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Objective: To examine associations between patient factors and increasing opioid access measured by three metrics: number of unique prescribers, pharmacies, and dispensings in 12 months., Methods: We used pharmaceutical claims for a random 10% sample of Australians age 18 years or older initiating or reinitiating strong opioid treatment (≥90 days of no strong opioid dispensing) between July 2010 and December 2012. We report the distribution of opioid access by metric. We used three separate zero-truncated negative binomial regressions to explore associations. We censored individuals 365 days after index date or at death, whichever occurred first., Results: Approximately 69,088 persons initiated or reinitiated strong opioid treatment; they were predominantly female (59.7%) with a median age of 71 years (interquartile range [IQR] = 58-81). Over one year, persons visited a median of two prescribers (IQR = 1-3), visited one dispensing pharmacy (IQR = 1-2), and had four opioid dispensings (IQR = 2-10). Three percent of people were in the top decile of opioid access distribution for all three metrics (four or more prescribers, three or more dispensing pharmacies, and 20 or more dispensings). Increasing opioid access was strongly associated with male sex, history of pain treatment (3 to 12 months prior to index date), malignancy treatment, or treatment for three or more other medical conditions., Conclusions: Delineating legitimate from extramedical opioid use based on pharmaceutical claims is imprecise. We demonstrated that "high" levels of access, defined in previous research, may reflect routine care for complex patients. Pharmaceutical claims have utility in examining population norms of prescription drug use and access patterns, and flagging persons at the extreme end of access, for at least one measure, who may warrant further investigation.

Purpose: Although pharmaceutical claims are an essential data source for pharmacoepidemiological studies, these data potentially under-estimate opioid utilisation. Therefore, this study aimed to quantify the extent to which pharmaceutical claims from Australia's national medicines subsidy programs (Pharmaceutical Benefits Scheme [PBS] and Repatriation Schedule of Pharmaceutical Benefits [RPBS]) under-estimate prescription-only and total national opioid utilisation across time and for different opioids. A secondary aim was to examine the impact of the 2012 policy change to record all PBS/RPBS dispensed medicines, irrespective of government subsidy, on the degree of under-estimation., Methods: Aggregated data on Australian opioid utilisation were obtained for the 2010 to 2014 calendar years, including all single ingredient and combination opioid analgesic preparations available on prescription or over-the-counter (OTC). Total opioid utilisation (oral morphine equivalent kilogrammes) was quantified using sales data from IMS Health and compared with pharmaceutical claims data from the PBS/RPBS., Results: PBS/RPBS claims data did not account for 12.4% of prescription-only opioid utilisation in 2014 and 19.1% in 2010, and 18.4% to 25.4% of total opioid use when accounting for OTC preparations. Between 2010 and 2014, 5.6% to 5.3% of buprenorphine, 8.1% to 6.3% fentanyl, 17.7% to 10.7% oxycodone, 18.4% to 11.0% tramadol, 38.4% to 21.0% hydromorphone, and 28.6% to 21.0% of prescription-only codeine utilisation were not accounted for in PBS/RPBS claims., Conclusions: Despite increased capture of less expensive (under co-payment) opioid items since 2012, PBS/RPBS claims still under-estimate opioid use in Australia, with varying degrees across opioids. The estimates generated in this study allow us to better understand the degree of under-estimation and account for these in research using Australia's national pharmaceutical claims data., (Copyright © 2017 John Wiley & Sons, Ltd.)

Background: Routine data collections are used increasingly to examine outcomes of real-world cancer drug use. These datasets lack clinical details about important endpoints such as disease progression., Aim: To validate a proxy for disease progression in metastatic cancer patients using prescribing and dispensing claims., Methods: We used data from a cohort study of patients undergoing chemotherapy who provided informed consent to the collection of cancer-treatment data from medical records and linkage to pharmaceutical claims. We derived proxy decision rules based on changes to drug treatment in prescription histories (n = 36 patients) and validated the proxy in prescribing data (n = 62 patients). We adapted the decision rules and validated the proxy in dispensing data (n = 109). Our gold standard was disease progression ascertained in patient medical records. Individual progression episodes were the unit of analysis for sensitivity and Positive Predictive Value (PPV) calculations and specificity and Negative Predictive Value (NPV) were calculated at the patient level., Results: The sensitivity of our proxy in prescribing data was 74.3% (95% Confidence Interval (CI), 55.6-86.6%) and PPV 61.2% (95% CI, 45.0-75.3%); specificity and NPV were 87.8% (95% CI, 73.8-95.9%) and 100% (95% CI, 90.3-100%), respectively. In dispensing data, the sensitivity of our proxy was 64% (95% CI, 55.0-77.0%) and PPV 56.0% (95% CI, 43.0-69.0%); specificity and NPV were 81% (95% CI, 70.05-89.0%) and 91.0% (95% CI, 82.0-97.0%), respectively., Conclusion: Our proxy overestimated episodes of disease progression. The proxy's performance is likely to improve if the date of prescribing is used instead of date of dispensing in claims data and by incorporating medical service claims (such as imaging prior to drug changes) in the algorithm. Our proxy is not sufficiently robust for use in real world comparative effectiveness research for cancer medicines., (© 2016 John Wiley & Sons Australia, Ltd.)

Background Acute alcohol consumption is a major risk factor for suicide, therefore investigating factors associated with alcohol-related self-harm warrant attention. Aims To investigate the influence of prescribed psychotropic medications on the odds of co-ingesting alcohol preceding or during intentional efforts to self-poison. Method A cross-sectional analysis of consecutive hospital presentations following intentional self-poisoning was conducted. A total of 7270 patients (4363 women) aged 18-96 were included. Results The odds of alcohol co-ingestion were increased in those not prescribed any medication (odds ratio (OR) = 1.27, 99% CI 1.10-1.46, P <0.001) and in impulsive self-poisonings (OR = 1.39, 99% CI 1.11-1.74, P <0.001). Odds were decreased in those prescribed anticonvulsants (OR = 0.69, 99% CI 0.51-0.93), antipsychotics (OR = 0.55, 99% CI 0.45-0.66) and antidepressants (OR = 0.87, 99% CI 0.77-0.99). Conclusions Findings indicate that being medicated for a psychiatric illness may reduce the likelihood of alcohol consumption during times of acute distress, hence perhaps may reduce the risk of intentional self-poisoning., (© The Royal College of Psychiatrists 2017.)

Objective: To compare data captured by an electronic general practice prescribing package with prescribing data from the Health Insurance Commission (HIC)., Methods: Twenty GPs from the Hunter Urban Division of General Practice (HUDGP) used the electronic prescribing package. Data for June-July 1996 were analysed. Prescribing data for all GPs (n = 369) in the HUDGP were extracted from HIC files to provide the comparison., Results: Each data source had limitations, and provided different, but complementary information. HIC data allowed calculation of prescribing rates (prescriptions per 100 Medicare services), but had incomplete capture of information on some classes of drugs, and no information on the patients receiving the drugs or the indications for the use of the drugs. The HUDGP database could only provide information on choice of agent when the decision to prescribe something had been made. However, it provided the context information (patient characteristics, indication for use, other medications) that could permit some assessment of the appropriateness of therapy., Conclusions: HIC data may be useful for an overall assessment of divisional activities. However, for a full assessment of the quality of prescribing at the level of individual GPs, additional patient related information is required. This requires much wider use of electronic prescribing packages that can capture the clinical details needed to review the appropriateness of treatment decisions.