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