NPS: Medicinewise

Aine Heaney

May 2013

www.nps.org.au

NPS: identifying barriers to evidence uptake

What we’ll cover today

-Who is NPS

-What do we do

-How do we do it (social marketing)

-Case study: antimicrobial resistance program

-Questions and discussion

NPS: Medicinewise

Established as the National Prescribing Service Limited in 1998

Funded by the Australian Government

Independent, not-for-profit organisation

Membership based

Work in partnership

- consumers

- health professionals

- government

- industryDr Lynn WeekesChief Executive Officer, NPS, since 1998

OUR PURPOSE

To enablethe best decisions

about medicines and related health technologies…

…creating better health and economic outcomes

NATIONAL MEDICINES POLICY (2000)

QUALITY USE OF MEDICINES and MEDICAL TESTS

NPS- the service agency for the Quality Use of Medicines arm of Australia’s

National Medicines Policy

Quality use of medicines means:- selecting management options wisely

- choosing the most suitable medicines if medicines are needed

- using medicines safely and effectively

HOW DO WE WORK?

WHO ARE OUR AUDIENCES?

Health professionals

- general practitioners

- medical specialists

- pharmacists

- nurses (primary health care)

- students

Consumers

- communities

- mass audience

Government

IndustryDr Janette Randall, Chair of NPS Board and general practitioner

HOW DO WE ADDRESS THE QUALITY OF USE OF MEDICINES AND MEDICAL TESTS?

Identifying problems at a community level and the changes that would be required for improvement

Attention on both the consumer and health professional issues

Understanding the clinical environment and maintaining relevance

Identifying barriers and enablers for change

Promoting evidence-based messages

Using a mix of interventions with a sound theoretical base

Working across disciplines and sectors

Monitoring and evaluating – using data to inform decisions and evaluate impact

Policies: decisions made by authorities concerning interventions

Michie S et al. The behaviour change wheel. Implementation Science 2011, 6:42

IMPACT OF NPS

QUALITY USE OF MEDICINES: improved health and economic outcomes

improved prescribing and use of medicines/medical tests

participation and exposure

improved attitudes, skills and knowledge

access

awareness

reach

influence

Impact?

Immediate impact

Intermittent impact

Enduring impact

ACTIVITIES TO IMPROVE MEDICINE AND TEST USE

Decision support

Guidelines

Drug information

Academic detailing

Peer group discussion

Audit and feedback

Continuing education

Undergraduate education

Research

Sustained behaviour change

“The limited success of behaviour-change efforts …. can be traced, in part, to:- failure to fully understand the determinants of the

behaviours - and a failure to properly apply health behaviour change

theory to the development and implementation of effective interventions.”

Andrea Gielen and David Sleet, Epidemiol Rev 2003;25:65-76

SOCIAL MARKETING FRAMEWORK

“The application of commercial marketing techniques to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare and that of society”

An effective marketing mix: - Product, Price, Place and Promotion

Selling an idea (change in behaviour) by highlighting the benefits, reducing the barriers and offering a better choice than the alternative (no change in behaviour)

Social Marketing

Aims to bring about behaviour change to benefit society- audience research to understand their world,

motivations, attitudes, beliefs and behaviours- segmentation of audiences to enable targeted

messages- attractive motivational exchanges with audiences- a complete marketing mix, not just communication- careful attention paid to highlighting benefits, reducing

barriers and enabling a better choice to the alternative

J Antimicrobial Chemotherapy 2009;63:230-237

Levels of influence

Glanz and Rimmer: Theory at a glance: a guide for health promotion practice. National Cancer Institute 1995

Interpersonal GATEWAYS AND INFLUENCES

The NPS approach....

Create awareness .... promote curiosity

Influence the influencers ... work with opinion leaders

Use simple messages and concepts that are relevant to everyday life

Work in partnership with others to encourage people to ask when, why and how to use medicines and medical tests

Case Study: antimicrobial resistance program

07/04/2023

Antibiotic Resistance in Respiratory Tract Infections

Antibiotic resistance has been identified as one of the greatest threats to human health, with potential for a return to the 'pre-antibiotic era' where many routine infections were untreatable. The key factor contributing to this resistance trend is the indiscriminate use of antibiotics.

Antibiotic resistance increases the risk of prolonged illness, complications and death.

• Patients remain infectious for longer and potentially spread resistant bacteria to others.

• Other treatments such as major surgery, organ transplant, cancer chemotherapy can be compromised.

• Finally, the need for more expensive therapies increases financial burden to families and society.

Preserving the miracle

“Our vision is that current and future generations will have access to effective prevention and treatment of bacterial infection as part of their right to health.”

This is the presentation name

Tell the story – make a case

22 - 24

Five year plan

Knowledge

Behaviour change

Knowledge

Behaviour change

Knowledge

Behaviour change

Knowledge

Behaviour change

Knowledge

Behaviour change

RTI – 47% UTI - 9.5% Skin - 5% STD - ? % Other

FACILITATED EDUCATION PROGRAMS

Primary care programs

Hospitals

Consumers

Key Messages

Antibiotic resistance requires consideration at both a population and individual level

Establish a patient’s beliefs and expectations about antibiotics for acute RTIs and tailor communication strategies accordingly

Consider the clinical usefulness and the associated risks to your patient before ordering an imaging test

Encourage self-management of acute RTIs and explain why antibiotics may not be appropriate

Consider the issue of resistance when prescribing antibiotics

Facilitated education: general practice doctors

How?- 150 trained Facilitators visit doctors 2-3 times each year

- Managed in partnership with General Practice networks across Australia

- Voluntary participation by doctors and practices

What?- Face-to-face visits with GPs

for one-on-one discussions with targeted and general messages (academic detailing)

- Peer group discussions (based on case studies)

DRUG AND THERAPEUTIC INFORMATION RESOURCES

Reviews and updates

- Australian Prescriber

New drugs

- NPS RADAR

- Medicines Update

(for consumers)

Topic directed updates

- NPS News

- Prescribing Practice Review prescribing feedback

http://www.nps.org.au/health_professionals/publications

Principles in providing information…

Must sound authoritative (reasons for using are understood and acknowledged)

Concise, up-to-date information which can be applied

Brief key points (with emphasis: 2-4 max)

Short headings, visually appealing

Derived from reputable sources (referenced)

Action-oriented and decisive

Use feedback to alter/ammend

Use local key opinion leaders/experts (add credibility & authority)

QI activities e.g. clinical self audits

General practitioners and pharmacists

Self-audits of records (paper or electronic)

Assesses practice in comparison with evidence-based guidelines (using indicators of quality prescribing)

Feedback on their practice in comparison with their peers

Symptomatic management prescription

WEB-BASED INTERACTIVE SELF LEARNING RESOURCES

Primary care practitioners

- Doctors

- Pharmacists

- Nurse practitioners

Hospital practitioners

- Mandated in accreditation standards

Health professional students

- National Prescribing Curriculum

National Prescribing Curriculum

Used by medical, pharmacy, nurse practitioner and dentistry students

Web-based interactive modules

Based on World Health Organization Guide to Good Prescribing

Case-based topics

Diagnosis provided – focus on prescribing

NPS: Consumer programs

Our CQUM program was set up in 2003-4

It takes a health promotion focus and centres on community engagement

We use social marketing techniques to improve medicines literacy

Facilitated education: consumers

Peer education

Managed in partnership with community organisations

Senior peer educators (trained volunteers)

Can reach culturally and linguistically diverse communities

Aligns expectations and builds medicines literacy

By 2013, 60% of Australians...

....taking one or more regular medicines have a basic understanding of quality use of medicines, and know we are a trusted

information source.

ENGAGING THE COMMUNITY

THE REAL CHALLENGEPEOPLE CARE MORE ABOUT WHAT’S IN THEIR CEREALS

OUR STRATEGY

build a recognisable brand

tell people about itand about being medicinewise

create compelling contents and formats

distribute widely, cost effectively and with longevity

continuously measure and refine as necessary

The connecting idea:Join the fight against antibiotic resistance

Consumer insight drivenPeople overestimate antibiotics & underestimate colds and flu

Everyday heroes who fight and winAimed at all Australians in particular Mums with kids u15

Significant media investment

Movement not campaignResistance fighter pledgeDrive to Facebook:

35,000 australians needed to preserve the

miracle of antibiotics

Antibiotic resistance fighters are everyday Australians who take action to fight antibiotic resistance.

If at least 35,000 Australians take action to stop the development and spread of antibiotic resistance, we could make a real difference – and bring Australia back in line with the average of the OECD countries

We are encouraging all Australians to sign up and pledge to become an antibiotic resistance fighter at www.facebook.com/NPSMedicinewise

Social Media Campaign

Political endorsement

TV ADVERTISING

DIGITAL ADVERTISINGEXAMPLES

OUTDOOR

EDITORIAL - TV

The Morning Show

Celebrity advocates: Tom Williams/Mel Doyle

Sunrise(Dr D’Arcy and Dr Ginny)

EDITORIALPRINT AND DIGITAL

Pacific Magazines Yahoo Answers

PHARMACY RESOURCES

Leaflets

Counter mats

Repeat prescription wallets

Hanging ceiling posters

Pharmacy TV

Pharmacy Assistants were engaged

CONTENT RICH WEBSITE

NPS: Medicinewise

In conclusion:

provides a national multidisciplinary program to promote quality use of medicines and medical tests in Australia

addresses issues from both the health professional and consumer perspective

supports public health initiatives through addressing barriers to evidence uptake.

contributes to better health and economic outcomes