Monash-Cabrini Department of Clinical Epidemiology

Monash-Cabrini Department of Clinical Epidemiology

Head: Professor Rachelle Buchbinder AO

We conduct high-quality clinical research and drive translation of research knowledge into practice and policy change for improved healthcare. Our work strives to optimise the value of healthcare, reduce low-value care arising from over-diagnosis and over-treatment, and identify ways to create a more sustainable healthcare system able to support future generations. We engage consumers as advisors, partners and participants in our research.

Director and NHMRC Senior Principal Research Fellow Professor Rachelle Buchbinder AO

Deputy Director, NHMRC Translating Research into Practice (TRIP) Fellow, Senior Research Fellow and Director of Australasian Satellite of Cochrane Effective Practice and Organisation of Care (EPOC) Dr Denise O’Connor

Managing Editor of Cochrane Musculoskeletal Dr Renea Johnston

Executive Officer, NHMRC, Centre of Research Excellence for the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network and Postdoctoral Research Fellow Dr Allison Bourne

Biostatistician Dr Lucy Busija Assistant Managing Editor of Cochrane Musculoskeletal Dr Sheila Cyril

Postdoctoral Research Fellows Dr Emma Gearon Dr Romi Haas Dr Polina Putrik Dr Jason Wallis Dr Tom Rozbroj

Research Fellows Dr Liesl Nicol Dr Jodie Avery Melanie Hawkins, Honorary Research Fellow Dr Teemu Karjalainen, Visiting Honorary Fellow (Finland) Dr Lars Christian Haugli Bråten, Visiting Honorary Fellow (Norway)

Practitioner Fellow Dr Sam Whittle

Project Manager, Targeted Therapies Alliance Program Dr Vanessa Glennon Australian Rheumatology Association Database (ARAD) Vibhasha Chand, Data Manager Ashley Fletcher, Project Officer

Research Assistant and Assistant Managing Editor for Cochrane EPOC Jia Xi (JC) Han

Research Assistant, PCHSS and Targeted Therapies Alliance Program Bayden McKenzie

Administrative Assistant Elizabeth Wolff

PhD Students Dr Bethan Richards, PhD (University of Sydney, 20112019) Michael Di Donato, PhD (Monash University, 2017-) Caitlin Farmer, PhD (Monash University 2017-) Liana Cahill, PhD (La Trobe University, 2016-) Gayanika Senarath, PhD (Monash University, 2019-) Pramila Rai, PhD (Monash University, 2020-) Jade Ting, Honours (Monash University, 2020-) Ahinsa Gunatilaka, Cabrini Medical Staff Research Scholarship Program (Cabrini Institute and Monash University, 2020) Dana Lee, Cabrini Medical Staff Research Scholarship Program (Cabrini Institute and Monash University, 2020) Xin Kwok, Cabrini Medical Staff Research Scholarship Program (Cabrini Institute and Monash University, 2020) Shiva Sridhar, Cabrini Medical Staff Research Scholarship Program (Cabrini Institute and Monash University, 2020)

Acknowledgement of Staff who have left (2019-2020) Dr Aislinn Lalor, Postdoctoral Research Fellow Dr Amanda Cross, Postdoctoral Research Fellow Cathy Matthews, Administrative Assistant

Highlights

Professor Buchbinder AO was recognised in the Australia Day Honours 2020 and became an Officer of the Order of Australia for ‘distinguished service to medical education in the fields of epidemiology and rheumatology, and to professional associations’. Seven staff and students from our department attended the International Preventing Overdiagnosis Conference in Sydney on 5-7 December 2019 and delivered nine presentations (including a plenary presentation by Professor Buchbinder AO on ‘Wiser healthcare for musculoskeletal conditions’). Professor Buchbinder AO contributed to the conference scientific committee and Dr O’Connor contributed to the local organising committee. Dr O’Connor also delivered a plenary presentation at the Rehabilitation Medicine Society of Australia and New Zealand Annual Scientific Meeting in Adelaide on 20-23 October 2019 on ‘The landscape of research translation in back pain: what do we know and where to next?’ The Wiser Healthcare Collaboration National Scientific Meeting was organised by our department and hosted at Cabrini Institute on 4-5 March 2020. Cabrini Chief Executive Sue Williams and Professor Buchbinder AO opened the meeting and participants included representatives from the Commonwealth Department of Health, Safer Care Victoria and the Australian Deprescribing Network.

Our Research

We are a large research department of over 30 research staff and students conducting numerous research projects. Below are three examples of projects being undertaken in the department.

Living guidelines for the management of rheumatoid arthritis

RESEARCHERS: BUCHBINDER R, WHITTLE S, JOHNSTON R, GLENNON V, NICOL L, AVERY J, MCKENZIE B, O’CONNOR D AND TARGETED THERAPIES ALLIANCE PROGRAM AND ANZMUSC COLLABORATORS

Rheumatoid arthritis involves chronic inflammation of the joints and other tissues resulting in pain, deformity and disability. Early use of disease modifying medicines can suppress disease activity and prevent joint damage. As part

(L-R) Professor Lee Boyd and Dr Denise O’Connor at Cabrini Research Week 2019 Poster Session.

of a three-year Targeted Therapies Alliance Program, we are developing a living clinical practice guideline for the pharmacological management of adults with rheumatoid arthritis. This guidance will assist medical practitioners to provide evidence-based care to people with rheumatoid arthritis based on up-to-date syntheses of best available evidence with the aim of optimising health outcomes for patients. The Targeted Therapies Alliance Program is funded by the Australian Government and involves a consortium of health organisations including ANZMUSC, Cochrane Musculoskeletal, Australian Rheumatology Association, NPS MedicineWise and other partners.

Systematic reviews of alternative models of care with potential to enhance health system sustainability

RESEARCHERS: BUCHBINDER R, O’CONNOR D, PUTRIK P, GEARON E, NICOL L, WALLIS J, MCKENZIE B AND PCHSS COLLABORATORS

Sustainability of healthcare systems is a key challenge worldwide. Our recent scoping review of systematic reviews has identified a number of models of healthcare delivery that provide alternatives to traditional models and that could increase sustainability by reducing costs while delivering equal or better outcomes for patients. Funding from the NHMRC Partnership Centre for Health System Sustainability

is being used to generate Cochrane systematic reviews of alternative models of healthcare delivery identified as high priority by policy-makers, health service managers, clinicians, consumer experts and academics. The models of care being investigated include provision of primary and/or specialist care to older adults living in aged care facilities and provision of chemotherapy at home vs. in hospital. Rigorous reviews of the value (effectiveness, cost-effectiveness and safety) of promising alterative models will inform future health system decision making.

Meta-synthesis of qualitative research exploring how patients and the public understand over-testing and over-diagnosis

RESEARCHERS: ROZBROJ T, HAAS R, O’CONNOR D, BUCHBINDER R AND WISER HEALTHCARE COLLABORATORS

Over-testing is when diagnostic tests that are not needed are used. Over-testing can lead to over-diagnosis which is when a diagnosis is made according to professional guidelines or standards but is unlikely to alter care and benefit the patient. Funding from the NHMRC Wiser Healthcare Collaboration is being used to conduct a thematic meta-synthesis of primary qualitative research exploring patient and public understanding of over-testing and over-diagnosis in order to identify common themes, inform the design of communication strategies about over-testing and over-diagnosis, and identify future research priorities. Grant Success Profile In the 12 months of this report we hold and have been awarded 31 grants totaling over $65 million. One important area of our department’s research over the past year has been the Targeted Therapies Alliance Program grant, funded by the Australian Government ($8.4 million over three years). The aim of the program is to optimise the quality use of medicines, including diseasemodifying anti-rheumatic drugs, to achieve better health outcomes for people with chronic inflammatory conditions. The program involves a consortium of health organisations including NPS MedicineWise, ANZMUSC, Cochrane Musculoskeletal, Australian Rheumatology Association, Arthritis Australia, Council of Australian Therapeutic Advisory Groups, Pharmaceutical Society of Australia, Quality Use of Medicines and Pharmacy Research Centre at the University of South Australia and the Society of Hospital Pharmacists of Australia. Our department is leading the development of living clinical practice guidelines for rheumatoid arthritis and contributes to other evidence-based tools, resources and interventions including clinician decision support algorithms, patient decision aids, clinician feedback reports, and educational webinars and resources. The program is facilitating increased collaboration between health practitioners and patients with inflammatory conditions about these complex medicines and is likely to lead to better quality use of medicines and better patient outcomes.

IN THE 12 MONTHS OF THIS REPORT WE HAVE HELD AND BEEN AWARDED

31

GRANTS TOTALING OVER $65 MILLION

+$3.7m

IN GRANT FUNDING

18

PUBLICATIONS

14

PRESENTATIONS

1

ACTIVE CLINICAL TRIALS