For decades, a paper based system has underpinned Australia’s strict medicines and poisons regulations. Within this system, doctors have no way of knowing if patients seeking controlled medicines are living with an undiagnosed addiction and securing multiple doses of the same drug from different practices.
Often, prescribing doctors say ‘yes’ and write a script because – based on the information they do have – it’s seemingly the most reasonable course of action to take in terms of treating the patient. Unbeknownst to them, however, the patient has sometimes secured harmful levels of that substance, placing them in a situation which may compromise their health.
While the issue may be difficult to quantify, the Parliament of Australia believes misuse of medications such as anti-anxiolytics, anti-depressants and drugs of addiction (e.g. codeine and morphine) may be rife in Australia. To a lesser degree, anabolic steroids and anti-obesity drugs.
To combat the issue, Federal Health Minister Greg Hunt announced an investment of over $16 million in July 2017 to deliver a national rollout of Real Time Prescription Monitoring (RTPM). The Commonwealth has been working closely with all States and territories to implement this national system.
Better informed prescribing decisions
RTPM will help doctors and pharmacists identify patients who are at risk of harm due to dependency, misuse or abuse of controlled medicines – and patients who are diverting these medicines.
Performing real-time checks of the National Data Exchange (NDE), it will use a traffic light system to signify whether patients are at high, medium or low risk.
The alerts also provide guidance on what to look out for, before a substance is prescribed or dispensed. For example, they could indicate a patient has sought multiple doses of the same drug from different practices, or multiple doses of similar drugs (e.g. drugs in the same opioid group).
Upon receiving an alert, the doctor or pharmacist can access the NDE, where they can view the patient’s medicine history for the past twelve months.
From there, they can make a more informed choice about whether or not to prescribe or dispense the substance.
Regulation and monitoring of controlled medicines will continue to be the responsibility of states and territories. Each has their own regulatory system that requires mandatory reporting by GP’s and pharmacists.
The national RTPM system supports this mandatory reporting, so, unlike My Health Record – and other digital disruptors in the healthcare space – it will be not opt-in.
Whilst this has raised some privacy concerns, proponents emphasise that medicine histories can only be accessed when a request meets the alert criteria – signalling the patient may be in a situation that could cause harm or diversion.
Doctors can still write prescriptions for patients who require these controlled medicines, even if an alert has been triggered. The system will provide information to more fully understand the patient’s circumstances.
Equipped with this information, clinicians can discuss different types of treatment regime. For example, pain management programs or counselling that may help them manage their situation more safely.
Better protecting patients
To be fully effective, a nationwide rollout of RTPM will be essential. So far, only Victoria has made the switch, but other states and territories are planning to follow suit in the coming months. This means patients in Victoria could still obtain controlled medicines in other states that haven’t yet connected to the national system.
Once all states and territories are on board, the system will better protect patients from obtaining harmful levels of controlled medicines. This is an important public health measure, providing regulators, doctors and pharmacists with information regarding supply of controlled and other medicines with the potential for misuse.
As states and territories brace for the impending transition to RTPM, Informa’s eMedication Management Conference will hear from Rowena Sierant, Director, Digital Delivery Section, Benefits Integrity and Digital Health Division, Health Resourcing Group at the Australian Government Department of Health.
Ms. Sierant will talk more about the RTPM rollout, addressing practical, legal and ethical concerns.
The conference will be held on 29-30 March at the Swissotel Sydney. Learn more and register.