Use of medicines is the most common health-related action taken by Australians and, for many, the only action taken. Medicines, if used correctly, can significantly improve levels of health. However, despite the benefits, medicine use is not without risks. There are also potential harms and negative consequences including treatment failure, adverse effects, economic waste and ecological change (for example, resistance to antibiotics).

Several key factors are recognised as influencing the potential of medicines to optimise health outcomes (and minimise health harms) for Australians, and represent the key objectives of Australia’s National Medicines Policy (NMP, 2000):

• timely access to the medicines that Australians need, at a cost that individuals and the community can afford
• medicines meeting appropriate standards of quality, safety and efficacy
• Quality Use of Medicines (QUM)
• maintaining a responsible and viable medicines industry.

National Medicines Policy

The National Medicines Policy (NMP) was developed to improve positive health outcomes for all Australians through their access to and wise use of medicines.

In 1985, the World Health Organisation held a Conference of Experts on the Rational Use of Drugs which developed a Revised Drug Strategy calling for governments to implement a National Medicinal Drug Policy. Australia participated in the development of the strategy after it was adopted by The World Health Assembly in 1986, at which Australia was also represented.

The Australian Pharmaceutical Advisory Council (APAC) was formed in 1991 allowing interested parties to contribute to the development of the policy. Policies were developed and implemented over several years with a major review in 1999 and a launch of the NMP in December 1999.

Quality Use of Medicines

QUM is one of four arms of the National Medicines Policy. It is defined as:

• judicious use (selecting management options wisely) — medicines, whether prescribed, recommended and/or self-selected should be used only when appropriate, with non-medicinal alternatives considered as needed
• appropriate use (choosing suitable medicines if a medicine is considered necessary) — choosing the most appropriate medicine, taking into account factors such as the clinical condition being treated, the potential risks and benefits of treatment, dosage, length of treatment and costs
• safe use (using medicines safely and effectively to get the best possible results) — misuse, including overuse and underuse, should be minimised and
• efficacious use – the medicines must achieve the goals of therapy by delivering beneficial changes in actual health outcomes.

QUM reflects the premise that if medicines result in better health outcomes, or the use of fewer health services such as hospitals, then meeting health care needs by prescribing medicines also represents value for money.

A national policy on QUM was published in 1992 and seeks to create partnership and cooperation between all groups whose activities influence medicine use and to promote the health care team, with the consumer, as an active partner. It also seeks to enable visible, effective and sustainable educational strategies that promote Quality Use of Medicines while developing a supportive environment.

National organisation formed

Following a review of the literature, research and experience in QUM, a number of key activities and strategies were identified as appropriate for a body such as a ‘national prescribing service’ to coordinate and disseminate QUM services. An extensive Australia-wide consultation process was then undertaken to obtain comments from stakeholders about the relevance of these activities and strategies, and to enable them to help shape the design and operation of such a service. The Commonwealth Department of Health and Family Services (now Australian Government Department of Health and Aged Care) managed the consultation process with an advisory group of doctors, general practice registrars, pharmacists and consumers.

In the 1997–98 Federal Budget the Australian Government announced the establishment of a national organisation to undertake work in QUM — the National Prescribing Service (NPS). The organisation was launched in March 1998. The underlying philosophy was to give health professionals and consumers access to information and other supports for good prescribing and medicine use decisions, thus promoting the best and most cost-effective treatments.

NPS builds on the foundations laid by the past work in QUM, and draws together the expertise of all those involved in medicine use. NPS is an independent public company operating within the framework of the National Medicines Policy. Members include Government and peak medical, pharmacy, consumer, nursing, pharmaceutical industry, and hospital organisations.

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