Choosing Wisely Pharmacy’s Role and Recommendations Mary Wong

Choosing Wisely NZ pharmacists in the health care team Choosing Wisely in United States of America Choosing Wisely in Australia Provider and patient dialogue

The pharmacist’s role in the healthcare journey Pharmacists may be at the beginning, as an information source Pharmacists may be at the end, after the clinician and consultant visits, providing prescribed medication Pharmacists are an accessible, trusted and integral member of the healthcare team Pharmacists are available to all sectors of the community

USA Choosing Wisely was an initiative led by the American Board of Internal Medicine This was for the safe and effective use of diagnostics and treatments Identified 415 evidence-based recommendations Developed by over 70 professional organisations Evidence did not support any benefit and in fact could cause harm 110 were related to medications

Medications identified Antimicrobials 21.8% Neurologic or behavioural medications 15.4% Analgesics 6.4% Anticoagulants 5.5% Oncology medication 5.5% Hormones 5.5% Steroids 4.5% Anti-diabetic, gastrointestinal, cardiac medication 3.6% each Antihistamines 2.7%

Pharmacy Recommendations (American Society of Health-System Pharmacists ASHP) 1) Antimicrobial stewardship, reassessing continuation and length of time of therapy of antibiotics 2) Reviewing medication for end of life 3) Verifying drugs when patients transfer from secondary to primary care, to prevent duplication of medication 4) Review of drugs at least annually to ensure all meds still required

Pharmacy recommendations 5) Review anticoagulant usage and concurrent medications, non-prescription medicines and herbal medicines 6)Do not initiate medication to treat symptoms, adverse events or side effects without determining if an existing therapy is the cause 7) Discontinuation of proton pump inhibitors except where patients have ulcers or are at risk of gastrointestinal complications

SHPA: Society of Hospital Pharmacists of Australia SHPA strongly supports evidence –based medicines Work to improve the quality use of medicines

SHPA: 5 statements on treatments 1) Don’t initiate and continue medicines for primary prevention for patients with a limited life expectancy 2) Don’t initiate antibiotics without identified indication and predetermined length of treatment or review date 3) Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months 4) Don’t recommend the regular oral use of NSAIDs in older people 5) Don’t recommend the use of sub-therapeutic doses of codeine in mild to moderate pain

Conversations within pharmacy Pharmacists can have the conversation with patients and with prescribers when evidence does not support the use of the medicine Questions for patients Do I really need this medicine? What are the risks? What other options are there? What if I don’t do anything? How much does it cost?