MEDICINES HEALTH LITERACY

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1 MEDICINES HEALTH LITERACY Australian Disease Management Association Conference 2011 Dr Danielle Stowasser NPS Clinical Advisor & Manager Program Design

2 OVERVIEW Focus on medicines health literacy High use of medicines High cost of medicines Evidence of poor literacy and impact on health High impact on patient safety if not understood Usage modifiable by improved health literacy NPS: Medicinewise an overview Examples of work to date Outcomes of work to date Questions

3 HIGH USE OF MEDICINES 112 million general practice consultations paid for by Medicare in 3/2008-4/ Average of 5.1 GP visits per person in % (11.3 million people) had received a prescription for medication People aged 15 years and over who had visited a GP in the past 12 months 1.

4 HIGH COST OF MEDICINES 14.3% of health goods and services expenditure of $80bil in on MEDICINES ($11.4 billion) Frequent option Costly option >$ billion in PBS costs $1.309billion in patient co-contributions (co-payments) >$1.6billion hospital / state funded medicines >$1billion Complementary and alternative medicines CBFCEB2FFD713CA EABCA/$File/0212%20Summary% pdf

5 ROOM FOR IMPROVEMENT IN MEDICINES HEALTH LITERACY Common colds as an example

6 FACTORS INFLUENCING KNOWLEDGE, EXPECTATION AND BEHAVIOUR TOWARDS RTI AND ANTIBIOTIC TREATMENT Education Socioeconomic status Age Gender Parental status Societal factors The majority of studies indicate lower education and social economic status are linked with lower knowledge and a resultant higher expectation for antibiotic treatment Legitimising sick days Child care Education level

7 EDUCATION LEVEL AND CONSUMER EXPECTATIONS FOR ANTIBIOTIC TREATMENT 68 Education levels Low (9 years of basic school education) Medium (10 years of extended school education) High (12 or 13 years of extended school education, including university ) Percentage who expected to use antibiotics to treat a common cold 19.9% 12.0% 7.6%

8 PROPORTION OF AUSTRALIAN ADULTS THAT BELIEVE THAT ANTIBIOTICS ARE ALWAYS OR NEARLY ALWAYS APPROPRIATE FOR MANAGING A COLD/FLU (BY AGE GROUPS),

9 EXPECTATIONS ABOUT RECEIVING AN ANTIBIOTIC - SELF-REPORTED OUTCOMES AMONGST SYMPTOMATIC PEOPLE WHO VISITED A DOCTOR WITHIN THE LAST 12 MONTHS, Expectations about receiving an antibiotic when visited doctor with cold/flu symptoms Australian population (n=170) Female parents of children aged 2 to 5 years (n=59) % % Hoping to get an antibiotic prescription but did not ask Hoping to get and antibiotic prescription and received one** Requested an antibiotic prescription 8 6 Requested an antibiotic prescription and received one** Presented with cold/flu symptoms and received an antibiotic prescription without any prior expectations** Diagnosed with cold/flu and received prescription and was hoping for one before seeing the doctor ** Antibiotic prescription was not necessarily for diagnosis of cold/flu

10 A PILL FOR EVERY ILL? Consumer expectation for a medicine? Dealing with patient expectations for antibiotics was confirmed as being a significant challenge in NPS key informant interviews with GPs Recent studies suggest that GPs trained in enhanced patient-centered communication skills are better equipped to respond to patient expectations or perceived expectations and thereby reduce the inappropriate use of antibiotics There remains a gap in understanding of how best to allay consumer expectations around the need for antibiotics and improve their awareness of the potential harms of antibiotic resistance

11 WHAT ARE THE OPTIONS FOR GPs? Nothing Non-medical Self-management Medical Surgical Medical» Medication» Diagnostic and related therapies» Psychological» Referral» Other services

12 PHARMACOLOGICAL AND NON-PHARMACOLOGICAL FACTORS WHICH INFLUENCE GP BEHAVIOURS AROUND ANTIBIOTIC PRESCRIBING FOR RTIS Pharmacological factors Diagnostic uncertainty Signs and symptoms Concern about possible complications Diagnostic labels GP knowledge and attitudes to antibiotic resistance Non pharmacological factors General practitioner and practice characteristics Practice population characteristics Consultation time Influence of patient expectations or perceived expectations GP reasons for meeting patient expectations for antibiotics An Australian study reported that patients who expected medication were nearly three times more likely to receive medication, whereas when the GP thought the patient expected medication the patient was 10 times more likely to receive it.

13 A LINK TO LEARNED BEHAVIOUR? Studies suggest that previous receipt of antibiotics has a medicalising effect on future consultations for RTIs including sore throat79, acute otitis media 80 and cough or LRTI. 81 Patient satisfaction has been shown to relate more closely to a GP s provision of information, reassurance, appropriate examination and adequate consultation time rather than receipt of a prescription for antibiotics.

14 HARM AND POOR MEDICINES LITERACY Calls to the Poisons Information Centre about errors involving paracetamol and ibuprofen given to children aged 0-14 years doubled between 2005 and 2008 Paracetamol is the most common over-the-counter medicine associated with unintentional overdose requiring hospitalisation in children under 5 years. Weighing a child Measurement devices Active ingredients NPS MedicineWise research confusion regarding the active ingredients contained in many common over-thecounter pain relief medicines. Berry J, Harrison J. Hospital separations due to injury and poisoning, Australia Injury research and statistics series. Adelaide: AIHW, 2008.

15 ACTIVE INGREDIENT Of the 502 respondents who had taken an over-the-counter or prescription medicine in the past three months, 80% said they had taken an OTC analgesic. When respondents were asked to name the active ingredient in the analgesic they had taken, there was notable confusion. For Nurofen 43% of respondents correctly named ibuprofen as the active ingredient. 39% incorrectly stated paracetamol 9% said Panadol For Panadol, 61% of respondents correctly naming paracetamol as the active ingredient 22% gave incorrect responses such as aspirin or ibuprofen or the brand name Panadol Panamax- Just under half of respondents correctly named paracetamol as the active ingredient Panadeine- 80% of respondents correctly named paracetamol and codeine as the active ingredients in the combination pain relief medicine

16 Provided to NPS by Anne McKenzie

17 Photos taken by Anne McKenzie

NATIONAL MEDICINES POLICY Timely access to necessary medicines at affordable cost Medicines meeting appropriate standards of quality, safety and efficacy Quality use of

19 NATIONAL MEDICINES POLICY Timely access to necessary medicines at affordable cost Medicines meeting appropriate standards of quality, safety and efficacy Quality use of medicines Maintaining a responsible and viable medicines industry The term medicine includes prescription and nonprescription medicines, including complementary healthcare products.

20 QUALITY USE OF MEDICINES (QUM) QUM can mean using more or less of a medicine or none at all. It can include prescription, over-the-counter, vitamin, herbal and natural medicines. It can have different meanings for different people: - For an individual, it means using (or not using) medicines appropriately, safely and effectively and having the knowledge and tools to do so - For health professionals, it means: choosing the most appropriate and cost effective treatment; and giving people the knowledge and skills to use medicines to their best effect - For providers of health services and products, it means contributing to best practice through appropriate information, education and promotional activities - For governments, it means developing public policy, health systems, regulation and education that support best medicines use - For the media, it means reporting issues around use of medicines accurately and responsibly.

21 IMPROVING MEDICINES LITERACY- NPS:MEDICINEWISE National Prescribing Service Not for profit, independent, government funded Evidence based Initial focus on independent, evidence base for health professionals Quickly included consumers Healthy Communities Priority Communities CALD FECCA Aging COTA ATSI NACHO Health Literacy Now mass audience (all communities)

22 NPS services Information/ education services Environmental updates Australian Prescriber New drugs NPS RADAR Medicines Update Topic directed updates NPS News Prescribing Practice Review Educational modules (online and face to face)

23 PATIENT CENTRIC EDUCATIONAL VISITING

26 % of population Integrating therapeutic topic activities across the spectrum of disease and NPS activities Motivation for change for consumer Health practitioner involvement Medicine use intensity Intensity of strategies Communication strategies, target groups and priority groups Public Health (inc Environmental health etc) Health promotion and prevention Primary prevention Acute / Symptomatic treatment Secondary prevention Chronic disease management Palliation / end of life management Disease severity Disease state specific Diagnosis, testing, monitoring Health promotion - Community capacity building, health literacy

27 REACHING CONSUMER AUDIENCES Consumer Publications - Medicine Update, reviews new medicines listed on the PBS - MedicinesTalk, written by consumers for consumers - Community Update Be Medicinewise Mass Media campaign Tools and Resources NPS website

28 BEING MEDICINEWISE PROMOTING MEDICINES LITERACY National Be medicinewise campaign introduces the term medicinewise as shorthand for quality use of medicines and medical tests Why? is the central theme of the campaign Being medicinewise means having the knowledge about medicines and medical tests to make informed decisions NPS wants all Australians to make better medicines decisions We can provide the right tools and resources to encourage informed discussions with health professionals to make the right decisions

29 CONSUMER ENGAGEMENT FRAMEWORK.

30 BE MEDICINEWISE CAMPAIGN

32 WHY SHOULD AUSTRALIANS BE MEDICINEWISE Being medicinewise means knowing the right questions to ask about your medicine Three steps to being medicinewise 1. Know it s a medicine - Medicines include tablets, lotions, drops, inhalers, herbs and vitamins 2. Find the active ingredient - Knowing this can help you avoid double dosing 3. Ask the right questions - Ask questions about medicines from trusted sources to help make better informed decisions

33 COLLABORATING WITH COMMUNITIES We work in partnership with a number of consumer organisations to deliver targeted programs: Council of the Ageing (COTA) to help seniors learn about the safe and wise use of medicines - The seniors peer education program offers free information sessions across Australia delivered by trained peer educators Culturally and linguistically diverse (CALD) audiences to ensure access to in language information about medicines - Partner with the Federation of Ethnic Communities Council Australia (FECCA) to deliver programs and resources Chronic conditions - Diabetes VIC, Diabetes TAS, Arthritis NSW and the National Heart Foundation

34 CONSUMER TOOLS AND RESOURCES Medicines Line 1300 MEDICINE ( ) NPS collaborates with healthdirect Australia to deliver Medicines Line, a telephone service providing consumers with information on prescription, over-the-counter and complementary medicines. Adverse Medicine Events Line provides consumers with avenue to discuss and report adverse medicine events Medicines List provides a place to record all medicines to keep track of them Medicinewise choices provides access to online resources to learn more about medicines

35 NEW WAYS! Medicines List i-phone app

36 Nps.org.au

37 FUTURE CHALLENGES AND OPPORTUNITIES Medicare Locals Community engagement Information, Information Technology, Information Management, Information Communications Technology. PCeHR ETP

39 Tall man lettering cefazolin ceftriaxone

40 WHERE TO FIND OUT MORE Visit us at Subscribe to our publications and order free resources Follow us on twitter - twitter.com/npsmedicinewise Watch our videos on You Tube - Youtube.com/npsmedicinewise Become a fan on Facebook

41 NPS: REACHING PEOPLE IN DIFFERENT WAYS, INCLUDING... Educational visits to health professionals, in partnership with Australian Divisions of General Practice Collaborative community based education programs Multi-platform national awareness campaigns Respected publications like Australian Prescriber and NPS RADAR Medical school curriculum and online education E-health applications and tools Online resources including

42 SUMMARY Medicines literacy is a fundamental component of health literacy There is much that is, and can be, done in the area of medicines health literacy NPS: Medicinewise is a keen partner in disease management and health literacy Best suggestion yet.? Removing acronyms and abbreviations.?

43 Questions.

45 QUM and the life journey The healthy - to stay healthy, lifestyle, complementary medicines, immunisation The acutely ill - Often self-limiting, benefits and harms, duration The chronically ill - Non-drug, information and skills, monitoring and review of goals The severely ill - Frequent changes, adverse events The very frail - Cessation, continuum of care The dying - Dignity at end of life, evidence, symptoms management Weekes LM. Quality use of medicines and the life journey. J Pharm Pract Res September;39(3):172-3.

MEDICATION MANAGEMENT CYCLE Guiding principles to achieve continuity in medication management APAC, adapted from: Australian Council for Safety and Quality in Health Care (2002).

46 MEDICATION MANAGEMENT CYCLE Guiding principles to achieve continuity in medication management APAC, adapted from: Australian Council for Safety and Quality in Health Care (2002). Second national report on patient safety: improving medication safety. July Canberra. Audit Commission UK. (2002). A spoonful of sugar: medicines management in NHS hospitals. UK. www2.audit-commission.gov.uk/itc/medman.shtml Lynne T (Ed.) (2003) Queensland Health Medication Management Manual. Queensland Health, Brisbane. (currently under review)

INTEGRATION ACROSS THE FULL MEDICATION MANAGEMENT CYCLE - Non-medicines options Opportunity to Influence use of tests, monitoring for ADEs, reminders to review, deprescribing, etc Opportunity to

47 INTEGRATION ACROSS THE FULL MEDICATION MANAGEMENT CYCLE - Non-medicines options Opportunity to Influence use of tests, monitoring for ADEs, reminders to review, deprescribing, etc Opportunity to influence others Consumers as an intervention - Appropriate option Appropriate medicine choice in appropriate regimen Safe and effective administration and recording Opportunity to influence choice and regimen with EDS Opportunity to influence stockpiling, expiry Nursing Home medicines management Opportunity to review Appropriateness of Medicines choice and regimen Opportunity to influence use Opportunity for self-improvement / QI

48 SOCIAL MARKETING FRAMEWORK: Selling an idea for public good Understand the nature and scale of the problem - Evidence-practice gap - Burden of illness / harm - Economic burden Decide what we want to achieve and who we want to influence - Raise awareness - Change behaviour (need to segment audience) - Sustain or enhance a previous change - Monitor the problem or change Consider resources available - $, people, time

49 UNDERSTAND BARRIERS TO CHANGE Awareness, knowledge Beliefs, attitudes Motivation, readiness for change Skills Systems, practicalities External environment Analysis of needs and barriers Literature Questionnaires Key informants Advisory groups Audits / observation Phone lines Practice research Evaluation results

50 UNDERSTAND POSSIBLE INTERVENTIONS Educational materials Educational meetings Educational visiting Clinical audit & feedback Opinion leaders Map barriers to interventions, considering: What needs to change Evidence for interventions Active v/s passive engagement Multi-faceted approach What will work in general practice Reminder systems Patient mediated strategies

53 WHY GPs? Besides hospitals, General practitioner visits provide the other major intervention (good or service) to address health/ill-health million general practice consultations paid for by Medicare in 3/2008-4/ Average of 5.1 GP visits per person in Most people who had visited a general practitioner in the past year (81% or 11.4 million people) had seen GP more than once in that time <75yrs most people had visited a GP two to three times in the past year 1 Around 70% of people aged 75 years and over had seen a GP four or more times in the year 24% of people >75 saw a GP 12 or more times in the year (24%)

54 WHY THE GROWTH? PBS expenditure increased by 9.2% from Increasing drug / manufacturer cost? Not according to Pfizer The growth in PBS expenditure is not driven by unduly high prices in Australia. Prices paid to manufacturers of medicines are among the lowest in the world 4 Increasing appropriate usage (especially aging etc) Total PBS prescription volumes increased by 6.2 per cent to a total of million, compared to million for the previous year. The growth in government expenditure compared with a smaller rise in prescription volume reflects the continuing trend of doctors prescribing newer and more expensive drugs

55 WHY APPROPRIATE MEDICINES USE? Elderly Patients Prescribed Inappropriate Medications at 8 Percent of Doctor Visits (February 9, 2004) Inappropriate Medication Prescribing for Elderly Ambulatory Care Patients, Archives of Internal Medicine. Journal of the American Medical Association, Volume 164. February 9, 2004 Inappropriate usage Not in alignment with guidelines Guidelines don t exist

56 WHY BE MEDICINEWISE? Why is this relevant to you (personally) and your role Why medicines and medicines use? Why is it government policy? Why medicinewise? Why patient centric healthcare Why? Why? Wise Wise Why medicines literacy and collaborating with communities Why NPS? Why patient centric educational visiting? Why other interventions? Future challenges and opportunities Asking the right questions when you get back

57 WHAT DO WE KNOW? million (Dec 08) people in Australia A subset of these people s health and wellbeing is effected by illness and ill-health Extent of ill-health - 8-9% GDP on health - $86.9billion spent on health goods and services in % of this is on recurrent G&S (remainder on infrastructure projects) 7.1% increase in expenditure over the previous year Equating to $4226 per person 2.

58 WHERE ARE SERVICES PROVIDED? Ill-health results in outcomes for people including: 8.1 million Hospital admissions (separations) per year million public hospital EAC visits per year 1 Outpatient visits Day cases $31.3billion on public hosp recurrent expenditure (38.9%) 1 Expenditure managed through state and territory structures Therefore, remainder on NON-public hospitals (61.1%) Who is looking after the 61.1%... Consumers and the Commonwealth of Australia 1.

59 WHY THE MEDICINES OPTION? Of people aged 15 years and over who had visited a GP in the past 12 months, 81% (11.3 million people) had received a prescription for medication. For the most part, women had received more prescriptions for medication than men. - This was particularly noticeable in the year age group (77% of women and 64% of men) and the year age group (83% of women compared with 71% of men). The proportion of people who had been prescribed medication generally increased with age for both sexes, reaching 91% for men and 97% for women aged 75 years and over. People who assessed their general health as fair or poor reported higher rates of receiving a prescription (94%, compared with 79% of people who rated their health as excellent, very good or good)

Outcome Statement: National Stakeholders Meeting on Quality Use of Medicines to Optimise Ageing in Older Australians

Outcome Statement: National Stakeholders Meeting on Quality Use of Medicines to Optimise Ageing in Older Australians Executive summary Australia has a significant opportunity to improve the quality use