Quality use of medicines - where to next?
- Robert F.W. Moulds
- Aust Prescr 1998;21:58-9
- 1 September 1998
- DOI: 10.18773/austprescr.1998.056
Variety is not only the spice of life, but also of continuing medical education and to ensuring the quality use of medicines. This was the main message from a symposium held during the most recent annual meeting of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT).
The symposium addressed where we are with the quality use of medicines in Australia, and gave interesting insights as to where we are likely to go in the future. The particular focus was drug information.
The speakers approached the issue from different directions. Dr Andrea Mant briefly described the Therapeutics Resource and Educational Network for Doctors (TREND) program. This program for general practitioners includes a practice assessment, a practice visit, a report on the doctor's prescribing, a newsletter and information sheets on the management of common conditions. When participants were asked which of the components they found the most valuable, it was clear that almost every resource was liked by some, and disliked by others. Dr Mant concluded that continuing education in therapeutics will require a menu from which general practitioners can choose.
A different approach was described by the Drug and Therapeutic Information Service (DATIS), which is based at the Repatriation General Hospital in Adelaide. This program largely centres on academic detailing, i.e. independent drug information pharmacists visit doctors in the same manner as pharmaceutical company representatives. It has focused on various therapeutic issues, including non-steroidal anti-inflammatory drugs, antihyperlipidaemic drugs and antidepressants. Importantly, the DATIS has found that hospital admissions caused by gastrointestinal pathologies commonly associated with NSAID use have declined in the geographical areas where the program operates. This change has not occurred in neighbouring areas. This is clearly a major achievement, although it has not as yet been translated (and may not be translatable) to other geographic areas.
Perhaps the most exciting aspect of the symposium was the prospect of the 3 major independent Australian sources of information about therapeutics coming together. These are Australian Prescriber, the Therapeutic Guidelines and the Australian Medicines Handbook.1 These 3 information sources should complement each other, and are likely to link more closely in the future, particularly when electronic versions become available, as they undoubtedly must.
Australian Prescriber will continue to occupy its prominent position as the major source of brief and authoritative reviews on therapeutic topics. The journal's main strength is that it can publish such reviews in a timely manner. It can particularly focus on areas in which therapeutic advances and thinking are changing relatively rapidly. Therapeutic Guidelines will be the major source of practical and concise advice on the treatment of common clinical conditions. The main strength of the Therapeutic Guidelines is that the advice is practical and covers most clinical conditions. The Australian Medicines Handbook should become the major national source of independent information about specific drugs. It contains practical information about adverse effects, drug interactions, special precautions and contraindications. Its particular strength will be the provision of class statements and comparisons of drugs within a class - information which is so difficult to obtain from product information and commercial sources of drug information.
The grand vision, of course, is that all of these independent sources will come together in an electronic version which, in the not too distant future, will be linked to prescribing packages. Then, when we are all prescribing electronically, we will be able to move easily between diagnostic information, review information, therapeutic advice and drug information during the course of a single consultation. It is exciting to think that we are not too far away from having a patient in front of us with, say, oesophagitis, and being able to move instantly to a recent review of the possible role of H. pylori in gastro-oesophageal ulceration (from Australian Prescriber), with one click move to the recommended regimens for the treatment of oesophagitis and for H. pylori eradication (from Therapeutic Guidelines - Gastrointestinal), and with one more click find the differences, if any, between the proton pump inhibitors currently available (from the Australian Medicines Handbook).
The Commonwealth Department of Health and Family Services indicated it is keen to facilitate these developments. It will be interesting to see how they relate to the new National Prescribing Service.
In a twist perhaps not anticipated by the organisers, the symposium finished on much the same note as it began. Dr Joe Collier, the Editor of the Drug and Therapeutics Bulletin, outlined the current situation in the U.K. regarding quality use of medicines. The U.K. government supports a variety of different approaches, including the free distribution to all medical practitioners of the Drug and Therapeutics Bulletin, The Prescribers' Journal, the British National Formulary, the Medicines Resource Centre Bulletin and pharmaceutical prescribing data for individual practices. Dr Collier thought this was deliberate Government policy because a spectrum of drug information was required - thus confirming that variety is truly the spice not only of life, but also of continuing medical education.
Director, Department of Clinical Pharmacology and Therapeutics, Royal Melbourne Hospital, Melbourne