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Marsha A Ivey,1,2 Sheree M Smith,3,4 Geza Benke,1 Brett G Toelle,5,6 Michael L Hunter,7 Alan L James,8 Graeme P Maguire,9 Richard Wood-Baker,10 David P Johns,11 Guy B Marks,5,12 Michael J Abramson1 1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; 2School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; 3School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia; 4Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; 5Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia; 6Sydney Local Health District, Sydney, NSW, 2050, Australia; 7School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia; 8Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia; 9Curtin Medical School, Curtin University, Perth, WA, 6102, Australia; 10School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia; 11Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 12School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, AustraliaCorrespondence: Michael J Abramson, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia, Tel +61 3 9903 0573, Fax +61 3 9903 0556, Email michael.abramson@monash.eduPurpose: Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors.Methods: We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥ 40 years from six site

Yijun Zhou,1 Maria R Ampon,2 Michael J Abramson,3 Alan L James,4 Graeme P Maguire,5 Richard Wood-Baker,6 David P Johns,6 Guy B Marks,1,7 Helen K Reddel,2,8,9 Brett G Toelle1,8,9 1The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 2Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 3School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Sir Charles Gairdner Hospital, Perth, WA, Australia; 5Curtin Medical School, Curtin University, Perth, WA, Australia; 6Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 7South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; 8Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia; 9Sydney Local Health District, Sydney, NSW, AustraliaCorrespondence: Brett G Toelle, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW, 2037, Australia, Email brett.toelle@woolcock.org.auPurpose: Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥ 40 years.Methods: We used data from the BOLD Australia study, which included randomly selected adults aged ≥ 40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV1 to forced vital capacity < 0.7) were grouped by GOLD spirometry grades 1– 4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health bu

Objectives To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care.

Kate Petrie,1 Brett G Toelle,2,3 Richard Wood-Baker,4 Graeme P Maguire,5 Alan L James,6,7 Michael Hunter,8,9 David P Johns,4 Guy B Marks,2,10 Johnson George,1,11 Michael J Abramson11 1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; 2Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 3Sydney Local Health District, Sydney, NSW, Australia; 4College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia; 5Western Clinical School, University of Melbourne, Melbourne, Australia and General Internal Medicine, Western Health, Melbourne, VIC, Australia; 6Sir Charles Gairdner Hospital, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Perth, WA, Australia; 7University of Western Australia, Medical School, Perth, WA, Australia; 8School of Population and Global Health, University of Western Australia, Perth, WA, Australia; 9Busselton Population Medical Research Institute, Busselton, WA, Australia; 10South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; 11School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, AustraliaCorrespondence: Michael J AbramsonSchool of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, AustraliaTel +61 3 9903 0573Fax +61 3 9903 0556Email michael.abramson@monash.eduPurpose: Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD.Patients and Methods: This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cros