1. The Black and White of Prescribing Looking for the Silver Lining Optimising Prescribing Project (OPP)

2. OPP: Budget Management in disguise? Historical Budget Management in NZ Use of formularies, guidelines, GP small group education, counter detailing Pharm Industry Significant cost variance across medicines

3. Current environment Guidelines and screening : CVD PHARMAC –Flatter pharmaceutical costs –Dispensing cost > cost of medicines –Rebates Aging population

4. OPP Project: Interventions Individual Medicines / Health Conditions High cost newer medicines Clinical need for medicines Safety of medicines –Adverse reactions –Interactions Population Issues High risk populations –Over 75 –Paediatrics Optimising medicines to reduce admissions or population health risk

5. Prescribing Variance

6. Medicine / Condition Focus Migraine Acute management Sumatriptan Oral Sumatriptan SC Rizatriptan Oral Prophylaxis Beta-blockers Avoid propranolol with rizatriptan 10mg Anticonvulsants Up titration of topiramate Calcium channe l blockers

7. Behaviour Change

8. The Data Lens: Patient / Population Practice/PatientDHB/PHO

9. Practise Audits Audit Audit of patients on 5 or more long term medicines Review of medicines, matched with patient problem list Outcomes Close monitoring of high risk patients –Renal impairment –CHF patients Discussion of how to manage high risk patients and how/when to discontinue

10. OPP: Resources and the present environment Current environment DHB contracts Integration Focus on resource, safety and quality PHARMAC and the medicines budget

11. Interventions targeted at both a medicines and population perspective

12. Outcomes Safety Costs Collaboration Partnership

13. Future Directions Long term conditions Acute demand Patient focused resources Clinical pharmacists support for general practise New roles for pharmacy Primary / secondary integration