Published: 17 September, 2021
Contents
2020 Annual Report is now available
The 2020 bpacnz Annual Report provides personalised pharmaceutical data covering the period from January,
2020 to December, 2020. This year the Annual Report has two parts:
- A national report
that provides an overview of dispensing during New Zealand’s 2020 COVID-19 pandemic response,
including analysis of the number of dispensed prescriptions overall and by ethnicity, trends in dispensing of antibiotics,
antidepressants, anti-anxiety and insomnia medicines, and preventative medicines used in the management of long-term
conditions.
- Individualised and practice reports
including pharmaceuticals dispensed in the community for any primary care
prescriber registered with us who had 250 or more prescriptions dispensed; aggregated reports are also provided for
DHB and PHO facilitators.
Examining the dispensing data provides an opportunity to reflect on whether there were any notable trends as a result of the changes to and
challenges of general practice during the 2020 pandemic response, and in light of the recent outbreak, whether these trends can be used to
inform prescribing practice during periods of COVID-19 restrictions.
This link takes you to the 2020 Annual Report page.
The page hosts the national dispensing report and for prescribers, individualised and
practice dispensing data via your bpac log in. If you were a primary care prescriber in 2020 but do not have a My Bpac account,
go to www.bpac.org.nz/signup to create an account and email
contact@bpac.org.nz to
request that an Annual Report be created for you.
Celebrating Māori Language week
Tēnā koutou katoa. Māori Language Week has been celebrated each year since 1975. It commemorates the presentation
of a petition to parliament in 1972 seeking for New Zealand’s indigenous language, te reo Māori, to be taught in schools.
Te Kaunihera Rata o Aotearoa (Medical Council of New Zealand) in their
latest
newsletter recognises the work of those
at the frontline during the current mate urutā (pandemic), encourages us to kia kaha (be strong) and outline their
five new core values. These are:
- Kotahitanga - We are a team - great things happen when we are unified
- Manaakitanga - We support each other - our environment is inclusive, diverse, and respectful
- Whakapono - We act with integrity - honesty and transparency are at the heart of everything we do
- Kaitiakitanga - We protect the public - this is our primary purpose and the touchstone for all decision-making
- Whakamārama - We lead by listening - always learning, forever innovating
Nga Korero a Ipurangi o Aotearoa (New Zealand History) discusses the origin of Māori Language Week and the history
of te reo Māori and provides several useful resources
with the meanings and pronunciation of many Māori words, phrases and placenames.
Ivermectin: current evidence does not support use
Ivermectin and its potential role in the COVID-19 pandemic continues to be a topic of interest in the media, particularly social media.
Medsafe have noted an increase in the number of requests for personal importation of ivermectin. In response to this, they have published a
new
alert communication: “Risks of importing or prescribing ivermectin for prevention or treatment of COVID-19”.
Read more
Medsafe state that as ivermectin is a prescription medicine, “if it is detected at the border, it can only be released to the individual on the authority of an authorised prescriber (usually a medical practitioner)”. The authorised prescriber takes responsibility for prescribing the medicine and “must be satisfied that the individual’s clinical need for the medicine outweighs the risks of taking the imported medicine”. Medsafe caution against the use of ivermectin for the prevention or treatment of COVID-19 as it is not approved for these indications and inappropriate use can be harmful. They refer readers to a recent Cochrane review (see below) for an examination of the evidence.
The
Ministry of Health and the Royal
New Zealand College of General Practitioners (RNZCGP) have also stated that the current evidence does not support the use of ivermectin in the prevention or treatment of COVID-19 and strongly recommend against its use. This aligns with recommendations from a recent
Cochrane systematic review. Major international health organisations including the National
institutes of Health (NIH), the World
Health Organization (WHO), the European
Medicines Agency (EMA) and the Australian National COVID-19 Clinical
Evidence Taskforce have all released statements advising against the use of ivermectin outside of well-designed clinical trials.
The U.S. Food and Drug Administration (FDA) released
a statement in August advising against the use of ivermectin to prevent or treat COVID-19 due to multiple reports of patients who had self-medicated with ivermectin intended for use in livestock and required medical attention including hospitalisation.
IMAC launches COVID-19 Clinical Immunisation Toolkit
The Immunisation
Advisory Centre has launched a COVID-19 Clinical Immunisation Toolkit designed to summarise and regularly update vaccination information with the aim of ensuring safe and efficient COVID-19 immunisation. The development of the toolkit was prompted by the need to inform frontline clinical staff of key vaccination information and any changes to this that may occur rapidly and regularly as the COVID-19 immunisation programme evolves. It provides a quick reference guide to key information, a summary of any recent changes and a centralised site for COVID-19 resources and supporting documentation. Information covers the practical areas of vaccine storage, preparation and administration, as well as actions to take when cold-chain breaches occur. The resource also addresses consent, pre-vaccination screening and adverse effects.
Monitor serum potassium levels with potassium-sparing diuretics
An
item in the latest Prescriber Update reminds clinicians of the need to monitor serum potassium regularly in patients who are taking spironolactone or amiloride.* There have been two recent reports to the Centre for Adverse Reactions Monitoring (CARM) of severe hyperkalaemia in patients taking a potassium-sparing diuretic and as of 30 June, 2021, a total of 12 reports have been made. Hyperkalaemia is a known adverse effect of treatment with these medicines. Groups that are at an increased risk of hyperkalaemia include patients with renal or hepatic impairment, those who are older and those who are also taking other medicines that can increase serum potassium (e.g. ACEis, ARBs and NSAIDs). Other times when the risk may be increased are at the initiation of treatment, during dose changes, or if the patient becomes unwell with any illness that causes renal dysfunction.
Read more
For patients with severe heart failure who are taking spironolactone, the New Zealand Formulary (NZF) recommends monitoring serum potassium (and usually serum creatinine as well):
- One week after initiation
- After any increase in dose
- Monthly for the first three months
- Then every three months for one year
- Six monthly after that
* Amiloride can only be prescribed currently as monotherapy under Section 29 as there are no approved products in New Zealand
Sodium valproate associated haematological effects
CARM has also recently received two reports of patients developing adverse haematological effects with sodium valproate treatment. The importance of monitoring for these adverse effects was highlighted
in the latest Prescriber Update. Treatment with sodium valproate is associated with an increased risk of thrombocytopaenia and more rarely pancytopaenia, leukopaenia or neutropaenia. Prescribers are reminded that a full blood count and liver function tests are required at baseline, at three months and annually after that. If there is any clinical suspicion of haematological or hepatic damage, the tests should be repeated or requested more frequently. Coagulation tests may also be required in some patients, e.g. if there is spontaneous bruising or bleeding. The risk of adverse haematological adverse effects, particularly thrombocytopaenia, is higher for older people, females and when higher doses are prescribed.
API withdrawing from NZ market
PHARMAC has announced that API Consumer Brands is closing its manufacturing plant in Auckland and withdrawing from the New Zealand market. Although there are no issues with supply of API’s products at present, this decision will in due course affect approximately 21 medicines that are currently funded (often branded as PSM), e.g. paracetamol oral liquid (Paracare), codeine phosphate tablets, citalopram, hydrocortisone cream, methadone tablets, the Lyderm brand of permethrin cream and the partly funded buccal form of prochlorperazine (Buccastem). PHARMAC states they will be working closely with API to manage their exit from the market and have issued a future Procurement Opportunity (FPO) on the NZ Government Tenders Service with a view to finding alternative suppliers for the affected products.
Paper of the week: Taking 7,000 steps a day associated with a lower risk of premature all-cause mortality
A paper recently published in JAMA
Network Open asked the question “Are step volume or intensity associated with premature mortality
among middle-aged Black and White women and men?” The conclusion was – Yes, step volume is.
The prospective cohort study from the USA included over 2,000 participants, with a mean age of around 45 years, who were monitored for a short period to assess their average daily step count. They were then followed up for approximately 11 years with the aim of determining if their step count or intensity was associated with premature all-cause mortality. The main finding was that individuals who took more than 7,000 steps a day had a 50 – 70% reduced risk of premature all-cause mortality. Increasing the step count to more than 10,000 did not appear to further reduce this risk.
A target of 10,000 steps per day is often found in health promotional material and is likely to be of value, but this study suggests that a target of 7,000 steps may provide significant benefit and be more feasible for people.
More on the study findings
The study was part of the larger Coronary Artery Risk Development in Young Adults (CARDIA) study. 2,110
participants already enrolled in the CARDIA study aged from 38 to 50 years wore an accelerometer for a week and
were followed up for a mean of around 11 years. Around 57% of the participants were female and approximately 58%
were White.
- Participants were grouped into categories based on the average number of steps per day – low (less than 7,000),
moderate (7,000 – 9,999) and high (more than 10,000). The primary outcome was all-cause mortality. Those who took
at least 7,000 steps per day had approximately 50 – 70% lower risk of premature all-cause mortality compared to
participants who took fewer than 7,000 steps per day
- Step intensity (i.e. walking faster) was also assessed but found not to be associated with a reduced mortality
risk
- A number of covariates were also assessed including body weight, height, age, ethnicity, gender, alcohol intake,
self-reported health status, blood pressure, medicine use and laboratory testing of blood glucose and cholesterol,
however, the authors caution that the potential for confounding remains
- Over the nearly 11 years of follow-up, 72 participants died (3.4%)
- There were no statistically significant differences noted between males and females or between Black and White
participants, although these conclusions were limited by the low mortality rate
- The findings are comparable to those reported by several similar recent studies
Encouraging people to walk appears a simple straight forward message to promote improved health. However, establishing
a clear link between steps per day and reduced mortality remains elusive. A number of limitations were discussed
by the authors of the study. These included the low rate of death (3.4%), the observational design of the study
which limits any conclusions regarding causality, and that the results only looked at premature all-cause mortality.
In addition, the types of step counters used in every-day life may not necessarily reflect measurements obtained
in studies such as this which utilise research-grade accelerometers.
Paluch AE, Gabriel KP & Fulton JE. Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary
Artery Risk Development in Young Adults Study. JAMA Network Open. 2021;4(9):e2124516. doi:10.1001/jamanetworkopen.2021.24516
This Bulletin is supported by the South Link Education Trust
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