Topics

Abstract

Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally.

Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.

Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.

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1 Burnet Institute, Melbourne, VIC
2 Western Health, Melbourne, VIC
3 National Drug Research Institute, Curtin University, Melbourne, VIC
4 Monash Addiction Research Centre, Monash University, Melbourne, VIC
5 Hunter New England Local Health District, Newcastle, NSW
6 University of Newcastle, Newcastle, NSW
7 Australian Injecting and Illicit Drug Users League, Sydney, NSW
8 St Vincent's Hospital Melbourne, Melbourne, VIC

Correspondence: jocelyn.chan@curtin.edu.au

Open access:

Open access publishing facilitated by Curtin University, as part of the Wiley ‐ Curtin University agreement via the Council of Australian University Librarians.

Acknowledgements:

The Consensus statement was prepared on behalf of the National Prisons Addiction Medicine Network (NPAMN). We acknowledge the time and contributions from everyone on the expert panel: Adrian Dunlop, Andrew Wiley, Bianca Davidde, Christine Watson, David Onu, Ele Morrison, Jeremy Hayllar, Jocelyn Chan, Katerina Lagios, Kevin Fontana, Mark Stoove, Peter Thompson, Rebecca Winter, Shalini Arunogiri, Suzanne Nielsen, Thileepan Naren, and Tom Turnbull. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Competing interests:

Rebecca Winter has received investigator‐initiated funding from Gilead Sciences for research unrelated to this work. Thileepan Naren has received speaking honoraria from Camarus. All other authors report no relevant disclosures.

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Perspective

A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm

Mya Cubitt and Seok Lim

Med J Aust 2025; 222 (4): . || doi: 10.5694/mja2.52588
Published online: 3 March 2025

Topics

Emergency medicine

General medicine

Health occupations

Health services administration

Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.1 Hospital‐in‐the‐home (HITH) models of care are suggested as sustainable patient‐centred, value‐based solutions.2

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1 Royal Melbourne Hospital, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 RMH@Home, Royal Melbourne Hospital, Melbourne, VIC

Correspondence: mya.cubitt@mh.org.au

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

We acknowledge the work of The Austin Hospital‐in‐the‐Home (HITH) team and creators of the flowcharts in the Box, supplied and included with permission. Our thanks to: Angela Sullivan, Nurse Unit Manager, HITH and Virtual Care; Mark Horrigan, Medical Director HITH and Virtual Care; Danielle Panaccio, HITH Consultant; and Daniel Thuys, HITH Case Manager.

Competing interests:

No relevant disclosures.

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Perspective

Online first

Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability

Rosemary Wyber, Glenn Pearson and Laurens Manning

Med J Aust || doi: 10.5694/mja2.52590
Published online: 24 February 2025

Topics

Cardiovascular diseases

Indigenous health

Pharmaceutical preparations

Benzathine benzylpenicillin G (BPG) is the most effective treatment for syphilis and prevention of rheumatic heart disease (RHD), both of which disproportionately affect Aboriginal and Torres Strait Islander people. The ongoing syphilis epidemic in Australia1 highlights the importance of a reliable supply of high quality BPG in achieving Australia's commitments to ending RHD and preventing new cases of congenital syphilis.2

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1 The Kids Research Institute Australia, Perth, WA
2 Yardhura Walani, Australian National University, Canberra, ACT
3 University of Western Australia, Perth, WA

Correspondence: rosemary.wyber@thekids.org.au

Open access:

Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.

Acknowledgements:

Laurens Manning is supported by a Medical Research Future Fund Investigator Grant (2020 Better penicillins, better hearts: improving secondary prevention of rheumatic heart disease; Emerging Leadership 2 APP1197177). Rosemary Wyber is supported by a National Health and Medical Research Council Emerging Leadership 2 Fellowship (GNT2025252). No funding agency had any role in study design, data collection, analysis or interpretation, reporting or publication.

Competing interests:

No relevant disclosures.

1. Department of Health and Aged Care. National syphilis monitoring reports. Canberra: Australian Government, 2024. https://www.health.gov.au/resources/collections/national‐syphilis‐monitoring‐reports?language=en (viewed Feb 2024).
2. Department of Health and Aged Care. National Aboriginal and Torres Strait Islander Health Plan 2021 – 2023. Canberra: Australian Government, 2021. https://www.health.gov.au/sites/default/files/documents/2022/06/national‐aboriginal‐and‐torres‐strait‐islander‐health‐plan‐2021‐2031.pdf (viewed Feb 2024).
3. Wyber R, Johnson T, Patel B. Supply of benzathine penicillin G: the 20‐year experience in Australia. Aust N Z J Public Health 2015: 39: 506‐508.
4. Nurse‐Findlay S, Taylor MM, Savage M, et al. Shortages of benzathine penicillin for prevention of mother‐to‐child transmission of syphilis: an evaluation from multi‐country surveys and stakeholder interviews. PLoS Med 2017; 14: e1002473.
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6. Australian Commission on Safety and Quality in Health Care. Fact sheet: Safety considerations during benzathine benzylpenicillin (Bicillin L‐A) supply disruption. 2024. https://www.safetyandquality.gov.au/publications‐and‐resources/resource‐library/fact‐sheet‐safety‐considerations‐during‐benzathine‐benzylpenicillin‐billin‐l‐supply‐disruption (viewed Jan 2024).
7. Australian Guidance. Preparation and dosing of long‐acting S19A benzathine benzylpenicillin EXTENCILLINE product [clinical information resource]. Northern Territory Government, National Aboriginal Community Controlled Health Organisation, Menzies School of Health Research, 2024. https://www.rhdaustralia.org.au/system/files/fileuploads/s19a_benzathine_benzylpenicillin_extencilline_preparation_and_dosing_information_resource_may_2024.pdf (viewed Aug 2024).
8. Kado J, Salman S, Hand R, et al. Population pharmacokinetic study of benzathine penicillin G administration in Indigenous children and young adults with rheumatic heart disease in the Northern Territory, Australia. J Antimicrob Chemother 2022; 77: 2679‐2682.
9. Manyemba J, Mayosi B. Penicillin for secondary prevention of rheumatic fever: Cochrane Database Syst Rev; 2002: CD002227.
10. Seghers F, Taylor MM, Storey A, et al. Securing the supply of benzathine benzylpenicillin: a global perspective on risks and mitigation strategies to prevent future shortages. Int Health 2024; 16: 279‐282.
11. Therapeutic Goods Administration. Medicine shortages in Australia ‐ challenges and opportunities. Feedback updated 29 July 2024. Australian Government Department of Health and Aged Care, 2024. https://consultations.tga.gov.au/tga/medicine‐shortages‐australia/consultation/published_select_respondent?show_all_questions=0&sort=submitted&order=ascending&_q__text=naccho (viewed Aug 2024).
12. Sandoz. Sandoz opens new antibiotic production facility in Austria, to significantly increase capacity for life‐saving medicines [media release]. 21 Mar 2024. https://www.sandoz.com/sandoz‐opens‐new‐antibiotic‐production‐facility‐austria‐significantly‐increase‐capacity‐life‐saving/ (viewed Oct 2024).
13. Mathews JA. The birth of the biotechnology era: penicillin in Australia, 1943–80. Prometheus 2008; 26: 317‐333.
14. Cook R. World‐class pharmaceutical facility delivers jobs boost for WA [media release]. 1 Aug 2024. Government of Western Australia. https://www.wa.gov.au/government/media‐statements/Cook‐Labor‐Government/World‐class‐pharmaceutical‐facility‐delivers‐jobs‐boost‐for‐WA‐20240801 (viewed Aug 2024).
15. National Tribune. Making modern medicines in Australia. Toowoomba: National Tribune, 2022. https://www.nationaltribune.com.au/insight‐making‐modern‐medicines‐in‐australia/ (viewed Oct 2024).
16. Department of Industry, Science and Resources. mRNA vaccines to be made in Australia [media release]. 14 Dec 2021. https://www.minister.industry.gov.au/ministers/taylor/media‐releases/mrna‐vaccines‐be‐made‐australia
17. Kado J, Salman S, Hla TK, et al. Subcutaneous infusion of high‐dose benzathine penicillin G is safe, tolerable, and suitable for less‐frequent dosing for rheumatic heart disease secondary prophylaxis: a phase 1 open‐label population pharmacokinetic study. Antimicrob Agents Chemother 2023; 67: e0096223.
18. Enkel SL, Kado J, Hla TK, et al. Qualitative assessment of healthy volunteer experience receiving subcutaneous infusions of high‐dose benzathine penicillin G (SCIP) provides insights into design of late phase clinical studies. PLoS One 2023; 18: e0285037.

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Research letter

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Use of ChatGPT to obtain health information in Australia, 2024: insights from a nationally representative survey

Julie Ayre, Erin Cvejic and Kirsten J McCaffery

Med J Aust || doi: 10.5694/mja2.52598
Published online: 17 February 2025

Topics

Health services administration

Information science

Environment and public health

Social determinants of health

Since the launch of ChatGPT in 2022,1 people have had easy access to a generative artificial intelligence (AI) application that can provide answers to most health‐related questions. Although ChatGPT could massively increase access to tailored health information, the risk of inaccurate information is also recognised, particularly with early ChatGPT versions, and its accuracy varies by task and topic.2 Generative AI tools could be a further problem for health services and clinicians, adding to the already large volume of medical misinformation.3 Discussions of the benefits and risks of the new technology for health equity, patient engagement, and safety need reliable information about who is using ChatGPT, and the types of health information they are seeking.

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The University of Sydney, Sydney, NSW

Correspondence: julie.ayre@sydney.edu.au

Open access:

Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.

Data Sharing:

The data underlying this report are available on reasonable request.

Acknowledgements:

Julie Ayre and Kirsten McCaffery are supported by National Health and Medical Research Council fellowships (APP2017278, APP2016719). The funders were not involved in study design, data collection, analysis or interpretation, reporting or publication. We acknowledge the contribution of Tara Haynes (Sydney Health Literacy Lab, University of Sydney) to the preparation of the ethics application for this study.

Competing interests:

No relevant disclosures.

1. Vallance C. ChatGPT: New AI chatbot has everyone talking about it. BBC [website], 7 Dec 2022. https://www.bbc.com/news/technology‐63861322 (viewed Jan 2025).
2. Wei Q, Yao Z, Cui Y, et al. Evaluation of ChatGPT‐generated medical responses: a systematic review and meta‐analysis. J Biomed Inform 2024; 151: 104620.
3. Dunn AG, Shih I, Ayre J, Spallek H. What generative AI means for trust in health communications. J Commun Healthc 2023; 16: 385‐388.
4. Social Research Centre. Life in Australia methods: documentation. Oct 2024. https://srcentre.com.au/wp‐content/uploads/2024/10/LinA‐recruitment‐sample‐and‐allocation‐description‐20241023‐final.pdf (viewed Oct 2024).
5. Wallace LS, Rogers ES, Roskos SE, et al. Screening items to identify patients with limited health literacy skills. J Gen Intern Med 2006; 21: 874‐877.
6. Australian Bureau of Statistics. Index of Relative Socio‐economic Advantage and Disadvantage (IRSAD). In: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2021. 27 Apr 2021. https://www.abs.gov.au/statistics/people/people‐and‐communities/socio‐economic‐indexes‐areas‐seifa‐australia/latest‐release#index‐of‐relative‐socio‐economic‐advantage‐and‐disadvantage‐irsad‐ (viewed Aug 2024).
7. Australian Bureau of Statistics. National, state and territory population, December 2023. 13 June 2024. https://www.abs.gov.au/statistics/people/population/national‐state‐and‐territory‐population/dec‐2023 (viewed Aug 2024).
8. Singla A, Sukharevsky A, Yee L, et al. The state of AI in early 2024: gen AI adoption spikes and starts to generate value. QuantumBlack, AI by McKinsey, 30 May 2024. https://www.mckinsey.com/capabilities/quantumblack/our‐insights/the‐state‐of‐ai (viewed Aug 2024).
9. Australian Department of Health and Aged Care. National Preventive Health Strategy 2021–2030. Updated 14 Dec 2021. https://www.health.gov.au/resources/publications/national‐preventive‐health‐strategy‐2021‐2030 (viewed Aug 2024).

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Medical education
Lessons from practice

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Putting international practice into action: the first case of lung transplantation for COVID‐19 in Victoria, Australia

Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad and Gregory I Snell

Med J Aust || doi: 10.5694/mja2.52597
Published online: 17 February 2025

Topics

Infectious diseases

Respiratory tract diseases

Surgical procedures, operative

A 61‐year‐old previously healthy man presented to hospital with acute type 1 respiratory failure after five days of coryzal symptoms and a positive coronavirus disease 2019 (COVID‐19) rapid antigen test. Within 24 hours, the patient became progressively hypoxic, was rapidly intubated and transferred to Alfred Health in December 2022, a tier one Victorian extracorporeal membrane oxygenation (ECMO) service site, for veno‐venous ECMO (Avalon Elite bi‐caval dual lumen catheter).

1 Alfred Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: me.wong@alfred.org.au

Patient consent:

The patient provided written consent for publication.

Competing interests:

No relevant disclosures.

1. Cypel M, Keshavjee S. When to consider lung transplantation for COVID‐19. Lancet Respir Med 2020; 8: 944‐946.
2. D'Cunha M, Jenkins JA, Wilson R, et al. Lung transplantation in the United States for COVID‐19 related lung disease during the pandemic. Lung 2024; 202: 723‐737.
3. Bharat A, Querrey M, Markov NS, et al. Lung transplantation for patients with severe COVID‐19. Sci Transl Med 2020; 12: eabe4282.
4. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: an update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40: 1349‐1379.
5. Bharat A, Machuca TN, Querrey M, et al. Early outcomes after lung transplantation for severe COVID‐19: a series of the first consecutive cases from four countries. Lancet Respir Med 2021; 9: 487‐497.
6. Kanne JP, Little BP, Schulte JJ, et al. Long‐term lung abnormalities associated with COVID‐19 pneumonia. Radiology 2023; 306: e221806.
7. Lang C, Ritschl V, Augustin F, et al. Clinical relevance of lung transplantation for COVID‐19 ARDS: a nationwide study. Eur Respir J 2022; 60: 2102404.
8. Bermudez C, Bermudez F, Courtwright A, et al. Lung transplantation for COVID‐2019 respiratory failure in the United States: outcomes 1‐year posttransplant and the impact of preoperative extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg 2024; 167: 384‐395.
9. King CS, Mannem H, Kukreja J, et al. Lung transplantation for patients with COVID‐19. Chest 2022; 161: 169‐178.
10. Young KA, Ali HA, Beermann KJ, et al. Lung transplantation and the era of the sensitized patient. Front Immunol 2021; 12: 689420.
11. Weinstock C, Schnaidt M. Human leucocyte antigen sensitisation and its impact on transfusion practice. Transfus Med Hemother 2019; 46: 356‐369.
12. Rees L, Kim JJ. HLA sensitisation: can it be prevented? Pediatr Nephrol 2015; 30: 577‐587.

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Perspective

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Genetic counsellors: facilitating the integration of genomics into health care

Tatiane Yanes, Eliza Courtney, Mary‐Anne Young, Amy Pearn, Aideen McInerney‐Leo and Jodie Ingles

Med J Aust || doi: 10.5694/mja2.52568
Published online: 3 February 2025

Topics

Medical genetics

Genomic testing is integral across all areas of health care and is a cornerstone of modern medicine. Beyond diagnosing rare conditions, genomic testing is routinely used to inform reproductive and prenatal care, augment risk assessments, guide therapies and inform management at the individual and public health level. There are over 25 conditions with federally funded Medicare Benefits Schedule (MBS) item numbers to deliver germline diagnostic genomic testing, including cancers, cardiac conditions, renal conditions and childhood hearing loss. Additional genomic testing is funded by state and territory public health departments and private out‐of‐pocket payments. The exponential growth of genomics knowledge and use in health care is likely to continue. Given its clinical value, genomic testing is increasingly offered by clinicians who do not have genetics subspecialty qualifications (referred to as non‐genetics clinicians), which has necessitated further education and upskilling of these clinicians. Although mainstreaming has been successful in some settings,1 most health services and clinicians are insufficiently prepared or resourced to address the complexities of genomic medicine.2,3

1 Frazer Institute, Dermatology Research Centre, University of Queensland, Brisbane, QLD
2 Children's Health Queensland Hospital and Health Service, Brisbane, QLD
3 Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW
4 Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW
5 Clinical Engagement and Translational Platform, Garvan Institute of Medical Research, Sydney, NSW
6 Genomics and Inherited Disease Program, Garvan Institute of Medical Research, University of New South Wales, Sydney, NSW
7 University of New South Wales, Sydney, NSW
8 The Gene Council, Perth, WA

Correspondence: t.yanes@uq.edu.au

Competing interests:

No relevant disclosures.

1. Jayasinghe K, Biros E, Harris T, et al. Implementation and evaluation of a national multidisciplinary kidney genetics clinic network over ten years. Kidney Int Rep 2024; 9: 2372‐2385.
2. Crellin E, McClaren B, Nisselle A, et al. Preparing medical specialists to practice genomic medicine: education an essential part of a broader strategy. Front Genet 2019; 10: 789.
3. O'Shea R, Ma AS, Jamieson RV, Rankin NM. Precision medicine in Australia: now is the time to get it right. Med J Aust 2022; 217: 559‐563. https://www.mja.com.au/journal/2022/217/11/precision‐medicine‐australia‐now‐time‐get‐it‐right
4. Mordaunt DA, Dalziel K, Goranitis I, Stark Z. Uptake of funded genomic testing for syndromic and non‐syndromic intellectual disability in Australia. Eur J Hum Genet 2023; 31: 977‐979.
5. Watts GF, Sullivan DR, Hare DL, et al. Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia. Heart Lung Circ 2021; 30: 324‐349.
6. Morrow A, Steinberg J, Chan P, et al. In person and virtual process mapping experiences to capture and explore variability in clinical practice: application to genetic referral pathways across seven Australian hospital networks. Transl Behav Med 2023; 13: 561‐570.
7. Shaw T, Fok R, Courtney E, et al. Missed diagnosis or misdiagnosis: common pitfalls in genetic testing. Singapore Med J 2023; 64: 67‐73.
8. Farmer MB, Bonadies DC, Pederson HJ, et al. Challenges and errors in genetic testing: the fifth case series. Cancer J 2021; 27: 417‐422.
9. Ackerman JP, Bartos DC, Kapplinger JD, et al. The promise and peril of precision medicine: phenotyping still matters most. Mayo Clin Proc 2016: S0025‐6196(16)30463‐3.
10. Ray T. Genetic testing challenges in oncology: immigrant mislabeled as BRCA‐Positive, regrets ovary removal. May 2021. Precision Medicine Online. https://www.precisionmedicineonline.com/molecular‐diagnostics/genetic‐testing‐challenges‐oncology‐immigrant‐mislabeled‐brca‐positive (viewed Oct 2024).
11. Bhatia A, Kliff S. When they warn of rare disorders, these prenatal tests are usually wrong. The New York Times, 1 Jan 2022. https://www.nytimes.com/2022/01/01/upshot/pregnancy‐birth‐genetic‐testing.html (viewed Oct 2024).
12. Bennett C. Ambiguous genetic test results can be unsettling. Worse, they can lead to needless surgeries. The Washington Post, 7 Feb 2021. https://www.washingtonpost.com/health/genetic‐tests‐uncertain‐results/2021/02/05/80a06d9a‐65a2‐11eb‐8468‐21bc48f07fe5_story.html (viewed Oct 2024).
13. Ma A, Newing TP, O'Shea R, et al. Genomic multidisciplinary teams: a model for navigating genetic mainstreaming and precision medicine. J Paediatr Child Health 2024; 60: 118‐124.
14. Kohut K, Limb S, Crawford G. The changing role of the genetic counsellor in the genomics era. Current Genetic Medicine Reports 2019; 7: 75‐84.
15. Austin J. 2020 Vision: genetic counselors as acknowledged leaders in integrating genetics and genomics into healthcare. J Genet Couns 2016; 25: 1‐5.
16. Smerecnik CM, Mesters I, Verweij E, et al. A systematic review of the impact of genetic counseling on risk perception accuracy. J Genet Couns 2009; 18: 217‐228.
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18. Athens BA, Caldwell SL, Umstead KL, et al. A systematic review of randomized controlled trials to assess outcomes of genetic counseling. J Genet Couns 2017; 26: 902‐933.
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22. Haidle JL, Sternen DL, Dickerson JA, et al. Genetic counselors save costs across the genetic testing spectrum. Am J Manag Care 2017; 23: Sp428‐Sp430.
23. Yanes T, Sullivan A, Barbaro P, et al. Evaluation and pilot testing of a multidisciplinary model of care to mainstream genomic testing for paediatric inborn errors of immunity. Eur J Hum Genet 2023; 31: 1125‐1132.
24. Coleman TF, Pugh J, Kelley WV, et al. Errors in genome sequencing result disclosures: a randomized controlled trial comparing neonatology non‐genetics healthcare professionals and genetic counselors. Genet Med 2024; 26: 101198.
25. McInerney‐Leo AM, Schmidts M, Cortés CR, et al. Short‐rib polydactyly and Jeune syndromes are caused by mutations in WDR60. Am J Hum Genet 2013; 93: 515‐523.
26. Tiller J, Bakshi A, Dowling G, et al. Community concerns about genetic discrimination in life insurance persist in Australia: a survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32: 286‐294.
27. Leslie F, Avis SR, Bagnall RD, et al. The New South Wales Sudden Cardiac Arrest Registry: a data linkage cohort study. Heart Lung Circ 2023; 32: 1069‐1075.
28. Human Genetics Society of Australasia. Genetic counselling training and accreditation 2024 [website]. https://hgsa.org.au/Web/Web/ET/Genetic‐Counselling.aspx?hkey=975b23ce‐fa8e‐485a‐a7ee‐fc88aab9a60d (viewed July 2024).
29. Nisselle A, Macciocca I, McKenzie F, et al. Readiness of clinical genetic healthcare professionals to provide genomic medicine: an Australian census. J Genet Couns 2019; 28: 367‐377.
30. Kanga‐Parabia A, Mitchell L, Smyth R, et al. Genetic counseling workforce diversity, inclusion, and capacity in Australia and New Zealand. Genetics in Medicine Open 2024; 101848.
31. Caleshu C, Kim H, Silver J, et al. Contributors to and consequences of burnout among clinical genetic counselors in the United States. J Genet Couns 2022; 31: 269‐278.
32. Medicare Benefits Schedule (MBS) Review Advisory Committee. Genetic Counselling Final Report 2022. https://www.health.gov.au/sites/default/files/2023‐04/mbs‐review‐advisory‐committee‐genetic‐counselling‐final‐report_0.pdf (viewed July 2024).
33. Hoskins C, Gaff C, McEwen A, et al. Professional regulation for Australasian genetic counselors. J Genet Couns 2021; 30: 361‐369.
34. Patrinos D, Ghaly M, Al‐Shafai M, Zawati MH. Legal approaches to risk of harm in genetic counseling: perspectives from Quebec and Qatar. Front Genet 2023; 14: 1190421.

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Research

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Bulk‐billing rates and out‐of‐pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data

Karinna Saxby and Yuting Zhang

Med J Aust || doi: 10.5694/mja2.52562
Published online: 27 January 2025

Topics

Health services administration

Abstract

Objectives: To examine bulk‐billing rates and out‐of‐pocket costs for non‐bulk‐billed general practitioner services in Australia at the Statistical Area 3 (SA3) level; to assess differences by area‐level socio‐economic disadvantage and remoteness.

Study design: Retrospective analysis of administrative data (Medicare claims data).

Setting, participants: All Medicare claims for non‐referred general practitioner services in Australia during the 2022 calendar year, as recorded in the Person Level Integrated Data Asset (PLIDA).

Main outcome measures: Mean proportions of general practitioner services that were bulk‐billed and mean patient out‐of‐pocket costs for non‐bulk‐billed general practitioner visits by SA3 region, adjusted for area‐level age and sex, both overall and by area‐level socio‐economic disadvantage (Index of Relative Socioeconomic Disadvantage quintile) and remoteness (simplified Modified Monash Model category).

Results: During 2022, 82% (95% confidence interval [CI], 80–83%) of general practitioner services in Australia were bulk‐billed; the mean out‐of‐pocket cost for non‐bulk‐billed visits was $43 (95% CI, $42–44). By SA3, mean bulk‐billing rates ranged between 46% and 99%, mean out‐of‐pocket costs for non‐bulk‐billed general practitioner visit between $16 and $99. Bulk‐billing rates were higher in regions in the most socio‐economically disadvantaged quintile (86%; 95% CI, 84–88%) than those in the least disadvantaged quintile (73%; 95% CI, 70–76%); the mean rate was not significantly different for remote (86%; 95% CI, 79–92%) and metropolitan areas (81%; 95% CI, 79–83%). Out‐of‐pocket costs for non‐bulk‐billed general practitioner services were higher in remote ($56; 95% CI, $46–66) than in metropolitan areas ($43; 95% CI, $42–44), and lower in areas in the most socio‐economically disadvantaged quintile ($42; 95% CI, $40–45) than in those in the least disadvantaged quintile ($47; 95% CI, $45–49).

Conclusion: Although most general practitioner services are bulk‐billed, out‐of‐pocket costs for non‐bulk‐billed services are relatively high, particularly for people in remote and socio‐economically disadvantaged areas of Australia.

Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, VIC

Correspondence: karinna.saxby@unimelb.edu.au

Data Sharing:

The Person Level Integrated Data Asset Data used for our analysis are available upon request to the Australian Bureau of Statistics.

Acknowledgements:

We thank the Australian Bureau of Statistics microdata team for their tireless vetting and assistance. We also thank Susan Mendez (Melbourne Institute, University of Melbourne), Dennis Petrie (Centre for Health Economics, Monash University), and the participants of the Medicare at 40 Event (Canberra. 19 February 2024) for useful feedback and suggestions. Yuting Zhang holds an Australian Research Council Australian Future Fellowship (FT200100630).

Competing interests:

No relevant disclosures.

1. Australian Department of Health and Aged Care. About Medicare. Updated 27 Sept 2023. https://www.servicesaustralia.gov.au/about‐medicare?context=60092 (viewed May 2024).
2. Carpenter A, Islam MM, Yen L, McRae I. Affordability of out‐of‐pocket health care expenses among older Australians. Health Policy 2015; 119: 907–914.
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4. Liu D, Yu S, Webster SB, et al. Geographic variation in out‐of‐pocket costs for radiation oncology services. Med J Aust. 2023; 218: 315–319. https://www.mja.com.au/journal/2023/218/7/geographic‐variation‐out‐pocket‐costs‐radiation‐oncology‐services
5. Young AF, Dobson AJ. The decline in bulk‐billing and increase in out‐of‐pocket costs for general practice consultations in rural areas of Australia, 1995–2001. Med J Aust 2003; 178: 122–126. https://www.mja.com.au/journal/2003/178/3/decline‐bulk‐billing‐and‐increase‐out‐pocket‐costs‐general‐practice
6. Callander E, Larkins S, Corscadden L. Variations in out‐of‐pocket costs for primary care services across Australia: a regional analysis. Aust J Prim Health 2017; 23: 379–385.
7. Ong GS, Lee SJ, Radeski D. Variation in outpatient consultant physician fees in Australia by specialty and state and territory. Med J Aust 2017; 207: 176–180. https://www.mja.com.au/journal/2017/206/4/variation‐outpatient‐consultant‐physician‐fees‐australia‐specialty‐and‐state‐and
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16. Australian Bureau of Statistics. 2021. Index of Relative Socio‐economic Disadvantage (IRSD). In: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2021. 27 Apr 2023. https://www.abs.gov.au/statistics/people/people‐and‐communities/socio‐economic‐indexes‐areas‐seifa‐australia/latest‐release#index‐of‐relative‐socio‐economic‐disadvantage‐irsd‐ (viewed May 2024).
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20. Zhang Y. How can the Australian government make primary care and private health insurance more affordable? Aust Econ Rev 2024; 57: 174–178.
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Research

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Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study

Berhe W Sahle, Emily Banks, Robyn Williams, Grace Joshy, Garry Jennings, Jonathan C Craig, Nicholas G Larkins, Francine Eades, Rebecca Q Ivers and Sandra Eades

Med J Aust || doi: 10.5694/mja2.52558
Published online: 20 January 2025

Topics

Cardiovascular diseases

Indigenous health

Abstract

Objective: To assess the distribution of blood pressure levels and the prevalence of hypertension and pre‐hypertension in young Indigenous people (10–24 years of age).

Study design: Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis.

Setting, participants: Aboriginal and Torres Strait Islander people aged 10–24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 – March 2020.

Main outcome measures: Blood pressure categorised as normal, pre‐hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10–17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18–24 years); associations of demographic characteristics and health behaviours with hypertension and pre‐hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs).

Results: Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60–8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76–1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28–0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35–0.57 mmHg) per 1.0 kg/m² increase in body mass index. Ninety‐one participants (11.8%) had blood pressure readings indicating pre‐hypertension, and 148 (19.2%) had hypertension. The risks of pre‐hypertension (RRR, 4.22; 95% CI, 2.52–7.09) and hypertension (RRR, 1.93; 95% CI, 1.27–2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre‐hypertension: RRR, 2.39 [95% CI, 1.26–4.55]; hypertension: RRR, 3.20 [95% CI, 1.91–5.35]) and for participants aged 16–19 years (pre‐hypertension: 3.44 [95% CI, 1.88–6.32]; hypertension: RRR, 2.15 [95% CI, 1.29–3.59]) or 20–24 years (pre‐hypertension: 4.12 [95% CI, 1.92–8.85]; hypertension: RRR, 4.09 [95% CI, 2.24–7.47]) than for those aged 10–15 years.

Conclusions: Blood pressure was within the normal range for most young Indigenous people in our study, but one in three had elevated blood pressure or hypertension. Community‐level, culturally safe approaches are needed to avoid the early onset of cardiovascular risks, including elevated blood pressure.

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1 The University of Melbourne, Melbourne, VIC
2 Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
3 Curtin University, Perth, WA
4 National Heart Foundation of Australia, Canberra, ACT
5 Flinders University, Adelaide, SA
6 Perth Children's Hospital, Perth, WA
7 The University of Western Australia, Perth, WA
8 East Metropolitan Health Service, Perth, WA
9 University of New South Wales, Sydney, NSW
10 The George Institute for Global Health, UNSW Sydney, Sydney, NSW

Correspondence: berhe.sahle@unimelb.edu.au

Acknowledgements:

The Next Generation Youth Well‐being Study was funded by the National Health and Medical Research Council (NHMRC; 1089104). Emily Banks is supported by an NHMRC Investigator grant (2017742). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

We recognise and pay respect to the Aboriginal Custodians of the land where the Next Generation Youth Well‐being Study was conducted, including the Arrernte, Awabakal, Bidjigal, Darkinjung, Dharug, Gadigal, Gamilaraay, Gumbaynggirr, Noongar, and Wiradjuri peoples. We acknowledge the support of our community partners: the Central Australian Aboriginal Congress, the Derbarl Yerrigan Health Service South West Aboriginal Medical Service, the Awabakal Medical Service, the Mingaletta Aboriginal and Torres Strait Islander Corporation, the Miimi Aboriginal Corporation, the Tamworth Regional Youth Centre, and Orange City Council Community Services. We acknowledge the Next Generation investigators and research team including Dennis Gray (Curtin University), Justine Whitby (University of Melbourne), and Peter Azzopardi (Murdoch Children's Research Institute).

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The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis

Rachel Farber, Nehmat Houssami, Kevin McGeechan, Alexandra L Barratt and Katy JL Bell

Med J Aust || doi: 10.5694/mja2.52566
Published online: 20 January 2025

Topics

Neoplasms

Environment and public health

Diagnostic techniques and procedures

Abstract

Objectives: To assess the impact of the transition from film to digital mammography in the Australian national breast cancer screening program.

Study design: Retrospective linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis.

Setting: New South Wales, 2002–2016.

Participants: Women aged 40 years or older with breast cancer diagnosed during 2002–2017 who had been screened by BreastScreen NSW and for whom complete follow‐up information until the end of the recommended re‐screening interval was available.

Intervention: Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality).

Main outcome measures: Population rates of screen‐detected cancer, interval cancer, recalls, and false positive findings.

Results: The study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002–2010) and 1 206 371 used digital mammography (2006–2016). The screen‐detected cancer rate was 4.86 (95% confidence interval [CI], 4.75–4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97–6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06–1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48–2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75–2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15–0.40] cases per 1000 screens). With the transition to digital mammography, the screen‐detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (–0.21 cases per 1000 screens) and the rise in the ductal carcinoma in situ detection rate (0.28 cases per 1000 screens); during 2009–2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive cancer: by 0.69 cases per 1000 screens); during 2009–2015, it declined by 0.13 cases per 1000 screens per year. The recall rate increased by 8.02 per 1000 screens and the false positive rate by 7.16 per 1000 screens following the transition; both rates subsequently declined to pre‐transition levels.

Conclusions: The increased screen‐detected cancer rate following the transition to digital mammography was not accompanied by a reduction in interval cancer detection rates.

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1 Sydney School of Public Health, the University of Sydney, Sydney, NSW
2 The Family Planning Australia Research Centre, Sydney, NSW

Correspondence: katy.bell@sydney.edu.au

Open access:

Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.

Data Sharing:

Access to the data and analysis files underlying this report is permitted only with the explicit permission of the approving human research ethics committees and the data custodians. Analysis of linked data is currently authorised at only one location.

Acknowledgements:

This study was supported by funding from the National Health and Medical Research Council (NHMRC) Centre for Research Excellence (CIA Alexandra Barratt, 1104136). Rachel Farber received funding from the NHMRC (1168688) and the National Breast Cancer Foundation (NBCF) (DS‐19‐02). Katy Bell holds an NHMRC Investigator grant (1174523). Nehmat Houssami holds an NHMRC Investigator grant (1194410) and an NBCF Chair in Breast Cancer Prevention grant (EC‐21‐001). The funders had no role in the study design, data collection, analysis or interpretation, reporting or publication.

Competing interests:

No relevant disclosures.

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Urban green space provision: the case for policy‐based solutions to support human health

Craig Williams, Christie Byrne, Shannon Evenden, Veronica Soebarto, Stefan Caddy‐Retalic, Carmel Williams, Yonatal Tefera, Xiaoqi Feng and Andrew Lowe

Med J Aust || doi: 10.5694/mja2.52569
Published online: 20 January 2025

Topics

Environment and public health

Global health

As one of the world's most urbanised nations, Australia1 is particularly vulnerable to diseases causally linked with urban living.2 Further urban growth requires systemic health policy solutions. Urban green spaces (UGS) are dynamic contributors to the wellbeing of our cities, offering benefits to the health of humans, society, and natural and managed ecosystems. Here we define UGS to encompass planned and intentional green spaces such as parks, curated gardens, sports and recreation areas as well as urban forests and nature reserves, and unconventional green zones such as easements, road and infrastructure routes, streetscapes and commercial precincts.

1 University of South Australia, Adelaide, SA
2 Environment Institute, University of Adelaide, Adelaide, SA
3 University of Adelaide, Adelaide, SA
4 University of Sydney, Sydney, NSW
5 South Australian Health and Medical Research Institute, Adelaide, SA
6 University of New South Wales, Sydney, NSW

Correspondence: craig.williams@unisa.edu.au

Acknowledgements:

We acknowledge the HEAL (Healthy Environments And Lives) National Research Network, which receives funding from the National Health and Medical Research Council Special Initiative in Human Health and Environmental Change (Grant No. 2008937). Support was also provided by the Environment Institute at the University of Adelaide. The funding source was not involved in the authoring of this work. The work of the Dynamic State Summit (2022) in catalysing this work is acknowledged.

Competing interests:

No relevant disclosures.

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