共找到 20 条结果
暂无摘要（点击查看详情）
To characterize annual trends in prescription medicine dispensing patterns among Australians aged ≥65 years from 2013-2023. Population-based retrospective descriptive study. A 10% sample of the Australian Pharmaceutical Benefits Scheme (PBS) dataset covering medicines dispensed between 2013 and 2023. All individuals aged ≥65 years with at least 1 dispensing during a calendar year were included. The PBS 10% sample was analyzed to determine the number of prescribers, prescriber visits, and pharmacy visits resulting in PBS medicines being dispensed. Prescribers were categorized as general practitioners (GPs), non-GP specialists, other medical practitioners (primary and secondary/tertiary care), unclassified nonspecialists, nonmedical practitioners, and unknown. Between 2013 (n = 3,159,050) and 2023 (n = 4,419,130), annual PBS dispensing per person decreased from a median of 34 [interquartile range (IQR), 17-57] to 31 (IQR, 15-53). Correspondingly, yearly pharmacy visits for PBS medicines declined slightly, from 17 (IQR, 12-27) to 16 (IQR, 10-24). Median prescriber visits resulting in PBS prescriptions decreased from 6 (IQR, 3-11) in 2013 to 5 (IQR, 3-9) in 2023. From 2013 to 2023, median GP visits resulting in a PBS prescription declined from 5 (IQR, 2-8) to 0 (IQR, 0-1), whereas visits to unclassified nonspecialist providers increased from 0 (IQR, 0-0) to 3 (IQR, 1-5). Visits to other prescriber subtypes resulting in PBS prescriptions remained relatively stable, whereas nonmedical prescribing demonstrated steady growth throughout the observation period. Prescription medicine dispensing among older individuals declined over the observation period, with GP prescriptions being increasingly replaced by those from unclassified nonspecialist providers. Changes in health care service delivery and workforce landscape over the last few years likely influenced this trend. Further research is needed to explore the impact of these shifts on health expenditures to inform resource allocation strategies.
Collaborative pharmacist prescribing models have been trialled and implemented in Australian hospitals and involve credentialed pharmacists working with doctors and patients to develop patient medicine plans and prescribe medicines. This study aimed to identify pharmacist prescribing policies and procedures in Australian hospitals and provide a narrative summary of the models and associated training. A scoping study was conducted using an exploratory and descriptive approach to identify and map pharmacist prescribing models implemented in Australian hospitals, and their associated training. Hospital pharmacy directors in Australia were contacted through a hospital pharmacy professional organisation in November 2023 and were asked to provide their pharmacist prescribing policies and procedures. Details of the models and training programs were extracted and summarised, with similarities and differences narratively reported. Fifteen different collaborative pharmacist prescribing models were reported to be implemented across more than 35 hospitals. Fourteen models had a formal training program. The models varied in scope of practice, particularly relating to medicine initiation and the timing of prescribing. The training and maintenance of currency of practice differed between models. Only three models recognised credentialing from other hospitals. The study reveals variation in scope of practice, training, and credentialing processes between pharmacist prescribing models, with limited recognition and transferability of prescribing skills across jurisdictions in Australia. Efforts to establish national accreditation standards for pharmacist prescriber education programs and the recent introduction of a national credentialing program, could pave the way for the standardisation of the models and training within Australian hospitals.
The Australian Pharmaceutical Benefits Scheme was changed on 15 January 2021 to provide people aged <18 years access to government-subsidised pre-exposure prophylaxis (PrEP) for HIV. This study investigated healthcare and service providers' attitudes and practices in discussing PrEP and impacts on PrEP prescribing practices, and the differences in the provision of PrEP to young adults aged >18 years compared with people aged <18 years. An online cross-sectional survey, conducted February to November 2023, used purposive, convenience and snowball sampling to recruit healthcare providers eligible to prescribe PrEP (GPs, nurse practitioners) and non-prescribing healthcare/service providers (sexual health nurses, HIV community workers) in Australia. Young people were split into three age groups for comparison between young adults (aged 18-24 years) and adolescents, including those above (aged 16-17 years) and below (<16 years) the age of consent in Australia. Cross-tabulation with Pearson's chi-squared and Fisher's exact tests were performed to investigate sexual health and PrEP-related attitudes and practices. Of the 122 respondents, 40.2% (49/122) were nurses, 18.0% (22/122) GPs, 11.5% (14/122) HIV community workers, 11.5% (14/122) were another profession (including public health physician, LGBTIQA child and family practitioner, social worker, counsellor), 10.7% (13/122) were sexual health physicians, 6.6% (8/122) nurse practitioners and two were HIV specialists. Most (73.8%, 90/122) reported initiating PrEP conversations with 18-24-year-olds, compared with 13.1% (16/122) with those aged >16 years. Of the 48 (39.3%) eligible PrEP prescribers, 47.9% (23/48) reported feeling 'extremely/somewhat' comfortable assessing PrEP eligibility, 41.7% (20/48) reported awareness of 2021 Pharmaceutical Benefits Scheme changes and 18.8% (9/48) reported changes to prescribing practices. Prescribers were significantly more likely than non-prescribers to consider PrEP suitable (54.2% vs 35.8%, P < 0.05) for clients aged <16 years. Guidelines and prescribing criteria need to reflect current Pharmaceutical Benefits Scheme eligibility for young people to support healthcare prescriber decision-making in recommending and prescribing PrEP for HIV for young people where appropriate. Greater education, training and support is required for healthcare providers to improve provider confidence in discussing sexual health needs, and recommending and prescribing PrEP to young people to optimise the possible benefits of access to sexual health services and PrEP in this priority sub-group.
Psychotropic medicine use in paediatric patients is increasing across many countries, despite limited regulatory approvals and evidence for safety and efficacy. This study investigated the extent of off-label use (OLU) of psychotropic medicines in paediatric patients in Australian primary care, using data from the Bettering the Evaluation and Care of Health (BEACH) program. We retrospectively analysed data collected from 15,276 general practitioners between 2000 and 2016, encompassing 144,397 encounters with children and adolescents aged 3-17 years. Psychotropic medicines were defined by the Anatomical Therapeutic Chemical Classification codes N05 (Psycholeptics) and N06 (Psychoanaleptics), except for prochlorperazine. OLU was defined as use outside of the approved age or indication as specified in the Australian Product Information. A total of 1650 psychotropic medicines were prescribed, with sertraline (14.55 %), fluoxetine (12.48 %), methylphenidate (9.27 %), diazepam (5.52 %), and citalopram (5.27 %) being the most common. Of these, 75.03 % (95 % CI: 71.98, 78.08) were off-label, predominantly due to age (51.74 %, 95 % CI: 48.22, 55.26), followed by indication (23.29 %, 95 % CI: 20.32, 26.27). Off-label rates were highest for citalopram and fluoxetine (both 100 %), followed by sertraline (97.08 %, 95 % CI: 94.94, 99.23), diazepam (41.76 %, 95 % CI: 31.43, 52.09), and methylphenidate (12.42 %, 95 % CI: 7.13, 17.70). Off-label psychotropic medicine use in paediatric patients is common in Australian primary care, with most OLU classified as age-based rather than indication-based. These findings demonstrate high off-label rates and, given limited paediatric evidence, underscore the need for targeted guidelines, enhanced prescriber education, and further research to improve safe and effective use in this population.
Gabapentinoid prescribing and related harms are increasing internationally, yet population-level evidence on non-medical use in Australia is lacking. This study estimated the prevalence and correlates of past-year non-medical gabapentinoid use and examined temporal trends. Data were pooled from the 2016, 2019 and 2022-2023 National Drug Strategy Household Surveys (N = 67,103). Analyses applied person-level survey weights and accounted for the complex design. Weighted descriptive, trend and multinomial logistic regression analyses were conducted, with covariates prespecified using a directed acyclic graph. Past-year non-medical gabapentinoid use among Australians aged ≥ 14 years increased from 0.06% in 2016 to 0.15% in 2022-2023 (Adjusted Wald F = 5.86, p = 0.016; OR = 1.57, 95% CI 1.09, 2.25). Among those reporting any non-medical pain medication use, the proportion involving gabapentinoids rose from 1.7% to 9.3%. Individuals reporting non-medical gabapentinoid use were more likely to report chronic pain (adjusted relative risk ratio [aRRR] = 5.66, 95% CI 3.18, 10.08), high psychological distress (aRRR = 4.26, 95% CI 2.31, 7.84), and socioeconomic disadvantage (aaRRR = 3.45, 95% CI 1.91, 6.27), compared to those reporting no non-medical pain medication use. Most (71%) also reported non-medical opioid use. Although non-medical gabapentinoid use remains uncommon in Australia, its prevalence is increasing. Findings are consistent with non-medical use occurring in the context of unmet pain and mental health needs rather than predominantly recreational use. Enhanced prescriber awareness, harm reduction initiatives, and expanded access to non-pharmacological pain and mental health care are needed. This study provides the first nationally representative estimate of non‐medical gabapentinoid use in Australia. Non‐medical gabapentinoid use has increased steadily since 2016. Use is strongly associated with chronic pain, high psychological distress and socioeconomic disadvantage. Most people reporting non‐medical gabapentinoid use also reported non‐medical prescription opioid use.
To determine which antiseizure medications (ASMs) provide the best overall compromise between a lower risk of foetal malformation and continuing control of maternal epilepsy during pregnancy. Analysis of relevant data on women taking one of the 5 most commonly prescribed ASMs (levetiracetam (LEV), lamotrigine (LTG), carbamazepine (CBZ). Topiramate (TPM) and valproate (VPA)) in 2403 pregnancies of women with epilepsy (WWE) contained in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR). LEV offered the greatest advantage with regard to low risk of foetal malformation, followed by LTG, then CBZ and then VPA. In relation to preserving seizure freedom throughout pregnancy valproate (VPA) was best, followed by LEV and CBZ, then LTG. When these individual rankings, equally weighted, were combined, LEV scored highest, followed by VPA and then LTG and CBZ (equal). However, if avoiding foetal malformation was weighted more heavily, the sequence became LEV, then LTG and CBZ, and then VPA. TPM rated poorly to all criteria assessed. Overall, LEV appeared the most advantageous ASM to employ in the population studied, balancing the risk of foetal malformations with the chance of maintaining seizure control. This outcome is broadly in conformity with prescriber behaviour determined largely by trial-and-error experience in contemporary Australian practice.
Acute coronary syndromes (ACS) remain a significant cause of disability and death in Australia. Following an initial acute coronary event, there is a significant risk of recurrence, particularly in the first 90 days. In April 2025, the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand launched a new Australian clinical guideline for diagnosing and managing ACS. The guideline includes recommendations for the secondary prevention of ACS. Pharmacotherapies for secondary prevention of ACS include antiplatelet and anticoagulant drugs, lipid-modifying therapy, beta blockers and renin-angiotensin antagonist therapies, plus - in select groups - colchicine and other therapies. Vaccination against influenza and other respiratory pathogens is recommended. Nonpharmacological interventions include cardiac rehabilitation, healthy behaviour changes and screening for mental health conditions. The importance of providing strategies to support adherence to long-term therapies is also emphasised.
暂无摘要（点击查看详情）
BACKGROUND: Vaccination coverage for influenza, SARS-CoV-2 and pneumococcal disease among older Australians remains suboptimal. Hospital admission is an underutilised opportunity for the vaccination of older adults. METHODS: We conducted a 12-week prospective, single-centre evaluation at a tertiary hospital in Australia (August–November 2024). Inpatients aged ≥ 65 years admitted under cardiology, geriatrics, geriatric rehabilitation, respiratory and infectious diseases were screened for eligibility for National Immunisation Program (NIP)-recommended vaccines (influenza, SARS-CoV-2, conjugate pneumococcal). Stage 1 (weeks 1–6) involved academic detailing of medical officers (including education on the clinical benefit and standard of care for older adult immunisation) and weekly reminders to vaccinate as a part of routine care. During Stage 2 (weeks 7–12), we stopped giving reminders to medical officers, and a part-time vaccine prescriber (5 h/week) screened, consented and prescribed vaccines. Barriers to vaccination were recorded during both stages. We compared vaccination uptake between Stage 1 and Stage 2. RESULTS: Of the 851 inpatients screened, 649 were eligible for 1,410 vaccines (76.3%), and 73 vaccinations were administered (5.2%). Overall uptake increased from 19/710 (2.7%) vaccinations during Stage 1, to 54/700 (7.7%) vaccinations during Stage 2 (OR 3.04, 95% CI 1.75–5.49; p < 0.001). An increase in vaccination uptake was observed for SARS-CoV-2 (Stage 1: 1/286, 0.3%; Stage 2: 12/280, 4.3%; OR 12.7, 95% CI 1.86–546.03) and pneumococcal vaccination (Stage 1: 8/247, 3.2%; Stage 2: 30/253, 11.9%; OR 4.0, 95% CI 1.75–10.34), but not for influenza (Stage 1: 10/177, 5.6%; Stage 2: 12/167, 7.2%; OR 1.29, 95% CI 0.5–3.44). CONCLUSIONS: Academic detailing and regular reminders for medical officers to vaccinate was associated with lower vaccination uptake of older adult inpatients than the use of a part-time vaccine prescriber.
Climate change negatively impacts millions of people with respiratory conditions. On the other hand, respiratory health care negatively impacts climate change given that mainstay inhaler treatment poses its own environmental risk. Pharmacists are frequently involved in managing chronic respiratory conditions including counselling on inhaler use, thus they are well-positioned to reduce associated environmental impacts, however this role is unexplored. This study aimed to investigate Australian pharmacists' perceptions on the impact of climate change on respiratory health and the impact of respiratory health care provision or treatment use on the environment. We also aimed to explore pharmacists' views about their potential roles in promoting sustainable respiratory health care. Following approval from an institutional ethics review committee, qualitative semi-structured interviews were conducted with consenting pharmacists who had at least one year of post-registration experience and were currently working in any clinical setting. The interviews explored pharmacists' general perspectives on climate change before delving specifically into respiratory health care. Interviews were recorded, transcribed verbatim and subjected to an inductive thematic analysis within a constructivist paradigm. Thirty-two participants (72% female, 28% male) were interviewed. Three key themes were derived from the analysis: (1) environment considerations as an afterthought, (2) linking environment to respiratory care, and (3) working towards sustainable practice. Patient health was expressed as the main concern in clinical practice, with environmental considerations reported as lower priority. Most participants saw their role as being the management of patients 'respiratory symptom control'. Barriers to climate action described by participants included prescriber and patient acceptance of recommendations and concerns about counselling patients on switching to low carbon footprint inhalers being beyond their current scope of practice. Participants recommended multi-stakeholder collaboration and inclusion of this topic in pharmacy curricula as key factors to address to build sustainable respiratory health care provision. Pharmacists' main focus in respiratory health care provision is on clinical rather than environmental change issues. Many barriers such as concerns about patients' acceptance of sustainability related advice or counselling, and limited training on the topic were cited. Further research should explore best ways to address these issues, preferably in co-design practices with stakeholders.
Australia's reclassification of psilocybin as a Schedule 8 substance for treatment-resistant depression represents a significant shift in psychiatric policy. While this regulatory change positions Australia as a global leader in psychedelic medicine, its implementation has revealed substantial challenges. This article critically examines the regulatory, ethical and operational complexities surrounding the provision of psilocybin-assisted therapy in clinical practice. Key issues include limited prescriber access, absence of Australian Register of Therapeutic Goods-listed products, lack of standardised training pathways and significant cost barriers. Ethical considerations such as informed consent, cultural safety and therapeutic fidelity are also discussed, particularly in the context of trauma-informed care. This article proposes a series of structural recommendations to support safe and equitable deployment, including national training accreditation and fidelity monitoring tools. In addition, to maximise the efficacy of psilocybin-assisted therapy, we recommend that research explores the potential of neurobiologically informed stratification models to assist with treatment recommendations. These recommendations aim to enhance clinical integrity through evidence-based patient selection, improved safety, and to ensure that emerging psychedelic treatments are integrated responsibly within Australia's mental health system. By addressing these foundational gaps, Australia can move beyond regulatory novelty ensuring the therapeutic potential of these products is realised in a manner which is scientifically sound and upholds the integrity of psychiatric practice.
Allergic rhinitis (AR) is a highly prevalent condition associated with significant morbidity globally. Few recent studies have detailed the experiences of sufferers and explored their perspectives of treatment options. Allergen immunotherapy (AIT) is an effective treatment option that remains underused in eligible patient populations. We sought to describe patient perspectives of AR and treatment options including AIT. Twenty-five semistructured interviews were conducted with adult participants at a tertiary hospital center in Sydney, Australia. Authors used an inductive thematic analysis methodology to code and interpret the data. Three major themes emerged from the qualitative thematic analysis: (1) a prolonged journey with symptoms, (2) multiple trials of therapy with incomplete symptom control, and (3) diverse experiences with AIT. Several subthemes were identified: (1) delays to diagnosis and management, (2) underestimating the impact of symptoms, (3) substantially impaired quality of life, (4) limited efficacy of symptomatic pharmacotherapy, (5) perceptions of tolerance and dependence, (6) motivations to access AIT, (7) diverse expectations of AIT, and (8) barriers to AIT access. Sufferers of AR experience an impactful symptom journey, with many achieving inadequate disease control despite symptomatic pharmacotherapy. The uptake of AIT is constrained by direct medication costs, insufficient public awareness, and limited prescriber availability. The findings of this study offer insights for health care professionals and policymakers to formulate strategies to enhance AR management and improve AIT access for eligible patients.
Cytomegalovirus (CMV) is the most common congenital infection in Australia and a leading cause of preventable childhood disability. Current Australian guidelines recommend targeted antenatal screening of women at higher risk for CMV infection. Serology testing should also be considered in women with clinical symptoms suggestive of CMV. Women with suspected CMV infection in pregnancy should be promptly referred to a maternal-fetal medicine or infectious diseases specialist. High-dose valaciclovir can reduce in utero transmission to the fetus following first-trimester maternal primary infection; however, long-term safety data are limited. Valaciclovir should only be prescribed by clinicians with specific expertise in CMV, such as maternal-fetal medicine or infectious diseases specialists. Universal hygiene counselling, targeted screening, careful timing of conception after infection, and structured psychological support are essential components of care.
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 1 in 3 Australian adults and is an under-recognised but growing cause of liver cirrhosis, hepatocellular carcinoma and liver transplantation. There is a major role for primary care in MAFLD prevention, diagnosis and management. Adults with obesity, type 2 diabetes or other metabolic risk factors should be assessed for MAFLD. Liver ultrasound is the recommended first-line test for diagnosing hepatic steatosis (fat accumulation in hepatocytes). Management of MAFLD includes noninvasive testing for liver fibrosis, addressing health risk behaviours and comorbidities, and hepatocellular carcinoma surveillance in those with liver cirrhosis.
Royal Commissions into the aged-care and disability sectors revealed significant concerns about the inappropriate use of psychotropic medicines as chemical restraint in people with cognitive disability or impairment. In response, the Australian Commission on Safety and Quality in Health Care developed the Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard (the Standard), aiming to guide psychotropic use and ensure best practice in supporting people with cognitive disability or impairment. This article provides an overview of the Standard and its application in the aged-care and disability sectors. The Standard promotes person-centred care and prioritises thorough assessment, non-medication strategies, and the development of individual behaviour support plans before considering psychotropic medicines. It encourages healthcare services to have clear policies around psychotropic use, including the need for documentation of non-medication strategies trialled before such use, and for monitoring the effectiveness of any psychotropic medicine prescribed. Informed consent is a regulatory requirement before using psychotropic medicines as a form of restrictive practice. Clear treatment goals, clinical handover during transitions of care, and regular psychotropic review and deprescribing are emphasised in the Standard to minimise harm, particularly in cases of long-term use and psychotropic polypharmacy.
One in seven Australians takes an antidepressant, with around half taking them long-term (over 12 months). Unnecessarily prolonged antidepressant use should be avoided because of the risk of adverse effects. A thorough mental health and medication history should inform whether it is appropriate to attempt to stop an antidepressant. The time to stop may be when the recommended duration of therapy is complete and there is no clinical indication for continued use, or where there are adverse effects that outweigh the benefits. Stopping antidepressants abruptly may precipitate withdrawal symptoms. Withdrawal symptoms may be more likely with longer duration of therapy and with certain antidepressants, such as duloxetine, venlafaxine and paroxetine. Slowly decreasing the antidepressant dose (tapering) can help to minimise withdrawal symptoms. The optimal antidepressant tapering approach is not yet known. Tapering usually involves decreasing the antidepressant dose in smaller decrements as the dose is lowered. In patients at low risk of withdrawal symptoms, guidelines recommend 25 to 50% dose reductions over 2 to 6 weeks (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). In patients at higher risk of withdrawal symptoms, and those who have experienced difficulty stopping, smaller dose reductions over many weeks or months, through to very low drug doses (e.g. sertraline 1 mg), may be necessary; this may require compounded or liquid 'mini doses'.
BACKGROUND: Technology such as continuous glucose monitors (CGMs) have the potential to dramatically improve diabetes care for people with type 2 diabetes (T2D), but optimised clinical support is also required. This study aims to explore the use of a new kaiāwhina (cultural support worker)-based model of T2D healthcare delivery, with and without the use of CGM, as models of care that can be implemented long-term into primary care. METHODS: This randomised controlled trial will be conducted within one geographical region (Waikato, New Zealand), and will be delivered by two general practice clinic providers (covering seven different clinic sites). A minimum of 90 adults with T2D with suboptimal glycaemic control (HbA1c > 9.5% [80 mmol/mol]) will be assigned by randomisation with minimisation to one of three trial arms for a period of 26 weeks. Intervention 1 consists of intermittant use of CGM plus kaiāwhina plus optimised nurse/prescriber-based clinical care. Intervention 2 consists of kaiāwhina plus optimised nurse/prescriber-based clinical care without CGM. The third arm consists of Usual Care i.e., patient-initiated clinic visits as required and any standard practice-initiated interaction with patients such as recall for medications and diabetes annual review. At 26 weeks, patients from Usual Care will be randomised with minimisation into either Intervention 1 or 2 for a further 26 weeks. The primary outcomes of the study are change in HbA1c at 26 weeks in both Intervention 1 and 2 versus Usual Care. Secondary outcomes include change in HbA1c between Intervention 1 and Intervention 2 (including those assigned to each intervention after completing the Usual Care arm), changes in HbA1c and cardiovascular measures at 12 and 26 weeks, changes in psychosocial test scores (DSMQ, PAID-II and PHQ), cost-effectiveness analysis (cost per quality-adjusted life-years) and targeted interviews with participants and clinicians to explore their respective experiences and perspectives of the two intervention arms. DISCUSSION: This trial has the potential to inform longer-term primary management of T2D, including the efficacy of both optimised clinical activity and technology use to support people with high-risk glycaemia in an equity-centred model of care. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12624000438550) on 10th April 2024.
Viscosupplementation with intra-articular hyaluronic acid derivatives and cross-linked polymers of hyaluronic acid is increasingly used to treat symptomatic osteoarthritis in the knee, hip and other joints. Most guidelines conditionally recommend against its use to treat knee osteoarthritis, and strongly or conditionally recommend against its use for other joints, indicating a large evidence-to-practice gap. Conclusive evidence from randomised placebo-controlled trials indicates that intra-articular hyaluronic acid provides no important benefits for people with knee (and other joints) osteoarthritis, and may have potentially serious harms including septic arthritis and severe inflammatory joint and cutaneous reactions. Use of computed tomography scans to guide hyaluronic acid injection exposes the patient to unnecessary radiation and has an unwarranted financial and environmental cost. When the topic arises in clinical practice, prescribers should use a shared decision-making approach that includes an explanation as to why hyaluronic acid injection is not recommended care for osteoarthritis and offer alternatives, taking into consideration the patient's values and preferences.