In her younger days Libby Roughead worked as a pharmacist in a suburban shop, dispensing medicines to members of the local community.
“Being in the shop could be fantastic,” she says. “The world walks in and you learn all sorts of interesting things about people.”
The pharmacy experience sparked her curiosity: she wanted to learn more – about people, the medicines they are prescribed, and what impacts, positive or negative, these medications may have.
And learn more she did. She embarked on a Masters by research and then a PhD.
“Now I think I’ve found my place,” she says.
Today, her work feeds in to national pharmaceutical policies and into developing and measuring performance indicators for the quality use of medicines and the national medicines policy.
Evaluating improvements in health care
Roughead’s research focuses on quantifying the extent of problems with medicines use, identifying the scale of adverse reactions to medicines, testing solutions for improving medicines use, and evaluating improvements in health care.
She is also the Director of the Quality Use of Medicines and Pharmacy Research Centre, leading a multidisciplinary team of researchers and support staff, as well as several PhD students.
Her work has had a dramatic impact through the Veterans’ MATES program, which provides information for health professionals to assist their veteran patients to manage their medical conditions, particularly through appropriate medicine use.
Among many honours and awards, Roughead received the Health Services Research Association of Australia and New Zealand (HSRAANZ) Distinguished Investigator Life Time Achievement Award for her “contribution to the field of health services and health policy research through scholarship and teaching, advancement of science and methods, and leadership”.
She has served on the Drug Utilisation Subcommittee of the Pharmaceutical Benefits Advisory Committee, providing advice on drug utilisation assessment for Australia; and has acted as a temporary advisor to the World Health Organisation at regional meetings on medicines policy, pricing and quality use of medicines.
Veterans leading healthier and more active lives
Many of Australia’s veterans are today leading healthier and more active lives thanks to a major achievement by Roughead and her team – the Department of Veterans’ Affairs Medicines Advice and Therapeutics Education Services (MATES) program, devised and implemented in partnership with UniSA.
The MATES program provides patient-specific feedback to prescribers, gleaned from unique UniSA software tools, which highlight the veterans who may be at risk of medication-related problems.
This is coupled with targeted educational material provided to both healthcare professionals and veterans.
“We’re trying to educate doctors and pharmacists, veterans and age care directors to think about and change the way they might be using medicines,” says Roughead.
And it’s working: to date across Australia, the MATES program has assisted more than 295,000 veterans, 33,000 doctors, 8,500 pharmacies and 2,600 directors of residential aged-care facilities – helping to improve healthcare practice and health outcomes for veterans while at the same time reducing costs.
The MATES program grew out of a Commonwealth government “audit and feedback” scheme that provided doctors with basic information on veteran health issues.
The veterans include “thousands” who served during the Second World War plus their spouses – many now aged 85 and over – as well as a “large cohort” who served in Vietnam, and many who served in countries such as Rwanda, the Solomon Islands, Bougainville, Iraq, and Afghanistan.
“We involved the veterans in developing the MATES program – that was a big thing, involving the major stakeholders,” she says. Veteran involvement meant that the program could also research issues of importance to veterans.
“For example, there were some observational studies that were showing that veterans with post traumatic stress disorder appeared to be at greater risk of dementia.
“The Australian Veterans’ Associations were very concerned about this and wanted to know if it was true, so we did the analysis for them examining how the medicines were being used.
“And for most veterans with PTSD there was no problem; for a small group there seemed to be an interaction between anti-psychotic drugs, PTSD and the risk of dementia. After we did that, the Americans did the same study and they got similar results.”
Education programs and supplying information
A large component of Veterans’ MATES involves conducting “interventions” – such as education programs and supplying information.
“We worked with the veterans themselves and they were involved in helping to develop the program. That’s been a nice part of the work,” she says.
The research work has included examining and evaluating “the whole range of available medicines”.
“There are some veterans with significant mental health issues, but there are others who don’t have those problems. And of course once you get to being over 75, it’s very rare not to be on some medicines and to have multiple chronic conditions.
“It is a big challenge to manage multiple chronic conditions. It is comparatively easy to treat one condition, but when you’ve got four or five that’s where it gets really, really difficult to work out what to do.”
Roughead and her team have spoken to numerous veterans during the course of their MATES research.
“They are teaching us too,” she says. “They assist us to identify and tackle their issues of concern, and they help us with the language that we use so we are communicating clearly.”
Dr Graeme Killer AO, former Principal Medical Officer to the Department of Veterans’ Affairs, says that by partnering with Roughead’s UniSA team “we created a truly exemplar program that resulted in profound improvements in veterans’ health outcomes, cost efficiencies and behavioural change in healthcare provision”.
The University team, he adds, “built a deep understanding of the DVA’s complex linked health database, leveraging its unique potential to achieve a picture of the entire system of health and medical services wrapped around each veteran; and innovatively using that data to bring about behavioural change to achieve improved medicine prescribing practices, tailored health reviews and overall healthcare system improvement for veterans”.
“The national public learning from this highly successful program for veterans has been far-reaching across the wider health system, as well as being acclaimed globally.”
Saving lives and promoting safe medicine use
The Quality Use of Medicines and Pharmacy Research Centre has driven research into “preventable medication issues” – a problem estimated to cost Australia up to $1.4 billion a year – helping to save lives and promoting safe medicine use, and undertaken research underpinning the 60,000-plus medication reviews provided annually via the Domiciliary Medication Management Review service.
By uniquely combining biostatistical and behavioural psychology approaches with clinical evidence, the UniSA team works with public health bodies to develop tools that monitor healthcare systems and then analyses them for evidence of complex interactions between diseases, medications and devices.
Collectively, harms from inappropriate use of medicines lead to over 250,000 hospital admissions each year, costing taxpayers and insurance companies an estimated $1.4 billion, in addition to the significant personal costs to individual health and wellbeing.
QUMPRC’s analysis method has been taken up in Canada and Korea. It has also been deployed elsewhere in Asia, North America and Europe – demonstrating the potential power of a global medicines surveillance approach.
‘I don’t meet anyone who can’t tell me a medicine story’
Roughead acknowledges the enormous benefits of modern medicines.
“They’re keeping us alive. People today are living so much longer than in previous generations, and that’s in large part due to the great medicines that are available today,” she says.
However, they can have side-effects and unintended consequences.
“I don’t meet anyone who can’t tell me a medicine story. If it’s not about them, it’s about their mother, their father, their husband, their wife, their child – everybody seems to have a story of where medicine went wrong.
“We’ve got some good medicines, and what we are trying to do is to optimise their benefits while reducing the harm – that’s the core of the work that we do here at QUMPRC. We’re using public health data to improve the prescribing and use of medicines.”
Another issue with medicines, she says, is that they can impact on individuals in different ways.
“We have groups of people who are non-responders and often that’s a difficult situation because we might assume that their condition is really bad as opposed to recognising them as a non-responder. For example, if you’ve got pain and you’ve taken medicine for that pain and it doesn’t work, you assume ‘oh my pain must be really, really bad’. But it’s just that the medicine is not working on you.”
Depression “is a good example” of where people can be non-responders to particular antidepressants – “so instead of realising that we often increase the doses instead of stopping that one and doing something different”.
Where these kind of issues are encountered, information is fed back to doctors and government agencies.
“That’s the beauty of having established those relationships,” Roughead says.