Validity of algorithms for identifying five chronic conditions in MedicineInsight, an Australian national general practice database.

Background MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. It is one of the largest and most widely used primary health care EHR databases in Australia. This study examined the validity of algorithms that use information from various fields in the MedicineInsight data to indicate whether patients have specific health conditions. This study examined the validity of MedicineInsight algorithms for five common chronic conditions: anxiety, asthma, depression, osteoporosis and type 2 diabetes. Methods Patients’ disease status according to MedicineInsight algorithms was benchmarked against the recording of diagnoses in the original EHRs. Fifty general practices contributing data to MedicineInsight met the eligibility criteria regarding patient load and location. Five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected from the MedicineInsight database. Trained staff reviewed the original EHR for as many of the selected patients as possible within the time available for data collection in each practice. Results A total of 475 patients were included in the analysis. All the evaluated MedicineInsight algorithms had excellent specificity, positive predictive value, and negative predictive value (above 0.9) when benchmarked against the recording of diagnoses in the original EHR. The asthma and osteoporosis algorithms also had excellent sensitivity, while the algorithms for anxiety, depression and type 2 diabetes yielded sensitivities of 0.85, 0.89 and 0.89 respectively. Conclusions The MedicineInsight algorithms for asthma and osteoporosis have excellent accuracy and the algorithms for anxiety, depression and type 2 diabetes have good accuracy. This study provides support for the use of these algorithms when using MedicineInsight data for primary health care quality improvement activities, research and health system policymaking and planning

The changing characteristics of patients with chronic hepatitis C prescribed direct acting antiviral medicines in general practice since listing of the medicines on the Australian Pharmaceutical Benefits Scheme

Background and Aim: The primary objective of this study was to determine whether the characteristics of patients prescribed direct acting antiviral (DAA) medicines have changed since initial listing of the medicines on the Australian Pharmaceutical Benefits Scheme (PBS). Methods: A cross-sectional study was conducted using data from MedicineInsight, an Australian database of general practice electronic health records, from March 2016 to August 2018. We compared sociodemographic, comorbidity, and clinical characteristics of patients aged at least 18 years who were prescribed at least one DAA in the first 4 months of PBS listing in 2016 with those prescribed at least one DAA in 2018. Results: There were 2251 eligible adult patients prescribed a DAA during the study period, 62% were men and 59% were aged 50 years and older. Patients prescribed DAA medicines initially were older (aged ≥50 years: 67.9% vs 49.3%; P 1 (20.4% vs 8.9%; P < 0.001) than those prescribed DAA medicines in 2018. A greater proportion of patients in regional/remote (46.5% vs 35.6%; P < 0.001) and socioeconomically disadvantaged areas (44.4% vs 34.5%; P = 0.003) accessed treatment in 2018 compared with 2016. Conclusions: Despite evidence of decreasing uptake of DAA medicines across Australia, this study indicates broadened uptake among younger age groups and those residing in regional/remote and socioeconomically disadvantaged areas since 2016. While uptake of DAA medicines in some population subgroups appears to have improved, continuous efforts to improve uptake across the Australian population are essential

Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study

Background: In 2013 pregabalin was subsidised by Australia′s Pharmaceutical Benefits Scheme (PBS) for neuropathic pain.Since the subsidy, pregabalin prescribing has been increasing in Australia and so has related harm.There are concerns it is being prescribed for indications other than neuropathic pain, which have little evidence of efficacy.Aim: To describe pregabalin prescribing in Australian general practice.Design & setting: A cross-sectional study of patients attending 445 general practice sites in the national MedicineInsight database from March 2012–February 2018.Method: The following aspects were calculated: the proportion of prescriptions that were for pregabalin per year; the prevalence of pain conditions in patients prescribed pregabalin; and same-day prescribing of pregabalin with opioids or benzodiazepines.Results: Prescribing increased from 13 per 10 000 to 104 per 10 000 prescriptions between 2012– 2013 and 2017–2018.A total of 1 891 623 patients were identified of whom 114 123 (6.0%) were prescribed pregabalin; 49.7% (n = 56 772) had a recorded diagnosis of neuropathic pain.Among people prescribed pregabalin without a recorded diagnosis of neuropathic pain, 43.5% (n = 24 927) had a diagnosis of back problems, 8.8% (n = 5073) chronic pain, and 26.4% (n = 30 146) had no pain diagnosis.Pregabalin was prescribed the same day as an opioid to 38.1% of patients (95% confidence interval [CI] = 37.1% to 39.1%) and a benzodiazepine to 13.1% of patients (95% CI = 12.5% to 13.7%).Patients with a diagnosis of chronic pain had the highest rate of same-day prescribing of pregabalin with an opioid (70.4%, 95% CI = 68.9% to 71.9%) or a benzodiazepine (25.8%, 95% CI = 24.2% to 27.4%) Conclusion: Substantial increases in pregabalin prescribing were identified in Australian general practice, but only half of patients had a neuropathic pain diagnosis recorded, the only approved indication for subsidy.High rates of same-day prescribing with opioids and benzodiazepines may put patients at increased risk of harm

Single-arm, observational study of the ease of use of a redesigned pen device to deliver recombinant human follicle-stimulating hormone (follitropin alfa) for assisted reproductive technology treatment

Peter J Illingworth,1 Robert Lahoud,1 Frank Quinn,1 Kendal Chidwick,2 Claire Wilkinson,2 Gavin Sacks1 1IVFAustralia, Greenwich, Sydney, NSW, Australia;&nbsp;2Scientific Affairs, Merck Serono Australia Pty Ltd, Frenchs Forest, Sydney, NSW, Australia Purpose: Evaluation of patients&rsquo; ease of use of the redesigned, disposable, ready-to-use &shy;follitropin alfa pen during controlled ovarian stimulation for assisted reproductive technology. Methods: This single-center, observational, open-label, single-arm study recruited infertile normo-ovulatory women (aged&nbsp;18&ndash;45&nbsp;years). Nurses trained patients to self-administer recombinant human follicle-stimulating hormone daily using the follitropin alfa pen (300&nbsp;IU,&nbsp;450&nbsp;IU, and&nbsp;900&nbsp;IU). Before treatment, patients completed Questionnaire A. Following self-administered treatment, on stimulation days&nbsp;5&ndash;6&nbsp;and&nbsp;7&ndash;8&nbsp;(within a day of receiving recombinant human chorionic gonadotropin), patients completed Questionnaire B. Nurses completed an ease-of-learning/teaching questionnaire. The primary endpoint was proportion of patients rating the pen as &ldquo;easy/very easy&rdquo; to use (Questionnaire B) on the final visit before recombinant human chorionic gonadotropin. Secondary endpoints included: proportion of patients rating the follitropin alfa pen as easy to learn, use, prepare, deliver, and dispose of (Questionnaires A and B). Proportions (95% confidence intervals [CIs]) were provided for primary and secondary endpoints. Adverse events were reported descriptively. Results: Eighty-six patients received recombinant human follicle-stimulating hormone. Of the&nbsp;72&nbsp;patients who had completed the overall assessment questions,&nbsp;66&nbsp;(91.7%;&nbsp;95% CI =82.7%&ndash;96.9%) found the pen &ldquo;easy&rdquo; to use. Also,&nbsp;70/86&nbsp;(81.4%) patients &ldquo;strongly agreed/agreed&rdquo; that, overall, it was easy to learn how to use the pen;&nbsp;72/86&nbsp;(83.7%) &ldquo;strongly agreed/agreed&rdquo; that easily understandable, verbal information was provided; and&nbsp;70/86&nbsp;(81.4%) were confident about using the pen correctly. In total,&nbsp;24/26&nbsp;nurses (92.3%;&nbsp;95% CI =74.9%&ndash;99.1%) rated the pen as easy to use. Clinical pregnancy rate/patient/cycle/embryo transfer was&nbsp;37%. Twenty-six ovarian hyperstimulation syndrome events were reported (none severe;&nbsp;16&nbsp;patients [19%]); of these,&nbsp;13&nbsp;occurred at embryo transfer. Conclusion: In this observational study, patients had a high acceptance of the redesigned follitropin alfa pen, with most finding it very easy/easy to use. Assisted reproductive technology nurses found the pen very easy/easy to teach. Keywords: controlled ovarian stimulation, ease of learning, ease of teaching, prefilled pen, questionnaire, self-injectio

Clinical bioethics integration, sustainability, and accountability: the Hub and Spokes Strategy

The "lone" clinical bioethicist working in a large, multisite hospital faces considerable challenges. While attempting to build ethics capacity and sustain a demanding range of responsibilities, he or she must also achieve an acceptable level of integration, sustainability, and accountability within a complex organisational structure. In an effort to address such inherent demands and to create a platform towards better evaluation and effectiveness, the Clinical Ethics Group at the Joint Centre for Bioethics at the University of Toronto is implementing the Hub and Spokes Strategy at seven hospitals. The goal of the Hub and Spokes Strategy is to foster an ethical climate and strengthen ethics capacity broadly throughout healthcare settings as well as create models in clinical bioethics that are excellent and effective