The studies in this thesis evaluated implementation of the brand substitution policy from Australia's National Medicines Policy perspective, by studying frequency of brand substitution for government subsidised medicines and the extent of switching between producrs by cohorts of individuals. Administrative claimd data for government subsidised medine dispensings were used.

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This research is focused on improving health outcomes for older people by improving the continuum of care at the critical hospital-community interface. The elderly are at particular risk of medication misadventure following hospital discharge. The smooth transition of patients across of the hospital-community interface requires the availability of quality information in a timely fashion to patients and the community-based health professionals. The principal objective of this thesis was to improve medication-related communication through the provision of a community-linked Medication Liaison Service involving hospital and community-based practitioners in the identification of at risk patients, delivery of services to those patients whilst in the hospital and immediately post-discharge in their own homes, and appropriate follow-up services.

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This research involved a rigorous implementation of the conceptual framework of Australia's National Strategy for Quality Use of Medicines through a planned sequence of studies across a large defined geographical region to test the hypothesis that: The National Strategy for Quality Use of Medicines can be used to design, implement and evaluate a research program to achieve sustained improvement in health care in a regional setting.

Medication is vital in treating chronic disease. Increasing use of medication, however, can lead to (potentially preventable) medication-related adverse events. Medication management offers a means of addressing such adverse events and pharmacists have an important role in this solution, especially in terms of reviews of patient medication. Improved availability and sharing of patient-related information are critical factors in medication management, so that providing access to this information becomes a major factor in effective medication reviews. Although clinical decision support tools can significantly assist doctors in accessing relevant point-of-care information for greater patient safety, it has proven difficult to ensure the availability and appropriate structure of patient-related information for such support tools. These information access and input problems are further exacerbated by a lack of existing research into suitable decision support solutions for pharmacists. This research project explored the suitability of an essential information model to support an electronic document solution to support clinical documentation and allow effective communication between pharmacists and doctors for medication reviews. The project investigated whether this approach could improve safety, quality and efficiency in the medication review process; as well as more generally identifying factors influencing development and uptake of document-based support tools in the Health sector. The project used a qualitative Design Research approach and iterated through three scenarios. The first, information-rich, hospital scenario developed an information model of essential medication management components, which underpinned the development of a digital document prototype implemented using XForms technology. In the second scenario, accredited pharmacists evaluated the digital document to enable refinement of the information model and its associated digital document for the broader community context. The third scenario involved field studies which evaluated the digital document (and thus the underlying information model) within the community, assessing its contribution to quality, safety and efficiency throughout the medication review process. The investigation identified a number of themes which guided design and development of the prototype; and which appeared likely to have a broader impact on successful uptake of decision support tools. Missing information proved to be a constant and serious problem for health professionals although, in this project, it also became a way of determining the value of an information element and thus its inclusion in the information model. Conversation played a significant role in the hospital environment to help supply pharmacists information needs. Information granularity, the language of health professionals; and their time constraints were major factors influencing design. Health professionals extensive use of their personal knowledge also suggested decision support tools in this sector should be systems for experts rather than expert systems, i.e. the decision support tool and its users personal knowledge should complement one another. The results of this proof-of-concept project suggest practice improvement in medication management is possible, with perceived improvements in safety, quality and efficiency of the medication management process. These benefits, however, now need to be affirmed in larger field studies. The contributions of this research are two-fold: firstly, it is possible to develop a model of essential medication-related information which is succinct, relevant and can be understood and shared by health professionals in conjunction with the individuals personal knowledge. Secondly, a document metaphor is a natural fit with health professionals for representing and communicating information. Expressing this metaphor as digital document overcomes the main problems of paper-based documents sharing and communication; and the dynamic properties of digital documents assist in decision-making.