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BPJ 76 July 2016

Best Practice Journal

Upfront: Tips for prescribing newly-subsidised medicines for patients with COPD

In March, 2016, subsidy changes came into effect for medicines used to treat patients with COPD. The large number of changes created the possibility for confusion among patients and prescribers. To provide clarity for health professionals in primary care, bpacnz asked respiratory physician Dr Ben Brockway for his thoughts on how the recent changes are likely to affect the management of patients with COPD. In order to provide point-of-care assistance to prescribers Dr Brockway also helped bpacnz develop a novel prescribing tool. View Article

Vitamin D and calcium supplementation in primary care: an update

In 2011, bpacnz produced guidance on vitamin D supplementation for primary care. In the past five years vitamin D use has risen substantially and it is now the 12th most frequently prescribed medicine in New Zealand. Previously, prescribing vitamin D on the basis of deficiency risk was recommended, without testing. This is still broadly considered best practice, however, it is now more evident which groups of patients are likely to benefit from supplementation. Dietary calcium should be optimised in people taking vitamin D supplements, but routine supplementation with calcium is not recommended. Despite the growing number of studies reporting associations between vitamin D deficiency and non-skeletal diseases, there remains no convincing evidence of a causal link from meta-analyses or randomised controlled trials. View Article

Diagnosis and management of axial spondyloarthritis in primary care

Ankylosing spondylitis is a relatively uncommon inflammatory cause of long-term back pain which can result in radiographic changes in the spine and sacroiliac joints. Ankylosing spondylitis is part of a spectrum of inter-related conditions collectively termed spondyloarthritis. Patients with axial spondyloarthritis have predominantly spinal symptoms and some will develop classical ankylosing spondylitis. Axial spondyloarthritis is an insidious disease and difficult to diagnose; patients have an average delay of eight years from the onset of symptoms to diagnosis. Recent evidence suggests early treatment with exercise, physiotherapy and pharmacological treatments may delay disease progression and therefore improve outcomes. View Article

Proton pump inhibitors and the risk of acute kidney injury

Proton pump inhibitors (PPIs) are among the most prescribed medicines in New Zealand. They are clinically effective and are widely believed to have few adverse effects. Recent research, however, has confirmed an association between PPI use and kidney injury. This article updates information on the safety of PPIs published in BPJ 61 (Jun, 2014). View Article


A general approach to managing infected wounds and when to remove sutures View Article