Money Matters Medical Markets National Prescribing Service Changes its Spots
National Prescribing Service Changes its Spots
Thursday, 01 July 2010
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Drugs-on-shelf-1The National Prescribing Service has a clear-cut cost saving agenda that includes imaging as well as prescribing.


When the National Prescribing Service (NPS) was launched it was all about promoting better standards of prescribing (“QUM”) and any suggestions there was a cost-saving agenda were decried. Things have changed. The Dept of Health & Ageing funded NPS to the tune of $75.8m during 2005-2009, under the condition that NPS was to deliver $160m of PBS savings to government during those four years. In its latest evaluation report (2008–09 Evaluation Report No. 12), NPS says it has delivered $47m in excess of that four-year savings target, saying that in 2008-2009 alone it saved government $17.7m from reduced antidepressant prescribing and $28.2m from PPI prescribing.

Other “key achievements” highlighted for 2008-2009 were:

  • Total savings of $45.9 million to the PBS,
  • Decrease in prescribing of COX-2 selective NSAIDs by 3.24 scripts per 1000 consultations where NPS had reached ~52% of GPs,
  • Decrease in prescribing of tramadol by 7.71 scripts per 1000 consultations where NPS had reached ~54% of GPs, and
  • Decrease in prescribing of high dose PPIs by 10.36 scripts per 1000 consultations where the NPS interventions had reached ~30% of GPs.

“NPS continues to positively influence prescribing practice and medicines use through expanding its reach and relevance amongst the Australian population, health professionals and health professional students,” the press release said. NPS has 150 facilitators – from pharmacy, nursing and medical backgrounds – working in divisions and networks of general practice around Australia.

A shift in NPS focus from doctors to consumers became obvious some years back. It was to do with antibiotics for ‘colds’. NPS seemed to give up on doctors and went directly to consumers to educate them away from asking for antibiotics. It did this successfully by, all accounts. As NPS now points out, use of its “products and services” increased significantly over 2005–09.

This included a lay media campaign to encourage consumers towards the use of generic medications. More recently, it has been funded by government to reverse the rising trend in diagnostics use. Government will hand NPS $9.4m to reduce “inappropriate use of diagnostic imaging”. NPS will also tackle pathology, at the same time that Medicare has flagged CT scans and other diagnostics for audits.

What is the connection between an organisation geared up for better prescribing and an attempt to influence how doctors order diagnostics? “The first phase of the NPS program will address technologies used to diagnose lower back pain, as back complaint is the second most common reason why people presented to their doctor asking for analgesics. Back pain generates 5% of imaging orders.” Figure that one out.

The “independent” NPS boasts its wide reach. “GP participation remains high with around 60% of the GP workforce participating in at least one NPS activity, while pharmacist participation rates have increased significantly to 21% of registered pharmacists. Also, the number of nurses has nearly doubled to 2504, which is particularly encouraging given the key and growing role of nurses in quality use of medicines.”

GP participation rates of 60% relate almost entirely to NPS activities for which the RACGP has allocated CPD points. At the same time, it seems strange that NPS has reduced its reach to the profession with the June 30 axing of its Therapeutic Advice and Information Service, a service that fielded 6000 phone calls per year from doctors seeking prescribing advice. It gave financial reasons but continued with the Awareness of Medicines helpline for consumers.

It says 27% of all Australians over age 15 and 32% over 50 years are aware of NPS, its “National Prescribing Curriculum” is in 23 institutions such as universities, it held 959 sessions for 21,468 seniors as part of its Seniors Peer Education program, and had 241,834 page views on its website during 2008-09. The website’s appearance has noticeably changed towards consumers in recent years.

It is hard to imagine this is an organisation with a dominant influence from the medical profession anymore despite having three GPs on the board, one as chair. The current RACGP president is also on the board, as is WA GP Dr Shiong Tan, listed as “clinical adviser to the Western Australian Department of Health”. Just about any medical organisation you can think of seems to be listed as a “member organisation”.

NPS should stop describing itself as independent. It functions as an arm of government. Whoever pays the piper calls the tune and NPS has a clear cost-saving agenda. In fact its very survival depends on this outcome.

The only thing to be sorted is whether the nation agrees that Australians are pill popping too much and doctors are prescribing too much. Given that compliance with prescribed medicines has repeatedly been shown to hover between 40% and 70%, you have to wonder how many billions are going down the toilet. Which brings us to the government’s apparent willingness to give pharmacists prescribing rights – a quirky conflict of interest, to say the least.

But why are we flogging the poor old GP when the big growth area is oncology (see table), pushed along by an ageing population and demanding consumers (with facilitating pharmaceutical companies in the background). Specialists seem curiously quarantined from the pressures GPs will be facing.

Table: Requested PBS Groups processed (May 2009 -April 2010)

Therapeutic Group

WA

Total (all States)

 

$Benefit

$Benefit

Alimentary Tract and Metabolism

77,549,799

926,061,597

Blood and Blood Forming Organs

29,614,291

308,844,922

Cardiovascular System

180,100,273

2,006,765,980

Dermatologicals

6,175,667

71,501,719

Genito Urinary System and Sex Hormones

9,571,538

87,138,232

Systemic Hormonal, excl. Sex Hormones

4,861,201

55,000,482

General Anti-Infectives for Systemic Use

21,466,397

255,407,500

Anti-Neoplastic & Immunomodulating Agents

142,181,975

1,339,114,710

Musculo-Skeletal System

21,394,574

264,175,107

Nervous System

112,342,875

1,243,933,959

Anti-Parasitic Products

59,886

901,994

Respiratory System

30,621,316

394,475,566

Sensory Organs

23,495,341

306,236,522

Various +

3,714,318

66,103,026

Other ++

142,175

3,137,133

Total

663,291,626

7,328,798,449