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  • Changes in Australian practice patterns for glaucoma management

    Author(s)
    Newman, Alexander R
    Andrew, Nicholas H
    Griffith University Author(s)
    Newman, Alexander R.
    Year published
    2019
    Metadata
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    Abstract
    Importance: The demand for glaucoma care is projected to increase significantly with the ageing population. Background: To characterize trends in Australian practice patterns for glaucoma management over the 15-y period between 2003 and 2017. Design: Retrospective audit. Samples: The Medicare eligible population. Methods: Audit of Medicare Benefits Schedule item number reimbursements in the private healthcare sector, and dispensed Pharmaceutical Benefits Scheme (PBS) prescriptions. Main Outcome Measures: Number, unadjusted cost and services per capita in the enrolled population. Results: The number of medication prescriptions ...
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    Importance: The demand for glaucoma care is projected to increase significantly with the ageing population. Background: To characterize trends in Australian practice patterns for glaucoma management over the 15-y period between 2003 and 2017. Design: Retrospective audit. Samples: The Medicare eligible population. Methods: Audit of Medicare Benefits Schedule item number reimbursements in the private healthcare sector, and dispensed Pharmaceutical Benefits Scheme (PBS) prescriptions. Main Outcome Measures: Number, unadjusted cost and services per capita in the enrolled population. Results: The number of medication prescriptions peaked in 2015, but then declined by 14.9%. PBS expenditure on glaucoma medications has been falling since 2012. There was a 9.2-fold increase in fixed-combination prescriptions and 281-fold increase in unpreserved medication prescriptions. In 2017, optometrists generated 1.86% of glaucoma prescriptions. Reimbursements for computerized perimetry increased dramatically for optometrists, and in 2017 optometrist-initiated perimetry exceeded ophthalmologist-initiated perimetry by 35.3%. There were significant increases in laser procedure rates, including laser trabeculoplasty (4.61-fold), laser iridotomy (2.55-fold) and cyclodestructive procedures (2.33-fold). There was a 3.83-fold increase in glaucoma drainage device insertions. Ab interno trabecular microbypass procedures increased 715% from 2014 to 2017. Adjusted for Medicare population, trabecular microbypass is performed at more than twice the rate of primary filtering operations. Conclusions and Relevance: This is the first time that glaucoma medication use and expenditure have declined since auditing began in 1992. Glaucoma laser procedures, drainage device implantation and trabecular microbypass increased substantially over the study period. In contrast, the rate of primary filtering operations increased in proportion to population growth. The increase in overall cost of glaucoma care has primarily been driven by computerized perimetry; however, this has been partially offset by a decline in medication expenditure.
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    Journal Title
    Clinical & Experimental Ophthalmology
    Volume
    47
    Issue
    5
    DOI
    https://doi.org/10.1111/ceo.13456
    Subject
    Clinical sciences
    Ophthalmology and optometry
    Health services and systems
    Public health
    Science & Technology
    Life Sciences & Biomedicine
    Ophthalmology
    glaucoma
    glaucoma incisional surgery
    Publication URI
    http://hdl.handle.net/10072/400092
    Collection
    • Journal articles

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