Treatment In Australia Research Articles

An in-Depth Exploration of Consumer and Consumer Representative Views on Chronic Pain Management in Australia: A Key Informant Interview Study

Chronic pain affects millions of Australians. Despite guidelines recommending non-pharmacological approaches as the first line treatment, opioid medications remain among the most common treatments. This study interviewed consumers and consumer representatives (i.e., representatives of peak pain advocacy organizations in Australia) to gain first-hand perspectives on chronic pain treatment in Australia. Individual semi-structured Key Informant Interviews (KIIs) with three consumers and three representatives were undertaken. Interviews were transcribed, and thematic analysis applied. Results showed that consumers and consumer representatives identified critical treatment access barriers. Another shared theme related to overarching principles of care, with sub-themes pertaining to the need for an interdisciplinary approach and pain education. A further shared theme focused on typical medical interventions, with one shared subtheme regarding the benefits and drawbacks of pain medications. Both groups highlighted the importance of a biopsychosocial approach with consideration of mental health, particularly related to perceived stigma and comorbidities. These findings highlight that chronic pain remains both undertreated and inadequately treated in Australia. There is a critical need to use novel approaches to overcome access barriers and stigma, and to advance precision medicine to match patients to the treatment most likely to be of benefit as early as possible in their journey.

Clinical profiles of people enrolling in alcohol and other drug treatment in Australia: Do youth differ from young adults and adults?

To examine and compare age groups on socio-demographic, substance use, mental health, social and risk behaviour profiles of people entering alcohol and other drug (AOD) treatment in a large non-government organisation (NGO) in Queensland and New South Wales, Australia. Design-Cross-sectional study; analysis of baseline routine outcome measures (ROM) and AOD minimum datasets for drug and alcohol treatment services. Setting and participants-People enrolling in Lives Lived Well, a large NGO AOD service between November 2020 and October 2022. Main outcome measures-Socio-demographic, substance use, mental health, social factors and risk behaviours, by youth (≤24 years), young adults (25-35 years) and adults (>35 years). Between November 2020 and October 2022, 9413 clients enrolled in Lives Lived Well (LLW) AOD services and completed baseline ROMs. Over one-fifth (21.9%) were youth (n = 2066), one-third (32.4%) were young adults (n = 3052) and just under half (45.6%) were adults >35 years (n = 4295). The most common primary drug of concern was cannabis for youth, methamphetamine for young adults and alcohol for adults >35 years. Nearly two-thirds (61.3%) reported moderate to severe symptoms of depression and 55.0% reported moderate to severe anxiety. Just under half (47.2%) screened positive for PTSD and two-in-five (40.4%) reported recent suicidal ideation. Co-occurring mental health symptoms were more common in youth compared with young adults and adults >35 years. Co-occurring mental health symptoms were high in the sample, particularly among youth. All age groups present with unique and complex socio-demographic and clinical profiles that are important to understand to provide the most appropriate and effective treatment.

Modelling and comparing the use of IVF and ICSI in Australia

PurposeThis study estimates the need of IVF/ICSI in Australia as compared to its actual uptake.MethodsWe created a model estimating for the annual demand for IVF/ICSI in a hypothetical infertile population, using demographic data from medical literature and Australian government databases. For each category of infertility (tubal, severe male, endometriosis, anovulation and unexplained), our estimated need for IVF/ICSI was compared to the actual IVF/ICSI uptake (ANZARD 2019). The model consisted of three categories depending on couples’ cause of infertility, i.e. couples with absolute indications for IVF/ICSI (couples with severe male factor infertility and tubal obstruction); couples with anovulatory infertility (couples with ovulation disorders) and couples with ovulatory infertility (couples suffering from unexplained infertility and endometriosis). The model was applied to each of these categories to determine the number of couples that would require IVF/ICSI treatment after failing to conceive naturally or after following alternative treatment plans. The main outcomes of this study were the estimate of IVF/ICSI cycles and the difference between the estimate and the reported number of IVF/ICSI cycles (2019 ANZARD report).ResultsWe estimated that approximately 35,300 couples required IVF/ICSI treatment in Australia in 2019, while in 2019 according to ANZARD, 46,000 couples underwent IVF/ICSI. A higher uptake of IVF/ICSI cycles than expected was specifically reported in couples with unexplained infertility, ovulation disorders and endometriosis, while for tubal and severe male infertility uptake seemed adequate.ConclusionIn Australia, there seems to be overservicing of IVF/ICSI, specifically for unexplained, ovulatory and endometriosis-related infertility.

Patient preferences for prophylactic regimens requiring regular injections in children and adolescents: a systematic review and thematic analysis

BackgroundAt present, limited literature exists exploring patient preferences for prophylactic treatment of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Given low treatment completion rates to this treatment in...

Supporting interdisciplinary mental health professionals through online professional development: eleven years of the MHPN webinar program in Australia

ABSTRACT Objective The Mental Health Professionals’ Network (MHPN) has been delivering webinars for professionals working in primary mental health care in Australia since 2010. This study aimed to investigate changes in engagement in and outcomes of MHPN webinars over 11 years from 2010 to 2020. Method Over 11-years, 75 webinars were delivered by a multi-disciplinary panel of mental health professionals, using a case-study format to stimulate discussion of collaborative care. Attendees were invited to complete a post-webinar online questionnaire to assess webinar effectiveness and impacts on work practice. Change over time was assessed using chi-square tests and analysis of variance. Results From 53,468 webinar attendances, 30,617 (57.3%) questionnaires were collated and analysed. There was a steady and significant increase in webinar attendance over time. The degree to which learning needs were met increased significantly over time, as did the relevance of the webinars and their anticipated impacts on improving work practice. Discussion The findings indicate that practitioner engagement in MHPN webinars and the associated positive impacts on work practice have both increased over the past decade. By improving the knowledge, attitudes and practice of mental health professionals, MHPN plays an important role in improving mental health promotion, prevention, early detection and treatment in Australia.

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia.

Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.

Variation in approaches to acute ANCA-associated vasculitis in Australia and New Zealand: rituximab, plasma exchange and glucocorticoids.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease which is managed by a range of specialities. There are limited data on treatment practices in Australia and New Zealand. To understand current patterns of acute AAV treatment in Australia and New Zealand. An online survey was conducted between July and October 2022 investigating physicians' views on the management of AAV, focusing on induction therapy. The survey contained questions pertaining to access to treatment and responses to clinical management scenarios. Eosinophilic granulomatosis with polyangiitis was not included. A chi-squared test of independence was performed for statistical analysis. From a total of 55 responses, plasma exchange was difficult to access for 44% of respondents, more so in rural centres, and they also had difficulty accessing infusion centres. New Zealand clinicians had more difficulty accessing rituximab, with only 44% reporting easy access compared with Australian clinicians (93%). With clinical management scenarios, there was variation in the dosing regimen of glucocorticoids and initiation of plasma exchange, with 42% of respondents prescribing a glucocorticoid regimen different from the standard of care, the 'reduced-dose' arm of the Plasma Exchange and Glucocorticoids for the Treatment of ANCA-Associated Vasculitis trial. The choice of cyclophosphamide or rituximab for induction therapy was based on patient characteristics and medical history. There is substantial variation in approaches to the acute management of AAV in Australia and New Zealand, including differences in resource availability. This variation in care demonstrates the need to implement current practice guidelines and institute contemporary monitoring of AAV management, to achieve best patient outcomes.

Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices.

Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. Appraise the clinical quality of the Australian treatment access criteria. The Fabry Australia Medical Advisory Committee (N = 6) used the Appraisal of Guidelines for REsearch and Evaluation Global Rating Scale (AGREE II GRS) to assess the clinical quality of the current treatment eligibility criteria. They reviewed the literature, developed 17 clinical statements to help guide reforms of the eligibility criteria and achieved consensus (achievement of ≥75% agreement in the range 5-7 on a 7-point Likert scale) through anonymous voting. The findings were applied to develop proposals for revised classification and treatment initiation criteria. The current treatment eligibility criteria underperformed on the AGREE II GRS. They are pragmatic but out-of-step with contemporary data. Consensus was achieved on all 17 proposed clinical statements. There was strong agreement to differentiate classical male Fabry patients to facilitate timelier access to Fabry-specific treatment. There was also agreement on the value of adopting relevant organ involvement criteria in classical female patients and patients with non-classical disease. Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.

Development of psycho-oncology telehealth guidelines: a modified Delphi consensus study

Abstract Objective: In response to COVID-19, psycho-oncology clinicians moved to a model of telephone and videoconference treatment in Australia. The Psycho-oncology Co-operative Research Group (PoCoG) identified a paucity of evidence available to guide adaptation of therapy for remote delivery. This research aimed to develop consensus for evidence-based guidelines on ways to adapt psychological therapies in psycho-oncology for remote delivery. Methods: A national expert advisory group (N = 11) was convened consisting of psycho-oncology clinicians and clinical researchers. An iterative codesign methodology was used to draft psycho-oncology telehealth guidelines. Australian psycho-oncology clinicians participated in a Delphi consensus process to guide the content included in the guidelines. Content was presented under six domains: (i) screening and outcome measures, (ii) formulation, (iii) safety considerations, (iv) resource adaptation, (v) adaptations to therapy, and (vi) example case studies. Participants rated items based on importance, therapeutic appropriateness, and/or usefulness. Consensus was defined as >80% agreement. Results: Thirty-two psycho-oncology clinicians with telehealth experience participated in three Delphi rounds. Agreement was reached on (i) the importance of including screening and outcome measures (90%) and items (n = 5) related to how best to facilitate this; (ii) the importance of addressing provision of a formulation (100%), although only 2/6 strategies presented to facilitate formulation reached consensus; (iii) the appropriateness of proposed risk assessment and management strategies (84%); (iv) therapeutic appropriateness of simplifying resources (100%), including 3/5 visual optimization strategies; and (v) common behavioral components of therapy (n=5). Conclusions: Providing guidance to psycho-oncology clinicians for integrating telehealth into routine clinical practice must go beyond logistical considerations. These consensus-based guidelines provide support to clinicians for adaptation of psycho-oncology therapy to telehealth and will ensure evidence-based practice.

PP87 Glecaprevir/pibrentasvir (Maviret®) Remains A Cost-effective Treatment For Chronic Hepatitis C Virus Infection After Changes To The Treated Population

IntroductionThe first direct-acting antiviral (DAA) therapies for chronic Hepatitis C virus (HCV) infection were reimbursed via Australia’s Pharmaceutical Benefits Scheme (PBS) in March 2016. This was based on the recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) that the regimens would be acceptably cost-effective at an incremental cost-effectiveness ratio (ICER) of AUD15,000/quality-adjusted life-year (QALY). Broad access to DAA therapies has been a key strategy in driving a national health goal to eliminate viral hepatitis as a major health threat by 2030. Since the initial PBS listings for DAA therapies and subsequent listings of newer DAA treatments such as Maviret, the demographics and disease characteristics of currently treated patients have markedly changed. The aim of our analysis was to reassess the cost-effectiveness of Maviret, accounting for the changes of the treated population characteristics and retreatment in first-line failures and reinfected individuals.MethodsTo assess the cost-effectiveness six years after initial listing of Maviret, an update was made to the Markov model used to achieve PBS reimbursement for Viekira-Pak® in May 2016. Amendments to the Viekira-Pak model include: changes to baseline age and fibrosis distribution of treated patients, and incorporation of retreatment of first-line failures (those not achieving a sustained virologic response (SVR)) and reinfected individuals. Treatment-related inputs including SVR response rates, adverse events, treatment-related disutility and discontinuations were sourced from pivotal glecaprevir/pibrentasvir clinical trials.ResultsUsing the published price of Maviret, the ICER is above AUD15,000/QALY but well below the commonly used ICER threshold in other chronic diseases (AUD45,000/QALY). When the confidential effective price is used, the ICER is under the AUD15,000/QALY cost-effectiveness threshold set by the PBAC for DAA therapies.ConclusionsDespite substantial changes to the population seeking treatment in Australia since reimbursement in 2016, Maviret remains a cost-effective treatment for chronic HCV infection.

Trends in use of medicines for opioid agonist treatment in Australia, 2013–2022

BackgroundThere are limited longitudinal data on national patterns of opioid agonist treatment (OAT). This study describes 10-year trends in the sales of OAT medicines in Australia. MethodsA descriptive and time-series analysis of methadone, sublingual (SL) buprenorphine (+/−naloxone), and long-acting injectable (LAI) buprenorphine sold in Australia between 2013 and 2022 was performed. Total units sold were converted into an estimate of the number of clients that could be treated over a 28-day period with that amount of medicine (‘client-months’). ResultsBetween January 2013 and December 2022, the estimated number of client-months on: any OAT increased by 50 % to 53,501, methadone decreased (−8.5%), SL buprenorphine increased (+78%), and LAI buprenorphine increased substantially after September 2019. In January 2013, 78 % of OAT client-months received methadone. By December 2022, 48 % received methadone, 26 % SL buprenorphine, and 26 % LAI buprenorphine. Between 2013 to 2022, OAT client-months per capita were highest in the state of New South Wales. Over the study period, greater increases in OAT were observed in very remote areas (88%) compared to major cities (53%). The number of client-months in non-community pharmacy settings remained stable from 2013 to 2019/20, before increasing markedly. The introduction of LAI buprenorphine was associated with an immediate, sustained increase of 1,636 OAT client-months, and further increases of 190 OAT client-months each month. ConclusionPatterns of OAT have shifted over the last 10-years with buprenorphine (SL/LAI) now the most common OAT used in Australia. The introduction of LAI buprenorphine has expanded OAT access, particularly in non-community pharmacy settings, and in remote areas.

Abstract 239: Effects of the COVID‐19 Pandemic on Stroke Treatment in Australia

Introduction In Australia, stroke is one of the leading causes of mortality, death, and disability (Kitsos et al., 2011; Coory et al. 2002). Although Australia has been known to offer excellent stroke treatment and care services in recent years (Deloitte Access Economics, 2020), the rise of the COVID‐19 pandemic caused a reduction in resource availability and delays in stroke treatment. Therefore, we studied the impact that the COVID‐19 pandemic had on stroke treatment in hospitals all over the country. Methods Initially, we conducted secondary research on stroke treatment in Australia. Using this information, we created a survey inquiring more about the COVID‐19 pandemic’s effect on stroke treatment from the physician's perspective. We also focused on inquiring about the disparities in access to stroke care for urban and rural regions in Australia. We compiled a list of clinical and academic neurologists and subsequently distributed the survey to them. We received a total of 4 survey responses from neurologists and additional supplementary information from 2 other neurologists. We also reached out to leaders of stroke support groups to learn more about stroke rehabilitation services and how the pandemic affected them. Furthermore, we conducted one interview with a support group leader from Melbourne, Victoria. Results Based on the survey results and interview, we believe that the main barrier affecting stroke treatment due to the pandemic was reductions in resource availability (including beds, general anesthesia, etc.). In addition, the hospital admission rate of stroke patients decreased during the initial stages of the pandemic in 2020. Some physicians mentioned that this may have been due to patients' fear of receiving care in hospitals that were prioritizing treatment of COVID‐19 rather than stroke. Survey responses indicated that physicians working in urban hospitals observed minor effects on stroke treatment due to the pandemic. However, urban hospitals, benefiting from Australia's advanced stroke treatment, generally managed to withstand these challenges. Although there may be multiple reasons for this, a major reason one of the neurologists mentioned was a lack of politicization regarding public health precautions, which contributed to the initial stages of the pandemic not being as detrimental to Australia as it was in other parts of the world. Conclusion Overall, the pandemic did not have a major effect on stroke treatment in Australia. Compared to before the pandemic, both stroke cases and stroke treatment numbers remained relatively the same. The most prominent effect was the reduction in resources for patients as well as healthcare workers. Patient concern about healthcare availability increased, and the number of patients reporting stroke concerns decreased. However, overall, because of Australia’s advanced treatment services, the COVID‐19 impact on stroke treatment was not significant. Due to the low impact COVID‐19 had on stroke treatment in Australia, we have shifted our interest to studying how stroke treatment in Australia has changed over the last 5 years to better understand changes that predated and currently exist after COVID‐19.

Rethinking the national quality framework: Improving the quality and safety of alcohol and other drug treatment in Australia

AbstractThe national quality framework (NQF) has been implemented to improve the safety and quality of alcohol and other drug (AOD) treatment and provide a nationally consistent approach to treatment quality in Australia. At the same time, concerns have been raised that, in the absence of appropriate regulatory structures to support the NQF, the quality and safety of AOD treatment services cannot be guaranteed in Australia. An effective enforcement strategy is critical to the ability of the NQF to provide a nationally consistent approach to the delivery of AOD treatment in Australia. The monitoring and enforcement strategy proposed by the NQF encompasses two different mechanisms. For specialist AOD treatment providers in receipt of government funding, monitoring and enforcement of the NQF will occur via contractual arrangements. For providers not in receipt of government funding, monitoring and enforcement will be managed by regulatory mechanisms as decided by each jurisdiction. This proposed enforcement strategy raises the question of whether contractual arrangements are the most effective mechanism for monitoring and enforcing the NQF in publicly funded specialist AOD treatment providers. This paper considers whether a licensing regime may address the shortcomings that arise from the proposed strategy. It argues that the pluralistic approach to the monitoring and enforcement of the NQF will result in substantive differences in how the NQF is enforced both within individual jurisdictions and on a broader national level. A licensing regime, therefore, would be a more appropriate monitoring and enforcement strategy.

Land Application of Biosolids-Derived Biochar in Australia: A Review

Thermal treatment in Australia is gaining interest due to legislative changes, waste reduction goals, and the need to address contaminants’ risks in biosolids used for agriculture. The resulting biochar product has the potential to be beneficially recycled as a soil amendment. On-farm management practices were reviewed to identify barriers that need to be overcome to increase recycling and examine the role of pyrolysis and gasification in effectively improving the quality and safety of biochar intended for land application. Key findings revealed the following: (1) thermal treatment can effectively eliminate persistent organic pollutants, microplastics, and pathogens, and (2) more than 90% of the total heavy metals content in biosolids may become immobilized when these are converted to biochar, thus reducing their bioavailability following land application. While the reported research on the short-term effects of biosolids-derived biochar suggests promising agronomic results, there is a dearth of information on long-term effects. Other knowledge gaps include the optimization of land application rates, understanding of the rate of breakdown, and the fate of contaminants in soil and water, including heavy metal mobility and redistribution in the environment by processes such as erosion and runoff following land application. An improved understanding of nutrients and contaminants dynamics in soils receiving biosolids-derived biochar is a pre-requisite for their safe use in Australian agriculture, and therefore, it is highlighted as a priority area for future research.

Methamphetamine dependence in Australia–why is ‘ice’ (crystal meth) so addictive?

Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia.

Evaluating informal caregivers’ needs in managing medicines for people receiving cancer treatment in Australia

Evaluating informal caregivers’ needs in managing medicines for people receiving cancer treatment in Australia

Development and Validation of txSim: A Model of Advanced Lung Cancer Treatment in Australia.

Since 2016, new therapies have transformed the standard of care for lung cancer, creating a need for up-to-date evidence for health economic modelling. We developed a discrete event simulation of advanced lung cancer treatment to provide estimates of survival outcomes and healthcare costs in the Australian setting that can be updated as new therapies are introduced. Treatment for advanced lung cancer was modelled under a clinician-specified treatment algorithm for Australia in 2022. Prevalence of lung cancer subpopulations was extracted from cBioPortal and the Sax Institute's 45 and Up Study, a large prospective cohort linked to cancer registrations. All costs were from the health system perspective for the year 2020. Pharmaceutical and molecular diagnostic costs were obtained from public reimbursement fees, while other healthcare costs were obtained from health system costs in the 45 and Up Study. Treatment efficacy was obtained from clinical trials and observational study data. Costs and survival were modelled over a 10-year horizon. Uncertainty intervals were generated with probabilistic sensitivity analyses. Overall survival predictions were validated against real-world studies. Under the 2022 treatment algorithm, estimated mean survival and costs for advanced lung cancer 10years post-diagnosis were 16.4months (95% uncertainty interval [UI]: 14.7-18.1) and AU$116,069 (95% UI: $107,378-$124,933). Survival and costs were higher assuming optimal treatment utilisation rates (20.5 months, 95% UI: 19.1-22.5; $154,299, 95% UI: $146,499-$161,591). The model performed well in validation, with good agreement between predicted and observed survival in real-world studies. Survival improvements for advanced lung cancer have been accompanied by growing treatment costs. The estimates reported here can be used for budget planning and economic evaluations of interventions across the spectrum of cancer control.

Provider responses to the expansion of public subsidies in healthcare: The case of oral chemotherapy treatment in Australia

We examine provider responses to the expansion of public subsidies in 2015 for innovative oral chemotherapy treatment, in a health system where providers were free to determine their own prices. The new treatment was known to have similar efficacy to its traditional intravenous alternative and was preferred by patients for its at-home administration. However, from a policymaker's perspective, the potential for misalignment between patient and provider preferences was significant given the shift to full reimbursement for the oral chemotherapy medication but no change in fee-for-service payments for associated chemotherapy services. Under this scenario, a shift away from traditional intravenous chemotherapy may entail reduced activity and revenues associated with infusions for providers, and we hypothesise that it may result in unintended policy consequences such as reduced take-up of the new therapy or higher prices. We implement a difference-in-difference model using national administrative data on services provided, and chemotherapy medications prescribed, by providers to 1850 patients in New South Wales, Australia. Our estimates indicate that the subsidies expanded access to oral chemotherapy for newly eligible patients by 15 percentage points. However, prices charged by providers for an episode of care rose by 23 percent, driven mostly by increases in service volumes. The results illustrate the importance of understanding differential provider responses to policy changes in financial incentives.

Deimplementation in the provision of opioid agonist treatment to achieve equity of care for people engaged in treatment: a qualitative study

BackgroundDeimplementation, the removal or reduction of potentially hazardous approaches to care, is key to progressing social equity in health. While the benefits of opioid agonist treatment (OAT) are well-evidenced, wide variability in the provision of treatment attenuates positive outcomes. During the COVID-19 pandemic, OAT services deimplemented aspects of provision which had long been central to treatment in Australia; supervised dosing, urine drug screening, and frequent in-person attendance for review. This analysis explored how providers considered social inequity in health of patients in the deimplementation of restrictive OAT provision during the COVID-19 pandemic.MethodsBetween August and December 2020, semi-structured interviews were conducted with 29 OAT providers in Australia. Codes relating to the social determinants of client retention in OAT were clustered according to how providers considered deimplementation in relation to social inequities. Normalisation Process Theory was then used to analyse the clusters in relation to how providers understood their work during the COVID-19 pandemic as responding to systemic issues that condition OAT access.ResultsWe explored four overarching themes based on constructs from Normalisation Process Theory: adaptive execution, cognitive participation, normative restructuring, and sustainment. Accounts of adaptive execution demonstrated tensions between providers’ conceptions of equity and patient autonomy. Cognitive participation and normative restructuring were integral to the workability of rapid and drastic changes within the OAT services. Key transformative actors included communities of practice and “thought leaders” who had long supported deimplementation for more humane care. At this early stage of the pandemic, providers had already begun to consider how this period could inform sustainment of deimplementation. When considering a future, post-pandemic period, several providers expressed discomfort at operating with “evidence-enough” and called for narrowly defined types of data on adverse events (e.g. overdose) and expert consensus on takeaway doses.ConclusionsThe possibilities for achieving social equity in health are limited by the divergent treatment goals of providers and people receiving OAT. Sustained and equitable deimplementation of obtrusive aspects of OAT provision require co-created treatment goals, patient-centred monitoring and evaluation, and access to a supportive community of practice for providers.

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers

IntroductionPeople with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. ObjectiveTo explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. Materials and MethodsAn online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. Results59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. ConclusionIndividualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.