Medicines Intelligence (MedIntel) Data Platform

Summary

The Medicines Intelligence (MedIntel) Data Platform is a new linked data resource established to generate evidence on prescribed medicine use, safety, costs, and cost-effectiveness in Australia. It adheres to best practice privacy principles, with no identifying information available to researchers. The platform comprises Medicare-eligible people who are ≥18 years and residing in New South Wales (NSW), Australia, any time during 2005-2020, with linked data on dispensed prescription medicines, Medicare services, emergency department visits, hospitalisations, cancer notifications, and deaths. In total, the platform includes 7.4 million unique people across all years, covering 36.9% of the Australian adult population. As of 1 January 2019 (the last pre-pandemic year), the cohort had a mean age of 48.7 years (51.1% female), with most people (4.4M, 74.7%) residing in a major city. In 2019, 4.4M people (73.3%) were dispensed a medicine (most commonly anti-infective, nervous system, and cardiovascular medicines), 1.2M (20.5%) were hospitalised, 5.3M (89.4%) had a GP or specialist appointment, and 54 003 people died. Data are available until 2022 with approval for annual updates. This platform creates opportunities for national and international research collaborations and enables us to address important questions about quality use of medicines and health outcomes.

Zoega, H., Falster, M., Gillies, M., Litchfield, M., Camacho, X., Bruno, C., Daniels, B., Donnolley, N., Havard, A., Schaffer, A., Chambers, G., Degenhardt, L., Dobbins, T., Gisev, N., Ivers, R., Jorm, L., Liu, B., Vajdic, C. and Pearson, S.-A. (2024), The Medicines Intelligence Data Platform: A Population-Based Data Resource From New South Wales, Australia. Pharmacoepidemiol Drug Saf, 33: e5887. https://doi.org/10.1002/pds.5887

Summary

In our study, we looked at the use of new medicines for Type 2 diabetes: SGLT2 inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP-1RAs) in New South Wales. These medicines, taken with traditional diabetes medicines significantly improve blood sugar levels, and reduce the risk of heart and kidney disease. We found only half of patients who were using traditional diabetes medicines also used SGLT2is, and approximately 15% used GLP-1RAs. Importantly, patterns of use varied depending on where people lived. SGLT2is were less commonly used in regions where people have lower incomes and poorer health. One area in north-east NSW showed higher GLP-1RA use than other regions. To increase the use of these highly effective medicines, we recommend lowering costs to patients, changing restrictions on who is eligible to access them, and educating care providers about their benefits for patients. Monitoring medicine use by where people live allows us to focus interventions in specific locations to maximise use in people who will benefit the most. For researchers, our findings highlight the importance of considering local prescribing patterns when exploring medicine use across geographies (e.g. urban and regional area) - as these can overshadow any broader trends observed.

de Oliveira Costa, J., Lin, J., Milder, T. Y., Greenfield, J. R., Day, R. O., Stocker, S. L., Neuen, B. L., Havard, A., Pearson, S. A., & Falster, M. O. (2024). Geographic variation in sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist use in people with type 2 diabetes in New South Wales, Australia. Diabetes Obes Metab. https://doi.org/10.1111/dom.15597 

Summary

Prescription medicines for strong pain relief known as opioids, such as oxycodone, morphine, or tramadol, are an important tool for reducing moderate to severe pain in the short-term and are often prescribed when patients have been discharged from a hospital or Emergency Department visit. However, they also have significant side effects, particularly when used for a long time. Until recently, Australia’s use of prescription opioids was increasing, and with it worries about dependence, overdose and death. Because of this, we were interested in looking at how often people continue using these medicines in NSW long-term (more than 90 days) after leaving hospital.

Our study was the first whole-of-population Australian study to estimate long-term opioid use following Emergency Department presentations and hospital admissions. The study used non-identifiable health data to follow all hospitalisations and Emergency Department visits in NSW between 2014-2020. We found that during this period, the overall number of people starting opioids for the first time decreased by 16%, from 8.7% to 7.2% of hospital/Emergency Department visits. Long-term opioid use decreased by 33%, from 1.3% to 0.8%.

Other important findings were about the use of these painkillers after visiting a hospital for different reasons. For example, the study found that one in four people admitted for traumatic injuries, like a physical injury or road accident, started an opioid and 2.3% of them went on to long-term use. This rate of long-term use is somewhat lower than reported in previous Australian research. We also found one in 15 people attending an ED started an opioid and only 1.0% of them went on to long-term use - lower than estimates from the US. 

Insights from such large studies like ours inform opioid prescribing policies in hospitals and promote quality prescribing practices. 

Gillies MB, Chidwick K, Bharat C, Camacho X, Currow D, Gisev N, Degenhardt L, Pearson, S-A. Long-term prescribed opioid use after hospitalization or emergency department presentation among opioid naïve adults (2014–2020)—A population-based descriptive cohort study. Br J Clin Pharmacol. 2024; 1-13. doi: https://doi.org/10.1111/bcp.16093

Summary

SGLT2 inhibitors are medications used to treat type 2 diabetes by lowering blood sugar levels. They are also very beneficial for treating heart failure. When people are admitted to the hospital, SGLT2 inhibitors are often stopped (e.g., due to a rare risk of acid buildup in the blood). However, most people should restart these medications once they leave the hospital and are eating and drinking reasonably.

Our research focused on people taking SGLT2 inhibitors for type 2 diabetes who were hospitalised for heart failure. We found that nearly 3 out of 10 people stopped these medications in the three months following hospitalisation, and most did not restart within the year. This gap in care between hospital and community settings is concerning because these medications help reduce the risk of further complications and readmission.

We discovered that those most likely to stop using these important medications were older adults, people with more previous hospital admissions, and those with chronic kidney disease. This is worrying because these patients often have more complex medical needs and are likely to benefit the most from these medications. While we do not know the exact reasons why people stopped taking their SGLT2 inhibitors after leaving the hospital, our findings highlight the need to prevent accidental stopping of these medicines, especially after a hospital admission for heart failure, where continued use is very important.

Milder T, Lin J, Pearson S, Costa J, Neuen B, Pollock C, Jun M, Greenfield J, Day RO, Stocker S, Brieger D, Falster M. Discontinuation of SGLT2i in people with type 2 diabetes following hospitalisation for heart failure: a cause for concern? Diabetes Obes Metab. 2024. https://doi.org/10.1111/dom.16061

Summary

People with an irregular heart rhythm (atrial fibrillation) often need to take anticoagulant medicines to prevent blood clots and serious outcomes such as stroke. Some of these people might also experience a heart attack and be admitted to hospital. After being discharged from hospital it is recommended they take antiplatelet medicine to prevent a subsequent blockage. However, the combination of these anticoagulant and antiplatelet medicines can increase the risk of bleeding. Little is known about how these combinations of medicines are being used in routine clinical care.

In our study we examined medicine use in people with atrial fibrillation who were hospitalised for a heart attack in NSW, and how this use aligned with best-practice recommendations. We found 1 in 4 people did not restart anticoagulant medicine after being in hospital for a heart attack. Of the people who received both anticoagulant and antiplatelet medicines, around 1 in 10 received combinations that increase bleeding risk, and almost half remained on antiplatelet medicine for longer than the recommended 12 months.

Our study showed there are potential gaps in best-practice medicine use for people with an irregular heart rhythm hospitalised after a heart attack. Our findings highlight the need for careful and coordinated medicines management across both hospital and community care – particularly in the GP setting - to ensure optimal use of these medicines.

Deakin C, Costa J, Brieger D, Lin J, Schaffer AL, Kidd M, Falster MO*, Pearson S*. Post-discharge pharmacotherapy in people with atrial fibrillation hospitalised for acute myocardial infarction: an Australian cohort study 2018-2022 European Heart Journal 2024. https://doi.org/10.1093/ehjqcco/qcae068

*Joint last authors