UTS site search

Associate Professor Beata Bajorek


A/Prof Bajorek is a registered clinical pharmacist, having practiced in community & hospital and is the inaugural Academic Pharmacist at Royal North Shore Hospital. Previously she has been a Research Fellow at the Clinical Practice Advancement Centre, University Health System Consortium (Chicago, USA), followed by 9 years in academia in the Faculties of Pharmacy and Nursing, University of Sydney (Australia).

She is a highly experienced clinical educator, having supervised countless clinical placements, served as education coordinator for the Society of Hospital Pharmacists of Australia (NSW) and authored over 125 educational articles for clinical practice journals. A/Prof Bajorek has been recognised through awards and nominations for Outstanding Teaching, Support for the Student Experience, and Research Supervision.

She also teaches specialised topics for the University of NSW and College of Nursing and has been an expert speaker/reviewer for various professional organisations including the National Prescribing Service, Pharmaceutical Society of Australia, Australian College of Pharmacy Practice, NSW Therapeutic Assessment Group and National Stroke Foundation. Her clinical research spans the Quality Use of Medicines (QUM), Cardiovascular Health, Medication Safety and pharmacist-led interventions.

She has been a member of teams that have been competitively awarded just over $3 million for research, and is one of a rare few Pharmacy Practice researchers to have been awarded NHMRC Project Grants as a Chief (Lead) Investigator. She has supervised over 35 research students and over 30 QUM research students from a range of national and international universities.

A/Prof Bajorek is an experienced doctoral supervisor and welcomes research degree enquiries via a formal expression of interest (please do not email directly).

Image of Beata Bajorek
Associate Professor, Pharmacy
Core Member, Health Services and Practice Research Strength
Bachelor of Pharmacy, GradCertEdStud(Higher Ed), Diploma in Hospital Pharmacy, Doctor of Philosophy
+61 2 9514 8301

Research Interests

A/Prof Bajorek is an experienced doctoral supervisor and welcomes research degree enquiries via a formal expression of interest (please do not email directly).

Can supervise: Yes

Clinical therapeutics
Clinical pharmacology
Professional practice and communication skills
Data handling and statistics
Clinical practice and residencies
Research methods
Dispensing practice
Applied pharmacology for health care professionals and prescribers

Journal Articles

Eissa, A., Krass, I., Levi, C., Sturm, J., Ibrahim, R. & Bajorek, B. 2013, 'Understanding the reasons behind the low utilisation of thrombolysis in stroke.', Australasian Medical Journal, vol. 6, no. 3, pp. 152-167.
View/Download from: OPUS |
Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice. Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009+July 2010), and reviewed the medical record of systematically chosen samples.
Stafford, L., van Tienen, E., Peterson, G., Bereznicki, L., Jackson, S., Bajorek, B., Mullan, J. & DeBoos, I. 2012, 'Warfarin management after discharge from hospital: a qualitative analysis', Journal Of Clinical Pharmacy And Therapeutics, vol. Sept 2011, pp. 1-5.
View/Download from: OPUS | Publisher's site
What is Known and Objective: Warfarin is recognized as a high-risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient+s discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the postdischarge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post-discharge warfarin management service. Methods: Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion-based sampling within two Australian states. Semi-structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach. Results: Forty-seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home-delivered services are valuable to both patients and healthcare professionals. Discussion: Although high-quality warfarin education and effective communication at the hospital+community interface were identified as important in post-discharge warfarin management, deficiencies were perceived within current systems. The role of home-delivered services in ensuring timely follow-up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post-discharge management should therefore focus on providing patients with a solid foundation to minimize future problems. What is New and Conclusion: Addressing the three identif ed facets of care within a new, collaborative post-discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short- and longer-term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.
Wright, L.C., Hill, K.D., Bernhardt, J., Lindley, R., Ada, L., Bajorek, B., Barber, P., Beer, C., Golledge, J., Gustafsson, L., Hersh, D., Kenardy, J., Middleton, S., Brauer, S. & Nelson, M.P. 2012, 'Stroke Management: Updated Recommendations For Treatment Along The Care Continuum', Internal Medicine Journal, vol. 42, no. 5, pp. 562-569.
View/Download from: Publisher's site
The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the
Bajorek, B., Masood, N. & Krass, I. 2012, 'Development Of A Computerised Antithrombotic Risk Assessment Tool (Carat) To Optimise Therapy In Older Persons With Atrial Fibrillation', Australian Journal of Ageing, vol. 31, no. 2, pp. 102-109.
View/Download from: Publisher's site
Aim: To develop and evaluate a novel Computerised Antithrombotic Risk Assessment Tool (CARAT) to aid clinicians' decision making regarding the riskbenefit of antithrombotic therapy in older patients. Methods: CARAT was developed in an iterative process i
Nasser, S., Mullan, J. & Bajorek, B. 2012, 'Challenges of older patients' knowledge about warfarin therapy', Journal of Primary Care & Community Health, vol. 3, no. 1, pp. 65-74.
View/Download from: Publisher's site
To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients+ warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients+ knowledge about their warfarin therapy.
Nasser, S., Mullan, J. & Bajorek, B. 2012, 'Assessing the quality, suitability and readability of internet-based health information about warfarin for patients', Australasian Medical Journal, vol. 5, no. 3, pp. 194-203.
View/Download from: OPUS |
The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet. Method Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites. Results The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an 'adequate' score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an 'adequate' score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less). Conclusion Despite the overall 'adequate' quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills
Bassett-Clarke, D., Krass, I. & Bajorek, B. 2012, 'Ethnic differences of medicines-taking in older adults: a cross cultural study in New Zealand', International Journal of Pharmacy Practice, vol. 20, pp. 90-98.
View/Download from: OPUS | Publisher's site
Objectives The literature identifies many barriers to medicines use, including bio-psycho-social issues, but less is known regarding ethno-cultural barriers, which are important in culturally diverse nations. The aim of this study was to explore ethnic differences in attitudes to medicines and medicines-taking, focusing on the main constituents of the New Zealand (NZ) population: NZ European, Maori (the indigenous people of NZ), Pacific and Asian peoples. Methods A qualitative study involving a series of focus groups was conducted. Participants (>50 years old) taking medicines were recruited from various community-based groups. The focus group discussions were transcribed verbatim and analysed for key themes via manual inductive coding and constant comparison. Key findings Twenty focus groups (n = 100 participants) were conducted. Three key common themes emerged: (1) conception of a medicine; (2) self-management of medication; and (3) seeking further medicines information. In general, NZ European participants had a very narrow view of what a medicine is, were motivated to source medicines information independently and were very proactive in medicines management.
Eissa, A., Krass, I. & Bajorek, B. 2012, 'Barriers to the utilization of thrombolysis for acute ischaemic stroke', Journal of Clinical Pharmacy & Therapeutics, vol. 37, pp. 399-409.
View/Download from: Publisher's site
Thrombolysis is currently the only evidence-based pharmacological treatment available for acute ischaemic stroke (AIS); however, its current utilization is suboptimal (administered to <3% of AIS patients). The aim of this article was to identify the potential barriers to the use of thrombolysis via a review of the available literature. Methods: Medline, Embase, International Pharmaceutical Abstracts and Google Scholar were searched to identify relevant original articles, review papers and other literature published in the period 1995-2011. Results and Discussion: Several barriers to the utilization of thrombolysis in stroke have been identified in the literature and can be broadly classified as 'preadmission' barriers and 'post-admission' barriers.The most effective interventions appear to be those comprising several strategies and those that target more than one barrier simultaneously. Therefore, optimal utilization of thrombolysis requires a systematic, integrated multidisciplinary approach across the continuum of acute care.
Bajorek, B. & Ren, S. 2012, 'Utilisation of antithrombotic therapy for stroke prevention in atrial fibrillation in a Sydney hospital: then and now', International Journal of Clinical Pharmacy, vol. 34, pp. 88-97.
View/Download from: OPUS | Publisher's site
Objective Evidence from pivotal clinical trials conducted more than a decade ago supports the use of antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF). Despite the wide dissemination of this evidence since that time, there is anecdotal evidence that utilisation of therapy remains suboptimal, especially in the target elderly population, which is reflected in the development of practice tools such as the TAG Clinical Indicator ('Antithrombotics in AF' Indicator 1.6, 2007). Therefore, the objective of this study was to determine the current utilisation of antithrombotic therapy for elderly patients with AF in the local setting, and to compare this utilisation with the results of a prior audit (AUDIT 1), as well as against the recommendations of the TAG Clinical Indicator(TAG IND).
Alene, M., Wiese, M.D., Angamo, M.T., Bajorek, B., Yesuf, E.A. & Wabe, N.T. 2012, 'Adherence to medication for the treatment of psychosis: rates and risk factors in an Ethiopian population', BMC Pharmacology and Toxicology, vol. 12, no. 10, pp. 1-9.
View/Download from: Publisher's site
Background: Medication-taking behavior, specifically non-adherence, is significantly associated with treatment outcome and is a major cause of relapse in the treatment of psychotic disorders. Non-adherence can be multifactorial; however, the rates and associated risk factors in an Ethiopian population have not yet been elucidated. The principal aim of this study was to evaluate adherence rates to antipsychotic medications, and secondarily to identify potential factors associated with non-adherence, among psychotic patients at tertiary care teaching hospital in Southwest Ethiopia. Methods: A cross-sectional study was conducted over a 2-month period in 2009 (January 15th to March 20th) at the Jimma University Specialized Hospital. Adherence was computed using both a compliant fill rate method and self-reporting via a structured patient interview (focusing on how often regular medication doses were missed altogether, and whether they missed taking their doses on time). Data were analyzed using SPSS for windows version 16.0, and chi-square and Pearsons r tests were used to determine the statistical significance of the association of variables with adherence.
Nasser, S., Mullan, J. & Bajorek, B. 2012, 'Educating patients about warfarin therapy using information technology: A survey on healthcare professionals perspectives', Pharmacy Practice, vol. 10, no. 2, pp. 97-104.
View/Download from: OPUS
Objective: To explore healthcare professionals views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. Methods: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. Results: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints.
Eissa, A., Krass, I. & Bajorek, B. 2012, 'Optimizing the management of acute ischaemic stroke: a review of the utilization of intravenous recombinant tissue plasminogen activator (tPA)', Journal of Clinical Pharmacy and Therapeutics, vol. 37, no. 6, pp. 620-629.
View/Download from: OPUS | Publisher's site
What is known and Objective: Thrombolysis using intravenous tissue plasminogen activator (tPA) is the only available evidence-based treatment for acute ischaemic stroke; however, its current utilization is very low. Therefore, the aim of this article is to review the literature regarding the use of intravenous tPA for the treatment of acute ischaemic stroke. The review will also compare utilization rates of thrombolysis in different centres across the world and identify key reasons for the underutilization of thrombolysis in stroke. Methods: MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA) and Google Scholar were searched for relevant original articles, review papers and other publications over the publication period 1995-2012. Results and Discussion: The National Institute of Neurological Disorders and Stroke (NINDS) (1995, N = 624 patients) and ECASS III (2008, N = 821 patients) are two pivotal randomized controlled trials providing evidence for the use of intravenous tPA within 3 h or 3-45 h from stroke onset, respectively. Both trials have shown that tPA administration decreases disability at 90 days from stroke. Furthermore, a recent pooled analysis of randomized controlled trials (2010, N = 3670 patients) supports these results, highlighting that early stroke treatment is associated with better outcomes, especially when treatment is started within 90 min of stroke onset (but suggesting that the benefit could be afforded within a 45-h time window). Three major observational trials, STARS (2000, N = 389 patients), CASES (2005, N = 1135 patients) and SITS-MOST (2007, N = 6483 patients), have reported acceptable safety and efficacy in clinical practice. However, only a small proportion of acute ischaemic stroke patients receive tPA in clinical practice, because of the limited availability of tPA-utilizing sites and suboptimal use of tPA in sites where it is available. What is new and Conclusion: tPA reduces disability in stroke patients
Nasser, S., Cecchele, R., Touma, S., Han, P., Nair, K., Vizgoft, J., Murdoch, V., Mullan, J. & Bajorek, B. 2012, 'Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit', Journal of Pharmacy Practice and Research, vol. 42, no. 2, pp. 129-133.
View/Download from: OPUS
Background: Effective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients. Aim: To review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education. Method: A prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (= 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay. Results: Data were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education. Conclusion: There is a need to improve documentation and provision of warfarin education to hospital patients
Stafford, L., Peterson, G., Bereznicki, L., Jackson, S., van Tienen, E., Angley, M., Bajorek, B., McLachlan, A., Mullan, J., Misan, G.M. & Gaetani, L. 2011, 'Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service', Annals Of Pharmacotherapy, vol. 45, no. 3, pp. 325-334.
View/Download from: Publisher's site
Background: Warfarin Remains A High-Risk Drug For Adverse Events, Especially Following Discharge From The Hospital. New Approaches Are Needed To Minimize The Potential For Adverse Outcomes During This Period. Objective: To Evaluate The Clinical Outcomes
Castelino, R., Bajorek, B. & Chen, T. 2011, 'Are interventions recommended by pharmacists during Home Medicines Review evidence-based?', Journal Of Evaluation In Clinical Practice, vol. 17, no. 1, pp. 104-110.
View/Download from: OPUS | Publisher's site
Introduction Over the past decade medication review services have been implemented in many countries, including Australia, UK and USA. Although, the attitudes and barriers to the implementation of evidence-based medicine have been investigated, the extent to which medication review recommendations are evidence-based is not known. Objective To determine (1) the extent to which pharmacist+s recommendations during medication review services were consistent with the evidence-based guides at the time of the review; and (2) the nature and extent of drug-related problems (DRPs) and the actions recommended by pharmacists to resolve DRPs. Method A retrospective review of Home Medicines Review cases performed on 224 community-dwelling older people (65 years or older). The chi-squared test for categorical variables was used to compare the proportion of recommendations that were evidencebased and recommendations for which no evidence could be identified in the most common Australian information sources. DRPs and the actions recommended to resolve the DRPs were classified according to previously employed criteria. Results Pharmacists made a total of 1114 therapeutic recommendations to general practitioners, of which 964 required supporting pharmacotherapeutic evidence. The majority (94%) of the pharmacists+ recommendations were in accordance with the evidence-based guides, as compared with the recommendations for which no evidence could be identified (P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with use of their medication detected.
Cao, B., Chow, C., Elliott, P., MacPherson, R., Crane, J. & Bajorek, B. 2011, 'Implementing a pharmacist charting service in the pre-admission clinic', Journal of Pharmacy Practice and Research, vol. 41, no. 2, pp. 102-107.
View/Download from: OPUS
Aim: To implement a pharmacist charting service in the pre- admission clinic (PAC) and describe a preparatory process for the initiation of this service. Method: Stage 1: a proposal for a pharmacist charting service in the PAC was devised via an iterative process with an advisory panel. Stage 2: feedback on the proposal was obtained from key staff via a survey comprising 15 linear scale statements (0 = strongly disagree to 10 = strongly agree) and open+ended questions. Stage 3: baseline data were collected on existing PAC service outcomes, e.g. consultation times, accuracy of medication charts.
Kumar, N., Knowler, C., Strumpman, D. & Bajorek, B. 2011, 'Facilitating medication misadventure risk assessment in the emergency medical unit', Journal of Pharmacy Practice and Research, vol. 41, no. 2, pp. 108-112.
Background: The risk of medication misadventure is heightened in emergency settings. Identifying at-risk patients is integral to minimising medication-related adverse events. Aim: To pilot a medication misadventure risk assessment tool to identify at-risk patients.
Yip, A. & Bajorek, B. 2011, 'Prescribing of anti-arrhythmics for atrial fibrillation', Australian Journal of Pharmacy, vol. 92, no. 1091, pp. 85-87.
View/Download from: OPUS
A retrospective clinical audit was conducted over a three-month period (August to October 2008) of the medical records of patients with AF at a large Sydney teaching hospital. The approval of the local human research ethics committee was obtained prior to study commencement.
Braidy, N., Bui, K. & Bajorek, B. 2011, 'Evaluating the impact of new anticoagulants in the hospital setting', Pharmacy Practice, vol. 9, no. 1, pp. 1-10.
View/Download from: OPUS
ABSTRACT* The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives. Objective: To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing. Method: A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009). Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials.
Bajorek, B., Masood, N. & Krass, I. 2011, 'Development of a computerised antithrombotic risk assessment tool (CARAT) to optimise therapy in older persons with atrial fibrillation', Australasian Journal on Ageing, vol. Online, pp. 1-8.
View/Download from: OPUS | Publisher's site
Aim: To develop and evaluate a novel Computerised Antithrombotic Risk Assessment Tool (CARAT) to aid clinicians+ decision making regarding the risk+benefit of antithrombotic therapy in older patients. Methods: CARAT was developed in an iterative process involving multidisciplinary feedback and computerisation of previously trialled algorithms. Hospital-based clinicians then applied the tool to patient cases, to evaluate its usability. Results: Overall, 94% of clinicians (n = 27 yielding 216 responses) were satisfied with CARAT+s format. Most (72%) clinician responses agreed with CARAT recommendations; over two-thirds agreed with estimates of stroke and bleeding risk. However, geriatricians were 3.5 times more likely to disagree with CARAT recommendations than cardiologists, particularly in cases of high fall risk. Overall, 63% responded that CARAT was at least `somewhat useful+ for clinical practice; 22% indicating it was `very useful+. Conclusion: CARAT has potential as a useful decision-support tool to assist clinicians in decision making regarding appropriate antithrombotic therapy in older patients.
Lee, Y., Levy, R. & Bajorek, B. 2011, 'Restricted Antimicrobial Use At Transitions Of Care At An Australian Hospital', Journal of Pharmacy Practice and Research, vol. 41, no. 4, pp. 283-287.
View/Download from: OPUS
Background: The emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials. Aim: To quantify restricted antimicrobial use among intensive care unit (ICU) discharg
Bajorek, B. 2011, 'A review of the safety of anticoagulants in older people using the medicines management pathway: weighing the benefits against the risks', Therapeutic Advances in Drug Safety, vol. 2, no. 2, pp. 45-58.
View/Download from: OPUS | Publisher's site
Anticoagulant drugs maintain a high potential for adverse events due to their inherent risk of haemorrhage and/or complex pharmacology. In addition, compromising the safety of these agents is the context in which they are principally used; that is, in the long-term prevention of thromboembolic diseases in an older patient population. These challenges are especially pronounced in the prevention of stroke in older persons with atrial fibrillation (AF), where the need for thromboprophylaxis is paramount and in whom the arrhythmia is most prevalent, but where the target population is simultaneously at high risk of adverse drug events. Essentially, this translates to the use of high-risk therapies on an indefinite basis, in persons who have multiple comorbidities, use polypharmacy, and who may have age-related functional and cognitive decline, culminating in a higher potential for medication misadventure. For this reason, anticoagulants mandate extra pharmacovigilance, and therefore the aim of this review is to address some of the key safety considerations in the use of anticoagulant drugs (warfarin, dabigatran, rivaroxaban), spanning the initiation of therapy to its ongoing management. Using the Medication Management Pathway (MMP) as a framework, in this review we canvas and highlight specific developments in practical strategies to facilitate the safe use of anticoagulants (particularly warfarin) in `at-risk' elderly patients including: comprehensive risk/benefit assessment using novel risk stratification tools; focused medicines review services; therapeutic drug monitoring services delivered in the primary care setting; and practical education strategies and resources targeting the older patient population.
Castelino, R., Chen, T., Guddattu, V. & Bajorek, B. 2010, 'Use of Evidence-Based Therapy for the Prevention of Cardiovascular Events Among Older people', Evaluation & The Health Professions, vol. 33, no. 3, pp. 276-301.
View/Download from: OPUS | Publisher's site
Evidence-based therapies (EBTs) for the prevention of cardiovascular disease (CVD) are reportedly underutilized in older people. The primary purpose of this study was to evaluate the use of EBTs for the prevention of CVD events in older people and secondarily whether a Home Medicines Review (HMR) service by pharmacists+ predicts the use of these medicines. A retrospective cross-sectional audit of HMR reports pertaining to 608 community-dwelling older people ( 65 years) was conducted. EBTs considered for this audit included four guideline-recommended therapies for CVD: antithrombotic therapy (warfarin+antiplatelet therapy), b-blockers, statins, and angiotensin agents (angiotensin-converting enzyme inhibitors [ACEI]+angiotensin II receptor blockers [ARBs]).
Castelino, R., Hilmer, S.N., Bajorek, B., Nishtala, P. & Chen, T. 2010, 'Drug Burden Index and Potentially Inappropriate Medications in Community-Dwelling Older People The Impact of Home Medicines Review', Drugs & Aging, vol. 27, no. 2, pp. 135-148.
View/Download from: OPUS |
Background: A Significant Problem In Older People (Aged >= 65 Years) Is The Use Of Potentially Inappropriate Medications (Pims), Including Those With Sedative And Anticholinergic Properties. However, Effective Intervention Strategies Have Yet To Be Ident
Castelino, R., Bajorek, B. & Chen, T. 2010, 'Retrospective evaluation of home medicines review by pharmacists in older australian patients using the medication appropriateness index', The Annals of Pharmacotherapy, vol. 44, no. 12, pp. 1922-1929.
View/Download from: OPUS | Publisher's site
Background: Home Medicines Review (HMR), a community-based collaborative service provided by general practitioners (GPs) and accredited pharmacists in Australia, has demonstrated effectiveness in preventing, detecting, and resolving medication-related pr
Yip, A. & Bajorek, B. 2010, 'Identifying temporal changes to the prescribing of anti-arrhythmics for atrial fibrillation', Journal of Pharmacy Practice and Research, vol. 40, no. 4, pp. 285-289.
View/Download from: OPUS
Background: There are a paucity of data on the use of antiarrhythmics for atrial fibrillation (AF), particularly in view of new treatment guidelines recommending rate control over rhythm control. Aim: To investigate the use of anti-arrhythmics for AF in the local clinical setting. Method: A retrospective clinical audit of the medical records of 174 adult patients with primary or secondary AF was conducted at a large Sydney teaching hospital. Data were collected on patients+ characteristics, medical history, factors affecting treatment choice and clinical outcomes.
Hilmer, S.N., Perera, V., Mitchell, S., Murnion, B., Dent, J., Bajorek, B., Matthews, S. & Rolfson, D. 2009, 'The assessment of frailty in older people in acute care', Australian Journal of Ageing, vol. 28, no. 4, pp. 182-188.
View/Download from: OPUS | Publisher's site
Aim: Develop A Measure Of Frailty For Older Acute Inpatients To Be Performed By Non-Geriatricians. Method: The Reported Edmonton Frail Scale (Refs) Was Adapted From The Edmonton Frail Scale For Use With Australian Acute Inpatients. With Acute Patients Ag
Perera, V., Bajorek, B., Matthews, S. & Hilmer, S.N. 2009, 'The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation', Age And Ageing, vol. 38, no. 2, pp. 156-162.
View/Download from: OPUS | Publisher's site
Objective: To Investigate The Impact Of Frailty On The Utilisation Of Antithrombotics And On Clinical Outcomes In Older People With Atrial Fibrillation (Af). Design: Prospective Study Of A Cohort Of 220 Acute Inpatients Aged >= 70 Years With Af, Admitted
Shaw, E., Tofler, G., Buckley, T.A., Bajorek, B. & Ward, M. 2009, 'Therapy for Triggered Acute Risk Prevention: A Study of Feasibility', Heart, Lung and Circulation, vol. 18, no. 5, pp. 347-352.
View/Download from: OPUS | Publisher's site
Background: Heavy physical exertion, emotional stress, heavy meals and respiratory infection transiently increase the risk of myocardial infarction, sudden death and stroke, however it remains uncertain how to use this information for disease prevention.
Bajorek, B., Ogle, S., Duguid, M., Shenfield, G. & Krass, I. 2009, 'Balancing risk versus benefit: The elderly patient's perspective on warfarin therapy', Pharmacy Practice, vol. 7, no. 2, pp. 113-123.
View/Download from: OPUS
Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored. Objective: To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy. Method: A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term ( 6 months) warfarin therapy were recruited by voluntary response to study flyers.
Bajorek, B., Yau, L., Lee, K. & Zulueta, W. 2009, 'Management of over-anticoagulation in warfarinised hospital patients', Journal of Pharmacy Practice and Research, vol. 39, no. 1, pp. 13-18.
View/Download from: OPUS
Aim: To determine the number of warfarinised hospital patients experiencing over-anticoagulation; to identify how overanticoagulation is managed and whether local guidelines are adhered to. Method: 2 prospective one-week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over-anticoagulation clinical management and treatment options.
Vermeer, N. & Bajorek, B. 2008, 'Utilization of evidence-based therapy for the secondary prevention of acute coronary syndromes in Australian practice', Journal Of Clinical Pharmacy And Therapeutics, vol. 33, no. 6, pp. 591-601.
View/Download from: OPUS | Publisher's site
Aim: To review and document the current utilization of pharmacotherapy for the secondary prevention of acute coronary syndromes (ACS) in patients discharged from an Australian hospital. Methods: A retrospective cross-sectional study was conducted at a major Sydney teaching hospital. Patients with either a primary or secondary diagnosis of acute coronary syndrome were identified from medical records over a 4-month period (January+April 2007). A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focussed on the use of four guideline-recommended therapies: aspirin clopidogrel, beta blockers, statins and ACEinhibitors (ACE-I), as well as the utilization of multiple antithrombotics.
Page, M., Bajorek, B. & Brien, J.E. 2008, 'Prescribing in teaching hospitals: A qualitative study of social and cultural dynamics', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 286-291.
View/Download from: OPUS
Background: General practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices. Aim: To explore the social and cultural dynamics of prescribing in teaching hospitals.
Su, E., Naganathan, V., Fallah, H., Bajorek, B. & McLachlan, A. 2008, 'Anticoagulation control in hospitalised patients on warfarin', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 292-295.
View/Download from: OPUS | Publisher's site
Background: Anticoagulation control is a strong predictor of clinical outcomes for patients on warfarin. Aim: To identify instances of excessive anticoagulation in hospitalised patients on warfarin and to determine the causes of international normalised ratios (INRs) of 5 and above and the management strategies used to correct it. Method: An observational descriptive study undertaken at a teaching hospital over a 3-month period. Data were reviewed prospectively and retrospectively to measure the percentage of time patients were maintained within their target INR range while in hospital and to identify cases of excessive anticoagulation. Patients were divided into a control group (INR < 5) and a high INR group (INR . 5). Possible causes of INRs of 5 and above and its management strategies were recorded.
Glover, S. & Bajorek, B. 2008, 'Exploring point-of-care testing of capillary blood in warfarin management', Journal of Pharmacy Practice and Research, vol. 38, no. 4, pp. 300-304.
View/Download from: OPUS
Background: Long-term warfarin therapy requires intensive laboratory monitoring of venous blood. Reliable and efficient point+of+care testing (POCT) of capillary blood offers an alternative to laboratory monitoring. Aim: To explore the perceptions of health professionals to POCT in warfarin management and to identify the models of monitoring warfarinised patients preferred by health professionals. Method: An exploratory descriptive study that purposively sampled health professionals (hospital pharmacists, specialists, nurses, general practitioners) involved in the management of anticoagulated patients and practising within an area health service. Health professionals were invited to participate in a group discussion on POCT and to then complete a brief survey ranking proposed monitoring models incorporating POCT.
Kung, M. & Bajorek, B. 2008, 'Medications in pregnancy: Impact on time to lactogenesis after parturition', Journal of Pharmacy Practice and Research, vol. 38, no. 3, pp. 205-208.
View/Download from: OPUS
Background: Although the many factors that affect the initiation of lactation have been identified, the impact of medications on lactogenesis remains largely unknown. Aim: To explore the impact of medications used during pregnancy on time to lactogenesis after parturition. Method: Data were collected prospectively from women admitted to a metropolitan Sydney hospital for parturition. Information was obtained via a short interview with each patient, as well as from medical notes, drug charts and infant feeding charts.
Buchan, D. & Bajorek, B. 2008, 'Incidence of venous thromboembolism and thromboprophylaxis after total hip or knee arthroplasty', Journal of Pharmacy Practice and Research, vol. 38, no. 3, pp. 200-204.
View/Download from: OPUS |
Background: Despite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice. Aim: To identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty. Method: Patients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3- month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes.
Vracar, D. & Bajorek, B. 2008, 'Australian general practitioners' views on pharmacist prescribing', Journal of Pharmacy Practice and Research, vol. 38, no. 2, pp. 96-102.
View/Download from: OPUS
Aim: To explore Australian general practitioners+ views on extending prescribing rights to pharmacists, the appropriateness of pharmacist prescribing models, and the influence of general practitioners+ characteristics on their preference for a particular pharmacist prescribing model. Method: The study consisted of two parts. Part A was a scenario-based questionnaire using Likert-scale responses and Part B was a semi-structured interview. General practitioners were randomly recruited from two Sydney divisions of general practice. Data were analysed using descriptive statistics and qualitative responses were thematically analysed.
Nguyen, N. & Bajorek, B. 2008, 'Pharmacist prescribing in warfarin therapy: Exploring clinical utility in the hospital setting', Journal of Pharmacy Practice and Research, vol. 38, no. 1, pp. 35-39.
View/Download from: OPUS
Background: Managing warfarin therapy can be challenging and a multidisciplinary approach to achieve optimal outcomes can be beneficial. Internationally, extended roles for pharmacists have involved collaborative prescribing privileges. Aim: To explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting. Methods: Pharmacists were recruited from a large Sydney teaching hospital. A questionnaire was used to simulate a pharmacist prescribing function and to explore their opinion of the usefulness of prescribing and their confidence to undertake such roles. The appropriateness of pharmacists+ prescribing decisions was evaluated.
Hilmer, S.N., Rangiah, C., Bajorek, B. & Shenfield, G. 2007, 'Failure to weigh patients in hospital: a medication safety risk', Internal Medicine Journal, vol. 37, no. 9, pp. 647-650.
View/Download from: OPUS | Publisher's site
Often Patients Are Not Weighed In Hospital. Failure To Weigh Patients Prescribed Renally Excreted Drugs May Correlate To Adverse Drug Events. We Carried Out A Cross-Sectional Study Of Patients Prescribed Common Renally Excreted Drugs (Heparin, Enoxaparin
Bajorek, B., Ogle, S., Duguid, M., Shenfield, G. & Krass, I. 2007, 'Management of warfarin in atrial fibrillation: Views of health professionals, older patients and their carers', Medical Journal of Australia, vol. 186, no. 4, pp. 175-180.
View/Download from: OPUS
Objective: To identify the views of health professionals, patients and their carers on strategies to improve the use and management of warfarin in older patients with atrial fibrillation. Design: Qualitative study based on analysis of group interviews. S
Bajorek, B., Krass, I., Ogle, S., Duguid, M. & Shenfield, G. 2006, 'Warfarin use in the elderly: The nurses' perspective', Australian Journal of Advanced Nursing, vol. 23, no. 3, pp. 19-25.
View/Download from: OPUS
Objective: To Explore The Barriers To Warfarin Use From The Perspective Of Nurses Working In Aged Care. Design: A Qualitative Study, Involving A Semi-Structured Group Interview, During March-April 2001. Setting And Subjects: Eleven Nurses, Employed Withi
Khoo, A. & Bajorek, B. 2006, 'Extended roles for pharmacists in warfarin therapy: Identifying opportunities for pharmacist prescribing', Journal of Pharmacy Practice and Research, vol. 36, no. 3, pp. 190-193.
View/Download from: OPUS
Background: Warfarin has traditionally posed a challenge to clinicians because ofits nan'ow therapeutic index. Extended roles for pharmacists may address some ofthe problems in warfarin management. International experience has involved anticoagulation clinics in which pharmacists have authority to engage in collaborative prescribing activities with physicians. Aim: To identify opportunities for pham1acist prescribing activities in warfarin management within the hospital setting. Method: Pham1acists from a Sydney teaching hospital were recruited. The first stage involved an audit of pharmacists' interventions in patients receiving warfarin. Stage two involved a focus group discussion to further explore these issues.
Bajorek, B., Krass, I., Ogle, S., Duguid, M. & Shenfield, G. 2005, 'Optimizing the use of antithrombotic therapy for atrial fibrillation in older people: A pharmacist-led multidisciplinary intervention', Journal of the American Geriatrics Society, vol. 53, no. 11, pp. 1912-1920.
View/Download from: OPUS | Publisher's site
OBJECTIVES: To develop, implement, and evaluate a pharmacist-led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested. DESIGN: Evidence-based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patient+s requirement for antithrombotic therapy was assessed. SETTING: A major Sydney teaching hospital. PARTICIPANTS: Two hundred eighteen consecutively admitted elderly patients (mean age 85.2) were recruited over a 6-month period.
Valiya, S. & Bajorek, B. 2005, 'Ximelagatran cost effectiveness for stroke prevention in atrial fibrillation', Journal of Pharmacy Practice and Research, vol. 35, no. 4, pp. 279-283.
View/Download from: OPUS
Background: The benefit of warfarin for stroke prevention in non-valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a nan'ow therapeutic window and carries a significant risk ofbleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability. Aim: To compare the costs and benefits of ximelagatran to that of warfarin and aspirin. Method: In a preliminary cost-effectiveness analysis, the costs and clinical consequences ofwarf31in, aspirin and ximelagatran were compared. The principal outcome was measured in the fonn of an incremental cost-effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data.
Hanes, C. & Bajorek, B. 2005, 'Pharmacist prescribing: Views of Australian hospital pharmacists', Journal of Pharmacy Practice and Research, vol. 35, no. 3, pp. 178-180.
View/Download from: OPUS
Aim: To explore the views of a sample ofAustralian hospital pharmacists on prescribing privileges. Method: The study involved a questionnaire and a focus group discussion for hospital pharmacists and teacher practitioners. Participants could participate in either or both ofthese activities. Results: 15 pharmacists completed the questionnaire and 8 participated in the focus group discussion. Several models of pharmacist prescribing (discharge and specialist settings) were seen to be appropriate and useful to Australian practice. 93% ofpharmacists noted that prescribing privileges would enable them to provide more efficient/improved pharmaceutical care; 64% that prescribing would result in reduced healthcare costs; and all noted physician opposition as a barrier. Pharmacists indicated that they already prescribed on' an 'unofficial' basis. Training and accreditation beyond registration was deemed necessary by all pharmacists.
Bajorek, B., Krass, I., Ogle, S., Duguid, M. & Shenfield, G. 2002, 'The impact of age on antithrombotic use in elderly patients with non-valvular atrial fibrillation', Australian Journal of Ageing, vol. 21, no. 1, pp. 36-41.
View/Download from: OPUS | Publisher's site
Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients +65 years, who were admitted to a Sydney teaching
Bajorek, B., Krass, I., Ogle, S., Duguid, M. & Shenfield, G. 2001, 'A survey of long-term antiarrhythmic therapy in elderly patients with atrial fibrillation', Australian Journal of Hospital Pharmacy, vol. 31, no. 2, pp. 93-97.
View/Download from: OPUS
Aim: To investigate the use of long-term antiarrhythmic (rhythm-control [RHY] and rate-control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients. Method: Data were collected retrospectively from the medical records of 255
Krass, I., Bajorek, B., Bagia, M., Fragoudakis, I., Ozgur, B. & Chin, S. 1997, 'An evaluation of three methods used in the prophylaxis of cyclophosphamide-induced haemorrhagic cystitis in bone marrow transplant patients', Journal of Oncology Pharmacy Practice, vol. 3, no. 4, pp. 193-199.
View/Download from: OPUS
Background. Bone marrow transplant (BMT) recipi ents, who receive high-dose cyclophosphamide as part of conditioning therapy, are at considerable risk of developing haemorrhagic cystitis (HC). The role of prophylaxis of cyclophosphamide-induced HC is wel