OECD health care quality and outcomes indicators, Australia 2022–23

This section presents data for the prescribing in primary care indicators supplied by Australia to the HCQO collection. It compares these data with the HCQO results for other OECD countries, and comments on the comparability of the data provided to the OECD specification (OECD 2021).

Medicines can contribute to quality of life by curing or relieving the symptoms of illness. They can also prevent complications in existing health conditions or delay the onset of disease. However, the overuse, underuse, or misuse of prescription medicines may lead to health hazards and wasteful expenditure (OECD 2021).

The OECD published all prescribing in primary care indicators in OECD.Stat and a selection of these indicators in Health at a glance 2023. Australia submitted data for all 11 prescribing in primary care indicators:

• People with diabetes with at least one prescription of cholesterol lowering medication
• People with diabetes with prescription of first choice antihypertensive medication
• Older adults with prescription of long-term benzodiazepines or related drugs
• Older adults with prescription of long-acting benzodiazepines or related drugs
• Proportion of older adults prescribed antipsychotics
• Patients with long-term prescription of any anticoagulating drug in combination with an oral nonsteroidal anti-inflammatory drug (NSAID)
• Total volume of antibiotics for systemic use
• Volume of second line antibiotics as a share of total volume
• Polypharmacy among people aged 75 and over
• Overall volume of opioids prescribed
• Proportion of the population who are chronic opioid users.

See Prescribing indicator definitions.

Overall data comparability and methods

The most recent data supplied by Australia for the prescribing in primary care indicators were for 2022. Data from other OECD countries published on OECD.Stat for 2022 are used for comparison and calculation of OECD averages in this section. These data were extracted from the OECD.Stat database in January 2024, and may not reflect subsequent updates made to the database.

The OECD requested primary care prescribing data, disaggregated by age and sex. These indicator rates were not age-sex standardised by the OECD. The indicators are presented on the same basis here.

A number of the primary care prescribing indicators specify the denominators to be calculated based on selected cohorts ‘in the prescribing database’. For Australia, this was calculated as a count of people who were dispensed medicines covered under PBS arrangements in the relevant year.

Health at a glance 2023 advised interpreting the data with caution ‘as variations may reflect differences in disease burden and clinical practice. Moreover, the same medicine can be used to treat multiple diseases, which may result in overreporting of consumption levels’ (OECD 2023).

Defined daily dose (DDD) is the assumed average dose per day for a drug when used for its main indication in adults (OECD 2021:156). DDDs do not necessarily reflect the true average daily dose used in a given country.

People with diabetes

Diabetes is a chronic condition marked by high levels of glucose in the blood. It is caused either by the inability to produce insulin (a hormone made by the pancreas to control blood glucose levels) or by the body not being able to use insulin effectively, or both.

Diabetes may result in a range of health complications, including heart disease, kidney disease, blindness, and lower limb amputation. It is frequently associated with other chronic health conditions, such as cardiovascular disease and chronic kidney disease.

In Australia, the percentage of people with diabetes dispensed at least one prescription of cholesterol lowering medication was 80%, higher than the OECD average of 64.5% of people with diabetes. Among the OECD countries that reported 2022 data for this indicator patients, Australia had the highest proportion.

In Australia, the percentage of people with diabetes dispensed at least one prescription of cholesterol lowering medication has stayed relatively stable since 2013. The percentage was higher for males (82%) than females (78%) in 2022.

Interactive PR1.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR1.2 presents Australia’s 10-year trend for this indicator.

For people with diabetes and hypertension concurrently, angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) are recommended in most national guidelines as first-line medications for reducing blood pressure (OECD 2021).

In Australia, the percentage of diabetic patients that were dispensed at least one prescription for a first-line antihypertensive medication was 88%, slightly lower than the OECD average of 89.5% of people with diabetes. Among the OECD countries that reported 2022 data for this indicator patients, Australia had the third highest proportion, behind Finland (118% of diabetic patients) and Slovenia (89.5% of diabetic patients).

In Australia, the percentage of diabetic patients that were dispensed at least one prescription for a for a first-line antihypertensive medication has stayed relatively stable since 2013 with the highest being 91% in 2013. In 2022, this percentage was higher for males (89%) than females (86%).

Interactive PR2.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR2.2 presents Australia’s 10-year trend for this indicator.

Figures PR1.1 and PR1.2

Figures PR2.1 and PR2.2

Refer to the Data tables for more information.

Benzodiazepine use among older adults

Benzodiazepine is a type of sedative, a group of drugs that cause calming and sedative effects due to their depressive activity on the central nervous system. It is commonly prescribed for older adults with anxiety and sleep problems. However, long-term use of benzodiazepines can lead to adverse events such as falls, road accidents and overdose, tolerance, dependence, and dose escalation (OECD 2017).

Long-acting benzodiazepines are not recommended for older adults as they take longer for the body to eliminate (OECD 2017). For this indicator, ‘older adults’ are defined as people aged 65 years and over and chronic benzodiazepine use is defined as ≥365 DDDs in one year.

In Australia, the rate of older patients with a prescribing pattern indicating long-term use of benzodiazepines or related drugs was 1.9 per 1,000 older adults, lower than the OECD average of 21 per 1,000 older adults. Australia had the lowest rate among the OECD countries that reported data for this indicator.

In Australia, the rate has decreased from 6.0 per 1,000 older adults in 2013. The rate was higher for females than males (2.1 and 1.6 per 1,000 older adults, respectively), although the gap between males and females has narrowed over the past decade.

Interactive PR3.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR3.2 presents Australia’s 10-year trend for this indicator.

In Australia, the rate of older adults who received a prescription for long-acting benzodiazepines or related drugs was 44 per 1,000 older adults, slightly lower than the OECD average of 45 per 1,000 older adults. Among the OECD countries that reported data for this indicator, Finland had the lowest rate with 5.1 per 1,000 older adults.

In Australia, the rate has decreased from 61 per 1,000 older adults in 2013. The rate was higher for females than males (52 and 34 per 1,000 older adults, respectively).

Interactive PR4.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR4.2 presents Australia’s 10-year trend for this indicator.

Figures PR3.1 and PR3.2

Figures PR4.1 and PR4.2

Antipsychotic use among older adults

People with dementia may experience changed behaviours, such as aggression, agitation, and delusions, commonly known as behavioural and psychological symptoms of dementia. To manage these symptoms, non-pharmacological interventions are recommended, but medical professionals may prescribe antipsychotics to people with behavioural and psychological symptoms of dementia as a last resort.

Inappropriate prescribing of antipsychotic medicines may be a problem among older people living in residential aged care and was a key issue raised in the Royal Commission into Aged Care Quality and Safety (Royal Commission 2021). For this indicator, ‘older people’ are defined as people aged 65 years and over.

In Australia, the rate of older adults prescribed antipsychotics in 2022 was 32 per 100,000 older adults, lower than the OECD average of 58 per 100,000 older adults. Australia had the lowest rate among the countries that reported data for this indicator.

In Australia, the rate has decreased from 39 per 100,000 older adults in 2013. Females were more likely to be prescribed antipsychotics than males (33 and 30 per 100,000 older adults, respectively).

Interactive PR5.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR5.2 presents Australia’s 10-year trend for this indicator.

Figures PR5.1 and PR5.2

Polypharmacy among people aged 75 years and over

Polypharmacy is the use of multiple medications concurrently. The OECD indicator measures the proportion of people aged 75 years and over who are taking more than five medications concurrently. Although polypharmacy is often necessary for people with many chronic health conditions, it increases the risk of medicines-related harm because of the greater chance of drug interaction and making mistakes with medicines (ACSQHC 2021).

In Australia, the proportion of older adults who were dispensed more than 5 medications concurrently was 40%, higher than the OECD average of 32%. Among the countries that reported data for this indicator Türkiye had the lowest rate with 5.4% of people aged 75 and over.

In Australia, the trend has remained relatively stable since 2016. The gap between males and females has narrowed over the past decade, with the two groups having the same proportions (41%) in 2022.

Interactive PR6.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR6.2 presents Australia’s 10-year trend for this indicator.

Figures PR6.1 and PR6.2

Long-term prescription of anticoagulants in combination with an oral non-steroidal anti-inflammatory drug

Anticoagulants are medicines that prevent or reduce the risk of blood clotting, such as warfarin. NSAIDs are widely used medications for treating pain, inflammation, and fever, such as aspirin and ibuprofen. The concurrent use of anticoagulants and NSAIDs can increase the risk of major bleeding and stroke (Kent et al. 2018).

In Australia, 11 per 100 long-term users of anticoagulants had at least one prescription of NSAID dispensed in 2022, lower than the OECD average of 13 per 100 long-term users of anticoagulants. Among the countries that submitted data, Finland had the lowest rate (5.2 per 100 long-term users of anticoagulants).

In Australia, the rate has decreased from 14 per 100 long-term users of anticoagulants in 2014 but is similar to the rate seen in 2011. The rate in 2022 was similar for males and females (11 per 100 long-term users of anticoagulants).

Interactive PR7.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR7.2 presents Australia’s 10-year trend for this indicator.

Figures PR7.1 and PR7.2

Refer to the Data tables for more information.

Antibiotic use

Antibiotics are medicines that destroy or slow the growth of bacteria. They are often prescribed to treat infection sites and infected wounds. However, unnecessary prescribing of antibiotics can increase anti-microbial resistance within the population (AIHW 2018a).

In Australia, the rate of total volume of antibiotics prescribed in primary care in 2022 was 28 DDDs per 1,000 population per day, higher than the OECD average of 15 DDDs per 1,000 population per day. Among the OECD countries that reported data for this indicator, Australia had the highest rate while Austria and Estonia had the lowest rate of 8.5 DDDs per 1,000 population per day.

Australia’s rate has fluctuated over time in the past decade, ranging between 34 DDDs per 1,000 population per day in 2014 and 2015 to 26 in 2021. Females were more likely to be prescribed antibiotics than males (30 and 24 DDDs per 1,000 population per day, respectively).

Interactive PR8.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR8.2 presents Australia’s 10-year trend for this indicator.

Second-line antibiotics are antibiotics that are given when the initial prescription of antibiotics was not effective.

In Australia, the rate of volume of second-line antibiotics was 16% of the total volume of antibiotics prescribed in 2022, higher than the OECD average of 15% of the total volume of antibiotics prescribed. Among the countries that reported 2022 data for this indicator, Denmark had the lowest rate with 2.7% of the total volume of antibiotics prescribed.

In Australia, the trend has remained relatively stable since 2013, ranging between 15% to 17% since 2012. The rate was the same for males and females (16% of the total volume of antibiotics prescribed).

Interactive PR9.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR9.2 presents Australia’s 10-year trend for this indicator.

Figures PR8.1 and PR8.2

Figures PR9.1 and PR9.2

Refer to the Data tables for more information.

Opioid use

Opioids are chemical substances that have a morphine-type action in the body. They are commonly prescribed for pain relief, but can lead to dependence, breathing difficulties, and death (OECD 2019). Opioid drugs can be obtained either illicitly or via prescription. Legal or pharmaceutical opioids (including codeine and oxycodone) are responsible for significantly more deaths and poisoning hospitalisations than illicit opioids (such as heroin) (AIHW 2018b).

In Australia, the overall volume of opioids prescribed in primary care for people aged 18 and over was 21.5 DDDs per 1,000 population per day in 2022, higher than the OECD average of 15 DDDs per 1,000 population per day. Among the countries that reported data for this indicator, Türkiye had the lowest rate with 0.2 DDDs per 1,000 population per day.

In Australia, the overall volume of opioids prescribed in primary care for people aged 18 and over has decreased from 31 DDDs per 1,000 population per day in 2013. The rate was similar for males and females (21% and 22%, respectively).

Interactive PR10.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR10.2 presents Australia’s 10-year trend for this indicator.

In Australia, the proportion of people aged 18 and over who were chronic opioid users was 4.8% in 2022, same as the OECD average of 4.8%. Among the countries that reported data for chronic opioid users aged 18 years and over, Slovenia had the lowest rate with 2.3 DDD per 1,000 people/day.

In Australia the rate has remained relatively stable since 2013. The rate was similar for males and females (4.5 and 5.1 DDDs per 1,000 population per day, respectively).

Interactive PR11.1 below compares OECD countries that submitted data for 2022 for this indicator, while PR11.2 presents Australia’s 10-year trend for this indicator.

Figures PR10.1 and PR10.2

Figures PR11.1 and PR11.2

Refer to the Data tables for more information.