Many people living with pain rely on medication as the most accessible and affordable treatment. While medication is recommended as one part of a holistic treatment strategy, and not necessarily for long term chronic pain management, the reality is that multidisciplinary treatments such as psychological support or physiotherapy are often not readily available. These multi-disciplinary treatments can also be expensive for people living with chronic pain, particularly when they come with large out of pocket costs.
While Painaustralia continues to try and make best practice pain management more accessible, the centrality of medication to manage chronic pain in Australia cannot be understated. In practice, the National Medicines Policy (NMP) is an essential framework for ensuring that people living with chronic pain continue to have timely access to new and innovative medication at a price they can afford.
The NMP was launched 21 years ago with the aim of improving health outcomes for all Australians. It was developed in partnership with healthcare professionals, consumers, and the pharmaceutical industry. The NMP can be viewed as a document that offends nobody and says all the right things, but more recently its capacity to provide innovative, current and effective treatments to Australians has come under increasing pressure. The emergence of precision medicine and more complex combination therapies that are far more sophisticated than a regular pill to treat a single condition has challenged some of the previous approaches outlined in the NMP.
The changing nature of the health landscape since 2000 requires ongoing review of the policies in place to guide the health system and ensure high quality evidence-based treatments are available to meet current and emerging need. For instance, we know that chronic conditions such as chronic pain now represent just under half (47.3%) of Australia’s health conditions and are projected to increase (ABS 2018).
The Australian Government began a review of the NMP in August and this provides an opportunity for the Minister for Health, the Hon Greg Hunt MP, and his department to make a real and meaningful commitment to chronic pain as a health priority that aligns with national approach endorsed by all Australian governments in the National Strategic Action Plan for Pain Management.
Painaustralia has made a submission to the review in which we highlighted several areas that could be fine-tuned and improved to make things better for people living with chronic pain. Some of Painaustralia’s comments and suggestions for improving the NMP included:
adding a principle of being ‘outcomes focused’. A criticism of the NMP raised by many stakeholders and particularly consumers is that it is unclear how the success or impact of the policy is measured, if at all;
while the NMP’s role in addressing chronic disease is a critical one, there is no mention of ‘chronic disease’ in the current NMP. Chronic conditions have arguably been the most significant shift in health status in the past 20 years and are projected to increase in the coming decade;
the definition of the word ‘medicine’ needs to include any product that acts like a medicine, which focuses on the therapeutic effect of a good rather than its form. After all, medicines are no longer just a pill;
while the inclusion of consumers on several initiatives related to the NMP, such as consumer representation on TGA and PBS advisory committees is a positive step, a broad-brush approach to consumer representation provides limited benefit when what is required is nuanced knowledge of specific conditions such as chronic pain. Along with this general consumer approach, Painaustralia would also welcome the participation of consumers who are living with or affected by the condition and use medication as part of future Government consultation processes;
clear messaging regarding decisions and changes to medicines-related policy needs to be considerate of the implications for specific consumer groups. These messages need to be developed with consumers and stakeholders who are knowledgeable about the nuances of specific conditions and cohorts, and how medicines are utilised in these groups;
consumer needs must be recognised in the pursuit of advancing medical technologies. To ensure that consumers are prepared and equipped for this rapidly evolving landscape, consumer health literacy must be improved, and greater awareness of treatment options and best-practice approaches, like a multidisciplinary approach to managing chronic pain, must be promoted; and
Painaustralia noted a lack of focus in the document on implementation including goals, measures, reporting and review frameworks which we suggested should be addressed in future versions.
(The Painaustralia NMP Review Submission 2021 is available on our website here.)
The NMP review provides an important opportunity to fundamentally change the way Australia’s medicines policy works to advance better health outcomes for consumers. In order to achieve this, it must not just be a set of words we can all agree to. An implementation plan supported by measurable, reported and regularly reviewed outcomes measures must sit alongside the policy. It is only by adopting this outcome informed approach that a high-level policy like the NMP can have positive impact in alleviating pressure on our health system.
If we are going to better address the modern and complex needs of Australians who benefit from medication, we need to ground our policies in the real experiences of those who use medicines. This is especially true when looking at the impact of medicines on the lives of people living with chronic pain.