1. Antibiotic Resistance and Medicinal Drug Policy Dr. Ken Harvey Dr. Ken Harvey School of Public Health, La Trobe University, Melbourne, Australia 1

2. Dr. Harvey’s visit to China was sponsored by The World Health Organization and hosted by Professor Yong-Hong Yang Beijing Children’s Hospital & Professor Li Dakui Peking Union Medical College 2

3. 3 Lecture outline Why the concern about antibiotic resistance? The history, microbiological and social determinants of antibiotic resistance Containing antibiotic resistance: microbiological surveillance, antibiotic utilization studies and other interventions One country’s response: the quality use of medicines pillar of Australian drug policy The current challenge – using information technology to further improve antibiotic use

4. 4 Therapeutic Guidelines: Evaluation Self-sufficiency was achieved (sales) So was improved prescribing –De Santis G, Harvey KJ, Howard D, et al. Improving the quality of antibiotic prescribing in general practice: the role of educational intervention. Med J Aust 1994; 160: 502-5. –Landgren FT, Harvey KJ, Mashford LM, et al. Changing antibiotic prescribing by educational marketing. Med J Aust 1988; 149 595-599. –Harvey KJ. Quality assurance of therapeutic products and practice. Med J Aust 1987; 147: 317. –Harvey KJ, Steward R, Hemming M, Moulds R. Antibiotic use in a large teaching hospital - the impact of antibiotic guidelines. Med J Aust 1983; 2:217-221 (but only when guidelines were augmented by drug audit, practitioner reflection and specific change strategies)

5. 5 Scaling up: Australian National Drug Policy

6. 6 Goals of medicinal drug policy High quality products, introduced in a timely manner Equity of access Viable pharmaceutical industry Quality of drug use

7. 7 Goal: Quality use of medicines Purpose –to improve health outcomes by optimising medicinal drug use Objectives –to improve the commitment of all players to QUM: government, health professionals, industry and consumers –to increase the partnership between them

8. 8 Quality use of medicines: Strategies Policy development and implementation National facilitation and co-ordination Objective information and ethical promotion Education and training Services and interventions Data collection

9. 9 Implementing quality use of medicines (QUM) The Pharmaceutical Education Program (and the National Prescribing Service) have funds available. Projects could include: –raising awareness of medicine use as a health issue –changing attitudes to the use of medicines –providing information to help people make informed decisions –highlight the alternatives to medicines use –monitor the good and bad effects of medicine Scholarships are also available

10. 10 QUM: Objective information

11. Change strategies 11

12. 12 http://www.qum.health. gov.au

13. 13 QUM Policy: Evaluation Report of the national indicators Evaluating the Quality Use of Medicines component of Australia’s National Medicines Policy Elizabeth E Roughead (1), Andrew L Gilbert (1), John G Primrose (2), Ken J Harvey (3), Lloyd N Sansom (1) (1) School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 5000 (2) Health Access & Financing Division, Department of Health and Aged Care, Canberra, 2601 (3) School of Public Health, La Trobe University, Bundoora, 3083

14. 14 QUM indicators: Impact

15. 15 QUM 2000: Strategy To get Guidelines, medication review and other proven QUM techniques off the library bookshelf......into day-to-day clinical decision making via health worker’s computers

16. 16 Internet: a source of excellent information http://www.who.int/medicines/edl.html http://www.who.int/gtb/publications/ dritw/download.html http://www.australianprescriber.com/ http://www.healthsci.tufts.edu/ APUA/apua.html

17. 17 Australia: incentives for computerization $3000 ($3500 in 1999-2000 only) $2000 ($4000 in 1999-2000 only) $2000 ($2500 in 1999- 2000 only) Agreement, in principle, to provide data to the National Insurance Commission Use of prescribing software for the majority of scripts Capacity to send and receive data, via modem and e-mail account Annual payment per full-time GP Activity

18. 18 QUM IT : Decision support Script, EAN, DUE CMI, etc. Physician patient decision e-Patient record Software checks databases, suggest action ADRAC Drug-drug interaction Drug information Therapeutic Guidelines Patient problem

19. 19 Challenges: E-conversion

20. 20 Challenges: E-Integration

21. Map clinical problem to a coded data dictionary (ICPC2) 21

22. Map to PBS options 22

23. 23 The Internet: Connecting everyone Regulator Therapeutic Information providers Funders Software vendors Prescriber Patient Dispenser Patient information Doctor’s records Pharmacist’s records

24. 24 Conclusions Increasing antibiotic resistance is a major threat to global public health National (and international surveillance) of resistance patterns is crucial to guide therapy; it also focuses the minds of clinicians, administrators and governments on the problem Excessive and inappropriate use of antibiotics occurs in all countries; this must be remedied at the national and local level Best-practice antibiotic guidelines coupled with drug audits, and other strategies can improve antibiotic use. The Internet and information technology holds promise for further improving prescribing in the future.

25. 25 In short: to contain antibiotic resistance Old dogs need to learn new tricks

26. 26 References: on the Internet WHO Report Overcoming Microbial Resistance: http://www.who.int/multimedia/antibiotic_res/index.html http://www.who.int/multimedia/antibiotic_res/index.html Australian Medicines Policy 2000: http://www.health.gov.au/haf/docs/nmp2000.htm http://www.health.gov.au/haf/docs/nmp2000.htm Australian Quality Use of Medicines Site: http://www.qum.health.gov.au/ http://www.qum.health.gov.au/ Australian Therapeutic Guidelines: http://www.tg.com.au/http://www.tg.com.au/ Australian prescribing decision support project: http://www- sph.health.latrobe.edu.au/telehealth/industry.htm#Electronichttp://www- sph.health.latrobe.edu.au/telehealth/industry.htm#Electronic Australian and International Medicinal Drug Resources: http://www-sph.health.latrobe.edu.au/Resources/druginfo.htm http://www-sph.health.latrobe.edu.au/Resources/druginfo.htm Australian HealthConnect Project: http://www.health.gov.au/healthonline/welcome.htm http://www.health.gov.au/healthonline/welcome.htm