The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
* Prevent stroke by using optimal antithrombotic therapy
* Drugs of little use in treating dementia
* Who is behind the medicines information on the internet?
* Side effects warning about varenicline (Champix)
* A clear explanation of prescription pricing
* The February issue of Australian Prescriber is out now in paper and online
Prevent stroke by using optimal antithrombotic therapy
The National Prescribing Service Limited (NPS) is advising health professionals to consider aspirin for primary stroke prevention in those at high cardiovascular risk, to prevent recurrent stroke by using antiplatelet therapy and to use warfarin in those with atrial fibrillation at higher risk of stroke.
Stroke is the second leading cause of death in Australia and often results in significant long-term disability.
The latest program, ‘Antiplatelet and anticoagulant therapy in stroke prevention’ focuses on:
Assessing absolute cardiovascular risk to establish which patients would benefit from aspirin in primary prevention of cardiovascular events
Deciphering the evidence behind aspirin, aspirin plus dipyridamole and clopidogrel to choose the appropriate antiplatelet to prevent recurrent stroke and transient ischaemic attacks (TIA)
Using scoring of risk factors in patients with atrial fibrillation to stratify stroke risk and decide between warfarin and aspirin
Assessing risk factors for bleeding in patients with atrial fibrillation before commencing warfarin therapy
Strategies, such as decision aids, that will help increase patient concordance with warfarin
The critical importance of maintaining INR within therapeutic range and educating patients on the safe use of warfarin
“Warfarin is underutilized in atrial fibrillation, and this program focuses on the importance of assessing a person’s risk of stroke to help decide on warfarin or aspirin. Warfarin reduces the relative risk of stroke by 64%, while aspirin reduces it by 22%,” says NPS clinical expert, Education and Quality Assurance Program Manager, Ms Judith Mackson.
“Elements of the program include one–to–one educational visits from NPS Facilitators, peer group discussion and a case study titled ‘Antithrombotic options in stroke prevention’; developed to help GPs, pharmacists, nurses and other health professionals refine their clinical decision-making skills.”
“NPS News (62) outlines the appropriate use of antiplatelet and anticoagulant therapies in the long-term prevention of ischaemic stroke and provides tools for communicating risks and benefits to patients, while Prescribing Practice Review (44) provides individual prescribing data for GPs and practical independent information,” Ms Mackson said.
GPs and GP Registrars will also be able to review practice through participating in a clinical audit. The audit, ‘Antiplatelet and anticoagulant therapy in stroke prevention’ will be available from 2 March 2009. To enrol, visit www.nps.org.au/health_professionals.
The GP audit is recognised by the RACGP Quality Assurance & Continuing Professional Development Program, total points 40 (category 1) and in the ACRRM Professional Development Program, 30 points (extended skills). It also qualifies as an activity for QPI of the PIP (Quality Prescribing Initiative of the Practice Incentives Program), year ending April 2010.
For more information visit the NPS website www.nps.org.au, phone (02) 8217 8700 or email firstname.lastname@example.org.
Drugs of little use in treating dementia
Investigation, diagnosis and treatment of dementia will increasingly be part of a GPs role as the number of new cases in Australia is forecast to reach 175,000 per year by 2050.
In the latest edition of Australian Prescriber, Dr Alisa Crouch, registrar in Geriatric medicine at Brisbane’s Princess Alexandra Hospital, discusses differential diagnosis of dementia and the place of non-drug and drug therapy within treatment plans.
The article summarises the available evidence for efficacy of non-drug and drug therapy – including cholinesterase inhibitors and memantine – and discusses when to stop drug treatment.
“Dementia is a progressive disease. Drug treatment at best only slows the decline in cognitive function,” Dr Crouch writes. “Timing of cessation of drug therapy for dementia is controversial, but should be considered if the patient is completely dependent in their care needs.”
“Cessation should be discussed with the patient’s family, particularly as they may notice some deterioration in the patient’s functional abilities.”
“Psychosocial interventions for carers are more effective if the patient is involved. [Non-drug] interventions can help to reduce the psychological burden and can reduce the need for institutional care,” Dr Crouch says.
GPs are the first point of contact in 93% of cases, making identification and treatment of alternative causes of cognitive impairment an important skill. Clinical features of alternative causes of cognitive impairment are listed.
The article also lists subtypes and features of dementia.
Dr Crouch concludes that while there is no cure for most types of dementia, if the diagnosis includes information about the subtype it allows a patient and their family to develop the most appropriate, individualised treatment plan.
“Early education and planning for future events can assist both the patient and their support network,” she says.
Carers and families may benefit from support materials from Alzheimer's Australia, which are available from www.alzheimers.org.au or 1800 100 500.
For a fully copy of the article visit www.australianprescriber.com.
Who is behind the medicines information on the internet?
Pharmaceutical companies are tapping into online social networking sites such as Facebook and MySpace and using new media forms to reach wider Australian audiences.
Writing in the latest edition of Australian Prescriber, health journalist Melissa Sweet discusses how the internet is helping to globalise and change pharmaceutical marketing, and how this poses challenges for regulators.
The article gives examples of evolving marketing practices such as using overseas blogs and websites in countries where pharmaceutical marketing is less regulated than in Australia to promote and sell products.
“Safety concerns have been raised about the purchase of prescription, non-prescription and complementary medicines over the internet,” Ms Sweet writes. “Company websites can link to other sites that may not meet regulatory requirements.”
Ms Sweet claims companies are using blogs and websites to develop customer relationships which may enable companies to gather patient stories and feedback for use in positioning their products, though consumers are often not aware of their involvement.
“It is not always clear from a website name who is behind it … and it can be extremely difficult to identify who is responsible for the content spread through [social] networks,” Ms Sweet writes.
“Drug companies are increasingly turning to electronic methods to market their products. [This] includes diverse strategies, is cheaper than traditional sales representatives and can result in a significant return on investment.
The article discusses how pharmaceutical companies are seeking to capitalise on medical social networking sites. One site earns money by letting clients such as hedge funds monitor doctors’ anonymous online conversations and thus gain insight into, say, the popularity of certain treatments.
“Apart from disseminating company-generated content, social networking sites also offer opportunities for companies to insert themselves into conversations between site users through postings and comments on blogs.”
“On the other hand, such networks are also being used for public health purposes, including promoting messages about the quality use of medicines,” Ms Sweet writes.
She acknowledges Medicines Australia’s efforts to police the promotion of medicines, but concludes that such regulation is going to become increasingly harder as technology evolves.
For a fully copy of the article visit www.australianprescriber.com.
A clear explanation of prescription pricing
Many Australians do not understand the complex pricing system for prescription medicines. If you’ve ever asked “How much will my prescription cost?” and were bamboozled by the answer, you are not alone.
In the latest edition of Australian Prescriber, Michael Tatchell, Health Economics Director of the Pharmacy Guild of Australia, explains the pricing structure of government-subsidised medicines.
Prescription medicines are either subsidised (through the Pharmaceutical Benefits Scheme, PBS, or the Repatriation Pharmaceutical Benefits Scheme, RPBS) or they are 'private' prescriptions, in which case no price regulation or subsidy applies. Subsidised medicines are largely paid for by the Australian government. The patient's contribution to this cost is called the co-payment.
The PBS co-payment for general patients is currently set at $32.90, and for concessional and repatriation patients it is $5.30.
Dr Tatchell explains that the price of non-subsidised medicines, or those below the co-payment, may vary between pharmacies. This depends on the pharmacy, the patients’ circumstances and any charges the manufacturer includes.
“The price of subsidised medicines is related to the patient's status (general, concession or repatriation), whether extra premiums or charges apply to the medicine, and whether the patient qualifies for the safety net,” Dr Tatchell writes.
“The PBS safety net protects patients and their families (particularly those who may be high users of medicines) from the high cumulative cost of prescription medicines,” Dr Tatchell says.
A full explanation of all these variables is provided in the article, along with more detail about the safety net and how premiums and charges continue after the safety net threshold is reached.
For a full copy of the article visit www.australianprescriber.com.
The February issue of Australian Prescriber is out now in paper and online
Highlights of this issue
Each new year brings an increase in prescription charges. However, co-payments are not the only component in prescription pricing. Michael Tatchell explains what else influences the prices patients pay.
While John Sullivan and Veronica Preda tell us about new treatments for psoriasis, Alisa Crouch's review shows there have been few recent advances in the drug treatment of dementia. There have been many advances in electronic communication, but Melissa Sweet warns us that some drug information on the internet is actually marketing material.
Pharmaceutical marketing and the internet - M Sweet
Prescription pricing demystified - M Tatchell
Treating dementia - AM Crouch
Treatments for severe psoriasis - JR Sullivan, VA Preda
Drug treatment of pituitary tumours - EM Lim
Medicinal mishap: Monitor morphine - JS Dowden
New drug reviews -
desvenlafaxine succinate - for depression
methylnaltrexone - for opioid-induced constipation
rivaroxaban - for prevention of postoperative venous thrombosis
triptorelin embonate - for porstate cancer
valsartan - for hypertension and heart failure
valsartan/hydrochlorothiazide - for hypertension
amlodipine/valsartan - for hypertension
Dental note: Psoriasis
Patient support organisation: Psoriasis Australia
Letters to the Editor
See also NPS News No 62 February 2009
Using antithrombotics wisely in stroke prevention
See also ADRAC Bulletin Vol 28 No 1 February 2009
Adverse reactions with botulinum toxin A (Botox, Dysport)
Proton pump inhibitors and possible fracture risk
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Happy reading from Australian Prescriber