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Australia’s National Medicines Policy was launched 20 years ago with the aim of improving health outcomes for all Australians. It was developed in partnership with healthcare professionals, consumers and the pharmaceutical industry The key parts of the Policy focus on timely access to high-quality and affordable medicines and their safe and judicious use. It also supports a viable and responsible pharmaceutical industry Since the Policy was first launched, Australia has seen significant changes in healthcare systems, medicines subsidies, health services remuneration, digital technologies and the pharmaceutical industry Medicines themselves have also changed, as have consumers’ expectations. To respond to these changes, the National Medicines Policy needs to be updated with a greater focus on implementing and measuring outcomes Keywords: drug regulation, National Medicines Policy, polypharmacy Introduction In October 2019, the health minister, Greg Hunt, announced there would be a review of Australia’s National Medicines Policy. The policy was one of the first of its kind when it was implemented in 1999.1 It provides overarching policy direction focusing on four interconnected pillars: timely access to medicines that are affordable to individuals and the community high-quality medicines that are safe and effective the quality use of medicines maintenance of a viable and responsible medicines industry. These objectives remain as important and relevant to the nation now as they did in the 1990s.

Editor, – The recent editorial by Andrew McLachlan (Aust Prescr 2014;37:110-1) overlooked an interesting point about reforms to the Pharmaceutical Benefits Scheme (PBS) in public hospitals. In some states, the reforms have seen patients discharged with one month’s supply of their medications, in place of the traditional few days' supply currently given in hospitals not affected by the reform.1 The model of minimal supply forces patients to visit their GP and pharmacy as soon as possible after discharge.1 This has significant impacts on continuity of care − if a month is left from discharge to visiting their GP, problems due to changes in medications at discharge may not be identified.1,2 PBS reform is intended to decrease confusion about changes to medications. However, it will not achieve this as hospitals will continue to keep only the single contracted brand of medication and there may be an increase in readmissions due to patients not being followed up by the GP after discharge.1 Further to this, the PBS reforms in public hospitals have given pharmacy departments the opportunity to profit from patients’ discharge medications, causing hospital pharmacies to focus on supply rather than clinical practices.3,4 This draws pharmacists away from important clinical roles including medication safety, counselling and education services, not to mention liaison with community services including the GP and pharmacy about the changes to patients’ medication regimens.3,4 Given that it has been shown that clinical pharmacists in hospitals reduce adverse drug events and improve patient safety, funding systems should focus on streamlining processes, community liaison and integration with community-based programs, not on increasing the burden on already short-staffed hospital pharmacy departments.3,4

boriginal people have higher rates of morbidity and mortality than other Australians and compare poorly to similar populations in other developed countries. In spite of this, access to medicines by Aboriginal people is poor, even for those living in urban areas. In remote areas there are different patterns of disease and bacterial infections are very common. The threshold for prescribing antibiotics is generally lower because Aboriginal patients are at higher risk of serious sequelae. Drug regimens should be simplified to increase the chance of successful treatment. Improving Aboriginal health will require reforms including improved access to and quality use of medicines, and legislative reform to support involvement of Aboriginal health workers in managing medicines.

Samples of drugs are often given to doctors by pharmaceutical representatives as part of a marketing strategy. Despite the well described advantages of drug samples, little has been published on the potential adverse outcomes. A series of consumer calls to the Adverse Medicine Events Line has highlighted concerns regarding the quality use of medicines associated with drug samples. The most commonly reported problems were drug samples being supplied to patients with inadequate information regarding dosage, administration, storage and possible adverse effects. In addition, some patients were given excessive quantities of a drug. To reduce such adverse outcomes, the drug industry, health professionals and consumers should be aware of the potential problems associated with starter packs.

Australia’s National Medicines Policy states that Australians should have timely access to medicines the consumer and the country can afford, medicines that are appropriate for them and their health problem, and that medicines should be used in a manner that maximises the benefits and minimises possible harmful effects.1 A challenge for the Policy is that the cost of access to medicines differs between public hospitals and the community. This has implications for continuity of care and the shifting of costs in the health system. The problem is accentuated in some states by the incomplete implementation of the Medicare reforms around medicines funding and access to medicines subsidised by the Pharmaceutical Benefits Scheme (PBS) in public hospitals. These reforms (implemented in Victoria, South Australia, Queensland, Western Australia, the Northern Territory and Tasmania) provide patients with PBS-subsidised access to one month’s supply of medicines on discharge from public hospitals supporting the continuity of care. In states where the reforms have not been implemented, patients on discharge are provided with a limited supply of their medicines, sometimes only a few days, requiring them to visit their GP and pharmacy to access medicines on the PBS

Education Ideally medical students should be educated in the principles of good prescribing before they enter the hospital. On the wards, these principles should be reinforced with bedside teaching and examinations. The quality use of medicines needs to be recognised as an important part of medical education and intern training programs. Junior medical staff make most of the prescribing decisions in hospitals and young interns prescribe largely by following the instructions of more senior residents and consultants. Educational activities should be tailored to the different levels of therapeutic decision-making in teaching hospitals. While they may be useful to disseminate information, didactic educational meetings such as lectures, alone, have little or no effect on practice. The impact of training and education seems to be increased by

In 1992 the Australian Government adopted a policy on the quality use of medicines, or QUM.1 The policy aimed to...

Health professionals, accustomed to the sales and marketing activities of pharmaceutical companies, may not be aware...

Health professionals, accustomed to the sales and marketing activities of pharmaceutical companies, may not be aware...

Summary Some of the pharmaceutical properties of thyroxine have important implications for the quality use of medicines. The stability of thyroxine tablets is limited and they may reach the expiry date before the bottle is finished. Administration should preferably be on an empty stomach and be consistent with respect to food and other drugs. The long half-life of thyroxine enables longer dosing intervals of up to a week if required. The two Australian brands of thyroxine are identical and patients can swap brands safely, but this should not be assumed for overseas brands.

1991 was a significant year for medicines in Australia. The Baume Report was released foreshadowing major reform of...

Variety is not only the spice of life, but also of continuing medical education and to ensuring the quality use of...