Title: Quality Use of Medicines Australian Experience
1Quality 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)
2External Vision of a Global Strategy to Improve
Drug Use
- Can the Australian vision and direction help
Quebec?
3Summary
- 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
4Australias 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
5Coming 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
6Quality, 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
7Timely 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
8Pharmaceutical 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
9Responsible, 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/
10More 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/)
11Quality 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
12What 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
13The Original Vision for QUM (1992)
14This has developed .
- From research and development into
implementation, service and evaluation - All partners have progressed
15Building 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
16Awareness
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
17Quality 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
19Manual 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
20Medication 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.
21Home 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
22HMR 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.
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25HMRs
- Currently can evaluate process and impact
indicators - Yet to describe good outcome indicators
- May be feasible with MediConnect/ HealthConnect
26www.mediconnect.gov.au
27Why 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
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29Data 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
30www.nps.org.au
31www.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)
32National 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
33NPS Interventions - examples
- Website (nps.org.au) freely available
information - Newsletters
- Prescriber feedback (educational)
- Academic detailing (educational visiting)
- Clinical audit
- Case scenarios
- Peer group meetings ..
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35www.australianprescriber.com
36NPS 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
37www.amh.net.au
38www.tg.com.au
39Back 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
40From NPS Evaluation report No 6 (Dec 2003)
41From NPS Evaluation report No 6 (Dec 2003)
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43From NPS Evaluation report No 6 (Dec 2003)
44From NPS Evaluation report No 6 (Dec 2003)
45Other 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)
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48Consumer 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)
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51Resources to help .. (www.nmp.health.gov.au/publi
cations.htm)
52So, 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
53Impact Indicators improving medication useRatio
of paracetamol to NSAIDs (from E.Roughead)
54Impact Indicators improving medication useRatio
of low-risk to high-risk NSAIDs (from E. Roughead)
55METFORMIN AND SULPHONYLUREAS
56Outcome indicators reducing morbidity
Hospitalization rates for peptic ulcer (from E.
Roughead)
57The quality use of medicines mapping project
58www.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)
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60National 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!!
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62Summary
- 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