Antibiotic Resistance and Medicinal Drug Policy

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

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

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

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 JAust 1983; 2:217-221 (but only when guidelines were augmented by drug audit, practitioner reflection and specific change strategies)

Scaling up: Australian National Drug Policy

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

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

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

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

QUM: Objective information

Change strategies 11

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

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 QUM Policy: Evaluation

QUM indicators: Impact

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

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

Activity Annual payment per full-time GP 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 $3000 ($3500 in 1999-2000 only) $2000 ($4000 in 1999-2000 only) $2000 ($2500 in 1999-2000 only) Australia: incentives for computerization

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

Challenges: E-conversion

Challenges: E-Integration

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

Map to PBS options 22

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

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.

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

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://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 • Australian HealthConnect Project: http://www.health.gov.au/healthonline/welcome.htm

Antibiotic Resistance and Medicinal Drug Policy