Anatomical Therapeutic Classification (ATC)

The classification system, as maintained by the World Health Organisation (WHO) that classifies medications into five hierarchical levels, from the bodily system or organ the medication targets at the highest level, to the specific chemical substance at the lowest level. This allows analysis at varying levels of granularity.

The following definitions for groups in the 1st level were sourced and paraphrased from the WHOCC (2018), online Cambridge University dictionary (2019) and AIHW (2017).

A – Alimentary tract and metabolism – the structures and functions of the body that enable nutrition, digestion and excretion. Medications can include antacids, laxatives, anti-diabetic or anti-obesity drugs.

B – Blood and blood forming organs – includes the bone marrow and the spleen. Medications can treat diseases like anaemia by assisting in red blood cell formation, or haemorrhage with coagulation agents and blood substitution products.

C – Cardiovascular system – includes the heart and blood vessels that distribute blood carrying oxygen and nutrients to cells in the body to support physiological functions. Medications in this class are prescribed to treat conditions like hypertension, high cholesterol and angina (ischaemic heart disease).

D – Dermatologicals – medications to treat or prevent diseases that affect the skin, nails and hair, such as acne or allergic reactions.

G – Genito-urinary system and sex hormones – diseases and dysfunction of the sexual organs and urinary system. Medications can include hormonal contraception, fertility agents, hormonal replacement and agents to improve bladder control.

H – Systemic hormonal preparations, excluding sex hormones and insulins – medications relating to the hormones produced by the endocrine system which regulate metabolism, growth and development. Medications can include thyroid and pancreatic hormones.

J – Antiinfective for systemic use – medications to treat or prevent infections caused by microorganisms, and include antibacterials, antivirals and vaccines.

L – Antineoplastic and immunomodulating agents – these medications are used to treat malignant tumours and other cancers such as leukaemia and lymphoma. This includes chemotherapy and immunotherapy regimes.

M – Musculo-skeletal system – The musculoskeletal system provides form, support, stability and movement. Medications related to treating diseases of the muscles, skeleton and connective tissue include muscle relaxants and drugs to treat bone disease.

N – Nervous system – includes the brain and all the nerves in the body that make consciousness, cognition, feeling and movement possible. Medications in this class include anaesthesics, stimulants, antiepileptics, sedatives, antidepressants and antipsychotic medications.

P – Antiparasitic products, insecticides and repellents – medications which are used to treat or prevent infections from organisms that feed and live on or in humans.

R – Respiratory system – relating to the lungs and airways which enable the absorption of oxygen and the discharge of carbon dioxide. Medications that treat diseases of the respiratory system like asthma and emphysema include bronchodilators, steroids and decongestants.

S – Sensory organs – relating to the eyes and ears. Most of these medication are topical medications to treat infective and inflammatory conditions.

V – Various – medications can include allergens, diagnostic agents and surgical dressings.

After categorisation at the first level, medications are divided into their therapeutic subgroup at the 2nd level, and then into their pharmacological and chemical subgroup at 3rd and 4th level, respectively. At the 5th level they are categorised into their chemical substance. The following definitions are for 3rd level medications mentioned in this report.

Antidepressants — medication used relieve symptoms of depression and anxiety, and other conditions such as sleep disorders.

Lipid modifying agents, plain — medication used in the treatment of high levels of fats such as cholesterol in the blood.

Opioids — medication that acts on the nervous system primarily for pain relief.

Drugs for peptic ulcer and gastro-oesophageal reflux disease (GORD) — medication that reduces the amount of stomach acid that leaks into the oesophagus allowing ulcers to heal and preventing heartburn or gastrointestinal pain.

Angiotensin II receptor blockers, plain and combination — medication used to treat high blood pressure (hypertension) by dilating veins and arteries, and reducing the work of the heart.

Anti-inflammatory and antirheumatic products, non-steroids — medicines to treat arthritis and rheumatic conditions by reducing inflammation, joint swelling and stiffness.

Antibacterials, penicillins — antibiotic medications used to treat bacterial infections.

Ace inhibitors, plain — medications used to treat high blood pressure (hypertension), heart failure and other conditions by relaxing the blood vessels and reducing the work of the heart.

Blood glucose lowering drugs — medications used to treat diabetes by lowering the glucose level in the blood.

Immunosuppressants — medications used to suppress a person’s immune response. They are used to prevent rejection of a transplanted organ and to treat autoimmune diseases such as rheumatoid arthritis.

Other antineoplastic agents — medications to prevent, inhibit or halt the development of a malignant tumour.

Concession Cardholder

Any contemporary ex-serving ADF member with at least one day of service since 2001, with a PBS dispensing recorded as ‘Concession’ in 2017–18, who has not held a DVA Gold Card or White Card since being discharged. It is not possible to determine the type of concession card an individual holds from the available data, however, concession cards available with the Australian population include:

  • Pension Concession Cards
  • Commonwealth Seniors Health Card
  • Health Care Card.

Given the inability to identify directly if an individual has a concession card, individuals in the underlying population who had no dispensings in 2017–18 were identified via dispensing information for 2016–17. That is, if these individuals received a concessional dispensing in 2016–17, it is assumed they were still concession cardholders in 2017–18, see more detail in the methods section below.

Contemporary ex-serving ADF population

The contemporary ex-serving ADF population is defined as all ADF members who have had at least one day of full-time or reserve service on or after 1 January 2001, and discharged after this time.

Contemporary ex-serving cohort

Any of the three ex-serving member population groups created for analysis in this report:

  • DVA Cardholder
  • Concession Cardholder
  • General Beneficiary.

Contemporary ex-serving member

For this report, a contemporary ex-serving member is an ex-serving ADF member who has had at least one day of full-time or reserve service on or after 1 January 2001, and discharged after this time, and who was dispensed a medication in 2017–18.

Dispensing/Medication dispensed

A dispensing for this report refers to the supply of a pharmaceutical benefit under the PBS or RPBS.

DVA Cardholder

Any contemporary ex-serving ADF member with at least one day of service since 2001, who has held a DVA Gold Card or White Card since being discharged.

General Beneficiary

Any contemporary ex-serving ADF member with at least one day of service since 2001, who received a ‘General Beneficiary’ dispensing in 2017–18 and who has not held a DVA Gold Card or White Card since being discharged, and not received a concessional dispensing in 2017–18.

Reporting period

The reporting period for the current study is the financial year between 1 July 2017 and 30 June 2018 (2017–18).