Antibiotic Resistance and Medicinal Drug Policy

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Antibiotic Resistance and Medicinal Drug Policy

• Dr. Ken HarveySchool of Public Health, La Trobe
  University,
• Melbourne, Australia

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Dr. Harveys visit to China was sponsored by

• The World Health Organization
• and hosted by Professor Yong-Hong Yang
• Beijing Childrens 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 countrys 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
  2217-221

(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
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QUM indicators Impact
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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 workers computers
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Internet a source of excellent information
http//www.healthsci.tufts.edu/APUA/apua.html
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Australia incentives for computerization
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QUMIT Decision support
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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
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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//www-sph.health.latrobe.edu.au/telehealth/in
  dustry.htmElectronic
• Australian and International Medicinal Drug
  Resources http//www-sph.health.latrobe.edu.au/Re
  sources/druginfo.htm
• Australian HealthConnect Project
  http//www.health.gov.au/healthonline/welcome.htm

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