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We aimed to explore managerial and project staff perceptions of the pilot implementation of an algorithm-supported care navigation model, targeting people at risk of hospital readmission. The pilot was implemented from May to November 2017 at a Victorian health service (Australia) and provided to sixty-five patients discharged from the hospital to the community. All managers and the single clinician involved participated in a semi-structured interview. Participants (n = 6) were asked about their perceptions of the service design and the enablers and barriers to implementation. Interviews were transcribed verbatim and analysed according to a framework approach, using inductive and deductive techniques. Constructed themes included the following: an algorithm alone is not enough, the health service culture, leadership, resources and the perceived patient experience. Participants felt that having an algorithm to target those considered most likely to benefit was helpful but not enough on its own without addressing other contextual factors, such as the health service's capacity to support a large-scale implementation. Deductively mapping themes to the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework highlighted that a formal facilitation would be essential for future sustainable implementations. The systematic identification of barriers and enablers elicited critical information for broader implementations of algorithm-supported models of care. [ABSTRACT FROM AUTHOR]

Objectives: To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians. Methods: PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub‐cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used. Results: There were 42,180 clients enrolled during the study (mean age 80 years, 80% female, 93% living alone). An ambulance attended 44% of the fall‐related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub‐cohort (n = 92), the majority of admissions (86%) followed an alarm activation coded as unwell. Conclusion: We demonstrated recurring patterns associated with the reasons for alarm use. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to describe patterns and rates of sport and active recreation injuries that result in major trauma or death and to examine trends in these rates for all sport and active recreation activities and key sporting groups, for the period July 2001–June 2007, in Victoria, Australia. Methods: All sport and active recreation related major trauma cases and deaths were extracted from the Victorian State Trauma Registry (VSTR) and the National Coroners Information System, for the period July 2001–June 2007. Participation data from the Exercise Recreation and Sports Survey (ERASS) was used to establish incidence rates for the group as a whole and for key sporting groups. Poisson regression analysis was used to examine trends in major trauma and death due to participation in sport and active recreation across the six year study period. Results: There were 1019 non-fatal major trauma cases and 218 deaths. The rate of major trauma or death from sport and active recreation injuries was 6.3 per 100,000 participants per year. There was an average annual increase of 10% per year in the major trauma rate (including deaths) across the study period, for the group as a whole (IRR 1.10, 95% CI, 1.06–1.14). There was no increase in the death rate (IRR=0.94, 95% CI, 0.87–1.02; p =0.12). Significant increases were also found for cycling (IRR 1.16, 95% CI, 1.09–1.24) off-road motor sports (IRR 1.10, 95% CI, 1.03–1.19), Australian football (IRR 1.21, 95% CI, 1.03–1.42) and swimming (IRR 1.16, 95% CI, 1.004–1.33). Conclusion: The rate of major trauma inclusive of deaths, due to participation in sport and active recreation has increased over recent years, in Victoria, Australia. Much of this increase can be attributed to cycling, off-road motor sports, Australian football and to a lesser extent swimming, highlighting the need for co-ordinated injury prevention in these areas. [Copyright &y& Elsevier]

The article presents a study on the twelve-month outcomes of a serious orthopaedic injuries due to sport and active recreation to patients that are admitted to Level 1 Trauma Centers in Melbourne, Victoria. It states that a total of 366 adults admitted to two Level 1 trauma centers for an orthopaedic sport and active recreation injury have participated to the study and they were captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). It reveals that almost one quarter of the patients were still experiencing moderate to severe physical disability, and the increasing age and patterns of injury were the main predictors of a poor physical outcome at 12 months. It also emphasizes the importance of further investigation into sports and recreation injury.

Purpose: Unmanaged mental health problems following a stroke can be detrimental to recovery. We aimed to explore the lived experience of (a) poststroke mental health difficulties, (b) help-seeking for mental health, including factors that influenced treatment access and utilization, and (c) receiving treatment and support. Research Method: Individual semistructured interviews were conducted in 2022 with 13 participants (62% female, age at stroke 35–76 years) who had experienced mental health difficulties following their stroke. Data were analyzed using reflexive thematic analysis with a critical realist approach. Results: Six themes were identified. Mental health challenges poststroke were diverse in nature. Attitudes and previous experiences relating to mental health influenced the inclination to seek help. Participants valued an individualized approach to the provision and timing of psychoeducation. Accessibility of services was impacted by financial and transportation barriers, as well as availability of services and appropriately trained clinicians. Participation in support groups was a positive experience for most participants. Lived experience of mental health treatment ranged from positive to negative, and participants conveyed helpful and unhelpful aspects. Conclusions: Findings highlight the importance of early screening and psychoeducation provision for poststroke mental health difficulties, alongside accessible community-based mental health support services throughout the stroke recovery journey. Having varied options for mental health support and treatment may aid stroke survivors in finding an approach that personally works for them. Additionally, it may be helpful to train clinicians to tailor mental health treatment to accommodate stroke-related impairments (e.g., cognitive, sensorimotor). Impact and Implications: Although poststroke mental health problems are common and can hinder recovery, existing research primarily examines mental health treatment access and utilization within the general population. This study expands on the existing limited quantitative evidence in the stroke population by investigating previously unexplored qualitative insights. This study offers a holistic understanding of the diverse nature and progression of mental health difficulties after stroke, as well as the challenges stroke survivors encounter when seeking mental health support. It highlights additional factors that require attention to ensure equitable treatment access and elucidates the perceived quality and effectiveness of mental health services and supports. It is important to screen for mental health problems and provide psychoeducation throughout the stroke recovery journey, starting in the hospital. Various formal and informal support options should be made available, tailored to individual preferences and stroke-related consequences. Engaging social supports (e.g., family, friends, stroke peers) in mental health management may be beneficial. [ABSTRACT FROM AUTHOR]

• Few studies have examined prescription drug monitoring programs outside the US. • Intended effects were not seen, with no change in high-opioid dose prescribing. • No reduction in prescribing of high-risk medication combinations was observed. • Possible substitution prescribing appears to be an unintended effect. Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the management in Victorian general practice of people who have been hospitalised with stroke or transient ischaemic attacks (TIA)., Study Design: Retrospective observational study; analysis of linked Australian Stroke Clinical Registry (AuSCR) and general practice data., Setting: 383 general practices in the Eastern Melbourne, South Eastern Melbourne, and Gippsland primary health networks (Victoria), 1 January 2014 - 31 December 2018., Participants: Adults who had been hospitalised with acute stroke or TIA and had at least two encounters with the same general practice during the observation period (7-18 months after the acute event)., Main Outcome Measures: Assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, urinary protein); prescribing of guideline-recommended prevention medications (blood pressure-, lipid-, or glucose-lowering, antithrombotic agents); attainment of guideline targets for cardiometabolic risk factors at final assessment during observation period., Results: During 2014-2018, 3376 eligible AuSCR registrants (1465 women, 43.4%) had at least two encounters with one of the 383 general practices during the observation period; median age at stroke onset was 73.9 (interquartile range, 64.4-81.9) years, 737 events were TIAs (21.8%). Blood pressure was assessed in 2718 patients (80.5%), serum lipids in 1830 (54.2%), blood glucose in 1708 (50.6%). Prevention medications were prescribed for 2949 patients (87.4%), including lipid-lowering (2427, 71.9%) and blood pressure-lowering agents (2363, 70.0%). Blood glucose targets had been achieved by 1346 of 1708 patients assessed for this risk factor (78.8%), blood pressure targets by 1935 of 2717 (71.2%), and serum lipid targets by 765 of 1830 (41.8%). The incidence of having risk factors assessed was lower among patients aged 60 years or younger (incidence rate ratio [IRR], 0.97; 95% confidence interval [CI], 0.92-1.03) and those over 80 years of age (IRR, 0.92; 95% CI 0.88-0.97) than for those aged 61-80 years, and for women (IRR, 0.91; 95% CI, 0.87-0.95) and people with dementia (IRR, 0.89; 95% CI, 0.81-0.98). The likelihood of having classes of prevention medication prescribed was lower for patients aged 60 years or younger (IRR, 0.92; 95% CI, 0.88-0.97) and those over 80 years of age (IRR, 0.96; 95% CI, 0.92-0.997) than for patients aged 61-80 years, and for women (IRR, 0.95; 95% CI, 0.91-0.98) and people with dementia (IRR, 0.88; 95% CI, 0.78-0.98)., Conclusions: The general practice management of people who have been hospitalised with stroke or TIA could be improved. Effective monitoring of cardiometabolic risk factors will enable general practitioners to optimise care for people who need careful attention to prevent adverse secondary events., (© 2024 AMPCo Pty Ltd.)

Background: Administrative data are used extensively for research purposes, but there remains limited information on the quality of these data for identifying comorbidities related to stroke., Objective: To compare the prevalence of comorbidities of stroke identified using International Classification Diseases, Australian Modification (ICD-10-AM) or Anatomical Therapeutic Chemical codes, with those from (i) self-reported data and (ii) published studies., Method: The cohort included patients with stroke or transient ischaemic attack admitted to hospitals (2012-2016; Victoria and Queensland) in the Australian Stroke Clinical Registry (N = 26,111). Data were linked with hospital and pharmaceutical datasets to ascertain comorbidities using published algorithms. The sensitivity, specificity, and positive predictive value of these comorbidities were compared with survey responses from 623 patients (reference standard). An indirect comparison was also performed with clinical data from published stroke studies., Results: The sensitivity of hospital ICD-10-AM data was poor for most comorbidities, except for diabetes (93.0%). Specificity was excellent for all comorbidities (87-96%), except for hypertension (70.5%). Compared to published stroke studies (3 clinical trials and 1 incidence study), the prevalence of diabetes and atrial fibrillation in our cohort was similar using ICD-10-AM codes, but lower for dyslipidaemia and anxiety/depression. Whereas in the pharmaceutical dispensing data, the sensitivity was excellent for dyslipidaemia (94%) and modest for anxiety/depression (77%). In the pharmaceutical data, specificity was modest for hypertension (78%) and anxiety or depression (76%), but specificity was poor for dyslipidaemia (19%) and heart disease (46%)., Conclusion: Variation was observed in the reporting of comorbidities of stroke in administrative data, and consideration of multiple sources of data may be necessary for research. Further work is needed to improve coding and clinical documentation for reporting of comorbidities in administrative data., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To examine associations of neighborhood greenery, air pollution and walkability with cardiometabolic disease in adults aged ≥45 years in the Frankston-Mornington Peninsula region, Victoria, Australia., Methods: A cross-sectional, ecological study design was used. We assessed mean annual neighborhood greenery using the Normalized Difference Vegetation Index; air pollution (fine particulate matter of diameter ≤2.5 μm [PM 2.5 ] and NO 2 ) using land-use regression models; and walkability using Walk Score (possible values 0-100). Medically diagnosed diabetes (~95% type-2), heart disease and stroke were self-reported in the Australian Census (2021). Multivariable regression was used to model associations between environmental exposures and area-level (neighborhood) cardiometabolic disease prevalence (age group ≥45 years), with socioeconomic status, age and sex as covariates. Air pollution was examined as a mediator of associations between greenery and disease prevalence., Results: Our sample comprised 699 neighborhoods with the following mean (SD) values: Normalized Difference Vegetation Index 0.47 (0.09), PM 2.5 , 8.5 (0.6) μg/m 3 and NO 2 , 5.2 (1.6) ppb. Disease prevalences were: heart disease, mean 8.9% (4.5%); diabetes, mean 10.3% (4.7%); and stroke, median 1.2% (range 0-10.9%). Greenery was negatively associated with diabetes (β = -5.85, 95% CI -9.53, -2.17) and stroke prevalence (β = -1.26, 95% CI -2.11, -0.42). PM 2.5 and NO 2 were positively associated with diabetes (β = 1.59, 95% CI 1.00, 2.18; β = 0.42, 95% CI 0.22, 0.62) and stroke prevalence (β = 0.15, 95% CI 0.01, 0.29; β = 0.06, 95% CI 0.01, 0.10). The association between greenery and diabetes was partially mediated by PM 2.5 (mediated effect -5.38, 95% CI -7.84, -3.03)., Conclusions: Greenery and air pollutants were associated with lower and higher prevalence, respectively, of self-reported diabetes and, to a lesser extent, stroke. These ecological findings require further exploration with stronger, longitudinal study designs to inform public health policy and directions. Geriatr Gerontol Int 2024; 24: 208-214., (© 2023 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Introduction: There is limited evidence about the management of cardiovascular risk factors within 12 months before stroke or transient ischaemic attack (TIA) in Australian general practices. We evaluated whether age and sex disparities in cardiovascular risk factor management for primary prevention exist in general practice., Methods: A retrospective cohort study using data from the Australian Stroke Clinical Registry (2014-2018) linked with general practice data from three Primary Health Networks in Victoria, Australia. We included adults who had ≥2 encounters with a general practitioner within 12 months immediately before the first stroke/TIA. Cardiovascular risk factor management within 12 months before stroke/TIA was evaluated in terms of: assessment of risk factors (blood pressure [BP], serum lipids, blood glucose, body weight); prescription of prevention medications (BP-lowering, lipid-lowering, glucose-lowering, antithrombotic agents); and attainment of risk factor targets., Results: Of 2,880 patients included (median age 76.5 years, 48.4% women), 80.9% were assessed for BP, 49.9% serum lipids, 46.8% blood glucose, and 39.3% body weight. Compared to patients aged 65-84 years, those aged &lt;65 or ≥85 years were less often assessed for risk factors, with women aged ≥85 years assessed for significantly fewer risk factors than their male counterparts. The most prescribed prevention medications were BP-lowering (64.9%) and lipid-lowering agents (42.0%). There were significant sex differences among those aged &lt;65 years (34.7% women vs. 40.2% men) and ≥85 years (34.0% women vs. 44.3% men) for lipid-lowering agents. Risk factor target attainment was generally poorer in men than women, especially among those aged &lt;65 years., Conclusion: Age-sex disparity exists in risk factor management for primary prevention in general practice, and this was more pronounced among younger patients and older women., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Understanding factors that influence the transition to permanent residential aged care following a stroke or transient ischemic attack may inform strategies to support people to live at home longer. We aimed to identify the demographic, clinical, and system factors that may influence the transition from living in the community to permanent residential care in the 6 to 18 months following stroke/transient ischemic attack., Methods: Linked data cohort analysis of adults from Queensland and Victoria aged ≥65 years and registered in the Australian Stroke Clinical Registry (2012-2016) with a clinical diagnosis of stroke/transient ischemic attack and living in the community in the first 6 months post-hospital discharge. Participant data were linked with primary care, pharmaceutical, aged care, death, and hospital data. Multivariable survival analysis was performed to determine demographic, clinical, and system factors associated with the transition to permanent residential care in the 6 to 18 months following stroke, with death modeled as a competing risk., Results: Of 11 176 included registrants (median age, 77.2 years; 44% female), 520 (5%) transitioned to permanent residential care between 6 and 18 months. Factors most associated with transition included the history of urinary tract infections (subhazard ratio [SHR], 1.41 [95% CI, 1.16-1.71]), dementia (SHR, 1.66 [95% CI, 1.14-2.42]), increasing age (65-74 versus 85+ years; SHR, 1.75 [95% CI, 1.31-2.34]), living in regional Australia (SHR, 31 [95% CI, 1.08-1.60]), and aged care service approvals: respite (SHR, 4.54 [95% CI, 3.51-5.85]) and high-level home support (SHR, 1.80 [95% CI, 1.30-2.48]). Protective factors included being dispensed antihypertensive medications (SHR, 0.68 [95% CI, 0.53-0.87]), seeing a cardiologist (SHR, 0.72 [95% CI, 0.57-0.91]) following stroke, and less severe stroke (SHR, 0.71 [95% CI, 0.58-0.88])., Conclusions: Our findings provide an improved understanding of factors that influence the transition from community to permanent residential care following stroke and can inform future strategies designed to delay this transition., Competing Interests: Disclosures Dr Dalli reports funding from GlaxoSmithKline with funds paid to their institution, Dr Kilkenny from the Australian Institute of Health and Welfare, the National Stroke Foundation, and the Health Information Management Journal, and Dr Cadilhac from Boehringer Ingelheim, Bristol Myers Squibb, Moleac, and Medtronic. Dr Cadilhac is the data custodian for the Australian Stroke Clinical Registry (AuSCR) and an executive officer of the Stroke Society of Australasia. Dr Lannin reports employment by Alfred Health and Medical Research Futures Fund grants. Dr Kilkenny and Dr Lannin report membership of the AuSCR Management Committee, and Dr Andrew reports a membership of the AuSCR Research Task Group. The other authors report no conflicts.

Objectives MePACS is a triage and support-based personal alarm emergency response system designed to assist older and/or disabled people to live safely in their homes. The aim of this study was to estimate avoidable ambulance attendances and transports to emergency departments and quantify the cost savings attributed to MePACS compared with a comparison cohort without a personal alarm system. Methods Alarm activation and demographic data for clients registered in the program from June 2016 to May 2017 and funded through the Personal Alert Victoria program were extracted from routinely collected MePACS electronic data. Information on alarm use, event outcomes and ambulance attendances was extracted. Using published Ambulance Victoria data, a comparison cohort was simulated to model the experience of a similar cohort without access to a personal alarm system who experienced a health emergency and called Australia's emergency call service number. The incremental management cost, incorporating the operation cost of MePACS and ambulance fees, was calculated to compare the potential cost savings of MePACS with the comparison cohort. Results Among 18421 eligible clients, there were 7856 emergency alarm activations due to falls or medical events from 4275 clients (79.5% female; 81.1% aged >75 years; 91.8% living alone). MePACS resulted in approximately one-third of ambulance attendances being avoided. Potential annual cost savings of A$1414732.8 (A$76.8 per person per year; 95% confidence interval A$60.0-93.6 per person per year; P<0.001) were attributed to avoidable ambulance utilisations for 18421 MePACS clients. Conclusion Triage-based personal alarm systems, such as MePACS, provide a cost-saving strategy because of fewer ambulance attendances and transports to emergency departments for older and/or disabled people living in the community. What is known about the topic? Personal alarm systems, either a safety alarm, a panic alarm or a medical alarm, have been widely used to support older people and at-risk groups to live independently. The health effects of personal alarm systems are well documented. There is limited information published on the potential economic benefits of these interventions. What does this paper add? We identified the potential economic benefits associated with the MePACS triage-based personal alarm system operating within Victoria, Australia. Personal alarm systems that are triage based and use the support of family members and carers may provide financial benefits not provided by alarm systems that do not provide this type of service. What are the implications for practitioners? The management of older people and at-risk groups living alone is a health care priority. Alternative models to calling emergency services, such as triage-based personal emergency response systems, may provide a low-cost, effective approach.