Quality use of medicines strategy - review

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Submission

to the Commonwealth of Australia

Department of Health and Aged Care

on the

External Review of Consumer Outcomes

of the

Quality Use of Medicines (QUM) Strategy in Australia

Prepared by:

Council on the Ageing (Australia)

Level 2, 3 Bowen Crescent, Melbourne VIC 3004

Phone: (03) 9820 2655
Fax: (03) 9820 9886
Email: cota@cota.org.au
www:cota.org.au

October 2000

*****

• Review of Quality Use of Medicines (QUM) Consumer Activities to date

Council on the Ageing (COTA) has conducted a substantial body of work in educational projects for older people on the wise use of medicines. These projects were developed out of COTA's early policy work in relation to Polypharmacy. In 1990, COTA established a large group titled the National Polypharmacy Taskforce to address the issues in relation to older people's use of multiple medicines.

The National Pharmacy Taskforce brought together key health professionals, service providers, older people and their advocates, drug manufacturers, researchers and state and federal government offices for the aged to address the issues and work towards strategies for change regarding medication and older people. The Taskforce worked on five major areas and formulated recommendations around the need for a national drug policy in Australia:

1. Consumer Information
2. Appropriate Packaging, Labeling and Languages
3. Education and Training
4. Research
5. Monitoring and Evaluation

Many of the recommendations of this Taskforce have been taken up through both the Australian Pharmaceutical Advisory Council (APAC) and the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee.

Other successful national projects delivering educational messages to older people at the local level run by COTA's National and State based networks are:

• Be wise with Medicines - National Medicines Week (NMW) 1996
• Being in Control: Older People and their Medicines - Council on the Ageing and The Pharmacy Guild. 2000

Both the above projects are based on a train-the-trainer, peer education model centred on the learning needs of older people about medicines. The peer education approach is particularly effective for passing on valuable knowledge about wise use of medicines to older people. Older people are trained in effective communication skills including the questions to ask a doctor or pharmacist about medicine.

These older peer educators then pass on their knowledge and skills to other older people in their local communities through peer education sessions conducted in older person's organisations.

The current project Being in Control: Older People and their medicines has included a member of the Pharmacy Guild in each State and Territory who has been able to discuss consumer the level of QUM information and medication management assistance that can be provided at a local community pharmacy level. Through its extensive network of members, the Pharmacy Guild has linked its community pharmacists with the COTA Peer Educators to support and promote the project. In this regard, the Pharmacy Guild of Australia has been an enthusiastic partner with COTA in this project and has actively engaged its members in the project at a local community level.

The Being in Control: Older People and their medicines project is being carried out in all States and Territories throughout 2000. Over 100 older people have been trained by State Coordinators who work on the staff of Council on the Ageing. It is expected that over 10,000 older people will be reached through this project. The key messages they are passing on to older people are:

• to ASK your pharmacists or doctor about your medicines
• be WISE with medicines, and
• to MANAGE your medicines – don't let them manage you.

Much of the training and activity in relation to The Wise Use of Medicines is done by older volunteers who display a great enthusiasm for the promotion of wise use of medicines. The networks of these older volunteers are extensive in their local communities and include service organisations, church groups, older women's groups, senior citizens clubs, self-help groups and Veterans groups. COTA' s experience has been that older people show great interest in self-management of health and the peer education model has been widely embraced by older people.

Following a formal presentation made in 1997 to the Board of Directors of COTA (A) by representatives of the Alice SpringsTangentyere Aboriginal Council on the plight of indigenous health, COTA applied and secured Pharmaceutical Education Program (PEP) funding for an QUM project for indigenous Australians.

The Commonwealth subsequently approved COTA's request to assign the contract and project management to the Tangentyere Council who produced a video on the Wise Use of Medicines. The video has been widely distributed to indigenous health services and screened in rural and remote community health centres. A training manual was also produced for the Councils Home and Older Peoples Service (HACC) workers. Further work is currently being progressed by the Alice Springs HACC Service to develop a 13 week accredited training module on QUM for HACC workers.

COTA has promoted the Tangentyere Council project through it's various publications, particularly the Australasian Journal on Ageing, and has used the education video in the current Being in Control:Older People and the Medicines project for rural and remote areas of Queensland.

• Assess the effectiveness of these approaches in introducing behavioral change against international best practice models.

A formal evaluation of the 1996 Be Wise With Medicines project found the project to be value for money given the large numbers of older people who participated in the activities (National Medicines Week Evaluation 1996) The current project was submitted to PHARM for funding through the Pharmaceutical Education budget, but it was passed onto the Office for the Aged who funded it for twelve months as part of the International Year of Older People (IYOP). COTA sought an external evaluation of the project through the Commonwealth Department of Health and Aged Care but funding was not available. COTA will be conducting its own internal evaluation of the project.

• Advise on achievements and areas for improvement

1. Achievements

• COTA believes the early work of the National Polypharmacy Taskforce was instrumental in focusing attention on the medication management issues for older people.

• The current QUM Peer Education Project Being in Control: Older People and their Medicine has been greatly enhanced by the successful business & community partnership of the Council on the Ageing and the Pharmacy Guild of Australia.

• It is COTA's experience that the use of older people's networks and the engagement of older volunteers as educators is a highly effective method of directly reaching a large number of older people who would not normally receive QUM information through other channels.

2. Areas for improvement

At the end of this year, the Being in Control: Older People and their Medicine project will be without funding unless some ongoing funding is found. Some funding through the Pharmaceutical Education Budget would be appropriate, as this approach to improving the knowledge and skills of older people about medicines has been shown to work effectively. Projects such as this, and the likes of the Australian Pensioners' and Superannuants' Federation, Medicines Information Persons (MIPS) need ongoing support so those messages are reinforced into the community on an ongoing basis.

• Projects that are modeled on a business & community partnership should be encouraged and given favorable consideration for Pharmaceutical Education funding.

• All material and consumer information published on QUM should be available in LOTE and on the Web. Consultation with target groups should occur prior to publication of consumer information.

• More media publicity is recommended for events such as National Medicines Week so that a major community focus is generated.

• Successful consumer messages that was an integral part of the 1996 National Medicines Week i.e., the appropriate use of antibiotics should be reinforced on a cyclical basis (say every 3 to 5 years) so that the change in consumer behavior is maintained.

• Increased consumer education at a grassroots level for Government initiatives such as the Enhanced Primary Care Packages.

• Increased funding for consumer education projects in rural and remote areas. COTA's experience of the Being in Control : Older People and their Medicines project is that regional areas have lobbied to have the project conducted in their areas, and have been critical of the previous lack of funding for programs in regional areas.

• The introduction of specific education programs targeted at health professionals to highlight the side effects to older peoples health caused by the misuse and over-use of benzodiazepines in residential care facilitates.

• Identify a range of areas for increasing the effectiveness of the consumer component of the QUM Strategy

• COTA has benefited greatly from its involvement with the National Prescribing Service, which has worked very effectively as a communication channel on QUM implementation. COTA believes the work of the NPS should be made available to all community and health organisations.

• Publications such as the Department's "MediScene" are a valuable resource should be made as widely available as possible.

• Quality use of Medicines materials such as the Be Wise with Medicines…the facts (March 2000). brouchure produced by PHARM should be available for distribution to consumers by GPs, pharmacies and local community health centres.

• Standardization of labelling and consumer warnings should be introduced to all pharmaceutical products.

• Continued education to encourage consumers of all ages to develop an active dialogue with their GP and Pharmacist about their medications.

• Continued funding for programs that encourage and highlight the need for consumers to dispose of out-of-date and unwanted pharmaceuticals.

• Recommend priorities and a strategy for the next five years for Australian QUM activities

• COTA believes that projects that have proven to be successful should have a longer funding period (say 2-3) years so that the impact of the project is continued and reinforced throughout the community.

• Projects that are business/community partnerships and those that engage the Divisions of GP's should be encouraged.

• Events such as National Medicines Week should be developed into major community campaigns.

• Funding should be available for all projects to be evaluated.

• Specific education and outreach programs and targets should be set and measured for high-risk groups.

Of concern to the Council on the Ageing is the increasing level of direct-to-consumer advertising of prescription medication in Australia. We believe the eventual outcome of direct to consumer advertising of prescription medications is increased drug use rather than effective or rational use, and results in increased costs to Australian health care systems. Such advertising tends to promote the use of drugs over alternatives such as lifestyle changes and non-drug therapies, and does not necessarily provide balanced consumer information.

COTA believes that all direct-to-consumer pharmaceutical advertisements should be regulated to include a warning for consumers to consult with their GPs or pharmacists about all pharmaceuticals including over-the-counter medications.

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Copyright © 2000 Council on the Ageing. All rights reserved.
Date: 11 January 2001
Revised: 30 October 2001

Council on the Ageing (Australia)
Level 2, 3 Bowen Crescent, Melbourne Vic 3004
Tel (03) 9820 2655 Fax (03) 9820 9886
email cota@cota.org.au