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Homaira N, Daniels B, Pearson S, Jaffe A. Dispensing Practices of Fixed Dose Combination Controller Therapy for Asthma in Australian Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165645. [PMID: 32764390 PMCID: PMC7460523 DOI: 10.3390/ijerph17165645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022]
Abstract
The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6-18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical Benefits Scheme dispensing claims from 2013-2018, we examined the annual incident FDC dispensing and the incident FDC dispensing without prior ICS up to 365 days. We also determined cost of FDCs to government and patients. During 2013-2018, there were 35,635 FDC initiations and 31,368 (88%) did not have a preceding ICS dispensing. The annual incidence of FDC dispensing declined from 14.7 to 7.2/1000 children. Incidence of FDC dispensing/1000 children without a preceding ICS declined from 2.1 to 0.5 in children aged 1-2 years, 7.2 to 1.7 in 3-5 years, 14.8 to 5.1 in 6-11 years, and 18.6 to 11.9 in ≥12years. The cost of FDCs was 7.8 million Australian dollars (AUD); of which 4.4 million AUD was to government and 3.3 million AUD was to patient. Despite inappropriate dispensing of FDCs in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding ICS is declining in Australia.
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Affiliation(s)
- Nusrat Homaira
- Discipline of Paediatrics, School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Sydney 2052, Australia;
- Respiratory Department, Sydney Children’s Hospital, Sydney 2031, Australia
- Correspondence:
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Sydney 2052, Australia; (B.D.); (S.P.)
| | - Sallie Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Sydney 2052, Australia; (B.D.); (S.P.)
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Sydney 2052, Australia;
- Respiratory Department, Sydney Children’s Hospital, Sydney 2031, Australia
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Hooper TD, Hibbert PD, Mealing N, Wiles LK, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Goldstein S, Hallahan AR, Wakefield JG, Murphy E, Lau A, Wheaton G, Williams HM, Hughes C, Braithwaite J. CareTrack Kids-part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review. BMJ Open 2015; 5:e007749. [PMID: 25854977 PMCID: PMC4390725 DOI: 10.1136/bmjopen-2015-007749] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. METHODS AND ANALYSIS A random sample of 6000-8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged <16 years who presented with at least one of the study conditions during 2012 and 2013 will be reviewed. ETHICS AND DISSEMINATION Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service and Women's and Children's Hospital Network (South Australia). An application is under review for the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and offer oral presentations to researchers, clinicians and policymakers at national and international conferences.
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Affiliation(s)
- Tamara D Hooper
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nicole Mealing
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Les White
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- New South Wales Health, NSW Kids and Families, Sydney, New South Wales, Australia
| | - Christopher T Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Mark F Harris
- Faculty of Medicine, Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - William B Runciman
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Stan Goldstein
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R Hallahan
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - John G Wakefield
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Elisabeth Murphy
- New South Wales Health, NSW Kids and Families, Sydney, New South Wales, Australia
| | - Annie Lau
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women's and Children's Health Network, South Australia, Australia
| | | | - Clifford Hughes
- Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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