title: Challenges in hemophilia care in Australia and New Zealand.
abstract: BACKGROUND
  Health and life expectancy for people with hemophilia have improved significantly in recent years, but we face new challenges, especially in the context of resource-constrained health services.
  
  
  OBJECTIVE
  This paper aims to highlight such challenges and propose practical solutions.
  
  
  METHODS
  Nine hemophilia specialists from Australia and New Zealand reached consensus on areas of greatest need for improvement in hemophilia care in these countries, based on clinical experience and published data, and agreed on how to address these.
  
  
  RESULTS
  Demography, optimizing treatment and assessing treatment success were identified as broad areas of challenge which included: comorbidities in ageing patients; transitioning from pediatric to adult care; equity of care for remote populations; weight-based dosing in obese patients; tailoring prophylaxis; accurate diagnosis of acute joint pain; managing chronic arthropathy; providing psychosocial support; consistency in definitions and assessment; and quantifiable outcome measures. Practice points included increased cross-specialty coordination and including psychologists and rheumatologists as part of comprehensive care teams; close collaboration between pediatric and adult centers to facilitate transition of care; systems such as telehealth that ensure continuity of care for remote populations; using pharmacokinetic data to tailor therapy; rapid and accurate diagnosis of acute joint pain; using data from bleeding registries to assess treatment effects and help with service planning; and ensuring consistency through benchmarking and standardization of HTCs.
  
  
  CONCLUSIONS
  Achieving treatment equity, optimal outcomes and cost savings may be possible through investing in national governance structures, expanding the comprehensive model of care and implementing innovative solutions tailored to local needs.
authors: a a Royal Children's Hospital Haematology , Brisbane , Queensland , Australia.|b b Pathology Queensland , Brisbane , Queensland , Australia.
authors: S A
authors: SA
authors: Brown
authors: c c Haematology Department , Wellington Hospital , Wellington , New Zealand.
authors: J
authors: J
authors: Phillips
authors: d d Haemophilia Treatment Centre, Royal Children's Hospital , Parkville , Victoria , Australia.
authors: C
authors: C
authors: Barnes
authors: e e Haematology Department , The Children's Hospital at Westmead , Westmead , New South Wales , Australia.
authors: J
authors: J
authors: Curtin
authors: f f Adult Haemophilia Treatment Centre, Royal Adelaide Hospital , Adelaide , South Australia , Australia.
authors: S
authors: S
authors: McRae
authors: g g Adult Haemophilia Treatment Centre, Auckland Hospital , Auckland , New Zealand.
authors: P
authors: P
authors: Ockelford
authors: h h Haemophilia Treatment Centre, Royal Brisbane and Women's Hospital , Brisbane , Queensland , Australia.
authors: J
authors: J
authors: Rowell
authors: i i Canterbury District Health Board, Christchurch Hospital , Christchurch , New Zealand.
authors: M P
authors: MP
authors: Smith
authors: j j Haemophilia Treatment Centre, Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia.
authors: S
authors: S
authors: Dunkley
mesh_terms: D000328:Adult; D001315:Australia; D002648:Child; D032921:Consensus; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D009520:New Zealand; D010372:Pediatrics; D060305:Transition to Adult Care
keywords: Benchmarking; Comprehensive healthcare; Demography; Health expenditures; Hemophilia; Outcome assessment