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Clinical, administrative and demographic health information is fundamental to understanding the nature of health and evaluating the effectiveness of efforts to reduce morbidity and mortality of the population. The demographic data item 'location' is an integral part of any injury surveillance tool or injury prevention strategy. The true value of location data can only be realised once these data have been appropriately classified and quality assured. Geocoding as a means of classifying location is increasingly used in various health fields to enable spatial analysis of data. This article reports on research carried out in Australia at the National Coroners Information System (NCIS). Trends in the use of NCIS location-based data by researchers were identified. The research also aimed to establish the factors that impacted on the quality of geocoded data and the extent of this impact. A systematic analysis of the geocoding process identified source documentation, data cleaning, and software settings as key factors impacting on data quality. Understanding and application of these processes can improve data quality and therefore inform the analysis and interpretation of these data by researchers.

Health Information Managers (HIMs) are responsible for overseeing health information. The change management necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs are a core health information system component which solve many of the problems that arise during this period of change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable, both between settings and through time. They are more amenable to change than conventional paradigms, and their design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to Health Information Managers. The literature was sourced in the English language sections of ScienceDirect, IEEE Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of archetypes for electronic health record storage, looking at the current areas of archetype research, appropriate usage, and future research. We also used reference lists from the cited papers, papers ref website, and the recommendations from experts in the area. Criteria for inclusion were (a) if studies covered archetype research and (b) were either studies of archetype use, archetype system design, or archetype effectiveness. The 47 papers included show a wide and increasing worldwide archetype usage, in a variety of medical domains. Most of the papers noted that archetypes are an appropriate solution for future-proof and interoperable medical data storage. We conclude that archetypes are a suitable solution for the complex problem of electronic health record storage and interoperability.

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.

Geographic information systems (GIS) are underused as a tool for health policy analysis. We present a case study that (i) identifies sociodemographic, environmental, and health variables for which spatial data are available for Melbourne, Australia; (ii) reviews the literature about the traffic‐related parameters that are risk factors for asthma emergencies; (iii) applies this information within a GIS to identify populations living in proximity to harmful exposures; and then (iv) maps the most at‐risk neighborhoods. The case study identifies the locations of residential districts with high asthma incidence rates that are located near highways. These places would likely be priority communities for public health asthma control interventions. Spatial analysis can be a valuable tool for design, implementation, and evaluation of cost‐effective policies. We recommend integrating more spatial epidemiology into evidence‐based policy, planning, and resource allocation decisions.

BackgroundThis study compared levels of physical activity completed by adults with and without Down syndrome.MethodFifteen adults with and 15 adults without Down syndrome matched for age and gender, took part. The intensity and duration of physical activity were measured using RT3 accelerometers worn for seven days.ResultsOnly, 12 participants with Down syndrome had complete physical activity data, and these participants and their matched controls (total: six females, 18 males; aged 25.8 ± 9.7) were included in the analyses. There were significantly lower levels of moderate and vigorous physical activity per day for people with Down syndrome (median = 27 min) compared to those without (median = 101 min) (p < .001). Participants without disability were twice more likely to achieve recommended levels of physical activity than people with Down syndrome.ConclusionsAdults with Down syndrome appear to participate in lower levels of physical activity than adults without Down syndrome. Further research should validate these estimates.

Background: Employability, employment destinations and utilisation of knowledge–skill domains of new graduate health information managers (HIMs) have not been explored. Objectives: To capture the timing from course completion to employment and employment locations of a 5-year cohort of health information management graduates of La Trobe University, Australia, in 2017–2018; identify professional knowledge and skills used by the graduates in executing their roles; and map these to four domains of the health information management curriculum. Method: A mixed-methods descriptive study utilising a survey investigated early career pathways of new graduates of health information management courses from 2012 to 2016. Demographic data included age, year of graduation, lead time from course completion to employment, position title, number of positions held post-graduation and knowledge–skills used in the workplace. Results: Eighty percent ( n = 167) of graduates working in Australia with known contact details responded to the survey. Of these, 96.4% ( n = 161) worked in at least one "health information management-related" position since graduation. Forty-five percent ( n = 72) of graduates obtained a position before course completion, and over 94% ( n = 150) were employed in the profession within 6 months of completion. Sixty percent ( n = 97) of graduates had worked in two or more positions from 2012 to 2016. The large majority of new graduate HIMs (82.4%) were employed in the public healthcare sector in "health information management" (44%), or "health classification" (28.1%) roles. Most graduates (61%) had utilised at least three or four domains of professional knowledge–skills in the workplace. Whereas 16% ( n = 26) of graduates used, solely, their health classification knowledge–skill set, almost 74% ( n = 117) undertook some health classification-related activities. Only 16% ( n = 26) of graduates were over 40 years of age, and there were no statistically significant differences between Bachelor and Master (Combined Degree Programs) graduates and Graduate-entry Master degree graduates in terms of lead time to employment, number of positions held, type of employing agency and professional knowledge–skills utilised in the workplace. Conclusion: Graduate HIMs have very high employability, demonstrate job mobility consistent with the national trends, are largely represented in the public sector but have presence throughout the healthcare system and utilise most or all of the specialised domains of professional knowledge and skills studied at university.