Healthcare expenditure and its socio-demographic and clinical predictors in Australians with poorly controlled asthma.

INTRODUCTION: Asthma has substantial and increasing health and economic burden worldwide. This study aimed to estimate healthcare expenditure and determine the factors that increase expenditure in Australians with poorly controlled asthma. METHODS: Individuals ≥18 years of age with poorly controlled asthma, as determined by a score ≥1.5 on the Asthma Control Questionnaire, were included in the study. Healthcare utilization costs from medical services and medications were estimated over an average follow-up of 12 months from administratively linked data: the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. A generalized linear model with gamma distribution and log link was used to predict participants' key baseline characteristics associated with variations in healthcare costs. RESULTS: A total of 341 participants recruited through community pharmacies were included. The mean (standard deviation, SD) age of participants was 56.6 (SD 17.6) years, and approximately 71% were females. The adjusted average monthly healthcare expenditure per participant was $AU386 (95% CI: 336, 436). On top of the average monthly costs, an incremental expenditure was found for each year increase in age ($AU4; 95% CI: 0.78, 7), being unemployed ($AU201; 95% CI: 91, 311), one unit change in worsening quality of life ($AU35; 95% CI: 9, 61) and being diagnosed with depression and anxiety ($AU171; 95% CI: 36, 306). CONCLUSIONS: In a cohort of Australian patients, characterized by poor asthma control and co-morbidities individuals impose substantial economic burden in terms of Medicare funded medical services and medications. Programs addressing strategies to improve the quality of life and manage co-morbid anxiety and depression and encourage asthma patients' engagement in clinically tolerable jobs, may result in significant cost savings to the health system.

Attitudes, behaviours, and self-reported confidence of Australian pharmacy students and interns towards nutritional counselling.

INTRODUCTION: Pharmacists play a prominent role in the counselling and education of patients complementary to provision of medicines. The increase in non-communicable diseases associated with poor quality diets has placed a greater demand on pharmacists to play a role in the provision of nutritional education to patients. This study aimed to investigate pharmacy students' and interns' attitudes, behaviours, and self-reported confidence towards nutritional counselling and to examine factors associated with their intention to counsel patients in nutrition. METHODS: An online survey was designed using the theory of planned behaviour and was distributed to final-year pharmacy students and interns enrolled at the University of Sydney. Data analysis was conducted to test for correlations between behavioural intentions, attitudes, confidence, subjective norms, and perceived behavioural control. RESULTS: Sixty-six surveys were completed, representing an average response rate of 19.6%. Half of all participants reportedly were providing nutritional advice to patients at least once per week or more often when working in a pharmacy. Participants' intention to counsel patients about nutrition was influenced by preceptors' encouragement. The participants' average level of confidence in having the knowledge and skills to provide nutritional counselling, reported over 13 medical conditions, showed that they were on average "somewhat confident" in providing nutritional counselling, with the level of confidence differing depending upon the specific topic areas. CONCLUSIONS: Participants acknowledged the role of pharmacists in the provision of nutritional counselling, but a more comprehensive nutrition curriculum integrated within existing pharmacy curricula is warranted to increase pharmacy students' and interns' confidence.

A review of primary healthcare practitioners' views about nutrition: implications for medical education.

Objectives: This study aimed to review literature that reports on the perspectives and opinions of Australian and New Zealand primary healthcare practitioners on their role in nutrition counselling of their patients. Methods: A systematic search of relevant articles reporting on attitudes towards nutrition counselling by Australian and New Zealand doctors/physicians, nurses including midwives, pharmacists and dentists was conducted. The search included literature from the past ten years until March 2021 and identified 21 relevant papers, with most of the studies including medical practitioners and nurses. Results: Three main themes were identified from qualitative and quantitative data, which included education and training, practitioner experiences and challenges. Consistent with previous literature, health care practitioners acknowledged their important role in the provision of dietary advice to patients. Challenges that influenced the provision of this advice included insufficient education and training, time constraints and limited knowledge and confidence. Time constraints during normal consultations led to a low priority of nutrition counselling. An absence of assessment opportunities to demonstrate nutrition competence and limited coverage of specific nutrition-related advice during training were also reported. Conclusions: Primary healthcare practitioners acknowledge the importance of playing a role in the provision of nutrition advice but require education and access to evidence-based information that can be utilised effectively within the time constraints of standard consultations. Medical education curricula can be improved to provide more emphasis on nutrition education, including relevant assessment opportunities.

Perceptions, opinions and knowledge of pharmacists towards the use of complementary medicines by people living with cancer.

Background Biologically-based complementary medicine (BB-CM) use is prevalent amongst people living with cancer. Pharmacists play an important role in the provision of standard treatments for cancer. Less is known about pharmacist's provision of BB-CM information. Objective This study investigated the opinions, perceptions and knowledge of pharmacists regarding the use of BB-CMs by people living with cancer and the facilitators and barriers to providing information and advice. Setting Australia. Method A cross-sectional 53-item survey was developed and the survey link distributed in two professional associations newsletters. The associations represent ~29,000 pharmacists. Questions were categories into pharmacist's perceptions, opinions, and knowledge towards the use of BB-CM in cancer. Main Outcome Measure Scores obtained from responses to perception, opinion and knowledge statements and responses to demographic questions Results Respondents (n=70) were predominantly female (73%), Caucasian (66%) and under 40 years of age (78%). Respondents estimated that 19% of daily inquiries related to BB-CMs. Seventy-two per cent of respondents believed they had a responsibility to advise about the concomitant use of BB-CM with standard cancer treatments despite 60% reporting a lack of confidence in their knowledge. There was a moderate positive association (Spearman's rho 0.41 p= 0.001) between a pharmacists confidence in their level of knowledge and their total knowledge scores. The main barriers to providing information about BB-CMs reported were inadequate training in BB-CMs (94%) and reservations about the evidence base for efficacy and safety (50%). Conclusion Pharmacists have a role to play in counselling people living with cancer about their use of BB-CMs and this role could be maximized with further training and education in this area.

Calcium consumption for osteoporosis prevention: knowledge, attitudes and behavior in the northeastern region, Thailand.

OBJECTIVE: Identified Thai adults' knowledge and attitudes towards calcium and determined factors predicting calcium consumption. MATERIAL AND METHOD: One thousand four hundred seventy five Thai adults, aged > or = 20 years old were interviewed, using a semi-structured questionnaire. Knowledge about role of calcium and good sources of calcium was measured using 17 questions. Attitudes towards calcium were measured with 10 opinion statements, using 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Calcium consumption, based on a 24-hour recall, was assessed using food frequency checklists and open-ended questions. RESULTS: The median score for knowledge was 15 (IQR: 12, 16; total possible score: 17). The overall median of attitudinal score was 5.6 (IQR: 4.9, 6.1; cronbach's alpha = 0.80). Approximately 10.9% consumed adequate amounts of calcium (800 mg/day). CONCLUSION: Factors significantly determining the likelihood an adequate intake of calcium were age < 35 years, support from peers and taking calcium-supplements.

Australian community pharmacists' practice in complementary medicines: a structural equation modeling approach.

OBJECTIVE: This survey tested a model of factors influencing pharmacists' practice in relation to complementary medicines (CMs). METHODS: Self-administered questionnaires were used to collect data from 212 community pharmacists in New South Wales. Structural equation modeling with AMOS version 6.0, was used to model two practices in relation to CMs: an evaluation of appropriateness of CM use and the decision to sell. RESULTS: Pharmacists' perceptions of their responsibilities in ensuring the safe use of CMs predicted the comprehensiveness of an evaluation for appropriateness of CM use (P=0.002). When level of comprehensiveness of evaluation increased, pharmacists were less likely to sell CMs in situations where the use of the products was not considered appropriate (P=0.021). Pharmacists' confidence in their CM knowledge, attitudes towards CMs, concern about pharmacy income and pharmacists' characteristics did not significantly affect their practice. CONCLUSION: Pharmacists' acceptance of their counseling responsibility with respect to CMs was the strongest predictor of both comprehensiveness of an evaluation and the decision to sell a CM. PRACTICE IMPLICATIONS: Pharmacists must be encouraged to recognise and accept their responsibility in ensuring the safe and effective use of CMs.