ࡱ> acb#` ;bjbjmm .:62222FFFF<,EBH-+E-E-E-E-E-E-E$GhVJpQE"QE22fE(2l+E+EnB,ED PTrXF=( C D4|E0E)CJeJ@EDED&JkD=|gdJ===QEQE===E  222222 THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email: Denise Tringham P O Box 22 234 Wellington Tel: (04) 938 4827 Fax: (04) 976 4827  HYPERLINK "mailto:psnz@paradise.net.nz" psnz@paradise.net.nz  Geraldine MacGibbon Therapeutic Group Manager PHARMAC PO Box 10-254 Wellington Dear Geraldine; Paediatric Society of New Zealand Position Statement Response to Pharmac Consultation Document (dated 23 November 2007) to replace the Special Authority for Dexamphetamine and Methylphenidate and amend the criteria for subsidy PSNZ supports the following principles: Specialist diagnosis of ADHD in the context of a multidisciplinary team management Ongoing medical surveillance of those on stimulants and intermittent Specialist review that the diagnosis and treatment remain appropriate. PHARMAC seeking to improve the standard of care for those needing stimulants and for those on them long-term. PSNZ has reservations about aspects of some of the proposed PHARMAC changes, in particular: the proposal that the recommending Specialists Name and Date of Recommendation is put on each prescription The change in wording which requires the General Practitioner to state the patient has been seen by a relevant specialist in the last 18 months who has recommended treatment. A. The requirement for writing date of specialist recommendation on each monthly prescription is burdensome, requires extra time in consulting the file for a prescription that has to be written so frequently and appears to add no additional safety or benefits. PHARMAC and the Pharmacist already have or can access details of the date of Special Authority approval, which in the proposed changes mandates specialist review. B. PSNZ members have not reached consensus about the requirement to see a Specialist at least every 18 months. Some members are concerned that the change will mean children who benefit from stimulants will be denied access to them, as this will place pressure on Paediatric and CAFS services which are already stretched. Other members agree that ideally all children with ADHD should see a Specialist at diagnosis and should be reviewed periodically by a Specialist. A compromise position could be that a Specialist is required to have seen the child when the Special Authority initial application is made, but not for subsequent reviews. Some PSNZ members question the need for the changes: If it aint broke dont fix it. PSNZ would require information about the degree of the problem of General Practitioners prescribing stimulants inappropriately, resulting in harm, before recommending a change. If this is an isolated issue would working with those GPs to improve their patient management be a more productive approach than a change to the Special Authority criteria? PSNZ suggests the potential benefits of the proposed changes (increased safety and decreased inappropriate prescribing) could be outweighed by the harms, which include: Decreased flexibility in developing pragmatic but safe models of care. PSNZ supports the multidisciplinary approach to ADHD diagnosis and management recommended in the Ministry of Health NZ ADHD guidelines. Child and Adolescent Psychiatrists and Paediatricians working in or with Child and Adolescent Mental Health services, Child Development teams, Schools, Special Education professionals and support services, all working together are likely to provide the best long-term treatment for children with ADHD, in which medication plays an important but not exclusive role. However, while ideal to have a Child and Adolescent Psychiatrists or Paediatrician directly involved, could a General Practitioner in some limited circumstances, and in the absence of good access to these Specialists provide the medical input required, particularly in reviewing a child who is stable and benefiting from medication? In some circumstances a formal diagnostic process by a Clinical Psychologist may be more robust than the diagnosis of ADHD made by a General Paediatrician. In Wellington, in response to a (correctly) perceived gap in service a Clinical Psychologist has been employed in a GP liaison role to make an appropriate diagnosis and up-skill and assist a small number of GPs with an interest and skills in ADHD management, with back-up (but without direct client contact unless complex case) from the CAFS Psychiatrist. This model would not be supported if the proposed change goes ahead. Lack of capacity in existing services to cope with extra demands change will create, leading to longer delays in other children being seen. Societal costs associated with under-treatment of ADHD in Childhood and Adulthood. It is likely society bears the financial costs for a number of accidents (workplace and vehicle) leading to injury or death and costs within the Justice and Welfare sectors that could be reduced if adults with ADHD were medicated with stimulants in childhood and also as adults. It is essential that Specialists continue to receive notification when a GP has applied or renewed a stimulant Special Authority on their behalf. This process does not automatically occur with electronic Special Authority applications. PSNZ members also would like to request that the availability of alternative stimulant brands (Ritalin LA, Concerta) should be addressed urgently in order to give prescribers and families more choices, and atomoxetine should be approved for subsidy for children who have unacceptable side-effects from stimulants. Yours sincerely Dr Andrew Marshall Developmental Paediatrician, on behalf of the PSNZ '()BC   # $ & ' ( ) * 㵥|pkcZKBh35mH sH h`EhSCJaJmH sH hS5mH sH hSmH sH  hZ5hZ0JCJOJQJ*jhZB*CJOJQJUph$jhZB*CJOJQJUphhZ5B*CJOJQJphhZB*CJOJQJphhZ5B*CJ(OJQJphhZ5B*CJ$OJQJphhZ5OJQJ%jhZ5OJQJUmHnHu()6789:<C`|$ !Sn#$Ifa$gdZ$ !n#'$If^'`a$gdZ$ !Sn#$Ifa$gdZ$ !Sn#$Ifa$gdZ x$IfgdZ  $IfgdZ 6:' ( ) * > XPPH$a$gdS$a$gdSnkd$$IfT\C*%?aytZT$ !n#$Ifa$gdZ$ !Sn#$Ifa$gdZ$ $Ifa$gdZ> X ` n y z { p q x C ` $ & F a$gd^a $ & F a$gdV_$a$gd $D^Da$gdV_ $ & Fa$gd$a$gdV_$a$gd3$a$gdS     o p q x   " + 2 D ĵĦėĦ}ӗn}n_h`Eh v@CJaJmH sH h`Eh/Q CJaJmH sH h`EhCJaJmH sH h`Eh`ECJaJh`EhgCJaJmH sH h`Eh`ECJaJmH sH h`Eh CJaJmH sH h`EhV_CJaJmH sH h`EhSCJaJmH sH h3mH sH h35mH sH hSh35mH sH % _ ` a c #0<   bMg ,ĴĥĥĥĆwhYYJJh`Eh5_CJaJmH sH h`EhDCJaJmH sH hh^aCJaJmH sH hh5_CJaJmH sH hh5_5CJaJmH sH h`Eh4CJaJmH sH h`EhV_CJaJmH sH h`Ehr.5CJaJmH sH h`Ehr.CJaJmH sH h`Eh^aCJaJmH sH h`Eh/Q CJaJmH sH h`EhgCJaJmH sH ` a  DEI $7$8$H$a$gd4 7$8$H$gdr0 $ & Fa$gdg. $ & Fa$gd>LQ $ & Fa$gdBo$a$gd^a$a$gd>LQ$a$gd5_$a$gd/Q $a$gdV_,6>PQdl'v9BCD4ָ֚֩||||m^Nh`Eh>LQ5CJaJmH sH h`Eh^aCJaJmH sH h`EhT&pCJaJmH sH h`EhOCJaJmH sH h`EhV4CJaJmH sH h`Ehr.CJaJmH sH h`Eh>LQCJaJmH sH h`EhV_CJaJmH sH h`EhDCJaJmH sH h`Eh5_CJaJmH sH h`EhgCJaJmH sH hK_CJaJmH sH 46hu+&vx[\de޼޼޼ͫͫͫxxxxc(h`EhO5B*CJaJmH phsH !h`EhOB*CJ^JaJph!h`EhT&pB*CJ^JaJph!h`Eh5_B*CJ^JaJph!h`Ehr0B*CJ^JaJph!h`EhyB*CJ^JaJph!h`EhgB*CJ^JaJph!h`EhmwB*CJ^JaJphh`EhBo5CJaJmH sH $HIFGscTHTLQCJaJmH sH h`EhT&pCJaJmH sH h`EhT&p5CJaJmH sH h`Eh>LQ5CJaJmH sH DT]a!569:;ʻ֬ʻ֝֎h^hn{h`EhBoCJaJmH sH h`EhT&pCJaJmH sH h`Eh4CJaJmH sH h`Eh`ECJaJmH sH hBoCJaJmH sH h`EhBoCJaJmH sH hK_CJaJmH sH h`Ehr0CJaJmH sH 6789:; 7$8$H$gd4 7$8$H$gdr0 ,1h. A!"#$% DyK psnz@paradise.net.nzyK 8mailto:psnz@paradise.net.nz$$If!vh55?55#v#v?#v#v:V 55?554ytZT@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No ListZ`Z ZHeader$ !a$5CJOJQJaJmH sH tH 0U`0 Z Hyperlink>*B*;;:()6789:<C`|'()*>X`nyz{pqxC`a   D E I6789<000000000000000000 0000000000000000 0 0 000 0 000000000000 0 0 0000000000000000000()6789:<C`|'(6<@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0 00( 00 ,4;> ` ;:#;X8@,(  t    S"8  BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@`   TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`h H2  #   H2  # ' B S  ?;/Lu OLE_LINK1 OLE_LINK2 _Hlk31519747<(((< /0ǁM0M Dǁ! v"u#n~$l%~%,%~Pmmnn<   ''_twxx< :*urn:schemas-microsoft-com:office:smarttagsStreet> *urn:schemas-microsoft-com:office:smarttags PersonName; *urn:schemas-microsoft-com:office:smarttagsaddress8*urn:schemas-microsoft-com:office:smarttagsdate9 *urn:schemas-microsoft-com:office:smarttagsplace8*urn:schemas-microsoft-com:office:smarttagsCityB *urn:schemas-microsoft-com:office:smarttagscountry-region z11200723DayMonthYear   4=6<  6<33())pw, 6 6 6 xx[\deHDT]a!55667788<6< C zU [/vJDYh_ZWJ^3ZWv:u4LQSV_5_K_T&pmwn{$Oy4 3^ar.)C'(<@  0;6  @{;@@Unknown Gz Times New Roman5Symbol3& z Arial?Bodoni BookEAGaramond BoldA& Arial NarrowG& Eras Medium ITC?5 z Courier New;Wingdings"qh P (P (!24d++2QHX)?S2DRAFTAndrew Marshall [CCDHB]devpaed@         Oh+'0  < H T`hpxDRAFTAndrew Marshall [CCDHB] Normal.dotdevpaed6Microsoft Office Word@e@qX@DErXP՜.+,D՜.+,4 hp  CCDHB( +' DRAFT Title4 P( _PID_HLINKS_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnceAp3Dmailto:psnz@paradise.net.nz <Draft position statement - ADHD Special authority changes Andrew.Marshall@ccdhb.org.nzAndrew Marshall [CCDHB]  !"#$%'()*+,-./0123456789:;<=>?@ABCDEFGHIJKMNOPQRSUVWXYZ[^Root Entry F@TrX`Data 1Table&KWordDocument.:SummaryInformation(LDocumentSummaryInformation8TCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89qRoot Entry F>eGsXgData 1Table&KWordDocument.:  !"#$%'()*+,-./0123456789:;<=>?@ABCDEFGHIJKMNOPQRSfed  _PID_HLINKS_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce _PreviousAdHocReviewCycleIDAp3Dmailto:psnz@paradise.net.nz6UConsultation on proposed changes to dexamphetamine/methylphenidate Special AuthorityDevpaed@adhb.govt.nz#Developmental Paeds/Rosemary Marks SummaryInformation(LDocumentSummaryInformation84CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q՜.+,D՜.+,4 hp  CCDHB( +' DRAFT Title P,4t Paediatric Society of New Zealand: Submissions
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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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