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The World Health Organisation’s Global Action Plan on Antimicrobial Resistance calls upon countries to strengthen antimicrobial resistance (AMR) surveillance. Australian governments have responded with a plan to implement a nationally coordinated, technologically enhanced surveillance program that takes a One Health approach. This policy brief outlines research and its policy implications regarding this technology and approach. It argues that: Spatial science and technology are central to an effective surveillance process and timely interventions; Data visualisation tools will be necessary for negotiating solutions to AMR problems identified by surveillance; Data analytics and data science will enable predictive inferencing using GeoAI with such tools enabling forms of citizen science engagement in the surveillance and response process.

Medication management for older persons can be complex. With over 50% of all hospital admissions being for people aged over 65 years, understanding age-related functional, cognitive and social factor changes and their impact on medication use is critical for pharmacists working in most adult medicine areas. This paper provides an overview of critical elements of medication management for older persons for pharmacists. Key elements include age-related changes impacting medication effectiveness and safety, frailty, geriatric syndromes, polypharmacy and deprescribing, minimising medication-related harm at transitions of care, dose administration aids and other strategies to support individuals in medication management and multidisciplinary comprehensive geriatric assessment.

Aims: The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimise the use of antibiotics and identify which interventions are most effective. Methods: This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient-reported outcomes. Risk of bias was assessed using the ‘Cochrane suggested risk of bias criteria’ and narrative synthesis of primary outcomes conducted. Results: Seventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over-the-counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [−0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. Conclusions: Our review suggests some positive results from pharmacist-led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high-quality research is needed.

Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications.The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents.A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient English language skills. The results were presented in two groups, the nursing and care staff, using descriptive statistics.A total of 176 individuals from nine RACFs completed the questionnaire of whom 160 were eligible for study inclusion. Most considered polypharmacy to be five or more different tablets and capsules per day (95% nursing and 82% care staff respectively). A wide range of beliefs about medication use and deprescribing that centred on what constitutes appropriate polypharmacy was identified. Most thought that preventive medications were essential for residents. Most nurses agreed that sleeping tablets and pharmacological management of verbal aggression and wandering behaviours should be used less frequently whilst most care staff agreed that medications should be used more frequently to manage physical aggression.To successfully and sustainably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.

The prevalence of hypertension increases with age making it a significant health concern for older persons. Aging involves a range of physiological changes such as increases in arterial stiffness, widening pulse pressure, changes in renin and aldosterone levels, decreases in renal salt excretion, declining in renal function, changes in the autonomic nervous system sensitivity and function and changes to endothelial function all of which may not only affect blood pressure but may also affect individual response to pharmacotherapy used to manage hypertension and prevent end organ damage and other complications associated with poor blood pressure control.Unlike many chronic conditions where there is limited evidence for management in older populations, there is good evidence regarding the management of hypertension in the elderly. The findings from multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults, showing that reduction of blood pressure in older hypertensive populations is associated with reduced mortality and morbidity. Diuretics, agents action on the renin angiotensin system, beta blockers and calcium channel blockers have all been well studied in older populations both in view of the benefits associated with blood pressure lowering and the risks associated with associated adverse events. While all antihypertensive agents will lower blood pressure, when managing hypertension in older persons the choice of agent is dependent not only on the ability to lower blood pressure but also on the potential for harm with older persons. Understanding such potential harms in older populations is essential with older persons experiencing increased sensitivity to many of the adverse effects such as dizziness associated with the use of antihypertensive agents.Despite the wealth of evidence regarding the benefits of managing hypertension in the old and very old, a significant proportion of older individuals with hypertension have suboptimal BP control. While there is good evidence supporting blood pressure lowering in older antihypertensive agents, these have not yet been optimally translated fully into clinical guidelines and clinical practice. There appear to be considerable differences between guidelines in terms of the guidance given to clinicians. Differences in interpretation of the evidence, as well as differences in study design and populations all contribute to differences in the guideline recommendations with respect to older populations, despite the strength of the underlying scientific evidence. Differences around who is considered "old" and what BP targets and management are considered appropriate may lead to confusion among clinicians and further contribute to the evidence-practice lag.

Background: The Netherlands Pharmacovigilance Centre Lareb received reports of six cases of hearing impairment in association with oral terbinafine use. This study describes these cases and provides support for this association from the Lareb database for spontaneous adverse drug reaction (ADR) reporting and from Vigibase™, the ADR database of the WHO Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre.

The findings of the 2010 national survey of nurse practitioner (NP) prescribing in Australia related to confidence in prescribing are reported. A significant correlation between years endorsed as a NP and prescribing confidence was found. NPs in Australia were significantly more confident in the prescribing aspects of commencing a new medication than adjusting or ceasing a medication prescribed by others. These findings are discussed in relation to promotion of the quality use of medicines and identification of potential strategies to promote the ongoing positive evolution of NP practice in Australia.

Objective. To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. Data Sources/Study Setting. Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is used as an example because, in this area, different quality indicators exist whose validity is questioned. The study is part of the European Drug Education Project. Study Design. Spearman rank correlations were assessed among the GPs' scores on self-report instruments, aggregated prescribing indicators, and individualized prescribing indicators. Kappa values were calculated as agreement measures for identifying low adherence to the guidelines. Data Collection. Prescribing data from GPs were collected through pharmacies, public health insurance companies, or computerized GP databases. Two self-report instruments were mailed to the GPs. The GPs first received a questionnaire assessing their competence regarding the treatment of asthma patients. Three months later they received a series of 16 written asthma cases asking for their intended treatment for each case. Principal Findings. Correlations between scores based on self-report instruments and indicators based on actual prescribing data were mostly nonsignificant and varied between 0 and 0.21. GPs identified as not adhering to the guidelines by the prescribing indicators often had high scores on the self-report instruments. Correlations between 0.20 and 0.55 were observed among indicators based on aggregated prescribing data and those based on individualized data. The agreement for identifying low adherence was small, with kappa values ranging from 0.19 to 0.30. Conclusions. Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an individual patient level. Caution is needed when using such prescribing indicators to identify low adherence to guidelines. Further validation studies using a gold standard comparison are needed to define the best possible indicator.

Background: Prescribing quality is a major issue in nursing home patients. Few cross-national comparisons of prescribing patterns have been carried out in this population. Objectives: To compare prevalence of medication use in nursing home patients between Australia and The Netherlands. Methods: An analysis of medication use based on pharmacy dispensing data was undertaken for residents in nursing homes in Australia (AU) and the Netherlands (NL). The data included residents >65 years old who remained in a high care nursing home in 2009 in AU (n = 1,560) or NL (n = 2,037). Annual prevalence was defined as the dispensing of 1 or more prescriptions for a drug during the study year expressed as percentage of all residents. Multiple logistic regression was used to calculate the prevalence odds ratios (OR) and associated 95% confidence intervals (CI), adjusted for gender and age. Results: The mean age of residents was 85.8 (SD 7.5) (AU) and 82.8 (SD 7.5) (NL), the majority were female (AU: 70.3%, NL: 68.2%). Residents used a mean of 11.4 (SD 5.3) (AU) and 10.8 (SD 7.0) (NL) drugs. The prevalence of medication use was similar in the two countries for most ATC groups. Major differences were observed in the use of benzodiazepines (anxiolytics: AU: 14.1%, NL: 27.8%, OR 0.41 (0.37-0.53)), osteoporosis medication (AU: 51.2%, NL: 28.9; OR 2.56 (2.22-2.96)). Overall use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04)) was similar, but choice of individual drugs differed, e.g. haloperidol (AU: 8.2%, NL: 19.7%; OR 0.34 (0.27-0.42)) and risperidone (AU: 17.4%, NL: 7.3%; OR 2.86 (2.30-2.57)). Systemic antibacterials (AU: 66.8%, NL 62.4%; OR 1.08 (0.93-1.24)) and cardiovascular system drugs (AU: 73.8%, NL: 72.9%; OR 1.05 (0.90-1.23)) overall were similar but major differences were also found in the choice of agents. Conclusions: There are many similarities, but also striking differences in prescribing patterns for nursing home patients between Australia and the Netherlands. Differences in policies, guidelines, education/training and cultural beliefs are possible explanations. Investigating this further should improve our understanding of the various influences on prescribing in nursing homes.

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