Topics
Population health
Time for an Update: The Currency of Clinical Guidelines in Australia—A Cross-Sectional Analysis
Objectives Long-term and chronic health conditions are associated with a significant burden of disease and economic impact in Australia. Although improving health outcomes requires a multifactorial approach, up-to-date clinical guidelines can optimise healthcare delivery by providing clinicians with evidence-based, actionable recommendations. We aimed to determine the currency and key methodological characteristics of national clinical guidelines published in Australia and focussed on areas of highest prevalence and burden of disease.Study Design and SettingWe conducted a cross-sectional analysis by searching PubMed, the Guidelines International Network International Guidelines Library and Australian college and society websites in July 2025 for national clinical guidelines in the five areas of highest prevalence and burden of disease, as defined by the Australian Bureau of Statistics and Australian Institute of Health and Welfare, respectively. Information and metrics relating to time since publication, time since last evidence search and methods and processes (e.g., reporting of clinical questions and Population, Intervention, Comparison, Outcome [PICO] criteria and approval of the guideline by the National Health and Medical Research Council [NHMRC]) were tabulated and analysed.ResultsThirty-one guidelines published between 2002 and 2025 were identified, with most relating to diabetes or mental health. The mean times since publication and last search date were 8.6 and 9.8 years, respectively. Most provided details regarding clinical questions (77%), PICO criteria (61%), search strategies (68%) and other methodological considerations, however, fewer than half used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess certainty of evidence or provided details regarding conflicts of interest (48% each). Of the 18 guidelines approved by the NHMRC, five were developed within the previous 5 years and remain approved.ConclusionFor most high-priority clinical conditions in Australia, there are no up-to-date evidence-based guidelines available to support clinical decision-making. Guideline developers and funders should invest more energy and resources into planning for updates and ensuring that methods and processes are optimised to facilitate this, such as considering a living approach.
Heath White, Ethan Fernandes, Kristina Peduru-Arachchige, Tari Turner, Steven McGloughlin, Steve McDonald
The Impact of Heat and Bushfire Smoke on Health System Utilisation in Australia
Objective To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment.DesignCross-sectional, population study, covering health conditions with the highest burden of disease.Setting and ParticipantsPeople in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions.Main Outcome MeasuresRelative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage.ResultsHeat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023–1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016–1.031; p < 0.001) for mental health conditions. PM2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m3 change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM2.5 (RR, 1.049 [95% CI, 1.040–1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014–1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains.ConclusionHeat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens.
Hwan-Jin Yoon, Justin Boyle, Ibrahima Diouf, Rajiv Jayasena
