Evaluating Australia‘s National Strategy for Quality Use of Medicines Results of indicator measurements 1992-2003

Quality Use of Medicines National Strategy for Quality Use of Medicines established 1992 http://www.health.gov.au/nmp/quality.htm

The Vision Partnership Awareness Enabling Maintaining Government Policy development Health professionals Government Industry Consumers Partnership Maintaining Facilitation and co-ordination Objective information and ethical promotion Healthy Consumers Education & training Services and interventions Routine data collection

The Original Vision for QUM (1992) National Facilitation & Co-ordination Objective Information Education & Training Consumer Services Provider Services Campaigns Australian National Formulary National Therapeutic Guidelines Australian Prescriber Consumer Medicines Information Consumer education for self-reliance School kits & adult learning Core curricula for providers Ethical promotion Undergraduate, postgraduate & continuing ed’n Multidisciplinary team approach Awareness Motivation Confidence Medication records Compliance aids Disposal of unwanted medicines Stimulate teamwork Academic detailing Models of practice Audit & feedback Critical appraisal of promotion General awareness Elderly Asthma Analgesics Out-of-date medication Targeted Grants for Further Development Medication review

Evaluation Indicators were developed in1993 to mirror the national strategy framework address all key strategies, all partners, all stages of learning monitor process, impact and outcome (implementation and effect) http://www.health.gov.au/nmp/publications/pharm.htm

Are there nationally recognised therapeutic guidelines? Process Indicator: Are there nationally recognised therapeutic guidelines? Therapeutic guidelines now cover ten therapeutic areas 60% general practitioners report using antibiotic guidelines http://www.tg.com.au/home/index.html

Process Indicator: Is there Consumer Medicines Information? Consumer medicines information developed for over 1900 products 60% of consumers report receiving consumer medicines information with their last new medicine http://www.health.gov.au/nmp/pdf/cmi.pdf

Process Indicator: Are medication review services available? 1998: services for aged care facilities 127,000 (85%) residents in Australia provided with the service in 2002 2001: funding for community services 1294 (~10%) pharmacists accredited, 3272 (~65%) pharmacies registered to provide the service 22,000 home visits in 2003 http://www.hic.gov.au/providers/incentives_allowances/pharmacy_agreement/about_hmr.htm

Guidelines for medication management in aged care facilities Process Indicator: Are there guidelines for medication management in aged-care facilities? Guidelines for medication management in aged care facilities 3rd edition 2003 ~40,000 distributed http://www.health.gov.au/nmp/pdf/resguide.pdf

Process Indicator: Is there a medication disposal service? Return Unwanted Medicines, established 1998 250 tonnes of medication collected in 2003 http://www.returnmed.com.au

Process Indicator: Is there Quality Use of Medicines education for health professionals? National Prescribing Service Newsletters & prescribing feedback over 20,000 GPs Locally based-facilitators Academic detailing, Clinical audits, Case studies, over 50% of GPs participating http://www.nps.org.au/

Impact indicators: Percent of consumers asking questions of their doctor when prescribed a new medicine

Impact indicator: changes in medication use Ratio of inhaled corticosteroids to short acting bronchodilators for asthma

Outcome indicators: changes in hospitalisation rates Hospitalisation rates for asthma

Where are we up to?

Partnership Awareness Enabling Maintaining Healthy Consumers National Health Policy National Medicines Policy Federal, State & Territory QUM Policies Integrated & consistent 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 National Prescribing Service Partnership QUM Curricula ( all groups) Complementary Health Care Information technology Other health policies Media Private health industry ADR reporting (HP’s & 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 National Data set

Lessons learned Useful for identifying successes and gaps in implementation & informing strategic action plans Articulation of essential activities in the policy document & in manual of indicators has led to prioritisation Continuous feedback through a number of different channels and in a number of different formats has been essential