Evaluation of 2012 blood glucose meters change

By moving to a single supplier for subsidised diabetes blood glucose meters and test strips PHARMAC made savings of about $10 million per year. This funding has enabled PHARMAC to make significant new investments in other pharmaceuticals, such as the new blood-thinning drug ticagrelor, new medicines for multiple sclerosis, and two brands of insulin pumps.

The change involved shifting people to one of three funded CareSens blood glucose meters. To support the change PHARMAC put in place a comprehensive range of activities such as training for pharmacists and diabetes nurses, and provided information for patients.

Evaluation of clinical impacts

PHARMAC commissioned this report to look at what, if any, clinical impacts occurred as a result in the blood glucose meters brand change.

Key points from the report

• The report shows that it is unlikely there was anything wrong with the three CareSens meters.  A match group of new meter users before and after the change showed no difference in hospitalisations over their first five months (228 in 2011, and 186 in 2014).
• It is possible that there were clinical impacts.  Well before the change to the meters there were increasing rates of people with diabetes being hospitalised.  This trend continued throughout the change and declined afterwards.  Whether this decrease was a result of the meter change or other changes in the health system, disease, or treatment, is unknown.
• Overall the report confirms that change in the health sector can have an impact on patient health. We want to maximise the beneficial impacts and minimise actions which have negative consequences. PHARMAC recognises that it has to be very careful when making change.

Evaluation of implementation

PHARMAC commissioned this evaluation to identify what went well, and what we can change to enable better implementation of decisions in future, particularly in relation to medical devices.

We welcome the recommendations made in the report.

Key areas identified by the evaluation

Key recommendations the report identified were:

• Inclusion of key questions as part of the consultation process so that it is clear what the consultation is seeking responses to.
• Regularly include face-to-face meetings with key stakeholders as part of consultation for major changes.
• Identify wider health sector impacts with major changes, and work closely with other agencies, where possible, to help make referral pathways and support easier for people to access.
• Take more time to identify what may be the key consumer concerns and provide messaging to health professionals to support and reassure people with changes.

Many improvements have been made and we’re still learning

We’ve already done much to improve the way we consult, and implement brand changes. We haven’t waited for the report to be finalised before making changes. The report’s recommendations help to firm up our thinking about the best way forward.

For example, our newly-formed engagement and implementation directorate and strengthened Implementation team have put a lot of work into ensuring brand changes for tacrolimus (an immunosuppressant), human growth hormone, and imatinib (for chronic myeloid leukaemia) were well resourced, closely monitored, and smoothly implemented. Features of these implementations included:

• Early and frequent engagement with patients and/or clinical groups throughout the implementation process (consultation, notification and change management communications).
• Communication with patients either directly by PHARMAC or through health professionals (via PHARMAC-developed letters).
• Creating a feedback loop through health professionals to monitor patient responses.

Better, more frequent, engagement with our stakeholders is now entrenched in our business processes.

We know that consideration of device usability will be important to our future success in managing change in hospital medical devices.