Topics

Abstract

Objective: To examine the accuracy of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the population‐based clinical quality registry for people with kidney failure, in identifying Aboriginal and/or Torres Strait Islander people.

Design: Population‐based cohort study of reporting accuracy.

Setting: New South Wales, 2006–2020.

Participants: Incident kidney failure patients.

Main outcome measures: Sensitivity and specificity of identification of Aboriginal and/or Torres Strait Islander people in ANZDATA compared with identification with Enhanced Reporting of Aboriginality (ERA) methods using linked health datasets.

Results: Of 11 708 patients, 693 (5.9%) were identified as Aboriginal and/or Torres Strait Islander people using ERA methods, with 484 recognised in ANZDATA. Overall ANZDATA sensitivity was 67.0% (95% CI, 63.3–70.5%), with high specificity (99.8%; 95% CI, 99.7–99.9%). Sensitivity was lowest for males (63.8%; 95% CI, 58.7–68.6), people aged under 18 years (45.0%; 95% CI, 23.1–68.5%) or over 65 years (61.7%; 95% CI, 53.8–69.2%), and those with greater socio‐economic advantage (56.6%; 95% CI, 46.6–66.2%), living in major cities (53.8%; 95% CI, 48.0–59.5%) and with no comorbidities (47.7%; 95% CI, 37.0–58.6%). Aboriginal and/or Torres Strait Islander people identified in ANZDATA had lower rates of waitlisting for kidney transplantation (17.8% v 25.3%; P = 0.016) and receiving a kidney transplant (12.2% v 23.1%; P < 0.001) and a higher rate of death (56.0% v 44.5%; P = 0.004) compared with those not recognised in ANZDATA.

Conclusion: Aboriginal and/or Torres Strait Islander people were under‐reported in ANZDATA. There were multiple biases in characteristics and outcomes for people identified in ANZDATA compared with those identified by ERA using linked data. This highlights the importance of data integration as a quality improvement mechanism and identifying barriers to disclosure.

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1 University of Sydney, Sydney, NSW
2 Children's Hospital at Westmead, Sydney, NSW
3 Ministry of Health, NSW Government, Sydney, NSW
4 University of Technology Sydney, Sydney, NSW
5 Charles Sturt University, Albury, NSW
6 UNSW Sydney, Sydney, NSW
7 Charles Darwin University, Darwin, NT
8 Monash University, Melbourne, VIC
9 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA
10 Royal Adelaide Hospital, Adelaide, SA
11 Centre for Renal and Transplant Research, Westmead Hospital, Sydney, NSW

Correspondence: heather.baldwin@sydney.edu.au

Open access:

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

Data sharing:

The data for this study will not be shared, as we do not have permission from the data custodians or ethics approval to do so. Data may be available upon request from the data custodians.

Acknowledgements:

Angela Webster is supported by a National Health and Medical Research Council Leadership Fellowship (1177117). This study was supported by a University of Sydney External Research Collaboration Seed Funding Grant (CT34675). We thank ANZDATA and the NSW Ministry of Health for access to registry and population health data, and the Centre for Health Record Linkage for linking the datasets. We are grateful to the MHLL Aboriginal Sovereign Steering Committee, Samantha Bateman and the ANZDATA Aboriginal and Torres Strait Islander Health Working Group for helpful feedback and guidance.

Competing interests:

No relevant disclosures.

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Consensus statement

Online first

National consensus statement on opioid agonist treatment in custodial settings

Jocelyn Chan, Jon Cook, Michael Curtis, Adrian J Dunlop, Ele Morrison, Suzanne Nielsen, Rebecca J Winter and Thileepan Naren

Med J Aust || doi: 10.5694/mja2.52603
Published online: 3 March 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Substance-related disorders

Social determinants of health

Abstract

Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally.

Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators.

Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.

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1 Burnet Institute, Melbourne, VIC
2 Western Health, Melbourne, VIC
3 National Drug Research Institute, Curtin University, Melbourne, VIC
4 Monash Addiction Research Centre, Monash University, Melbourne, VIC
5 Hunter New England Local Health District, Newcastle, NSW
6 University of Newcastle, Newcastle, NSW
7 Australian Injecting and Illicit Drug Users League, Sydney, NSW
8 St Vincent's Hospital Melbourne, Melbourne, VIC

Correspondence: jocelyn.chan@curtin.edu.au

Open access:

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

Acknowledgements:

The Consensus statement was prepared on behalf of the National Prisons Addiction Medicine Network (NPAMN). We acknowledge the time and contributions from everyone on the expert panel: Adrian Dunlop, Andrew Wiley, Bianca Davidde, Christine Watson, David Onu, Ele Morrison, Jeremy Hayllar, Jocelyn Chan, Katerina Lagios, Kevin Fontana, Mark Stoove, Peter Thompson, Rebecca Winter, Shalini Arunogiri, Suzanne Nielsen, Thileepan Naren, and Tom Turnbull. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Competing interests:

Rebecca Winter has received investigator‐initiated funding from Gilead Sciences for research unrelated to this work. Thileepan Naren has received speaking honoraria from Camarus. All other authors report no relevant disclosures.

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74. Peeler M, Fiscella K, Terplan M, Sufrin C. Best practices for pregnant incarcerated women with opioid use disorder. J Correct Health Care 2019; 25: 4‐14.
75. Kim SB, White B, Roberts J, Day CA. Substance use among pregnant women in NSW prisons. Int J Drug Policy 2023; 122: 104256.
76. Australian Institute of Health and Welfare. National Opioid Pharmacotherapy Statistics annual data collection, 2022. AIHW, 2023. https://www.aihw.gov.au/about‐our‐data/our‐data‐collections/nopsad‐collection (viewed Jan 2025).
77. Grella CE, Ostile E, Scott CK, et al. A scoping review of barriers and facilitators to implementation of medications for treatment of opioid use disorder within the criminal justice system. Int J Drug Policy 2020; 81: 102768.

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Perspective

A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm

Mya Cubitt and Seok Lim

Med J Aust 2025; 222 (4): . || doi: 10.5694/mja2.52588
Published online: 3 March 2025

Correction(s) for this article:

Erratum | Published online: 13 December 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

General medicine

Health occupations

Health services administration

Australia's health care system is grappling with a mismatch of demand and capacity, with bottlenecks in access to, and transitions of, care and rising costs.1 Hospital‐in‐the‐home (HITH) models of care are suggested as sustainable patient‐centred, value‐based solutions.2

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1 Royal Melbourne Hospital, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 RMH@Home, Royal Melbourne Hospital, Melbourne, VIC

Correspondence: mya.cubitt@mh.org.au

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 work of The Austin Hospital‐in‐the‐Home (HITH) team and creators of the flowcharts in the Box, supplied and included with permission. Our thanks to: Angela Sullivan, Nurse Unit Manager, HITH and Virtual Care; Mark Horrigan, Medical Director HITH and Virtual Care; Danielle Panaccio, HITH Consultant; and Daniel Thuys, HITH Case Manager.

Competing interests:

No relevant disclosures.

1. Kerr R. Time for a revolution in funding public hospital capacity. Sydney: Australasian Medical Publishing Company, 2022. https://insightplus.mja.com.au/2022/46/time‐for‐a‐revolution‐in‐funding‐public‐hospital‐capacity/ (viewed Sept 2024).
2. Reddy S, Phelps G, Rasa J. Australia's acute care system: more hospital beds or fewer? Sydney: Australasian Medical Publishing Company, 2022. https://insightplus.mja.com.au/2022/44/australias‐acute‐care‐system‐more‐hospital‐beds‐or‐fewer/ (viewed Sept 2024).
3. Hospital in the Home Society Australasia Ltd. Position statement: Definition of Hospital in the Home. HITH Society Australasia Ltd, 2019. https://www.hithsociety.org.au/Definition (viewed Sept 2024).
4. Critical Intelligence Unit. Evidence brief: Hospital in the Home. Sydney: NSW Health, 2024.
5. Partington A, Schultz T, Gray J, et al. Identifying potential populations for home hospitalisation: a scoping review of the literature to support the review of the South Australian My Home Hospital service. Adelaide: Flinders University; 2022.
6. Levine DM, Findeisen S, Desai MP, et al. Hospital at home worldwide: program and clinician characteristics from the World Hospital at Home Congress survey. J Am Geriatr Soc 2024; 12: 3824‐3832.
7. Board N, Brennan N, Caplan GA. A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients. Aust N Z J Public Health 2000; 24: 305‐311.
8. Leong MQ, Lim CW, Lai YF. Comparison of Hospital‐at‐Home models: a systematic review of reviews. BMJ Open 2021; 11: e043285.
9. Sriskandarajah S, Hobbs J, Roughead E, et al. Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: a systematic review of observational studies. Int J Clin Pract 2018: e13216.
10. Lim AKH, De Silva ML, Wang RSH, et al. Observational study of the incidence and factors associated with patient readmission from home‐based care under the Hospital in the Home programme. Intern Med J 2021; 51: 1497‐1504.
11. Australian Commission on Safety and Quality in Health Care. Recognising and Responding to Acute Deterioration Standard. Sydney: ACSQHC, 2021. https://www.safetyandquality.gov.au/standards/nsqhs‐standards/recognising‐and‐responding‐acute‐deterioration‐standard (viewed Sept 2024).
12. College of Intensive Care Medicine of Australia and New Zealand, Australian and New Zealand Intensive Care Society. Joint position statement on rapid response systems in Australia and New Zealand and the roles of intensive care. CICM and ANZICS, 2016. https://www.anzics.org/wp‐content/uploads/2018/09/ANZICS_CICMRapidResponseSystemsPositionStatement_2016.pdf (viewed Sept 2024).
13. Jones D. The epidemiology of adult Rapid Response Team patients in Australia. Anaesth Intensive Care 2014; 42: 213‐219.
14. Subramaniam A, Botha J, Tiruvoipati R. The limitations in implementing and operating a rapid response system. Intern Med J 2016; 46: 1139‐1145.
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16. Colt Cowdell J, Lopez E, Haney A, et al. Risk factors associated with escalation of care in a quaternary academic hospital at home program. J Hosp Med 2024; 19: 1‐8.
17. Sriskandarajah S, Ritchie B, Eaton V, et al. Safety and clinical outcomes of Hospital in the Home. J Patient Saf 2020; 16: 123‐129.
18. Daniels A, Walsh D, Ledford C, Wilkins T. Hospital at home readmissions. Ann Fam Med 2023; 21: 3756.
19. Hecimovic A, Matijasevic V, Frost SA. Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney. BMC Health Serv Res 2020; 20: 1090.
20. Pati S, Thompson GE, Mull CJ, et al. Improving patient selection and prioritization for hospital at home through predictive modeling. AMIA Annu Symp Proc 2023; 2022: 856‐865.
21. Aagaard N, Larsen AT, Aasvang EK, Meyhoff CS. The impact of continuous wireless monitoring on adverse device effects in medical and surgical wards: a review of current evidence. J Clin Monit Comput 2023; 37: 7‐17.
22. Paganelli AI, Mondéjar AG, da Silva AC, et al. Real‐time data analysis in health monitoring systems: a comprehensive systematic literature review. J Biomed Inform 2022; 127: 104009.
23. Gray E, Currey J, Considine J. Hospital in the Home nurses’ recognition and response to clinical deterioration. J Clin Nurs 2018; 27: 2152‐2160.
24. McCullough K, Baker M, Bloxsome D, et al. Clinical deterioration as a nurse sensitive indicator in the out‐of‐hospital context: a scoping review. J Clin Nurs 2024; 33: 874‐889.
25. Oakley E, Moulden A, Mills E, et al. Improving the safety of care for Victorian children. Melbourne: Safer Care Victoria; 2023.
26. Hodge SY, Ali MR, Hui A, et al. Recognising and responding to acute deterioration in care home residents: a scoping review. BMC Geriatr 2023; 23: 399.
27. van Oppen JD, Coats T, Conroy S, et al. Person‐centred decisions in emergency care for older people living with frailty: principles and practice. Emerg Med J 2024: 41: 694‐699.
28. Moss CT, Schnipper JL, Levine DM. Caregiver burden in a home hospital versus traditional hospital: a secondary analysis of a randomized controlled trial. J Am Geriatr Soc 2024; 72: 286‐289.
29. Australian College for Emergency Medicine, Australian and New Zealand College of Anaesthetists, College of Intensive Care Medicine of Australia and New Zealand. PG52 Guideline for transport of critically ill patients 2024. ACEM, ANZCA, CICM, 2024. https://www.anzca.edu.au/getattachment/bd5938d2‐d3ab‐4546‐a6b0‐014b11b99b2f/PG52(G)‐Guideline‐for‐transport‐of‐critically‐ill‐patients‐(PS52) (viewed Oct 2024).
30. Adams D, Wolfe AJ, Warren J, et al. Initial findings from an acute hospital care at home waiver initiative. JAMA Health Forum 2023; 4: e233667.
31. Pandit JA, Pawelek JB, Leff B, Topol EJ. The hospital at home in the USA: current status and future prospects. NPJ Digit Med 2024; 7: 48.

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Consensus statement

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Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement

Stephen Muhi, Victoria RV Cox, Matthew O'Brien, Jonathan T Priestley, Jodie Hill, Adrian Murrie, Anthony McDonald, Peter Callan, Grant A Jenkin, N Deborah Friedman, Kasha P Singh, Callum Maggs, Peter Kelley, Eugene Athan, Paul DR Johnson and Daniel P O'Brien

Med J Aust || doi: 10.5694/mja2.52591
Published online: 24 February 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Wounds and injuries

Abstract

Introduction: Buruli ulcer, caused by Mycobacterium ulcerans, is increasing in incidence and spreading to new areas in southeast Australia. With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up‐to‐date recommendations to clinicians who may encounter this disease. The emergence of Buruli ulcer in previously non‐endemic areas highlights the importance of increasing clinician and community awareness of this disease.

Main recommendations and changes in management as a result of this consensus statement:

Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and Queensland. Cases identified in other states or territories should be discussed with relevant health authorities. We call for Buruli ulcer to be made nationally notifiable to monitor for its potential emergence in non‐endemic regions.
Diagnosis using polymerase chain reaction is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non‐ulcerated skin, they can give a false negative result.
There is high quality evidence to support treatment of eight weeks’ duration using rifampicin‐based dual oral antibiotic therapy, in combination with clarithromycin or a fluoroquinolone; relapse is very rare but can occur in people with risk factors. There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in those who have undergone surgical excision of the lesion (four weeks).
Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion of antibiotics, and take a median of four to five months to heal.
Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions.
Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing.
Good wound care is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection.
Compared with adults, children have a higher proportion of non‐ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.

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1 Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
2 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
3 Menzies School of Health Research, Darwin, NT
4 Monash Children's Hospital, Melbourne, VIC
5 South Coast Medical, Blairgowrie, VIC
6 Sorrento Medical Centre, Sorrento, VIC
7 Barwon Health, Geelong, VIC
8 Monash Medical Centre, Melbourne, VIC
9 Peninsula Health, Melbourne, VIC
10 Eastern Health, Melbourne, VIC
11 Centre for Innovation in Infectious Disease and Immunology Research, Deakin University, Geelong, VIC
12 Austin Health, Melbourne, VIC

Correspondence: steve.muhi@unimelb.edu.au

Acknowledgements:

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.

Competing interests:

No relevant disclosures.

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58. Muhi S, Stinear TP. Systematic review of M. bovis BCG and other candidate vaccines for Buruli ulcer prophylaxis. Vaccine 2021; 39: 7238‐7252.

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Perspective

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Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability

Rosemary Wyber, Glenn Pearson and Laurens Manning

Med J Aust || doi: 10.5694/mja2.52590
Published online: 24 February 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Indigenous health

Pharmaceutical preparations

Benzathine benzylpenicillin G (BPG) is the most effective treatment for syphilis and prevention of rheumatic heart disease (RHD), both of which disproportionately affect Aboriginal and Torres Strait Islander people. The ongoing syphilis epidemic in Australia1 highlights the importance of a reliable supply of high quality BPG in achieving Australia's commitments to ending RHD and preventing new cases of congenital syphilis.2

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1 The Kids Research Institute Australia, Perth, WA
2 Yardhura Walani, Australian National University, Canberra, ACT
3 University of Western Australia, Perth, WA

Correspondence: rosemary.wyber@thekids.org.au

Open access:

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

Acknowledgements:

Laurens Manning is supported by a Medical Research Future Fund Investigator Grant (2020 Better penicillins, better hearts: improving secondary prevention of rheumatic heart disease; Emerging Leadership 2 APP1197177). Rosemary Wyber is supported by a National Health and Medical Research Council Emerging Leadership 2 Fellowship (GNT2025252). No funding agency had any role in study design, data collection, analysis or interpretation, reporting or publication.

Competing interests:

No relevant disclosures.

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9. Manyemba J, Mayosi B. Penicillin for secondary prevention of rheumatic fever: Cochrane Database Syst Rev; 2002: CD002227.
10. Seghers F, Taylor MM, Storey A, et al. Securing the supply of benzathine benzylpenicillin: a global perspective on risks and mitigation strategies to prevent future shortages. Int Health 2024; 16: 279‐282.
11. Therapeutic Goods Administration. Medicine shortages in Australia ‐ challenges and opportunities. Feedback updated 29 July 2024. Australian Government Department of Health and Aged Care, 2024. https://consultations.tga.gov.au/tga/medicine‐shortages‐australia/consultation/published_select_respondent?show_all_questions=0&sort=submitted&order=ascending&_q__text=naccho (viewed Aug 2024).
12. Sandoz. Sandoz opens new antibiotic production facility in Austria, to significantly increase capacity for life‐saving medicines [media release]. 21 Mar 2024. https://www.sandoz.com/sandoz‐opens‐new‐antibiotic‐production‐facility‐austria‐significantly‐increase‐capacity‐life‐saving/ (viewed Oct 2024).
13. Mathews JA. The birth of the biotechnology era: penicillin in Australia, 1943–80. Prometheus 2008; 26: 317‐333.
14. Cook R. World‐class pharmaceutical facility delivers jobs boost for WA [media release]. 1 Aug 2024. Government of Western Australia. https://www.wa.gov.au/government/media‐statements/Cook‐Labor‐Government/World‐class‐pharmaceutical‐facility‐delivers‐jobs‐boost‐for‐WA‐20240801 (viewed Aug 2024).
15. National Tribune. Making modern medicines in Australia. Toowoomba: National Tribune, 2022. https://www.nationaltribune.com.au/insight‐making‐modern‐medicines‐in‐australia/ (viewed Oct 2024).
16. Department of Industry, Science and Resources. mRNA vaccines to be made in Australia [media release]. 14 Dec 2021. https://www.minister.industry.gov.au/ministers/taylor/media‐releases/mrna‐vaccines‐be‐made‐australia
17. Kado J, Salman S, Hla TK, et al. Subcutaneous infusion of high‐dose benzathine penicillin G is safe, tolerable, and suitable for less‐frequent dosing for rheumatic heart disease secondary prophylaxis: a phase 1 open‐label population pharmacokinetic study. Antimicrob Agents Chemother 2023; 67: e0096223.
18. Enkel SL, Kado J, Hla TK, et al. Qualitative assessment of healthy volunteer experience receiving subcutaneous infusions of high‐dose benzathine penicillin G (SCIP) provides insights into design of late phase clinical studies. PLoS One 2023; 18: e0285037.

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Research letter

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Use of ChatGPT to obtain health information in Australia, 2024: insights from a nationally representative survey

Julie Ayre, Erin Cvejic and Kirsten J McCaffery

Med J Aust || doi: 10.5694/mja2.52598
Published online: 17 February 2025

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AUTHORS
REFERENCES

Topics

Health services administration

Information science

Environment and public health

Social determinants of health

Since the launch of ChatGPT in 2022,1 people have had easy access to a generative artificial intelligence (AI) application that can provide answers to most health‐related questions. Although ChatGPT could massively increase access to tailored health information, the risk of inaccurate information is also recognised, particularly with early ChatGPT versions, and its accuracy varies by task and topic.2 Generative AI tools could be a further problem for health services and clinicians, adding to the already large volume of medical misinformation.3 Discussions of the benefits and risks of the new technology for health equity, patient engagement, and safety need reliable information about who is using ChatGPT, and the types of health information they are seeking.

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The University of Sydney, Sydney, NSW

Correspondence: julie.ayre@sydney.edu.au

Open access:

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

Data Sharing:

The data underlying this report are available on reasonable request.

Acknowledgements:

Julie Ayre and Kirsten McCaffery are supported by National Health and Medical Research Council fellowships (APP2017278, APP2016719). The funders were not involved in study design, data collection, analysis or interpretation, reporting or publication. We acknowledge the contribution of Tara Haynes (Sydney Health Literacy Lab, University of Sydney) to the preparation of the ethics application for this study.

Competing interests:

No relevant disclosures.

1. Vallance C. ChatGPT: New AI chatbot has everyone talking about it. BBC [website], 7 Dec 2022. https://www.bbc.com/news/technology‐63861322 (viewed Jan 2025).
2. Wei Q, Yao Z, Cui Y, et al. Evaluation of ChatGPT‐generated medical responses: a systematic review and meta‐analysis. J Biomed Inform 2024; 151: 104620.
3. Dunn AG, Shih I, Ayre J, Spallek H. What generative AI means for trust in health communications. J Commun Healthc 2023; 16: 385‐388.
4. Social Research Centre. Life in Australia methods: documentation. Oct 2024. https://srcentre.com.au/wp‐content/uploads/2024/10/LinA‐recruitment‐sample‐and‐allocation‐description‐20241023‐final.pdf (viewed Oct 2024).
5. Wallace LS, Rogers ES, Roskos SE, et al. Screening items to identify patients with limited health literacy skills. J Gen Intern Med 2006; 21: 874‐877.
6. Australian Bureau of Statistics. Index of Relative Socio‐economic Advantage and Disadvantage (IRSAD). In: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2021. 27 Apr 2021. https://www.abs.gov.au/statistics/people/people‐and‐communities/socio‐economic‐indexes‐areas‐seifa‐australia/latest‐release#index‐of‐relative‐socio‐economic‐advantage‐and‐disadvantage‐irsad‐ (viewed Aug 2024).
7. Australian Bureau of Statistics. National, state and territory population, December 2023. 13 June 2024. https://www.abs.gov.au/statistics/people/population/national‐state‐and‐territory‐population/dec‐2023 (viewed Aug 2024).
8. Singla A, Sukharevsky A, Yee L, et al. The state of AI in early 2024: gen AI adoption spikes and starts to generate value. QuantumBlack, AI by McKinsey, 30 May 2024. https://www.mckinsey.com/capabilities/quantumblack/our‐insights/the‐state‐of‐ai (viewed Aug 2024).
9. Australian Department of Health and Aged Care. National Preventive Health Strategy 2021–2030. Updated 14 Dec 2021. https://www.health.gov.au/resources/publications/national‐preventive‐health‐strategy‐2021‐2030 (viewed Aug 2024).

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Medical education
Lessons from practice

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Putting international practice into action: the first case of lung transplantation for COVID‐19 in Victoria, Australia

Melanie Wong, Bradley Gardiner, Rob Stirling, Golsa Adabi, Brooke Riley, Jyotika D Prasad and Gregory I Snell

Med J Aust || doi: 10.5694/mja2.52597
Published online: 17 February 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Respiratory tract diseases

Surgical procedures, operative

A 61‐year‐old previously healthy man presented to hospital with acute type 1 respiratory failure after five days of coryzal symptoms and a positive coronavirus disease 2019 (COVID‐19) rapid antigen test. Within 24 hours, the patient became progressively hypoxic, was rapidly intubated and transferred to Alfred Health in December 2022, a tier one Victorian extracorporeal membrane oxygenation (ECMO) service site, for veno‐venous ECMO (Avalon Elite bi‐caval dual lumen catheter).

1 Alfred Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: me.wong@alfred.org.au

Patient consent:

The patient provided written consent for publication.

Competing interests:

No relevant disclosures.

1. Cypel M, Keshavjee S. When to consider lung transplantation for COVID‐19. Lancet Respir Med 2020; 8: 944‐946.
2. D'Cunha M, Jenkins JA, Wilson R, et al. Lung transplantation in the United States for COVID‐19 related lung disease during the pandemic. Lung 2024; 202: 723‐737.
3. Bharat A, Querrey M, Markov NS, et al. Lung transplantation for patients with severe COVID‐19. Sci Transl Med 2020; 12: eabe4282.
4. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: an update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40: 1349‐1379.
5. Bharat A, Machuca TN, Querrey M, et al. Early outcomes after lung transplantation for severe COVID‐19: a series of the first consecutive cases from four countries. Lancet Respir Med 2021; 9: 487‐497.
6. Kanne JP, Little BP, Schulte JJ, et al. Long‐term lung abnormalities associated with COVID‐19 pneumonia. Radiology 2023; 306: e221806.
7. Lang C, Ritschl V, Augustin F, et al. Clinical relevance of lung transplantation for COVID‐19 ARDS: a nationwide study. Eur Respir J 2022; 60: 2102404.
8. Bermudez C, Bermudez F, Courtwright A, et al. Lung transplantation for COVID‐2019 respiratory failure in the United States: outcomes 1‐year posttransplant and the impact of preoperative extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg 2024; 167: 384‐395.
9. King CS, Mannem H, Kukreja J, et al. Lung transplantation for patients with COVID‐19. Chest 2022; 161: 169‐178.
10. Young KA, Ali HA, Beermann KJ, et al. Lung transplantation and the era of the sensitized patient. Front Immunol 2021; 12: 689420.
11. Weinstock C, Schnaidt M. Human leucocyte antigen sensitisation and its impact on transfusion practice. Transfus Med Hemother 2019; 46: 356‐369.
12. Rees L, Kim JJ. HLA sensitisation: can it be prevented? Pediatr Nephrol 2015; 30: 577‐587.

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Perspective

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Genetic counsellors: facilitating the integration of genomics into health care

Tatiane Yanes, Eliza Courtney, Mary‐Anne Young, Amy Pearn, Aideen McInerney‐Leo and Jodie Ingles

Med J Aust || doi: 10.5694/mja2.52568
Published online: 3 February 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Medical genetics

Genomic testing is integral across all areas of health care and is a cornerstone of modern medicine. Beyond diagnosing rare conditions, genomic testing is routinely used to inform reproductive and prenatal care, augment risk assessments, guide therapies and inform management at the individual and public health level. There are over 25 conditions with federally funded Medicare Benefits Schedule (MBS) item numbers to deliver germline diagnostic genomic testing, including cancers, cardiac conditions, renal conditions and childhood hearing loss. Additional genomic testing is funded by state and territory public health departments and private out‐of‐pocket payments. The exponential growth of genomics knowledge and use in health care is likely to continue. Given its clinical value, genomic testing is increasingly offered by clinicians who do not have genetics subspecialty qualifications (referred to as non‐genetics clinicians), which has necessitated further education and upskilling of these clinicians. Although mainstreaming has been successful in some settings,1 most health services and clinicians are insufficiently prepared or resourced to address the complexities of genomic medicine.2,3

1 Frazer Institute, Dermatology Research Centre, University of Queensland, Brisbane, QLD
2 Children's Health Queensland Hospital and Health Service, Brisbane, QLD
3 Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW
4 Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW
5 Clinical Engagement and Translational Platform, Garvan Institute of Medical Research, Sydney, NSW
6 Genomics and Inherited Disease Program, Garvan Institute of Medical Research, University of New South Wales, Sydney, NSW
7 University of New South Wales, Sydney, NSW
8 The Gene Council, Perth, WA

Correspondence: t.yanes@uq.edu.au

Competing interests:

No relevant disclosures.

1. Jayasinghe K, Biros E, Harris T, et al. Implementation and evaluation of a national multidisciplinary kidney genetics clinic network over ten years. Kidney Int Rep 2024; 9: 2372‐2385.
2. Crellin E, McClaren B, Nisselle A, et al. Preparing medical specialists to practice genomic medicine: education an essential part of a broader strategy. Front Genet 2019; 10: 789.
3. O'Shea R, Ma AS, Jamieson RV, Rankin NM. Precision medicine in Australia: now is the time to get it right. Med J Aust 2022; 217: 559‐563. https://www.mja.com.au/journal/2022/217/11/precision‐medicine‐australia‐now‐time‐get‐it‐right
4. Mordaunt DA, Dalziel K, Goranitis I, Stark Z. Uptake of funded genomic testing for syndromic and non‐syndromic intellectual disability in Australia. Eur J Hum Genet 2023; 31: 977‐979.
5. Watts GF, Sullivan DR, Hare DL, et al. Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia. Heart Lung Circ 2021; 30: 324‐349.
6. Morrow A, Steinberg J, Chan P, et al. In person and virtual process mapping experiences to capture and explore variability in clinical practice: application to genetic referral pathways across seven Australian hospital networks. Transl Behav Med 2023; 13: 561‐570.
7. Shaw T, Fok R, Courtney E, et al. Missed diagnosis or misdiagnosis: common pitfalls in genetic testing. Singapore Med J 2023; 64: 67‐73.
8. Farmer MB, Bonadies DC, Pederson HJ, et al. Challenges and errors in genetic testing: the fifth case series. Cancer J 2021; 27: 417‐422.
9. Ackerman JP, Bartos DC, Kapplinger JD, et al. The promise and peril of precision medicine: phenotyping still matters most. Mayo Clin Proc 2016: S0025‐6196(16)30463‐3.
10. Ray T. Genetic testing challenges in oncology: immigrant mislabeled as BRCA‐Positive, regrets ovary removal. May 2021. Precision Medicine Online. https://www.precisionmedicineonline.com/molecular‐diagnostics/genetic‐testing‐challenges‐oncology‐immigrant‐mislabeled‐brca‐positive (viewed Oct 2024).
11. Bhatia A, Kliff S. When they warn of rare disorders, these prenatal tests are usually wrong. The New York Times, 1 Jan 2022. https://www.nytimes.com/2022/01/01/upshot/pregnancy‐birth‐genetic‐testing.html (viewed Oct 2024).
12. Bennett C. Ambiguous genetic test results can be unsettling. Worse, they can lead to needless surgeries. The Washington Post, 7 Feb 2021. https://www.washingtonpost.com/health/genetic‐tests‐uncertain‐results/2021/02/05/80a06d9a‐65a2‐11eb‐8468‐21bc48f07fe5_story.html (viewed Oct 2024).
13. Ma A, Newing TP, O'Shea R, et al. Genomic multidisciplinary teams: a model for navigating genetic mainstreaming and precision medicine. J Paediatr Child Health 2024; 60: 118‐124.
14. Kohut K, Limb S, Crawford G. The changing role of the genetic counsellor in the genomics era. Current Genetic Medicine Reports 2019; 7: 75‐84.
15. Austin J. 2020 Vision: genetic counselors as acknowledged leaders in integrating genetics and genomics into healthcare. J Genet Couns 2016; 25: 1‐5.
16. Smerecnik CM, Mesters I, Verweij E, et al. A systematic review of the impact of genetic counseling on risk perception accuracy. J Genet Couns 2009; 18: 217‐228.
17. Rutherford S, Zhang X, Atzinger C, et al. Medical management adherence as an outcome of genetic counseling in a pediatric setting. Genet Med 2014; 16: 157‐163.
18. Athens BA, Caldwell SL, Umstead KL, et al. A systematic review of randomized controlled trials to assess outcomes of genetic counseling. J Genet Couns 2017; 26: 902‐933.
19. Kentwell M, Dow E, Antill Y, et al. Mainstreaming cancer genetics: a model integrating germline BRCA testing into routine ovarian cancer clinics. Gynecol Oncol 2017; 145: 130‐136.
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23. Yanes T, Sullivan A, Barbaro P, et al. Evaluation and pilot testing of a multidisciplinary model of care to mainstream genomic testing for paediatric inborn errors of immunity. Eur J Hum Genet 2023; 31: 1125‐1132.
24. Coleman TF, Pugh J, Kelley WV, et al. Errors in genome sequencing result disclosures: a randomized controlled trial comparing neonatology non‐genetics healthcare professionals and genetic counselors. Genet Med 2024; 26: 101198.
25. McInerney‐Leo AM, Schmidts M, Cortés CR, et al. Short‐rib polydactyly and Jeune syndromes are caused by mutations in WDR60. Am J Hum Genet 2013; 93: 515‐523.
26. Tiller J, Bakshi A, Dowling G, et al. Community concerns about genetic discrimination in life insurance persist in Australia: a survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32: 286‐294.
27. Leslie F, Avis SR, Bagnall RD, et al. The New South Wales Sudden Cardiac Arrest Registry: a data linkage cohort study. Heart Lung Circ 2023; 32: 1069‐1075.
28. Human Genetics Society of Australasia. Genetic counselling training and accreditation 2024 [website]. https://hgsa.org.au/Web/Web/ET/Genetic‐Counselling.aspx?hkey=975b23ce‐fa8e‐485a‐a7ee‐fc88aab9a60d (viewed July 2024).
29. Nisselle A, Macciocca I, McKenzie F, et al. Readiness of clinical genetic healthcare professionals to provide genomic medicine: an Australian census. J Genet Couns 2019; 28: 367‐377.
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31. Caleshu C, Kim H, Silver J, et al. Contributors to and consequences of burnout among clinical genetic counselors in the United States. J Genet Couns 2022; 31: 269‐278.
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Closing the gap in kidney disease: validating the reporting of Aboriginal and/or Torres Strait Islander identification in a clinical quality registry using linked data

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National consensus statement on opioid agonist treatment in custodial settings

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A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm

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Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement

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Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability

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Use of ChatGPT to obtain health information in Australia, 2024: insights from a nationally representative survey

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Author

Putting international practice into action: the first case of lung transplantation for COVID‐19 in Victoria, Australia

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Genetic counsellors: facilitating the integration of genomics into health care

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Bulk‐billing rates and out‐of‐pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data

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Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study

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Closing the gap in kidney disease: validating the reporting of Aboriginal and/or Torres Strait Islander identification in a clinical quality registry using linked data

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National consensus statement on opioid agonist treatment in custodial settings

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A future for the hospital‐in‐the‐home (HITH) deteriorating patient: shifting the paradigm

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Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement

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Shortages of benzathine benzylpenicillin G in Australia highlight the need for new sovereign manufacturing capability

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Use of ChatGPT to obtain health information in Australia, 2024: insights from a nationally representative survey

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Putting international practice into action: the first case of lung transplantation for COVID‐19 in Victoria, Australia

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Genetic counsellors: facilitating the integration of genomics into health care

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Bulk‐billing rates and out‐of‐pocket costs for general practitioner services in Australia, 2022, by SA3 region: analysis of Medicare claims data

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Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study

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