Friday, August 21, 2015

NPS MedicineWise National Medicines Symposium 2014: Day 2

Pat Branford, HCCA Consumer Representative, attended the National Prescribing Service (NPS) MedicineWise National Medicines Symposium in late 2014 which was held over three days. The theme of the conference was ‘Medicines in Health: Shaping Our Future’.
Here is a summery on the second day. To read more about the other two days of the conference, click here.

Day 2 Plenary 2 – Sustainability
For these plenary sessions the theme was about exploring the future in terms of cost, benefit, access, quality and safety and investment in an increasingly competitive health environment with a focus on sustainability.

Sustainability and innovation – can we actually afford medicines – Professor Ian Frazer, CEO and Director of Research, Translational Research Institute
The main points discussed were:
·         Research priority is determined by a person’s interest and is not dictated by government interest;
·         The longer we live the less likely we are to be healthy and as we age we use the health system increasingly more;
·         As a community of connectedness (i.e. via social media/internet) you know what other healthy communities are receiving in terms of health care and you know that you are not getting it and you want it;
·         The need to meet consumer demand and treat non-infectious chronic conditions increases as we age;
·         Whether a person receives optimal health care is determined by a persons’ ability to pay i.e. it is determined by their income and it is not a right i.e. it is not a universal health care system; and
·         There is a stringent need for safety regarding medications however, the cost of new medications are past onto patients.

Cost and value: a consumer perspective – What rights do I have? What should I be able to expect? How are my expectations and values recognised? Durhane Wong – Rieger, President and CEO, the Institute for Optimizing Health Outcomes, Canada
Durhane saw the role of a consumer as being:Durhane saw the role of a consumer in relation to medications as being:



Appropriate access to medications:
·         An assessment of benefits, risks, range of patient trade-offs;
·         Medications need to be personalised – i.e. right medication, right patient, right time;
·         Regulatory uncertainty of medication balanced by post market surveillance.
Responsible access to medications:
·         Taking medications as prescribed;
·         Monitor for adverse effects; and
·         Feedback on real – world effectiveness.
Sustainable access to medications:
·         Affordable cost to patients (i.e. co-payment);
·         Pricing based on comparative value (two systems); and
·         Sufficient return on investment – so there is an incentive for innovation.
Irresponsible use of medications is unsustainable and costs over 9% of the health expenditure or $500B globally on irresponsible use of medications and there is approximately 54% non adherence to medication use.

Patient Self-Funding of High-Cost Medications – what are the ethical issues? Dr Jennie Louise, University of Adelaide
Arguments for self funding of high-cost medications are:
·         Respect for patients autonomy:
o   Patient is in the best position to determine the merits for themselves; and
o   Not giving patients information is paternalistic.
·         Patients should be given information that they would deem to be relevant or they would care to know about.
·         There were some reasons for caution given:
·         Patients may not be best placed to evaluate complex evidence regarding effectiveness of the medication;
·         (generalisations were made) that most patients are desperate and vulnerable;
·         (generalisations were made) that most patients are not in a position to objectively weigh information; and
·         Doctors may influence decisions even if they are not trying to.
There could/would be great variability in patient’s circumstances:
·         Disease and prognosis would differ between patients;
·         Treatment whilst evidence based, the likelihood of benefit, toxicity and side effects could well be different; and
·         A patient’s non-medical circumstances, goals and concerns would also need to be taken into account.
The unintended negative consequences for social and health systems are;
·         More pressure by patients, groups/public to fund no-cost effective medications
·         Undermining bargaining power of giants; and
·         Creating additional costs to the public system.
Monitoring for toxicity, treatment side effects, longer consultation times, administration of medication will drive up the costs.

Equity considerations
·         Particularly important for the public system;
·         Inequitable more affluent patients can access treatment not available to others in their home state; and
·         Rural customers can’t access treatment at all.

Other sources of inequity
·         Could lead to distortions in health care funding that further adds to inequity;  and
·         May have to pay for health care beyond basic health care.

Suggestions
·         Cost sharing by paying 50% of the medication;
·         ‘patient advocate’ make a more autonomous decision i.e. impartial third party.
·         Defensible presumption against self; and
·         HCCA could be a patient advocate but I was told that they would need skills to determine what patients want.

Chronic Conditions, financial burden and pharmaceutical pricing: insights from Australian Consumers Associate Professor Jennifer Whitty, School of Medicine, Griffith University; School of Pharmacy, The University of Queensland
·         Prescription medication (Pharmaceutical Benefit Scheme - PBS) spending was approximately A$10.1 Billion pa in 2011/12;
·         Consumers (patients) fund approximately 17%  - A$1.7 Billion pa;
·         Australians median (average) out of pocket prescription costs are $199 pa; and
·         Patients don’t fill prescriptions because of the cost.

Findings re Financial Burden – Aggravating Factors
·         dose, administration, aids, Webster packs all equal additional costs;
·         once cease employment medication costs too much money; and
·         lack of consistency between pharmacies and costs of medications.

Consequences
·         reduced adherence to taking medications because of the cost;
·         stockpiling of medications by some patients;
·         cost displaces luxuries (example given was cigarettes); and
·         not working so patients can get a health care card and get medications cheaper.

Understanding and beliefs related to pharmaceutical pricing
·         relief of costs can be obtained by either and/or having a health care card and the safety net;
·         access to medications not on the PBS in chronic conditions is an extra cost; and
·         fairness is an issue as a patient you have paid your taxes and you are not to blame for your condition but you have to pay high costs for your medication.

Conclusion
·         Australian consumers with chronic conditions and carers perceive there is a financial burden associated with medication use; and
·         This financial cost is compounded by the ongoing need for medical care and medication.

Dementia and care transitions: actions to translate data and knowledge into practice – Professor Gabrielle Cooper, Discipline of Pharmacy, University of Canberra
·         It is illegal to do research on dementia care patients in the ACT.

Issue of Identity
·         Lack of timely and accurate information sharing between the range of providers (GP/hospital/pharmacy/RACF);
·         Lack of awareness by a range of clinical staff of a patients possible dementia diagnosis e.g. ED, X-Ray, orthopaedics, pharmacy, support staff;
·         Inconsistent use/type of medication supports e.g. dose, administration aids;
·         Limited access to appropriate trained support staff to assist or just assist in settling patients; and
·         Hospital pharmacies have different alignment of Webster care packs.

Other points
·         Need to settle patients – calm considered approach. Dementia training also required for pharmacy staff and meals person;
·         There are medication discrepancies between care settings which aren’t reconciled and recommendations aren’t being followed up on due to lack of documentation and communication strategies e.g. need transition medication charts;
·         Lack of after hour support for families and small facilities to avoid acute readmissions. Graduate nurses could go with a patient to a facility/hospital to help settle a patient in;
·         Best practice was centred on individual champions – GPPAD ACT.

Pat Branford

HCCA Consumer Representative

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