Atlas: Too much, too little, too soon

Healthcare use in four clinical areas is widely varied across Australia with patterns of medicine use also showing disparity.

The Third Australian Atlas of Healthcare Variation Report has highlighted medicine use for common groups of medicines in Australia as cause for concern – in particular, overuse of antibiotics in children and antipsychotics in those over 65.

The Atlas also reveals both overuse and underuse of certain procedures in paediatric and neonatal health, cardiac tests, thyroid investigations and treatments, and gastrointestinal investigations and treatments in different regions leading to potentially adverse outcomes for the youngest members of the community as well as older Australians.

Antimicrobials were found to be frequently prescribed inappropriately, particular in children aged up to nine years, with those aged up to four showing the highest rate of antibiotic prescription. Overall, dispensing rates for antibiotics are triple those in similar countries.

Overuse of antibiotics potentially leads to changes in a child’s normal gut bacteria and an increased risk of a number of conditions in later years, including asthma, Crohn’s disease and weight gain.

The Atlas found a four-fold difference between the lowest and highest rates in PBS dispensing of proton pump inhibitor medicines (PPIs) for infants aged one year and under. As with antibiotics, PPIs can also adversely affect the gut bacteria, leading to increased risk of infections such as gastroenteritis and pneumonia and to food allergies.

The Atlas revealed that, in some areas, one in five planned births were before 37 weeks with no clear indication. Caesarean sections increase short-term risk to babies and emerging evidence also links early births to an increased risk of long-term developmental problems such as poorer school performance and ADHD.

Wide variations in numbers of two of the most common medical procedures performed in Australia – gastroscopy and colonoscopy – were identified, showing a clear anomaly between cancer burden and use of investigations for gastrointestinal diseases in Australia, indicating that gastroscopy may be substantially overused.

“While some variation in healthcare use by area is expected given the needs of different populations, wide variations can be a sign that some people are getting healthcare that they don’t need, while others may be missing out on the healthcare that they do need,” Australian Commission on Safety and Quality in Health Clinical Director Professor Anne Duggan said.

“The Atlas ensures that we keep Australia’s healthcare system one of the best in the world by helping us deliver the right care, for the right person, at the right time.

“The data and recommendations in this Atlas will be used by clinicians, consumers, policymakers, and researchers across Australia to deliver important improvements in healthcare.”

The full report is available at: https://www.safetyandquality.gov.au/Atlas/

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