The Central Statistics Office (CSO) recently published statistics that provide in-depth detail into the prescribing patterns relating to medical card holders in the Analysis of prescriptions dispensed under the General Medical Services (GMS) Scheme, 2018-2023 release. The statistics cover what medications, by Anatomical Therapeutic Classification (ATC) code, medical card holders receive, polypharmacy on a calendar year basis, as well as investigating co-prescribing patterns. Accompanying the statistical release were online databases with detailed data that can be interrogated or downloaded and analysed in software packages such as Excel. A Google search for ‘site:cso.ie prescriptions GMS’ will return the release webpage. Detailed statistics on the online database can be accessed by visiting data.cso.ie and searching for ‘GMS’.
The statistical analysis makes considerable use of ATC codes that classify, in a standardised way, the medications received by medical card holders. They are a globally adopted method of classifying medications into categories based on various levels, from Level One, the anatomical target, to Level Five, the distinct chemical compound. The ATC is a key enabler in identifying the use for specific medications. The use of this classification in statistical products contributes to providing insights about the health of our population, particularly where specific ATC codes can be used as a marker or a likelihood indicator for a specific condition/morbidity.
The data in the release is provided to the CSO by the HSE’s Primary Care Reimbursement Service (PCRS). The PCRS is responsible for reimbursing GPs, dentists, pharmacists, optometrists/ophthalmologists, and other contractors who provide free or reduced-cost services to the public across a range of primary care schemes. All medical card/General Medical Services (GMS) Scheme claims to pharmacies are processed and paid for by the PCRS and were the focus of this analysis. PCRS claims are also submitted under the Drug Payment Scheme and Long-Term Illness Scheme. The data in the release includes people who received an item on the GMS scheme only. From reviewing prescriptions that were reimbursed from 2018 to 2023, data was explored by year, age, sex, ATC code, and HSE Health Region.
Key findings:
Please note, being active on the GMS scheme refers to people who were reimbursed for at least one prescribed item in the calendar year.
In absolute terms, the largest five-year changes between 2018 and 2023 were seen in the Alimentary Tract and Metabolism (+91,700 people), Cardiovascular System (+81,700 people), and Blood and Blood Forming Organs (+52,000 people), categories. In terms of percentage change, Antineoplastic and Immunomodulating Agents saw the largest five-year change, with a 19.8 per cent increase. The largest absolute changes over the period 2022 to 2023 were for the Alimentary Tract and Metabolism (+29,400 people), Anti-infectives for Systemic Use (+27,300 people), and Cardiovascular System (+26,900 people) categories.
In terms of increases, the Third-level ATC code Antidepressants had a large increase in usage between 2018 and 2023 and went up from 21.3 per cent to 25.5 per cent, corresponding to 57,000 prescribed people. Drugs for Peptic Ulcer and Gastro-Oesophageal Reflux Disease (A02B) were next in terms of the percentage point change, up 4 percentage points, or 52,200 prescribed people.
In terms of decreases, Hormonal Contraceptives for Systemic Use changed from 7.7 per cent to 4.7 per cent between 2018 and 2023, seeing the largest percentage point fall of -3.0, corresponding to 40,600 prescribed people. It should be noted that the HSE’s Free Contraception Scheme began in 2022 and gradually expanded from then. This may have been a driver for the decrease.
It should be noted that the top increases and decreases statistics were based on ATC Level 3 categories that are reported on in the CSO’s PxStat tables. Some categories were excluded due to Statistical Disclosure Control.
The number of people who received 20 or more medications over the year in 2023 as a percentage of active people was 9 per cent, with this rising as people got older from 0 per cent in the under 18 age group to 30 per cent in the 90+ age group, indicating people use more medications as they get older.
About the author: Tomás Kelly is a Statistician in the Health Division of the CSO. Prior to working on this project, he worked on a release entitled Mortality Indicators by Ethnicity and Deprivation and the Electoral Division, IHA, CHN and Health Region profiles, which is located at edprofiles.cso.ie.
The Central Statistics Office (CSO) is Ireland’s national statistical institute. Our role is to provide independent statistics about our society, economy, and environment, which are freely available to everyone and support evidence-informed decision making. The CSO has statutory powers to collect data (including personal data) for statistical purposes. See cso.ie for more information.
After the recent pandemic and the role the CSO played in enabling statistical information flows for decision making, a new health statistics team was set up in 2024. The role of this team is to work and collaborate with the various bodies in the advancement of statistical capabilities in this area. In particular, the strong partnership between the HSE and CSO, is enabling significant developments in advancing statistical capabilities. Two additional developments at the CSO that may be of interest to readers are:
Tomás Kelly
Statistician, Health Division, CSO
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