Youths in custody in NSW: aspirations and strategies for the future

Aim: To investigate the extent to which youths in custody 1) rate specific life goals as important and likely to eventuate; 2) have strategies to achieve their goals; and 3) can anticipate barriers to achieving their goals.Method: A total of 107 detainees drawn from NSW Juvenile Justice centres were interviewed about their life goals.Results: Most youths rated specific life goals, such as having a well-paying job and avoiding trouble with the police, as ‘quite important’ or ‘very important’ goals to achieve in the future. When youths were asked how likely it was that these specific goals would be realised, the most common response was ‘quite likely’ or ‘very likely’. The most frequently identified strategies for having a well-paying job included getting the necessary diplomas and starting in a junior position to get experience. The most frequently identified strategies for avoiding trouble with the police were resisting peer pressure and obeying the law. Commonly reported barriers to achieving these goals included associating with antisocial peers, drugs and alcohol usage. Many youths also recognised that getting into trouble with the law would also be a barrier to having a well-paying job.Conclusion: Most youths interviewed in this study placed high importance on specific life goals and were generally optimistic about achieving them. Furthermore, most youths could think of strategies that would help them achieve their goals as well as identify possible barriers to achieving them. These findings have the potential to help service providers and policy makers target their services and policies appropriately

What is normal? A critical analysis of the methods quantifying prescription drug use and potential misuse in pharmaceutical claims

Our overall objective is to examine methods of quantifying prescription drug misuse in pharmaceutical claims. We approach this by undertaking a systematic review of the global literature measuring the extent of prescription drug misuse in pharmaceutical claims. Our review highlights four measures, number of prescribers, number of dispensing pharmacies, volume of drug dispensed and number of early refills, are used frequently to define prescription drug misuse. Despite this homogeneity, we found heterogeneity in the thresholds delineating use from misuse and a lack of established or validated benchmarks to accurately measure misuse in pharmaceutical claims. In our empirical work, we focus on prescription opioid analgesics due to the recent and considerable global increase in use and opioid- related harms. We use publically available, routinely collected data to document increases in prescription opioid use and related harms in Australia over 20 years. Over three chapters we explore population norms of prescription drug access in national dispensing claims and examine how access patterns relate to the metrics defining ‘misuse’ identified in our systematic review. We compare prescription drug access in Australia and British Columbia, Canada, for prescription opioids and statins, drug classes with high or no known abuse potential, respectively. We found access norms are remarkably similar across drug classes and healthcare settings. However, extreme access patterns are more common in people dispensed opioids, younger age groups or those receiving income assistance. We then examine opioid access in Australian adults initiating or reinitiating strong opioid treatment. We found the standard metrics defining ‘misuse’, including doctor and pharmacy shopping, are non-specific in that they identify misuse, but are also likely to capture high-need patient groups including individuals with a history of cancer treatment. From a translational perspective, our findings are particularly important as the US Food and Drug Administration recently endorsed using routinely collected data, including pharmaceutical claims, to quantify prescription opioid misuse and measure the effectiveness of interventions aimed to curb the ‘opioid epidemic’. We recommend using these commonly established metrics with caution due to their inability to isolate a population of people misusing opioids

Participant satisfaction with Youth Justice Conferencing

Aims: To evaluate offender and victim satisfaction with New South Wales (NSW) Youth Justice Conferences (YJCs) immediately after conference participation and to re-assess victim satisfaction 4 months after the conference date.Method: A self-report survey designed to assess satisfaction with YJCs was completed by 263 offenders and 141 victims immediately following their participation in a NSW YJC. Additionally, 96 victims also participated in a phone-based survey 4 months after the conference.Results: When asked immediately following the conference, more than 85 per cent of offenders and victims reported being ‘satisfied’ or ‘very satisfied’ with most aspects of the conference. High levels of satisfaction with conferencing were also reported by victims 4 months after the conference. For some measures, however, the percentage of victims who were ‘satisfied’ or ‘very satisfied’ was not as high at the 4-month follow-up, as it was in the baseline survey. The aspect of conferencing that victims at the 4-month follow-up reported the least satisfaction with was the lack of feedback they received from conference staff about the offender’s completion of the outcome plan. Fewer than half of the victims were ‘satisfied’ or ‘very satisfied’ with this part of the conference.Conclusion: The results of this study suggest that offender and victim satisfaction is high immediately following a YJC. Even 4 months after a YJC, victim satisfaction with most aspects of conferencing remains high. Satisfaction levels may be increased still further if, at some point prior to the end of the statutory time-period for completing the plan, victims were provided with feedback about the offender’s progress towards completing the outcome plan. Further research also needs to be conducted comparing victim satisfaction following a conference with victim satisfaction following a court appearance

The POPPY Research Programme protocol: investigating opioid utilisation, costs and patterns of extramedical use in Australia

Introduction Opioid prescribing is increasing in many countries. In Australia, there is limited research on patterns of prescribing and access, or the outcomes associated with this use. The aim of this research programme is to use national dispensing data to estimate opioid use and costs, including problematic or extramedical use in the Australian population. Methods and analysis In a cohort of persons dispensed at least one opioid in 2013, we will estimate monthly utilisation and costs of prescribed opioids, overall and according to individual opioid formulations and strengths. In a cohort of new opioid users, commencing therapy between 1 July 2009 and 31 December 2013, we will examine patterns of opioid use including initiation of therapy, duration of treatment and concomitant use of opioids and other prescribed medicines. We will also examine patterns of extramedical opioid use based on indicators including excess dosing, use of more than one opioid concomitantly, doctor/pharmacy shopping and accelerated time to prescription refill. Ethics and dissemination This protocol was approved by the NSW Population and Health Services Ethics Committee (March 2014) and data access approved by the Department of Human Services External Review Evaluation Committee (June 2014). This will be one of the first comprehensive Australian studies with the capability to investigate individual patterns of use and track extramedical use. In the first instance our analysis will be based on 5 years of dispensing data but will be expanded with ongoing annual data updates. This research has the capability to contribute significantly to pharmaceutical policy within Australia and globally. In particular, the trajectory of extramedical prescription-opioid use has been the subject of limited research to date. The results of this research will be published widely in general medical, pharmacoepidemiology, addiction and psychiatry journals

Harmonizing post-market surveillance of prescription drug misuse: A systematic review of observational studies using routinely collected data (2000–2013)

Background Prescription drug misuse is a growing public health concern globally. Routinely collected data provides a valuable tool for quantifying prescription drug misuse. Objective To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. Methods We searched MEDLINE, Embase, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar for relevant articles published between January 1 2000-July 31 2013. We screened 10,803 abstracts and retrieved 281 full-text manuscripts. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria: an aim/method investigating prescription drug misuse and a measure of misuse derived exclusively from prescription/dispensing data. Results Four proxies of prescription drug misuse were used commonly across studies: number of prescribers, dispensing pharmacies, early refills and volume of drugs dispensed. We identified 89 unique measures of misuse across the 52 studies, reflecting the heterogeneity in how measures are constructed; single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported: 0.01-93.5%), variations and factors associated with prescription drug misuse. Conclusion Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.This research has been supported, in part, by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines (APP1060407). Bianca Blanch is supported by a University of Sydney Postgraduate Award (2013–2016); Sallie-Anne Pearson is supported by a Cancer Institute New South Wales Career Development Fellowship (ID: 12/CDF/2-25); Nicholas Buckley and Andrew Dawson receive support for toxicovigilance studies through an NHMRC Program Grant (1055176); and Andrew Dawson is also supported by an NHRMC practitioner fellowship (1059542)

How do medical doctors use a web-based oncology protocol system? A comparison of Australian doctors at different levels of medical training using logfile analysis and an online survey

BACKGROUND: Electronic decision support is commonplace in medical practice. However, its adoption at the point-of-care is dependent on a range of organisational, patient and clinician-related factors. In particular, level of clinical experience is an important driver of electronic decision support uptake. Our objective was to examine the way in which Australian doctors at different stages of medical training use a web-based oncology system (http://www.eviq.org.au). METHODS: We used logfiles to examine the characteristics of eviQ registrants (2009–2012) and patterns of eviQ use in 2012, according to level of medical training. We also used a web-based survey to evaluate the way doctors at different levels of medical training use the online system and to elicit perceptions of the system’s utility in oncology care. RESULTS: Our study cohort comprised 2,549 eviQ registrants who were hospital-based medical doctors across all levels of training. 65% of the cohort used eviQ in 2012, with 25% of interns/residents, 61% of advanced oncology trainees and 47% of speciality-qualified oncologists accessing eviQ in the last 3 months of 2012. The cohort accounted for 445,492 webhits in 2012. On average, advanced trainees used eviQ up to five-times more than other doctors (42.6 webhits/month compared to 22.8 for specialty-qualified doctors and 7.4 webhits/month for interns/residents). Of the 52 survey respondents, 89% accessed eviQ’s chemotherapy protocols on a daily or weekly basis in the month prior to the survey. 79% of respondents used eviQ at least weekly to initiate therapy and to support monitoring (29%), altering (35%) or ceasing therapy (19%). Consistent with the logfile analysis, advanced oncology trainees report more frequent eviQ use than doctors at other stages of medical training. CONCLUSIONS: The majority of the Australian oncology workforce are registered on eviQ. The frequency of use directly mirrors the clinical role of doctors and attitudes about the utility of eviQ in decision-making. Evaluations of this kind generate important data for system developers and medical educators to drive improvements in electronic decision support to better meet the needs of clinicians. This end-user focus will optimise the uptake of systems which will translate into improvements in processes of care and patient outcomes

Implantable cardioverter-defibrillator therapy in Australia, 2002-2015

Objectives: Quantify hospitalisation trends for implantable cardioverter-defibrillator (ICD) procedures and costs. Design and setting: Retrospective observational study using Australian hospitalisation procedure data. Participants: Patients with an ICD insertion, replacement, adjustment or removal procedure code (2002-2014). Main outcome measures: Number of ICD procedures stratified by procedure year, patient age (0-34; 35-69; ≥70 years) and sex. Age-adjusted population procedure rates per 100,000 population. Number of procedures associated with a complication. Estimated annual hospitalisation costs for ICD procedures. Results: Between 2002 and 2014, the annual number of ICD procedures increased 2.5-fold (1,844 to 6,504). Across all procedures, patients aged ≥70 years had considerably higher rates than their younger counterparts. For example, in 2014, the ICD replacement rate was 70 times higher for those aged ≥70 years than patients aged 0-34 years (43.9 vs. 0.6/100,000 population). The complication rate decreased from 45% to 19%, due primarily to a coding change. Across all years and procedure types, males underwent the majority of procedures (67-86%). The annual number of removals represented ≥4% of the number of insertions per year. Between 2011 and 2013, the annual cost of ICD hospitalisations increased 7% (A$144,036,822 vs. A$154,555,814) and aggregate costs for these 3 years was A$445,644,566. Conclusion: ICD procedures are increasing in Australia across all age groups, particularly for Australians aged ≥70 years. Given these increases, further studies should examine patterns of care associated with ICD therapy, particularly examining patient and/or hospital factors associated with adverse events, such as removals, to better understand and ultimately improve patient outcomes

The Australian Genetic Heart Disease Registry: Protocol for a Data Linkage Study

BackgroundGenetic heart diseases such as hypertrophic cardiomyopathy can cause significant morbidity and mortality, ranging from syncope, chest pain, and palpitations to heart failure and sudden cardiac death. These diseases are inherited in an autosomal dominant fashion, meaning family members of affected individuals have a 1 in 2 chance of also inheriting the disease (“at-risk relatives”). The health care use patterns of individuals with a genetic heart disease, including emergency department presentations and hospital admissions, are poorly understood. By linking genetic heart disease registry data to routinely collected health data, we aim to provide a more comprehensive clinical data set to examine the burden of disease on individuals, families, and health care systems. ObjectiveThe objective of this study is to link the Australian Genetic Heart Disease (AGHD) Registry with routinely collected whole-population health data sets to investigate the health care use of individuals with a genetic heart disease and their at-risk relatives. This linked data set will allow for the investigation of differences in outcomes and health care use due to disease, sex, socioeconomic status, and other factors. MethodsThe AGHD Registry is a nationwide data set that began in 2007 and aims to recruit individuals with a genetic heart disease and their family members. In this study, demographic, clinical, and genetic data (available from 2007 to 2019) for AGHD Registry participants and at-risk relatives residing in New South Wales (NSW), Australia, were linked to routinely collected health data. These data included NSW-based data sets covering hospitalizations (2001-2019), emergency department presentations (2005-2019), and both state-wide and national mortality registries (2007-2019). The linkage was performed by the Centre for Health Record Linkage. Investigations stratifying by diagnosis, age, sex, socioeconomic status, and gene status will be undertaken and reported using descriptive statistics. ResultsNSW AGHD Registry participants were linked to routinely collected health data sets using probabilistic matching (November 2019). Of 1720 AGHD Registry participants, 1384 had linkages with 11,610 hospital records, 7032 emergency department records, and 60 death records. Data assessment and harmonization were performed, and descriptive data analysis is underway. ConclusionsWe intend to provide insights into the health care use patterns of individuals with a genetic heart disease and their at-risk relatives, including frequency of hospital admissions and differences due to factors such as disease, sex, and socioeconomic status. Identifying disparities and potential barriers to care may highlight specific health care needs (eg, between sexes) and factors impacting health care access and use. International Registered Report Identifier (IRRID)DERR1-10.2196/4863

The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients : a 12-week single-blind randomized study

Objective: To pursue the previously long-standing but formally untested clinical view that melancholia is preferentially responsive to antidepressant medication in comparison with psychotherapy [specifically Cognitive Behavior Therapy (CBT)]. Second, to determine whether a broader action antidepressant medication sequencing regimen is superior to a Selective Serotonin Reuptake Inhibitor (SSRI) alone. Method: We sought to recruit a large sample of participants with melancholic depression for a 12-week trial but inclusion criteria compromised recruitment and testing the second hypothesis. The first hypothesis was evaluated by comparing 18 participants receiving antidepressant medication to 11 receiving CBT. Primary study measures were the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Endogenous Subscale (HES), rated blindly, while several secondary measures also evaluated outcome. Results: Participants receiving medication had a superior 12-week outcome to those receiving CBT, with significant differences present on primary measures as early as 4 weeks. At trial conclusion, the percentage improvement in HAM-D scores was 59.5% vs. 32.5%, respectively [Number Needed to Treat (NNT) = 3.9] and with those in receipt of medication returning non-significantly higher HAM-D responder (66.6% vs. 36.4%, NNT = 3.3) and remission (66.7% vs. 45.4%, NNT = 4.7) rates.1 Conclusion: As the sample size was small and participants evidenced only moderate levels of depression severity, the study risked being underpowered and idiosyncratic. Despite the small sample, the superiority of antidepressant medication to CBT in those with a melancholic depression was distinctive in this pilot study