Call to Find Ways to Cut Prescribing to Elderly

By Eileen Goodwin, Otago Daily Times 

October 27, 2010

New Zealand

Ways must be found to reduce the amount of medication prescribed to the elderly because it was costly and might not be doing any good, a Southern District Health Board committee was told in Dunedin yesterday. 

The disability support and community and public health committee invited the government-funded medical education group Best Practice Advocacy Centre (BPAC) to present information on GP prescribing after concerns earlier this year it was too high in Otago and Southland. 

BPAC manager Tony Fraser said costs were driven by elderly patients' prescriptions. 

Rather than the cost of individual drugs, it was the volume of medications the elderly were prescribed which drove overall costs. 

New Zealand 's drug-buying agency, Pharmac, had been effective in keeping a lid on the cost of individual drugs by promoting generic brands and limiting GPs' prescribing options, he said. 

Southern DHB was not out of line with other DHBs, with the seventh-highest GP-prescribed spend of the country's 20 DHBs in 2009-10. 

With 14% of the population 65 and over, Southern DHB GPs prescribed $130 worth of medication per head of population during the period. 

South Canterbury , with the highest proportion of elderly (19%), spent the most nationally on GP prescriptions per head of population ($150). 

Mr Fraser said there was much debate internationally about levels of medication for the elderly and whether it could do more harm than good. 

Cholesterol-controlling statins were a case in point, with indications the drugs did not extend people's lives, but meant they developed other problems and died anyway, he said. 

Increasing numbers of prescriptions for costly anti-psychotic drugs were also concerning, especially if they were used to manage people's behaviour rather than being clinically necessary. 

While Southland GPs prescribed more heavily than their counterparts in Otago, Mr Fraser did not think there were regional factors influencing prescribing. 

From April 2009 to March 2010, Southland GPs issued an average 7176 prescriptions each compared with 6859 each in Otago. 

Aside from the elderly, a particular area of concern was the Southern DHB spending nearly $1 million a year on blood-sugar test strips for diabetics. 

Diabetics were using test strips which had no clinical benefit and could exacerbate anxiety, he said. 

Mr Fraser said BPAC, which has its national headquarters in Dunedin , was keen to see the Southern DHB lead the way in reducing prescriptions. 

Committee member Branko Sijnja, a Balclutha GP, said it was not unusual for people to have a stack of unused medication sitting at home. 

He noted discussion of restricting medication for the elderly was "dangerous territory" and caution was necessary. 

Committee member Peter Barron, a pharmacist, took issue with bulk prescribing and dispensing, citing paracetamol as a drug patients were often over-prescribed. 

Bulk paracetamol dispensing was an example of "low-hanging fruit" DHBs could target in a cost-cutting drive. 

As a pharmacist, he had noticed people often had no idea why they had been prescribed certain medicines. 

Studies indicated seven out of 10 people did not take medicines exactly as the prescriber intended, he said. 

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