Prescribing ‘nudge’ campaigns on hold after NPS closure

Medicine

By Geir O'Rourke

30 Jun 2024

The dissolution of NPS MedicineWise means Australia has lost significant educational capacity around quality prescribing, with initiatives targeting specialists amongst those in limbo.

Programs on hold or shuttered completely include the PBS and MBS Practice Reviews schemes and MedicineInsight database, which was used to conduct post-market medicines surveillance.

Meanwhile, the specialist-focused Value in Prescribing bDMARDs program was last updated in December 2022, a month before NPS MedicineWise was formally wound up.

It follows a federal government redesign of the funding for so-called ‘quality use of medicines’ programs, which saw NPS’ functions put up for tender, or handed over to bodies such as the Australian Commission on Safety and Quality in Health Care (ACSQHC).

But this had left behind a ‘void’ in the space, according to an editorial published in Australian Prescriber (link here), the former NPS journal spun off to new owners as part of the overhaul.

“The ACSQHC, recognised for their work on standards for hospitals and building on their existing quality use of medicines expertise, has become the custodian of many assets,” they wrote.

“The National Medicines Symposium 2023 was hosted by the ACSQHC in November 2023. Most other activities are under review and have not yet been updated (e.g. Choosing Wisely Australia, RADAR) or are not yet fully operational (e.g. MedicineInsight), while the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) Practice Reviews remain on hold.”

“It is unclear if these activities and resources will remain fit for purpose to deliver their intended benefit. This situation is not surprising given how rapidly assets were transferred; however, in time it may improve.”

Among the editorial’s authors was Professor Catherine Hill, the 2020-22 president of the Australian Rheumatology Association and chair of the consortium behind the Value in Prescribing bDMARDs Program.

Attracting controversy for its use of ‘nudge’ tactics to influence prescribers’ behaviour, the initiative saw hundreds of letters sent to rheumatologists, dermatologists and gastroenterologists with individualised data on their prescribing of bDMARDS and other drugs with comparisons to average prescribers.

NPS always stressed these reports were “intended for health professional personal reflection and not regulatory auditing processes.”

In the editorial, Professor Hill and her co-authors said that with the program on hold, it was unclear how the quality use of medicine needs of specialists would be supported in the future.

“The Value in Prescribing Program launched this work in 2019 with a focus on bDMARDs and immunoglobulins, but seems to have been paused since the closure of NPS MedicineWise,” they wrote.

The authors added: “The void left by NPS MedicineWise has emphasised that no single organisation or individual needs to, should, or does own quality use of medicines, but rather all of us as providers and users of medicines have a stake.”

“An overarching governance network of key quality use of medicines stakeholders would help to foster a shared agenda, bring attention to high-need issues and populations, encourage innovation and data-driven interventions, improve coordination, and aim for a collective impact approach across the sector to deliver public value.”

“This could be coupled to an evaluation framework with indicators to determine whether quality use of medicines is improving nationally, and whether stakeholders and audiences are better served through the changes.”

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