Medicines taken by older Australians after transient ischaemic attack or ischaemic stroke: a retrospective database study.

Background: Guidelines recommend patients diagnosed with transient ischaemic attack (TIA) or ischaemic stroke receive antihypertensive, antithrombotic and lipid lowering medicines. Reassessment of the need for medicines associated with an increased risk of stroke is also recommended.

Objective: To determine changes in the use of medicines recommended for secondary stroke prevention, medicines commonly used for treating stroke-related complications and medicines not recommended for use after ischaemic stroke, and to determine patient characteristics associated with use of all three stroke prevention medicines after TIA or ischaemic stroke.

Use of secondary stroke prevention medicines in Australia: national trends, 2003-2009.

Objective: To examine recent trends in the use of secondary stroke prevention medicines by transient ischaemic attack (TIA) and ischaemic stroke survivors.

Design, Setting And Participants: Retrospective observational study of patients aged ≥ 65 years who were hospitalised with a TIA or ischaemic stroke between January 2000 and December 2009. Use of antihypertensive, antithrombotic and lipid-lowering medicines by patients was determined monthly, using claims data from the Australian Government Department of Veterans' Affairs, commencing in January 2003.

Do South Australian pharmacy interns have the educational and behavioural precursors to meet the objectives of Australia's health care reform agenda?

Objective: To explore South Australian (SA) pharmacy interns' values, beliefs and motivations to study pharmacy and their assessment of how well their pharmacy education has prepared them for activities required of all health professionals under Australia's health care reforms.

Methods: A postal questionnaire was sent to all 136 SA pharmacy interns enrolled in SA intern training programmes in February 2010 (second month of the intern training programme).

Key Findings: Sixty (44%) of SA pharmacy interns responded; 75% selected pharmacy as a career because of an interest in health-related sciences and 65% valued working with patients.

Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans.

Background: The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program.

Methods: The program provides targeted patient-specific feedback to medical practitioners.

Prenatal exposure to selective serotonin reuptake inhibitors and childhood overweight at 7 years of age.

Purpose: To investigate a possible association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and childhood overweight at 7 years of age.

Methods: Information on pregnancy exposures and prevalence of childhood overweight at 7 years of age was obtained from the Danish National Birth Cohort. Overweight was classified as body mass index >85th percentile, based on age and sex.

Comorbid diabetes and COPD: impact of corticosteroid use on diabetes complications.

Objective: To identify if there is a dose-dependent risk of diabetes complications in patients treated with corticosteroids who have both diabetes and chronic obstructive pulmonary disorder (COPD).

Research Design And Methods: A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2001 to 30 June 2008, of diabetes patients newly initiated on metformin or sulfonylurea. COPD was identified by dispensings of tiotropium or ipratropium in the 6 months preceding study entry.

Transient ischaemic attack and ischaemic stroke: constructing episodes of care using hospital claims data.

Background: Stroke patients may have multiple hospital separations relating to the same stroke. Understanding the pattern of hospitalisations for these patients enables first and recurrent events to be distinguished to better understand care. The aim of this study was to investigate reasons for hospital separations after transient ischaemic attack (TIA) or ischaemic stroke and construct episode of care criteria.

Does antidepressant medication use affect persistence with diabetes medicines?

Purpose: This study aimed to examine the effect of antidepressant use on persistence with newly initiated oral antidiabetic medicines in older people.

Methods: A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2000 to 30 June 2008 of new users of oral antidiabetic medicines (metformin or sulfonylurea). Antidepressant medicine use was determined in the 6 months preceding the index date of the first dispensing of an oral antidiabetic medicine.

Methodological challenges in using routinely collected health data to investigate long-term effects of medication use during pregnancy.

To date, the investigation of teratogenic effects of medications has largely focused on physical alterations present at birth (i.e. malformations) as opposed to functional alterations (i.

Providing community-based health practitioners with timely and accurate discharge medicines information.

Background: Accurate and timely medication information at the point of discharge is essential for continuity of care. There are scarce data on the clinical significance if poor quality medicines information is passed to the next episode of care. This study aimed to compare the number and clinical significance of medication errors and omission in discharge medicines information, and the timeliness of delivery of this information to community-based health practitioners, between the existing Hospital Discharge Summary (HDS) and a pharmacist prepared Medicines Information Transfer Fax (MITF).

The Australian pharmacist workforce: employment status, practice profile and job satisfaction.

Objective: The aims were to determine Australian registered pharmacists' current employment status, practice profile and professional satisfaction.

Method: A questionnaire was mailed to all registered pharmacists (n=7764) on the Pharmacy Boards of Victoria and South Australia's registers; 19 were returned undeliverable. Quantitative data were entered and analysed using the Statistical Package for Social Sciences Version 17.

Why do Australian registered pharmacists leave the profession? a qualitative study.

Background: Understanding why people choose to leave their professions is important to inform workforce planning to meet community needs. Poor job satisfaction has been linked to health practitioners expressing intentions to leave in other professions such as nursing, occupational therapy and medicine, but little is known about the reasons why pharmacists leave their profession.

Objective: To explore reasons why Australian pharmacists leave the profession.

Chronic disease management: does the disease affect likelihood of care planning?

Objective: To compare the demographic, socioeconomic, and medical characteristics of patients who had a General Practitioner Management Plan (GPMP) with those for patients without GPMP.

Methods: Cohort study of patients with chronic diseases during the time period 1 July 2006 to 30 June 2008 using the Australian Department of Veterans' Affairs (DVA) claims database.

Results: Of the 88 128 veterans with chronic diseases included in the study, 23 015 (26%) veterans had a GPMP and 11 089 (13%) had a Team Care Arrangement (TCA).

Neonatal outcomes after late-gestation exposure to selective serotonin reuptake inhibitors.

Objective: This study aimed to investigate neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) during late-gestation.

Methods: A retrospective cohort study was conducted using linked records from the Women's and Children's Health Network in South Australia, Australia, including the Perinatal Statistics Collection and the Hospital Pharmacy Dispensing Records. Women were eligible to participate if they gave birth to singleton, live-born infants between September 2000 and December 2008 (n = 33,965).

Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm.

Objective: To identify the prevalence of potentially preventable medication-related hospitalizations amongst elderly Australian veterans by applying clinical indicators to administrative claims data.

Design And Setting: Retrospective cohort study in the Australian veteran population from 1 January 2004 to 31 December 2008.

Participants: A total of 109 044 veterans with one or more hospitalizations defined by the medication-related clinical indicator set, during the 5-year study period.

Long term impact of prenatal exposure to SSRIs on growth and body weight in childhood: evidence from animal and human studies.

Prenatal exposure to SSRIs has the potential to alter fetal 5-HT signalling during critical periods of development: the long-term consequences of which have not been well studied. Of particular interest are the potential long-term effects of prenatal SSRI exposure on growth and body weight in later life, given the role of the serotonergic system in regulating food intake and body weight. Animal studies demonstrate that changes in 5-HT homeostasis during critical periods of fetal development can lead to sex-specific molecular and functional alterations in the serotonergic and HPA systems, leading to an increased risk of overweight in male, but not female, offspring in later life.

Managing glaucoma in those with co-morbidity: not as easy as it seems.

Purpose: To identify the extent of use of medicines recommended to be used with caution in glaucoma patients with specified comorbidities and to determine evidence of associated harm. Retrospective cohort analysis from administrative claims data and prescription/event sequence symmetry analysis.

Participants: Australian Government Department of Veterans' Affairs treatment card holders dispensed glaucoma eye-drops.

Investigating outcomes associated with medication use during pregnancy: a review of methodological challenges and observational study designs.

In the absence of randomised controlled trials, knowledge of outcomes associated with medication use during pregnancy is dependent on observational studies. Numerous observational study designs exist, with the decision on which is most appropriate depending on a number of factors, including the exposure and outcome under investigation and knowledge of key methodological issues. This review provides an overview of the key methodological issues involved in undertaking observational studies to investigate medication use during pregnancy, including selection bias, exposure and outcome classification, information bias, confounding and statistical analysis.

Pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles.

Objective: To explore pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles.

Methods: Four focus groups were conducted with 32 South Australian pharmacists: two groups included community pharmacists and pharmacy owners; one included hospital pharmacists and another, consultant pharmacists.

Key Findings: Four themes emerged: (1) poor awareness of health care reform agenda; (2) strong adherence to the supply model; (3) lack of appreciation of alternative models; and (4) communication barriers.

Ageing well: improving the management of patients with multiple chronic health problems.

Aim: To identify and evaluate the management and care of older people with multiple chronic health problems (MCHP).

Methods: Administrative health data from the Department of Veterans' Affairs and bio-social data from the Australian Longitudinal Study of Ageing are used to determine prevalence of MCHP, treatment patterns and patient outcomes. Focus groups and semistructured interviews are used to gain patient and health practitioner perspectives.

Exposed or not exposed? Exploring exposure classification in studies using administrative data to investigate outcomes following medication use during pregnancy.

Purpose: The aim of this systematic review was to examine and compare differences in the way medication exposures are classified in studies using linked administrative data to investigate outcomes following medication use during pregnancy. This was undertaken with a focus on studies investigating specific neonatal outcomes following prenatal exposure to selective serotonin reuptake inhibitors (SSRIs).

Methods: We searched Medline and Embase to identify studies that used linked administrative data to investigate specific neonatal outcomes (congenital malformations, birth weight, gestational age) following prenatal exposure to SSRIs.

Stroke risk and NSAIDs: an Australian population-based study.

Objective: To determine the risk of stroke associated with non-steroidal anti-inflammatory drug (NSAID) use.

Design, Setting And Participants: Retrospective cohort study of 162,065 Australian veterans with incident dispensing of an NSAID between 1 January 2001 and 31 December 2008, using prescription event sequence symmetry analysis.

Main Outcome Measures: Hospitalisation for stroke, ischaemic stroke or haemorrhagic stroke.

Major bleeding risk associated with warfarin and co-medications in the elderly population.

Purpose: Warfarin management in the elderly population is complex as medicines prescribed for concomitant diseases may further increase the risk of major bleeding associated with warfarin use. We aimed to quantify the excess risk of bleeding-related hospitalisation when warfarin was co-dispensed with potentially interacting medicines.

Methods: A retrospective cohort study was undertaken over a 4-year period from July 2002 to June 2006 to examine bleeding risk associated with medications co-administered in patients taking warfarin using an administrative claims database from the Australian Department of Veterans' Affairs.

Investigating outcomes following the use of selective serotonin reuptake inhibitors for treating depression in pregnancy: a focus on methodological issues.

The aim of this review was to critically appraise the existing literature with a particular focus on identifying methodological issues associated with studying outcomes following the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Existing studies evaluating outcomes following prenatal SSRI exposure suffer from a number of important methodological limitations that should be taken into account when interpreting their results. The contradictory results obtained from prospective and retrospective cohort studies and case-control studies could be accounted for by dissimilarity between study populations, selection bias, detection bias, confounding, or differences in underlying maternal illness, data sources used, exposure classification, follow-up and statistical power/analysis.