Promotion and Rational Use Workshop

Rational use: up from down under

Dr John S Dowden

Editor, Australian Prescriber

Singapore December 2010

Are regulators rational people?

Why should regulators be interested in the rational use of medicines?

What activities encourage the rational use of medicines?

WHO meeting Australia 1995

Objectives of national drug policies

•Improve health outcomes

•Equitable access

•Affordable price

•Rational use

•Quality and safety

Australian National Medicines Policy

•Quality, Safety and Efficacy

•Access to Medicines

•Quality use of medicines

•Responsible and viable medicines industry

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

Australian National Medicines Policy

•Quality Safety and Efficacy

•Access to Medicines

•Quality use of medicines

•Responsible and viable medicines industry

Quality use of medicines

Evidence of inappropriate use

Alliance of clinical pharmacologists and consumers

1992 QUM Policy

•Identified the need for national co-ordination

National Prescribing Service (NPS)

Established in 1998Independent, not-for-profit organisation Membership basedWorks in partnership

- health professionals- consumers- government- industry

NPS interventions

Academic detailingDrug informationAudit and feedbackDecision supportCase studiesPeer group discussionContinuing educationUndergraduate educationResearch

Academic detailing (educational outreach)

Face‐to‐face, one‐to‐one visits with GPs

Small groups

Trained facilitators, usually pharmacists

Specific and general messages

Drug and therapeutic information resources

Australian Prescriber

NPS RADAR

NPS News

Prescribing Practice Review

- prescribing feedback

http://www.nps.org.au/health_professionals/publications

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.

»3500 topics in 13 titles and one Management Guideline

Supporting information

Therapeutic Guidelines

Supporting information

National formulary

•Australian Medicines Handbook

• Concise drug information

• Comparisons

• Interactions

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

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

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

Common colds campaign

Consumer resources

Health professional resources

Key messages

Discourage use of antibiotics for upper respiratory tract infections

First line use of amoxycillin if an antibiotic is needed

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

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

NPS Financial impact

2009-10

Savings $A 45.9 million

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

Dr John S Dowden

31/05/2011This is the presentation name

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