Posted 20th Feb 2013 in Health Quality Evaluation

The Health Quality & Safety Commission has been looking at variation across district health boards (DHBs) in the use of polypharmacy in older people and the management of gout. This information is presented in the Commission’s Atlas of Healthcare Variation.

The Atlas is a tool which enables clinicians, providers and users of health services to see variation in the health care patients receive, by geographical area. There are already Atlas domains with information on maternity, demography and cardiovascular disease on the Commission’s website.

Atlas findings are intended to encourage questions about why variation in health care exists, rather than make assumptions about the cause of variation.

Gout

The Atlas organises information on gout by DHB, including occurrence of the condition.

Gout is the most common form of inflammatory arthritis and is caused by high levels of uric acid in the blood. It is estimated to affect 3.75 percent of adult New Zealanders. Acute attacks of gout can be extremely painful and disrupt work and home life. Tophaceous gout causes bone and joint damage and musculoskeletal disability.

Treatments for gout include the use of non-steroidal anti-inflammatory drugs (NSAIDs) which treat pain, allopurinol which reduces the amount of uric acid in the blood and prevents acute attacks, and colchicine. The use of colchicine for acute attacks is only recommended if people cannot take NSAIDs.

If a person experiences more than one acute gout attack per year it is recommended they take medication to both reduce the amount of uric acid in the blood and prevent further acute gout attacks. The most common and well tolerated medication for this is allopurinol.

The Atlas data shows that areas where more patients take allopurinol regularly also have lower rates of hospital admission for gout, and fewer patients taking other medicines to treat gout.

The data shows one in 20 people with gout received colchicine, but no allopurinol in the same year, suggesting there are some gout sufferers who would benefit from better long term management of their gout.

Data showed people with gout used more drugs to treat pain over a one-year period, than the general population. It is likely this difference represents higher dispensing for acute gout flares, instead of the use of allopurinol to prevent acute attacks.

The Commission hopes clinicians can use this information to improve outcomes for patients living with gout.

Polypharmacy in older people (65 years or older)

Polypharmacy describes the prescribing of many medicines (five or more) or inappropriate prescribing – for example, prescribing medicines or combinations of medicines that are not effective for a condition or that may cause harm.

The Atlas data shows prescribing information by DHB, including how many long-term medicines people are taking and the use of antipsychotic[i] medications and benzodiazepines[ii].

Atlas data shows the use of antipsychotic medicines increased with age; up to one in 12 people aged over 85 years received antipsychotics in 2011, which was 3.5 times higher than those aged 65-74 years. Likewise, the dispensing of benzodiazepines increased; one in five people over 85 received these medicines in 2011, which was twice as much as those aged 65-74.

The number of people receiving five or more long-term medicines increased with age from a quarter of those aged 65-74 to over half of those aged 85 and older.

The Commission encourages the sector to use this data to look at prescribing practices, to ensure patients are getting the best possible treatment for their condition.

Anyone worried about their medication should talk to their doctor, but not stop taking it. Bring the medicines you are on to your doctor, and ask them if you are not sure why you are taking a particular medicine. For more information please go to http://www.hqsc.govt.nz/assets/Medication-Safety/Other-PR/brochure-Taking-Your-Medicine-Safely-WEB.pdf.


[i] Medicines used to treat bipolar disorder, schizophrenia and delusional disorder.

[ii] Medicines used to treat anxiety, insomnia, pain and agitation, more commonly known as sedatives or hypnotics.

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