Hi Ciara,

Further to that email, I have been able to obtain further Queensland-specific data.

Please see attached advice in relation to ED presentations and hospital admissions in Qld.

Medication Services Queensland have confirmed that there are no surprises in the data.

Let me know if you have any questions.

Cheers, Mark

The ED presentation data in the word document is not exactly what was being asked for, because the EDs presentation data does not routinely or reliably drill down to the type of medication that has caused the person to present. The priority of the ED to stabilise the patient/respond to their immediate symptoms. There are limitations to accurately recording the medication involved in the ED presentation, such as, further treatment/testing (not in ED) may be required to ascertain the exact cause of the issue.

From: To: Subject: Date: Attachments:

Please note these are counts of ICD codes, not actual episodes of care, so if one episode had several drug codes recorded, they are all counted individually. For example, if someone had attempted suicide using a mixture of prescription drugs that episode of care will appear more than once in the data provided.

I do realise that is response is after the due date, but I am sure the Committee would be interested in the data.

Mark Lock BSc BPharm MBA MPS AAICD AACPA State Manager - Queensland P: 07 3186 2800 | | F: 07 3186 2820 Pharmaceutical Society of Australia Level 2, 225 Montague Road WEST END QLD 4101 P.O. Box 6120, WOOLLOONGABBA QLD 4102 RTO Provider No: 122206

www.psa.org.au

Mark Lock State Development. Natural Resources and Agricultural Industry Development Committee RE: Question on Notice - Medicines and Poisons Bill 2019 Wednesday, 26 June 2019 5:13:05 PM image002.jpg image003.jpg image004.jpg image005.jpg image007.jpg image001.jpg SSB31590 meds 24Jun19 TOP 20.xlsx 20190626 Pharmaceutical Society request medication related presentations and admissions.pdf

Hi Ciara,

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Kind regards, Mark

From: To: Cc: Subject: Date: Attachments:

I haven't been able to get detailed data related to specific medicines causing the hospital admissions. The information that I do have is as follows:

I am liaising with Queensland Health to see if we can get some further data on this that I can forward through. I hope the Committee will find the above information useful in the absence of more detailed information.

Mark Lock BSc BPharm MBA MPS AAICD AACPA State Manager - Queensland P: 07 3186 2800 | F: 07 3186 2820 Pharmaceutical Society of Australia Level 2, 225 Montague Road WEST END QLD 4101 P.O. Box 6120, WOOLLOONGABBA QLD 4102 RTO Provider No: 122206

www.psa.org.au

• For those admitted to hospital due to adverse drug reactions: 50% had a single adverse reaction 32.5% had 2 adverse reactions 15% had 3 or more adverse reactions 70% of cases the adverse reactions were due to multiple medication use 87% of cases were considered preventable

• 13% of were readmitted with a hospital admission due to an adverse reactions within 12 months following their first admission due to an adverse reaction

• People aged over 65 with medical and surgical admissions - 55% were on potentially inappropriate medications

• People with poor renal function at the time of admission: o 16% were on a contraindicated medicine o 21% were on an inappropriate dose of medicine

Mark Lock Ciara Furlong State Development. Natural Resources and Agricultural Industry Development Committee RE: Question on Notice - Medicines and Poisons Bill 2019 Tuesday, 25 June 2019 5:43:31 PM image002.ipg image003.jpg image004.jpg image005.ipg image001.ipg imaged770a8.JPG

Source: Queensland Hospital Admitted Patient Data Collection, Statistical Services Branch, Department of Health, Queensland

Prepared by: Statistical Reporting & Coordination Unit, Statistical Services Branch, Department of Health

Date: 24 June 2019

Notes: 1. Includes number of diagnosis codes recorded within the specified range ond with condition onset flag of 'Condition present on admission'

2. 'Poisoning by drugs, medicaments and biological substances' defined by ICD-IO-AM 10th Edition principal diagnosis of T36 - T509

3. Excludes episodes of care for newborns without qualified days, posthumous organ procurement and boarders.

4. Data from July 2018 are preliminary and subject to change.

5. An episode of care for an admitted patient may be a total hospital stay or

a portion of a stay that begins or ends in a change of care type.

6. An episode of care may include more than 1 diagnosis code within the specified range.

Count of diagnosis codes^ (top 20) for episodes of admitted patient care with principal or other diagnosis of

Poisoning by drugs, medicaments and biological substances^ Queensland Hospitals, 2017/2018 and 2018/2019 (July to December)

DBNo: 31590

Table 1: Top 20 ICD-IO-AM 10th Edition diagnosis codes by number of recorded codes, for 'Poisoning by drugs, medicaments and biological substances'.

Queensland hospitals, 2017/2018

2017/2018ICD-IO-AM 10th Edition code Description T424 Benzodiazepines 2,901 T391 4-Aminophenol derivatives 2,803 T432 Other and unspecified antidepressants 1,895 T402 Other opioids 1,803 T435 Other and unspecified antipsychotics and neuroleptics 1,446 T393 Other nonsteroidal anti-inflammatory drugs [NSAID] 916 T427 Antiepileptic and sedative-hypnotic drugs, unspecified 533 T383 Insulin and oral hypoglycaemic [antidiabetic] drugs 475 T426 Other antiepileptic and sedative-hypnotic drugs 468 T433 Phenothiazine antipsychotics and neuroleptics 463 T450 Antiallergic and antiemetic drugs 418 T430 Tricyclic and tetracyclic antidepressants 392 T404 Other synthetic narcotics 382 T509 Other and unspecified drugs, medicaments and biological substances 318 T4369 Other psychostimulants with potential for use disorder 276 T447 Beta-adrenoreceptor antagonists, not elsewhere classified 275 T407 Cannabis (derivatives) 249 T4361 Psychostimulants with potential for use disorder, methylamphetamine 236 T465 Other antihypertensive drugs, not elsewhere classified 232 T406 Other and unspecified narcotics 183 Top 20 total 16,664 Other codes(n=103) 3,040 Total 19,704

Table 2: Top 20 ICD-IO-AM 10th Edition diagnosis codes by number of recorded codes, for 'Poisoning by drugs, medicaments and biological substances',

Queensland hospitals, July - December 2018

ICD-IO-AM 10th Edition code Description July - December 2018**’

T391 4-Aminophenol derivatives 1,417 T424 Benzodiazepines 1,391 T432 Other and unspecified antidepressants 979 T435 Other and unspecified antipsychotics and neuroleptics 808 T402 Other opioids 715 T393 Other nonsteroidal anti-inflammatory drugs [NSAID] 496 T427 Antiepileptic and sedative-hypnotic drugs, unspecified 315 T430 Tricyclic and tetracyclic antidepressants 242 T383 Insulin and oral hypoglycaemic [antidiabetic] drugs 237 T433 Phenothiazine antipsychotics and neuroleptics 227 T450 Antiallergic and antiemetic drugs 222 T426 Other antiepileptic and sedative-hypnotic drugs 204 T404 Other synthetic narcotics 199 T4369 Other psychostimulants with potential for use disorder 173 T447 Beta-adrenoreceptor antagonists, not elsewhere classified 170 T4361 Psychostimulants with potential for use disorder, methylamphetamine 146 T509 Other and unspecified drugs, medicaments and biological substances 143 T465 Other antihypertensive drugs, not elsewhere classified 141 T407 Cannabis (derivatives) 139 T390 Salicylates 107 Top 20 total 8,471 Other codes (n=99) 1,775 Total 10,246

Emergency Department presentations:

Note also, this is presentation data, not number of people/patients

Hospitals - Admitted Patient Care:

Reference: Australian Institute of Health and Welfare 2018. Emergency department care 2017-18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW. See: https://www1.racgp.org.au/newsgp/professional/new-studies-examine-australian-ed-presentations

The attached file includes the number of diagnosis codes recorded for episodes of admitted patient care, 2017/2018 and July to December 2018 (preliminary), for a select range of ICD-10-AM 10th Edition codes that have been coded as being 'present on admission to hospital'. Codes have been selected within range T36 - T509 'Poisoning by drugs, medicaments and biological substances', for all Queensland public and private hospitals.

Please note that there are limitations to this data as they are a count of the diagnosis codes based on clinical coding rules. They do not show the number of episodes of admitted patient care or the number of patients with these codes and may not be equivalent to the way the medication-related admissions in the various studies cited in the PSA report were defined.

The AIHW Emergency department care 2017-18: Australian hospital statistics (an annual report) report over 400,000 ED presentations in Queensland under the classification of 'injury, poisoning and other consequences of external causes' for Queensland in the 2017-2018 year. While medicines- related presentations may be included in this classification, it is not possible to determine the specific proportion.

Data are shown on two worksheets including: • the number of times each code within the range has been recorded; and • the top 20 codes recorded for each year

Table 4.6: Emergency department presentations'*' by principal diagnosis In ICO-10-AM^ cheptere, states and territories, 2017-18

Principal tfiagrxMls NSW Vk QW WA SA Ta* ACT NT Tfrtai

A0G-B99 Cartaln infacttous and paraaitic dbaa*** t4J311 86432 81 560 48 393 23130 7 137 9163 8204 407 330

COO-048 Naoplaamt 11 202 5510 6,308 2565 1542 744 385 287 28 543

050-089 Okaata* ot the blood and blood-fonnng organa and cartan daordara bwoKing lha atmuna machanbrn 13 536 11945 6.939 3917 2768 759 605 362 40 831

E0O-E9O Cndocrina nuirftonaJ and maiaboic tfaaataa 25.488 15 341 13667 6836 5192 1 653 1 349 3288 72814

FW-fW Mamai and bahavioufal OMfdira 95,090 57 527 57 022 35 634 24 350 5817 4 626 6919 286 985

000-099 0laa«»aft of lha narvous ayalam 29.749 32133 23.943 12783 8 545 3635 2494 2 064 115 346

H0C-M59 OtaaMM of (ha tya and adnaxa 48 082 32,820 14 790 9943 4 922 1 384 1 905 2.270 116916

H$0-H95 Olsaaaat of iha oar and maaloM procaaa J4710 24 189 18 329 10 184 4899 1.565 1 773 2 596 98245

108-199 OlaaMaa of lha circulatory ayaCam 103134 79 989 91 247 33 046 18 836 7620 5038 4 380 343 290

JOO-J99 Diaaaaaa of lha (atpiraaofy arMam 235.020 131827 119 194 65410 39574 13004 11 317 14 101 629 447

KOO-K93 Diaa«aM of lha di^aaVra ar***'* 146 784 95 366 81994 51 168 27.450 9 737 8136 7586 428 141

L08-L99 Oiaaaaaa of lha «Juh artd aubculartaoua tbaua 97612 53 912 51 694 31946 14 550 5064 4214 9 371 268 363

M08-W99 CHaaaaaa of lha mwicwloUaiataf ayatam and connacihra ttaaua 165 201 80 747 47 465 32 652 22 292 8.164 6195 10 334 373.050

N(W-N99 Diaaaaaa of (ha ^andourtnary tyaiam 108 522 73 860 65917 35083 17 288 6419 6 130 6550 319 769

000-099 Pragnancy chldbalh and tha puarparium 29 575 38 540 14 776 10957 5730 1 347 1 808 999 103732

P08-P98 Caruln condMlona odglnating in tha partnaial partod 1556 4 492 3222 1281 625 146 131 117 11 570

000-099 ConganNal maitormaibona datormattona and etwomoaomal abnormaBdaa 661 335 593 202 298 10 29 22 2150

R00-R99 Symptom* aigna and abrxKmal cMcai ar>d laboralorv findnga ml atoanbara daasiftad 668 690 361 764 260.290 144 376 117 437 30 440 30n6 25218 1658 991

SOO-T98 Injury, portoning and cartain othar conaaduancaa of artarnal caum 679 280 423 427 414583 233975 111991 44 022 39 981 31 112 1 978.371

U50-Y98 Exlamal cauaaa of morbidly and mortality 16 239 187 15 069 1 707 3611 42 465 1 129 38 449

200-299 Faclora influancing haaUb atatos and contact wflh haalb aarvtoaa 158 699 69 502 44036 59 028 37 323 13717 11258 9683 403 246

Not laportatf 67 426 93061 79 480 25621 14 141 15 0 12 169 291913

Total 2W287 1,792.906 1.512.118 856.707 506.494 162.441 147,778 158.761 8.017.492