Primary care

Objective To examine changes in rates of primary care patients seeing multiple prescribers and characteristics of patients who ceased seeing multiple prescribers for monitored medicines after voluntary implementation of the Victorian prescription drug monitoring program (PDMP). Study Design Controlled interrupted time series analysis of primary care electronic medical records. Setting A total of 562 general practices across three Victorian healthcare networks (Monash Health, Peninsula Health, Eastern Health). Patients People prescribed at least one PDMP-monitored medicine (e.g., opioids, benzodiazepines) and/or non-monitored psychotropic medicines (e.g., antidepressants, antipsychotics) between 1 January 2017 and 30 June 2023. Intervention Voluntary (1 April 2019) and mandatory (1 April 2020) implementation of the Victorian PDMP. Main Outcome Measures Changes in the monthly rate of people seeing multiple prescribers (defined as four or more prescribers) following PDMP implementation for monitored medicines, with non-monitored medicines used as a control; characteristics of people who ceased seeing multiple prescribers for monitored medicines following PDMP implementation. Results Following voluntary PDMP implementation (1 April 2019), there was a significant reduction in the differential step and trend changes in the rates of seeing multiple prescribers between people prescribed monitored and non-monitored medicines (differential step change: β, −3.55 [95% confidence interval (CI), −5.08 to −2.03]; differential trend change: β, −0.29 [95% CI, −0.46 to −0.12]). Following mandatory PDMP implementation (1 April 2020), there was no significant step change difference. However, there was an increase in the differential trend change in the rate of seeing multiple prescribers between those prescribed monitored and non-monitored medicines (differential trend change: β, 0.21 [95% CI, 0.05–0.37]; p=0.009). Logistic regression revealed that older age (95% CI, 1.39–1.75), male gender (95% CI, 1.09–1.25), metropolitan residence (95% CI, 1.04 and 1.23) and substance use disorder diagnosis (95% CI, 1.07–1.28) were associated with significantly higher odds of seeing multiple prescribers before PDMP implementation. Conclusions Implementation of the PDMP was associated with meaningful reductions in people accessing monitored medicines from four or more prescribers.

Louisa Picco, Monica Jung, Grant Russell, Samanta Lalic, Mahbod A. Fini, Dan I. Lubman, Rachelle Buchbinder, Ting Xia, Suzanne Nielsen

Objectives To examine two decades of Australian expenditure trends across components of primary health and to assess whether recent expenditure changes have been equitably distributed. Study Type Descriptive modelling using standardised framework for classifying primary care expenditure. Setting Australian public and private health expenditure data (2002–03 to 2022–23) were disaggregated into: broad primary health care services (Tier A); direct primary care, predominantly funding general practice (Tier B); and funding for enhanced primary care for people with greater needs (Tier C). Distributional analysis was conducted across geographies. Participants No individual participants; analysis used aggregated health expenditure data across 327 Statistical Area Level 3 geographies. Main Outcome Measures Proportions of total and public expenditure allocated to each tier; equity in public Tier B and Tier C spending across areas, assessed using standardised slope indices. Results The share of total health spending allocated to primary care declined over the period. Tier A spending declined from 36.3% to 33.0% of total health spending; Tier B fell more sharply from 8.0% to 5.5%; and Tier C remained flat at 0.7%. Public spending trends were similar, but declines were more muted, with Tier C unchanged at 1.0%. Public spending on Tier B was 13% higher in the most disadvantaged areas than in the most advantaged areas in 2013–14; by 2023–24, this declined to 7%. Public Tier C spending remained progressive at 35% higher in the most disadvantaged areas, but decreased from 51% over the decade. Exploratory multivariate analyses suggested that Tier C spending was more redistributive than Tier B after accounting for need. Conclusions Data indicate that primary care has declined as a funding priority in relative terms in Australia, and investment in high-value care has remained stagnant and appears increasingly less redistributive. These patterns may have implications for health equity.

Rafal Chomik, Shona M. Bates, Michael Wright

Gin S. Malhi, Erica Bell, Kinga Szymaniak, Philip M. Boyce, Jeffrey C. L. Looi

Katharine A. Wallis, Joanna Moncrieff