Antipsychotic medicines dispensing, 65 years and over, from 2016–17 to 2020–21

This report examines antipsychotic medicines dispensing in people 65 years and over in the community across Australia from 2016–17 to 2020–21. It reports trends at national, state and territory, Primary Health Network and local area levels, building on data in the Third Australian Atlas of Healthcare Variation.

Why is this important?

Antipsychotic medicines are used to manage serious mental health conditions such as schizophrenia. Some antipsychotic medicines are also used to manage changed behaviours in people with dementia, known as the behavioural and psychological symptoms of dementia (BPSD). However, for most people with BPSD, the risk of harm from these medicines outweighs the potential benefit.

What we found

There was an 11% reduction in the rate of antipsychotic medicines dispensed in people aged 65 years and over nationally between 2016–17 and 2020–­21, continuing the trend for the period 2013–14 to 2016–17 seen in the Third Australian Atlas of Healthcare Variation (the Third Atlas). There was a 5% decrease in the overall volume of antipsychotic medicines dispensed to older people. Dispensing rates were generally higher in major cities than in regional areas and rates increased with socioeconomic disadvantage for each of the five years. There was a 22% reduction in the magnitude of variation: in 2020–­21, the number of prescriptions dispensed was 12.3 times higher in the area with the highest rate compared to the area with the lowest rate. In 2016–17, the magnitude of variation was 15.7.

What has changed in the past five years?

A wide range of initiatives and reforms, including prescribing restrictions, education, quality improvement programs and legislative changes, are likely to have contributed to the reduction in antipsychotic medicines dispensing.

What more can be done?

Initiatives that could further reduce the inappropriate prescribing of antipsychotic medicines include public reporting of antipsychotic medicines use in residential aged care, more work to upskill the aged care workforce in the appropriate management of BPSD, increasing the aged care workforce, and medication monitoring and review.

Interactive graphs and data

Data show variation in rates by geographic location of patient residence. To use the interactive maps and graphs:

  • Hover or click on maps and graphs for details of data points
  • Use the dropdown boxes at the bottom of graphs to select states and territories, SA3s or PHNs

Learn more about using the interactive Atlas

National, state and territory and local trends

National overview

State and territory rates across the years

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Consistently high or low local areas

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National overview

State and territory rates across the years

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Consistently high or low local areas

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Remoteness and socioeconomic status

Rates for 2020-21

Rates across the years

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Rates for 2020-21

Rates across the years

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Primary Health Network trends

PHN overview

PHN table

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Consistently high or low local areas by PHN

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PHN overview

PHN table

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Consistently high or low local areas by PHN

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Prescriber, patient and volume trends

Prescriber by state

Prescriber across the years

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Patient rate

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Volume (defined daily dose)

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Prescriber by state

Prescriber across the years

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Patient rate

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Volume (defined daily dose)

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Technical resources

Technical note

This technical note accompanies the report: Antipsychotic medicines dispensing 65 years and over, 2016-17 to 2020-21 and builds on reporting in the Third Australian Atlas of Healthcare Variation. Information regarding data from 2013–14 to 2016–17 is available in the Technical Supplement for the Third Atlas.

This time series report provides statistics identifying variation across Australia for antipsychotic medicines dispensing 65 years and over, 2016–17 to 2020–21. Rates are presented by local areas using Statistical Area Level 3 (SA3) geography defined by the Australian Bureau of Statistics (ABS), as well as Primary Health Network (PHN) areas defined by the Australian Government Department of Health and Aged Care, at state and territory, and national levels.

About the data

Data are sourced from the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) database. The PBS and RPBS are the two main Australian Government subsidy schemes for medicines managed by the Department of Health and Aged Care and the Department of Veterans’ Affairs respectively. Both programs are administered by Services Australia.

The scheme is available to all Australian residents who hold a current Medicare card and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. Data are from claim records of prescriptions dispensed under the PBS or RPBS where either:

  • The Australian Government paid a subsidy, or
  • The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.

The PBS/RPBS data cover all prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies, and dispensing doctors. 

Data exclusions:

The PBS /RPBS do not include:

  • Over-the-counter purchases (non-prescription)
  • Private prescriptions
  • Medicines supplied to admitted patients in public hospitals (although discharge prescriptions dispensed in all states and territories except New South Wales and the Australian Capital Territory are included).

Patient characteristics (date of birth and sex) were sourced from the patient's Medicare enrolment details at date of supply as recorded in the PBS claim (extracted on 12 October 2021). Details were taken from the latest available claim record for each patient and applied for all that patient's records to ensure that each patient had unique characteristics for the whole period of analysis. Geographic analysis was based on the patient’s Medicare enrolment postcode at date of supply as recorded in the PBS claim, not the place of the prescriber or dispensing pharmacy. If the postcode could not be mapped to a SA3 using the concordance file, the postcode was replaced with the postcode of the dispensing pharmacy.

In previous versions of the Atlas of Healthcare Variation, postcode 7001 Hobart PO Boxes has been mapped by the ABS to the SA3 of either Hobart Inner or Central Highlands. Consistent with the treatment of other capital city PO Boxes, postcode 7001 has now been excluded from the SA3 and PHN level analysis. This will result in a decrease in script volume for either Hobart Inner or Central Highlands from numbers reported in earlier versions.

Defined daily dose

Number of defined daily doses (DDD) was calculated using the defined daily dose amounts 2021 sourced from the Department of Health. DDD is the average maintenance dose per day for a medicine used for its main indication in adults, defined by the WHO. DDDs are assigned to medicines by the WHO Collaborating Centre for Drug Statistics Methodology. Using DDDs allows comparisons of medicine dispensing independent of price, preparation and quantity per prescription. Medicine dispensing expressed in DDDs per thousand people per day (DDDs/1,000/day) allows data for medicines with differing daily doses to be aggregated. However, the DDD is only a unit of measurement and does not necessarily reflect the recommended or average prescribed dose. DDDs are not established for all medicines. More information on DDD is available at https://www.who.int/tools/atc-ddd-toolkit

Technical note

This technical note accompanies the report: Antipsychotic medicines dispensing 65 years and over, 2016-17 to 2020-21 and builds on reporting in the Third Australian Atlas of Healthcare Variation. Information regarding data from 2013–14 to 2016–17 is available in the Technical Supplement for the Third Atlas.

This time series report provides statistics identifying variation across Australia for antipsychotic medicines dispensing 65 years and over, 2016–17 to 2020–21. Rates are presented by local areas using Statistical Area Level 3 (SA3) geography defined by the Australian Bureau of Statistics (ABS), as well as Primary Health Network (PHN) areas defined by the Australian Government Department of Health and Aged Care, at state and territory, and national levels.

About the data

Data are sourced from the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) database. The PBS and RPBS are the two main Australian Government subsidy schemes for medicines managed by the Department of Health and Aged Care and the Department of Veterans’ Affairs respectively. Both programs are administered by Services Australia.

The scheme is available to all Australian residents who hold a current Medicare card and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. Data are from claim records of prescriptions dispensed under the PBS or RPBS where either:

  • The Australian Government paid a subsidy, or
  • The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.

The PBS/RPBS data cover all prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies, and dispensing doctors. 

Data exclusions:

The PBS /RPBS do not include:

  • Over-the-counter purchases (non-prescription)
  • Private prescriptions
  • Medicines supplied to admitted patients in public hospitals (although discharge prescriptions dispensed in all states and territories except New South Wales and the Australian Capital Territory are included).

Patient characteristics (date of birth and sex) were sourced from the patient's Medicare enrolment details at date of supply as recorded in the PBS claim (extracted on 12 October 2021). Details were taken from the latest available claim record for each patient and applied for all that patient's records to ensure that each patient had unique characteristics for the whole period of analysis. Geographic analysis was based on the patient’s Medicare enrolment postcode at date of supply as recorded in the PBS claim, not the place of the prescriber or dispensing pharmacy. If the postcode could not be mapped to a SA3 using the concordance file, the postcode was replaced with the postcode of the dispensing pharmacy.

In previous versions of the Atlas of Healthcare Variation, postcode 7001 Hobart PO Boxes has been mapped by the ABS to the SA3 of either Hobart Inner or Central Highlands. Consistent with the treatment of other capital city PO Boxes, postcode 7001 has now been excluded from the SA3 and PHN level analysis. This will result in a decrease in script volume for either Hobart Inner or Central Highlands from numbers reported in earlier versions.

Defined daily dose

Number of defined daily doses (DDD) was calculated using the defined daily dose amounts 2021 sourced from the Department of Health. DDD is the average maintenance dose per day for a medicine used for its main indication in adults, defined by the WHO. DDDs are assigned to medicines by the WHO Collaborating Centre for Drug Statistics Methodology. Using DDDs allows comparisons of medicine dispensing independent of price, preparation and quantity per prescription. Medicine dispensing expressed in DDDs per thousand people per day (DDDs/1,000/day) allows data for medicines with differing daily doses to be aggregated. However, the DDD is only a unit of measurement and does not necessarily reflect the recommended or average prescribed dose. DDDs are not established for all medicines. More information on DDD is available at https://www.who.int/tools/atc-ddd-toolkit