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Background MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. It is one of the largest and most widely used primary health care EHR databases in Australia. This study examined the validity of algorithms that use information from various fields in the MedicineInsight data to indicate whether patients have specific health conditions. This study examined the validity of MedicineInsight algorithms for five common chronic conditions: anxiety, asthma, depression, osteoporosis and type 2 diabetes. Methods Patients’ disease status according to MedicineInsight algorithms was benchmarked against the recording of diagnoses in the original EHRs. Fifty general practices contributing data to MedicineInsight met the eligibility criteria regarding patient load and location. Five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected from the MedicineInsight database. Trained staff reviewed the original EHR for as many of the selected patients as possible within the time available for data collection in each practice. Results A total of 475 patients were included in the analysis. All the evaluated MedicineInsight algorithms had excellent specificity, positive predictive value, and negative predictive value (above 0.9) when benchmarked against the recording of diagnoses in the original EHR. The asthma and osteoporosis algorithms also had excellent sensitivity, while the algorithms for anxiety, depression and type 2 diabetes yielded sensitivities of 0.85, 0.89 and 0.89 respectively. Conclusions The MedicineInsight algorithms for asthma and osteoporosis have excellent accuracy and the algorithms for anxiety, depression and type 2 diabetes have good accuracy. This study provides support for the use of these algorithms when using MedicineInsight data for primary health care quality improvement activities, research and health system policymaking and planning.

Background/Objectives: The prevalence of atopic dermatitis (AD) has increased significantly in industrialised countries in recent decades but data about the incidence or prevalence of AD in Australia are sparse. We aimed to determine the prevalence and incidence of AD among patients seen in Australian general practice and the use of specified medicines. Methods: This was a cross-sectional study of 2.1 million patients attending 494 general practices in the MedicineInsight program from 1 January 2017 to 31 December 2018. We assessed the prevalence (lifetime and current), incidence, management and severity of AD. Results: The lifetime (ever diagnosed) prevalence of AD in this general practice population was 16.4% and was greater in females (17.3%) than males (15.3%). One in five patients with AD were classified as having moderate-to-severe disease. Prevalence over the last two years was 6.3%. The incidence of AD in 2018 was 2.0% and was greater in females (2.2%) and for patients aged 0-4 years (3.9%). Patients with AD had an increased risk of insomnia, anxiety and depression, compared to those with no recorded AD. For AD patients, topical corticosteroids were the most commonly prescribed AD medication (36.5%) and topical calcineurin inhibitors the least (0.1%), with systemic corticosteroids (15.6%) more commonly prescribed than other immunosuppressants (0.9%). Conclusions: Our findings provide important insights into the epidemiology of AD and its management in Australian general practice. This information is likely to be useful in planning effective interventions to support GPs in the optimal management of patients with AD.

BackgroundIn 2013 pregabalin was subsidised by Australia’s Pharmaceutical Benefits Scheme (PBS) for neuropathic pain. Since the subsidy, pregabalin prescribing has been increasing in Australia and so has related harm. There are concerns it is being prescribed for indications other than neuropathic pain, which have little evidence of efficacy.AimTo describe pregabalin prescribing in Australian general practice.Design & settingA cross-sectional study of patients attending 445 general practice sites in the national MedicineInsight database from March 2012–February 2018.MethodThe following aspects were calculated: the proportion of prescriptions that were for pregabalin per year; the prevalence of pain conditions in patients prescribed pregabalin; and same-day prescribing of pregabalin with opioids or benzodiazepines.ResultsPrescribing increased from 13 per 10 000 to 104 per 10 000 prescriptions between 2012–2013 and 2017–2018. A total of 1 891 623 patients were identified of whom 114 123 (6.0%) were prescribed pregabalin; 49.7% (n = 56 772) had a recorded diagnosis of neuropathic pain. Among people prescribed pregabalin without a recorded diagnosis of neuropathic pain, 43.5% (n = 24 927) had a diagnosis of back problems, 8.8% (n = 5073) chronic pain, and 26.4% (n = 30 146) had no pain diagnosis. Pregabalin was prescribed the same day as an opioid to 38.1% of patients (95% confidence interval [CI] = 37.1% to 39.1%) and a benzodiazepine to 13.1% of patients (95% CI = 12.5% to 13.7%). Patients with a diagnosis of chronic pain had the highest rate of same-day prescribing of pregabalin with an opioid (70.4%, 95% CI = 68.9% to 71.9%) or a benzodiazepine (25.8%, 95% CI = 24.2% to 27.4%)ConclusionSubstantial increases in pregabalin prescribing were identified in Australian general practice, but only half of patients had a neuropathic pain diagnosis recorded, the only approved indication for subsidy. High rates of same-day prescribing with opioids and benzodiazepines may put patients at increased risk of harm.

The burden of inflammatory bowel disease (IBD) in Australia is increasing but national data about the current prevalence are limited. We aimed to estimate the prevalence of IBD (including Crohn’s disease, ulcerative colitis and unspecified IBD) as well as Crohn’s disease and ulcerative colitis separately in a general practice population in Australia. We also assessed risk factors associated with Crohn’s disease and ulcerative colitis. We conducted a cross-sectional study using data from MedicineInsight, a national database of general practice electronic health records, from 1 July 2017 to 30 June 2019. The prevalence of IBD was calculated and stratified by sociodemographic characteristics. Logistic regression analysis was conducted to assess risk factors associated with Crohn’s disease and ulcerative colitis. The study comprised 2,428,461 regular patients from 481 practices. The estimated crude prevalence of IBD was 653 per 100,000 patients; Crohn’s disease was 306 per 100,000 and ulcerative colitis was 334 per 100,000. Males were independently associated with a lower risk of Crohn’s disease (OR: 0.86; 95% CI: 0.81, 0.90) but a greater risk of ulcerative colitis (OR: 1.12; 95% CI: 1.06, 1.17) than females. Compared to non-smokers, patients who were current smokers were associated with a greater risk of Crohn’s disease (OR: 1.13; 95% CI: 1.04, 1.23) but a lower risk of ulcerative colitis (OR: 0.52; 95% CI: 0.47, 0.57). Other factors positively associated with both Crohn’s disease and ulcerative colitis were age (≥ 25 years), non-Indigenous status and socioeconomic advantage. Our findings provide a current estimate of the prevalence of IBD, Crohn’s disease and ulcerative colitis in a large national general practice population in Australia and an assessment of the factors associated with Crohn’s disease and ulcerative colitis. These data can assist in estimating the health burden and costs, and planning for health services.

IVIG preparations have a similar therapeutic spectrum of antibodies when prepared from plasma sourced either from the UK or the US.

Little is known about private-market opioid prescribing and how Australian opioid policies impact prescribing across public and private markets in Australia. We aimed to investigate publicly subsidised and privatemarket opioid prescribing from 2013 to 2018. We used prescribing records from MedicineInsight, an Australian primary care database, to examine trends in prescriptions for non-injectable opioid formulations from October 2013 to September 2018. We examined annual opioid prescribing trends overall, by opioid agent, and by market (public and private). We further examined patterns of fentanyl patch prescribing focusing on co-prescribed medicines and use in opioid-naïve patients. Opioids accounted for 8% of all prescriptions over the study period and 468 893 patients were prescribed at least one opioid of interest. Prescribing rates for oxycodone/naloxone and tapentadol increased, whereas those for fentanyl patches, morphine and single-agent oxycodone decreased over the study period. Private-market prescribing rates of codeine (schedule 4) increased notably following its up-scheduling to prescription-only status. Among patients prescribed fentanyl patches, 29% were potentially opioid-naïve and 49% were prescribed another opioid on the same day. The private-medicines market is a small but growing component of opioid use in Australia and one way in which prescribers and patients can avoid access restrictions in the public market for these medicines. Although fentanyl patch prescribing declined, there is room for improvement in prescribing fentanyl patches among opioid-naïve patients, and co-prescribing of fentanyl patches with other sedatives.