We thank Dr Ziegler for his comments - similar sentiments have been expressed by a number of people.
The basic reason for the adoption of the anatomical therapeutic chemical (ATC) format, as explained in the December 1993 and April 1994 editions of the Schedule of Pharmaceutical Benefits when a move to ATC groupings was foreshadowed, was to provide a logical hierarchy of PBS listed drugs so that prescribers would have information on the drugs used for similar purposes in the same section of the book. The former alphabetical listing did not allow this. The PBAC has always considered that the Schedule has an important educational role, both in relation to the restrictions imposed, and to the notes and cautions which are included. The intention of the new format was to further expand this function. It was felt that the listing of drugs in ATC groups would facilitate drug selection and thus increase the book's usefulness, rather than being simply an alphabetical list of drugs currently available for subsidy.
In the longer term, it is also envisaged that the Schedule will be incorporated into a new publication, the Australian Medicines Handbook (AMH). The introduction of this publication is being overseen by the Royal Australian College of General Practitioners, the Pharmaceutical Society of Australia, and the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. Prior to the commencement of planning of the AMH, a randomised survey of prescribers was carried out to determine, inter alia, a suitable format. This survey, which elicited views from both general practitioners and various specialist groups, indicated that a format incorporating therapeutic groupings would be acceptable to prescribers. It was considered that a classification by therapeutic use was reasonable, since such a system is already in use in publications such as MIMS.
The ATC system of therapeutic classification has been adopted for use in the AMH because it is used internationally and endorsed by the World Health Organization. It was felt that the use of the same system in the Schedule would facilitate the incorporation of information on pharmaceutical benefit listings into the AMH.
The ATC code can be used in association with the 'defined daily dose' (DDD) as a unit for comparative drug consumption studies and also in the field of adverse drug reaction studies. With uniform coding, comparisons of drug usage can be made between different hospitals, different communities, different States and even different countries. The Australian Register of Therapeutic Goods is also linked into ATC coding.
Therefore, every effort has been made to ensure that the revised classification of the Schedule is consistent with the ATC system. We acknowledge that there are some anomalies in the classification, particularly for drugs with multiple therapeutic uses. As pointed out by Dr Ziegler, the terminology is also somewhat clumsy at times. However, the advantages of an internationally accepted and used classification outweigh these small problems.