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Pharmaceutical Management Agency

information sheet

Improving access and optimal use of medicines

Making the best use of medicines

The debate about access to medicines is often focused around new medicines. But getting the best out of what’s already in the medicines ‘toolbox’ is just as important. The optimal use of medicines – ensuring medicines aren’t overused, underused or misused – is an important way to improve people’s health using medicines that are already available. PHARMAC works on the ‘optimal use of medicines’ to ensure medicines reach the people they are intended for, and are used well. In addition, there are inequities in the way some New Zealanders access medicines. For example, we know that Māori and Pacific peoples do not access medicines at the same rate as other New Zealanders, yet their burden of disease is higher. One of the goals of the Government’s Medicines New Zealand strategy is to ensure equity of access to medicines for New Zealanders. We have nine Decision Criteria that we use to decide which medicines should be funded. One of these criteria – the particular health needs of Māori and Pacific peoples – is in place specifically to help reduce inequalities in access to medicines. • avoiding inefficiency • reducing disparity

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• allowing other medicines to be subsidised with the money saved from optimal use.

How do we promote the optimal use of medicines?

We work closely with District Health Boards in this area and have a joint working group. We also work closely with health professionals and other organisations. Our work includes: • promoting best practice prescribing – some of which we contract out to bpacnz (an independent organisation based at the University of Otago). bpacnz promotes evidence based healthcare interventions which meet patient needs and are cost effective and suitable for use in New Zealand; • providing information to support new medicine subsidies and/or brand changes; • running population health programmes, which have led to both reduced (such as the Wise Use of Antibiotics campaign) or increased (such as the One Heart Many Lives campaign) use of medicines. We have had a Māori Responsiveness Strategy since 2002. The current action plan – Te Whaioranga – aims to ensure equitable access to medicines for Māori. This was developed after extensive consultation with the Māori community and guides us on how to best meet the needs of Māori. The six strategic goals are: • incorporate Māori strategic priorities into wider PHARMAC work • improve human resources • improve ethnicity data collection and analysis • improve our performance in negotiating with suppliers and assessing new drug applications • improve our performance in informing Māori about available subsidised medicines • improve Māori representation and participation in PHARMAC’s work. The Strategy has led to a number of activities that improve our responsiveness to Māori. There is now Māori representation on PHARMAC’s Board and in advisory bodies. One specific campaign, He Rongoā Pai, He Oranga Whānau, has been developed to help improve use of medicines by Māori. This campaign delivers education sessions to high-needs communities and the health professionals who service these communities to empower management of health at a community level. During 2010 PHARMAC also developed a Pacific Responsiveness Strategy and has commenced implementation.

Reducing inequalities in access to medicines

The reasons for differences in access may be financial (such as the cost of going to the doctor), geographic (how close people live to a doctor or pharmacy), awareness (knowing what medicines or health services are available), poor prescribing, or because the person prefers an alternative non-funded treatment (such as a herbal remedy or traditional medicine), or no treatment at all. Using asthma as an example, our analysis shows that in 2007 medicines usage was higher for European New Zealanders and much lower for Māori and Pacific peoples. At the same time, Māori and Pacific peoples had higher rates of hospitalisation. This illustrates how differences in usage patterns can contribute to health disparities among different population groups.

PHARMAC’s response

Promoting the responsible use of medicines (‘optimal use’) is one of PHARMAC’s statutory functions. Optimal Use initiatives help make the best use of the pharmaceutical budget by: • encouraging appropriate medicines provision and use • promoting greater use where appropriate • reducing use where appropriate

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PHARMAC Information sheet

Population Health Programmes

Wise Use of Antibiotics Co-ordinated and funded by PHARMAC since 1999, Wise Use of Antibiotics has raised awareness that antibiotics are not effective as a treatment for winter colds and ‘flu. Research shows that awareness of the correct role of antibiotics in treating colds and ‘flu has increased since the campaign began, and expectations of receiving an antibiotic for a cold have fallen.

Space to Breathe – taking care of asthma The Space to Breathe programme aims to help New Zealand families improve management of asthma. We work with The Asthma Foundation to encourage the optimal use of asthma medicines, particularly promoting the appropriate use of inhaled corticosteroids, the most common asthma preventer medicine. We continue to work with the Asthma Foundation and associated societies to develop education resources to use with families for asthma education. We also support review of best-practice asthma guidelines to ensure that all resources are in line with best practice recommendations.

A large component of the Space to Breathe programme, currently being piloted in Waitemata, focuses on improving asthma management among children aged 0 to 5 years old. The programme delivers asthma education and helpful reinforcement tools to families of children with asthma, through Early Childhood Education Centres.

One Heart Many Lives Originating in 2003, this programme promotes awareness of cardiovascular disease. It is particularly aimed at Māori and Pacific men aged 35 and over, who have a higher risk of suffering heart disease than other New Zealanders. The campaign has increased awareness about heart disease and how to manage risk factors by eating better, stopping smoking and becoming more physically active. We’ve also seen an increase in use of the SPARC Green Prescriptions programme, and greater than average increase in prescriptions for cholesterol-lowering medication in areas where the programme has been run.

Since 2010 the programme has moved from a regional base to a more national footing.

Antipsychotics in Dementia Antipsychotic medicines have an important place in the treatment of mental illness. However, there is concern about their use in rest homes as behaviour management tools. We have worked with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) previously to develop a programme to raise awareness and promote audits of rest home patients prescribed antipsychotic medicines.

We are currently reviewing the level of inappropriate prescribing of antipsychotics in rest homes. Once more robust information has been gathered, we will continue to work with the RANZCP and the College of General Practitioners to further develop work in this area.

Contacting Us

Call us on 0800 66 00 50 (between 9am and 5pm, Monday to Friday), Write to us at: PHARMAC, PO Box 10 254, Wellington – we respond to all letters Email us at enquiry@pharmac.govt.nz – we respond to all emails Information Sheets on various PHARMAC topics are available from our website: www.pharmac.govt.nz/patients/infosheets If you have specific areas of interest (such as consultations, committees or vacancies), visit our website and subscribe to news feeds in the area(s) of interest to you: http://pharmac.govt.nz/feeds