Transcript Antibiotic resistance and medicinal drug policy

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
DDDs/1000 population/day
30
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
Therapeutic
Guidelines
Drug information
Physician
patient
decision
Software
checks
databases,
suggest
action
Script,
EAN,
DUE
CMI,
etc.
Drug-drug interaction
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
Therapeutic
Information
providers
Prescriber
Funders
Dispenser
Software
vendors
Patient
information
Doctor’s
records
Pharmacist’s
records
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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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