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Published: 13 November, 2020


New Primary Care Update series topic now available

A new topic is now available in the musculoskeletal theme – Rheumatoid arthritis: a collaborative approach to management. To purchase access to this topic, and browse other available topics, click here.

This update covers the detection and management of rheumatoid arthritis, with guest commentary from Associate Professor Simon Stebbings. It includes a narrated 30-minute slideshow, management summary, practice tool on diagnosis and a CME case study. Although most patients with rheumatoid arthritis are initially managed in secondary care, best patient outcomes are achieved when secondary and primary care clinicians work collaboratively to promptly diagnose, initiate treatment and monitor disease progression and adverse effects of medicines.

Medicine supply updates

A reminder that the latest medicine supply/discontinuation issues are listed on the PHARMAC website here.

Bisoprolol brand change

The funded brand of bisoprolol has changed. The new funded brand will be Bisoprolol Mylan, replacing Bosvate. For five months from 1 November, 2020, both brands will be funded to allow patients to transition to the new funded brand. From 1 April, 2021, Bosvate will no longer be funded. Patients should be reassured that Bisoprolol Mylan contains exactly the same active ingredient as Bosvate, however, the tablets look quite different (a patient information sheet is available to download that includes pictures of both brands). A brand switch fee will be available for pharmacists.

Oral contraceptive supply issues continue

PHARMAC has advised that there are ongoing supply issues with oral contraceptives and we have noted these shortages in previous bulletins.

Necon and Brevinor 28 were listed to cover a shortage of Norimin (ethinyloestradiol 35 micrograms with norethisterone 500 micrograms). There is now little or no remaining stock of Brevinor 28. However, additional supplies of Necon have been secured and it is anticipated that there will be sufficient supply to bridge the gap until Norimin is expected to back in stock in mid-February, 2021.

Mercilon (ethinyloestradiol 20 micrograms with desogestrel 150 micrograms), will be available fully funded without restriction from 14 December, 2020, until 28 February, 2021. Until now, Mercilon has been partly funded for most patients or fully funded with Special Authority approval for low income patients. Mercilon may be a suitable alternative for patients who cannot tolerate COCs containing levonorgestrel (e.g. Microgynon 20 ED and Levlen ED), or where a progesterone only pill or long acting reversible contraceptive is unsuitable.

For further information on selecting a contraceptive, see:

Alternative brand of pregabalin available

There is a temporary shortage of the current funded brand of pregabalin (Pregabalin Pfizer), due to shipping delays. An alternative brand, Lyrica, has been sourced by the supplier and this should now be available. The capsules of both brands look identical, although the packaging is different.

For further information on the use of gabapentinoids, see:

Shortage of 1 mg bumetanide tablets

The supplier of bumetanide has advised PHARMAC that there is a shortage of the 1 mg Burinex brand of bumetanide. An alternative brand (also called Burinex) has already been sourced by the supplier and listed on the Pharmaceutical Schedule. However, the replacement product is not an approved medicine in New Zealand and therefore must be supplied under Section 29 of the Medicines Act, meaning that it needs to be prescribed by a registered doctor. It is anticipated that the approved Burinex brand will be available again by late December, 2020.

New Privacy Act 2020

The new Privacy Act 2020 comes into force on 1 December, 2020. The updated Act recognises the important technological changes that have occurred since the 1993 Privacy Act. A new Health information Privacy Code 2020 will also come into force on 1 December, 2020, updating the existing code from 1994. Changes reflecting the requirements of the new Privacy Act 2020 are being made to The Royal New Zealand College of General Practitioners Foundation and Cornerstone quality programmes.

Paper of the week: Adherence to metformin in people with type 2 diabetes in New Zealand

A new study published in the Journal of Primary Health Care has characterised metformin adherence and the association with glycated haemoglobin (HbA1c) levels in a cohort of over 1500 patients with type 2 diabetes from ten general practices in the Waikato region. Māori patients received fewer metformin prescriptions than New Zealand Europeans and had higher HbA1c levels. When metformin was prescribed, there was no difference in the dispensing rate or the extent of HbA1c reduction, suggesting equal adherence.

Type 2 diabetes continues to be a significant health issue in New Zealand, particularly for Māori and Pacific peoples. Further work to understand why Māori are prescribed less metformin, the first-line pharmacological treatment, is necessary to achieve equitable treatment and outcomes.

This Bulletin is supported by the South Link Education Trust

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