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author:("oakland, Don")
1.  The association between serious upper gastrointestinal bleeding and incident bisphosphonate use: a population-based nested cohort study 
BMC Geriatrics  2013;13:36.
Oral bisphosphonates are commonly used to prevent / treat osteoporosis. However, bisphosphonate treatment is not without risk and serious adverse effects, including upper gastrointestinal bleeding (UGIB) have been described. We sought to determine if new users of bisphosphonate drugs were more likely to suffer a serious UGIB within 120 days of drug initiation.
This was a population-based nested cohort study utilizing administrative healthcare data in British Columbia, Canada. Community based individuals ≥ 65 years with a new prescription for a bisphosphonate between 1991 and 2007 were included. A multivariate logistic regression model was used to examine the relationship between older age and the development of a serious UGIB within 120 days of new exposure to oral bisphosphonate drugs.
Within the exposure cohort (n = 26,223), 117 individuals had suffered a serious UGIB within 120 days of incident bisphosphonate use. Cases tended to be > 80 years old, and were significantly more likely to have had a past history of gastric ulcer disease, a remote history of serious UGIB, and had been dispensed proton pump inhibitor (PPI) medications (p < 0.001 for all comparisons). After adjustment for confounding covariates, those > 80 years were more than twice as likely to suffer a UGIB when compared to those ≤ 80 years (adjusted OR = 2.03; 95% CI 1.40–2.94). A past history of serious UGIB was the strongest predictor of UGIB within 120 days of incident bisphosphonate use (adjusted OR = 2.28; 95% CI = 1.29–4.03) followed by PPI use (adjusted OR = 2.04; 95% CI = 1.35–3.07). Males were 70% more likely to suffer an UGIB compared to females (adjusted OR = 1.69; 95% CI = 1.05–2.72).
Upper GIB is a rare, but serious, side effect of bisphosphonate therapy more often afflicting older individuals. At the same time, concern about potential rare adverse events should not discourage clinicians from prescribing bisphosphonate drugs, particularly in older patients who have already sustained a fragility fracture. Clinicians must remain cognizant of potential adverse events associated with bisphosphonate use and should routinely ask about pre-existing GI disorders and concurrent medication history prior to prescribing these drugs.
PMCID: PMC3653746  PMID: 23602075
Osteoporosis; Bisphosphonates; Adverse events; Upper gastrointestinal bleed; Claims data
2.  Challenges of recruiting farm injury study participants through hospital emergency departments 
Injury Prevention  2007;13(2):88-92.
Hospital emergency departments are common recruitment sites for injury studies. Yet recruitment method details, capture rates and response fractions are not consistently reported. As privacy legislation increasingly impinges on research activity, these parameters become even more important. The authors describe their experience with recruitment via emergency departments and outline subsequent adjustments to the recruitment approach.
The FIRM study was an Australian case‐control study of serious farm work‐related injury. Cases were identified prospectively by hospital staff on presentation to emergency departments. Consistent with the Victorian Health Records Act, potential cases were initially approached by hospital staff, and full recruitment was subsequently undertaken by study staff. Manual hospital record audits were conducted at five recruitment sites to determine the proportion of eligible cases approached.
Among 660 medical records audited, 19 eligible cases were confirmed, 9 of whom were approached by hospital staff (47%, 95% CI 25 to 70%). In response, an additional process was established to capture missed cases, who were sent a letter from the hospital providing the opportunity to opt out of telephone contact by study staff. Early indications were that 34% (41/122) of missed cases actively declined to be contacted. Among those who were contacted and eligible, 84% (21/25) agree to study participation.
Recruitment of injury research participants via hospital emergency departments is challenging, particularly where authorities require an intermediary to make the initial contact. Removal of some constraints imposed by privacy legislation would considerably simplify recruitment and enhance scientific rigour in conducting epidemiological research.
PMCID: PMC2610597  PMID: 17446247
3.  Strengthening Medicare: Will increasing the bulk-billing rate and supply of general practitioners increase access to Medicare-funded general practitioner services and does rurality matter? 
Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and particularly the bulk-billing incentives, are 'working'. Given the enduring geographic differences in the supply of general practitioners (GPs) it is timely to reconsider the impact that this increase in the provision of 'free care' will have on access to Medicare-funded GP services in rural and urban areas of Australia. Utilisation has been modelled as two different stochastic processes: the decision to consult and the frequency of consultation.
In the decision to consult model the supply of FFS GPs is a more important predictor of utilisation than the bulk-billing rate. Paradoxically the modelling predicts that ceteris paribus increases in either GP supply or the bulk-billing rate appear to have perverse effects in some areas by decreasing utilisation. In the frequency of consultation model, GP density is not a predictor and increasing the bulk-billing rate will unambiguously increase the frequency of consultation across all areas. In both models, the positive impacts associated with changes in supply and cost are constrained outside the inner metropolitan area by reduced geographic accessibility to Medicare-funded GP services. The modelling also shows that people are more likely to consult a GP in areas of high socioeconomic disadvantage, although socioeconomic status is not a predictor of frequency of consultation.
Bulk-billing rates and the supply of FFS GPs are important features of the Australian health care system that are, potentially, amenable to policy manipulation. The implications of this research are that government policies designed to achieve similarity in these characteristics across geographic areas will not result in equity of access because they fail to address problems caused by geographic inaccessibility in rural and remote areas. Attempting to increase bulk-billing rates in some of these areas may, in fact, reduce access to FFS GP services.
PMCID: PMC1215471  PMID: 16111496

Results 1-3 (3)