The Black and White of Prescribing Looking for the Silver Lining Optimising Prescribing Project...
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Transcript of The Black and White of Prescribing Looking for the Silver Lining Optimising Prescribing Project...
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