The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
* NPS RADAR reviews venlafaxine metabolite
* Avoid further costs by taking your medicine as prescribed
* NPS audit reveals positive prescribing practices in hospitals
* 11th Evaluation Report demonstrates value of NPS
* Get to know your medicines with the NPS Medicine Name Finder
* Be aware of limitations in clinical software systems
NPS RADAR reviews venlafaxine metabolite
There is no evidence that desvenlafaxine (Pristiq) is more effective, safer or better tolerated than its parent drug, venlafaxine, or other antidepressants, NPS advises in the latest edition of NPS RADAR.
Desvenlafaxine was recently listed on the PBS for major depressive disorder. It is the active metabolite of venlafaxine but there is no evidence that it has any particular advantage over venlafaxine.
The review notes that the lowest effective dose of desvenlafaxine is not known, and that doses above 50 mg/day are unlikely to provide further clinical benefit and are associated with a higher incidence of adverse effects. Common adverse effects include nausea, headache, dizziness, dry mouth and diarrhoea.
NPS RADAR recommends dose deceases should occur slowly to avoid discontinuation symptoms.
Desvenlafaxine should not be used in children and adolescents.
NPS RADAR has previously reviewed a number of drugs for depressive disorders and depression. To view the full review or register for free email alerts go to www.npsradar.com.au.
Avoid further costs by taking your medicine as prescribed
People facing financial hardship are urged to speak to their doctor or pharmacist if they are concerned about the cost of their medicines, as suddenly stopping a prescribed medicine can have dangerous consequences.
New research from the Menzies Centre for Health Policy has shown a direct correlation between financial stress and consumers failing to collect prescriptions and skipping doses of medication, which can result in further health complications.
“Reports that people are not taking their medicine because they cannot afford it are extremely concerning,” NPS CEO, Dr Lynn Weekes said.
“Many people are recalculating their household budgets. When you are determining where cutbacks need to be made, I urge you not to put your health at risk by eliminating necessary medicines or missing doses to make your supply last longer.”
The medicine regimen that has been prescribed for you has been designed to ensure you receive the maximum health benefit. Changing that regimen without consulting your doctor may compromise your health.
“What may seem like a simple cost saving by skipping doses or not having a repeat script filled can result in long term lifestyle disruption,” Dr Weekes said.
“If you are having trouble with the cost of your medicines, speak to your doctor or pharmacist about ways of reducing your spending on medicines without compromising your health. This may include having your medicines reviewed to see whether you need the medicines you have been prescribed or utilising the PBS safety net scheme”
“The consequences of suddenly stopping a medicine could be far more expensive than a trip to the doctor,” Dr Weekes said.
For further information about your medicines call the NPS Medicines Line on 1300 888 763 (Mon-Fri 9am-6pm EST) and speak to a pharmacist for the cost of a local call (mobiles may cost more).
NPS audit reveals positive prescribing practices in hospitals
Findings from a quality improvement project funded by the National Prescribing Service Ltd (NPS) focusing on optimising Discharge Management of Acute Coronary Syndromes (DMACS) in hospitals, show that guideline-recommended therapies are prescribed most frequently.
The DMACS project involves 49 public and private hospitals across Australia in collaboration with state based Therapeutic Advisory Groups/Drug Use Evaluation Groups in QLD, NSW, VIC, TAS and SA. The state groups represent experts in drug therapy (clinical pharmacologists, pharmacists and other clinicians) from the major teaching hospitals and affiliated academic units.
The project focuses on three key areas; prescription of cardiovascular medications; education on lifestyle modifications; and communication with patients and GPs.
“From June to December 2008, a baseline audit was completed in hospitals to understand management of patients with acute coronary syndromes (ACS),” NPS clinical expert, Education and Quality Assurance Program Manager, Judith Mackson said.
“Some of our results are consistent with the National Heart Foundation ACS Guideline recommendations and observations in the Australian Collaborative Acute Coronary Syndromes Prospective Audit (ACACIA) study, which described current practice of ACS care in Australia.“
“Of the five guideline recommended therapies, there were high prescribing rates for blood thinning/antiplatelet agents and statins/cholesterol lowering drugs compared with other proven therapies like ACE inhibitors and beta blockers. The ACACIA study provided the basis for quality improvement initiatives such as ours,” Ms Mackson said.
Key findings include:
· Among 1545 patients with a discharge diagnosis of ACS, guideline-recommended therapies were prescribed most frequently - antiplatelet agents (97%) and statins (92%), compared with angiotensin-modifying drugs (78%) and beta blockers (75%)
· 57% of 1545 patients with diagnosis of ACS were referred to cardiac rehabilitation before discharge
· Of 731 GPs who took part in a post-discharge survey, 77% reported receiving a discharge summary at the time of survey. Of these, 65% rated the quality of information from the hospital to be ‘very good’ to ‘excellent’
· Among 1319 patients that participated in the phone survey at 90 days post-discharge, 48% reported taking a combination of life-saving/guideline-recommended therapies (antiplatelet agents, beta blocker, angiotensin-modifying drugs, and statin)
As part of the DMACS project, an educational intervention is being carried out in hospitals until May 2009. This includes feedback of baseline audit results and promotion of best practice guidelines followed by a repeat audit.
Key messages for health professionals include:
* Initiate a long-term management plan for all patients with ACS
* Consider guideline-recommended medications for all patients with ACS
* Identify risk factors and refer all patients with ACS to secondary prevention programs
* Communicate management plan to the patient, carers and the community health care providers.
Final results of the DMACS project, including recommendations are expected by December 2009.
Health professionals and consumers can now refer to certain complementary medicine information resources with confidence, following a review and categorisation of existing databases commissioned by the National Prescribing Service Ltd (NPS).
The study was conducted by the Mater Health Services Brisbane, Bond University and the University of Queensland between June and November 2008.
Researchers considered the technical and content quality and clinical utility of 26 short-listed complementary medicine information resources, and ranked the most useful sources in two tiers. Of those reviewed, six were identified as being of highest quality (Tier One) and three were identified as being of high quality (Tier Two).
“Research conducted by NPS in 2008 found that in spite of widespread use of complementary medicines, both health professionals and consumers struggle to find reliable and accurate information about the safety and efficacy of these medicines,” NPS CEO, Dr Lynn Weekes said.
“Information gaps about complementary medicines were first identified in 2003 by the Expert Committee on Complementary Medicines in the Health System. People have been waiting a long time for an independent review of existing resources and trusted recommendations on which sources to use.”
A number of recommendations have been made by the authors including that the highest quality sources be made available in a number of formats for health professionals and consumers.
“Formats might include online and paper-based versions with brief monographs, and complementary medicine-drug interaction alerts incorporated into clinical software,” research Project Manager, Dr Treasure McGuire said.
“We also believe organisations responsible for providing complementary medicine information to consumers and health professionals should have access to either the Natural Standard Professional Database or Natural Medicines Comprehensive Database (Health Professional Edition), and actively refer people to the resources ranked as Tier One or Tier Two,” Dr McGuire said.
1. Natural Standard (online subscription database package with access to detailed and brief complementary medicine monographs)
2. Natural Medicines Comprehensive Database (Health Professional Edition)
3. Natural Standard - Professional monographs (subset of Natural Standard)
4. Herbal Medicines & Dietary Supplements package (via MedicinesComplete)
5. Natural Standard - Bottom Line monographs (subset of Natural Standard)
6. MedlinePlus: Drugs, Supplements & Herbal Information
1. Barnes et al. Herbal Medicines. 3rd ed 2007 (via Medicines Complete)
2. Natural and Alternative Treatments (EBSCO)
3. Braun and Cohen. Herbs and natural supplements: An evidence-based guide 2nd ed. 2007
To view the full report visit www.nps.org.au.
enquiries to Katie Butt, NPS Media Adviser, 0419 618 365 or email firstname.lastname@example.org.
In December 2008 NPS published two reports into the complementary medicine information needs and uses of consumers and health professionals. In these studies consumers, general practitioners (GPs) and pharmacists identified a number of gaps in the quality use of complementary medicines.
Individuals in all groups lacked knowledge about the safety and effectiveness of complementary medicines and many were unaware of independent and reliable sources of information about complementary medicines. GPs and pharmacists reported their need to access summary information while consulting with patients. They also reported a need to access more detailed information to answer specific clinical questions.
The recommendations from these reports were that health professionals and consumers have access to independent, regularly updated and evidence-based resources on the Internet, in clinical software, phone advisory services and/or in paper format.
Informed by this work, published in 2008, NPS commissioned further work to investigate ways to meet the demand for high quality information about complementary medicines. An independent evaluation of complementary medicines information resources was competed with a view to helping Australians make better informed decisions around the use of complementary medicines.
The evaluation involved four phases:
- Identifying a list of complementary medicines information resources linked from reputable sources which met the objectives of the review.
- Testing resources against broad criteria encompassing currency, coverage, transparency and content quality to produce a manageable short-list of complementary medicines information resources to be subjected to more rigorous detailed review.
- Conducting an in-depth review of the short-listed complementary medicines information resources in the three areas:
a. Technical quality
b. Content quality
c. Clinical utility
- Synthesising findings and making recommendations: short-listed resources were scored and compared across the three areas of quality, with a total score calculated for each resource. Key features of each resource, its intended target audience, profile format, strengths, weaknesses and costs were also compared.
In the first phase, 52 complementary medicines information resources were identified. After short-listing, this was reduced to 26 resource variants for the in-depth review.
11th Evaluation Report demonstrates value of NPS
The positive impact of the National Prescribing Service Ltd (NPS) on prescribing practice and medicines use has been reaffirmed in its latest evaluation report, launched online today.
NPS rigorously assesses the impact of its work and publishes an evaluation report documenting this assessment each year for its members and stakeholders, including the Department of Health and Ageing. It is increasingly accessed and referenced by opinion leaders, academics and researchers.
“Many of our projects are unique, making the data invaluable for key decision makers,” NPS CEO, Dr Lynn Weekes said.
“This also requires our evaluation methods to be world-class, hence the working group which contributes to the development of evaluation frameworks comprises industry experts and innovation leaders.”
Last financial year NPS saved the Pharmaceutical Benefits Scheme over $58 million, well in excess of its contractual requirements. This was through initiatives such as educational outreach visits to doctors, pharmacists and nurses, training programs, resources for consumers, campaigns, and online activities, all of which were supported by its network of member organisations.
“Since its inception in 1998, the breadth and reach of NPS activities has grown significantly. The 11th evaluation report provides measurable evidence that NPS activities continue to result in better prescribing practices, use of medicines and economic outcomes in terms of savings to the PBS,” Dr Weekes said.
“We will continue to build on our success, particularly in the four key areas we identified in our refunding submission to the Department of Health and Ageing. These areas include complementary medicines, continuity of care processes, enhanced phone line services for consumers and health professionals, and an evidence-based website about medicines issues.”
Key NPS achievements for 2007-08 highlighted in the 11th evaluation report include:
§ Positive changes in the prescribing of antithrombotics to prevent cardiovascular events and beta blockers for heart failure.
§ 11,908 individual GPs and 3,318 pharmacists actively voluntarily participated in NPS core activities.
§ More than 2,000 senior medical students from 12 medical schools accessed the National Prescribing Curriculum modules as part of their health professional training.
§ More than 800 practice nurses participated in two therapeutic topics.
§ Telephone services took nearly 20,000 calls from consumers and 6000 calls from health professionals.
§ Of those GPs and pharmacists aware of NPS in 2008, 90% and 95% respectively perceived NPS to be valuable.
§ Australian Prescriber and NPS News continue to be published bi-monthly and distributed to more than 60,000 health professionals.
§ Nearly 2 million visits were made to the NPS and Australian Prescriber website home pages.
§ Approximately 79,500 seniors around Australia have participated in the Peer Education program since 1999.
For a fully copy of the report visit http://www.nps.org.au/eval_report_11
Get to know your medicines with the NPS Medicine Name Finder
Each year 140,000 people are hospitalised because of adverse events relating to medicine. Many of these cases could be avoided if people had a better understanding of how their medicines work.
To help people get to know their medicines, the National Prescribing Service Ltd (NPS) has developed an online tool, NPS Medicine Name Finder, which identifies the active ingredient* in a prescription medicine and the brand names it is known as.
Launched at Parliament House in Canberra today by the Parliamentary Secretary to the Minister for Health and Ageing, Senator Jan McLucas, the NPS Medicine Name Finder is NPS’ debut in online social innovation products.
“This unique tool has been designed to help people learn how to quickly and accurately identify important information about prescription medicines. Understanding your medicines can help reduce the likelihood of an adverse event and enable you to have informed discussions with health professionals about managing your health,” NPS CEO, Dr Lynn Weekes said.
When a brand name is entered into the NPS Medicine Name Finder, the active ingredient name appears and vice versa when the active ingredient name is entered. Consumers are then prompted to record their medicine details on a downloadable Medicines List or print the information to discuss it with their health professional. A link is also provided to the Consumer Medicine Information (CMI) leaflet which contains more details about the medicine.
“Some medicines are known by a number of different names. The NPS Medicine Name Finder will help both consumers and health professionals quickly identify which active ingredients are marketed under which brand names,” Dr Weekes said.
The data supporting the online tool is provided by the Pharmaceutical Benefits Division of the Department of Health and Ageing and updated monthly. It does not cover over-the-counter, natural or herbal medicines, nor medicines not listed on the Pharmaceutical Benefits Scheme.
The NPS Medicine Name Finder is available to both consumers and health professionals at www.nps.org.au/medicine_name_finder.
For specific advice about your medicines speak to your doctor or pharmacist.
NPS Medicine Name Finder has been funded by the Department of Health and Ageing as part of the Generic medicines are an equal choice campaign.
Be aware of limitations in clinical software systems
Research conducted by the National Prescribing Service Limited (NPS) has found that while most clinical software systems pick up important drug interactions, improvements need to be made to ensure doctors and pharmacists do not become desensitised to prompts and alerts.
The study, published in the latest edition of the Medical Journal of Australia, looked at six prescribing software systems commonly used by GPs, three dispensing software systems commonly used by pharmacists and a range of drug interactions reference sources.
While most systems picked up the 20 clinically important drug interactions and all gave alerts for 2 potentially life-threatening interactions, they provided little or no information on clinical effects of the interaction and advice on management.
“GPs and pharmacists need to be aware of the limitations of the decision support features in software systems, including the quality and source of the underlying evidence,” Dr Lynn Weekes, NPS CEO, said.
“Deficiencies in drug interaction decision support can impede the quality use of medicines, both in terms of individual patient management and more broadly by causing “alert fatigue”, desensitising users to prompts and alerts.”
Previous NPS research showed that some GPs and pharmacists were dissatisfied with the drug interaction alerts in their systems, citing too many alerts, and concerns about comprehensiveness and accuracy.
“We believe what users need is more information about the clinical effects of an interaction and advice on patient management, fewer alerts about minor interactions, and clearer presentation. We know that some software vendors have already taken steps to improve their systems and we congratulate them on this,” Dr Weekes said.
The lack of national guidelines or standards for pharmaceutical decision support tools has been identified as one reason why there are inconsistencies and limitations in Australian systems.
“The Government has identified the need for national standards for decision support in clinical software in its National e-Health Strategy. We agree that this would make it easier for software vendors to improve the quality of their systems, and enable greater consistency between systems,” Dr Weekes said.
“We have been and will continue to work with drug information publishers, software vendors, pharmacists and GPs, and the Medical Software Industry Association. The outcomes of this and future research will enable us to make recommendations for features that should be in software to support quality and safety.”