Burden Of Disease In Australia Research Articles

Respiratory syncytial virus disease morbidity in Australian infants aged 0 to 6 months: a systematic review with narrative synthesis

BackgroundA significant proportion of the global respiratory syncytial virus (RSV) associated morbidity is accounted for by infants aged 0 to 6 months, who are particularly vulnerable to severe disease. In 2015, 44% of global hospitalisations in infants in this age group were secondary to RSV. The objective of this systematic review is to appraise and synthesise the local evidence of RSV infection morbidity among Australian infants aged 0 to 6 months and to assess the implications for future immunisation strategies.MethodsElectronic databases (Medline, Embase, Pubmed and Global Health) were searched for full-text articles published between 2000 and 2023 in English language. Studies that examined markers of RSV disease morbidity in infants aged 0 to 6 months in Australia who had laboratory confirmed RSV infection were eligible for inclusion. The outcomes of interest were incidence, prevalence, testing rate, positivity rate, mortality, emergency department visits, community health visits, hospitalisation, intensive care unit admission, supplementary oxygen use, mechanical ventilation, risk factors for disease severity and monoclonal antibody use.ResultsThe database search identified 469 studies. After removal of duplicates and full-text review, 17 articles were eligible for inclusion. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis without meta-analysis guidelines.ConclusionsQualitative analysis of the included studies showed that Australian infants aged 0 to 6 months have higher rates of RSV testing, positivity and incidence; and more likely to develop severe disease that requires hospitalisation, intensive care unit admission or respiratory support, compared to children and adults of all ages. Aboriginal and Torres Strait Islander infants aged 0 to 6 months demonstrated higher rates of RSV infection and hospitalisation, compared to non-Indigenous infants. Age-related trends persisted in geographic areas with varying seasonal transmission of RSV, and during the SARS-CoV-2 pandemic. Passive immunisation strategies targeting infants in their first 6 months of life, either via vaccination of pregnant women or administration of long-acting monoclonal antibody during infancy, could effectively reduce RSV disease burden in Australia.

Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.

The burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made. Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Bill & Melinda Gates Foundation.

A protocol for modelled evaluations to maximise the long-term health and economic gains of lung cancer interventions in Australia: The Lung cancer Evaluation And Policy program (LEAPp)

Background: Tobacco control interventions in Australia have had success in recent decades, international screening trials have yielded significant mortality benefits, and therapeutic innovation in disease management is burgeoning; however, lung cancer remains the leading cause of cancer death and disease burden in Australia and the most appropriate combination of interventions to address this is unclear. Underpinned by modelling infrastructure, The Daffodil Centre’s Lung cancer Evaluation And Policy program (LEAPp) combines large-scale linked data analysis, clinical trial data, statistical projections, evidence review, and stakeholder engagement to quantify and optimise the long-term health and economic impacts of lung cancer interventions for Australia, both alone and in combination.

Oral health research funding in relation to disease burden in Australia.

This study aims to investigate and compare the major Australian government research funding schemes for oral health science with other disciplines from the burden of disease perspective. Major government research funding scheme outcomes were identified. An innovative index of Fair Research Funding (FRF) was developed to examine the extent to which National Health and Medical Research Council funding is aligned with the disease burden. In addition to comparing different diseases, overall governmental research funding for different areas of oral health sciences was explored. Oral disorders with $15 million NHMRC grant funds (2017-2021) and FRF of 10.7 has the lowest and most inequitable amount of Australian government support in relation to disease burden. The share of oral health science in the Australian Research Council and Medical Research Future Fund was very minimal, with $3.43 and $1.88 million respectively. Governmental research funding for oral health sciences is inequitable according to the disease burden. More dedicated oral health sciences research funding schemes are essential. Funding for prevention-focused public oral health programmes is a vital requirement towards reducing the inequalities in population oral health.

EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR)

PurposeLung cancer is the leading cause of cancer mortality and comprises the largest national cancer disease burden in Australia and New Zealand. Local and regional reports identify substantial evidence-practice gaps with unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The ANZLCR will monitor the safety, quality, and effectiveness of lung cancer care by collecting, analysing, and reporting key quality indicators of lung cancer management.

Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper

IntroductionLung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from...

"Dietitians May Only Have One Chance"-The Realities of Treating Obesity in Private Practice in Australia.

Introduction: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. Methods: This study used descriptive qualitative methods to explore accredited practicing dietitians’ (APDs’) perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. Results: In the context within which dietitians’ practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians’ preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. Conclusion: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.

Mitigating the SARS-CoV-2 Delta disease burden in Australia by non-pharmaceutical interventions and vaccinating children: a modelling analysis

BackgroundIn countries with high COVID-19 vaccination rates the SARS-CoV-2 Delta variant resulted in rapidly increasing case numbers. This study evaluated the use of non-pharmaceutical interventions (NPIs) coupled with alternative vaccination strategies to determine feasible Delta mitigation strategies for Australia. We aimed to understand the potential effectiveness of high vaccine coverage levels together with NPI physical distancing activation and to establish the benefit of adding children and adolescents to the vaccination program. Border closure limited SARS-CoV-2 transmission in Australia; however, slow vaccination uptake resulted in Delta outbreaks in the two largest cities and may continue as international travel increases.MethodsAn agent-based model was used to evaluate the potential reduction in the COVID-19 health burden resulting from alternative vaccination strategies. We assumed immunity was derived from vaccination with the BNT162b2 Pfizer BioNTech vaccine. Two age-specific vaccination strategies were evaluated, ages 5 and above, and 12 and above, and the health burden determined under alternative vaccine coverages, with/without activation of NPIs. Age-specific infections generated by the model, together with recent UK data, permitted reductions in the health burden to be quantified.ResultsCases, hospitalisations and deaths are shown to reduce by (i) increasing coverage to include children aged 5 to 11 years, (ii) activating moderate NPI measures and/or (iii) increasing coverage levels above 80%. At 80% coverage, vaccinating ages 12 and above without NPIs is predicted to result in 1095 additional hospitalisations per million population; adding ages 5 and above reduces this to 996 per million population. Activating moderate NPIs reduces hospitalisations to 611 for ages 12 and over, and 382 per million for ages 5 and above. Alternatively, increasing coverage to 90% for those aged 12 and above is estimated to reduce hospitalisations to 616. Combining all three measures is shown to reduce cases to 158, hospitalisations to 1 and deaths to zero, per million population.ConclusionsDelta variant outbreaks may be managed by vaccine coverage rates higher than 80% and activation of moderate NPI measures, preventing healthcare facilities from being overwhelmed. If 90% coverage cannot be achieved, including young children and adolescents in the vaccination program coupled with activation of moderate NPIs appears necessary to suppress future COVID-19 Delta-like transmission and prevent intensive care unit surge capacity from being exceeded.

1260Contribution of risk factors to disease burden in Australia in 2018

Abstract Background The Australian Burden of Disease Study 2018 estimated the burden due to 219 diseases and injuries and 40 risk factors (attributable burden). Attributable burden is the amount of health loss that would be prevented if exposure to the risk factor had been avoided or reduced to the lowest possible exposure. Methods Attributable burden was estimated for 2003, 2011, 2015 and 2018 using comparative risk assessment methodology. Estimates of exposure to risk factors were sourced from Australian survey data and used with global measures of effect size to estimate population attributable fractions (PAFs). Results In 2018, 37% of the burden of disease in Australia could have been prevented by reducing or avoiding exposure to the modifiable risk factors included in the study. The leading five risk factors contributing to total burden were: tobacco use (8.6%), overweight & obesity (8.4%), dietary risks (5.4%), high blood pressure (5.1%) and alcohol use (4.5%). While tobacco use remains the leading risk factor causing burden, the gap between tobacco use and overweight & obesity has almost closed. The burden attributable to most risk factors was higher in males than in females. The lowest socioeconomic group experienced greater burden compared with the highest group for all risk factors. Conclusions Addressing modifiable risk factors could prevent up to 37% of disease burden in Australia. Key messages In 2018, 37% of the burden of disease could have been prevented. Tobacco use and overweight & obesity were the leading risk factors.

1262Burden of disease and injury in Australia

Abstract Background Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2018 estimated the health impact of 219 diseases and injuries on the Australian population. Methods Burden of disease measures years of healthy life lost from living with (non-fatal) and dying prematurely from (fatal) disease and injury. Fatal and non-fatal burden combined provides the total burden, measured in disability-adjusted life years (DALY). One DALY equals 1 year of healthy life lost. Disease burden was estimated for the years 2018, 2015, 2011 and 2003 for Australia. Results In 2018, 5.0 million years of healthy life were lost from disease and injury. Living with illness or injury caused more total disease burden than dying prematurely (52% vs 48%). Between 2003 and 2018, total burden decreased by 13%, driven by less premature deaths. Disease groups with the biggest absolute reductions in burden (DALY rate) were cardiovascular diseases and cancers. The five leading causes of burden were coronary heart disease, back pain, dementia, chronic obstructive pulmonary disease and lung cancer. Males experienced more burden than females for most age groups. Conclusions Overall burden of disease declined between 2003 and 2018, due to a large reduction in burden from dying prematurely. Living with the impact of chronic diseases contributed substantial burden in Australia in 2018. Key messages Living with illness or injury accounts for most of the disease burden in Australia. There have been improvements in fatal burden since 2003.

Can National Oral Health Policy Reform Be Successfully Translated into Practice and Reduce the Burden of Disease in Australia?

BACKGROUND: The discrepancy between policy makers decisions, current research and clinical practice is of huge significance to the health industry and the Australian community. 
 AIM: Evaluate of translational research frameworks and policy formulation within the Australian oral health context. 
 METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a focused systematic search was conducted using an electronic search of the CINAHL database, including Medline, Cochrane and Scopus. A combination of key terms including “oral health”, “prevention’’, 'translational research’, “public policy”, were used for the searches. 
 RESULTS: The initial literature search found 561 abstracts in CINAHL database. Review against the inclusion criteria and removal of duplicates yielded 129 abstracts; further reviewed against the inclusion criteria resulted in 35 included in the review of translational research models. Across the 35 papers 8 different frameworks for translation of research evidence into policy and practice were utilised across the literature. The results reported in this studies show that the PARiHS framework depicts successful translation as a function of the relationship between evidence, context and facilitation. These interplays of elements are particularly of relevance to oral health due to the complexity of the sector. Context (current and historical) and facilitation (including governance/regulation) are the foundational drivers of successful implantation of evidence into practice. 
 CONCLUSION: The PARiHS framework for implementing research into practice is an appropriate model for oral health. Universal access is a feasible step in addressing the current inequities of access to oral health care.

Implementation of a patient centred medical home (PCMH) initiative in general practices in New South Wales, Australia

BackgroundWith an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN).MethodQualitative and quantitative data were collected over a twelve month period, including semi-structured interviews, participant observation, and practice data to present a detailed examination of a subject of study; the implementation of PCMH projects in seven general practices. We conducted 49 interviews (24 pre and 25 post) with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data.ResultsFacilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change; whole of practice engagement with a shared vision towards PCMH change; engaged leadership; training and support; and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change.ConclusionsOur study examined the experiences of implementing PCMH initiatives in an Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects.

A comparison of the distribution of Medical Research Future Fund grants with disease burden in Australia.

A comparison of the distribution of Medical Research Future Fund grants with disease burden in Australia.

Telephone Consultations for Cardiac Outpatients During COVID-19—A Review of Acceptability and Impact

Cardiovascular disease is the leading cause of mortality and disease burden in Australia, with higher mortality rates in regional, rural, and remote areas, and amongst First Nations’ peoples. A postulated reason for higher mortality rates in non-metropolitan areas is lack of accessibility. Whilst Telemedicine is not a new modality, there is minimum literature on its routine use for appropriately triaged patients with cardiac conditions. The aim of the project was to determine if Telephone consultations are an acceptable means of conducting outpatient Cardiac Clinic appointments, so that alternative modalities can be considered as a means of addressing clinic waitlists and optimising timely care delivery.

Chronic pain and cardiovascular disease prevention in primary care: a review of Australian primary health network needs assessments

Objective Chronic pain and cardiovascular disease (CVD) have a high disease burden. This research aimed to understand whether Australian primary health networks (PHNs) are recognising the need for the prevention of these conditions by investigating what local health and service issues have been identified. Methods Separate sets of needs assessments were analysed for chronic pain and CVD for all 31 PHNs using a document analysis approach. Framework analysis was undertaken to ascertain the types of health and service issues, prevention-related issues and supporting data sources identified, as well as to quantify the number of PHNs identifying these issues. Results Fewer PHNs identified health issues for chronic pain (n = 13) compared with CVD (n = 30), with the most common being disease prevalence and burden supported by National Health Survey data. Service issues were identified by fewer than half the PHNs (n = 13 for each disease), which were largely informed by stakeholder consultation and related to service integration, service accessibility and health professional training. Prevention-related issues were frequently identified for CVD (n = 26), but not chronic pain (n = 3). Conclusions This paper highlights the need for a greater focus on chronic pain- and CVD-related issues by PHNs. This could be supported nationally by recognising chronic pain and risk factors in national datasets and PHN performance frameworks, and locally via greater stakeholder consultation to inform PHN population health planning. What is known about the topic? Chronic pain and CVD are the two leading causes of total disease burden in Australia. PHNs are well positioned to address prevention locally through population health planning, supporting primary healthcare providers, health care integration and coordination and commissioning necessary services. What does this paper add? This paper highlights gaps in data availability, the proportion of PHNs identifying local service issues for both chronic pain and CVD and health- and prevention-related issues for chronic pain. What are the implications for practitioners? Although PHNs are constrained by government priorities and funding, greater stakeholder consultation is one potentially promising strategy to overcome local data gaps to identifying and prioritising chronic pain and CVD prevention.

The impact of coronary heart disease on productivity in Australia over ten years

Abstract Background Coronary heart disease (CHD) is the highest individual disease burden in Australia and associated with productivity losses through unplanned absence from work, reduced output while at work and early labour force withdrawal. Approximately eighty per cent of CHD cases in Australia are preventable, suggesting the potential benefit of employing preventive strategies addressing populations at risk of CHD. Purpose To determine the preventable productivity burden attributable to CHD over the next ten years, using the novel productivity measure: the “productivity-adjusted life year” (PALY). Methods A dynamic life table model was constructed for the total Australian population, separated by CHD status. Analysis was limited to the Australian working-age population (15–69 years) over ten years (2020–2029). Australian age- and sex-specific prevalence, incidence, migration and mortality data was employed, and productivity estimates were sourced from the literature. The PALY was ascribed a financial value in terms of gross domestic product (GDP) per equivalent full-time worker. The total number of years lived, total PALYs, and total economic burden (in terms of cost of PALYs) were estimated for each year. The model simulation was repeated assuming incidence was reduced, and the differences represented the preventable productivity burden attributable to CHD. All outcomes beyond the first year were discounted by 5% per annum. Results Over the next ten years, the total projected years lived and PALYs among the Australian working-age population (with and without CHD) were approximately 132 million and 83 million, respectively, amounting to A$17.2 trillion (€10.5 trillion) in GDP. We predicted nearly 40,000 new (incident) CHD cases over this ten-year period. If, however, we could prevent these new cases of CHD, a total of 14,000 deaths could be averted, resulting in more than 8,000 years of life saved and 100,000 PALYs gained, equivalent to A$21 billion (€12.9 billion) in GDP. Conclusion Prevention of CHD will prolong both years of life lived and productive life years, resulting in substantial economic benefit. Policy makers and employers are encouraged to engage in preventive measures addressing CHD. Funding Acknowledgement Type of funding source: None

Self-management behaviour and knowledge of patients with musculoskeletal complaints attending an Australian osteopathy clinic: A consecutive sampling design

BackgroundMusculoskeletal complaints present a substantial disease burden worldwide and account for nearly 8% of the total disease burden in Australia. Like other chronic diseases, self-management plays a significant role in the overall management plan for musculoskeletal complaints. ObjectiveEvaluate the self-management behaviours of patients seeking care for a primary musculoskeletal complaint in an Australian osteopathy clinic. DesignConsecutive sampling design. SettingVictoria University Osteopathy Clinic (Melbourne, Australia). MethodsPatients were invited to complete a health information and demographic questionnaire in addition to the Partners in Health (PiH) scale prior to their initial consultation. The PiH subscales and total score were evaluated to ascertain their relationship with gender, age, and other health demographic variables. ParticipantsConsecutive patients attending the Victoria University Osteopathy Clinic. ResultsData from 331 patients was available for analysis. The PiH total score mean was 70.9 (±14.3). Reliability estimations for the PiH subscales were acceptable (McDonald's omega > 0.75). PiH total and subscale scores were not associated with age, and not significantly different for gender and chronicity of complaint. Significant differences for other health behaviours (smoking, blood pressure assessment) were identified. ConclusionsThe current study provides support for the use of the PiH in a patient population seeking osteopathy care for primary acute or chronic musculoskeletal complaint, and also in younger populations seeking care. The results of the study suggest that osteopathy patients seeking care for a primary musculoskeletal complaint demonstrated a relatively high disposition towards the self-management of their health complaints.

Use of an Abbreviated Geriatric Screening Tool in the Assessment of Older Cancer Patients' Functional Status, Dependency, and Comorbidities: Cross-Sectional Audit and Observations From a Regional Cancer Center in Australia.

BackgroundMalignancies are the leading cause of disease burden in Australia, comprising 19% of total diseases. Approximately 1 in 4 men and 1 in 6 women die from malignancies by 85 years of age, with patients aged 65 years and older contributing to 58% of diagnoses and 76% of cancer mortality. In the context of malignancy-related disease and age-related degeneration, there is a need for comprehensive assessment of older patients to plan for appropriate management and predict prognosis. The utility of available comprehensive geriatric assessment tools has been limited in routine practice because of their time-consuming nature, despite their informing clearer understanding of patients’ functional status, better clinical decision making, prevention of unpredictable admissions and emergency department overload, and support services planning. Though there are several promising tools available, there is a lack of literature on tools that can comprehensively assess functional status in an expedited fashion.ObjectiveThis study aimed to document functional status and comorbidities among a geriatric oncology patient cohort attending a regionally located, dedicated cancer care facility, using the completed Adelaide tool assessments. This study documents cohort characteristics, including sociodemographics, malignancy type, and comorbidities. Secondarily, we observed the utility of an abridged functional assessment in the multidisciplinary team (MDT) management of older cancer patients.MethodsThe study comprised a facility-based cross-sectional audit of results obtained from a screening tool administered to patients aged 65 years and older and attending an outpatient medical oncology clinic for management of cancer from late 2015 to 2017. Data relating to five domains were collected, including instrumental activities of daily living, activities of daily living, performance status, unintended weight loss, and exhaustion. Sociodemographic and disease-related factors were summarized as frequencies with percentages or mean with SD. Distribution of functional status based on sociodemographic characteristics, living status, disease-related factors, and comorbidities was analyzed using a chi-square test. Cumulative dependencies in the five domains were identified, and patients were classified as fit, vulnerable, or frail. Supplementary review of presentation notes for cases discussed at MDT meetings was undertaken to identify discrepancies.ResultsA majority of the study population showed poor functional status, with 88.7% (243/274) categorized as vulnerable and 8.4% (23/274) as frail. Exhaustion and unintended weight loss were identified as the most common contributors to dependency. Polypharmacy was strongly associated with decreased functional status.ConclusionsThe outcomes of this study are congruent with the existence of dependency in various domains, and with similar research in geriatric oncology. The Adelaide tool provided a useful basis for MDT discussion and management, where cases were referred to the MDT. We recommend further examination of the tool’s utility and impact in clinical decision making, and the distribution of dependencies in a rural cohort compared with metropolitan patients.

Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting.

Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general practitioners. This study explored how staff in general practices are managing alcohol in patients with chronic disease with a view to determining what additional services may be appropriate. Brief interviews were conducted with doctors, nurses and allied health practitioners across three general practices in a regional centre. Interviews were analysed using abductive thematic techniques to elicit broad themes. In all, 18 interviews were conducted. All interviewees found the management of patients with chronic disease who were drinking in excess of guidelines to be challenging. The complexity of patients, in terms of health needs and social circumstances, affected management and self-care. Australian drinking cultural norms also affected patients' and practitioners' behaviour. Multidisciplinary care was highlighted by all health professionals; however, there were challenges maintaining staff motivation, a lack of training in alcohol management and a lack of referral or assistance services. Experienced practitioners identified that the patient was the key stakeholder who needed to take ownership of their health. The combined burden of excess alcohol consumption and chronic disease is a common management challenge faced by staff in general practice. Although there was evidence of awareness of the issue and a concerted effort to address the problem, most staff felt they had inadequate training, skills and resources. More undergraduate or postgraduate training in alcohol management and more resources are required to support general practitioners in this area.