Medical Journal of Australia最新文献

{"title":"Updates on chronic liver disease","authors":"Alison Williams","doi":"10.5694/mja2.70030","DOIUrl":"https://doi.org/10.5694/mja2.70030","url":null,"abstract":"<p>This issue of the <i>MJA</i> brings a focus on chronic liver disease, which was the ninth leading cause of fatal burden in Australia in 2023 and which is largely preventable.<span>¹</span> Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver condition in Australia;<span>²</span> however, to date there has been a lack of clear and current guidance on its detection and management. So why does MAFLD matter? If left unchecked, MAFLD will be an increasingly important public health issue. Although patients with MAFLD are most likely to die from cardiovascular disease or extrahepatic cancers, MAFLD can progress to advanced stages of liver disease, including cirrhosis and liver cancer.<span>³</span> Additionally, MAFLD is a condition that often goes undetected, and is frequently asymptomatic, especially in the early stages, with many patients only diagnosed when undergoing tests for other reasons, or following up abnormal liver function tests.<span>⁴</span> Aimed towards individuals working in primary care, Adams and colleagues present a consensus statement summary of evidence-based recommendations covering key clinical areas such as screening and diagnosis of MAFLD, assessment of extrahepatic comorbid conditions and underlying liver disease, and monitoring over time. Importantly, MAFLD should be considered in people with obesity and/or type 2 diabetes, or two or more metabolic risk factors.<span>⁵</span> As such, general practitioners are in a unique position to implement these guidelines, and assess and monitor patient's liver and metabolic health over time.</p><p>Hepatitis C virus (HCV) infection, another important cause of liver disease, is fortunately one in which significant progress has been made towards elimination, with the overall hepatitis C notification rate declining by 36% from 2014 to 2023.<span>⁶</span> This decline can partly be attributed to the availability of direct-acting antivirals (DAAs), as well as primary prevention strategies. DAAs are oral medications that are highly effective and widely accessible in primary care — a model that helps to reduce waiting times and improve access to treatment. However, in some cases, people with HCV infection are referred to tertiary centres for management by non-general practitioner specialists, but little is known about the clinical outcomes of DAA treatment in this context. To bridge this knowledge gap, Layton and colleagues described the cascade of care for a subset of 50 patients identified in the Coordinated Hepatitis response to Enhance the Cascade of Care by optimising existing Surveillance systems (CHECCS) cohort who had been referred to specialist care for HCV in Victoria.<span>⁷</span> They found that most patients were offered appointments and attended, and that the majority of patients with HCV infections commenced treatment and achieved sustained viral response. Ho","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 5","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing equity: the urgent need to include trans and gender diverse people in cervical cancer prevention in Australia","authors":"Kade Booth,&nbsp;Jamie Bryant,&nbsp;Shiva Chandra,&nbsp;Cristyn Davies,&nbsp;Lucille Kerr,&nbsp;Katie Wynne,&nbsp;Melissa A Carlson,&nbsp;Barrie Shannon,&nbsp;Sav Zwickl,&nbsp;Tamara Butler,&nbsp;Lisa J Whop","doi":"10.5694/mja2.70041","DOIUrl":"10.5694/mja2.70041","url":null,"abstract":"&lt;p&gt;The right to safe, equitable, and timely health care is recognised as a fundamental human right.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Despite this, trans and gender diverse people face significant barriers to accessing safe, appropriate, and inclusive health care tailored to their specific needs, including cancer prevention and follow-up services.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The federal government's 2023 &lt;i&gt;National strategy for the elimination of cervical cancer in Australia&lt;/i&gt; recognises the disparities faced by trans and gender diverse people, and identifies cervical cancer as a preventable disease of inequity.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The strategy further recognises trans and gender diverse people as a population at risk of being left behind in the government's aim to “achieve equitable elimination of cervical cancer as a public health problem by 2035”, and a priority population requiring a targeted approach.&lt;/p&gt;&lt;p&gt;We position ourselves as a diverse team of researchers, clinicians, and people who use health care committed to equitable health. In this work, we bring a range of perspectives, which includes trans and gender diverse, LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other diverse sexualities and genders), Aboriginal, Torres Strait Islander, racial minority, and neurodivergent researchers. Our team has decades of relevant expertise, as reflected in our research, clinical practice, and importantly, our lived experience. We draw from our individual and collective expertise to highlight current issues and challenges, and advocate for improved access to cervical cancer prevention for trans and gender diverse people to work toward equitable elimination of cervical cancer.&lt;/p&gt;&lt;p&gt;Cervical cancer is now “almost entirely a disease of inequity; without systematically addressing inequities, Australia will not achieve elimination”.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; It is estimated that at least 2–3% (between 64 000 and 96 000) of young people are trans and gender diverse in Australia,&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; who will continue to experience poorer health outcomes without systemic change and investment to address barriers in human papillomavirus (HPV)-related cancer prevention care.&lt;/p&gt;&lt;p&gt;Trans and gender diverse people experience heightened exposure to cancer and cervical cancer-related risk factors (such as smoking)&lt;span&gt;&lt;sup&gt;7-9&lt;/sup&gt;&lt;/span&gt; and disproportionate cancer-related burden compared with the general population.&lt;span&gt;&lt;sup&gt;9, 10&lt;/sup&gt;&lt;/span&gt; Trans and gender diverse people with a cervix have equivalent rates of cancer-causing HPV as cis women, yet are recognised as a group at risk of being under-represented across the three pillars required to meet the national strategy elimination targets: (i) HPV vaccination,&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; (ii) routine cervical screening and treatment for pre-cancers&lt;span&gt;&lt;sup&gt;2, 12&lt;/sup&gt;&lt;/span&gt; and (iii) early access to treatment and care.&lt;span&gt;&lt;sup&gt;2, 6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;One national study found that only a","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"338-342"},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of GLP-1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system","authors":"Patrick GM Bolton","doi":"10.5694/mja2.70044","DOIUrl":"10.5694/mja2.70044","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of GLP-1 receptor agonists in the management of obesity: risks and opportunities for the Australian health care system","authors":"Deshan Sebaratnam,&nbsp;Jessie T Lu,&nbsp;Helen Y Sun","doi":"10.5694/mja2.70042","DOIUrl":"10.5694/mja2.70042","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication delivery and dispensing interval preferences of people who use antihypertensive medications in Australia: a survey study","authors":"Carissa Bonner,&nbsp;Michael A Fajardo,&nbsp;Rachael M Keast,&nbsp;Emily Atkins,&nbsp;Niamh Chapman,&nbsp;Kristie R Weir,&nbsp;Anthony Rodgers,&nbsp;Aletta E Schutte","doi":"10.5694/mja2.70034","DOIUrl":"10.5694/mja2.70034","url":null,"abstract":"&lt;p&gt;Pharmacy-related costs and fees comprise 51% of the total cost of hypertension medications in Australia, largely because of 30-day dispensing periods, increasing out-of-pocket costs for patients.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In 2022, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended 60- or 90-day dispensing periods for hypertension medications, a proposal supported by the Australian Hypertension Taskforce.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The World Health Organization recommends 90-day dispensing periods for improving medication adherence and long term blood pressure control.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The recent move from 30- to 60-day dispensing in Australia to reduce costs&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; has been controversial.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We therefore explored the perspectives of hypertension medication purchasers in Australia to provide information that could inform dispensing policy. We investigated medication dispensing method preferences in an online survey codesigned with community panel members by the Sydney Health Literacy Lab.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; The design phase included iterative discussion, development, testing, and refinement by a group of seven men and women aged 30–85 years with differing cardiovascular risk and medications experience. Forced choice questions that compared different dispensing options were developed (Box 1). Estimated costs for people with or without concession card holders were based on Pharmaceutical Benefits Scheme (PBS) copayment thresholds and prices in May 2024 (Box 2).&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The participants in our survey were members of the Dynata market research panel (https://www.dynata.com), who receive points for completing a survey they could exchange for gift vouchers. Participation was anonymous, but we collected demographic characteristics, medication experience, and dispensing preference information. We used soft quota sampling to ensure diversity with respect to age (over or under 65 years of age), education (with or without university education), and gender (men or women) to recruit a national sample of 2000 adults (18 years or older) currently using blood pressure medications, sufficiently large to facilitate exploratory demographic subgroup analyses (Supporting Information, part 2). The Qualtrics survey (https://www.qualtrics.com) was available for online completion during 27 November 2024 – 21 January 2025. We summarise participant characteristics as descriptive statistics. We assessed the preferred mode of medication collection (pharmacy pickup or postal delivery) when the cost implications of choices were not provided in logistic multivariate regression models adjusted for reaching the Pharmaceutical Benefits Scheme (PBS) safety threshold, location (major city or other), preferred medication delivery duration, education level, gender, age, and income; we report adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Analyses were undertaken in SPS","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"423-425"},"PeriodicalIF":8.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Aboriginal women-led approach to design a maternal and child health model when cardiometabolic complications are experienced in pregnancy in South Australia","authors":"Karrina DeMasi (Barkandji),&nbsp;Dana Shen (Ngarrindjeri),&nbsp;Phoebe McColl,&nbsp;Amanda Richards-Satour (Adnyamathanha and Barngarla),&nbsp;Carolyn Renehan (Central Arrernte),&nbsp;Kim Morey (Anmatyerr and Eastern Arrernte),&nbsp;Karen Glover (Mein:tnk and Wotjobaluk),&nbsp;Cathy Leane (Dharug),&nbsp;Kristine Woods-Hampton (Anmatijerre),&nbsp;Lorraine Garay (Anangu),&nbsp;Eloise Baker (Adnyamathanha and Barngarla),&nbsp;Rebecca Nielsen (Kalkadoon),&nbsp;Katharine Brown","doi":"10.5694/mja2.70033","DOIUrl":"10.5694/mja2.70033","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To develop a culturally responsive maternal and child health model, centred on Aboriginal and Torres Strait Islander women's knowledge of health, wellbeing and expressed health priorities, to address gaps in care for those who experience cardiometabolic complications in pregnancy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Health services and systems co-design.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Health services in South Australia providing maternal and child primary, acute and chronic disease management care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Nineteen Aboriginal women from urban, regional and remote areas of South Australia participated in 2024, with most having personal experience of cardiometabolic complications in pregnancy and some contributing professional experience.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main outcome measure&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Development of a culturally responsive, evidence-based model of care to support Aboriginal women with cardiometabolic complications in pregnancy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Through a collaborative approach and an iterative co-design process, participants shared lived experiences, identified systemic issues and developed solutions to address gaps in maternal and child health care. Culturally safe spaces enabled deep reflection, open dialogue and collective decision making. With this, we developed a model of care that included a vision statement, guiding principles, a conceptual framework and 18 priority areas. In addition, eight health system enablers were identified to support implementation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This project demonstrates the value of Aboriginal women's leadership in shaping health systems. This process highlights the value of culturally grounded, community-led co-design approaches to health service and system reform. For health systems and service providers and managers, this is an opportunity to foster meaningful change by listening to and acting on the voices of Aboriginal women. In doing so, they will meet their responsibility to address inequities. Researchers and health organisations must do more than amplify these voices; rather, they must listen, act and ensure that systems respond t","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"312-319"},"PeriodicalIF":8.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Values in health and health care for Indigenous people globally: an umbrella review","authors":"Lynda J Coe,&nbsp;Yvonne Dimitropoulos,&nbsp;Kiri Mealings,&nbsp;Dylan Barnes,&nbsp;Catherine M McMahon","doi":"10.5694/mja2.70027","DOIUrl":"10.5694/mja2.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To review and synthesise the global evidence regarding what Indigenous people value in health and health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>The Joanna Briggs Institute (JBI) protocol for umbrella reviews was used. Thematic meta-synthesis was conducted using collaborative yarning with an Indigenous researcher and a non-Indigenous researcher to generate concepts of value in health and health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data sources</h3>\u0000 \u0000 <p>Systematic, scoping and narrative reviews, written in English and published between 1 January 2000 and 1 January 2024, which directly included the perspectives of Indigenous people describing the value of health and/or a field of health care, were included. Databases searched included MEDLINE, Embase, CINAHL, Scopus and the Cochrane Database of Systematic Reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data synthesis</h3>\u0000 \u0000 <p>Twenty-five reviews that analysed what is valued in health and health care by Indigenous people globally were identified. The literature demonstrated a clear distinction between Indigenous and Western paradigms of health and health care, with Indigenous paradigms grounded in culture. Indigenous cultural determinants of health included: identity; land, Country and community; and spirituality and traditional healing. For health care, five core values for Indigenous people globally were identified: decolonised and holistic systems of care; culturally safe health services and care; Indigenous and culturally aware non-Indigenous workforce; accessibility; and communication, trust and rapport building.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This umbrella review highlights the importance of culture, Indigenous sovereignty and self-determination in health and accessing health care. It also reveals the importance of cultural safety and responsiveness in the delivery of health care services. The findings will be used to inform a conceptual framework of values in health and health care to develop a community-reported outcome measure. This framework will guide genuine and meaningful engagement with Indigenous communities to co-design and deliver health care that is effective, responsive and culturally safe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 6","pages":"320-325"},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic position and the prevalence of ten chronic diseases in Australia, 2021: a whole of population census data analysis.","authors":"Joanna Y Gong, Emily D Williams, Agus Salim, Spiros Fourlanos, Jonathan E Shaw, Dianna J Magliano","doi":"10.5694/mja2.70032","DOIUrl":"10.5694/mja2.70032","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio-economic position, and by age group and sex, using representative national census population data.</p><p><strong>Study design: </strong>Cross-sectional, whole of population study; analysis of 2021 Australian census data.</p><p><strong>Participants, setting: </strong>People aged 40 years or older for whom 2021 Australian census health status and socio-economic position-related data were available.</p><p><strong>Main outcome measures: </strong>Age-standardised prevalence of ten chronic diseases (arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke), by socio-economic position (Index of Relative Socio-economic Disadvantage [IRSD], income category, educational level, occupational grade), age group, and sex; mean change in prevalence across socio-economic position categories.</p><p><strong>Results: </strong>Health status responses and data that allowed IRSD categorisation were available for 11.3 million people aged 40 years or older (92% of all adults aged 40 years or older). The proportions of people who reported nine chronic diseases (exception: cancer) increased with increasing socio-economic disadvantage as measured by IRSD decile and income. The increases were less marked for people aged 80 years or older than for those aged 40-79 years, and more marked for women than men. For people aged 40-59 or 60-79 years, the increase in age-standardised chronic disease prevalence per one decile decrease in IRSD was greatest for lung disease in both women (40-59 years, 18.4% per decile; 60-79 years, 10.6% per decile) and men (40-59 years, 16.9% per decile; 60-79 years, 11.0% per decile). In people aged 80 years or older, the increase in prevalence per one decile decrease in IRSD was greatest for kidney disease in women (6.0% per decile) and for mental health conditions in men (7.1% per decile). The age-standardised prevalence of cancer decreased by 0.4-1.1% per one decile decrease in IRSD for all age groups and both sexes, except for men aged 40-59 years (increased by 0.1% per IRSD decile). Consistent relationships with educational level or occupational grade were not found.</p><p><strong>Conclusions: </strong>The prevalence of chronic disease differs by socio-economic position, but the direction, magnitude, and consistency of the effect differs by disease, socio-economic position measure, age, and sex. Understanding the relationship between different socio-economic position measures and chronic diseases facilitates the formulation of directed interventions.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioids and the challenges of managing chronic non-cancer pain in rural Australia: a qualitative study.","authors":"Jessica A Thomas, Jill Benson, Philip Davidson, Paul R Ward","doi":"10.5694/mja2.70022","DOIUrl":"10.5694/mja2.70022","url":null,"abstract":"<p><strong>Objective: </strong>To investigate why rural general practitioners prescribe opioids for people with chronic non-cancer pain, with the aims of explaining geographic differences in opioid prescribing and improving pain management in rural areas.</p><p><strong>Study design: </strong>Qualitative study; interviews with convenience sample of rural general practitioners.</p><p><strong>Setting, participants: </strong>Seventeen rural general practitioners who had prescribed opioids for people with chronic non-cancer pain during the preceding twelve months; the interviews were undertaken during 11 September 2023 - 31 May 2024.</p><p><strong>Major outcome measures: </strong>Contextual and individual factors that influence decision making by rural general practitioners about prescribing opioids for people with chronic non-cancer pain.</p><p><strong>Results: </strong>We found that rural opioid prescribing is influenced more by health care system deficiencies than lack of knowledge among practitioners. Two major themes were identified: systematic constraints (insufficient time for alternative management strategies and the influence of Medicare remuneration); and limited access to multidisciplinary pain management (limited availability of non-pharmaceutical treatments, colleagues for consultation, and referral pathways). Participants described feeling trapped between brief consultations and complex deprescribing requirements; Medicare remuneration schedules encourage shorter appointments (and therefore continuing current management) rather than comprehensive pain management. Implementing evidence-based guidelines was difficult in rural areas with limited resources. The limited availability of allied health services further restricted alternative pain management approaches. Participants reported greater psychological pressure to justify opioid deprescribing than prescribing. Doctors acknowledged that the evidence for the value of opioids for managing chronic pain was limited but felt caught between inadequate system resources and patient demands.</p><p><strong>Conclusion: </strong>We found a marked disparity between evidence-based guidelines for chronic pain management and the reality of rural medical practice. Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value. Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural area-specific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Federal health workforce policy in Australia and its implications: a descriptive policy document review.","authors":"Stephanie M Topp, Thu Nguyen, Lana M Elliott","doi":"10.5694/mja2.70021","DOIUrl":"https://doi.org/10.5694/mja2.70021","url":null,"abstract":"<p><strong>Objective: </strong>To identify which federal health workforce policies are current in Australia, and describe their mode, scope, and focus.</p><p><strong>Study design: </strong>Descriptive policy document review; categorisation according to the Howlett-Ramesh policy instrument framework.</p><p><strong>Setting: </strong>Health workforce policy documents available on the Australian Department of Health and Aged Care website, 1 June - 31 October 2024.</p><p><strong>Main outcome measures: </strong>Primary policy focus (specific health profession, population group or location); scope of policy (alignment with one or more strategic domains: supply, distribution, or performance), service sectors affected by policy, substantive mention of specific health professions; policy instrument types.</p><p><strong>Results: </strong>We included 121 policy documents in our analysis. By policy group, the number of documents was greatest for the rural health workforce (35), aged care (22), and Aboriginal and Torres Strait Islander health workforce (19); the numbers were lowest for pharmacy (three) and allied health (one), and none had public health or emergency care as their focus. Mixed policy instruments (multiple interest group programs, sub-programs, incentives, grants) were more numerous (98 documents) than government-led instruments (23 documents). Health workforce supply was a focus of 72 documents, performance of 57 documents, and distribution of 42 documents. Document nomenclature was inconsistent; 44 documents had policy labels that did not correspond to their content or purpose.</p><p><strong>Conclusion: </strong>We identified substantial fragmentation in Australian federal health workforce policy. The absence of a unified federal health workforce strategy exacerbates policy fragmentation, undermining coordinated workforce planning and equity. Adopting a consistent policy nomenclature and reducing imbalances in strategic focus are critical for effective health workforce reform. Our findings provide a baseline for analyses of policy processes and governance in Australian health workforce policymaking.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}