South Australian Public Hospitals Research Articles

Sodium-Glucose Cotransporter 2 Inhibitors in South Australia: The Magic Before the Fame

Recent clinical trials have demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i), which were previously only indicated in treatment of type 2 diabetes mellitus (T2DM), can markedly reduce heart failure hospitalisation (HFH), with less striking potential reductions in acute coronary syndromes and cardiac arrhythmias. To evaluate the impact of SGLT2i on cardiovascular outcomes in real-world practice, we performed a retrospective cohort analysis on South Australian (SA) data. A total of 842 individuals with T2DM receiving SGLT2i were identified from SA public hospitals between 2011 and 2019. Episodes of care were temporally matched with those of 3,128 individuals with T2DM not receiving SGLT2i (control). Baseline characteristics were adjusted using inverse probability treatment weighting. The incidence of cardiovascular events at 12 and 24 months was evaluated using coded (International Classification of Diseases, Tenth Revision, Australian Modification [ICD-10-AM]) data. The primary outcome of HFH was lower with SGLT2i use at 12 months (adjusted hazard ratio [HRadj] 0.44; 95% confidence interval [CI] 0.29-0.68; p<0.001) and 24 months. There were also lower hospitalisations due to acute myocardial infarction (HRadj 0.42; 95% CI 0.21-0.85; p=0.015) and atrial or ventricular arrhythmias (HRadj 0.29; 95% CI 0.14-0.59; p=0.001), with no difference observed in hospitalisation due to ischaemic cerebrovascular events. There was no difference in all-cause mortality at 12 months but interestingly a higher rate at 24 months (HRadj 2.08; 95% CI 1.59-2.72; p<0.001). Despite this, similar reductions in cardiovascular outcomes were observed at 24 months. Use of SGLT2i in patients with T2DM in SA was associated with reductions in cardiovascular events even before their recent Pharmaceutical Benefits Scheme (PBS) listing for heart failure. Furthermore, this analysis supports that SGLT2i play a role not only in HFH reduction but also in reducing coronary and tachyarrhythmic events. This real-world evidence supports the use of SGLT2i as broadly protective cardiovascular drugs.

Stakeholder expectations, experiences, and perceived outcomes: Implementation of a practice-integrated hospital pharmacist foundation residency program

IntroductionIn 2017, a practice–integrated hospital pharmacist foundation residency program, modelling well-established international programs, was made available to all eligible hosting hospital pharmacy service providers in Australia. The South Australian public hospital pharmacy service implemented the nation's first accredited statewide residency model that also incorporates enrolment and completion of a tailored post-graduate qualification. This study aimed to explore stakeholder perspectives pertaining to implementation and adoption of the South Australian public hospital pharmacy statewide residency program. MethodsEligible participants were recruited via purposeful sampling. Stakeholders overseeing preceptors and residents as well as those with authority to influence decision-making for future program planning were invited to participate in semi-structured interviews. Each interview was audio-recorded, transcribed, and organized using qualitative data analysis software. Reflexive thematic analysis was applied to data synthesis, and findings were discussed through the lens of the PRECEDE logic framework. ResultsThirty-three participants were consented and de-identified. Three themes were identified: resource capacity for program sustainability; current and expected future impact on workforce development and career progression; and conflicts around uniformity, selectivity, and individual motivations. ConclusionsResearch findings affirmed program benefits to overall workforce development whilst highlighting persisting program sustainability dilemmas. Findings have highlighted the need for a cost benefit analysis of each aspect of the residency program and the importance of tailoring to individual and site differences. Several strategies were recommended to optimize resources for increased capacity, to better support residents and preceptors, and to reduce program intensity.

CE-452774-3 SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR USE IN TYPE II DIABETES MELLITUS IS ASSOCIATED WITH A LOWER RATE OF ATRIAL ARRHYTHMIAS IN A REAL-WORLD POPULATION

Sodium glucose co-transporter 2 inhibitors (SGLT2i) have been reported, in post hoc analyses of clinical trial populations, to be associated with lower rates of atrial and ventricular arrhythmias. The real-world effect on cardiac arrhythmias is unknown. We sought to determine the effects of SGLT2 inhibitors on cardiac arrhythmias in a real-world population. We conducted a retrospective cohort study to evaluate the effects of SGLT2i on cardiac arrhythmias in South Australia. Using an existing database, 882 patients with type 2 diabetes mellitus (T2DM) on oral diabetic therapy (33.6% females, median age 62.3, IQR 53.9, 68.1), who received SGLT2 inhibitors were identified through their episodes of care at South Australian public hospitals from 2011-2019, a period when SGLT2i use was predominantly limited to the treatment of T2DM. Patients were temporally matched with 3282 controls who did not receive SGLT2i. Baseline characteristics were adjusted using inverse probability treatment weighting. The quality of propensity matching was confirmed using standard difference of the means. The incidence of outcomes was determined from hospital admission ICD-10 data. Cox regression analysis was performed. SGLT2i were associated with a significantly lower rate of atrial arrhythmias (HR 0.17, 95% CI 0.07-0.40, p<0.001) at 2-years follow up. When the analysis was repeated with added standard covariates, the independent relationship between SGLT2i use and atrial arrhythmias remained. The relationship between SGLT2i use and ventricular arrhythmias (HR 0.25, 95% CI 0.06-1.02, p=0.054), or cardiac arrest (HR 0.82, 95% CI 0.19-3.43, p=0.789) did not reach statistical significance, see table 1. When tachyarrhythmias as a group were evaluated, there was a reduction associated with SGLT2i use (HR 0.32, 95% CI 0.13-0.78, p=0.011). Interestingly, all-cause mortality was higher in the SGLT2i use group (HR 2.03, 95% CI 1.56-2.56, p<0.001), despite propensity matching for known patient factors. Although this is a limitation of this non-randomised and retrospective dataset, it does suggest that the ‘sicker’ cohort were indeed receiving SGLT2i and despite this, the cohort on SGLT2i therapy had less atrial arrhythmias observed, adding to the strength of the finding. In this real-world patient cohort, SGLT2i use was associated with a lower incidence of atrial arrhythmias. Prospective randomised trials are underway to determine the effects of SGLT2i as specific AF pharmacotherapy.Tabled 1Table 1. Hazard ratio associated with SGLT2i use, compared to propensity matched group not treated with SGLT2i.Hazard Ratio with SGTL2i use (95% CI)p-valueAtrial arrhythmias0.17 (0.07-0.40)p<0.001Ventricular arrhythmias0.25 (0.06-1.02)p=0.054Cardiac arrest0.82 (0.19-3.43)p=0.789Tachyarrhythmias0.32 (0.13-0.78)p=0.011 Open table in a new tab

Variations in Patterns of Care of Rectal Cancer Patients in South Australia According to Sociodemographic Characteristics:A Registry Study

Objective. To explore variations in patterns of care over three decades for a subgroup of rectal cancer patients in South Australia according to sociodemographic characteristics. Methods. This study evaluated three decades of retrospective data from the South Australian Clinical Cancer Registry. A total of 4,131 patients diagnosed with rectal cancer between 1982 and 2015 and treated in South Australian public hospitals were included. Study outcomes were age at diagnosis, area of primary residence, cancer stage, and primary treatment (surgery, chemotherapy, or radiotherapy). Results. There was a significantly lower likelihood of conventional therapy for the elderly. Adjusted odds of receiving surgery or radiotherapy decreased by 70% and those of receiving chemotherapy by 90% in the 80+ age group, compared to the 50–59 age group. No significant variation was detected according to area-level socioeconomic status or remoteness. Conclusion. Socioeconomic factors showed little impact on the receipt of therapies for rectal cancer patients in South Australia. Variation in treatment by age, irrespective of disease stage or period of diagnosis, requires further investigation.

Hospital Acquired Complications in South Australian major public hospitals.

The prevalence of Hospital Acquired Complications (HACs) within major hospitals and intensive care units (ICUs) is often used as an indication of care quality. We performed a retrospective cohort study of acute care separations from four adult public hospitals in the state of South Australia, Australia. Data were derived from the Integrated South Australian Activity Collection (ISAAC) database, subdivided into those admitted to ICU or non-ICU (Ward) in tertiary referral or (other major) metropolitan hospitals. During the five-year study period (1 July 2013 to 30 June 2018), there were 471,934 adult separations with 65,133 HAC events reported in 43,987 (9.32%) at a mean rate of 13.8 (95% confidence interval (CI) 13.7 to 13.9) HAC events per 100 separations and 18.5 (95% CI 18.4 to 18.7) per 1000 bed days. The Ward cohort accounted for the majority (430,583 (91.2%)) of separations, in-hospital deaths (6928 (66.4%)) and HAC events (29,826 (67.8%)). The smaller ICU cohort (41,351 (8.76%)) had a higher mortality rate (8.46% versus 1.61%; P < 0.001), longer length of stay (median 10.0 (interquartile range (IQR) 6.0-18.0) days versus 4.0 (IQR 3.0-8.0) days P < 0.001), and higher HAC prevalence (62.1 (95% CI 61.3 to 62.9) versus 9.16 (95% CI 9.07 to 9.25) per 100 separations P < 0.001). Both ICU and Ward HAC prevalence rates were higher in tertiary referral than major metropolitan hospitals (P < 0.001). In conclusion, higher HAC prevalence rates in the ICU and tertiary referral cohorts may be due to high-risk patient cohorts, variable provision of care, or both, and warrants urgent clinical investigation and further research.

‘Bushfire Season’ in Australia: Determinants of Increases in Risk of Acute Coronary Syndromes and Takotsubo Syndrome

BackgroundClimate change has resulted in an increase in ambient temperatures during the summer months as well as an increase in risk of associated air pollution and of potentially disastrous bushfires throughout much of the world. The increasingly frequent combination of elevated summer temperatures and bushfires may be associated with acute increases in risks of cardiovascular events, but this relationship remains unstudied. We evaluated the individual and cumulative impacts of daily fluctuations in temperature, fine particulate matter of less than 2.5 µm (PM2.5) pollution and presence of bushfires on incidence of acute coronary syndromes and Takotsubo syndrome. MethodsFrom November 1, 2019, to February 28, 2020, all admissions with acute coronary syndromes or Takotsubo syndrome to South Australian tertiary public hospitals were evaluated. Univariate and combined associations were sought among each of 1) maximal daily temperature, 2) PM2.5 concentrations, and 3) presence of active bushfires within 200 km of the hospitals concerned. ResultsA total of 504 patients with acute coronary syndromes and 35 with Takotsubo syndrome were studied. In isolation, increasing temperature was associated (rs = 0.26, P = .005) with increased incidence of acute coronary syndromes, while there were similar, but nonsignificant correlations for PM2.5 and presence of bushfires. Combinations of all these risk factors were also associated with a doubling of risk of acute coronary syndromes. No significant associations were found for Takotsubo syndrome. ConclusionThe combination of high temperatures, presence of bushfires and associated elevation of atmospheric PM2.5 concentrations represents a substantially increased risk for precipitation of acute coronary syndromes; this risk should be factored into health care planning including public education and acute hospital preparedness.

"Trying to develop a better workforce": Stakeholders' perspectives of a practice-integrated Australian hospital pharmacist foundation residency program.

BackgroundPractice-integrated education and professional development programs (also known as residencies), have been available to pharmacists in America and the United Kingdom for many years. In 2016, the Society of Hospital Pharmacists of Australia launched Australia’s novel Foundation Residency Program to support the development of early-career pharmacists, and has been implemented across many hospitals nationally. This model was adopted by the South Australian (SA) public hospital pharmacy statewide service and was granted full accreditation. The study aimed to explore key stakeholders’ expectations and early perceptions of the structure, role and impact of the SA program and in that process, to identify key influencing factors and strategies informing future program planning and design.MethodsPurposeful sampling was adopted to recruit participants who oversee preceptors and residents, across all employment levels and pharmacy service sites. Stakeholders participated in individual semi-structured interviews. Each interview was audio-recorded and transcribed verbatim. The transcribed dataset was managed using NVivo softwareTM (version 10) and analysed using reflexive thematic analysis through the lens of the PRECEDE-PROCEED logic model framework.ResultsThirty-three staff consented to participate. Participants were de-identified with a randomly assigned code number. Three key themes were identified using reflexive thematic analysis; alignment of program goals and visions, culture shift to prioritising workforce development as core business, program structure supports focused workforce development.ConclusionsParticipants view the residency as beneficial for development of the residents, preceptors, and the hospital pharmacy workforce. The multisite structure was a strength of the program. Whilst it was acknowledged that the rotations, cross-site rotations, and research project presented challenges, they were deemed worth the investment. Overall, it was felt that incremental increases in program capacity will occur over time, as culture changes, and as investing in workforce development becomes core business. The findings have led to several key recommendations to guide program expansion.

The clinical and genetic features of hereditary pancreatitis in South Australia

ObjectiveTo characterise the clinical phenotypes and genetic variants of hereditary pancreatitis in people diagnosed in South Australia.Design, setting, participantsCross‐sectional study of people who received molecular diagnoses of hereditary pancreatitis from one of four major diagnostic services in South Australia, 1 January 2006 – 30 June 2021.Main outcome measuresGenotypic and clinical features of people with hereditary pancreatitis, including age at onset, attack frequency, pain indices, use of opioid medications, and physical and mental health impact of hereditary pancreatitis.ResultsWe identified 44 people from ten families who received molecular diagnoses of hereditary pancreatitis during 2006–21 (including 25 Indigenous people [57%] and 27 women [61%]): 36 with PRSS1, five with SPINK1, and three with PRSS1 and SPINK1 mutations (determined by whole exome sequencing). Symptom onset before the age of ten years was reported by 37 people (84%). Pancreatitis‐related pain during the preceding four weeks was described as moderate or high by 35 people (79%); 38 people regularly used opioids (86%). Fifteen patients had diabetes mellitus (34%), and eight had undergone pancreatic surgery (18%). The estimated prevalence of hereditary pancreatitis was 1.1 (95% CI, 0.72–1.4) cases per 100 000 population for non‐Indigenous and 71 (95% CI, 66–77) cases per 100 000 population for Indigenous South Australians. Among people with adult‐onset chronic pancreatitis admitted to South Australian public hospitals during 2001–2019, the proportions of Indigenous people (12%) and women (38%) were smaller than we report for hereditary pancreatitis.ConclusionThe estimated prevalence of hereditary pancreatitis in South Australia is higher than in Europe. PRSS1 gene mutations are important causes, particularly among Indigenous young people.

Syndromic surveillance to detect disease outbreaks using time between emergency department presentations.

Early warning of disease outbreaks is paramount for health jurisdictions. The objective of the present study was to develop syndromic surveillance monitoring plans from routinely collected ED data with application to detecting disease outbreaks. The study involved secondary data analysis of ED presentations to major public hospitals in Queensland and South Australia spanning 2017-2020. Monitoring plans were developed for all major Queensland and South Australian public hospitals using an adaptation of Exponentially Weighted Moving Averages - a process control method used in detecting anomalies in industrial production processes. The methods rely on setting a threshold (control limit) relating to the time between an event of interest (e.g. flu outbreak) using ED presentations as a signal to monitor. An outbreak is flagged as this time gets significantly smaller, and each event offers a decision point on whether an outbreak has occurred. The models incorporate differing levels of temporal memory to cover outbreaks of different sizes. The novel approach to real-time outbreak detection indicates outbreaks for individual hospitals coinciding with the first wave of the COVID-19 outbreak in Queensland and South Australia as well as the large 2017 and 2019 influenza seasons. Outbreak detection models demonstrate the ability to quickly flag an outbreak based on clinician-assigned ED diagnoses. An implemented syndromic surveillance approach can pick up geographic outbreaks quickly so they can be contained. Such capability can help with surveillance related to the current COVID-19 pandemic and potential future pandemics.

The Epidemiology and Burden of Childhood Chronic Pancreatitis in South Australia

To assess longitudinal, population-based data on the prevalence and impact of chronic pancreatitis in children. Administrative data linkage was used to ascertain an index cohort consisting of all individuals who had an initial diagnosis of chronic pancreatitis before age 19years in the South Australian public hospital system between June 2000 and June 2019. Age- and sex-matched controls were drawn from the general population of South Australia, children with type 1 diabetes, and children with type 2 diabetes. Main outcomes and measures included hospital visits, days in hospital, emergency department (ED) visits, intensive care unit (ICU) admissions, education comparators, and incidence and prevalence estimates. A total of 73 incident cases were identified. The crude prevalence and incidence of pediatric chronic pancreatitis were estimated at 6.8/100 000 and 0.98/100 000 per year, respectively. Of the index cohort, 24 cases (32.8%) of pediatric chronic pancreatitis were identified as occurring in children of Aboriginal and/or Torres Strait Islander descent. Compared with matched general population controls, children with chronic pancreatitis averaged 11-fold more hospital visits, 5-fold more ED visits, and 9-fold more ICU admissions; spent 10-fold more days in the hospital; and had a 2-fold higher rate of absence from school (P<.001 for all). Similarly, children with chronic pancreatitis used substantially more health resources than children with type 1 or 2 diabetes. Pediatric patients with chronic pancreatitis consume a high volume of public health services and are significantly impacted in their ability to engage in education.

Healthcare professionals\u2019 perspectives of patient and family preferences of patient place of death: a qualitative study

BackgroundHome death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient’s carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap.MethodsThirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed.ResultsTwo major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals’ perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death.ConclusionHealthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.

Appropriateness of inpatient dosing of direct oral anticoagulants for atrial fibrillation.

Direct oral anticoagulant (DOAC) use for stroke prevention in atrial fibrillation (AF) has dose reduction criteria including age, weight, serum creatinine, and creatinine clearance. There is a paucity of data for rates of inappropriate inpatient DOAC dosing in Australia. The objective was to determine the rates of inappropriate inpatient DOAC dosing in AF and identifying its associated underlying factors. We conducted a retrospective cross-sectional study from December 2013 to November 2019 across six South Australian public hospitals utilising a centralised electronic health record. Multivariate analysis was used to identify factors associated with underdosing of patients prescribed apixaban. Of 1882 inpatients, 544 (28.9 %) were inappropriately dosed. Underdosing was the most common form of inappropriate dosing with rates of 22.9 % (n = 295), 7.1 % (n = 7), and 25.1 % (n = 124) for apixaban, dabigatran, and rivaroxaban, respectively. Independent factors predictive of apixaban underdosing included higher age (adjusted odds ratio (aOR) 1.63 [95 % Confidence Interval (CI): 1.47-1.81]), higher serum creatinine (aOR 1.13 [95 % CI: 1.08-1.19]), higher total number of drugs on discharge (aOR 1.08 [95 % CI: 1.04-1.11]), and being already prescribed a DOAC on admission (aOR 1.63 [95 % CI: 1.12-2.38]). Nearly one quarter of all apixaban prescribing was inappropriately underdosed. Older patients with multimorbidity, frailty and polypharmacy present a challenge for clinicians in balancing risks of thromboembolism and bleeding. It is likely prescribers are more conservative in their apixaban dosing in this population. Clinicians should consider alternative drug regimens to avoid DOAC use at inappropriate doses at unknown safety and efficacy.

Predictors of Obstructive Sleep Apnoea (OSA) Population in the Coronary Angiogram Database of South Australia (CADOSA).

Obstructive sleep apnoea (OSA) is increasingly recognized to be a risk factor for cardiovascular disease. This study assessed the prevalence and clinical predictors of OSA in patients undergoing coronary angiography. Consecutive patients undergoing coronary angiography in South Australian public hospitals from 2015 to 2018 were included. Clinical details for consecutive patients undergoing coronary angiography in South Australian public hospitals were captured by the Coronary Angiogram Database of South Australia (CADOSA) registry staff, with OSA identified by patient report. Among the 9,885 patients undergoing coronary angiography for the investigation of chest pain, 11% (n = 1,089) were documented as having OSA. Independent clinical predictors of OSA included male gender (OR 2.22, 1.86-2.65, P < 0.001), diabetes mellitus (OR 1.84, 1.58-2.14, P < 0.001), depression (OR 1.81, 1.55-2.12, P < 0.001), prior heart failure (OR 1.63, 1.22-2.18, P = 0.001), hypertension (OR 1.61, 1.32-1.95, P ≤ 0.001), asthma (OR 1.61, 1.34-1.93, P < 0.001), not a current smoker (OR 1.60, 1.30-1.96, P < 0.001), dyslipidaemia (OR 1.46, 1.22-1.76, P < 0.001), non-acute coronary syndrome presentation (OR 1.45, 1.25-1.69, P < 0.001), chronic lung disease (OR 1.40, 1.12-1.73, P = 0.003), cerebrovascular disease (OR 1.36, 1.07-1.73, P = 0.012), non-obstructive coronary artery disease (NOCAD) (OR 1.30, 1.10-1.55, P = 0.003) and atrial fibrillation/flutter (OR 1.30, 1.06-1.60, P = 0.012). Finally, stable angina (32.1% vs 22.7%) and NOCAD (29.1% vs 26.3%, P = 0.051) were trended more common in patients with OSA versus no OSA. In addition to established risk factors for OSA, this study found NOCAD to be independent predictor of OSA; especially in those presenting with a stable angina presentation. This suggests that coronary vasomotor disorders may be associated with OSA, although further detailed studies are required.

P0049 / #710: EARLY MOBILISATION IN CRITICALLY ILL CHILDREN: DOES ROUTINE PATIENT SCREENING CHANGE PRACTICE?

Aims & Objectives: Aims and Objectives: The survival rate in Australasian PICUs has improved and with this improvement there is increased morbidity following critical illness. This demands a shift in PICU care to consider the long-term outcomes for children post critical illness. This study explored whether the routine use of an “Early Mobilisation(EM) Screening Checklist’ by medical staff would reduce patient time to mobilisation. Methods: Methods: A prospective study with historical controls was undertaken in a PICU of a South Australian public hospital. Data on time to mobilisation and patient characteristics was extracted via an unblinded case note audit of patients admitted over 5-months in 2018 for the baseline group (n=36) and over a corresponding period in 2019 for the intervention group (n=36). Time to mobilisation between groups was compared using Survival analysis. Results: Results: The intervention group were 1.3 times more likely to be mobilised, although this was not significant (p=0.33, 95% CI [0.77-2.17], Cox regression). Patients with motor impairment were 38% less likely to be mobilised (P= p=0.11, 95% CI [0.35, 1.12], Cox regression), while those who were mechanically ventilated were 44% less likely to be mobilised (p=0.03, 95% CI 0.33-0.95). Nil adverse events were reported. Conclusions: Conclusions: The absence of significant change between baseline and intervention groups may be due to the small sample size, or the number of lower acuity subjects diluting the sample. The identification of groups less likely to receive mobilisation interventions warrants further exploration. The absence of any adverse events supports that EM in PICU is safe.

South Australian Medicines Evaluation Panel in review: providing evidence-based guidance on the use of high-cost medicines in the South Australian public health system.

Objective The South Australian Medicines Evaluation Panel (SAMEP) was established in 2011 to make evidence-based recommendations on the funding of high-cost medicines in South Australian public hospitals via a high-cost medicines formulary. SAMEP represents one component of South Australia's process for state-based health technology assessment (HTA). The aim of this study was to describe the experience of SAMEP in the context of Australia's complex governance model for hospital-based care. Methods A retrospective review was conducted of the SAMEP process and outcomes of medicine evaluations. Decision summaries and meeting minutes were reviewed and reflected upon by the authors to explore the views of the SAMEP membership regarding the function of the committee and state-based HTA more broadly. Results SAMEP has reviewed 29 applications, with 14 (48%) listed on the high-cost medicines formulary. Three applications have been the subject of outcome review and confirm expectations of patient benefit. Conclusion Retrospective review of the committee experience suggests that state-based HTA as operationalised by SAMEP is feasible, provides greater equity of access to high-cost medicines in the South Australian public hospital system and allows for access with evidence development. What is known about the topic? State-based hospital funders often need to make decisions on the provision of high-cost medicines for which there is no national guidance or subsidy. Little published information exists about state-based approaches to medicines evaluation and reimbursement within public hospitals in Australia. What does this paper add? The South Australian experience demonstrates a method for states and territories to tackle the challenges of providing evidence-based access to high-cost medicines in Australian public hospitals. What are the implications for practitioners? This paper provides information for other jurisdictions considering state-based approaches to medicines evaluation and contributes to the broader literature about state-based HTA in Australia.

Cancers of the corpus uteri treated in South Australian public hospitals: Trends in clinical management and survival across three decades.

To investigate treatment and survival over three decades. Clinical registry data from three major public hospitals analysed using Kaplan-Meier product-limit estimates and multivariate proportional hazard regression to determine disease-specific survival. Five-year survival increased from 75% to 84%. The adjusted hazard ratio (HR, 95% CI) was 0.56 (0.41, 0.77) for 2010-2016 compared with 1984-1989 and was higher for: ages 80+ years; more advanced stages; poorly differentiated tumours; and complex mixed epithelial and mesenchymal tumours and sarcomas. Treatment was by surgery (92%), radiotherapy (33%), chemotherapy (12%) and hormone therapy (10%). Adjusted analyses showed radiotherapy and hormone therapy were less common from 1990 and chemotherapy more common for 2010-2016. Treatment likelihood was lower for ages ≥80years, mixed epithelial and mesenchymal tumours receiving surgery and chemotherapy, but higher for radiotherapy. Advanced cancers (FIGO stage IV) had less surgery but more non-surgical treatments. Marginal evidence presented of more hormone therapy for high socio-economic areas. Survival was equivalent to national figures for Australia and the United States, but potentially higher than for England and Wales. Cases aged 80+ years had less care and poorer survival. Findings illustrate the complementary roles of hospital and population-based registries in local service evaluation.

Estimating the utilisation of unregistered antimicrobials in Australia.

To identify and estimate the usage of unregistered antimicrobial drugs in Australian clinical practice. A descriptive pharmaco-epidemiological study, utilising three data sources: analysis of Special Access Scheme (SAS) applications for unregistered antimicrobials included in clinical guidelines over a five year period, analysis of antimicrobials dispensed from South Australian public hospital pharmacy departments over a two year period and analysis of National Antimicrobial Utilisation Surveillance Program (NAUSP) data for reported inpatient usage of unregistered antimicrobials in Australian hospitals over the last 5 years. 59 unregistered antimicrobials were identified using the mixed methods. 18,362 Special Access Scheme applications were submitted between May 2012 and April 2017 to access the 20 unregistered antimicrobials identified in the Therapeutic Guidelines® (eTG complete); 51.4% were determined by the prescriber to be for life-threatening indications. Annual applications more than doubled over the five years. 34 unregistered antimicrobials were dispensed from South Australian public hospitals between July 2015 and June 2017. On average, 1.1% of total antimicrobial usage (Defined Daily Doses) per month was accessed via the SAS, of which 87.7% were for outpatients or discharged patients. 34 unregistered antimicrobials for systemic use identified in the NAUSP database were used in Australian hospitals between 2013 and 2018. The use of unregistered antimicrobials in Australian clinical practice is not uncommon. With increasing antimicrobial resistance, there will be a continued reliance on older less-used antimicrobial agents and an increasing need for novel drugs, therefore regulatory pathways need to facilitate security of supply and assurance of medicine quality and safety.

551 Sex Differences in the Chest Pain Characteristics of Acute Myocardial Infarction Patients: Insights From the CADOSA Registry

There is limited data evaluating chest pain characteristics in men and women experiencing an acute myocardial infarction (AMI). This study assessed the chest pain features in consecutive AMI patients undergoing coronary angiography. All consecutive AMI patients in South Australian public hospitals enrolled in the CADOSA (Coronary Angiogram Database of South Australia) Registry between 2012-16 were included. Comparison of chest pain symptoms, precipitating factors, relieving factors and associated symptoms between women and men were performed using age-adjusted logistic regression. Below are the findings from 10,738 consecutive patients (mean age 64±14 years, 29% women, 40% STEMI. There are sex-differences in the chest pain characteristics of AMI patients, which may potentially impact on clinical diagnosis.

Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year follow-up of the North West Adelaide Health Study

IntroductionStudies examining potential factors of all-cause mortality comprehensively at community level are rare. Using long-term community-based follow-up study, we examined the association of sociodemographic and behavioural characteristics, metabolic and chronic...

Impact of Cardiac Rehabilitation on Late Clinical Outcomes: Non–Attenders Versus Attenders On Behalf of the South Australian Public Hospital Cardiac Rehabilitation Service Providers

Impact of Cardiac Rehabilitation on Late Clinical Outcomes: Non–Attenders Versus Attenders On Behalf of the South Australian Public Hospital Cardiac Rehabilitation Service Providers