In the 5 years to 2020–21, the number of palliative care-related prescriptions dispensed increased overall by 28% (from 908,100 to 1.17 million), however in recent years this increase has slowed and declined in the 12 months to 2020–21. The largest increase over this period occurred between 2016–17 and 2017–18 (25% increase), then slowed in the 12 months to 2018–19 (6.8% increase), then stablised and declined (by 4.2%) in the 12 months to 2020–21 (Figure PBS.5). This trend was largely driven by changes in the number of medications prescribed for pain relief, which makes up 89% of all palliative care-related prescriptions.
Prescriptions increased for all types of palliative care-related medications between 2016–17 and 2020–21 (Table PBS.5). The largest average annual increase over the 5-year period was for prescriptions for gastrointestinal symptoms (13% increase), followed by neurological symptoms (12%) and the smallest increase was for pain relief (5.5%). The number of medications prescribed for pain relief peaked in 2018–19 (1.11 million) and has decreased since (1.04 million in 2020–21).
Palliative care-related prescribing by all clinicians has increased overall between 2016–17 and 2019–20, with a slight dip in 2020–21. However, over this period there have been slightly different patterns by specific prescribers, particularly in the 12 months to 2020–21. The number of prescriptions by GPs, the largest prescriber of palliative-care related prescriptions, increased steadily between 2016–17 and 2019–20 before declining by 4.7% in the 12 months to 2020–21. This decrease was driven by changes in prescriptions of pain relief medications, which may be due to some of these items being delisted in 2020–21. For palliative medicine specialists, the number of prescriptions also steadily increased over the 5 year period, with the largest increases occurring in the 12 months to 2020–21 (30% increase compared with 13% increase between 2018–19 and 2019–20). For other clinicians, the numbers remained relatively stable over the 4-year period to 2020–21.
Impacts of the COVID-19 pandemic
By looking at monthly PBS data, we can assess the effect of the public health response to the COVID-19 pandemic on PBS service utilisation during 2020 and 2021. In March 2020, there was a 19% increase in palliative care-related prescriptions from February 2020 levels and 13% higher than the corresponding period in 2019. Following this spike, there was a 20% drop in April 2020 from March 2020 and 7% drop from April 2019 levels (Table PBS.12).
This pattern was observed across most medication types, not only those relating to palliative care, and was largely due to changes in consumer behaviour coinciding with the introduction and then easing of restrictions during the COVID-19 pandemic in 2020. Also, in response to this dramatic increase in demand for medicines during early March which resulted in reported shortages in medicines, the Australian Government implemented temporary changes to medicines regulation to support continued access to PBS medicines (AIHW 2020).
Between July and December 2020 the number of prescriptions was relatively similar to previous years, before another large drop was observed for most months between January to May 2021 (3–15% below the 2019 levels for the corresponding months). These trends were largely driven by trends in the number of prescriptions for pain relief by GPs.
For more information see: Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme: quarterly data (AIHW 2021).
Figure PBS.5 Trends in palliative care-related prescriptions from the Palliative Care Schedule, by medication type and prescribing clinician, 2016–17 to 2020–21