Background: The prevalence of comorbidity is high, with 80% of the elderly population having three or more chronic conditions. Comorbidity is associated with a decline in many health outcomes and increases in mortality and use of health care resources. The aim of this study was to identify, review and summarise studies reporting the prevalence of comorbidity of chronic diseases in Australia.

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Objective: To implement and evaluate a collaborative medication management service model. Design: Participatory action research. Setting and participants: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated. Interventions:A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented. Outcome measures: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken. Results: Overall, 2764 problems were identified. The most common medicationrelated problem (17.5% of all problems) was the need for additional tests. Thirtyseven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving". Conclusion: This implementation model was successful in engaging GPs and MJA 2002; 177: 189-192 pharmacists and in assisting in the resolution of medication-related problems.

Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.

Objectives: To determine the extent to which medications are altered or crushed prior to administration to residents of aged‐care facilities, the medications involved and the methods employed. Method: Observation of medication rounds at a representative sample of South Australian aged‐care facilities. Results: At least one medication was altered in 34% of the 1207 occasions of medication administration observed within ten residential aged‐care facilities in South Australia. 17% of medicines which were altered, had the potential, because of the alteration, to cause increased toxicity, decreased efficacy, unpalatability, safety or stability concerns. The process of altering medicines was found to be problematic. In all occasions where more than one medicine was altered, they were crushed together within the same vessel. In 59% of occasions where the same vessel was shared amongst residents, the vessel was not cleaned between residents and in 70% of cases where medicines were altered, spillage, and thus potential loss of dosage, was observed. Conclusions: Guidelines outlining best practice for the alteration and administration of medications in residential aged‐care facilities are required. In addition, accurate and up‐to‐date information needs to be available for carers and health practitioners in residential aged‐care facilities detailing those medications which should not be altered, the potential risks of alternating medicines and other options.

Background-Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded. Methods and Results-This retrospective cohort study using administrative claims data included veterans 65 years and older receiving bisoprolol, carvedilol, or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure. We compared those exposed to a general practitioner-pharmacist collaborative home medication review with those who did not receive the service. The service includes physician referral, a home visit by an accredited pharmacist to identify medication-related problems, and a pharmacist report with follow-up undertaken by the physician. Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups. There were 273 veterans exposed to a home medicines review and 5444 unexposed patients. Average age in both groups was 81.6 years (no significant difference). The median number of comorbidities was 8 in the exposed group and 7 in the unexposed (PϽ0.0001). Unadjusted results showed a 37% reduction in rate of hospitalization for heart failure at any time (hazard ratio, 0.63; 95% CI, 0.44 to 0.89). Adjusted results showed a 45% reduction (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) among those who had received a home medicines review compared with the unexposed patients. Conclusion-Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines. (Circ Heart Fail. 2009;2:424-428.)

Focus group methodology was used to determine the barriers to smoking cessation for pregnant women prior to the commencement of a randomised controlled smoking cessation trial (RCT), using nicotine patches in the treatment arm. Attitudes to the use of nicotine patches and perceptions of care provider counselling were also explored. Women were identified by researcher interview in the antenatal clinics as current smokers or recent 'quitters' and recruited to one of three focus groups. A number of barriers to achieving smoking cessation were identified. Pregnancy-specific barriers included scepticism about smoking-related harms. Other barriers, such as addiction to nicotine and the smoking behaviour of others, particularly partners, are generic. The latter is magnified in pregnancy by the heightened complexities of familial relationships. Potential use of patches was acceptable to most women, although some high-risk patients expressed doubts about safety and believed continued smoking was preferable. Women recounted that care providers differed in approaches to smoking cessation. Reporting 'cutting down' generally avoided further inquiries about smoking. The knowledge gained of pregnant women's perspectives enhanced the researchers' understanding in these areas. These insights have been incorporated into staff training initiatives, have guided the planning of the RCT, and have continued to inform its conduct.

This analysis reveals the need for ongoing vigilance of, and support for, people at high risk of medication misadventure. This information is also useful for informing the design of public health or health promotion strategies aiming to reduce the prevalence of these problems.