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D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale
 

D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale

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  • Pt centred care – consumers were always at the heart of our NMP. 1st developed world to have an NMP – long gestation period, grew out of the consumer movement. Not BUM…
  • Identifying QUM problems at a community level and the changes that would be required for improvementAttention on the consumer issues and the medicines issuesUnderstanding clinical environment and maintaining relevanceIdentifying barriers and enablers for changePromoting evidence-based messagesUsing a mix of interventions with a sound theoretical baseWorking across disciplines and sectors
  • Interventions that evolve from a comprehensive planning process, build on prior research, and use health behavior theories are more likely to be effective and produce sustained change. By investigating what factors influence the target population’s behavior, including their social and physical environments, practitioners gain the raw materials they need to meet the needs of that population. Theory helps practitioners to interpret the findings of their research, making the leap from facts on a page to understanding the dynamic interactions between behavior and environment. Systematic approaches to tailoring, targeting, implementing, and evaluating programs provide practitioners with a framework for translating this insight into actions that improve health outcomes.
  • Social marketing is not a theory, but an approach to promoting health behaviour. Alan Andreason defines it as “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”. It assumes that the marketing organisation ezists to fulfill its mission, and the target audience members act in their own interests.Social marketing programs are generally ‘consumer-driven’ rather than ‘expert-driven’. Audiences are typically segmented into smaller subgroups with distinct, unifying characteristics and needs.The process involves identifying an effective ‘marketing mix’ of product, price, place and promotion (the 4 Ps). In our case we are selling an idea (ie a change in behaviour) and we need to highlight the benefits, reduce the barriers and offer a better choice than the alternative (ie not changing behaviour).Social marketing uses marketing techniques to influence the voluntary behaviour of individuals within a target audience in order to create a health benefit. It is distinct from health education in that it goes beyond informing or persuading people to reinforcing behaviour with incentives and other benefits. It also differs from commercial marketing because the people who gain from it are usually part of the target audience, and success is defined in terms of positive effects on society.When we begin the process of planning an intervention to change health behaviour, we use theory to develop a series of assumptions about factors contributing to the health problem. We then undertake research to test, adjust and add to these assumptions. In particular, we focus on assessing the needs of the target audience at multiple levels of the problem. We then design a target intervention strategy, including evaluation to measure whether or not the approach is effective and choosing realistic and actionable goals that define in advance what success will look like. The process
  • Ultimate goal of social marketing is to bring about behaviour change that benefit society, as well as the audience…So to achieve that, it is important not to have an expert driven approach, but to understand the issue from the audience’s perspective and in the context of their lives. This involves extensive formative research, as well as focus groups and interviews – in our context this is for health professional and consumer audiences.That is a “one size fits all approach” will rarely succeed, so we divide (or segment) our audiences to allow specific targeting of messages and interventions. e.g. GPs, pharmacists, opinion leaders, consumer groups (CALD, Aboriginal, young mothers, elderly)Using attractive motivational exchanges with the audience is based on the theory that we are need-directed beings with a natural inclination to try and improve our own situation, but it is often difficult to identify an exchange that will resonate with the audience and allow them to see immediate benefits for themselves (therein lies the challenge – example of antibiotic side effects, cost when they don’t change the course of the illness)Marketing is promotion which includes communication and education, but there is more to the mix – the so called 4 P’s – promotion, product, price, and place.The product is a much easier sell if it tangible, but social marketing is often an intangible such as an idea or change in behaviour – need to have clear compelling messages and objectives that resonate and motivate a behaviour change)The price – may be monetaryCommunication, participation, concise educational materialsConcise educational materialsKey messages repeatedReinforce through subsequent visits
  • In translating the ecological model into action programs, Glanz and Rimmer describe three levels and the theories that are useful at each.First is the intrapersonal level, which refers to the influence of the an individual’s knowledge, attitudes, and beliefs on his or her behaviour. Theories of cognition, perception and motivation are relevant here.Second is the interpersonal level, which refers to how significant other people such as family, friends and coworkers influence and individual’s behaviour. Theories that are relevant here include those related to social influence and social norms (eg the influence of key opinion leaders).The intra- and interpersonal levels are sometimes referred to as simply the individual level.The third level is the community level. Here we need to consider organisational settings and their influences (workplaces, schools, churches), social and health policies, and other societal influences such as poverty. Institutions (such as hospitals) can influence individual behaviour and community norms through expectations and sanctions. Macro-level policies can affect access to resources as well as sanction behaviours and shape community norms. Different intervention strategies and methods are available to for working with individuals and communities. For example, at an individual level, typical intervention strategies include a variety of educational, counselling, skill development and training methods. Innovative technologies, such as computer-tailored messaging and web-based learning and techniques such as motivational interviewing are approaches that can strengthen the impact of individual level interventions.When interventions focus on organisations, communities and policies, the use of social marketing, mass media, and media advocacy are important, as well as building coalitions, influencing social planning and community development.
  • And so our approach is to:Find ways to create awareness and promote curiosity amongst consumers ... Most people know more about the content of their breakfast cereal than they do about their medicinesFind ways to influence the influencers – opinion leaders in communities and in the mediaUse messages and concepts that are simple and relevant to everyday lifeWork in partnership with others to promote the role of questioning how, why and when to use medicines Provide tools that help people put theory into action in a positive wayKeep the person and their carers at the centre and be wherever they are
  • To focus on example of interactive self learning…Fairly good evidence that it is effectiveOther notes:Potential for data extraction from prescribing software
  • Moving online
  • Anthony CarrAt the beginning of 2011, we set out to cause an effect in the community.Our goal was that By 2013, 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.
  • People sometimes care more about what’s in their cereals than what’s in their medicines…
  • Kicking off a 5 year programeducate consumers on antibiotic resistancework with health professionals to reduce use of antibioticsYear 1: focus on antibiotic resistance in respiratory tract infectionsFebruary 2012: starting the conversation with health professionalsApril 2012: consumer campaign launch
  • Parliamentary Secretary for Health and Ageing Ms Catherine King
  • Swap to web to play one of the 30-second TVads at: http://www.nps.org.au/bemedicinewise/whatson Suggest playing “Be Medicinewise TV spot 30 seconds” at full screen. If running ahead of time, could play a couple of videos.

D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale D1 - Barriers to evidence uptake - Aine Heaney - Brownsdale Presentation Transcript

  • NPS: MedicinewiseAine HeaneyMay 2013www.nps.org.au
  • NPS: identifying barriers to evidence uptakeWhat we’ll cover today- Who is NPS- What do we do- How do we do it (social marketing)- Case study: antimicrobial resistance program- Questions and discussion
  • NPS: MedicinewiseEstablished as the National PrescribingService Limited in 1998Funded by the Australian GovernmentIndependent, not-for-profit organisationMembership basedWork in partnership- consumers- health professionals- government- industryDr Lynn WeekesChief Executive Officer,NPS, since 1998
  • OUR PURPOSETo enablethe best decisionsabout medicines and relatedhealth technologies……creating better health and economic outcomes
  • NATIONAL MEDICINES POLICY (2000)
  • QUALITY USE OF MEDICINES and MEDICAL TESTSNPS- the serviceagency for the Quality Use of Medicines arm of Australia’sNational Medicines PolicyQuality use of medicines means:- selecting management options wisely- choosing the most suitable medicines if medicines are needed- using medicines safely and effectively
  • HOW DO WE WORK?
  • WHO ARE OUR AUDIENCES?Health professionals- general practitioners- medical specialists- pharmacists- nurses (primary health care)- studentsConsumers- communities- mass audienceGovernmentIndustryDr Janette Randall, Chair ofNPS Board and generalpractitioner
  • HOW DO WE ADDRESSTHE QUALITY OF USE OF MEDICINES AND MEDICAL TESTS?Identifying problems at a community level and the changes that wouldbe required for improvementAttention on both the consumer and health professional issuesUnderstanding the clinical environment and maintaining relevanceIdentifying barriers and enablers for changePromoting evidence-based messagesUsing a mix of interventions with a sound theoretical baseWorking across disciplines and sectorsMonitoring and evaluating – using data to inform decisions and evaluateimpact
  • Policies:decisions madeby authoritiesconcerninginterventionsMichie S et al. The behaviour change wheel. Implementation Science 2011, 6:42
  • IMPACT OF NPSQUALITY USE OF MEDICINES:improved health andeconomic outcomesimproved prescribingand use of medicines/medical testsparticipation and exposureimproved attitudes,skills and knowledgeaccessawarenessreachinfluence
  • Impact?Immediate impactIntermittent impactEnduring impactWhendecisionsare madeBetweendecision makingTeaching how to makedecisionsBuilding the evidence baseACTIVITIES TO IMPROVE MEDICINE AND TEST USE Decision support Guidelines Drug information Academic detailing Peer group discussion Audit and feedback Continuing education Undergraduateeducation Research
  • Sustained behaviour change“The limited success of behaviour-change efforts …. canbe traced, in part, to:- failure to fully understand the determinants of thebehaviours- and a failure to properly apply health behaviour changetheory to the development and implementation ofeffective interventions.”Andrea Gielen and David Sleet, Epidemiol Rev 2003;25:65-76
  • SOCIAL MARKETING FRAMEWORK“The application of commercial marketing techniques tothe analysis, planning, execution and evaluation ofprograms designed to influence the voluntarybehaviourof target audiences in order to improve their personalwelfare and that of society”An effective marketing mix:- Product, Price, Place and PromotionSelling an idea (change in behaviour) by highlighting thebenefits, reducing the barriers and offering a betterchoice than the alternative (no change in behaviour)
  • Social MarketingAims to bring about behaviour change to benefit society- audience research to understand theirworld, motivations, attitudes, beliefs and behaviours- segmentation of audiences to enable targetedmessages- attractive motivational exchanges with audiences- a complete marketing mix, not just communication- careful attention paid to highlighting benefits, reducingbarriers and enabling a better choice to the alternativeJ Antimicrobial Chemotherapy 2009;63:230-237
  • Levels of influenceGlanz and Rimmer: Theory at a glance: a guide for health promotion practice. National Cancer Institute 1995
  • InterpersonalGATEWAYS AND INFLUENCESFamily &friendsGeneralpractitionerNon medicalprescribersOther healthprofessionalsPharmacistInternetMedia
  • The NPS approach....Create awareness .... promote curiosityInfluence the influencers ... work with opinion leadersUse simple messages and concepts that are relevant toeveryday lifeWork in partnership with others to encourage people toask when, why and how to use medicines and medicaltests
  • Case Study: antimicrobial resistance program
  • Antibiotic Resistance in Respiratory Tract InfectionsAntibiotic resistance has been identified asone of the greatest threats to humanhealth, with potential for a return to the pre-antibiotic era where many routine infectionswere untreatable. The key factorcontributing to this resistance trend is theindiscriminate use of antibiotics.Antibiotic resistance increases the risk ofprolonged illness, complications and death.• Patients remain infectious for longer andpotentially spread resistant bacteria toothers.• Other treatments such as majorsurgery, organ transplant, cancerchemotherapy can be compromised.• Finally, the need for more expensivetherapies increases financial burden tofamilies and society.Preserving the miracle“Our vision is that current and futuregenerations will have access toeffective prevention and treatment ofbacterial infection as part of their rightto health.”7/05/2013This is the presentation name
  • Tell the story – make a case22 - 24
  • Five year planKnowledgeBehaviour changeKnowledgeBehaviourchangeKnowledgeBehaviourchangeKnowledgeBehaviourchangeKnowledgeBehaviourchangeRTI – 47% UTI - 9.5% Skin - 5% STD - ? % Other
  • FACILITATED EDUCATION PROGRAMSPrimary care programsHospitalsConsumers
  • Key Messages Antibiotic resistance requires consideration at both apopulation and individual level Establish a patient’s beliefs and expectations aboutantibiotics for acute RTIs and tailor communicationstrategies accordingly Consider the clinical usefulness and the associated risksto your patient before ordering an imaging test Encourage self-management of acute RTIs and explainwhy antibiotics may not be appropriate Consider the issue of resistance when prescribingantibiotics
  • Facilitated education: general practice doctorsHow?- 150 trained Facilitators visit doctors 2-3 times each year- Managed in partnership with General Practice networks acrossAustralia- Voluntary participation by doctors and practicesWhat?- Face-to-face visits with GPsfor one-on-one discussions withtargeted and general messages(academic detailing)- Peer group discussions(based on case studies)
  • DRUG AND THERAPEUTIC INFORMATION RESOURCESReviews and updates- Australian PrescriberNew drugs- NPS RADAR- Medicines Update(for consumers)Topic directed updates- NPS News- Prescribing Practice Review prescribing feedbackhttp://www.nps.org.au/health_professionals/publications
  • Principles in providing information…Must sound authoritative (reasons for using are understood andacknowledged)Concise, up-to-date information which can be appliedBrief key points (with emphasis: 2-4 max)Short headings, visually appealingDerived from reputable sources (referenced)Action-oriented and decisiveUse feedback to alter/ammendUse local key opinion leaders/experts (add credibility & authority)
  • QI activities e.g. clinical self auditsGeneral practitioners andpharmacistsSelf-audits of records (paper orelectronic)Assesses practice in comparisonwith evidence-based guidelines(using indicators of qualityprescribing)Feedback on their practice incomparison with their peers
  • Symptomatic managementprescription
  • WEB-BASED INTERACTIVE SELF LEARNING RESOURCESPrimary care practitioners- Doctors- Pharmacists- Nurse practitionersHospital practitioners- Mandated in accreditation standardsHealth professional students- National Prescribing Curriculum
  • National Prescribing CurriculumUsed bymedical, pharmacy, nursepractitioner and dentistrystudentsWeb-based interactivemodulesBased on World HealthOrganization Guide toGood PrescribingCase-based topicsDiagnosis provided – focuson prescribing
  • NPS: Consumer programsOur CQUM program was set up in 2003-4It takes a health promotion focus and centres on community engagementWe use social marketing techniques to improve medicines literacy
  • Facilitated education: consumersPeer educationManaged in partnership withcommunity organisationsSenior peer educators(trained volunteers)Can reach culturally andlinguistically diversecommunitiesAligns expectations andbuilds medicines literacy
  • By 2013, 60% of Australians.......taking one or more regular medicines havea basic understanding of quality use ofmedicines, and know we are a trustedinformation source.ENGAGING THE COMMUNITY
  • THE REAL CHALLENGEPEOPLE CARE MORE ABOUT WHAT’S IN THEIR CEREALS
  • OUR STRATEGYbuild a recognisable brandtell people about itand about being medicinewisecreate compelling contentsand formatsdistribute widely, cost effectively and withlongevitycontinuously measure and refine asnecessary
  • The connecting idea:Join the fight against antibiotic resistanceConsumer insight drivenPeople overestimate antibiotics&underestimate colds and fluEveryday heroes who fight and winAimed at all Australiansin particular Mums with kids u15Significant media investmentMovement not campaignResistance fighter pledgeDrive to Facebook:
  • 35,000 australiansneeded to preserve themiracle of antibioticsAntibiotic resistance fighters are everyday Australians who take action tofight antibiotic resistance.If at least 35,000 Australians take action to stop the development andspread of antibiotic resistance, we could make a real difference – andbring Australia back in line with the average of the OECD countriesWe are encouraging all Australians to sign up and pledge to become anantibiotic resistance fighter at www.facebook.com/NPSMedicinewise
  • Social Media Campaign
  • Political endorsement
  • TV ADVERTISING
  • DIGITAL ADVERTISINGEXAMPLES
  • OUTDOOR
  • EDITORIAL - TVThe Morning ShowCelebrity advocates:Tom Williams/Mel DoyleSunrise(Dr D’Arcy and Dr Ginny)
  • EDITORIALPRINT AND DIGITALPacific Magazines Yahoo Answers
  • PHARMACY RESOURCESLeafletsCounter matsRepeat prescriptionwalletsHanging ceiling postersPharmacy TV
  • Pharmacy Assistants were engaged
  • CONTENT RICH WEBSITE
  • NPS: MedicinewiseIn conclusion:provides a national multidisciplinary program to promotequality use of medicines and medical tests in Australiaaddresses issues from both the health professional andconsumer perspectivesupports public health initiatives through addressingbarriers to evidence uptake.contributes to better health and economic outcomes