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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [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: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Al-Diery T, Freeman H, Page AT, Cross AJ, Hawthorne D, Lee K. What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis. Int J Clin Pharm 2023:10.1007/s11096-023-01561-5. [PMID: 36932315 DOI: 10.1007/s11096-023-01561-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/17/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Comprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. AIM This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. METHOD Australian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis. RESULTS Seventy-two de-identified reports from eight consultant pharmacists located in five of the eight Australian States and Territories were included for analysis. From the evaluated reports, four major categories of information were identified: (1) patient details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); (2) pharmacist assessment including assessment of the patient (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); (3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and (4) patient-centred experiences such as perspectives on medicines (n = 56, 78%). Reporting of patient-centred experiences appeared most variably in the included reports, including patient concerns (n = 38, 53%), willingness for change (n = 27, 38%), patient preferences (n = 13, 18%), and patient goals (n = 7, 10%). CONCLUSION Pharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the patients they care for. However, variability across reports has the potential to impact consistent service delivery.
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Affiliation(s)
| | - Hollie Freeman
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia
| | - Amy Theresa Page
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, School of Allied Health, University of Western Australia, Perth, Australia.,Consultant Pharmacist Services Research Network, Coherent, Australia
| | - Amanda J Cross
- Consultant Pharmacist Services Research Network, Coherent, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
| | - Deborah Hawthorne
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Western Australian Centre for Health and Ageing, School of Allied Health, University of Western Australia, Perth, Australia.,Consultant Pharmacist Services Research Network, Coherent, Australia
| | - Kenneth Lee
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
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Cross AJ, Hawthorne D, Lee K, O'Donnell LK, Page AT. Factors influencing pharmacist interest and preparedness to work as on-site aged care pharmacists: Insights from qualitative analysis of free-text survey responses. Arch Gerontol Geriatr 2023; 110:104971. [PMID: 36842404 DOI: 10.1016/j.archger.2023.104971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND High rates of suboptimal medication use exist in residential aged care facilities (RACFs). Pharmacist interventions can improve medication appropriateness. In 2023 there will be a phased implementation of pharmacists working on-site in Australian RACFs. OBJECTIVE To explore factors influencing Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in RACFs. METHODS A national cross-sectional anonymous online survey of Australian pharmacists was conducted. Pharmacists were recruited using a broad advertising strategy. The 36-question survey included three free-text questions that are the focus of this study. The questions asked participants (1) what influenced their interest in the role, (2) what influenced how prepared they felt for the role, and (3) if they had any other comments about the role. Responses were thematically analysed by two investigators using an inductive approach. RESULTS Most survey respondents (n=546, 84.9%) answered at least one free-text questions. Four factors influenced interest: on-site pharmacist role, aged care setting, individual pharmacist circumstances and employment model. Four factors influenced preparedness: familiarity with aged care setting, resident-level clinical skills; ability to communicate and work with a multidisciplinary team, and experience with system-level quality use of medicines activities. Four factors important for successful roll-out emerged from the 'other comments': pharmacist attributes, pharmacist workforce planning, resources and support, and RACF stakeholder engagement. CONCLUSION Key factors influencing pharmacist interest and preparedness to work on-site in RACFs and factors important for success were identified. These findings will support the national roll-out of the role, particularly as most identified factors are currently modifiable.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, 381 Royal Parade, Parkville, Vic 3052, Australia.
| | - Deborah Hawthorne
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Kenneth Lee
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Ageing, Faculty of Medicine and Health, Kolling Institute, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Amy T Page
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia; Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
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Page AT, Potter K, Naganathan V, Hilmer S, McLachlan AJ, Lindley RI, Coman T, Mangin D, Etherton-Beer C. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Gerontol Geriatr 2023; 105:104849. [PMID: 36399891 DOI: 10.1016/j.archger.2022.104849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe medicines regimens used by older people living in residential aged care facilities (RACFs). MATERIALS AND METHODS This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. RESULTS Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. CONCLUSION(S) Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.
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Affiliation(s)
- Amy Theresa Page
- Centre for Optimisation of Medicines, School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia; WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia.
| | | | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrew J McLachlan
- ydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- University of Sydney, Sydney, Australia and the George Institute for Global Health, Sydney, Australia
| | - Tracy Coman
- Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland, Australia
| | | | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Development and Pilot Implementation of a Training Framework to Prepare and Integrate Pharmacy Students into a Multicentre Hospital Research Study. PHARMACY 2022; 10:pharmacy10030057. [PMID: 35736772 PMCID: PMC9229207 DOI: 10.3390/pharmacy10030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
A unique approach was introduced to integrate pharmacy students into a multicentre patient-centred research project predicting medication related harm (MRH) post-discharge. A training framework was developed to prepare students for research participation and integration. The framework aligned research project tasks with the pharmacists’ national competency standards framework. The framework was piloted on four research placement students from two local universities during three hospital placements, from October 2020 to August 2021. Following their initial orientation and training, students collected data from 38 patients and were involved in patient screening processes, interviewing, data collection and analysis. Patients’ MRH risk scores correlated with re-admission rates with 16/38 (42%) of patients re-admitted within eight weeks following discharge. Their participation in the research enabled students to obtain skills in (1) literature searching, (2) maintaining patient confidentiality, (3) interviewing patients, (4) obtaining data from medical records, (5) communicating with patients and clinicians, and (6) the use of clinical information to predict MRH risk.
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Graham K, Matricciani L, Banwell H, Kumar S, Causby R, Martin S, Nissen L. Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross-sectional survey. J Foot Ankle Res 2022; 15:11. [PMID: 35135610 PMCID: PMC8822637 DOI: 10.1186/s13047-022-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-medical prescribing is one healthcare reform strategy that has the potential to create health system savings and offer equitable and timely access to scheduled medicines. Podiatrists are well positioned to create health system efficiencies through prescribing, however, only a small proportion of Australian podiatrists are endorsed to prescribe scheduled medicines. Since scheduled medicines prescribed by Australian podiatrists are not subsidised by the Government, there is a lack of data available on the prescribing practices of Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists and to explore barriers and facilitators that influence participation in endorsement. Methods Participants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists who were recruited through a combination of professional networks, social media, and personal contacts. Respondents were invited to complete a customised self-reported online survey, developed using previously published research, research team’s expertise, and was piloted with podiatrists. The survey contained three sections: demographic data including clinical experience, questions pertaining to prescribing practices, and barriers and facilitators of the endorsement pathway. Results Respondents (n = 225) were predominantly female, aged 25–45, working in the private sector. Approximately one quarter were endorsed (15%) or in training to become endorsed (11%). Of the 168 non-endorsed respondents, 66% reported that they would like to undertake training to become an endorsed prescriber. The most common indications reported for prescribing or recommending medications include nail surgery (71%), foot infections 474 (88%), post-operative pain (67%), and mycosis (95%). The most recommended Schedule 2 medications were ibuprofen, paracetamol, and topical terbinafine. The most prescribed Schedule 4 medicines among endorsed podiatrists included lignocaine (84%), cephalexin (68%), flucloxacillin (68%), and amoxicillin with clavulanic acid (61%). Conclusion Podiatrists predominantly prescribe scheduled medicines to assist pain, inflammatory, or infectious conditions. Only a small proportion of scheduled medicines available for prescription by podiatrists with endorsed status were reportedly prescribed. Many barriers exist in the current endorsement for podiatrists, particularly related to training processes, including mentor access and supervised practice opportunities. Suggestions to address these barriers require targeted enabling strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00515-w.
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Affiliation(s)
- Kristin Graham
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Lisa Matricciani
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.,Clinical & Health Sciences, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Helen Banwell
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saravana Kumar
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Ryan Causby
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saraid Martin
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Lisa Nissen
- Faculty of Health School of Clinical Sciences, Queensland University of Technology, Brisbane, QL, 4000, Australia
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Kouladjian O'Donnell L, Reeve E, Cumming A, Scott IA, Hilmer SN. Development and dissemination of the national strategic action plan for reducing inappropriate polypharmacy in older Australians. Intern Med J 2021; 51:111-115. [PMID: 33572018 DOI: 10.1111/imj.15155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023]
Abstract
A cohesive, national approach is needed to address inappropriate polypharmacy in older adults and promote deprescribing. We describe the dissemination of the Quality Use of Medicines to Optimise Ageing in Older Australians: Recommendations for a National Strategic Action Plan to Reduce Inappropriate Polypharmacy, and the initiatives taken to date that align with, and assist in operationalising this plan.
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Affiliation(s)
- Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Anne Cumming
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Dooley M. Findings from afar and translation closer to home. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Page AT, Falster MO, Litchfield M, Pearson SA, Etherton-Beer C. Polypharmacy among older Australians, 2006-2017: a population-based study. Med J Aust 2019; 211:71-75. [PMID: 31219179 DOI: 10.5694/mja2.50244] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/06/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of polypharmacy among Australians aged 70 years or more, 2006-2017. DESIGN, SETTING AND PARTICIPANTS Analysis of a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for people aged 70 or more who were dispensed PBS-listed medicines between 1 January 2006 and 31 December 2017. MAIN OUTCOME MEASURES Prevalence of continuous polypharmacy (five or more unique medicines dispensed during both 1 April - 30 June and 1 October - 31 December in a calendar year) among older Australians, and the estimated number of people affected in 2017; changes in prevalence of continuous polypharmacy among older concessional beneficiaries, 2006-2017. RESULTS In 2017, 36.1% of older Australians were affected by continuous polypharmacy, or an estimated 935 240 people. Rates of polypharmacy were higher among women than men (36.6% v 35.4%) and were highest among those aged 80-84 years (43.9%) or 85-89 years (46.0%). The prevalence of polypharmacy among PBS concessional beneficiaries aged 70 or more increased by 9% during 2006-2017 (from 33.2% to 36.2%), but the number of people affected increased by 52% (from 543 950 to 828 950). CONCLUSIONS The prevalence of polypharmacy among older Australians is relatively high, affecting almost one million older people, and the number is increasing as the population ages. Our estimates are probably low, as we could not take over-the-counter or complementary medicines or private prescriptions into account. Polypharmacy can be appropriate, but there is substantial evidence for its potential harm and the importance of rationalising unnecessary medicines, particularly in older people.
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Affiliation(s)
- Amy T Page
- Alfred Health, Melbourne, VIC.,Centre for Medicine Use and Safety, Monash University, Melbourne, VIC.,Centre for Optimisation of Medicines, University of Western Australia, Perth, WA
| | | | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Australia, Sydney, NSW.,Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, University of Western Australia, Perth, WA.,Royal Perth Hospital, Perth, WA
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