Introduction: Esketamine, an N-methyl-D-aspartate receptor antagonist, was first approved by the United States (US) Food and Drug Administration in March 2019 as a novel treatment for treatment-resistant depression, which affects approximately 30% of people with major depressive disorder. Despite its clinical importance, global patterns of esketamine adoption and utilisation remain unclear.

Aims: To describe multinational trends in esketamine adoption and utilisation from 2019 to 2024.

Methods: This cross-sectional ecological study used quarterly pharmaceutical sales data from January 2019 to December 2024 across 54 countries, obtained from the IQVIA Multinational Integrated Data Analysis System. Esketamine consumption was estimated as the absolute number of defined daily dose (DDD) sold and DDDs per 1,000,000 inhabitants per day (DDD/1,000,000/day). Trends were analysed globally and stratified by country and income level. Adoption was defined as the first quarter with recorded esketamine sales in each country.

Results: Global esketamine consumption increased substantially after approval, reaching 11.57 million DDDs in 2024. The US was the earliest adopter and showed sustained growth, accounting for 7.84 million DDD (67.7% of global consumption) in 2024; while Austria had the highest population-standardised consumption in 2024, reaching 66.04 DDD/1,000,000/day. Although global consumption increased steadily, utilisation varied markedly by income group. High-income countries adopted esketamine earliest, with use beginning in 2019, and demonstrated the steepest growth, reaching approximately 29.06 DDD/1,000,000/day in 2024. However, adoption in upper-middle- and lower-middle-income countries was delayed by approximately one to two years and remained limited, with utilisation remaining below 1 DDD/1,000,000/day throughout the study period.

Conclusions: Esketamine utilisation increased rapidly between 2019 and 2024, driven predominantly by high-income countries, particularly the US. Marked differences across countries in both the adoption timing and consumption highlight substantial disparities in access to novel treatments for treatment-resistant depression.

Introduction: Parkinson’s disease (PD) is the second most common neurological disorder in Australia. Despite advances in device-aided therapies (DAT), population-level evidence on how socioeconomic status and geographic remoteness influence progression from oral therapy to advanced PD treatment (aPD) and DAT remains limited.

Aims: Describe socioeconomic and geographic characteristics of people receiving PD medications or DAT in New South Wales (NSW) and quantify allied health utilisation across treatment stages.

Methods: A retrospective, population-based cohort study was conducted, using the Medicines Intelligences Data Platform-a linked dataset integrating Pharmaceutical Benefits Scheme (PBS) dispensing, hospital admissions, Medicare Benefits Schedule (MBS) claims and mortality data in NSW (2013-2020). Adults initiating PD medicines (no prior PD dispensing in 365 days) were followed longitudinally to subsequent initiation of aPD and DAT, defined using validated medicine-based proxies informed by clinical guidance. Postcode of residence was mapped to SEIFA disadvantage quintiles and ASGS remoteness categories. Allied health MBS items were grouped using AIHW definitions.

Results: Among 43,810 people initiating PD therapy, 11,550 (26%) progressed to aPD treatment and 224 (0.5%) to DAT. Median follow-up from PD treatment was 3.2 years (IQR 1.5-5.4). The proportion residing in the most socioeconomically advantaged quintile increased across treatment stages (23% in PD, 26% aPD, and 36% DAT, p <0.001). While 12% of NSW residents live in regional/remote areas, only 5-7% of each cohort did. Allied health utilisation was low across cohorts, averaging 2.3 MBS claims per person-year.

Conclusions: In NSW, DAT uptake was concentrated in the most socioeconomically advantaged areas, with geographic variation and under-representation of regional/remote residents. Allied health use was similar across cohorts, supporting need to better understand barriers to multidisciplinary PD care. Linked administrative data provides robust information on population-level understanding of PD treatment patterns in Australia.

Keywords: Real-world evidence; Parkinson’s disease; linked administrative data

Introduction: The World Health Organization (WHO) updated its recommendations on dosing for drug-susceptible tuberculosis (DS-TB) in 2022 to improve treatment effectiveness and programmatic feasibility. However, translating these recommendations into routine practice remains challenging, particularly in high TB burden settings such as Indonesia. Understanding the behavioural and contextual determinants influencing implementation is essential to support guideline uptake.

Aims: This study aimed to explore barriers and facilitators influencing the implementation of WHO-recommended dosing for DS-TB in Indonesian primary healthcare settings.

Methods: A qualitative descriptive study guided by the Theoretical Domains Framework (TDF) was conducted in Banyumas Regency, a high TB burden district in Central Java, Indonesia. Data were collected through face-to-face focus group discussions with 45 healthcare providers, including doctors, nurses, and pharmacists, from 20 primary healthcare centers in December 2025. A semi-structured interview guide based on the 14 TDF domains was used. Discussions were transcribed verbatim and analysed using thematic analysis, with findings mapped to relevant TDF domains.

Results: Determinants influencing implementation were identified across all TDF domains. Key barriers included limited awareness of updated dosing details, confusion during the transition from previous dosing practices, increased workload related to patient education, lack of incentives, and inconsistencies between formal policies and digital information systems. Facilitators included clear professional role delineation, strong peer support, supervisory guidance, optimism related to drug availability, and formal policy endorsement from health authorities. Emotional responses characterised by uncertainty, particularly in referral cases, also influenced decision-making.

Conclusions: Implementation of WHO-recommended dosing for DS-TB is influenced by interacting behavioural, social, and system-level factors. Theory-informed and multi-level implementation strategies may strengthen guideline adoption in decentralized TB service settings.

Keywords: pulmonary anti-tubercular agents, primary health care, qualitative research

Introduction: In recent years, escalating rates of high-risk psychotropic medicines use and harms have gained international concern, with benzodiazepines being the most commonly identified single drug type in drug-induced deaths in Australia. Despite the growing burden of benzodiazepine-related harms particularly with long-term or persistent use, research examining patterns of benzodiazepine prescribing remains limited both internationally and in Australia.

Aims: The aim of this study was to examine the predictors of persistent benzodiazepine receptor agonist (i.e. benzodiazepines and z-drugs; BZRA) prescriptions in people initiating BZRAs in Australian primary care.

Methods: This retrospective cohort study included adults (≥18 years) prescribed BZRAs between January 2018 and December 2025 using data accessed through the Population Level Analysis and Reporting (POLAR) database. Persistence was defined as being prescribed BZRAs for ≥90 days, with a gap of <60 days between subsequent prescriptions.

Results: Of a total sample of 538,095 people initiating BZRAs, 19,831 (3.7%) received persistent BZRA prescriptions, with diazepam (45.2%) and temazepam (34.7%) being the most frequently prescribed types in both persistent and non-persistent cohorts. Adjusted multivariable logistic regression showed that concessional beneficiaries (2.43, 2.35-2.51), individuals with substance use disorder diagnosis (2.63, 2.44-2.82), those prescribed opioids (1.86, 1.80-1.91), antipsychotics (1.74, 1.66-1.83) and cannabinoids (1.81, 1.21-2.71) in the year prior to BZRA initiation, and those provided ≥2 types of BZRAs (2.02, 1.83-2.23) and repeat/refill prescriptions at initiation (2.74, 2.58-2.90) had significantly higher odds of persistence following BZRA initiation.

Conclusions: Further research is needed to determine whether persistent BZRA prescriptions are associated with any unintended or adverse health outcomes. The patient-level factors associated with persistence identified in this study, such as concessional status and substance use disorder diagnosis, may help to risk stratify patients and inform policy and practice aimed at promoting safe prescribing and mitigating unintentional long-term BZRA use.

Key words: Benzodiazepines, long-term prescriptions, primary care.

Introduction: Repeat drug allergy exposure is a preventable medication safety event. Root cause analysis identified major gaps in allergy information transfer, particularly during out-of-hours services, resulting in delayed documentation, incomplete hospital information system (HIS) records, A closed-loop real-time allergy communication system was developed to improve multidisciplinary allergy reporting and strengthen prevention of repeat drug allergy exposure.

Aims: To evaluate the impact of a closed-loop real-time allergy communication system on allergy documentation and prevention of repeat drug allergy exposure.

Methods: A quasi-experimental before-and-after study was conducted in inpatient and outpatient settings. The pre-intervention period was April–September 2023 using routine allergy reporting processes, while the post-intervention period was April 2024–December 2025 following implementation of a closed-loop real-time allergy communication system. The intervention integrated a Line Official Account platform into multidisciplinary workflows to facilitate real-time referral of patients with previous drug allergies identified by physicians, nurses, pharmacists, and dentists. Pharmacists on duty performed immediate allergy documentation and allergy alert activation in the HIS, including during out-of-hours periods, while ADR pharmacists subsequently verified documentation completeness during routine service hours.

Results: Documented previous drug allergy reports increased from 13.2 to 31.8 per 1,000 outpatient prescriptions (p<0.001) and from 19.4 to 44.7 per 1,000 inpatient medication orders (p<0.001). Completeness of HIS allergy documentation improved from 81.6% to 99.7%. Out-of-hours reporting increased from 11.3% to 49.5% of total reports. Median time from referral to HIS documentation decreased from 15.2 hours to 18 minutes (p<0.001). The system identified and prevented 172 repeat prescribing events in patients with known drug allergies. No severe repeat drug allergy exposure events were identified after implementation.

Conclusions: The closed-loop real-time allergy communication system significantly improved timely HIS documentation, closed the out-of-hours reporting gap, and effectively prevented repeat drug allergy exposure through continuous multidisciplinary communication.

Keywords: drug allergy; medication safety; communication system

Introduction: General practices are the primary providers of contraceptive care in Australia where patients access most of the contraceptive types under the Pharmaceutical Benefits Scheme (PBS) for subsidised rates. However, national evidence on prescribing patterns and associated factors in this setting remains limited.

Aims: To examine longitudinal trends in contraceptive prescribing in Australian general practice

Methods: A retrospective cohort study of females aged 15 to 49 years who attended a general practice between 2011 and 2021 was conducted, using the large general research dataset, MedicineInsight. We calculated annual age standardised rates of contraceptive prescriptions overall and stratified by patient demographic characteristics.

Results: Among a total of 1,660,406 females, the annual age-standardised prevalence of contraceptive prescriptions was consistently the highest among those aged 15-29 years between 2011 and 2021. Combined hormonal contraceptive (CHC) prescribing showed a declining trend, whereas levonorgestrel intrauterine devices (LNG-IUDs) use increased from 1.0% to 1.7%, with the largest increases in those aged 15-19 years (0.2% to 0.9%) and 20-29 years (0.8% to 1.8%). The prevalence of non-PBS-listed CHC prescribing was significantly higher in females without a concession card compared to their counter parts. The prevalence of prescribing of LNG-IUDs was higher in the 40-49 years old females than in younger patients and in regional areas than in major cities. Implants were more commonly prescribed for females with concession card, living in disadvantaged areas, and residing outside major cities.

Conclusion: Contraceptive prescribing among females attending general practice declined between 2011 and 2021, driven largely by reductions in combined hormonal contraceptive prescribing. In contrast, prescribing of LNG-IUDs increased substantially, particularly among younger females, suggesting a gradual shift towards long-acting reversible contraceptives. Considerable differences in contraceptive prescribing by patient demographics highlight potential inequities in contraceptive access and choice that warrant further investigation.

Keywords: Contraception; drug utilisation; primary care

Introduction: Universal hepatitis B virus (HBV) screening is mandated before initiating biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) to prevent reactivation. Despite guidelines, screening adherence often remains suboptimal in routine clinical practice due to fragmented workflows. Closing this gap is critical to ensure patient safety during potent immunosuppressive therapy.

Aims: This study evaluated the impact of a workflow-embedded clinical decision support system (CDSS) on HBV screening completion. We further assessed the association between improved screening processes and HBV-related clinical outcomes.

Methods: A retrospective, staged implementation study was conducted comparing three periods: baseline (2004–2016), education (2017–2020), and workflow-integrated (2021–2024). Participants included adults with rheumatic diseases initiating b/tsDMARD therapy identified from a tertiary center database. The CDSS automatically verified HBV serology and generated missing screening orders at the point of computerized prescription.

Results: The analytical cohort comprised 1,909 adults across the three implementation stages. The full three-marker panel screening rate increased from 47% at baseline to 75% during the education stage and 90% in the workflow-integrated stage. These process improvements were associated with a significant reduction in HBV reactivation rates from 5.2% at baseline to 1.5% in the last stage (p<0.001). Hepatitis flares also decreased from 1.9% to 0.2% across stages (p<0.001). However, antiviral prophylaxis before treatment remained consistently low (4.2%) and longitudinal virologic monitoring was infrequently performed.

Conclusions: Workflow-embedded automation achieved near-universal HBV screening and significantly reduced clinical reactivation and flares. Future systems should incorporate automated longitudinal monitoring and stronger enforcement of prophylactic guidelines to address residual risks.