td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6970 [post_author] => 82 [post_date] => 2019-07-18 11:32:30 [post_date_gmt] => 2019-07-18 01:32:30 [post_content] => A new report investigating polypharmacy among older Australians emphasises the need for greater pharmacist involvement in medicine management. The report, led by the University of Western Australia and University of New South Wales, estimated rates of polypharmacy in people aged 70 and older across an 11-year period (2006–2017) after analysing Pharmaceutical Benefits Scheme data. In 2017, the authors found that 36% (935,240) of older Australians were impacted by continuous polypharmacy, where five or more medicines are dispensed to an individual concurrently. Rates of polypharmacy were higher among women than in men (36.6% versus 35.4%) and highest in patients aged aged 80–84 years (43.9%) or 85–89 years (46%). Older Australians had higher rates of polypharmacy than previous research had found for older people in the United Kingdom and the United States. The report found that the proportion of older people using polypharmacy had risen by 9% since 2006. The study’s lead author, Dr Amy Page, PSA Victorian Branch Committee Member, Adjunct Research Fellow at Monash University and Adjunct Senior Lecturer at the University of Western Australia, said: ‘The increase in polypharmacy can partially be attributed to the fact that more people are living into older age, which is obviously a wonderful thing. But we were also able to show that the prevalence of polypharmacy was increasing as well, which is not such a wonderful thing.’ While polypharmacy may be appropriate in some instances, careful medicine management to mitigate the risk of adverse health outcomes in older patients is necessary found the report, funded by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Medicines & Ageing, led by Professor Andrew McLachlan.
Pharmacist involvementPSA National President Dr Chris Freeman said the report highlighted the need for pharmacists to have greater involvement in medicine management. ‘As the report states, older people are likely to be using several medicines at once, which places them at greater risk of medicine-related harm,’ Dr Freeman said. ‘It is therefore vital that all people taking multiple medicines have regular medicine reviews with the added ability for the pharmacist to follow up with the patient as clinically indicated. Pharmacists, with their unique expertise in medicines and medicine management, are the best placed to conduct these reviews to identify and resolve any issues.’ The consequences of inaction were detailed in PSA’s Medicine Safety: Take Care report, which found that:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6861 [post_author] => 76 [post_date] => 2019-07-17 10:25:23 [post_date_gmt] => 2019-07-17 00:25:23 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Healthcare professionals have reaffirmed the importance of vaccines this flu season, after the mutation of the H3N2 strain rendered some vaccines less effective. A spokesperson for the World Health Organisation Influenza Centre recently confirmed that the strain, which is one of several in circulation, has mutated. But pharmacist and senior lecturer at the University of Canberra, Dr Mary Bushell MPS, told Australian Pharmacist that a flu virus mutating is not unusual. ‘Influenza viruses are constantly changing, due to gradual drifts in influenza surface antigens. Such drift is the major reason for seasonal epidemics and the rationale behind changing the influenza vaccine composition each year,’ she said. While Dr Bushell noted that most cases of the flu this year have been a match for the subtypes in current vaccines, approximately 20% of H3N2 cases are not ‘matched’, meaning that vaccines may be less effective in some people. ‘This is causing concern as we are seeing an increase in the incidence of this subtype of flu when compared to last year,’ she said. Furthermore, Dr Bushell said that the H3N2 strain can be more severe than other strains of influenza, and cause more deaths and complications – including pneumonia. Even so, she emphasised the ongoing importance of the flu vaccine, pointing out that the ‘majority’ of H1N1, H3N2 and influenza B cases reported have been antigenically matched to the vaccine. She also noted that the vaccine can be helpful, even in cases where an individual is infected with the mutated strain. ‘Annual vaccination remains the best protection against the flu. If getting the vaccine doesn’t prevent an individual from getting sick, it has been shown that it reduces the severity of illness,’ she said. Dr Bushell urged pharmacists to remind consumers that, while flu season is underway, they can still receive their vaccine. She said this is particularly important for people in at-risk groups, including the elderly and the very young. She also noted that pharmacists can remind their consumers of lifestyle factors that can reduce an individual’s chance of contracting the flu – including regular hand washing, avoiding touching their eyes, nose and mouth, covering their mouth and nose when coughing or sneezing, and disposing of tissues properly. For more information about managing influenza, refer to the recent CPD article, colds and influenza. [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Pharmacists reaffirm need to vaccinate, as flu strain mutates [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-reaffirm-need-to-vaccinate-as-flu-strain-mutates [to_ping] => [pinged] => [post_modified] => 2019-07-17 10:52:58 [post_modified_gmt] => 2019-07-17 00:52:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6861 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists reaffirm need to vaccinate, as flu strain mutates [title] => Pharmacists reaffirm need to vaccinate, as flu strain mutates [href] => https://www.australianpharmacist.com.au/pharmacists-reaffirm-need-to-vaccinate-as-flu-strain-mutates/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6862 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6901 [post_author] => 82 [post_date] => 2019-07-16 12:01:05 [post_date_gmt] => 2019-07-16 02:01:05 [post_content] => There is limited research on the effectiveness of pharmacotherapy in treating in children with chronic pain. So what is the best approach and how can pharmacists help? Approximately 25% of children and adolescents experience chronic pain, with around 5% describing this pain as debilitating. While pharmacotherapy is often the first-line treatment option in chronic pain in adults, a recent systematic review and meta-analysis found that there is little evidence for its efficacy and safety in children with chronic non-cancer pain (CNCP).1 The authors of the review paper indicated that this is partially due to the lack of clinical trials in children with chronic pain. There are ethical considerations to withholding medications from children experiencing pain, however analgesics are often prescribed to children with CNCP or chronic cancer-related pain (CCRP) – relying on evidence from adult-based studies. Researchers analysed reviews from the Cochrane Database of Systematic Reviews, Medline and Medline in process, EMBASE and DARE up until March 2018. In total 23 systematic reviews investigating children with CNCP and CCRP were included for analysis. Of the seven reviews included, six trials that involved children with CNCP; there were no randomised controlled trials relating to the reduction of CCRP. Although there is a lack of evidence, the authors acknowledged that children with CNCP or CCRP should not be denied potential pain relief.1 The authors suggested that there is a need to establish national or transnational registries focusing on analgesic medicines specific to patients with chronic pain to better capture benefits, harms and harm reduction. Furthermore, they recognise that barriers to evidence production in childhood chronic pain need to be better understood and that clinical trials, including alternative randomised controlled trial methods, need to be better integrated into routine clinical care.1
Pain management in practiceDebbie Rigby, Consultant Clinical Pharmacist and Chair of the NPS MedicineWise Board Audit and Risk Committee, said that when faced with a lack of evidence, pharmacists should consult the best available evidence such as Australian Medicines Handbook Children's Dosing Companion and the Therapeutic Guidelines. Ms Rigby conceded that it can be difficult to ethically and morally conduct randomised controlled trials in children and that there are challenges in terms of the relatively high placebo effect when treating CNCP (30–50% in adults). Pharmacist and pain expert Joyce McSwan said that because of the high potency of medicines, the exposure rate in children tends to be relatively low. Conducting an evidence trial in itself is also difficult in terms of subject selection. ‘We don’t yet know the pharmacodynamics (of all medicines in) ...children – how they are going to react to medications or whether their genetic make-up has an impact,’ Ms McSwan said. ‘Because you have a very tender subject, it makes it hard to collect that sort of information.’ In terms of treatment, Ms McSwan said that – particularly in children – a non-pharmacological approach is firstline. ‘Of course this is not to deny pharmacological management, either with opioids or simple analgesics, if necessary – but reducing the use of opioids is optimum. Simple analgesics are the frontline pharmacological treatment for chronic pain in children.’
Advice for pharmacistsChildren who experience chronic pain need specialist help, Ms McSwan said. ‘They need to enter pain programs specifically designed for children. It’s not something I think primary healthcare can treat very well. Intensive allied health support via public or private hospital care is really important here.’ These programs are under-resourced, however, with only 12 services available across Australia. Ms McSwan said pharmacists should refer children to services, such as the Royal Children’s Hospital (RCH) in Melbourne or SKiP programs (support kids in chronic pain) – started by a paediatric pain specialist – which run holiday education camp programs for young chronic pain sufferers. Online resources such as Pain, Pain, Go Away: Helping Children With Pain can also help. If pharmacists see that patients are using too much simple analgesia, taking antihistamines to sleep or being prescribed pain medicine copiously, they should identify why, she said.
The pharmacist and motherRuth Parker is a pharmacist who is also the mother of a daughter with chronic pain and knows firsthand the struggles faced by children and parents alike. ‘My daughter has CRPS (complex regional pain syndrome). She had a fracture when she was four, she’s now 11. The manifestations of the CRPS didn’t actually come out until about three years after the injury. Her foot changed colour, the sensation of hot and cold was skewed, and it was painful even to the lightest touch.’ When the symptoms appeared, Ms Parker sought clinical care. ‘We saw the children’s hospital and they diagnosed her with CRPS. Initially she began treatment on gabapentin as a trial which I wasn’t that comfortable with, not knowing how she would react, as children don’t react in the same way as adults to medication. ‘I was interested in other methods for treating the pain, so with the help of an occupational therapist (OT) and physiotherapist, we used mirror box therapy. There’s a lot of psychosocial elements associated with pain, particularly in children where it often comes about through an emotional state.’ Ms Parker said they relied more on psychological rather than pharmacological treatment to treat her daughter’s pain. ‘She only stayed on gabapentin for a short period of time before we realised it wasn’t really changing her condition and she responded best to behavioural therapy. ‘We also tried a technique called craniosacral therapy (CST), an osteopathy technique that gently manipulates the central nervous system, which helps to settle the trauma and the child to relax.’ In terms of pharmacist advice to patients, Ms Parker said that validation is key. If the child is showing behavioural signs of being in pain, it’s important for parents to validate, but not catastrophise, the pain – which could actually set off the child. She said that pharmacological treatment should be offered where appropriate, but it’s important to let parents know that there are many other options available. Collaborative pain groups in hospitals such as the RCH incorporate a psychiatrist, psychologist an OT and physiotherapist. ‘They all sit down and consult with you on the same day, gather all the information and formulate the best strategy,’ Ms Parker said. ‘It’s best to refer complex patients onto pain clinics that specialise in paediatrics.’ Discussing the benefits of behavioral therapy for children is also key. Children are the perfect candidates for this method of treatment, Ms Parker said, as they learn faster and are more open to new experiences than adults, whose belief system can be a limitation. ‘Encourage parents to be compassionate to both themselves and the child, because it can be quite a terrifying situation,’ she said. ‘While my daughter is not going through pain now, we are acutely aware that when she does, it can go from 1–10 very quickly unless we go back through the techniques that we’ve learned.’ References
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- Eccleston C et al. Pharmacological interventions for chronic pain in children: an overview of systematic reviews. The Journal of the International Association for the Study of Pain. June 1029. At: https://journals.lww.com/pain/Abstract/publishahead/Pharmacological_interventions_for_chronic_pain_in.98682.aspx
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6864 [post_author] => 76 [post_date] => 2019-07-16 10:49:10 [post_date_gmt] => 2019-07-16 00:49:10 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A new study suggests that consumer-generated health data (CGHD) could empower patients, improve health outcomes, and reduce instances of self-diagnosis online. The Australian research examined the efficacy of CGHD using a 2-study research agenda. The first component of the research, ‘study 1’ conducted semi-structured interviews with 60 patients, carers and healthcare practitioners who used consumer-generated photography throughout the course of their treatment.1 Meanwhile in study 2, researchers trained 30 parents of children undergoing laparoscopic appendectomy surgeries to take photographs of their children’s surgical site wounds every two days and email them to the staff for the 10 days after the procedure. They then conducted interviews with the parents.1 The data collected from both studies indicated that CGHD could have a positive impact on treatment. An analysis of responses indicated that it aided healthcare practitioners in diagnosis and management, improve communication, and can reduce unnecessary consultations.1 Researchers also said that CGHD improved communication between healthcare providers and patients. ‘CGHD is another tool to manage the patient journey, allowing providers an opportunity to assure consumers that healing is occurring,’ the report read.1 Patients also responded positively to the use of CGHD, reporting that it helped them to make sense of their condition, instigated a greater sense of personal responsibility for their healthcare outcomes and helped to promote healthy behaviours.1 Researchers noted that healthcare practitioners willingness to embrace CGHD could reduce patients’ impulses to self-diagnose online.1 ‘Prescribing data collection may reduce instances of self-diagnosis. If data are supported then it can lead to higher service satisfaction, higher service confidence, and an improved therapeutic relationship,’ the report read. 1 While healthcare practitioners said that they would be reluctant to diagnose a condition based only on CGHD, they said that it could be useful for treating patients in rural areas where access to in-person healthcare is limited.1 Pharmaceutical Society of Australia Project Pharmacist Jarrod McMaugh said that the idea of CGHD is not new, but the ready availability to high-quality photos through camera phones has allowed for increasingly high quality data, that is easy for patients to generate. ‘At its core, all information provided by the patient is “consumer-generated,” the difference is, people are now recording this information rather than relying on recall, so in some instances it is more reliable,’ he told Australian Pharmacist. Mr McMaugh, who is also on an International Pharmaceutical Federation working group examining digital health, said that photographs are particularly useful, as they allow pharmacists to observe changes in a patient's condition. He pointed to rashes, lesions and erythema, for example, which can be photographed multiple times over the course of several days. However, he noted that not all CGHD is clinically useful. Devices that track steps, heart rate and sleeping patterns, for example, can be useful for looking at general behavioural trends, but are not always accurate. Even so, he said that CGHD can be highly useful for both patients and pharmacists, when it is managed correctly. ‘Overall, anything a person does to capture data that can help a pharmacist answer their health questions is good, but context is always important, and part of the pharmacists role in these situations is tempering a person’s expectations for the usefulness of some consumer generated data,’ he said. References:
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Consumer-generated data could improve health outcomes [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => consumer-generated-data-could-improve-health-outcomes [to_ping] => [pinged] => [post_modified] => 2019-07-17 10:51:32 [post_modified_gmt] => 2019-07-17 00:51:32 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6864 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Consumer-generated data could improve health outcomes [title] => Consumer-generated data could improve health outcomes [href] => https://www.australianpharmacist.com.au/consumer-generated-data-could-improve-health-outcomes/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6865 )
- Burns K, McBride CA, Patel B, FitzGerald G, Mathews S, Drennan J. Creating Consumer-Generated Health Data: Interviews and a Pilot Trial Exploring How and Why Patients Engage. J Med Internet Res 2019;21(6). At: https://www.jmir.org/2019/6/e12367/
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6913 [post_author] => 10 [post_date] => 2019-07-16 09:34:24 [post_date_gmt] => 2019-07-15 23:34:24 [post_content] => Point-of-care testing is expanding as community pharmacies deepen their engagement with consumers. With more than 5,700 locations dotted across Australia, ranging from the busiest metropolitan high streets to tiny rural hamlets, Australia’s community pharmacists are undeniably the most accessible of all healthcare professionals in this country. This accessibility underpins the increased uptake of point-of-care testing (PoCT) in community pharmacy in recent years, as many pharmacies use their reach and convenience to expand their services. It has been a natural progression. Advances in technology and design have made these tests more efficient, portable and practical; through their implementation, pharmacists have sought to contribute to the health of their communities through screening, monitoring and engagement with consumers. It is an expanding sphere of pharmacists’ work that falls well within their scope of practice. Community pharmacies can now measure everything from blood pressure to international normalised ratios (INRs), from HbA1c and blood glucose monitoring and cholesterol studies to COPD screening with PiKO testing of FEV1/FEV. The case for the expansion of PoCT in community pharmacies is clear, with a raft of evidence supporting improved patient outcomes as a result. A 2018 literature review found ‘sufficient evidence for the ectiveness of most of the pharmacy services reviewed’.1 A recent trial, the Pharmacy Diabetes Screening Trial, saw PoCT used for diabetes screening with over 30,000 patients at community pharmacies around Australia. The University of Canberra’s Head of Pharmacy, Dr Mark Naunton, was part of the team behind the trial. ‘In our recent systematic review of the analytical quality and effectiveness of PoCT in community pharmacies, we found that for point-of-care tests there was satisfactory analytical quality and that the interventions applying these tests were effective overall,’ Dr Naunton says.
Collaborative careThe PoCT and screening services offered by pharmacists don’t exist in a vacuum. Patients have general practitioners (GPs) and other specialists involved in their healthcare, and with concerns over the fragmenting of healthcare it is deemed vital that community pharmacy PoCT is integrated with a patient’s overall healthcare. In fact, Dr Naunton sees PoCT as an opportunity for pharmacists to deepen their collaboration with other healthcare professionals rather than a fragmentary pressure. Evidence from recent PoCT research shows that strong relationships with other healthcare providers facilitate pharmacy PoCT. Services can be enhanced by interlinking and integrating pharmacy PoCT with care provided by GPs and other health professionals. Rosy Tirimacco is network operations and research manager with Integrated Cardiovascular Clinical Network South Australia (SA) and Chair of the PoCT committee at the Australasian Association of Clinical Biochemists (AACB). Ms Tirimacco sees pharmacies as ideally placed to monitor INR levels and chronic disease but emphasises the need for them to be well connected with general practice. ‘If a pharmacist is just doing PoCT and results just go to their database and aren’t shared, that is an issue. Doctors should have easy access to any information regarding their patients’ medical history,’ she says. Country Health SA Local Health Network has a database where results from home monitoring programs are available to local GPs, and Ms Tirimacco says it’s important that pharmacy PoCT be incorporated in such systems. Tirimacco has proposed a collaborative model with pharmacists providing PoCT. If a test result is normal, a patient can be scheduled for their next test and results are sent to a portal available to local health professionals. If a result is abnormal, pharmacists can contact a GP for an appointment to review results. ‘There is a huge space in this area in terms of screening and undiagnosed diabetes. If we all worked together, we could probably do a way better job than we currently are,’ Ms Tirimacco says. It’s an approach outlined in PSA’s Pharmacists in 2023 report, which emphasises the importance of collaborative care teams, whether in the same location, or through the use of digital technology. Ms Tirimacco argues that a secure, digital data-sharing system would be vital to such a model. My Health Record (MHR) could be the basis for such a system, for those who actually have a MHR. Recent work by the Australian Digital Health Agency is ensuring the interoperability of various digital messaging and referral systems, making them another possible avenue for pharmacists to share PoCT results with GPs and others. For those pharmacists looking to offer PoCT, Ms Tirimacco draws attention to the Australian Point-of-Care Practitioners Network (APPN) website. Originally funded by the Federal Government, the AACB now maintains the website. ‘It’s an online resource for training and competency,’ says Ms Tirimacco. The site provides checklists for determining the need for a PoCT service, flowcharts and resources to help pharmacists and others implement a PoCT service, quality guidelines and quality control logs, and PoCT device reviews. Importantly, the site also provides training resources for providers and staff. ‘It’s a way of doing training for your devices with minimal cost. You don’t have to go to a two-or three-day course. You can just do it online and you’ll get a certificate to say that you can use that machine,’ says Ms Tirimacco. Before launching PoCT services, it’s important to be connected with GPs and clinics, and to research what other local pharmacies are doing. Services can be advertised as long as they comply with Pharmacy Board of Australia guidelines.
Funding the futureIn Action 6 of the 2023 report, PSA identified the opportunity to build upon the accessibility of community pharmacies in primary care to improve consumer access to health services; as part of this goal, PSA has called for practice change and funding to support evidence-based screening and risk assessment for priority health areas for at-risk populations. ‘Community pharmacists have played a key role in managing patients’ health concerns by using their clinical training to ‘assess then treat or refer’ based on the patient’s needs. This contribution provides timely access to care and reduces the burden on general practice and hospitals. Working collaboratively with general practice and Primary Health Networks will ensure that these services are integrated into local practice environments. ‘Now and in the future, consumers will continue to seek accessible and convenient care. Community pharmacies differentiating as primary healthcare hubs within their communities and offering a broad range of healthcare services will facilitate how pharmacists in 2023 contribute to accessible, safe, quality, efficient and effective healthcare.’ System changes are also identified in the report: ‘Practice change and funding to support evidence-based screening and risk assessment for priority health areas for at-risk populations. National screening and risk assessment initiatives should be identified that are appropriate to community pharmacy to identify individuals at risk of specific conditions, and either manage, or refer care along an agreed management pathway.’ It’s a call for ‘better utilisation of pharmacists to proactively tackle public population health priorities ... and implement health prevention and treatment strategies.’ A vital direction to take in these testing times. PSA offers a comprehensive online diabetes course that covers topics related to PoCT. PSA members can access the full course for $300. References
1. Buss V, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. At: https://joppp.biomedcentral.com/articles/10.1186/s40545-018-0149-7[post_title] => The growing importance of point-of-care testing [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => growing-importance-point-of-care-testing [to_ping] => [pinged] => [post_modified] => 2019-07-16 18:37:21 [post_modified_gmt] => 2019-07-16 08:37:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6913 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The growing importance of point-of-care testing [title] => The growing importance of point-of-care testing [href] => https://www.australianpharmacist.com.au/growing-importance-point-of-care-testing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6916 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6441 [post_author] => 76 [post_date] => 2019-07-12 10:20:59 [post_date_gmt] => 2019-07-12 00:20:59 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]While most women experience primary dysmenorrheoa (period pain), a recent longitudinal study has revealed the extent of its impact on the academic, social and professional lives of young women. The Australian retrospective study analysed data on dysmenorrheoa in women with mean ages between 13–23 years from 37 studies. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline, Embase and PsychINFO was carried out, and in total, 20,813 women were included in the meta-analysis.1 Primary dysmenorrhoea is the presence of pain during menstruation without an underlying pathology. Secondary dysmenorrhoea is menstrual pain associated with an identifiable cause. Armour et al found that dysmenorrhoea affects 70.8% of young women, regardless of their geographical location, and can impact their education. A significant amount (20%) of young women reported absences from school as a result of menstrual symptoms and 40% reported that classroom performance was negatively affected.1 The authors noted that dysmenorrhea can impact young women in their late teens – a crucial point in their academic lives – potentially impacting on opportunities in tertiary education as well as future career prospects.1 In over one third of women (37%), dysmenorrhoea resulted in a reduction in social and sporting activities. In an article for The Conversation, the authors of the study emphasised the importance of these activities for overall good health in adolescence.1 Misinformation Despite the impact and prevalence of dysmenorrhea, researchers found that many women reported a reluctance to seek help from healthcare professionals, believing that their symptoms were ‘normal, and therefore not worth reporting’.1 Sexual Health Physician and Director of the Master of Women’s Health Medicine Degree at the University of New South Wales, Dr Therese Foran, noted that this perception is often compounded by generational misinformation surrounding both the severity of symptoms and treatment. ‘Young women’s perceptions may be reinforced by surrounding mothers and older women who may have had significant period pain themselves when they were adolescents, but found that it settled as they got older – the underlying message being that it will get better if you just wait it out. Some of these women and their mothers may even be reluctant to consider measures such as the oral contraceptive pill or nonsteroidal anti-inflammatory drugs (NSAIDs) because of concerns about side-effects and complications,’ she told Australian Pharmacist. Furthermore, researchers said their findings did not indicate a reduction in symptoms of dysmenorrhea over time and noted that ‘a significant proportion of women with severe dysmenorrhoea may go on to develop more persistent pelvic pain.1 Dr Foran said that these persistent mistaken perceptions can prevent women from seeking necessary treatment. In order to improve health outcomes, she reinforced the researcher’s conclusion that the commonality of primary dysmenorrhea should not stop women seeking treatment. ‘While primary dysmenorrhoea is normal, pain so severe that you have to miss school or work is not, and the effects both on the young woman and her future should not be minimised or accepted,’ she said. Community pharmacist Taren Gill told Australian Pharmacist that community events, such as Women’s Health Week – where members of the community are invited to access their community pharmacists and discuss a range of issues relating to women’s health, including menstruation and dysmenorrhoea – can increase community knowledge about symptoms and treatment. Treatment Ms Gill said that the accessibility of pharmacists, as well as their access to effective over the counter medicines, makes them are ideally placed to support women experiencing dysmenorrhoea. Dr Foran emphasised that by validating their symptoms, pharmacists are in a strong position to support women; previous research indicates that many women report their pain being dismissed by family, partners and healthcare providers. While researchers noted in the Conversation article that there is no ‘one-size-fits-all approach’ to treating the symptoms of primary dysmenorrhea, there are a number of ways that symptoms can be alleviated. Dr Foran echoed this, pointing to NSAIDs as an ‘obvious starting point,’ providing there are no contraindications. She noted that it can be useful to advise patients to take NSAIDs regularly for the first few days of the period, not just if pain becomes intolerable. ‘The object here is reduction of inflammation not just analgesia,’ she said. She also noted that pharmacists can be a valuable voice in validating the need for patients to see a GP if NSAIDs are ineffective, or pain extends beyond the standard symptoms of primary dysmenorrhoea. This can be necessary if, for example, pain continues throughout menstruation, bleeding between periods, associated fever or pain with intercourse or defecation. Ms Gill agreed, noting a depressed mood or migraines around the time of menstruation can also suggest that the patient should be referred to their GP for additional support. To this end, Dr Foran noted that it is often valuable for pharmacists to keep a list of local ‘youth friendly’ GPs, who are willing to bulk bill people who come to their practice. Furthermore, noting the prevalence of generational misinformation about primary dysmenorrhoea, she said that it is worth reminding young patients that they can get their own Medicare card at 15 years of age so that they can ‘start taking control of their own health issues’. Hear more from Dr Therese Foran at PSA19, held in Sydney from 26–28 July. Register here to attend. References:
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- Armour M, Parry K, Manohar N et al. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. Journal of Women’s Health 2019. Epub 2019 June 6. At: https://www.liebertpub.com/doi/abs/10.1089/jwh.2018.7615?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=jwh
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6437 [post_author] => 176 [post_date] => 2019-07-10 13:00:31 [post_date_gmt] => 2019-07-10 03:00:31 [post_content] => Groundbreaking new research has found that current smokers are three times more likely to die from cardiovascular disease (CVD), but these risks greatly decrease among those who quit. Combining fast-acting nicotine replacement therapy (NRT) can have a big impact on the likelihood of cessation. The Australian study comprised 188,167 participants aged 45 and above who did not have CVD or cancer, in a linked questionnaire with 267,153 people aged 45 and over. Of the participants, 8% were current and 34% were past smokers. Event rates for 29 out of the 36 most common CVD subtypes were significantly increased in current smokers.1
Helping smokers quitA Cochrane Systematic Review found that combining a fast-acting NRT such as gum or lozenge with a patch has higher long-term quit rates for smokers than any single form of NRT.2 There was also high-certainty evidence that 4 mg versus 2 mg nicotine gum increases the chances of successfully quitting after six months, according to the review of randomised controlled trials, cluster-randomised and quasi-randomised trials involving the use of NRT. The review identified 63 trials with 41,509 participants, mostly adults, recruited from the community or healthcare clinics across the United States (39 studies), Europe (14), Australasia (4), South Africa (2) and South America, Canada, China and multiple regions (1 each). Participants typically smoked at least 15 cigarettes daily and were motivated to quit.2 NRT is available as skin patches, mouth sprays, inhalators, gum and lozenges. It is formulated for absorption through oral or nasal mucosa or skin and is recommended by multiple clinical guidelines as a first-line treatment to break the psychological and physiological dependence on smoking which is one of the leading causes of preventable disease in Australia. The review’s comparison of nicotine patch doses found that higher quit rates were more likely if people used higher dose nicotine patches. Patches of 25 mg (worn over 16 hours) were compared to 15mg (worn over 16 hours), and 21 mg patches (worn over 24 hours) were compared to or 14 mg patches (worn over 24 hours). However, the evidence for these findings was of moderate certainty due to imprecision in the results (low numbers). The review found no evidence of an effect on duration of nicotine patch use (16 hours versus 24 hours daily).2 High-certainty evidence suggested that fast-acting NRT such as lozenges or gum resulted in similar quit rates to nicotine patches when used as a single treatment. While there is ‘moderate-certainty evidence’ that using NRT prior to quit day – instead of from the day of cessation – may improve quit rates, further research is needed to establish this finding, the authors concluded.2 Most comparisons found no evidence of serious adverse effects, although the evidence for the comparative safety and tolerability of different types of NRT use was of low certainty. The authors recommended that cardiac adverse events and serious adverse events, and withdrawals from trials due to treatment, should be measured and reported in any new studies.2 There is clear evidence that NRT used after smoking cessation is effective, but this review aimed to determine whether different forms, deliveries, doses, durations of treatment, or use before cessation, improved its efficacy in achieving long-term smoking cessation. However the authors did acknowledge limitations of this systematic review, as mentioned earlier, and implications that further research is needed. More high quality studies are needed to compare high versus low-dose patches, different durations of therapy, different types of fast-acting NRT, and NRT pre-loading versus standard use.2
Pharmacist involvementThe rate of smoking cessation in Australia has slowed over the last few years, most likely due to a decrease in public education campaigns to motivate people. Pharmacists are seen as an authoritative but underutilised asset in smoking cessation. They can provide advice on proven methods such as outlined in this review. Pharmacist and Mayo Clinic Certified Tobacco Treatment Specialist Lyn Baucia said that in most cases, depending on the level of dependence, pharmacists should always recommend high dose patches and faster acting gum and lozenges as this results in higher quit rates. She said that evidence points the effectiveness of 4 mg gum, which can result in 12% to 83% higher quit rates than 2 mg gum, and that a pre-cessation nicotine patch (preloading) can increase the effect by 34%. ‘Reducing to quit, where NRT is used to reduce the number of cigarettes smoked before stopping completely has also been shown to assist smokers, especially those not willing to quit.’ Ms Baucia said that pharmacists are perfectly placed to address smoking cessation with their patients, and that there are many opportunities where pharmacists can ask patients about their smoking, offer education and provide support. ‘It is highly recommended that smokers that identify as dependent are encouraged to use Combination NRT Therapy. Pharmacists should give detailed information about the different products, their use and methods of quitting. Follow up support should be a part of our clinical practice. ‘Awareness that the phrase “quit smoking” has negative connotations for many smokers and referring to it as “managing smoking” can in many cases make this unsurmountable goal achievable,’ she said. References
[post_title] => Is combined NRT therapy the best bet for smoking cessation? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => combined-nrt-therapy-best-bet-for-smoking-cessation [to_ping] => [pinged] => [post_modified] => 2019-07-10 14:35:58 [post_modified_gmt] => 2019-07-10 04:35:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6437 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Is combined NRT therapy the best bet for smoking cessation? [title] => Is combined NRT therapy the best bet for smoking cessation? [href] => https://www.australianpharmacist.com.au/combined-nrt-therapy-best-bet-for-smoking-cessation/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6440 )
- Banks E, Joshy G, Rosemary J. Korda RJ, Stavreski B, Soga K, Egger S, Day C, Clarke NE, Lewington S, Lopez AD. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Medicine 2019. At: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1351-4
- Lindson L, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Systematic Review, April 2019. At: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013308/full
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6423 [post_author] => 76 [post_date] => 2019-07-08 18:38:08 [post_date_gmt] => 2019-07-08 08:38:08 [post_content] => A recent study identified that the risk of hip fracture was increased with the use of psychotropic drugs in elderly people. The highest risk was seen when opioids or selective serotonin reuptake inhibitor (SSRI) antidepressants were started. While a range of health professionals should be involved in identifying and managing the risk of falls in the elderly, pharmacists in particular can recognise a patient’s medicines that are likely to increase the risk of falls, and be alert for adverse effects. The matched case-control study, conducted by researchers from the Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, analysed data from the Department of Veterans Affairs – comparing a 6-month medication history of 8,828 veterans with hip-fractures with matched controls of the same age and gender.1 Researchers noted that hip fractures in the elderly can cause significant harm. More than 50% of elderly patients experience persistent mobility-related disabilities in the year following the injury. More than 10% are discharged from a hospital to an aged care facility, and an estimated 5% die in hospital.1 The report stated that falls typically result from multiple interacting factors. A person is more likely to fall when more factors are present. Medicines are a modifiable risk factor. The study focused on five groups of drugs – antidepressants, opioids, antiepileptic drugs, benzodiazepines and antipsychotics. Researchers found that the risk of hip fracture was increased with all five groups. However the risk more than doubled when SSRIs or opioids were started, and remained high with ongoing use.1 While prescribing antipsychotics to elderly patients already taking SSRIs increased the risk of hip fractures, researchers found that the highest risk of injury was when SSRIs and benzodiazepines were started together, increasing the risk of hip fracture fivefold. ‘Prescribing a benzodiazepine with an antidepressant to treat anxiety and depression is thought to provide relief from acute symptoms and improve adherence to treatment by reducing the adverse effects of the antidepressant, especially during the first month of treatment. However, this combination is not safe in the elderly and a patient’s risk of falling should be assessed before prescribing,’ the report read.1 Director of the Quality Use of Medicines and Pharmacy Research Centre and lead author Libby Roughead told Australian Pharmacist that undesirable medicine combinations can also be the result of a lack of medication reviews in elderly patients. ‘One of the dangers when we get older is that we can incrementally add medicines and we forget to stop them. The ongoing message is to always review,’ she said. Dr Roughead urged pharmacists to take note of the medicines being prescribed to their elderly patients, and encouraged them to ask patients about side effects. She noted that asking if a patient is sleeping more, feeling unsteady on their feet or confused, is particularly important in understanding whether they are at risk of injury. They should then be referred back to the prescriber to explore other options. She said that pharmacists are particularly well equipped to understand the impact that medicines might be having on elderly patients since interactions with them are often regular, and have taken place over a long period of time. Pharmacists are therefore qualified to observe adverse medicine reactions and ensure that conversations around their medicines are ongoing. References
[post_title] => Opioids, antidepressants and the risk of hip fracture [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => opioids-antidepressants-risk-hip-fracture [to_ping] => [pinged] => [post_modified] => 2019-07-10 15:46:26 [post_modified_gmt] => 2019-07-10 05:46:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6423 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Opioids, antidepressants and the risk of hip fracture [title] => Opioids, antidepressants and the risk of hip fracture [href] => https://www.australianpharmacist.com.au/opioids-antidepressants-risk-hip-fracture/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6426 )
- Westaway K, Blacker N, Shute R, et al. Combination psychotropic medicine use in older adults and risk of hip fracture. Aust Prescr 2019;42(3):93-6. https://www.nps.org.au/australian-prescriber/articles/combination-psychotropic-medicine-use-in-older-adults-and-risk-of-hip-fracture
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6332 [post_author] => 76 [post_date] => 2019-07-04 11:51:22 [post_date_gmt] => 2019-07-04 01:51:22 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]As cold and flu season reaches fever pitch, the demand for complementary medicines to help prevent and manage colds and influenza is increasing. A new paper emphasises the risks associated with these medicines, and the role pharmacists have in advising consumers about the evidence of efficacy and possible drug interactions. The paper, published in Australian Prescriber, noted that interactions between complementary medicines and prescription drugs are common, but can be difficult to prevent given the different legislative process between registered medicines and complementary medicines.1 The paper’s author and Associate Professor at the University of Queensland’s School of Pharmacy, Dr Geraldine Moses, told Australian Pharmacist that these findings are particularly important during cold and flu season when complementary medicines ‘sell like hotcakes’, even when there is limited evidence to support their efficacy. She noted that complementary medicines do not undergo the same rigorous regulatory process from the Therapeutic Goods Administration (TGA) as other medicines. They are instead classified as ‘listed medicines’, meaning that manufacturers submit a listing request to the TGA and pay the necessary fee before marketing is approved. ‘As a result, the stated ingredients of complementary medicines are accepted on trust. There is no guarantee that the ingredients list is accurate,’ the paper read. The paper stated both misinformation on labels and a lack of knowledge around the way in which complementary medicines interact with other medications, can impact their efficacy and increase their toxicity.1 To ensure that patients do not experience interactions between complementary medicines and their other medications, Dr Moses urged pharmacists to discuss possible interactions with their customers, especially those who are taking other medicines. She encouraged pharmacists to be particularly aware of echinacea, which can aggravate autoimmune disease and can impair the activation of oseltamivir (Tamiflu), a drug used to treat influenza, along with a host of other medicines. Dr Moses also noted that many herbal remedies have antiplatelet effects which can increase the risk of bleeding from other ‘blood-thinning’ drugs. They can also inhibit metabolic enzymes and drug transporters, altering the serum levels of other medicines. ‘Our role is to help consumers make informed decisions. It’s a coaching role rather than educational. Consumers need to learn to seek information about potential risks of complementary medicines, which should be weighed against the potential benefit, and needs to be expressed in terms of a concrete functional outcome,’ she said. ‘Most consumers realise this once you explain it to them, it’s just that few people take the time to explain it and show them how to do it.’ References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Complementary medicines during cold and flu season [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-complementary-medicines-during-cold-and-flu-season [to_ping] => [pinged] => [post_modified] => 2019-07-04 17:04:14 [post_modified_gmt] => 2019-07-04 07:04:14 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6332 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Complementary medicines during cold and flu season [title] => Complementary medicines during cold and flu season [href] => https://www.australianpharmacist.com.au/managing-complementary-medicines-during-cold-and-flu-season/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6340 )
- Moses G. What’s in complementary medicines? Aust Prescr 2019;42:82–3. At: https://www.nps.org.au/australian-prescriber/articles/whats-in-complementary-medicines
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 6328 [post_author] => 82 [post_date] => 2019-07-03 10:12:50 [post_date_gmt] => 2019-07-03 00:12:50 [post_content] => Cost is a major factor associated with non-adherence to asthma treatment in Australia, recent research revealed. Healthcare providers can assist patients with adherence by discussing more cost-effective treatment options. In an online cross-sectional survey conducted between December 2015 and March 2016, 792 adults with asthma and 609 parents of children with asthma aged 5–17 were surveyed to determine the extent of cost-related treatment underuse. Participants were recruited using Australian Bureau of Statistics data to represent various ages, genders and residences.1 The majority (77.5%) of the adult participants had partly or poorly controlled asthma symptoms, with 58.7% having used inhaled corticosteroid (ICS) within the previous year. A similarly large proportion of children with asthma (75.6%) had partly or poorly controlled asthma symptoms with usage rates of any ICS-containing medicines numbering 47.1%. Over half of the adults surveyed (52.9%) along with 34.3% of the parents reported underuse of asthma medicines due to cost, primarily decreasing or skipping doses to prolong the use of asthma medicines. Interestingly, the rate of cost-related underuse was found to be comparatively higher in this study than in similar US studies, which have indicated that 20–31% of adults determined cost as a deterrent.1
Risks of non-adherenceLead researcher and registered pharmacist Dr Tracey-Lea Laba, from The George Institute for Global Health, said ‘the risks of stopping or not using an asthma medicine in the way that it’s meant to be used could mean an exacerbation in asthma and all the consequences associated with that, such as hospitalisations due to acute asthma attacks and death.’ ‘As with any medicine, if you’re not using it in the way it’s meant to be used, your condition will only get worse and you will potentially incur more costs due to worsening health,’ she said. ‘It becomes a vicious cycle where you need more healthcare because your asthma is not being controlled. Looking broader than that, if your asthma is not controlled then you might not be able to attend work or school, and it can really affect quality of life as well.’ ‘If a pharmacist suspects that a patient is not taking their medicine due to cost-related non-adherence, they should continue to emphasise the health consequences of under-use and provide suggestions for more cost-friendly treatments’, Dr Laba said. Dr Laba said that the high rates of ICS/long-acting beta2-agonists (LABA) usage in Australia could be contributing to cost-based non-adherence. Dr Laba referenced 2017 research into the use of ICS/LABA across New Zealand and Australia, that found only 44.4% of New Zealanders using ICS/LABA medicines compared with 81.5% of Australians.2 ICS/LABA medicines are considerably more expensive than ICS-only medicines. A 2018 study into the cost of asthma medicines showed that cost could be minimised to about $6/month if patients used an ICS-only treatment. This is in comparison to over $40/month for some ICS/LABA combination treatments, even though these treatments are PBS-listed.3 People with asthma in Australia are treated using a stepped approach to medication, which is detailed in the Australian Asthma Handbook, version 2.0. Considerations for treatment of newly diagnosed asthma includes ICS, plus SABA (as needed). Medication is only stepped up further if good control is not achieved despite good adherence and correct inhaler technique.4 ‘If pharmacists are able to identify that cost might be a problem that’s leading to non-adherence or underuse of medicines, then they might be able to review these medicines and consider whether there is an option to use alternative treatments.’ To hear more about asthma treatment, attend the PSA19 session: Enhancing the role of pharmacist immunisers in asthma and COPD. Register here to attend the conference, held 26–28 July in Sydney. References
[post_title] => Cost of asthma treatment – a deterrent to use [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => cost-asthma-treatment-deterrent-use [to_ping] => [pinged] => [post_modified] => 2019-07-05 10:25:08 [post_modified_gmt] => 2019-07-05 00:25:08 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6328 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Cost of asthma treatment – a deterrent to use [title] => Cost of asthma treatment – a deterrent to use [href] => https://www.australianpharmacist.com.au/cost-asthma-treatment-deterrent-use/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6336 )
- Laba TL et al. Cost-Related Underuse of Medicines for Asthma—Opportunities for Improving Adherence, 2019. At: www.ncbi.nlm.nih.gov/pubmed/30928659
- Reddel HK, Beckert L, Moran A, Ingham T, Ampon RD, Peters MJ, Sawyer SM. Is higher population-level use of ICS/LABA combination associated with better asthma outcomes? Cross-sectional surveys of nationally representative populations in New Zealand and Australia, 2017. At: www.ncbi.nlm.nih.gov/pubmed/28791752
- Reddel HK, Lembke K, Zwar NJ. The cost of asthma medicines. Australian Prescriber Volume 41: number 2: April 2018. At: www.nps.org.au/australian-prescriber/articles/the-cost-of-asthma-medicines
- National Asthma Council Australia. Australian asthma handbook. Version 2.0. At: https://www.asthmahandbook.org
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5170 [post_author] => 82 [post_date] => 2019-05-16 09:13:50 [post_date_gmt] => 2019-05-15 23:13:50 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Faye McMillan is a pioneer, paving the way for other Aboriginal and Torres Strait Islander people who want to work in the pharmacy profession. When she’s not busy winning awards, she works as a community pharmacist, university lecturer and is a founding member of Indigenous Allied Health Australia.
Why did you decide to become a pharmacist?Over 20 years ago, I was working as a pharmacy assistant in my hometown of Trangie (NSW) when I thought to myself, ‘I actually want to be the pharmacist.’ The pharmacist I was working with at the time was extremely supportive and encouraged me to apply to study. I ended up being part of the inaugural cohort of students when Charles Sturt University introduced their pharmacy program in Wagga Wagga, NSW in 1997.
What’s the main focus of your practice?I’m a community pharmacist, and I also teach in the area of Indigenous health, mental health and pharmacy at CSU. But the main focus of my work is patient-centred care, and ensuring that I’m working with people, so that they feel engaged. That’s what really drew me to pharmacy in the first place – an opportunity to have a relationship and help people as they navigate their health journey.
You’re passionate about recruiting Indigenous Australians into healthcare. What work do you do in this area?As a founding member of Indigenous Allied Health Australia (IAHA), we strive to recognise Aboriginal and Torres Strait Islander people in the allied health workforce. I sat on the board from its inception in 2009 until 2017 and I was also the chair from 2010–2016. We started with just seven members, now we have 1,500. IAHA is seen as one of the key bodies representing Aboriginal and Torres Strait Islander people to government and was involved in the development and implementation of the National Aboriginal and Torres Strait Islander Health Plan. We also work with universities to ensure that when Aboriginal and Torres Strait Islander students undertake allied health courses, they are being provided with support, mentors and networking opportunities. But at IAHA, it’s not just about how we recruit people, it’s how we retain them. We work to ensure they feel engaged, not just in their profession but as a part of their community in the form of a trained healthcare professional.
You were Australia’s first registered Indigenous pharmacist and won the 2019 NSW Aboriginal Woman of the Year Award. How do you feel about being a role model?It didn’t sit comfortably at first, but I think I’ve settled into it and recognised that people do need role models. When I was starting out I looked around for role models, and I appreciated the journeys of the people who I looked up to. If I’m that to someone else, then that’s a wonderful thing. Sometimes you’re able to use the platform of being an award recipient to give a nuanced opinion or view, and we need people to take up those positions.
You’re also a member of PSA’s National Aboriginal Community Controlled Health Organisation Leadership Group. Why is pharmacist intervention in Indigenous health so important?Pharmacists play an integral role in the lives of so many people, whether clinically, in the community, or in hospitals – there are so many touch points where pharmacists can be included to provide insight into the health of Aboriginal and Torres Strait Islander people. The knowledge and skills that pharmacists have through their education, their life experiences and by being a consistent presence in the community means that they are able to provide a point of reference for other health professionals. The Leadership Group is making significant contributions by ensuring people have access to a highly skilled and trained workforce, as well as providing education around the medicines that are needed in these communities, while ensuring they are accessible and affordable.
What’s the next big project that you’re working on?I’m putting the final touches on a mental health app that I’ve been developing over the past 18 months. I wanted to create something that would provide meaningful support to people – not in place of trained mental health professionals, of course. The app is an extension of an existing self-awareness app that keeps you connected with people you’ve identified in your contact list as your ‘caring community’. It assesses where people are sitting on the scale of mental wellness, followed by contact from someone who will reach out and have a conversation with you. It’s all about having real conversations – listening out for warning signs such as changes in the timbre of the voice, and pauses, things that are easily masked in social media use. Get more news at www.australianpharmacist.com.au [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Pushing boundaries: the pioneer pharmacist [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pushing-boundaries-the-pioneer-pharmacist [to_ping] => [pinged] => [post_modified] => 2019-05-16 11:27:59 [post_modified_gmt] => 2019-05-16 01:27:59 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=5170 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pushing boundaries: the pioneer pharmacist [title] => Pushing boundaries: the pioneer pharmacist [href] => https://www.australianpharmacist.com.au/pushing-boundaries-the-pioneer-pharmacist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 5171 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4455 [post_author] => 20 [post_date] => 2019-03-07 21:35:04 [post_date_gmt] => 2019-03-07 11:35:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] A range of apps enable pharmacists and patients to see and/or manage their medical information. As the benefits of My Health Record (MHR) become more widely known, its uptake and usage can be expected to grow. As pharmacists, we are well positioned to take a leadership role and guide patients on this topic, given our status as the most digitally enabled of all health professionals. It is important for patients who wish to play an active role in their healthcare, or carers of vulnerable patient groups (e.g. children, disabled, elderly, mentally impaired), to understand what information is available to them and how they can access and control access to clinical documents (shared health summary, discharge summary, pathology, diagnostic imaging), prescriptions (prescriptions issued and dispense uploads), consumer documents (patient health summaries, patient notes) and Medicare documents (e.g. immunisation register, organ donor status, Medicare benefits).
How do patients access their MHR?There are two ways for patients to access their My Health Record. 1. WEB PORTAL (myrecord.ehealth.gov.au) This site:
|Using a great smartphone app with your patients? Share your insights with your colleagues. Email email@example.com and tell us about your experience and the results you’ve seen.|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4386 [post_author] => 76 [post_date] => 2019-03-04 09:51:42 [post_date_gmt] => 2019-03-03 23:51:42 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A new MedicineWise program aims to increase the number of patients seeking help for anxiety and other mood disorders by educating healthcare professionals. Anxiety disorders, including panic disorder, agoraphobia, social anxiety disorder and generalised anxiety disorder, are the most common mental health conditions in Australia. According to a 2008 national survey conducted by the Australian Bureau of statistics the conditions affect 14% of people aged 16–85 years. But despite their ubiquity, a study has indicated that it takes Australians between the ages of 18 and 77 an average of 8.2 years to seek treatment for anxiety and mood disorders. Pharmacist, mental health researcher and lecturer at the University of Sydney Dr Claire O’Reilly, told Australian Pharmacist that there are many reasons why patients might delay seeking treatment for anxiety disorders, including a lack of awareness surrounding the condition. ‘The symptoms are a bit varied between the different types of anxiety disorders, so when we talk about anxiety there’s all sorts of different anxiety disorders and there can be a lot of crossover between them,’ she said. ‘But also, we all feel stressed from time-to-time, so the feeling of anxiety is a normal mechanism for us. It’s about being able to recognise when it’s more than that. When it’s more severe and longer lasting, it interferes with your work and your relationships. And I think people aren’t always able to pick that up themselves.’ She said that community pharmacists could play an important role in recognising symptoms of anxiety in their patients, and encourage them to seek specialised treatment. The new program from NPS MedicineWise is based on new clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists, and aims to equip healthcare professionals to perform a similar function by increasing their access to educational tools, including free one-on-one educational visits for GPs, access to a webinar, clinical audit, patient decision aid and other information for health. NPS MedicineWise told Australian Pharmacist that pharmacists working in general practice are invited to attend small group meetings to discuss therapeutic areas, including resources to support patient decision-making around medicines and health technologies. For practices enrolled in MedicineInsight, these facilitated quality improvement meetings that involve all practice staff, including pharmacists, and utilise individualised practice data to support interventions and to improve patient outcomes in general practice. Dr O’Reilly, who has consulted with NPS MedicineWise about the involvement of pharmacists in the program, welcomes educational opportunities for pharmacists in the area of anxiety. ‘I think pharmacists can upskill by learning about psychological therapies so that we’re informed when approaching people about treatment options. Pharmacists don’t necessarily have to be experts in this area, but it’s about having an awareness of the options and knowing where to refer people for help,’ she said. Dr O’Reilly said that education in this area is particularly important given the sensitive nature of mental health. While some patients might already suspect that they are experiencing anxiety, others could be more resistant. In these cases, she advised pharmacists to be aware of patients’ need for privacy, and offer to have a conversation with patients in a private area. She also stressed the importance of having information on hand, such as self-care cards, BeyondBlue information or NPS MedicineWise resources. There are also some PSA State offices that offer Mental Health First Aid courses. References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Anxiety is often untreated – how pharmacists can help [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => patients-often-dont-seek-treatment-for-anxiety-how-pharmacists-can-help [to_ping] => [pinged] => [post_modified] => 2019-03-07 09:46:53 [post_modified_gmt] => 2019-03-06 23:46:53 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4386 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Anxiety is often untreated – how pharmacists can help [title] => Anxiety is often untreated – how pharmacists can help [href] => https://www.australianpharmacist.com.au/patients-often-dont-seek-treatment-for-anxiety-how-pharmacists-can-help/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4387 )
- Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Media%20Release12007?opendocument&tabname=Summary&prodno=4326.0&issue=2007&num=&view=
- Thompson, A., Issakidis, C., & Hunt, C. Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behaviour Change 2008; 25(2):71–84. At: https://www.cambridge.org/core/journals/behaviour-change/article/delay-to-seek-treatment-for-anxiety-and-mood-disorders-in-an-australian-clinical-sample/9DF8128BE0F802DB0F6D76724FDEA776
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] => 6337 [post_author] => 82 [post_date] => 2019-07-04 10:36:14 [post_date_gmt] => 2019-07-04 00:36:14 [post_content] => Suzanne Greenwood, a leader in the not-for-profit hospital and aged care service sectors, has been appointed as the new Executive Director of the Pharmacy Guild of Australia. Ms Greenwood has been CEO of Catholic Health Australia, the largest non-government provider of health and aged care services, for the last five years and will commence her leadership of the Guild later this year. PSA National President Dr Chris Freeman has congratulated Ms Greenwood on her appointment and looks forward to working with her to continue the advancement of pharmacy practice and community health throughout the nation. ‘PSA looks forward to working with Ms Greenwood and the Guild on shared interests to progress roles, recognition and remuneration for all pharmacists in Australia,’ Dr Freeman said. ‘In partnership with the Guild, we will continue to empower pharmacists to deliver the best possible care and improve health outcomes for all Australians.’ George Tambassis, National President of the Guild, similarly extended a warm welcome to Ms Greenwood. ‘I’m delighted Ms Greenwood will be joining the Guild as our National Executive Director. She has held senior positions with a number of membership organisations in the health and community services sector, has a background in health and social service delivery, and is a fierce advocate for expanding access to health and well-being services for all Australians. ‘Suzanne’s extensive experience as a CEO, her training as a lawyer and executive MBA qualification, together with her professional background in health ethics, policy and regulation, positions her extremely well to advance the interests of our members and their patients across the pharmacy network,’ Mr Tambassis said. Before her post at Catholic Health Australia, Ms Greenwood was National CEO of the Institute of Arbitrators and Mediators Australia, General Counsel at the St Vincent de Paul Society of Queensland, and Corporate Counsel of St Vincent’s Health Australia in Queensland. She was also a senior lawyer at Queensland Health and was awarded the Australian Healthcare, Pharmaceuticals and Biotech Lawyer of the Year in 2017. Of her new appointment, Ms Greenwood said: ‘I look forward to furthering the Guild’s vision to enable community pharmacies to have a viable, long-term future as an integral part of the Australian healthcare system serving the needs of increasingly empowered health consumers. ‘Like most Australians, my local pharmacy is my first port of call to care for my family’s health, whether that’s a flu shot, getting medication advice or just picking up the essentials such as prescriptions and other healthcare products. It is an honour to work with the community pharmacy sector to expand the contribution the Guild’s members make towards better health and well-being outcomes for everyone in the community,’ she said. [post_title] => PSA welcomes the Pharmacy Guild’s new Executive Director [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psa-welcomes-pharmacy-guilds-new-executive-director [to_ping] => [pinged] => [post_modified] => 2019-07-04 11:00:38 [post_modified_gmt] => 2019-07-04 01:00:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=6337 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PSA welcomes the Pharmacy Guild’s new Executive Director [title] => PSA welcomes the Pharmacy Guild’s new Executive Director [href] => https://www.australianpharmacist.com.au/psa-welcomes-pharmacy-guilds-new-executive-director/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 6339 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5480 [post_author] => 82 [post_date] => 2019-06-21 10:57:30 [post_date_gmt] => 2019-06-21 00:57:30 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]In 2016, Melissa Sheldrick experienced the unthinkable when her son Andrew died due to a medication error. Without apportioning blame, she has since worked tirelessly to implement system changes so that it doesn’t happen again. Melissa will be a keynote speaker at next month’s PSA19 in Sydney.
Can you tell us Andrew’s story?Andrew was diagnosed with a sleep disorder when he was five and a half and was prescribed the amino acid tryptophan to regulate his sleep cycle. While it was very effective, the tablets were big and chalky and he needed to take five every night before bed. It was always really difficult to get him to take them, so we would try to disguise the taste as best we could by crushing the tablets and making smoothies out of them. But it was always a battle. A year later when he turned seven we needed to have a sleep study done, and the doctor again prescribed tryptophan. I asked her if there was an easier way for him to take it, and she suggested finding a compounding pharmacy. At the time I didn’t know what that was, but I found the one that was closest to home and they made it into a liquid for him. We gave it to him every night for a year and a half and it was so much easier – he didn’t fight it. The liquid tryptophan needed to be refrigerated and the prescription refilled fortnightly, as it only had a shelf life of two weeks. On Saturday, 12 March 2016 we picked up a batch from the pharmacy and gave him his dose that night. Then he didn’t wake up the next morning. Naturally, you’re traumatised and panic-stricken. We had no idea what had happened, and we didn’t find out why he died for four and a half months. Then we were told by the police and the coroner that the medicine they took from our fridge had no tryptophan in the bottle at all. It was all baclofen, a very powerful muscle relaxant. The pharmacist who mixed the compound had grabbed the wrong bottle off the shelf.
How did your advocacy work begin?There were actually several errors made by the pharmacy within the workflow and packaging procedures that contributed to Andrew’s passing. I then discovered that in Ontario, where we live in Canada, there was no reporting mandate. Nobody needed to know about this error, which wasn’t okay with me. I petitioned and met with a government official, who directed me to our regulatory body in Ontario. In Canada, all of our provinces have their own health ministry. There’s ten different provinces and three territories that all run their pharmacies very differently. I discovered that there was only one province, Nova Scotia, that reported their pharmacy errors, which boggled my mind. The idea that this kind of error could happen to another family was unthinkable. I started working with our regulators, the Ontario College of Pharmacists, and we formed a task force that developed a medication safety program, which is a continuous quality improvement program here in Ontario. All community pharmacies are now mandated to report their errors and near misses anonymously, so the data that comes in can be analysed and reports can be produced. The reports are sent back to community pharmacies with the understanding that they will take action and communicate with staff about how to prevent future errors, reduce harm and increase patient safety. The provinces of Saskatchewan, Manitoba and New Brunswick have since launched programs, and other provinces are in the process of doing so.
What further changes would help to improve medicines safety?My first goal is to get all the provinces participating in the same program, whereby they mandate that pharmacies have to report events and incidents, and devise methods to prevent future errors. My other goal is to do whatever I can to help other countries do the same. That’s why I’m so pleased to be able to come to Australia and share my message. We can’t learn if we don’t have the data to show us what needs to change. Pharmacists and pharmacy staff all have to be willing to collect that data, so it can be analysed and shared, and then best practices developed. Without communication and collaboration, change won’t happen – be it systemic or front line.
What have you learned that you’d like to share with pharmacists throughout the world?That communication is key, whether it’s between patient and professional, inter-professionally between doctors and pharmacists, or within the pharmacy team. A culture of communication needs to be fostered. We want to ensure pharmacies are safe places to work and that pharmacists and pharmacy staff have the required training to prevent errors from happening. Hear more form Melissa Sheldrick at PSA19, held in Sydney from 26–28 July. Register at www.bit.ly/2PIX3Dx Andrew Sheldrick tragically lost his life due to medication misadventure. [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => A tragic medication error [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => a-tragic-medication-error [to_ping] => [pinged] => [post_modified] => 2019-06-21 12:29:26 [post_modified_gmt] => 2019-06-21 02:29:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=5480 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => A tragic medication error [title] => A tragic medication error [href] => https://www.australianpharmacist.com.au/a-tragic-medication-error/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 5482 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5484 [post_author] => 82 [post_date] => 2019-06-02 07:08:48 [post_date_gmt] => 2019-06-01 21:08:48 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Daniel Gilbertson is a pharmacist with a mind for business. Now the head of healthcare operating models at Medibank, he previously worked as a community pharmacist and hospital pharmacist.
Tell us about your current role.I oversee the design of new healthcare services for our customers, identifying areas where we think we think we can have a positive impact and how we want our services delivered. Currently, I’m working on our at-home clinical services and telehealth businesses – estimating how many employees we need, the locations we need to service – and ensuring we can deliver affordable care with the best possible patient experience.
You’ve had an interesting career path. How did your start in pharmacy help you get to this point?I’ve always had a desire to help people and improve their health and wellbeing – and pharmacy is a great way to be able to do that. I have both a hospital and community pharmacy background, and I started working in a community pharmacy as a student in my first year of uni. I completed my intern year at The Royal Melbourne Hospital and then continued to work there as a full-time pharmacist while also working at a community pharmacy at night and weekends. Overall, I worked in community pharmacy for over 15 years and hospital for nine years. I believe this made me quite a well-rounded pharmacist with broad experience. Hospital and community pharmacy are, at their core, still very similar to each other. Both roles are about dispensing the right medicine for the right patient at the right time, ensuring they understand how to use it, and giving them appropriate counselling and advice. But the questions that patients ask in community and hospital settings are quite different. In community pharmacy, you’re asked much more about primary care and over-the-counter medicines. In a hospital, you are often involved in the decisions to start medications and you’re able to provide patients with a lot of information, which they are generally very receptive to. After nine years at Royal Melbourne and having completed a Master of Business Administration through the University of Melbourne, I decided that I would benefit from a change in roles and I joined the healthcare consulting team at PricewaterhouseCoopers. Here I was able to use my experience of working in a hospital and community pharmacy while working on projects that changed the health system at a state and national level. Now at Medibank, I can bring all of this experience to the design and running of a broad range of health services.
How do you apply your pharmacist skills in your role every day?I think pharmacists are very good problem solvers, which is probably one of the best ways to describe the work we do. Essentially, we have a set of problems which are analogous to a patient coming in and describing a set of symptoms. We will ask questions to determine how severe the symptoms are, and if there is anything else that might be associated with it – such as when a patient comes in for a cough, and we ask if they also have a fever or runny nose. Asking the right questions at the right time really does help in terms of trying to understand a problem. While I might be describing some slightly different problems now, the steps that I learned and the processes I went through as a pharmacist are still very applicable now. Then there’s the collaborative aspect of pharmacy – how you can interact with general practitioners, specialists, nurses, physios or occupational therapists etc. For me, it’s about how the entire system can be brought together to improve the health outcomes for individual patients. I’m just doing that on a larger scale now.
From what you have observed, what advice would you offer pharmacists?To be really bold and think about where you can use your skills to best meet the needs of your patients. One of the challenges I think we have is public recognition of the value of pharmacists bring beyond the dispensing of prescriptions. Pharmacists need to differentiate themselves. Shout it out from the rooftops that pharmacists are delivering high-quality professional services. It’s just being upfront and advertising how good we really are. We need to make people aware of the effort pharmacists put in that often goes unnoticed.
Further resourcesWant to find out more about different career pathways for pharmacists? Contact PSA at firstname.lastname@example.org
A DAY IN THE LIFE of Daniel Gilbertson, operational pharmacist, Melbourne8.10 am: Preparation The day starts by reviewing documents for meetings that day with senior Medibank team members and making any last-minute adjustments. 9.00 am: Collaboration Meet with various teams, both Medibank and external customers, to discuss the progress of current work for services we already have as well as new opportunities that we are exploring. This includes identifying the role of pharmacists within our in-home services such as chemotherapy and palliative care. 12.30 pm: Pitstop Grab some lunch and review emails and messages that have come in during the morning, including operational issues and specific questions about how our services should be delivered. 1.00 pm: Forward looking Meet with the finance team to discuss current performance and plans for the next few years. 3.00 pm: Check-in Review the to-do list for the day and week and make sure that everything is on track and prepared for the next day’s meetings. 5.00 pm: Catch up Respond to emails that have come through during the day and share information with colleagues – either about specific projects, pharmacy-related questions or new service opportunities. 6.00 pm: Finish Head home for the day to enjoy family time and exercise.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5162 [post_author] => 130 [post_date] => 2019-05-29 21:07:08 [post_date_gmt] => 2019-05-29 11:07:08 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Prescribing is more than just putting pen to paper – but falls well within pharmacists’ scope of practice. Adding prescribing to the repertoire of the pharmacist has been on the ‘agenda’ in Australia now for nearly two decades. Despite a growing body of evidence supporting pharmacist prescribing, we still are yet to see this role realised. Debate has now resurfaced with the recent release of the Pharmacy Board of Australia’s discussion paper on pharmacist prescribing. We are one step closer. The discussion paper was informed by a Pharmacist Prescribing Forum in June 2018 attended by interdisciplinary stakeholders and outlines three different models of pharmacist prescribing: i) Prescribing under a structured arrangement, ii) Prescribing under supervision, iii) Autonomous prescribing. In February this year, PSA launched the Pharmacists in 2023 report that sets the scene for healthcare evolution. A key action of the report calls for the facilitation of pharmacist prescribing within a collaborative care model. Pharmacists in 2023 describes how patients will benefit from collaborative pharmacist prescribing through:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5173 [post_author] => 82 [post_date] => 2019-05-21 06:18:54 [post_date_gmt] => 2019-05-20 20:18:54 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Michael Bakker MPS is an ECP on the move. He’s a pharmacist team leader at South Australia (SA) Health’s Flinders Medical Centre, and in his spare time he volunteers with Parkinson’s SA.
Describe your role as team leader at SA Health.I’m the team leader for rehabilitation, palliative care and mental health. The team leader roles were introduced 12 months ago and attached to our clinical portfolios. The idea behind the roles is to assist with operational activities in the department, such as organising rosters, contributing to the development program for senior and rotational pharmacists and managing high-performance sessions. As team leaders we regularly catch up with our team to see what challenges they might be facing, as well as ensuring their activities are aligned with our broader focus in the department. An important part of the role is leading back up the chain of command, so senior managers are aware of what’s happening on the ground. When we get direction from above, we make sure that it’s implemented and championed on the wards.
How is telehealth used in your role?Part of our service in ambulatory rehabilitation is providing treatment to people in their own homes. I’ll often use video conferencing or telehealth to reconcile medicines with patients or to deliver medicines education in their rehab program at home. We have the option to remotely monitor people’s blood sugar levels or weight when required. It has given us the opportunity to scale our service, so we don’t have to spend time on the road travelling between clients, improving access for rural and remote clients. It means I can tailor the time I discuss medicines with them and their carers to when they are most receptive and comfortable.
What sparked your interest in pharmacy practice for Parkinson’s disease?It all started from very subtle origins and has grown into a much bigger volunteering experience that I love. I was working in a community pharmacy and a nurse from Parkinson’s SA came in and asked me if I’d be able to give her some information to relay to her clients. I didn’t want to have anything lost in translation, so I thought it would be a good idea if I offered to give a talk to their clients, which they were ecstatic about. I started to realise community support organisations aren’t often getting much support from pharmacists, and my knowledge and participation has grown from there. I began giving talks to their consumer groups around six or seven years ago across metropolitan Adelaide and rural SA, and I’m now very proud to represent the organisation as a board member.
How has being involved with the SA Early Career Pharmacist Working Group (ECPWG) helped your pharmacy practice?When I reflect on my time with the ECPWG, I think of the transition from being a student to intern, then going out and working by myself, to becoming a managing pharmacist. Your skills need to change during that time and you need to access different support structures. Being part of the ECPWG has always helped me navigate periods of change. I’ve always found that there’s someone to approach who can offer advice on their experiences moving from one role to the other. Now I get to help provide that support and direction to others.
What opportunities come through involvement in ECP Working Groups?In our ECPWG, we try to provide people with the opportunity to be involved in the design of projects as well as talk to community groups. We put boots on the ground and create networking opportunities, so the ECPs can utilise the information that they’ve developed. I’ve had plenty of opportunities to present to other groups of pharmacists – whether that’s through our Accredited Pharmacist Special Interest Group or through our educational events. I’ve also had a great opportunity to MC a number of panel discussions through the ECPWG, such as the Networking and Careers day for PSA SA/NT last year and the NAPSA conference, which is really great for my development in public speaking.
A TYPICAL DAY in the life of Michael Bakker, hospital pharmacist8.45 am – The day begins My day starts with a handover meeting in the hospice. I hear from nurses about patient management overnight, which informs my priorities for review that day. 9:15 am – Coverage I confirm all service areas are covered and make plans to respond to staff vacancies. 10:15 am – The ward I prioritise seeing new patients, managing patient discharges and participation in ward rounds. Being present for treatment reviews assists value alignment and identifying the goals and direction of treatment for patients. 12:15 am – Job change I plan the home visits I’ll be doing that day, and I communicate with clinicians on any concerns for home rehabilitation clients. I may need to catch up with my team or team members to support their work. 1:00 pm – Head out My afternoon consists of hitting the road for home visits or organising video calls with patients. These visits are similar to Home Medicines Reviews with a focus on supporting rehabilitation goals and management at home. 4:00 pm – Write it up I come back home to write up my notes from visits and touch base with clinicians about clients they are concerned about. Whenever I have a moment, I try to get some writing done, whether academic writing, opinion pieces, preparing for journal clubs or reviewing my talks for a Parkinson’s group.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.