Article Types
Research
Intergenerational Child Protection Contact and Child Development Outcomes: A Whole Population Linked Data Study
Objectives To investigate maternal child protection histories, and offspring child protection contacts and developmental outcomes, for children at age 5 years.Study DesignObservational cohort study using linked South Australian administrative birth, perinatal, child protection and child development data.Participants, SettingChildren with a South Australian birth registration and a record in the 2009, 2012, 2015 or 2018 Australian Early Development Census (AEDC).Main Outcome MeasuresHighest level of child protection system contact for children before starting school, and developmental vulnerability on one or more AEDC domains.ResultsOf 69,332 children, 7522 (10.8%) had a mother with a history of any child protection contact, and 1019 (1.5%) had a mother with at least one out-of-home care placement. Maternal child protection history was associated with increasing levels of socio-economic and health disadvantage around the time of birth. For example, overall there were 8245/69,332 (11.9%) children born into a home where the parent(s) were unemployed, compared with 549/1019 (53.9%) with a maternal out-of-home care history. For children whose mothers had child protection contact, 3793/7522 (50.4%) had their own child protection contact by age 5 years, compared with 7033/61,810 (11.4%) for children whose mothers had no contact. Of 6771 children whose mothers had child protection contact, 2724 (40.2% [95% confidence interval], 39.1%–41.4%) were developmentally vulnerable on one or more AEDC domains when they started school, compared with 12,002/58,165 (20.6% [95% confidence interval], 20.3%–21.0%) children with no maternal child protection history.ConclusionChild protection contact is common in both mothers and children, and maternal child protection history carries an increased burden of poor development outcomes at school entry. The scale and intersection of child protection system contact, early life disadvantage and poor development outcomes have implications for appropriately resourcing health-led supportive responses as early as possible during the perinatal and early childhood periods.
Meredith Forsyth, Alicia Montgomerie, Kathleen Falster, Deepa Jeyaseelan, Paul Hotton, John Lynch, Rhiannon M. Pilkington
Treatment and Survival Outcomes for Indigenous and Non-Indigenous Australians Within the Victorian Lung Cancer Registry: A Retrospective Cross-Sectional Cohort Study
Objectives Our goal was to explore and compare risk factors, patterns of management and survival outcomes in Indigenous compared with non-Indigenous Australian patients using the Victorian Lung Cancer Registry (VLCR).Study TypeA retrospective observational cohort study of the VLCR.SettingData collected from the VLCR between 18 January 2011 and 24 January 2024.ParticipantsPrimary lung cancer patients in the VLCR.Main Outcome MeasuresPatient, disease and management characteristics of Indigenous and non-Indigenous Australian patients. Impacts of patient and clinical variables on treatment and survival, measured by multivariable Cox regression and propensity-matched survival analysis.ResultsWe included 186 Indigenous and 17,439 non-Indigenous Australian patients. Indigenous Australian lung cancer patients were younger in age {median, 62 years (interquartile range [IQR], 55–69 years) vs. median, 71 years (IQR, 63–77 years); p < 0.001}, had lower socio-economic status (lowest quintile, 57 patients [31%] vs. 3274 patients [19%]; p < 0.001), were more likely to be current smokers (118 patients [65%] vs. 5963 patients [35%]; p < 0.001) and had higher levels of respiratory comorbidity (64 patients [34%] vs. 4088 patients [23%]; p < 0.001). There were no statistically significant differences in receipt of guideline-concordant treatment (82 patients [51%] vs. 8036 patients [56%]; p = 0.12) and survival outcomes (median survival, 1.4 vs. 1.5 years; hazard ratio, 1.06 [95% confidence interval, 0.88–1.27]).ConclusionWe found lung cancer patients of Indigenous status were more likely to have demographic disadvantage and clinical risk factors that may contribute to discrepancies in management compared with patients of non-Indigenous status. Identifying barriers to healthcare and treatment in the Indigenous Australian population is an important research priority to improve disparities between the two populations.
Melanie Wong, Mike Lloyd, Jessie Zeng, Sanuki Tissera, Kalinda E. Griffiths, Justine Clark, Jonathan Gillies, Lisa Briggs, Jacqueline Lesage, Tom Wood, Craig Underhill, Sagun Parakh, Louis B. Irving, Wasek Faisal, Rob Blum, Gary E. Richardson, Phillip Parente, Michelle Caldecott, Inger Olesen, Javier Torres, Evangeline Samuel, Christopher Lyne, Katharine See, David Langton, Thomas John, Gavin Wright, Matthew Conron, James Bartlett, Golsa Adabi, Maggie Moore, Susan Harden, Zoe K. McQuilten, John R. Zalcberg, Rob Stirling
Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021
Objectives To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Study Type Cross-sectional web-based survey (February–March 2021; n=5427), compared with a similar 2012 survey (n=2686). Setting/Participants Adults (≥18years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Main Outcome Measures Asthma control test (ACT), healthcare utilisation and medications. Results Median age was 46years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT≥20: 2021, 48.0%; 2012, 54.4%; p<0.001), and more had very poorly controlled symptoms (ACT 5–15: 2021, 26.8%; 2012, 22.9%; p<0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37–1.69]; p<0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p<0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p<0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p<0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥3 inhalers in the previous year, and 10.5% obtained ≥12 inhalers. For symptom relief in the previous 4weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS–formoterol). Conclusion Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. Trial Registration ACTRN12620000977976p
Helen K. Reddel, Maria R. Ampon, Leanne M. Poulos, Sharon R. Davis, Brett G. Toelle, Guy B. Marks, Taehoon Lee
Stigmatising Attitudes Towards People With Depression, Bipolar Disorder, Borderline Personality, ADHD and Early and Long-Term/Untreated Schizophrenia: Representative Survey of Australian Adults
Objectives To examine the prevalence in Australia of stigmatising attitudes towards people with six different mental health conditions: depression, early and long-term/untreated forms of schizophrenia, bipolar disorder, borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD). Design Cross-sectional population-based survey using the probability-based online panel Life in Australia. Participants responded to one of six vignettes describing a person with a mental health condition. Setting Australia, 11–25 November 2024. Participants Representative sample of 6032 adult residents of Australia. Main Outcome Measures Proportions of participants who agreed or strongly agreed with 13 stigmatising attitudes and proportions who were definitely or probably unwilling to interact in five different social situations with the person in the vignette. Results Stigmatising attitudes were generally lowest for depression and highest for long-term schizophrenia and borderline personality disorder. Beliefs about unpredictability had the highest endorsement: 61.9% (95% confidence interval [CI], 58.2%–65.5%) for long-term schizophrenia; 56.3% (95% CI, 52.5%–59.9%) for borderline personality disorder; 52.8% (95% CI, 49.0%–56.6%) for early schizophrenia; 50.7% (95% CI, 47.0%–54.4%) for bipolar disorder; 29.2% (95% CI, 25.9%–32.7%) for ADHD and 23.3% (95% CI, 20.2%–26.7%) for depression. Forcing treatment was endorsed by 25.9% (95% CI, 22.6%–29.5%) for early schizophrenia and 24.1% (95% CI, 21.0%–27.6%) for long-term schizophrenia. For all conditions, at least 20% of participants did not agree that the person in the vignette was a person of worth, with agreement ranging from 78.5% (95% CI, 75.1%–81.6%) for early schizophrenia to 67.4% (95% CI, 63.8%–70.9%) for long-term schizophrenia. There were high levels of unwillingness for the person in the vignette to marry into the family: ranging from 29.7% (95% CI, 26.4%–33.2%) for ADHD to 64.4% (95% CI, 60.7%–67.9%) for long-term schizophrenia. Conclusions Stigma related to mental health conditions remains prevalent in Australia and contributes to social and economic exclusion among those affected. Sustained action is needed across multiple sectors to address stigma, particularly towards conditions such as schizophrenia and borderline personality disorder, which are poorly understood within the community.
Amy J. Morgan, Anna M. Ross, Gayle McNaught, Rachel Green, Nicola J. Reavley
Continuity of Care in General Practice in Australia: A Whole-Of-Population Serial Cross-Sectional Study
Objective To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care. Design and Setting Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021). Participants Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population). Main Outcome Measure Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016–2017 to 2022–2023). High continuity was defined as having ≥70% of visits with one provider. Results About one-third of the population had high continuity of care (range: 31.3% in 2018–2019 to 37.2% in 2020–2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥70years vs. 0–14years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43). Conclusion While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care.
Rosemary J. Korda
Short-Term Safety and Adverse Event Risk Profiles for SARS-CoV-2 Booster Vaccine Doses in Australian Adults: A Survey Study
Objective This study quantifies the short-term risk profiles of seven severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) vaccines—Comirnaty Bivalent BA.1, Comirnaty Bivalent BA.4-5, Comirnaty XBB.1.5, Spikevax Bivalent BA.1, Spikevax Bivalent BA.4-5, Spikevax XBB.1.5 and Nuvaxovid—administered as booster doses in Australia. Design This is a survey study using data collected from online surveys sent via AusVaxSafety, the Australian active vaccine safety surveillance system, 3days post-vaccination, soliciting reports of adverse events following vaccination. Participants and Setting Individuals 18years and older who received a SARS-CoV-2 vaccine booster at an AusVaxSafety vaccine surveillance site between 1 January 2023 and 31 August 2024. Main Outcome Measures Bayesian logistic regression was used to estimate risk of reported adverse events, seeking medical advice and impact on daily activities. Results Of 197,476 respondents, 59,089 (29.9%) reported at least one adverse event, of which the most commonly reported symptoms were injection site reaction (23.8% [46,988/197,476]) and fatigue (19.4% [38,352/197,476]). Symptom resolution was reported by 69.9% (41,299/59,089) by day 3 and 5.6% (11,006/197,476) reported any time lost from daily activities. The unadjusted proportion of respondents who sought medical advice was higher in those who received Spikevax XBB.1.5 (1.2% [212/17,551]) than the other vaccines (0.5% [379/69,493] to 0.7% [147/20,271]), but the modelled, adjusted mean risk of medical advice was similar (<2.5%) across subgroups for vaccine brands, co-administered vaccines, medical conditions, age, sex and Indigenous status. The modelled risk of any adverse event at age 40years ranged from 35.2% (95% credible interval [CrI], 32.2%–38.5%) for men who had received Comirnaty XBB.1.5 to 75.5% (95% CrI, 71.9%–78.8%) for women who had received Spikevax XBB.1.5. At age 80years, this risk was lowest across all vaccines, ranging from 12.0% (95% CrI, 11.2%–13.0%) for men who had received Comirnaty BA4-5 to 36.7% (95% CrI, 34.6%–38.7%) for women who had received Spikevax XBB.1.5. Conclusions The results of this study confirm the short-term safety and low impact on daily living of SARS-CoV-2 booster vaccine administration to Australian adults.
Evelyn Tay, Michael Dymock, Lucy Dawes, Lucy Deng, Thuy Nguyen, Alan Leeb, Julie A. Marsh, Nicholas Wood, Kristine Macartney, Thomas L. Snelling
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Objectives To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Study Type Retrospective observational cohort study. Setting Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Participants Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Main Outcome Measures Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. Results There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33years (standard deviation [SD], 7.4years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426–$34,544). Conclusion Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons.
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
The Effects of Social Media on Adolescent Mental Health: Findings From a Population-Based Cohort Study in Australia
Objectives To examine the effects of social media on future mental health problems (depressive symptoms, anxiety symptoms, poor well-being and self-harm) in adolescents aged 12–18years, overall and stratified by sex and age periods (early, middle and late adolescence).Study TypeProspective longitudinal study.SettingParticipants were recruited in 2012 through schools in Melbourne, selected using stratified random sampling. In wave 1 (2012), 1239 Grade 3 students participated and have since completed annual surveys.ParticipantsThe analysis used data up to wave 11 (2022). Participants with no data on mental health, social media and confounders were excluded, leaving a sample of 1195 (552 [46%] male participants).Main Outcome MeasuresExposure was self-reported duration of daily social media use at each wave, from waves 4 to 10 (ages 12–18years). Outcomes (self-reported depressive symptoms, anxiety symptoms, well-being, self-harm) were assessed at the subsequent annual wave, from waves 5 to 11 (ages 13–19years).ResultsAcross adolescence, >2h versus <1h of daily social media use was associated with a small increase in risk of high depressive symptoms (risk difference [RD] per 100, 6.3 [95% CI, 2.7–9.9]) and poor well-being (RD, 4.9 [95% CI, 1.1–8.6]) at the subsequent annual wave. Estimated risks for all mental health problems were greatest in early adolescence (12–13years), with the largest effects observed for high depressive symptoms in female participants (>2h vs. <1h: RD, 10.8 [95% CI, 2.7–18.9]).ConclusionsHigher levels of social media use were associated with small increases in future risk of high depressive symptoms and poor well-being across adolescence. The largest risks for all mental health problems were observed during early adolescence for both male and female participants, supporting the need to consider policies that mitigate the adverse effects of social media on the mental health of younger adolescents.
Nandita Vijayakumar, S. Ghazaleh Dashti, Louise Canterford, Susan Ellul, Anthony J. A. Parissi, Anne-Lise Goddings, Russell M. Viner, Paul Moran, Rohan Borschmann, Lisa K. Mundy, Ellie M. Robson, Susan M. Sawyer
Impact of the 2025 New South Wales Respiratory Syncytial Virus Prevention Program on Infant Notifications and Hospitalisations: A Population-Based Analysis
The 2025 NSW RSV Prevention Program, which achieved an estimated coverage of 63% maternal vaccination and 18% for infant immunisation, led to more than 40% reduction in RSV notifications and hospitalisations among infants aged younger than 6months.
Janaki Amin, Sally L. Ellis, Christopher Lambeth, Jessica Gugusheff, Christine Selvey
Impact of Prescription Drug Monitoring Program Implementation on Rates and Characteristics of People Seeing Multiple Prescribers in Primary Care: A Controlled Interrupted Time-Series Analysis
Objective To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of the Victorian prescription drug monitoring program (PDMP). Study Design Controlled interrupted time series analysis of primary care electronic medical records. Setting A total of 562 general practices across three Victorian healthcare networks (Monash Health, Peninsula Health, Eastern Health). Patients People prescribed at least one PDMP-monitored medicine (e.g., opioids, benzodiazepines) and/or non-monitored psychotropic medicines (e.g., antidepressants, antipsychotics) between 1 January 2017 and 30 June 2023. Intervention Voluntary (1 April 2019) and mandatory (1 April 2020) implementation of the Victorian PDMP. Main Outcome Measures Changes in the monthly rate of people seeing multiple prescribers (defined as four or more prescribers) following PDMP implementation for monitored medicines, with non-monitored medicines used as a control; characteristics of people who ceased seeing multiple prescribers for monitored medicines following PDMP implementation. Results Following voluntary PDMP implementation (1 April 2019), there was a significant reduction in the differential step and trend changes in the rates of seeing multiple prescribers between people prescribed monitored and non-monitored medicines (differential step change: β, −3.55 [95% confidence interval (CI), −5.08 to −2.03]; differential trend change: β, −0.29 [95% CI, −0.46 to −0.12]). Following mandatory PDMP implementation (1 April 2020), there was no significant step change difference. However, there was an increase in the differential trend change in the rate of seeing multiple prescribers between those prescribed monitored and non-monitored medicines (differential trend change: β, 0.21 [95% CI, 0.05–0.37]; p=0.009). Logistic regression revealed that older age (95% CI, 1.39–1.75), male gender (95% CI, 1.09–1.25), metropolitan residence (95% CI, 1.04 and 1.23) and substance use disorder diagnosis (95% CI, 1.07–1.28) were associated with significantly higher odds of seeing multiple prescribers before PDMP implementation. Conclusions Implementation of the PDMP was associated with meaningful reductions in people accessing monitored medicines from four or more prescribers.
Louisa Picco, Monica Jung, Grant Russell, Samanta Lalic, Mahbod A. Fini, Dan I. Lubman, Rachelle Buchbinder, Ting Xia, Suzanne Nielsen
Two Decades of Primary Care Funding in Australia: A Descriptive Time-Series and Distributional Analysis
Objectives To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. Study Type Descriptive modelling using standardised framework for classifying primary care expenditure. Setting Australian public and private health expenditure data (2002–03 to 2022–23) were disaggregated into: broad primary health care services (Tier A); direct primary care, predominantly funding general practice (Tier B); and funding for enhanced primary care for people with greater needs (Tier C). Distributional analysis was conducted across geographies. Participants No individual participants; analysis used aggregated health expenditure data across 327 Statistical Area Level 3 geographies. Main Outcome Measures Proportions of total and public expenditure allocated to each tier; equity in public Tier B and Tier C spending across areas, assessed using standardised slope indices. Results The share of total health spending allocated to primary care declined over the period. Tier A spending declined from 36.3% to 33.0% of total health spending; Tier B fell more sharply from 8.0% to 5.5%; and Tier C remained flat at 0.7%. Public spending trends were similar, but declines were more muted, with Tier C unchanged at 1.0%. Public spending on Tier B was 13% higher in the most disadvantaged areas than in the most advantaged areas in 2013–14; by 2023–24, this declined to 7%. Public Tier C spending remained progressive at 35% higher in the most disadvantaged areas, but decreased from 51% over the decade. Exploratory multivariate analyses suggested that Tier C spending was more redistributive than Tier B after accounting for need. Conclusions Data indicate that primary care has declined as a funding priority in relative terms in Australia, and investment in high-value care has remained stagnant and appears increasingly less redistributive. These patterns may have implications for health equity.
Rafal Chomik, Shona M. Bates, Michael Wright
Predictors of Ambulance Transport to Hospital for Older People Living in Tasmanian Aged Care Facilities: A Retrospective Cohort Study
Objectives To quantify factors associated with paramedic transport to hospital for older people in residential aged care facilities (RACFs) and supported accommodation, and to identify modifiable drivers of non-transport. Study Type Retrospective cohort study using routinely collected electronic patient care records, analysed with gradient boosting models and multivariable logistic regression. Setting Ambulance Tasmania attendances to RACFs and supported accommodation across Tasmania, 1January 2018 to 31 December 2024. Study Population All eligible ambulance attendances for people aged 65years or older at these facilities. Main Outcome Measures The primary outcome was transport to hospital. Scene time and clinical status at first assessment, summarised using the National Early Warning Score 2 (NEWS2) and Shock Index, were descriptive variables and candidate predictors. Results Of 23,317 attendances, 19,386 (83.1%) resulted in transport and 3931 (16.9%) did not. Most attendances were low risk. Crew skill set, calendar month, initial pain score, respiratory rate and NEWS2 category were the strongest predictors of transport. In adjusted logistic regression, extended care paramedic attendance was associated with markedly lower odds of transport than attendance by standard paramedic crews (adjusted odds ratio, 0.09 [95% CI, 0.07–0.12]), corresponding to an adjusted transport probability of 0.50 compared with 0.85 for intensive care paramedic crews, 0.86 for standard paramedic crews and 0.69 for other crews. Conclusions Paramedic transport decisions for RACF residents were strongly associated with acute illness severity, but crew skill set was also independently associated with transport. Attendances managed by extended care paramedics had lower adjusted probabilities of hospital transport. These findings suggest that extended-scope paramedic models warrant prospective evaluation in this setting.
Sharon Andrews, Pieter F. Fouche, Belinda Flanagan, Michael McDermott, Melanie Greenwood
Kidney Failure After Living Kidney Donation in Australia: A National Registry Linkage Study, 2004-2024
National linkage of the Australia and New Zealand Living Kidney Donor Registry and the Australia and New Zealand Dialysis and Transplant Registry provides the first Australian estimates of kidney failure treated with kidney replacement therapy (KRT) after living kidney donation (2004–2024). Out of 5291 donors (56,962 person-years; median follow-up, 10.96years), three donors underwent KRT (0.53 per 10,000 person-years). No events occurred within 10years of donation. Australian clinicians can now counsel and guide potential donors using local data: risk of kidney failure requiring KRT is very low, but late events warrant lifelong follow-up.
Melanie Wyld, Kate Wyburn
The Oral Health and Well-Being Experiences of Indigenous South Australians: A Qualitative Study
Objectives To explore the perceptions of Indigenous South Australian adults regarding their oral and general health, social and emotional well-being and dental care experiences. Study Design Qualitative study; interviews with Indigenous South Australian adults involved in a non-randomised implementation and service-delivery project evaluating provision of culturally safe, comprehensive dental care. Study governance was provided by an Indigenous Oral Health Unit Reference Group with Indigenous leadership to centre cultural authority and cultural safety across all study dimensions. Participants Setting Semi-structured interviews were conducted with 136 Indigenous South Australian participants at a location of their choosing (e.g., their home, a community centre, a research facility), which were held at baseline (1 July 2022–15 December 2023) and 12-month follow-up (1 March 2024–31 March 2025). Intervention The overarching study consisted of a pre–post assessment of oral health embedded in routine dental care with oral epidemiological examinations and assessment of systemic health biomarkers (blood glucose, inflammation, cholesterol, kidney function). This was followed by semi-structured interviews at 12-month follow-up. Main Outcome Measure Qualitative outcomes—participant experiences, understandings and recommendations around supporting oral health, social and emotional well-being and culturally safe dental care for Indigenous South Australians. Results Reflexive thematic analysis was used to analyse interview data, from which five themes were developed. Participants described the importance of oral health for overall health, aesthetic and functional impacts and judgement and discrimination related to poor oral health, all of which were linked to social and emotional well-being. Culturally safe care that includes oral health assessments alongside assessments of biomarkers for systemic health were suggested to promote self-confidence, reduce feelings of shame and empower communities. Conclusion This study highlights the need to incorporate holistic approaches in promoting Indigenous oral and systemic health and in supporting social and emotional well-being. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12626000046303; retrospectively registered)
Ria Aiyar, Sonia Nath, Joanne Hedges, Gina L. Guzzo, Kostas Kapellas, Alexander Pham, Emma Flanagan, Tiyanna-Marie Mastrosavas, Ebony Wallace, Lisa M. Jamieson
Cost-Effectiveness of Donanemab for Early Alzheimer Disease in Australia
Objectives To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives. Design A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care. Setting, Participants Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER-ALZ eligibility criteria: mean age 75years, amyloid-β-positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with APOEE4 homozygotes, in line with the Australian labelling. Donanemab administered every 4weeks with magnetic resonance imaging (MRI)-based amyloid-β-related imaging abnormalities monitoring and treatment suspension upon amyloid-β clearance or progression to severe Alzheimer disease, compared with standard care. Main Outcome Measures Incremental costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses. Results Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness-to-pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure. Conclusion Donanemab provides clinical benefits but is unlikely to be cost-effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real-world evidence and disaggregated analyses by geography and socioeconomic status is warranted.
Lan Gao, Rosie Watson, Nawaf Yassi
Awareness, Usage and Perceptions of Doxycycline Post-Exposure Prophylaxis (doxyPEP) for Prevention of Sexually Transmitted Infections in Australia: Insights From a National Cross-Sectional Survey
Objective To examine the awareness, usage and perceptions of doxycycline post-exposure prophylaxis (doxyPEP) for sexually transmitted infection (STI) prevention among gay and bisexual men and transgender (trans) and gender diverse people in Australia. Design Cross-sectional online survey. Setting, Participants National multi-site survey in Australia from 1 July 2024 to 30 November 2024, recruiting from 13 sexual health and community clinics, 6 general practices, social media, dating applications, and university portals. Gay and bisexual men and trans and gender diverse people aged ≥18years living in Australia were included in the study. Main Outcome Measures DoxyPEP awareness, ever use, recent use (past 12months), dosage regimens, sourcing methods and planned future use. Results Among 2095 participants, half (1080/2095, 51.6%) had heard of doxyPEP. Of those aware, 323/1080 (29.9%) had ever used doxyPEP, and 306/1080 (28.3%) were recent users. DoxyPEP awareness and usage varied by HIV status and pre-exposure prophylaxis (PrEP) use (p<0.0001). Nearly two-thirds of users had taken the recommended 200mg within 72h after sex (205/323, 63.5%). Among recent users, 29/306 (9.5%) reported recent syphilis diagnoses, and 85/306 (27.8%) had ≥2 STI diagnoses in the past 12months. Of those who had ever used doxyPEP, 135/323 (41.8%) obtained prescriptions from clinicians, 17/323 (5.3%) obtained it online, and 28/323 (8.7%) purchased it in person overseas without a prescription. Of those aware of doxyPEP, 490/1080 (45.4%) planned to use doxyPEP in the next 12months, primarily to prevent chlamydia (460/490, 93.9%), gonorrhoea (422/490, 86.1%) or syphilis (386/490, 78.8%). Some intended to prevent Mycoplasma genitalium (92/490, 18.8%) or mpox (36/490, 7.4%). Among non-users, 306/756 (40.5%) worried about antibiotic resistance. Conclusions DoxyPEP use was happening quickly but often involved non-recommended regimens and unsupervised sourcing. Urgent educational interventions and improved clinical access are needed for safe implementation.
Catriona S. Bradshaw, Dash Heath-Paynter, Benjamin Riley, Daniel Grace, Fabian Y. S. Kong, Eric P. F. Chow
Genomic Newborn Screening: Verdict From an Australian Citizens’ Jury
Objective To support a nationally representative group of Australians to make informed, reasoned recommendations on the use of genomics in newborn screening programmes. Design Hybrid Citizens’ Jury method. Setting, Participants Thirty Australian adults recruited by random ballot invitation and stratified selection against population-based demographic targets of age, sex, ancestry, highest level of education, location of residence (state/territory, urban/non-urban), experience of disability and parent/non-parent. Main Outcome Measures Jury recommendations with reasons. Results The jury made 11 recommendations. The jury agreed whole genome sequencing could be used in the programme, but only if conditions were met regarding national consistency, benefit, Australian Government oversight, consent, reporting to parents, data protection, supporting parents and the healthcare system, and parent and public education. All of these conditions were agreed by consensus, except reporting to parents and parent and public education, where there was a supermajority (24/30) in agreement and minority dissent. The jury were split on Recommendation 11: how much genomic data should be extracted and retained. Nine jurors supported whole genome sequencing only if data extraction and retention were limited to interpretable, actionable genetic information; 21 jurors supported a more expansive approach. Conclusions To maintain public trust in Australian newborn screening, programmes should take a more conservative approach to data extraction and storage until concerns are addressed and safeguarding conditions implemented. Jurors' key concerns include identifiability of genomic data, risk of data misuse and potential to undermine trust and participation in newborn screening.
Emma Frost, Zornitza L. Stark, Kristen Nowak, Louise Healy, Sarah Norris, Stacy M. Carter
Uptake and Costs of the 60-Day Dispensing Policy for Antihypertensive Medicines in Australia: A Mixed Methods Study
Objectives To evaluate the uptake of a new 60-day dispensing policy for antihypertensive medicines and estimated cost savings compared with conventional 30-day dispensing; and to explore general practitioner and pharmacist perspectives on the new policy. Study Design Mixed methods design; analysis of Pharmaceutical Benefits Scheme (PBS) dispensing claims from 1 September 2023 to 30 April 2025; and semi-structured interviews with 20 general practitioners and four pharmacists from 13 June 2024 to 24 September 2024 to gauge their perspectives on 60-day dispensing. Setting, Participants General practitioners and pharmacists practising in New South Wales, Victoria and Queensland, Australia. Main Outcome Measure Antihypertensive prescription volumes; patient and government cost savings; and perceptions of the policy from general practitioners and pharmacists. Results The 60-day antihypertensive prescription volume increased from 75,500 to 877,700 over 20months, accounting for 21.2% of all antihypertensive dispensing by 30 April 2025. We estimate the total cost savings for patients were up to ~$65 million, and the government saved ~$87 million and paid pharmacies ~$86.7 million via the Additional Community Supply Support (ACSS) payment program, with a net effect of ~$0.3 million. In interviews, general practitioners indicated varied utilisation of 60-day prescriptions, with some actively providing 60-day prescriptions, but some rarely or not at all. Barriers included keeping abreast of eligible and ineligible medicines for 60-day prescriptions and perceived resistance from pharmacists. Pharmacists were concerned about incorrect dispensing and potential medication shortages. Conclusion At 20months after the introduction of the new policy, 21.2% of antihypertensive prescriptions were for 60-day dispensing. The slow uptake is likely due to low uptake among general practitioners and resistance from pharmacists. The 60-day policy has demonstrated substantial financial savings for patients. If uptake of 60-day dispensing increased to 50%, annual savings from antihypertensive medicines could rise to up to ~$165 million for patients and ~$11.6 million for the government.
Tian Wang, Huy L. Nguyen, Isabella Tan, Dean S. Picone, Emily Atkins, Sonali R. Gnanenthiran, Michael O. Falster, Sallie-Anne Pearson, Anthony Rodgers, Aletta E. Schutte
Motor Neuron Disease Mortality Trends in Australia From 1986 to 2023: A Population-Based Study
Objectives To analyse longitudinal change in motor neuron disease (MND) mortality in Australia from 1986 to 2023. Design Australian population-based study of MND mortality. Setting All MND mortality and Australian population data from 1 January 1986 to 31 December 2023 were obtained from the Australian Bureau of Statistics. Main Outcome Measures MND mortality records were analysed, and certified deaths were summarised by year of registration. MND mortality rates, 95% confidence intervals (CIs) and Joinpoint regression trends were calculated. Data were further subset by demographic and geographical categories to report Australian MND mortality by age group, sex, state/territory location and remoteness areas classification. Results In Australia, the total number of MND deaths more than tripled over the past 37years, from 238 in 1986 to 781 in 2023. The unadjusted mortality rate in 1986 was 1.49 (95% CI, 1.30–1.69) per 100,000 population and increased to 2.93 (95% CI, 2.73–3.14) per 100,000 population by 2023. After age standardisation, the annual percentage change across 1986–2023 was determined to be 0.47% (95% confidence limit, 0.16–0.86). Joinpoint modelling suggests a more recent reduction in adjusted mortality rates. In 2023, MND accounted for 0.43% of all-cause deaths in Australia, increasing from 0.21% in 1986. The number of MND deaths in Australia peaked at age 70–79years. MND mortality was higher among men than women (rate ratio, 1.41; 95% CI, 1.33–1.51). MND mortality rates were similar among New South Wales, Victoria and Queensland (2.93, 3.08 and 2.85 per 100,000 population, respectively), with higher rates in South Australia and Tasmania (3.44 and 4.12 per 100,000 population, respectively). MND mortality rates were higher in inner and outer regional areas (3.90 and 3.24 per 100,000 population, respectively) compared with major cities (2.79 per 100,000 population). Conclusions Adjusted MND mortality rates in Australia increased over 37years.
Carol M. Y. Lee, Rupendra N. Shrestha, Julian Gold, Mark Stevenson, Kelly L. Williams, Lyndal Henden, Sandrine K. K. Chan Moi Fat, Zoe Zussa, Amanda Wright, Martin Jude, Mark A. S. Laidlaw, Willem J. R. Fokkink, Dominic B. Rowe
Emergency Department Presentations and Hospitalisations for Elder Abuse in People Accessing Aged Care Services in Australia: A Retrospective Cross-Sectional Study
Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.
Stephanie L. Harrison, Sahar Barmomanesh, Bryan Morden, Maria C. Inacio, Gillian E. Caughey, on behalf of the ROSA Consumer and Community Advisory Committee
The Association Between Alignment to the Breast Cancer Optimal Care Pathways and Patient Survival in Victoria, Australia, 2012–2019: A Retrospective Population-Based Cohort Study
Objectives To quantify the association between care alignment to the treatment step of the Cancer Council Victoria and Department of Health Victoria Optimal care pathways for people with breast cancer (OCP) (second edition) and survival. Design Retrospective population-based cohort study using the Victorian Cancer Registry and linked administrative health datasets. Setting, Participants Adult women diagnosed with invasive, unilateral breast cancer from 1 July 2012 to 31 December 2019 in Victoria, Australia. Main Outcome Measures Breast cancer-specific and overall survival for women whose care did or did not align to the treatment step of the OCP expressed as adjusted hazard ratios. Interaction between OCP alignment and cancer stage at diagnosis was also assessed. Results Of 29,591 eligible women, 17,152 (58.0%) were fully aligned, 7086 (23.9%) were partially aligned and 5353 (18.1%) were not aligned to the treatment step of the breast cancer OCP. Median follow-up was 1481days (interquartile range, 850–2210days). Adjusting for measured sociodemographic and clinical factors, OCP treatment alignment was associated with 23% (95% confidence interval [CI], 14%–31%) and 34% (95% CI, 29%–40%) lower risk of death from breast cancer and all causes, respectively, compared with non-alignment. By cancer stage, OCP alignment was significantly associated with 40% (95% CI, 27%–50%) and 30% (95% CI, 14%–42%) lower risk of breast cancer death for Stage II and III cancers, respectively, and 39% (95% CI, 26%–49%), 49% (95% CI, 42%–55%) and 33% (21%–44%) lower risk of all-cause death for Stage I, II and III cancers, respectively. Conclusions Risk of death was lower for women with breast cancer whose treatment aligned to the OCP compared with women whose treatment did not align. Our findings support the promotion and implementation of the breast cancer OCP.
Brandon S. Hao, Juan C. Quiroz, Ian N. Olver, Claire M. Vajdic
Malignant Otitis Externa in Central Australia: A 15-Year Retrospective Review Between 2009 and 2024
We performed a 15-year retrospective audit of all cases of malignant otitis externa (MOE) referred to Alice Springs Hospital in Central Australia from 2009 to 2024, the largest Australian series of MOE. Data on demographics, risk factors, microbiological culture results, management and outcomes were collected, identifying 64 cases of MOE, with the incidence increasing over time. The incidence of MOE was associated with Indigenous status and the presence of diabetes mellitus and chronic kidney disease. Pseudomonas, Staphylococcus aureus and fungal pathogens predominate as causal agents. Complications and mortality were common.
George P. Drewett, Mini Jacob, Belle Culhane, Amy Booth, Connor Wright, Sajan Thomas, Anjali Abraham
Ngalaiya Boorai Gabara Budbut: A Qualitative Study With Primary Care Providers to Understand Perceived Needs, Enablers, Barriers and Opportunities to Strengthen Care
Objective To explore primary care providers' perspectives on (i) healthcare needs and barriers to care for Aboriginal and Torres Strait Islander children and adolescents; and (ii) enablers and opportunities to strengthen care. Study Design A qualitative study; interviews and open-ended survey responses. Setting Primary care providers who work with Aboriginal and Torres Strait Islander children and young people in health and education settings in New South Wales and the Australian Capital Territory. Data were collected between 23 March 2022 and 13 October 2023. Main Outcome Measures Sixteen interviews and 33 open-ended survey responses were analysed using reflexive thematic analysis with a hybrid inductive/deductive approach. Results Participants reported that some of the most important health needs for children and young people related to mental health. They recognised that the presenting complaint was not always the underlying or only concern, demonstrated an understanding of trauma-informed care and acknowledged the importance of collaborative services that engaged support networks. Barriers to care included a lack of cultural safety in mainstream services, challenging social circumstances, financial concerns, being unaware of available services and privacy and confidentiality concerns. To improve care, staff identified several areas needing change including having a package of services tailored for young people; additional training for providers in child and adolescent health, particularly for mental healthcare, trauma-informed care and communication with young people; providing a safe and engaging environment; support for staff self-care; and additional resources. Conclusions Supporting mental health needs is a key aspect of caring for children and adolescents. To provide optimal primary healthcare, service providers require specialist skills. To support adolescents and children, participants identified a need for ongoing training, professional development and organisational support to ensure best practice care is sustained. This work has informed the development of training and other resources for partner health services.
Christianna Digenis, Rachel Reilly, Peter Azzopardi, Hilina Winkenweder, Odette Pearson, Kane Ellis, Jane Fisher, Debra J. Rickwood, Choong-Siew Yong, Ngiare Brown
Strategies for Reducing Access Block and Waiting Time for Patients Seeking Emergency Hospital Care: Results of a Ward-Level Discrete Event Simulation at Queensland's Largest Public Hospitals
Objective To assess the impact of strategies to improve public hospital emergency access using a detailed ward-level simulation modelling approach. Design and Setting Discrete event simulation was used to simulate patient flow at three principal referral Australian hospitals from 1 September 2021 to 31 August 2022. Models were developed and validated using every emergency department (ED) presentation, inpatient episode of care and patient ward movement at the study hospitals. Main Outcome Measures Mean and total ED length of stay, mean waiting time, access block rate, 4-h rule compliance and bed utilisation for patients admitted from the ED. Results Reducing ED demand via arrangements that accommodate the same proportion and types of admissions from the ED as the existing ED presenting population reduces access block, with larger impacts in winter than in summer. However, reducing ‘general practitioner-type patients’ in EDs has negligible impact on access block. Tangible impacts on improving patient flow can be achieved by removing maintenance care patients from hospitals (reducing the percentage of access block by up to a third) and reducing elective admissions. Strategies that emphasised morning, midday and early afternoon discharges led to large flow improvements. The strategy already practised by most hospitals of sharing patients among wards greatly improves emergency access, and gains are the same order of magnitude as reducing overall ED demand. Conclusions The study provides support to policymakers looking for evidence regarding strategies to improve emergency access to public hospital care.
Hamed Hassanzadeh, Justin Boyle, Vahid Riahi, Hwan-Jin Yoon, Ibrahima Diouf, Sankalp Khanna, Clair Sullivan, Andrew Staib, Emma Bosley, Mahnaz Samadbeik, James F. Lind
The Impact of Hospital Bed Occupancy on Patient Flow and Emergency Department Access: A 25-Hospital Cohort Study
Objectives To evaluate the effect of hospital occupancy levels on inpatient and emergency department (ED) flow rates, ED length of stay (ED) and access block, and identify critical occupancy thresholds above which patient flow deteriorates. Design Retrospective cohort study using routinely collected administrative data. Setting Twenty-five public hospitals in Queensland, Australia, over a 5.5-year period (1 April 2017 to 31 August 2022). Main Outcome Measures ED presentation and discharge rates, inpatient admission and discharge rates, hospital occupancy levels, length of stay, access block and 4-h rule compliance. Results The analysis reveals a significant performance shift as hospital occupancy levels increase and identifies site-specific critical ‘choke points’ where patient flow deteriorates. Notably, as occupancy rises, we observed a growing divergence between ED presentations and discharge rates, and between inpatient admissions and discharges, indicating system congestion. Additionally, when assessing flow across the 25 hospitals, the data demonstrates that a 10% increase in bed occupancy rate correlates with a 0.32-h (19-min) extension in ED length of stay (or 33min for patients admitted from the ED). Also, significant disparities in hospital operations were observed between weekends and weekdays, with weekday admissions and discharges up to three times higher than weekends, highlighting the increased operational pressure during the work week. Conclusions The investigation challenges the traditional 85% occupancy target, demonstrating that optimal occupancy levels vary by hospital. The study also underscores the strong correlation between hospital bed occupancy and ED access performance, with higher hospital occupancy correlating with longer ED stays and decreased adherence to performance indicators. As hospitals approach full capacity, the pressure on ED resources intensifies, resulting in longer wait times and delays in care.
Vahid Riahi, Justin Boyle, Hwan-Jin Yoon, Hamed Hassanzadeh, Ibrahima Diouf, Sankalp Khanna, Andrew Staib, Mahnaz Samadbeik, Clair Sullivan, Emma Bosley, James F. Lind