The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia. Established in 1948 the PBS now supplies approximately 140 lifesaving and disease-preventing drugs as part of its national health-care scheme and is one of the Australian Government’s fastest growing area of health expenditure. In the 2001-2002 financial year it is estimated to cost $4.837 billion, 13.6 per cent more than it did in the previous year. In the last decade it has experienced an estimated average annual expenditure growth rate of around 14 per cent.
Restrictions for prescribing medicines apply to 778 of the medicines on the PBS. The suggestion by the level that the Australian National Audit Office (ANAO), though, is that the complex nature of the prescribing restrictions introduces an unnecessary administrative burden to prescribing, one that results in the under-utilisation of medicines in areas that would be clinically appropriate and cost-effective, and hence results in fewer health benefits being delivered to the Australian population. This growing impact and complexity of restrictions is well evidenced by the fact that the wording associated with Authority restrictions has exponentially increased from an average word count of 19.4 in 2000 to 354.0 in 2005. As a result, the ANAO suggests that many medicines are not reaching the patient populations for whom they are considered cost-effective.
In delivering business performance improvement to the Department of Health and Ageing, whose Pharmaceutical Benefits Advisory Committee (PBA) makes recommendations to its government Minister regarding wording for prescription restrictions, the area of these restrictions was targeted for investigatory analysis. This aim was to ascertain whether improvements could be made to the processes of authoring restrictions wording, specifically to increase consistency and decrease complexity through better codification of the restrictions themselves. The awareness, though, that the current restrictions contained a high variance of styles, terms, formatting, and had largely evolved over the entire life of the PBS, had limited the ability of previous investigations to both come to terms with the business processes that produced them, as well as identify commonality for the basis of a lexicon that could be drawn from for codification and support from an IT system. Analysis and categorisation of this content would have been simpler if it was written in a structured, logical and consistent way.
This is, of course, no different to normal, every day English. English can be a messy language, with exceptions to rules, different styles of writing, and a multitude of different ways to write about exactly the same thing. This apparent lack of structure means that analysis is always hard and very time consuming – even if the output is just to refine the navigation of an organisation’s website. This task is made all the more difficult if the analysis is performed by someone without domain knowledge.
Typically, the approach taken to understand and categorise content is through conduct content audits and content analysis, but an alternate approach was taken in this instance to understand both the processes that produced the prescription restrictions as well as the business taxonomy that produced it – semantic analysis.
This presentation will introduce a case study involving the analysis of medical restrictions text will be used to demonstrate the effectiveness of the use of a linguistic semantic approach, and how it informed the creation of an IT tool that would help codify the content, make it machine readable for repurposing, and introduce a higher level of standardisation.