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Computachem Editor's Note:
We are pleased to announce that we have formed an alliance with Health Communications Network (HCN), an Australian company that is heavily involved in e-health. With permission, we have extracted focus items from their recent newsletter which should prove of interest to pharmacists.
Note that the second item, the top 20 prescriptions written by GP's is provided by the GPRN database noted above.

Disease focus

The focus of this week’s HCW is Allergic Rhinitis. This condition is the second most frequently self-reported condition in Australia1, with up to two million people experiencing symptoms of Allergic Rhinitis (or hay fever as it is commonly called).

HCW will also commence a weekly surveillance of numbers of patients attending their general practitioners with the condition. As an introduction in this issue, some data will be presented profiling patients with the condition.

1 Weiner JM, Abramsin Mj, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonistsin Allergic rhiniti:systematic review of RCTs BMJ 1998;317:12:1624-1629

Profile of patients with Allergic Rhinitis

Data used: GPRN database
Data range: Prescriptions written and/or condition recorded as Allergic Rhinitis between 1 Jan 1999 – 14th Oct 2001
Number of patients: 4,845

Top ten medications prescribed for Allergic Rhinitis patients
Number of patients: 10,003 Sex: 43% male 57% female Age 9% patients aged less than 10 30% of patients aged 30-49 years

Top ten medications prescribed for Allergic Rhinitis patients

The majority of prescribed medications were for nasal sprays (96%) with only 4% being for oral preparations Loratidine, Fexofenadine and Cetrizine.
From this data we cannot quantify the level of OTC usage in these patients.

Dosage & Regimen of Budesonide

Table 1: Dosage & Regimen of Budesonide
There were 1,799 scripts for the most frequently prescribed medication, Budesonide spray that included dosing information, the majority, (98%) of which were for the higher strength 100mcg spray. The mean daily dose of this formulation was 100mcg per day. The majority of patients were prescribed the 100mcg spray at a regimen of 1 dose daily, (73.4%)

Medication name	Doses	Frequency	No. of scripts	%
Budesonide nasal spray 100mcg/dose	1	Daily	1321	73.4%
Budesonide nasal spray 100mcg/dose	1	Twice a day	262	14.6%
Budesonide nasal spray 100mcg/dose	1	3 times a day	13	0.7%
Budesonide nasal spray 100mcg/dose	1	4 times a day	1	0.1%
Budesonide nasal spray 100mcg/dose	1	As directed	2	0.1%
Budesonide nasal spray 100mcg/dose	1.5	Daily	50	2.8%
Budesonide nasal spray 100mcg/dose	1.5	Twice a day	3	0.2%
Budesonide nasal spray 100mcg/dose	2	Daily	74	4.1%
Budesonide nasal spray 100mcg/dose	2	Twice a day	32	1.8%
Budesonide nasal spray 100mcg/dose	3	Daily	7	0.4%
Budesonide nasal spray 64mcg/dose	1	Daily	18	1.0%
Budesonide nasal spray 64mcg/dose	1	Twice a day	6	0.3%
Budesonide nasal spray 64mcg/dose	1.5	Daily	1	0.1%
Budesonide nasal spray 64mcg/dose	2	Daily	9	0.5%
Total			1799

Table 2: Number of GP visits per year for patients with Allergic Rhinitis

For the 4,845 patients identified as having Allergic Rhinitis, sufficient data was available to calculate the number encounters each patients had in a year for 4,507 patients (93%). Note this may have been where a condition other than Allergic Rhinitis was being managed. Two third of patients with Allergic Rhinitis were seen less than four times in a year. Note that patients who have <1 visit per year are those who could, for example, be seen once every 2 years	Number of GP visits/year	n	%
	<1	841	18.7
	1	825	18.3
	2	647	14.4
	3	536	11.9
	4	362	8.0
	5-7	548	12.1
	8-10	275	6.1
	11+	473	10.5

Sources of information on Allergic Rhinitis:

For GPs From the National Prescribing Service, an up-date on the management of Allergic Rhinitis

http://nps.org.au/Docs/pdfs/RhinitisPharmacyletter.pdf

An over-view of Allergic Rhinitis by Assoc. Prof. Ron Walls from the University of Sydney. He states that the prevalence of the disease has doubled over the past 25 years and presents some useful information on clinical presentation and management.

http://www.allergy.org.au/gpnews/vol1_no2/Rhinitis.htm

For patients

Within Medical Director, follow prompts for Patient Education leaflets as below:

Allergic Rhinitis surveillance

The chart below shows the rate of Allergic Rhinitis visits per 1000 up till 14 October 2001. A visit for Allergic Rhinitis is considered to have taken place if the GP has recorded either Allergic Rhinitis or hay fever as a diagnosis or has prescribed either Mometasone nasal spray or Ipratropium nasal spray. These two products were chosen as their indications are specifically Allergic Rhinitis and not for other Allergic conditions. Part of the challenge of attempting surveillance of this condition is that a large proportion of the treatments are available as over-the-counter preparations. Nevertheless it is reasonable to assume that for those patients requiring more aggressive therapy, GPRN data should reflect the seasonal nature of the condition.

Last data supplied: 14 October 2001 Data source: GPRN Health Communication Network Note this chart will feature in forth-coming issues, replacing Influenza surveillance

Top 20 Medications prescribed in General Practice this week

	This Month		Last Month		This Year
Generic medication	Rank	Percent	Rank	Percent	Rank	Percent
Amoxycillin	1	3.63	1	4.2	4	2.72
Paracetamol/ codeine phosphate	2	3.18	3	3.1	2	3.18
Temazepam	3	2.92	2	3.2	1	3.32
Paracetamol	4	2.90	4	3.0	3	2.99
Amoxycillin/potassium clavulanate	5	2.01	5	2.4	10	1.58
Cephalexin	6	1.84	8	1.9	6	1.82
Roxithromycin	7	1.72	6	2.0	13	1.37
Salbutamol sulfate	8	1.58	7	1.9	8	1.72
Celecoxib	9	1.54	10	1.6	5	2.00
Diazepam	10	1.54	12	1.5	7	1.72
Levonorgestrel/ ethinyloestradiol	11	1.54	11	1.5	9	1.60
Rofecoxib	12	1.39	17	1.2	30	0.74
Mometasone furoate	13	1.33	18	1.1	20	1.10
Doxycycline	14	1.31	13	1.3	19	1.12
Oxazepam	15	1.28	14	1.3	11	1.51
Simvastatin	16	1.25	16	1.2	14	1.28
Cefaclor	17	1.24	9	1.7	16	1.25
Atorvastatin	18	1.24	15	1.3	15	1.26
Chloramphenicol	19	1.24	22	1.1	24	0.93
Aspirin	20	1.20	21	1.1	21	1.08

This month = four weeks ending 14 October 2001
Last month = four weeks ending 16 September 2001
This year = 15 September 2000 to 14 October 2001
Last data supplied: 14 October 2001
Data source: GPRN Health Communication Network

Editorial Review:
Geoffrey Sayer * Dr Frank Pyefinch
Contributing Authors:
Fiona Horn * Leigh Hendrie * Kevin McGeechan * Geoffrey Sayer
Editor:
Alice Bhasale
Health Communication Network, PO Box 67 St Leonards NSW 1590 ph 02 9906 6633
email: research@hcn.com.au.

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