OBJECTIVE: To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of...OBJECTIVE: To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of the Victorian prescription drug monitoring program (PDMP). STUDY DESIGN: Controlled interrupted time series analysis of primary care electronic medical records. SETTING: A total of 562 general practices across three Victorian healthcare networks (Monash Health, Peninsula Health, Eastern Health). PATIENTS: People prescribed at least one PDMP-monitored medicine (e.g., opioids, benzodiazepines) and/or non-monitored psychotropic medicines (e.g., antidepressants, antipsychotics) between 1 January 2017 and 30 June 2023. INTERVENTION: Voluntary (1 April 2019) and mandatory (1 April 2020) implementation of the Victorian PDMP. MAIN OUTCOME MEASURES: Changes in the monthly rate of people seeing multiple prescribers (defined as four or more prescribers) following PDMP implementation for monitored medicines, with non-monitored medicines used as a control; characteristics of people who ceased seeing multiple prescribers for monitored medicines following PDMP implementation. RESULTS: Following voluntary PDMP implementation (1 April 2019), there was a significant reduction in the differential step and trend changes in the rates of seeing multiple prescribers between people prescribed monitored and non-monitored medicines (differential step change: β, -3.55 [95% confidence interval (CI), -5.08 to -2.03]; differential trend change: β, -0.29 [95% CI, -0.46 to -0.12]). Following mandatory PDMP implementation (1 April 2020), there was no significant step change difference. However, there was an increase in the differential trend change in the rate of seeing multiple prescribers between those prescribed monitored and non-monitored medicines (differential trend change: β, 0.21 [95% CI, 0.05-0.37]; p = 0.009). Logistic regression revealed that older age (95% CI, 1.39-1.75), male gender (95% CI, 1.09-1.25), metropolitan residence (95% CI, 1.04 and 1.23) and substance use disorder diagnosis (95% CI, 1.07-1.28) were associated with significantly higher odds of seeing multiple prescribers before PDMP implementation. CONCLUSIONS: Implementation of the PDMP was associated with meaningful reductions in people accessing monitored medicines from four or more prescribers.
OBJECTIVES: To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. STUDY TYPE: Descriptive modelling...OBJECTIVES: To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. STUDY TYPE: Descriptive modelling using standardised framework for classifying primary care expenditure. SETTING: Australian public and private health expenditure data (2002-03 to 2022-23) were disaggregated into: broad primary health care services (Tier A); direct primary care, predominantly funding general practice (Tier B); and funding for enhanced primary care for people with greater needs (Tier C). Distributional analysis was conducted across geographies. PARTICIPANTS: No individual participants; analysis used aggregated health expenditure data across 327 Statistical Area Level 3 geographies. MAIN OUTCOME MEASURES: Proportions of total and public expenditure allocated to each tier; equity in public Tier B and Tier C spending across areas, assessed using standardised slope indices. RESULTS: The share of total health spending allocated to primary care declined over the period. Tier A spending declined from 36.3% to 33.0% of total health spending; Tier B fell more sharply from 8.0% to 5.5%; and Tier C remained flat at 0.7%. Public spending trends were similar, but declines were more muted, with Tier C unchanged at 1.0%. Public spending on Tier B was 13% higher in the most disadvantaged areas than in the most advantaged areas in 2013-14; by 2023-24, this declined to 7%. Public Tier C spending remained progressive at 35% higher in the most disadvantaged areas, but decreased from 51% over the decade. Exploratory multivariate analyses suggested that Tier C spending was more redistributive than Tier B after accounting for need. CONCLUSIONS: Data indicate that primary care has declined as a funding priority in relative terms in Australia, and investment in high-value care has remained stagnant and appears increasingly less redistributive. These patterns may have implications for health equity.
OBJECTIVES: To quantify factors associated with paramedic transport to hospital for older people in residential aged care facilities (RACFs) and supported accommodation, and to identify modifiable drivers of non-transpor...OBJECTIVES: To quantify factors associated with paramedic transport to hospital for older people in residential aged care facilities (RACFs) and supported accommodation, and to identify modifiable drivers of non-transport. STUDY TYPE: Retrospective cohort study using routinely collected electronic patient care records, analysed with gradient boosting models and multivariable logistic regression. SETTING: Ambulance Tasmania attendances to RACFs and supported accommodation across Tasmania, 1 January 2018 to 31 December 2024. STUDY POPULATION: All eligible ambulance attendances for people aged 65 years or older at these facilities. MAIN OUTCOME MEASURES: The primary outcome was transport to hospital. Scene time and clinical status at first assessment, summarised using the National Early Warning Score 2 (NEWS2) and Shock Index, were descriptive variables and candidate predictors. RESULTS: Of 23,317 attendances, 19,386 (83.1%) resulted in transport and 3931 (16.9%) did not. Most attendances were low risk. Crew skill set, calendar month, initial pain score, respiratory rate and NEWS2 category were the strongest predictors of transport. In adjusted logistic regression, extended care paramedic attendance was associated with markedly lower odds of transport than attendance by standard paramedic crews (adjusted odds ratio, 0.09 [95% CI, 0.07-0.12]), corresponding to an adjusted transport probability of 0.50 compared with 0.85 for intensive care paramedic crews, 0.86 for standard paramedic crews and 0.69 for other crews. CONCLUSIONS: Paramedic transport decisions for RACF residents were strongly associated with acute illness severity, but crew skill set was also independently associated with transport. Attendances managed by extended care paramedics had lower adjusted probabilities of hospital transport. These findings suggest that extended-scope paramedic models warrant prospective evaluation in this setting.
Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by...Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.
Australia's rate of living donor kidney transplantation has stagnated. In 2024, there were 253 living donor kidney transplants, down from 354 in 2008, with the living donor rate falling to 9.5 donors per million populati...Australia's rate of living donor kidney transplantation has stagnated. In 2024, there were 253 living donor kidney transplants, down from 354 in 2008, with the living donor rate falling to 9.5 donors per million population-well below peer nations. Despite growth in deceased donation, waiting list times continue to lengthen and can now reach 6-7 years for some groups, reflecting the rising numbers of Australians living with kidney failure. Access is unequal: First Nations people receive few living donor transplants; women are more likely to donate than men but are less likely to receive a living donor transplant; and people from lower socio-economic groups are disadvantaged. Barriers include information gaps, limited multilingual resources, time-intensive workups and financial disincentives. A coordinated reset, supported by national leadership, contemporary guidance, better data and streamlined, culturally safe pathways can restore growth.
OBJECTIVE: To determine whether the screening age for atrial fibrillation (AF) should be lowered for Indigenous Australians with the goal of reducing risk of stroke and other health burdens. STUDY DESIGN: Systematic revi...OBJECTIVE: To determine whether the screening age for atrial fibrillation (AF) should be lowered for Indigenous Australians with the goal of reducing risk of stroke and other health burdens. STUDY DESIGN: Systematic review of medical databases identified 24 studies reporting outcome measures: AF incidence/prevalence, age of AF occurrence/diagnosis, cardiovascular risk factors and stroke risk. Risk of bias was evaluated using the Joanna Briggs Institute quality appraisal tools. Meta-analysis of mean age of AF onset was performed. An expert panel reviewed the evidence and formed consensus recommendations regarding screening for AF for Indigenous Australians. DATA SOURCES: MEDLINE, Embase, Scopus, Cochrane, CINAHL, Australian Indigenous HealthInfoNet and grey literature. DATA SYNTHESIS: The review yielded five key findings. Indigenous Australians when compared with non-Indigenous Australians have: (i) higher AF rates at every age group, and meta-analysis showed onset of AF for Indigenous people at 15.9 years (95% CI, 11.5-20.4), younger than for other Australians; (ii) higher prevalence of cardiovascular risk factors; (iii) higher stroke rates (38%-47% vs. 10%-15% of all strokes occur before age of 55 years), higher mortality and other adverse outcomes after stroke and the nationally age standardised risk ratio of death from AF was 1.8 for 1997-2022; (iv) less likelihood of receiving optimal treatment; and (v) greater cost of care for stroke rehabilitation. CONCLUSIONS: The evidence supports an amendment to the AF guideline to opportunistically screen Indigenous Australians from at least age 55 years, and when AF is found, follow guideline recommendations for management of rate, rhythm, stroke prevention and concomitant risk factors/comorbidities. Further, the logistics of care should be considered when deciding on the localised care pathway. National implementation of these recommendations should minimise missed diagnoses and ensure timely, accessible and appropriate care/treatment. REGISTRATION: Prospective registration with PROSPERO (CRD42024514586) on 13 May 2024.
National linkage of the Australia and New Zealand Living Kidney Donor Registry and the Australia and New Zealand Dialysis and Transplant Registry provides the first Australian estimates of kidney failure treated with kid...National linkage of the Australia and New Zealand Living Kidney Donor Registry and the Australia and New Zealand Dialysis and Transplant Registry provides the first Australian estimates of kidney failure treated with kidney replacement therapy (KRT) after living kidney donation (2004-2024). Out of 5291 donors (56,962 person-years; median follow-up, 10.96 years), three donors underwent KRT (0.53 per 10,000 person-years). No events occurred within 10 years of donation. Australian clinicians can now counsel and guide potential donors using local data: risk of kidney failure requiring KRT is very low, but late events warrant lifelong follow-up.
OBJECTIVES: To explore the perceptions of Indigenous South Australian adults regarding their oral and general health, social and emotional well-being and dental care experiences. STUDY DESIGN: Qualitative study; intervie...OBJECTIVES: To explore the perceptions of Indigenous South Australian adults regarding their oral and general health, social and emotional well-being and dental care experiences. STUDY DESIGN: Qualitative study; interviews with Indigenous South Australian adults involved in a non-randomised implementation and service-delivery project evaluating provision of culturally safe, comprehensive dental care. Study governance was provided by an Indigenous Oral Health Unit Reference Group with Indigenous leadership to centre cultural authority and cultural safety across all study dimensions. PARTICIPANTS SETTING: Semi-structured interviews were conducted with 136 Indigenous South Australian participants at a location of their choosing (e.g., their home, a community centre, a research facility), which were held at baseline (1 July 2022-15 December 2023) and 12-month follow-up (1 March 2024-31 March 2025). INTERVENTION: The overarching study consisted of a pre-post assessment of oral health embedded in routine dental care with oral epidemiological examinations and assessment of systemic health biomarkers (blood glucose, inflammation, cholesterol, kidney function). This was followed by semi-structured interviews at 12-month follow-up. MAIN OUTCOME MEASURE: Qualitative outcomes-participant experiences, understandings and recommendations around supporting oral health, social and emotional well-being and culturally safe dental care for Indigenous South Australians. RESULTS: Reflexive thematic analysis was used to analyse interview data, from which five themes were developed. Participants described the importance of oral health for overall health, aesthetic and functional impacts and judgement and discrimination related to poor oral health, all of which were linked to social and emotional well-being. Culturally safe care that includes oral health assessments alongside assessments of biomarkers for systemic health were suggested to promote self-confidence, reduce feelings of shame and empower communities. CONCLUSION: This study highlights the need to incorporate holistic approaches in promoting Indigenous oral and systemic health and in supporting social and emotional well-being. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12626000046303; retrospectively registered).
Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a 'big factor' in autism, citing a systematic review ba...Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a 'big factor' in autism, citing a systematic review based solely on observational studies. The review's selective reporting, methodological flaws (including applying an environmental health rather than evidence-based medicine framework) and lack of causal evidence provided weak justifications for its conclusions and have fuelled public confusion about paracetamol safety in pregnancy. This article critically appraises the review and examines how scientific uncertainty can be manipulated and amplified within broader public health domains.
Primary hyperparathyroidism has a prevalence of around 1% in the general population. Diagnosis requires biochemical testing of serum (for calcium and parathyroid hormone) and urine (for calcium excretion), as well as wid...Primary hyperparathyroidism has a prevalence of around 1% in the general population. Diagnosis requires biochemical testing of serum (for calcium and parathyroid hormone) and urine (for calcium excretion), as well as wider screening for complications including osteoporosis, renal disease, abdominal symptoms and neuropsychiatric disturbance. In selected individuals, genetic testing is a key consideration because up to 10% have hereditary primary hyperparathyroidism. Surgery is curative, with a minimally invasive approach preferred after identifying the abnormal parathyroid glands on preoperative imaging. Uncertainty surrounds the diagnosis of non-classical manifestations of primary hyperparathyroidism, preoperative imaging algorithms and management pathways in normocalcaemic primary hyperparathyroidism.
Rural and remote Australians experience persistent health inequities. Although randomised controlled trials (RCTs) remain the most rigorous method for establishing causal relationships and informing equitable health poli...Rural and remote Australians experience persistent health inequities. Although randomised controlled trials (RCTs) remain the most rigorous method for establishing causal relationships and informing equitable health policy, they are challenging to conduct in rural settings, contributing to under-representation in research. When RCTs are not feasible, observational analyses using the target trial framework provide a rigorous and pragmatic alternative. Despite growing international adoption, this approach has not been applied to rural contexts. The recently published TARGET guideline offers transparent reporting standards for these studies, providing a new methodological tool to advance rural and remote health research.
Chronic kidney disease (CKD) affects over 2 million Australians and imposes substantial clinical, societal and economic burdens. A pervasive yet under-recognised consequence is progressive muscle loss and functional decl...Chronic kidney disease (CKD) affects over 2 million Australians and imposes substantial clinical, societal and economic burdens. A pervasive yet under-recognised consequence is progressive muscle loss and functional decline, manifesting as sarcopenia and frailty, which are highly prevalent across CKD stages and strongly associated with hospitalisation, disability and mortality. Although exercise-based interventions improve physical function, quality of life and cardiovascular risk profiles, access and participation remain limited. Furthermore, compared with cardiac and pulmonary rehabilitation, funding for CKD-specific allied health services is fragmented and inadequate, with no dedicated funding pathways. Strategic policy reform is urgently needed to embed renal rehabilitation into standard kidney care.
INTRODUCTION: Patent foramen ovale (PFO) is implicated in 25%-50% of cryptogenic strokes in patients aged < 60 years. Recent clinical trials demonstrated the benefit of PFO closure in selected patients. However, there is...INTRODUCTION: Patent foramen ovale (PFO) is implicated in 25%-50% of cryptogenic strokes in patients aged < 60 years. Recent clinical trials demonstrated the benefit of PFO closure in selected patients. However, there is considerable variability in Australian and New Zealand clinical practice regarding investigation and management approaches. A multidisciplinary consensus group comprising stroke neurologists and an interventional cardiologist from major centres employed a modified nominal group technique to develop evidence-based recommendations for standardising PFO-associated stroke management. MAIN RECOMMENDATIONS: Twelve recommendations were developed across three domains. For patient selection: Universal PFO screening for cryptogenic stroke patients aged ≤ 60 years, with selective screening for patients aged > 60 years with embolic stroke of undetermined source, absent vascular risk factors and excluded atrial fibrillation. For diagnostic investigations: Transcranial Doppler (TCD) bubble study as preferred first-line screening where available, with transthoracic echocardiography as an alternative when TCD is unavailable and transoesophageal echocardiography for confirmation before closure consideration. For treatment decisions: Incorporation of the PFO-Associated Stroke Causal Likelihood (PASCAL) classification system rather than the Risk of Paradoxical Embolism (RoPE) score alone, consideration of TCD grading results for risk stratification and mandatory multidisciplinary heart-brain team evaluation for all closure decisions. CHANGES IN MANAGEMENT AS A RESULT OF THIS CONSENSUS STATEMENT: These recommendations will standardise practice through enhanced TCD service provision, structured heart-brain team development and evidence-based patient selection using the PASCAL classification. The emphasis on TCD as first-line screening represents a departure from traditional transthoracic echocardiography-based approaches. Implementation will improve patient outcomes through appropriate intervention in suitable candidates while avoiding unnecessary procedures in those unlikely to benefit, thereby promoting equitable access to optimal PFO management across Australia and New Zealand.
The world is on the brink of tipping points for climate disaster and transformative action. Decisions taken now will shape the health of millions. So, will the Australian Government use its COP31 Presidency of Negotiatio...The world is on the brink of tipping points for climate disaster and transformative action. Decisions taken now will shape the health of millions. So, will the Australian Government use its COP31 Presidency of Negotiations to prioritise the health of current and future generations and champion the end of fossil fuels? Despite recent positive shifts in some areas of climate policy, Australia's status as the world's third largest exporter of fossil fuels means strong pressure must be applied from the health professions to maximise political, social and economic progress towards a health-focussed transition to a sustainable society.
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) or metabolic (dysfunction)-associated steatotic liver disease (MASLD) is the most common and fastest growing cause of chronic liver disease worldwide. There...Metabolic (dysfunction)-associated fatty liver disease (MAFLD) or metabolic (dysfunction)-associated steatotic liver disease (MASLD) is the most common and fastest growing cause of chronic liver disease worldwide. There has been a substantial increase in the epidemiological research regarding MASLD/MAFLD originating from Australia since 2020. This narrative review summarises these pivotal epidemiological studies investigating the disease prevalence, natural history, prognostication and management of this condition. The Australian literature demonstrates the prevalence to be between one-third and two-fifths of adults affected, depending on nomenclature, with a heightened risk of cardiovascular disease irrespective of terminology. Current local data support guideline-based disease staging with non-invasive tests of fibrosis and the management continues to centre on diet and lifestyle interventions, with directed therapy on the horizon.
Chopra S, Tornvall I, Reid N
… +22 more, Whiting E, Hilmer SN, Job J, Villani A, Maiorana AJ, Morgan M, Fox S, Young A, Gibson C, Reidlinger DM, Burton E, Gordon EH, Baker J, Shafiee Hanjani L, Kouladjian O'Donnell L, Sim M, Miller M, Dampney P, Levinger P, King S, Hubbard RE, Australian Frailty Network Working Group
INTRODUCTION: This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults....INTRODUCTION: This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults. METHODS: The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement. MAIN RECOMMENDATIONS: A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities. An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein-energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty. Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals. Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level. A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty. Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care. CHANGES IN MANAGEMENT INFORMED BY THIS STATEMENT: The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.
We describe the clinical presentation, laboratory findings and complications of severe paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS), al...We describe the clinical presentation, laboratory findings and complications of severe paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS), also known as multisystem inflammatory syndrome in children in a 16-year-old female diagnosed in June 2025. This case highlights the importance of prompt diagnosis of PIMS-TS in the post-coronavirus disease 2019 pandemic era to ensure timely and appropriate management.