Want to receive Best Practice Bulletin directly to your inbox?
Sign up here.
Published: 7 August, 2020
Contents
Medsafe monitoring Smith BioMed Rapid Pregnancy Tests
Medsafe has received reports about the Smith BioMed Rapid Pregnancy Test
(also known as the Yes! Cassette Pregnancy Test Kits) showing false positive and inconclusive results.
The results present as faint lines. Medsafe has asked healthcare professionals to report any problems with these test kits.
Mini-ACE replaces MoCA as the recommended cognitive screening test
The Cognitive Impairment Assessment Review (CIAR) Working Group have
prepared
a report on the preferred test for assessing cognitive decline in New Zealand.
The Mini-Addenbrooke’s Cognitive Examination (Mini-ACE or M-ACE) is now recommended as the preferred screening tool. Online training and access to the test is
available at www.nzdementia.org/mini-ace and from 1 September, 2020, Mini-ACE will be incorporated into
the cognitive impairment pathway on HealthPathways.
From 1 September, 2019, it has been mandatory to have completed a training and certification programme from the MoCA institute and after 1 September, 2020,
access to the test will be restricted to officially certified users.
Norimin and Brevinor-1 28 day temporarily out of stock
Norimin out of stock: The supplier of Norimin 28, a combined oral contraceptive (COC), has advised
that stock has now run out, but supply should be restored by mid-October, 2020. An alternative product, Necon, has been
listed on the Pharmaceutical Schedule. Necon contains the same active ingredients as Norimin (norethisterone 500 micrograms
with ethinyloestradiol 35 micrograms) but has different packaging and product information to Norimin. Medsafe have given
a time limited, conditional approval for Necon for use during the out of stock period.
Ensure patients switching brands understand the seven-day rule to maintain effective contraception due to possible
bioequivalence differences.
Information for community pharmacists: Necon can be substituted for Norimin if patients have any repeat prescriptions owing.
For further information on these changes, see:
https://www.pharmac.govt.nz/information-for/enquiries/oral-contraceptives-supply-updates/ethinyloestradiol-35mcg-with-norethisterone-500mcg-norimin/
Shortage of Brevinor-1 28 day tablets: The supplier has advised that stock of Brevinor-1
28 day (Brevinor 1/28), a combined oral contraceptive (norethisterone 1mg + ethinyloestradiol 35 micrograms), will run out
in August, 2020; more stock is expected to arrive in New Zealand by mid-October 2020. The supplier has been unable
to source an alternative brand that is chemically equivalent, therefore, patients taking Brevinor 1/28 will need to switch
to another contraceptive.
For further information, see:
https://www.pharmac.govt.nz/information-for/enquiries/oral-contraceptives-supply-updates/brevinor28/
For further information on selecting a contraceptive, see:
www.bpac.org.nz/2019/contraception/options.aspx
Reminder: Brevinor 21 day and Brevinor-1 21 day were delisted on 1 July, 2020; Marvelon has been discontinued
and stocks are depleted; a delisting date will be announced soon.
Rivaroxaban dosing with renal impairment altered
The NZF have updated rivaroxaban dosing recommendations in people with renal impairment
following an update to the manufacturer’s data sheet. It can now be prescribed
with caution to people with creatinine clearance of 15-29 mL/min. Previously, it was recommended that rivaroxaban be avoided in people with creatinine clearance
15–29 mL/minute who were taking this medicine for prevention of stroke and systemic embolism in atrial fibrillation or for the prevention and treatment of deep
vein thrombosis (DVT) and pulmonary embolism (PE).
For updated dosing recommendations and further information on
prescribing rivaroxaban, see: https://bpac.org.nz/2018/rivaroxaban.aspx
Paper of the week: Cognitive behavioural therapy delivered electronically may be more effective
than face-to-face consultations for patients with depression
Difficulty accessing face-to-face psychological therapy, e.g. cognitive behavioural therapy (CBT), is a problem in
many countries including New Zealand, due to factors such as resource limitation, long waiting times,
cost and geographical limitations. Increasing provision of electronically delivered resources, e.g. cognitive behavioural
therapy (eCBT) has the potential to reduce barriers to access and increase adherence to treatment.
A systematic review and meta-analysis that included 17 studies (eight from the United States, three from Australia and the remainder from Europe) found that eCBT
was more effective at reducing depression severity than face-to-face CBT. There was no significant difference in patient satisfaction between the two types of
intervention. The review also looked at other outcomes including quality of life and global [overall] functionality but the results did not show any statistically
significant differences.
Read more
The eligible randomised controlled trials compared face-to-face CBT with therapist supported eCBT. Patients were able to access eCBT via a range of media
including web-based applications, email, video conferencing and texting and a therapist connected with participants at least once during the trial.
There was no limit on the number of electronic sessions or the duration of follow-up. Face-to-face CBT included both individual and group sessions
and as with eCBT there were no limits on the number of sessions or the length of follow-up. The mean dropout rate was similar for both groups.
Participants all had a primary diagnosis of a depressive disorder and there were no restrictions on symptom severity, depression subtype,
co-morbidities, age, sex or ethnic background.
Non-pharmacological interventions are first-line in the management of depression and should be continued if an antidepressant is initiated.
This study provides moderate evidence that eCBT is at least as effective as traditional face-to-face CBT for patients with depression.
The reasons why eCBT may be more effective are unknown. The authors suggest this may be because eCBT has the advantage of being flexible in timing of
delivery, thereby allowing patients to choose a time that suits them, there is also potentially unlimited access to the intervention and it is less costly.
Patients who are uncomfortable discussing their mental health may also prefer the relative anonymity of the electronic intervention.
Anecdotal evidence suggests that patients are increasingly at ease with online consultations and there are already online CBT programmes in
New Zealand for depression and anxiety, e.g. beating the blues and
just a thought.
On a practical level, interventions that are delivered electronically have the
advantage of reducing some of the barriers to treatment, e.g. access to and the cost of transport, having to arrange childcare or time off work
and minimising the problem of limited resources. In the future, online resources such as eCBT are likely to have an increasing role in the management of depression.
Luo C, Sanger N, Singhal N, et al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in
depressive disorders: A systematic review and meta-analysis. EClinicalMedicine 2020;24:100442.
doi:10.1016/j.eclinm.2020.100442.
Full paper available from:
www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30186-3/fulltext
This Bulletin is supported by the South Link Education Trust
If you have any information you would like us to add to our next bulletin, please email:
editor@bpac.org.nz
© This resource is the subject of copyright which is owned by bpacnz. You may access it, but you may not reproduce it or any part of it except in the limited situations described in the terms of use on our website.
