Gizat Molla Kassie

Objective: To investigate the benefits and harms associated with antenatal corticosteroids (ACS) prior to planned caesarean birth at late preterm or early term. Design: Retrospective cohort study. Setting: South Australia, Australia, 2005–2018. Patients: Women with singleton pregnancies undergoing planned caesarean birth between 36 ⁺⁰ and 38 ⁺⁶ weeks’ gestation. Methods: We used routinely collected electronic maternity and neonatal data. Adjusted risk differences (aRD) with 95% CIs were calculated for neonatal and maternal outcomes. Outcome measures: Neonatal outcomes included respiratory distress requiring oxygen, hypoglycaemia requiring glucose, neonatal unit (NNU) admission and prolonged NNU admission (≥48 hours). Results: Among the cohort of 4049 women, the proportion receiving ACS was 54.8%, 48.4% and 5.6% at 36, 37 and 38 completed weeks’ gestation, respectively. ACS administration was associated with a significant reduction in respiratory distress across all gestations, with the greatest reduction seen at 36 weeks’ gestation (aRD −12.5%; 95% CI −21.4% to −3.6%). At 38 weeks’ gestation, ACS administration was associated with an increased risk of neonatal hypoglycaemia (aRD 5.7%; 95% CI 1.1% to 10.2%), NNU admission (aRD 5.4%; 95% CI 0.1% to 10.7%) and prolonged NNU admission (aRD 4.6%; 95% CI 0.2% to 8.9%). Conclusions: ACS administration prior to late preterm and early term planned caesarean birth was associated with reduced risk of respiratory distress. The net benefit of ACS administration before planned caesarean birth remains unclear; however, there was evidence of potential neonatal harm when birth occurred after 37 weeks’ gestation.

Background: Anti‐Müllerian hormone (AMH) tests are often promoted as a measure of fertility; however, AMH adds limited predictive value beyond age alone for estimating the likelihood of live birth in couples trying to conceive. Aims: This study aimed to examine longitudinal trends in the rate of AMH testing for fertility in the Australian general practice setting. Materials and Methods: Retrospective open cohort study of 1,393,931 females aged 20–44 years attending Australian general practices between 2011 and 2021 using the national general practice database, MedicineInsight. Free text ‘test reason’ fields were examined to identify AMH tests ordered by General Practitioners for fertility assessment. We calculated age‐standardised annual prevalence rates for AMH tests overall, as well as stratified by age group and concession card status. To examine between‐practice variation, the intraclass correlation coefficient (ICC) was estimated using a two‐level logistic regression model. Results: The annual age‐standardised prevalence of AMH test requests increased from 0.32 per 1000 females in 2011 to 4.33 per 1000 females in 2021. AMH testing was more common among those residing in a major city and of higher socioeconomic status, but less common among concession card holders. Following adjustment for patient case‐mix, 21% (95% CI 18%–24%) of observed variation in AMH testing was attributable to differences between practices, with 45/423 (10.6%) of general practices having no patients with an AMH test. Conclusions: The noted substantial increase in clinical and consumer demand for AMH testing does not appear to be evidence‐based, with substantial patient‐ and practice‐level variation in testing evident.

Introduction: Spontaneous adverse drug reactions (ADRs) are underreported. Digital reporting systems are increasingly used to address this issue; however, limited knowledge exists about the barriers and facilitators influencing their use by consumers. Aim: To explore facilitators and barriers influencing consumers’ use of digital tools for ADR reporting, and to identify the factors, expectations and preferences that affect their engagement with these tools. Method: An exploratory qualitative descriptive study using semi-structured in-depth interviews was conducted among Australian adults who self-reported having experienced an ADR. Interviews were conducted face-to-face or via Zoom, audio-recorded, transcribed verbatim, and analysed inductively using reflexive thematic analysis. Themes were mapped onto domains of the Combined Technology Acceptance Model and Theory of Planned Behaviour (C-TAM-TPB) framework. Results: Fourteen participants were interviewed. Consumers expressed positive intentions to use online ADR reporting tools. Identified facilitators included user-friendly and accessible tools that are simple to complete, the use of images to aid comprehension, integration with existing patient health records, the ability to submit reports to both healthcare professionals and regulators, and a tool designed specifically for consumers using layperson language. Identified barriers included lack of awareness that consumers could report ADRs using online tools, the need for registration, complex medical terminology, compulsory fields, and the absence of feedback after submission. Conclusion: Consumers were willing to use online ADR reporting tools but were largely unaware of their existence. Enhancing usability through user-friendly design, and reporting forms specifically designed for consumers may increase engagement. Addressing barriers such as lack of awareness, registration requirements, medical jargon, and lack of feedback may improve usability and contribute to strengthening pharmacovigilance systems.

Objectives: To examine longitudinal trends in the provision of medication abortion (MA) in Australian general practice. Study design: Retrospective study of Australian females aged 14–49 years attending Australian general practices between 2014 and 2021. Data were sourced from the national general practice dataset, MedicineInsight. We calculated rates of MA provision and reported characteristics of those receiving and providing MA services. Results: We identified 4306 instances of MA provision to 3980 unique individuals. The rate of MA provision increased from 0.11 per 1000 females in 2014/15 to 2.10 per 1000 females in 2020/21. A greater absolute increase in the rate of MA was evident among those aged 25–29 years, those residing in regional areas or those in areas of lower socioeconomic status. The proportion of general practices providing MA increased from 4.4% in 2014 to 22.7% in 2021. The proportion of general practices providing MA was higher among those located outside of major cities and in higher socioeconomic status areas. Conclusions: Despite modest increases in the rates of MA provision in general practice over time, less than one third of general practices provide MA. Significant geographical variation in MA provision is also evident according to remoteness, socioeconomic status and state/territory. The findings emphasise the need for additional initiatives to ensure equitable access to abortion care within the general practice setting, and future research should examine the underlying reasons for differences in MA uptake by patient characteristics and geographical location, informing targeted interventions and service planning.

Background: Utilisation of intravenous iron is increasingly recognised as a viable option for treating iron deficiency, especially when oral iron is ineffective or intolerable. However, there are no updated data on the longitudinal trends of utilisation of intravenous iron among women of reproductive age (18–44) in Australia Aims: The aim of this study was to assess the longitudinal trends of intravenous iron utilisation among Australian women aged 18–44 years. Methods: We conducted a retrospective observational study (2013–2024) using the 10% Pharmaceutical Benefit Scheme dataset. We examined the longitudinal trends in the rate of intravenous iron dispensing and total dose dispensed for unique treatment episodes according to iron type and examined variation according to age group, state/territory, prescriber type and health care concession card status. Results: The rate of dispensed intravenous iron increased from 0.3 in 2013 to 5.0 per 100 women in 2024, with ferric carboxymaltose making up 93.9% of total claims. In 2024, one in 20 Australian women aged 18–44 years was dispensed intravenous iron. Total expenditure on intravenous iron increased from $1.1 million in 2013 to $82.3 million in 2024. Significant variation in type of intravenous iron and total treatment doses dispensed was evident according to age group, state/territory, concession card status and prescriber type. Conclusions: Overall rates and expenditure on intravenous iron among women of reproductive age have rapidly increased between 2013 and 2024, with high levels of practice variation evident. Identifying the underlying reasons for the observed variation in intravenous iron utilisation is warranted.

Objective: To determine the prevalence and predictors of persistent antidepressant use among Australian children and adolescents. Methods: A population-based cohort study was conducted, including children and adolescents aged from 5 to 18 years who initiated an antidepressant between 2014 and 2022, using 10% randoms sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. We measured persistence at 1 and 2 years after initiation, as defined by continuous supply of any antidepressant with no gaps of more than 90 days between dispensings. Results: A total of 44,366 children and adolescents initiated on antidepressants during the study period. Approximately one-quarter (23.1%) received only a single antidepressant dispensing, with a further 33.0% considered persistent users after 1 year and 19.8% considered persistent users after 2 years. Persistence at 1 year was significantly higher in females (adjusted odds ratios (aOR) 1.13 [1.09–1.18]) than males, and in concurrent users of antipsychotics (aOR 1.37 [1.22–1.54]) or psychostimulants (aOR 1.60 [1.49–1.71]) than non-users. The likelihood of persistent antidepressant use at 1 year was lower in individuals with a concession card (aOR 0.81 [0.78–0.85]) than general beneficiaries and in those who initiated with serotonin and norepinephrine reuptake inhibitors (aOR 0.60 [0.54–0.67]) or mirtazapine (aOR 0.45 [0.34–0.51]) compared with selective serotonin reuptake inhibitors. Findings were similar for persistent antidepressant use at 2 years. Conclusion: Persistent antidepressant use beyond 1 or 2 years is common among children and adolescents and shows an increasing trend over time. The reasons for and appropriateness of prolonged treatment with antidepressants in this population warrant further investigation.

Objective: To examine geographical variation in utilisation of hormonal long-acting reversible contraceptives (LARCs), namely the hormonal intrauterine device (IUD) and implant. Study design: Cross-sectional study of Australian women aged 15–54 years using Pharmaceutical Benefits Scheme (PBS) dispensing data from 2018 to 2021. We calculated age‐standardised rates of LARC dispensing per 1000 women across each Statistical Area Level 3 (SA3) according to remoteness and socioeconomic status (SES) indices. Differences between minimum and maximum rates of LARC utilisation in SA3s were used to determine magnitude of variation. Results: Between 2018 and 2021, hormonal IUD dispensing rates increased from 18.4 to 21.6 per 1000 women in major cities, 25.2 to 30.6 per 1000 in inner regional, 25.4 to 28.7 per 1000 in outer regional, and 17.7 to 20.0 per 1000 in remote areas. This corresponded to decreases in implant dispensing rates from 14.6 to 12.6 per 1000 women in major cities, 25.3 to 23.1 per 1000 in inner regional, 28.0 to 25.3 per 1000 in outer regional, and 20.7 to 19.6 per 1000 in remote areas. Rates of LARC utilisation varied considerably across SA3s, ranging from 10.9 to 37.8 per 1000 women. Increasing SES was associated with increasing hormonal IUD rates in major cities (incidence rate ratio (IRR) 1.06, 95% CI 1.04 to 1.08), inner regional (IRR 1.06, 95% CI 1.03 to 1.09) and remote (IRR 1.44, 95% CI 1.12 to 1.85) areas, but decreasing implant rates in major cities (IRR 0.89, 95% CI 0.86 to 0.91) and inner regional areas (IRR 0.91, 95% CI 0.88 to 0.94). Conclusion: Given observed variation in LARC utilisation, efforts to identify and address barriers towards more equitable access to LARC methods appear warranted.

Background: Antidepressant switching is often indicative of treatment dissatisfaction; however, data regarding patterns, associated factors and timing of switching in children and adolescents remain limited. Objectives: This study aimed to determine switching patterns of antidepressant use and predictors of switching in Australian children and adolescents. Methods: A retrospective cohort study of children and adolescents aged 5–18 years who initiated antidepressants between 2014 and 2022 was conducted, using a 10% random sample of the national Pharmaceutical Benefits Scheme dispensing data. We determined the proportions of initiators who switched between antidepressants within 12 months of initiation. A Cox proportional hazards model was used to determine the risk of switching by patient characteristic factors, and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were reported. Results: We included 44,381 child and adolescent antidepressant initiators, the most commonly initiated antidepressant being fluoxetine. Approximately one in six children and adolescents aged 5–18 years at initiation (15.0%) switched to a different antidepressant within the first 12 months. Most switches were to selective serotonin reuptake inhibitors. Individuals with a commonwealth healthcare concession card were less likely to switch antidepressants within 12 months (aHR 0.91, 95% CI 0.86, 0.96). Females (aHR 1.24, 95% CI 1.17, 1.31), those starting with antidepressants other than fluoxetine and concurrent anxiolytic users were more likely to switch. Conclusions: Switching between antidepressants is a common practice among children and adolescents in Australia, with most switches occurring during the early phases of treatment and primarily to selective serotonin reuptake inhibitors. A better understanding of the reasons for switching is important for informing tailored management approaches and improving treatment outcomes.

Background: Psychotropic medications are often inappropriately prescribed for behavioural and psychological symptoms of dementia (BPSD), posing significant risks such as falls, stroke and death. Although non-pharmacological interventions (NPIs) are the first-line treatment for BPSD, their use in practice remains limited. Objectives: This study explored general practitioners’ (GPs’) and physicians’ perspectives on using psychotropic medications compared to NPIs for managing BPSD in Australian residential aged care homes (RACHs). Design: Semi-structured online in-depth interviews were conducted with GPs and physicians managing BPSD in Australian RACHs. Methods: The interviews were audio-recorded, transcribed and analysed using inductive thematic analysis, with transcripts coded using NVivo 14 to generate themes. Results: Four GPs and eleven physicians were interviewed, and four major themes emerged: (1) knowledge of best practices of BPSD management, (2) awareness of current challenges in BPSD management, (3) non-involvement, blame shifting and rationalisation: perceived reasons for the current challenges and (4) suggested solutions. GPs and physicians were aware of best practices in managing BPSD, highlighting the importance of NPIs as more effective first-line strategies, with psychotropic medications reserved as a last resort. They also admitted that psychotropic over-prescription and inadequate NPI implementation persisted in BPSD management in Australian RACHs. Physician participants often distanced themselves from and blamed the GPs, staff and relatives of residents with dementia for the current problems. Systemic barriers, including insufficient resources, limited care continuity and organisational structures, were also reported to hinder psychotropic deprescribing. Implementing NPIs was deemed to be impeded by inadequate training and low confidence in their effectiveness. The participants suggested strengthening workforce capacity, incentivising NPIs and encouraging interdisciplinary collaboration. Conclusion: The results highlighted the gap between GPs’ and physicians’ knowledge of best practices and actual prescribing practices for BPSD in Australian RACHs. Improved workforce and support for NPIs could reduce reliance on psychotropics and align BPSD management with best practices.