How COVID times guide our future medicines policy
The National Medicine Policy Review now underway comes at an opportune, if bitter-sweet, time. The all-embracing impact that COVID-19 has wielded in the health system holds important lessons for the future shape of the way Australia — its consumers, clinicians and industry — manage medicines.
That was one of the messages that came out of last week’s CHF webinar, Building a Better National Medicines Policy. The webinar came just before CHF concludes its consultation on the NMP Review this week. It is vital consumers have effective input given the transformations underway with exponential advances in areas such as medicine-linked device technologies and genomics — developments that make health care more complex and powerful.
That makes a strong and informed consumer voice to promote the best access and outcomes both more necessary and more challenging.
The webinar provided a range of thoughtful stimuli for the review. It brought together the Health Department’s Deputy Chief Medical Officer, Professor Michael Kidd, CHF board member Jan Donovan and Medicines Australia CEO Elizabeth de Somer. Professor Kidd and Jan Donovan are members of the Policy’s Independent Review Panel.
A key theme emerging from the webinar was the need to further develop the NMP to empower consumer-centred knowledge and understanding of rapidly advancing medicines and associated technology. To ensure that outcome the NMP needs to craft a stronger principle to assure better transparency and accountability.
Professor Kidd said two important developments had emerged from the disruptive dynamics of COVID.
Firstly, we now have a population that knows a lot more about epidemiology, public health and vaccines and wishes to have a voice in many of these areas. And along with that health literacy has also grown in some areas.
Secondly we have seen the growth in new forms of communication. As Professor Kidd said, 18 months ago not many of us thought that we'd be spending a lot of our time doing meetings by Zoom. We have brought together people virtually from across the country in the format. And with the introduction of whole of population telehealth has come e-prescribing and dispensing. That move away from face-to-face contact has opened a whole new array of questions of how we ensure best advice and use of medicines.
Another nudge to medicines policy has been the need for greater recognition of the different needs of a diverse population. The current policy does recognise the importance of consumers, but it doesn't really acknowledge the diversity of consumers and their specific needs. It has more of a passive approach to engagement.
Professor Kidd said that during the pandemic, we've seen how important it is to understand the diversity of consumers in Australia as we develop health care policies to best meet the needs of everybody. What happened when some groups of consumers, remained less visible than others in national responses underlined the need to learn from these experiences. He emphasised the importance of consumers communicating the lessons of their experiences to the review.
Jan Donovan, who is CHF representative on the policy review panel, said the consumer movement had been greatly assisted by the pandemic. One positive that had come out of it is that we know a lot more about vaccines and we know a lot more about how medicine is supplied than we used to.
It means consumers can participate more in decision-making about our care and also participate in broader health policy. So while the current national medicines policy does emphasise the central role of consumer, it does not acknowledge how diverse the consumer community is and specific needs for diverse communities.
We understand the challenges vulnerable people often have with multiple chronic illnesses. Older people who were once on five to 10 different medicines, now might be on 10 to 15 or 20.
The prevalence of polypharmacy remains a challenge. People being prescribed 15 or more medication present a range of risks to themselves. Preventable harm from medicines is a critical consumer issue.
Jan cited a report by the Pharmaceutical Society of Australia recently which outlined that more than 250,000 Australians are admitted to hospital each year because of the problems related to their medicines, at a cost in excess of $1.5 billion annually to the health system.
It shows the need for a patient-centric focus with the national medicines policy to empower consumers to make informed choices about the quality use of medicines.
She said the revised policy will need to explicitly capture the cultural, geographical, socioeconomic diversity and disadvantage of many.
Because of the more complex treatment options, more effort now is needed to ensure that consumers participate as partners in their treatments and care.
We know consumers with low health literacy are more likely to have worse health outcomes overall and adverse health behaviours and they tend to have higher hospital, readmission rates.
Elizabeth de Somer told the webinar that in setting the NMP framework the important questions were, what are we trying to achieve and how are we going to achieve it? We think we've got this fabulous policy but can we really, truly say we're achieving quality use of medicines if we still have such large numbers of preventable, hospitalisations caused by medicines, use or misuse?
Also there was the issue of health literacy, she said. There was an enormous level of health illiteracy and misinformation being spread and it was actually expanding. So how do we counter that? And is the policy going to provide the right framework?
The answer may come partly at least from Jan’s hoped-for outcomes from a refreshed NMP. She wants to see more engagement and collaboration between consumers and the system to foster the trust and belief that the system is working for them. That should encourage more people to ask about their treatment, medicines and vaccines.
Professor Kidd said the aim of the review was to formulate high level principles of evaluation and accountability to respond to the exponential growth in technologies.
He said what he would like to see flowing from the NMP was greater equity in access to medicines, further improvements in quality use of medicines and greater integration in medicine and technologies such as the great advances in genomics and the intersection between treatment of disease and preventive care.
To follow the conversation on Twitter see #NMPReview