4364.0.55.015 - National Health Survey: Persons accessing Pharmaceutical Benefits Scheme subsidised prescriptions, 2014-15  
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Use of PBS subsidised prescriptions

This section explores the linked dataset from the integration between the 2014-15 NHS and the MADIP asset. It presents data on the use of PBS subsidised prescriptions by certain characteristics of people in the 2014-15 NHS.

Data is presented across a range of medications according to the World Health Organization Anatomical Therapeutic Chemical (ATC) Classification System[1]. It is a classification system that classifies the active ingredients of medications according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties. The ATC Classification System categorises medicines into one of fourteen anatomical groups, which are presented in this research paper.

For the 12 months prior to the 2014-15 NHS interview:

    • Seven in ten (70.5%) people had at least one script filled for a PBS subsidised prescription.
    • Antiinfectives for systemic use, which include antibiotics, were the most commonly accessed type of medication, with almost half (45.5%) of all people having at least one script filled.
    • Nervous system medications, which include mental health and psychoactive related medications, were the second most commonly prescribed medications. Just over one quarter (26.2%) of all people accessing at least one PBS subsidised prescription for this medication type.
    • On average, the highest number of scripts filled per person was for Cardiovascular system medications with an average of 18.5 scripts per person.


Table 1: Persons who accessed (a) PBS subsidised prescription(s) up to 12 months prior to 2014-15 NHS interview

Estimate
('000)
Proportion
(%)
Number of scripts
('000)
Average number of scripts
no. per person

Anatomical Therapeutic Chemical (ATC) Classification System(b)

Alimentary tract and metabolism
Blood and blood forming organs
Cardiovascular system
Dermatologicals
Genito-urinary system and sex hormones
Systemic hormonal preparations, excluding sex hormones and insulins
Antiinfectives for systemic use
Antineoplastic and immunomodulating agents
Musculo-skeletal system
Nervous system
Antiparasitic products, insecticides and repellents
Respiratory system
Sensory organs
Various

Total people who used at least one PBS subsidised script up to 12 months prior to NHS interview

All people in 2014-15 NHS
4,579.7
1,667.9
4,825.0
2,455.3
2,207.7
2,451.7
10,439.3
407.8
2,993.0
6,010.7
55.3
2,465.0
2,384.2
127.5

16,192.5

22,966.6
19.9
7.3
21.0
10.7
9.6
10.7
45.5
1.8
13.0
26.2
0.2
10.7
10.4
0.6

70.5

100.0
39,492.5
10,901.3
89,476.2
4,647.4
7,804.6
6,085.8
29,871.8
3,628.8
11,874.2
57,594.5
66.3
13,296.9
10,369.0
479.6

285,588.7

. .
8.6
6.5
18.5
1.9
3.5
2.5
2.9
8.9
4.0
9.6
1.2
5.4
4.3
3.8

17.6

. .

(a) Persons represented in the linked 2014-15 NHS dataset.
(b) The ATC classification system has fourteen main anatomical or pharmacological groups (first level). These first level anatomical main groups are presented in this publication.

Age and sex

In terms of age, older people were more likely to access PBS subsidised prescriptions, which could be attributed to factors such as increasing life expectancy, prevalence of conditions and polypharmacy.

Of all people in the NHS who accessed at least one PBS subsidised prescription up to 12 months prior to their 2014-15 NHS interview:
    • Females (75.9%) were more likely than males (65.0%), to access at least one PBS prescription medication.
    • Generally, access to PBS subsidised prescriptions increased with age. The majority of people aged 75 years and over (97.8%) accessed at least one PBS subsidised prescription.
    • The largest difference between females and males by age group was at 18-24 years (81.4% compared with 49.5% respectively). This difference generally reflects females’ gynaecological and reproductive health needs.

Proportion of persons who accessed PBS subsidised prescription(s) up to 12 months prior to 2014-15 NHS interview

Graph: Showing proportion of people who accessed at least one PBS subsidised prescription up to 12 months prior to 2014-15 NHS interview by age and sex
Source: MADIP, 2014-15


Across most age groups for males and females, Antiinfectives for systemic use medications were the most commonly accessed subsidised prescription in the linked dataset. However, the relative pattern of use for males and females differed across age, particularly in adults aged 18-44 years. The rate did not necessarily increase with age, as typically observed in other ATC medication groups.

Antiinfectives for systemic use medications include antibiotics which help stop infections that are caused by bacteria. Australia has a relatively higher rate of antibiotic prescribing compared with the Organisation for Economic Co-operation and Development (OECD) average (23.4 per 1,000 people, compared with an OECD average of 20.6 per 1,000 people)[2].

Proportion of persons who accessed Antiinfectives for systemic use PBS subsidised prescription(s) up to 12 months prior to 2014-15 NHS interview

Graph: Showing proportion of persons who accessed Antiinfectives for systemic use PBS subsidised prescription up to 12 months prior to 2014-15 NHS interview by age and sex
Source: MADIP, 2014-15

Nervous system medications were the second most commonly accessed subsidised prescription in the linked dataset and include antipsychotics, anxiolytics/hypnotics and sedatives, antidepressants and psychostimulants medications. Whilst young males (0-17 years) were slightly more likely than females to have accessed a Nervous system prescription, for all other age groups females were more likely than males. The largest difference between males and females was at ages 65-74 years (41.9% compared with 54.3% respectively). Generally, use of Nervous system medications increased with age and people aged 75 years and over had the highest rate of any age group, with six in ten people (61.7%) having accessed a Nervous system prescription via the PBS.

Proportion of persons who accessed Nervous system PBS subsidised prescription(s) up to 12 months prior to 2014-15 NHS interview
Graph: Showing proportion of persons who accessed Nervous system PBS subsidised prescription up to 12 months prior to 2014-15 NHS interview by age and sex
Source: MADIP, 2014-15

Cardiovascular system medications were the third most commonly accessed subsidised prescription in the linked dataset and are used in treating cardiovascular disease, such as heart, stroke and vascular disease. They are also used to prevent risk factors such as high blood pressure and high cholesterol. Rates of use generally increased with age for both males and females with a similar proportion of males and females in each age group. There was a slight difference at ages 55-64 years with 48.4% of males compared with 40.4% of females. Generally, use of Cardiovascular system medications increased with age and people aged 75 years and over had the highest rate of any age group at 85.1%.

Proportion of persons who accessed Cardiovascular system PBS subsidised prescription(s) up to 12 months prior to 2014-15 NHS interview
Graph: Showing proportion of persons who accessed Cardiovascular system PBS subsidised prescription up to 12 months prior to 2014-15 NHS interview by age and sex
Source: MADIP, 2014-15

Self-reported long-term health conditions

Long-term health conditions are typically managed by prescribed medications. However, there is no detailed information regarding what conditions prescription medications are being prescribed for in the PBS and limited information from the NHS. To better understand the relationship between long-term health conditions and medication use, the integrated data can be used to cross-classify and highlight medication prescribing patterns in the PBS subsidised prescriptions to better understand comorbidity and polypharmacy.

This section looks at those people who self-reported a long-term health condition in the 2014-15 NHS and the types of PBS subsidised prescriptions they accessed in the 12 months prior to 2014-15 NHS interview. Long-term health conditions self-reported by respondents in the 2014-15 NHS are presented using a classification originally developed for the 2001 NHS by the Family Medicine Research Centre, University of Sydney, in conjunction with the ABS. The classification is based on the 10th revision of the International Classification of Diseases (ICD).

Of those people who self-reported a long-term health condition in the 2014-15 NHS, the proportion who accessed at least one PBS subsidised prescription were as follows:
    • Hypertension and Diabetes mellitus – both at 97.3%
    • Osteoporosis – 96.0%
    • Heart, stroke and vascular disease – 95.6%
    • Chronic obstructive pulmonary disease (COPD) – 92.7%
    • Cancer (malignant neoplasms) – 91.5%
    • Arthritis – 91.2%
    • Kidney disease – 91.0%
    • Asthma – 87.5%
    • Mental and behavioural conditions – 84.6%
    • Back problems (dorsopathies) – 80.0%
    • Hayfever and allergic rhinitis – 72.2%

For further information on prevalence rates of self-reported long-term health conditions in the 2014-15 NHS, see 4364.0.55.001 - National Health Survey: First Results, 2014-15.

Of those who self-reported a long-term health condition, the following PBS subsidised prescriptions were accessed:
    • Of those who self-reported having Hypertension, 93.5% had at least one PBS subsidised prescription for Cardiovascular system medications.
    • More than four in five (85.2%) of those who self-reported having diabetes had at least one Alimentary tract and metabolism script, which comprises medications targeted for diabetes. This was closely followed by Cardiovascular system (83.0%) which could be explained by people with diabetes often taking blood pressure lowering medications in combination. People who have diabetes are at risk of heart disease. Heart attacks and strokes are up to four times more likely in people with diabetes[3].
    • Seven in ten (70.3%) who self-reported having COPD had a PBS subsidised prescription for Antiinfectives for systemic use. This medication group includes antibiotics which are commonly used for the management of COPD.
    • Four in five people (83.2%) who self-reported having Heart, stroke and vascular disease had a Cardiovascular system script. Around half of these people (50.4%) with this condition also had a PBS subsidised prescription for Blood and blood forming organs medication.
    • Musculo-skeletal medications were most commonly accessed by people who self-reported having Osteoporosis at 51.4%.
    • More than half of the people who self-reported having COPD (53.9%) and Asthma (53.0%) had a PBS subsidised prescription filled for a Respiratory system medication.

Endnotes

1. World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology <www.whocc.no/atc_ddd_index/> last accessed 12/03/2020.
2. OECD (Organisation for Economic Co-operation and Development) 2017, Health at a glance 2017: OECD indicators. Paris: OECD Publishing <https://www.oecd.org/australia/Health-at-a-Glance-2017-Key-Findings-AUSTRALIA.pdf> accessed 31/03/2020.
3. Diabetes Australia, Living with Diabetes, Preventing Complications, Heart disease - <https://www.diabetesaustralia.com.au/heart-disease> accessed 17/04/2020.


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