Consumer Health Forum Workshops - Informed Consent & Quality Use of Medicines in Hospitals, March 2013

On the 25 and 26 of March, the Consumer Health Forum held two workshops; one on informed consent and the other on quality use of medicines in hospitals. Joanne Baumgartner, a HCCA member, attended on both days. Joanne completed this report to share with other consumers.

Workshop 1:  Informed Consent

This followed on from a previous workshop on Informed Financial Consent and discussion was focussed on the forms signed by consumers prior to their procedure or operation.

The general consensus was that patients/consumers need to be provided with substantially more information regarding

• The procedure itself;
• Who would conduct the procedure;
• The likely outcomes;
• Risks involved;
• Discharge and rehabilitation processes;
• Support options available, e.g. supported accommodation 

Consumers felt that these issues were not properly considered by health professionals and were rarely, if ever, discussed. In particular, rural consumers are often transferred to major city hospitals without their Informed Consent paperwork and are expected to simply accept whatever procedures were carried out at those hospitals. There was also no access to adequate post-discharge care in rural areas.

Treatment of mental health consumers was also an area of concern with regard to consent, as consumers felt that unnecessary force was being used too often with Involuntary Patients. This was considered to be an abuse of human rights. New procedures and protocols are required to ensure that all consumers are treated with dignity and respect.

Papers were presented by a range of health care professionals, including medical specialists and university researchers in the area as well as the Health Care Complaints Commissioner. These professionals agreed with consumers that more information needed to be provided to patients during the consent process. The suggestion was made that both consumers and clinicians could be required to check boxes indicating that sufficient information had been provided before signing off on a procedure.

Workshop 2: Quality Use of Medicines in Hospitals

This workshop specifically focussed on the lack of continuity of care and poor record keeping with regard to prescriptions in hospitals. The gaps between the emergency department and inpatient wards as well as poor communication on discharge were discussed. Consumers identified one of the main issues to be that many consumers, especially the elderly, did not have adequate knowledge or understanding of their medications to keep track of their own prescriptions.

A study has found that patients experienced fewer adverse effects from medications when they were able to keep them in a cabinet drawer by their bed and able to follow their medication regime on their own. However, consumers are rarely afforded this level of trust by clinicians with regard to administering their own medications.

Consumers also agreed that the use of generic medications is often confusing in hospitals, as it is hard for them to check whether they are being given the correct medicine and dosage. A hospital pharmacist explained to the group that hospitals were now using generic medications to save money, making it unlikely that consumers would receive the medications that they were used to at home. In this case, hospital staff need to ensure that consumers are told which medication is which to help them keep track of what they are taking.

Five ‘Rights’ for Quality Use of Medicines were identified as follows:

·         Right Patient

·         Right Drug

·         Right Dose

·         Right Route

·         Right Time

The workshop attendees agreed that all consumers have the right to receive information regarding their medications in an understandable format, rather than the many pages of unrelated information that is currently provided.

Joanne Baumgartner
HCCA Member and Consumer Representative 

Rising cost of medicines affect consumers in ACT and Australia

Two recent surveys have reported that increasing financial pressures and costs have reduced consumers’ use of prescribed medicines. The findings of these reports are a matter of concern and need to be addressed through appropriate government action.

The survey by Council on the Ageing–ACT (COTA-ACT) was of 700 older Canberra residents; the second study analysed Pharmaceutical Benefits Scheme (PBS) data from the Department of Health and Ageing to determine the effect of increased consumer payments for medicines on use of the medicines.

The survey “The Seniors Lifestyle and Finance Survey” (1) available on www.cota-act.org.au has produced some worrying findings, including health issues. HCCA wishes to thank COTA-ACT for permission to quote from their report.

While the background to the survey was to collect data on lifestyle and financial issues that had been raised anecdotally, there was also a need to clarify whether older Canberrans face the same economic pressures as other Australians and are not all on high retirement incomes with good social support. The survey sought responses on the impact of income and cost pressures on older people in the four principle areas of accommodation, income, health and social and recreational aspects of life.

In general the survey supported the view that older Canberrans were being forced to compromise on critical lifestyle issues because of severe financial constraints.

In the health area rising costs had resulted in 15% ceasing private health insurance with 31% of respondents not having private health insurance. 56% do not have access to bulk billing through their general practitioner. As a consequence of increasing costs 13% have stopped or reduced their medical treatment, with 7% reducing or giving up their medication. Increased food costs have also resulted in 33% of respondents buying less or cheaper food and changing their diets. This included reduced purchases of fruit and vegetables. The medium to long term effect of many of these changes have the potential to be serious.

As well as the direct health issues an important finding with health implications was that older Canberrans had significantly reduced their social and recreational activity, which includes volunteering.

The second survey (2) looked specifically at the impact of the cost to consumers of medicines under the government subsidised PBS. The survey was conducted by researchers from the Universities of WA, SA, Adelaide and Curtin. This survey, using government data on prescribed dispensing of 17 selected categories of medicine, looked at the changes in amount of the medicines dispensed after the consumer contribution (co-payment) was increased in January 2005. The study compared data from 2000 to 2004 with that from 2005 to 2007. Co-payments were increased by 24%, together with increased safety net thresholds in January 2005; there were also subsequent increases in the safety net thresholds in January 2006 and 2007.

The selected categories of medicines included hypnotics, beta-blockers, insulin, anti-Parkinson’s treatments, statins (cholesterol lowering), muscle relaxants, osteoporosis treatments, thyroxine, combination asthma medicines, glaucoma treatments and acid-related upper gastrointestinal disorder treatments.

The findings of the study indicated that the increased cost of medicine to consumers resulted in reduced use by consumers of medicines. The study showed that the amount dispensed of 12 of the 17 medicines decreased after the cost increased. The largest decrease observed was for medicines taken for asymptomatic conditions or for which there were over-the-counter substitutes. The cost of medicines appears to have particularly reduced the medicine use by social security beneficiaries. The findings noted that the increased costs to consumers reduced the volume dispensed of both discretionary and essential medicines. While the increased co-payments may achieve the policy objective of reducing the cost of the PBS this study suggests that there may be longer term health affects for consumers, especially the most socially disadvantaged.

Tony

1 COTA-ACT; Finance and Lifestyle Survey, 09-2008
2 Hynd, Anna; et al The impact of co-payment increases on dispensings of government subsidised medicines in Australia: Pharmacoepidemiology and Drug Safety (2008)