1. Choosing Wisely Pharmacy’s Role and Recommendations Mary Wong

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

3. 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

4. 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

5. 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%

6. 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

7. 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

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

9. 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

10. 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?