Improving Use of Medicines and Medical Tests in Primary Care

Foreword by Anthony Smith
Foreword by Richard Laing
Preface
	NPS MedicineWise
	Australian Health System and the Pharmaceutical Benefits Scheme (PBS)
Acknowledgements
About This Book
	Chapter 1. Introduction: Why Is Improving Use of Medicines and Medical Tests Important?
	Chapter 2. Theoretical Bases of Interventions to Improve Use of Medicines and Tests
	Chapter 3. Interventions Supporting Consumers to Achieve the Best from Medicines and Tests
	Chapter 4. Evidence for and Implementation of Academic Detailing
	Chapter 5. Evidence for Audit and Feedback
	Chapter 6. Choosing Wisely: Clinicians as Agents for Change
	Chapter 7. A Program to Improve Management of Patients with Type 2 Diabetes
	Chapter 8. Program to Improve Antibiotic Prescribing in Primary Care
	Chapter 9. Raising Community Awareness: The Role of Public Relations in Health Communication
	Chapter 10. A Program to Improve Use of Antithrombotic Medicines and Reduce the Incidence of Stroke
	Chapter 11. A Program to Reduce Imaging for Acute Low Back Pain
	Chapter 12. A Program to Reduce Ankle and Knee Imaging
	Chapter 13. Evaluation of Multifaceted Programs
	Chapter 14. Lessons for Success
	Terminology
	Disclaimer
Contents
Contributors
Abbreviations
1 Introduction: Why Is Improving Use of Medicines and Medical Tests Important?
	1.1 Why Improving Use of Medicines Is Important
		1.1.1 Critical Role of Medicines
		1.1.2 Realizing Benefits and Avoiding Harms
		1.1.3 Secondary Prevention of Myocardial Infarction and Stroke
		1.1.4 Management of Type 2 Diabetes Mellitus
		1.1.5 Vaccines
		1.1.6 Appropriate Use of Antibiotics
		1.1.7 Anticholinergic Burden in Elderly
	1.2 Why Improving the Use of Medical Tests Is Important
	1.3 Financial and Economic Considerations: Patients, Health Systems and Society
		1.3.1 The Era of Universal Health Coverage
	1.4 Measuring and Monitoring
	1.5 Conclusion
	References
2 Theoretical Bases of Interventions to Improve Use of Medicines and Tests
	2.1 Why Is Theory Important?
	2.2 Behavioural Influences, Decision Making and Adopting Change
	2.3 Behaviour Change Theories
		2.3.1 Mindlines
		2.3.2 Complexity
		2.3.3 The Theoretical Domains Framework
	2.4 Menu of Behavioural Interventions
	2.5 Using Theory to Design Interventions: Some Brief Examples
	2.6 Conclusions
	References
3 Interventions Supporting Consumers to Achieve the Best from Medicines and Tests
	3.1 Using Interventions to Support Decisions by Consumers and Carers
	3.2 Types of Interventions Supporting Decisions About Tests and Medicines Use
		3.2.1 Cochrane Systematic Reviews
		3.2.2 Websites and Applications
	3.3 Interventions for Adherence to Medicines
		3.3.1 Cochrane Reviews
		3.3.2 Websites and Applications
	3.4 Support by Health Professionals and Proponents of the Health System
		3.4.1 Health System Factors
		3.4.2 Health Professional Factors
	3.5 Conclusion
	References
4 Evidence for and Implementation of Academic Detailing
	4.1 Introduction
		4.1.1 Change in Mindset as to What Was Possible
		4.1.2 Defining Academic Detailing?
	4.2 Evidence for Academic Detailing
	4.3 When to Use Academic Detailing
	4.4 Workforce Selection and Training
	4.5 Evaluating the Effectiveness of the NPS MedicineWise Detailing Visits
	4.6 Conclusion
	References
5 Evidence for Audit and Feedback
	5.1 What Is Audit and Feedback?
		5.1.1 What Are the Key Stages to Audit and Feedback?
		5.1.2 When Should I Choose an Audit and Feedback Activity?
		5.1.3 When Should I Think About Co-interventions?
	5.2 What Is the Evidence for Audit and Feedback?
		5.2.1 New Directions in the Evidence
	5.3 When and Why Does Audit and Feedback Work?
		5.3.1 Why Is This Problem Happening?
		5.3.2 How Does Audit and Feedback Work?
	5.4 Practical Advice for Designing Audit and Feedback
		5.4.1 NPS MedicineWise Specialist Audit and Feedback for Rheumatoid Arthritis
		5.4.2 Health Quality Ontario Primary Care Audit and Feedback for Opioid Prescribing
		5.4.3 MedicineInsight Primary Care Audit and Feedback for Stroke Prevention
	5.5 Conclusion
	References
6 Choosing Wisely: Clinicians as Agents for Change
	6.1 Introduction
	6.2 The Origins of Choosing Wisely
	6.3 Why We Need Better Conversations
	6.4 A Growing International Campaign
	6.5 Enabling Change
		6.5.1 Recognition and Empowerment
		6.5.2 Networks and Peer-to-Peer Communication
		6.5.3 Choosing Wisely Champion Health Services Initiative
		6.5.4 Enablement
	6.6 Measuring the Impact of Choosing Wisely
	6.7 Future Challenges and Opportunities
	References
7 A Program to Improve Management of Patients with Type 2 Diabetes
	7.1 Introduction
	7.2 Rationale for Topic Selection
	7.3 Quality Use of Medicines Issues
	7.4 Program Goal, Objectives and Audiences
	7.5 Key Messages
	7.6 Selection of Behavior Change Interventions
	7.7 Program Implementation and Impact
	7.8 Conclusions
	References
8 Program to Improve Antibiotic Prescribing in Primary Care
	8.1 Introduction
	8.2 Problem Definition
	8.3 Quality Use of Medicines Issues
	8.4 Scope and Audience
	8.5 Desired Outcomes
	8.6 Key Messages
	8.7 Selection of Behaviour Change Interventions
	8.8 Program Implementation
		8.8.1 Clinical Audits
		8.8.2 Respiratory Tract Infection Action Plan
		8.8.3 Prescribing Feedback (Using Administrative Claims Data)
		8.8.4 Prescribing Feedback (Using Clinical Records Data and Facilitated Practice Meeting)
		8.8.5 Online Learning Activities, Including Case Studies
		8.8.6 Medicine Use Review in Aged Care
		8.8.7 Email Newsletters
		8.8.8 Online Resources
		8.8.9 Campaign and Partnerships
		8.8.10 Practice Resource Kits
		8.8.11 Choosing Wisely
	8.9 Program Impact
	8.10 Using Evaluation for Program Improvement
	8.11 Conclusions
	References
9 Raising Community Awareness: The Role of Public Relations in Health Communication
	9.1 Introduction
	9.2 What Is Public Relations?
	9.3 The Importance of Third-Party Channels
	9.4 Leveraging Public Relations to Drive Stakeholder Engagement
	9.5 Public Relations as an Enabler for Broader Health Communications
		9.5.1 Example 1: Winter Is Coming
	9.6 Public Relations as a Tool to Build Health Literacy
		9.6.1 Example 2: Be Medicinewise Week
	9.7 Conclusions
	References
10 A Program to Improve Use of Antithrombotic Medicines and Reduce the Incidence of Stroke
	10.1 Introduction
	10.2 Rationale for Topic Selection and Problem Definition for the Therapeutic Program
	10.3 Formative Research and Stakeholder Engagement
		10.3.1 Stroke
		10.3.2 Antithrombotic Medicine Utilisation
	10.4 Quality Use of Medicine Issues
	10.5 Program Design
	10.6 Program Goal and Objectives
	10.7 Key Messages
	10.8 Program Interventions
	10.9 Program Implementation
	10.10 Program Evaluation
		10.10.1 GP Survey
		10.10.2 Impact of the Program on Clopidogrel Prescribing
		10.10.3 Health Outcome Evaluation
	10.11 Lessons and Conclusions
	References
11 A Program to Reduce Imaging for Acute Low Back Pain
	11.1 Introduction
	11.2 Rationale for Topic Selection and Problem Definition
	11.3 Quality Use of Medical Tests
	11.4 Program Objectives
	11.5 Key Messages
	11.6 Selection of Interventions
		11.6.1 Evidence for Interventions for Consumers or Patients
		11.6.2 Evidence for Interventions for Health Professionals
		11.6.3 Evidence for Interventions for Both Patients and Health Professionals
	11.7 Program Implementation
	11.8 Program Evaluation
	11.9 Lessons and Conclusions
	References
12 A Program to Reduce Ankle and Knee Imaging
	12.1 Introduction
	12.2 Rationale for Topic Selection and Problem Definition
	12.3 Quality Use of Medical Tests
		12.3.1 Supporting Evidence for overuse of Ultrasound for New Ankle Sprains and Strains
		12.3.2 Supporting Evidence for Overuse of MRI of the Knee
		12.3.3 Supporting Evidence for Overuse/or Inappropriate Use of X-rays for New Ankle and Knee Sprains and Strains
	12.4 Program Goal and Objectives
	12.5 Key Messages and Calls to Action
	12.6 Selection of Interventions
	12.7 Program Implementation
	12.8 Program Evaluation
	12.9 Conclusion
	References
13 Evaluation of Multifaceted Programs
	13.1 Introduction
	13.2 Evaluation Frameworks
	13.3 Evaluating Changes in Prescriber Knowledge and Attitudes
	13.4 Evaluating Economic Benefits
		13.4.1 Time Series Analysis
		13.4.2 Modelling PBS Prescription Volume and Expenditure
	13.5 Evaluation of the Asthma Program: Methodology Case Study 1
		13.5.1 Cost–Benefit Analysis Using PBS Data
		13.5.2 Using MedicineInsight Data for Evaluation
		13.5.3 PBS 10% Adherence Study
	13.6 Evaluating Health Outcomes of a Heart Failure Program: Methodology Case Study 2
	13.7 Conclusions
	References
14 Lessons for Success
	14.1 Introduction
	14.2 The Local Culture and Health System
	14.3 Designing Interventions: Adapting Evidence and Incorporating Theoretical Frameworks
	14.4 Scaling for Widespread Implementation
		14.4.1 Topic Selection and Program Objectives
		14.4.2 Program Interventions and Resources
		14.4.3 Workforce and Training
		14.4.4 Collaborations
	14.5 Evaluation
	14.6 Conclusions
	References
Appendix  Interventions Used Routinely by NPS MedicineWise and Referred to in Exemplar Programs in This Book
-4pt-  Glossary