D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale
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Transcript of D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale
NPS: Medicinewise
Aine Heaney
May 2013
www.nps.org.au
NPS: identifying barriers to evidence uptake
What we’ll cover today
-Who is NPS
-What do we do
-How do we do it (social marketing)
-Case study: antimicrobial resistance program
-Questions and discussion
NPS: Medicinewise
Established as the National Prescribing Service Limited in 1998
Funded by the Australian Government
Independent, not-for-profit organisation
Membership based
Work in partnership
- consumers
- health professionals
- government
- industryDr Lynn WeekesChief Executive Officer, NPS, since 1998
OUR PURPOSE
To enablethe best decisions
about medicines and related health technologies…
…creating better health and economic outcomes
NATIONAL MEDICINES POLICY (2000)
QUALITY USE OF MEDICINES and MEDICAL TESTS
NPS- the service agency for the Quality Use of Medicines arm of Australia’s
National Medicines Policy
Quality use of medicines means:- selecting management options wisely
- choosing the most suitable medicines if medicines are needed
- using medicines safely and effectively
HOW DO WE WORK?
WHO ARE OUR AUDIENCES?
Health professionals
- general practitioners
- medical specialists
- pharmacists
- nurses (primary health care)
- students
Consumers
- communities
- mass audience
Government
IndustryDr Janette Randall, Chair of NPS Board and general practitioner
HOW DO WE ADDRESS THE QUALITY OF USE OF MEDICINES AND MEDICAL TESTS?
Identifying problems at a community level and the changes that would be required for improvement
Attention on both the consumer and health professional issues
Understanding the clinical environment and maintaining relevance
Identifying barriers and enablers for change
Promoting evidence-based messages
Using a mix of interventions with a sound theoretical base
Working across disciplines and sectors
Monitoring and evaluating – using data to inform decisions and evaluate impact
Policies: decisions made by authorities concerning interventions
Michie S et al. The behaviour change wheel. Implementation Science 2011, 6:42
IMPACT OF NPS
QUALITY USE OF MEDICINES: improved health and economic outcomes
improved prescribing and use of medicines/medical tests
participation and exposure
improved attitudes, skills and knowledge
access
awareness
reach
influence
Impact?
Immediate impact
Intermittent impact
Enduring impact
ACTIVITIES TO IMPROVE MEDICINE AND TEST USE
Decision support
Guidelines
Drug information
Academic detailing
Peer group discussion
Audit and feedback
Continuing education
Undergraduate education
Research
Sustained behaviour change
“The limited success of behaviour-change efforts …. can be traced, in part, to:- failure to fully understand the determinants of the
behaviours - and a failure to properly apply health behaviour change
theory to the development and implementation of effective interventions.”
Andrea Gielen and David Sleet, Epidemiol Rev 2003;25:65-76
SOCIAL MARKETING FRAMEWORK
“The application of commercial marketing techniques to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare and that of society”
An effective marketing mix: - Product, Price, Place and Promotion
Selling an idea (change in behaviour) by highlighting the benefits, reducing the barriers and offering a better choice than the alternative (no change in behaviour)
Social Marketing
Aims to bring about behaviour change to benefit society- audience research to understand their world,
motivations, attitudes, beliefs and behaviours- segmentation of audiences to enable targeted
messages- attractive motivational exchanges with audiences- a complete marketing mix, not just communication- careful attention paid to highlighting benefits, reducing
barriers and enabling a better choice to the alternative
J Antimicrobial Chemotherapy 2009;63:230-237
Levels of influence
Glanz and Rimmer: Theory at a glance: a guide for health promotion practice. National Cancer Institute 1995
Interpersonal GATEWAYS AND INFLUENCES
The NPS approach....
Create awareness .... promote curiosity
Influence the influencers ... work with opinion leaders
Use simple messages and concepts that are relevant to everyday life
Work in partnership with others to encourage people to ask when, why and how to use medicines and medical tests
Case Study: antimicrobial resistance program
07/04/2023
Antibiotic Resistance in Respiratory Tract Infections
Antibiotic resistance has been identified as one of the greatest threats to human health, with potential for a return to the 'pre-antibiotic era' where many routine infections were untreatable. The key factor contributing to this resistance trend is the indiscriminate use of antibiotics.
Antibiotic resistance increases the risk of prolonged illness, complications and death.
• Patients remain infectious for longer and potentially spread resistant bacteria to others.
• Other treatments such as major surgery, organ transplant, cancer chemotherapy can be compromised.
• Finally, the need for more expensive therapies increases financial burden to families and society.
Preserving the miracle
“Our vision is that current and future generations will have access to effective prevention and treatment of bacterial infection as part of their right to health.”
This is the presentation name
Tell the story – make a case
22 - 24
Five year plan
Knowledge
Behaviour change
Knowledge
Behaviour change
Knowledge
Behaviour change
Knowledge
Behaviour change
Knowledge
Behaviour change
RTI – 47% UTI - 9.5% Skin - 5% STD - ? % Other
FACILITATED EDUCATION PROGRAMS
Primary care programs
Hospitals
Consumers
Key Messages
Antibiotic resistance requires consideration at both a population and individual level
Establish a patient’s beliefs and expectations about antibiotics for acute RTIs and tailor communication strategies accordingly
Consider the clinical usefulness and the associated risks to your patient before ordering an imaging test
Encourage self-management of acute RTIs and explain why antibiotics may not be appropriate
Consider the issue of resistance when prescribing antibiotics
Facilitated education: general practice doctors
How?- 150 trained Facilitators visit doctors 2-3 times each year
- Managed in partnership with General Practice networks across Australia
- Voluntary participation by doctors and practices
What?- Face-to-face visits with GPs
for one-on-one discussions with targeted and general messages (academic detailing)
- Peer group discussions (based on case studies)
DRUG AND THERAPEUTIC INFORMATION RESOURCES
Reviews and updates
- Australian Prescriber
New drugs
- NPS RADAR
- Medicines Update
(for consumers)
Topic directed updates
- NPS News
- Prescribing Practice Review prescribing feedback
http://www.nps.org.au/health_professionals/publications
Principles in providing information…
Must sound authoritative (reasons for using are understood and acknowledged)
Concise, up-to-date information which can be applied
Brief key points (with emphasis: 2-4 max)
Short headings, visually appealing
Derived from reputable sources (referenced)
Action-oriented and decisive
Use feedback to alter/ammend
Use local key opinion leaders/experts (add credibility & authority)
QI activities e.g. clinical self audits
General practitioners and pharmacists
Self-audits of records (paper or electronic)
Assesses practice in comparison with evidence-based guidelines (using indicators of quality prescribing)
Feedback on their practice in comparison with their peers
Symptomatic management prescription
WEB-BASED INTERACTIVE SELF LEARNING RESOURCES
Primary care practitioners
- Doctors
- Pharmacists
- Nurse practitioners
Hospital practitioners
- Mandated in accreditation standards
Health professional students
- National Prescribing Curriculum
National Prescribing Curriculum
Used by medical, pharmacy, nurse practitioner and dentistry students
Web-based interactive modules
Based on World Health Organization Guide to Good Prescribing
Case-based topics
Diagnosis provided – focus on prescribing
NPS: Consumer programs
Our CQUM program was set up in 2003-4
It takes a health promotion focus and centres on community engagement
We use social marketing techniques to improve medicines literacy
Facilitated education: consumers
Peer education
Managed in partnership with community organisations
Senior peer educators (trained volunteers)
Can reach culturally and linguistically diverse communities
Aligns expectations and builds medicines literacy
By 2013, 60% of Australians...
....taking one or more regular medicines have a basic understanding of quality use of medicines, and know we are a trusted
information source.
ENGAGING THE COMMUNITY
THE REAL CHALLENGEPEOPLE CARE MORE ABOUT WHAT’S IN THEIR CEREALS
OUR STRATEGY
build a recognisable brand
tell people about itand about being medicinewise
create compelling contents and formats
distribute widely, cost effectively and with longevity
continuously measure and refine as necessary
The connecting idea:Join the fight against antibiotic resistance
Consumer insight drivenPeople overestimate antibiotics & underestimate colds and flu
Everyday heroes who fight and winAimed at all Australians in particular Mums with kids u15
Significant media investment
Movement not campaignResistance fighter pledgeDrive to Facebook:
35,000 australians needed to preserve the
miracle of antibiotics
Antibiotic resistance fighters are everyday Australians who take action to fight antibiotic resistance.
If at least 35,000 Australians take action to stop the development and spread of antibiotic resistance, we could make a real difference – and bring Australia back in line with the average of the OECD countries
We are encouraging all Australians to sign up and pledge to become an antibiotic resistance fighter at www.facebook.com/NPSMedicinewise
Social Media Campaign
Political endorsement
TV ADVERTISING
DIGITAL ADVERTISINGEXAMPLES
OUTDOOR
EDITORIAL - TV
The Morning Show
Celebrity advocates: Tom Williams/Mel Doyle
Sunrise(Dr D’Arcy and Dr Ginny)
EDITORIALPRINT AND DIGITAL
Pacific Magazines Yahoo Answers
PHARMACY RESOURCES
Leaflets
Counter mats
Repeat prescription wallets
Hanging ceiling posters
Pharmacy TV
Pharmacy Assistants were engaged
CONTENT RICH WEBSITE
NPS: Medicinewise
In conclusion:
provides a national multidisciplinary program to promote quality use of medicines and medical tests in Australia
addresses issues from both the health professional and consumer perspective
supports public health initiatives through addressing barriers to evidence uptake.
contributes to better health and economic outcomes