Factors associated with general practitioner visits for pain in people experiencing chronic pain.

Introduction Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015-2021 were included (N = 84 829). Results Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users' GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration.

Validation of Frail Scale and comparison with hospital frailty risk score to predict hospital use in a cohort of older Australian women.

INTRODUCTION: With no standard frailty tool for clinical care, research and policymaking, identifying frail older people is a challenge. AIMS: This study aimed to compare two validated scales, which are the Frail Scale and Hospital Frailty Risk Score (HFRS) for their ability in identifying frailty in older Australian women and predicting hospital use. METHODS: This study included older Australian women aged 75-95 years, who had unplanned overnight hospital admission as an index admission between 2001 and 2016. Data from the Australian Longitudinal Study on Women's Health (ALSWH) were linked with administrative hospital data to calculate HFRS (using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes) and the Frail Scale (using the ALSWH self-reported survey). RESULTS: The Frail Scale identified a higher proportion of older frail women (30.54%) compared to the HFRS (23.0%). Frail older women, classified by Frail Scale, were at higher risk of long hospital stay (adjusted odds ratio = 1.28, 95% CI = 1.02-1.60), repeated admission (adjusted hazard ratio [AHR] = 1.30, 95% CI = 1.03-1.41) and death (AHR = 1.70, 95% CI = 1.45-2.01). HFRS was associated with longer hospital stay and mortality. CONCLUSIONS: The proportion of older women classified as frail by the Frail Scale tool was higher than women classified as frail by HFRS. The Frail Scale and HFRS were not significantly associated with each other. While both tools were associated with the risk of long hospital stay and mortality, only the Frail Scale predicted the risk of repeated admission.

A decade of outcomes: The evolution of an australasian outcomes collaboration for chronic pain services.

Since the establishment of the electronic Persistent Pain Outcomes Collaboration (ePPOC) in 2013, ongoing improvements in benchmarking and quality improvement activities have provided the opportunity for ePPOC to grow to support more than one hundred adult and pediatric services delivering care to Individuals living with persistent pain throughout Australia and New Zealand. These improvements straddle multiple domains, including benchmarking and indicators reports, internal and external research collaboration and the integration of quality improvement initiatives with pain services. This paper outlines improvements undertaken and lessons learned in relation to the growth and maintenance of a comprehensive outcomes registry and its articulation with pain services and the wider pain sector.

Charlson Comorbidity Index as a predictor of repeated hospital admission and mortality among older women diagnosed with cardiovascular disease.

BACKGROUND: Comorbidity can complicate cardiovascular diseases (CVDs), increasing the risk of adverse events including hospitalisation and death. This study aimed to assess the Charlson Comorbidity Index (CCI) as a predictor of repeated hospital admission and mortality in older CVD patients. METHODS: This study linked data from the Australian longitudinal study on women's health (ALSWH) with hospital and National Death Index datasets to identify dates for hospital admission, discharge, and death for women born 1921-26. CCI was calculated using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. RESULTS: Women with a higher CCI on index admission had increased risk of repeated hospital admission (AHR = 1.29, 95% CI 1.06, 1.58) and mortality (AHR = 3.05, 95% CI 2.15, 4.31). Older age and hypertension were also significantly associated with a higher risk of repeated hospital admission and mortality. Living in a remote area was associated with a higher risk of mortality. CONCLUSIONS: The Charlson Comorbidity Index predicts repeated hospital admission and mortality incidences among older women with CVD. Improving management of comorbidities for older CVD patients should be considered as part of a strategy to mitigate subsequent repeated hospitalisation and delay mortality.

Validation of hospital frailty risk score to predict hospital use in older people: Evidence from the Australian Longitudinal Study on Women's Health.

BACKGROUND: Frailty is among the most serious global public health challenges due to the rapid increase in the ageing population and age-associated declines in health. We aimed to validate hospital frailty risk score (HFRS) for its ability to predict prolonged hospital length of stay, 28-day unplanned readmission, repeated admission, and mortality in older people over a 15-year follow-up period. METHODS: We linked data from the Australian Longitudinal Study on Women's Health (ALSWH) with hospital admission and National Death Index datasets to identify admitted patients and death dates. This study included patients with an index unplanned admission resulting in an overnight hospital stay in 2001-2016 and aged 75-95 years at the time of admission. HFRS and Charlson comorbidity index (CCI) were calculated from the hospital data using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. RESULTS: Of 2740 older women aged 75 years and over with unplanned admission, the proportions of patients with low, intermediate, and high frailty risks were 77.15 % (n = 2114), 20.95 % (n = 574), and 1.90 % (n = 52), respectively. The 15-year follow-up revealed that high frailty risk patients increased 5-fold in 2015 (15.67 % patients, mean age = 92.26 years) compared to 2001 (2.56 % patients, mean age = 77.96 years). Prolonged hospital length of stay was higher in the intermediate (AOR = 2.86, 95 %CI: 2.26, 3.62) and high frailty risk group (AOR = 4.26, 95 %CI: 2.32, 7.63) compared to the low frailty risk group. Frailty risk was not associated with unplanned or repeated hospital admission. However, the intermediate frailty risk group (AHR = 1.78, 95 %CI: 1.47, 2.17) and the high frailty risk group (AHR = 4.17, 95 %CI: 2.00, 8.66) had a significant risk of mortality compared to the low frailty risk group. CONCLUSIONS: This study confirms the ability of HFRS to identify older, frail people at higher risk of prolonged hospital length of stay and increased mortality risk. However, we did not observe a significant association between HFRS and 28-day unplanned readmission or repeated hospital admission.

Estimating unplanned and planned hospitalization incidents among older Australian women aged 75 years and over: The presence of death as a competing risk.

OBJECTIVES: To estimate the incidence of unplanned and planned hospitalization and identify associated factors among older women aged 75 years and over. METHODS: This study is a prospective longitudinal cohort study (over the period 2001-2016). Women born between 1921 and 1926 were included from the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH self-reported data were linked with New South Wales's state Admitted Patient Data Collection. A competing risk analysis was performed using SAS v 9.4. RESULTS: Overall, during the 15-year observation period, 86.7% of women experienced at least one unplanned admission and 60.3% experienced at least one planned admission. The complement of Kaplan-Meier survival function overestimates hospitalization incidence compared to cumulative incidence function in the presence of a competing risk, that is, "death." Predisposing factors (older age and not partnered) and need factors (hospital doctor visit, GP or family doctor visit, poor perceived general health, and having at least one chronic disease) were associated with increased unplanned admission. First language other than English and not having private health insurance showed a negative association with planned admission; specialist doctor visits had a positive association. CONCLUSIONS: Hospital admission was influenced by predisposing and enabling factors, as well as need. Intervention aiming to support older people who do not have private health insurance may be required to improve the goal of equal access to healthcare through planned admissions people with equal need.

Unplanned Readmission within 28 Days of Hospital Discharge in a Longitudinal Population-Based Cohort of Older Australian Women.

This study aimed to estimate the incidence of 28-day unplanned readmission among older women, and associated factors. Data were used from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health. Linkage of self-reported survey data with the Admitted Patient Data Collection allowed the identification of hospital admissions for each woman and the corresponding baseline characteristics. The Cox proportional-hazards model was used to identify factors associated with time to unplanned readmission, using SAS software V 9.4. (SAS Institute, Cary, NC, USA). Of 2056 women with index unplanned admission, 363 (17.5%) were readmitted within 28 days of discharge, and of these 229 (11.14%) had unplanned readmission. Among women with unplanned readmission, 24% were for the same condition as for the index hospitalisation. Cardiovascular diseases were the main diagnoses for the index admission and readmission. Unplanned readmission risk was higher if not partnered (hazard ratio (HR) = 1.43, 95% confidence interval (CI): 1.05-1.95), of non-English speaking background (HR = 1.62%, 95% CI: 1.07-2.47), more than three days length of stay on index admission (HR = 1.41%, 95% CI: 1.04-1.90) and one or two of the assessed chronic diseases (HR = 1.68, 95% CI: 1.19-2.36). At least one in ten women had unplanned readmission at some time between ages 75-95 years. Women who are not partnered, not of English-speaking background, with longer hospital stay and those with multi-morbidity, may need further efforts during their stay and on discharge to mitigate unplanned readmission.

Determinant of time-to-first birth interval after marriage among Ethiopian women.

BACKGROUND: Time-to-first birth after marriage has a significant role in the future life of each individual woman and has a direct relationship with fertility. This study aimed to see the determinant of time-to-first birth interval after marriage among Ethiopian women. METHODS: The data was obtained from 2011 Ethiopia Demographic and Health Survey which is the third survey. The sample was selected using a stratified; two-stage cluster sampling design and the data was analysed using parametric shared frailty model. RESULTS: A total of 7925 ever married women from the nine region of the country were included in this study. Of the total women, 5966 (75.3%) of them gave firstbirth. Age, residence area, employment status, contraceptive use and education of women were associated significantly to time-to-first birth. CONCLUSIONS: Women having younger age at first marriage, urban women, contraceptive users had prolonged time to first birth interval. There is a need of teaching family for contraceptive use and improving women education to increase the length of first birth interval in Ethiopia.