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Quality Use of Medicines Australian Experience

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Title: Quality Use of Medicines Australian Experience


1
Quality Use of Medicines Australian Experience
  • Quebec City, Canada
  • May 2004
  • Professor Susan Tett,
  • School of Pharmacy, University of Queensland,
    Brisbane, Australia
  • (with thanks to my PHARM colleagues for
    discussion, ideas, slides and other help!
    Especially Libby Roughead, Andy Gilbert, Tony
    Wade)

2
External Vision of a Global Strategy to Improve
Drug Use
  • Can the Australian vision and direction help
    Quebec?

3
Summary
  • Brief overview of relevant Australian medicines
    history
  • Development of Australias National Medicines
    Policy (four interlinked arms)
  • More focus on the Quality Use of Medicines
    aspects, examples of progress from research
    development through service implementation
    evaluation

4
Australias National Medicines Policy 2000
  • Quality, safety efficacy of medicines
  • Timely access, at affordable cost
  • Responsible viable industry
  • Quality use of medicines
  • www.nmp.health.gov.au/pdf/nmp2000.pdf

5
Coming together .
  • 1950 Pharmaceutical Benefits Scheme
  • to provide equitable access to medicines
  • 1958 Therapeutic Goods Administration
  • safety, quality and efficacy
  • 1988 Pharmaceutical Industry investment program
    and later versions
  • viable and responsible industry
  • 1992 Policy on the Quality use of Medicines

6
Quality, safety efficacy
  • Therapeutic Goods Administration
    www.health.gov.au/tga
  • Registration process similar to Canada, except
  • Australian Drug Evaluation Committee (ADEC)
    Adverse Drug Reaction Advisory Committee (ADRAC)
    . for prescription national expert committees

7
Timely access, at affordable cost
  • National pharmaceutical benefits scheme (PBS)
    www.health.gov.au/pbs
  • Ensures all Australian residents access to
    necessary life-saving medication at an
    affordable price
  • All covered. Two different co-payments 23.70 or
    3.80 (a safety net operates)
  • About 600 drugs covered, 1500 dosage forms,
    2,500 different brands

8
Pharmaceutical Benefits Scheme
  • Pharmaceutical Benefits Advisory Committee (PBAC)
    (1954), established by National Health Act
  • www.health.gov.au/pbs/healthpro/outcomes_full.htm
  • Make recommendations to Minister, consider
    effectiveness and cost, compare with alternative
    (including non-drug) therapies
  • Economics Sub-Committee (ESC) (1993),
    cost-effectiveness analysis
  • 4,755 million (5 billion) cost to Australian
    Government for year to end Dec 2003

9
Responsible, viable medicines industry
  • After product registration (TGA), company submits
    application for PBS listing for prescription
    products
  • PBAC evaluates and recommends
  • Pharmaceutical Benefits Pricing Authority
    negotiates price www.health.gov.au/pbs/pharm
    /med_price.htm
  • Industry incentives moved away from PBS eg. P3
    (Industry), tax incentives.
  • Pharmaceutical Industry Action Agenda
    www.industry.gov.au/assets/documents/itrinternet/P
    harmAAReport2002.pdf
  • Pharmaceuticals Partnership Program
    www.ausindustry.gov.au/

10
More on the above
  • Discussion, comparisons to Canada and some
    strengths, weaknesses and opportunities presented
    in
  • Tett SE. A perspective on Australias National
    Medicines Policy. Canadian Journal of Clinical
    Pharmacology 2004 11 e5 (1-11)
    (http//www.cjcp.ca/hm/)

11
Quality Use of Medicines
  • Australian Pharmaceutical Advisory Council (APAC)
    and Pharmaceutical Health Rational use of
    Medicines (PHARM) committee
  • APAC representation www.nmp.health.gov.au/advis
    ory/apac.htm
  • PHARM - 12 people with expertise in QUM
    (appointed by Minister) www.nmp.health.gov.au/adv
    isory/pharm.htm

12
What does QUM mean?
  • Selecting management options wisely
  • Choosing suitable medicines if a medicine is
    considered necessary
  • Using medicines safely and effectively to get the
    best possible results
  • www.nmp.health.gov.au/quality.htm Plain
    English Edition of The National Strategy for
    Quality Use of Medicines available through
    publications link

13
The Original Vision for QUM (1992)
14
This has developed .
  • From research and development into
    implementation, service and evaluation
  • All partners have progressed

15
Building blocks needed to achieve QUM
  • Policy development and implementation
  • Facilitation and coordination of QUM initiatives
  • Provision of objective information and ethical
    promotion of medicines
  • Education and training
  • Provision of services and appropriate
    interventions
  • Strategic research, evaluation and routine data
    collection

16
Awareness
The Vision
Enabling
Policy development/ implementation
Maintaining
Facilitation and co-ordination
Government
Objective information and ethical promotion
Health professionals
Partnership
Healthy Consumers
Industry
Education training
Services and interventions
Consumers
Strategic research, data collection
17
Quality use of medicines initiatives in Australia
include .
  • Medication management reviews
  • www.qummap.health.gov.au
  • National Prescribing Service activities eg.
    facilitators, clinical audits
  • National Medicines Symposium
  • MediConnect (HealthConnect)
  • QUM indicators and their measurement
  • QUM building blocks

18
QUM - a decade of research, development and
service activity www.nmp.health.gov.au/pdf/qumres
earch.pdf
19
Manual of Indicators (1994)
  • To measure the effect of initiatives under the
    Quality Use of Medicine arm of the National
    Medicinal Drug policy
  • Process indicators
  • Impact indicators
  • Outcome indicators
  • Report baseline 1992 measurement, 1998 update,
    re-measurement, where possible, 2003

20
Medication management reviews
  • Example of QUM Indicator (process)
  • Are there mechanisms to enable consumers to
    regularly have their medicines reviewed
  • 1992 No review services/ need recognized
  • 1995 studies funded in nursing homes/ community
  • 1998 Australian Government funding for aged care
    facilities
  • 2001 Australian Government funding for home
    medication review (HMR) services announced.
    Facilitators employed in GP Divisions.

21
Home Medicines Review
  • Australian Government funded program began Oct
    2001
  • Pharmacists remunerated for medication management
    reviews (HMR) for people living in community.
  • COLLABORATIVE service
  • Payment of 140 GST per service
  • Guidelines and standards, more information
  • Eg. www.hic.gov.au/providers/incentives_allowances
    /pharmacy_agreement/about_hmr.htm
  • www.guild.org.au/public/dmmrfiles/qa.adp

22
HMR how did it happen?
  • Gathering the evidence finding what works.
    Numerous projects, some funded by Australian
    Government.
  • Moving from evidence to national implementation.
    Again, funded implementation trials reduction
    in medication costs to the PBS demonstrated.
  • Outcomes Australian Government funded services
    (over 45,000 HMRs), estimated savings between
    27.6 and 51.2 million annually to the health
    system.

23
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25
HMRs
  • Currently can evaluate process and impact
    indicators
  • Yet to describe good outcome indicators
  • May be feasible with MediConnect/ HealthConnect

26
www.mediconnect.gov.au
27
Why MediConnect
  • Recognized that at least 80,000 hospital
    admissions each year in Australia are related to
    problems with medicine (eg. Roughead et al MJA
    1998 168 405-8)
  • MediConnect reduce adverse drug events and
    hospitalizations due to adverse drug events by
    improving access to more complete medication
    records

28
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29
Data that MediConnect can provide
  • Complete subsidized prescription record (PBS
    medications)
  • In time . Private prescriptions, over the
    counter and complementary medicines
  • Links to demographics (only available on a
    population basis for PBS data since 2002, no
    linking to other databases permitted)
  • reason for prescribing

30
www.nps.org.au
31
www.nps.org.au
  • National Prescribing Service an independent
    incorporated organization
  • Funded by from Australian Government, only on
    proviso of savings to the Pharmaceutical Benefits
    Scheme (initially required to save 45 million
    over 4 years achieved 49 million in first 3
    years current four-year funding of 46 million
    requires 111 million savings over 4 years)

32
National Prescribing Service
  • Mission create an awareness, culture and
    environment that will support QUM among all
    stakeholders
  • Multi-strategic approach draws on evidence in
    education, community development, social
    marketing, health promotion .. Want to achieve
    sustainable behavioral change

33
NPS Interventions - examples
  • Website (nps.org.au) freely available
    information
  • Newsletters
  • Prescriber feedback (educational)
  • Academic detailing (educational visiting)
  • Clinical audit
  • Case scenarios
  • Peer group meetings ..

34
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35
www.australianprescriber.com
36
NPS news, Australian Prescriber
  • Building block 3 for QUM provision of objective
    information
  • New drugs RADAR (Rational Assessment of Drugs
    and Research) www.npsradar.org.au

37
www.amh.net.au
38
www.tg.com.au
39
Back to NPS .
  • Regular evaluations - Examples from
    www.nps.org.au/resources/evaluation/report_06.pdf
  • Process, scope and reach of NPS
  • Changes in awareness, skills and behaviors
    towards QUM
  • Changes in prescribing behavior, changes in
    health outcomes

40
From NPS Evaluation report No 6 (Dec 2003)
41
From NPS Evaluation report No 6 (Dec 2003)
42
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43
From NPS Evaluation report No 6 (Dec 2003)
44
From NPS Evaluation report No 6 (Dec 2003)
45
Other health profession targets
  • Pharmacists self-audits (eg. NSAIDs, allergic
    rhinitis) case studies (1st national survey
    indicated that participants had greater knowledge
    about specified topics)
  • Students Curriculum and training (nurses,
    pharmacists, medical students PG1)

46
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47
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48
Consumer Medicines Information
  • In Australia, all new prescription medicines must
    have CMI in specific format as part of the
    application for registration (company prepares
    these, TGA reviews and comments, CMI Quality
    Assurance Reference Group reviews a random
    selection)

49
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51
Resources to help .. (www.nmp.health.gov.au/publi
cations.htm)
52
So, what impact are we having?
  • Not too difficult to measure process indicators
    are services set up, has implementation been
    effective etc
  • What is the impact, for example prescribing rates
    for various target drugs are also able to be
    assessed, although hard to link cause and
    effect sometimes

53
Impact Indicators improving medication useRatio
of paracetamol to NSAIDs (from E.Roughead)
54
Impact Indicators improving medication useRatio
of low-risk to high-risk NSAIDs (from E. Roughead)
55
METFORMIN AND SULPHONYLUREAS
56
Outcome indicators reducing morbidity
Hospitalization rates for peptic ulcer (from E.
Roughead)
57
The quality use of medicines mapping project
58
www.qummap.health.gov.au
  • 1135 projects entered on the map, end April 2004
  • Interactive, web-based tool
  • People add their own projects
  • QUM building blocks identified
  • Search basic and advanced
  • (Roughead, Monteith, Harvey, Tett. Evaluating
    Australias National Medicines Policy using
    geographical mapping. Internal Medicine Journal
    20023266-71)

59
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60
National Medicines Symposium
  • www.nps.org.au/nms2004
  • Wed 28th Fri 30th July, Brisbane
  • 3rd biennial symposium, run by PHARM and NPS
  • Over 190 abstracts, plenary sessions and plenty
    of discussions!! All about QUM!!

61
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62
Summary
  • Overview of some examples of QUM activities in
    Australia
  • Medication management reviews
  • www.qummap.health.gov.au
  • National Prescribing Service activities
  • National Medicines Symposium
  • MediConnect (HealthConnect)
  • QUM indicators and their measurement
  • QUM building blocks
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