David Reith

Publications of David Reith

• Access to children's medicines in the United Kingdom, Australia and New Zealand in 1998, 2002 and 2007.

  Authors: Rajan Ragupathy, June Tordoff, Pauline Norris, David Reith

  Pharmacy world & science : PWS. 03/2010; 32(3):386-93.

  To describe the listing of prescription entities (unique active agents only available on prescription) in standard reference texts that were licensed for children (0-18 years), in dosage formsTo describe the listing of prescription entities (unique active agents only available on prescription) in standard reference texts that were licensed for children (0-18 years), in dosage forms suitable for children, and subsidised (Government funded) for children. Setting The United Kingdom, Australia and New Zealand in 1998, 2002 and 2007. A review of data from 1998, 2002, and 2007 using standard prescribing and subsidy reference sources in each country. The study examined all prescription entities, orally available entities, and entities newly licensed for children 2002-2007. Changes in the number of prescription entities that were licensed, suitably formulated and subsidised for children over the period. Results The United Kingdom had the highest number of prescription entities (1149 in 1998; 1049 in 2007), entities licensed for children (677; 564), entities suitably formulated for children (791; 676), and entities licensed for children and subsidised (677; 562) over the period. However, the numbers and proportions of entities licensed for children and suitably formulated for children decreased over the period of the study. New Zealand and Australia had lower numbers throughout the period, but the number of entities licensed for children (New Zealand 319-450, Australia 288-466) and entities licensed for children and subsidised (New Zealand 245-288, Australia 155-254) increased over the period. Over the period of the study, there was a decrease in listed prescription entities that were licensed for children in the United Kingdom, but an increase in Australia and New Zealand. There were considerably fewer entities licensed, suitably formulated and subsidised for children than for adults at all three time points and in all three countries. This reinforces the need for the current initiatives to improve access to medicines for children.

• The Impact of Pharmaceutical Cost Containment Policies on the Range of Medicines Available and Subsidized in Finland and New Zealand.

  Authors: Katri Aaltonen, Rajan Ragupathy, June Tordoff, David Reith, Pauline Norris

  Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 10/2009;

  ABSTRACT Objective: To identify differences in the range of medicines available and subsidized for ambulatory care in Finland and New Zealand. Methods: Medical entities listed in national productABSTRACT Objective: To identify differences in the range of medicines available and subsidized for ambulatory care in Finland and New Zealand. Methods: Medical entities listed in national product information sources and their subsidy statuses were compared. The number and overlap of entities available and subsidized were determined. Differences in the age of subsidized medicines were compared using the date of first registration. Differences in licensing delays were compared using a selection of new innovative medicines that provide health gain. Results: Within the inclusion criteria, 779/763 entities were available and 495/471 subsidized in Finland/New Zealand, of which around 30% (30.9% Finland, 29.5% New Zealand) were not available and approximately 40% (41.4% Finland, 38.4% New Zealand) not subsidized in the other country. The proportion of fully subsidized entities was higher in New Zealand (86.2%/29.1%). The entities only subsidized in New Zealand were significantly older than those only subsidized in Finland and the share of licensed and launched innovative medicines was significantly smaller in New Zealand. The differences were equally distributed across the therapeutic groups but clinically relevant differences were rarely found. Conclusions: In New Zealand, medicines are heavily subsidized across therapy groups, but those uniquely subsidized were older entities. In Finland, more "newer" medicines are subsidized and available, but the level and coverage of subsidy is lower and thus, the patient cost burden is higher. The cost containment policies adopted seem to affect patients' access to medicines mainly by availability in New Zealand and by affordability in Finland.

• Individualised dosing of amikacin in neonates.

  Authors: Catherine Sherwin, Roland Broadbent, Natalie Medlicott, David Reith

  European journal of clinical pharmacology. 09/2009;

• Individualised dosing of amikacin in neonates: a pharmacokinetic/pharmacodynamic analysis.

  Authors: Catherine Sherwin, Sofia Svahn, Antje Van Der Linden, Roland Broadbent, Natalie Medlicott, David Reith

  European journal of clinical pharmacology. 04/2009;

  PURPOSE: To examine the pharmacokinetics of amikacin and its pharmacokinetic pharmacodynamic (PKPD) relationship in neonates. To develop an alternative dosing strategy for amikacin in neonates.PURPOSE: To examine the pharmacokinetics of amikacin and its pharmacokinetic pharmacodynamic (PKPD) relationship in neonates. To develop an alternative dosing strategy for amikacin in neonates. METHODS: A population PKPD analysis was performed using data collected from 80 neonates with gestational ages from 24 to 41 weeks. The final pharmacokinetic model analysed 358 amikacin concentrations. All neonates were > 72 hours postnatal age. Simulations were performed to develop a new dosing strategy. RESULTS: The final covariate model was clearance = 0.23 x (current weight/2)(0.691) x (postmenstrual age/40)(3.23) and volume of distribution = 0.957 x (current weight/2)(0.89). Following the logistic regression analysis of treatment failure, new amikacin target concentrations were estimated and used in development of an alternative dosing strategy. CONCLUSION: Simulation of a new dosing regimen yielded the following recommendations: 15 mg/kg at 36-h intervals, 14 mg/kg at 24-h intervals and 15 mg/kg at 24-h intervals for neonates </=28 weeks, 29-36 weeks and >/=37 weeks postmenstrual age respectively.

• Access to prescribing information for paediatric medicines in the USA: post-modernization.

  Authors: Larissa Young, Francis Lawes, June Tordoff, Pauline Norris, David Reith

  British journal of clinical pharmacology. 01/2009;

  WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Children have reduced access to medicines because of inadequate prescribing information and paucity of suitable formulations. * The USA has implemented aWHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Children have reduced access to medicines because of inadequate prescribing information and paucity of suitable formulations. * The USA has implemented a series of measures designed to improve the licensing of medicines for children, which has resulted in an increase in the number of studies and the number of patients studied in investigational trials of medicines in children. * These measures have increased the number of targeted medicines that have had their labelled use extended to children. WHAT THIS STUDY ADDS * Information in the Physicians' Desk Reference did not indicate that there was an improvement in overall access to, and prescribing information about, drugs in the paediatric population in the USA over the time period 1998-2007. AIMS The aims of the present study were to examine the Physicians' Desk Reference (PDR) for changes in the listing of medicines licensed for children in the USA over a 10-year period (1998-2007). METHODS The USA PDR was used to identify products listed in 1998, 2002 and 2007. Information about generic name (active agent), salt, strength, brand name, suitability of formulation, paediatric licensing information and the lowest age of licensing was extracted. Prescription products were collapsed down to chemical entities/fixed-dose combinations. RESULTS Of the prescription entities listed in the PDR, 538 (55.9%), 488 (54.3%) and 394 (51.3%) were licensed for children in 1998, 2002 and 2007, respectively. There was a 39% decrease in the number of entities licensed for the newborn and a 34% decrease for children aged 2-6 years between 1998 and 2007. Formulations suitable for children were listed for 611 (63.4%), 550 (61.2%) and 430 (60.6%), respectively. Prescription entities with both a suitable oral formulation and licensing for children numbered 161 (16.7%), 148 (16.5%) and 100 (14.1%) in 1998, 2002 and 2007, respectively. CONCLUSIONS The listings in the PDR suggest that overall access to prescribing information about drugs in the paediatric population has not shown an increase over the decade. This particularly affected the neonatal age group.

• Incidence, Preventability, and Impact of Adverse Drug Events (ADEs) and Potential ADEs in Hospitalized Children in New Zealand: A Prospective Observational Cohort Study.

  Authors: Desireé L Kunac, Julia Kennedy, Nicola Austin, David Reith

  Paediatric drugs. 01/2009; 11(2):153-60.

  Adverse drug events (ADEs) are an important problem in all hospitalized patients as these events represent medication-related patient harm. Few epidemiologic data exist regarding ADEs in theAdverse drug events (ADEs) are an important problem in all hospitalized patients as these events represent medication-related patient harm. Few epidemiologic data exist regarding ADEs in the pediatric inpatient setting and, in particular, the economic impact of such ADEs upon the healthcare sector. To evaluate the incidence, preventability, and seriousness of ADEs and potential ADEs occurring in hospitalized children and to examine the cost implications of these ADEs. This was a prospective observational cohort study conducted in the pediatric, neonatal intensive care unit (NICU), and postnatal wards of a university-affiliated urban general hospital in Dunedin, New Zealand (NZ). The study population was all patients admitted to these wards for >24 hours over a 12-week period from 18 March 2002 to 9 June 2002. Medication-related events were identified by chart review, attendance at multidisciplinary clinical meetings, parent/carer/child interviews, and voluntary and verbally solicited reports from staff. All suspected medication-related events were reviewed by a panel of three health professionals who independently categorized the events and rated them for seriousness, preventability, and causality, using a standardized reviewer form. Costs attributable to ADEs were calculated using both the average cost of a bed day, and specific costs for diagnostic groupings. The main outcome measures of the study were ADEs and potential ADEs. There were 495 eligible study patients, who had a total of 520 admissions and 3037 patient-days of admission, during which 3160 prescription episodes were written. There were 67 ADEs, of which 38 (56.7%) were classified as preventable, and 77 potential ADEs. ADEs occurred at a rate of 2.1 per 100 prescription episodes, 12.9 per 100 admissions, and 22.1 per 1000 patient-days. Potential ADEs occurred at a rate of 2.4 per 100 prescription episodes, 14.6 per 100 admissions, and 25 per 1000 patient-days. Although the greatest number (and rate per 100 admissions) of ADEs occurred in NICU patients, surgical pediatric ward patients had the greatest rate of ADEs per 1000 patient-days. Few events occurred in postnatal patients. Forty-six percent of ADEs were classified as being serious; 15% were deemed to result in persistent disability or were classified as life threatening. Potential ADEs were deemed more likely to be serious with 82% classified as potentially serious events; 33% were deemed as having the potential to result in persistent disability, or the potential to cause a life-threatening event. Fifteen ADEs were judged to have caused the hospital admission or to have prolonged hospital stay. The total number of days attributed to ADEs was 92 (range 1-26 days); of these, 58 were deemed preventable days and 34 non-preventable days. This extrapolates to a total annual cost of $NZ235 214 (2002 values) to the pediatric service, subdivided into $NZ148 287 for preventable ADEs and $NZ86 927 for non-preventable ADEs. ADEs and potential ADEs represent a considerable hazard for the pediatric inpatient population and ADEs represent a large cost imposition upon the healthcare sector. Over half of the ADEs were deemed preventable. This highlights the importance of developing strategies to prevent and ameliorate ADEs both to improve the quality of patient care and to reduce healthcare costs.

• Utility of Interleukin-12 and Interleukin-10 in Comparison with Other Cytokines and Acute-Phase Reactants in the Diagnosis of Neonatal Sepsis.

  Authors: Catherine Sherwin, Roland Broadbent, Sarah Young, Janie Worth, Frances McCaffrey, Natalie Medlicott, David Reith

  American journal of perinatology. 11/2008;

  We compared the test characteristics of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12(p-70), tumor necrosis factor-alpha (TNF-alpha), procalcitonin (PCT), C-reactive protein (CRP), and full bloodWe compared the test characteristics of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12(p-70), tumor necrosis factor-alpha (TNF-alpha), procalcitonin (PCT), C-reactive protein (CRP), and full blood count (FBC) in the diagnosis of neonatal sepsis. This prospective cohort study in the Neonatal Intensive Care Unit of Dunedin hospital of patients between July 1, 2002 and February 28, 2007 included 117 neonates commenced on antibiotics for 164 episodes of suspected sepsis. Blood cultures, FBC, CRP, IL-1beta, IL-6, IL-8, IL-10, IL-12(p-70), TNF-alpha, and PCT were obtained at the time sepsis was first suspected and for the following 3 days. Receiver operator characteristics (ROC) plots and test characteristics were determined using culture-positive sepsis as the gold standard. At the time sepsis was first suspected, the most promising individual test was IL-12(p70) with an area under the curve (95% confidence interval [CI]) for the ROC of 0.74 (0.63 to 0.86), which (with a cutoff at 75 pg/mL) had a sensitivity (95% CI) of 28% (20 to 36%) and a specificity of 98% (96 to 100%). IL-10 had a sensitivity of 17% (10 to 23%) and a specificity of 99% (97 to 100%). IL-10 and IL-12(p70) are promising diagnostic tests that can be used to confirm sepsis in neonates.

• Individualising netilmicin dosing in neonates.

  Authors: Catherine Sherwin, Roland Broadbent, Natalie Medlicott, David Reith

  European journal of clinical pharmacology. 08/2008;

  PURPOSE: The aim of this study was develop an optimal dosing regimen for netilmicin in neonates. METHODS: This was a population pharmacokinetic study in 97 neonates aged from 2 to 28 days after thePURPOSE: The aim of this study was develop an optimal dosing regimen for netilmicin in neonates. METHODS: This was a population pharmacokinetic study in 97 neonates aged from 2 to 28 days after the due date who were being treated with netilmicin for suspected sepsis. The model was used to simulate dosing regimens. RESULTS: The principle factors influencing netilmicin clearance (CL) were postmenstrual age (PMA) and current body weight (CWT), and the principal determinant of volume of distribution (V) was CWT. The final covariate model was CL = 0.192 x (CWT/2)(1.35) x (PMA/40)(1.03), V = 1.5 x (CWT/2)(0.3). The optimal dosing was 5 mg/kg ever 36 h, 5 mg/kg every 24 h, 6 mg/kg every 24 h and 7 mg/kg every 24 h for neonates </=27, 28-30, 31-33 and >/=34 weeks PMA, respectively. CONCLUSION: Individualisation of netilmicin dosing in neonates requires adjustment of dose by body weight, and dosing interval by both PMA and CWT.

• Establishing a baseline for the monitoring of medicines availability for children in the UK: 1998-2002.

  Authors: Komathi Balakrishnan, June Tordoff, Pauline Norris, David Reith

  British journal of clinical pharmacology. 02/2007; 63(1):85-91.

  AIM: To determine changes in the availability, in terms of licensing and formulations, of medicines for children in the UK between 1998 and 2002. METHODS: Using the Association of BritishAIM: To determine changes in the availability, in terms of licensing and formulations, of medicines for children in the UK between 1998 and 2002. METHODS: Using the Association of British Pharmaceutical Industry (ABPI) Compendium of Data Sheets and Summaries of Product Characteristics (SPC) 1998 and the Medicines Compendium 2002, licensed medicines available in the UK in the calendar years 1998 and 2002 were examined. RESULTS: In 1998, 61% of chemical entities/fixed-dose combinations were licensed in some form for children compared with 64% in 2002. Of the chemical entities/fixed-dose combinations with oral formulations, 250 (33%) in 1998 had an oral formulation suitable for use by children and in 2002 there were 284 (34%). Of the 129 new chemical entities registered in the UK between 1998 and 2002, only 30 (23%) were licensed for under the age of 12 years and 19 (15%) for the neonatal age group. A total of 480 medicines licensed for children were withdrawn from marketing but only cisapride and primidone had no generic or therapeutic alternatives. CONCLUSION: Although there was improvement in the availability of medicines for children in the UK over the 5-year period (1998-2002), considerable inequities still existed between children and adults.

• Pediatric licensing status and the availability of suitable formulations for new medical entities approved in the United States between 1998 and 2002.

  Authors: Komathi Balakrishnan, Joanne Grieve, June Tordoff, Pauline Norris, David Reith

  Journal of clinical pharmacology. 10/2006; 46(9):1038-43.

  The availability of new medical entities for children in the United States was examined at the time of marketing approval and 3 years later. New medical entities approved in the United States in eachThe availability of new medical entities for children in the United States was examined at the time of marketing approval and 3 years later. New medical entities approved in the United States in each of the years 1998 to 2002 were identified using the Center for Drug Evaluation and Research Web site. Each Physicians' Desk Reference published in the years 1998 to 2005 was examined to determine formulations and licensing information. For the 133 new medical entities licensed to be marketed in the period 1998 to 2002, the number licensed for children increased from 5 (4%) to 39 (29%) in the 3 years after registration. After 3 years' marketing, 79 (59%) drugs were in formulations suitable for children, and 27 (20%) of the new medical entities were licensed and had a suitable formulation for children. Incentives to improve access for children to medicines should focus more on demonstration of improved access.

• Continuation of proton pump inhibitors from hospital to community.

  Authors: Kenneth Grant, Noor Al-Adhami, June Tordoff, Jocelyn Livesey, Gil Barbezat, David Reith

  Pharmacy world & science : PWS. 09/2006; 28(4):189-93.

  OBJECTIVES: To evaluate the appropriateness of initiation of proton pump inhibitor (PPI) treatment in hospital, the quality of discharge information, and any association with continued treatment inOBJECTIVES: To evaluate the appropriateness of initiation of proton pump inhibitor (PPI) treatment in hospital, the quality of discharge information, and any association with continued treatment in the community. METHOD: Survey of all inpatients newly initiated on a PPI in June-August 2003. Assessment of appropriateness of therapy and completeness of discharge information; assessment of continuation of PPI therapy in the community after 6 months. RESULTS: Thirty-five of 58 patients (60%) were considered appropriately commenced on PPI treatment. Less than 25% of patients discharged on a PPI had discharge information recommending duration of treatment or review. In the "appropriate" group 30 patients (86%) were discharged on omeprazole, and 13/21 (62%) evaluable patients remained on this at 6 months. In the "inappropriate" group 15 (65%) were discharged on omeprazole, and 10/14 (71%) evaluable patients remained on this at 6 months. Older patients remained on omeprazole for a longer duration but appropriateness of commencement did not influence the duration of treatment. Dose titration was attempted for 10 (29%) patients including three from the "inappropriate" group. CONCLUSION: Care should be taken to commence PPIs only when clinically indicated. Discharge information to GPs, especially recommendations for duration of treatment and/or dose titration, requires improvement.

• Characteristics of general practitioner consultations prior to suicide: a nested case-control study in New Zealand.

  Authors: Rebecca Didham, Susan Dovey, David Reith

  The New Zealand medical journal. 02/2006; 119(1247):U2358.

  AIM: To examine characteristics of general practice consultations in a New Zealand primary care population of patients who died by suicide. METHODS: Case control study design, with data linkageAIM: To examine characteristics of general practice consultations in a New Zealand primary care population of patients who died by suicide. METHODS: Case control study design, with data linkage between the RNZCGP Research Unit Database, the National Mortality Database and the Hospital Separation Diagnosis Database (hospital discharges) from 1996 to 2001. The cases were suicides who had attended a general practice contributing data to the Research Unit database. Each case was matched by gender and age to three randomly selected patients from the Research Unit database. RESULTS: There were 221 cases of suicide identified, of which 60% had a general practice consultation in the 6 months prior to death. The significant exposure variables, corrected OR (95% CI) in the multivariate analysis were: any previous hospital admission (between January 1996 and date of death) for a psychiatric condition, 23.75 (9.01 to 62.63); any notation in the general practice record of depression, suicidal ideation or self-harm, 14.97 (4.61 to 48.65); previous hospital admission with self-harm, 8.39 (1.73 to 40.65); and general practice prescription of sedatives, 4.34 (1.69 to 11.10). CONCLUSIONS: In general, general practice patients who commit suicide have higher rates of depression, suicidal ideation, previous self harm, and sedative prescription than average.

• The influence of PHARMAC's National Hospital Pharmaceutical Strategy on Quality Use of Medicines activities in New Zealand hospitals.

  Authors: June Tordoff, Pauline Norris, Julia Kennedy, David Reith

  The New Zealand medical journal. 01/2006; 119(1239):U2100.

  AIM: To determine the influence of PHARMAC's National Hospital Pharmaceutical Strategy (NHPS) on Quality Use of Medicine (QUM) activities in New Zealand hospitals. METHOD: In July 2002 and July 2004,AIM: To determine the influence of PHARMAC's National Hospital Pharmaceutical Strategy (NHPS) on Quality Use of Medicine (QUM) activities in New Zealand hospitals. METHOD: In July 2002 and July 2004, a questionnaire-based cross-sectional survey on QUM activities was administered to chief pharmacists at all 30 New Zealand public hospitals employing a pharmacist (29 in July 2004), to examine pre and post-NHPS activity. RESULTS: Both surveys achieved a 97% response rate. A range of QUM activities were undertaken in hospitals. Overall, Drug Utilisation Reviews (DURs) significantly decreased (67 vs 42) (p<0.05), although antimicrobial guidelines and intranet formularies significantly increased (p<0.05). PHARMAC's QUM initiatives, still evolving, did not appear to positively influence QUM activity in 2002-4. In 2004, PHARMAC put their original plans to coordinate QUM activity on hold and chose to participate in the processes of the Safe and Quality use of Medicines Group (SQM). Formed in 2003 by the District Health Boards of New Zealand, SQM focused attention on anticoagulants and high-risk medicines. CONCLUSION: QUM activities, similar in both periods, were not positively influenced by PHARMAC's Strategy.

• Deaths from poisoning in New Zealand--new study helps identify and justify priorities for prevention.

  Authors: Michael Beasley, David Reith

  The New Zealand medical journal. 12/2005; 118(1225):U1723.

• Quality use of medicines activities: QSUM and PHARMAC.

  Authors: June Tordoff, Pauline Norris, Julia Kennedy, David Reith

  The New Zealand medical journal. 07/2005; 118(1217):U1538.

• Effect of the pediatric exclusivity provision on children's access to medicines.

  Authors: Joanne Grieve, June Tordoff, David Reith, Pauline Norris

  British journal of clinical pharmacology. 07/2005; 59(6):730-5.

  AIMS: To determine the paediatric licensing status in the USA, UK, Australia and New Zealand of the 79 medicines granted paediatric exclusivity in the USA, and to assess the importance of thoseAIMS: To determine the paediatric licensing status in the USA, UK, Australia and New Zealand of the 79 medicines granted paediatric exclusivity in the USA, and to assess the importance of those medicines to paediatric practice. METHODS: The medicines granted a patent extension in the USA as of 10 November 2003 were identified from the FDA website. Data on paediatric licensing were obtained from the Physicians Desk Reference (USA), the Electronic Medicines Compendium (UK), the Australian Prescription Products Guide (Australia) and the MedSafe website (New Zealand). A questionnaire was administered to seven paediatric consultants to assess the importance of the 79 PEMs for use in children. The questionnaire sought opinions on each drug, by age grouping, regarding: usefulness in patients with the condition, number of patients likely to be treated with each drug in a year, and acceptable therapeutic alternatives. RESULTS: Fifty-eight (73%) of the medicines had attained paediatric licensing in the USA. Sixty were licensed for adults in all four countries and of these 45 (75%) were licensed for children under 12 years in the USA compared with 31 (52%) to 33 (55%) for the other three countries. The proportion of these medicines licensed for children under 1 month, under 2 years and under 6 years of age ranged from 10% to 58% and there were no significant differences between the countries. For all four countries perceived usefulness and predicted numbers of patients both had some influence on the odds of a medicine having paediatric licensing. CONCLUSIONS: Improvements in licensing of some medicines for children have occurred in the USA, relative to the UK, Australia and New Zealand, subsequent to the Paediatric Exclusivity Provision. Improvements occurred for children over the age of six, but not for younger children.

• Changes in availability of paediatric medicines in Australia between 1998 and 2002.

  Authors: Jocelyn Chui, June Tordoff, David Reith

  British journal of clinical pharmacology. 07/2005; 59(6):736-42.

  AIMS: To determine changes in the availability of medicines for children in Australia and to determine the status of newly introduced chemical entities by age category. METHODS: Using the AustralianAIMS: To determine changes in the availability of medicines for children in Australia and to determine the status of newly introduced chemical entities by age category. METHODS: Using the Australian Prescription Products Guide and the Schedule of Pharmaceutical Benefits, licensed medicines available in Australia in the calendar years 1998 and 2002 were examined. RESULTS: The total number of medicines licensed in Australia increased from 1544 to 1903, the number of licensed paediatric items increased from 579 (37.5%) to 725 (38.1%), and those both licensed for paediatric use and subsidized increased from 356 (23.1%) to 441 (23.2%). The number of medicines with formulations suitable for paediatric use increased from 861 (55.7%) to 967 (50.8%), and of these 382 (24.7%) and 466 (24.5%) were licensed for paediatric use. Of the 90 new orally available chemical entities licensed for adults only 12 (13%) were licensed for children. Three (3%) were licensed for the 0-28 days and 28 days to 23 months age groups, eight (9%) for 2-11 years and 12 (13%) for 12-18 years. An additional 14 orally available chemical entities previously only licensed for adults, were licensed for children by 2002. CONCLUSIONS: There have been some improvements in medicines licensing for older children, but not for children under the age of two years.

• Opioid poisoning deaths in New Zealand (2001-2002).

  Authors: David Reith, John Fountain, Murray Tilyard

  The New Zealand medical journal. 03/2005; 118(1209):U1293.

  AIM: To investigate the rates of opioid deaths in New Zealand relative to the utilisation of opioids. METHODS: Deaths from opioid poisonings for New Zealand from 1 January 2001 to 31 December 2002AIM: To investigate the rates of opioid deaths in New Zealand relative to the utilisation of opioids. METHODS: Deaths from opioid poisonings for New Zealand from 1 January 2001 to 31 December 2002 were identified from chemical injury cases that are routinely collected for surveillance purposes by the Institute of Environmental Science and Research from the Coronial Services Office in Wellington. Prescriptions for medicines containing morphine, methadone, and dextropropoxyphene were identified from the PharmHouse database from 1 January 2001 to 31 December 2002. RESULTS: There were 92 poisoning deaths involving opioids: morphine in 33, methadone in 31, dextropropoxyphene in 16, and codeine/dihydrocodeine in 12. The rate (95% CI) of deaths per 100,000 prescriptions was 5.94 (4.09 to 8.34) for morphine, 1.34 (0.91 to 1.91) for methadone, and 2.5 (1.45 to 4.12) for dextropropoxyphene. The rate of deaths (95% CI) per 1,000,000 defined daily doses was 0.94 (0.65 to 1.32) for morphine, 0.40 (0.27 to 0.56) for methadone, and 0.14 (0.08 to 0.22) for dextropropoxyphene. CONCLUSIONS: Restrictions in the availability of dextropropoxyphene, and increased monitoring of prescription and dispensing of methadone, should be considered in order to reduce deaths due to opioids in New Zealand.

• Quality Use of Medicines activities in New Zealand hospitals from 2000 to 2002.

  Authors: June M Tordoff, Pauline Norris, Julia Kennedy, David Reith

  The New Zealand medical journal. 02/2005; 118(1208):U1259.

  AIMS: To review current activities promoting Quality Use of Medicines (QUM) in New Zealand hospitals in 2000-2002, and to identify attitudes to possible centralisation of activities. METHOD:AIMS: To review current activities promoting Quality Use of Medicines (QUM) in New Zealand hospitals in 2000-2002, and to identify attitudes to possible centralisation of activities. METHOD: Questionnaire-based cross-sectional survey of 30 New Zealand public hospitals. Respondents were chief pharmacists in all hospitals employing at least one pharmacist. RESULTS: Twenty-nine hospitals (96.7%) responded; 3 were linked to a tertiary hospital for QUM activities. From the 26 independent hospitals, 64 Drug Utilisation Reviews (DURs) and 63 hospital-wide campaigns were reported, and 103 medicines information bulletins produced. Nineteen (63.3%) hospitals had their own hospital formulary. Twenty-four percent of respondents reported they would use centrally-developed guidelines only if in total agreement with their own. All hospitals reported disseminating drug expenditure information; feedback comments were predominantly from financial and nursing managers. All hospitals reported providing some form of drug information service (DI) and two-thirds a drug utilisation service (DU); 70% of total dedicated staff-time to these services was in tertiary hospitals. An increase in staff-time (fulltime-equivalent staff/100 beds) for clinical pharmacists, and DU+DI pharmacists, was associated with an increase in the number of DURs undertaken (p<0.05). CONCLUSION: A range of activities to promote QUM were undertaken in New Zealand hospitals, with greater activity in tertiary and secondary hospitals. Respondents reported some resistance to centrally-developed guidelines. Promotion of QUM may be assisted by an increase in clinical pharmacy resources.

• Trends in accessibility to medicines for children in New Zealand: 1998-2002.

  Authors: Jocelyn Chui, June Tordoff, Julia Kennedy, David Reith

  British journal of clinical pharmacology. 04/2004; 57(3):322-7.

  BACKGROUND: Reported rates of unlicensed and off-label use of medicines in children raise concerns regarding overall access of children to medicines OBJECTIVE: To assess changes in availability ofBACKGROUND: Reported rates of unlicensed and off-label use of medicines in children raise concerns regarding overall access of children to medicines OBJECTIVE: To assess changes in availability of proprietary formulations suitable for infants and young children; licensing of medicines; and subsidization of medicines for children in New Zealand. METHODS: Review of the New Ethicals Catalogue, New Ethicals Compendium, product data sheets and the New Zealand Pharmaceutical Schedule covering the years 1998-2002 inclusive. RESULTS: There was a decrease in the total number of medicines licensed in New Zealand from 2014 to 1840; but there was an increase in the number and percentage of suitable formulations that were licensed for paediatric use from 616[31%] to 642[35%]. The number of suitable paediatric formulations that were subsidized decreased from 281[13.9%] to 260[14.1%]. The number of orally available chemical entities with suitable formulations, licensed and subsidized for paediatric use declined from 101[5.0%] to 94[5.1%], but all of these chemical entities that were withdrawn had therapeutic alternatives that were licensed and subsidized. Only 36% of new medicines that had licensing for children were licensed for the 0-23 month age group. CONCLUSION: There have been modest improvements in licensing of medicines for children in New Zealand from 1998 to 2002.