Background/Objectives: The prevalence of atopic dermatitis (AD) has increased significantly in industrialised countries in recent decades but data about the incidence or prevalence of AD in Australia are sparse. We aimed to determine the prevalence and incidence of AD among patients seen in Australian general practice and the use of specified medicines. Methods: This was a cross-sectional study of 2.1 million patients attending 494 general practices in the MedicineInsight program from 1 January 2017 to 31 December 2018. We assessed the prevalence (lifetime and current), incidence, management and severity of AD. Results: The lifetime (ever diagnosed) prevalence of AD in this general practice population was 16.4% and was greater in females (17.3%) than males (15.3%). One in five patients with AD were classified as having moderate-to-severe disease. Prevalence over the last two years was 6.3%. The incidence of AD in 2018 was 2.0% and was greater in females (2.2%) and for patients aged 0-4 years (3.9%). Patients with AD had an increased risk of insomnia, anxiety and depression, compared to those with no recorded AD. For AD patients, topical corticosteroids were the most commonly prescribed AD medication (36.5%) and topical calcineurin inhibitors the least (0.1%), with systemic corticosteroids (15.6%) more commonly prescribed than other immunosuppressants (0.9%). Conclusions: Our findings provide important insights into the epidemiology of AD and its management in Australian general practice. This information is likely to be useful in planning effective interventions to support GPs in the optimal management of patients with AD.

Introduction Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence‐based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. Main recommendations Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non‐cancer or chronic cancer‐survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid‐related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid‐related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence‐based care, such as medication‐assisted treatment of opioid use disorder; and use of evidence‐based co‐interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. Changes in management as a result of these guidelines To our knowledge, these are the first evidence‐based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.

Background and objectiveApproximately 65% of cardiovascular disease (CVD)-related deaths in Australia occur in people with diabetes or pre-diabetes. The aim of this study was to investigate general practice management of risk factors among patients with both conditions. MethodsThis was a cross-sectional study of 33,559 adult patients with both type 2 diabetes and CVD at 1 November 2018, using the general practice data program MedicineInsight. ResultsOne-third of patients did not have a record in their current medications list for all three recommended medicines to reduce cardiovascular risk. Potentially suboptimal monitoring and achievement of targets for diabetes and cardiovascular risk factors was also identified. Most patients using metformin-based combination therapy were prescribed blood glucose-lowering medicines that do not have evidence of cardiovascular benefit. DiscussionThese data suggest opportunities to support general practices to optimise patient management. Datasets such as MedicineInsight can help practices identify patients who may benefit from recall.APPROXIMATELY 65% of all cardiovascular disease (CVD)-related deaths in Australia occur in people with diabetes or pre-diabetes. 1 The mortality rate in people with type 2 diabetes (T2D) almost doubles with the coexistence of CVD, resulting in an estimated 12-year reduction in life expectancy. 2 Typically, people with T2D experience atherosclerotic CVD earlier and with greater severity than people without T2D. 3 Despite their significantly elevated risk, suboptimal prescribing of blood pressure (BP)-lowering, 4,5 lipid-modifying 4-6 and antiplatelet therapy 5 for patients with diabetes and CVD has been reported in Australian primary care. Australian data also show that many patients with diabetes and/or CVD do not meet guideline recommendations for prescribing, 4-10 monitoring and treatment targets for managing cardiovascular risk. 5,7 Blood glucose-lowering medicine (GLM) selection is also increasingly complex because of the increase in available medicines, and the focus on cardiovascular safety since the US Food and Drug Administration mandated in 2008 that all new studies must demonstrate cardiovascular safety. 11 Several trials have shown not only cardiovascular safety, but also additional cardiovascular and renal benefits over placebo. [12][13][14][15][16][17][18][19][20] The aim of this study was to investigate management of T2D and atherosclerotic CVD risk factors in general practice, using MedicineInsight data to explore medicines prescribed, monitoring performed and achievement of treatment targets. The study was part of a quality improvement program that ran from June 2018 to April 2019 and involved presenting practicelevel data to general practitioners (GPs) at small group meetings to identify opportunities for improvement in clinical care. MethodsA cross-sectional study was conducted using MedicineInsight, a large national general practice database developed and managed by NPS MedicineWise, with funding support from the Australian Gover...

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