NATIONAL MEDICAL CARE STATISTICS 2010 CHAPTER 6 | MANAGEMENT OF MORBIDITY 6.1 PRESCRIBED MEDICATION Anatomical Therapeutic Chemical (ATC) Classification System The drugs prescribed in a primary care setting were coded according to the ATC classification, which categorises the active ingredients into different groups according to the body system or organ on which they exert their effects as well as their chemical, pharmacological and therapeutic properties. According to the code, each drug is classified at five different levels. first Level is the main group, which consists of mostly organs or body systems. Each of the 14 main groups in Level 1 are divided at 2nd Level according to their pharmacological and therapeutic effects, which are further subdivided at 3rd and 4th levels based on their chemical, pharmacological and therapeutic properties. The 5th Level of the code indicates the chemical substance1. An example of ATC classification for amlodipine is shown below. The full ATC code for plain amlodipine products is thus C08CA01. LEVELS ATC CODE ATC DESCRIPTION 1 C Cardiovascular system 2 C08 Calcium channel blockers 3 C08C Selective calcium channel blockers with mainly vascular effects 4 C08C A Dihydropyridine derivatives 5 C08C A01 Amlodipine Types of Drugs Prescribed A total of 54,532 drugs were prescribed in NMCS 2010, out of which 54,204 drugs (99.4%) were coded according to the ATC classification. The remaining 328 drugs could not be coded due to illegible writing or spelling errors. In this report, data is being presented according to the main groups (ATC Level 1 – Table 6.1) and main therapeutic groups (ATC Level 2 – Table 6.2) followed by a list of Top 100 most prescribed medications, in descending order (Table 6.3). Overall, respiratory system drugs were the highest prescribed (R – 24.1%), with an average of 59.8 encounters (95%CI 59.7 – 59.9) being given a drug from this group in every 100 encounters. This is followed by drugs for alimentary tract and metabolism (A – 18.5%) and drugs for nervous system (N – 14.2%) (Table 6.1). Antihistamines for systemic use (R06 – 13.4%) were the most frequently prescribed main therapeutic group (ATC Level 2), followed by analgesics (N02 – 12.0%), antibacterials for systemic use (J01 – 11.1%), anti-inflammatory and antirheumatic products (M01 – 9.3%) and cough and cold preparations (R05 – 4.3%). All 78 ATC Level 2 Codes identified in NMCS 2010 are listed in Table 6.2. Among all the 54,204 coded drugs, paracetamol (11.1%) was the most prescribed drug, far outnumbering diphenhydramine combination products (4.3%), chlorphenamine (or chlorpheniramine – 3.8%), mefenamic acid (3.4%) and amoxicillin (3.3%) (Table 6.3). Reference 1. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2011. Oslo, 2010. Management of Morbidity 6 17 NATIONAL MEDICAL CARE STATISTICS 2010 Table 6.1 Distribution of prescribed medications by ATC Level 1 in NMCS 2010, in descending order PROPortion 95 % CI RATE PER 100 ATC OF PRESCRIBED NO ATC LEVEL 1 DESCRIPTION NUMBER* ENCOUNTER L1 MEDICATIONS (%)** (N = 21,868) LOWER UPPER (N = 54,204) 1 R Respiratory system 13,068 24.11 59.76 59.66 59.86 2 A Alimentary tract and metabolism 10,039 18.52 45.91 45.82 46.00 3 N Nervous system 7,710 14.22 35.26 35.19 35.34 4 M Musculo-skeletal system 7,239 13.36 33.10 32.02 33.18 5 J Antiinfectives for systemic use 6,657 12.28 30.44 30.37 30.51 6 C Cardiovascular system 3,340 6.16 15.27 15.22 15.33 7 D Dermatologicals 2,478 4.57 11.33 11.29 11.38 Systemic hormonal preparations, 8 H 1,239 2.29 5.67 5.63 5.70 excl. sex hormones and insulins 9 B Blood and blood forming organs 848 1.56 3.88 3.85 3.90 10 S Sensory organs 781 1.44 3.57 3.55 3.60 Genitourinary system and sex 11 G 478 0.88 2.19 2.17 2.21 hormones Antiparasitic products, 12 P 317 0.58 1.45 1.43 1.47 insecticides and repellents 13 V Various 8 0.01 0.04 0.03 0.04 Antineoplastic and 14 L 2 0.00 0.01 0.01 0.01 immunomodulating agents TOTAL CODED DRUGS 54,204 100.00 - - - * frequency of total coded drugs ** calculated based on total coded drugs (n = 54,204) 18 NATIONAL MEDICAL CARE STATISTICS 2010 Table 6.2: Distribution of prescribed medications by ATC level 2 in NMCS 2010, in descending order PROPortion 95 % CI RATE PER 100 OF PRESCRIBED NO ATC L2 ATC LEVEL 2 DESCRIPTIONS NUMBER* ENCOUNTER MEDICATIONS (%)** (N = 21,868) LOWER UPPER (N = 54,204) 1 R06 Antihistamines for systemic use 7,191 13.35 32.88 32.80 32.96 2 N02 Analgesics 6,455 11.98 29.52 29.45 29.59 3 J01 Antibacterials for systemic use 5,992 11.12 27.40 27.33 27.47 Antiinflammatory and 4 M01 5,000 9.28 22.86 22.80 22.93 antirheumatic products 5 R05 Cough and cold preparations 2,316 4.30 10.59 10.55 10.63 6 A02 Drugs for acid related disorders 2,315 4.30 10.59 10.54 10.63 Drugs for functional 7 A03 2,144 3.98 9.80 9.76 9.85 gastrointestinal disorders Antidiarrheals, intestinal 8 A07 antiinflammatory / 1,764 3.27 8.07 8.03 8.10 antiinfective agents 9 R01 Nasal preparations 1,636 3.04 7.48 7.45 7.52 10 A11 Vitamins 1,560 2.90 7.13 7.10 7.17 11 H02 Corticosteroids for systemic use 1,194 2.22 5.46 5.43 5.49 12 A10 Drugs used in diabetes 1,188 2.21 5.43 5.40 5.46 Drugs for obstructive airway 13 R03 1,104 2.05 5.05 5.02 5.08 diseases Corticosteroids, dermatological 14 D07 835 1.55 3.82 3.79 3.84 preparations 15 R02 Throat preparations1 821 1.52 3.75 3.73 3.78 Other drugs for disorders of the 16 M09 775 1.44 3.54 3.52 3.57 musculo-skeletal system2 17 M03 Muscle relaxants 728 1.35 3.33 3.30 3.35 18 C07 Beta blocking agents 718 1.33 3.28 3.26 3.31 19 C10 Lipid modifying agents 681 1.26 3.11 3.09 3.14 20 N05 Psycholeptics 663 1.23 3.03 3.01 3.05 21 C08 Calcium channel blockers 650 1.21 2.97 2.95 3.00 Agents acting on the 22 C09 633 1.17 2.89 2.87 2.92 renin-angiotensin system Topical products for 23 M02 596 1.11 2.73 2.70 2.75 joint and muscular pain 24 B03 Antianemic preparations3 573 1.06 2.62 2.60 2.64 Antifungals for 25 D01 499 0.93 2.28 2.26 2.30 dermatological use 26 S01 Ophthalmologicals 492 0.91 2.25 2.23 2.27 27 A12 Mineral supplements 427 0.79 1.95 1.93 1.97 Management of Morbidity 4 28 N07 Other nervous system drugs 416 0.77 1.90 1.88 1.92 6 19 NATIONAL MEDICAL CARE STATISTICS 2010 Table 6.2: Distribution of prescribed medications by ATC level 2 in NMCS 2010, in descending order (CONT) PROPortion 95 % CI RATE PER 100 OF PRESCRIBED NO ATC L2 ATC LEVEL 2 DESCRIPTIONS NUMBER* ENCOUNTER MEDICATIONS (%)** (N = 21,868) LOWER UPPER (N = 54,204) 29 C03 Diuretics 404 0.75 1.85 1.83 1.87 Antibiotics and chemotherapeutics 30 D06 371 0.69 1.70 1.68 1.71 for dermatological use 31 J07 Vaccines 326 0.61 1.49 1.47 1.51 Antipruritics, incl. antihistamines, 32 D04 312 0.58 1.43 1.41 1.44 anesthetics, etc. Sex hormones and modulators of 33 G03 268 0.50 1.23 1.21 1.24 the genital system 34 A01 Stomatological preparations 264 0.49 1.21 1.19 1.22 35 B01 Antithrombotic agents 237 0.44 1.08 1.07 1.10 36 A06 Laxatives 207 0.38 0.95 0.93 0.96 37 P01 Antiprotozoals 204 0.38 0.93 0.92 0.95 38 D02 Emollients and protectives 190 0.35 0.87 0.86 0.88 Ophthalmological and 39 S03 170 0.32 0.78 0.77 0.79 otological preparations 40 J02 Antimycotics for systemic use 168 0.31 0.77 0.76 0.78 Antiseptics and disinfectants, 41 D08 161 0.30 0.74 0.72 0.75 topical 42 G04 Urologicals 160 0.30 0.73 0.72 0.74 43 M04 Antigout preparations 133 0.25 0.61 0.60 0.62 44 J05 Antivirals for systemic use 127 0.24 0.58 0.57 0.59 45 S02 Otologicals 119 0.22 0.54 0.53 0.55 46 C05 Vasoprotectives 115 0.21 0.53 0.52 0.54 47 N06 Psychoanaleptics 106 0.20 0.48 0.48 0.49 48 C01 Cardiac therapy5 78 0.14 0.36 0.35 0.36 Ectoparasiticides, incl. scabicides, 49 P03 61 0.11 0.28 0.27 0.29 insecticides and repellents 50 C02 Antihypertensives 60 0.11 0.27 0.27 0.28 51 A13 Tonics 55 0.10 0.25 0.24 0.26 52 P02 Anthelmintics 52 0.10 0.24 0.23 0.24 Gynecological antiinfectives 53 G01 48 0.09 0.22 0.21 0.23 and antiseptics Antiobesity preparations, excl.