Evaluation of non-medical prescribing

The supply and access to safe, effective and efficient use of medicines is guided by the National Medicines Policy and the Policy for the Quality Use of Medicines.

Evidence suggests that health services in Australia may not be currently meeting these requirements.1,2

The access to health services, and medicines, has resulted in changes to thePBSand health service provision, such as the Rural and Remote Section 100 program.

The National Health and Hospitals Reform Commission and the establishment of the National Health Workforce Taskforce have recognised the need to reform the way health care services in Australia are delivered.

In an effort to improve access to medicines in the UK, Canada, USA and New Zealand non-medical prescribing has been introduced. However, resistance to such change exists in Australia.3

There have also been understandable calls for evidence to prove the effectiveness of non-medical prescribing services.4 This evidence must be provided in a robust, credible and consistent manner in order to address some of this resistance to change, and a uniform framework for the evaluation of nonmedical prescribing is required.

In 2008, the Australian Institute of Health and Welfare prepared a set of performance indicators across the healthcare system.5 To ensure the quality and safety of non-medical prescribing, it is proposed that the dimensions within this framework (better health, focus on prevention, access, appropriateness, safety, continuity, responsiveness, efficiency and sustainability), could be applied to future research.

Although the framework would not provide definitive outcome measures, it would provide guidance on the domains that should be considered when assessing the quality of healthcare service delivery. It may be possible to measure 'safety' in several different ways, depending on the model of non-medical prescribing. For example, 'safety' in one model may mean an assessment of the numbers of prescribing errors, whereas in a different model of care may be assessment of the numbers of adverse drug reactions.

It may also not be possible, or indeed necessary, for each pilot to cover every domain within the framework, for example some pilots may be designed to solve an 'access' problem, whereas others may be more suited towards solving a 'safety' issue.

Outcomes from pilots could be compared and combined to provide an evidence base, which many see as essential to the successful implementation of this new Australian initiative.

[Reference]

References

1 Second national Report on Medication Safety. Improving Medication Safety. Australian Council for Safety and Quality in Healthcare; 2002. Available at http://www.safetyandquality.gov.au/internet/safety/ publishing.nsf/Content/F0FD7442D1F2F8DDCA2571C6000894FF/ $File/med_saf_rept.pdf [verified June 2009].

2 Hughes CF. Medication errors on hospital: what can be done? Med J Aust 2008; 188: 267-8.

3 Van Der Weyden MB. Doctor displacement: a political agenda or a health care imperative? Med J Aust 2008; 189: 608-9.

4 Ford P. Medication prescribing - not a task for non-medical health practitioners. JPPR 2008; 38: 256.

5 A set of performance indicators across the health and aged care system. Australian Institute of Health and Welfare for Health Ministers; 2008. Available at http://www.aihw.gov.au/indicators/performance_indicators_ 200806_draft.pdf [verified June 2009].

Manuscript received 5 October 2009, accepted 6 June 2010

[Author Affiliation]

Andrew R. Hale1,4 BPharm(Hons), Program Co-ordinator (Pharmacist Prescribing Project)

Ian D. Coombes1,2 BPharm, MSc, PhD, Team Leader (Medication Practitioner Development Team), Associate Lecturer (UQ)

Danielle A. Stowasser2,3 BPharm, PGDipClinHospPharm, PhD, Associate Professor, Clinical Advisor (Quality Use of Medicine Programs)

Lisa Nissen2 BPharm, PhD, MPS, FSHP, Associate Professor - Quality Use of Medicines, Deputy-Director (CSEP)

1Safe Medication Management Unit (SMMU), Medication Services Queensland, Citilink Building 2, Lobby 4, Level 1, 153 Campbell Street, Bowen Hills, QLD 4006, Australia. Email: ian_coombes@health.qld.gov.au

2School of Pharmacy, Centre for Safe and Effective Prescribing (CSEP), Pharmacy Australia Centre of Excellence, University of Queensland, St Lucia, QLD 4067, Australia. Email: l.nissen@uq.edu.au; danielle_stowasser@hotmail.com

3National Prescribing Service, Level 7, 418a Elizabeth Street, Surry Hills, NSW 2010, Australia.

4Corresponding author. Email: andrew_hale@health.qld.gov.au