National Medicines Policy: Who Is Making The Decisions

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National Medicines PolicyWho Is Making The
Decisions?
Chair Shane Carney
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The Perspective Of Pharmaceutical Health
Rational Use Of Medicines Committee

• Richard Day

Chair Shane Carney
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National Medicines Policy Who is making the
Decisions?

• Ric Day
• Chairman Pharmaceutical Health Rational Use of
  Medicines Committee
• PHARM

Acknowledgements Drs E.Roughead, A.Gilbert
PHARM committee
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Australias National Medicines Policy 2000

• To meet medication and related service needs, so
  that both optimal health outcomes and economic
  objectives are achieved

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National Medicines Policy
Equitable access to necessary medicines
Quality use of medicines QUM
Medicines of high quality safety and efficacy
A viable responsible local pharmaceutical
industry
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What is QUM?

• When medicines are the right option, use them
  wisely and safely

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The Core NMP QUM organisations

• APAC
• Representative Committee
• Oversees National Medicines Policy
• PHARM
• Expert Advisory Committee
• Oversees QUM component of NMP
• National Prescribing Service (NPS)
• QUM implementation
• PBAC
• Advises on PBS listings

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NMP QUM Partners
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Co-ordination of the NMP

• Australian Pharmaceutical Advisory Council
• A national representative council
• consists of 23 member organisations representing
  health professionals, consumers, industry, media,
  indigenous peoples, government

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PHARM Committee

• Reports to Minister for Health Ageing
• Advises the Minister Dept. on how to achieve
  Quality Use of Medicines (QUM) within the
  National Medicines Policy

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Definition of QUM

• Judicious selection of treatment options,
  including the choice between drug, non-drug and
  no treatment.
• Appropriate choice, when medication is required,
  within and across drug categories
• Safe and efficacious use

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Statement on the Quality Use of Medicines

• Auspiced by PHARM in early 90s in response to
  data on medicines indicating
• Over, under inappropriate use,
• Adverse health consequences
• Consistent pressure from consumers
• Recognition of need for fresh approach by
  government, researchers practitioners.
• Updated 2002 with partners

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Residential aged-care data

• Between 50-80 of residents in RACs are long-term
  users of benzodiazepines. (Gilbert et al 1995)
• 30 of people referred to an aged-care assessment
  team improved significantly when all medication
  were ceased
• (Henschke P Popplewell 1990)
• Quality Use of Medicines and Pharmacy Research
  Centre
• University of South Australia

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Quality Use of Medicines

• National Strategy for Quality Use of Medicines
• http//www.qum.health.gov.au

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Australias Statement on the Quality Use of
Medicines

• Aim
• Better health through better use of medicines
• Hypothesis
• QUM can be achieved through a multi-level,
  multi-strategic, systems-based approach engaging
  all stakeholders as active partners.

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The PHARM approach

• Recognise the need and gather ideas
• Gather evidence of what works through funded
  projects
• Move from successful projects to national
  implementation
• Monitor and evaluate outcome

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Awareness
The Vision
Enabling
National policy development
Maintaining
National facilitation and co-ordination
Government
Objective information and ethical promotion
Health professionals
Partnership
Healthy Consumers
Industry
Education training
Services and interventions
Consumers
Routine data collection , research evaluation
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How do we achieve QUM?

• Change behaviour
• Develop partnerships

• Use a multi-strategic, multi-level, systems
  approach
• Involve all groups who influence QUM
• Include all stages of learning
• Include all relevant settings

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Indicators for QUM

• Indicators were developed to mirror the national
  strategy framework
• Indicators address all key strategies, all
  partners, all stages of learning

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Evidence Based Medication Management services in
aged care facilities

• QUM Research - Optimise the quality of drug use
  in the elderly in long term care facilities in
  Australia Roberts et al, 1993
• Development of APAC guideline - Integrated best
  practice model for medication management in
  residential aged care facilities 1997
• Accreditation standards - Standards for Aged
  Care facilities in Australia
• QUM Research - Medication management in hostels
  Roberts et al, 1998
• QUM Research - three projects funded to
  investigate the barriers to implementing the APAC
  guidelines across aged care facilities

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• Guidelines and Standards to assist implementation
• Integrated best practice model for medication
  management in residential aged-care facilities
• 1st edition 1997
• 2nd edition 2000
• Standards for aged-care facilities in Australia
• 1998.

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Medication Management services in aged care
facilities

• Outcomes
• cost savings
• national practice standards
• model practices
• health care teams

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Evidence into Policy APAC Continuity of Care
Guidelines

• QUM research
• Results and recommendations to APAC about what
  works
• APAC guidelines disseminated
• Informs standards, accreditation, credentialling
  etc

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Developing Academic Detailing Services

• Evidence via QUM funded research
• NSAIDs prescribing safety
• Allopurinol dosing for efficacy and safety
• DATIS Program, SA, subsequently funded by GP
  Branch
• TREND programme in General Practice
• National Prescribing Service - Prescribing
  Intervention and Feedback Program
• Analysis of Academic Detailing Programmes
• Outcomes
• DATIS shows reduction in NSAIDs links to
  reduction in admissions for GI bleeding
• National Prescribing Service funds programs for
  Divisions
• Cost savings proven along with improved adherence
  to guidelines

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Process indicatorsQUM resources in Australia
2002

• National formulary, the Australian Medicines
  Handbook, is now published annually
• First published 1998
• Distribution 8000

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Process indicatorsQUM resources in Australia
2002

• Consumer medicines information developed
• for over 900 products
• 60 of consumers report receiving consumer
  medicines information with their last new medicine

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Impact Indicators improving medication useRatio
of inhaled corticosteroids to inhaled
bronchodilators
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• National Health Policy
• National Medicines Policy
• National Medicines Disposal Policy
• Federal, State Territory QUM Policies
• Integrated consistent

Process Indicators
Awareness
Enabling
Maintaining
Medication Review funds

• Co-ordination, facilitation mechanism
• Funding evaluation process
• Dialogue collaboration
• All involved endorsed

• Therapeutic Guidelines
• National Therapeutics Bulletin
• National Formulary
• CMI
• Codes of Conduct

Healthy Consumers
Partnership
NPS
Mediconnect?

• QUM Curricula ( all groups)

Information technology?

• ADR reporting (HPs consumers)
• Medication management aids (funded)
• Discharge planning standards
• Medication review services
• Medication disposal services
• Drug utilisation feed back
• Campaigns
• National Media Liaison Strategy
• Drug use audits

Complementary Health Care?
Media?
Consumer education initiative?
Other health policies?

• National Data set

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Where to look for help!
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Conclusions

• PHARM is a small, expert committee that
  oversights our national effort to achieve QUM
• PHARM advises government and key stakeholders
  about evidence based, effective initiatives to
  achieve QUM
• PHARM works synergistically with APAC, NPS PBAC
  in the interests of the National Medicines Policy
  QUM.
• PHARM promotes the investigation of innovative
  approaches to achieving QUM and the
  implementation of effective programmes
• Currently focussed on ensuring National Health
  priorities incorporate QUM principles and access
  QUM resources and networks