Figure PBS.1 Alternative text - Source data: Palliative care-related medication tables (119KB XLS)
Male and female patients received a similar proportion of palliative care-related prescriptions (subsidised and under co-payment) in 2017–18 (48.8% male and 51.2% female). Males and females averaged 2.0 and 2.1 prescriptions per patient respectively.
The highest rate of patients being dispensed palliative care-related prescriptions (2,740.4 per 100,000 population) was recorded for patients from Inner regional areas followed by Outer regional areas (2,595.6).
Types of palliative care-related prescriptions and prescribing clinicians
This section presents information on both the number and type of PBS/RPBS subsidised palliative care-related prescriptions and on the prescribing clinician. A variety of health professionals are able to prescribe medications listed on the palliative care schedule, including palliative medicine specialists, other medical specialists, GPs and nurse practitioners.
Broadly, the medications included in the PBS/RPBS palliative care schedule fall into the following groups:
- analgesics (drugs that relieve pain)
- anti-epileptics (drugs that treat seizures)
- anti-inflammatory and anti-rheumatic products (drugs that treat inflammation)
- drugs for functional gastrointestinal disorders (drugs that treat impaired gastrointestinal function)
- drugs for constipation (laxatives)
- psycholeptics (drugs that tranquillise/depress the central nervous system)
- stomatological preparations (drugs that treat diseases of the mouth).
Anti-inflammatory and anti-rheumatic products were the most commonly prescribed subsidised medication type (54.0%), followed by analgesics (35.4%) and drugs for constipation (6.8%).
GPs prescribed the majority (94.3%) of subsidised palliative care-related medications. Other clinicians (including medical specialists from other disciplines and nurse practitioners) prescribed 5.2% of the medications, followed by palliative medicine specialists (0.5%).
Subsidised medications prescribed varied according to the type of clinician, however, anti-inflammatory and anti-rheumatic medications and analgesics were the 2 most commonly prescribed medication groups for all clinician types, with the exception of palliative medicine specialists who were most likely to prescribe analgesics followed by drugs for functional gastrointestinal disorders.
Palliative care-related prescriptions by state and territory
The rate of subsidised palliative care-related prescriptions dispensed nationally in 2017–18 was 3,020.6 per 100,000 population. Rates ranged from 1,504.2 per 100,000 population in the Northern Territory to 5,031.1 in Tasmania.
Nationally, anti-inflammatory and anti-rheumatic medications accounted for the highest rate of subsidised prescriptions for all states and territories, followed by analgesics and drugs for constipation (1,631.3, 1,069.2 and 205.4 per 100,000 population, respectively).
Palliative care-related prescriptions over time
From 1 April 2012, changes to the National Health Act (1953) require pharmacies to supply data for prescriptions that are priced below the patient co-payment level (non-subsidised) to the Department of Human Services (Department of Health 2011 ). Prior to this, data on non-subsidised palliative care-related medications were not available. These data are now reported alongside PBS/RPBS subsidised medication data.
Due to significant changes to the restriction level of some medications listed in the PBS palliative care schedule from June 2016, data from 2016–17 onwards are not comparable with previous years. Assuming reasonable stability of the items listed on the schedule and their restriction levels in future, discussion of the time series data will recommence once sufficient data are available.
The pattern for medications prescribed from the PBS palliative care schedule is influenced by GPs prescribing the vast majority of these prescriptions. The proportion of GP prescribed PBS/RPBS subsidised prescriptions increased between 2013–14 and 2017–18 (from 87.4% to 94.3%), and the proportion prescribed by palliative medicine specialists and other clinicians decreased.
Palliative care schedule items for pain relief
In 2017–18, almost all (97.6%) palliative care-related prescriptions for pain relief medications (analgesics) were PBS/RPBS subsidised. An analysis of these pain relief items indicates that 56.5% of medications in this group were paracetamol, with the remainder being opioids. About 1 in 5 (18.9%) subsidised prescriptions for opioids were repeat scripts in 2017–18, compared with about half for paracetamol (47.6%). Nationally, there were 1,069.2 per 100,000 population subsidised prescriptions for pain relief medications in 2017–18, with opioids dispensed at a rate of 465.1 and paracetamol at 604.1.
For subsidised opioid prescriptions, rates ranged from 190.3 per 100,000 population for the Northern Territory to 1,197.5 for Tasmania. For paracetamol, the rates ranged from 189.9 per 100,000 population for the Northern Territory to 862.1 for New South Wales (Figure PBS.2). Western Australia, South Australia, Tasmania and the Northern Territory had higher rates of opioid than paracetamol prescriptions. Opioid prescriptions were dominated by Buprenorphine patches (91.9% of all opioid prescriptions).