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Origins of National Medicines Policy & Quality Use of Medicines in Australia

  • Consumer Health Forum (CHF)
    • "Towards a national medicinal drug policy for Australia, 1988"

The concerns that lead to National Medicines Policy & QUM

  • Data on
    • over use,
    • under use,
    • inappropriate use,
    • adverse health consequences from medicines.

Politics!

Examples of overuse

  • Benzodiazepenes: fractures, tolerance, hypnotic/drowsy
  • Opioids: tolerance; adverse effects
  • Antidepressants: disease mongering (SSRIs)
  • Antipsychotics
  • Antibiotics - resistance

Examples of underuse

  • Blood pressure medication (half are untreated, half of those treated are undertreated)
  • Insulin with diabetes
  • Asthma
  • CCF

Inappropriate use

  • Statins (need to use the CVD risk management); people who have had a heart attack should be on a statin
    • Side-effects - muscle pain
  • National medicines policy came from a politician's relative having woken up from a vegetative state due to being on psychoactive medicines

National Medicines Policy

Memorise this. Product information is on MIMS (agreed to by the regulator)

  1. Medicines of high quality safety and efficacy (TGA is the regulatory body for this)
  2. Quality use of medicines (basis of today's talk)
  3. Equitable access to necessary medicines (Pharmaceutical Benefit Scheme) - drugs we need at a price we can afford
  4. A viable & responsible local pharmaceutical industry (requires well-educated people; profitable; big export)
    • Note the influence of the pharmaceutical industry marketing machine (do things in the interest of the patient and society)
  • Very little counterfeiting in Australia

What is quality use of medicines

  • Selecting management options wisely (Includes NOT using drugs if it's a good option (e.g. antibiotics))
  • Choosing suitable medicines if a medicine is considered necessary (Pick the right one if you do need to use a medicine. It must fit the patient's characteristics; individualising therapy; kidney function, weight, genetics).
  • Using medicines safely and effectively (monitoring; when to stop medications)
    • "QUM Filter"

Quality Use of Medicines Goal

  • To optimise medicinal drug use (both prescription, OTC & complementary) to improve health outcomes for all Australians
    • More sales for pharmaceutical companies, and less price for taxpayer
    • In NZ+USA, complementary medicines are NOT drugs but foods.

How do we achieve QUM?

  1. Change behaviour
    • Eg. appreciate that not everyone is adherent
  2. Develop partnerships
    • With other healthcare professionals to help the patient to look after themselves
    • Not just us and the patient

Use a multi-strategic, multi-level, systems approach

  • Involve all groups who influence QUM
  • Include all stages of learning
  • Include all relevant ‘settings’

We are the leader to make sure all these things happen

Complementary therapy

  • It's all about communication and the psychology associated with misinformation. Treat bad communication from each other

Quality use of medicines legal strategy

  • See the diagram which shows the factors that result in healthy consumers, and the people involved in the partnership

Informative products

  • Using consumer medicine information effectively
  • Therapeutic guidelines - respiratory
  • Australian prescriber
  • Medimate

etc

National prescribing service limited

  • Established 1998
  • At arm’s length from government but with government service contract
  • Required to deliver QUM (and make savings on pharmaceutical expenditure)
  • Budget 2009-12 $35+million/pa
  • >100 staff and field force of 120 facilitators employed through Divisions of General Practice

NPS:For health professionals

  • Therapeutic topic modules eg Rx Type 2 diabetes
    • Written materials
    • Prescription analysis and feedback
    • Assisted self audits
    • Case studies
    • Academic detailing
    • Peer group discussions with scenarios and/or data

NPS: For students

  • Curriculum for medical students & early post- graduates
    • Web-based, problem-based learning modules for Australian students & postgraduates
  • Pharmacy and nursing schools

NPS: For consumers

‘awareness and attitudes’

  • National advertising campaigns
    • Newspaper & Magazine articles
    • Radio interviews, talk back
    • Television news items and information pieces
    • Distributed via health professionals, websites, community groups, local government
  • Senior Peer Educators
  • Culturally and linguistically diverse communities
  • Aboriginal & Torres Strait Islanders

NPS Radar

  • Information on New medicines, changes to PBS listings. *Commentaries on what new clinical research means.
  • Explains why a medicine has a particular PBS listing.
  • RADAR Incorporated into prescribing software.

QUM in Practice (acknowledgement: Tony Wade)

  • Ted aged 54: along- term smoker, overweight and sedentary.
  • Visits his pharmacy and asks the pharmacy assistant for some “decent pain relief” for headache.
  • Referred to the pharmacist.
  • Ted describes bad, throbbing headaches on exertion daily? “too many smokes” or after “too much red wine”. Panadeine, is “not strong enough”.

QUM in Practice

  • Pharmacist finds BP 170/110. Recommends GP review ASAP. Paracetamol stat.
  • Ted’s GP: history of sleep apnoea, borderline LVH, elevated (F) BSL, pl.creatinine & urate. ECG: old inferior infarct. Given his age, family history and multiple issues, recommends review by a local General Physician.
  • GP recommends Ted stop smoking (and the local pharmacist to help), decrease his salt & calorie intake and regularly exercise and return in 1 week for BP check and follow-up.
  • The Physician reinforces the importance of controlling BP and the lifestyle measures proposed. He also recommends an ACE inhibitor & the accompanying CMI, highlighting key ADRs to watch out for.
    • ACEI: Cough
  • Very powerful if everyone says the same thing

QUM in Practice: Ted

  • Ted notes the GP suggested the Pharmacist could assist with “getting him off the smokes”
  • After a discussion to assess Ted’s readiness to quit, the pharmacist offers Ted a nicotine replacement therapy program with regular monitoring and support.
  • He provides a CMI for the ACE inhibitor, which Ted recalls was recommended by the GP and Physician and emphasises the importance of maintaining this therapy and regular monitoring of blood pressure.
  • Ted successfully stops smoking and has taken up a daily

walk with his wife. He credits the pharmacy, GP & Physician with having “given me a lot more years”.

Areas where QUM strategies can be applied: illustrated by Ted

  • Working in partnership – Involvement of all health care providers, carers, family and social supports to support & maintain behaviour change.
  • Effective patient engagement – Consistent messages from health professionals based on good communication and access to evidence-based guidelines.
  • Choice of intervention –Health professionals need to be familiar with behaviour change models.
  • Adherence –critical.
  • Safety - includes the use of
  • Access – Factors that may inhibit people from undertaking desirable health behaviours, eg financial, cultural or cognitive need to be considered.
  • Targeting - Part of preventive strategies & requires an understanding of risk and the impact of multiple risk factors.