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The Black and White of Prescribing
Looking for the Silver LiningOptimising Prescribing Project (OPP)
OPP: Budget Management in disguise?
Historical Budget Management in NZ•Use of formularies, guidelines, GP small group education, counter detailing Pharm Industry •Significant cost variance across medicines
Current environment
• Guidelines and screening : CVD
• PHARMAC – Flatter pharmaceutical
costs – Dispensing cost > cost of
medicines – Rebates
• Aging population
OPP Project: Interventions
Individual Medicines / Health Conditions
• High cost newer medicines• Clinical need for medicines • Safety of medicines
– Adverse reactions– Interactions
Population Issues
• High risk populations– Over 75 – Paediatrics
• Optimising medicines to reduce admissions or population health risk
Prescribing Variance
Medicine / Condition Focus Migraine
Acute management
•Sumatriptan Oral•Sumatriptan SC•Rizatriptan Oral
Prophylaxis
•Beta-blockersAvoid propranolol with rizatriptan 10mg
•AnticonvulsantsUp titration of topiramate
•Calcium channel blockers
Behaviour Change
The Data Lens: Patient / Population
Practice/Patient DHB/PHO
Practise Audits
Audit •Audit of patients on 5 or more long term medicines•Review of medicines, matched with patient problem list
Outcomes•Close monitoring of high risk patients
– Renal impairment– CHF patients
•Discussion of how to manage high risk patients and how/when to discontinue
OPP: Resources and the present environment
Current environment•DHB contracts•Integration •Focus on resource, safety and quality •PHARMAC and the medicines budget
Current Yr. PHARMAC
ProjectionVariance
$240,852 $498,797
Reduction in prescription items: 83,214
-$1,052,426
$519,505
Antipsychotics
Risperidone Start: Jul-2010
Reducing number of items, risperidone and quetiapine dose in elderly patients, and use in non psychotic patients as a sedative.
Quetiapine Start: Jul-2010
Reducing number of items, risperidone and quetiapine dose in elderly patients, and use in non psychotic patients as a sedative.
Endocrine
Calcium carbonate Start: Jul-2010
Reducing calcium carbonate use in women due to change in evidence that indicates increase risk of MI.
Glucose sel f-management Start: Jul-2010
Reducing the number and quantity of test strips ordered for patients with diabetes who do not require strict blood glucose monitoring.
Safe use of metformin Start: Jul-2010
Ensuring the safe dosing and use of metformin in patients with renal dysfunction.
$339,987 $460,795 -$120,808
$891,520
-$257,945
$78,980,664 $80,033,090Reimbursement Cost - Al l Medicines July 2010 - March 2011
Poly-pharmacy in the elderly
Start: Oct-2010 Supporting GP to review elderly patients on mutiple medicines
-$372,015
Interventions targeted at both a medicines and population perspective
Outcomes
• Safety • Costs• Collaboration • Partnership
Future Directions
• Long term conditions• Acute demand • Patient focused resources • Clinical pharmacists support for general
practise• New roles for pharmacy• Primary / secondary integration
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