Quality Use of Medicines for Cardiovascular Health - National Heart ...

Quality Use of Medicines for
Cardiovascular Health
QUM
Executive Summary
An initiative of the Heart Foundation Pharmaceutical Roundtable
Rob Wiseman, Anne-Marie Scully, Hayley Caspers red 3 – 2006
QUM

This project was supported by the following members of the Pharmaceutical Roundtable:
© 2006 National Heart Foundation of Australia. All rights reserved.
This is an executive summary of the Quality use of medicines in cardiovascular health report. The
report is available at www.heartfoundation.org.au
This report builds on research reported in: Wiseman R and White S (2005) Views of Quality
Use of Medicines: Stakeholders perceptions of their needs, values and responsibilities, and the
opportunities and barriers for QUM. Sydney: The Pharmaceutical Alliance.
This is available from: www.pharmalliance.com.au/files/QUM_2005_Report.pdf
National Heart Foundation of Australia (The Heart Foundation Pharmaceutical Roundtable)
The views expressed in this report are those of the authors and not necessarily those of the Heart
Foundation Pharmaceutical Roundtable or its partner organisations: the National Heart Foundation
of Australia, Alphapharm, Astrazeneca, Bristol-Myer Squibb, Merck Sharp & Dohme, Pfizer
Australia, Roche, sanofi-aventis, Solvay Pharmaceuticals and Servier Laboratories.
This work is copyright. No part may be reproduced in any form or language without prior written
permission from the National Heart Foundation of Australia (national office). Enquiries concerning
permissions should be directed to copyright@heartfoundation.org.au
Suggested citation: National Heart Foundation of Australia (Wiseman R, Scully, AM and Caspers
H on behalf of the Heart Foundation Pharmaceutical Roundtable). Quality Use of Medicines in
cardiovascular health (executive summary). West Melbourne, Victoria, 2006.
National Library of Australia Cataloguing-in-Publication data
Wiseman, Rob, 1969– . Quality Use of Medicine in cardiovascular health (executive summary).
Print: ISBN-10: 1-921226-07-2 ISBN-13: 978-1-921226-07-6
1. Cardiovascular agents—Australia. 2. Cardiovascular diseases—Australia—Treatment.
3. Pharmaceutical policy—Australia. I. Scully, Anne-Marie. II. Caspers, Hayley. III. Title.
615.71
[ 2 ]

Contents
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
The Heart Foundation Pharmaceutical Roundtable . . . . . . . . . . . . . . . . . . . . . . . 2
About the project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Medicines and CVD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Quality Use of Medicines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Contents
Stages of Quality Use of Medicines in Cardiovascular Health. . . . . . . . . . . . . . . . . . . . . . 4
Before a cardiovascular event. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Identifying people at risk of CVD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Encouraging consumers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Enabling General Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Initiating medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Counselling and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
– Consumer medicine information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Adherence in the longer term . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
– Home medicine reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
During a cardiovascular event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Getting people to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Admission to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Engaging specialist physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
After a cardiovascular event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Discharge: from hospital to home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medicines at discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Increasing use of rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Supporting environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Information for consumers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Linking health consumer organisations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Practice nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
IT, connectivity and data exchange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Tracking medicine use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Missing in action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Hospital administrators and private health insurers . . . . . . . . . . . . . . . . . . . . . . 11
Carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
[ 1 ]

Background
Background
The Heart Foundation Pharmaceutical
Roundtable
The Pharmaceutical Roundtable is made up of
the National Heart Foundation of Australia and
11 pharmaceutical manufacturers: Alphapharm,
AstaZeneca, CSL Biotherapies, Gilead, Eli Lilly,
Merck Sharp & Dohme, Pfizer Australia, Roche,
sanofi-aventis, Solvay Pharmaceuticals and
Servier Laboratories.
About the project
In July 2005, the Pharmaceutical Roundtable
commissioned red 3 to explore Quality Use of
Cardiovascular Medicines. Specific goals of the
project were to:
• identify barriers to Quality Use of
Cardiovascular Medicines
• help the Roundtable develop strategies to
overcome these barriers
• prioritise actions to help the Roundtable
achieve Quality Use of Cardiovascular
Medicines.
red 3 conducted the research in three stages:
1 Interviewing nearly fifty key stakeholders
in cardiovascular health and Quality Use
of Medicines.
2 Collating the contributions of these
stakeholders and presenting the results to
a National Stakeholder Workshop, held
in Canberra on 25 November 2005. The
event was structured to fill gaps in the
work to date, correct misunderstandings
and mistakes, and to add further detail. It
also sought suggestions for practical action
to achieve Quality Use of Medicines in
Cardiovascular Health.
3 Combining the workshop’s outcomes with
findings reported in the research literature.
This project built on previous research by red 3
for the National Medicines Policy and The
Pharmaceutical Alliance.
[ 2 ]

Cardiovascular disease
Quality Use of Medicines
Cardiovascular disease (CVD) is the cause of
more deaths in Australia than any other group
of diseases. CVD accounted for 37.6 per cent of
all deaths in Australia during 2002. The burden
of CVD continues to grow, as more and more
Australians are living with the disease as a
chronic condition.
CVD is also a leading cause of long-term
disability. In 1998, over 1.1 million Australians
were affected —nearly one third of all people
with a disability. Of concern is evidence that
the burden of CVD is growing: in the 1990s,
the prevalence of heart, stroke and vascular
conditions rose by 18.2 per cent.
The burden of cardiovascular disease is not
spread evenly in the Australian community.
CVD is more common among people in lower
socio¬economic groups, and they are at a higher
risk of developing the disease. People living in
rural and remote areas are also more likely to die
of CVD, as are Indigenous Australians.
Co-morbidities with CVD are common—
diabetes, renal failure and depression in
particular. Over 80 per cent of elderly
Australians have at least one chronic illness,
and many have two or more.
There is strong evidence that the burden
of CVD on Australia’s health care system
is growing. Cardiovascular conditions
account for about 11 per cent of all problems
managed by GPs in 2002–2003. CVD was the
principal diagnosis of 7 per cent of all people
hospitalised in 2001–2002.
Medicines and CVD
Medicines are one part of treating CVD.
The main strategy for managing CVD is risk
reduction, through lifestyle changes. Ways that
medicines are used to treat CVD include:
• reducing the risk of CVD—for example by
lowering blood pressure, modifying lipid
levels, and preventing blood clots
• helping to open blocked arteries after a heart
attack or stroke
• helping to prevent the body rejecting
implants and tissue grafts
In the 1990s, Australia developed a National
Medicines Policy. It has four central objectives:
• timely access to medicines that Australians
need at a cost individuals and the
community can afford
• medicines meeting appropriate standards of
quality, safety and efficacy
• quality use of medicines
• maintaining a responsible and viable
medicines industry.
The Quality Use of Medicines involves:
1 Selecting management options wisely by:
• considering the place of medicines in
treating illness and maintaining health
• recognising that there may be better ways
than medicine to manage many disorders.
2 Choosing suitable medicines if a medicine
is considered necessary, so that the best
available option is selected by taking into
account:
• the individual
• the clinical condition
• risks and benefits
• dosage and length of treatment
• any co-existing conditions
• other therapies
• monitoring considerations
• costs for the individual, the community
and the health system as a whole.
3 Using medicines safely and effectively to get
the best possible results by:
• monitoring outcomes
• minimising misuse, over-use and
under-use
• improving people’s ability to solve
problems related to medication,
such as negative effects or managing
multiple medications.
CVD / QUM
• aiding recovery after surgery.
[ 3 ]

Stages of Quality of Quality Use of Use Medicines of Medicines in Cardiovascular in Cardiovascular Health Health
Stages of QUM in CV Health
This summary presents the issues of
This summary presents the issues of greatest importance to those consulted. It has been organised
greatest importance to those consulted. It
around the patient’s journey through cardiovascular disease, summarised in the following diagram.
has been organised around the patient’s
journey through cardiovascular disease,
summarised in the following diagram.
before an event
identifying
people at risk
1A
diagnosing
disease
1B
during an event
cardiovascular
event
2
lifestyle advice and
prescribing medicine
1
getting
people to
hospital
lifestyle
changes
3A
3B
dispensing
medicine
2
admission
4
counselling and
education
3
intervention
5
taking
medicine
4
recovery
6
monitoring use
and effects
5
discharge
7
adhering
after an event
1A
2A
3 4
1B
GP
1C
rehab
2B
carers
support
groups
specialist
physician
community
pharmacist
nurses and
allied health
4
[ 4 ]

Before a cardiovascular event
Identifying people at risk of CVD
Early identification of people at risk of CVD
helps prevent the disease developing. Many
people do not realise they are at risk until it is
too late.
There is strong support for a national risk
assessment program to identify Australians at
a higher risk of CVD. Those consulted stressed
that such a program should cover other chronic
illnesses, not just cardiovascular disease.
Benefits of a national risk assessment program
could include:
• earlier identification of cardiovascular risk
and cardiovascular disease
• early targeting of specific risk factors
• reducing mortality from CVD, improving
quality of life, and potentially reducing the
severity of cardiovascular events
• lowering the financial burden of
CVD on consumers, families and the
Australian community
• creating greater predictability in health
budgets and resource use by improved
cost effectiveness.
The main barriers to comprehensive risk
assessment identified in this project were:
• motivating Australians—particularly men—to
go to a health professional for an assessment
• generating enough time for health
professionals to carry out a comprehensive
risk assessment
• funding.
Encouraging consumers
A barrier to improving treatment outcomes is
that many Australians believe ‘doctor knows
best’, and leave important decisions to their
health professionals. There is good evidence
that consumers can achieve better health
outcomes and quality of life if they actively take
part in treatment decisions.
Consumers should be encouraged to:
• discuss their health, medical history and
illnesses with their health professionals
• discuss their willingness to try various
management options (such as better
nutrition, physical activity, smoking
cessation, and use of medicines)
• provide health professionals with accurate
information about all their medicines—
including prescription, over-the-counter and
complementary medicines
• discuss costs and other constraints before
selecting treatment options.
Enabling General Practitioners
There is already a great deal of information
and training materials on cardiovascular health
for consumers and health professionals. But,
while these resources exist, they can be hard
to find. Many documents, training courses,
and educational resources are not available in
an electronic format and therefore cannot be
accessed online. Working out whether medical
information is evidence-based, up¬to-date and
accurate can also be difficult for consumers and
health care professionals alike.
One way to improve access to information
is to develop a portal for all cardiovascular
information, which brings together:
Before a cardiovascular event
• educational materials
• clinical evidence
• clinical practice guidelines
• research
• projects underway and completed
• health services
• support groups.
[ 5 ]

Before a cardiovascular event (cont.)
Before a cardiovascular event
The bulk of cardiovascular risk assessment
and prescribing is done in general practice.
However, general practice is under significant
pressure. A particular problem for GPs is the
growing volume of clinical evidence and
guidelines they are expected to know. The
amount is far greater than they have to time
read, and the volume too large to remember.
GPs find keeping up to date difficult, especially
when their patients have several conditions or
are taking several medicines. The information
available to guide GPs is very fragmented
and difficult to access as a whole. There is
growing evidence that guidelines are not being
translated into clinical practice.
More effective ways need to be found to
provide GPs with information in ways that are
manageable and memorable. Where effective
methods have been found, they need to be
more widely used.
Counselling and education
Some patients do not understand what their
doctor tells them about cardiovascular disease or
their treatment. Research has shown that patient
confusion is responsible for nearly two-thirds
of medicine-related problems after discharge
from hospital. Research has also found that,
while consumers are generally satisfied with
their doctor’s technical knowledge, they felt that
GPs’ greatest weakness is in communicating.
The problem is not just a matter of doctors’
skill, but also a lack of time to counsel patients,
particularly when managing chronic diseases.
Possible solutions include:
• providing doctors with training on how to
communicate with their patients
• making greater use of nurses in general
practice and hospitals to ‘interpret’ doctors’
directions for patients and carers
[ 6 ]
Initiating medicines
There is evidence that some doctors are underprescribing
medicines which have been shown
to be effective in reducing the risk of CVD.
These include ACE inhibitors, beta-blockers and
lipid-modifying drugs. Doctors would benefit
from advice and training on:
• the degree of current under-prescribing
• risks posed by under-use of these medicines
• appropriate use of these medicines
• appropriate target doses
Some of the common medicines used to reduce
risk of cardiovascular disease can have side
effects initially, and it may take doctors some
time to find a formulation or combination
of medicines that is well-tolerated by the
patient. This might involve switching between
medicines, as well as titrating doses up and
down. Many patients do not understand the
reasons for these changes. Because of this, and
the side effects, some patients refuse treatment.
Some doctors need help explaining to
consumers —before commencing a new
medicine—why switching and changing doses
is often necessary initially, and how long it may
take to find a suitable medicine or combination
of medicines.
• greater counselling by pharmacists when
dispensing medicines.
Consumer medicine information
An important tool for educating consumers
about their medicines is the Consumer
Medicine Information (CMI) sheet. By law, all
prescription and pharmacist-only medicines
must have CMI. Topics that CMIs cover include:
– the purpose of the medicine
– issues to consider before taking the medicine
– how to take the medicine correctly
– what to do while taking the medicine
– side effects
– a description of the medicine.
CMI is the only standardised consumer
information prepared for each individual
medicine. They are normally provided
by pharmacists at the time the medicine
is dispensed.
A 2004 review of pharmacies found that only
12 per cent of consumers received a CMI when
dispensed a prescription medicine. Also, many
health professionals, including nurses and
specialist doctors, do not know that CMI exist.
There is a widespread belief that consumers do
not know to ask for CMI.

Consumers and health professionals need to
be further educated about CMI. Consumers
should be encouraged to ask for CMI when
collecting medicines.
Adherence in the longer term
There is evidence that once a person has started
taking medicines, their adherence is likely to be
poor—particularly to long-term management of
chronic disease.
Adherence to preventative treatments is
particularly low among patients without
symptoms. Since many of the medicines
prescribed for cardiovascular disease require
minimum concentration levels to have any
effect, low adherence means the medicine has
either limited or no effect.
Strategies shown to improve adherence include:
• prescribing fewer daily doses (the more
doses a person has to take, the more likely
they are to miss one)
• helping patients develop a schedule for their
medicines
• helping patients select reminders and
• cues to take their medicines.
Research shows that, while these strategies
might work in the short term, few have been
proved effective for long-term treatment. This is
important for CVD, where the condition often
requires long-term medicine use. Further work
to promote long-term adherence to medication
is needed.
Home Medicine Reviews
One tool to improve the use, effectiveness
and safety of medicines is the Home Medicine
Review (HMR). During an HMR, a pharmacist
visits a patient’s home, to:
– check that medicines are being used
appropriately
– identify problems with use
– track medicine use
– identify potential interactions
– check for expired medicines
Once completed, the pharmacist reports the
results of the HMR to the referring doctor.
HMRs are seen as particularly valuable after
discharge from hospital, when they can help
increase patient adherence and improve
medication management.
More pharmacists need to be trained to carry
out HMRs, and doctors encouraged to request
them when appropriate. Giving specialist
doctors authority to order HMRs may also
be helpful.
Before a cardiovascular event
[ 7 ]

During a cardiovascular event
During a cardiovascular event
Getting people to hospital
When a cardiovascular event occurs, it is
crucial to get treatment as soon as possible. A
quarter of Australians die within an hour of their
first symptoms, and the risk is greater for people
who have already experienced a heart attack.
Unfortunately, many people do not seek
help early enough. They either die or sustain
permanent damage. Currently, half of all
heart attack deaths occur before the person
reaches hospital.
People at risk of CVD and their families need to
be educated about:
• recognising the symptoms of acute
cardiovascular events
• what to do if a cardiovascular event occurs
—and how quickly action is required.
Admission to hospital
A major barrier to QUM in hospitals is
inaccuracies in the medicine records developed
at admission. Developing this record is often
difficult because:
• many patients cannot accurately remember
what medicines they are using
• the patient may be unable to speak
• most patients do not keep a medicines list
with them
• patients or family members may not think to
bring medicines when they come to hospital,
and often do not bring packages with them,
making identification difficult
Further complications result from differences
between hospitals. Each hospital has different
processes for developing medicine lists.
Hospitals also vary in how they record
information for future reference—especially
for discharge.
Possible solutions include:
• creating a transferable or centralised
electronic medicine record
• developing a standard procedure for
recording patients’ medicine details
at admission
• asking people—particularly those at risk of
an acute cardiovascular event—to keep an
up-to-date record of their medicines with
them at all times.
Engaging specialist physicians
In the community, general practitioners make
most decisions about the management of CVD,
including use of medicines. In the last decade,
there have been many programs to help GPs
achieve Quality Use of Medicines.
In hospitals, the key decisions about prescribing
cardiovascular medicines are made by
cardiologists. Compared with GPs, there have
been few QUM programs designed specifically
for specialists. New programs are needed for
specialist doctors, including cardiologists—
especially as they are reported to be a major
influence on GPs’ prescribing behaviour.
• many patients do not mention overthe¬counter
or complementary medicines.
[ 8 ]

After a cardiovascular event
Discharge: from hospital to home
A major source of problems in the use of
cardiovascular medicines—and for the
ongoing management of cardiovascular
disease generally —is in the transition from
hospital to home or residential care. Less than
a third of GPs are told that their patients have
been to hospital, or receive information from
the hospital.
A particular object of criticism is the hospital
discharge letter. Problems include:
• many patients are not given a letter
• many patients do not have a doctor to give
the letter to
• each hospital has its own discharge letter,
leading to inconsistencies and omissions
• many letters do not explain which medicines
are to be reduced after discharge
• many letters do not supply contact details in
case of questions
• letters frequently contain errors.
One potential solution to this problem is to
better align the PBS and hospital formularies.
Hospital pharmacists can also help by advising
specialists on the availability and cost of
medicines for consumers after discharge.
Increasing use of rehabilitation
Medicines are only one part of management
after a cardiovascular event. There is also a
range of services to help people recover from a
cardiovascular event, including rehabilitation,
physiotherapy, specialised gymnasium
programs, and community health centres. These
are often poorly coordinated and information
about such programs can be difficult for both
consumers and health professionals to obtain.
There is evidence of under-referral of patients to
cardiac rehabilitation programs. This is because:
• referral to rehabilitation is often not
standard practice
• rehabilitation is not accessible for all
Australians, especially those in rural and
remote areas
After a cardiovascular event
There is broad agreement that electronic
or transferable health records would be the
best way to reduce the loss of information at
discharge. In the absence of electronic records,
an alternative is to improve and standardise
discharge communication processes.
Medicines at discharge
Hospital pharmacies are funded separately
from the PBS, and each hospital has its own
formulary. As a consequence:
• hospitals may use medicines not listed on
the PBS
• hospitals and specialists may use medicines
that are difficult or expensive for consumers
to obtain after discharge.
As a result, after a patient is discharged, their
GP may need to change medicines prescribed
in hospital. Some patients, however, can
be unwilling to change from the medicines
prescribed by their specialist. This can lead to
unnecessarily high costs, patients not filling
scripts, double-dosing, and lower adherence.
• rehabilitation is not sufficiently attractive
for Indigenous Australians, older women,
people who do not speak English, and other
disadvantaged groups.
Ways to improve use of rehabilitation services,
and therefore improve health outcomes for
those recovering from a cardiovascular event,
include:
• updating and promoting the Heart
Foundation’s register of cardiac rehabilitation
centres and their services
• developing and publicising a directory of
service providers, including physiotherapists,
certified gymnasium instructors, and
community health centres
• encouraging GPs and cardiologists to
make greater use of rehabilitation services
where appropriate
• encouraging patients to attend and complete
rehabilitation courses.
[ 9 ]

Supporting environment
Supporting environment
Information for consumers
There is a substantial amount of information
available on topics such as healthy eating and
physical activity for consumers and health
professionals. However, it is highly fragmented
and often inconsistent. This can confuse
consumers and discourage them from making
positive changes to their lifestyle.
Much existing lifestyle advice does not take into
account the differing dietary requirements of
people with chronic diseases (such as limiting
fluids or reducing salt intake). Some information
fails to explain how to balance competing
demands for people with co-morbidities.
Likewise, physical activity programs tend to
focus on the impact of activity on individual
diseases, but ignore the contributions of exercise
to general well-being and mental health.
There is a need for groups providing health
advice to work together in order to develop
consistent advice on nutrition and physical
activity for people with CVD.
Linking health consumer organisations
Different health consumer organisations have
much to learn from one another and to gain by
pooling their skills. Greater collaboration could
lead to:
• better advocacy
• better coordination
• development and dissemination of consistent
health messages
• better services for rural and remote areas,
where resources are scarce.
Practice nurses
To date, the health professionals who have
received the most attention in QUM programs
have been doctors and pharmacists.
Nurses also have an important role to play, but
many are unaware of the basic QUM principles
and lack access to key resources (such as
CMI). Areas where nurses might play a greater
role include:
• undertaking cardiovascular risk assessments
• follow-up after hospital discharge
• checking adherence and medicine use
• managing medical records
• providing counselling and information to
consumers and families
• translating medical advice for consumers
and carers.
IT, connectivity and data exchange
Treating cardiovascular diseases involves
long-term treatment, often by many health
professions in several health settings. Treatments
frequently evolve over the patient’s lifetime.
Management of many chronic diseases would
be easier with electronic health records.
There is strong support for electronic health
records, either as a portable medical record
or in a centrally-maintained database. It is
believed that this will:
• reduce error rates
• reduce uncertainty when transferring patients
between health care settings
• reduce duplication of effort
• allow tracking of medicine use.
Ultimately, all of these things will help improve
health outcomes.
Greater use of IT connectivity may also improve
communication between health professionals
and aid their decision-making.
Tracking medicine use
It is very difficult to track the use of medicines.
This affects all levels of the health system. For
example, at the practice level, it may be difficult
for a doctor to know whether patients are filling
their scripts and using their medicines. At the
national level, there is currently little linkage
between medication use and health outcomes,
so it is difficult to assess the efficacy, safety and
cost-effectiveness of treatment in everyday life.
Identifying interactions and reasons for nonadherence
is also difficult. More coordinated
tracking of medicine use could help develop
better policies and programs.
[ 10 ]
• giving advice to patients on nutrition and
physical activity

Missing in action
Hospital administrators and private
health insurers
Private health insurers fund a large part of
health spending. They are well placed to
influence the uptake of QUM, particular by
hospital health professionals. They are in a
position to encourage health service providers
to adopt methods that provide QUM—such
as early risk assessment and continuity of care
plans. They also have the potential to link
funding across different health settings in order
to support ongoing care.
Hospital administrators have not been drawn
into QUM. Without their involvement, changes
in hospital practice are unlikely.
Carers
Carers have proved difficult to draw into
QUM. Other stakeholders recognise that they
have a large role to play in helping patients
make decisions about medicines and adhere
to treatment. Lack of engagement is a barrier
to QUM.
Carers have needs of their own, which can
be quite unlike those of patients. In particular
they can need help to deal with the stress,
social isolation, depression and anxiety that
often results from supporting a person who
is living with chronic CVD or has suffered an
acute event.
Carers’ needs include:
Missing in action
• information on the cardiovascular disease
affecting the person they are caring for
• knowledge about the treatments—
particularly how to help people adhere to
their medicines and lifestyle changes
• psychological, social and emotional support.
[ 11 ]

Notes
Notes
[ 12 ]

Australian Capital
Territory
Canberra
15 Denison Street
Deakin ACT 2600
T: (02) 6282 5744
New South Wales
Sydney
Level 3, 80 William Street
Sydney NSW 2011
T: (02) 9219 2444
Northern Territory
Darwin
Darwin Central Offices
3rd Floor, 21 Knuckey Street
Darwin NT 0800
T: (08) 8981 1966
Queensland
Brisbane
557 Gregory Terrace
Fortitude Valley QLD 4006
T: (07) 3872 2500
Tasmania
Hobart
86 Hampden Road
Battery Point TAS 7004
T: (03) 6224 2722
Northern Tasmania
Kings Meadows Community
Health Centre, McHugh Street
Kings Meadows TAS w7249
T: (03) 6336 5116
Victoria
Heart Foundation Offices
Newcastle
Suite 5, OTP House
Bradford Close
Kotara NSW 2289
T: (02) 4952 4699
Illawarra
Kiama Hospital and
Community Health Service
Bonaira Street
Kiama NSW 2533
T: (02) 4232 0122
Townsville
Suite 7B, 95 Denham Street
Townsville QLD 4810
T: (07) 4721 4686
South Australia
Adelaide
155-159 Hutt Street
Adelaide SA 5000
T: (08) 8224 2888
Melbourne
Level 12, 500 Collins Street
Melbourne VIC 3000
T: (03) 9329 8511
Western Australia
Perth
334 Rokeby Road
Subiaco WA 6008
T: (08) 9388 3343
[ 13 ]

Quality Use of Medicines for Cardiovascular Health
An initiative of the Heart Foundation Pharmacies Rountable
Executive Summary
Cardiovascular diseases are the greatest cause
of death and disability in Australia, and they are
becoming more common.
Along with healthy lifestyle changes, medications
are the main treatment for cardiovascular
diseases. The Australian community spends over
$1.5 billion a year on cardiovascular medicines.
There is agreement that many are not being used
to their best effect. Some are under prescribed.
Many patients do not remain on long-term
treatments. There are great losses of medicine
information when patients move between
health care settings particularly into and out
of hospitals. Providing consumers, carers and
health professionals with medicine information is
a continuing problem.
In 2005, stakeholders were asked what was
needed to achieve Quality Use of Medicines
(QUM) in cardiovascular health. Consumers,
policy-makers, health professionals and
manufacturers all contributed.
The result, presented in this report, was 128
practical suggestions for action, along with a rich
description of the problems and goals of those
concerned with cardiovascular disease, and an
outline of groups still to be engaged in QUM.
The Heart Foundation Parmaceutical Roundtable members:
HFN0490 JUL10
©2010 National Heart Foundation of Australia ACN 008 419 761