Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population

BACKGROUND: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. RESULTS: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. CONCLUSION: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation

Disparities in cataract surgery between Aboriginal and non-Aboriginal people in New South Wales, Australia

<b>Background:</b> To investigate variation in rates of cataract surgery in New South Wales (NSW), Australia by area of residence for Aboriginal and non-Aboriginal adults.<p></p> <b>Design:</b> Observational data linkage study of hospital admissions.<p></p> <b>Participants:</b> 289 646 NSW residents aged 30 years and over admitted to NSW hospitals for 444 551 cataract surgery procedures between 2001 and 2008.<p></p> <b>Methods:</b> Analysis of linked routinely collected hospital data using direct standardisation and multilevel negative binomial regression models accounting for clustering of individuals within Statistical Local Areas (SLAs).<p></p> <b>Main outcome measures:</b> Age-standardised cataract surgery rates and adjusted rate ratios (ARRs).<p></p> <b>Results:</b> Aboriginal people had lower rates of cataract procedures than non-Aboriginal people of the same age and sex, living in the same SLA (ARR 0.71, 95% CI 0.68-0.75). There was significant variation in cataract surgery rates across SLAs for both Aboriginal and non-Aboriginal people, with the disparity higher in major cities and less disadvantaged areas. Rates of surgery were lower for Aboriginal than non-Aboriginal people in most SLAs, but in a few, the rates were similar or higher for Aboriginal people.<p></p> <b>Conclusions:</b> Aboriginal people in NSW received less cataract surgery than non-Aboriginal people, despite evidence of higher cataract rates. This disparity was greatest in urban and wealthier areas. Higher rates of surgery for Aboriginal people observed in some specific locations are likely to reflect the availability of public ophthalmology services, targeted services for Aboriginal people and higher demand for surgery in these populations.<p></p&gt

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study

Aims and objectives: This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. Background: With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. Design: A triangulation strategy consisting of three phases. Methods: A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Findings: Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. Conclusions: The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Relevance to clinical practice: Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd

Do the individual, social, and environmental correlates of physical activity differ between urban and rural women?

In this article, associations between individual, social, and environmental factors and physical activity among 3,669 women (18-45 years) living in socioeconomically disadvantaged urban and rural areas were compared. In 2007-2008, participants reported levels of leisure-time physical activity (LTPA) and transport-related physical activity (TRPA) as well as five individual, four social, and three environmental factors. Physical activity self- efficacy demonstrated stronger associations with LTPA among urban relative to rural women; child care was associated with LTPA and intentions with TRPA among urban women only, and enjoyment was associated with TRPA among rural women only. Correlates of physical activity among urban and rural women were generally similar, although some tailoring of physical activity promotion strategies may be warranted. <br /

Trends in hospital admissions and mortality from asthma and chronic obstructive pulmonary disease in Australia, 1993-2003

The document attached has been archived with permission from the editor of the Medical Journal of Australia (8 May 2008). An external link to the publisher’s copy is includedObjective: To examine evolving changes in asthma and chronic obstructive pulmonary disease (COPD) in South Australia and Australia as a whole from the perspective of hospital admissions, ventilatory support and mortality data. Design: Retrospective analyses, for the period 1993–2003, of hospital separations data from the Australian Institute of Health and Welfare and the Integrated South Australian Activity Collection, and mortality data from the Australian Bureau of Statistics and South Australian hospital morbidity collection. Main outcome measures: Hospital separations, ventilatory support episodes, mortality rates, burden-of-disease rankings. Results: Between 1993 and 2003, in SA and nationally, hospital separations for asthma declined but separations for COPD increased significantly. Falling mortality rates from asthma in both men and women, and from COPD in men, contrast with increasing rates of COPD-related hospitalisation and mortality in women. Conclusions: Hospital admissions and mortality associated with asthma have fallen. Admission rates for COPD are declining for men, but there is no indication that admission rates for women have reached a peak. There is a need for higher prioritisation of COPD, including policies to reduce smoking in women, and medical practice initiatives to support primary and secondary prevention, pulmonary rehabilitation and appropriate drug therapies.David H Wilson, Graeme Tucker, Peter Frith, Sarah Appleton, Richard E Ruffin and Robert J Adam

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Background - Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods - Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results - Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions - Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people

National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1-0.7)% per year, with the same decline in remote and non- remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non-remote areas. In non-remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2-0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0-0.8)% per year. From 2002 to 2008, the percentage of ever-smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non-remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous-specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister’s goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008

Genetic and environmental risk factors in the non-medical use of over-the-counter or prescribed analgesics, and their relationship to major classes of licit and illicit substance use and misuse in a population-based sample of young adult twins

Background and Aims: The non-medical use of over-the-counter or prescribed analgesics (NMUA) is a significant public health problem. Little is known about the genetic and environmental etiology of NMUA and how these risks relate to other classes of substance use and misuse. Our aims were to estimate the heritability NMUA and sources of genetic and environmental covariance with cannabis and nicotine use, cannabis and alcohol use disorders and nicotine dependence in Australian twins. Design: Biometrical genetic analyses or twin methods using structural equation univariate and multivariate modeling. Setting: Australia. Participants: A total of 2007 young adult twins [66% female; μ\ua0=\ua025.9, standard deviation (SD)\ua0=\ua03.6, range\ua0=\ua018–38] from the Brisbane Longitudinal Twin Study retrospectively assessed between 2009 and 2016. Measurements: Self-reported NMUA (non-opioid or opioid-based), life-time nicotine, cannabis and opioid use, DSM-V cannabis and alcohol use disorders and the Fagerström Test for Nicotine Dependence. Findings: Life-time NMUA was reported by 19.4% of the sample. Univariate heritability explained 46% [95% confidence interval (CI)\ua0=\ua00.29–0.57] of the risks in NMUA. Multivariate analyses revealed that NMUA is moderately associated genetically with cannabis (r\ua0=\ua00.41) and nicotine (r\ua0=\ua00.45) use and nicotine dependence (r\ua0=\ua00.34). In contrast, the genetic correlations with cannabis (r\ua0=\ua00.15) and alcohol (r\ua0=\ua00.07) use disorders are weak. Conclusions: In young male and female adults in Australia, the non-medical use of over-the-counter or prescribed analgesics appears to have moderate heritability. NMUA is moderately associated with cannabis and nicotine use and nicotine dependence. Its genetic etiology is largely distinct from that of cannabis and alcohol use disorders

'Zero tolerance' and drug education in Australian Schools

For a decade in Australia, drug education in schools has been shaped by the approach of harm minimization adopted by state and national governments alike. Harm minimization has been accepted broadly by drug educators, and has encouraged schools to deepen their commitment to drug education, allowed them to communicate honestly with students, and to respond to instances of drug use in a less confrontational and more caring manner. Despite those advances, the notion of 'zero tolerance' within schools has been promoted recently by protagonists in the formulation of drug policy and it is mentioned in the recently published national school drug education policy. This article suggests that the adoption of a zero tolerance policy will end the consensus among drug educators, reduce the efficacy of drug education, lead to more punitive treatment of youthful drug experimenters, while doing nothing to reduce drug use. It concludes the existing policy of harm minimization offers schools more scope to address drug issues in a constructive manner than does zero tolerance, which in practice may inflate the harmful effects on young people of drug use