We highlight Why 'Too Much Medicine' can be problematic for most patients, How Electronic Prescribing can help Pharmacies improve and information about New Clinical Trials to improve cancer treatments.
Why 'Too Much Medicine' is a Problem
The RACGP released a Position Statement: 'Too Much Medicine' to support the use of optimal medicine, which resulted from testing and treatments being carefully weighed against any harms to prevent injury and waste for patients.
They raised concerns within the medical community about the excessive and unnecessary use of tests, medicines, and procedures. This may result in problems that cause real harm to patients and to the healthcare system.
The harm from too much medicine includes the concepts of over-diagnosis, over-detection, over-treatment, over-utilisation, disease mongering, medicalisation, false positives and misdiagnosis.
A coordinated response from medical practitioners, the healthcare industry and government is required.
Unnecessary testing and treatments can carry risks of complication that can affect a patient's quality of life, or in extreme cases also trigger life-threatening problems for patients.
Some issues may happen almost immediately, such as adverse drug reactions and unplanned hospitalisation. Others issues can happen more insidious, such as the increased risks from exposure to radiation as a result from extensive treatments.
Other times, receiving abnormal test results, even if they are harmless, or being labelled as having a disease, or undergoing an invasive procedure for a minor issue, may have a high potential to provoke anxiety and stress to the patients.
Unnecessary care is also expensive for patients in many cases, who may need to pay out-of-pocket for treatments that are not covered under the Medicare Benefits Schedule (MBS). These indirect costs can also be affected through life insurance exclusions and insurance loading.
General Practitioner Dr Paul Glasziou, a Professor of Evidence-Based Medicine at Bond University, told newsGP the problems are especially prevalent in the case of over-detection of cancers.
According to Dr Paul, over-diagnosis is when a patient is labelled with a condition that would never have caused them health problems normally in their life.
Specifically he mentions with prostate, breast, thyroid and renal cancers, all have over-detection rates that vary between 40% and up to 100%. Only one out of three diagnosis for thyroid cancer for example may be real cancer, not getting it right will several impact a patient's life.
Using too much medicine is also wasteful in that it diverts valuable resources away from the people who really need care. Such as patients with serious, chronic or threatening conditions who will benefit from medical intervention.
The inappropriate use of particular drugs can also contribute to the bigger and global problem of antimicrobial resistance, which is a serious threat to human being's defences against infections.
The Statement from the RACGP suggested a number of potential solutions to the problem, including Clinician governance, Evidence-based medicine, Industry regulations, Community education as well as GP strategies to combat the problem as a whole.
General Practitioners are also encouraged to employ a variety of approaches to monitor and reduce the use of particular interventions when necessary.
In applicable cases, they should try to reduce inappropriate polypharmacy, particularly in older patients This is an area where behavioural change on the part of GPs could significantly take away the burden of too much medicine.
We mentioned the potential harms to the elderly patients from polypharmacy in our previous Gorilla Jobs blogs, the solutions require strong collaborations between GPs and pharmacists.
What do you think about what General Practitioners in Australia could do to minimise the impact of over-diagnosis? Please contact one of our friendly team of consultants Today
How Electronic Prescribing Can Help Pharmacies
Electronic Prescribing is an option for prescribers and their patients to choose to have an electronic prescription instead of a traditional paper-based prescription.
Electronic Prescribing was identified as part of the 2018-19 Federal Budget of $28.2 million over five years to implement the national electronic prescribing system. The Australian Digital Health Agency is collaborating with the Department of Health, the Department of Human Services, and industry stakeholders to deliver this system.
The system is perceived as a key priority to improve the efficiency, compliance, drug safety and data collection of Pharmaceutical Benefits Scheme (PBS) medications.
In line with the National Digital Health Strategy, Electronic Prescribing will aim to have digitally enabled paper-free options for all medications management in Australia in 2020. One of the key benefits of the system is that it allows people to manage prescriptions electronically. This will increase convenience and improve medication safety for patients.
The implementation of Electronic Prescribing will require the development of regulatory frameworks, as well as changes to existing systems and software that will enable the safe and secure use of an electronic prescription system as a legal alternative to a paper prescription.
The changes will adhere to a number of principles for Electronic Prescribing:
- Security of patient information (privacy)
- Integrity of prescription data (Safety)
- Continues to support patient choice of prescriber
- Continues to support patient choice of pharmacy
- Electronic and paper prescriptions will co-exist as the legal form of the prescription
- National Electronic Prescribing framework
- Support existing PBS polices
- Leveraging the existing assets and capabilities
New amendments to the rules for PBS claims will provide the legislative framework for prescribers and their patients to have the option to use an electronic prescription as an alternative to the paper-based prescription.
It also sets the rules for how electronic prescription should be differentiated from paper ones. This includes mandatory information that would be required from approved suppliers in relation to the supply of pharmaceutical benefits with electronic prescription.
The key change is that the active ingredient of the medicine must be listed on the electronic PBS prescription, not the current practice of stating only the brand name.
This is also one of the Federal Government's initiatives directed at managing the uptake of generic medicines.
According to the legislation, the decision for either a paper or electronic prescription will be made at the point of prescribing.
And in order to prevent and avoid duplication, any subsequent change to a different format (from paper to electronic or vice versa) would require cancellation of the existing prescription and a new script.
The amendment has been enacted, but there is still further work required before the system is fully up and running.
CEO of Fred IT Group, which runs the eRx Script Exchange, said that while the e-prescription network has already existed for 10 years, this legislation means paper scripts are no longer required.
According to the timeline, small-scale deployments should occur early next year with additional roll-outs planned after that.
The system offers significant benefits for patients and medical practitioners.
Doctors will no longer need to print and sign scripts if the patient chooses to have them electronically.
For pharmacists, a lot of the benefits will come from reducing transcription and retyping. It also makes it safer because there will be less room for errors in the process.
The system also aims to improve the level of efficiency for the pharmacists, since no longer having to put claims stickers on paper and file will normally take a fair amount of time.
Less administrative time means that more time is spent providing professional services and medical advice to patients.
Regarding privacy and security risks, Fred IT Group said there will have to be appropriate measures in place to ensure cyber security.
It is important that patients will be able to choose between paper and electronic prescriptions, if they are not comfortable with their information being used in such a way they can choose to keep the paper-based prescription.
What do you think about the new changes for Electronic Prescribing? We would love to hear from you.
New Clinical Trials to Improve Cancer Treatment
Researchers at the Royal Adelaide Hospital are set to start clinical trials on a new treatment for lung and ovarian cancers, with the aim to find and hopefully destroy the necessary cells.
Adelaide doctors believe they have made a major breakthrough in treatments, and will conduct clinical trials of a new technology to find and destroy dangerous cells.
South Australia's health minister Stephen Wade told the ABC that the partnership driven by AusHealth has linked researchers with pharmaceutical investors and will help to fast-track this important technology for patients.
This trial is the result of almost a decade of research and development at the Royal Adelaide Hospital.
The treatment has secured $33 million in funding to move to human trials, after researchers found success in treating mice suffering with lymphoma.
Royal Adelaide Hospital Clinical Trial Unit head professor Michael Brown said in an interview that the treatment deploys APOMAB antibody technology to treat solid tumours and has a strong potential to improve the survival rates among patients.
The trial would include 18 patients to be observed over the course of six weeks after treatment with the recruitment of patients to begin in early 2020.
The testing uses antibodies with a low dose of radiation and targets a specific protein that is created by dying or otherwise dead cells.
The radiation signal is picked up on a PET scan, enabling to see which patients have received the therapy and how well the chemotherapy is doing its job on the dangerous cells.
The treatment has the potential to change the way solid cancers are fought. It hopes to enhance the effects of chemotherapy, by helping doctors directly target the drug to the cells they need to.
The trial aims to test how well the antibodies can target specific cells in order to deliver low-dosage radiation.
The trial will first be tested on lung and ovarian patients, however Professor Brown mentioned researchers are hopeful the approach will also boost the effect of other treatments.
AusHealth managing director and CEO highlighted this is a partnership from the culmination of a decade of research and development by Professor Brown and his team.
They look forward to the outcomes of the trial and to evaluate the success of targeted radiation and whether it has the potential to be a breakthrough treatment.
South Australian Health Minister mentioned the $33 million investment in the local research was the largest in 20 years for Adelaide to develop medical technology.
What are your thoughts on the potential from the clinical trials? And how do you think it will impact the Radiology industry? We would love to hear from you.
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