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Fahridin S, Agarwal N, Bracken K, Law S, Morton RL. The use of linked administrative data in Australian randomised controlled trials: A scoping review. Clin Trials 2024; 21:516-525. [PMID: 38305216 PMCID: PMC11304639 DOI: 10.1177/17407745231225618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND/AIMS The demand for simplified data collection within trials to increase efficiency and reduce costs has led to broader interest in repurposing routinely collected administrative data for use in clinical trials research. The aim of this scoping review is to describe how and why administrative data have been used in Australian randomised controlled trial conduct and analyses, specifically the advantages and limitations of their use as well as barriers and enablers to accessing administrative data for use alongside randomised controlled trials. METHODS Databases were searched to November 2022. Randomised controlled trials were included if they accessed one or more Australian administrative data sets, where some or all trial participants were enrolled in Australia, and where the article was published between January 2000 and November 2022. Titles and abstracts were independently screened by two reviewers, and the full texts of selected studies were assessed against the eligibility criteria by two independent reviewers. Data were extracted from included articles by two reviewers using a data extraction tool. RESULTS Forty-one articles from 36 randomised controlled trials were included. Trial characteristics, including the sample size, disease area, population, and intervention, were varied; however, randomised controlled trials most commonly linked to government reimbursed claims data sets, hospital admissions data sets and birth/death registries, and the most common reason for linkage was to ascertain disease outcomes or survival status, and to track health service use. The majority of randomised controlled trials were able to achieve linkage in over 90% of trial participants; however, consent and participant withdrawals were common limitations to participant linkage. Reported advantages were the reliability and accuracy of the data, the ease of long term follow-up, and the use of established data linkage units. Common reported limitations were locating participants who had moved outside the jurisdictional area, missing data where consent was not provided, and unavailability of certain healthcare data. CONCLUSIONS As linked administrative data are not intended for research purposes, detailed knowledge of the data sets is required by researchers, and the time delay in receiving the data is viewed as a barrier to its use. The lack of access to primary care data sets is viewed as a barrier to administrative data use; however, work to expand the number of healthcare data sets that can be linked has made it easier for researchers to access and use these data, which may have implications on how randomised controlled trials will be run in future.
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Affiliation(s)
- Salma Fahridin
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Neeru Agarwal
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Law
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Barbosa MM, Dos Santos AJM, Galli N, Vidal RVC, Grande GHD, Oliveira CB. Perceptions of medical doctors and patients about imaging for people with low back pain: A qualitative study. PM R 2024. [PMID: 38984505 DOI: 10.1002/pmrj.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Low-value care is the use of substitutive/ineffective/harmful strategies based on available evidence, and it is considered one of the main contributors to the burden related to low back pain in health care systems. The use of routine imaging for patients with low back pain is the main example of inappropriate care. Therefore, understanding the perceptions of medical doctors and patients from Brazil about this practice may help propose strategies to reduce imaging rates. OBJECTIVE To investigate the perceptions of medical doctors and patients about imaging for the diagnosis of nonspecific low back pain. DESIGN A qualitative study using the framework analysis method. SETTINGS Primary and secondary care. PARTICIPANTS Fifteen patients with low back pain and 15 doctors participated in this study. DATA COLLECTION Sociodemographic data were collected from all participants, and the interviews were performed using a set of questions created based on the literature. MAIN RESULTS Patients and doctors believe that the main reason for ordering imaging tests is to identify the source of pain, and imaging could be useful for tracking disease progression over time or if there is a lack of improvement after treatment. Patients' expectations and pressures play a role in the decision to order imaging tests, but clinicians believe that education is the preferred strategy to reduce imaging rates. CONCLUSION Identifying the source of pain, tracking the disease progression, and patients' expectations and pressures were the main drivers of imaging requests for low back pain. Educational strategies were suggested to reduce the use of routine imaging.
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Affiliation(s)
- Mariana M Barbosa
- University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | | | - Nilva Galli
- University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Rubens V C Vidal
- University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Guilherme H D Grande
- University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
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Alves GS, Vera GEZ, Maher CG, Ferreira GE, Machado GC, Buchbinder R, Pinto RZ, Oliveira CB. Clinical care standards for the management of low back pain: a scoping review. Rheumatol Int 2024; 44:1197-1207. [PMID: 38421427 PMCID: PMC11178557 DOI: 10.1007/s00296-024-05543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The objective of this study is to compare and contrast the quality statements and quality indicators across clinical care standards for low back pain. Searches were performed in Medline, guideline databases, and Google searches to identify clinical care standards for the management of low back pain targeting a multidisciplinary audience. Two independent reviewers reviewed the search results and extracted relevant information from the clinical care standards. We compared the quality statements and indicators of the clinical care standards to identify the consistent messages and the discrepancies between them. Three national clinical care standards from Australia, Canada, and the United Kingdom were included. They provided from 6 to 8 quality statements and from 12 to 18 quality indicators. The three standards provide consistent recommendations in the quality statements related to imaging, and patient education/advice and self-management. In addition, the Canadian and Australian standards also provide consistent recommendations regarding comprehensive assessment, psychological support, and review and patient referral. However, the three clinical care standards differ in the statements related to psychological assessment, opioid analgesics, non-opioid analgesics, and non-pharmacological therapies. The three national clinical care standards provide consistent recommendations on imaging and patient education/advice, self-management of the condition, and two standards (Canadian and Australian) agree on recommendations regarding comprehensive assessment, psychological support, and review and patient referral. The standards differ in the quality statements related to psychological assessment, opioid prescription, non-opioid analgesics, and non-pharmacological therapies.
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Affiliation(s)
- Gabriel S Alves
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Gustavo E Z Vera
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rafael Z Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil.
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Badejo O, Saleeb M, Hall A, Furlong B, Logan GS, Gao Z, Barrett B, Alcock L, Aubrey-Bassler K. Audit and feedback to change diagnostic image ordering practices: A systematic review and meta-analysis. PLoS One 2024; 19:e0300001. [PMID: 38837994 DOI: 10.1371/journal.pone.0300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/19/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Up to 30% of diagnostic imaging (DI) tests may be unnecessary, leading to increased healthcare costs and the possibility of patient harm. The primary objective of this systematic review was to assess the effect of audit and feedback (AF) interventions directed at healthcare providers on reducing image ordering. The secondary objective was to examine the effect of AF on the appropriateness of DI ordering. METHODS Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registry on December 22nd, 2022. Studies were included if they were randomized control trials (RCTs), targeted healthcare professionals, and studied AF as the sole intervention or as the core component of a multi-faceted intervention. Risk of bias for each study was evaluated using the Cochrane risk of bias tool. Meta-analyses were completed using RevMan software and results were displayed in forest plots. RESULTS Eleven RCTs enrolling 4311 clinicians or practices were included. AF interventions resulted in 1.5 fewer image test orders per 1000 patients seen than control interventions (95% confidence interval (CI) for the difference -2.6 to -0.4, p-value = 0.009). The effect of AF on appropriateness was not statistically significant, with a 3.2% (95% CI -1.5 to 7.7%, p-value = 0.18) greater likelihood of test orders being considered appropriate with AF vs control interventions. The strength of evidence was rated as moderate for the primary objective but was very low for the appropriateness outcome because of risk of bias, inconsistency in findings, indirectness, and imprecision. CONCLUSION AF interventions are associated with a modest reduction in total DI ordering with moderate certainty, suggesting some benefit of AF. Individual studies document effects of AF on image order appropriateness ranging from a non-significant trend toward worsening to a highly significant improvement, but the weighted average effect size from the meta-analysis is not statistically significant with very low certainty.
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Affiliation(s)
- Oluwatosin Badejo
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Maria Saleeb
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
- Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Gabrielle S Logan
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Brendan Barrett
- Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Lindsay Alcock
- Health Sciences Library, Memorial University of Newfoundland and Labrador, Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
- Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
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Verdini NP, Gelblum DY, Vertosick EA, Ostroff JS, Vickers AJ, Gomez DR, Gillespie EF. Evaluating a Physician Audit and Feedback Intervention to Increase Clinical Trial Enrollment in Radiation Oncology in a Multisite Tertiary Cancer Center: A Randomized Study. Int J Radiat Oncol Biol Phys 2024; 119:11-16. [PMID: 37769853 DOI: 10.1016/j.ijrobp.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Clinical trial participation continues to be low, slowing new cancer therapy development. Few strategies have been prospectively tested to address barriers to enrollment. We investigated the effectiveness of a physician audit and feedback report to improve clinical trial enrollment. METHODS AND MATERIALS We conducted a randomized quality improvement study among radiation oncologists at a multisite tertiary cancer network. Physicians in the intervention group received quarterly audit and feedback reports comparing the physician's trial enrollments with those of their peers. The primary outcome was trial enrollments. RESULTS Among physicians randomized to receive the feedback report (n = 30), the median proportion of patients enrolled during the study period increased to 6.1% (IQR, 2.6%-9.3%) from 3.2% (IQR, 1.1%-10%) at baseline. Among those not receiving the feedback report (n = 29), the median proportion of patients enrolled increased to 4.1% (IQR, 1.3%-7.6%) from 1.6% (IQR, 0%-4.1%) at baseline. There was a nonsignificant change in the proportion of enrollments associated with receiving the feedback report (-0.6%; 95% CI, -3.0% to 1.8%; P = .6). Notably, there was an interaction between baseline trial accrual and receipt of feedback reports (P = .005), with enrollment declining among high accruers. There was an increase in enrollment throughout the study, regardless of study group (P = .001). CONCLUSIONS In this study, a positive effect of physician audit and feedback on clinical trial enrollment was not observed. Future efforts should avoid disincentivizing high accruers and might consider pairing feedback with other patient- or physician-level strategies. The increase in trial enrollment in both groups over time highlights the importance of including a comparison group in quality improvement studies to reduce confounding from secular trends.
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Affiliation(s)
- Nicholas P Verdini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jamie S Ostroff
- Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Oncology, University of Washington, Seattle, Washington.
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Gillespie EF, Santos PMG, Curry M, Salz T, Chakraborty N, Caron M, Fuchs HE, Ledesma Vicioso N, Mathis N, Kumar R, O’Brien C, Patel S, Guttmann DM, Ostroff JS, Salner AL, Panoff JE, McIntosh AF, Pfister DG, Vaynrub M, Yang JT, Lipitz-Snyderman A. Implementation Strategies to Promote Short-Course Radiation for Bone Metastases. JAMA Netw Open 2024; 7:e2411717. [PMID: 38787561 PMCID: PMC11127116 DOI: 10.1001/jamanetworkopen.2024.11717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Abstract
Importance For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings. Objective To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions). Design, Setting, and Participants This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023. Exposures Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians. Main Outcomes and Measures The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy. Results Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly. Conclusions and Relevance In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.
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Affiliation(s)
- Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle
| | - Patricia Mae G. Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Curry
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nirjhar Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Caron
- Department of Strategic Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah E. Fuchs
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nahomy Ledesma Vicioso
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rahul Kumar
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami
| | - Connor O’Brien
- Department of Radiation Oncology, Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | - Shivani Patel
- Department of Radiation Oncology, Lehigh Valley Cancer Institute, Allentown, Pennsylvania
| | - David M. Guttmann
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew L. Salner
- Department of Radiation Oncology, Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | - Joseph E. Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami
| | - Alyson F. McIntosh
- Department of Radiation Oncology, Lehigh Valley Cancer Institute, Allentown, Pennsylvania
| | - David G. Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Max Vaynrub
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan T. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, NYU School of Medicine, New York, New York
| | - Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Vo J, Gray S, Traeger AC, Di Donato M. Can General Practitioner Opioid Prescribing to Compensated Workers with Low Back Pain Be Detected Using Administrative Payments Data? An Exploratory Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10194-y. [PMID: 38564158 DOI: 10.1007/s10926-024-10194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Approximately one third of Australians with accepted time loss workers' compensation claims for low back pain (LBP) are dispensed opioid analgesics. Structured administrative payments data is scalable but does not directly link opioids to prescribers. We sought to determine whether opioid prescribing by general practitioners (GPs) to workers with workers' compensation claims for LBP can be detected in structured administrative payments data. METHODS We used a sample of workers with accepted time loss workers' compensation claims for low back pain from 2011 to 2015 from the Australian states of Victoria and South Australia. We structured administrative data to test the assumption that opioid dispenses that occurred immediately after a GP encounter in sequence and occurred on the same date as the GP encounter are likely to be related. We measured the number and proportion of opioid dispenses with a GP encounter prior and the days between a GP encounter and opioid dispense. RESULTS Nearly one third of workers (32.2%, N = 4,128) in our sample (n = 12,816) were dispensed opioids a median of five times (interquartile range 2, 17). There were 43,324 opioid dispenses to included workers. 30,263 (69.9%) of opioid dispenses were immediately preceded by a GP encounter. Of those dispenses, 51.0% (n = 15,443) occurred on the same day as the GP encounter. CONCLUSION At least one third of opioids dispensed to workers with claims for LBP can be potentially linked to GP prescribing using workers' compensation structured administrative payments data. This approach could have potential applications in supporting monitoring and audit and feedback systems. Future research should test this approach with a more diverse array of pain medicines and medical practitioners.
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Affiliation(s)
- Jennifer Vo
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Michael Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Stormon N, Do L, Hopcraft M, Sexton C. Geographic patterns of dental service use in the Child Dental Benefits Schedule: 6 years of claims in the Longitudinal Study of Australian Children. Health Promot J Austr 2023. [PMID: 37839800 DOI: 10.1002/hpja.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
ISSUE ADDRESSED This article explores the geographic patterns of claims within the Australian Government's Child Dental Benefits Schedule (CDBS). BACKGROUND The CDBS is a means-tested schedule implemented in 2014 to improve access to dental services for children. Under the schedule, eligible children receive funding to subsidise dental services. METHODS This study used data from the Longitudinal Study of Australian Children and linked data from the Medicare universal healthcare system, to examine dental service use amongst a subset of children aged 10 and 14 years. Dental service items were classified using Two-step Cluster Analysis, and appointments were analysed using multinomial logistic regression. Geographic characteristics were included as predictor variables. RESULTS The study found that the majority of dental appointments were non-operative (70.7%, n = 5808), with diagnostic, radiographic, and preventive items being the most common. There were slightly higher proportions of operative appointments (fillings and extractions) compared with non-operative appointments in remote and very remote areas, low socio-economic areas, and Queensland and Northern Territory. Cluster analysis identified eight groups of non-operative appointments and four groups of operative appointments. New South Wales had a higher proportion of 'prophylactic IV' appointments than any other State and Territory, which included debridement and topical fluoride services. CONCLUSION Cluster analysis identified distinct groups of non-operative and operative appointments, each with unique characteristics. The distribution of appointments varied by State/Territory and region. SO WHAT Further research and interventions are needed to ensure equitable access to services and a shift to preventive care for disadvantaged populations of Australian children. Exploring alternative funding models that support clinically relevant claims, rather than maximising financial benefits such as time-based renumeration models should be explored.
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Affiliation(s)
- Nicole Stormon
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Health, Metro North Health Service, Community and Oral Health, Brisbane, Queensland, Australia
| | - Loc Do
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Hopcraft
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- eviDent Foundation, Melbourne, Victoria, Australia
| | - Christopher Sexton
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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Oliveira CB, Coombs D, Machado GC, McCaffery K, Richards B, Pinto RZ, O'Keeffe M, Maher CG, Christofaro DGD. Process evaluation of the implementation of an evidence-based model of care for low back pain in Australian emergency departments. Musculoskelet Sci Pract 2023; 66:102814. [PMID: 37421758 DOI: 10.1016/j.msksp.2023.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The Sydney Health Partners Emergency Department (SHaPED) trial targeted ED clinicians and evaluated a multifaceted strategy to implement a new model of care. The objective of this study was to investigate attitudes and experiences of ED clinicians as well as barriers and facilitators for implementation of the model of care. DESIGN A qualitative study. METHODS The EDs of three urban and one rural hospital in New South Wales, Australia participated in the trial between August and November 2018. A sample of clinicians was invited to participate in qualitative interviews via telephone and face-to-face. The data collected from the interviews were coded and grouped in themes using thematic analysis methods. RESULTS Non-opioid pain management strategies (i.e., patient education, simple analgesics, and heat wraps) were perceived to be the most helpful strategy for reducing opioid use by ED clinicians. However, time constraints and rotation of junior medical staff were seen as the main barriers for uptake of the model of care. Fear of missing a serious pathology and the clinicians' conviction of a need to provide something for the patient were seen as barriers to reducing lumbar imaging referrals. Other barriers to guideline endorsed care included patient's expectations and characteristics (e.g., older age and symptoms severity). CONCLUSIONS Improving knowledge of non-opioid pain management strategies was seen as a helpful strategy for reducing opioid use. However, clinicians also raised barriers related to the ED environment, clinicians' behaviour, and cultural aspects, which should be addressed in future implementation efforts.
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Affiliation(s)
- Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (Unoeste), Presidente Prudente, Sao Paulo, Brazil; Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
| | - Danielle Coombs
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rafael Z Pinto
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Diego G D Christofaro
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
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10
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O'Connor DA, Glasziou P, Schram D, Gorelik A, Elwick A, McCaffery K, Thomas R, Buchbinder R. Evaluating an audit and feedback intervention for reducing overuse of pathology test requesting by Australian general practitioners: protocol for a factorial cluster randomised controlled trial. BMJ Open 2023; 13:e072248. [PMID: 37197811 DOI: 10.1136/bmjopen-2023-072248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of AF for reducing requests for commonly overused pathology test combinations by high-requesting Australian general practitioners (GPs) compared with no intervention control. A secondary aim is to evaluate which forms of AF are most effective. METHODS AND ANALYSIS This is a factorial cluster randomised trial conducted in Australian general practice. It uses routinely collected Medicare Benefits Schedule data to identify the study population, apply eligibility criteria, generate the interventions and analyse outcomes. On 12 May 2022, all eligible GPs were simultaneously randomised to either no intervention control or to one of eight intervention groups. GPs allocated to an intervention group received individualised AF on their rate of requesting of pathology test combinations compared with their GP peers. Three separate elements of the AF intervention will be evaluated when outcome data become available on 11 August 2023: (1) invitation to participate in continuing professional development-accredited education on appropriate pathology requesting, (2) provision of cost information on pathology test combinations and (3) format of feedback. The primary outcome is the overall rate of requesting of any of the displayed combinations of pathology tests of GPs over 6 months following intervention delivery. With 3371 clusters, assuming no interaction and similar effects for each intervention, we anticipate over 95% power to detect a difference of 4.4 requests in the mean rate of pathology test combination requests between the control and intervention groups. ETHICS AND DISSEMINATION Ethics approval was received from the Bond University Human Research Ethics Committee (#JH03507; approved 30 November 2021). The results of this study will be published in a peer-reviewed journal and presented at conferences. Reporting will adhere to Consolidated Standards of Reporting Trials. TRIAL REGISTRATION NUMBER ACTRN12622000566730.
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Affiliation(s)
- Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Dina Schram
- Department of Health and Aged Care, Australian Government, Canberra, Australian Capital Territory, Australia
| | - Alexandra Gorelik
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Amelia Elwick
- Department of Health and Aged Care, Australian Government, Canberra, Australian Capital Territory, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Docking S, Gao L, Ademi Z, Bonello C, Buchbinder R. Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:467-475. [PMID: 36940059 PMCID: PMC10119214 DOI: 10.1007/s40258-023-00799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Limited evidence is available on the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. Decision analytic modelling may be an appropriate method to synthesise evidence from multiple sources, and overcomes issues with trial-based economic evaluations. OBJECTIVE The aim was to describe the reporting of methods and objectives utilised in existing decision analytic modelling studies that assess the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. METHODS Decision analytic modelling studies investigating the use of any imaging modality for people of any age with back, neck, knee, or shoulder complaints were included. No restrictions on comparators were applied, and included studies were required to estimate both costs and benefits. A systematic search (5 January 2023) of four databases was conducted with no date limits imposed. Methodological and knowledge gaps were identified through a narrative summary. RESULTS Eighteen studies were included. Methodological issues were identified relating to the poor reporting of methods, and measures of effectiveness did not incorporate changes in quantity and/or quality of life (cost-utility analysis in only ten of 18 studies). Included studies, particularly those investigating back or neck complaints, focused on conditions that were of low prevalence but have a serious impact on health (i.e. cervical spine trauma, cancer-related back pain). CONCLUSIONS Future models should pay particular attention to the identified methodological and knowledge gaps. Investment in the health technology assessment of these commonly utilised diagnostic imaging services is needed to justify the current level of utilisation and ensure that these services represent value for money.
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Affiliation(s)
- Sean Docking
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Christian Bonello
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Haas R, Gorelik A, Busija L, O’Connor D, Pearce C, Mazza D, Buchbinder R. Prevalence and characteristics of musculoskeletal complaints in primary care: an analysis from the population level and analysis reporting (POLAR) database. BMC PRIMARY CARE 2023; 24:40. [PMID: 36739379 PMCID: PMC9898983 DOI: 10.1186/s12875-023-01976-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/06/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level. AIM To describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints. DESIGN AND SETTING A five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia. METHOD We included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis. RESULTS 324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18-64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included 'pain' and/or 'ache' (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4-12). CONCLUSION The burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed.
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Affiliation(s)
- Romi Haas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. .,Cabrini Health, Malvern, VIC, 3144, Australia.
| | - Alexandra Gorelik
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
| | - Ljoudmila Busija
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia
| | - Denise O’Connor
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
| | | | - Danielle Mazza
- grid.1002.30000 0004 1936 7857Department of General Practice, Monash University, Notting Hill, VIC 3168 Australia
| | - Rachelle Buchbinder
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
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13
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Stone L, Frank O, Tam CWM. Effect of an Individualized Audit and Feedback Intervention on Rates of Musculoskeletal Diagnostic Imaging Requests. JAMA 2023; 329:175. [PMID: 36625817 DOI: 10.1001/jama.2022.20739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Louise Stone
- Australian National University, Canberra, Australia
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14
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O'Connor DA, Glasziou P, Buchbinder R. Effect of an Individualized Audit and Feedback Intervention on Rates of Musculoskeletal Diagnostic Imaging Requests-Reply. JAMA 2023; 329:175-176. [PMID: 36625813 DOI: 10.1001/jama.2022.20742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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