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,
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.
For a sneak peek of this topic, click here.
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
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.
There are two main areas within the new Act that are directly relevant to primary care:
- “If a business or organisation has a privacy breach that has caused serious harm to someone (or is likely to do so), it will need to
notify the Office of the Privacy Commissioner as soon as possible. It is an offence to fail to notify the Privacy Commissioner of a
notifiable privacy breach”
- “A New Zealand business or organisation may only disclose personal information to an overseas agency if that agency has a
similar level of protection to New Zealand, or the individual is fully informed and authorises the disclosure”
If a breach of privacy occurs, an online tool is available
which will help work out if a privacy breach needs to be reported and if so, the
tool will guide you through the process. It is also a requirement that affected people should be notified. Practices may need to consider how
effective their current systems are in securely holding all digital and printed patient information. There should also be processes in place
that allow a breach of privacy to be identified and reported.
The 2020 Act contains a new privacy principle (Principle 12) relating to the disclosure of personal information outside New Zealand.
This may apply if a patient moves overseas and their notes are requested or a New Zealander becomes unwell while overseas and requires
personal medical information to be sent to assist in their care.
Further information on the new Act is available
on the website of the Privacy Commissioner. The resources
section includes information sheets, videos, podcasts and e-learning modules.
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.
- 71% of all patients received five to seven metformin prescriptions, the appropriate number required to provide
continuous treatment across the 18-month study period; the majority (86%) of these patients had all of their
metformin prescriptions dispensed (i.e. 100% prescription adherence)
- Māori received fewer metformin prescriptions than New Zealand Europeans; prescription adherence did not
differ by ethnicity
- Prescription adherence was lower in younger patients (aged 45–59 years) than older patients (aged 60–74
- In patients who were dispensed enough metformin to cover at least 80% of the study period, mean HbA1c levels
were reduced by 4.8 mmol/mol overall and 5.0 mmol/mol in Māori patients
- Health literacy, disease awareness, acceptability of treatment and access to healthcare were suggested as
explanations for why over one-quarter of patients did not receive the required number of prescriptions for
- The authors recommended that general practitioners monitor prescription frequency in patients with less
severe disease and younger patients, to minimise the risk of disease progression
Read the full paper here: Chepulis L, Mayo C, Morison B, et al. Metformin adherence in patients with type 2
diabetes and its association with glycated haemoglobin levels. J Prim Health Care 2020;12
Expert commentary on the paper is available here
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