Better Medication Management System Bill 2001

Better Medication Management System Bill

Council on the Ageing (Australia)

Submission to the

Department of Health and Aged Care

Better Medication Management System Bill 2001

Council on the Ageing (Australia)
Level 2, 3 Bowen Crescent
Melbourne Victoria 3004

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

July 2001

Introduction

Council on the Ageing supports the need for an electronic medicines record that includes prescription, over-the-counter and complementary medicines. Council on the Ageing (COTA) also supports the principle of older people's access to their medicines record as a means of ensuring that they have all the information about their current medicines when needed for example, at admission to hospital. COTA also supports the extension of the system as soon as practical to hospitals and to residential aged care.

Older people are higher users of medicines than other population groups due

to higher rates of chronic illness. They are at greater risk of adverse drug events as they are more likely to be taking multiple medicines. Changes in physiology and social and physical circumstances also contribute to the risk of adverse drug events. In addition, older people are more likely to experience poor vision, hearing and memory loss and have altered metabolic rates. (National Prescribing Service News 2000)

An electronic medication record that includes prescription, over the counter and complementary medicines could be a very helpful and practical way for older people prescribed a number of medicines to keep track of all the medicines they are taking. The BMMS will also record any allergies, adverse drug reactions and drug interactions. This will enable more information to be available to older people and their GPs, specialists and pharmacists and assist at admission to hospital or residential aged care. An up to date electronic record (with the informed consent of the older person) could also assist with the implementation of regular medication reviews and enable better medication management by service providers in Community Care.

However, COTA also supports the strongest possible privacy protection to individual medicines records as outlined in the BMMS Bill. COTA also supports each individuals right to be fully informed about the BMMS and for the implementation of an " informed consent process" as a fundamental principle underpinning participation in the system. The sense of control over personal health information is particularly important for vulnerable older people and their carers who in many respects may be experiencing a loss of control in many areas of their lives. Older people should be in control of their record and the BMMS needs to be a system to enable active participation rather than passive participation by consumers. BMMS information to consumers should also encourage the quality use of medicines through active discussions with their doctor and their pharmacist about their medicines.

Council on the Ageing supports the Object of the Act which states

The primary object of this Act is to improve levels of access to medication information for participating doctors and participating suppliers through the establishment and maintenance of an electronic record that will contain the medications histories of participating consumers. It is intended that improving levels of access to medication information will assist in reducing adverse drug reactions outcomes/events) and interactions and hospitalisations.

COTA can also see the logic in pilot testing the BMMS to ensure processes are in place which enable older people as well as doctors and pharmacists to participate in the system with confidence.

Specific Issues to be addressed in this submission include informed consent, BMMS agents, BMMS participation information, suppression of record, copy of consumers medication record, complaints and extension of the system to hospitals and residential aged care.

Part 3: Participation in the System

Sections 19 & 20

Division 2 Approved Forms

Whilst agreeing that information about the BMMS be provided at the time of applying to the BMMS, it could be an accompanying document or brochure as used by some health funds and insurance companies. Information on the rights and responsibilities of a participant in the BMMS as an easy to read brochure attachment to the application form would also be very helpful.

The actual application form to register for the BMMS should be streamlined so that older people are not overwhelmed by a mountain of paperwork. A complex application form would not be helpful to older people and would act as a barrier to applying. Too much information on one form is almost as bad as not enough. The participant should be able to retain the information.

Unless the BMMS application process is widely advertised to the public, people may be slow to apply. The BMMS could be advertised in the general media including television and radio. Participation information could also be targeted to those on multiple medicines through advertising in the older peoples press and on ethnic radio.

Education programs about the BMMS should include working with consumer organisations such as COTA to educate their members about the possible advantages of applying to participate, that they may abstain from participation and that they are free to withdraw their consent to participate in the BMMS at any time. This strategy would also be helpful to people from non english speaking backgrounds. However, COTA recognises that participation in the BMMS by older people is very much dependent on GPs and pharmacists also participating in the system. Consequently, the success of the BMMS and the numbers of people opting in very much depends on the numbers of GP's and pharmacists also opting–in.

COTA recommends that a range of mechanisms be available to enable participation in BMMS in addition to registering with Doctors and Pharmacists.

COTA recommends that the BMMS be trialed by piloting to test among other things "informed consent " processes, access to a paper copy of the BMMS record, nomination of agents, training of participants in privacy protections, application forms and registration processes.

Part 4 Information on the record

Division 4. Board may amend record.

29.(3) Amendments of participation information

This section is too cumbersome as it stands for many older people. If there is an error in the record, writing to the BMMS to have it corrected is not very practical. If there is a simple error in the persons address for example, the participating doctor or pharmacist should be able to change it using authentication with the consent of the consumer.

Part 4: Division 6 BMMS suppression of medication information

Section 32 & 33

Whilst privacy is a very important issue for consumers, there may be instances in relation to some medicines where it would not be in the interests of the health outcomes of the individual consumer to suppress specific medications. It would be advisable for the doctor to discuss and counsel their patient about the likely implications and health impact of suppressing a medicine. If the consumer still chooses to suppress certain medicines after they have been given all the facts in regard to the implications for their health then that is their choice. Paragraph 33 (3) (a) and (b) (i) a pharmacist may be asked to suppress a medication during a dispensing event. It should be clear that only the prescriber can do this in the first instance.

Part 5: Division 1 BMMS Consent

Section 36,39,41,42

It is important that all consumers have a full understanding of the object of the BMMS and of how it will work for them before giving their "informed consent" to participate in the BMMS. The right to privacy and consent are essential elements to the trust and integrity of the doctor–patient relationship. Personal health information is highly sensitive and is often collected in circumstances of vulnerability and trust.

Consequently a major aspect of consumer education about the BMMS should address full information about the operation of the BMMS to all consumers and particularly to those vulnerable consumers, frail older people on multiple medicines, who are major users of health services. Older people should also be informed about the privacy safe guards that the BMMS will put in place to ensure that their personal medicines information is secure and confidential. They should also be fully informed of their rights and responsibilities as participating consumers including the possible uses of their information for research and their right to withdraw their consent. Once people have given their "informed consent" in writing for the recording of their medicines on the BMMS, the system should work smoothly and efficiently.

Currently, there are three types of consent: specific consent, standing consent and general consent. Older people who opt into the system need simplicity, clarity and certainty about what they are opting into. They may need assistance with choosing an ongoing consent process to make their interactions with their doctor and pharmacist straight forward, simple and clear such as oral consent.

Part 5: Division 7 BMMS Agents

Section 45

The concept of full and partial agents may need to be broadened to include the organisation that is acting for the person. For example, where there are groups of intellectually disabled people living in a community house, the local Home and Community Care or Community Aged Care organisation may be acting on behalf of some people These organisations need to be considered for inclusion in the term full or partial agent.

Actions of a BMMS Agent 47 requires clarification as currently the language used is vague.

Section 49 Revocation or change in agency of BMMS agent

The process of changing an agent solely by a formal letter may be too lengthy. In terms of privacy, it may also be acceptable for the person who appointed the agent to notify the BMMS Board of a change of agent through the local Medicare office or a telephone call to the BMMS using authentication such as a Pin number held by the consumer. For example, telephone banking and telephone payment of bills.

Part 9

Section 105 Obligation to provide copy of participating consumers medication record
Access to the Record by the consumer

"The purpose of the collection of personal health information is to benefit the person who confides or permits the information to be collected for a therapeutic purpose and to enhance the persons continuing care. " Proposed World Medical Association Statement on the Ethical Considerations Regarding Health Databases. May 2001

Consequently, COTA strongly supports access to the record and the option of a print out of the record four times per year " free of charge " . The majority of older people are on low fixed incomes, so payment for the record would be a barrier to access their record and an added financial burden. Access to the record is also a fundamental principle to the participation of older people in this system.

A hand held medicines record is particularly useful for older people prescribed multiple medicines as an aid in the appropriate use of their medicines. It would also greatly assist their GP at admission to hospital as all the information could relayed by the consumer at admission to hospital.

Design of the actual "paper record" needs to ensure that it is easy to read and understand. The record should provide information to the consumer which is in plain English as far as possible and complete.

In the future it may be possible for consumers to be able to access their record electronically through the Health Insurance Commission.

PART 10: Complaints and investigations

A complaints process developed for the BMMS needs to be linked with counselling and training of all the participants, doctors, pharmacists and consumers so that the process is linked into Quality Assurance. In particular all groups using the BMMS consumers, doctors and pharmacists need to be educated about their rights and responsibilities in relation to the Information Privacy Principles and the National Privacy Principles as well as the privacy safeguards embedded in the BMMS Exposure Draft. An education campaign for health professionals and consumers around the Privacy safe guards could be an effective mechanism for preventing breaches of the privacy principles and reduce the number of complaints in relation to breaches of privacy.

Hospital Participation

Hospital participation in the BMMS should be pursued as a priority. Many older people in country areas in Queensland obtain all of their medication from the local hospital. In urban areas, there may also be duplication of medications when older people are discharged from hospital. The patients GP and pharmacist need to be fully informed of any new medicines or changes in medicines, such as dose, that occurred while in hospital. In turn, the hospital needs to know what medicines people have taken when they are admitted to hospital to check that there have been no adverse drug reactions or interactions. The extension of the BMMS to hospitals and residential aged care would assist with the implementation of the quality use of medicines and best practice in relation to the use of medicines in hospitals and residential aged care.

Conclusion

With the qualifications and refinements to the proposed BMMS legislation as suggested in this submission, COTA generally supports its intent and purpose and sees it as a useful means of tracking medication usage amongst older people for their benefit.

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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
www.cota.org.au