Consumer Perspectives on Managing Multiple Medicines - PHARM

Consumer Perspectives on Managing Multiple Medicines - PHARM

Consumer Perspectives on Managing Multiple Medicines - PHARM


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<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> perspectives <strong>on</strong><br />

managing multiple medicines<br />

A summary of c<strong>on</strong>sumer<br />

c<strong>on</strong>sultati<strong>on</strong>s c<strong>on</strong>ducted<br />

by the Pharmaceutical<br />

Health and Rati<strong>on</strong>al<br />

use of <strong>Medicines</strong> (pharm)<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee<br />

during 1998–2000<br />

Funding for the c<strong>on</strong>sultati<strong>on</strong>s<br />

and the producti<strong>on</strong> of this<br />

report was provided by the<br />

Comm<strong>on</strong>wealth Department<br />

of Health and Aged Care.

C<strong>on</strong>tents<br />

Acknowledgements<br />

Summary 3<br />

The <strong>PHARM</strong> <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee<br />

members at the time of the c<strong>on</strong>sultati<strong>on</strong>s<br />

were<br />

Introducti<strong>on</strong> 4<br />

T<strong>on</strong>y Wade<br />

Bella Brushin<br />

Nick Carr<br />

Ric Day<br />

Sarah Fogg<br />

Rosemary Knight<br />

John Morgan<br />

Adele Stevens<br />

Ros Wood<br />

The c<strong>on</strong>sultati<strong>on</strong>s 6<br />

Method 6<br />

Rati<strong>on</strong>ale 8<br />

The <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee welcomes<br />

feedback <strong>on</strong> this report. Please send<br />

your comments to<br />

T<strong>on</strong>y Wade<br />

Chair, <strong>PHARM</strong> <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee<br />

Department of Health and Aged Care<br />

Quality Use of <strong>Medicines</strong><br />

MDP 83<br />

GPO Box 9848<br />

Canberra act 2601<br />

<strong>PHARM</strong>@health.gov.au<br />

The <strong>PHARM</strong> <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee<br />

would like to thank all those who<br />

participated in the c<strong>on</strong>sultati<strong>on</strong>s<br />

and shared their experiences of using<br />

medicines and their ideas <strong>on</strong> how to<br />

solve some of the problems they face.<br />

© Pharmaceutical Health and Rati<strong>on</strong>al use<br />

of <strong>Medicines</strong> Committee (pharm) 2001<br />

This report may be reproduced in whole<br />

or in part provided that an acknowledgement<br />

of the source is included.<br />

isbn: 0642735883<br />

pan: 2892<br />

Designed by<br />

Octavo typography & informati<strong>on</strong> design<br />

The findings 9<br />

Unexplained changes 10<br />

Ineffective pharmacy labels 12<br />

Attitudes and understanding 13<br />

Access to important informati<strong>on</strong> 13<br />

Inadequate communicati<strong>on</strong> 16<br />

Cost issues 18<br />

Lack of co-ordinati<strong>on</strong> 18<br />

Inappropriate prescribing 19<br />

Some soluti<strong>on</strong>s 20<br />

Making day-to-day management easier 20<br />

Better labelling and packaging 20<br />

Better access to independent informati<strong>on</strong> 21<br />

Improving customer-provider communicati<strong>on</strong> 21<br />

Improving provider-provider communicati<strong>on</strong> and co-ordinati<strong>on</strong> 22<br />

Enhancing c<strong>on</strong>sumer networks 22<br />

C<strong>on</strong>clusi<strong>on</strong> 23

1 Summary<br />

This report describes a series of c<strong>on</strong>sultati<strong>on</strong>s in 1998 to 2000 with<br />

c<strong>on</strong>sumers who take multiple medicines <strong>on</strong> a l<strong>on</strong>g-term basis. The<br />

c<strong>on</strong>sultati<strong>on</strong>s sought ideas and feedback <strong>on</strong>:<br />

■ the problems c<strong>on</strong>sumers face in managing multiple medicines<br />

■ the possible soluti<strong>on</strong>s needed to address those problems.<br />

The c<strong>on</strong>sultati<strong>on</strong>s were c<strong>on</strong>ducted by the <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee of the<br />

Pharmaceutical Health and Rati<strong>on</strong>al use of <strong>Medicines</strong> Committee (<strong>PHARM</strong>)<br />

in order to inform the work of the <strong>PHARM</strong> Committee in promoting the<br />

quality use of medicines. The <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee met with more<br />

than 110 c<strong>on</strong>sumer organisati<strong>on</strong>s: some large state-based c<strong>on</strong>sumer groups,<br />

others smaller self-help and specialist community groups whose members<br />

have chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong>s necessitating the use of multiple medicines.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s rarely set out deliberately to misuse their medicines. From their<br />

perspective the decisi<strong>on</strong>s they make about using medicines are reas<strong>on</strong>ed<br />

<strong>on</strong>es but sometimes they make those decisi<strong>on</strong>s without the full facts or<br />

the necessary skills and support. Their decisi<strong>on</strong>s may also be affected by<br />

other persuasive influences that are not c<strong>on</strong>ducive to the quality use of<br />

medicines. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s described situati<strong>on</strong>s in which their own attitudes<br />

or lack of understanding c<strong>on</strong>tributed to problems. They also reported<br />

problems accessing important informati<strong>on</strong>, and inadequate communicati<strong>on</strong><br />

between c<strong>on</strong>sumers and doctors, and c<strong>on</strong>sumers and pharmacists. They<br />

reported difficulties managing complex regimes of multiple medicines and<br />

obtaining help to overcome or compensate for those difficulties.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s also described a number of systemic issues that can c<strong>on</strong>tribute<br />

to poor quality use of medicines. These included a lack of appreciati<strong>on</strong><br />

of c<strong>on</strong>sumer perspectives <strong>on</strong> medicine use, poor communicati<strong>on</strong> and<br />

co-ordinati<strong>on</strong> between the different secti<strong>on</strong>s of the health system and<br />

between different health professi<strong>on</strong>als, the existence of different brands<br />

of the same medicine, inadequate labelling, and an over-reliance <strong>on</strong><br />

medicines when other forms of therapy may be more appropriate.<br />

The findings from<br />

these c<strong>on</strong>sultati<strong>on</strong>s<br />

add important<br />

perspectives which,<br />

together with<br />

evidence from other<br />

c<strong>on</strong>sumer research<br />

and c<strong>on</strong>sultati<strong>on</strong>s,<br />

should inform the<br />

activities of <strong>PHARM</strong><br />

and other quality<br />

use of medicines<br />

partners.<br />

Input and feedback from c<strong>on</strong>sumers—in this case, those taking multiple<br />

medicines <strong>on</strong> a l<strong>on</strong>g-term basis and their carers—is essential if successful<br />

strategies are to be developed and implemented to improve the quality<br />

use of medicines.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: summary 3

2 Introducti<strong>on</strong><br />

From February 1998 to August 2000 the <strong>PHARM</strong> <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee<br />

(CSC) c<strong>on</strong>ducted a series of c<strong>on</strong>sultati<strong>on</strong>s with c<strong>on</strong>sumer organisati<strong>on</strong>s<br />

whose members often take multiple medicines <strong>on</strong> a l<strong>on</strong>g-term basis. At<br />

each c<strong>on</strong>sultati<strong>on</strong> the topics discussed were:<br />

■<br />

■<br />

the problems c<strong>on</strong>sumers face in managing multiple medicines<br />

the possible soluti<strong>on</strong>s needed to address those problems.<br />

The c<strong>on</strong>sultati<strong>on</strong>s were c<strong>on</strong>ducted by the CSC in order to inform the work<br />

of the Pharmaceutical and Rati<strong>on</strong>al use of <strong>Medicines</strong> Committee (<strong>PHARM</strong>)<br />

in promoting the quality use of medicines (QUM). The CSC is an expert<br />

group whose members include a general practiti<strong>on</strong>er, a pharmacologist,<br />

a pharmacist and c<strong>on</strong>sumers.<br />

A central tenet of the quality use of medicines policy is partnership and<br />

co-operati<strong>on</strong> between all groups whose activities influence the quality<br />

use of medicines. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s, as <strong>on</strong>e of these groups and the ultimate<br />

users of medicines, need to be involved in developing and implementing<br />

strategies and m<strong>on</strong>itoring and evaluating the outcomes.<br />

The terms of reference of the CSC include providing policy advice to<br />

<strong>PHARM</strong> <strong>on</strong> c<strong>on</strong>sumer issues influencing the use of medicines. In<br />

c<strong>on</strong>ducting these c<strong>on</strong>sultati<strong>on</strong>s the CSC aimed to draw <strong>on</strong> and harness<br />

the experience of high users of medicines, that is, people who take<br />

multiple medicines <strong>on</strong> a l<strong>on</strong>g-term basis. It recognised that it is am<strong>on</strong>g<br />

these c<strong>on</strong>sumers that the potential to reduce misuse, safety problems<br />

and adverse events and to improve the quality use and health outcomes<br />

is probably the greatest.<br />

The c<strong>on</strong>sultati<strong>on</strong>s build <strong>on</strong> a number of other important c<strong>on</strong>sumer<br />

research projects and c<strong>on</strong>sultati<strong>on</strong>s c<strong>on</strong>ducted in Australia by c<strong>on</strong>sumer<br />

organisati<strong>on</strong>s and others over the last decade.<br />

4<br />

pharm c<strong>on</strong>sumer sub-committee

Quality use of medicines<br />

Australia has a well established policy <strong>on</strong> the quality use of medicines<br />

(QUM). It is <strong>on</strong>e arm of the Nati<strong>on</strong>al <strong>Medicines</strong> Policy 1 , al<strong>on</strong>g with timely<br />

access to medicines, medicines that meet appropriate standards of<br />

quality, safety and efficacy, and maintaining a resp<strong>on</strong>sible and viable<br />

pharmaceutical industry.<br />

The aim of the QUM policy is to improve the way medicines are<br />

prescribed and used to ensure better health outcomes for all<br />

Australians. Quality use of medicines is defined as…<br />

C<strong>on</strong>siderati<strong>on</strong> and selecti<strong>on</strong> of best management opti<strong>on</strong>s<br />

This means c<strong>on</strong>siderati<strong>on</strong> of the place of medicines in treating illness<br />

and maintaining health, recognising that for the management of many<br />

disorders n<strong>on</strong>-drug therapies may be the best opti<strong>on</strong>.<br />

Appropriate choice of medicines and dosage regimens<br />

This means that, when medicines are required, selecting the best opti<strong>on</strong><br />

from the range available taking into account the individual, the clinical<br />

c<strong>on</strong>diti<strong>on</strong>, risks, benefits, dosage, length of treatment, co-morbidities,<br />

other therapies and m<strong>on</strong>itoring c<strong>on</strong>siderati<strong>on</strong>s. Appropriate selecti<strong>on</strong><br />

also requires a c<strong>on</strong>siderati<strong>on</strong> of costs, both human and ec<strong>on</strong>omic. These<br />

costs should be c<strong>on</strong>sidered both for the individual, the community and<br />

the health system as a whole.<br />

Safe and effective use<br />

This means ensuring best possible outcomes of therapy by m<strong>on</strong>itoring<br />

outcomes, minimising misuse, over-use and under-use, as well as<br />

improving the ability of all individuals to take appropriate acti<strong>on</strong>s to<br />

solve medicati<strong>on</strong>-related problems, eg. adverse effects and managing<br />

multiple medicati<strong>on</strong>s.<br />

The aim of<br />

the QUM<br />

policy is to<br />

improve the<br />

way medicines<br />

are prescribed<br />

and used<br />

to ensure<br />

better health<br />

outcomes for<br />

all Australians.<br />

1 Comm<strong>on</strong>wealth Department of Health and Aged Care, Nati<strong>on</strong>al <strong>Medicines</strong> Policy 2000, Canberra<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: introducti<strong>on</strong> 5

3 The c<strong>on</strong>sultati<strong>on</strong>s<br />

3.1 Method<br />

Six c<strong>on</strong>sultati<strong>on</strong>s were held in four states, including <strong>on</strong>e rural locati<strong>on</strong>.<br />

Altogether, the CSC met with representatives of over 110 c<strong>on</strong>sumer<br />

organisati<strong>on</strong>s, ranging from large state-based c<strong>on</strong>sumer groups with<br />

memberships in their thousands to smaller self-help and specialist<br />

community groups with 40 members or less. Many were organisati<strong>on</strong>s<br />

that are in c<strong>on</strong>tact with a c<strong>on</strong>stituency well bey<strong>on</strong>d their own membership<br />

or client group. Several, for example, offer an informati<strong>on</strong> service<br />

to the public and through this are in touch with the c<strong>on</strong>cerns of a<br />

greater number of c<strong>on</strong>sumers.<br />

Table 1: Details of c<strong>on</strong>sultati<strong>on</strong>s<br />

Where When <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> groups involved<br />

Melbourne Feb 1998 Range of health c<strong>on</strong>sumer and community groups<br />

Sydney Jun 1998 Range of health c<strong>on</strong>sumer and community groups<br />

Perth May 1999 Range of health c<strong>on</strong>sumer and community groups<br />

Melbourne Nov 1999 Health c<strong>on</strong>sumer and community groups of people of n<strong>on</strong>-English<br />

speaking backgrounds<br />

Campbell Town, May 2000 Health c<strong>on</strong>sumer and community groups of people living in regi<strong>on</strong>al<br />

Tasmania<br />

centres and rural areas<br />

Melbourne Aug 2000 Mental health c<strong>on</strong>sumer and community groups<br />

CSC met with<br />

representatives<br />

of over 110<br />

c<strong>on</strong>sumer<br />

organisati<strong>on</strong>s…<br />

One c<strong>on</strong>sultati<strong>on</strong> was held exclusively for c<strong>on</strong>sumers with mental<br />

health c<strong>on</strong>diti<strong>on</strong>s and their representatives. At each of the other<br />

c<strong>on</strong>sultati<strong>on</strong>s older people’s organisati<strong>on</strong>s were well represented,<br />

as were organisati<strong>on</strong>s whose members suffer from chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong>s<br />

such as asthma, diabetes, arthritis, Parkins<strong>on</strong>’s disease, schizophrenia<br />

and coeliac disease. Carers of people taking multiple medicines were<br />

also represented. The Melbourne meeting with people of n<strong>on</strong>-English<br />

speaking backgrounds was attended by representatives of 13 ethnic<br />

communities and was c<strong>on</strong>ducted in English.<br />

6<br />

pharm c<strong>on</strong>sumer sub-committee

In inviting organisati<strong>on</strong>s to attend the c<strong>on</strong>sultati<strong>on</strong>s the CSC worked with<br />

local c<strong>on</strong>sumer representatives to develop mailing lists and distribute<br />

invitati<strong>on</strong>s to c<strong>on</strong>sumer and community organisati<strong>on</strong>s whose members<br />

(or clients) comm<strong>on</strong>ly take multiple medicines <strong>on</strong> a l<strong>on</strong>g-term basis.<br />

A small payment for travel and other expenses was offered to minimise<br />

the financial barriers that might prevent c<strong>on</strong>sumers from attending.<br />

At each c<strong>on</strong>sultati<strong>on</strong> comprehensive notes were taken. CSC members also<br />

took notes and participated in the discussi<strong>on</strong>. Immediately after each<br />

meeting CSC members reviewed their immediate impressi<strong>on</strong>s and clarified<br />

key points for the record. A written summary was produced and sent back<br />

to the participants for validati<strong>on</strong> and feedback. Comments were collated<br />

and included in the revised summary.<br />

At the start of each c<strong>on</strong>sultati<strong>on</strong> participants were given a short briefing<br />

<strong>on</strong> the Quality Use of <strong>Medicines</strong> Program and its Nati<strong>on</strong>al <strong>Medicines</strong><br />

Policy c<strong>on</strong>text. Pointers to further resources for local use, such as QUM<br />

community grants, the QUM website map of projects, 2 and current QUM<br />

publicati<strong>on</strong>s, were also given. The majority of participants asked to be<br />

put <strong>on</strong> the mailing list for newsletters and informati<strong>on</strong> about quality use<br />

of medicines issues and developments.<br />

…organisati<strong>on</strong>s<br />

ranged from<br />

large statebased<br />

c<strong>on</strong>sumer<br />

groups to<br />

smaller self-help<br />

and specialist<br />

community<br />

groups.<br />

2 www.qumap.health.gov.au<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the c<strong>on</strong>sultati<strong>on</strong>s 7

3.2 Rati<strong>on</strong>ale<br />

C<strong>on</strong>sultati<strong>on</strong>s<br />

also fostered<br />

links between<br />

c<strong>on</strong>sumer<br />

organisati<strong>on</strong>s<br />

with a comm<strong>on</strong><br />

interest in the<br />

quality use of<br />

medicines.<br />

This method of c<strong>on</strong>sultati<strong>on</strong> was chosen for several reas<strong>on</strong>s. It was relatively<br />

c<strong>on</strong>venient and cost-effective, and ensured that the CSC would reach a wide<br />

range of c<strong>on</strong>sumers in different states. The c<strong>on</strong>sultati<strong>on</strong>s were timed to fit in<br />

with the CSC’s existing schedule of meetings.<br />

The c<strong>on</strong>sultati<strong>on</strong>s allowed the CSC direct c<strong>on</strong>tact and open enquiry with a<br />

broad spectrum of c<strong>on</strong>sumers and their representatives. They also enabled<br />

the CSC to provide informati<strong>on</strong> to, and promote strategic alliances with,<br />

c<strong>on</strong>sumer organisati<strong>on</strong>s interested in promoting the quality use of medicines.<br />

The c<strong>on</strong>sultati<strong>on</strong>s also fostered links between c<strong>on</strong>sumer organisati<strong>on</strong>s with a<br />

comm<strong>on</strong> interest in the quality use of medicines.<br />

Participants at the c<strong>on</strong>sultati<strong>on</strong>s highlighted these points in their feedback<br />

comments. What they found most useful in attending the c<strong>on</strong>sultati<strong>on</strong>s<br />

tended to be:<br />

■ the opportunity for discussi<strong>on</strong> between c<strong>on</strong>sumers, c<strong>on</strong>sumer<br />

representatives and c<strong>on</strong>sumer organisati<strong>on</strong>s <strong>on</strong> important quality<br />

use of medicines issues<br />

■ the chance to articulate important community needs and c<strong>on</strong>cerns<br />

■ the recogniti<strong>on</strong> that their c<strong>on</strong>cerns were shared by others, were legitimate<br />

and were being c<strong>on</strong>sidered in the development of policy directi<strong>on</strong>s.<br />

Some participants said that the c<strong>on</strong>sultati<strong>on</strong>s had bolstered their group’s<br />

c<strong>on</strong>fidence to take steps to address some of the issues that were crucial to<br />

their group.<br />

In their feedback (average resp<strong>on</strong>se rate 45%) the majority of resp<strong>on</strong>dents<br />

said the meeting process was valued and worthwhile, and the meeting<br />

summaries were accurate.<br />

The c<strong>on</strong>sultati<strong>on</strong>s did not specifically address issues that affect occasi<strong>on</strong>al<br />

users of medicines or people who usually take <strong>on</strong>ly <strong>on</strong>e medicine. Other<br />

c<strong>on</strong>sumer groups taking multiple medicines that were not included in these<br />

c<strong>on</strong>sultati<strong>on</strong>s or included <strong>on</strong>ly to a limited extent were indigenous people,<br />

parents of young children, young people, residents of nursing homes and<br />

hostels, and people with disabilities.<br />

Clearly, the method chosen does not allow the drawing of firm c<strong>on</strong>clusi<strong>on</strong>s<br />

about the prevalence of the issues raised. However, the comm<strong>on</strong>ality between<br />

the issues raised by the different c<strong>on</strong>sumer groups in different parts of the<br />

country gives c<strong>on</strong>siderable c<strong>on</strong>fidence that these issues are real, widespread<br />

and the <strong>on</strong>es that are important to c<strong>on</strong>sumers of multiple medicines.<br />

8<br />

pharm c<strong>on</strong>sumer sub-committee

4 The findings<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s talked about the problems they face when managing multiple<br />

medicines. They also identified a range of factors that may prevent or<br />

make it difficult for them to be active partners in the use of their<br />

medicines and to act wisely when using them.<br />

C<strong>on</strong>tributing factors include:<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s<br />

identified a range<br />

■<br />

c<strong>on</strong>sumer attitudes that may not be c<strong>on</strong>ducive to the quality use<br />

of medicines<br />

of factors that<br />

■ difficulty accessing important informati<strong>on</strong> when it is needed<br />

■ inadequate communicati<strong>on</strong> between c<strong>on</strong>sumers and doctors, and<br />

c<strong>on</strong>sumers and pharmacists<br />

■ difficulty managing regimes of multiple medicines and accessing<br />

help to overcome or compensate for that difficulty<br />

■ cost.<br />

These factors affect different c<strong>on</strong>sumers in different ways. For example,<br />

some may be a significant issue for older people but not relevant to<br />

younger people. Each is discussed in more detail below.<br />

These factors do not exist in a vacuum. They are, in part, a product of<br />

systemic issues such as:<br />

■ the complexity of the health system<br />

■ the lack of communicati<strong>on</strong> and co-ordinati<strong>on</strong> between different<br />

secti<strong>on</strong>s of the health system and between different health<br />

professi<strong>on</strong>als<br />

■ the complex and sophisticated nature of medicinal drug therapy and<br />

the need to follow detailed and specific instructi<strong>on</strong>s<br />

may prevent or<br />

make it difficult<br />

for them to be<br />

active partners<br />

in the use of their<br />

medicines and to<br />

act wisely when<br />

using them.<br />

■<br />

■<br />

easier access to medicines than to other forms of therapy that may<br />

be more appropriate (for example, physiotherapy or counselling)<br />

a lack of understanding of c<strong>on</strong>sumer perspectives by other<br />

stakeholders.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 9

An example of the latter is the lack of appreciati<strong>on</strong> that prescribers and<br />

dispensers may have of the practical difficulties c<strong>on</strong>sumers face when<br />

managing a complex medicine regime <strong>on</strong> a l<strong>on</strong>g-term day-to-day basis.<br />

Tensi<strong>on</strong>s within the Nati<strong>on</strong>al <strong>Medicines</strong> Policy were also noted — for<br />

example, between the aims of promoting a competitive and viable<br />

pharmaceutical industry and promoting the quality use of medicines.<br />

4.1 Unexplained changes<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s reported having had problems as a result of their dispensed<br />

medicines being changed — whether to a different brand or a different<br />

medicine — without any<strong>on</strong>e having made sure that they (or their carers)<br />

understood what had been d<strong>on</strong>e.<br />

Brand substituti<strong>on</strong> changes can upset the finely balanced arrangements<br />

that c<strong>on</strong>sumers make for remembering which medicines to take and when.<br />

Many c<strong>on</strong>sumers identify their medicines by colour and shape and are<br />

disrupted when these change unexpectedly or frequently.<br />

It was also clear that many c<strong>on</strong>sumers do not distinguish between a<br />

change to a different brand of the same medicine (for example, by the<br />

pharmacist or the hospital) and a change to a different medicine. As far<br />

as the c<strong>on</strong>sumer is c<strong>on</strong>cerned the name of the medicine — and, hence,<br />

the medicine itself — has changed in both situati<strong>on</strong>s.<br />

As a result, c<strong>on</strong>sumers, especially older c<strong>on</strong>sumers, may be unclear as to<br />

whether their previous medicine should be c<strong>on</strong>tinued as well. They may<br />

decide to take both medicines or to make a reas<strong>on</strong>ed but perhaps wr<strong>on</strong>g<br />

decisi<strong>on</strong> not to take the new and unfamiliar-looking medicine.<br />

These problems are reported to be getting worse as generic brands<br />

become more comm<strong>on</strong>. Older c<strong>on</strong>sumers with poor eyesight, frail older<br />

people and people with low literacy appear to be the most affected.<br />

Community health workers, such as diabetes educators, reported that they<br />

were not being given enough informati<strong>on</strong> about these changes to their<br />

clients’ medicines and so were not in a positi<strong>on</strong> to warn or help them.<br />

It was also clear that the c<strong>on</strong>venti<strong>on</strong>s for naming medicines are not<br />

understood by c<strong>on</strong>sumers — namely, that medicines have an approved<br />

10<br />

pharm c<strong>on</strong>sumer sub-committee

generic name and a brand or trade name. If this is not understood or<br />

not clearly c<strong>on</strong>veyed <strong>on</strong> the labelling and packaging it is more difficult<br />

for c<strong>on</strong>sumers to deal with brand changes appropriately and the chances<br />

of making mistakes is greater.<br />

An older c<strong>on</strong>sumer in Tasmania reported that she<br />

had been told that her new medicine was a generic<br />

and she was assured that there was absolutely no<br />

difference between generics and premium brands.<br />

She suffered new and unpleasant side effects<br />

when using the new medicine and as a result was<br />

c<strong>on</strong>vinced that generic brands are not the same.<br />

While reporting this episode at the c<strong>on</strong>sultati<strong>on</strong> it<br />

transpired that the new medicine was not a generic<br />

bioequivalent brand but was a brand that c<strong>on</strong>tained<br />

a higher dose.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 11

4.2 Ineffective pharmacy labels<br />

A critical aspect of the quality use of medicines is knowing what you are<br />

taking. Labels are a vital source of informati<strong>on</strong> and they are critical in<br />

enabling c<strong>on</strong>sumers to manage their medicines <strong>on</strong> a day-to-day basis.<br />

Older c<strong>on</strong>sumers, who often have eyesight problems that cannot be<br />

corrected by glasses, said they wanted better and clearer labels with<br />

larger f<strong>on</strong>ts that would be easier to read and understand. They also<br />

wanted a simple indicati<strong>on</strong> of what the medicine was for <strong>on</strong> the label —<br />

for example, ‘Heart tablets’ for digoxin or ‘Arthritis tablets’ for diclofenac.<br />

Some label instructi<strong>on</strong>s were reported to be unclear or unhelpful and<br />

therefore ineffective. For example, ‘Take as directed’ may be of no use to<br />

a carer or a pers<strong>on</strong> who has forgotten what the doctor said or when the<br />

prescripti<strong>on</strong> is delivered by bus some days after the c<strong>on</strong>sultati<strong>on</strong>. Another<br />

example is ‘Store at less than 25ºC’. A rural c<strong>on</strong>sumer said this left him in<br />

a quandary about how to store his medicine that he had to take during<br />

the day when he worked outside all day in summer.<br />

Some participants said they wanted more dosage informati<strong>on</strong> <strong>on</strong> the<br />

label, such as whether to take before or with food.<br />

Another problem occurs when the label and its instructi<strong>on</strong>s are placed <strong>on</strong><br />

the outer packaging but not <strong>on</strong> the medicine c<strong>on</strong>tainer itself. As a result<br />

the instructi<strong>on</strong>s and the medicine can become separated. A typical example<br />

given was asthma inhalers, where the labels are usually placed <strong>on</strong> the<br />

cardboard packaging but not <strong>on</strong> the inhalers themselves. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s<br />

were also c<strong>on</strong>cerned about pharmacy labels obscuring important<br />

informati<strong>on</strong> like the expiry date.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s taking multiple medicines said they had difficulty<br />

remembering to take their medicines at the right time each day <strong>on</strong> a<br />

l<strong>on</strong>g-term basis, and of having no way of checking whether or not they<br />

had taken a particular dose.<br />

12<br />

pharm c<strong>on</strong>sumer sub-committee

4.3 Attitudes and understanding<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> groups reported some c<strong>on</strong>sumer attitudes towards medicines<br />

that may not be c<strong>on</strong>ducive to the quality use of medicines and to which<br />

health professi<strong>on</strong>als are not sufficiently attuned. These included:<br />

■<br />

■<br />

■<br />

■<br />

■<br />

■<br />

Sharing of medicines. For example, in some ethnic communities<br />

c<strong>on</strong>sumers may accept a recommendati<strong>on</strong> from trusted members of<br />

the community or family and friends to try what worked for them<br />

rather than seeking out their doctors’ opini<strong>on</strong>s. Others may share<br />

medicines to save m<strong>on</strong>ey.<br />

Fears of becoming addicted to their medicines. These fears may be<br />

realistic, such as with benzodiazepines and some pain killers, or<br />

unrealistic, such as with asthma puffers.<br />

Not completing courses of medicines because they feel better.<br />

Sometimes this is appropriate, at other times not.<br />

Taking less than the recommended dose to save m<strong>on</strong>ey or to minimise<br />

the side effects. Again, in some circumstances this may be appropriate,<br />

in others not.<br />

Keeping and using medicines bey<strong>on</strong>d their expiry dates as a result of<br />

c<strong>on</strong>cerns about waste and lifetime habits of thrift.<br />

A lack of awareness that medicine regimes followed successfully for<br />

many years may need reviewing and altering periodically.<br />

4.4 Access to important informati<strong>on</strong><br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s reported a number of difficulties in obtaining the informati<strong>on</strong><br />

they needed and wanted. The lack of easy access to important<br />

informati<strong>on</strong> about their medicines and appropriate use at the right time<br />

was a barrier to the quality use of medicines.<br />

Comm<strong>on</strong>ly menti<strong>on</strong>ed problems included:<br />

■<br />

■<br />

■<br />

Having to rely wholly <strong>on</strong> their doctor and/or pharmacist for informati<strong>on</strong><br />

and <strong>on</strong> being able to remember what was said.<br />

Having to rely <strong>on</strong> the doctor and/or pharmacist volunteering important<br />

informati<strong>on</strong> because they do not know what questi<strong>on</strong>s to ask.<br />

Wanting more informati<strong>on</strong> about particular medicines than is generally<br />

c<strong>on</strong>veyed in normal c<strong>on</strong>sultati<strong>on</strong>s. For example, informati<strong>on</strong> about side<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 13

effects, interacti<strong>on</strong>s, c<strong>on</strong>tra-indicati<strong>on</strong>s, potentially allergic comp<strong>on</strong>ents<br />

and equivalence between overseas and local brands. (This sort of<br />

informati<strong>on</strong> is included in <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Medicine Informati<strong>on</strong> or CMI.<br />

However, despite being a well informed group, most of those c<strong>on</strong>sulted<br />

had not heard of or knowingly received CMI.)<br />

■<br />

■<br />

■<br />

Language barriers between n<strong>on</strong>-English speaking c<strong>on</strong>sumers and their<br />

doctors and pharmacists. Some recent migrants said they had expected<br />

to receive more informati<strong>on</strong> from their pharmacists or in the packaging<br />

of the medicine.<br />

Difficulty obtaining informati<strong>on</strong> about prescripti<strong>on</strong> medicines and the<br />

wise use of medicines in languages other than English. Informati<strong>on</strong><br />

in English tends to be ignored by people with poor English.<br />

Wanting easier access to independent sources of informati<strong>on</strong> and<br />

advice, that is, independent from their normal providers. For example,<br />

over the ph<strong>on</strong>e. This was particularly so for c<strong>on</strong>sumers in rural areas.<br />

A well known and respected illness support group<br />

identified frequent adverse interacti<strong>on</strong>s in c<strong>on</strong>sumers<br />

with the c<strong>on</strong>diti<strong>on</strong> receiving nursing home care. The<br />

associati<strong>on</strong> produced and distributed a brochure to<br />

local GPs about medicine interacti<strong>on</strong>s in the c<strong>on</strong>diti<strong>on</strong>.<br />

However, the GPs ignored the mailout and said that<br />

they did not want a third party involved.<br />

■<br />

■<br />

■<br />

Under-use of the potential of c<strong>on</strong>sumer and self-help groups to be<br />

a valuable source of informati<strong>on</strong> and an ally in the quality use of<br />

medicines. They felt that GPs were generally ill informed about what<br />

self-help groups can offer, were resistant to using their expertise, and<br />

were reluctant to refer c<strong>on</strong>sumers to them.<br />

Carers said they were unable to access informati<strong>on</strong> about their loved<br />

<strong>on</strong>es’ medicines due to privacy c<strong>on</strong>cerns. For example, side effects to<br />

watch for and how to distinguish them from clinical symptoms, serious<br />

side effects in the case of anti-psychotics, and dosage regimes.<br />

Difficulty finding informati<strong>on</strong> about whether vaccines and other<br />

medicines c<strong>on</strong>tain certain products. For example, pork and alcohol<br />

products that are prohibited for some c<strong>on</strong>sumers <strong>on</strong> religious grounds<br />

or fillers to which some people are allergic.<br />

14<br />

pharm c<strong>on</strong>sumer sub-committee

■<br />

People with rare or intractable c<strong>on</strong>diti<strong>on</strong>s said they wanted easier<br />

access to informati<strong>on</strong> about new treatments. For example, a c<strong>on</strong>sumer<br />

with HIV/AIDS living in a rural area said that getting informati<strong>on</strong> about<br />

newer anti-viral agents was difficult.<br />

Better access to informati<strong>on</strong> about side effects was particularly important<br />

to people taking medicines for serious mental health c<strong>on</strong>diti<strong>on</strong>s.<br />

Psychiatrists, especially, were reported as being very reluctant to provide<br />

informati<strong>on</strong> about the often c<strong>on</strong>siderable side effects associated with<br />

medicines for serious mental illnesses, apparently out of c<strong>on</strong>cern that the<br />

c<strong>on</strong>sumers would refuse to take them. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s, however, reported that<br />

if they did not discuss side effects they were unsure whether the effects<br />

they were experiencing were a result of their c<strong>on</strong>diti<strong>on</strong>, were a normal effect<br />

of their medicine, or an adverse effect. Some side effects, particularly if<br />

not adequately explained, can add to a pers<strong>on</strong>’s depressi<strong>on</strong> and anxiety.<br />

‘For example, doctors tend to tell you not to drink<br />

when you are <strong>on</strong> this or that medicine. In fact, in<br />

some cases it is perfectly alright to have <strong>on</strong>e drink<br />

sometimes, just not more than that. There are also<br />

some medicines where you can safely give yourself<br />

a ‘drug holiday’ and temporary relief from the side<br />

effects such as loss of libido. If you’re taking medicines<br />

indefinitely it really helps to be told these things.'<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s with mental illnesses also wanted c<strong>on</strong>structive advice <strong>on</strong><br />

living with their medicines <strong>on</strong> a l<strong>on</strong>g-term basis and to be given strategies<br />

for minimising the side effects. They also wanted more informati<strong>on</strong> about<br />

the l<strong>on</strong>g-term effects of taking particular medicines as they were likely to<br />

have to take them indefinitely.<br />

The stigma attached to mental illness can make it harder for c<strong>on</strong>sumers<br />

with mental illnesses to actively seek out informati<strong>on</strong> about their<br />

medicines.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 15

4.5 Inadequate communicati<strong>on</strong><br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s frequently said that poor communicati<strong>on</strong> between c<strong>on</strong>sumers<br />

and doctors during prescribing c<strong>on</strong>sultati<strong>on</strong>s and between c<strong>on</strong>sumers and<br />

pharmacists during dispensing c<strong>on</strong>sultati<strong>on</strong>s can impede the quality use<br />

of medicines.<br />

Problems included:<br />

■<br />

■<br />

■<br />

■<br />

■<br />

■<br />

■<br />

■<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s not receiving adequate explanati<strong>on</strong>s of the risks and benefits<br />

of their medicines, because of a perceived lack of time or because of<br />

an apparent unwillingness of the doctor to provide such informati<strong>on</strong>.<br />

The reluctance of some c<strong>on</strong>sumers to ask questi<strong>on</strong>s of their doctors<br />

because of a percepti<strong>on</strong> that asking questi<strong>on</strong>s may cause offence or<br />

imply a lack of trust in their expertise, or because in some cultures<br />

asking direct questi<strong>on</strong>s is not c<strong>on</strong>sidered an appropriate way of<br />

exchanging informati<strong>on</strong>. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s may ‘agree’ with what their<br />

doctors say without really understanding what has been said.<br />

A percepti<strong>on</strong> that some doctors are too quick to prescribe medicines<br />

and do so to avoid discussing broader issues, pers<strong>on</strong>al problems or<br />

other treatment opti<strong>on</strong>s.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s not disclosing their use of over-the-counter or complementary<br />

medicines because it does not occur to them to do so or because they<br />

fear getting a negative resp<strong>on</strong>se from their doctors. In some communities<br />

complementary medicines have a str<strong>on</strong>g history of traditi<strong>on</strong>al use or may<br />

be c<strong>on</strong>sidered more a form of food. Many c<strong>on</strong>sumers are unaware of the<br />

possibility of interacti<strong>on</strong>s between over-the-counter or complementary<br />

medicines and prescripti<strong>on</strong> medicines. The problem is exacerbated<br />

when c<strong>on</strong>sumers <strong>on</strong>ly have c<strong>on</strong>tact with the pharmacy assistant rather<br />

than the pharmacist when prescripti<strong>on</strong>s or pharmacist-<strong>on</strong>ly medicines<br />

are dispensed. Many c<strong>on</strong>sumers are not aware of how much expertise<br />

pharmacists have <strong>on</strong> matters such as drug interacti<strong>on</strong>s.<br />

Doctors and hospitals not using interpreters when needed so that any<br />

communicati<strong>on</strong> about medicines is very superficial.<br />

Doctors not being sufficiently attuned to cultural differences in<br />

attitudes about medicines and inaccurate assumpti<strong>on</strong>s being made by<br />

doctors based <strong>on</strong> the ethnic background of the c<strong>on</strong>sumer.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s may not think of or feel comfortable with ringing their GP<br />

or pharmacist to clarify dosage instructi<strong>on</strong>s.<br />

Pharmacists wr<strong>on</strong>gly assuming that teenagers who are taking resp<strong>on</strong>sibility<br />

for their medicine use for the first time are being given instructi<strong>on</strong>s<br />

by their parents and so do not need counselling by the pharmacist.<br />

16<br />

pharm c<strong>on</strong>sumer sub-committee

An elderly man with limited English was discharged<br />

from hospital with a list of 13 medicines written in<br />

English. The instructi<strong>on</strong>s for taking them were not<br />

adequately explained to him. His family had to<br />

translate the list. In a later episode the hospital<br />

teleph<strong>on</strong>ed with instructi<strong>on</strong>s for him to stop<br />

taking aspirin prior to his forthcoming surgery.<br />

He misinterpreted this as an instructi<strong>on</strong> to stop<br />

all his medicines. It appeared in both episodes<br />

that insufficient effort was made to ensure he<br />

understood the instructi<strong>on</strong>s.<br />

It is unrealistic to expect c<strong>on</strong>sumers who are in a crisis or who are very<br />

sick to be able to negotiate with their health professi<strong>on</strong>als about medicine<br />

matters and to be active c<strong>on</strong>sumers. On the other hand, c<strong>on</strong>sumers with<br />

chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong>s often have c<strong>on</strong>siderable experience and knowledge of<br />

the interacti<strong>on</strong>s and adverse reacti<strong>on</strong>s they have experienced previously.<br />

However, they said they were often ignored and their knowledge dismissed<br />

when they attempted to inform professi<strong>on</strong>als (usually in hospital) about<br />

such problems.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 17

4.6 Cost issues<br />

Issues of cost and access are outside the terms of reference of the<br />

<strong>PHARM</strong> <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Sub-Committee except when they have implicati<strong>on</strong>s<br />

for quality use. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s gave some examples of this occurring:<br />

■<br />

■<br />

■<br />

The desire to save m<strong>on</strong>ey results in some c<strong>on</strong>sumers keeping nol<strong>on</strong>ger-used<br />

and out-of-date medicines, taking less than the appropriate<br />

dose to make them last l<strong>on</strong>ger, sharing medicines with others, delaying<br />

the filling of scripts, and using traditi<strong>on</strong>al plant medicines.<br />

The cost of medicine delivery devices, such as spacers for asthma inhalers,<br />

deters some c<strong>on</strong>sumers from using them or using the right <strong>on</strong>es.<br />

The cost of having blister packs made up or dosette boxes filled is too<br />

great for some c<strong>on</strong>sumers.<br />

The cost of medicines is rarely discussed during doctors’ c<strong>on</strong>sultati<strong>on</strong>s<br />

though it may be a c<strong>on</strong>siderati<strong>on</strong> in a c<strong>on</strong>sumer’s decisi<strong>on</strong> to take a<br />

medicine or not. If cost is not discussed the opportunity to c<strong>on</strong>sider<br />

cheaper opti<strong>on</strong>s is missed.<br />

Cost c<strong>on</strong>siderati<strong>on</strong>s most affect c<strong>on</strong>sumers <strong>on</strong> low incomes, especially<br />

those with chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong>s. Certain groups, for example, people living<br />

in boarding houses, may have extremely limited disposable incomes after<br />

paying for board and accommodati<strong>on</strong> so the cost of prescripti<strong>on</strong>s, even<br />

at the PBS c<strong>on</strong>cessi<strong>on</strong>al rate, may be a major problem. Professi<strong>on</strong>als’<br />

views and low income c<strong>on</strong>sumers’ views about affordability may be<br />

very different.<br />

4.7 Lack of co-ordinati<strong>on</strong><br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s described a range of problems arising because of a lack of<br />

communicati<strong>on</strong> and co-ordinati<strong>on</strong> between different prescribers, and<br />

between hospitals and GPs.<br />

Comm<strong>on</strong> examples were:<br />

■<br />

■<br />

New prescribers (for example, a hospital or after-hours doctor) varying<br />

earlier prescribing without telling the original prescriber or giving an<br />

adequate explanati<strong>on</strong> to the c<strong>on</strong>sumer.<br />

Prescribers being unaware of the medicines prescribed by another<br />

prescriber or paying insufficient attenti<strong>on</strong> to the possibility of<br />

18<br />

pharm c<strong>on</strong>sumer sub-committee

interacti<strong>on</strong>s between medicines. This is particularly a problem for<br />

c<strong>on</strong>sumers who need to see several different prescribers.<br />

■<br />

Hospital emergency services not having access to informati<strong>on</strong> about<br />

a pers<strong>on</strong>’s medicines and sensitivities to medicines.<br />

The results for c<strong>on</strong>sumers can be a disrupti<strong>on</strong> of treatment, avoidable<br />

interacti<strong>on</strong>s and adverse drug reacti<strong>on</strong>s, duplicati<strong>on</strong> of medicines, and<br />

c<strong>on</strong>fusi<strong>on</strong> and worry for c<strong>on</strong>sumers (and their carers) in the days<br />

immediately after leaving hospital.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s in rural areas <strong>on</strong> complex treatments had particular difficulties<br />

with c<strong>on</strong>tinuity of care where access to specialist advice was limited, for<br />

both GPs and c<strong>on</strong>sumers.<br />

4.8 Inappropriate prescribing<br />

Two fundamental tenets of the quality use of medicines are that the choice<br />

of therapy is the right <strong>on</strong>e — that is, that medicines are used <strong>on</strong>ly when they<br />

are more appropriate than n<strong>on</strong>-drug therapy or no therapy at all and that, if<br />

medicinal therapy is chosen, the most appropriate medicine is prescribed.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s were c<strong>on</strong>cerned that insufficient attenti<strong>on</strong> is sometimes given to<br />

n<strong>on</strong>-drug therapies in favour of prescribing new medicines or prescribing<br />

medicines bey<strong>on</strong>d their appropriate time. For example:<br />

■<br />

■<br />

■<br />

■<br />

Overprescribing of benzodiazepines, particularly to older migrant women.<br />

Sleeping tablets that were appropriately used during a hospital episode<br />

being inappropriately prescribed l<strong>on</strong>g term afterwards.<br />

N<strong>on</strong>-drug therapies not being adequately c<strong>on</strong>sidered and discussed<br />

during c<strong>on</strong>sultati<strong>on</strong>s.<br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s seeking and being prescribed medicines for essentially social<br />

problems and lifestyle-related c<strong>on</strong>diti<strong>on</strong>s, such as homelessness, drug<br />

and alcohol abuse, and l<strong>on</strong>eliness, which are more appropriately dealt<br />

with in other ways.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: the findings 19

5 Some soluti<strong>on</strong>s<br />

Many soluti<strong>on</strong>s<br />

are strategies<br />

intended to take<br />

the guess work<br />

out of managing<br />

multiple medicines<br />

<strong>on</strong> a day-to-day<br />

basis or are<br />

about giving<br />

c<strong>on</strong>sumers<br />

more informati<strong>on</strong><br />

and c<strong>on</strong>trol over<br />

A number of suggesti<strong>on</strong>s were made about ways of avoiding and minimising<br />

the problems discussed above. Many are strategies intended to take the<br />

guess work out of managing multiple medicines <strong>on</strong> a day-to-day basis or are<br />

about giving c<strong>on</strong>sumers more informati<strong>on</strong> and c<strong>on</strong>trol over their medicines.<br />

5.1 Making day-to-day management easier<br />

Suggesti<strong>on</strong>s included:<br />

■ The introducti<strong>on</strong> of a full medicine record held voluntarily by the<br />

c<strong>on</strong>sumer in the form of a printout, a smart card or an electr<strong>on</strong>ic record<br />

that health providers could access under appropriate circumstances.<br />

There was c<strong>on</strong>siderable support for such a record. It was seen as<br />

potentially empowering for the c<strong>on</strong>sumer, as the holder would know<br />

more about what they were taking and could produce the informati<strong>on</strong><br />

if needed by a health professi<strong>on</strong>al. It was also seen as assisting in<br />

emergency situati<strong>on</strong>s and would promote better c<strong>on</strong>tinuity of care<br />

between GPs and specialists and hospitals.<br />

■ Standardising the colour, size and shape of bioequivalent brands.<br />

■ Providing more informati<strong>on</strong> and support for carers resp<strong>on</strong>sible for<br />

another pers<strong>on</strong>’s medicine management.<br />

■ Encouraging regular medicine reviews that provide an opportunity for<br />

more thorough discussi<strong>on</strong> between c<strong>on</strong>sumers, carers and service<br />

providers about medicines and their management.<br />

5.2 Better labelling and packaging<br />

Suggesti<strong>on</strong>s included:<br />

their medicines.<br />

■<br />

■<br />

Clearer, easier-to-read pharmacy labels with larger f<strong>on</strong>ts and more<br />

detailed instructi<strong>on</strong>s.<br />

The additi<strong>on</strong> of a special sticker <strong>on</strong> the pharmacy label that would<br />

indicate in simple terms what the medicine was for.<br />

20<br />

pharm c<strong>on</strong>sumer sub-committee

■<br />

■<br />

■<br />

C<strong>on</strong>sistent labels <strong>on</strong> inner c<strong>on</strong>tainers as well as any outer packaging if the<br />

two could become separated.<br />

More use of packaging marked with the days of the week. This type of<br />

packaging is regarded as very helpful because it takes the guesswork out of<br />

remembering whether a medicine has been taken or not.<br />

Access to dosette boxes at a discount rate for low income c<strong>on</strong>sumers.<br />

5.3 Better access to independent informati<strong>on</strong><br />

Suggesti<strong>on</strong>s included:<br />

■<br />

■<br />

■<br />

■<br />

■<br />

Establishing teleph<strong>on</strong>e medicine informati<strong>on</strong> services for c<strong>on</strong>sumers to allow<br />

easy, n<strong>on</strong>-threatening and c<strong>on</strong>fidential access to independent informati<strong>on</strong>.<br />

Ensuring that <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g> Medicine Informati<strong>on</strong> (CMI) is widely offered and<br />

easy to obtain. Many felt that CMIs should come with all medicines and<br />

some said there should be a central source of CMIs that could be easily<br />

accessed by c<strong>on</strong>sumers.<br />

Health professi<strong>on</strong>als assisting c<strong>on</strong>sumers who want more detailed<br />

informati<strong>on</strong>. For example, helping c<strong>on</strong>sumers to make better use of the<br />

informati<strong>on</strong> held by self-help groups, encouraging c<strong>on</strong>sumers to make<br />

better use of pharmacists’ knowledge and the informati<strong>on</strong> they hold,<br />

and guiding c<strong>on</strong>sumers to sources of quality informati<strong>on</strong> <strong>on</strong> the internet.<br />

Wider distributi<strong>on</strong> of informati<strong>on</strong> to promote the quality use of medicines<br />

in English and other community languages.<br />

Making better use of doctors’ surgeries as points of distributi<strong>on</strong> of<br />

informati<strong>on</strong> for c<strong>on</strong>sumers.<br />

5.4 Improving c<strong>on</strong>sumer–provider communicati<strong>on</strong><br />

It was suggested that a range of educati<strong>on</strong> strategies are needed:<br />

■<br />

■<br />

To encourage c<strong>on</strong>sumers to ask questi<strong>on</strong>s and equip them with the right<br />

questi<strong>on</strong>s to ask. Similarly, to encourage doctors and pharmacists to<br />

reciprocate by giving positive feedback to c<strong>on</strong>sumers with questi<strong>on</strong>s. It<br />

would be helpful to some groups of c<strong>on</strong>sumers to identify, say, the three<br />

most important questi<strong>on</strong>s they should ask their doctors or pharmacists.<br />

To encourage c<strong>on</strong>sumers to ask for l<strong>on</strong>ger c<strong>on</strong>sultati<strong>on</strong>s when appropriate<br />

to allow fuller discussi<strong>on</strong> of, for example, c<strong>on</strong>cerns about medicine use or<br />

n<strong>on</strong>-drug opti<strong>on</strong>s.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: some soluti<strong>on</strong>s 21

■<br />

■<br />

■<br />

To encourage c<strong>on</strong>sumers to ask for and participate in medicine<br />

reviews.<br />

To equip prescribers to be more sensitive to the differences in<br />

attitudes towards medicines of different demographic and cultural<br />

groups, and to assist prescribers to improve their communicati<strong>on</strong><br />

with people from other cultures.<br />

To encourage prescribers to write down critical instructi<strong>on</strong>s.<br />

5.5 Improving provider–provider<br />

communicati<strong>on</strong> and co-ordinati<strong>on</strong><br />

Suggesti<strong>on</strong>s included:<br />

■<br />

■<br />

■<br />

■<br />

Developing electr<strong>on</strong>ic medicine records that are accessible by<br />

providers in appropriate circumstances.<br />

Better discharge planning by hospitals and immediate communicati<strong>on</strong><br />

of discharge informati<strong>on</strong> to GPs.<br />

Better co-ordinati<strong>on</strong> between specialists and GPs <strong>on</strong> medicine issues,<br />

especially in relati<strong>on</strong> to c<strong>on</strong>sumers with mental health and other<br />

chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong>s.<br />

Better co-ordinati<strong>on</strong> between professi<strong>on</strong>als involved in providing care<br />

to residents of aged-care facilities.<br />

5.6 Enhancing c<strong>on</strong>sumer networks<br />

Suggesti<strong>on</strong>s included:<br />

■<br />

■<br />

The development and expansi<strong>on</strong> of peer educati<strong>on</strong> strategies to<br />

promote the quality use of medicines by engaging community networks<br />

and enlisting community leaders in positi<strong>on</strong>s of trust and influence,<br />

especially in, but not limited to, ethnic communities.<br />

Strengthening the capacity of c<strong>on</strong>sumer and community groups to<br />

actively promote the quality use of medicines within their memberships<br />

and client groups.<br />

22<br />

pharm c<strong>on</strong>sumer sub-committee

6 C<strong>on</strong>clusi<strong>on</strong><br />

<str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s rarely set out deliberately to misuse their medicines. From their<br />

perspective the decisi<strong>on</strong>s they make about using medicines are reas<strong>on</strong>ed<br />

<strong>on</strong>es but, as described here, sometimes they make those decisi<strong>on</strong>s without<br />

the full facts or the necessary skills and support. Their decisi<strong>on</strong>s may<br />

also be affected by other persuasive influences that are not c<strong>on</strong>ducive<br />

to the quality use of medicines. <str<strong>on</strong>g>C<strong>on</strong>sumer</str<strong>on</strong>g>s also described a number of<br />

systemic issues that c<strong>on</strong>tribute to poor quality use of medicines.<br />

Input and feedback from c<strong>on</strong>sumers — in this case, those taking multiple<br />

medicines <strong>on</strong> a l<strong>on</strong>g-term basis and their carers — is essential if successful<br />

strategies are to be developed and implemented to improve the quality<br />

use of medicines. The findings from these c<strong>on</strong>sultati<strong>on</strong>s add important<br />

perspectives which, together with evidence from other c<strong>on</strong>sumer research<br />

and c<strong>on</strong>sultati<strong>on</strong>s, should inform the activities of <strong>PHARM</strong> and other quality<br />

use of medicines partners.<br />

c<strong>on</strong>sumer perspectives <strong>on</strong> managing multiple medicines: c<strong>on</strong>clusi<strong>on</strong>s 23

<strong>PHARM</strong> Committee<br />

Department of Health and Aged Care<br />

Quality Use of <strong>Medicines</strong><br />

MDP 83<br />

GPO Box 9848<br />

Canberra act 2601<br />


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