- 1 ￼￼￼￼￼￼￼￼￼￼￼Origins of National Medicines Policy & Quality Use of Medicines in Australia
- 2 The concerns that lead to National Medicines Policy & QUM
- 3 National Medicines Policy
- 4 What is quality use of medicines
- 5 Quality Use of Medicines Goal
- 6 How do we achieve QUM?
- 7 Complementary therapy
- 8 Quality use of medicines legal strategy
- 9 Informative products
- 10 National prescribing service limited
- 11 NPS:For health professionals
- 12 NPS: For students
- 13 ￼￼￼￼￼NPS: For consumers
- 14 NPS Radar
- 15 QUM in Practice (acknowledgement: Tony Wade)
- 16 QUM in Practice
- 17 QUM in Practice: Ted
- 18 Areas where QUM strategies can be applied: illustrated by Ted
￼￼￼￼￼￼￼￼￼￼￼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.
Examples of overuse
- Benzodiazepenes: fractures, tolerance, hypnotic/drowsy
- Opioids: tolerance; adverse effects
- Antidepressants: disease mongering (SSRIs)
- Antibiotics - resistance
Examples of underuse
- Blood pressure medication (half are untreated, half of those treated are undertreated)
- Insulin with diabetes
- 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)
- Medicines of high quality safety and efficacy (TGA is the regulatory body for this)
- Quality use of medicines (basis of today's talk)
- Equitable access to necessary medicines (Pharmaceutical Benefit Scheme) - drugs we need at a price we can afford
- 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?
- Change behaviour
- Eg. appreciate that not everyone is adherent
- 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
- 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
- Using consumer medicine information effectively
- Therapeutic guidelines - respiratory
- Australian prescriber
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
- 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.