Recommendations The Commission hosts a roundtable of service providers and consumers from remote areas to identify successful strategies for implementing best practice primary and secondary prevention services for patients with chronic diseases in remote Australia. Asthma and chronic obstructive pulmonary disease medicines dispensing and hospital admissions The Australian Government Department of Health encourages primary health networks to develop local models of integrated care for asthma and chronic obstructive pulmonary disease to ensure properly coordinated community prevention strategies are implemented. State and territory health departments and primary health networks jointly review the uptake of vaccinations against respiratory diseases in high-risk populations and their influence on local variation. Heart failure hospital admissions 40 years and over Primary health networks, state and territory health departments and clinicians collaborate to improve access for patients with heart failure to comprehensive heart failure programs consistent with evidence-based best practice. Diabetes-related lower limb amputation hospital admissions 18 years and over Public and private hospitals and primary health networks adopt risk-stratified levels of support for managing diabetes care, including earlier diagnosis and intervention. Primary health networks and state and territory health departments collaborate to improve access to coordinated services that deliver evidence-based care for those with diabetes, including at multidisciplinary foot clinics, and care by vascular, endocrine and orthopaedic specialists. Stroke average length of stay in hospital 65 years and over Hospital and ambulance services ensure patients have access to care that aligns with the Stroke Clinical Care Standard. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data for stroke. Relevant clinical colleges ensure educational and training material, as well as continuing professional development requirements, are in keeping with the Stroke Clinical Care Standard. Background Chronic diseases are the leading cause of illness, disability and death in Australia and internationally. Cardiovascular diseases, cancers, respiratory diseases and diabetes account for 82 per cent of chronic disease deaths worldwide1,2 and 75 per cent of chronic disease deaths in Australia.2 In Australia, chronic diseases accounted for 90 per cent of all deaths in 2011.3 Chronic diseases have complex causes and multiple risk factors. Many common risk factors, including smoking, poor nutrition, alcohol and lack of physical activity. With changing lifestyles and ageing populations, chronic diseases have become increasingly common in Australia and cause most of the burden of ill health.4 Depression is also a risk factor for chronic disease.5
Magnitude of variation In 2013–14, were 1,659,993 PBS prescriptions dispensed for asthma medicines, representing 20,425 prescriptions per 100,000 people aged 20 to 44 years (the Australian rate). The number of PBS prescriptions dispensed for asthma medicines across 325* local areas (SA3s) ranged from 2,244 to 44,092 per 100,000 people aged 20 to 44 years. The number of prescriptions was 19.6 times higher in the area with the highest rate compared to the area with the lowest rate. The average number of prescriptions dispensed varied across states and territories, from 9,521 per 100,000 people aged 20 to 44 years in the Northern Territory, to 32,260 in Tasmania. After excluding the highest and lowest results, the asthma medicine prescription rate across the 306 remaining local areas was 3.4 times higher in one local area compared to another. Dispensing rates tended to be higher in inner and outer regional areas than in major cities and were lowest in remote communities. There was a clear relationship with socioeconomic status in all categories of remoteness, with dispensing rates highest in areas of low socioeconomic status and decreasing as the socioeconomic status increased. Interpretation Potential reasons for the variation include differences in: rates of smoking, which is a known trigger for asthma. Higher rates of smoking are evident in those from low socioeconomic groups1, and among Aboriginal and Torres Strait Islander people2 distribution of Indigenous people, who are almost twice as likely as people to report having asthma3 levels of adherence to medicines – poor adherence to preventive medicines results in poor asthma control4,5 clinicians’ prescribing preferences, including for combination products or single-agent products distribution of concession cardholders as current PBS arrangements result in a cost gap for buying asthma relievers but not preventers use of spirometric assessments by general practitioners to determine asthma severity levels of access to, and of, over-the-counter reliever medications. It is also important to note that the dispensing of medicines in remote areas by some Aboriginal Health Services is not captured in the PBS. To explore this variation, further analysis could focus on: the variation in dispensing of relievers and preventers for asthma across states and territories the extent to which higher smoking rates are linked to locations with higher asthma medicine dispensing rates.