11 MARCH 2009 ISSUE
Spot of bother for acne CME
Amanda Cameron
acameron@nzdoctor.co.nz
Attempts to educate GPs on acne care since Pharmac widened access to isotretinoin and acitretin are being hampered by difficulties finding dermatologists to help.
Pharmac announced in December that, from 1 March, vocationally registered GPs and nurse practitioners would be able to prescribe these drugs on a subsidised basis provided they have training and Special Authority from Pharmac.
However, at the time of writing, Pharmac had not managed to get a dermatologist to take part in a planned seminar series on acne care. New Zealand Doctor had similarly failed to find a dermatologist to author a clinical article on acne treatment.
New Zealand Dermatolog-ical Society president Elizabeth Baird did not return New Zealand Doctor’s calls. However, the society issued a media release in December saying it and the Australasian College of Dermatologists were “worried that the current, stringent, safety measures will not be upheld if the drugs are more easily prescribed”.
Isotretinoin is more teratogenic than the highly restricted drug thalidomide, according to a dermatologist who does not want to be identified. The drug’s Medsafe data sheet also contains a long list of adverse effects including depression and other psychiatric disorders.
GPs have always been able to prescribe isotretinoin but, until 1 March, it was only funded when prescribed by a dermatologist.
Pharmac medical director Peter Moodie says the agency is confident GPs will prescribe the drug safely, and enabling GPs to prescribe isotretinoin will mean more people who need the drug will get it.
Pharmac seminar series director and Feilding GP Jacqui Virtue, who has been approaching dermatologists to help out with the seminar series on acne care, says she is hopeful they will eventually cooperate.
“When things are new it takes people a while to realise their professional responsibilities,” Dr Virtue says.
As New Zealand Doctor went to press, she was planning to write to the Dermatological Society asking them to provide someone to help with the seminar series.
The first seminar, planned for 16 April, will be provided by Tom James, a Gisborne GP with a special interest in dermatology, Stephanie Moore, a child psychiatrist in Christchurch, Wellington pharmacologist Carl Burgess, Dr Moodie and Dr Virtue.
Dr Moodie says he is comfortable the seminar series will be of good quality, adding that GPs are well placed to manage the main issues associated with isotretinoin – unplanned pregnancies and suicidal ideation and depression.
A new BMJ Learning module on isotretinoin, commissioned by the RNZCGP, is expected to be available in April. BPAC is also in the final stages of preparing a decision support tool.
Medical Council spokesperson on the issue Barnett Bond says it is unacceptable for any doctor or group of doctors to withhold information from another doctor or group of doctors that could have an impact on patient safety.
However, whether dermatologists would be breaching their ethical responsibilities by not helping Pharmac with a seminar series would depend on whether the specialist information they would provide could be sourced elsewhere, Dr Bond says.
“[The council] would need to have a lot more information to persuade it that patients are being put at risk [by a lack of dermatologist input],” he says.
« Go Back