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Meeting Outcome Statement

Outcome Statement of the NMP Partnerships Forum - 29 June 2009

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Outcome Statement – National Medicines Policy Partnerships Forum 29 June 2009 Old Parliament House, Canberra

Background

The National Medicines Policy (NMP) is a broad framework that aims to improve health outcomes for all Australian’s through access to and appropriate use of medicines. The overall aim of the NMP is to meet medication and related service needs, so that both optimal health outcomes and economic objectives are achieved. In this context “medicines” means prescription, non-prescription and complementary healthcare products. The NMP has four central objectives:
timely access to the medicines that Australian’s need, at a cost individuals and the community can afford;
medicines meeting appropriate standards of quality, safety and efficacy;
quality use of medicines (QUM); and
maintaining a responsible and viable medicines industry.

Purpose

Over 100 stakeholders, which included consumer, clinical practice, medicines industry, Federal Government and state/territory jurisdiction stakeholders, were invited to participate in the first annual NMP Partnerships Forum (refer attached). This was held on 29 June 2009 in Canberra and hosted by the NMP Executive and Committee.

Stakeholder input into the principles, policy and practice of the NMP is important. The annual Partnerships Forum provides stakeholders with an opportunity to exchange information on the policy and to discuss its implementation, partnerships, challenges and opportunities.

The purpose of the first Partnerships Forum was for the Executive and Committee to share information on the new NMP advisory arrangements, to introduce the members, and to seek stakeholders’ input and views on priorities for the NMP, particularly for the coming year.

Participants noted that the outcomes from the Forum would help the Executive and Committee in their process of identifying priorities to present to the Minister for Health and Ageing.

Context

In the opening session participants were provided with an overview of the NMP, the history to the NMP advisory arrangements and the introduction of the new arrangements (further information on the new advisory structure is available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-news.htm. This was followed by an overview of the Executive and Committee’s process to date in identifying priorities for the NMP. Participants noted that the process to date had included consideration of:

The uncompleted work from the previous NMP advisory structure;
Current and emerging issues, taking into account current Government priorities; and
The input received from Forum participants, prior to the Forum, in response to a Forum input proforma.

Participants also noted that the outcomes of this process would be presented as key themes and issues during the course of the day, which the Executive and Committee would be seeking participants’ input and views on to further inform their process. Opportunities were also provided for participants to identify issues they considered relevant and not specifically discussed during the day.

Consideration of key themes and issues

Discussion at the Forum was structured around three key themes:

Supporting appropriate use of medicines;
Generating the evidence; and
Supporting the system.

Throughout the day three group work sessions took place to discuss the key issues identified for each theme. Each table was assigned one key issue for each theme, with the option of considering other key issues once the set questions had been completed for the allocated key issue. At the completion of each group work session, an overview of the key points from each table discussion was provided by table leaders to the broader group.
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Outlined below are the six key issues that were discussed under each theme.

Supporting appropriate use of medicines	Generating the evidence	Supporting the system
Medication adherence (including psycho-social aspects of medicines)	Converging technologies (including related technologies)	Future models of health care delivery
Appropriate processes	Internationalisation of Health Technology Assessment	Competency standards
Medication pathway	Post-market monitoring	Equity of access
Evidence informed decisions	Off label use	Timely access to new medicines
Continuity of care	Influencing the public research agenda	System sustainability
Informed and active consumers	Clinical trial relevance	Stimulating/rewarding innovation

Key messages

Forum participants demonstrated a high level of commitment and good will resulting in valuable strategic discussion. Outlined below are the main points highlighted during discussion on each key issue.

Medication adherence – the ability to measure the impact of medication adherence on health outcomes was considered a key issue for the NMP. The need to consider what is already known in relation to this issue to assist system and behavioural improvement was highlighted. In this context, informed and active consumers and coordinated care, in relation to improving partnerships and feedback loops at all levels, were considered essential.

Appropriate processes – the strong established prescribing, dispensing, administrating and monitoring of medicines processes already in place were noted, but the need for further education (particularly as more professions adopt wider roles in the system), consumer health literacy, and clear accountabilities across all processes were highlighted. The key priorities identified for this issue were: improving consumer information and coordinated care (the E record was considered key for improvement in this area).

Medication pathway – the need for QUM throughout the entire medication lifecycle was highlighted, particularly to avoid therapeutic need being commercially driven. In this context, consumer health literacy and involvement throughout the pathway was considered important, particularly to assist in identifying therapeutic gaps. A planned research agenda in this area, informed by international learnings, was also considered important.

Evidence informed decisions – The use and application of evidence to inform decisions at all levels was the area of focus for this issue. In this context, the need for a systematic approach to pre and post market data collection and use was considered essential. Promoting the primacy of the consumer was also raised, particularly in terms of ensuring that consumers have access to the information they need to make informed decisions about their healthcare.

Continuity of care – This issue was considered particularly important given the strong evidence for action. Revisiting the APAC Guiding principles to achieve continuity in medication management, in the context of the current IT environment, was suggested as one way to further enhance activity this area, particularly in relation to encouraging structural improvements, knowledge, understanding and education.

Informed and active consumers – Better informed consumers, improved consumer awareness and health literacy were considered key issues for the NMP. It was suggested that improved consumer health literacy, via educational curriculum programs or charter of care approach, was a key component to achieving this. Enhanced health professional training and education to develop interactive partnerships between consumers and/or other health professionals was also considered essential. One area of concern raised was the shortcomings of current consumer medicine information.

Converging technologies – This was considered an emerging and growing issue that requires a watching brief approach at this stage. The need for a clearer definition and better understanding of ‘converging technologies’, from a NMP perspective, was highlighted. It was suggested that the need for any activity to be undertaken in this area may be informed by the Health Technology Assessment Review.
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Internationalisation of Health Technology Assessment – A key issue which needs to be considered in the Australian context, and defined more broadly to encompass not only drug safety, but accessibility and usability and, in the light of converging technologies, clinical pathways. It was considered that the outcomes from the Health Technology Assessment Review may inform where there may be opportunities to provide leadership in this area, given Australia is ahead of international developments.

Post-market monitoring – The need for post-market monitoring to ensure medicines are used safely, and positive health outcomes are being achieved, was considered a key issue. The need to not only monitor safety components, but also cost effectiveness in the context of health outcomes, was highlighted, as was the need for health professional and consumer education on the importance of reporting. It was suggested that the current process for reporting adverse events could be streamlined.

Off label use – A key issue given the wide spread use and impact on equity of access. The need to identify the size and scope of off label use and to identify where research should be targeted was highlighted. The need for different registration and listing pathways to consider new indications and increase transparency was also discussed.

Influencing the public research agenda – The need to develop research capacity and a strategic medicines research agenda was discussed. In this context, the need for research specific to Australian conditions, disease trends, and areas where evidence is lacking was raised. To assist this, it was suggested that a coordinated approach and quarantined funding would be required.

Clinical trial relevance – The need to increase clinical trials that inform decision making was identified as a key issue. It was suggested that improvements in the collection of evidence/data outside the current clinical trial context (ie. medicines use outside of the approved registration or listing indication or off patent medicines) was needed. The need for funding for post market/post listing studies/data collection was also discussed. The ultimate aim is to ensure the right data is being collected to inform the end decision.

Future models of health care delivery – The need to develop a clearer understanding of the roles of different health professionals, due to the re-focussed health care delivery model, was highlighted. In this context, the need to further develop professional competencies (in relation to promoting and ensuring QUM), consumer knowledge (in terms of identifying the best health care pathway), and improve workforce efficiency to improve health outcomes was discussed.

Competency standards – The competency of both health professionals and consumers was discussed. The need for a nationally consistent approach to this issue was highlighted, given the current variances between different health professionals and different states. It was suggested that the focus should be on medication management and QUM, rather than professional classification. Matching consumer/health professional ideals of competency to develop a standard definition was also suggested.
Equity of access – Although a fundamental plank of the NMP, it is recognised that there are access gaps for some sub-population groups, which need to be improved. In this context, the need to identify the size of the issue for each sub-population group, which could be informed by evaluating current activities, was discussed.

Timely access to new medicines – This was considered a context specific issue as opposed to a key issue, which needs open dialogue and a framework for ongoing consideration. The main point from the discussion was that, the earlier the access to new medicines the greater the uncertainty, in terms of risk and cost benefit, which impacts on sustainability. Better use of data and post-market monitoring will further inform this issue.

System sustainability – This was considered a key issue, particularly in terms of monitoring long term sustainability. In this context, the need to understand the value of medicines (in terms of productivity/quality of life/system benefits) and manage expectations was highlighted. The need to further integrate NMP principles into medicines delivery and emerging health policies was also discussed. The importance of competency standards based on good patient care and the emergence of pharmacogenomics were also raised as factors for consideration.

Stimulating/rewarding innovation - – Considered an important issue in terms of maintaining a viable pharmaceutical industry and promoting pharmaceutical research in Australia. The development of a national strategy to address this issue was discussed, particularly in terms of identifying opportunities to invest in this area and to consider different funding models for incentives.

The discussion of the issues above identified the need for: partnership, through ongoing consultation, coordination with other NMP/QUM activities, and alignment and integration with other health policy, as the Executive and Committee develop and implement the agreed priorities for the coming year.

Given the enormous change and innovation in health care delivery over recent years, and the rapid growth in technology solutions, a common theme throughout the day was the need to also consider Australia’s electronic health programs and how they can assist in achieving NMP priorities.

Next steps

Participants were advised that the outcomes from the Forum will be used to help the Executive and Committee to develop a set of priority proposals to put to the Minister for Health and Ageing for consideration.

Participants were also advised that the Executive and Committee welcomed continual input and views from stakeholders, particularly in relation to planning for the next Forum. In this context, an input proforma is available on the Department’s website at: http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-partnerships-feedback, which provides stakeholders with opportunity to identify key issues in the context of the NMP. Input received will be provided to the Executive and Committee for consideration during their planning processes.
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The annual Partnerships Forum, and continual input process, both form part of the Executive and Committee’s consultation framework. Targeted consultation will also be undertaken as the agreed priorities are developed and implemented over the coming year.

Forum Participant List

Name	Organisation	Name	Organisation
Dr Michael Ackland	Department of Human Services Victoria	Dr John Aloizos
Ms Diane Aldous	Queensland Health	Ms Yvonne Allinson	Society of Hospital Pharmacists of Australia
Ms Kylie Barsley	National Medicines Policy Secretariat	Mr John Baxter	National Herbalists Association of Australia
Mr Graham Bedford	Australian Commission on Safety and Quality in Healthcare	Professor Alan Bensoussan	National Medicines Policy Committee
Ms Carol Bennett	Consumers’ Health Forum of Australia	Mr Kim Bessell	Department of Health and Ageing
Dr Jim Buttery	National Medicines Policy Committee	Ms Michelle Burke	Medicines Australia
Mr Robert Boyd-Boland	Australian Dental Association	Dr Andrew Boyden	The Heart Foundation
Ms Naomi Burgess	Department of Health South Australia	Mr Michael Bolt (scribe)	Department of Health and Ageing
Ms Sue Campion	Department of Health and Ageing	Associate Professor Shane Carney	Royal Australasian College of Physicians
Mr Ian Chalmers	Medicines Australia	Mr Peter Chesworth	Department of Innovation, Industry, Science and Research
Ms Mimi Chu (scribe)	Department of Health and Ageing	Ms Charmaine Crowe	Australian Pensioners’ & Superannuants’ Federation
Ms Vicky Cogley	The Heart Foundation	Mr Paul Creech (scribe)	Department of Health and Ageing
Mr Glenn Cross	Ausbiotech Ltd	Ms Sally Cross	Australian Medical Association
Professor Ric Day		Ms Karen Davidson	National Medicines Policy Secretariat
Mr Will Delaat	Medicines Australia	Mr Stephen Dellar	Department of Health and Ageing
Ms Kathy Dennis	Medicare Australia	Ms Vicki Drabsch (scribe)	Department of Health and Ageing
Professor Patricia Dunning	National Medicines Policy Committee	Ms Ann Eayrs	Alzheimers Australia
Ms Julia Evans	Medicare Australia	Ms Sarah Finnerty	National Medicines Policy Secretariat
Ms Elizabeth Foley	Australian Nursing Federation	Mr Peter Flemming	National E-Health Transition Authority
Ms Meredith Freeman (scribe)	Department of Health and Ageing	Ms Jenny Giam	Professional Compounding Chemists of Australia
Dr Madlen Gazarian	Royal Australasian College of Physicians	Professor Andrew Gilbert	University of South Australia

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Name	Organisation	Name	Organisation
Ms Natalie Goodisson (scribe)	Department of Health and Ageing	Ms Linda Graudins	Women’s and Children’s Hospitals Australasia
Associate Professor Tim Gill	The Australian and New Zealand Obesity Society	Professor Sally Green	National Medicines Policy Committee
Ms Janice Hadgraft	Aged and Community Services Australia	Dr Ken Harvey
Dr Neil Hearnden	Osteoporosis Australia	Dr Geoffrey Herkes	Australian Drug Evaluation Committee
Ms Bernadette Hodgins	WA Health Department	Ms Charis Ianniello (scribe)	Department of Health and Ageing
Ms Eithne Irving	Department of Health and Ageing	Ms Linda Jackson	Department of Health and Ageing
Associate Professor Hong Xu	Australian Acupuncture and Chinese Medicine Association	Ms Karen Kaye	National Prescribing Service
Mr Neil Keen	Society of Hospital Pharmacists of Australia	Dr Peter Kennedy	NSW Clinical Excellence Commission
Professor Rosemary Knight	Department of Health and Ageing	Ms Andrea Kunca	Department of Health and Ageing
Dr Poh-Kooi Loh	Council of Australian Therapeutic Advisory Groups	Ms Kate Lynch	Generic Medicines Industry Association
Professor Lyn Littlefield	Allied Health Professions of Australia	Dr Ruth Lopert	Therapeutic Goods Administration
Ms Diana Macdonell	Secretary, Pharmaceutical Benefits Advisory Committee	Professor Andrew McLachlan	Chair, National Medicines Policy Committee
Ms Ruth McQuaid (Scribe)	Department of Health and Ageing	Dr Mona Marabani	Arthritis Australia
Mr Toby Mathieson	National E-Health Transition Authority	Dr Peter Mansfield	Healthy Skepticism Inc
Ms Deborah Monk	Quality Assurance Reference Group	Ms Stacie Murphy	Royal College of Nursing Australia
Mr John Newsom	Cancer Voices Australia	Mr Declan O’Connor Cox	Department of Health and Ageing
Mr Robin Ould	Asthma Foundations Australia	Mr Charlie O’Sullivan	Generic Medicines Industry Association
Mr Robert Peck	Department of Veterans’ Affairs	Mr Ken Pettifer	National Medicines Policy Executive
Mr Andrew Petrie	Queensland Health	Ms Debra Petrys	Council on the Ageing (Seniors voice)
Ms Adriana Platona (scribe)	Department of Health and Ageing	Dr John Primrose	Department of Health and Ageing
Dr Greg Pearce	Generic Medicines Industry Association	Dr John Russell	Australian College of Rural and Remote Medicine
Dr Janette Randall	National Medicines Policy Executive	Ms Maxine Robinson (scribe)	Department of Health and Ageing

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Name	Organisation	Name	Organisation
Ms Catherine Rokahr	Department of Human Services Victoria	Ms Jess Reid	National Seniors Australia
Ms Toni Riley	Pharmacy Guild of Australia	Associate Professor Mark Roth	Optometrists Association of Australia
Ms Amber Roberts	Department of Health and Human Services Tasmania	Dr Alison Roberts	Pharmaceutical Society of Australia
Professor Paul Rolan	National Medicines Policy Committee	Mr Sebastian Rosenberg	Mental Health Council of Australia
Associate Professor Libby Roughead	University of South Australia	Dr Peter Richmond	Australian Technical Advisory Group on Immunisation
Ms Gay Santiago	Department of Health and Ageing	Mr Steve Sant	Rural Doctors Association of Australia
Professor Lloyd Sansom	National Medicines Policy Executive	Ms Juliet Seifert	Australian Self-Medication Industry
Mr Tim Sloan-Gardner (scribe)	Department of Health and Ageing	Dr Carolyn Stapleton	Australian General Practice Network Ltd
Ms Gillian Shaw (scribe)	Department of Health and Ageing	Dr Brendan Shaw	Medicines Australia
Ms Julie Stokes	Queensland Safe Medication Practice Unit	Dr Sue Whicker	Royal Australian College of General Practitioners
Mr Michael Smith	Therapeutic Goods Administration	Professor Tony Smith	Complementary Medicines Evaluation Committee
Dr Linda Swan	National Medicines Policy Committee	Ms Lisa Talevich	National Medicines Policy Secretariat
Ms Diane Walsh	National Medicines Policy Committee	Mr Vincent Wong (scribe)	Department of Health and Ageing
Dr Ian White	Diabetes Australia

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