Janet K, Collier, Luke R, Bartholomaeus, Jonathan D, Inacio, Maria C, Wesselingh, Steve L, and Caughey, Gillian E
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medicine.medical_specialty ,Health Personnel ,Health, Toxicology and Mutagenesis ,Service provision ,Medical practitioner ,nursing homes ,Pharmacists ,Article ,medication therapy management ,residential aged care ,Medication therapy management ,medicine ,Humans ,National trends ,Aged care ,medication review ,Aged ,business.industry ,Public Health, Environmental and Occupational Health ,Australia ,Restricted access ,residential facilities ,Interrupted Time Series Analysis ,Long-term care ,Policy ,Family medicine ,Medicine ,long-term care ,Older people ,business - Abstract
Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among older Australians during 2009–2019 and determined the impact of program changes on service provision. Monthly rates of general medical practitioner (GP) HMR claims per 1000 people aged ≥65 years and RMMR claims per 1000 older residents of aged care facilities were determined using publicly available data. Interrupted time series analysis was conducted to examine changes coinciding with dates of program changes. In January 2009, monthly HMR and RMMR rates were 0.80/1000 older people and 20.17/1000 older residents, respectively. Small monthly increases occurred thereafter, with 1.89 HMRs/1000 and 34.73 RMMRs/1000 provided in February 2014. In March 2014, immediate decreases of –0.32 (95%CI –0.52 to –0.11) HMRs/1000 and –12.80 (95%CI –15.22 to –10.37) RMMRs/1000 were observed. There were 1.07 HMRs/1000 and 35.36 RMMRs/1000 provided in December 2019. In conclusion, HMR and RMMR program changes in March 2014 restricted access to subsidized medicines reviews and were associated with marked decreases in service provision. The low levels of HMR and RMMR provision observed do not represent a proactive approach to medicines safety and effectiveness among older Australians. Refereed/Peer-reviewed
- Published
- 2021
9. Variation in Provision of Collaborative Medication Reviews on Entry to Long-Term Care Facilities.
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Sluggett, Janet K., Bell, J. Simon, Lang, Catherine, Corlis, Megan, Whitehead, Craig, Wesselingh, Steve L., and Inacio, Maria C.
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ELDER care , *DEMENTIA , *INTERPROFESSIONAL relations , *LONG-term health care , *LONGITUDINAL method , *MULTIPLE regression analysis , *RESIDENTIAL care , *RETROSPECTIVE studies , *MEDICATION therapy management , *DESCRIPTIVE statistics , *MEDICATION reconciliation , *ODDS ratio - Abstract
Residential medication management reviews (RMMRs) are comprehensive medication reviews conducted by clinical pharmacists and general medical practitioners. RMMRs are the primary government-funded service to optimize medication management in Australian residential aged care facilities (RACFs) and are recommended for all new residents. This study investigated resident characteristics associated with timely RMMR provision within 90 days of RACF entry and national intrafacility variation in timely RMMR provision. National retrospective cohort study. Individuals aged ≥65 years who first entered permanent residential aged care in Australia between January 1, 2012, and December 31, 2015, received at least 1 medication in the previous year, and were alive at 90 days post-RACF entry. Resident characteristics associated with timely RMMR provision were determined using multivariate logistic regression. Crude and risk-adjusted funnel plots were used to examine intrafacility variation in timely RMMR provision. Of the 143,676 residents from 2799 RACFs included, 30,883 (21.5%) received an RMMR within 90 days. Resident characteristics associated with timely provision included dementia (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.02–1.08), primary language other than English (aOR 1.04, 95% CI 1.01–1.09), number of unique prescriptions dispensed in the previous year (aOR [per additional 5 prescriptions] 1.02, 95% CI 1.01–1.03), need for medication administration assistance (aORs ranged from 1.35 to 1.42, compared with residents self-managing) and facility remoteness (aORs ranged from 0.67 to 0.75 for residents outside major cities). The proportion of new residents receiving a timely RMMR ranged from 0% (n = 303 RACFs) to 100% (n = 4 RACFs). There were 174 RACFs (6.2%) in which ≥50% of new residents received a timely RMMR. Although there was some evidence that RMMRs are targeted to individuals with a greater burden of medication use and those living with dementia, considerable variation in provision exists nationally. This flagship medication review service is generally underutilized among residents of Australian RACFs. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
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