For the past 5-10 years the NPS told us that 1st line treatment for Hypertension in Australia is Diuretics / Betablockers. Evidence based medicine moved away from that many years ago. Finally in the last 3 months the NPS has discovered that they the NPS was wrong. Yet they now want to develop this software. I haven't yet seen the NPS's views on treating cholesterol in diabetics. PBS won't subsidise treatment at the levels the DM association here & overseas advocates. If NPS want to become more credible, they should be vocal on this topic.
Cedtric ____________________________________________________________________________ ____________________________________________________________________________ -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ken Harvey Sent: Monday, 19 June 2006 8:17 AM To: General Practice Computing Group Talk Subject: [GPCG_TALK] NPS plans new drug interaction software for GPs NPS plans new drug interaction software for GPs http://www.pharmainfocus.com.au/feature.asp?featureid=148 The National Prescribing Service believes current drug interaction software used by GPs and pharmacists is less than useful and is developing evidence-based software of its own that it hopes medical professionals will embrace. Pharma in Focus looks at the reasons behind the initiative and what it aims to achieve. A couple of years ago the National Prescribing Service commissioned research into the level of consistency of drug-drug interactions listed in Australia's four most commonly used clinical prescribing software packages. What it found was disturbing. There was extraordinary variability between the packages, the NPS' Stephen Phillips recalls. "There were different levels of information on alerts between different packages, absence of alert in some packages but not in others and so on. It made you ask the question 'what is the usefulness and actual utility of that information with so much variability?". The NPS is soon to repeat the research exercise, but in the meantime has begun work on an independent software system that will use an evidence-based list of drug interactions. The NPS hopes to complete the system within 12 months. Phillips, a Sunshine Coast GP and chair of the NPS pharmaceutical division support working group, says the lack of standardisation and the sensitivity of alerts for drug-drug interaction and drug-disease interaction is a recognised problem among doctors and pharmacists using clinical prescribing and clinical dispensing software. "In the context of drug interactions, for example, you can go to any number of clinical prescribing systems in Australia and the drug interaction, drug-drug interaction reference source that those prescribing systems use may well be different for each system. So doctors A, B and C can prescribe the same drug for the same patient on the same other medications and depending on the system they're using may get a different warning - or no warning at all - for a potential drug-drug interaction". PI's the source of the problem Phillips believes the problem stems in part from the fact that much of the drug interaction and side effect information contained on current software systems comes from PI's (product information). "There's a debate starting to happen about the context of that information itself. Most people would agree that the PI is largely a medico-legal document that may not connect to the most relevant information that you need to have on a clinical, day to day working basis. If the interaction data bases that are available at the moment are predominantly extracted or lifted from the PI, you may also have a relatively insensitive and indiscriminate - in clinical terms - listed information". The end result of all of these issues, according to Phillips, is a situation where doctors and pharmacists have become cynical about the accuracy of the data presented to them. "And if they are not confident of the evidence base or the place from where that information is coming, then they tend to become desensitised to it.[that results in] a flow-on loss of useful advice in a clinical decision making process and potential loss of appropriate advice in a prescribing decision". However, Best Practice's Director of Development, GP Dr Frank Pyefinch, said he was not convinced that doctors have become cynical about the accuracy of data. "I do believe that doctors ignore pop up prompts if they are too frequent and if they often relate to relatively insignificant interactions. [However] to get around this, some of the software products in the market allow the user to set the level of severity of warnings to display". Pyefinch says finding the balance between not enough and too many prompts is a challenge and it will be interesting to see how the NPS handle this. Meanwhile, the NPS has yet to decide what evidence based resource it will use for its new database. It is currently scanning and analysing resources in conjunction with an expert reference group. What is certain, however, is that the resource they select will have multi-level capacity in terms of testing clinical meaningfulness, clinical relevance and so on. No hard sell from NPS Phillips says while the NPS has a working relationship with HCN, whose product Medical Director boasts the lion's share of the clinical software prescribing market - it has not approached the company, or any others, about swapping databases. "That's not the way we're coming at it. We'll develop the resource and put it out there and then hopefully the market will see the benefit of the resource [and can take up]". "In the ideal world what we'd be saying is that the NPS has done the due diligence on this work and we believe what we've put forward is something you can rely on as being meaningful and useful and relevant and therefore people would take notice of it and plug it into their decision making."; Chief executive officer of HCN, John Frost, said while he was aware that some software products didn't have comprehensive drug-drug and drug disease interaction mechanisms, "we would argue that Medical Director is by a long stretch the leader in that area in terms of the various interactions that we do flag." He said Medical Director's interaction database was developed with input from a number of sources including HCN, a pharmacist, a GP, pharma companies and MIMS PI's. Open-minded vendors As for whether HCN would ever consider replacing its database with the NPS version, Frost says he's open minded. "Look, our goal is to provide the best clinical tool to our customer bas... and we'd welcome any such improvement if indeed it was an improvement". Best Practice's Frank Pyefinch is equally open-minded. "I think that it is a positive step for the NPS to get involved in setting some standards in this area and I am supportive of their effort in principle". "In practice though, we would need to assess any dataset of drug interactions that they developed carefully before deciding whether we would replace our existing database. We would need to be certain that the new one was better than what we are currently using. If it were not as extensive, we would need to consider the medico-legal ramifications of not warning about interactions that it did not contain.. if it were more extensive, we would need to look at whether the extra warnings might contribute to the problem of pop up 'overload'". Questions about maintenance and update frequency would also need to be answered. "Depending on the answers to the above questions, we would want to know whether we could use the NPS dataset as a base, but then supplement it if necessary with any interactions that it did not contain". Despite tipping the apple cart, so to speak, Phillips says he hasn't received flak from any quarter over the NPS proposal - and doesn't expect to. "We're not trying to be controversial or confrontational about this, we're seeing it as an area of prescribing decision support that needs some assistance. It's probably acknowledged across the industry [that it needs] work and we're putting ourselves forward to do some of that work without a proprietary interest". "If we can refine information to make drug interaction warnings sensible and relevant to daily practice, then I think it will be welcomed by medical and pharmacy practitioners and consumers. As for pharma, I really can't see a downside at all". --- Copied in the public interest _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
