BEHAVIOUR CHANGE HTA, clinical protocols and guidelines. How to engage health professionals, patients, prescribers and the community? Aine Heaney NPS Medicinewise
IDENTIFYING BARRIERS TO EVIDENCE UPTAKE What we ll cover today - What do we do - How do we do it (social marketing) - Case study: antimicrobial resistance program - Questions and discussion
WHO ARE OUR AUDIENCES? Health professionals - general practitioners - medical specialists - pharmacists - nurses (primary health care) - students Consumers - communities Dr Janette Randall, Chair of NPS Board and general practitioner - mass audience Government Industry
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
IMPACT OF NPS QUALITY USE OF MEDICINES: improved health and economic outcomes improved prescribing and use of medicines/medical tests influence improved attitudes, skills and knowledge participation and exposure access awareness reach
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
GATEWAYS AND INFLUENCES Family & friends Non-medical prescriber General practitioner Media Specialist Internet Pharmacist
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
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. 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. * *ReActgroup.org Finally, the need for more expensive therapies increases financial burden to families and society.
TELL THE STORY MAKE A CASE 22-24
FIVE YEAR PLAN RTI 47% UTI - 9.5% Skin - 5% STD 3% Revisit RTI/other Behaviour change Behaviour change Behaviour change Behaviour change Behaviour change Knowledge Knowledge Knowledge Knowledge Knowledge
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
Feedback on their practice in comparison with their peers 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)
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
ENGAGING THE COMMUNITY By 2014, 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.
CONSUMER CAMPAIGN The consumer campaign was launched 2012 STORY TELLING Multi part: Resistance. Colds POSITIONING Treat antibiotics with respect OBJECTIVE Reduce levels of demands RESISTANCE FIGHTER CALL TO ACTION Join the fight against antibiotic resistance TARGET AUDIENCE Mums with kids u15. Overheard by everyone INSIGHT People underestimat e colds and overestimate antibiotics
THE CONNECTING IDEA: JOIN THE FIGHT AGAINST ANTIBIOTIC RESISTANCE Consumer insight driven People overestimate antibiotics & underestimate colds and flu Everyday heroes who fight and win Aimed at all Australians in particular Mums with kids u15 Significant media investment Movement not campaign Resistance fighter pledge Drive to Facebook:
SOCIAL MEDIA CAMPAIGN
POLITICAL ENDORSEMENT
TV ADVERTISING
OUTDOOR
COLDS AND FLU WORKPLACE ENGAGMENT
EDITORIAL - TV The Morning Show Celebrity advocates: Tom Williams/Mel Doyle Sunrise(Dr D Arcy and Dr Ginny)
EDITORIAL PRINT AND DIGITAL Pacific Magazines Yahoo Answers
PHARMACY RESOURCES Leaflets Counter mats Repeat prescription wallets Hanging ceiling posters Pharmacy TV
Pharmacy Assistants were engaged
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