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Health Care Use by Older Australian Women with Asthma

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Health Care Use by Older Australian Women with Asthma HEALTH CARE USE BY OLDER AUSTRALIAN WOMEN WITH ASTHMA Parivash Eftekhari (PharmD, PhD) Thesis submitted for the degree of Doctor of Philosophy (Gender and Health) School of Medicine and Public Health Faculty of Health University of Newcastle March 2018 ii Statement of Originality “I, solemnly and sincerely declare that thesis entitled Quality of care in older women with asthma is my own research work and to the best of my knowledge contains no material that has been published previously or accepted for the award of any other degree in any university or other tertiary institution by me or any other person except where due references and acknowledgements are made. I give consent to the final version of my thesis being made available worldwide when deposited in the University’s Digital Repository**, subject to the provisions of the Copyright Act 1968.” **Unless an Embargo has been approved for a determined period. Parivash Eftekhari Date: 29/03/2018 iii Statement of Collaboration “I hereby certify that the work embodied in this thesis has been done in collaboration with other researchers. I have included as part of the thesis a statement clearly outlining the extent of collaboration, with whom and under what auspices.” Parivash Eftekhari Date: 29/03/2018 iv Copyright Permission “I warrant that I have obtained, where necessary, permission from the copyright owners to use any third party copyright material reproduced in the thesis (e.g. questionnaires, artwork, unpublished letters), or to use any of my own published work (e.g. journal articles) in which the copyright is held by another party (e.g. publisher, co-author).” Parivash Eftekhari Date: 29/03/2018 v Acknowledgements of authorship “I hereby certify that the work embodied in this thesis contains a published paper/scholarly work of which I am joint author. I have included as part of the thesis a written statement, endorsed by my supervisor, attesting to my contribution to the joint publication/scholarly work.” Parivash Eftekhari Date: 29/03/2018 vi Thesis publications and presentations Published manuscripts 1. Eftekhari P, Forder PM, Majeed T, Byles JE. Impact of asthma on mortality in older women: An Australian cohort study of 10,413 women. Resp Med. 2016; 119: 102-108. 2. Eftekhari P, Forder PM, Byles JE. Asthma Cycle of Care uptake among Australian older women with asthma. Intern Med J. 2016; 46(8):990-1. Conference presentations 1. Eftekhari P, Forder PM, Byles JE. Survival and Comorbidity Association in Older Women with Asthma: Australian Longitudinal Study on Women's Health (ALSWH). American Thoracic Society (ATS) International Conference; 2014 May 16-21 San Diego, California. 2. Eftekhari P, Forder PM, Byles JE. Medical Service Utilization among Australian Older Women with Asthma. American Thoracic Society (ATS) International Conference; 2016 May 13-18 San Francisco, California. vii Statement of contribution for Chapter 4 viii Conflict of interest “I hereby declare that there are no conflicts of interests.” Parivash Eftekhari Date: 29/03/2018 ix Acknowledgements of data use The research on which this thesis is based was conducted as part of the Australian Longitudinal Study on Women's Health by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. We acknowledge the Department of Health and Medicare Australia for providing the PBS and MBS data. We also acknowledge the Australian Institute of Health and Welfare (AIHW) as the integrating authority for these data. We acknowledge the assistance of the Data Linkage Unit at the Australian Institute of Health and Welfare (AIHW) for undertaking the data linkage to the National Death Index (NDI). x Acknowledgement I am very fortunate to have undertaken this PhD at the University of Newcastle. Although these four and a half years haven’t always been the easiest, they have been the best years of my life. I would like to take this opportunity to thank everyone who played a role in completing this piece of work which is an important step in reaching my goals in life. Foremost, I would like to thank my supervisors Professor Julie Byles and Ms. Peta Forder for your support, both professionally and emotionally. I am very grateful to you both for your guidance and encouragement over the past four and a half years, you always had time for me in your busy schedules. Without you, this thesis would not have been possible and I thank you for believing in me and giving me this opportunity. Melissa, although I wasn’t fortunate enough to have you as a co-supervisor from the beginning, I have learned a lot from you. Thank you for your encouragement, and your advice on writing was very helpful. I would also like to thank Associate Professor Erica James and Dr. Natalie Johnson for their support as Research Higher Degree Coordinators. Acknowledgements to my friends at the Research Centre for Generational Health and Ageing. I have been very lucky to have all your support over the period of my candidature. My friends and fellow students at HMRI, Tanmay, Shahinoor, Tazeen, Befikadu, Bernadette, Adam, Iqbal, Candice, Maha, Shazia, Mijan, Melissa, Smriti and Nanda, I am grateful to you all and I feel privileged to have had you by my side during this journey. We have so many memories together which I will cherish for the rest of my life. Dr. Robyn Kenough and Dr. Xenia Dolja-Gore, I consider you both friends and mentors, thank you for all your support on this piece of work. I really appreciate the emotional support you two xi provided for me during my candidature. Robyn, I appreciate your kind offer to proof read my thesis, and Xenia, thank you for all the analysis tips and SAS codes. Thank you to all the participants and staff of the ‘Australian Longitudinal Study on Women’s Health’ for your time and effort during all these years, the data you have provided is invaluable. Mum and Dad, you have always encouraged me to follow my dreams and become a better person. Now here I am, submitting my thesis for a second PhD. Dad, I know it wasn’t easy to pay for my education and I thank you for the sacrifices you made. Mum, thank you for the countless nights that you stayed up and helped me with my assignments. You both always believed in me and I can assure you that your hard work has paid off. My appreciation goes to my fiancé’s patents, Martin and Janet Ryan. You have always supported me emotionally and treated me like your daughter. Jewels of my life, Suzie, Charlie, Dr. Mikie and Cinnamon. Although you are only birds, with your cuteness you give me the energy to go on. Thank you for chirping all the time and giving me company. Lastly, I want to thank my love, my joy and my happiness, my fiancé, Hayden. Thank you for always being there for me and listening to my ideas, questions, complaints and everything else. You have supported me like no one else, and have been there no matter what. You held my hand this whole time and walked with me step by step through all the joy and pain. You have instilled in me confidence to aim high and never stopped believing in me. Thank you for being self-less and compromising. You are the most amazing person I have ever met and I am the luckiest women in the world to be your fiancé. I love you with all my heart and I would like to dedicate all the hard work that has gone into writing this thesis to you. xii Contents Chapter 1 Background: Asthma in context ............................................................. 17 Clinical definition of asthma ............................................................................. 17 Why is asthma important? ............................................................................... 18 1.2.1 Burden of asthma ........................................................................................... 18 Costs of asthma ...................................................................................... 19 Asthma mortality .................................................................................... 19 Asthma in older age .......................................................................................... 20 Definition of older age ............................................................................ 20 Population Ageing ................................................................................... 20 Why is asthma important in older people? ............................................ 21 Significance of thesis investigations ................................................................. 24 Thesis framework ............................................................................................. 25 Aims and objectives ................................................................................ 25 Structure of this thesis ............................................................................ 26 Section 1. Background, study aims and literature review (Chapter 1 and 2) 26 Data sources, methods and analyses ..................................................... 26 Section 2. Asthma and mortality (Chapter 4) ......................................... 26 Section 3. Asthma groups and self-reported health service use (Chapter 5 and 6) 26 Section 4. Asthma groups and Medicare health service use (Chapter 7 and 8) 26 Chapter 2 Literature review .................................................................................... 27 Introduction .....................................................................................................
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