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BPJ 69 August 2015

Best Practice Journal

Piles of pills: Prescribing appropriate quantities of medicines

Medicine wastage is a significant problem in New Zealand, with large quantities of subsidised medicines dispensed, but never used. There are various strategies that can be undertaken by prescribers, pharmacists and patients to reduce medicine wastage and prevent “piles of pills” creating a safety issue in homes. These strategies include regular review of a patient’s current medicines, the use of trial periods for new medicines, prescribing appropriate quantities of “as required” medicines, utilisation of the Long Term Condition Service and being aware of “safety medicines.” An underlying component of all of these strategies is patient education and support. Gaining an understanding of the Pharmaceutical Schedule rules regarding subsidised community pharmaceuticals can also help clinicians prescribe appropriately. View Article

Melatonin: is it worth losing any sleep over?

Modified-release melatonin is an unsubsidised medicine that is approved for, and moderately effective at, improving sleep quality in adults with insomnia; other formulations of melatonin are unapproved. Shift-workers or people concerned about jet lag may wish to discuss the “off-label” benefits of melatonin treatment. Melatonin also may be used in specialist situations, such as in children or adolescents with neurodevelopmental disorders and sleep disturbances. Prescribers should be mindful that melatonin must be dosed at the correct time in order to be effective for assisting sleep. Due to a lack of studies on the potential adverse effects of the long-term use of melatonin, prescribing for prolonged periods should be approached with caution, particularly in children and adolescents. View Article

Prescribing testosterone in ageing males: why you shouldn’t read this article

Testosterone supplementation may be an appropriate treatment for males with clinical features of androgen deficiency and early morning serum total testosterone levels consistently below the accepted threshold of normal. Testosterone supplementation is not, however, appropriate for ageing males with non-specific symptoms and signs and slowly declining testosterone levels; the risks and benefits of treatment are uncertain for these patients. A mildly subnormal testosterone level may improve with changes in lifestyle, such as reducing alcohol intake, weight loss in those who are overweight or obese or improving sleep patterns. A significant rise in prescriptions for testosterone in older males has been observed in New Zealand, as it has in other countries such as the United States, United Kingdom and Australia. If you have never had cause to prescribe testosterone in an ageing male with non-specific symptoms and signs and slowly declining testosterone levels, continue this practice and read no further… View Article

A follow-up to acute coronary syndromes

The article: "The immediate management of acute coronary syndromes in primary care” attracted some interest from emergency care clinicians around the country. In the interests of clarity we provide supplementary material on some of the more contentious issues. View Article

“Steady as she goes”: helping older people Stay Independent

This month we release a range of resources aimed at falls prevention within the community, developed in partnership with the Health Quality & Safety Commission. The resources are based on the STEADI falls campaign developed by the United States Centers for Disease Control and Prevention (CDC), and have been adapted for use in New Zealand. View Article

Bestpractice Decision Support

BPAC Inc is pleased to be able to offer general practices a suite of clinical decision support modules, free-of-charge. These modules have been nationally funded for healthcare professionals in New Zealand through arrangements with the Ministry of Health, PHARMAC and Medsafe. View Article

News Update: Pertussis vaccine now subsidised for all pregnant women

Changes to the funding criteria for diphtheria, tetanus and pertussis (Tdap) vaccine (Boostrix) came into effect on 1 August, 2015. The new criteria mean that all pregnant women between 28 and 38 weeks’ gestation are now eligible for subsidised vaccination, whereas previously this was only the case during a pertussis epidemic. Pertussis vaccination is also included in the National Immunisation Schedule at age six weeks, three months and five months. View Article

Peer Group Discussion

We look back at the key messages and practice points from selected articles in Best Practice Journals View Article