Australian Health Review
Volume 47 Number 2 2023
AH22198Factors associated with Pharmaceutical Benefits Advisory Committee decisions for listing medicines for diabetes and its associated complications
What is known about the topic? Most studies on Pharmaceutical Benefits Advisory Committee (PBAC) decisions focused mainly on the cost-effectiveness, while some assessed only the financial impact of medicines. A few PBAC studies analysed the reimbursement decisions for medicines targeting specific disease groups, e.g. oncology, orphan disease, and multiple sclerosis. What does this paper add? This study presents an in-depth retrospective analysis of the PBAC decisions for listing medicines related to diabetes and its complications on the Pharmaceutical Benefits Scheme and contributes to the existing evidence-based knowledge of health technology assessment. What are the implications for practitioners? Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions.
AH22108Change in costs to funders of maternity care over time: an analysis of Queensland births
What is known about the topic? Public maternity care costs vary in Australia dependent upon place of birth, even after adjusting for clinical and demographic factors. What does this paper add? This paper compares the change in costs for mother and baby from birth through to 12 months for births across Queensland over time. Costs for maternity care have increased over time and higher-cost treatment does not necessarily result in better health outcomes. What are the implications for practitioners? Reporting of cost alongside clinical outcomes should be included in performance monitoring of public hospital maternity care.
AH22108 Abstract | AH22108 Full Text | AH22108PDF (985 KB) Open Access Article
AH22120The financial implications of investigating false-positive and true-positive mammograms in a national breast cancer screening program
What is known about the topic? Screening mammogram results suggesting cancer later found to be wrong by follow-up testing (false-positive mammograms) consume healthcare resources unnecessarily and increases anxiety among screened women. What does this paper add? This paper estimates the share of total annual costs of Australia’s national breast screening program caused by follow up testing of false-positive mammograms at approximately 15%. What are the implications for practitioners? The share of annual breast cancer screening costs from follow-up testing of false-positive mammograms can be monitored over time using the transparent and non-onerous method developed in this paper.
AH22120 Abstract | AH22120 Full Text | AH22120PDF (665 KB) | AH22120Supplementary Material (627 KB) Open Access Article
AH22118Use and cost of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme services following inpatient rehabilitation for acquired disability in Australia
What is known about the topic? Acquired brain injury and spinal cord injury incur high long-term health costs, yet little is known about Medicare service use and costs in the early post-acute phase. What does this paper add? This study provides insight into service use and the burden of injury on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme systems in the 12 months after hospital discharge. High and variable system and patient expenditure are most notable. What are the implications? Highly variable patient costs raise concerns about the access and affordability of sufficient healthcare services in the post-acute rehabilitation period.
AH22118 Abstract | AH22118 Full Text | AH22118PDF (1 MB) | AH22118Supplementary Material (126 KB) Open Access Article
What is known about the topic? Telehealth item numbers were introduced to the Medicare Benefits Schedule (MBS – part of Australia’s health scheme) in response to the COVID-19 pandemic to facilitate continued access to health services, including exercise physiology (EP). What does this paper add? The uptake of telehealth service modalities has been minimal for EP through 2020–21. What are the implications for practitioners? The minimal uptake telehealth suggests that further research, advocacy and promotion is needed to ensure that telehealth can be a viable option for patients to consider when accessing EP services.
AH22220 Abstract | AH22220 Full Text | AH22220PDF (868 KB) | AH22220Supplementary Material (716 KB) Open Access Article
What is known about the topic?. The personal importation scheme has not been studied extensively. This paper investigates whether recent updates to the advertising laws will affect the operation of the personal importation scheme and health practitioners’ ability to refer to it in public. What does this paper add? This paper represents the first ever analysis of the way in which the personal importation scheme interacts with health practitioners’ statements, buyer’s clubs, and the internet. What are the implications for practitioners? The study finds that health practitioners who promote the availability of unapproved medicines through the personal importation scheme outside professional consultations are likely to be liable to enforcement action from the Therapeutic Goods Administration.
AH22278Is Australia’s lack of national clinical leadership hampering efforts with the oral health policy agenda?
What is known about the topic? Many countries, including Australia, currently do not provide universal access to affordable oral healthcare. There are significant oral health inequities that exist in Australia, particularly for priority populations who are at higher risk for oral diseases. What does this paper add? National clinical leadership on oral health is needed to implement evidence-based oral health policy. This commentary provides justification for the Australian Government to appoint a Commonwealth Chief Dental Officer. What are the implications for practitioners? Strengthening advocacy efforts by the public health practitioners and other stakeholders is important to promote oral health as a critical health issue for urgent action.
What is known about the topic? Rigorous HPE can be difficult in rural and remote settings. Policymakers often do not adapt evaluative design to suit complex implementation settings such as those in rural and remote Australia. What does this paper add? This paper characterises HPE experiences of Australian rural and remote health policymakers, indicating the need to tailor HPE to contexts and communities of rural and remote Australia. What are the implications for practitioners? Policymakers should incorporate community co-design into policy for contextually relevant HPE. Government agencies are responsible for developing workforce capacity for better HPE and embedding co-design in practice.
AH22280Potential therapeutic value of new drugs approved in Australia: a retrospective cohort study
What is known about the topic? Different numbers of new medicines are typically introduced in different jurisdictions. What does this paper add? There is no difference in the Australian introduction of medicines with and without potential significant therapeutic value that were approved in the US between 2015 and 2020. What are the implications for practitioners? New medicines should not be assumed to have or not have potential significant therapeutic value.
AH22257Healthcare practitioner use of real-time prescription monitoring tools: an online survey
What is known about the topic? Real-time prescription monitoring tools have been implemented in most states and territories across Australia to reduce the harms of prescription medication misuse. What does this paper add? This is the first study to explore pharmacists’ and prescribers’ perspectives on tool use in clinical practice, and the impact of these tools on clinical decision-making and clinical interventions. What are the implications for practitioners? Practitioners can optimise tool use in clinical practice to provide patients with best quality health care.
AH22247Opioid dispensing 2008–18: a Queensland perspective
What is known about the topic? Opioid dispensing is known to have increased in Australia over recent decades. However, most existing data hails from the Pharmaceutical Benefits Scheme (PBS), which has small gaps in quantifying opioids that are not subsidised. What does this paper add? This retrospective study uses an alternative database, adding information about non-PBS dispensing of tapentadol and buprenorphine, accompanied by rates of opioid dispensing in Queensland by age, oral morphine equivalent and geographical area. What are the implications for practitioners? This research highlights recent changes in opioid dispensing and opportunities for further studies to best inform practice improvement.
AH22160Emergency clinician perceptions of patients who present frequently to the emergency department: a snapshot of current practice
What is already known on the subject? Patients who present frequently to the emergency department are a heterogenous group making policy difficult to target and implement. What this study adds? The views of emergency clinicians working directly with patients who present frequently to the emergency department have not previously been elicited or used to inform policy in an Australian context. What are the implications for practitioners? These practical insights from clinical practice can be used to inform policy to address the complexities and nuances of patients who present frequently to the emergency department. The aim is to understand current practices and what can be changed to improve outcomes for this cohort of patients.
What is known about the topic? Some common quality assurance indicators may underrepresent the true incidence of critical events or their impact on ICU team workload, given that often only adverse outcomes are captured Our study is significant because it captures all such workload. What does this paper add? By identifying periods of peak internal emergency activity, our study demonstrates the utility of collecting internal ICU emergency data for purposes of roster coordination. What are the implications for practitioners? We propose consistent senior medical presence and minimised non-essential interruptions during the hours of peak activity. Our method is easily reproducible and our findings, although from a single centre, are broadly generalisable, given that we discuss their similarity with other published works.
What is known about the topic? After a cardiac event, people living in rural and remote Australia face many barriers to cardiac rehabilitation (CR) attendance. What does this paper add? This paper demonstrates the need to improve CR service access provision in rural and remote Australia via alternate models of delivery. What are the implications for practitioners? Exploring barriers to and facilitators of the uptake of hybrid models of delivery is recommended to ensure that CR services reach and support all people living in rural and remote Australia after a cardiac event.
AH23004Demographic changes in Australia’s regulated health professions: 6-year trends
What is known about the topic? Several studies have demonstrated changes in the demography of the Australian health workforce, they tend to focus on individual professions, prescribed geographic areas, or are based on data that are dated or incomplete. What does this paper add? This study presents a national picture of 15 regulated health professions’ demographic changes in Australia across a 6-year period and allows for comparisons between professions. What are the implications for practitioners? Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling.
AH23004 Abstract | AH23004 Full Text | AH23004PDF (708 KB) | AH23004Supplementary Material (365 KB) Open Access Article
AH22219Hepatitis B immune status of staff in smaller acute healthcare facilities
What is known about the topic? Non-immune healthcare staff are at risk of acquiring hepatitis B in the event of an occupational exposure to blood-borne pathogens. What does this paper add? An update about the proportion of staff employed in healthcare facilities with evidence of optimal long-term immunity to hepatitis B. What are the implications for practitioners? To mitigate risk, enhanced immunisation policies and programs are needed to actively support healthcare staff hepatitis B vaccination and serological testing; this includes documented follow up of those staff whose immune status is currently reported as unknown.
AH22219 Abstract | AH22219 Full Text | AH22219PDF (706 KB) Open Access Article
What is known about the topic? When assessing real growth in costs, it is important to adjust for inflation through indexation to the Consumer Price Index (CPI). The change in prices or costs over time can be calculated in constant currency amounts by adjusting by a ratio of the CPI in the year of interest to the CPI in the baseline year. What does this paper add? Rosenberg et al. (2022) did not calculate out-of-pocket costs in constant currency, which does not give an accurate estimation of costs adjusted for inflation. What are the implications for practitioners? We calculated examples to illustrate the impact of such adjustments, which substantially impact the results of the study.