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Promotion and Rational Use Workshop
Rational use: up from down under
Dr John S Dowden
Editor, Australian Prescriber
Singapore December 2010
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Are regulators rational people?
Why should regulators be interested in the rational use of medicines?
What activities encourage the rational use of medicines?
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WHO meeting Australia 1995
Objectives of national drug policies
•Improve health outcomes
•Equitable access
•Affordable price
•Rational use
•Quality and safety
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Australian National Medicines Policy
•Quality, Safety and Efficacy
•Access to Medicines
•Quality use of medicines
•Responsible and viable medicines industry
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Advertising in Australia
Therapeutic Goods Act
Prescription medicines
- cannot be advertised to the public
- co-regulation with industry
journal advertising
educational meetings
sponsorship
company representatives
relationship with health professionals
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Australian National Medicines Policy
•Quality Safety and Efficacy
•Access to Medicines
•Quality use of medicines
•Responsible and viable medicines industry
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Quality use of medicines
Evidence of inappropriate use
Alliance of clinical pharmacologists and consumers
1992 QUM Policy
•Identified the need for national co-ordination
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National Prescribing Service (NPS)
Established in 1998Independent, not-for-profit organisation Membership basedWorks in partnership
- health professionals- consumers- government- industry
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NPS interventions
Academic detailingDrug informationAudit and feedbackDecision supportCase studiesPeer group discussionContinuing educationUndergraduate educationResearch
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Academic detailing (educational outreach)
Face‐to‐face, one‐to‐one visits with GPs
Small groups
Trained facilitators, usually pharmacists
Specific and general messages
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Drug and therapeutic information resources
Australian Prescriber
NPS RADAR
NPS News
Prescribing Practice Review
- prescribing feedback
http://www.nps.org.au/health_professionals/publications
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Audit and feedback
E-audit
• Hypertension
• Proton pump inhibitors
General practitioners
• collect information about how they manage each patient by completing data collection for each patient, and submitting it to NPS
• review their current practice and implement changes in practice
• receive a feedback report including individual results, aggregate results of all participants' practices and an expert commentary on the aggregate results
• record patients' progress and identify improvements in practice
• reflect on changes in management.
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»3500 topics in 13 titles and one Management Guideline
Supporting information
Therapeutic Guidelines
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Supporting information
National formulary
•Australian Medicines Handbook
• Concise drug information
• Comparisons
• Interactions
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Web-based interactive modules
WHO Guide to Good Prescribing
Case-based topics
Diagnosis provided – focus on prescribing
Medical, pharmacy, nurse practitioner and dentistry students
National Prescribing Curriculum
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Peer education
Consumer Medicines Information
Campaigns
Publications: Medicines Update and Medicines Talk
Media interviews and press releases
Radio and television
Telephone line
Promoting quality use in the community
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Seniors program – peer education model
Working in partnership with Council on the Ageing
Run a national peer education program
Trained over 250 volunteer peer educators
Delivered 2,209 information sessions on medicines to 50,700 seniors in community
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Common colds campaign
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Consumer resources
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Health professional resources
Key messages
Discourage use of antibiotics for upper respiratory tract infections
First line use of amoxycillin if an antibiotic is needed
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All 9 URTI antibiotics - 1996 - 2007 rate of prescribing DOP O&R
0
10
20
30
40
50
60
70
80
90
Jul-9
6
Jan-
97
Jul-9
7
Jan-
98
Jul-9
8
Jan-
99
Jul-9
9
Jan-
00
Jul-0
0
Jan-
01
Jul-0
1
Jan-
02
Jul-0
2
Jan-
03
Jul-0
3
Jan-
04
Jul-0
4
Jan-
05
Jul-0
5
Jan-
06
Jul-0
6
Jan-
07
Rat
e pe
r 1,0
00 c
onsu
ltatio
ns
Source: Medicare Australia
Targeted antibiotics – prescribing rates
26
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NPS Activities 2009-10
National Medicines Symposium
Australian Prescriber, Radar and NPS News sent to 60,000 people
Six Prescribing Practice Reviews sent to 45,000 health professionals
Prescribing feedback to 20,000 GPs
Visits to 10,000 GPs (2-3 topics)
Self-audits by 4,500 GPs, 4,000 pharmacists
Case studies by 4,000 GPs, 1000 pharmacists
23,000 phone calls from the public
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NPS Financial impact
2009-10
Savings $A 45.9 million
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Conclusion
Regulators are rational people
• Rational use of medicines that are safe and effective
• Product information is vital for the rational use of medicines
• but it may not be enough
• Promotion needs regulation
• Rational use can improve health
• Rational use can save money
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Dr John S Dowden
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31/05/2011This is the presentation name
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Providing information and advice Ciclesonide
• Australian Prescriber
• Until more data are made available for scrutiny, there seems to be little justification for doctors to add ciclesonide to their choice of inhaled corticosteroids.
• Radar
• Ciclesonide is not more effective or safer than other inhaled corticosteroids
Combination analgesics
• Australian Prescriber
• current data suggest that paracetamol alone has greater efficacy than paracetamol combined with codeine at doses under 60 mg
• Radar
• the benefit of adding caffeine to paracetamol is uncertain