Pharmaceutical Benefits Scheme Data Research Articles

Comparison of General Practice and Pharmaceutical Dispensing Data for Pharmacoepidemiological Research: Assessing the Risk of Urinary-Tract Infections with Sodium Glucose Cotransporter 2 Inhibitors for Diabetes

Background. This study compared results of a study undertaken using Australia’s general practice electronic health record database, MedicineInsight, to assess risk of urinary-tract infections with sodium glucose cotransporter 2 inhibitors (SGLT2) for diabetes, by undertaking the same study in a 10% random sample of data from the national Pharmaceutical Benefits Scheme data. Methods. Cohort studies were undertaken using deidentified data from the two national datasets. In each dataset, initiators of SGLT2 inhibitors were compared to initiators of dipeptidyl peptidase 4 (DPP-4) inhibitors in the period Jan 2012 to Sep 2015. The risk of urinary-tract infections (UTI) was assessed in six-month follow-up after initiation of SGLT2 and DPP-4. Results. There were 1,977 people in the SGLT2 and 1,964 people in the DPP-4 cohort (MedicineInsight data) and 3,120 in the SGLT2 and 12,359 in the DPP-4 cohort (10% PBS data). In both datasets, the risk of UTI after initiation of SGLT2 was not significantly increased in comparison to DPP-4 cohort (MedicineInsight: 3.6% versus 4.9%; aHR=0.90, 95% CI 0.66-1.24; PBS: 3.0% versus 3.9%; aHR=0.90, 95% CI 0.72-1.13, 10%). Conclusions. Comparison of MedicineInsight data to PBS national pharmacy data demonstrated highly comparable results for the specific study question. MedicineInsight is a reliable source of data that can be used for pharmacoepidemiological studies.

Predictors of statin use among older adults: A nationwide cross-sectional study

Statins comprise a key strategy for the prevention and treatment of arteriosclerotic cardiovascular disease, but prescribing remains suboptimal. The objective of this study was to characterize the predictors of statin use among adults aged ≥65years. A cross-sectional study using Pharmaceutical Benefits Scheme (PBS) data on reimbursed prescriptions for a 10% random sample of the Australian population in 2016 was performed. Predictors of statin use were identified via multivariable logistic regression. Analyses were performed separately for people who were concessional beneficiaries (with a low, capped copayment) and other ("general") people. Among 351,471 (concessional=295,875 and general=55,596) older adults, 44.2% were dispensed statins (concessional=46.4% and general=32.2%). Among the concessional beneficiaries, people aged 75 to 84years were more likely to use statins (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10), whereas those aged ≥85years were less likely to use statins (OR 0.71, 95% CI 0.69-0.72), compared with people aged 65 to 74years. Men were more likely to use statins than women (OR 1.14, 95% CI 1.12-1.16). Diabetes was associated with over 2-fold (OR 2.48, 95% CI 2.43-2.53) increased likelihood of statin use. People with cardiovascular-related conditions including hypertension, angina, and congestive heart failure experienced increased likelihood of statin use as was being dispensed anticoagulant or antiplatelet medication. Having malignancy, psychotic illness, or pain were associated with lower likelihood of statin use. Similar predictors of statin use were noted for the general population. More than 40% of older adults in Australia used statins in 2016 with uptake dependent on individual-level factors such as demographics and comorbidities. Future research should examine the extent to which provider and/or health system-level factors contribute to the variable uptake of statin therapy.

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Statins reduce the risk of cardiovascular disease in patients with diabetes. This study examined the prevalence of statin use and assessed long-term adherence and persistence among people aged ≥65 years with diabetes. Pharmaceutical Benefits Scheme data covering a 10% random sample of the Australian population were analyzed. Among older adults with diabetes, the yearly prevalence of statin use was compared via Poisson regression modeling using 2006 as the reference year. A cohort of 7400 new statin users (mean age 72.9 years; 46.2% female) was followed longitudinally. Adherence was assessed via the proportion of days covered (PDC). Statin discontinuation was defined as the first ≥90 days without statin coverage. The prevalence of statin use increased from 52.0% in 2006 to 71.2% in 2016 (age and sex-adjusted rate ratio 1.37; 95% confidence interval 1.33-1.41). No gender differences in statin use were observed, but the likelihood of being dispensed statin decreased with increasing age. Among the longitudinal cohort, the proportion adherent (PDC ≥0.80) decreased from 54.0% at 6 months to 37.0% at 9 years. Over a mean follow-up of 4.9 years, 66.8% discontinued, and the likelihood of stopping statin medication within the first year was 42.7%. No age or gender differences in statin discontinuation were evident. Statin use has increased among older adults with diabetes. However, adherence is low and discontinuation is high. Further investigations into the factors associated with non-adherence or discontinuation of statins are important so as to optimize statin use towards achieving the intended cardiovascular benefits among older people with diabetes.

Comorbidities in Australian women with hormone-dependent breast cancer: a population-based analysis.

To compare how frequently selected chronic diseases developed in women with breast cancer receiving endocrine therapy, and in women without cancer. Retrospective, rolling cohort study, analysing a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for the period 1 January 2003 - 31 December 2014. Women with breast cancer who first commenced endocrine therapy between January 2004 and December 2011 were identified, and age- and sex-matched (1:10) by comorbidity with control groups of women who did not have a dispensing record for antineoplastic agents during the study period or the comorbidity of interest at baseline. Development of any of eight pre-selected comorbidities, identified in PBS claims data with the RxRisk-V model. Women with hormone-dependent breast cancer were significantly more likely than women in the control group to develop depression (overall hazard ratio [HR], 1.36; 95% CI, 1.26-1.46), pain or pain-inflammation (HR, 1.30; 95% CI, 1.23-1.38), osteoporosis (overall HR, 1.27; 95% CI, 1.17-1.39), diabetes (HR, 1.24; 95% CI, 1.10-1.41), cardiovascular disorders (overall HR, 1.22; 95% CI, 1.13-1.32), and gastric acid disorders (HR, 1.20; 95% CI, 1.13-1.28). The hazard ratios for developing cardiovascular disorders, depression and osteoporosis were highest during the first year of endocrine therapy. The risk of hyperlipidaemia was lower among women with breast cancer than in the control group (HR, 0.88; 95% CI, 0.81-0.96). There was no significant difference between the two groups in the risk of reactive airway diseases (HR, 1.05; 95% CI, 0.98-1.13). Comorbid conditions are more likely to develop in women who have been diagnosed with hormone-dependent breast cancer than in women without cancer. Our results further support the need to develop appropriate models of care to manage the multiple chronic disorders of breast cancer survivors.

Incidence of comorbidities in women with breast cancer treated with tamoxifen or an aromatase inhibitor: an Australian population-based cohort study.

BackgroundThe development of comorbidities has become increasingly relevant with longer-term cancer survival.ObjectiveTo assess the pattern of comorbidities among Australian women with breast cancer treated with tamoxifen or an aromatase inhibitor.DesignRetrospective cohort study using Pharmaceutical Benefits Scheme (PBS) data (10% sample) from January 2003 to December 2014. Dispensing claims data were used to identify comorbidities and classified with the Rx-Risk-V model. The breast cancer cohort had tamoxifen or an aromatase inhibitor dispensed between 2004 and 2011 with no switching between types of endocrine therapy. Comparisons were made between the breast cancer cohort and specific control groups (age- and sex-matched at 1:10 ratio without any dispensing of anti-neoplastic agents during the study period) for the development of five individual comorbidities over time using Cox regression models.ResultsWomen treated with tamoxifen had a higher incidence of cardiovascular conditions, diabetes, and pain or pain-inflammation, but a lower incidence of hyperlipidaemia compared with non-cancer control groups, as indicated by PBS data. Women treated with aromatase inhibitors were more likely to develop cardiovascular conditions, osteoporosis, and pain or pain-inflammation compared with non-cancer control groups. The risks of hyperlipidaemia and osteoporosis were significantly lower among tamoxifen users compared with aromatase inhibitor users.ConclusionsWomen with hormone-dependent breast cancer treated with an endocrine therapy had a higher risk of developing specified comorbid conditions than women without cancer, with different comorbidity profiles for those on tamoxifen versus aromatase inhibitors. Further research into the causes and mechanism of development and management of comorbidities after cancer is needed.

We have had a gutful: The need for deprescribing proton pump inhibitors.

Proton pump inhibitor (PPI) prescribing may often be inappropriate and expose patients to a risk of adverse effects, while incurring unnecessary healthcare expenditure. Our objective was to determine PPI usage in Australia since 2002 and review international studies investigating inappropriate PPI prescribing, including those that discussed interventions to address this issue. Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) data were analysed. A narrative literature review relevant to the objective was conducted. Time series analysis was also used to examine the trend of reported PPI appropriate use across the international studies included in this review. Proton pump inhibitor use in Australia increased between 2002 and 2010 and then gradually decreased. Estimates of the extent of inappropriate use in the international literature had a wide variation (11-84%). There appeared to be little change in the extent of appropriate PPI use reported through 34 international studies from 2000 to 2016. Interventions to address inappropriate use included patient-centred deprescribing, academic detailing, educational programmes and drug safety notifications. Proton pump inhibitors continue to be overused worldwide and should be a focus for deprescribing programmes. Ongoing education and awareness campaigns for health professionals and patients, including electronic reminders at the point of prescribing, are strategies that have potential to reduce PPI use in individuals who do not have an evidence-based clinical indication for their long-term use.

High rates of general practice attendance by former prisoners: a prospective cohort study.

To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters. Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups. Rates of general practice attendance by former prisoners during the 2 years following their release from prison. In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00-2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58-2.10). Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care.

Chronic hepatitis C burden and care cascade in Australia in the era of interferon-based treatment.

Interferon-free direct-acting antiviral regimens for hepatitis C virus (HCV) infection have been recently available in Australia, beginning a new era in clinical and public health management of HCV infection. This study provided updated estimates of the HCV infection care cascade and burden in Australia as a reliable platform for assessing the future impact of interferon-free therapies. A modeling approach was applied to estimate the number of individuals living with chronic HCV infection and with various liver disease stages. Data from national registries of HCV notification and liver transplantation, literature review, and expert consensus informed the model parameters. HCV notification and Pharmaceutical Benefits Scheme data were used to estimate the number of HCV diagnosed individuals and treatment uptake. In 2014, an estimated 230 470 individuals (range: 180 490-243 990) were living with HCV, among whom 75% were diagnosed (n = 172 720; range: 156 720-188 770), 20% had ever received treatment (n = 45 000; range: 39 280-50 720), and 11% had been cured (n = 24 750; range: 21 520-27 990). Among individuals with HCV infection, the proportion with hepatic fibrosis stage ≥F3 doubled during the last decade, increasing from 9% (n = 18 580) in 2004 to 19% (n = 44,730) in 2014. Individuals initiating HCV treatment increased from 1100 in 1997 to 3840 in 2007, plateaued until 2010 and decreased to 2790 in 2014. The burden of HCV-related liver disease has increased markedly. Although the proportion diagnosed was high, treatment uptake remained low, with no increase over the last 7 years. Reducing the HCV burden in Australia requires scale-up of interferon-free HCV therapies.

Access to Subsidized Smoking Cessation Medications by Australian Smokers Aged 45 Years and Older: A Population-Based Cohort Study.

The principal aim of this study was to assess the accessibility of subsidized cessation medications to socioeconomically disadvantaged smokers, including smokers living in regional and remote communities. Analyses used baseline questionnaire and linked Pharmaceutical Benefits Scheme data for 18 686 regular smokers participating in the 45 and Up Study, a large-scale Australian cohort study of people aged 45 years and older. Participants who were dispensed nicotine replacement therapy, varenicline, or bupropion were identified from the Pharmaceutical Benefits Scheme data, which provide an essentially complete record of participants' access to subsidized pharmaceuticals. Associations between the supply of each pharmacotherapy and a range of sociodemographic and health-related variables were evaluated using multiple logistic regression. The odds that participants were supplied with a cessation medication declined markedly with increasing age for participants older than 60 years and were substantially higher for participants who smoked 20 or more cigarettes/day than for participants who smoked fewer than 10 cigarettes/day. Participants with no formal qualification and those residing in socioeconomically disadvantaged areas had higher odds of receiving nicotine replacement therapy or varenicline than university-educated participants and participants living in the least disadvantaged areas. There was no evidence that participants residing in regional and remote communities had lower odds of receiving a cessation medication than participants residing in major cities. Older Australian smokers' access to cessation pharmacotherapies is determined predominantly by age and daily cigarette consumption and does not appear to be limited by educational achievement, socioeconomic disadvantage, or remoteness. Promoting the use of cessation medications is a principal measure proposed to achieve Australia's National Tobacco Strategy 2012-2018 goal of reducing cigarette consumption among socioeconomically disadvantaged smokers. The results of this large-scale cohort study indicate that access to cessation pharmacotherapies is determined primarily by age and daily cigarette consumption, and is not limited by socioeconomic circumstances, providing some reassurance that existing government subsidies are sufficient to ensure that pharmaceutical aids are accessible to all Australian smokers.

Lifetime direct costs of stroke for indigenous patients adjusted for comorbidities.

To estimate the lifetime health costs of stroke by comorbidity and indigenous status in Australia's Northern Territory (NT), where a large indigenous population resides. Incidence-based cohort study using linked hospital, primary care, and Pharmaceutical Benefits Scheme data to estimate lifetime direct costs for hemorrhagic stroke (HS), ischemic stroke (IS) and undetermined stroke (UND). Inverse probability-weighted survival analysis was adapted to adjust for loss to follow-up. Log-linear modeling was used to analyze the net stroke costs and marginal comorbidity costs by indigenous status. Between 1992 and 2013, there were 3,733 patients admitted with stroke in the NT (74% were incident strokes, 38% indigenous, 56% male, 56% IS). In 2012/2013 Australian dollars, the estimated lifetime cost for an incident stroke in NT was $302,538 AUD ($207,218 USD) per patient. The net lifetime cost per non-indigenous female HS patient aged <45 years without comorbidity (reference category) was $72,773 AUD ($49,844 USD); IS cost 54% and UND 9% more than HS (p < 0.01). Stroke cost was greater for indigenous patients (∆ 44%) and patients with renal disease (∆ 71%), coronary heart disease (∆ 44%), hypertension (∆ 30%), and diabetes (∆ 28%) in comparison with the reference category (all p < 0.01). Chronic obstructive pulmonary disease, atrial fibrillation, depression, and cancer were negatively associated with lifetime stroke costs. The costs of stroke for indigenous people and patients with different comorbidities are substantial and an integrated prevention strategy is needed.

The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers.

BackgroundThe Pharmaceutical Benefits Scheme (PBS) is Australia’s national drug subsidy program. This paper provides a practical guide to researchers using PBS data to examine prescribed medicine use.FindingsExcerpts of the PBS data collection are available in a variety of formats. We describe the core components of four publicly available extracts (the Australian Statistics on Medicines, PBS statistics online, section 85 extract, under co-payment extract). We also detail common analytical challenges and key issues regarding the interpretation of utilisation using the PBS collection and its various extracts.ConclusionsResearch using routinely collected data is increasing internationally. PBS data are a valuable resource for Australian pharmacoepidemiological and pharmaceutical policy research. A detailed knowledge of the PBS, the nuances of data capture, and the extracts available for research purposes are necessary to ensure robust methodology, interpretation, and translation of study findings into policy and practice.

Studies using Australia's Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: a systematic review of the published literature (1987-2013).

Research using dispensing claims is used increasingly to study post-market medicines use and outcomes. The purpose of this review is to catalogue more than 25 years of published literature using Australia's Pharmaceutical Benefits Scheme (PBS) dispensing records. We searched MEDLINE, PreMEDLINE and Embase and conducted author searches for studies published from 1987 to 2013. Independent reviewers screened abstracts of 3209 articles and reviewed 264 full-text manuscripts. Included studies used PBS dispensing data to measure patterns and/or outcomes of prescribed medicines use or dispensing claims to derive a proxy for a specific disease cohort or health outcome. Of the 228 studies identified, 106 used PBS claims only (56 using claims-level data and 50 using individual-level data) and 63 studies linked individual-level PBS claims to other health data. Most commonly, studies examined trends in drug utilisation (33%), clinician and patient practices (26%), drug use and outcomes (18%) and evaluations of intervention impacts (17%). Sixty-two percent of studies using individual-level data were based on a subset of elderly Australians. Most studies focused on drug classes acting on the nervous system (36%), cardiovascular system (15%) and alimentary tract (11%). Few studies examined prescribed medicines use in children and pregnant women. Pharmaceutical Benefits Scheme claims represent a significant resource to examine Australia's billion-dollar annual investment in prescribed medicines. The body of research is growing and has increased in complexity over time. Australia has great potential to undertake world-class, whole-of-population pharmacoepidemiological studies. Recent investment in data linkage infrastructure will significantly enhance these opportunities.

An observational study of the discrediting of COX-2 NSAIDs in Australia: Vioxx or class effect?

BackgroundWhen a medicine such as rofecoxib (Vioxx) is withdrawn, or a whole class of medicines discredited such as the selective COX-2 inhibitors (COX-2s), follow-up of impacts at consumer level can be difficult and costly. The Australian Longitudinal Study on Women's Health provides a rare opportunity to examine individual consumer medicine use following a major discrediting event, the withdrawal of rofecoxib and issuing of safety warnings on the COX-2 class of medicines. The overall objective of this paper was to examine the impact of this discrediting event on dispensing of the COX-2 class of medicines, by describing medicine switching behaviours of older Australian women using rofecoxib in September 2004; the uptake of other COX-2s; and the characteristics of women who continued using a COX-2.MethodsParticipants were concessional beneficiary status women from the Older cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health who consented to linkage to Pharmaceutical Benefits Scheme data, with at least one rofecoxib prescription dispensed in the 12 months before rofecoxib withdrawal. A prescription was defined as one dispensing occasion. Women were grouped by rofecoxib pattern of use: continuous (nine or more prescriptions dispensed in the 12 months prior to rofecoxib withdrawal) or non-continuous (eight or less prescriptions dispensed in the 12 months prior to rofecoxib withdrawal) users. Incidence rate per 100,000 person days and incidence risk ratio described uptake of alternate medicines, following rofecoxib withdrawal. Kaplan-Meier curves described differences in uptake patterns by medicine and pattern of rofecoxib use. Patterns of use of COX-2s in the next 100 days after first COX-2 uptake were described.ResultsMedicine switches and pattern of medicines uptake differed significantly depending upon whether a woman was a continuous or non-continuous rofecoxib user prior to rofecoxib discrediting. Continuous rofecoxib users overwhelmingly switched to another COX-2 and remained continuing COX-2 users for at least 100 days post-switch.ConclusionsThe typical switching behaviour of this group of women suggests that the issues leading to the discrediting of rofecoxib were not seen as a COX-2 class effect by prescribers to this high use group of consumers.

Spotlight on the August 2 Issue

#### Notable in Neurology This issue features an article investigating the associations of previously reported Alzheimer disease dementia genomic variants with common neuropathologies, and another examines the relationship between cortical function and survival in amyotrophic lateral sclerosis. A featured article evaluates the feasibility, safety, and tolerability of noninvasive vagus nerve stimulation for the prevention of chronic migraine attacks. ### Lifetime direct costs of stroke for indigenous patients adjusted for comorbidities This study used linked hospital, primary case, and Pharmaceutical Benefits Scheme data to estimate lifetime direct costs for hemorrhagic, ischemic, and undetermined stroke. The findings show that costs of stroke for indigenous people and …

Influence of the dramatic fall of hormone replacement therapy (HRT) prescription on postmenopausal breast cancer incidence: The Austrian data

1529 Background: The Women's Health Initiative trial showed a significant increase in breast cancer risk among women using HRT. This publication led to a dramatic fall in HRT prescription worldwide. Several studies argued that the ensuing decline in breast cancer incidence among postmenopausal women was due to the reduced HRT prescriptions. We have investigated whether the strong decline in HRT prescription in Austrian women from 2002 onward was associated with a decrease in postmenopausal breast cancer incidence in Austria. Methods: Breast cancer incidence data were obtained from the National Austrian Cancer Registry. HRT prescription data were calculated using Pharmaceutical Benefits Scheme data. Hormone receptor expression data were taken from the pathology report of all patients with breast cancer, who were operated on at the Division of Special Gynecology, as well as the Department of Surgery, Medical University of Vienna (MUW), from 1998 to 2000, and 2005 to 2007, respectively. Chi-Square test was used to identify significant differences. Results: HRT prescription slightly increased from 1998 to 2000, but dramatically decreased by 70% after 2003, reaching a significantly lower level. When comparing breast cancer incidence data from 1999 and 2004, a nonsignificant trend toward a decreased incidence in 50- to 54-year-old women could be observed. Comparing predicted breast cancer incidence for 2004 with the actual incidence for 2004 in this group, a significant decrease could be demonstrated. Ten percent to 12% of all new breast cancers in Austria are treated at the MUW every year. Regarding histopathologic breast cancer parameters of patients treated at the MUW from 1998 to 2000 and 2005 to 2007, respectively, a nonsignificant decline of hormone receptor positive tumors in 50- to 54-year-old patients with breast cancer could be observed. Conclusions: The decline of HRT use in Austria is associated with a reduction in breast cancer incidence in postmenopausal women. Our data underline the association between HRT and breast cancer. No significant financial relationships to disclose.

Influence of the dramatic fall of HRT prescription on postmenopausal breast cancer incidence: the Austrian Data

Aims: The Women's Health Initiative trial showed a significant increase in breast cancer risk among women using HRT. This publication led to a dramatic fall in HRT prescription worldwide. Several studies argued that the ensuing decline in breast cancer incidence among postmenopausal women was due to the reduced HRT prescriptions. We have investigated whether the strong decline in HRT prescription in Austrian women from 2002 onwards was associated with a decrease in postmenopausal breast cancer incidence in Austria. Methods: Breast cancer incidence data were obtained from the National Austrian cancer registry. HRT prescription data were calculated using Pharmaceutical Benefits Scheme data. Hormone receptor expression data were taken from the pathology report of all breast cancer patients, who were operated at the Division of Special Gynecology as well as the Department of Surgery, Medical University of Vienna (MUW), during 1998–2000, and 2005–2007, respectively. Chi Square test was used to identify significant differences.

Gender, socioeconomic status, need or access? Differences in statin prescribing across urban, rural and remote Australia

To assess differences in statin prescribing across Australia by geographic area. A cross-sectional study using Pharmaceutical Benefits Scheme data on statin prescribing by rurality, gender and patient postcode for the period May to December 2002. Participants were the Australian population, stratified by gender, quintile of index of relative socioeconomic disadvantage and rural, remote and metropolitan areas classification. Statin prescribing (scripts per 1000 population per month) was higher in urban areas (women, 51.915; men, 51.892) than in rural (women, 48.311; men, 48.098) or remote (women, 39.679; men, 34.145) areas. In urban areas, weighted least squares regression analysis showed a significant negative linear association between statin prescribing and socioeconomic status for both women (weighted least squares slope, -3.358; standard error (SE) 0.057; P < 0.0001) and men (slope, -0.507; SE 0.056; P < 0.0001). A similar association occurred in rural areas: women (slope, -4.075; SE 0.122; P < 0.0001) and men (slope, -3.455; SE 0.117; P < 0.0001), but not in remote areas where there was a positive linear association (slope, 3.120; SE 0.451; P < 0.0001) and men (slope, 3.098; SE 0.346; P < 0.0001). Our results suggest differences in statin prescribing in Australia across geographic location, adjusting for age, gender and socioeconomic status. These findings suggest that health inequalities due to geography should be addressed.

Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia

To determine if the recent rapid fall in use of hormone replacement therapy (HRT) in Australia has been followed by a reduction in breast cancer incidence among women aged 50 years or older, but not among younger women. Analysis of trends in annual prescribing of HRT, using Pharmaceutical Benefits Scheme data, and in annual age-standardised breast cancer incidence rates in Australian women for the period 1996-2003. In Australia, prescribing of HRT increased from 1996 to 2001, but dropped by 40% from 2001 to 2003. Age-standardised breast cancer incidence rates in women aged > or = 50 years also increased to 2001 but declined thereafter. The incidence rates in this age group were lower by 6.7% (95% CI, 3.9%-9.3%; P < 0.001) in 2003 compared with 2001, equivalent to 600 (95% CI, 350-830) fewer breast cancers (out of about 9000 incident breast cancers annually for women this age). There was no significant change in breast cancer incidence for women aged < 50 years. While other factors may have contributed to a recent reduction in breast cancer incidence among Australian women aged > or = 50 years, the available evidence suggests that much of the decrease is due to the recent fall in use of HRT. This is consistent with other evidence that the HRT-associated increase in risk of breast cancer is reversible after ceasing use of HRT.

Risk Factors for Rhabdomyolysis with Simvastatin and Atorvastatin

To assess the frequency of risk factors for rhabdomyolysis with simvastatin and atorvastatin in cases reported to the Australian Adverse Drug Reactions Advisory Committee (ADRAC). Reports meeting the definition of rhabdomyolysis were reviewed for risk factors including age > or = 70 years, dose > or = 40 mg, hepatic dysfunction, diabetes mellitus, hyperkalaemia, hypothyroidism and the use of concomitant interacting medications. Only one report associated with simvastatin and five reports associated with atorvastatin did not list any risk factors for rhabdomyolysis. Interacting medicines featured in 77% of reports of rhabdomyolysis associated with simvastatin and 44% of reports associated with atorvastatin. A comparison of the age profile for reports of atorvastatin- and simvastatin-associated rhabdomyolysis with that for all adverse drug reaction reports received, and for all reports of muscle disorders, suggested a trend towards an increasing risk of rhabdomyolysis with increasing age with simvastatin but not with atorvastatin. Similarly, comparing prescribed tablet strengths from Pharmaceutical Benefits Scheme data with the HMG-CoA reductase inhibitor ('statin') doses in reports of rhabdomyolysis suggested a dose-related risk with simvastatin, but a less increased risk with high-dose atorvastatin. Risk factors for rhabdomyolysis featured in nearly all of the reports of statin-associated rhabdomyolysis and the majority of reports listed multiple risk factors, although dependence on risk factors appeared to be stronger with simvastatin than atorvastatin. The multiplication of risk factors in patients taking simvastatin and atorvastatin should be minimised.

General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia

Objective: Previous Australian research suggests there is very little difference in the prevalence of mental health disorders across rural, remote and metropolitan areas. However, mental health specialists are particularly scarce in rural and remote areas and some researchers have argued that non-metropolitan residents rely heavily on general practitioners (GPs) for mental health care. This article investigated rates of GP services for psychological problems across rural, remote and metropolitan areas.Method: The Bettering the Evaluation and Care of Health (BEACH) program, Medicare and Pharmaceutical Benefits Scheme data were used in this report. Data included all psychological, depression and anxiety problems reported as managed by GPs and prescriptions for mental health medications (written and filled). Problem and medication rates are given per 100 patient encounters and per 1000 population.Results: Only a few regional differences were evident in the rate of psychological problems and prescriptions for mental health medications per 100 GP-patient encounters. However, rural and remote residents visited GPs less frequently than their metropolitan counterparts. Lower rates of GP encounters for psychological problems were evident for residents of most non-metropolitan areas (per 1000 population). Additionally, GPs prescribed mental health medications at half the rate for residents of remote areas than capital cities.Conclusions: General practitioners provide fewer mental health services per capita in nonmetropolitan areas. This difference could represent completely untreated psychological problems or fewer follow-up consultations. While non-metropolitan residents have limited access to specialists, rates of GP encounters for psychological problems are also very low.