td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4251 [post_author] => 74 [post_date] => 2019-02-13 13:52:27 [post_date_gmt] => 2019-02-13 03:52:27 [post_content] => In 2023 pharmacists will be the custodians of medicine safety, embedded wherever medicines are used, and more responsible and accountable for the safe and effective use of medicines, a new report reveals. Pharmacists in 2023: For patients, for our profession, for Australia’s health system, developed by the Pharmaceutical Society of Australia (PSA), reveals the 11 system changes needed for healthcare evolution to deliver safety and quality improvements in the use of medicines, and better use of pharmacists to improve access to healthcare. Today also marks 11 years since PSA achieved national unification, further demonstrating just how far the organisation has come. PSA National President Dr Chris Freeman launched the report today at a breakfast event in Parliament House attended by political leaders and pharmacy experts from across the country. 'Pharmacists in 2023 is the pharmacy profession’s response to the national medicine safety problem,' Dr Freeman said. 'The report unlocks the potential for pharmacists to improve healthcare access and outcomes for Australians and reduce variability in care.' PSA recently showed in its Medicine Safety: Take Care report that 250,000 people are admitted to hospital each year as a result of medicine-related problems, costing the Australian health system $1.4 billion per annum.
Dr Chris Freeman at the Pharmacists in 2023 report launch‘Medicine safety should be a national priority,’ Dr Freeman said. ‘The Pharmacists in 2023 report identifies the key actions needed to address this issue by unlocking more opportunities for pharmacists as the guardians of medicine safety. ‘Pharmacists must be empowered to do more than the current system allows them to do. As the only health professionals trained with a specific focus on the effective and safe use of medicines, pharmacists must lead a culture change to embed medicine safety at every point of healthcare delivery. ‘Rather than gazing into a crystal ball, we have laid out an ambitious agenda for change with tangible and practical actions to support all pharmacists to reach their full potential and provide more effective and efficient healthcare. All of the actions in Pharmacists in 2023 aim to ensure pharmacists practise to the full extent of their expertise, are recognised for their key role in healthcare and are remunerated appropriately. ‘Our goal is to ensure any Australian, no matter where they live, can receive the best possible care from a pharmacist, and that pharmacists are supported to address their patients’ needs using the full extent of their training and expertise.” The PSA report is the result of two years of consultation with a wide range of pharmacy, consumer and health stakeholders. For pharmacists in 2023 to address the health needs of all Australians, the report identifies 11 actions for change:
Dr Freeman said, 'I now look forward to working with pharmacy leaders, other healthcare groups, consumers and government to advance the role of pharmacists in 2023 – for patients, for our profession and for Australia’s health system.' Read Pharmacists in 2023. [post_title] => Broadening pharmacists' role to improve health [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => broadening-pharmacists-role-improve-health-2023 [to_ping] => [pinged] => [post_modified] => 2019-02-13 15:59:56 [post_modified_gmt] => 2019-02-13 05:59:56 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4251 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Broadening pharmacists’ role to improve health [title] => Broadening pharmacists’ role to improve health [href] => https://www.australianpharmacist.com.au/broadening-pharmacists-role-improve-health-2023/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4255 )
- Empower and expect all pharmacists to be more responsible and accountable for medicine safety.
- Enhance the role of community pharmacists to have a greater level of responsibility and accountability for medicines management.
- Embed pharmacists within healthcare teams to improve decision making for the safe and effective use of medicines.
- Facilitate pharmacist prescribing within a collaborative care model.
- Improve pharmacist stewardship of medicine management to improve outcomes at transitions of care.
- Utilise and build upon the accessibility of community pharmacies in primary care to improve consumer access to health services.
- Equip the pharmacist workforce, through practitioner development, to address Australia’s existing and emerging health challenges.
- Establish additional funding models to recognise the value and quality of pharmacist care.
- Allow greater flexibility in funding and delivery of pharmacist care to innovate and adapt to the unique patient needs in regional, rural and remote areas.
- Develop and maintain a research culture across the pharmacist profession to ensure a robust evidence base for existing and future pharmacist programs.
- Embrace digital transformation to improve the quality use of medicines; support the delivery of safe, effective, and efficient healthcare; and facilitate collaborative models of care.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4245 [post_author] => 74 [post_date] => 2019-02-13 13:27:21 [post_date_gmt] => 2019-02-13 03:27:21 [post_content] => Federal Minister for Health Greg Hunt has committed to PSA being a signatory of the Seventh Community Pharmacy Agreement (7CPA), due for commencement in 2020. Mr Hunt, attending the launch of the PSA’s Pharmacists in 2023 report at Parliament House in Canberra, praised the work of the PSA – and flagged an important development in the governance of pharmacy remuneration in Australia. ‘As we look forward to pharmacy in 2023, and go through this report, the goal is the integrated role of pharmacists practising to their full scope. We will now work with you on these recommendations … and I make this commitment that you (PSA) will be the signatories for the first time for the 7CPA. ‘I would like to build in to that agreement the expanded scope of practice where pharmacy will be involved increasingly in preventive health ... to keep more people out of hospitals, keep more people healthy, save lives and protect lives.’
Greg Hunt at the Pharmacists in 2023 report launch.Mr Hunt also praised the work of PSA in its advocacy for funding support for a number of pharmacy trials, in particular chronic pain MedsCheck. ‘What we do on these MedsChecks literally saves lives and protects lives, and that’s a united front we have to have,’ Mr Hunt said. Mr Hunt also stated that real-time prescription monitoring would be rolled out across Australia in the coming year. ‘Real-time monitoring is something that the PSA has championed, (and we are) now working with the states to have a single standard on that. This is about protecting patients and protecting the broader community. I am very confident that it will be up and running across the nation for the course of this calendar year, and it would not have happened without the Society and without your support.’ [post_title] => Minister Hunt commits to PSA being a signatory to 7CPA [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psa-sign-7cpa [to_ping] => [pinged] => [post_modified] => 2019-02-13 16:00:34 [post_modified_gmt] => 2019-02-13 06:00:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4245 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Minister Hunt commits to PSA being a signatory to 7CPA [title] => Minister Hunt commits to PSA being a signatory to 7CPA [href] => https://www.australianpharmacist.com.au/psa-sign-7cpa/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4248 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4231 [post_author] => 82 [post_date] => 2019-02-12 11:30:22 [post_date_gmt] => 2019-02-12 01:30:22 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Pharmacists have been recommended to access Medicare Benefits Schedule (MBS) items to manage medicines for patients who require complex care. The Pharmaceutical Society of Australia (PSA) said that the move will help ensure that medicines are used safely and effectively. A report of recommendations was recently released by the Allied Health Reference Group of the Medicare Benefits Schedule Review Taskforce, with a recommendation to allow non-dispensing pharmacists to access allied health items. A further recommendation has also been made by the Primary Care Clinical Committee in regards to remunerating healthcare professionals who are not doctors to take part in case conferencing. PSA National President Dr Chris Freeman said that both recommendations would significantly facilitate pharmacist involvement in a collaborative approach to primary care alongside other healthcare professionals, a necessity that is more pertinent than ever, as outlined in PSA’s Medicine Safety: Take Care report. ‘We have known for a long time that there are financial and structural impediments to pharmacist involvement in case conferencing, and these recommended changes will help overcome those barriers,’ said Dr Freeman. ‘PSA has advocated over many years to diversify remuneration to reflect pharmacists’ extensive expertise and contribution to Australia’s health. Pharmacists have been calling for access to the MBS to reflect their skills, training and experience for longer than many of us can remember.’ Dr Freeman said that after PSA’s policy and advocacy work in a 2019-20 pre-Budget submission to include pharmacists in the list of eligible allied health practitioners to deliver MBS services to the chronically ill, they have been successful in this pursuit. He said that the MBS is a ‘key funding mechanism’ to support models of care for complex conditions that are both innovative and collaborative and will help reduce medicine-related harm. ‘Pharmacists should be able to deliver these services from any setting, including general practice, Aboriginal health services and community pharmacies. This is about the right pharmacist, with the right skill set at the right time working as part of a multidisciplinary collaborative team,’ he said. Also included in PSA’s pre-Budget submission is an appeal for continued funding to integrate pharmacists into Aboriginal Community Controlled Health Services to assist in chronic disease management. In accordance with this recommendation, the Reference Group has recommended investing in an allied health research base in order to facilitate the development of evidence-based strategies that will allow for collaborative approaches to managing chronic disease. Dr Freeman said that the inequalities faced by Aboriginal and Torres Strait Islander peoples and those in rural and remote communities can be better approached as a result of the recommendations. This will help address health inequalities for Aboriginal and Torres Strait Islander peoples and rural and remote communities,” Dr Freeman said. ‘We are excited that our advocacy is unlocking opportunities for pharmacists to realise their full potential. We look forward to working with the committees involved in the Medicare Benefits Schedule Review as they undertake their consultation on these recommendations, and finally when they will be presented to the Minister for Health,’ he said. ‘We also look forward to the Minister for Health making these recommendations a reality after the consultation process has been finalised to ensure pharmacists can do more with medicines for more Australians.’ [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => PSA successfully lobbies for pharmacist recommendations [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psa-lobbies-pharmacist-recommendations [to_ping] => [pinged] => [post_modified] => 2019-02-13 09:54:47 [post_modified_gmt] => 2019-02-12 23:54:47 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4231 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PSA successfully lobbies for pharmacist recommendations [title] => PSA successfully lobbies for pharmacist recommendations [href] => https://www.australianpharmacist.com.au/psa-lobbies-pharmacist-recommendations/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4237 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4125 [post_author] => 11 [post_date] => 2019-02-11 02:10:24 [post_date_gmt] => 2019-02-10 16:10:24 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] As Australia gathers persuasive evidence from the Health Care Homes trial, it’s becoming clearer how to integrate pharmacists into primary healthcare. Doors are opening: there are now more opportunities than ever for Australian pharmacists to be embedded in primary healthcare teams. The national Health Care Homes trial recently welcomed community pharmacists to join care teams through the Community Pharmacy in Health Care Homes trial, while around the country more pharmacists are being invited into general practice clinics. The integration of community pharmacy in Health Care Homes is a seismic shift in integrating the work of community pharmacists alongside the work of general practitioners. This model of care, which is fully supported by the Pharmaceutical Society of Australia, provides an opportunity for holistic medication management for patients with chronic and complex conditions by community pharmacists and is a welcome addition to the services delivered by community pharmacists. PSA General Manager – Program Delivery Jan Ridd welcomes the shift towards pharmacists working to their full scope of practice. ‘In addition to a greater role for community pharmacists in managing medicines, we see that the placement of pharmacists in GP clinics, residential care facilities and Indigenous health centres would ensure appropriate prescribing, reduce errors, enhance adherence and improve patient outcomes,’ she says. ‘Pharmacists should be embedded wherever medicines are used.’
Community pharmacy in the Health Care Homes Trial ProgramThe Community Pharmacy in Health Care Homes Trial Program1 aims to support the incorporation of medication management planning and programs within the Health Care Homes model. It began late last year and 300 pharmacies had registered by December. PSA National President Dr Chris Freeman sees this model of care as a gamechanger for the role of community pharmacy. ‘Never have we had a program for patients with multiple chronic and complex illnesses that allows us to provide ongoing care through consultations with patients about their medications,’ he says. Dr Freeman encourages every community pharmacy that could be involved to register in the program to show that they can deliver this type of longitudinal integrated medication management support for patients with chronic disease. ‘The training programs that have been built by PSA for this program are extremely useful not only for participation in the trial, but also for identifying how to integrate consultations with patients into care delivery and to better integrate with other care providers,’ he says. Says PSA’s Jan Ridd: ‘In the coming months, community pharmacies in close proximity to the primary health networks participating2 in the Health Care Homes trial can expect to receive invitations to access patient Shared Care Plans and to participate in the Trial Program.’ Once a pharmacy registers, receives a referral and gains patient consent, an initial consultation can occur. The PSA Guidelines for pharmacists participating in the Community Pharmacy in Health Care Homes Trial Program outline the professional standard to which the services should be delivered.3 During the consult, pharmacists can work with a patient and their Health Care Home to:
|TRAINING MODULE||CPD CREDITS|
|Preparing your pharmacy for the Community Pharmacy in Health Care Homes Trial||Up to 1.5|
|Delivering the Community Pharmacy in Health Care Homes Trial Program||Up to 1.5|
|Health Care Homes model in practice||Up to 1.5|
|Developing a Medication Management Plan||Up to 1.0|
|Implementing and reviewing a Medication Management Plan||Up to 1.0|
|Team-based health care||Up to 1.5|
|Enhanced communication for a new model of care||Up to 1.5|
|Embracing a new approach to community pharmacy practice||Up to 1.0|
|Patient journeys||Up to 2.0|
|Health Care Homes: What pharmacy assistants need to know||N/A|
General practice pharmacist in actionTIM PERRY, GENERAL PRACTICE PHARMACIST, HILLS FAMILY GENERAL PRACTICE: ‘One of our Health Care Home patients was discharged from hospital where he had been commenced on a new inhaler and nebulised salbutamol. He had previously been using MDI salbutamol and a different combination puffer and was now totally confused. He came in seeking prescriptions for nebulised salbutamol a week after leaving hospital. ‘Instead of seeing the GP he saw the practice nurse, who then asked me to join them to discuss the inhaled medications. I was able to clarify the patient’s confusion, simplify his regimen by changing to salbutamol MDI via a spacer, check and correct his inhaler technique, and schedule a follow-up. ‘The patient left with a new Asthma Action Plan and confidence in what he was doing. His regular doctor wasn’t involved at all and was able to see three other urgent patients while this was happening.’
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4195 [post_author] => 76 [post_date] => 2019-02-06 13:00:46 [post_date_gmt] => 2019-02-06 03:00:46 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]As the Aged Care Royal Commission begins, Minister for Aged Care Ken Wyatt, has released a statement reaffirming the government’s commitment to the regulation of chemical and physical restraint in aged care facilities. But experts say that meaningful change requires funding for multidisciplinary healthcare teams that include pharmacists. The wellbeing of residents in aged care facilities came into sharp focus last year when the ABC uncovered alarming footage of physical restraints being used on residents for extended periods of time, as well as evidence of chemical restraints. Pharmacist and researcher Amy Page, who specialises in the quality use of medicines for older adults and has been involved extensively with aged care facilities, told Australian Pharmacist that problems in aged care have been an ‘open secret’ for some time, and that understaffed and underfunded facilities create an environment that is ripe for medicine misuse. ‘Medicines are often being used as a substitute for care because facilities just aren’t adequately staffed to be able to manage people,’ she said. Recently the Department of Health changed the guidance notes for providers, announcing that the list of questions to be used by quality assessors at unannounced monitoring will include specific questions about restrictive practises, but former pharmacist and University of Tasmania researcher Juanita Westbury expressed concern that these early updates were ‘vague and unspecific,’ and made no mention of the role of pharmacists. ‘It’s not just antipsychotics that are overused. Other agents, especially benzodiazepines, are not referred to at all,’ she told The Australian. At present the role of pharmacists in providing support for medication use in aged care facilities is limited by a lack of funding, according to Dr Page. She said that if facilities had the resources to expand the role of pharmacists they could play a valuable role in alleviating the burden on carers and provide a higher quality of medical care for residents. ‘I would like to see, depending on the size of the facility, pharmacists there on a part or full-time basis,’ she said. ‘It’s having someone there to actually answer questions from the residents and their families. Somebody to be available to answer questions for the nursing staff and the carers and facilitate with the GP’s and other healthcare providers when they need new medicines and scripts written – that sort of thing.’ Pharmacists are a particularly important recourse for residents of aged care facilities, who are often taking multiple medications, and with no access to a community pharmacist they have limited ways of getting information about the way they are managed, Dr Page said. She also noted that pharmacists could offer support for carers who often have minimal access to information about medication administration techniques. The Commission has announced their intent to investigate the options for seniors remaining at home. Dr Page said that pharmacists might also play a role in this area of aged care, particularly in medication management. ‘One of the reasons that people end up going into care is that they can no longer manage their medications themselves,’ she said. ‘Part of the role of pharmacists is having a look at ways we can simplify people’s medicine so that it’s easier for them to manage and administer their own medicine – sometimes a device might be too fiddly to use, and finding ways that we can support them in working out which medicines are really essential.’ While each patient should be approached on a case-by-case basis, Dr Page suggested that pharmacists can play a role in ensuring that a patient’s medication matches their care goals – which will likely differ between patients who prioritise staying at home and patients who are willing to enter an aged care facility. Ultimately, she said, the Royal Commission could provide a valuable opportunity to increase the resources available to healthcare professionals in the aged care sector, where pharmacists could ‘fill a niche’. ‘Ideally, the role that I’d like to see for pharmacists is being available to support residents and their families,’ she said. ‘But also to support the other healthcare practitioners and people working in that environment to administer medicines properly and advocate for the best possible use of medicines.’ [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => What the Aged Care Royal Commission means for pharmacists [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => what-the-aged-care-royal-commission-could-mean-for-pharmacists [to_ping] => [pinged] => [post_modified] => 2019-02-12 09:07:30 [post_modified_gmt] => 2019-02-11 23:07:30 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4195 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What the Aged Care Royal Commission means for pharmacists [title] => What the Aged Care Royal Commission means for pharmacists [href] => https://www.australianpharmacist.com.au/what-the-aged-care-royal-commission-could-mean-for-pharmacists/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4196 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4267 [post_author] => 82 [post_date] => 2019-02-14 15:29:36 [post_date_gmt] => 2019-02-14 05:29:36 [post_content] => Two additional targeted biologicals for severe chronic plaque psoriasis are now listed on the Pharmaceutical Benefits Scheme (PBS), offering relief for adults with the often underestimated condition. Chronic plaque psoriasis (often referred to as psoriasis) is thought to affect between 2.3% –6.6% of Australians. Chronic plaque psoriasis is the most common form of the condition, accounting for approximately 90% of all psoriasis cases.1,2 Psoriasis is an immune mediated condition that can cause red scaly patches, itchiness and flaking of the skin.3 It is associated with higher rates of depression and anxiety; the psychosocial impact of psoriasis affects quality of life. Patients with psoriasis are also at an increased risk of conditions such as metabolic syndrome and cardiovascular disease.4 The two new PBS listed medicines, tildrakizumab (Ilumya) and guselkumab (Tremfya) could alleviate the condition in patients. ‘While psoriasis was once thought of as little more than “influenza of the skin”, our improved understanding of the immunological pathways involved in the disease has led to the development of ...biologicals with a more targeted mechanism of action,’ said Associate Professor Peter Foley, clinical dermatologist and Director of Research, Skin & Cancer Foundation Inc, in a statement. In psoriasis, there is an increase in interleukin-23 (IL-23), a pro-inflammatory cytokine. Tildrakizumab and guselkumab, both monoclonal antibodies and inhibitors of IL-23, relieves inflammation and symptoms of psoriasis.5,6 The recommended dose of tildrakizumab is 100mg subcutaneously at week 0 and week 4, and every 12 weeks thereafter.5 Conversely, the recommended dose of guselkumab is 100 mg subcutaneously at week 0 and week 4, and every 8 weeks thereafter.6 Both tildrakizumab and guselkumab are immunomodulators and as such appropriate precautions prior to commencement of therapy should be taken (e.g. screening for tuberculosis and hepatitis B, immunisations etc.5,6 Professor Foley said that, while there is no cure for psoriasis, the development of biologicals is promising. However, there may still be barriers to widespread usage. ‘It would appear that a significant portion of patients are not presenting to their GPs because they are not aware that newer, less toxic therapies are available or they have been told years ago that there is no cure,’ he said.4 With tildrakizumab’s and guselkumab’s inclusion on the PBS and continued research and development of biologicals, more effective treatment could be within reach, he said. References
[post_title] => New PBS listing could change psoriasis treatment [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-pbs-listing-psoriasis-treatment [to_ping] => [pinged] => [post_modified] => 2019-02-14 15:32:10 [post_modified_gmt] => 2019-02-14 05:32:10 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4267 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New PBS listing could change psoriasis treatment [title] => New PBS listing could change psoriasis treatment [href] => https://www.australianpharmacist.com.au/new-pbs-listing-psoriasis-treatment/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4269 )
- Griffiths CE, Christophers E, Barker JN, et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258-262. At: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.2006.07675.x
- Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013 133(2):377-85. At: https://www.ncbi.nlm.nih.gov/pubmed/23014338
- Victoria State Government Better Health Channel, Psoriasis. At: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/psoriasis
- Woodley, M. PBS listing could save psoriasis patients tens of thousands a year. News GP 25 January 2019. At: https://www1.racgp.org.au/newsgp/professional/pbs-listing-could-save-psoriasis-patients-tens-of
- TREMFYA (guselkumab) Australian product information. At: https://www.tga.gov.au/sites/default/files/auspar-guselkumab-181105-pi.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4204 [post_author] => 82 [post_date] => 2019-02-08 15:41:43 [post_date_gmt] => 2019-02-08 05:41:43 [post_content] => There has been an increase in incidents of community-associated Staphylococcus aureus bloodstream infections (CA-SABs) in Victoria and Western Australia (WA). Pharmacists have a role to play in infection control and prevention. A study, which surveyed 10,320 hospital-reported S. aureus bacteraemia (SAB) cases in Victoria and WA from 2011-2016, found that 6,800 cases were community-associated (CA), as opposed to healthcare-associated, with the number of CA-SABs increasing by eight and six per cent per year in Victoria and WA respectively.1 Methicillin-susceptible S.aureus (MSSA) was the cause of most CA-SABs. Importantly, patients 60 years and over had higher incidences of CA-SABs, with men twice as likely to acquire the infection than women of the same age. The study comes in response to hospital reports received by the Victorian Healthcare Associated Infection Surveillance System (VICNISS) and Healthcare Infection Surveillance Western Australia (HISWA) in 2016 and 2017, informing them of increased incidences of CA-SABs. These increases may be due to virulent S. aureus strains or changes in host risk factors.1 Aged care facility residents may be at particular risk as infections in this group would have been classified as CA-SABs in the study.
Pharmacists’ role in infection control and preventionAccording to Naomi Weier, Project Pharmacist at the Pharmaceutical Society of Australia (PSA), ‘pharmacists have a key role to play in counselling patients on infection control and prevention’. ‘This includes counselling patients on hygiene measures such as covering sores or wounds and correct use of dressings, counselling and promotion of the importance of correct handwashing techniques and washing hands regularly and providing education and advice on exclusion periods for infectious conditions if required,’ she said. According to health.vic The incubation period is most commonly 4—10 days, although this can vary. Transmission is usually via direct or indirect contact with a person who has a discharging wound or clinical infection (e.g. respiratory or urinary tract), or who is colonised with S.aureus (e.g. approximately 50% of the population). Infection control and prevention is required for as long as the lesions are purulent and continue to drain or carrier state continues. Weier also sees an opportunity for pharmacists to ‘educate patients with risk factors (e.g immunocompromised patients etc) for certain infections on symptoms to look out for and strategies for reducing the risk of infection’.
Recognising infection in patientsS. aureus is most commonly responsible for skin infections and will likely present with redness, swelling, pain, heat and pus-filled lesions such as boils and abscesses.2 However, S. aureus can also infect joints, bones, blood, the gastrointestinal tract and other major organs, with symptoms varying based on the infection’s location in the body. Sepsis, symptoms include rapid breathing, an elevated heart rate, fever, chills and disorientation.3
Dangers of infectionWhile boils and abscesses are often relatively mild infections and can be easily treated with drainage and appropriate antibiotics, invasive S. aureus infections can be more difficult to treat and can often be life-threatening. In fact, S. aureus bacteremia has an in-hospital mortality of 20-30%, a 2018 review reported.2,4 S. aureus can cause complications such as endocarditis (infection and inflammation of the heart’s inner lining) and septic thrombophlebitis (clot/venous thrombus). Increased microbial load and a decrease in the body’s ability to fight the infection, if left unchecked, can lead to organ failure.4 Sources of infection should always be identified to decrease rates of mortality. Persistent fever should be monitored and blood cultures sampled.4 Further complications arise when patients have methicillin-resistant S. aureus (MRSA), as the bacteria will not be susceptible to the penicillins normally used to treat MSSA. Instead, patients will need to be identified as soon as possible and treated with the appropriate antibiotic(s) (e.g. vancomycin, teicoplanin, daptomycin etc.) in order to clear the infection.4 Further information can be found in eTG and AMH.
Referring patients to seek medical helpAccording to Weier, ‘pharmacists should refer patients presenting with symptoms of bacterial infection requiring antibiotics to their doctor immediately,’ while also taking the opportunity to explain the role of antibiotics, knowing what to expect and when they should be used. Repeat prescriptions for an antibiotic should only be dispensed after clarifying clinical appropriateness, in line with PSA’s Choosing Wisely Recommendations. ‘Also, when presented with a prescription for an antibiotic, pharmacists should review the prescription to assess its appropriateness for the patient – including the correct antibiotic, dose, directions, and duration – and counsel patients on the role of antibiotics and their correct use,’ she said. This is in line with the International Pharmaceutical Federation’s views, suggesting that the pharmacist’s role is to encourage responsible use of antibiotics to achieve optimal patient outcomes and prevent antibiotic resistance.5 Finally, ‘pharmacists should refer patients back to their doctor if there is no improvement or if symptoms worsen’, Weier explained.
[post_title] => The rise of community-associated golden staph infections [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rise-community-associated-staph-infections [to_ping] => [pinged] => [post_modified] => 2019-02-08 15:46:31 [post_modified_gmt] => 2019-02-08 05:46:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4204 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The rise of community-associated golden staph infections [title] => The rise of community-associated golden staph infections [href] => https://www.australianpharmacist.com.au/rise-community-associated-staph-infections/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4205 )
- Imam N, Tempone S, Armstrong P, et al. Increased incidence of community-associated Staphylococcus aureus bloodstream infections in Victoria and Western Australia, 2011-2016, 2019. The Medical Journal of Australia. At: https://www.mja.com.au/journal/2019/210/2/increased-incidence-community-associated-staphylococcus-aureus-bloodstream
- Staphylococcus aureus infection, Queensland Government. 2017. At: http://conditions.health.qld.gov.au/HealthCondition/condition/14/33/132/staphylococcus-aureus-infection
- Staph infections: What you should know, Penn Medicine. 2018. At: https://www.pennmedicine.org/updates/blogs/health-and-wellness/2018/may/staph-infections
- Jung N, Rieg S. Essentials in the management of S. aureus bloodstream infection. 2018. Infection. At: https://www.ncbi.nlm.nih.gov/pubmed/29512028
- Fighting antimicrobial resistance, International Pharmaceutical Federation. 2015. At: https://www.fip.org/files/fip/publications/2015-11-Fighting-antimicrobial-resistance.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4162 [post_author] => 76 [post_date] => 2019-02-01 13:39:01 [post_date_gmt] => 2019-02-01 03:39:01 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A medication that promises to alleviate symptoms of severe asthma is now listed on the Pharmaceutical Benefits Scheme (PBS) under Section 100, giving patients access to the potentially life-saving treatment. There are 2.5 million Australians (10% of the population) estimated to be living with asthma, and while many patients are able to manage their condition, severe asthma continues to challenge some of them. It is estimated that up to 10% of patients with asthma may have severe asthma.1,2 Benralizumab (Fasenra) was developed to treat eosinophilic-driven asthma, a factor in some severe asthma cases. This condition occurs when there is an excess of eosinophils, a type of white blood cell, in the blood and airways which increase the severity of asthma symptoms as well as the number of flare-ups.3 According to the data from a small sample to validate the Asthma Control Test (Asthma Score), conducted by The National Asthma Council Australia, 89% of sufferers report daily wheezing, 56% report daily cough, and 39% report experiencing phlegm and shortness of breath every day.4 Patients with severe asthma who are unable to control their symptoms with inhalers alone, may rely on oral corticosteroids to assist in symptom management during acute flare-up. Chronic or long-term oral corticosteroid use increases risk of systemic adverse effects which includes weight gain, diabetes, coronary heart disease, depression, osteoporosis and fractures.5 Benralizumab promises to alleviate symptoms by working ‘with the body’s immune system to reduce the number of eosinophils in the blood and lungs,’ the medicine’s parent company, AstraZeneca, said in a statement. Two Phase III asthma studies (SIROCCO and CALIMA) and one oral corticosteroid (OCS)-sparing phase III study (ZONDA) found benralizumab as an add-on therapy significantly benefited patients over the age of 12 years with uncontrolled severe asthma.6-8 Benefits observed were improved lung function, reduced asthma symptom score, improved quality of life and reduced number of asthma exacerbations. ‘Fasenra demonstrated significant reductions in annual asthma exacerbation rates of 51% and 28% versus placebo, when 8-weekly dosing, following the first 3 doses administered 4-weekly given as add-on maintenance treatment in patients with blood eosinophil count ≥300 cells,’ AstraZeneca’s statement said. Even so, researchers note that the medicine is not free from adverse effects, which can include headaches, sore throats, fever/high temperature and injection site reactions – although these are considerably less severe than the long-term impacts of cortisol.9 Benralizumab’s inclusion in the PBS promises to greatly increase the number of people able to access the medicine. ‘Around 670 patients a year will now be able to access this medicine, which would cost more than $21,000 per year of treatment without the PBS subsidy. When this medicine is subsidised under the PBS, patients will pay $39.50 per script or just $6.40 a script for concessional patients,’ Health Minister Greg Hunt said in a statement. The move has been praised by the National Asthma Council Australia. ‘The day-to-day burden of living with severe asthma can be considerable, including side-effects from frequent oral corticosteroid use, and new treatments provide additional options those affected,’ Siobhan Brophy, the Council’s Chief Executive Officer, said. References:
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- Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–73
- Hekking PP, et al. The prevalence of severe refractory asthma. J Allergy Clin Immunol 2015;135(4):896–902.
- Australian Institute of Health and Welfare. Asthma web report. Available from: https://www.aihw.gov.au/reports/asthma-other-chronic-respiratory-conditions/asthma/data Date accessed: August 2018.
- Nelsen LM, Kimel M, Murray LT, et al. Qualitative evaluation of the St George's Respiratory Questionnaire in patients with severe asthma. Respir Med 2017. Epub 2017 February 2018. At: https://www.ncbi.nlm.nih.gov/pubmed/28427547
- Lefebrve P, et al. Acute and chronic systemic corticosteroid–related complications in patients with severe asthma. J Allergy Clin Immunol. 2015;136: 1488–95.
- FitzGerald JM, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, doubleblind, placebo-controlled phase 3 trial. Lancet 2016;388(10056):2128–41.
- Bleecker ER, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with highdosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebocontrolled phase 3 trial. Lancet 2016;388(10056):2115–27.
- Nair P, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med 2017;376(25):2448– 58.
- Fasenra® (benralizumab) Product Information. August 2018.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3860 [post_author] => 82 [post_date] => 2019-01-29 08:31:05 [post_date_gmt] => 2019-01-28 22:31:05 [post_content] => Dementia Australia recently called for shared responsibility between healthcare professionals and aged care organisations in the care of people living with dementia. But where do pharmacists fit into this equation? Dementia Australia CEO Marie McCabe said that a collaborative approach would allow for ‘clinical leadership’ and ‘evidence-based care’ in the treatment of people with dementia, notably the minimisation of antipsychotic medicine and restraint techniques. ‘A partnership between the person living with dementia, family carers, their treating doctor, pharmacist and other health and aged care professionals is crucial to providing alternatives to the use of antipsychotic medicines,’ Ms McCabe said. She also said that non-pharmacological options should be the first option in managing some of the symptoms of dementia that can be more difficult.
Pharmacists’ involvementA 2018 study RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities, demonstrated that pharmacists are indeed central to the reduction in use of these medicines amongst all aged care residents, not just those with dementia. There were 150 Australian residential aged care facilities (with 12,157 residents) that participated in the study, along with a group of consultant pharmacists and a group community pharmacists. Psychotropic medicine audits were conducted along with staff education, followed by two reviews at the three and six month stages. Throughout the intervention process, the prescription of antipsychotics reduced by 13%, and regular prescription of benzodiazepines by 21%.1 Dr Andrew Stafford, Director of Dementia Training Australia and Consultancy Pharmacy Services, and an adjunct Senior Lecturer, School of Pharmacy and Biomedical Sciences at Curtin University, said that medication management for people living with dementia is a complex and challenging process, especially for carers. But, he said, all pharmacists no matter where they work have the ability to participate in shared care. Community pharmacists who assist with medication supply, can help by ‘filling their prescriptions, packing their medicines into dose administration aids, translating information about PRN (taken when needed) medicines and making sure that these medicines are being used appropriately,’ he said. Pharmacists who work in medication review roles in residential care can look for opportunities to deprescribe, identify the side effects of medicines that may exert adverse effects on cognition, or ensure antipsychotics and other sedatives are being used correctly – in low doses, for short periods of time and only when absolutely necessary. There’s also a role for hospital pharmacists, by making sure that medicines will not affect cognition and that any changes made to a person’s regimen in the hospital are clearly explained to carers when the person is discharged. As detailed in a previous Australian Pharmacist article about medicine overuse, PSA advocates for pharmacists to be placed in residential aged care facilities. 'PSA has called for pharmacists to be embedded in residential care facilities to reduce inappropriate medicine use and help address the overuse of opioids and antipsychotics,' said PSA Vice President and Chair of Policy and Advocacy, Dr Shane Jackson.
Working togetherDr Stafford emphasised the importance of collaboration in the care of people living with dementia. ‘Get involved. Don’t be afraid to talk to prescribers or nurses if you’re working in a residential care facility. And talk to the people living with dementia and their carers themselves, who are at the centre of shared care.’ MedsChecks and Home Medicines Reviews are useful services for carers of people living with dementia, Dr Stafford said. ‘MedsChecks provide a really good opportunity to identify where changes can be made to improve compliance or address issues with concordance. They also provide information and education opportunities.’
AntipsychoticsThere are several ways that all pharmacists can have an impact on reducing antipsychotic use by people living with dementia, Dr Stafford said. Community pharmacists that pack medicine in dose administration aids can provide reminder services, helping to monitor antipsychotic medicine use. Pharmacists providing medication reviews within residential facilities can focus on antipsychotic medicines by looking at the duration of use, and whether there have been attempts to reduce the dosage through tapering and withdrawal. ‘They can also provide Quality Use of Medicines services to ensure that nursing staff know about the relative ineffectiveness of these medicines and the high degree of risk associated with them,’ Dr Stafford said.
Treatment alternativesPharmacists can help to find other ways to treat patients living with dementia, Dr Stafford said. Importantly, when they know the resident or person, alternatives to antipsychotic medicines can be determined by understanding what they are trying to tell you by their behaviour. ‘Rather than just giving a person an antipsychotic medicine, we need to figure out what the problem actually is and address it appropriately and specifically. So if the person is overstimulated, place them somewhere quieter. If they are bored, give them something to do that provides meaning. ‘What you need to do before you go reaching for the pillbox is make sure you’ve alleviated all causes for this person’s agitation, aggression or distress,’ he said. Refer tor Guidelines for pharmacists performing Homes Medicines Reviews: https://my.psa.org.au/s/article/Guidelines-for-Home-Medicines-Reviews For more information on Quality Use of Medicines services in residential facilities, see: https://my.psa.org.au/s/article/Guidelines-for-pharmacists-providing-RMMR References
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- Westbury JL, Gee P, Ling T, Brown DT, Franks KH, Bindoff I, Bindoff A, Peterson GM. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities, Med J Aust 2018. At: https://www.mja.com.au/journal/2018/208/9/reduse-reducing-antipsychotic-and-benzodiazepine-prescribing-residential-aged
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Laudanum’s use, and abuse, has set the tone for the use and abuse of opiates from the 17th century until the present day.From pre-history through Sumerian, Greek and Roman cultures, opium has been used for pain management. But it was in the preparation known as laudanum that it entered the modern world of medicine. Formulated by renowned Swiss chemist/alchemist Paracelsus in the early Renaissance, laudanum was made up of a concoction of substances that could include pearls, musk, amber, ambergris, nutmeg and of course opium. Many chemists formulated their own laudanum recipes, with British chemist Thomas Sydenham creating a version in the 1670s which popularised the drug in the UK and led to its spread around the world, and saw it referenced in literature of the time as ‘a panacea for all human woes ... the secret of happiness’. Sydenham’s laudanum was a mix of wine, beer, saffron, clove, cinnamon and opium, and was used in treating headaches, cough and tuberculosis, gout, rheumatism, diarrhoea, menstrual pain, as well as depression (melancholy). Laudanum would become one of the first ‘cure all’ medicines and was available freely in most jurisdictions without prescription until the 1920s.
In actionLaudanum is an opium tincture made from poppy seeds and contains almost all the 20 opium alkaloids, such as morphine and codeine. The drug works on the central nervous system to slow transmission of signals within the body as well as slowing respiratory and heart function. Apart from its role in pain management, one of its main historical uses, and continued uses today, has been in treating dysentery or diarrhoea. In the gut, laudanum increases the tone of intestinal muscles, slowing the passage of faecal material, thereby allowing for increased fluid absorption, aiding a patient in cases of persistent diarrhoea.
Use in AustraliaOn our shores, laudanum was commonly used from the first days of British settlement. Little has been specifically written about the use of laudanum in Australia, but opioids themselves have been popular in Australia since the early days of settlement. The decline of laudanum use began in 1897 when legislation in Queensland first tried to restrict the sale of opiates; all sales would finally be restricted in 1926 when Australia joined the 1925 Geneva Convention on Opium and Other Drugs. But despite the decline in the use of opium in formulations such as laudanum, opiate use is still very common in Australia, with 2.8 million Australians (as of 2014) prescribed opiates. Today laudanum is used in the treatment of severe diarrhoea, when all other treatments fail, and in infants when treating neonatal abstinence syndrome (NAS), namely addiction to opiates in newborns whose mothers used opiates during pregnancy.
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- Duarte Danilo Freire. Opium and opioids: a brief history. Rev. Bras. Anestesiol. [Internet]. 2005 Feb [cited 2018 Oct 08] ; 55( 1 ): 135-146. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942005000100015&lng=en. http://dx.doi.org/10.1590/S0034-70942005000100015.
- Gall L. Laudanum: Freedom from Pain for the Price of Addiction Museum of Health Care. [Internet] 2015 July 20. [Cited 2018 October 8] Available from: https://museumofhealthcare.wordpress.com/2015/07/20/laudanum-freedom-from-pain-for-the-price-of-addiction/
- Gaita P. Laudanum: The Opioid Epidemic of the 19th Century? The Fix [Internet] 2017 October 19 [Cited 2018 October 8] Available from: https://www.thefix.com/laudanum-opioid-epidemic-19th-century
- drugs.com [Internet] 2001 July 9 [Cited 2018 October 8] Available From: https://www.drugs.com/mmx/laudanum.html
- Opium Tincture National Cancer Institute. [Internet} 2018 September 24 [Cited 2018 October 8] Available from: https://www.cancer.gov/publications/dictionaries/cancer-drug/def/opium-tincture
- Bolt S. A brief history of Australian drug laws. unharm.org [Internet] 2015 July 16 [Cited 2018 October 8] Available from: https://www.unharm.org/a_brief_history
- State Library of New South Wales. History of drug laws [Internet] 2016 December 16 [Cited 2018 October 8] Available from: https://druginfo.sl.nsw.gov.au/drugs-drugs-and-law/history-drug-laws
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3685 [post_author] => 76 [post_date] => 2019-01-21 14:45:31 [post_date_gmt] => 2019-01-21 04:45:31 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Psilocybin, a psychoactive compound found in ‘magic mushrooms’, is being trialled in the treatment of terminally ill patients to reduce symptoms of depression and anxiety at Melbourne’s St Vincent’s Hospital. The treatment has proven to be successful in several international clinical trials, including US-based John Hopkins University in 2016 and Imperial College in London in 2017. The St Vincent’s trial, headed by clinical psychologist Dr Margaret Ross, aims to provide relief for terminally ill patients – many of whom suffer from underdiagnosed mental health problems. Major depression in terminally ill patients has been found to be common, ranging from 25% to 77%.1 While depression can diminish quality of life for patients, it has also been associated with a further decline in survival rate and treatment adherence in terminally ill cancer patients. A 2013 study found that about a third of patients with non-small cell lung cancer were suffering from depression. Those patients showed a median overall survival rate of 6.8 months, compared to that in non-depressed patients whose median survival rate was 14 months.2 Researchers from the John Hopkins University trial reported that the compound psilocybin is particularly effective at altering damaging thought processes.3 Serotonergic hallucinogens, including psilocybin (psilocin) and lysergic acid diethylamide (LSD) and mescaline, are a structurally diverse group of compounds that are 5-HT2A receptor agonists. They produce a unique profile of changes in thoughts, perceptions, and emotions.3,4,5 The John Hopkins trial administered psilocybin to cancer patients with a life-threatening diagnosis. Varying doses of psilocybin were given over a period of nine months, with five weeks between sessions. The study found that patients who received high doses of psilocybin (22 or 30 mg) reported decreases in symptoms of depression and anxiety as well as increased quality of life and optimism. Patient reports were echoed by psychiatrists who observed similar results.3 Furthermore, these changes were sustained with 80% of participants continuing to show ‘significant’ decreases in symptoms of depression and anxiety at a six-month follow-up. Similarly, the Imperial College study found patients with severe depression experienced decreased symptoms after they were given two doses of psilocybin, 10 mg and 25 mg respectively, one week apart.3 fMRI scans revealed observable changes in their cognitive functioning. ‘Whole-brain analyses revealed post-treatment decreases in cerebral blood flow (CBF) in the temporal cortex, including the amygdala. Decreased amygdala CBF correlated with reduced depressive symptoms,’ researchers said in the subsequent paper.6 The St Vincent’s trial will commence in April, when a group of 30 patients will be given 25 mg of synthetic psilocybin alongside psychotherapy sessions. ‘We don't want it to be underwhelming, we don't want it to be overwhelming,’ Dr Ross said. ‘We know that higher doses are associated with anxiety but if it's too low a dose you're not really going to experience that psychological shift in the thinking that we're really looking for.’ While more trials need to be conducted, the positive results suggest that with more research, psilocybin could be offered routinely for relief of anxiety and depression in terminally ill patients. References:
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => How psilocybin can help terminally ill patients [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psilocybin-help-terminally-ill-patients [to_ping] => [pinged] => [post_modified] => 2019-01-22 16:33:13 [post_modified_gmt] => 2019-01-22 06:33:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3685 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How psilocybin can help terminally ill patients [title] => How psilocybin can help terminally ill patients [href] => https://www.australianpharmacist.com.au/psilocybin-help-terminally-ill-patients/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3690 )
- Fine RL. Depression, anxiety, and delirium in the terminally ill patient. Proc (Bayl Univ Med Cent). 2001;14(2):130-3. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/
- Arrieta Ó, Angulo LP, Núñez-Valencia C et al. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Ann Surg Oncol 2013; 20: 1941-1948. https://doi.org/10.1245/s10434-012-2793-5
- Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D. Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197. https://journals.sagepub.com/doi/full/10.1177/0269881116675513#_i37
- Halberstadt AL. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behav Brain Res 2015; 277: 99–120. At: https://www.sciencedirect.com/science/article/pii/S0166432814004562?via%3Dihub
- Nichols DE. Psychedelics. Pharmacol Rev 2016; 68(2): 264-355 http://pharmrev.aspetjournals.org/content/68/2/264
- Carhart-Harris RL, RosemanL et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific Reports 2017. Epub 2017 October 13: https://www.nature.com/articles/s41598-017-13282-7#article-info
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2806 [post_author] => 27 [post_date] => 2018-10-01 13:30:59 [post_date_gmt] => 2018-10-01 03:30:59 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Lithium is an invaluable and lifesaving treatment for a range of psychiatric disorders, but its origins lie in patent medicine and the pioneering work of an Australian doctor. People have been flocking to hot springs of lithium-heavy water for their perceived health benefits for millennia, but it was not until the second half of the 19th century that modern medicine put the element to use. In 1859, an English physician described the use of lithium carbonate to treat gout by solubilising uric acid in the blood, as well as treating ‘brain gout’, or mental upset. Over the next few decades, some US and Danish doctors reported that lithium carbonate could calm patients with ‘general nervousness’, mania or depression.1 However, its use in medicine remained rare, with most use instead in food products. Until 1950, popular soft drink 7-Up2 contained lithium citrate and even beer3 was brewed with lithium-heavy water and promoted for its mood-enhancing abilities. However, both the real and perceived health benefits of lithium were overshadowed when lithium was prescribed to patients with heart disease as a replacement for salt.4 The resulting overdoses and deaths led to the US banning lithium as an additive in 1950. Elemental reactions The exact action of lithium to manage mood remains unclear, though it is clear the molecule acts on the brain on multiple levels. It offers neuroprotective and neuroproliferative effects on brain structure, as well as plasticity.5 It also modulates neurotransmission, inhibiting excitatory neurotransmitters such as dopamine and glutamate,6 and promoting GABA-mediated neurotransmission.6 In 1949 in a Melbourne mental hospital for World War II veterans, Dr John Cade theorised the mania he witnessed in his patients might be linked to the high levels of uric acid he detected in their urine, in line with the 19th century theories about gout. He experimented with injecting the urine collected from patients demonstrating mania into guinea pigs, which subsequently showed signs of agitation.1 Guinea pigs that were subsequently administered lithium following the urine injections rapidly calmed. Dr Cade then experimented on himself and when he showed no ill effects after a dose of lithium, he started a trial on 10 patients.7 His trial showed significant positive results, but a mixture of poor timing (given lithium’s then-recent banning from food) and the then-obscurity of the Medical Journal of Australia where his article was published meant little acknowledgment.¹ Instead, Danish research published in 1954 detailing the results of a randomised trial kick-started lithium’s renaissance.1 By 1970, lithium had been widely approved for treating bipolar disorder and other mental health issues.1 Thinking big In recent years, some studies have found a correlation between high levels of naturally occurring lithium in tap water and lower rates of suicide and mental health problems.2 However, these studies have had many limitations and there is no reliable evidence that says lithium addition to water or food would provide any health benefits.5 References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => The story of lithium and mental health [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-story-of-lithium-and-mental-health [to_ping] => [pinged] => [post_modified] => 2018-10-03 14:18:15 [post_modified_gmt] => 2018-10-03 04:18:15 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2806 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The story of lithium and mental health [title] => The story of lithium and mental health [href] => https://www.australianpharmacist.com.au/the-story-of-lithium-and-mental-health/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 2811 )
- Shorter E. The History of Lithium Therapy. Bipolar Disorders. 2009;11.
- Fels A. Should We All Take A Bit of Lithium? The New York Times. 2014 September 13. At: https://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html?_r=0.
- Shepherd R. Lithia Beer returns to West Bend, expands across Wisconsin. Isthmus. At: https://isthmus.com/food-drink/beer/lithia-beer-returns-to-west-bend-expands-across-wisconsin/.
- Hardman JG. Limbird PB. Gilman AG. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th Ed. New York. McGraw-Hill. 2001:507.
- Sachdev P. Let’s not put lithium in the drinking water just yet. Medical Republic. 2017 November 21. At: http://medicalrepublic.com.au/lets-not-put-lithium-drinking-water-just-yet/11998.
- Brunton L. Chabner B. Knollman B. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th Ed. New York. McGraw-Hill. 2010:445.
- Mitchell PB. Hadzi-Pavlovic D. Lithium treatment for bipolar disorder. [Reproduced from The Medical Journal of Australia]. Bulletin of the World Health Organization, 2000;78(4):515.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2425 [post_author] => 12 [post_date] => 2018-08-22 08:45:22 [post_date_gmt] => 2018-08-21 22:45:22 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]With community pharmacies feeling the squeeze, there has never been a more important time to provide continuity of care by building patient loyalty. Self-serve checkouts, online stores and banking through phone apps: these days there’s often little need to talk to a person when making day-to-day purchases or transactions. Pharmacy, however, remains one of the last bastions of good ol’ fashioned human connection. ‘Patients are looking for connection,’ said Capital Chemist’s Elise Apolloni MPS. ‘So often when people engage with services or businesses there’s nothing magical about the interaction.’ Fortunately, pharmacists can use these increasingly rare personal interactions to provide patient-centred service and foster continuity of care, bringing positive patient outcomes. What customers want The strength of a patient’s loyalty is primarily driven by the behaviour of the pharmacist treating them – not the price of the medication or the location of the pharmacy. And there’s no shortage of studies that reach this conclusion. A 2013 Griffith University study found that patient-centred care, such as providing individualised medication counselling, continuity of care, development of relationships and respectful advice, emerged as the most important attribute when it came to retention of regular community pharmacy users. Additionally, a US study published in the Journal of the American Pharmacists Association found that a pharmacist’s patient-centred communication style had a major influence on whether a patient would return to the pharmacy. Associate Professor in Marketing at the QUT Business School Dr Gary Mortimer said while many customers seek pharmacies with lower prices, consumers are turning to pharmacy for healthcare solutions and triage prior to consulting their GP. ‘We see this mostly in consumers seeking access to flu jabs and health check-ups, possibly as a result of patients looking to avoid the high costs of seeing a GP for minor healthcare matters,’ said Dr Mortimer, who is currently working on the research topic ‘Clinical trials or pharmacist advice: The influence on health consumers’ perceptions of trust and decision making’. PSA NSW Branch Vice President Krysti-Lee Rigby MPS said that consumers also wanted value. But that does not necessarily mean being the cheapest. ‘Value can come from having engaged and competent staff, service that meets or exceeds expectations, the pharmacist being accessible, being able to trust their pharmacist, and of course convenience,’ Ms Rigby said. Holistic care benefits for patients The relationship between pharmacist and patient should not be the transactional kind of relationship you have at your local convenience store, Dr Mortimer said. ‘Better patient healthcare outcomes result from ongoing, regular contact based on continuity of service and advice,’ he said. Ms Apolloni said this was particularly apparent in the chronic disease space, where often a one visit solution wasn’t possible. ‘If a patient is not dazzled by your pharmacy and team, they may not return and you’ve missed an opportunity to build a therapeutic relationship with that person and contribute positively to their healthcare,’ Ms Apolloni said. ‘We’ve laughed with patients – and cried with them. I can’t see how that kind of connection and holistic care can be anything but great for the patient, the job satisfaction of the pharmacist, and the wider healthcare system.’ Ms Rigby added: ‘By building trust with patients, we can increase compliance of medications, create better health outcomes by educating patients on how to better manage their medications, and empower patients to take a proactive approach to their health.’ Ensuring continuity of care Dr Mortimer suggests pharmacies take a five-stage approach to maximising holistic care opportunities, starting with establishing integrity. ‘Pharmacy must consistently deliver open and honest information across all touch points with consumers. Integrity cultivates trust between the patient and the pharmacy retailer,’ he said. Pharmacists and assistants then need to provide expert advice around purchasing decisions. ‘Consumers have access to significant amounts of information today,’ Dr Mortimer said. ‘If a pharmacy assistant delivers inaccurate advice, or ill-informed advice that is not consistent, the patient-pharmacist trust relationship is damaged.’ The third ingredient for maximising holistic care opportunities is ensuring the security of personal data, said Dr Mortimer. And fourth, pharmacies need to demonstrate competence. ‘Trust and continuity of care decrease when the consumer perceives that the pharmacy is incompetent in its dealings with them,’ he said. ‘For example, if the pharmacy is unable to perform transactions efficiently, loses prescriptions, has poor service, fails to offer a lower-priced generic alternatives, or fails to keep promises.’ Finally, and most importantly, said Dr Mortimer, the pharmacy must exhibit benevolence. ‘When a pharmacy demonstrates or promotes actions that indicate the support of the welfare of others over financial outcomes, consumers develop stronger levels of trust,’ Dr Mortimer said. ‘Benevolence is di cult to cultivate, as benevolent acts must be purely altruistic.’ Ms Apolloni added that being genuinely present and interested in a patient was another important precondition for holistic care. ‘We have many competing priorities, but it takes very little extra time to really listen and repeat back key pieces of information,’ she said. Digital solutions One way pharmacists can deliver more holistic care and maximise time with patients is by harnessing the power of technology. Robert Read is CEO of MedAdvisor, a mobile and web app that manages all aspects of prescription medication use. One of the advantages of this type of digital solution, said Mr Read, was that it prompted patients when it was time to re-order their medication. ‘And 50% of orders from the app go into the pharmacy outside of business hours,’ he said. ‘A pharmacy can then process those scripts before the doors even open so that when the patient comes in they can spend quality time counselling them.’ ‘It’s really busy at the dispensary and pharmacists are doing all this processing work and not spending time talking to the patient about all the various things they might be eligible for,’ Mr Read said. ‘What MedAdvisor does is identify all the eligible consumers, and then helps you invite them to services they’re eligible for.’ Mr Read said their research showed more than 90% of patients stayed loyal to the pharmacy that signed them up to the app. ‘Not only does it play a big role in driving loyalty, but it improves a patient’s adherence to their medication,‘ he said. Another way pharmacists are spending more time in front of patients is by purchasing an automated dispensing cabinet. Pharmacy owner and technology consultant Robert Sztar MPS said the cabinets could free up your staff to deliver high-quality services, while the dispenser tackles the more routine tasks. Avoiding poor patient service Making patients aware of additional services they’re eligible for is an important part of providing holistic care, but Dr Mortimer said pharmacists need to be aware that not all up-sells are appreciated – especially product-based ones. ‘It frustrates consumers. They’ll pop in to collect a prescription and be up-sold OTC products, cosmetics or skincare products,’ he said. ‘While revenue and the bottom line is important, pushing sales is a short-term solution. If a consumer genuinely feels a pharmacy is taking the time to get to know them, really understanding their needs to develop healthcare solutions, they will keep coming back.’ Take a stand While consumers do not necessarily become loyal to a particular brand or pharmacy, they do become loyal to what the business stands for, Ms Rigby suggested. ‘For community pharmacies to continue to be viable, they need to have clear missions and values, and ensure their staff align with them,’ she said. ‘Pharmacies need to show consumers what they stand for, besides making money.’
|Ways to foster patient loyalty
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2442 [post_author] => 66 [post_date] => 2018-08-07 11:45:10 [post_date_gmt] => 2018-08-07 01:45:10 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A group of Melbourne pharmacists have developed a data aggregation and visualisation platform used for strengthening health supply chains, disaster response and improving health services throughout the South Pacific. In June, the project won the People’s Prize at the the Australian Public Service Innovation Awards in Canberra. The tool builds a map of every health facility within the countries that are participating in the project. Currently, six countries have partnered (Solomon Islands, Vanuatu, Kiribati, Cook Islands, Tokelau and Tonga) and that number is expected to grow further in 2018, with potential applications for Australia. ‘Kiribati has seen a 21% increase in the availability of medicines at the primary healthcare level since September 2017, which is a terrific result in a difficult geographic area,’ project member Kahlinda Mahoney said. The project is named after Tupaia, a legendary Pacific Island navigator who joined Captain Cook’s crew as he sailed through Tahiti in 1769. Using an app called Tupaia MediTrak to collect information from public health facilities, the tool syncs this information with data pulled from the pharmacy software used in each country – mSupply, used in about 30 countries around the world. Tupaia also pulls data from the software used for disease tracking in many countries in the region (using open-source health information software DHIS2) and it presents this information in preconfigured dashboards and map overlays on a public website. Password-enabled access allows higher-level users to see more data but the public can see the location of facilities, the services they provide and their opening hours. So far, the project has mapped all 600 facilities across the six partner countries. ‘Tupaia can be used for a huge range of programs. For example, it provides a map of the fridges in all the health clinics in Solomon Islands, showing whether they are working or not. This can be used by the national cold chain manager there to help plan their annual maintenance schedule,’ mapping team lead Susie Lake said. ‘The EPI program manager in Vanuatu might use it to map the availability of vaccines and pregnant mums might look up the location of the nearest facility that can handle emergency obstetric situations.’ The project is strongly focused on improving access to essential medicines. In Kiribati, Tupaia worked in partnership with mSupply to roll-out a mobile version of the widely used pharmacy software. Ms Mahoney said the current version of mSupply Mobile was launched in 2016 and Australia’s Department of Foreign Affairs and Trade (DFAT) paid for it to be released ‘open-source’ in 2017. ‘This meant countries were able to roll it out more quickly and more widely than was possible before, as there are no longer licensing fees attached to it,’ she said. ‘We started this project to strengthen health supply chains in the Pacific, to make sure that medicines were getting to the right people at the right time – but it has grown to include disaster response, disease tracking, infrastructure, HR – it’s exciting but we’re always keen to do more,’ Ms Lake said. ‘There may be application here in Australia, particularly with recent commentary and events around medicines and vaccine stock-outs but we’ll just have to wait and see.’ Now 12 months old, the Tupaia project has been funded by the innovationXchange, part of the aid program at Australia’s DFAT. The focus on essential medicines in the region comes at a time when antimicrobial resistance, counterfeit medicines and medicines shortages are being recognised as serious regional health threats. [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Navigating South Pacific health care on a sea of data [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => navigating-south-pacific-health-infrastructure-on-a-sea-of-data [to_ping] => [pinged] => [post_modified] => 2018-08-07 12:01:36 [post_modified_gmt] => 2018-08-07 02:01:36 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2442 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Navigating South Pacific health care on a sea of data [title] => Navigating South Pacific health care on a sea of data [href] => https://www.australianpharmacist.com.au/navigating-south-pacific-health-infrastructure-on-a-sea-of-data/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_primary_cat] => 26 [smart_list_template] => td_smart_list_5 ) [is_review:protected] => [post_thumb_id:protected] => 2443 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2191 [post_author] => 2 [post_date] => 2018-07-28 14:00:30 [post_date_gmt] => 2018-07-28 04:00:30 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Pharmacist-led health interventions in Aboriginal communities came under the spotlight at PSA18 in Sydney yesterday, as delegates got early insight into some of the Pharmacy Trial Program (PTP) studies currently underway. The 6CPA allocated $50 million to fund the program, aimed at gathering evidence to expand the role of pharmacy in delivering a wider range of primary healthcare services, with a particular focus on Aboriginal and Torres Strait Islander populations. One trial currently in start-up is the Indigenous Medication Review Service Feasibility Study (IMeRSe), led by Griffith University’s Professor Amanda Wheeler. ‘The overall goal is to improve medication management and health and wellbeing for Aboriginal and Torres Strait Islander people through strengths-based collaborative and culturally appropriate pharmacy service,’ she said. ‘We know that medication reviews are funded but the research told us that for Indigenous people they have problems accessing medication reviews for many reasons. One of those is that talking to a pharmacist at a pharmacy or in their own home may not be a culturally safe space.’ ‘That review service doesn’t involve anyone from the Aboriginal Health Service (AHS) – their trusted person who they work with and knows them so well. Only a GP may refer someone for a Home Medicines Review and that process may take several weeks. ‘They also tend to be a one-off and there is no ability for the pharmacist to check in in a funded way and see how things are going or tackle complex problems over a few months. There is also a lack of integration between pharmacists and Aboriginal Health Services.’ IMeRSe will involve up to 23 pharmacies across Queensland, the Northern Territory and New South Wales, and up to 540 AHS patients. ‘It’s a pharmacy service to promote health and wellbeing by optimising an individual’s medication management through a culturally responsive medication review service,’ Prof Wheeler said. ‘It will be delivered by community pharmacists but they are going to be integrated with Aboriginal Health Services as part of holistic care. We want to enhance existing services.’ With seven patients already recruited, the project is already gathering positive feedback, including from involved GPs.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Greater pharmacist role in Aboriginal health trialled [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => trials-lead-the-way-for-greater-pharmacist-role-in-aboriginal-health [to_ping] => [pinged] => [post_modified] => 2018-07-28 14:01:52 [post_modified_gmt] => 2018-07-28 04:01:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2191 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Greater pharmacist role in Aboriginal health trialled [title] => Greater pharmacist role in Aboriginal health trialled [href] => https://www.australianpharmacist.com.au/trials-lead-the-way-for-greater-pharmacist-role-in-aboriginal-health/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_primary_cat] => 21 ) [is_review:protected] => [post_thumb_id:protected] => 2256 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4119 [post_author] => 11 [post_date] => 2019-02-05 02:01:00 [post_date_gmt] => 2019-02-04 16:01:00 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]The same day Jessica Chapman-Goetz MPS became a registered pharmacist in late 2015 she received a diagnosis for breast cancer. But she wasn’t about to step away from the job she loved, and has come to understand the integral role that pharmacists can play in providing supportive care for oncology patients.
How did you manage your treatment while working as an early career pharmacist?It certainly wasn’t easy, but I made a decision that I wanted to try and limit the impact that breast cancer was going to have on my life. So I would organise treatment on a Friday afternoon, try to be back at work (at TerryWhite Chemmart Grange, in South Australia) by Tuesday, and then I was able to work full-time for about two and a half weeks before the next round of treatment. It was important for my mental health to work during treatment and be surrounded by my co-workers and beautiful community.
In what ways did your personal experience inform how you approach oncology care with patients?As a patient I was observing what information was given at different stages and who provided it. I noticed that quite a lot was lacking. I also noticed that a lot of women were using online breast cancer forums to ask about the management of common chemotherapy adverse effects, and often the answers were not evidence-based. That prompted me to investigate how pharmacists feel about providing supportive care in the community for oncology patients. I found that a lot of community pharmacists feel a bit apprehensive about it because they’re not sure exactly what treatment the person is on, or what it’s for. They more commonly refer to a GP because they feel more comfortable doing so than, say, managing basic mucositis themselves.
You said you noticed that quite a lot was lacking in terms of information. How can pharmacists help fill the gap?Pharmacists can help make sure patients are getting information as they go through their journey, rather than all at once at the time of diagnosis, which is what commonly happens. Along the way, pharmacists can provide support and prompts by saying, ‘Okay, how is your mental health going? Have you thought about calling Cancer Council for services there? How are you going with side effects?’ Also, check what medicine information the oncology team has given the patient and, if there are gaps, offer to provide education from resources like EviQ (www.eviq.org.au). I didn’t receive anything from my oncology unit in terms of printed medication lists, and I know many other patients haven’t either.
What role could pharmacists be playing in assisting with treatment?The biggest gap would be managing what would be termed ‘minor’ adverse effects from chemotherapy, whether it’s oral or intravenous. Often the oncology patient will feel like it’s too minor to bother the oncologist, or they’ll call the oncology nurse which takes them away from caring for inpatients. But often these minor adverse effects are something a pharmacist could really assist with. If patients aren’t managing side effects such as small mouth ulcers, they can progress to the point where they can’t eat. And if you’re having multiple side effects at one time it really doesn’t take much for you to feel like everything’s too much. So pharmacists can make a big difference.
You’re now working as a hospital pharmacist at Flinders Medical Centre in Adelaide, but you’re continuing to explore ways of improving care for oncology patients. How?I’ve done the Cancer Pharmacists Group Foundation Course with the Clinical Oncology Society of Australia (COSA). I could do stage two, which would make it easier for me to work in hospital oncology, but at the moment I don’t know that I want to do it full-time – it’s still a little bit close to home. Instead I’m really enjoying empowering other pharmacists to provide supportive oncology care. I started off with a presentation here in Adelaide just with some peers. I’ve also spoken in Whyalla, Alice Springs and Darwin, and I’m going to be presenting at the TerryWhite Chemmart masterclass in April. I’ve also established connections with the Cancer Council to increase pharmacist involvement in allied healthcare for oncology patients. Photography: Simon Casson [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Inside oncology pharmacy [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => ready-inside-story-oncology-pharmacy [to_ping] => [pinged] => [post_modified] => 2019-02-05 15:01:26 [post_modified_gmt] => 2019-02-05 05:01:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4119 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Inside oncology pharmacy [title] => Inside oncology pharmacy [href] => https://www.australianpharmacist.com.au/ready-inside-story-oncology-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4190 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4116 [post_author] => 130 [post_date] => 2019-02-01 01:55:16 [post_date_gmt] => 2019-01-31 15:55:16 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A key tenet of PSA’s strategic intent is ensuring pharmacists are rewarded and recognised to reflect our high levels of training, our expertise and our contribution to the health system. I know many pharmacists are greatly dissatisfied with how their efforts in improving patient care are currently recognised. Role fulfilment and acknowledgment of our integral place within the healthcare team are important, but many believe pharmacist remuneration is key to increasing professional satisfaction. The funding frameworks used to remunerate pharmacist practice are largely governed by the Community Pharmacy Agreement (CPA). If individual pharmacist remuneration is to increase, we must seek an improvement in the application of the funding within the CPA to ensure a services or consultation model of pharmacy practice is worthy of genuine commitment by the community pharmacy sector. But the CPA should not be seen as the only funding source; we must also look to diversify. The Medicare Benefits Schedule (MBS) presents an obvious funding pool which currently not only finances the services delivered by medical practitioners but an array of nursing and allied health practitioners. Many PSA members have been perplexed and disappointed that pharmacists have not been included through this mechanism. Given the funding freezes and relative low base of reimbursement, the MBS is no silver bullet. But it is a logical adjunct to the CPA. The current review of the MBS provides a unique opportunity to drive this agenda. If we, as a profession, are to make claims of remuneration for services under the MBS, then we need to be specific about what this model might look like, what services should be funded, and how the health system will benefit from this investment. PSA has written to the MBS Review Taskforce, again calling for inclusion of pharmacists as eligible allied health professionals to access MBS items as part of Team Care Arrangements within Chronic Disease Management (CDM) items. We remain highly concerned that pharmacists continue to be the only AHPRA-registered allied health professionals who are not eligible to provide allied health services through the CDM services. This exclusion causes major problems with integration and collaboration in primary care. Given the central role of medicines in the treatment of these patients, this exclusion doesn’t make sense, with the potential for sub-optimal health outcomes. Inclusion of pharmacists (irrespective of setting) as eligible allied health professionals would have minimal, if any, impact on the budget for those MBS items, as GPs can only refer up to a maximum of five items within a 12-month period. But the inclusion of pharmacists as eligible allied health professionals would enable greater flexibility for the GP to engage with pharmacists to support patients with their chronic disease management. Let me be clear: PSA is strongly advocating for inclusion of pharmacists on the MBS. It has been one of our major priorities in 2018, and continues to be so. PSA is highly concerned that pharmacists continue to be the only AHPRA-registered allied health professionals who are not eligible. DR CHRIS FREEMAN FPS BPharm, GDipClinPharm, PhD, AACPA, AdvPracPharm, BCACP, MAICD [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => From the President: Include pharmacists on the Medicare Benefits Schedule [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-medicare-benefits-schedule [to_ping] => [pinged] => [post_modified] => 2019-02-14 09:17:29 [post_modified_gmt] => 2019-02-13 23:17:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4116 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => From the President: Include pharmacists on the Medicare Benefits Schedule [title] => From the President: Include pharmacists on the Medicare Benefits Schedule [href] => https://www.australianpharmacist.com.au/pharmacists-medicare-benefits-schedule/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4117 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3614 [post_author] => 74 [post_date] => 2019-01-10 14:00:59 [post_date_gmt] => 2019-01-10 04:00:59 [post_content] => The new President of the Pharmaceutical Society of Australia (PSA) is Dr Chris Freeman – currently Clinical Senior Lecturer and the Director of the Centre for Optimising Pharmacy Practice-based Excellence in Research (COPPER) at the University of Queensland and Consultant Practice Pharmacist at Camp Hill Healthcare in Brisbane. Chris’ professional contribution began in 2009 when he joined the PSA’s Early Career Pharmacist working group of the Queensland Branch – he was elected Chair soon after. By 2016 he had been elected National Vice President of PSA with significant contributions to the policy, advocacy and innovation at the organisation. His full biography is available here. Australian Pharmacist sat down for a chat soon after his appointment. AP: Congratulations on your new role, Chris. What can you say about those shoes you’re stepping into? CF: It's been an absolute honour to serve as Shane Jackson's Vice President. I've not come across anyone who has invested his level of energy, enthusiasm and commitment – not only to the PSA but to the profession more widely. He has been a passionate advocate for moving the profession forward on a very positive pathway, and he's certainly set the platform for me. I hope I’m able to continue his great work. AP: The trajectory of your career path seems to have been aimed towards this kind of leadership role. CF: An opportunity came up to join the PSA Queensland Branch’s ECP working group and I thought I had something to offer. I felt compelled to try and do something about the issues that pharmacists were facing, rather than sitting on the sidelines. Over time, I found that I also wanted to contribute to the governance of the PSA given my interest in policy and innovation. I love my profession and want to see pharmacists respected and rewarded for the integral role we have in the health system. This continues to drive me today and stepping into the Presidency of the PSA provides me with an opportunity to do just that. AP: Do you still plan to maintain your role as a consultant pharmacist in a general practice setting? CF: Yes, the body of work that I've been focused on recently has been trying to further develop collaborative practice models and the evidence to support those practice models. I've tried to do that by example, not just within my own research work, but also in my own clinical practice. I plan to maintain my clinical activity moving forward – I think it provides a great touchpoint with consumers and a grounding so that I can have an understanding of the things that are going on within the profession. And it's an absolute pleasure to work alongside GPs and other allied health professionals who genuinely believe in interdisciplinary care, where they see a genuine role for pharmacists and community pharmacy in the care of patients. AP: That is a big part of the PSA’s vision for the profession, and will be headlined in the Pharmacists In 2023 launch in March. How would you summarise that vision for the future of pharmacy in Australia? CF: I want to see pharmacists practising to their full scope, filling genuine patient need, and this drives everything that we've done from the PSA point of view. The underlying philosophy is that whenever or wherever a medicine is being used or considered, a pharmacist should be involved to ensure the quality use of that medicine is being considered. This ensures that pharmacists are regarded by consumers, the public, by government and other health professionals as integral members of the healthcare team. Sometimes pharmacists are seen as nice to have but not a necessity. Pharmacists In 2023 will provide the platform from which we can say we are a necessity in the healthcare team. Patient outcomes are improved if pharmacists are provided with opportunities to meaningfully engage with their care and we can do this by delivering that care to our full scope of practice. Pharmacists In 2023 provides the action items – not only for the PSA, but for the profession more widely, to achieve that goal. AP: What are the impediments to achieving these goals? CF: We have to facilitate pharmacists to practise to the best of their ability, and that's done through professional support and tools led by professional organisations such as the PSA. It's through setting standards and enabling quality of practice. It’s also ensuring that we've got the right funding framework to allow pharmacists to meaningfully engage in a model of practice where patients are going to get the most out of the pharmacist’s care. And that might include things like external funding from Primary Health Networks, the Medicare Benefits Schedule (MBS) or it might be related to how the Community Pharmacy Agreement is structured. AP: A bit about yourself. How do you achieve work/life balance? CF: I've got a really young family – a six and a four-year-old. So a lot of my spare time is focused on the children and their activities. I love spending time at home here in Brisbane with them and my wife, and I try to make the most out of that. I've tried to manoeuvre things around my clinical practice as well as my practice at the university to really allow me to still dedicate genuine family time. AP: And if you have any time to yourself? CF: Exercise is my release. When I do get a bit of spare time I'm either out at the gym or on the bike. It gives me some thinking time, too, and is really important for maintaining the energy levels. I'm really focused on trying to maintain that energy in my role as President of the PSA. [post_title] => Meet PSA's new President [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => meet-psas-new-president [to_ping] => [pinged] => [post_modified] => 2019-01-14 13:45:26 [post_modified_gmt] => 2019-01-14 03:45:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3614 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Meet PSA’s new President [title] => Meet PSA’s new President [href] => https://www.australianpharmacist.com.au/meet-psas-new-president/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3622 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3439 [post_author] => 82 [post_date] => 2019-01-04 09:00:50 [post_date_gmt] => 2019-01-03 23:00:50 [post_content] => What happens when emotional pain becomes physical? Dr Anchita Karmakar and clinical pharmacist and PainWISE Director Joyce McSwan explore this concept. When Dr Karmakar lost her daughter, abducted by the child’s father and taken to a foreign country, it began a decade-long quest for justice. ‘As a parent you never imagine that someday, you will not be able to see, hug and love your beautiful children,’ she said. ‘You assume that you will watch your children grow up, go through their milestones and ensure that they have the best shot in life with the support and love you provide for them.’ Dr Karmakar and Ms McSwan have a close working relationship, with Dr Karmakar often referring patients to PainWISE. But unbeknownst to Ms McSwan, Dr Karmakar was suffering from pain of her own. At one point in her journey, Dr Karmakar began to experience tangible, debilitating physical pain in her hand. After having a series of tests including X-Rays for conditions such as carpal tunnel syndrome, no underlying physical causes for the pain were unearthed. ‘We were rather perplexed by her pain condition, because it wasn’t caused by anything physical as such. It turned out that it was actually emotional pain that turned into physical pain,' Ms McSwan said.
How the pain manifestsAccording to Ms McSwan, the progression of this type of pain is insidious. ‘People will complain of a pain of some kind – it could be whole body or limited to a certain limb,’ she said. ‘It has to do with how our brain expresses pain and the regions in the brain where this occurs and more importantly how our brain is massively connected with the rest of the body as a single entity. What has to be acknowledged here is that there are direct neural connections between all our body systems and each feedback and modulate the other. Whether we allow ourselves to be aware of it or not, the psychobiological connection is there and ongoing. And the expression of pain is real. ‘Pain is truly very complex. The neural, blood, and immune pathways between brain and body are tagged with body location information in the somatosensory part of our brain. The involvement of our communication pathways of the spinal cord, brain stem and thalamus, continues to add layers of complexities until the pain experience becomes conscious and grabs our attention. Our nervous system is a true marvel,’ Ms McSwan said. ‘Pain is protective for our survival so this alert can maladapt to stay on high alert. The nervous system, brain and body is just doing the job it is designed to do. And what we have to do is acknowledge that it is there, feel the pain (even if it is unpleasant) and seek treatment supportively to be able to help our system to modulate back again. There are many techniques these days to help with that.’ Ms McSwan said that the typical investigative routes of pain, such as MRIs and X-rays, will not reveal the underlying cause. She said it’s imperative that investigation extends beyond these limited methods. ‘We have to talk to the patients and look at the pain in a broader context, such as finding out when it began and some history of what kind of things were happening around the time the pain response started. ‘In Dr Karmakar’s case, we couldn’t see anything in the conventional tests, but the pain was incredibly real. On the hand she had the pain in, she used to wear a ring associated with her daughter. So, the emotional pain was expressed in that hand, almost to the finger that she wore it on,’ Ms McSwan said. Once they worked out that it was emotional pain, the underlying trauma needed to be dealt with through therapy. Dr Karmakar’s recovery is ongoing, but she has healed through writing the book – and proven that despite the distress and despair she experienced, she could use the pain for greater good. She hopes it will help others who are faced with emotional pain that presents physically to be validated, acknowledged and assisted without judgement, Ms McSwan said.
Working togetherMs McSwan said that it’s important for doctors and physicians to collaborate through patients, and that in her experience, doctors appreciate the support in their understanding of pharmacology and pain management. It is simply impossible to manage such complex care needs on their own. ‘If they know your intention of care, they value that support. It’s vital to communicate – but it takes an investment of time and effort to cultivate these relationships,’ she said. It all comes down to picking up the phone and figuring out the best way to communicate in order to express a concern, Ms McSwan said. When faced with a patient that has complex care needs, she recommended asking them who their doctor is so everyone involved in their care can be on the same page and can express any concerns. The initial effort expended saves time in the long run. It’s equally important to bear in mind that pain is subjective, and that’s it’s vital to listen to patients, she said. ‘There are some good assessments that we as pharmacists can do – for example, asking patients about daily function, their barriers and their limitations. Before long, you will get a good idea of how pain is affecting their lives. If they say they have been screened and nothing indicates a reason for the physical pain, that's when it’s time to help them unpack some of their thoughts and emotions about the pain experience.’ Assessing the ‘yellow flags’ will highlight some important aspects of the patient’s beliefs about their pain. Catastrophisation or rumination, for example, will slow down healing process, Ms McSwan said. She also said that it’s important not to judge, but to be empathetic, and recommended finding a psychologist that they can collaborate with and link the patient to. Patients who are taking analgesics for their physical pain will achieve so much more when it is combined with emotional support. Through the rapport pharmacists have with their patients, they can really help to facilitate the patient’s confidence to engage with this support. ‘Being able to use the right language to help the patient understand their pain is vital. Rather than saying, “I think you need to see a psychologist for your pain”, which can send the wrong message that you think their pain is in their head, perhaps let them know that the way they think about their pain can affect how they experience their pain. A psychologist can teach them some helpful tools on how to influence this.’ For further information on pain management, pharmacists can refer to PSA’s Chronic Pain MedsCheck CPD modules (Identifying patients and Using a chronic pain MedsCheck). Joyce McSwan and Anchita Karmakar have authored the book, ‘With or Without your Smile’. [post_title] => The connection between emotional and physical pain [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => connection-emotional-physical-pain [to_ping] => [pinged] => [post_modified] => 2019-01-08 11:09:19 [post_modified_gmt] => 2019-01-08 01:09:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3439 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The connection between emotional and physical pain [title] => The connection between emotional and physical pain [href] => https://www.australianpharmacist.com.au/connection-emotional-physical-pain/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3443 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3148 [post_author] => 74 [post_date] => 2018-11-30 09:30:04 [post_date_gmt] => 2018-11-29 23:30:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Ravi Sharma’s credentials in pharmacy are formidable. Recently appointed the Royal Pharmaceutical Society’s (RPS’s) director for England, he was also National Clinical Lead for Clinical Pharmacy and Genomics for the National Health Service (NHS) while holding several honouree and advisory positions. His key role has been focussed on the development of integrated/collaborative and innovative roles for pharmacists. He has published several articles in reputable journals and is involved in several research projects around the impact of clinical pharmacy within primary care. He was recently invited to Australia on a speaking tour by PSA to share his insights, research and inspiration. Before his departure, Australian Pharmacist sat down with him to discover his impressions of Australian pharmacy – and what we need to do to catch up. You were here in 2015 on a speaking tour. What changes are you noticing in the pharmacy landscape in Australia between then and now? I’m really seeing some traction around integration and collaborative working. I’ve had some very interesting days catching up with internal and external healthcare stakeholders. I think there is now more open dialogue between the PSA and various healthcare organisations on the role and the clinical contributions that pharmacists can make being part of collaborative and integrated multidisciplinary teams – utilising the pharmacist’s expertise in medicines to help improve patient care and safety, and ensuring people get the best out of their medicines. Integrated care and collaborative care are what I’m truly passionate about, and I feel that here in Australia it’s starting to be acknowledged that there is evidence out there. We’re not here in a silo, we’re here to work collaboratively as a team using pharmacists’ expertise. These teams will drive improvements in the healthcare system and most importantly patient quality of life. You appear to be leading the way in the UK in the advancement of pharmacists’ roles and the integration of pharmacists into various models of primary care. How far behind is Australia? I think it is fair to say there’s growing recognition and body of evidence around non-prescribing and prescribing pharmacists’ contribution to healthcare. The UK has been on a real journey to enable some of those models of care and practices to develop. In the UK we are currently focussing on medicines value and safety. In the last five years there has been a real change in the landscape to enable greater multidisciplinary working to ensure members of the public get the best use out of their medicines. Subsequently, this has opened the door for pharmacists to go into many new and exciting roles. We are not only seeing pharmacists work in community, hospital, industry or academia. We’re seeing non-dispensing pharmacist roles in general practice, aged care settings, urgent care, mental health services, prison services, and other community services such as homeless care or social care. Many of which are pharmacist prescribers. We are evaluating the impacts that many of these roles have on patient care and how they benefit the wider healthcare system. I believe PSA are and continue to be strong advocates for positive change in the pharmacy profession in Australia. I see many new roles opening for pharmacists here, particularly in general practice and aged care settings. I am positive that in the future there will be many opportunities for pharmacists to be able to collaboratively prescribe within integrated teams alongside our medical colleagues. Have you been able to discern the biggest obstacles to these advances in Australia? It is important for healthcare professionals and the public to understand the knowledge and skills that pharmacists have. We undergo a significant amount of training in medicines and the application of medicines in real-life clinical practice. Furthermore, there is a growing evidence base showcasing the impacts that pharmacists can make on improving the delivery of care, improving patient care and safety, improving access to the medicines at the right time for the right individuals while improving greater collaborative multidisciplinary working between healthcare professionals. We do need to work on changing the culture, perceptions and behaviours of other healthcare professionals and help them understand the value that pharmacists bring to the management of people’s care. Upon reflection, there’s something about the contracting and payment mechanism in Australia that is very different to the UK mechanisms. The UK mechanisms of funding and contracting enables greater collaborative and integrated working with multiple healthcare professionals. If that was to happen in Australia, I think it would enable further forward-thinking conversations around pharmacist role extension and collaborative prescribing. What about yourself? Was there any single episode or patient interaction where you realised you could really advance pharmacy? When working in general practice you have access to patient medical records, their histories and pathologies such as blood tests. I soon could see how I could make a huge difference to care by ensuring people were being prescribed the best medicines for their conditions. One episode that comes to mind; I had a 65-year-old patient who was on three antihypertensive medicines. They had been on these medicines for a number of years. The patient came in for a clinical medication review with me in the GP practice. During the review, I measured his blood pressure and it was extremely low, something like 80/42 mmHg, suggesting that he was being overprescribed his current medication. I was able to go through his medications and overall care in detail. He had clear signs and symptoms of hypotension and was at potential risk of falls. I suggested to the patient it would be appropriate to take them off one or two of his medications. I initially started off by taking off one of the antihypertensive medications and the plan was to follow him up within the next coming days. The patient was happy with the approach. Obviously working as part of the general practice team I can speak to the doctor about these decisions, but generally, the doctors appreciate that pharmacists know lots about medications and trust us to help improve patient care on a day-to-day basis. After deprescribing one of the medicines, I followed up with the patient a week later and the blood pressure had improved to around 100/60 mmHg. I then decide to titrate the second antihypertensive medication down (i.e. a lower dose) and followed up the patient a week later. The patient returned with a blood pressure reading of around 120/75. The patient’s signs and symptoms of hypotension had resolved completely. Not only did the patient enjoy the conversation and approach to their care, the doctors were impressed by the pharmacist’s ability to manage, monitor and review the patients long-term condition. I reflected on this one example and thought to myself, ‘This is me being an autonomous clinician with the support of a collaborative environment. The patient’s symptoms have been alleviated. I had monitored the patient, I’d reviewed their medications; I was able to educate the patient on their medicines and on how to take them. It was a detailed consultation that my GP colleagues respected – they really saw my ability to contribute.’’ There’s also work that I and my team of pharmacists have done in GP practices around complex polypharmacy – people on loads of medicines with lots of comorbidities, going through those medicines in detail and seeing if all of them are needed. And we’ve done some great work around patient safety deprescribing, as well as reducing medicine-related errors in general practice. As an undergraduate, I really wanted to do this type of work. I’d learned about medicines, I’d learned about how they work. I’d applied my clinical knowledge, and this was unleashing that potential. It enabled me to work with colleagues around a person-centred approach to healthcare. What advice would you give an early career pharmacist about their future? I would tell them their profession is getting very exciting. Some advice I would give:
Overall, be the change you want to see in the profession. I have met with some early career pharmacists during my trip and have been amazed by their enthusiasm, their vision for change and their will to make a difference to patient care. That’s the leadership we should be embracing and elevating. I am confident that the future of pharmacy in Australia is in safe hands. What do you see are the most exciting new realms of pharmacy? I would like pharmacists involved with collaborative prescribing – the ability to work as part of a team to improve patient care. The PSA has said that they want this happening by 2020. This holds great opportunity – to develop your clinical skills, to enable greater collaborative working with doctors, to work at the top of your scope, but also enhance your skills to extend your scope of practice. That is really exciting. Other areas in the future? Artificial intelligence, digital medicine and genomics, particularly pharmacogenomics – being able to personalise medicines based on a person’s genomic makeup. This holds real opportunities for the pharmacy profession to ensure people get the best use of their medicines. We are the experts in medicine after all.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Royal Pharmaceutical Society director on the future of pharmacy [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => royal-pharmaceutical-societys-director-on-the-future-of-pharmacy [to_ping] => [pinged] => [post_modified] => 2018-11-30 09:34:37 [post_modified_gmt] => 2018-11-29 23:34:37 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3148 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Royal Pharmaceutical Society director on the future of pharmacy [title] => Royal Pharmaceutical Society director on the future of pharmacy [href] => https://www.australianpharmacist.com.au/royal-pharmaceutical-societys-director-on-the-future-of-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3149 )
- Make sure you always put patient care first.
- Collaborate and work alongside other healthcare professionals. Be open and inclusive to those discussions.
- Develop your network in and outside of pharmacy. Many opportunities can come from broadening your network and connecting with new like-minded people.
- Seek new opportunities that goes beyond the traditional role of pharmacists e.g. artificial intelligence, genomics, health informatics and digital healthcare.
- Never burn bridges or ruin relationships. You never know when you will need work with people in the future.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.