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New Zealand – Can we live up to the ‘clean-green’ image?

New Zealand – Can we live up to the ‘clean-green’ image?. Dr Rhiannon Braund School of Pharmacy University of Otago New Zealand. Pharmaceutical Policies In NZ. Strong focus on ‘access’ to medications (and healthcare in general).

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New Zealand – Can we live up to the ‘clean-green’ image?

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  1. New Zealand – Can we live up to the ‘clean-green’ image? Dr Rhiannon Braund School of Pharmacy University of Otago New Zealand

  2. Pharmaceutical Policies In NZ • Strong focus on ‘access’ to medications (and healthcare in general). • Individuals and families with lower income have reduced costs to see a Dr or to collect medications. • Pharmaceutical budget (~ $550 million p.a) maintained by a government agency (Pharmac) and they control the pharmaceutical schedule.

  3. Collecting Prescription Medications • A prescriber writes a prescription for three months. • Historically this was issued as one month and two repeats. • Patient paid a co-payment for first dispensing and the additional two were at no cost, but could not collect them until at least 20 days had passed. • This co-payment was either $15, $3, $2 or $0 depending on income and number of items collected in a year.

  4. What has changed? • In 2004, introduction of ‘stat’ or ‘all-at-once’ dispensing. • Save ~$60 million in dispensing/professional fees • ~$24 million in wastage • Overall savings of ~$36 million p.a • Recently (2007) the patient co-payment was reduced to $3 (NZD) for everyone.

  5. ↑ Access = ↑ Excess ? • If the obvious answer is yes, then the next question(s) are: • How much? • At what cost? (Clinical, Financial and Environmental) • Can we minimize this excess without compromising access?

  6. Identification of returns (Study 1) • ODHB pay for the destruction of medications returned to pharmacies • A random sample of boxes for destruction were put aside for analysis • Almost 1300 kg returned in 9 month period • Analysed 160 kg (12%)

  7. Braund et al 2007 NZFP

  8. Conclusion (Study 1) • All of the 20 most returned items = ‘stat’ but caution as ‘stat’ was intended to increase access • One patient returned • 1198 paracetamol • 1157 paracetamol/codeine • 469 doxepin 25mg • 362 warfarin tablets • 7 100g tubes of hydrocortisone

  9. Why are they being returned (Study 2) • Previous overseas study found that those who returned medications brought back average of 60% of original prescription • The reasons included • Bereavement (26%) • Expired medication (25%) • Person felt better (11%) • Doctor changed medication (11%) • Allergic reactions (8%) • Person did not want to take the drug (7%) Cameron S. 1996 Can Med Assn J

  10. Situation in Dunedin (Study 2) • Pilot study • Two local pharmacies • Five week collection • Patients returning medication for disposal were asked to complete a brief questionnaire

  11. Braund et al 2008 NZFP

  12. Reasons for unused medications Braund et al 2008 NZFP

  13. Conclusions (Study 2) • Initiation of ‘trial’ prescribing • Quantity of ‘prn’ medications • Amount vs period of supply • One patient = ~ $15 000 worth of medication

  14. Media Interest

  15. Situation in Hutt (Study 3) • Approached by HVDHB to assist • Used our surveys • ‘The main objective of this programme was to minimise the potential risk of household poisonings via safe and efficient methods of disposing unused medications.’ • Question about medication storage added

  16. 31 community pharmacies • Four week collection period • 1605 bags returned • 653 completed questionnaires • Sample analysed (329 with 149 questionnaires) • All Qs were also analysed

  17. Returns by quantity

  18. Why was the medicine(s) not used?

  19. Conclusions (Study 3) • Trial prescribing • ‘prn’ medications • Inhaler returns • Pharmac change in June 2008 • Susan Judd

  20. Storage and disposal survey (study 4) • Online Survey (via NZ poison centre) • Collecting medications • Collecting repeats • Storage • Disposal • Over a three month period 516 people viewed the survey and it was completed by 452 individuals

  21. Results • 62 % said that they currently had leftover or unwanted medications at home. • 48 % of people store their medications in the kitchen, 29 % bathroom, 13 % bedroom

  22. Disposal of unused

  23. Reasons for unused medication

  24. Why do you keep unused medications

  25. Where to from here? • In 2009, will start analysis of different water systems to determine if trace levels of pharmaceuticals • Also ‘life of a prescription’ study. This will investigate what types of medications are not collected, used etc

  26. Acknowledgements • Community Pharmacists • Undergraduate Pharmacy Students • NZPERF • NZ National Poison Centre

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