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Quality use of medicines in the community: the Australian experience.

It is surprising that countries which for many years have had a strong regulatory system for medicinal drugs, and have provided financial support from the public purse to ensure that the disadvantaged in society have access to them, have only recently begun to be concerned about the quality of use, and cost-effectiveness, of those medicines in the community. 
 
In Australia, one of the stimuli for concern has been the rapidly increasing cost of medicines to whomever pays – be it the individual, the Federal or State Government, or some other third-party payer. Another, undoubtedly, has been the increasing pressure to align the use of medicines with best evidence derived from the increasing number of high quality, randomised, controlled trials. An important third factor has been political pressure from vocal and informed consumer groups who have put their case to government and have drawn health professionals and the pharmaceutical industry into a debate on the need for a set of national medicinal drug policies. 
 
Over the past decade, these pressures have created novel and sometimes contentious responses. Almost all Australian clinical pharmacologists have found themselves involved in helping to shape, or implement, medicinal drug policy, and have been obliged to push back the boundaries of what has been, at times, a too narrowly defined specialty. In doing this, they have had to build unanticipated partnerships (for example, with epidemiologists and economists), and to learn to implement new approaches as members of a team that often comprises other health professionals, consumers, the pharmaceutical industry, and government. 
 
Far from perceiving this as a threat, most clinical pharmacologists have enjoyed their expanded role – often with the feeling that their expertise is only now being harnessed appropriately to ensure that the community gets the best out of its medicines.