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Background: The MS disease-modifying therapies (DMTs) prescribing landscape in Australia have changed over time. Objectives: This study evaluated the utilisation and cost trends of MS-related DMTs in Australia over 10 years and investigated differences between States/Territories. Methods: The prescription and costs of 16 DMTs were extracted from the Pharmaceutical Benefits Scheme for 2013–2022. Descriptive approaches analysed the total number of people prescribed DMTs and total DMT costs per 10,000 population, proportions of prescriptions/costs by DMT groups and the number of people prescribed each individual DMT and costs of each DMT over the 10-year period. All estimates were for Australia and each State/Territory individually. Results: The number of people prescribed DMT and costs per 10,000 population had substantial growth between 2013 and 2022: 125%/164% for Australia, and 94%–251%/129%–373% for individual States/Territories. Higher efficacy group accounted for 54% of total people prescribed DMTs in 2013 and 75% in 2022. Fingolimod was the most popular DMT until 2020, then was dominated by ocrelizumab. The trends of individual DMT prescriptions and costs differed between states particularly in Western Australia (WA), Tasmania and Northern Territory (NT). Conclusion: DMT prescriptions and costs continuously increased over the last decade, particularly for higher efficacy DMTs, and their trends differed between States/Territories. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the impact of recent notified medicine shortages on dispensing patterns of 30, 40, 50, and 60 mg strengths of lisdexamfetamine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Australia., Methods: Pharmaceutical Benefits Scheme (PBS) aggregate dispensing data for 2022-2024 were analysed. Monthly dispensings and Defined Daily Doses (DDDs) for lisdexamfetamine were calculated overall and by product strength., Results: From January 2022 to August 2023, there was a constant increase in overall dispensing and volume of lisdexamfetamine likely due to expansion of PBS prescribing restrictions allowing subsidy of this medicine for patients 18 years and older in February 2021. Dispensings of the 30 mg strength decreased from August 2023 corresponding with shortages of this product. Dispensings of the 50 mg peaked in October 2023 then decreased. During the shortage of the 30 and 50 mg strengths, dispensings of the 40 and 60 mg strengths increased, however, by December 2023 dispensings of these strengths were also decreasing. Dispensings of 70 mg strengths grew steadily throughout 2024. DDDs changed substantially during the shortage period suggesting that people likely transitioned to different strengths of lisdexamfetamine to maintain their dose., Conclusion: Dispensing patterns of lisdexamfetamine, by strength, changed significantly during the medicines shortages periods revealing potential changes in prescriber and patient behaviours, such as switching to higher strength products or using medicines intermittently, to maintain continuity of care. To facilitate quality use of medicines during shortages, dispensing patterns must be monitored so that inequities of access can be identified and addressed., (© 2025 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

Objectives This study aimed to characterise utilisation and expenditure patterns associated with erythropoietin stimulating agents (ESAs) (darbepoetin alfa, epoetin alfa, epoetin beta, epoetin lambda and methoxy polyethylene glycol-epoetin beta) and immunosuppressants (mycophenolate, tacrolimus, ciclosporine, sirolimus and everolimus) in the Australian chronic kidney disease (CKD) population from 2010–2018. Methods Utilisation and expenditure data for each drug were obtained from the Pharmaceutical Benefit Scheme and Highly Specialised Drugs program. Utilisation data were provided a number of dispensing per year, which was then converted to the daily defined dose per 1000 population per day for each year. Temporal trends were then analysed. Key findings Over the study period, utilisation of methoxy polyethylene glycol-epoetin beta and epoetin lambda rose by 13.7 and 81.4-fold, respectively. Contrastingly, the utilisation of darbepoetin alfa, epoetin alfa and epoetin beta declined by 6%, 42% and 70%, respectively. In 2018, tacrolimus, sirolimus, everolimus and mycophenolate utilisation was up 126%, 16.9%, 125% and 182% respectively; conversely, ciclosporine utilisation dropped 19%. Total Australian expenditure on all ESAs examined remained stable at around AUD 128 million over the study period, while total Australian expenditure across all immunosuppressants increased 1.1-fold reaching just over AUD 98 million. Conclusions It appears that immunosuppressant utilisation and expenditure are rising as transplantation rates in Australia continue to increase. Conversely, ESA utilisation and expenditure remained relatively unchanged over the study period. This may be due to increasing concerns around the safety of ESAs offsetting the increasing number of people with CKD. [ABSTRACT FROM AUTHOR]

Background : Endometriosis‐specific (advanced gynaecological) ultrasound is recommended as part of preoperative work‐up of women with suspected endometriosis. Aim : To evaluate the awareness and utilisation of advanced gynaecological ultrasound in the preoperative work‐up of women with suspected endometriosis among active RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) fellows and trainees. Materials and methods : Anonymous online survey invitations were emailed to all active RANZCOG fellows in Australia and New Zealand. Descriptive analysis of responses and multivariate analysis where appropriate were performed. P < 0.05 was considered statistically significant. Results : A 17% (437/2567) survey response rate and 93% (409/437) completion rate were recorded; 59% (248/421) of respondents identified as generalists, whereas 15% (63/421) identified as advanced laparoscopic surgeons. Routine pelvic ultrasound (88.9%, 361/406) was the most common imaging modality requested by respondents; 32% (128/405) of respondents would also always request advanced gynaecology ultrasound. Respondents' self‐reported practice type was significantly associated with utilisation of advanced gynaecological ultrasound (P = 0.03); 79.6% (348/437) agreed with our proposed definition of advanced gynaecological ultrasound for endometriosis. A major limitation to the utilisation of advanced gynaecological ultrasound for endometriosis was the lack of local expertise (63.8%, 233/356). Conclusion : The utilisation of advanced gynaecological ultrasound for endometriosis is significantly influenced by respondents' self‐reported practice type and limited by the lack of local expertise. [ABSTRACT FROM AUTHOR]

The health conditions associated with extreme prematurity will likely require life-long treatment and management. As such, planning for the provision of healthcare services is essential in order to maximise their long-term well-being. We sought to quantify the use of healthcare services and the associated costs for extremely premature babies compared to preterm and term babies in Australia using a whole-of-population linked administrative dataset. In the first year of life, extremely premature babies had an average of 3.4 hospital admissions, and 2 emergency department presentations. They also had an average of 16 specialist attendances, 33 pathology tests and 6 diagnostic imaging tests performed. This was more than that utilised by preterm and full-term babies. The mean annual cost of hospitalisations was $182,312 for extremely premature babies in the first year and $9958 in the second year. The mean annual out-of-pocket fees for these services were $2212 and $121 in the first and second years respectively.Conclusion: Understanding the long-term healthcare needs of extremely premature babies in order to provide both an adequate number of services and also connection between services should be a central part of health system planning as the survival rates of extremely premature babies improve over time. What is Known: • The health service use of extremely premature babies is higher at the time of birth. • Health conditions and disabilities associated with extreme prematurity require life-long care. What is New: • Extremely premature babies have more diverse and frequent access to services than premature and term babies until at least age 2. • This comes at higher cost to families through out-of-pocket payments. [ABSTRACT FROM AUTHOR]

Highlights • We compared four methods of estimating actual radiotherapy utilisation rates (A-RUR). • We used individual patient data from the 45 and Up Study, New South Wales, Australia. • A-RUR estimates differed depending on the method used to estimate. • All methods found A-RUR rates that were below optimal for this population. • The method for estimating A-RUR should depend on the availability of the data. Abstract Aim To compare four methods for estimating actual radiotherapy utilisation (A-RUR) reported in the literature. Materials and methods Participants in the 45 and Up Study in New South Wales (NSW) Australia completed a baseline questionnaire during 2006–2009 and consented to record linkage with administrative health datasets. Incident primary cancers (2006–2010) were identified through linkage with the NSW Cancer Registry. Radiotherapy receipt was identified through linkage with the Medicare Benefits Schedule and/or NSW Admitted Patient Data Collection (2006–2014). The four methods for estimating A-RUR were: 1 – crude proportion; 2 – crude proportion for patients followed for a defined period; 3 – life table without censoring of deaths; 4 – life table with censoring of deaths. Results There were 9817 participants with a diagnosis of cancer between recruitment and end of 2010, median follow-up 5.4 years. Crude A-RUR for the cancer cohort was 30.2%, below the "optimal" 48%. The 5 yr A-RUR was 29.7%, 29.8% and 33.4% using methods 2–4 respectively. Conclusions A-RUR estimates differed depending on the method used and all were below optimal. The method for estimating A-RUR for future studies should depend on the availability of the data as well as the intended audience for the results. [ABSTRACT FROM AUTHOR]

Background: Utilisation of radiation therapy for regional Australia and around the world has been the focus of much health policy the last decade. Radiation therapy centres have been built in Australian regional and rural areas to improve access to radiation therapy and reduce the tyranny of distance as a barrier to access. After this the enablers, barriers and perceptions of patients has been evaluated to determine utilisation once centres have been built. Thisreview looks the impact of rural radiation services in the developed world, barriers and enablers of establishing a rural radiation centre, and patients' and service providers' perspectives and preferences around the uptake of rural radiation therapy.Methods: Online search of peer reviewed literature was undertaken using MeSH terms relating to the topic. Inclusion criteria were regional radiation therapy centres in developing countries, any year of publication, in English, and qualitative or quantitative methodologies. Articles were reviewed by two authors with conflicts discussed with a third.Results: Twenty three studies addressed the theme directly. Distance barriers have been overcome by building regional centres and health economic burden was lower for government service providers with this strategy. However distance still plays an important role in influencing uptake of radiation therapy. Cultural expectations, influence of the family doctor and perception of care was influential. Carer support, duration of displacement from home, financial impact of the required care and seasonal weather were practical factors on a patient's decision.Conclusions: Regional radiation therapy centres have improved access to radiation therapy in developing countries. However the complex nuances between socio-economic, cultural and health system factors that influence regional patient's decision making bears further consideration, as distance is not the only issue. [ABSTRACT FROM AUTHOR]

Background: The Australian College of Critical Care Nurses published the third edition of practice standards (PSs) for specialist critical care nurses in 2015. Higher-education providers currently use these standards to inform critical care curricula; however, how critical care nurses perceive and use PSs in clinical practice is unknown., Objectives: The objective of this study was to explore critical care nurses' perceptions about the Australian College of Critical Care Nurses PS for specialty critical care nursing, to understand how the PSs are used in clinical practice, and what opportunities exist to support their implementation., Methods: An exploratory qualitative descriptive design was used. A purposive sampling strategy was used, with 12 critical care specialist nurses consenting to participate in semistructured interviews. The interviews were recorded and transcribed verbatim. Transcripts were analysed thematically using an inductive coding approach., Findings: Three main themes were identified: (i) lack of awareness of the PS; (ii) minimal to no utilisation of the PS in clinical practice and the challenges contributing to this; and (iii) improving the implementation and utilisation of the PS in clinical practice., Conclusions: There is a significant lack of awareness and utilisation of the PS in clinical practice. To overcome this, increasing recognition, endorsement, and valuation of the PSs to stakeholders at an individual, health service, and legislative level are suggested. Further research is required to establish relevance of the PS in clinical practice and understand how clinicians use the PS to promote and develop critical care nursing., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: In Australia, the approach to health workforce planning has been supply-led and resource-driven rather than need-based. The result has been cycles of shortages and oversupply. These approaches have tended to use age and sex projections as a measure of need or demand for health care. Less attention has been given to more complex aspects of the population, such as the increasing proportion of the ageing population and increasing levels of chronic diseases or changes in the mix of health care providers or their productivity levels. These are difficult measures to get right and so are often avoided. This study aims to develop a simulation model for planning the general practice workforce in South Australia that incorporates work transitions, health need and service usage.Methods: A simulation model was developed with two sub-models--a supply sub-model and a need sub-model. The supply sub-model comprised three components--training, supply and productivity--and the need sub-model described population size, health needs, service utilisation rates and productivity. A state transition cohort model is used to estimate the future supply of GPs, accounting for entries and exits from the workforce and changes in location and work status. In estimating the required number of GPs, the model used incidence and prevalence data, combined with age, gender and condition-specific utilisation rates. The model was run under alternative assumptions reflecting potential changes in need and utilisation rates over time.Results: The supply sub-model estimated the number of full-time equivalent (FTE) GP stock in SA for the period 2004-2011 and was similar to the observed data, although it had a tendency to overestimate the GP stock. The three scenarios presented for the demand sub-model resulted in different outcomes for the estimated required number of GPs. For scenario one, where utilisation rates in 2003 were assumed optimal, the model predicted fewer FTE GPs were required than was observed. In scenario 2, where utilisation rates in 2013 were assumed optimal, the model matched observed data, and in scenario 3, which assumed increasing age- and gender-specific needs over time, the model predicted more FTE GPs were required than was observed.Conclusions: This study provides a robust methodology for determining supply and demand for one professional group at a state level. The supply sub-model was fitted to accurately represent workforce behaviours. In terms of demand, the scenario analysis showed variation in the estimations under different assumptions that demonstrates the value of monitoring population-based need over time. In the meantime, expert opinion might identify the most relevant scenario to be used in projecting workforce requirements. [ABSTRACT FROM AUTHOR]

The role of clinical leadership in implementing evidence based practice is increasingly recognised in the health and social care fields. This paper briefly reviews the literature on clinical leadership and evidence-based practice in aged care and describes the established of an aged care clinical fellowship program in Australia. The purpose of this paper is to introduce the reports of four aged care clinical fellows reported elsewhere in this issue of the International Journal of Evidence-Based Healthcare. [ABSTRACT FROM AUTHOR]

Commercial replacement of fluorocarbons in mobile air conditioning systems (MACS) with typically HC-290/600a[60/40] and minimal precautions began in Idaho in 1993. R290/600a has low environmental impact but mixed with air is flammable and frequencies for fire, injury and cabin overpressure were predicted. No such accidents are known from 1993 to mid-2003. R290/600a suppliers consumption, representative MACS charges and charge termination frequency were used to predict yearly total MACS numbers. Mid-2002 in Australia there were 0.33×106 and at end 2002 in the USA 4.7×106 R290/600a MACS. Integrating over time gave usage for Australia to the end 2002 as 1.09×106 car-years and to mid-2003 for the USA 21.7×106 car-years. The measured US fire, injury and cabin overpressure frequencies are less than 3.2×10−7 per car year with high probability. This fire frequency is a hundred times lower than predicted because most R290/600a leaks in MACS use are effectively non flammable. [Copyright &y& Elsevier]

Background: Many palliative care patients attend emergency departments (EDs) in acute Hospital. However, very limited studies inform about their presentations and appropriateness., Objectives: This study explored the reasons and appropriateness of palliative care presentations in a regional Australian ED setting., Methods: A retrospective, single-centre observational study was conducted in a regional Australian hospital. All patients between January and December 2018 known to palliative care services presented to ED were included. Appropriateness of presentations was determined based on urgency of tests and treatments received, and practicability of obtaining these in a different setting., Results: A total of 35 patients made 85 presentations to the ED in 2018. The most common individual presenting complaints were shortness of breath (18.9%) followed by pain (14.1%), fever (11.8%), fall (8.2%), reduced oral intake or dehydration (8.2%), and bleeding (8.2%). The patients were brought by an ambulance in 56.5% presentations, and 63.5% presentations were admitted. About 93% presentations were referred by community healthcare professionals or required urgent investigation or management., Conclusions: This study found the majority of presentations were appropriate since their management could not be delivered at other primary care settings. This study adds value to the growing body of evidence and supports future multi-site longitudinal studies.

Background: Little is known about the utilisation and safety of catheter ablation of atrial fibrillation (AF) among public and private sector hospitals., Aims: To examine the uptake of AF ablations and compare procedural safety between the sectors., Method: Hospitalisation data from all public and private hospitals in four large Australian states (NSW, QLD, VIC and WA) were used to identify patients undergoing AF ablation from 2012 to 17. The primary endpoint was any procedure-related complications up to 30-days post-discharge. Logistic regression was used to evaluate the association between treatment at a public hospital and risk of complications adjusting for covariates., Results: Private hospitals performed most of the 21,654 AF ablations identified (n = 16,992, 78.5 %), on patients who were older (63.5 vs. 59.9y) but had lower rates of heart failure (7.9 % vs. 10.4 %), diabetes (10.2 % vs. 14.1 %), and chronic kidney diseases (2.4 % vs. 5.2 %) (all p < 0.001) than those treated in public hospitals. When compared with private hospitals, public hospitals had a higher crude rate of complications (7.25 % vs. 4.70 %, p < 0.001). This difference remained significant after adjustment (OR 1.74 [95 % CI 1.54-2.04]) and it occurred with both in-hospital (OR 1.83 [1.57-2.14]) and post-discharge (OR 1.39 [1.06-1.83]) complications, with certain complications including acute kidney injury (OR 5.31 [3.02-9.36]), cardiac surgery (OR 5.18 [2.19-12.27]), and pericardial effusion (OR 2.18 [1.50-3.16])., Conclusions: Private hospitals performed most of AF ablations in Australia with a lower rate of complications when compared with public hospitals. Further investigations are needed to identify the precise mechanisms of this observed difference., (© 2021. The Author(s).)

Background: Aged care support services in Australia are delivered through home care packages, permanent residential care, respite care and transition care. This study aimed to determine age and gender specific incidence rates of aged care service utilisation in Australia between 2008-09 and 2015-16.Methods: This is a population-based epidmiological study of people accessing aged care services in Australia. The trends and characteristics of people (over the age of 65 years old) accessing aged care services in Australia were evaluated, using data (2008-09 and 2015-16) from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The yearly utilisation incidence rates (per 1000 people) per service type were calculated and changes in incidence rate ratios (IRR) of service utilisation for the study period were estimated using Poisson regression models.Results: The proportion of older Australians aged ≥65 years who used aged care services remained similar between 2008-09 (5.4%, N = 208,247) and 2015-16 (5.6%, N = 248,669). However, the incidence use of specific services changed during the study period. Specifically, admissions into permanent residential care decreased (from 23.8/1000 people in 2008-09 to 19.6/1000 in 2015-16, at a IRR of 0.84/year, p < 0.001) but increased for transition care (from 4.3/1000 in 2008-09 to 6.6/1000 in 2015-16, at a IRR of 1.57/year, p < 0.001) and home care packages (from 8.04/1000 in 2008-09 to 12.0/1000 per 1000 in 2015-16, at a IRR of 1.52/year, p < 0.001). Between 2008-09 and 2015-16, the greatest changes in IRR were observed in males aged 80-89 years accessing transition care (IRR = 1.68/year, p < 0.001). A higher proportion of people aged between 80-89 years (≥45%), females (≥60%), Australia born (≥ 60%) and English speakers (≥80%) used all the service types.Conclusions: Patterns of service utilisation for aged care services changed over the study period with a decrease in incidence of individuals accessing permanent residential care but increased for other service types. This finding reflects changes in attitudes regarding ageing in place and policies. These findings are helpful to inform key stakeholders on service planning to further improve quality of the aged-care services in Australia. [ABSTRACT FROM AUTHOR]

Purpose: Countries worldwide are developing a variety of strategies to combat the opioid epidemic, such as restricting access to high-strength opioid formulations. We aimed to examine the dispensing patterns of strong opioids by dose units (DUs), age, and sex., Methods: We used Australian population-level dispensing data from January 2003 to December 2015 and categorised strong opioids by DU: very low, low, moderate, and high, corresponding to total daily doses of less than or equal to 25, 26 to 50, 51 to 100, and greater than 100 morphine milligramme equivalents, respectively. We measured trends in strong opioid use as dispensings/1000 population/year and stratified dispensing in 2015 by patient age and sex., Results: From 2003 to 2015, strong opioid dispensing of very low, low, moderate, and high DU increased 6.7-, 6.2-, 2.2-, and 1.8-fold, respectively. The increase in very low and low DU dispensing was driven primarily by oxycodone (5, 10, and 15 mg tablets and capsules) and buprenorphine transdermal patches. In 2015, the number of dispensings/1000 population for very low, low, moderate, and high DU were 180.3, 77.0, 52.7, and 34.8, respectively. Females aged greater than or equal to 85 years had the highest opioid use, ranging from 157.1 dispensings/1000 population for high DU to 2104.5 dispensings/1000 population for very low DU. In contrast, the high DU dispensings in males aged 25 to 64 years exceeded their female counterparts by approximately 1.3-fold., Conclusion: Relative to moderate and high DU strong opioids, dispensing of very low and low DU strong opioids increased dramatically during the study period in Australia. Future studies investigating opioids use and harms in elderly females and males between 25 to 64 years are warranted., (© 2019 John Wiley & Sons, Ltd.)

With the introduction of new disease modifying medicines (DMM) for relapsing remitting multiple sclerosis (RRMS) in Australia, we aimed to examine trends in utilisation from 1996 to 2013. We analysed trends in use by administrative area (state/territory). Prescription data from Medicare Australia were converted to defined daily doses (DDD)/1000 population/day using population data. Overall RRMS DMM use increased progressively from 0.024 to 0.68 DDD/1000 population/day between 1996 and 2013. From 1996 to 1999 interferon β1B was the only such agent available. Interferon β1A became the most widely used RRMS DMM in 2001. Glatiramer acetate became available in 2004 and its use thereafter increased slowly. Natalizumab was introduced in 2008 with slow growth and fingolimod use grew substantially once it was subsidised in 2011. Both these medicines have accounted for the growth in total use of RRMS DMM in 2012 and 2013. Overall RRMS DMM use was higher in more southern states than in northern states. Patterns of preferred agent varied between different Australian states and territories. RRMS DMM use in Australia has grown progressively since 1996, probably related to growing medical and patient confidence in the benefits obtained from using such drugs, longer survival in MS patients (partly related to use of drug treatments), and easier recognition of MS with the wider availability of magnetic resonance imaging (MRI). The availability of fingolimod, the first DMM that can be taken by mouth, may have led RRMS patients who rejected parenteral therapy to commence treatment of their disease., (Copyright © 2014 Elsevier Ltd. All rights reserved.)