PART TWO: THE FRAMEWORK Goals 1. To reduce the misuse of pharmaceutical drugs and associated harms in Australia. 2. To enhance the quality use of pharmaceutical drugs without stigmatisation or limiting their accessibility for therapeutic use. Focus The Framework is underpinned by a focus on the quality use of prescription and opioids and benzodiazepines. This includes the use of evidence-based alternative therapies. The Framework seeks to minimise the intentional and unintentional misuse of these medicines and to develop approaches that could also be applied to other potentially problematic medicines. Priority The Framework adopts a holistic approach to addressing these problems which is in keeping with the complex range of factors that contribute to pharmaceutical drug misuse. The Framework is consistent with Australia’s National Strategy for the Quality Use of Medicines. Nine priority areas for action are identified. These were informed by an extensive consultation process involving written submissions, consultation workshops, a review of the literature, discussions with key experts and guidance from an Expert Reference Group and a Project Steering Committee. Priority Areas Actions Coordinated medication management system A coordinated medication management system is an on line, real time tool that provides information on patients’ relevant medication usage for prescribers, pharmacists and regulators. It is important that such a system be linked to the regulatory and monitoring approaches outlined in Priority Area 4. Progress implementation of the nationally-based and jurisdictionally consistent Electronic Recording and Reporting of Controlled Drugs (ERRCD) system which enables prescribers, dispensers and regulators to have real time online access to information concerning patients’ access to prescription opioids and other Schedule 8 medicines. Consider future enhancements to the ERRCD system to meet the characteristics of a comprehensive coordinated medication management system. Where necessary, enhance the required regulatory infrastructure to respond to ERRCD system-generated data. Coordinate national education about the ERRCD system for health and welfare professionals and the broader community. Supporting prescribers This area focuses on a range of strategies that enhance prescribing practice to minimise intentional and unintentional misuse. This includes Develop and/or promote national guidelines for the (non-pharmacological and pharmacological) treatment of conditions commonly implicated in the problematic use of these pharmaceuticals including: Pain (acute, chronic non-malignant and cancer); pharmacological
the development of prescribing guidelines and workforce development measures. Mental health problems (e.g. anxiety); Sleep disorders; and Alcohol and other drug use problems (including pharmacotherapy). Explore options to enhance peer review mechanisms, practice enhancement approaches and disciplinary measures for prescribers who consistently and inappropriately prescribe outside the boundaries of the proposed guidelines. Enhance undergraduate, postgraduate and in-service education programs for the medical, health and human services workforces about the quality management of problems such as pain, mental health problems, sleep disorders and alcohol and other drug problems. Identify opportunities to better support prescribers who feel pressured by patients to provide medications inappropriately. Supporting pharmacists and other health professionals This includes actions to enhance the role of pharmacists in medication management as well as a range of practice enhancement measures for this group. It also highlights the need for other health professionals to be more aware of and involved in the appropriate treatment options for conditions such as pain, anxiety and sleep disorders. Explore opportunities to enhance the contribution that pharmacists can make to the care plans of patients. Review and, necessary, enhance protocols for pharmacists concerning acceptable practice in the dispensing of these medications. Investigate options to improve access to undergraduate and in-service professional development programs for pharmacists to better utilise their professional abilities to enhance the quality use of these medications. Investigate options to establish or enhance peer review mechanisms and practice enhancement measures for pharmacists who dispense outside of protocol boundaries. Enhance the current pharmacy staged supply arrangements. Enhance the quality use of medicines in residential aged care facilities. Enhance the awareness of a range of health and welfare professionals regarding effective treatments for: Pain (acute, chronic non-malignant and cancer); Mental health problems (e.g. anxiety); Sleep disorders; and Alcohol and other drug use problems (including pharmacotherapy). 4 Regulation and monitoring This includes a range of enhancements to, and standardisation of, the ways medications are regulated and monitored and the ways in which data about pharmaceutical Evaluate the extent to different jurisdictional regulatory models impact on the misuse of these drugs and identify standardisation benchmarks for good practice. Provide this Framework to the delegate of the Secretary of the Department of Health for
2.3 Enhance undergraduate, postgraduate and in-service education programs for the medical, health and human services workforces about the quality management of problems such as pain, mental health problems, sleep disorders and alcohol and other drug problems . Supporting approaches : Workforce – Commitment to workforce development. Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 3: Skilled professionals and best practice evidence based care, Objective 9 (Train and support health practitioners in best-practice pain assessment and management) and Objective 10 (Establish and promote systems and guidelines to ensure adequate management of acute, chronic and cancer pain). Policy direction 8: (Workforce). 2.4 Identify opportunities to better support prescribers who feel pressured by patients to provide medications inappropriately. Pillar 2: Supply Reduction, Objective 2 (Control and Manage the supply of alcohol, tobacco and legal drugs). Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 3: Skilled professionals and best practice evidence based care, Objective 9 (Train and support health practitioners in best-practice pain assessment and management). 3.1 Explore opportunities to enhance the contribution that pharmacists can make to the care plans of patients. Supporting approaches: Workforce – Commitment to workforce development. Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 3: Skilled professionals and best practice evidence based care, Objective 9 (Train and support health practitioners in best-practice pain assessment and management) and Goal 4: Access to interdisciplinary care at all levels, Objective 12 (Develop and evaluate service delivery in the community provide interdisciplinary assessment, care and support as part of comprehensive primary health care centres and services). Policy direction 8: (Workforce). 3.2 Review and, where necessary, enhance protocols for pharmacists concerning acceptable practice in the dispensing of these medications. Supporting approaches : Workforce – Commitment to workforce development. Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 3: Skilled professionals and best practice evidence based care, Objective 9 (Train and support health practitioners in best-practice pain assessment and management). Policy direction 8: (Workforce). Policy direction 8 (Workforce).
Pillar 3: Harm reduction, Objective 3 (Reduce to individuals); Supporting approach 1: (Workforce); and Supporting approach 2: (Commitment to evidence). healthcare providers and health educators. interdisciplinary assessment, care and support as part of comprehensive primary health care centres and services), Objective 14 (Expedite access to tier 1 multidisciplinary pain clinics for people with more complex problems) and Objective 15 (Ensure tertiary specialist pain clinics have resources needed to support key strategies). Goal 5: Quality improvement and evaluation, Objective 19 (Ensure equity of access and appropriate use of non-pharmaceutical interventions). 5.2 Explore opportunities to enhance liaison in transitional medication management between hospitals and community settings. Pillar 1: Demand reduction, Objective 2 (Reduce the use of drugs in the community); and Supporting approach 1 (Workforce). Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 3: Skilled professionals and best practice evidence based care, Objective 9 (Train and support health practitioners in best-practice pain assessment and management). 5.3 possible enhance the range of medication pack sizes and/or dispensing options for Pharmaceutical Benefits Scheme medications. Pillar 1: Demand reduction, Objective 2 (Reduce the use of drugs in the community). Goal 3:,Skilled professionals and best practice evidence based care, Objective 10 (Establish and promote systems and guidelines to ensure adequate management of acute, chronic and cancer pain). 5.4 Promote utilisation by prescribers of Medicare Benefits Schedule items which remunerate and target medication review and/or management of conditions such as pain and mental illness. Supporting approach 1: (Workforce). Objective 2: Improve the quality use of medicines by health practitioners, healthcare providers and health educators. Goal 4: Access to interdisciplinary care at all levels, Objective 12 (Develop and evaluate service delivery and funding models for pain management in the community which provide interdisciplinary assessment, care and support as part of comprehensive primary health care centres and services).