Medications dispensed to contemporary ex-serving members, by medication class

This section presents key results from the analysis of medications dispensed by the first and third levels of the Anatomical Therapeutical Chemical (ATC) classification, see below. Results include numbers of the medications most frequently dispensed, the proportions of individuals who were dispensed medications as well as average numbers of dispensings per person within ATC classes.

Anatomical Therapeutical Chemical (ATC) classification

This report uses the Anatomical Therapeutical Chemical (ATC) classification system, as maintained by the World Health Organization (WHO) to classify medications. This system 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 (WHOCC 2018). This allows analysis at varying levels of granularity. 

Table 2 below provides an example of the complete classification for Rosuvastatin.

Table 2: Example ATC classification: Rosuvastatin

ATC level

Classification

ATC code

1st level, anatomical main group

Cardiovascular System

C

2nd level, therapeutic subgroup

Lipid Modifying Agents

C10

3rd level, pharmacological subgroup

Lipid Modifying Agents, Plain

C10A

4th level, chemical subgroup

HMG CoA reductase inhibitors

C10AA

5th level, chemical substance

Rosuvastatin

C10AA07

Note: Medicines are given an ATC classification in the Schedule of Pharmaceutical Benefits according to their main therapeutic use in Australia as registered with TGA and listed on the PBS.

Source: World Health Organization.

At the first ATC level, the most common medications dispensed to contemporary ex-serving members in the study period were those relating to the nervous system, which accounted for 33% of all medications dispensed (Supplementary table S5). This category includes medications such as antidepressants, anticonvulsants and analgesics. This was followed by medications relating to the cardiovascular system, which accounted for 26% of all medications dispensed. Together these two categories accounted for 59% of all dispensed medications.

Nervous system medications

The 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 anaesthetics, stimulants, antiepileptics, sedatives, antidepressants and antipsychotic medications.

One third (33%) of all contemporary ex-serving ADF members were dispensed at least one nervous system medication. Overall 55% of DVA cardholders and 54% of concession cardholders were dispensed at least one nervous system medication (Supplementary table S6). Among general beneficiaries this proportion was 23%.

After adjusting for age and sex, more contemporary ex-serving ADF members (37%) were dispensed at least one nervous system medication compared with the Australian population (31%) (Figure 8 and Supplementary table S4).

Figure 8: Comparison of nervous system medications dispensed to contemporary ex-serving members and Australian population (age and sex-standardised), 2017–18

This bar chart shows the age and sex-adjusted rates of dispensing per person for nervous system medications was higher in the contemporary ex-serving population than in the Australian population, 37 per person and 31 per person, respectively.

Note: Standardised to the Australian 2001 population, see Methods for more information.

Sources: AIHW analysis of linked PMKeyS–PBS/RPBS data 2017–18 (Contemporary ex-serving population); AIHW analysis of Department of Health PBS and RPBS data, 2017–18 (Australian population).

The most commonly dispensed medications at the third ATC level across all cohorts were antidepressants, which accounted for 15% of all medications dispensed to contemporary ex-serving ADF members (Table 3). Antidepressants were dispensed at least once to 33% of all DVA cardholders, which was more than any other class of medication. That percentage was 30% for concession cardholders and 10% among general beneficiaries. After adjusting for age and sex, more contemporary ex-serving ADF members were dispensed antidepressants (20%) compared with the Australian population (15%) (Supplementary table S6). 

It should be noted that policies regarding mental health treatment for ex-serving personnel have undergone change in recent years to facilitate early access to mental health treatment, and the full effect of these changes may not be reflected in this study population. For example, DVA’s policy relating to non-liability health care for mental health conditions was expanded in 2016 to cover all current and former ADF members for post-traumatic stress disorder (PTSD), anxiety, depression, alcohol and substance use disorders. This was expanded again on 1 July 2017 to include all mental health conditions.

Within nervous system medications, the second most commonly dispensed medicines were opioids, which accounted for 8% of all dispensings among the study population (Table 3). Opioids were dispensed to 29% of DVA cardholders, 25% of concession cardholders and 11% of general beneficiaries. After adjusting for age and sex, similar proportions of contemporary ex-serving members were dispensed opioids when compared with the Australian population (17% and 15%, respectively) (Supplementary table S6).

DVA cardholders who were dispensed an opioid received an average of 7 opioid dispensings per year. This was 6 per person among concession cardholders and 2 per person among general beneficiaries (Supplementary table S6).

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Cardiovascular system medications

The 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).

Cardiovascular medications were dispensed to 18% of all contemporary ex-serving ADF members. The proportion of DVA cardholders who received at least one cardiovascular system medication was 35%. Eleven percent of general beneficiaries and 30% of concession cardholders received cardiovascular medicines (Supplementary table S5).

After accounting for age and sex differences, the proportion of contemporary ex-serving ADF members dispensed a cardiovascular system medication was 22% compared with 24% in the Australian population (Figure 9 and Supplementary table S4).

Figure 9: Comparison of cardiovascular system medications dispensed to contemporary ex-serving ADF members and Australian population (age and sex-standardised), 2017–18

This bar chart shows the age and sex adjusted rates of dispensing per person for cardiovascular system medications were higher in the Australian population than in the Contemporary ex-serving population, 24.3 per person and 21.9 per person, respectively.

Note: Standardised to the Australian 2001 population, see Methods for more information.

Sources: AIHW analysis of linked PMKeyS–PBS/RPBS data 2017–18 (Contemporary ex-serving population); AIHW analysis of Department of Health PBS and RPBS data, 2017–18 (Australian population). 

For those dispensed a cardiovascular medication the average number of cardiovascular dispensings was 14 per person. Within the Australian population it is 17 per person. The average number of dispensings per person indicates that individuals who were dispensed cardiovascular medications tended to receive them regularly over the course of the year, or received multiple types of medication within this category, consistent with expected use for persons with heart disease. Within this group, at the ATC fifth-level, individuals were dispensed an average of 2 different types of cardiovascular medication over the study period.

Within this category the most commonly dispensed medications were lipid modifying agents, which accounted for 9% of all medications dispensed to contemporary ex-serving members (Table 3). After adjusting for age and sex, the proportion of contemporary ex-serving members dispensed lipid modifying agents was 11% and for the Australian population was 13%

Anti-infectives for systemic use

These medications are used to treat or prevent infections caused by microorganisms, and include antibacterials, antivirals and vaccines.

In terms of the number of individuals being dispensed medications, anti-infectives for systemic use were dispensed to the most people, with more than one third (34%) of all contemporary ex-serving ADF members being dispensed at least one. This is consistent with Australian use with 41% of both the contemporary ex-serving population and the Australian population receiving at least one anti-infective medication after accounting for age and sex differences (Figure 10 and Supplementary table S4).

Among concession cardholders 49% received an anti-infective, as did 41% of DVA cardholders and 30% of general beneficiaries. Among general beneficiaries who were dispensed anti-infectives, the average number of dispensings over the study period was 2 per person (Table 3). Among DVA cardholders and concession cardholders there was an average of 3 per person. Consistent with recommended use, the results suggest anti-infectives were used short term. 
The most commonly dispensed anti-infectives were ‘beta-lactam antibacterials, penicillins’, which were dispensed to 20% of all contemporary ex-serving ADF members, which is consistent with national patterns of anti-infective use (Supplementary table S6). 

Figure 10: Comparison of anti-infectives for systemic use dispensed to contemporary ex-serving ADF members and the Australian population (age and sex-standardised), 2017–18

This bar chart shows the age and sex adjusted rates of dispensing per person for anti-infectives for systemic use were similar for the contemporary ex-serving and Australian populations, 41.0 per person and 40.5 per person, respectively.

Note: Standardised to the Australian 2001 population, see Methods for more information.

Sources: AIHW analysis of linked PMKeyS–PBS/RPBS data 2017–18 (Contemporary ex-serving population); AIHW analysis of Department of Health PBS and RPBS data, 2017–18 (Australian population).

Musculo-skeletal medications

These medications are prescribed to treat conditions related to the muscles and skeleton including bones, joints and tendons. Medications in this class include anti-inflammatories and muscle relaxants.

Musculo-skeletal system medications were dispensed to 15% of all contemporary ex-serving members. After accounting for age and sex differences, the proportion of contemporary ex-serving ADF members dispensed a musculo-skeletal system medication was 18% compared with 16% in the Australian population (Figure 11 and Supplementary table S4).

The average number of dispensings for these medications was 3 dispensings per person for the contemporary ex-serving population, consistent with expected short term use of for acute conditions. As some medications used for musculo-skeletal conditions are available over-the-counter — for example, non-steroidal anti-inflammatory drugs (NSAIDs) — these numbers may underestimate the total use of medications in this category for both populations.

Figure 11: Comparison of musculo-skeletal system medications dispensed to contemporary ex-serving members and the Australian population (age and sex-standardised), 2017–18

This bar chart shows the age and sex adjusted rates of dispensing per person for musculo-skeletal system medications were higher in the contemporary ex-serving population than in the Australian population, 18.2 per person and 15.7 per person, respectively.

Note: Standardised to the Australian 2001 population, see Methods for more information.

Sources: AIHW analysis of linked PMKeyS–PBS/RPBS data 2017–18 (Contemporary ex-serving population); AIHW analysis of Department of Health PBS and RPBS data, 2017–18 (Australian population).

Overall 28% of contemporary DVA cardholders were dispensed at least one musculo-skeletal medication, 21% of concession cardholders and 10% of general beneficiaries. The most common medications in this category were non-steroidal anti-inflammatory drugs NSAIDs (ATC third level M01A), which were dispensed at least once to 24% of contemporary DVA cardholders, 17% of contemporary concession cardholders and 9% of contemporary general beneficiaries. After adjusting for age and sex, the proportion of the population dispensed NSAIDs was 15% for contemporary ex-serving ADF members and 12% for the Australian population.

Most frequently dispensed medication classes

The top ten most frequently dispensed medication classes to all contemporary ex-serving ADF members at ATC third level are presented in Table 3.

Table 3: Top ten medication classes most frequently dispensed to contemporary ex-serving ADF members in 2017-18 at third ATC level

 

No. of medications dispensed

Avg no. per person

% of population dispensed at least 1

% of ex-serving population dispensed at least 1 (age-sex-standardised(a))

% of Aust. population dispensed at least 1 (age-sex-standardised(a))

Antidepressants (N06A)

163,195

9

16.7

19.7

14.6

Lipid modifying agents, plain (C10A)

93,313

9

9.4

10.8

12.8

Opioids (N02A)

83,614

5

16.4

17.2

15.2

Drugs for peptic ulcer and GORD (A02B)

76,654

6

11.4

15.0

14.8

Angiotensin II receptor blockers, plain (C09C)

36,999

9

4.0

4.8

6.1

Beta-lactam antibacterials, penicillin (J01C)

36,850

2

20.3

22.6

23.9

Non-steroidal anti-inflammatory drugs (NSAIDs) (M01A)

36,777

3

13.5

15.4

12.1

ACE inhibitors, plain (C09A)

36,688

8

4.1

5.0

5.3

Blood glucose lowering drugs (ex. insulin) (A10B)

35,674

10

3.2

3.3

5.3

Angiotensin II receptor blockers, combination (C09D)

27,968

10

2.7

3.2

4.2

Total dispensed 2017-18

1,072,731

16

64.4

. .

. .

(a) Standardised to 2001 Australian population.

Notes:

  1. Contemporary ex-serving member does not refer to the entire ex-serving ADF population. It includes only ex-serving ADF members with at least one day of full-time or reserve service on or after 1 January 2001, and discharged before 1 July 2017.
  2. For 81 contemporary ex-serving members with a prescription in 2017–18, there were 1,678 prescriptions with insufficient information to assign them to an ex-serving cohort.
  3. Dispensings for DVA card holders may be for either the PBS or RPBS, this is particularly relevant for DVA White card holders.
  4. Average number per person is the number of dispensings for a particular medication class, divided by the number of individuals with a dispensing for the same medication class.

Source: AIHW analysis of linked PMKeyS–PBS/RPBS data 2017–18.

References

WHOCC (World Health Organization) Collaborating Centre) 2018. ATC - Structure and principles. Oslo: WHO Collaborating Centre of Drug Statistics Methodology, Norwegian Institute of Public Health. Viewed 1 July 2019.