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Background: Vitiligo is a depigmenting condition that can cause significant psychological distress. The use of camouflage products leads to an improvement in self-esteem and the quality of life of patients with vitiligo. Despite this the familiarity with these products amongst dermatologists and the recommendation for their use is unknown. We aimed to determine dermatologists' familiarity with and use of camouflage products for patients with vitiligo. Method(s): A cross-sectional survey was sent to Australian dermatologists (08/2021). Descriptive statistics was used. Result(s): A total of 122 surveys were completed (48% male; 42% aged 50 years or more; 82% in private practice only and 96% metropolitan practice). Around 20% of dermatologists reported having a special interest in vitiligo and 73% consulted <5 patients with vitiligo/- month. Over 80% of dermatologists ?agreed? or ?strongly agreed? that the use of camouflage has a positive impact on their vitiligo patients but only 60% considered themselves as being ?not at all? or ?slightly? familiar with camouflage products. Majority of dermatologists ?agreed? or ?strongly agreed? that they needed to improve their knowledge about camouflage. Only 18% of dermatologists ?always? discussed camouflage with their patients during a consultation. There was more familiarity with older camouflage products and less familiarity with newer and better performing products. Most ?agreed? or ?strongly agreed? that there was a need for more trained camouflage experts (84%), and online videos that demonstrated for doctors and patients the use of camouflage techniques (95%). Conclusion(s): Education for dermatologists on camouflage products for patients with vitiligo is needed.

Background: Little is known about factors influencing the transition to Permanent Residential Aged Care (PRAC) for those living in the community following stroke. Aim(s): To identify factors associated with new entry into PRAC 6-18 months following stroke. Method(s): Retrospective cohort, assembled for the PRECISE study, involving person-level linkages between the Australian Stroke Clinical Registry (AuSCR, 2012-2016), Medicare, Pharmaceutical, National Aged Care Data Clearinghouse (NACDC), Death and hospital data for Adult registrants from Queensland and Victoria. New entries to PRAC within 6-18 months following stroke admission was determined using items from the Medicare and NACDC datasets. Multivariable competing risks survival analysis, adjusted for death as a competing risk, was performed to determine factors associated with new PRAC entry. Result(s): 15,872 of the linked cohort were eligible for inclusion (median age 71 years, 42% female, 45% severe stroke). In the 6-18 months following stroke, there were 883 (6%) new entries into PRAC (median 326 days post-admission). Factors associated with transition to PRAC included having a severe stroke (subhazard ratio 1.30 [95% confidence interval 1.10, 1.54], p=0.002), being discharged to in-patient rehabilitation (1.79 [1.50, 2.12], p<0.001), having >=3 comorbidities (1.70 [1.39, 2.09], p<0.001), having dementia (2.48 [1.88, 3.27], p<0.001), and receiving a government-subsidised home care package (2.29 [1.84, 2.84], p<0.001). Conclusion(s): We provide new data that afford insights into transition to PRAC following stroke. Results suggest that survivors needing increased support to delay transition to PRAC after stroke, include those with greater stroke severity and comorbidity, including dementia.

Background and Aims: Interventions to reduce readmissions and support recovery on discharge from hospital after stroke are limited. Our aim was to test the feasibility of an innovative, electronic support package that includes educational and motivational messages aligned with patient-centred goals for recovery and secondary prevention for survivors of stroke. Method(s): Multicentre (n=3) randomised controlled feasibility trial of our novel 12-week electronic support package Patients were recruited in hospital. At 7-14 days after discharge consent was confirmed via telephone and participants randomised. Control participants received 6 administrative messages only, while intervention participants received up to 7 (range 4-7) messages/week aligned to their goals, plus the administrative messages. Feasibility was assessed by examining participation, completion of outcome measurements, and trial processes (with hospital and trial coordination staff). Outcomes obtained by a blinded assessor at 90-days post randomisation included readmission/s, goal achievement, disability/dependence and quality-of-life. Result(s): Among 105 eligible patients, 25 refused, 24 were discharged prior to consent, 37 (35%) were recruited (68% male, median age 64), and 33/37 were randomised (3 ineligible; 1 lost to follow-up). Participation in the trial was 85% (15/17 intervention; 14/16 control). One participant (intervention group) requested the messages to stop. Follow-up assessments were completed in 28/29 participants. Greatest barriers to recruitment were time constraints for comprehensive goal setting by hospital clinicians and early discharge. Conclusion(s): Findings from this Phase II feasibility trial confirmed acceptability of the ReCAPS intervention and informed the methods for the Phase III study which is currently underway in 12 Australian hospitals.

Background: Aphasia is associated with increased hospital stays and use of rehabilitation services. Little is known about the hospitalisation costs for patients with aphasia in Australia. Aim(s): To compare the costs of hospitalisation for patients with and without aphasia. Method(s): Data on patients admitted with stroke/TIA to Queensland hospitals (n=22) participating in the Australian Stroke Clinical Registry were linked to administrative datasets. The International Classification of Diseases 10th Revision codes were used to identify patients with aphasia (R470). These codes were selected from emergency department presentations and hospital admissions for linked cases using a 5-year look back period. Clinical costing data were obtained from Queensland Health and were inflated to a 2013/2014 financial year equivalent using the Total Health Price Index. The additional cost associated with aphasia was assessed using median regression analysis, with clustering by hospital. Result(s): There were 1043/4195 (26.5%) patients recorded as having aphasia (49% female; 78 median age; 83% ischaemic stroke). Greater overall costs per person were observed for medical (median cost $2273 vs. $1727, p<0.05), nursing ($3829 vs. $2748, p<0.05), non-clinical ($765 vs. $601, p<0.05), and allied health ($1138 vs. $720, p<0.05) activities. After adjustment for confounding factors, patients with aphasia had $2882 greater total costs of admission on average than patients without aphasia (95% confidence interval $1880 to $3884). Conclusion(s): Greater costs were associated with hospitalisation for patients with aphasia after stroke. This has implications for the economic burden of healthcare provision for patients with post-stroke aphasia in Australia.

Background And Aims: Little is known about long-term outcomes associated with access to inpatient rehabilitation after stroke. Aim(s): to compare long-term outcomes for patients discharged directly home with those discharged to inpatient rehabilitation after stroke. Method(s): Data collected in the Australian Stroke Clinical Registry (2010-2013) were linked to hospital admission records and the national death index as part of the Stroke123 study. Multilevel multivariable regression analyses were conducted, adjusting for patient and hospital factors. Outcomes were death and hospital readmissions up to 365-days and health-related quality of life (HRQoL) at 90-180days. Result(s): 7,847 patients were included (median age 71 years, 59% male, 83% ischemic stroke); 4405 (56%) were discharged home and 3,442 (44%) to inpatient rehabilitation. Patients discharged directly home were more likely to be aged under 65 years and to walk independently at hospital admission. Patients discharged to inpatient rehabilitation had more comorbidities and greater odds of having dementia. Hazard of death was not significantly different between the two groups. Patients discharged directly home were more likely to be readmitted to hospital than patients discharged to inpatient rehabilitation (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93). Patients discharged directly home had higher HRQoL scores, but were more likely to report mobility problems (adjusted OR 0.54, 95%CI 0.47, 0.63). Conclusion(s): Patients discharged directly home have higher risks of readmission and self-reported mobility problems than patients discharged to inpatient rehabilitation. To reduce this disadvantage, better support is indicated for people who are discharged directly home after stroke.

Background: General practice management plans (GPMPs) are recommended for the long-term management of chronic diseases including stroke or transient ischaemic attack (TIA). The extent to which GPMPs affect adherence to medication is unknown. Aim(s): To determine whether GPMP utilisation improves medication adherence after stroke/TIA. Method(s): Retrospective cohort study of community-dwelling survivors of stroke/TIA from Victoria and Queensland, identified using the Australian Stroke Clinical Registry (Jan 2012-Jun 2016). We individually linked our cohort with administrative claims data and defined our cohort and analytical methods to emulate a randomised controlled trial. Provision of a GPMP or review was identified using Medicare claims during the exposure period (6-18 months post-stroke). Using Pharmaceutical Benefits Scheme data, we determined the proportion of days covered (PDC) by each medication class (antihypertensive, lipid-lowering, non-aspirin antithrombotics) during the outcome period (18-30 months post-stroke). The average treatment effect of GPMPs on being adherent (PDC>=80%) was determined using propensity-score adjusted logistic regression, accounting for differences in sociodemographics, prognostic factors and pre-stroke medication adherence. Result(s): Among 14,465 survivors of stroke/TIA (median age 70 years; 42% female), 44% received a GPMP (median age 73-years; 45% female). During the 1-year outcome period, median PDC was 80% for antihypertensive, 81% for lipid-lowering, and 62% for non-aspirin antithrombotic medications. Provision of GPMPs was associated with being adherent to antihypertensive (odds ratio [OR]: 1.13; 95% CI: 1.05-1.22), lipid-lowering (OR: 1.21; 95% CI: 1.13-1.30), and non-aspirin antithrombotic medications (OR: 1.14; 95% CI: 1.06-1.23). Conclusion(s): Provision of GPMPs is associated with improved adherence to prevention medications following stroke/TIA.

Background: General Practitioners (GPs) are incentivised through Medicare funded Team Care Arrangements (TCAs) to provide multidisciplinary care. It is unknown whether these items are appropriately targeted among survivors of stroke. Aim(s): To describe, by impairment, the use of TCAs in survivors of stroke living in the community. Method(s): Data from the Australian Stroke Clinical Registry (AuSCR: 2010-2014, N=26 hospitals, five states) were linked with Medicare. Adults registrants who provided EQ-5D health status survey data between 90-180 days were included. Receipt of TCA items during the 18-month period following stroke were identified using Medicare data. Latent Class Analysis (LCA) was used to classify registrants based on their EQ-5D dimension responses (mobility, self-care, anxiety/depression, pain, usual activities). The relationships between LCA classes and TCAs were explored using multivariable logistic regression. Result(s): 5,432 AuSCR registrants were included (44% female, median age 74 years, 86% ischaemic). Of these, 34% received a TCA and 24% had an allied health claim (66% podiatry, 25% physiotherapy, others<5%). Most TCAs (86%) involved only one type of allied health professional. Registrants were classified into three latent classes defined as: minimal, moderate and severe impairment. Receipt of a TCA varied by class: mild (32%), moderate (40%), severe (25%). Compared with minimal impairment, the odds of receiving a TCA were greater for those in the moderate (aOR: 1.37, 95%CI: 1.21, 1.55), but lower for those in the severe impairment class (aOR: 0.75, 95%CI: 0.60, 0.94). Conclusion(s): While one in three survivors accessed TCAs for multidisciplinary care, rates were lower in those with more severe impairment. Greater uptake of these items could fill gaps in long-term care after stroke, especially for those who may benefit most.

Background And Aims: Prescription of multiple classes of medications (antihypertensive, antithrombotic and lipid-lowering) is recommended in clinical guidelines for ischemic stroke (IS) and transient ischemic attack (TIA) to prevent further vascular events. We aimed to determine the association between optimal combination medication treatment (supply of all three classes, "optimal treatment") and survival after IS/TIA. Method(s): Cohort of patients with first-ever IS/TIA from the Australian Stroke Clinical Registry (2010- 2014) linked with pharmaceutical claims data. We excluded patients who died within 30 days of admission. Cox regression was used to determine associations between optimal treatment and 1-year (from day 30 to 395) survival using landmark methods, adjusting for socio-demographics (age, sex, socioeconomic position) and clinical characteristics (stroke type, discharge destination). Result(s): Among 8136 survivors with first-ever IS/TIA satisfying inclusion criteria (45% female, median age 74 years), 75.5% received >=1 medication class, and 34.0% had optimal treatment. Patients with optimal treatment (N=2765) were more often aged >=75 years (51.3% vs 44.3%; p<0.001), discharged directly home (65.8% vs 49.5%; p<0.001) and experienced a less severe stroke (53.2% vs 43.5%; p<0.001), than those without optimal treatment. Compared to no medication, treatment with two medications was associated with a 42% lesser risk of death (95%CI: 27-55%); and optimal treatment, a 68% lesser risk of death (95% CI: 49-65%). Survival was similar between those with one or no medication. Conclusion(s): Patients with stroke/TIA who received optimal combination medication treatment within 30-days of admission had greater one-year-survival. Further research is required to understand reasons for sub-optimal medication treatment.