Chloroplast Sec14-like 1 (CPSFL1) is essential for normal chloroplast development and affects carotenoid accumulation in Chlamydomonas.

Plastid isoprenoid-derived carotenoids serve essential roles in chloroplast development and photosynthesis. Although nearly all enzymes that participate in the biosynthesis of carotenoids in plants have been identified, the complement of auxiliary proteins that regulate synthesis, transport, sequestration, and degradation of these molecules and their isoprenoid precursors have not been fully described. To identify such proteins that are necessary for the optimal functioning of oxygenic photosynthesis, we screened a large collection of nonphotosynthetic (acetate-requiring) DNA insertional mutants of Chlamydomonas reinhardtii and isolated cpsfl1 The cpsfl1 mutant is extremely light-sensitive and susceptible to photoinhibition and photobleaching. The CPSFL1 gene encodes a CRAL-TRIO hydrophobic ligand-binding (Sec14) domain protein. Proteins containing this domain are limited to eukaryotes, but some may have been retargeted to function in organelles of endosymbiotic origin. The cpsfl1 mutant showed decreased accumulation of plastidial isoprenoid-derived pigments, especially carotenoids, and whole-cell focused ion-beam scanning-electron microscopy revealed a deficiency of carotenoid-rich chloroplast structures (e.g., eyespot and plastoglobules). The low carotenoid content resulted from impaired biosynthesis at a step prior to phytoene, the committed precursor to carotenoids. The CPSFL1 protein bound phytoene and ß-carotene when expressed in Escherichia coli and phosphatidic acid in vitro. We suggest that CPSFL1 is involved in the regulation of phytoene synthesis and carotenoid transport and thereby modulates carotenoid accumulation in the chloroplast.

Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia.

INTRODUCTION: Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. METHODS: In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as 'healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. RESULTS: Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. CONCLUSION: Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes.

An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial.

BACKGROUND: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. OBJECTIVE: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. METHODS: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). RESULTS: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001). CONCLUSIONS: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results. TRIAL REGISTRATION: Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx.

Can we measure integration of healthcare from administrative and clinical records?

BACKGROUND: A major component of integrated care is shared information. Computer-based clinical and administrative systems, particularly in multidisciplinary environments, provide an opportunity to directly measure the degree of integration. OBJECTIVE: The objective of this article is to explore the viability of automated measurement of integration within a multidisciplinary healthcare centre. METHODS: With the assistance of practice staff, researchers explored the structure and content of selected patient records in two practices to understand the viability of automated measurement. RESULTS: Extracted patient records can be used to understand integration to the degree that communication is recorded, but at significant expense to the practices and researchers. Automated systems are practical to the degree that clinicians complete all relevant identifying fields. DISCUSSION: Computerised clinical systems provide opportunities for exploring integration of care if they include a range of care providers and all relevant fields are always completed. The latter condition will always be difficult to achieve.

When is a GP home-visit program financially viable?

Despite a decline in GP home visits in Australia, these services remain an important aspect of healthcare access and delivery for the aged population. Home visits can both provide better care and decrease use of ambulance and emergency department (ED) services. The net costs of providing GP visits are complex, depending on the relative costs of home visits and ED attendances, the number of ED attendances saved by GP visits, and the number of services provided per day by a visiting GP. The Australian Capital Territory government created the General Practice Aged Day Service (GPADS) program in March 2011. Using data and information from this program as a basis, we examine the financial aspects of a daytime home-visit program in the Australian context. Whether or not a program is financially viable depends on a range of parameters; if all factors are aligned a program can generate net savings. While there is no information available on the net health benefits of home visits relative to ED attendance, these differences need not be large for the program to be cost-effective.

Community cardiovascular disease risk from cross-sectional general practice clinical data: a spatial analysis.

INTRODUCTION: Cardiovascular disease (CVD) continues to be a leading cause of illness and death among adults worldwide. The objective of this study was to calculate a CVD risk score from general practice (GP) clinical records and assess spatial variations of CVD risk in communities. METHODS: We used GP clinical data for 4,740 men and women aged 30 to 74 years with no history of CVD. A 10-year absolute CVD risk score was calculated based on the Framingham risk equation. The individual risk scores were aggregated within each Statistical Area Level One (SA1) to predict the level of CVD risk in that area. Finally, the pattern of CVD risk was visualized to highlight communities with high and low risk of CVD. RESULTS: The overall 10-year risk of CVD in our sample population was 14.6% (95% confidence interval [CI], 14.3%-14.9%). Of the 4,740 patients in our study, 26.7% were at high risk, 29.8% were at moderate risk, and 43.5% were at low risk for CVD over 10 years. The proportion of patients at high risk for CVD was significantly higher in the communities of low socioeconomic status. CONCLUSION: This study illustrates methods to further explore prevalence, location, and correlates of CVD to identify communities of high levels of unmet need for cardiovascular care and to enable geographic targeting of effective interventions for enhancing early and timely detection and management of CVD in those communities.

Doctors on the move: National estimates of geographical mobility among general practitioners in Australia.

BACKGROUND: The aim of this study was to examine the geographical mobility patterns on a national level of general practitioners (GPs) across degrees of rurality. While this is a topic with great policy implications, negligible published research exists in Australia on this topic. METHODS: Publicly available data for all registered GPs with specialist 'general practice' registration for 2011 and 2013 were obtained from the Australian Health Professional Registration Agency (AHPRA) and analysed. RESULTS: Annually, about 10% of Australian GPs have changed their principal place of practice (PPP), and about 1% of GPs moved between states. A net move into major cities was observed. Major cities were the most favoured destination of GPs moving out of a remote area, and the largest source of GPs moving into remote and very remote areas. Among GPs, there was a gradient of increasing distances moved with increasing rurality. DISCUSSION: This study shows for the first time that annually, about 10% of GPs change their PPP over a short time period. The drift of GPs away from rural areas indicates that policymakers should focus on recruitment and retention in these areas, preferably providing incentives for moving specifically from metropolitan areas.

Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned.

Surveys of GPs are essential to facilitate future planning and delivery of health services. However, recruitment of GPs into research has been disappointing with response rates declining over recent years. This study identified factors that facilitated or hampered GP recruitment in a recent survey of Australian GPs where a range of strategies were used to improve recruitment following poor initial responses. GP response rates for different stages of the survey were examined and compared with reasons GPs and leaders of university research networks cited for non-participation. Poor initial response rates were improved by including a questionnaire in the mail-out, changing the mail-out source from an unknown research team to locally known network leaders, approaching a group of GPs known to have research and training interests, and offering financial compensation. Response rates increased from below 1% for the first wave to 14.5% in the final wave. Using a known and trusted network of professionals to endorse the survey combined with an explicit compensation payment significantly enhanced GP response rates. To obtain response rates for surveys of GPs that are high enough to sustain external validity requires an approach that persuades GPs and their gatekeepers that it is worth their time to participate.

A brief report on Primary Care Service Area catchment geographies in New South Wales Australia.

BACKGROUND: To develop a method to use survey data to establish catchment areas of primary care or Primary Care Service Areas. Primary Care Service Areas are small areas, the majority of patients resident in which obtain their primary care services from within the geography. METHODS: The data are from a large health survey (n =267,153, year 2006-2009) linked to General Practitioner service use data (year 2002-2010) from New South Wales, Australia. Our methods broadly follow those used previously by researchers in the United States of America and Switzerland, with significant modifications to improve robustness. This algorithm allocates post code areas to Primary Care Service Areas that receive the plurality of patient visits from the post code area. RESULTS: Consistent with international findings the median Localization Index or the median percentage of patients that obtain their primary care from within a Primary Care Service Area is 55% with localization increasing with rurality. CONCLUSIONS: With the additional methodological refinements in this study, Australian Primary Care Service Areas have great potential to be of value to policymakers and researchers.

What primary health-care services are Australian consumers willing to accept from nurse practitioners? A National Survey.

BACKGROUND: Nurses are becoming increasingly important as providers of primary health care in Australia. In November 2010, Medicare provider rights and Pharmaceutical Benefits Scheme rights for nurse practitioners, working in private practice and in collaboration with a medical practitioner, were introduced in Australia. Although international evidence suggests that nurse practitioners would be appropriate and acceptable providers of care at the first point of contact, such as primary health care, there is little Australian evidence about what care consumers are willing to accept from nurse practitioners. OBJECTIVES: To ascertain what care Australian health-care consumers would accept from nurse practitioners in this setting. PARTICIPANTS: Australian adults over 18 years of age. METHODS: National Survey delivered online. Information about the survey was disseminated through a media campaign, stakeholder engagement and through the health-care consumer networks nationally. RESULTS: The total number of respondents that started the survey was n = 1883. Ninety-five percentage (n = 1784) of respondents completed the survey. The majority of respondents were women, aged 25-54 years, had completed tertiary education and had an annual household income of more than A$80,000. The majority of the respondents (n = 1562, 87%) said they would be prepared to see a nurse practitioner for some of their primary health-care needs. CONCLUSIONS: The findings of this study suggest consumers are accepting of a range of activities undertaken by nurse practitioners in primary health care and this has relevance for primary health-care workforce mix and organization, particularly for areas that are underserved by medical practitioners.

Out-of-pocket expenditure by Australian seniors with chronic disease: the effect of specific diseases and morbidity clusters.

BACKGROUND: Out of pocket expenditure (OOPE) on healthcare is related to the burden of illness and the number of chronic conditions a patient experiences, but the relationship of these costs to particular conditions and groups of conditions is less studied. This study examines the effect on OOPE of various morbidity groupings, and explores the factors associated with a 'heavy financial burden of OOPE' defined by an expenditure of over 10% of equivalised household income on healthcare. METHODS: Data were collected from 4,574 senior Australians using a stratified sampling procedure by age, rurality and state of residence. Natural clusters of chronic conditions were identified using cluster analysis and clinically relevant clusters based on expert opinion. We undertook logistic regression to model the probability of incurring OOPE, and a heavy financial burden; linear regression to explore the significant factors of OOPE; and two-part models to estimate the marginal effect of factors on OOPE. RESULTS: The mean OOPE in the previous three months was AU$353; and 14% of respondents experienced a heavy financial burden. Medication and medical service expenses were the major costs. Those who experienced cancer, high blood pressure, diabetes or depression were likely to report higher OOPE. Patients with cancer or diabetes were more likely than others to face a heavy burden of OOPE relative to income. Total number of conditions and some specific conditions predict OOPE but neither the clusters nor pairs of conditions were good predictors of OOPE. CONCLUSIONS: Total number of conditions and some specific conditions predict both OOPE and heavy financial burden but particular comorbid groupings are not useful in predicting OOPE. Low-income patients pay a higher proportion of income than the well-off as OOPE for healthcare. Interventions targeting those who are likely to face severe financial burdens due to their health could address some of these differences.

Improving coordination through information continuity: a framework for translational research.

BACKGROUND: There is good evidence that coordination can have beneficial impacts on patient care and outcomes but the mechanisms by which coordination is to be achieved are poorly understood and rarely identified in relevant policies. One approach suggests that continuity of information is a key element but research is yet to provide guidance on how to optimise coordination through improving continuity in healthcare settings. DISCUSSION: In this paper we report on the development of a conceptual framework of information continuity in care coordination. We drew on evidence from systematic reviews of coordination and empirical studies on information use in integrated care models to develop the framework. It identifies the architecture, processes and scope of practices that evidence suggests is required to support information continuity in a population based approach to care coordination. The framework offers value to policy makers and practitioners as a map that identifies the multi-level elements of an integrated system capable of driving better coordination. Testing of the framework in different settings could aid our understanding of information continuity as a mechanism for linking coordination strategies that operate at different levels of the health system and enable synthesis of findings for informing policy and practice.

People with multiple unhealthy lifestyles are less likely to consult primary healthcare.

BACKGROUND: Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. METHODS: A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. RESULTS: After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. CONCLUSION: To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles.

Supply and demand in physician markets: a panel data analysis of GP services in Australia.

To understand the trends in any physician services market it is necessary to understand the nature of both supply and demand, but few studies have jointly examined supply and demand in these markets. This study uses aggregate panel data on general practitioner (GP) services at the Statistical Local Area level in Australia spanning eight years to estimate supply and demand equations for GP services. The structural equations of the model are estimated separately using population-weighted fixed effects panel modelling with the two stage least squares formulation of the generalised method of moments approach (GMM (2SLS)). The estimated price elasticity of demand of [Formula: see text] is comparable with other studies. The direct impact of GP density on demand, while significant, proves almost immaterial in the context of near vertical supply curves. Supply changes are therefore due to shifts in the position of the curves, partly determined by a time trend. The model is validated by comparing post-panel model predictions with actual market outcomes over a period of three years and is found to provide surprisingly accurate projections over a period of significant policy change. The study confirms the need to jointly consider supply and demand in exploring the behaviour of physician services markets.

Time to care? Health of informal older carers and time spent on health related activities: an Australian survey.

BACKGROUND: Little is known about the time spent on specific health related activities by older adult informal carers who assist people with chronic illness. Research has not yet addressed the association between carer health status and their care demands. Such information could inform policy and health system efforts to manage chronic illness. METHODS: We conducted an Australia wide survey using recall questionnaires to record time use. The study asked how much time is spent on "most days" for the most common activities like taking medication, self-treatment and testing, and how much time in the last month on less common activities like attending a physician or shopping associated with health needs. The survey was mailed to 5,000 members of National Seniors Australia; 2,500 registrants on the National Diabetes Services Scheme; and 3,100 members of the Australian Lung Foundation. A total of 2519 people responded, including 313 people who identified as informal carers. Statistical analysis was undertaken using Stata 11. Standard errors and confidence intervals were derived using bootstrapping techniques within Stata 11. RESULTS: Most carers (96.2%) had chronic illness themselves, and those with greater numbers of chronic illnesses were those who faced the greatest overall time demands. The top decile of carers devoted between 8.5 and 10 hours a day to personal and caring health related activities. Informal carers with chronic illness spent more time managing their own health than people with chronic illness who were not informal carers. These carers spent more time on caring for others than on caring for their own health. High levels of caring responsibility were associated with poorer reported carer health. CONCLUSIONS: Policy and health care services will need to adapt to recognise and reduce the time burden on carers who themselves have chronic illness. More carefully targeted investment in the social infrastructure of formal care would free up carers for other activities (including their own care) and holds the potential to improve the quality of life as well as the health outcomes of this population.

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare.

BACKGROUND: Good quality spatial data on Family Physicians or General Practitioners (GPs) are key to accurately measuring geographic access to primary health care. The validity of computed associations between health outcomes and measures of GP access such as GP density is contingent on geographical data quality. This is especially true in rural and remote areas, where GPs are often small in number and geographically dispersed. However, there has been limited effort in assessing the quality of nationally comprehensive, geographically explicit, GP datasets in Australia or elsewhere.Our objective is to assess the extent of association or agreement between different spatially explicit nationwide GP workforce datasets in Australia. This is important since disagreement would imply differential relationships with primary healthcare relevant outcomes with different datasets. We also seek to enumerate these associations across categories of rurality or remoteness. METHOD: We compute correlations of GP headcounts and workload contributions between four different datasets at two different geographical scales, across varying levels of rurality and remoteness. RESULTS: The datasets are in general agreement with each other at two different scales. Small numbers of absolute headcounts, with relatively larger fractions of locum GPs in rural areas cause unstable statistical estimates and divergences between datasets. CONCLUSION: In the Australian context, many of the available geographic GP workforce datasets may be used for evaluating valid associations with health outcomes. However, caution must be exercised in interpreting associations between GP headcounts or workloads and outcomes in rural and remote areas. The methods used in these analyses may be replicated in other locales with multiple GP or physician datasets.

From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?

The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.

Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models.

BACKGROUND: Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. METHODS: Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. RESULTS: The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. CONCLUSIONS: The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved.

Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey.

BACKGROUND: The use of complementary and alternative medicines (CAM) and CAM practitioners is common, most frequently for the management of musculoskeletal conditions. Knowledge is limited about the use of CAM practitioners by older people, and specifically those with other long term or chronic conditions. METHODS: In 2011 we conducted an Australia wide survey targeting older adults aged over 50 years (n = 2540). Participants were asked to identify their chronic conditions, and from which health professionals they had 'received advice or treatment from in the last 3 months', including 'complementary health practitioners, e.g. naturopath'. Descriptive analyses were undertaken using SPSS and STATA software. RESULTS: Overall, 8.8% of respondents reported seeing a CAM practitioner in the past three months, 12.1% of women and 3.9% of men; the vast majority also consulting medical practitioners in the same period. Respondents were more likely to report consulting a CAM practitioner if they had musculoskeletal conditions (osteoporosis, arthritis), pain, or depression/anxiety. Respondents with diabetes, hypertension and asthma were least likely to report consulting a CAM practitioner. Those over 80 reported lower use of CAM practitioners than younger respondents. CAM practitioner use in a general older population was not associated with the number of chronic conditions reported, or with the socio-economic level of residence of the respondent. CONCLUSION: Substantial numbers of older Australians with chronic conditions seek advice from CAM practitioners, particularly those with pain related conditions, but less often with conditions where there are clear treatment guidelines using conventional medicine, such as with diabetes, hypertension and asthma. Given the policy emphasis on better coordination of care for people with chronic conditions, these findings point to the importance of communication and integration of health services and suggest that the concept of the 'treating team' needs a broad interpretation.