Variability in the rate of prescription and cost of domiciliary oxygen therapy in Australia

Abstract

Objectives: To determine the rate of prescription of and government expenditure for domiciliary oxygen therapy (DOT) in Australia, and to identify interstate differences in rates, costs and service provision. Design: Retrospective observational study. Participants and setting: Government departments and health services (state and federal) that funded DOT in Australia in the 2004–05 financial year (including the Department of Veterans’ Affairs [DVA] and the Department of Health and Ageing [DoHA]). Main outcome measures: Prescription rates, cost of DOT in 2004–05, and services provided in each jurisdiction. Results: In 2005, 20 127 patients were using DOT, giving a national prevalence of 100 prescriptions per 100 000 population. The total cost was about $31 million. State governments, the DVA and the DoHA funded 13 899 (69%), 4084 (20%) and 2144 (11%) patients, respectively. Prescription rates varied threefold between the states, ranging from 44 (Northern Territory) to 133 (Tasmania) per 100 000 population. Cost per patient per year varied fourfold between the DVA and the DoHA. All jurisdictions funded oxygen according to the clinical criteria of the Thoracic Society of Australia and New Zealand, but considerable variability in service provision was identified. Conclusion: DOT prescription rates and costs vary considerably between jurisdictions. An urgently needed national DOT register would enable the current variability to be understood and allow service planning and benchmarking of clinical outcomes.

Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

“…Compatibility of guideline implementation with the clinician’s professional role has previously been described as a key factor,19 and is also highly specific to the sample. For example, in this study the prescription of oxygen for hypoxemic patients was seen as a “well- established” process from the perspective of the GP and general medicine registrar, which masks the documented problems with criteria-based oxygen prescription including variability in service provision24 and inappropriate prescription 25. The use of persuasive communication by medical practitioners in this study included sub-categories of awareness and familiarity with recommendations, belief in health benefits, motivation and prioritization, all frequently described as influential in whether or not clinicians implement evidence-based practice 14,19,21.…”

Optimising the therapeutic use of oxygen in Australia

“…Much work still needs to be done to determine who benefits from oxygen therapy and whether those Australians currently using oxygen — and the community, as a whole — are getting the best value they can from this treatment. Serginson and colleagues call for a national register of domiciliary oxygen therapy 9 . Similar recommendations were made by the Australian Lung Foundation in their funding submission to Treasury in 2006 11 .…”

“…The article by https://doi.org/10.5694/j.1326-5377.2009.tb03308.x in this issue of the Journal is very opportune, 9 coming at a time when the National Health and Hospitals Reform Commission has highlighted the fragmentation of our health system, with its complex divisions of funding responsibilities and performance accountabilities between different levels of government 10 . Serginson and colleagues show that there is considerable variability in prescription rates of oxygen, costs of oxygen therapy, and types of oxygen services provided across different Australian states and jurisdictions.…”

Advances in chronic obstructive pulmonary disease

“…The use of domiciliary oxygen is common at the more severe end of the COPD spectrum. In 2005 21 000 Australians were receiving domiciliary oxygen therapy, at an estimated annual cost of over A$32 million, with the major indication being COPD . Long‐term continuous oxygen therapy has been proven to offer survival benefits in patients with COPD and severe hypoxaemia (PaO 2 ≤ 55 mmHg or 55–59 mmHg with evidence of end‐organ damage).…”