Suchergebnisse

BackgroundEstimates of age-specific mortality rates and relative mortality risks are useful for a variety of health, actuarial and life insurance purposes. Mortality risk may also be associated with individual health service utilisation.
Main AimWe aimed to identify mortality events using pharmaceutical administrative data and quantify mortality rates and their relationship to levels of pharmaceutical health utilisation.
ApproachA publicly available Australian Pharmaceutical Benefits Scheme (PBS) database was employed for this study. For all individuals listed in the dataset the last recorded prescription exchange was used to define a proxy mortality event and health utilisation was quantified by the average number of prescriptions exchanged per year (ppy). Age-specific mortality rates were calculated from PBS data for a range of heath utilisation levels and used with Australian Bureau of Statistics (ABS) death rate data to estimate relative mortality risk.
ResultsThe age-specific population profile of 256 190 persons utilising PBS services closely correlated with Australian census data (r=0.97). Age specific PBS mortality rates calculated using proxy mortality events correlated well with ABS death rates for persons aged >45 years but correlated poorly in younger age groups. In these younger age cohorts PBS utilisation was associated with a high relative mortality risk, whereas for older persons aged mortality rates approached equivalence with ABS data.
Mortality rates were associated with use of the PBS. High PBS use (>20 ppy) was associated with poorer mortality rates whereas moderate PBS use (5-19 ppy) was associated with improved mortality as compared to persons using PBS minimally (<5 ppy) (p<.05).
ConclusionPharmaceutical administrative data can identify mortality events and provide estimates of mortality rates and relative mortality risks associated with health care use.

Background Pharmaceutical data can be used to identify the presence of drug-treated chronic diseases (CD) in individuals using assigned World Health Organization Anatomic Therapeutic Chemical (ATC) classifications of medicines prescribed. ATC codes define treatment domains and provides a method to case define CD that has previously been used to estimate CD prevalence within populations.
Main Aim We determined selected CD incidence from an administrative pharmaceutical dataset, and compared them with published CD incidence results.
Approach An Australian Pharmaceutical Benefits Scheme (PBS) database covering the period 2003-14 was used for this study. The earliest prescriptions exchanged by individuals for an ATC defined CD were identified and the annual count recorded. These values were combined with Australian population census data to calculate the annual incidence of ATC defined CD. Australian PBS derived incidence estimates (PDI) were compared with published Australian and world incidence data.
Results The PDI of 16 chronic diseases were compared with incidence estimates using self-report surveys from the literature. Mean percentage differences between PDI estimates varied greatly when compared to survey data (mean 33% (SD ±79%). Diabetes (-29%), gout (4%), glaucoma (69%) and tuberculosis (14%) showed closer associations. In contrast, PDI estimates (n/1000/year) showed particularly high incidence levels as compared with self-report data for dyspepsia (16.9 v 4.5), dyslipidaemia (11.6 v 5.6) and respiratory illness (17.6 v 2.6).
Conclusion Incidence estimates of drug treated chronic disease can be obtained using pharmaceutical data and may be a useful source for a number of conditions. Some PDI differ considerably from survey data. The interpretation of PDI requires context on how a particular CD presents. Accuracy and relevance are likely to depend upon how drug treatments relate to the initial management of the chronic disease.

BackgroundAntidepressant management with Selective Serotonin Reuptake Inhibitors (SSRI) during pregnancy is associated with risks of congenital malformations and adverse pregnancy outcomes.
Main AimWe examined the incidence of SSRI use during pregnancy using Australian administrative pharmaceutical data linked to medical service data detailing antenatal consultations to assess pregnancy risk at current levels of treatment.
MethodA published data source from the Australian Pharmaceutical and Medical Benefit Schemes was used to identify pregnant women starting new onset treatments with SSRI medications during the provision of antenatal services. A longitudinal profile of SSRI incidence in the pre, peri and post pregnancy periods were constructed to define incident SSRI use. The potential increased burden from adverse pregnancy outcomes was calculated using estimates of risks from the literature.
ResultsFrom 2005-2011, 40,778 women were identified to have started de novo SSRI treatments within 10 years of pregnancy (n=172,951). The prenatal monthly incidence of SSRI prescriptions was 25 per 1000 women in 2005 and 7.5/1000 in 2011. During pregnancy, this incidence fell to 7.5 and 4/1000 women in years, and rose above perinatal levels to between 13 and 33/1000 women one year postnatally (X2 p<.001). At these incidence rates, an estimated 2400 women per year receive SSRI's during pregnancy. In comparison, with non-depressed pregnant women this potentially results in 10 further cardiovascular defects, 94 pre-term births, and 1 still birth annually.
ConclusionThis pharmaco-surveillance study has demonstrated continued use of SSRIs in Australian women of childbearing age but diminishing usage during pregnancy. A small number of women continue to be prescribed SSRI during the prenatal period in Australia with risks of adverse pregnancy outcomes.

BackgroundAdministrative data base research may have a role in surgical quality outcome evaluation. Such data provide independent and epidemiological perspectives of surgical performance that may differ from the results generated by the surgical units themselves. This may be of significance in decisions concerning health resource allocation, the appraisal of procedures and identification of specialised units. Primary hypoparathyroidism is recognised as associated with several chronic conditions and parathyroidectomy is an established surgical treatment.
ObjectivesThis study examines the scope of a linked Australian pharmaceutical database to assess patient outcomes following parathyroidectomy for primary hypoparathyroidism using therapeutic profiles and chronic conditions defined by proxy.
MethodsThe prevalence of a range of chronic conditions were identified within a surgical cohort (age>50, N=610) using allocated World Health Organization Anatomical-Therapeutic codes.
An observational study with quasi experimental design was employed to track the pre and post-operative prevalence trends of chronic diseases and treatment groupings. Treatment efficacy was assessed by regression discontinuity after surgery and mortality estimated by proxy using service discontinuation.
FindingsParathyroidectomy had significant beneficial effects upon the prevalence of bodily and bone pain, treatments for cardiovascular disorders and infective episodes. In contrast, dyslipidaemias, psychosis, depression, glaucoma and obstructive airways diseases showed no evidence of regression discontinuity. Four year survival was 89%.
ConclusionsThe Australian data employed can define chronic conditions and track pre and post-operative prevalence trends to provide an alternative perspective for assessment of surgical treatment. This method has the potential for the evaluation of infrequently performed procedures and may reduce reporting biases and provide new insights into surgical practice.

BackgroundPharmaceutical administrative data can provide an alternative method to assess chronic disease prevalence. The data within prescription exchanges includes the specific nature of the medication dispensed which can be utilised for case definition by proxy of certain chronic diseases.
ObjectivesThis study examines the potential of Australian administrative pharmaceutical data to define chronic disease and provide population prevalence estimates. The utility of allocated World Health Organization Anatomical Therapeutic Chemical (ATC) codes to the treatment supplied will be assessed and the validity of the results generated compared with other Australian sources of chronic disease prevalence.
Methods23 chronic conditions were defined by ATC codes within an Australian (administrative) Pharmaceutical Benefits Scheme (PBS) dataset. This enabled calculation of chronic disease prevalences for the period 2003 to 2014 using Australian census data as denominator values.
FindingsPrevalence estimates from PBS data when compared with questionnaire based studies demonstrated homogeneity overall (Mann-Whitney P>0.05). PBS prevalence estimates of diabetes, gout and asthma showed respective correlations of 0.999, 0.8385 and 0.58 to 0.82 with community surveys. In general, the prevalence of most chronic conditions rose. Cardiovascular disorders, iron deficiency treatment, HIV and prescription pain medication however demonstrated notable increases. Prevalence estimates were influenced by artefactual factors including new government regulation in 2012. For diabetes prevalence estimates this improved the correlation associated with community survey data.
ConclusionsAustralian pharmaceutical administrative data have potential utility for chronic disease prevalence estimates. Advantages include low costs, speed of analysis, high power and good representation. We consider the technique offers a complimentary perspective of chronic disease prevalence providing new insights into population health.

IntroductionEstimating the mortality risk of persons with diabetes can be challenging. Associated conditions such as cardiovascular disease can become the primary cause of mortality and the underlying contribution of diabetes not recorded. Alternative methods to assess mortality risk in people with diabetes would be useful.
ObjectiveTo evaluate an Australian pharmaceutical database to identify multi-morbidity cohorts associated with diabetes and determine mortality rates in these groups using prescription exchange cessation as a proxy event for death.
MethodsAustralian Pharmaceutical Benefits Scheme data covering the period 2003–14 were used. Persons with diabetes, cardiovascular diseases and dyslipidemia were identified using Anatomic Therapeutic Chemical codes allocated to their recorded dispensed treatments. People with combinations of these conditions were followed and the last recorded prescription exchange used as a proxy event for mortality. Age and gender specific mortality rates and mortality rate ratios for the multi-morbidity cohorts were then calculated from the number of deaths occurring within 10 years.
Results346,201 individuals were identified as taking treatments for diabetes, dyslipidemia and cardiovascular conditions in 2004, 86,165 deaths occurred within 10 years of follow up. Overall crude mortality was 26.2/1,000 person years. Age specific mortality rates and rate ratios were calculated for various multi-morbidity groupings. Statin treatments improved the mortality rates associated with diabetes and cardiovascular disease in persons age >54 (Log–Rank <.001).
ConclusionsAdministrative pharmaceutical data can be used to identify persons with diabetes and associated multi-morbidities. Proxy mortality events defined by the cessation of treatment can generate mortality rates, providing an alternative perspective for the assessment of mortality risk.

Introduction:
Chronic disease (CD) is a leading cause of population mortality, illness and disability. Identification of CD using administrative data is increasingly used and may have utility in monitoring population health. Pharmaceutical administrative data using World Health Organization Anatomic Therapeutic Chemical Codification (ATC) assigned to prescribed medicines may offer an improved method to define persons with certain CD and enable the calculation of population prevalence.

Objective:
To assess the feasibility of Australian Pharmaceutical Benefits Scheme (PBS) dispensing data to provide realistic measures of chronic disease prevalence using ATC codification and compare values with international data using similar ATC methodology and Australian community surveys.

Methods:
Twenty-two chronic diseases were identified using World Health Organization (WHO) formulated ATC codes assigned to treatments received and recorded in a PBS database. Distinct treatment episodes prescribed to individuals were counted annually for prevalence estimates. Comparisons were then made with estimates from international studies using pharmaceutical data and published Australian community surveys.

Results:
PBS prevalence estimates for a range of chronic diseases listed in European studies and Australian community surveys demonstrated good correlation (r > .83, p < .001). PBS estimates of the prevalence of diabetes, cardiovascular disease and hypertension, dyslipidemia, and respiratory disease with comparable Australian National Health Survey data by age groupings (>45 years) showed correlations of between (r = 0.82 - 0.99, p < .001) and a range of percentage difference of -15% to 77%. However, other conditions such as psychological disease and migraine showed greater disparity and correlated less well.

Conclusions:
Although not without limitations, Australian administrative pharmaceutical dispensing data may provide an alternative perspective on population health and a useful resource to estimate the prevalence of a number of chronic diseases within the Australian population.

A pilot study was conducted in rural northern New South Wales from 15 July to 28 August 2009, during Australia's Protect Phase response to the Influenza A H1N1 California 7/09 pandemic. This study explored the feasibility of using administrative data, generated from the distribution of stockpiled antivirals, as a syndromic surveillance system. The purpose was to identify recently affected towns or those with increasing influenza-like illness activity to assist in rural health service operational planning. Analysis of antiviral distribution data was restricted to 113 general practices in rural parts of the Hunter New England Area Health Service. By 2 September 2009 a total of 6,670 courses of antivirals for adults, of which 455 courses were replacement orders, had been distributed to these general practices. Distribution of replacement antivirals were mapped to local government areas on a weekly basis. The syndromic surveillance system delivered timely data on antiviral distribution; used readily available software to generate visual activity maps in less than 30 minutes; proved adaptable; was of low cost; and was well received by health service planners. Full evaluation of the system's utility was limited by the relatively large initial distribution of antivirals and the brief nature of Australia's first pandemic wave. The pilot study demonstrated that a syndromic surveillance system based on distribution of supplies, such as treatment or vaccines, can support local health service operational planning during health emergencies.

A pilot study was conducted in rural northern New South Wales from 15 July to 28 August 2009, during Australia's Protect Phase response to the Influenza A H1N1 California 7/09 pandemic. This study explored the feasibility of using administrative data, generated from the distribution of stockpiled antivirals, as a syndromic surveillance system. The purpose was to identify recently affected towns or those with increasing influenza-like illness activity to assist in rural health service operational planning. Analysis of antiviral distribution data was restricted to 113 general practices in rural parts of the Hunter New England Area Health Service. By 2 September 2009 a total of 6,670 courses of antivirals for adults, of which 455 courses were replacement orders, had been distributed to these general practices. Distribution of replacement antivirals were mapped to local government areas on a weekly basis. The syndromic surveillance system delivered timely data on antiviral distribution; used readily available software to generate visual activity maps in less than 30 minutes; proved adaptable; was of low cost; and was well received by health service planners. Full evaluation of the system's utility was limited by the relatively large initial distribution of antivirals and the brief nature of Australia's first pandemic wave. The pilot study demonstrated that a syndromic surveillance system based on distribution of supplies, such as treatment or vaccines, can support local health service operational planning during health emergencies.

Objective: To review Australian legislation about privacy, focusing on provisions within the regulations to conduct health research using identified data and lobby for regulatory change in the ACT. Method: A systematic review of Commonwealth and jurisdiction health privacy regulation. Results: Australia has a number of regulations for the protection of privacy of health information. In addition to Commonwealth privacy laws, there are jurisdictional regulations concerning protection of health information. These range from no specific legislation in Western Australia, to a code of practice in South Australia, and Commonwealth legislation that deals with use and disclosure of identified health information to conduct health research (Sections 95 and 95A of the Privacy Act 1988). At the time of this review, all but one jurisdiction, the Australian Capital Territory (ACT), had provisions for disclosing identified health information for health research. Conclusion: The ACT's Health Records (Privacy and Access) Act was inconsistent with the other Australian regulation concerning the use of identified health data in health research. Implications: The information from the review was used to inform the ACT Government that the health privacy regulations in place were inconsistent with the rest of Australia and resulted in regulatory change in the ACT. ACT legislation was amended to include provisions for the disclosure of identified health information for health research under controlled circumstances. The amendments were passed in December 2005, facilitating future health research involving data linkage in the ACT.

Objective: To review Australian legislation about privacy, focusing on provisions within the regulations to conduct health research using identified data and lobby for regulatory change in the ACT. Method: A systematic review of Commonwealth and jurisdiction health privacy regulation. Results: Australia has a number of regulations for the protection of privacy of health information. In addition to Commonwealth privacy laws, there are jurisdictional regulations concerning protection of health information. These range from no specific legislation in Western Australia, to a code of practice in South Australia, and Commonwealth legislation that deals with use and disclosure of identified health information to conduct health research (Sections 95 and 95A of the Privacy Act 1988). At the time of this review, all but one jurisdiction, the Australian Capital Territory (ACT), had provisions for disclosing identified health information for health research. Conclusion: The ACT's Health Records (Privacy and Access) Act was inconsistent with the other Australian regulation concerning the use of identified health data in health research. Implications: The information from the review was used to inform the ACT Government that the health privacy regulations in place were inconsistent with the rest of Australia and resulted in regulatory change in the ACT. ACT legislation was amended to include provisions for the disclosure of identified health information for health research under controlled circumstances. The amendments were passed in December 2005, facilitating future health research involving data linkage in the ACT.

Background: The Victorian Government Department of Health funded a diphtheria, tetanus and acellular pertussis vaccine for parents of infants from June 2009 to June 2012 as part of a cocooning strategy for the control of pertussis. The aim of this study w

Background: The Victorian Government Department of Health funded a diphtheria, tetanus and acellular pertussis vaccine for parents of infants from June 2009 to June 2012 as part of a cocooning strategy for the control of pertussis. The aim of this study w

Abstract Background The Victorian Government Department of Health funded a diphtheria, tetanus and acellular pertussis vaccine for parents of infants from June 2009 to June 2012 as part of a cocooning strategy for the control of pertussis. The aim of this study was to assess parents' attitudes and awareness of the vaccination program, and to estimate vaccine uptake. Methods A cross-sectional survey of 253 families with a child born in the first quarter of 2010 residing within five metropolitan and four rural local government areas in Victoria was conducted. Univariate analyses were performed to describe the relationship between demographic variables, knowledge and awareness of the disease, the vaccine program and vaccine uptake. Multivariate analyses examining predictors for awareness of the vaccine program and for the uptake of vaccination were also conducted. Results One hundred and five families were surveyed (response rate 43%). Of these, 93% indicated that they had heard of 'pertussis' or 'whooping cough' and 75% of mothers and 69% of fathers were aware the pertussis vaccine was available and funded for new parents. Overall, 70% of mothers and 53% of fathers were vaccinated following their child's birth, with metropolitan fathers less likely to be vaccinated as rural fathers (RR = 0.6, p = 0.002). Being a younger mother (p = 0.02) or father (p = 0.047), and being an Australian-born father (RR = 1.9, p = 0.03) were found to predict uptake of the vaccine in parents. Conclusion Parents indicated a reasonable level of knowledge of pertussis and a willingness to be vaccinated to protect their child. However, vaccine uptake estimates indicated further opportunity for program improvement. Future cocooning strategies would benefit from specifically targeting fathers and metropolitan maternity hospitals to increase vaccine uptake. Wider promotion of the availability of vaccine providers may increase uptake to maximise the success of cocooning programs. Further investigation of the effectiveness of the cocooning strategy in decreasing infant morbidity and mortality is required.

Background: The Australian Government launched a mass media campaign in 2009 to raise awareness of the harms and costs associated risky drinking among young Australians. The aim of this study was to assess if young people attending a music festival who report frequent risky single occasions of drinking (RSOD) recognise the key message of the campaign, "Binge drinking can lead to injuries and regrets", compared to young people who report less frequent RSOD. Methods. A cross-sectional behavioural survey of young people (aged 16-29 years) attending a music festival in Melbourne, Australia, was conducted in January 2009. We collected basic demographics, information on alcohol and other drug use and sexual health and behaviour during the previous 12 months, and measured recognition of the Australian National Binge Drinking Campaign key message. We calculated the odds of recognition of the key slogan of the Australian National Binge Drinking Campaign among participants who reported frequent RSOD (defined as reported weekly or more frequent RSOD during the previous 12 months) compared to participants who reported less frequent RSOD. Results: Overall, three-quarters (74.7%) of 1072 participants included in this analysis recognised the campaign message. In the adjusted analysis, those reporting frequent RSOD had significantly lower odds of recognising the campaign message compared to those not reporting frequent RSOD (OR 0.7, 95% CI 0.5-0.9), whilst females had significantly greater odds of recognising the campaign message compared to males (OR 1.8, 95% CI 1.4-2.1). Conclusions: Whilst a high proportion of the target group recognised the campaign, our analysis suggests that participants that reported frequent RSOD - and thus the most important group to target - had statistically significantly lower odds of recognising the campaign message.