Skills – interpreting data, understanding policy responses, communicating to the public/patient Kweku Rockson and Alex Dodoo MeTA CSO/Media Orientation 16 th April 2009

Overview Interpreting data Understanding policy responses Communicating with the public MeTA CSO Training 16th April 2009

Interpreting data

Understanding policy responses

Communicating with the public

Interpreting data - I “ Lies, damn lies and statistics” Facts or spinning Drug X doubles your risk of having cancer What is the incidence of cancer in this population being referred to? What is the risk of cancer in the general population? What are the benefits of taking this medicine? What will happen if this medicine is NOT taken (will the patient die or suffer complication)? Are there alternatives? MeTA CSO Training 16th April 2009

“ Lies, damn lies and statistics”

Facts or spinning

Drug X doubles your risk of having cancer

What is the incidence of cancer in this population being referred to?

What is the risk of cancer in the general population?

What are the benefits of taking this medicine?

What will happen if this medicine is NOT taken (will the patient die or suffer complication)?

Are there alternatives?

Interpreting data - II Benefits of medicines (or the medicine) The available alternatives The cost (not price) of the alternatives Terminologies used Relative risk Absolute risk Effective Cost effective Efficacious Safe Beware of statistics, especially percentages Always look for the “raw data” i.e. the absolutes MeTA CSO Training 16th April 2009

Benefits of medicines (or the medicine)

The available alternatives

The cost (not price) of the alternatives

Terminologies used

Relative risk

Absolute risk

Effective

Cost effective

Efficacious

Safe

Beware of statistics, especially percentages

Always look for the “raw data” i.e. the absolutes

Understanding policy responses National Drug Policy National Malaria Policy National HIV/AIDS Policy National TB Policy How are these policies developed? Where can they be found? Can or should government be held to account to deliver as per the policies? MeTA CSO Training 16th April 2009

National Drug Policy

National Malaria Policy

National HIV/AIDS Policy

National TB Policy

How are these policies developed?

Where can they be found?

Can or should government be held to account to deliver as per the policies?

How are policies developed? In response to a national need Experts gather and use “best practice” and evidence-based approach Reference to international organizations usually WHO and WHA Global information customized to fit the local situation Policy formed should be informed by several factors including adaptability, acceptability and ability of the system to pay for it and ensures it appropriate application MeTA CSO Training 16th April 2009

In response to a national need

Experts gather and use “best practice” and evidence-based approach

Reference to international organizations usually WHO and WHA

Global information customized to fit the local situation

Policy formed should be informed by several factors including adaptability, acceptability and ability of the system to pay for it and ensures it appropriate application

The Malaria Example - I Chloroquine the mainstay of malaria treatment Parasite developed resistance The drug did not work Patients were not getting cured Why did this happen? Patients adherence Doctors and other health workers practices Manufacturing practices WHO recommendation to “change policies” when treatment failure rates gets to 20% or more Failure rates in Ghana falling Ascertained by sentinel site testing (how representative are these sentinel sites) Did the drug really fail or did we want to change? MeTA CSO Training 16th April 2009

Chloroquine the mainstay of malaria treatment

Parasite developed resistance

The drug did not work

Patients were not getting cured

Why did this happen?

Patients adherence

Doctors and other health workers practices

Manufacturing practices

WHO recommendation to “change policies” when treatment failure rates gets to 20% or more

Failure rates in Ghana falling

Ascertained by sentinel site testing (how representative are these sentinel sites)

Did the drug really fail or did we want to change?

The Malaria Example - II Ghana decided to move to Artemisinin-combination therapy (ACT) Four ACTs recommended by WHO Amodiaquine + artesunate Artesunate + SP Artemether + lumefanthrine Artesunate + mefloquine Amodiaquine + Artesunate chosen because of Cost Ability to manufacture locally (do we have the ability?) Was that the best and most cost effective treatment? Safety issues MeTA CSO Training 16th April 2009

Ghana decided to move to Artemisinin-combination therapy (ACT)

Four ACTs recommended by WHO

Amodiaquine + artesunate

Artesunate + SP

Artemether + lumefanthrine

Artesunate + mefloquine

Amodiaquine + Artesunate chosen because of

Cost

Ability to manufacture locally (do we have the ability?)

Was that the best and most cost effective treatment?

Safety issues

The Malaria Example - III New proposed policy Three first line medicines for uncomplicated malaria Artesunate + amodiaquine Artemether + lumefanthrine Dihydroartemisinin + piperaquine Awaiting cabinet approval Is that the best? DHA+P not yet “recommended by WHO” MeTA CSO Training 16th April 2009

New proposed policy

Three first line medicines for uncomplicated malaria

Artesunate + amodiaquine

Artemether + lumefanthrine

Dihydroartemisinin + piperaquine

Awaiting cabinet approval

Is that the best?

DHA+P not yet “recommended by WHO”

Communicating with the public and patients Multiple ways of communicating From proper labelling of medicines to provision of drug information services to public health campaigns and programmes Why should we be interested in communicating with the public? MeTA CSO Training 16th April 2009

Multiple ways of communicating

From proper labelling of medicines to provision of drug information services to public health campaigns and programmes

Why should we be interested in communicating with the public?

Challenges Facing Patients - I More medicines available Pharmaceutical industry coming up with more medicines Global initiatives e.g. 3-by-5, GFATM, ACT subsidy Increasing use of therapeutic agents Increased switches from “prescription only” to “over the counter” status Cheaper medicines (generics) Influx of counterfeits, sub-standard products etc Increased use of traditional/herbal remedies either alone or concomitantly with allopathic medicines MeTA CSO Training 16th April 2009

More medicines available

Pharmaceutical industry coming up with more medicines

Global initiatives e.g. 3-by-5, GFATM, ACT subsidy

Increasing use of therapeutic agents

Increased switches from “prescription only” to “over the counter” status

Cheaper medicines (generics)

Influx of counterfeits, sub-standard products etc

Increased use of traditional/herbal remedies either alone or concomitantly with allopathic medicines

Challenges Facing Patients - II Explosion in information available to consumers Increased direct-to-consumer advertising Unregulated advertising (and challenges of restricting this) Use of different media to promote medicines Internet, TV, radio, newspapers, printed materials etc Increased claims (and counter-claims) by various health professionals End result: Confusion to patients AND Acute need for CREDIBLE info on safety and efficacy MeTA CSO Training 16th April 2009

Explosion in information available to consumers

Increased direct-to-consumer advertising

Unregulated advertising (and challenges of restricting this)

Use of different media to promote medicines

Internet, TV, radio, newspapers, printed materials etc

Increased claims (and counter-claims) by various health professionals

End result:

Confusion to patients AND

Acute need for CREDIBLE info on safety and efficacy

How can health professionals communicate with the public Written information Television programmes Telephone answering services Leaflets and manuals MeTA CSO Training 16th April 2009

Written information

Television programmes

Telephone answering services

Leaflets and manuals

Television Programmes Several programmes on TV talking about medicines and health Let’s Talk About Drugs Funded by the Department for International Development, UK 30-minute series on National TV during Prime Time hours Used well-known actors (comedians) Fictitious story lines interspersed with factual comments and “PowerPoint” slides Very popular with the public Omnibus version for public to phone in MeTA CSO Training 16th April 2009

Several programmes on TV talking about medicines and health

Let’s Talk About Drugs

Funded by the Department for International Development, UK

30-minute series on National TV during Prime Time hours

Used well-known actors (comedians)

Fictitious story lines interspersed with factual comments and “PowerPoint” slides

Very popular with the public

Omnibus version for public to phone in

Other examples What are the other ways in which we can communicate with the public? Is Access to Medicines an interesting topic? How can the message be packaged appropriate? MeTA CSO Training 16th April 2009

What are the other ways in which we can communicate with the public?

Is Access to Medicines an interesting topic?

How can the message be packaged appropriate?