Topics

The National Clinical Evidence Taskforce (NCET) established coronavirus disease 2019 (COVID‐19) drug treatment guidelines in March 2020 to provide clinicians with living evidence‐based recommendations for the care of patients with COVID‐19. These guidelines have been widely used and have informed practice in Australia and beyond. However, there are limitations to the available evidence, and, as the COVID‐19 pandemic has progressed, the NCET has had to address a number of challenges. This perspective article discusses these limitations and challenges and the strategies developed to ensure that the guidelines remain relevant and useful for clinicians (Box).

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 QIMR Berghofer Medical Research Institute, Brisbane, QLD
2 Royal Brisbane and Women's Hospital, Brisbane, QLD
3 Monash University, Melbourne, VIC
4 Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA
5 John Hunter Hospital, Newcastle, NSW
6 University of Newcastle, Newcastle, NSW
7 Alfred Hospital, Melbourne, VIC

Correspondence: bridget.barber@qimrberghofer.edu.au

Correspondence: tari.turner@monash.edu

Open access:

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

Acknowledgements:

The National COVID‐19 Clinical Evidence Taskforce is funded by the Australian Government Department of Health and Aged Care, the Victorian Department of Health and Human Services, the Ian Potter Foundation and the Walter Thomas Cottman Endowment Fund (managed by Equity Trustees), and the Lord Mayors’ Charitable Foundation. We thank all members of the National COVID‐19 Clinical Evidence Taskforce for their contributions to the work described in this article, and acknowledge the Taskforce member organisations and our partners.

Competing interests:

All authors are members of the National Clinical Evidence Taskforce. No personal payments have been received by any authors.

1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924‐926.
2. National Clinical Evidence Taskforce. Caring for people with COVID‐19 — living guidelines. https://clinicalevidence.net.au/covid‐19/ (viewed June 2023).
3. Tendal B, Vogel JP, McDonald S, et al. Weekly updates of national living evidence‐based guidelines: methods for the Australian living guidelines for care of people with COVID‐19. J Clin Epidemiol 2021; 131: 11‐21.
4. Hewitt J, McDonald S, Poole A, et al. Weekly updating of guideline recommendations was feasible: the Australian National COVID‐19 Clinical Evidence Taskforce. J Clin Epidemiol 2023; 155: 131‐136.
5. Hammond J, Leister‐Tebbe H, Gardner A, et al. Oral nirmatrelvir for high‐risk, nonhospitalized adults with COVID‐19. N Engl J Med 2022; 386: 1397‐1408.
6. Gottlieb RL, Vaca CE, Paredes R, et al. Early remdesivir to prevent progression to severe COVID‐19 in outpatients. N Engl J Med 2022; 386: 305‐315.
7. Butler CC, Hobbs FDR, Gbinigie OA, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID‐19 at increased risk of adverse outcomes (PANORAMIC): an open‐label, platform‐adaptive randomised controlled trial. Lancet 2023; 401: 281‐293.
8. Reis G, Moreira Silva EAS, Medeiros Silva DC, et al. Early treatment with pegylated interferon lambda for COVID‐19. N Engl J Med 2023; 388: 518‐528.
9. Jagannathan P, Andrews JR, Bonilla H, et al. Peginterferon Lambda‐1a for treatment of outpatients with uncomplicated COVID‐19: a randomized placebo‐controlled trial. Nat Commun 2021; 12: 1967.
10. Feld JJ, Kandel C, Biondi MJ, et al. Peginterferon lambda for the treatment of outpatients with COVID‐19: a phase 2, placebo‐controlled randomised trial. Lancet Resp Med 2021; 9: 498‐510.
11. Group RC. Dexamethasone in hospitalized patients with COVID‐19. N Engl J Med 2021; 384: 693‐704.
12. Blennow O, Vesterbacka J, Tovatt T, Nowak P. Successful combination treatment for persistent severe acute respiratory syndrome coronavirus 2 infection. Clin Infect Dis 2023; 76: 1864‐1865.
13. Trottier CA, Wong B, Kohli R, et al. Dual antiviral therapy for persistent coronavirus disease 2019 and associated organizing pneumonia in an immunocompromised host. Clin Infect Dis 2023; 76: 923‐925.
14. RECOVERY Collaborative Group. Baricitinib in patients admitted to hospital with COVID‐19 (RECOVERY): a randomised, controlled, open‐label, platform trial and updated meta‐analysis. Lancet 2022; 400: 359‐368.
15. Wolfe CR, Tomashek KM, Patterson TF, et al. Baricitinib versus dexamethasone for adults hospitalised with COVID‐19 (ACTT‐4): a randomised, double‐blind, double placebo‐controlled trial. Lancet Resp Med 2022; 10: 888‐899.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research

Online first

Hospital utilisation in Australia, 1993–2020, with a focus on use by people over 75 years of age: a review of AIHW data

Natasha Reid, Thakeru Gamage, Stephen J Duckett and Leonard C Gray

Med J Aust || doi: 10.5694/mja2.52026
Published online: 24 July 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Gerontology

Environment and public health

General medicine

Abstract

Objectives: To assess Australian hospital utilisation, 1993–2020, with a focus on use by people aged 75 years or more.

Design: Review of Australian Institute of Health and Welfare (AIHW) hospital utilisation data.

Setting, participants: Tertiary data from all Australian public and private hospitals for the financial years 1993–94 to 2019–20.

Main outcome measures: Numbers and population‐based rates of hospital separations and bed utilisation (bed‐days) (all and multiple day admissions) and mean hospital length of day (multiple day admissions), overall and by age group (under 65 years, 65–74 years, 75 years or more).

Results: Between 1993–94 and 2019–20, the Australian population grew by 44%; the number of people aged 75 years or more increased from 4.6% to 6.9% of the population. The annual number of hospital separations increased from 4.61 million to 11.33 million (146% increase); the annual hospital separation rate increased from 261 to 435 per 1000 people (66% increase), most markedly for people aged 75 years or more (from 745 to 1441 per 1000 people; 94% increase). Total bed utilisation increased from 21.0 million to 29.9 million bed‐days (42% increase), but the bed utilisation rate did not change markedly (1993–94, 1192 bed‐days per 1000 people; 2019–20, 1179 bed‐days per 1000 people), primarily because the mean hospital length of stay for multiple day admissions declined from 6.6 days to 5.4 days; for people aged 75 years or more it declined from 12.2 to 7.1 days. However, declines in stay length have slowed markedly since 2017–18. Total bed utilisation was 16.8% lower than projected from 1993–94 rates, and was 37.3% lower for people aged 75 years or more.

Conclusion: Hospital bed utilisation rates declined although admission rates increased during 1993–94 to 2019–20; the proportion of beds occupied by people aged 75 years or more increased slightly during this period. Containing hospital costs by limiting bed availability and reducing length of stay may no longer be a viable strategy.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Centre for Health Services Research, the University of Queensland, Brisbane, QLD
2 The University of Melbourne, Melbourne, VIC

Correspondence: n.reid@uq.edu.au

Open access:

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

Competing interests:

No relevant disclosures.

1. World Health Organization; National Institute on Aging (US); National Institutes of Health (US). Global health and aging (NIH publication no. 11‐7737). Oct 2011. https://www.nia.nih.gov/sites/default/files/2017‐06/global_health_aging.pdf (viewed June 2022).
2. Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community‐dwelling population: a claims data based observational study. BMC Health Serv Res 2015; 15: 23.
3. Ruiz M, Bottle A, Long S, Aylin P. Multi‐morbidity in hospitalised older patients: who are the complex elderly? PLoS One 2015; 10: e0145372.
4. Calver J, Brameld KJ, Preen DB, et al. High‐cost users of hospital beds in Western Australia: a population‐based record linkage study. Med J Aust 2006; 184: 393‐397. https://www.mja.com.au/journal/2006/184/8/high‐cost‐users‐hospital‐beds‐western‐australia‐population‐based‐record‐linkage
5. Forero R, Hillman KM, McCarthy S, et al. Access block and ED overcrowding. Emerg Med Australas 2010; 22: 119‐135.
6. Australasian College for Emergency Medicine. State of emergency 2022, version 1.0. Nov 2022. https://acem.org.au/getmedia/81b2f4f8‐c0f2‐46a0‐86c1‐64b7d1d311c2/State‐of‐Emergency‐D32‐MSTC (viewed Mar 2023).
7. Australian Medical Association. Public hospital report card 2011. 3 Nov 2011. https://www.ama.com.au/articles/ama‐public‐hospital‐report‐card‐2011 (viewed June 2022).
8. Innes G. Sorry: we're full! Access block and accountability failure in the health care system. CJEM 2015; 17: 171‐179.
9. Keegan AD. Hospital bed occupancy: more than queuing for a bed. Med J Aust 2010; 193: 291‐293. https://www.mja.com.au/journal/2010/193/5/hospital‐bed‐occupancy‐more‐queuing‐bed
10. Gray LC, Yeo MA, Duckett SJ. Trends in the use of hospital beds by older people in Australia: 1993–2002. Med J Aust 2004; 181: 478‐481. https://www.mja.com.au/journal/2004/181/9/trends‐use‐hospital‐beds‐older‐people‐australia‐1993‐2002
11. Van Den Heede K, Bouckaert N, Van de Voorde C. The impact of an ageing population on the required hospital capacity: results from forecast analysis on administrative data. Eur Geriatr Med 2019; 10: 697‐705.
12. Australian Institute of Health and Welfare. Principal diagnosis data cubes (Cat. no. WEB 216). Updated 8 July 2022. https://www.aihw.gov.au/reports/hospitals/principal‐diagnosis‐data‐cubes (viewed Mar 2023).
13. Australian Institute of Health and Welfare. METEOR: metadata online registry. https://meteor.aihw.gov.au/content/181162 (viewed Mar 2023).
14. Australian Bureau of Statistics. National, state and territory population. Reference period December 2022. 15 June 2023. https://www.abs.gov.au/statistics/people/population/national‐state‐and‐territory‐population/dec‐2022 (viewed June 2022).
15. Song Z, Ferris TG. Baby boomers and beds: a demographic challenge for the ages. J Gen Intern Med 2018; 33: 367‐369.
16. Flinders Consulting for the Department of Health (Australia). National evaluation of the Transition Care Program. 31 May 2008. https://apo.org.au/node/2652 (viewed June 2022).
17. Kaboli PJ, Go JT, Hockenberry J, et al. Associations between reduced hospital length of stay and 30‐day readmission rate and mortality: 14‐year experience in 129 Veterans Affairs hospitals. Ann Intern Med 2012; 157: 837‐845.
18. Rachoin JS, Aplin KS, Gandhi S, et al. Impact of length of stay on readmission in hospitalized patients. Cureus 2020; 12: e10669.
19. Humpel N, O'Loughlin K, Wells Y, Kendig H. The health of Australian baby boomers. Australas J Ageing 2010; 29: 8‐13.
20. Busse R, Krauth C, Schwartz FW. Use of acute hospital beds does not increase as the population ages: results from a seven year cohort study in Germany. J Epidemiol Community Health 2002; 56: 289‐293.
21. Australian Institute of Health Welfare. Australia's health 2014 (Cat. no. AUS 178). Canberra: AIHW, 2014. https://www.aihw.gov.au/reports/australias‐health/australias‐health‐2014/overview (viewed June 2022).
22. Knickman JR, Snell EK. The 2030 problem: caring for aging baby boomers. Health Serv Res 2002; 37: 849‐884.
23. Australian Bureau of Statistics. Talkin’ ’bout our generations: where are Australia's baby boomers, generation X & Y and iGeneration? In: 3235.0. Population by age and sex, regions of Australia, 2014. 18 Aug 2015. https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/3235.0Feature%20Article12014 (viewed June 2022).
24. Castanares‐Zapatero D, Chalon P, Kohn L, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med 2022; 54: 1473‐1487.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Editorials

Health economic aspects of inherited retinal diseases: looking for cost‐effective treatments

Benjamin Kamien, Rachael Heath Jeffery and Fred K Chen

Med J Aust 2023; 219 (2): . || doi: 10.5694/mja2.52012
Published online: 17 July 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Eye diseases

Medical genetics

Until recently, the management of people with inherited retinal diseases (IRDs) was largely limited to referral for vision aids and registration as being legally blind. This situation is now rapidly changing in the disciplines of ophthalmology and clinical genetics, largely due to the emergence of gene‐based therapies that halt disease progression. IRDs comprise a group of diverse disorders that includes retinitis pigmentosa, Stargardt disease, choroideraemia, Best disease, congenital stationary night blindness, achromatopsia, Leber congenital amaurosis, and similar conditions. Four decades of research have led to the identification of pathogenic variants in more than 300 IRD‐causing genes. While the individual conditions and gene variants are rare, together they affect up to one in 1000 people in Australia, or as many as 25 000 people; IRDs are the leading cause of blindness in working age adults.1,2 The loss of central or peripheral vision, profound nyctalopia, and debilitating photophobia have a significant impact on daily activities and consequently the independence of people with these conditions. For example, IRDs can affect navigation, facial recognition, and driving: all significant for quality of life.3

1 Genetic Services of Western Australia, Perth, WA
2 The University of Western Australia, Perth, WA
3 Lions Eye Institute, University of Western Australia Centre for Ophthalmology and Visual Science, Perth, WA
4 Royal Perth Hospital, Perth, WA

Correspondence: benjamin.kamien@health.wa.gov.au

Competing interests:

Fred Chen receives consultancy fees from Novartis, PYC Therapeutics, and Janssen.

1. Heath Jeffery RC, Mukhtar SA, McAllister IL, et al. Inherited retinal diseases are the most common cause of blindness in the working‐age population in Australia. Ophthalmic Genet 2021; 42: 431‐439.
2. Hanany M, Rivolta C, Sharon D. Worldwide carrier frequency and genetic prevalence of autosomal recessive inherited retinal diseases. Proc Natl Acad Sci U S A 2020; 117: 2710‐2716.
3. Heath Jeffery RC, Lo J, Thompson JA, et al. Driving with retinitis pigmentosa. Ophthalmic Genet 2023; https://doi.org/10.1080/13816810.2023.2196338 [online ahead of print].
4. Bhattacharya SS, Wright AF, Clayton JF, et al. Close genetic linkage between X‐linked retinitis pigmentosa and a restriction fragment length polymorphism identified by recombinant DNA probe L1.28. Nature 1984; 309: 253‐255.
5. Roshandel D, Thompson JA, Heath Jeffery RC, et al. Multimodal retinal imaging and microperimetry reveal a novel phenotype and potential trial end points in CRB1‐associated retinopathies. Transl Vis Sci Technol 2021; 10: 38.
6. Britten‐Jones AC, Gocuk SA, Goh KL, et al. The diagnostic yield of next generation sequencing in inherited retinal diseases: a systematic review and meta‐analysis. Am J Ophthalmol 2023; 249: 57‐73.
7. Britten‐Jones AC, O'Hare F, Edwards TL, Ayton LN; VENTURE Study Consortium. Victorian evolution of inherited retinal diseases natural history registry (VENTURE study): rationale, methodology and initial participant characteristics. Clin Exp Ophthalmol 2022; 50: 768‐780.
8. Schofield D, Lee E, Parmar J, et al. Economic evaluation of population‐based, expanded reproductive carrier screening for genetic diseases in Australia. Genet Med 2023; 25: 100813.
9. Hu ML, Edwards TL, O'Hare F, et al. Gene therapy for inherited retinal diseases: progress and possibilities. Clin Exp Optom 2021; 104: 444‐454.
10. Therapeutic Goods Administration. Luxturna [Australian prescription medicine decision summaries]. 13 Aug 2020. https://www.tga.gov.au/resources/auspmd/luxturna (viewed June 2022).
11. Hu ML, Edwards TL, O'Hare F, et al. Gene therapy for inherited retinal diseases: progress and possibilities. Clin Exp Optom 2021; 104: 444‐454.
12. Schofield D, Kraindler J, Tan O, et al. The health care and societal costs of inherited retinal diseases in Australia: a microsimulation modelling study. Med J Aust 2023; 219: 70‐76.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Perspectives

Sleepwalking towards more harm from asthma

Christine R Jenkins, Philip G Bardin, John Blakey, Kerry L Hancock, Peter Gibson and Vanessa M McDonald

Med J Aust 2023; 219 (2): . || doi: 10.5694/mja2.52000
Published online: 17 July 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Respiratory tract diseases

General medicine

The burden of asthma for patients and doctors can be reduced through simple evidence‐based approaches to care and self‐management

In 2017–18, there were almost 40 000 hospitalisations for asthma, up to 80% of which could have been avoided with better asthma care and resources in the community.11,12,13 In 2020–21, the numbers were reduced, paradoxically thanks to the COVID‐19 pandemic.14 However, children aged under 15 years still constitute the largest proportion of people presenting to emergency departments in Australia with a respiratory condition, and asthma is the leading preventable cause of these presentations.15,16,17 Respiratory conditions generally account for the highest proportion of emergency department presentations in relation to other disease systems, and around one‐third of these people are admitted to hospital.5 These presentations and admissions for asthma comprise a large group of patients with a readily treatable disease.12 Further, there is a tenfold variation in hospitalisation rate between the highest and the lowest socio‐economic regions, and people with asthma in low income settings and in rural Australia are doing worst of all.5,18 This is not inevitable — much of it can be prevented by simple evidence‐based approaches to asthma care, including assessing triggers, performing spirometry, devising a written action plan, and checking device use and adherence.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 The George Institute for Global Health, Sydney, NSW
2 UNSW Sydney, Sydney, NSW
3 Monash Lung and Sleep, Monash Health, Melbourne, VIC
4 Sir Charles Gairdner Hospital, Perth, WA
5 Curtin University, Perth, WA
6 Chandlers Hill Surgery, Adelaide, SA
7 John Hunter Hospital, Newcastle, NSW
8 Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW

Correspondence: christine.jenkins@sydney.edu.au

Open access:

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

Competing interests:

Christine Jenkins has received honoraria from AstraZeneca, GSK, Boehringer Ingelheim, Novartis and Chiesi for educational and advisory activities. Philip Bardin has received honoraria from GSK, AstraZeneca and Sanofi for educational activities. John Blakey has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Sanofi for educational activities. Kerry Hancock has received honoraria from AstraZeneca, Chiesi, Novartis, BI Arterial Education, Asthma Australia and Spirometry Learning Australia for educational activities. Peter Gibson has received honoraria from AstraZeneca, GSK, Novartis and Chiesi for educational activities. Vanessa McDonald has received honoraria from GSK, AstraZeneca, Novartis, Boehringer Ingelheim and Menarini for educational and advisory activities.

1. Australian Institute of Health and Welfare. Australia's health 2022: in brief. https://www.aihw.gov.au/reports/australias‐health/australias‐health‐2022‐in‐brief/summary (viewed Mar 2023).
2. Reddel HK, Ampon RD, Sawyer SM, Peters MJ. Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over‐the‐counter reliever use in a cross‐sectional population survey. BMJ Open 2017; 7: e016688.
3. Goeman DP, Douglass JA, Hogan CD, et al. Barriers to delivering asthma care: a qualitative study of general practitioners. Med J Aust 2005; 183: 457‐460. https://www.mja.com.au/journal/2005/183/9/barriers‐delivering‐asthma‐care‐qualitative‐study‐general‐practitioners
4. Azzi EA, Kritikos V, Peters MJ, et al. Understanding reliever overuse in patients purchasing over‐the‐counter short‐acting beta‐2 agonists: an Australian community pharmacy‐based survey. BMJ Open 2019; 9: e028995.
5. Australian Commission on Safety and Quality in Health Care. Fourth Australian Atlas of Healthcare Variation 2021. Sydney: ACSQHC, 2021. https://www.safetyandquality.gov.au/publications‐and‐resources/resource‐library/fourth‐australian‐atlas‐healthcare‐variation‐2021 (viewed Oct 2022).
6. Hew M, McDonald VM, Bardin PG, et al. Cumulative dispensing of high oral corticosteroid doses for treating asthma in Australia. Med J Aust 2020; 213: 316‐320. https://www.mja.com.au/journal/2020/213/7/cumulative‐dispensing‐high‐oral‐corticosteroid‐doses‐treating‐asthma‐australia
7. Blakey J, Chung LP, McDonald V, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: a position paper from the Thoracic Society of Australia and New Zealand. Respirology 2021; 26: 1112‐1130.
8. Beyene T, Harvey ES, Van Buskirk J, et al. ‘Breathing fire’: impact of prolonged bushfire smoke exposure in people with severe asthma. Int J Environ Res Public Health 2022; 19: 16.
9. Sigfrid L, Drake TM, Pauley E, et al. Long Covid in adults discharged from UK hospitals after Covid‐19: a prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. Lancet Reg Health Eur 2021; 8: 100186.
10. Chen YC, Tu YK, Huang KC, et al. Pathway from central obesity to childhood asthma. Physical fitness and sedentary time are leading factors. Am J Respir Crit Care Med 2014; 189: 1194‐1203.
11. Lartey ST, Lung T, Serhal S, et al. Healthcare expenditure and its socio‐demographic and clinical predictors in Australians with poorly controlled asthma. PLoS One 2023; 18: e0279748.
12. Zwar NA, Hasan I, Hayen A, et al. Giving Asthma Support to Patients (GASP) program evaluation. Aust J Gen Pract 2022; 51: 257‐261.
13. Kauppi P, Linna M, Martikainen J, et al. Follow‐up of the Finnish Asthma Programme 2000‐2010: reduction of hospital burden needs risk group rethinking. Thorax 2013; 68: 292‐293.
14. Australian Institute of Health and Welfare. Chronic respiratory conditions [web report]. https://www.aihw.gov.au/reports/chronic‐respiratory‐conditions/chronic‐respiratory‐conditions/contents/asthma (viewed May 2023).
15. Harrison P, Duggan W, Preddy J, Moline A. Asthmatic children from lower‐income families are less likely to own an individualised asthma action plan. J Paediatr Child Health 2020; 56: 194‐200.
16. Simunovic M, Erbas B, Boyle J, et al. Characteristics of emergency patients admitted to hospital with asthma: A population‐based cohort study in Queensland, Australia. Emerg Med Australas 2021; 33: 1027‐1035.
17. Australian Institute of Health and Welfare. Australia's health 2022: data insights. https://www.aihw.gov.au/reports‐data/australias‐health (viewed Mar 2023).
18. Borchers‐Arriagada N, Jones PJ, Palmer AJ, et al. What are the health and socioeconomic impacts of allergic respiratory disease in Tasmania? Aust Health Rev 2021; 45: 281‐289.
19. Reddel H, Ampon R, Davis S, et al. Asthma outcomes in Australia – changes from 2012 to 2021 [TSANZ abstract TP 027]. Respirology 2023; 28 (S2): 126.
20. Reddel HK, Sawyer SM, Everett PW, et al. Asthma control in Australia: a cross‐sectional web‐based survey in a nationally representative population. Med J Aust 2015; 202: 492‐497. https://www.mja.com.au/journal/2015/202/9/asthma‐control‐australia‐cross‐sectional‐web‐based‐survey‐nationally
21. Hiles SA, Gibson PG, Agusti A, McDonald VM. Treatable traits that predict health status and treatment response in airway disease. J Allergy Clin Immunol Pract 2021; 9: 1255‐1264.
22. Chapman KR, Hinds D, Piazza P, et al. Physician perspectives on the burden and management of asthma in six countries: the Global Asthma Physician Survey (GAPS). BMC Pulm Med 2017; 17: 153.
23. To T, Zhu J, Williams DP, et al. Frequency of health service use in the year before asthma death. J Asthma 2016; 53: 505‐509.
24. Hartmann B, Leucht V, Loerbroks A. Work stress, asthma control and asthma‐specific quality of life: Initial evidence from a cross‐sectional study. J Asthma 2017; 54: 210‐216.
25. Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197: 100‐105. https://www.mja.com.au/journal/2012/197/2/caretrack‐assessing‐appropriateness‐health‐care‐delivery‐australia
26. Schatz M, Zeiger RS, Yang SJ, et al. Change in asthma control over time: predictors and outcomes. J Allergy Clin Immunol Pract 2014; 2: 59‐64.
27. Department of Health of Health and Aged Care. Strengthening Medicare Taskforce. https://www.health.gov.au/committees‐and‐groups/strengthening‐medicare‐taskforce (viewed May 2023).
28. Serhal S, Saini B, Bosnic‐Anticevich S, et al. A multi‐mode education program to enhance asthma care by pharmacists. Am J Pharm Educ 2022; 86: 8633.
29. Mahmoud A, Mullen R, Penson PE, Morecroft C. The management of asthma in adult patients in the community pharmacy setting: literature review. Res Soc Admin Pharm 2021; 17: 1893‐1906.
30. Azzi E, Kritikos V, Peters M, et al. Perceptions, attitudes, and behaviors of short‐acting beta‐2 agonist users: an Australian cross‐sectional community pharmacy‐based study. J Asthma 2022; 59: 178‐188.
31. Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J 2022; 59: 17‐35.
32. Nwaru BI, Ekstrom M, Hasvold P, et al. Overuse of short‐acting beta‐2 agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J 2020; 55: 1901872.
33. Hew M, McDonald VM, Bardin PG, et al. Cumulative dispensing of high oral corticosteroid doses for treating asthma in Australia. Med J Aust 2020; 213: 316‐320. https://www.mja.com.au/journal/2020/213/7/cumulative‐dispensing‐high‐oral‐corticosteroid‐doses‐treating‐asthma‐australia
34. Amin S, Soliman M, McIvor A, et al. Usage patterns of short‐acting beta‐2 agonists and inhaled corticosteroids in asthma: a targeted literature review. J Allergy Clin Immunol Pract 2020; 8: 2556‐2564.
35. Nwaru BI, Ekstrom M, Hasvold P, et al. Overuse of short‐acting β2‐agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J 2020; 55: 1901872.
36. Hardy J, Baggott C, Fingelton J, et al. Budesonide‐formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52‐week, open‐label, multicentre, superiority, randomised controlled trial. Lancet 2019; 394: 919‐928.
37. Vervloet M, van Dijk L, Spreeuwenberg P, et al. The relationship between real‐world inhaled corticosteroid adherence and asthma outcomes: a multilevel approach. J Allergy Clin Immunol Pract 2020; 8: 626‐634.
38. National Asthma Council. Australian Asthma Handbook. Managing asthma in adults. https://www.asthmahandbook.org.au/management/adults (viewed May 2023).
39. Hatter L, Houghton C, Bruce P, et al. Asthma control with ICS‐formoterol reliever versus maintenance ICS and SABA reliever therapy: a post hoc analysis of two randomised controlled trials. BMJ Open Respir Res 2022; 9: e001271.
40. Australian Institute of Health and Welfare. Impact of overweight and obesity as a risk factor for chronic conditions. Canberra: AIHW, 2017. https://www.aihw.gov.au/reports/burden‐of‐disease/impact‐of‐overweight‐and‐obesity‐as‐a‐risk‐factor‐for‐chronic‐conditions/summary (viewed May 2023).
41. Wee LE, Conceicao EP, Tan JY, et al. Reduction in asthma admissions during the COVID‐19 pandemic: consequence of public health measures in Singapore. Eur Respir J 2021; 57: 2004493.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research letters

Suboptimal experiences with out‐of‐pocket costs, financial disclosure, and support information among people treated for cancer

Victoria White, Karla Gough, Colin Wood, Raymond Chan and Michael Jefford

Med J Aust 2023; 219 (1): . || doi: 10.5694/mja2.51993
Published online: 3 July 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Social determinants of health

Health services administration

The direct and indirect costs of cancer care are rising and can influence treatment decisions and outcomes for patients.1 Several patient‐level characteristics are risk factors for financial burden, including lower age, chemotherapy, and poorer general health.2 Health professionals have a role in providing information, resources, and support to mitigate financial distress for patients.3

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Deakin University, Geelong, VIC
2 The University of Melbourne, Melbourne, VIC
3 Peter MacCallum Cancer Centre, Melbourne, VIC
4 Caring Futures Institute Flinders University, Adelaide, SA

Correspondence:

jefford@unimelb.edu.au, michael.jefford@petermac.org

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 Victorian Department of Health as the source of the Victorian Health Experience Survey data. We also thank all participants who completed the survey.

Competing interests:

No relevant disclosures.

1. Rodriguez‐Acevedo AJ, Chan RJ, Olsen CM, et al. Out‐of‐pocket medical expenses compared across five years for patients with one of five common cancers in Australia. BMC Cancer 2021; 21: 1055.
2. Smith GL, Lopez‐Olivo MA, Advani PG, et al. Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. J Natl Compr Canc Netw 2019; 17: 1184‐1192.
3. Ragavan M, Parikh D, Patel M. Defining the clinician's role in mitigating financial toxicity: an exploratory study. Support Care Cancer 2021; 29: 4835‐4845.
4. Victorian Department of Health. Patient experience. Updated 20 July 2022. https://www.health.vic.gov.au/health‐strategies/victorian‐cancer‐patient‐experience‐survey‐tool‐project (viewed Nov 2022).
5. Department of Health and Social Care (UK). National Cancer Patient Experience Survey Programme: 2010 national survey report. 10 Dec 2010. https://www.gov.uk/government/publications/national‐cancer‐patient‐experience‐survey‐programme‐2010‐national‐survey‐report (viewed Sept 2022).
6. Australian Bureau of Statistics. 2033.0.55.001. Census of Population and Housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016. 27 Mar 2018. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~IRSAD~20 (viewed Mar 2023).
7. Australian Department of Health and Aged Care. Modified Monash Model. Updated 14 Dec 2021. https://www.health.gov.au/topics/rural‐health‐workforce/classifications/mmm (viewed Dec 2022).

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Guideline summary

Online first

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

Aili V Langford, Christine CW Lin, Lisa Bero, Fiona M Blyth, Jason Doctor, Simon Holliday, Yun‐Hee Jeon, Joanna Moullin, Bridin Murnion, Suzanne Nielsen, Rawa Osman, Jonathan Penm, Emily Reeve, Sharon Reid, Janet Wale, Carl R Schneider* and Danijela Gnjidic*

Med J Aust || doi: 10.5694/mja2.52002
Published online: 26 June 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Pharmaceutical preparations

General medicine

Abstract

Introduction: Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence‐based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain.

Main recommendations: Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve:

implementation of a deprescribing plan at the point of opioid initiation;
initiation of opioid deprescribing for persons with chronic non‐cancer or chronic cancer‐survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid‐related adverse effects;
gradual and individualised deprescribing, with regular monitoring and review;
consideration of opioid deprescribing for individuals at high risk of opioid‐related harms;
avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated;
avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence‐based care, such as medication‐assisted treatment of opioid use disorder; and
use of evidence‐based co‐interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care.

Changes in management as a result of these guidelines: To our knowledge, these are the first evidence‐based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
2 University of Sydney, Sydney, NSW
3 Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW
4 Center for Bioethics and Humanities, University of Colorado, Aurora (CO), USA
5 University of Southern California, Los Angeles (CA), USA
6 University of Newcastle, Newcastle, NSW
7 Curtin University, Perth, WA
8 Western Sydney Local Health District, Sydney, NSW
9 Monash Addiction Research Centre, Monash University, Melbourne, VIC
10 NPS MedicineWise, Sydney, NSW
11 Prince of Wales Hospital and Community Health Services, Sydney, NSW
12 University of South Australia, Adelaide, SA
13 Melbourne, VIC

Correspondence: aili.langford@monash.edu

Open access:

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

Acknowledgements:

Aili Langford was funded by a Research Training Program Scholarship and Supplementary Scholarship from the University of Sydney throughout her PhD candidature. The research team were awarded a 2019 Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney Research Support Grant. Christine Lin is funded by a National Health and Medical Research Council (NHMRC) Investigator Grant (1193939). Danijela Gnjidic is funded by the NHMRC Dementia Leadership Fellowship (1136849). Emily Reeve is funded by an NHMRC Investigator Grant (1195460). Suzanne Nielsen is funded by an NHMRC Career Development Fellowship (1163961). The funding bodies/sources had no role in the planning, writing or publication of this work.

We acknowledge Jack Collins (Postdoctoral Research Associate, University of Sydney) and Benita Suckling (Master of Philosophy Candidate, University of Sydney, and Pharmacist at Caboolture Hospital, Queensland Health, Brisbane) for their contributions to the synthesis and appraisal of evidence informing this guideline. We also acknowledge Steven Agiasotis (undergraduate pharmacy student, University of Sydney) for his contribution to the development of the guideline algorithm.

Competing interests:

Emily Reeve receives royalties from UpToDate (Wolters Kluwer) for writing a chapter on deprescribing. Suzanne Nielsen has received untied educational grants from Seqirus to study prescription opioid poisoning, and was a named investigator on a buprenorphine depot implementation trial funded by Indivior, both unrelated to this work. Simon Holliday was provided an honorarium by Indivior for two presentations unrelated to this work.

1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204‐1222.
2. Australian Institute of Health and Welfare. Chronic pain in Australia [Cat. No. PHE 267]. AIHW, 2020. https://www.aihw.gov.au/reports/chronic‐disease/chronic‐pain‐in‐australia/contents/summary (viewed June 2021).
3. Organisation for Economic Co‐operation and Development. Addressing problematic opioid use in OECD countries. Paris: OECD Publishing, 2019. https://www.oecd‐ilibrary.org/sites/a18286f0‐en/index.html?itemId=/content/publication/a18286f0‐en (viewed Mar 2023).
4. Lalic S, Ilomäki J, Bell JS, et al. Prevalence and incidence of prescription opioid analgesic use in Australia. Br J Clin Pharmacol 2019; 85: 202‐215.
5. Holliday S, Morgan S, Tapley A, et al. The pattern of opioid management by Australian general practice trainees. Pain Med 2015; 16: 1720‐1731.
6. Reid S, Day C, White N, et al. Opioid prescribing in general practice: an Australian cross‐sectional survey. BMC Prim Care 20222; 23: 171.
7. Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta‐analysis. JAMA 2018; 320: 2448‐2460.
8. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain‐related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018; 319: 872‐882.
9. Kalso E, Edwards JE, Moore AR, McQuay HJ. Opioids in chronic non‐cancer pain: systematic review of efficacy and safety. Pain 2004; 112: 372‐380.
10. World Health Organization. Medication without harm — WHO Global Patient Safety Challenge. WHO, 2017. https://www.who.int/publications/i/item/WHO‐HIS‐SDS‐2017.6 (viewed Mar 2023).
11. Australian Commission on Safety and Quality in Health Care. Medication without harm — WHO Global Patient Safety Challenge: Australia's response. ACSQHC, 2020. https://www.safetyandquality.gov.au/publications‐and‐resources/resource‐library/medication‐without‐harm‐who‐global‐patient‐safety‐challenge‐australias‐response (viewed Mar 2022).
12. Langford AV, Gnjidic D, Lin CWC, et al. Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis. BMJ Qual Saf 2020; 30: 133‐140.
13. Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015; 80: 1254‐1268.
14. Therapeutic Guidelines. Pain and Analgesia. [website]. Melbourne: Therapeutic Guidelines Limited, 2021. https://www.tg.org.au (viewed Feb 2022).
15. Agnoli A, Xing G, Tancredi DJ, et al. Association of dose tapering with overdose or mental health crisis among patients prescribed long‐term opioids. JAMA 2021; 326: 411‐419.
16. Oliva EM, Bowe T, Manhapra A, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ 2020; 368: m283.
17. Farrell B, Pottie K, Rojas‐Fernandez CH, et al. Methodology for developing deprescribing guidelines: using evidence and GRADE to guide recommendations for deprescribing. PLoS One 2016; 11: e0161248.
18. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010; 182: e839‐e842.
19. National Health and Medical Research Council. Guidelines for guidelines handbook. https://www.nhmrc.gov.au/guidelinesforguidelines (viewed Sept 2022).
20. National Health and Medical Research Council. Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines [May 2011, version 1.1.] https://www.nhmrc.gov.au/sites/default/files/documents/reports/clinical%20guidelines/meeting‐clinical‐practice‐guidelines.pdf (viewed June 2022).
21. Langford AV, Schneider CR, Lin CWC, et al. Evidence‐based clinical practice guideline for deprescribing opioid analgesics: administrative report. Sydney: University of Sydney, 2022. https://www.opioiddeprescribingguideline.com/guideline (viewed Mar 2022).
22. Langford AV, Schneider CR, Lin CWC, et al. Evidence‐based clinical practice guideline for deprescribing opioid analgesics: technical report. Sydney: University of Sydney, 2022. https://www.opioiddeprescribingguideline.com/guideline (viewed Mar 2022).
23. Langford AV, Gnjidic D, Lin CWC, et al. “The lesser of two evils”: a framework analysis of consumers’ perspectives on opioid deprescribing and the development of opioid deprescribing guidelines. Pain 2021; 162: 2686‐2692.
24. Langford AV, Schneider CR, Lin CC, et al. Patient‐targeted interventions for opioid deprescribing: an overview of systematic reviews. Basic Clin Pharmacol Toxicol 2023; https://doi.org/10.1111/bcpt.13844 [Epub ahead of print].
25. Schünemann H, Brożek J, Guyatt G, Oxman A; editors. GRADE handbook [updated Oct 2013]. GRADE Working Group, 2013. https://gdt.gradepro.org/app/handbook/handbook.html (viewed Nov 2022).
26. Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation — determinants of a recommendation's direction and strength. J Clin Epidemiol 2013; 66: 726‐735.
27. Langford AV, Gnjidic D, Schneider CR. Communication techniques for opioid analgesic tapering conversations. Sydney: University of Sydney, 2020. https://imh.org.au/wp‐content/uploads/2021/07/Communication‐techniques‐for‐opioid‐analgesic‐tapering‐conversations.pdf (viewed Sept 2022).
28. Langford AV, Schneider CR, Lin CWC, et al. Evidence‐based clinical practice guideline for deprescribing opioid analgesics. Sydney: University of Sydney, 2022. https://www.opioiddeprescribingguideline.com/guideline (viewed Mar 2022).
29. Neumann I, Schünemann HJ. Guideline groups should make recommendations even if the evidence is considered insufficient. CMAJ 2020; 192: E23‐E24.
30. Deyo RA, Hallvik SE, Hildebran C, et al. Association between initial opioid prescribing patterns and subsequent long‐term use among opioid‐naïve patients: a statewide retrospective cohort study. J Gen Intern Med 2017; 32: 21‐27.
31. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long‐term opioid use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: 265‐269.
32. McAuliffe Staehler TM, Palombi LC. Beneficial opioid management strategies: a review of the evidence for the use of opioid treatment agreements. Subst Abus 2020; 41: 208‐215.
33. Frank JW, Lovejoy TI, Becker WC, et al. Patient outcomes in dose reduction or discontinuation of long‐term opioid therapy: a systematic review. Ann Intern Med 2017; 167: 181‐191.
34. Fishbain DA, Pulikal A. Does opioid tapering in chronic pain patients result in improved pain or same pain vs increased pain at taper completion? A structured evidence‐based systematic review. Pain Med 2019; 20: 2179‐2197.
35. Mackey K, Anderson J, Bourne D, et al. Benefits and harms of long‐term opioid dose reduction or discontinuation in patients with chronic pain: a rapid review. J Gen Intern Med 2020; 35: 935‐944.
36. Garland EL, Manusov EG, Froeliger B, et al. Mindfulness‐oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early‐stage randomized controlled trial. J Consult Clin Psychol 2014; 82: 448‐459.
37. Hassan S, Zheng Q, Rizzolo E, et al. Does integrative medicine reduce prescribed opioid use for chronic pain? A systematic literature review. Pain Med 2020; 21: 836‐859.
38. Pollard EM, Lamer TJ, Moeschler SM, et al. The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain: A systematic review of randomized controlled trials and meta‐analysis. J Pain Res 2019; 12: 1311‐1324.
39. Mathieson S, Maher CG, Ferreira GE, et al. Deprescribing opioids in chronic non‐cancer pain: systematic review of randomised trials. Drugs 2020; 80: 1563‐1576.
40. LeVoir A, Lee M, Fitzgibbon D, et al. Chronic opioid therapy in cancer survivors at a specialty oncology pain clinic: opioid dosing, efficacy, and safety during five years of pain management. J Pain Symptom Manage 2021; 61: 1080‐1087.
41. Paice JA, Portenoy R, Lacchetti C, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2016; 34: 3325‐3345.
42. Jairam V, Yang DX, Verma V, et al. National patterns in prescription opioid use and misuse among cancer survivors in the United States. JAMA Netw Open 2020; 3: e2013605.
43. Webster LR, Cochella S, Dasgupta N, et al. An analysis of the root causes for opioid‐related overdose deaths in the United States. Pain Med 2011; 12 (Suppl): S26‐S35.
44. Le TT, Park S, Choi M, et al. Respiratory events associated with concomitant opioid and sedative use among Medicare beneficiaries with chronic obstructive pulmonary disease. BMJ Open Respir Res 2020; 7: e000483.
45. Campbell G, Nielsen S, Larance B, et al. Pharmaceutical opioid use and dependence among people living with chronic pain: associations observed within the Pain and Opioids in Treatment (POINT) cohort. Pain Med 2015; 16: 1745‐1758.
46. Bruneau J, Ahamad K, Goyer MÈ, et al. Management of opioid use disorders: a national clinical practice guideline. CMAJ 2018; 190: E247‐E257.
47. Gowing L, Ali R, Dunlop A, et al. National guidelines for medication‐assisted treatment of opioid dependence. Canberra: Commonwealth of Australia, 2014. https://www.health.gov.au/resources/publications/national‐guidelines‐for‐medication‐assisted‐treatment‐of‐opioid‐dependence (viewed Feb 2022).
48. Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med 2015; 9: 358‐367.
49. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain — United States, 2016. JAMA 2016; 315: 1624‐1645.
50. Nielsen S, Larance B, Degenhardt L, et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016; (5): CD011117.
51. Lerner A, Klein M. Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Commun 2019; 1: fcz025.
52. Hallvik SE, El Ibrahimi S, Johnston K, et al. Patient outcomes after opioid dose reduction among patients with chronic opioid therapy. Pain 2022; 163: 83‐90.
53. Mark TL, Parish W. Opioid medication discontinuation and risk of adverse opioid‐related health care events. J Subst Abuse Treat 2019; 103: 58‐63.
54. Pergolizzi Jr JV, Raffa RB, Rosenblatt MH. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: current understanding and approaches to management. J Clin Pharm Ther 2020; 45: 892‐903.
55. Bienek N, Maier C, Kaisler M, et al. Intensity of withdrawal symptoms during opioid taper in patients with chronic pain‐individualized or fixed starting dosage? Pain Med 2019; 20: 2438‐2449.
56. Darnall BD, Juurlink D, Kerns RD, et al. International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering. Pain Med 2018; 20: 429‐433.
57. He Y, Guo X, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta‐analysis. JAMA Oncol 2019; 6: 271‐278.
58. Nielsen S, Sabioni P, Trigo JM, et al. Opioid‐sparing effect of cannabinoids: a systematic review and meta‐analysis. Neuropsychopharmacology 2017; 42: 1752‐1765.
59. Ratnayake CB, Bunn A, Pandanaboyana S, Windsor JA. Spinal cord stimulation for management of pain in chronic pancreatitis: a systematic review of efficacy and complications. Neuromodulation 2020; 23: 19‐25.
60. Langford AV, Schneider CR, Lin CWC, et al. Evidence‐based clinical practice guideline for deprescribing opioid analgesics: treatment algorithm. Sydney: University of Sydney, 2022. https://www.opioiddeprescribingguideline.com/resources (viewed Mar 2022).

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Research

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

Jasmin Grigg, Victoria Manning, Darren Lockie, Michelle Giles, Robin J Bell, Peta Stragalinos, Chloe Bernard, Christopher J Greenwood, Isabelle Volpe, Liam Smith, Peter Bragge and Dan I Lubman

Med J Aust 2023; 218 (11): . || doi: 10.5694/mja2.51991
Published online: 19 June 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Substance-related disorders

Health services administration

Environment and public health

Neoplasms

Women's health

Abstract

Objectives: To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening.

Design: Single‐site, double‐blinded randomised controlled trial.

Setting: Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program.

Participants: Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February – 27 August 2021.

Intervention: Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). Control arm: lifestyle health promotion only.

Major outcome measure: Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure).

Results: The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40–87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18–97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8–8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm.

Conclusion: A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle‐aged and older women and evidence that even very light alcohol consumption increases breast cancer risk.

Registration: ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Turning Point, Eastern Health, Melbourne, VIC
2 Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC
3 Maroondah BreastScreen, Eastern Health, Melbourne, VIC
4 Monash University, Melbourne, VIC
5 Deakin University, Geelong, VIC
6 Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC
7 Monash Sustainable Development Institute, Monash University, Melbourne, VIC

Correspondence: jasmin.grigg@monash.edu

Open access:

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

Acknowledgements:

This study was supported by research grants from VicHealth and the Eastern Health Foundation. The funders had no role in any part of this study. We thank BreastScreen Victoria for their support. We thank the staff of Maroondah BreastScreen for supporting this project at their clinic, and we gratefully acknowledge all Maroondah BreastScreen clients who participated in the trial. We thank Erin Flatters (Jumbla Animation Studios) for producing the intervention animations. We thank Alun Pope (Analytical Insight) for his contribution to data preparation and statistical analyses.

Competing interests:

Dan Lubman, Victoria Manning, Robin Bell, and Jasmin Grigg have received grants from the National Health and Medical Research Council. Dan Lubman, Victoria Manning and Robin Bell have received grants from the Medical Research Future Fund. Dan Lubman, Victoria Manning, and Jasmin Grigg have received funding from Shades of Pink and the Victorian Department of Health. Dan Lubman and Victoria Manning have received grants from the HCF Research Foundation, the Alcohol and Drug Research Innovation Agenda, the Alcohol and Drug Foundation, the Eastern Health Foundation, the Victorian Responsible Gambling Foundation, and the National Centre for Clinical Research on Emerging Drugs. Dan Lubman has received grants from Google, the Australian Research Council, VicHealth, and the Australian Department of Health and Aged Care. Victoria Manning has received funding from the Transport Accident Commission (Victoria). Jasmin Grigg has received funding from the Victorian Department of Transport and Planning. Dan Lubman is supported by a National Health and Medical Research Council Leadership Fellowship. Isabelle Volpe is supported by an Australian Government Research Training Program stipend.

1. Rumgay H, Shield K, Charvat H, et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population‐based study. Lancet Oncol 2021; 22: 1071‐1080.
2. Liu H, Shi W, Jin Z, et al. Global, regional, and national mortality trends of female breast cancer by risk factor, 1990–2017. BMC Cancer 2021; 21: 459.
3. Arriaga ME, Vajdic CM, Canfell K, et al. The preventable burden of breast cancers for premenopausal and postmenopausal women in Australia: a pooled cohort study. Int J Cancer 2019; 145: 2383‐2394.
4. Sinclair J, McCann M, Sheldon E, et al. The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics. BMJ Open 2019; 9: e027371.
5. Choi YJ, Myung SK, Lee JH. Light alcohol drinking and risk of cancer: a meta‐analysis of cohort studies. Cancer Res Treat 2018; 50: 474‐487.
6. Chen WY, Rosner B, Hankinson SE, et al. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA 2011; 306: 1884‐1890.
7. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019 (Cat. no. PHE 270); Alcohol supplementary tables. 16 July 2020. https://www.aihw.gov.au/getmedia/4f178aed‐4301‐4d49‐8fe6‐c9fa663d914e/aihw‐phe‐270‐3‐Alcohol‐tables.xlsx.aspx (viewed Mar 2023).
8. Miller M, Mojica‐Perez Y, Livingston M, et al. The who and what of women's drinking: examining risky drinking and associated socio‐demographic factors among women aged 40–65 years in Australia. Drug Alcohol Rev 2022; 41: 724‐731.
9. Keyes KM, Jager J, Mal‐Sarkar T, et al. Is there a recent epidemic of women's drinking? A critical review of national studies. Alcohol Clin Exp Res 2019; 43: 1344‐1359.
10. Haber PS, Riordan BC, Winter DT, et al. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 (7 Suppl): S3‐S32. https://www.mja.com.au/system/files/2021‐09/Sup_215_7_4%20Oct.pdf
11. Kaner EF, Beyer FR, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; CD004148.
12. Kypri K, McAnally HM. Randomized controlled trial of a web‐based primary care intervention for multiple health risk behaviors. Prev Med 2005; 41: 761‐766.
13. Holmwood CB. Screening and brief interventions for harmful alcohol use: where to now? Med J Aust 2021; 214: 153‐154. https://www.mja.com.au/journal/2021/214/4/screening‐and‐brief‐interventions‐harmful‐alcohol‐use‐where‐now
14. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332.
15. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208.
16. National Health and Medical Research Council: Department of Health and Ageing. Healthy eating for adults (N55g). 2013. www.eatforhealth.gov.au/sites/default/files/2022‐09/n55g_adult_brochure.pdf (viewed Jan 2023).
17. World Health Organization. Screening and brief interventions for substance use problems. Geneva: World Health Organization, 2022. www.who.int/activities/screening‐and‐brief‐interventions‐for‐substance‐use‐problems (viewed Mar 2023).
18. Riper H, Spek V, Boon B, et al. Effectiveness of e‐self‐help interventions for curbing adult problem drinking: a meta‐analysis. J Med Internet Res 2011; 13: e42.
19. Dotson KB, Dunn ME, Bowers CA. Stand‐alone personalized normative feedback for college student drinkers: a meta‐analytic review, 2004 to 2014. PLoS One 2015; 10: e0139518.
20. Witte K, Allen M. A meta‐analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav 2000; 27: 591‐615.
21. Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: a meta‐analytic review. Ann Behav Med 2012; 43: 101‐116.
22. Grigg J, Manning V, Volpe I, et al. A pre‐implementation study to understand women's knowledge of the alcohol–breast cancer link, and acceptability of alcohol brief intervention in the breast screen setting [abstract: APSAD 2021 conference, 7–10 November 2021, virtual]. Drug Alcohol Rev 40 (Suppl. 1): S75‐S76.
23. Cancer Australia. Breast cancer risk factors. 2019. www.breastcancerriskfactors.gov.au/risk‐factors (viewed Jan 2023).
24. Sobell LC, Sobell MB. Timeline follow‐back: a technique for assessing self‐reported ethanol consumption. In: Litten RZ, Allen JP, editors. Measuring alcohol consumption: psychosocial and biological methods. Totowa (NJ): Humana Press, 1992; pp. 41‐72.
25. Martin N, Buykx P, Shevills C, et al. Population level effects of a mass media alcohol and breast cancer campaign: a cross‐sectional pre‐intervention and post‐intervention evaluation. Alcohol Alcohol 2018; 53: 31‐38.
26. Twisk J, de Boer M, de Vente W, Heymans M. Multiple imputation of missing values was not necessary before performing a longitudinal mixed‐model analysis. J Clin Epidemiol 2013; 66: 1022‐1028.
27. Australian Bureau of Statistics. 1270.0.55.005. Australian Statistical Geography Standard (ASGS). Volume 5: Remoteness structure, July 2016. 16 Mar 2018. https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016?OpenDocument (viewed Mar 2023).
28. Neale ZE, Salvatore JE, Cooke ME, et al. The utility of a brief web‐based prevention intervention as a universal approach for risky alcohol use in college students: evidence of moderation by family history. Front Psychol 2018; 9: 747.
29. DiClemente CC, Graydon MM. Changing behavior using the transtheoretical model. In: Hagger MS, Cameron LD, Hamilton K, et al, editors. The handbook of behavior change. Cambridge: Cambridge University Press, 2020; pp. 136‐149.
30. Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health 1998; 13: 623‐649.
31. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010; 376: 1261‐1271.
32. Rehm J, Baliunas D, Borges GLG, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105: 817‐843.
33. Beyer F, Campbell F, Bertholet N, et al. The Cochrane 2018 review on brief interventions in primary care for hazardous and harmful alcohol consumption: a distillation for clinicians and policy makers. Alcohol Alcohol 2019; 54: 417‐427.
34. McCambridge J. Research assessments: instruments of bias and brief interventions of the future? Addiction 2009; 104: 1311‐1312.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Perspectives

Advancing menopause care in Australia: barriers and opportunities

Susan R Davis and Karen Magraith

Med J Aust 2023; 218 (11): . || doi: 10.5694/mja2.51981
Published online: 19 June 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Endocrine system diseases

Musculoskeletal diseases

Lack of clinician knowledge, poor access to services, negative attitudes, and lagging research have led to substandard menopause‐related health care

The menopause is the permanent loss of ovarian reproductive function. Irrespective of symptoms, menopause causes silent biological changes that may increase women's risks of cardiovascular disease, diabetes, osteoporosis, and some cancers.1 Consequently, it should be expected that health care providers, especially general practitioners, are equipped to provide evidence‐based menopause advice to the 3.28 million Australian women aged 40–59 years. Sadly, this is not the case.

Please login with your free MJA account to view this article in full

CREATE AN ACCOUNT

Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

View on Wiley Online Library

1 Monash University, Melbourne, VIC
2 University of Tasmania, Hobart, TAS

Correspondence: susan.davis@monash.edu

Open access:

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

Competing interests:

Susan Davis reports honoraria from Besins Healthcare, Mayne Pharma, Pfizer Australia, BioFemme, Lawley Pharmaceuticals, Southern Star Research, and Que Oncology. She has served on advisory boards for Mayne Pharma, Gedeon Richter, Astellas Pharmaceuticals, Roche Diagnostics, Theramex, and Abbott Laboratories; and is an institutional investigator for Que Oncology and Ovoca Bio. Karen Magraith has received honoraria for presentations from Mylan, Jean Hailes for Women's Health, and the Australasian Menopause Society.

1. Davis SR, Baber RJ. Treating menopause — MHT and beyond. Nat Rev Endocrinol 2022; 18: 490‐502.
2. Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause 2015; 22: 694‐701.
3. Worsley R, Bell RJ, Gartoulla P, et al. Moderate–severe vasomotor symptoms are associated with moderate–severe depressive symptoms. J Womens Health (Larchmt) 2017; 26: 712‐718.
4. Zheng J, Islam RM, Bell RJ, et al. Prevalence of low sexual desire with associated distress across the adult life span: an Australian cross‐sectional study. J Sex Med 2020; 17: 1885‐1895.
5. Worsley R, Bell RJ, Gartoulla P, Davis SR. Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross‐sectional community study of Australian women. Menopause 2015; 23: 11‐17.
6. Sowers MR, Zheng H, Jannausch ML, et al. Amount of bone loss in relation to time around the final menstrual period and follicle‐stimulating hormone staging of the transmenopause. J Clin Endocrinol Metab 2010; 95: 2155‐2162.
7. Cooke G, Valenti L, Glasziou P, Britt H. Common general practice presentations and publication frequency. Aust Fam Physician 2013; 42: 65‐68.
8. Davis SR, Herbert D, Reading M, Bell RJ. Health‐care providers’ views of menopause and its management: a qualitative study. Climacteric 2021; 24: 612‐617.
9. Herbert D, Bell RJ, Young K, et al. Australian women's understanding of menopause and its consequences: a qualitative study. Climacteric 2020; 23: 622‐628.
10. North American Menopause Society. The 2012 hormone therapy position statement of the North American Menopause Society. Menopause 2012; 19: 257‐271.
11. Hormone Therapy Position Statement of the North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of the North American Menopause Society. Menopause 2022; 29: 767‐794.
12. Webber L, Davies M, Anderson R, et al. ESHRE guideline: management of women with premature ovarian insufficiency. Hum Reprod 2016; 31: 926‐937.
13. Vinogradova Y, Coupland C, Hippisley‐Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case‐control studies using the QResearch and CPRD databases. BMJ 2019; 364: k4810.
14. Ortmann O, Beckermann MJ, Inwald EC, et al. Peri‐ and postmenopause — diagnosis and interventions interdisciplinary S3 guideline of the association of the scientific medical societies in Germany (AWMF 015/062): short version. Arch Gynecol Obstet 2020; 302: 763‐777.
15. Adams MR, Register TC, Golden GL, et al. Medroxyprogesterone acetate antagonizes inhibitory effects of conjugated equine estrogens on coronary artery atherosclerosis. Arterioscler Thromb Vasc Biol 1997; 17: 217‐221.
16. Fournier A, Mesrine S, Dossus L, et al. Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort. Breast Cancer Res Treat 2014; 145: 535‐543.
17. Lobo RA, Archer DF, Kagan R, et al. A 17β‐estradiol‐progesterone oral capsule for vasomotor symptoms in postmenopausal women: a randomized controlled trial. Obstet Gynecol 2018; 132: 161‐170.
18. Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 1996; 275: 370‐375.
19. Klipping C, Duijkers I, Parke S, et al. Hemostatic effects of a novel estradiol‐based oral contraceptive: an open‐label, randomized, crossover study of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel. Drugs R D 2011; 11: 159‐170.
20. Morimont L, Haguet H, Dogne JM, et al. Combined oral contraceptives and venous thromboembolism: review and perspective to mitigate the risk. Front Endocrinol (Lausanne) 2021; 12: 769187.
21. Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta‐analysis of randomised controlled trial data. Lancet Diabetes Endocrinol 2019; 7: 754‐766.
22. Fooladi E, Bell RJ, Jane F, et al. Testosterone improves antidepressant‐emergent loss of libido in women: findings from a randomized, double‐blind, placebo‐controlled trial. J Sex Med 2014; 11: 831‐839.
23. Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. Climacteric 2019; 22: 429‐434.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Australian National Clinical Evidence Taskforce COVID‐19 drug treatment guidelines: challenges of producing a living guideline

Topics

Author

Hospital utilisation in Australia, 1993–2020, with a focus on use by people over 75 years of age: a review of AIHW data

Topics

Abstract

Author

Health economic aspects of inherited retinal diseases: looking for cost‐effective treatments

Topics

Author

Sleepwalking towards more harm from asthma

Topics

Author

Suboptimal experiences with out‐of‐pocket costs, financial disclosure, and support information among people treated for cancer

Topics

Author

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

Topics

Abstract

Author

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

Topics

Abstract

Author

Advancing menopause care in Australia: barriers and opportunities

Topics

Author

Reimagining medical abortion in Australia: what do we need to do to meet women's needs and ensure ongoing access?

Topics

Author

Mortality among people admitted to Australian intensive care units for reasons other than COVID‐19 during the COVID‐19 pandemic: a retrospective cohort study

Topics

Abstract

Author

Australian National Clinical Evidence Taskforce COVID‐19 drug treatment guidelines: challenges of producing a living guideline

Topics

Author

Comment

Do you have any competing interests to declare? *

Hospital utilisation in Australia, 1993–2020, with a focus on use by people over 75 years of age: a review of AIHW data

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Health economic aspects of inherited retinal diseases: looking for cost‐effective treatments

Topics

Author

Comment

Do you have any competing interests to declare? *

Sleepwalking towards more harm from asthma

Topics

Author

Comment

Do you have any competing interests to declare? *

Suboptimal experiences with out‐of‐pocket costs, financial disclosure, and support information among people treated for cancer

Topics

Author

Comment

Do you have any competing interests to declare? *

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Advancing menopause care in Australia: barriers and opportunities

Topics

Author

Comment

Do you have any competing interests to declare? *

Reimagining medical abortion in Australia: what do we need to do to meet women's needs and ensure ongoing access?

Topics

Author

Comment

Do you have any competing interests to declare? *

Mortality among people admitted to Australian intensive care units for reasons other than COVID‐19 during the COVID‐19 pandemic: a retrospective cohort study

Topics

Abstract

Author

Comment

Do you have any competing interests to declare? *

Pagination