Antibiotic Resistance and Medicinal Drug Policy
Dr. Ken Harvey
School of Public Health, La Trobe University, Melbourne, Australia
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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
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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
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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)
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Scaling up: Australian National Drug Policy
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Goals of medicinal drug policy
• High quality products, introduced in a timely manner • Equity of access • Viable pharmaceutical industry • Quality of drug use
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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
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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
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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
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QUM: Objective information
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Change strategies
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http://www.qum.health. gov.au
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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
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QUM indicators: Impact
Antibiotics, community use
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DDDs/1000 population/day
25 20 15 10 5 0
1990
1991
1992
1993
1994
1995
1996
1997
1998
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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
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Internet: a source of excellent information
http://www.healthsci.tufts.edu/ APUA/apua.html
http://www.who.int/medicines/edl.html http://www.who.int/gtb/publications/ dritw/download.html
http://www.australianprescriber.com/
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Australia: incentives for computerization
Activity Annual payment per full-time GP
Agreement, in principle, to $3000 ($3500 in 1999-2000 provide data to the National only) Insurance Commission Use of prescribing software $2000 ($4000 in 1999-2000 for the majority of scripts only)
Capacity to send and receive data, via modem and e-mail account $2000 ($2500 in 19992000 only)
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QUMIT: Decision support
Patient problem
Physician patient decision Software checks databases, suggest action
Therapeutic Guidelines
Drug information
Drug-drug interaction
Script, EAN, DUE CMI, etc.
ADRAC
e-Patient record
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Challenges: E-conversion
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Challenges: E-Integration
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Map clinical problem to a coded data dictionary (ICPC2)
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Map to PBS options
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The Internet: Connecting everyone
Regulator Patient
Patient information Doctor’s records Pharmacist’s records
Therapeutic Information providers
Prescriber
Funders
Dispenser
Software vendors
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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.
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In short: to contain antibiotic resistance
Old dogs need to learn new tricks
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References: on the Internet
• WHO Report Overcoming Microbial Resistance: http://www.who.int/multimedia/antibiotic_res/index.html • Australian Medicines Policy 2000: http://www.health.gov.au/haf/docs/nmp2000.htm • Australian Quality Use of Medicines Site: http://www.qum.health.gov.au/ • Australian Therapeutic Guidelines: http://www.tg.com.au/ • Australian prescribing decision support project: http://wwwsph.health.latrobe.edu.au/telehealth/industry.htm#Electronic • Australian and International Medicinal Drug Resources: http://www-sph.health.latrobe.edu.au/Resources/druginfo.htm • Australian HealthConnect Project: http://www.health.gov.au/healthonline/welcome.htm
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