Quality use of medicines: who owns it now?

In December 2022 after 24 years, NPS MedicineWise was closed, thus ending its role as an independent, not-for-profit organisation working alongside government as steward of the quality use of medicines (QUM) objective of the National Medicines Policy.¹ This followed the redesign of the Australian Government–funded Quality Use of Diagnostics, Therapeutics and Pathology Program. This change also occurred in the context of a revision of the National Medicines Policy, which resulted in a greater focus on consumer-led initiatives, implementation and evaluation. So, with this change, who now owns QUM and what tangible outcomes might there be for health professionals and consumers?

While QUM activities have always been undertaken by a range of organisations, NPS MedicineWise took a leading role in the national stewardship approach. The policy shift and wind-up of NPS MedicineWise have created opportunities: an increased role for consumers and other stakeholders; funding for new players and new ideas; more focus on systems at the practice level and capability building; and potential for innovation and efficiencies. Effort may shift further to areas of even greater need within the health sector, such as aged care and Aboriginal and Torres Strait Islander health. There are also some standout risks: less centralised oversight and focus on QUM; greater fragmentation in delivery with potential for inefficiencies and mixed and competing messages; and loss of concentrated capability, capacity and sustained action to improve the use of medicines. There is also the potential for loss of trust and credibility with consumers and health professionals in QUM activities. What ultimately matters is the shared purpose of achieving better medicine use and health outcomes. As we transition to newer arrangements, we need to maximise the opportunities and mitigate the risks to improve QUM in the context of a distributed stewardship function.

The dissolution of NPS MedicineWise resulted in activities and resources being distributed to multiple organisations (see Table 1). The Australian Commission on Safety and Quality in Health Care (ACSQHC), recognised for their work on standards for hospitals and building on their existing QUM expertise, has become the custodian of many assets. The National Medicines Symposium 2023 was hosted by the ACSQHC in November 2023. Most other activities are under review and have not yet been updated (e.g. Choosing Wisely Australia, RADAR) or are not yet fully operational (e.g. MedicineInsight), while the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) Practice Reviews remain on hold.² It is unclear if these activities and resources will remain fit for purpose to deliver their intended benefit. This situation is not surprising given how rapidly assets were transferred; however, in time it may improve.

Table 1 Distribution of NPS MedicineWise resources and activities²

Resource or activity	Description	New custodian	Status
National Medicines Symposium	Annual, cross-disciplinary event bringing together leading organisations, experts, clinicians, consumers and policymakers to discuss and debate key issues around QUM	ACSQHC	Held 8 November 2023
NPS MedicineWise website	Information and resources for health professionals and consumers on priority QUM topics	ACSQHC	Remains available. Currently under review. Last updated December 2022
NPS MedicineWise online learning platform (now QUM Learning)	Online learning for health professionals on priority QUM topics	ACSQHC	Remains available and is now hosted by ACSQHC (see also National Prescribing Curriculum below)
Value in Prescribing bDMARDs materials	Program and content supporting highly specialised medicines and focused on specialist prescribing	ACSQHC	Remains available. Last updated December 2022
Prescribing Competencies Framework	Describes prescribing expectations for all prescribers, and curriculum design for medical, pharmacy and allied health courses	Unclear	2021 version available through NPS MedicineWise, hosted by ACSQHC
MedicineWise app	Medicine and health management app that helps people and their carers keep track of medicines and important health information	ACSQHC	Remains available on app stores. Currently under review
Doctor’s Bag app	Provides recommended drug doses for emergency situations	ACSQHC	Remains available on app stores. Currently under review. Last updated in 2022
RADAR	Information on new medicines and medical tests, and changes to listings on the PBS (and MBS)	ACSQHC	Remains available. Currently under review. Last updated December 2022
MedicineInsight	A data collection and quality improvement program for primary care and postmarket surveillance of medicines	ACSQHC	Ethics approval July 2023. Practices reconsenting. Not operational as at 6 May 2024
Choosing Wisely Australia	A collaborative movement with health professional colleges, societies and associations to address low-value and unnecessary healthcare practices	ACSQHC	Remains available. Currently under review. Last updated 2022
PBS and MBS Practice Reviews	Reviews of individual GP data for dispensing of PBS medicines or ordering of MBS tests related to a specific clinical area to support professional development and quality improvement	ACSQHC	On hold while the ACSQHC undertakes appropriate access agreements
Australian Prescriber	Independent peer-reviewed journal providing critical commentary on drugs and therapeutics for health professionals	Therapeutic Guidelines Ltd (through competitive tender)	Continuing to publish new articles and issues as previously
National Prescribing Curriculum	Online learning for health professional students on priority QUM topics	University of Tasmania (through competitive tender)	Available
Medicines Line and Adverse Medicine Events Line (now 1300 MEDICINE)	Telephone service staffed by pharmacists to answer consumer questions about medicines and help consumers report adverse reactions to medicines and vaccines	Australian Healthcare Associates Pty Ltd (through competitive tender)	Available
National QUM education programs	Multifaceted education programs for health professionals and consumers targeting national priority areas	Competitive grants distributed to multiple organisations	New grants awarded from August 2023 to different consortia and programs in development for implementation in 2024 – see Health Professional Education stream and Consumer Health Literacy stream
Good Medicine Better Health	Series of learning modules and consumer resources on topics developed for Aboriginal and Torres Strait Islander Health Workers and Practitioners and their communities	National Aboriginal Community Controlled Health Organisation (NACCHO)	Remains available. Currently under review. Last updated 2022
ACSQHC = Australian Commission on Safety and Quality in Health Care; bDMARDs = biological disease-modifying antirheumatic drugs; GP = general practitioner; MBS = Medicare Benefits Schedule; PBS = Pharmaceutical Benefits Scheme; QUM = quality use of medicines

Some other resources were taken over by custodians after competitive tender processes; for example, Australian Prescriber is now published by Therapeutic Guidelines Ltd, Medicines Line has become 1300 MEDICINE and is operated by Australian Healthcare Associates, and the National Prescribing Curriculum is delivered by the University of Tasmania.

A key mechanism used by NPS MedicineWise to address changing QUM priorities was national education programs, with academic detailing (particularly for general practices) to support local implementation. These were targeted programs, with strategies for both health professionals and consumers, and scaled up for Australia-wide impact. This approach has now been submitted to a competitive process for grants focused on health professional education or consumer health literacy. From August 2023, grants have been awarded to different consortia. Over the next 12 months, as these new grant programs are implemented, we will see a range of QUM topics addressed, and methodologies and strategies used. Of particular importance may be how they will compete for the attention of health professionals and consumers.

There are other important questions to consider. First, what will become the primary freely available source for information about medicines for consumers and health professionals, replacing the once heavily utilised NPS MedicineWise website? Second, as the scope of practice for different disciplines evolves with expanded and new prescribing rights, how will QUM be addressed at a national level given the varying pace of this change across states and territories? And finally, how will the QUM needs of non-GP specialists be supported in the future? The Value in Prescribing Program launched this work in 2019 with a focus on biological disease-modifying antirheumatic drugs (bDMARDs) and immunoglobulins, but seems to have been paused since the closure of NPS MedicineWise.

The void left by NPS MedicineWise has emphasised that no single organisation or individual needs to, should, or does own QUM, but rather all of us as providers and users of medicines have a stake. An overarching governance network of key QUM stakeholders would help to foster a shared agenda, bring attention to high-need issues and populations, encourage innovation and data-driven interventions, improve coordination, and aim for a collective impact approach across the sector to deliver public value. This could be coupled to an evaluation framework with QUM indicators to determine whether QUM is improving nationally, and whether stakeholders and audiences are better served through the changes.

This editorial was finalised on 6 May 2024.

Conflicts of interest: Jonathan Dartnell is Managing Director of QUM Connect, a member of the Quality Use of Medicines Alliance, which has won Quality Use of Diagnostics, Therapeutics and Pathology Program grants from the Australian Government Department of Health and Aged Care for health professional education and consumer health literacy. He was previously Programs and Clinical Services Manager at NPS MedicineWise.

Darlene Cox is Executive Director of the Health Care Consumers’ Association (HCCA). HCCA is a member of the Quality Use of Medicines Alliance and is the lead agency for a consumer health literacy grant for Quality Use of Diagnostics, Therapeutics and Pathology Program from the Australian Government Department of Health and Aged Care. Darlene was a consumer representative with NPS MedicineWise and has a long-standing relationship as a consumer representative with the Australian Commission on Safety and Quality in Health Care.

Paresh Dawda is Founder, Director and Principal at Prestantia Health and Co-Founder, Director and Principal at Next Practice Deakin. Prestantia Health is a consultancy organisation and Next Practice Deakin is a clinical services provider. He is Deputy Chair of The Royal Australian College of General Practitioners (RACGP) Expert Committee – Quality Care. A register of all interests is available at https://www.prestantiahealth.com/about-paresh-dawda.

Catherine Hill is a consultant rheumatologist and clinical epidemiologist at Central Adelaide Local Health Network. She is an associate of QUM Connect. She was previously a member of the Pharmaceutical Benefits Advisory Committee, President of the Australian Rheumatology Association (2020 to 2022) and Chair of the Consortium Leadership Committee of the Value in Prescribing bDMARDs Program grant (2019 to 2022).

This article is peer reviewed.

 

References

1. Rigby D. The end of NPS MedicineWise. Aust Prescr 2022;45:186-7.
2. Australian Commission on Safety and Quality in Health Care. Quality Use of Medicines Stewardship program. 2024. [cited 2024 Apr 17]