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New Zealand Can we live up to the cleangreen image

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Strong focus on access' to medications (and healthcare in general) ... Patients returning medication for disposal were asked to complete a brief questionnaire ... – PowerPoint PPT presentation

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Title: New Zealand Can we live up to the cleangreen image


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

2
(No Transcript)
3
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4
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.

5
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.

6
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.

7
? 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?

8
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)

9
Braund et al 2007 NZFP
10
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

11
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
12
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

13
Braund et al 2008 NZFP
14
Reasons for unused medications
Braund et al 2008 NZFP
15
Conclusions (Study 2)
  • Initiation of trial prescribing
  • Quantity of prn medications
  • Amount vs period of supply
  • One patient 15 000 worth of medication

16
Media Interest
17
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

18
  • 31 community pharmacies
  • Four week collection period
  • 1605 bags returned
  • 653 completed questionnaires
  • Sample analysed (329 with 149 questionnaires)
  • All Qs were also analysed

19
Returns by quantity
20
Why was the medicine(s) not used?
21
Conclusions (Study 3)
  • Trial prescribing
  • prn medications
  • Inhaler returns
  • Pharmac change in June 2008
  • Susan Judd

22
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

23
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

24
Disposal of unused
25
Reasons for unused medication
26
Why do you keep unused medications
27
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

28
Acknowledgements
  • Community Pharmacists
  • Undergraduate Pharmacy Students
  • NZPERF
  • NZ National Poison Centre
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