QUM the script for patient-centred care
The power of modern drugs makes it more important than ever that consumers are supported to know and understand their impact. Think of the potency and benefits of opioids, antimicrobials and anti-psychotics, yet all too often they are also associated with harms that could have been avoided.
It’s why Quality Use of Medicines is such a fundamental focus for CHF and why the recent NPS-MedicineWise National Medicines Symposium,‘Evaluating quality use of medicines: How do we know if we're making a difference?’ was of such interest to us.
I was privileged to speak at the conference and among the questions I addressed was what outcomes matter in improving QUM.
Most seriously of course, QUM should reduce medication-linked harms and deaths flowing from the adverse events and medication misadventure.
Positive measures can include closing the chasm people have to cross as they transition between care settings between hospital and home when medication plans can often go awry.
We are striving for higher levels of consumer medication literacy – giving consumers information and the agency to ask questions, understand their consumer medicine information (CMI) and feel confident proactively to seek medication reviews.
On a separate but associated front, we are also working on “5 Questions to Ask your Pharmacist”, borrowing from the 5 Questions format of the Choosing Wisely program. I will come back to that later in this article.
We need to increase consumers’ capacity to manage and feel in control of their health care, including with QUM.
That’s a challenge when we know that significant numbers of Australians appear to lack the capacity to access, understand, appraise and use crucial information to make health-related decisions.
So it’s really important that we benchmark and improve so-called medicines literacy because we know those at higher risk of medication-related risks are those with multiple conditions, those who are taking lots of medications and those with English as a second language
A reduction in unnecessary costs – enabled where QUM intersects with the value-based health care – ensuring right medications, right dose at the right time
And it’s not only about costs to the system, it’s also about consumer out of pocket costs
We need to take complementary and over-the-counter medications into account here when Australians spend billions of dollars a year on products that have little or no proven efficacy.
Supporting patient-centred models of care will advance QUM. Having non-prescribing pharmacists in general practice represents a really powerful development.
We have the workforce in pharmacists who can work with prescribers to use localised data to look at prescribing patterns, medication reviews, and most importantly work with the GP to educate and better equip consumers – particularly those with many medications or who have English as a second language.
And, of course in aged care where there are such routine and complex issues with medication, pharmacists would have a vital role.
That’s where our proposal for 5 Questions to Ask your Pharmacist mentioned earlier comes in.
Those questions will cover issues such as the benefits, risks and costs of medicine. We need to help consumers be wise consumers, to know their choices and be equipped to make the right decisions.
The core essence of being a clinician is having a conversation with your patient – and that is what Choosing Wisely is all about.
We need care providers to see the whole person, to see patients as having some expertise about their conditions, seeing them as partners in care, not passive bystanders – the idea of the expert patient as promoted in England. The idea of the wise consumer came up at our Summit conference in March.
There are several ways to involve patients as partners and build their skills and confidence. These include shared decision-making tools at the point of care, and at the policy and system level, our Collaborative Pairs joint leadership training.
There are barriers in our system to Choosing Wisely’s goals. Conversations in medical consultation take time and our fee for service funding arrangements do not encourage that.
This needs reform – and there have been some encouraging directions towards that in the primary health care 10-year reform plan.
We are witnessing the importance of medicine literacy in the COVID context – not only vaccine hesitancy but also in compliance and understanding of the public health messages such as wearing face masks, social distancing and hand washing.
Consumers need to trust that they can and should ask questions and can expect to have a conversation with primary health carers.
Consumers should expect a real say in their health care especially because their outcomes are likely to improve where consumers and care providers collaborate as partners in care.
The consumer is often the only individual in the care setting to have insider experience and knowledge about all aspects of their care.
There needs to be a more structured approach to the development of health consumer leaders, advocates and their organisations as an integral part of the health system – a key recommendation is the establishment of an academy for research, education and training.
CHF is taking every opportunity to strengthen the health consumer role. Recently we launched Consumer Link – an initiative to support consumer representatives from across the country to network, learn and exchange information. We are also seeking further development and uptake of tools to systematically gather and analyse consumer stories and sentiment with CHF initiatives such as Real People, Real Data and the Australian Health Consumer Sentiment Survey.
When involving consumer advocates, their insights and advice must also be recognised with appropriate remuneration.
The consumer of tomorrow will be recognised as a full actor of care, own their medical information, understand the value of evidence-based medicine, be better decision-makers and be fully engaged as transformational partners.