Topics

Cardiovascular diseases

Health services administration

Summary

Chest pain is the second most common reason for adult emergency department presentations.
Most patients have low or intermediate risk chest pain, which historically has led to inpatient admission for further evaluation.
Rapid access chest pain clinics represent an innovative outpatient pathway for these low and intermediate risk patients, and have been shown to be safe and reduce hospital costs.
Despite variations in rapid access chest pain clinic models, there are limited data to determine the most effective approach. Developing a national framework could be beneficial to provide sites with evidence, possible models, and business cases. Multicentre data analysis could enhance understanding and monitoring of the service.

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1 Liverpool Hospital, Sydney, NSW
2 Royal North Shore Hospital, University of Sydney, Sydney, NSW
3 University of Sydney, Sydney, NSW
4 Westmead Applied Research Centre and Westmead Hospital, Sydney, NSW

Correspondence: kenneth.cho@westernsydney.edu.au

Open access:

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

Competing interests:

No relevant disclosures.

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2. Klimis H, Khan ME, Thiagalingam A, et al. Rapid access cardiology (RAC) services within a large tertiary referral centre — first year in review. Heart Lung Circ 2018; 27: 1381‐1387.
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5. Kozor R, Mooney J, Lowe H, et al. Rapid access chest pain clinics: an Australian cost–benefit study. Heart Lung Circ 2019; 28: S315.
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8. Richards MJ, Russo PL. Surveillance of hospital‐acquired infections in Australia — one nation, many states. J Hosp Infect 2007; 65: 174‐181.
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11. Bayley MD, Schwartz JS, Shofer FS, et al. The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Ann Emerg Med 2005; 45: 110‐117.
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24. Yu C, Brazete S, Gullick J, et al. Long‐term outcomes following rapid access chest pain clinic assessment: first Australian data. Heart Lung Circ 2021; 30: 1309‐1313.
25. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013; 168: 2153‐2158.
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27. Fox KF, Tenkorang J, Rogers A, Wood DA. Are rapid access cardiology clinics a valued part of a district cardiology service? Int J Cardiol 2009; 137: 42‐46.
28. Rajpura A, Sethi S, Taylor M. An evaluation of two rapid access chest pain clinics in central Lancashire, UK. J Eval Clin Pract 2007; 13: 326‐336.
29. Boyle RM. Value of rapid‐access chest pain clinics. Heart 2007; 93: 415‐416.
30. Ingram SJ, McKee G, Quirke MB, et al. Discharge of non–acute coronary syndrome chest pain patients from emergency care to an advanced nurse practitioner–led chest pain clinic: a cross‐sectional study of referral source and final diagnosis. J Cardiovasc Nurs 2017; 32: E1‐E8.
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34. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78: e187‐e285.

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Editorials

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Reducing the risks of nuclear war — the role of health professionals

Kamran Abbasi, Parveen Ali, Virginia Barbour, Kirsten Bibbins‐Domingo, Marcel GM Olde Rikkert, Andy Haines, Ira Helfand, Richard C Horton, Bob Mash, Arun Mitra, Carlos A Monteiro, Elena N Naumova, Eric J Rubin, Tilman A Ruff, Peush Sahni, James Tumwine, Paul Yonga and Chris Zielinski

Med J Aust || doi: 10.5694/mja2.52054
Published online: 7 August 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war.1 In August 2022, the UN Secretary‐General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War”.2 The danger has been underlined by growing tensions between many nuclear armed states.1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet — and urge action to prevent it.

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1 The BMJ, London, UK
2 International Nursing Review, Sheffield, UK
3 Medical Journal of Australia, Sydney, NSW
4 JAMA, Chicago, IL, USA
5 Dutch Journal of Medicine, Amsterdam, Netherlands
6 London School of Hygiene and Tropical Medicine, London, UK
7 International Physicians for the Prevention of Nuclear War, Malden, MA, USA
8 The Lancet, London, UK
9 African Journal of Primary Health Care and Family Medicine, Cape Town, South Africa
10 Revista de Saúde Pública, São Paulo, Brazil
11 Journal of Public Health Policy, Boston, MA, USA
12 New England Journal of Medicine, Waltham, MA, USA
13 National Medical Journal of India, New Delhi, India
14 African Health Sciences, Kampala, Uganda
15 East African Medical Journal, Nairobi, Kenya
16 Centre for Global Health, University of Winchester, Winchester, UK

Correspondence: czielinski@ippnw.org

Competing interests:

Virginia Barbour is an unpaid committee member of Wildlife Queensland. Kirsten Bibbins‐Domingo is a full‐time employee of the American Medical Association, working as the Editor‐in‐Chief of JAMA and the JAMA Network. Marcel Olde Rikkert has received research grants from the Dutch Research Council (NOW; grant no. COMPL.21COV.001) and the Netherlands Organisation for Health Research and Development (ZonMw; grant no. 09120012010063), and is chair of the Dutch guideline committee on cognitive impairments and dementia. Andy Haines is Principal Investigator for the Pathfinder Initiative 2020–2025, co‐investigator of the Sustainable and Healthy Food Systems research program 2017–2023, and co‐investigator with Complex Urban Systems for Sustainability and Health (CUSSH) 2017–2023, all funded by the Wellcome Trust, with additional funding from the Oak Foundation for the Pathfinder Initiative; has received royalties or licences from Cambridge University Press for the co‐authored book Planetary Health; has received consulting fees paid to his institution as senior advisor on climate and health, Wellcome Trust; and has received travel support related to the World Health Organization and the Human Frontiers Science Program. He has also had unpaid roles as a member of the cool roofs trial steering committee, Nouna Research Centre, Burkina Faso/University of Heidelberg; co‐chair of the International Advisory Committee, NIHR CLEAN‐Air (Africa) Global Health Research Unit; member of the Independent Advisory Group, Collaboration for the Establishment of an African Population Cohort Consortium (CE‐APCC); co‐chair of the InterAcademy Partnership, Climate Change and Health working group; and co‐chair of the Academy of Medical Sciences/Royal Society working group on “A healthy future: tackling climate change mitigation and human health together”. Ira Helfand reports honoraria for several speaking engagements, all donated to Back from the Brink, International Physicians for the Prevention of Nuclear War, or Physicians for Social Responsibility; travel and lodging support for attendance at the World Summit of Nobel Peace Laureates and the World Congress on Public Health; and lodging support for the UN Human Rights Youth Summit. He also reports unpaid membership of the board of International Physicians for the Prevention of Nuclear War, the International Steering Group of the International Campaign to Abolish Nuclear Weapons, the board of Physicians for Social Responsibility, and the Steering Committee of Back from the Brink; and has been a Trustee for Phillips Exeter Academy. Tilman Ruff reports consulting fees as part of a contract with the Institute for Energy and Environmental Research (USA) for papers addressing the health and environmental consequences of nuclear testing in multiple locations including Australia, French Polynesia, central Pacific and China; honoraria from the Chosunilbo media group in South Korea for a lecture on nuclear weapons at the Asian Leadership Conference in Seoul and from Gangwon Province for contributions to the JeongSeon Forum, and honoraria for nuclear weapons presentations from Hyogo Medical Practitioners Association (Japan), Peace Boat (Japan) and the University of Sydney; and payment for testimony as an expert witness on radiation and health for Environmental Justice Australia acting for Mine‐Free Glenaladale regarding the proposed Fingerboards mineral sands mine to the Victorian Government Fingerboards Inquiry and Advisory Committee. He also reports membership of the RV3 Rotavirus Vaccine Scientific Advisory Committee at Murdoch Children's Research Institute/Royal Children's Hospital, Melbourne; the Committee of the International Campaign to Abolish Nuclear Weapons Australia; the Internet Peace Prize Award Committee; the International Humanitarian Law Advisory Committee of the Australian Red Cross; the board of the Initiative for Peacebuilding at the Faculty of Arts, University of Melbourne; the board of International Physicians for the Prevention of Nuclear War; co‐presidency of the International Physicians for the Prevention of Nuclear War; and is an Honorary Principal Fellow at the Melbourne School of Population and Global Health, University of Melbourne. Paul Yonga was Principal Investigator for a COVID‐19 antiviral clinical trial funded by Atea Pharmaceuticals, for which he received no payments; has received honoraria from bioMérieux and Pfizer Pharmaceuticals for lectures, presentations and educational events; has participated on an advisory board for Pfizer Pharmaceuticals; and is a member of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) antimicrobial stewardship study group executive committee and a member of the ESCMID clinical practice guideline panel on vaccinations in immunocompromised hosts. Chris Zielinski reports fees from International Physicians for the Prevention of Nuclear War as Senior Advisor on the international journals project. All authors were paid by their respective employers.

This Comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full‐list‐authors‐and‐signatories‐nuclear‐risk‐editorial‐august‐2023.

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2. United Nations. Future generations counting on our commitment to step back from abyss, lift cloud of nuclear annihilation for good, Secretary‐General tells review conference. Press release, 1 Aug 2022, SG/SM/21394. https://press.un.org/en/2022/sgsm21394.doc.htm (viewed July 2023).
3. Tollefson J. Is nuclear war more likely after Russia's suspension of the New START treaty? Nature 2023; 615: 386.
4. United Nations. 2005 Review Conference of the Parties to the Treaty on the Non‐Proliferation of Nuclear Weapons (NPT). 2‐27 May 2005, New York. https://www.un.org/en/conf/npt/2005/npttreaty.html (viewed June 2023).
5. Mukhatzhanova G. 10th NPT Review Conference: why it was doomed and how it almost succeeded. Arms Control Association, October 2022. https://www.armscontrol.org/act/2022‐10/features/10th‐npt‐review‐conference‐why‐doomed‐almost‐succeeded (viewed June 2023).
6. Lewis P, Williams H, Pelopidas, Aghlani S. Too close for comfort, cases of near nuclear use and options for policy. Chatham House Report, 28 April 2014. https://www.chathamhouse.org/2014/04/too‐close‐comfort‐cases‐near‐nuclear‐use‐and‐options‐policy (viewed June 2023).
7. Bivens M. Nuclear famine. IPPNW, August 2022. https://www.ippnw.org/wp‐content/uploads/2022/09/ENGLISH‐Nuclear‐Famine‐Report‐Final‐bleed‐marks.pdf (viewed June 2023).
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Editorials

Insomnia and lost productivity among young adults: there is still much work to do

Alan Young and Denise O'Driscoll

Med J Aust 2023; 219 (3): . || doi: 10.5694/mja2.52025
Published online: 7 August 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Respiratory tract diseases

Insomnia, obstructive sleep apnoea, and restless legs syndrome are the most frequent sleep disorders in Australia, together affecting almost half of all middle‐aged people.1 These conditions cost the Australian economy an estimated $11 billion per year in lost work productivity, comprising both absenteeism (absence from work) and presenteeism (people present at work but not fully functional).2 Less is known about the impact of sleep disorders on productivity in younger adults. The study by Reynolds and colleagues in this issue of the Journal3 fills an important gap in understanding how sleep disorders affect the productivity of young working adults.

1 Eastern Health Clinical School, Monash University, Melbourne, VIC
2 Box Hill Hospital, Melbourne, VIC

Correspondence: alan.young@monash.edu

Correspondence: alan.young@easternhealth.org.au

Competing interests:

No relevant disclosures.

1. McArdle N, Reynolds AC, Hillman D, et al. Prevalence of common sleep disorders in a middle‐aged community sample. J Clin Sleep Med 2022; 18: 1503‐1514.
2. Deloitte Economics. Rise and try to shine: the social and economic cost of sleep disorders in Australia. May 2021. https://www2.deloitte.com/au/en/pages/economics/articles/rise‐try‐to‐shine.html (viewed June 2023).
3. Reynolds AC, Coenen P, Lechat B, et al. Insomnia and workplace productivity loss among young working adults: a prospective observational study of clinical sleep disorders in a community cohort. Med J Aust 2023; 219: 107‐112.
4. Jennum P, Coaquira Castro JP, Mettam S, et al. Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5. Sleep Med 2021; 84: 46‐55.
5. Kivimäki M, Head J, Ferrie JE, et al. Working while ill as a risk factor for serious coronary events: the Whitehall II study. Am J Public Health 2005; 95: 98‐102.
6. Collins JJ, Baase CM, Sharda CE, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med 2005; 47: 547‐557.
7. Kessler RC, Berglund PA, Coulouvrat C, et al. Insomnia and the performance of US workers: results from the America insomnia survey. Sleep 2011; 34: 1161‐1171.
8. Buysse DJ, Angst J, Gamma A, et al. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008; 31: 473‐480.
9. The Lancet. Waking up to the importance of sleep. Lancet 2022; 400: 973.
10. Haycock J, Grivell N, Redman A, et al. Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners. BMC Fam Pract 2021; 22: 158.
11. House of Representatives Standing Committee on Health, Aged Care and Sport. Bedtime reading. Inquiry into sleep health awareness in Australia. 4 Apr 2019. https://apo.org.au/node/228986 (viewed June 2023).

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Perspectives

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

Bridget E Barber, Heath White, Alexis P Poole, Joshua S Davis, Steven A McGloughlin and Tari Turner, For the COVID‐19 Drug Treatment Panel of the National Clinical Evidence Taskforce

Med J Aust || doi: 10.5694/mja2.52044
Published online: 31 July 2023

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Infectious diseases

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).

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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.

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Research

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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

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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.

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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).
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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.

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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.

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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.

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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.

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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

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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).

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Rapid access chest pain clinics in Australia and New Zealand

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Reducing the risks of nuclear war — the role of health professionals

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Insomnia and lost productivity among young adults: there is still much work to do

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

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

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

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Sleepwalking towards more harm from asthma

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

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Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

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

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Rapid access chest pain clinics in Australia and New Zealand

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Reducing the risks of nuclear war — the role of health professionals

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Insomnia and lost productivity among young adults: there is still much work to do

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

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

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

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Sleepwalking towards more harm from asthma

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

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Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

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

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Pagination