Georgie Lee

@uwa.edu.au

Allied Health
University of Western Australia

Research area of interest is in the quality use of medicines, focusing on the patterns and implications of potentially suboptimal medicine regimens among older adults and the methods used to measure potential exposure.

EDUCATION

Bachelor of Public Health and Health Promotion (Deakin University)
Bachelor of Health and Medical Science (Hons) (Deakin University)
PhD candidate in Pharmacoepidemiology (University Of Western Australia)

RESEARCH, TEACHING, or OTHER INTERESTS

Pharmacology (medical), Epidemiology, Public Health, Environmental and Occupational Health, Geriatrics and Gerontology

Scopus Publications

Scholar Citations

Scholar h-index

Scholar i10-index

Scopus Publications

Defining polypharmacy in older adults: a cross-sectional comparison of prevalence estimates calculated according to active ingredient and unique product counts
Georgie B. Lee, Sarah M. Hosking, Christopher Etherton-Beer, Julie A. Pasco, Lana J. Williams, Kara L. Holloway-Kew, and Amy T. Page
Springer Science and Business Media LLC
Abstract Background Polypharmacy is common in older adults and may be associated with poor outcomes. However, methods used to define polypharmacy are rarely reported precisely, with potential implications for polypharmacy exposure estimates. Aim The aim was to investigate prevalence estimates according to different methods in an Australian population-based sample of older adults. Method This cross-sectional study included 735 adults aged ≥ 60 years participating in the Geelong Osteoporosis Study. Current prescription, non-prescription and complementary and alternative medicines were self-reported. Counting methods included the number of active ingredients and unique products. Polypharmacy and hyperpolypharmacy were determined using ≥ 5 and ≥ 10 medicine cut points respectively. Prevalence was estimated using ingredient- and product-level counts according to criteria defined by medicine schedule and type (i.e. scheduled prescription, non-prescription). Non-parametric testing measured differences between counting methods, univariate logistic regressions investigated disagreement between total counts and polypharmacy exposure. Results Polypharmacy prevalence (scheduled prescription medicines) was 30.3% and 35.9% (products versus ingredients). Prevalence increased to 52.8% and 57.3% when counts considered any medicine. Adults aged ≥ 80 years were most likely to use prescription combination products (OR 2.22 [95% CI 1.46, 3.35] p < 0.01), however, age was not associated with disagreement between product and ingredient polypharmacy exposure. Being male was associated with both prescription combination product use (OR 1.79 [95% CI 1.29, 2.47] p < 0.001) and disagreement between polypharmacy exposures (OR 2.29 [95% CI 1.15, 4.47] p=0.02). Conclusion Polypharmacy prevalence estimates varied substantially depending on the method applied. These data indicate the need for standardised reporting specific to medicines data and polypharmacy measures.

Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors
Suzanne Rayner, Hayden Richards, Georgie B Lee, Elleanor Lee, and Andrew Rixon
Wiley
AbstractObjectivesEmergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter‐professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: ‘What are the experiences and perceptions of leadership by EM doctors?’MethodsThis single‐site qualitative study was undertaken using semi‐structured in‐depth individual interviews to collect data. Interviews were audio recorded, transcribed and de‐identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software.ResultsOur sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately.ConclusionsLeadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.

The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta-analysis
Hui Wen Quek, Amy Page, Kenneth Lee, Georgie Lee, Deborah Hawthorne, Rhonda Clifford, Kathleen Potter, and Christopher Etherton‐Beer
Wiley
AbstractAimsPrevious systematic reviews suggest that deprescribing may improve survival, particularly in frail older people. Evidence is rapidly accumulating, suggesting a need for an updated review of the literature.MethodsWe updated a 2016 systematic review and meta‐analysis to include studies published from inception to 26 April 2024 from specified databases. Studies in which older people had at least one medication deprescribed were included and grouped by study designs and targeted medications. The risk of bias was assessed using the Cochrane tool and the Newcastle‐Ottawa tool. Odds ratios (OR) or mean differences were calculated as the effect measures using either the Mantel–Haenszel or generic inverse‐variance method with fixed‐ or random‐effects meta‐analyses. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, physical health, cognitive function, quality of life and effect on medication regimen. Subgroup analyses were performed based on age and intervention types.ResultsA total of 259 studies (reported in 286 papers) were included in this updated review. Deprescribing polypharmacy did not result in a significant reduction in mortality in both randomized (OR 0.96, 95% confidence interval [CI] 0.84–1.09) and non‐randomized studies (OR 0.70, 95% CI 0.36–1.38). Further subgroup analyses of randomized studies on deprescribing polypharmacy demonstrated a significant reduction in mortality in the young old (aged 65–79) (OR 0.71, 95% CI 0.51–0.99) and when patient‐specific interventions were applied (OR 0.79, 95% CI 0.63–0.99).ConclusionsDeprescribing can be achieved with potentially important benefits in terms of improved survival, particularly when patient‐specific interventions are applied and initiated early in the young old.

Medicines Regimens Charted for Older People Living in Residential Aged Care: A Repeated Cross-Sectional Study Describing the Number of Medicines, Regimen Complexity, High-Risk Prescribing, and Potential Underprescribing
Amy Theresa Page, Kathleen Potter, Georgie Lee, Hend Almutairi, Kenneth Lee, Kate Wang, Nagham Ailabouni, and Christopher Etherton-Beer
Elsevier BV

Health literacy and cardiovascular disease prevention: a systematic scoping review protocol
Bonnie Beasant, Georgie Lee, Vanessa Vaughan, Mojtaba Lotfaliany, and Sarah Hosking
BMJ
IntroductionHealth literacy is ‘The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare’. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations.Methods and analysisA scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 ‘pilot’ articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts.Ethics and disseminationThis review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation.Article summaryCVD is the leading cause of death around the world. This paper proposes an exploration of health literacy’s relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.

Applicability of explicit potentially inappropriate medication lists to the Australian context: A systematic review
Georgie Lee, Joy‐Francesca Lim, Amy T. Page, Christopher Etherton‐Beer, Rhonda Clifford, and Kate Wang
Wiley
AbstractObjectivesTo determine i) the similarity of potentially inappropriate medications specified in and between existing explicit lists and ii) the availability in Australia of medications included on existing lists to determine their applicability to the Australian context.MethodsThis systematic review identified explicit potentially inappropriate medication lists that were published on EMBASE (1974 – April 2021), MEDLINE (1946 – April 2021) and Elsevier Scopus (2004 – April 2021). The reference lists of seven previously published systematic reviews were also manually reviewed. Lists were included if they were explicit, and the most recent version and the complete list were published in English. Lists based on existing lists were excluded if no new items were added. Potentially inappropriate medications identified on each list were extracted and compared to the medications available on the Australian Register of Therapeutic Goods and Australian Pharmaceutical Benefits Schemes.ResultsThirty‐five explicit published lists were identified. A total of 645 unique potentially inappropriate medications were extracted, of which 416 (64%) were available in Australia and 262 (41%) were subsided by the general Pharmaceutical Benefits Scheme. Applicability of each explicit list ranged from 50–96% according to medications available in Australia and 25‐83% according to medications available under subsidy.ConclusionsPooling data from different lists may help to identify potentially inappropriate medications that may be applicable to local settings. However, if selecting a list for use in the Australian context, consideration should also be given to the intended purpose and setting for application.

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review
Georgie B. Lee, Christopher Etherton-Beer, Sarah M. Hosking, Julie A. Pasco, and Amy T. Page
SAGE Publications
In the context of an ageing population, the burden of disease and medicine use is also expected to increase. As such, medicine safety and preventing avoidable medicine-related harm are major public health concerns, requiring further research. Potentially suboptimal medicine regimens is an umbrella term that captures a range of indicators that may increase the risk of medicine-related harm, including polypharmacy, underprescribing and high-risk prescribing, such as prescribing potentially inappropriate medicines. This narrative review aims to provide a background and broad overview of the patterns and implications of potentially suboptimal medicine regimens among older adults. Original research published between 1990 and 2021 was searched for in MEDLINE, using key search terms including polypharmacy, inappropriate prescribing, potentially inappropriate medication lists, medication errors, drug interactions and drug prescriptions, along with manual checking of reference lists. The review summarizes the prevalence, risk factors and clinical outcomes of polypharmacy, underprescribing and potentially inappropriate medicines. A synthesis of the evidence regarding the longitudinal patterns of polypharmacy is also provided. With an overview of the existing literature, we highlight a number of key gaps in the literature. Directions for future research may include a longitudinal investigation into the risk factors and outcomes of extended polypharmacy, research focusing on the patterns and implications of underprescribing and studies that evaluate the applicability of tools measuring potentially inappropriate medicines to study settings.Plain Language SummaryA review on potentially inappropriate medicine regimens Medicine use in older age is common. Older adults with more than one chronic condition are likely to use multiple medicines to manage their health. However, there are times when taking multiple medicines may be unsafe and the number of medicines, or the combination of medicines used, may increase the risk of poor health outcomes. The term medicine regimens is used to describe all the medicines an individual takes. There are several ways to measure when a medicine regimen may be inappropriate and, therefore, potentially harmful. Much research has been published looking into potentially inappropriate medicine regimens. To bring together the current research, this review provides a background on the different measures of potentially inappropriate medicine regimens. It also summarizes how many people may experience potentially inappropriate medicine regimens, the impact it is having on their health and who may be at greater risk. In doing so, we found a number of gaps in the existing evidence, indicating that our understanding of potentially inappropriate medicine regimens is incomplete. This review highlights gaps in knowledge that can be addressed by future research. With an improved understanding of potentially inappropriate medicine regimens, we may be able to better identify those at greater risk to prevent or minimize the impact of poorer health outcomes related to unsafe medicine use.

Discussing diabetes, palliative and end of life care: choosing the 'right' language
Trisha Dunning, Peter Martin, Sharyn Milnes, Nick Simpson, Georgie B. Lee, and Neil Orford
AME Publishing Company
BACKGROUND Palliative care and advance care planning are important components of diabetes and other chronic disease management plans. Most people with diabetes do not have conversations about palliative/end of life (EOL) care or advance care directives; often because diabetes clinicians are reluctant to discuss these issues. Guidelines for conversations and decision aids can assist shared decision-making for both clinicians and patients. The aim was to co-design information with older people with diabetes, families and clinicians to facilitate conversations about palliative and EOL care and to identify the language (words) people with diabetes, families and diabetes clinicians use to discuss death and dying. METHODS We co-designed and tailored the information with advisory groups: (I) older people with diabetes/families, (II) interdisciplinary expert clinicians and undertook a scoping literature review to identify relevant content. The penultimate versions were independently evaluated in focus groups and via written feedback from representative stakeholder clinicians, people with diabetes and international experts in communication, palliative care and diabetes. RESULTS The information met design and language criteria: 62 people participated in focus groups (48 clinicians, 14 older people with diabetes and 4 family members). There were important differences between people with diabetes and diabetes clinicians concerning the words used to refer to death: 'the language of death'. Diabetes clinicians choose soft words/euphemisms such as 'passed away' and 'gone' and indicated they mirrored patient language. People with diabetes preferred clear language and indicated euphemisms were confusing and misleading. Diabetes clinicians, rarely encountered death in their practice and indicated they lacked education about how to discuss diabetes EOL care. CONCLUSIONS Co-design with key end-users improved relevance to these groups. Diabetes clinicians prefer to use euphemisms for death and would benefit from education and strategies to help them initiate conversations about EOL diabetes care.

RECENT SCHOLAR PUBLICATIONS

Defining polypharmacy in older adults: a cross-sectional comparison of prevalence estimates calculated according to active ingredient and unique product counts
GB Lee, SM Hosking, C Etherton-Beer, JA Pasco, LJ Williams, ...
International Journal of Clinical Pharmacy, 1-10 2025

Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors
S Rayner, H Richards, GB Lee, E Lee, A Rixon
Emergency Medicine Australasia 36 (6), 868-875 2024

The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis
HW Quek, A Page, K Lee, G Lee, D Hawthorne, R Clifford, K Potter, ...
British Journal of Clinical Pharmacology 90 (10), 2409-2482 2024

Medicines regimens charted for older people living in residential aged care: a repeated cross-sectional study describing the number of medicines, regimen complexity, high-risk
AT Page, K Potter, G Lee, H Almutairi, K Lee, K Wang, N Ailabouni, ...
Journal of the American Medical Directors Association 25 (6), 104944 2024

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review
GB Lee, C Etherton-Beer, SM Hosking, JA Pasco, AT Page
Therapeutic advances in drug safety 13, 20420986221100117 2022

Health literacy and cardiovascular disease prevention: a systematic scoping review protocol
B Beasant, G Lee, V Vaughan, M Lotfaliany, S Hosking
BMJ open 12 (6), e054977 2022

Applicability of explicit potentially inappropriate medication lists to the Australian context: a systematic review
G Lee, JF Lim, AT Page, C Etherton‐Beer, R Clifford, K Wang
Australasian journal on ageing 41 (2), 200-221 2022

Discussing diabetes, palliative and end of life care: choosing the'right'language
T Dunning, P Martin, S Milnes, N Simpson, GB Lee, N Orford
Deakin University 2021

MOST CITED SCHOLAR PUBLICATIONS

Discussing diabetes, palliative and end of life care: choosing the'right'language
T Dunning, P Martin, S Milnes, N Simpson, GB Lee, N Orford
Deakin University 2021
Citations: 7

Health literacy and cardiovascular disease prevention: a systematic scoping review protocol
B Beasant, G Lee, V Vaughan, M Lotfaliany, S Hosking
BMJ open 12 (6), e054977 2022
Citations: 3