Christopher Pearce

Most adults with neurological disability rely on general practitioners for managing and preventing health complications. This study analysed patterns of general practice service utilisation among National Disability Insurance Scheme (NDIS) participants with neurological disability and compared these with people who are not NDIS participants, referred to as the rest of the population (ROP). Modelled annualised rates of recorded clinic and GP activity were approximately twice as high among participants with neurological disability as among the ROP (IRR range 1.87–2.28). Differences in the number of distinct GPs seen and clinics visited were smaller and condition‐specific; for example, the annualised number of distinct clinics visited was lower for participants with cerebral palsy (IRR = 0.86, 95% CI [0.81, 0.91]) and higher for participants with acquired brain injury (IRR = 1.06, 95% CI [1.01, 1.12]). Together, these findings indicate substantially higher recorded general practice activity among participants with neurological disability, while differences in the number of GPs and clinics involved in care were more modest. Investigating the factors that influence general practice service utilisation, as well as the quality and continuity of care experienced by adults with neurological disability, remains a critical area for future research.

Introduction Access to safe, high quality, acceptable and sustainable general practice (GP) and primary care services is essential to improved health outcomes and quality of life for people living in residential aged care homes (RACH). There are, however, critically low levels of service availability and a decline in GPs providing RACH services globally, suggesting there is an urgent need for safe and effective models of care. Telehealth, delivered as part of a holistic model of care, offers a solution to address this gap but comprehensive, person-centred research is needed to directly assess its effect on safety and quality of care in RACH settings. Objectives This collaborative 4-year project (General practice and Residential Aged CarE: GRACE video-telehealth) will (1) scope current telehealth models of care and their acceptability and person-centredness, including identifying the barriers and enablers experienced by RACH residents, carers, staff, GPs and practice managers; (2) co-design a best-practice model of care with an accompanying suite of digital resources and education materials to improve the uptake of video-telehealth; and (3) implement and evaluate this best-practice model of care. Methods and analysis This is a mixed-methods study of residents, carers, RACH staff, GPs and their practice teams that will be conducted across New South Wales, Australia. This protocol describes a staged approach across three phases. In Phase 1, we will collect baseline measures of the frequency of telehealth use in GP practices and RACHs, clinical outcomes (eg, hospitalisations), questionnaires to measure person-centred care, satisfaction and usability of telehealth and qualitative observations and semi-structured interviews. In Phase 2, we will conduct workshops to co-design an intervention that will include developing a model of care to support person-centred video-telehealth, with an accompanying online hub of resources and educational materials to facilitate and support its utilisation. In Phase 3, we will implement and evaluate the intervention. Data will be analysed statistically and thematically and synthesised. Ethics and dissemination Ethics approval has been obtained from the University of Sydney Human Research Ethics Committee (2025/000340) (human.ethics@sydney.edu.au). Prior informed written consent will be obtained from all research participants. Findings from each phase of the study will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales and Australia.

Opioid deprescribing is recommended to reduce opioid-related harms; however, research suggests that opioid dose changes may lead to adverse health outcomes. We aimed to determine if opioid dose changes are associated with mental health–related or substance use–related emergency department (ED) presentations. This self-controlled case-crossover study used POpulation Level Analysis and Reporting (POLAR) primary care data linked with data from 3 metropolitan hospitals in Victoria, Australia. People who had a mental health–related or substance use–related ED (MHSU-ED) presentation between April 2018 and May 2022 and had received ≥4 opioid prescriptions in the 12 months preceding their ED presentation were included. Adjusted odds ratios (aOR) for MHSU-ED presentations were estimated using conditional logistic regression, comparing opioid dose change in the 30 days before MHSU-ED presentation to that in 5 corresponding sets of control periods of equal length not immediately preceding MHSU-ED presentation. Of the 1458 eligible patients, 75.9% experienced a >25% reduction in their prescribed opioid dose in the 30 days before MHSU-ED presentation. Compared with receiving no opioid prescriptions in the 30 days prior, a >25% reduction in prescribed opioid dose (aOR: 1.78; 95% confidence interval [CI]: 1.44-2.21) or opioid discontinuation (aOR: 2.04; 95% CI: 1.48-2.82) was linked to higher odds of a MHSU-ED presentation whilst a 10% to 25% reduction (aOR: 0.15; 95% CI: 0.10-0.23) or a stable or increased dose (aOR: 0.01; 95% CI: 0.008-0.022) was associated with lower odds of MHSU-ED presentation. Larger opioid dose reduction or discontinuation is associated with increased risk of subsequent mental health–related and substance use–related ED presentations.

Aim: To evaluate the demographic and clinical factors that influence the initiation of weak versus strong opioids among opioid-naïve patients in Australian primary care settings. Methods: This retrospective cohort study focused on opioid-naïve patients, defined as those receiving an eligible opioid prescription with no prior opioid prescriptions in the prior year. The study used general practice data extracted in partnership with Primary Health Networks via the POpulation Level Analysis and Reporting (POLAR) platform. Opioid prescriptions at the time of initiation were categorized as weak or strong. We used multivariate probit model analysis to identify the demographic and clinical factors associated with type of opioid at initiation of prescribing. Results: We identified 415 098 opioid-naïve patients in primary care between January 1, 2018, and July 31, 2023, with 17% initiated on strong opioids. The probability of initiation with a strong opioid increased in patients who were more than 80 years of age by 25.0% (95% CI: 0.244 to 0.257) compared with patients who were 20–29 years of age. Patients with diagnoses of pain related to injury procedures (9.7% increase; 95% CI: 0.093 to 0.101) or with prior antipsychotic prescriptions (6.2% increase; 95% CI: 0.055 to 0.067) had higher probabilities of being prescribed strong opioids at initiation than did those without these conditions. Conclusion: One in 6 patients initiated on opioids in primary care was prescribed a strong opioid. This study highlights key factors associated with initiation of strong opioids among opioid-naïve patients. Further assessment of clinical suitability and outcomes associated with strong opioid prescribing can inform our understanding of opioid use in primary care.

Objective: Our objective was to examine referral patterns for people with musculoskeletal complaints presenting to Australian general practitioners (GPs).Methods: This longitudinal analysis from the Population Level Analysis Reporting (POLAR) database includes 133,279 patients with low back (≥18 years old) or neck, shoulder, and/or knee (≥45 years old) complaints seen by 4,538 GPs across 269 practices from 2014 through 2018. Referrals to allied health and medical and/or surgical specialists were included. We determined the number of patients with referrals and GPs who made referrals and examined their timing, associations, and trends over time.Results: A total of 43,666 patients (33%) received and 3,053 GPs (67%) made at least one referral. Most referrals were to allied health (n = 25,830, 19%), followed by surgeons (n = 18,805, 14%). Surgical referrals were higher for knee complaints (n = 6,140, 24%) compared with low back, neck, and shoulder complaints (range 8%–15%). The referral category varied predominantly by body region followed by gender, socioeconomic status, and primary health network. Time to allied health referral ranged between median (interquartile range [IQR]) 14 days (0–125 days) for neck complaints and 56 days (5–177 days) for knee complaints. Surgical referrals occurred sooner for those with knee complaints (15 days, IQR 0–128 days). There was a 2.2% (95% confidence interval [CI] 1.9%–2.4%) annual increase in the proportion of allied health referrals and a 1.9% (95% CI 1.6%–2.1%) decrease in surgical referrals across all sites.Conclusion: One‐third of patients receive, and two‐thirds of GPs make, referrals for musculoskeletal complaints. Understanding the reasons for referral and differences between GPs who refer more and less frequently may identify factors that explain variations in practice.

Current research indicates that tapering opioids may improve pain and function in patients with chronic noncancer pain. However, gaps in the literature remain regarding the choice of opioid and nonopioid interventions to support a successful taper. This study used an Australian primary care data set to identify a cohort of patients on long-term opioid therapy commencing opioid taper between January 2016 and September 2019. Using logistic regression analysis, we compared key clinical factors associated with differing taper outcomes. Of a total of 3371 patients who commenced taper, 1068 (31.7%) completed taper within 12 months. In the 3 months after commencement of taper, compared with those who did not complete taper, patients who successfully completed opioid taper were less likely to be prescribed buprenorphine (odds ratio [OR] 0.691; 95% CI: 0.530-0.901), fentanyl (OR, 0.429; 95% CI: 0.295-0.622), and long-acting (LA) opioids, including methadone (OR, 0.349; 95% CI: 0.157-0.774), oxycodone–naloxone (OR, 0.521; 95% CI: 0.407-0.669), and LA tapentadol (OR, 0.645; 95% CI: 0.461-0.902), but more likely to be prescribed codeine (OR, 1.308; 95% CI: 1.036-1.652). Compared with those who did not complete taper, patients who successfully tapered were less likely to be prescribed any formulations of oxycodone (short-acting [SA]: OR, 0.533; 95% CI: 0.422-0.672, LA: OR, 0.356; 95% CI: 0.240-0.530) and tramadol (SA: OR, 0.370; 95% CI: 0.218-0.628, LA: OR, 0.317; 95% CI: 0.234-0.428). The type of opioid prescribed in the months after commencement of taper seems to influence the taper outcomes. These findings may inform prospective studies on opioid taper.