For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews
DHB psychologists to vote on new offer
DHB psychologists to vote on new offer

Six hundred psychologists employed by District Health Boards, and members of the union APEX, will begin voting next week on a new offer from their employers to settle their collective agreement negotiations.1
Psychologists are in their third month of partial strike action after negotiations broke down in July over the DHBs failure to make an adequate offer to address understaffing, low pay and professional development. Psychologists will begin voting on the offer next week with results due on Tuesday 29 October.
The offer does not meet key union claims that psychologists identified as important prior to bargaining beginning in March 2019, including closing the salary gap with other state sector employers of psychologists and committing DHBs to employ one psychologist for every 5000 people living in a DHB area.
“We understand the Ministry of Health has failed to fund an offer that would have addressed the $20,000 salary gap between psychologists employed at DHBs and the Department of Corrections,” said Annmaree Kingi, consultant clinical psychologist at Canterbury DHB and Psychologists’ Division Secretary.
“It is disappointing the Ministry of Health do not seem to recognise the scale of the recruitment and retention issues affecting the psychology workforce. For example the 64 bed Adult Inpatient Service at Hillmorton Hospital has just 0.8 FTE of psychology attached to it,” continued Ms Kingi.
“The DHBs have utterly failed to recognise the rapidly deteriorating state of the psychology workforce. It is disheartening that they continue to offer no meaningful solutions to keep psychologists in DHBs. It leaves us questioning the DHBs commitment to providing New Zealanders with access to psychologists,” added Amber Barry, consultant clinical psychologist at Midcentral DHB and APEX delegate.
“At present in Midcentral DHB there are two rural adult mental health teams, one rural child and adolescent mental health team, an inpatient 24-bed mental health ward, a Maori mental health team, an older adult mental health team, and an early intervention in psychosis team all operating without any psychologists. This shows the level of the crisis affecting the psychology workforce and patients of DHBs,” concluded Ms Barry.