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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 23793 [post_author] => 3387 [post_date] => 2024-03-19 10:21:08 [post_date_gmt] => 2024-03-18 23:21:08 [post_content] => Since 1 November 2023, almost 5 million Australians at risk of severe complications from shingles have had access to the SHINGRIX vaccine under the National Immunisation Program (NIP). Herpes zoster (HZ), a reactivation of the varicella-zoster virus in patients who have had chicken pox previously, has a significant disease burden. Of all vaccine preventable diseases, HZ and its complications accounted for 7% of the overall burden in 2015. One of the most common complications from the virus is post-herpetic neuralgia (PHN), particularly among older and immunocompromised patients. Up to 5–30% of patients with HZ go on to develop PHN, with risks of this complication increasing with age. PHN, a type of nerve pain described as having a burning sensation that can persist long after acute HZ symptoms resolve, can be debilitating. One in three Australians will get shingles in their lifetime. Vaccination can reduce this likelihood.What’s changed and why?
SHINGRIX replaced Zostavax on the NIP following advice from the Pharmaceutical Benefits Advisory Committee and the Australian Technical Advisory Group on Immunisation. SHINGRIX is administered as two doses, 2–6 months apart, at a current private market cost of approximately $560. The age limit for NIP shingles vaccination eligibility is now 65 years and older, down from 70 years. Patients eligible to receive SHINGRIX under the NIP include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25470 [post_author] => 3410 [post_date] => 2024-03-18 12:06:45 [post_date_gmt] => 2024-03-18 01:06:45 [post_content] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. A sizable proportion of the clientele at Emerton Amcal Pharmacy in Western Sydney are Aboriginal and Torres Strait Islander peoples, with First Nations clients making up around 15.3% of the patient base. In the quest to provide culturally safe health care services, all pharmacists at Emerton, owned by Curtis Ruhnau MPS, Margaret Ruhnau MPS and Matthew Quick MPS, have completed PSA’s Deadly pharmacists foundation training course. Yet, despite their training, the pharmacists at Emerton (and sometimes, the proprietors) felt reluctant to wear First Nations designs, shirts, or pins for fear of appearing tokenistic. Ahead of National Close the Gap Day (21 March 2024), an Early Career Pharmacist explains how she overcame these feelings of imposter syndrome through a mix of client reception and acquiring cultural knowledge to work towards improving health outcomes for Aboriginal and Torres Strait Islander peoples.Turning points
Before completing the Deadly pharmacists training course, Zara Gul MPS was just trying to fulfil her role as a health professional when providing services to Aboriginal and Torres Strait Islander clients. ‘I was aiming to treat everyone the same, adapting my approach based on health literacy,’ she said. Post-training, she has a much broader understanding of how Aboriginal and Torres Strait Islander clients view health, the importance of a good yarn, and how to tailor information accordingly. But it took some time to arrive at this point, and feel comfortable rocking the deadly pharmacists shirt. ‘I finished the course earlier on, so it was just me wearing it at first, along with Curtis, Margaret and Matthew,’ said Ms Gul. ‘I would have my cardigan over the top just in case I offended someone or overstepped any cultural boundaries.’ It was the positive feedback from Aboriginal and Torres Strait Islander clients, coupled with some gentle leadership encouragement, that helped Ms Gul and her colleagues feel comfortable wearing First Nation designs. The starting point was when a young Aboriginal client complimented Margaret on her shirt, and she pointed out that Zara was wearing one too. ‘Margaret said, “she's also done her training”, and the client gave me two big thumbs up,’ she said. ‘We’ve since had a lot of positive feedback from clients. Everyone [says], “We like your shirt. Where did you get your shirt from? Can we get a shirt?”’ This has fueled a rapport with clients, with Ms Gul noticing people from the Aboriginal Torres Strait Islander backgrounds feel comfortable speaking more openly with her about their health. ‘We try not to stay behind the counter so we can chat face-to-face with clients,’ she said. ‘We also let clients know we've earned this shirt, and that we had to do a course that helped to improve our knowledge for providing healthcare to First Nations people.’Collaborative healthcare
A key takeout for Ms Gul from undergoing the Deadly Pharmacists training was the understanding that First Nations clients take a community approach to healthcare. ‘It's not just individual patients, they work with other members in the community and receive a lot of help from their family,’ she said. ‘It's about understanding that we need to take an integrated approach to healthcare, including with doctors and medical centres that clients frequent to ensure timely access to medicines.’ The team also strives to facilitate access to funded services. ‘For example, with conditions such as sleep apnea, we can work with the Integrated Team Care Program to help Aboriginal and Torres Strait Islander clients obtain funding for their devices,’ said Ms Gul. Working closely with Aboriginal health and support workers, particularly when organising dose administration aids (DAA), is also an important component of providing community-based care. ‘We liaise with them, make sure clients’ scripts are organised, and that medications are ready for pickup when they come in, so there are no gaps in care.’ Through relationship building, health outcomes for one Aboriginal and Torres Strait Islander client with significant mental health issues drastically improved. ‘Some of her medications are quite regulated, so by communicating well with her as well as her doctor, we're getting the scripts for the regulated medicines prepared in a timely manner,’ she said. When the client comes to pick up her medication every week, her DAA is complete, removing any additional stressors. ‘Her mental health is no longer deteriorating because she’s more adherent to her medication, and she's coming in to pick up her DAA on the right days as well,’ said Ms Gul. Programs such as the Deadly Pharmacists foundation training course are not only for those interested in working in Aboriginal Community-Controlled Health Services, but for any pharmacist who wants to improve service delivery. ‘Now that we've received such positive feedback, it has built my confidence – both in terms of wearing the shirt and providing information to First Nations clients about their healthcare,’ she said. The pharmacy’s floor staff have also undergone cultural competency training, earning the right to wear their own shirts with Aboriginal and Torres strait Islander designs. ‘That way, on Mondays and Fridays, we all wear the shirts. So we stand united as a team,’ added Ms Gul.Get involved
Any pharmacist can undertake PSA’s Deadly pharmacists foundation training course as part of their continuing professional development to improve cultural awareness and safety while earning up to 14 Group 2 CPD credits. Pharmacists who have completed the course still have the opportunity to purchase a Deadly Pharmacist polo shirt or scarf through reaching out to projects@psa.org.au. For pharmacists who identify as Aboriginal and Torres Strait Islander individuals, Expressions of Interest (EOI) for the annual PSA Faye McMillan Conference Grant to attend PSA24, sponsored by Care Pharmaceuticals and Hydralyte, opens this Thursday (21 March). The EOI is open until 16 May, with the successful applicant announced on 27 May. [post_title] => Wearing Aboriginal and Torres Strait Islander designs with intention [post_excerpt] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => wearing-aboriginal-and-torres-strait-islander-designs-with-intention [to_ping] => [pinged] => [post_modified] => 2024-03-18 15:02:03 [post_modified_gmt] => 2024-03-18 04:02:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25470 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Wearing Aboriginal and Torres Strait Islander designs with intention [title] => Wearing Aboriginal and Torres Strait Islander designs with intention [href] => https://www.australianpharmacist.com.au/wearing-aboriginal-and-torres-strait-islander-designs-with-intention/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25478 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25458 [post_author] => 175 [post_date] => 2024-03-17 20:53:09 [post_date_gmt] => 2024-03-17 09:53:09 [post_content] => The ACT Pharmacist of the Year Kirstin Turner MPS has forged a non-traditional, speciality role that is ideal for her life.Why did you choose pharmacy?
Since I was a teenager I have wanted to become a pharmacist. I believed that it would combine my love for medicine with opportunities to contribute to the health of people in the community as well as allow me to have endless career opportunities. And it has done exactly that. I completed a Bachelor of Pharmacy and was awarded the Academic Medal for bachelor coursework at James Cook University in Townsville in 2008 where I interned at a local community pharmacy through the PSA intern program until registering as a pharmacist in 2009.Did you follow the traditional community/hospital pharmacy route?
I worked in community pharmacy for a decade until 2019. In that time, I worked as an intern pharmacist, front-of-shop pharmacist and as pharmacist in charge within QLD, WA, and the ACT. I have always enjoyed being a pharmacist, however felt something was always missing; that I didn’t quite belong within the community setting. I found it difficult to incorporate my credentialed pharmacist, credentialed diabetes educator and GP pharmacist work within my community pharmacy roles over the years. In 2019 I was given the opportunity to extend my position as a GP Pharmacist and made the leap to leave community pharmacy so I could build up my own career path to ensure I had job mobility, stability, and flexibility all the while maintaining professional satisfaction. And again, no regrets.Which of your specialties came first?
I became a Credentialed Pharmacist through the PSA course in 2010. Interested in diabetes and chronic disease management through the Home Medicines Reviews I was undertaking at the time, I then became a Credentialed Diabetes Educator, starting my study after the birth of my first child. I completed my credentialing while in hospital after the birth of my second child in 2016. In 2018, I was offered an opportunity to participate in phase 2 of the Pharmacists in GP Practice Program and continued in that role for more than 5 years – and continue now, just in my own way.With your varied specialisations, how have you managed a work/life balance with two young children?
I am fortunate that as a pharmacist, I have been able to incorporate all my specialties into my daily practice where I can work as part of a healthcare team and improve the health outcomes of people within the community without restriction. Working for myself has allowed me to have the flexibility for the work/life balance my young family requires. Health care never stops and working independently has allowed me the flexibility to work late nights, weekends, make after-hours phone calls to GPs or patients, and even sneak off during a scouts camp to find mobile reception to finish a report. I can also do research or attend an online meeting, all the while making sure I can still attend my children’s activities and appointments. As they grow, I envisage that my role will also grow and I will never be short on work opportunities, hopefully.How did you get into mentoring younger pharmacists?
I kind of fell into mentoring. As a very approachable and accommodating person, I’ve been mentoring pharmacists ever since I was registered, and it is something that I absolutely love! I mentor pharmacists at any stage of their career and under any circumstance – newly registered pharmacists, university students, prospective Credentialed Diabetes Educators or GP pharmacists and others who are just curious about what I do. I have lost count as I do it formally through ADEA for CDE accreditation and informally by allowing myself to be contactable by any pharmacist via any means – for an on-off discussion or as a long-term professional contact. I just wish that I had the same mentor access when I was starting out.Any advice for ECPs?
Find a mentor in the career pathway that interests you. Be open to accept mistakes and grow, welcome feedback, set goals, ask for help, grow your professional network, and identify your strengths and interests to develop your own career path.
8.30 am | Get sorted Drop kids at before-school care. Pack bags and Home Medicines Review (HMR) schedules, usually 2 per day. Organise referrals for three diabetes education patients, seen at my home clinic room or alongside HMRs. |
9.00 am | Administration Triple check calendar, send out recalls and confirmations for appointments tomorrow, and contact recipients of referrals. |
10.00 am | HMR/diabetes education home visit Drive to see woman, 80, recently moved from a regional area to the ACT. New GP requires a medicine reconciliation and patient history for multiple diagnoses, including diabetes, asthma, gout, retinopathy, hypertension, microalbuminuria, back pain and osteoarthritis. Records from previous GP not sent. Medicine reconciliation identifies three missing medicines (aspirin, furosemide, and an iron supplement). Significant drug-related problems identified include: (1) metformin (1,000 mg tds) and pioglitazone (45 mg once daily) over recommended dose for current renal function and well-controlled diabetes (2) triple whammy (perindopril, furosemide and celecoxib) (3) non-adherence to inhalers (4) no indication for furosemide, aspirin or paracetamol and codeine phosphate hemihydrate (Panadeine Forte) (5) adverse effects of fluid retention, oedema, constipation and GI bleeding noted. Urgent contact was made with the GP who implemented recommended changes immediately. HMR report issued and patient was booked for follow-up reviews. While patient was willing to make changes, she was surprised so many problems had been identified with the apparent ‘set and forget’ medicine regimen. |
2–5.00 pm | Referrals, appointments, emails Referrals received for HMRs and diabetes education contacted for appointments. Write reports, check emails for mentoring or potential work or educational opportunities |
5.00 pm | Home time Collect kids for extracurricular engagements. After dinner – write reports, mentor, etc. |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25217 [post_author] => 3919 [post_date] => 2024-03-14 10:23:24 [post_date_gmt] => 2024-03-13 23:23:24 [post_content] =>Pain is a highly complex and subjective phenomenon, characterised by high levels of inter-individual variability.1,2 This can make it difficult to quantify and compare pain between individuals and different population groups.1,2
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]Access to timely and appropriate pain management is also influenced by numerous factors, including some related to the patient, such as level of health literacy, socio-economic disadvantage, geographic location, and others related to society, including, discrimination, stigma, and gender norms.3
Considering this, there has been growing literature citing the presence of what has been termed a 'gender pain gap' both locally and globally.4–11 This article shares insights from an Australian survey of healthcare professionals evaluating attitudes towards unconscious gender biases, with the aim of helping pharmacists conceptualise the gender pain gap as it applies to their own practice as well as the broader healthcare landscape. It includes practical strategies to help pharmacists identify and address unconscious gender biases relating to the management of pain in their practice. While this article focuses on the gender pain gap as it pertains to cisgender women and men, it’s crucial to acknowledge that gender bias may similarly impact non-cisgender individuals experiencing pain.12,13 Many of the strategies aimed at mitigating unconscious bias discussed may also be relevant for addressing disparities faced by non-cisgender individuals.12,13
Learning objectivesAfter reading this article, pharmacists should be able to:
Competency (2016) Standards addressed: 1.1, 1.4, 1.5, 1.6, 2.1, 2.4, 3.1, 3.5, 3.6 Accreditation expiry: CAP2404SYPCP Accreditation number: 31/03/2027 |
The term ‘gender pain gap’ is usually used to refer to the disparities in the pain experience between men and women. In literature, the term encompasses ideas such as4–8:
NOTE: In discussing the 'gender pain gap', it’s important to note that while ‘sex’ refers to biological differences between males and females, ‘gender’ encompasses the sociocultural, psychological, and behavioural aspects associated with being male, female, or another gender identity.14 Therefore, while in places this paper discusses data comparing males and females, we recognise that gender is a multifaceted construct that goes beyond biological differences and influences individuals’ experiences of pain and pain management. |
The gender pain gap has been demonstrated in Australian healthcare settings in relation to the diagnosis and treatment of pain.9–11 A retrospective audit in the Australian acute care setting (n = 192) demonstrated that women presenting with acute abdominal pain received different analgesics, fewer doses of analgesics, and experienced longer wait times for analgesics to be administered compared to men.9 With regard to gender specific conditions, a study of Australian women with endometriosis (n = 532) indicated many felt let down by medical staff, with their pain often viewed as psychological or the reported severity being distrusted.10 Additionally, diagnosis of endometriosis in Australia has been shown to be delayed by an average of 6.4 years due to various reasons, including misunderstanding and lack of knowledge of endometriosis by healthcare professionals, misdiagnoses and normalisation of period pain.11
Several factors contribute to the gender pain gap. Historically, women have been under-represented in medical research.15,16 Initial pain studies included average male subjects with results being generalised to females, contributing to a poorer understanding of how certain pain conditions manifest or need to be managed in this demographic.6,15,16 Differences in physiological pain pathways between men and women have now been reported, but a comprehensive understanding of these distinctions remains elusive.17,18 While representation of female subjects has been increasing in research, many areas of medicine still lack gender-specific recommendations.19
Moreover, another key cited contributor to the gender pain gap is unconscious gender bias.7–9
Awareness of this phenomenon was evaluated in a quantitative online survey of Australian pharmacists and general practitioners (n = 305) conducted in December 2023.20 The vast majority of respondents believed in the existence of unconscious biases among healthcare professionals, indicating that this is generally a well-known and accepted concept (see Figure 1). These unconscious biases were primarily reported to manifest in relation to gender, culture and race. When questioned about the existence of gender biases in the context of patient care, this was again widely acknowledged and almost half of the healthcare professionals considered it to be a widespread problem.20
In the pain treatment setting, a common perception was that gender bias among healthcare professionals manifested in the form of female pain being overlooked, underdiagnosed, misdiagnosed, and taking too long to be diagnosed (see Figure 2).20
Unconscious bias (also known as implicit bias) often differs starkly from an individual’s conscious beliefs.21 It develops in early life from repeated reinforcement of social stereotypes until they become automatic.21 In this context, stereotypes refer to well-learned sets of associations between certain traits and a social group.21 For example, from a very young age, children are socialised to react to pain in certain ways; in particular, most societies discourage men from expressing their emotions while women are taught to verbalise discomfort.6,7,22 While gender stereotypes are nuanced, a common overarching theme is the perception of men as stoic and/or rational, and that of women as emotional, dramatic and/or prone to exaggeration.5,7
Although these social stereotypes are not consciously endorsed in healthcare settings, healthcare professionals are not immune to them.21 Furthermore, the uncertainty and time pressures in most healthcare settings may favour reliance on stereotypes for decision making.21,24
Pain management is an area that may be particularly vulnerable to unconscious biases, given that pain is a subjective experience, likely influenced by biological, psychological, and social factors.25 When managing pain, healthcare professionals are required to make inferences about pain authenticity and intensity.5,8 These judgements cannot be objectively verified and can be influenced by perceiver biases based on gender, race, and other contextual factors.5,8
For instance, a healthcare providers’ perception of a patients’ trustworthiness may impact their pain assessment and treatment decisions.26 In a United Kingdom study where pain clinicians and medical students made judgements based on a video and a brief history of a patient with shoulder pain, women, especially those rated as being of low trustworthiness (ratings were provided by trainee clinical psychologists), were estimated to have less pain, and judged to be more likely to exaggerate. For treatment recommendations, men were more likely to be recommended analgesics while women were more likely to be recommended psychological treatment.26
In the Chronic Pain Australia 2023 National Pain Survey, findings indicated that women felt they are less likely to be believed when presenting with chronic pain.27 Some respondents described feelings of judgement, shame and ridicule when accessing healthcare. Many (76.3%) shared experiences of feeling ignored or dismissed.27
In the present survey, healthcare professionals recognised that unconscious gender bias could potentially influence the mental health of female patients and impact their experience of pain conditions, as well as impact their interactions with healthcare providers in a negative manner (see Figure 3).20
Figure 3 – Australian healthcare professional perceptions of the impacts of gender pain bias
The International Pharmaceutical Federation (FIP) 2023 report on the role of pharmacists in closing the gender pain gap noted that the topic was not well covered during pharmacy education.23 This was reflected in the present survey where most healthcare professionals, including pharmacists, noted that they had not received any training on understanding and addressing female pain experiences (see Figure 4).20
Figure 4 – Training on understanding and addressing female pain experiences in Australia
Unconscious gender bias needs to be addressed at all levels of healthcare. In the context of pain management, pharmacists play a key role – from providing medicines advice and dispensing to referring patients to other healthcare professionals as needed. As such, pharmacists need to be aware of gender stereotypes in pain management to be able to identify and address any inequities in care.23
It is important to keep in mind that different genders have different pain management needs that change at each stage of life.3 Closing the gender pain gap doesn’t mean providing the same pain care for all genders, but rather working towards equitable care for all.
Unconscious gender biases are complex, thus there is no single debiasing strategy that will work for everyone.21,28 However, since gender biases are automatic, habitual activation of stereotypes, the first step to addressing them is for healthcare professionals to be aware of their susceptibility to them.16,28
While it is difficult to quantify bias, these strategies may be useful for identifying unconscious gender biases:
Some strategies that may help to address unconscious gender biases include:
These strategies can help to improve the quality of communication with patients and may prevent filling in partial information with stereotype-based assumptions.21,23 Self-reflection when interacting with patients may also help to avoid stereotype-based assumptions – ask yourself questions such as28:
A simple acronym such as ACE (see Figure 5) may be helpful for habitualising this process during interactions with patients seeking analgesia.
Figure 5 – ACE acronym
Finally, keep in mind that men and women tend to express pain differently due to early socialisation of pain responses,6,7,22 and this should be considered during consultations to help avoid stereotypical categorisations.
For instance6,7:
The gender pain gap refers to the disparities in the pain experience between genders. While a range of factors contribute to the gender pain gap, unconscious gender bias has been cited as one of the key factors.
Unconscious biases develop early in life from repeated reinforcement of social stereotypes until they become automatic. Given that pain is a subjective experience, pain management may be particularly vulnerable to unconscious biases.
The issue of unconscious gender biases needs to be tackled at all levels of healthcare. Taking small steps in the pharmacy to address it can help lay the foundations for closing the gender pain gap and ensure equitable provision of healthcare services for all patients.
[cpd_submit_answer_button]Dr Jacinta Johnson PhD, FANZCAP (Edu. Research), FPS, FSHP is a credentialed Advanced Practice Pharmacist. She is a Senior Lecturer in Pharmacy at the University of South Australia and Senior Pharmacist for Research within SA Pharmacy.
Jacinta Johnson has received consultancy fees for development and delivery of educational materials or Advisory Group participation from Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd.
[post_title] => Are unconscious gender biases widening the Australian gender pain gap? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2 [to_ping] => [pinged] => [post_modified] => 2024-03-15 14:00:32 [post_modified_gmt] => 2024-03-15 03:00:32 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25217 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Are unconscious gender biases widening the Australian gender pain gap? [title] => Are unconscious gender biases widening the Australian gender pain gap? [href] => https://www.australianpharmacist.com.au/are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 25220 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25417 [post_author] => 7918 [post_date] => 2024-03-13 12:48:04 [post_date_gmt] => 2024-03-13 01:48:04 [post_content] => Expert advice for applying the right dosage instructions on medicine labels on a case-by-case basis. How do you word instructions on dispensing labels? Could some simple changes make your instructions clearer for patients? Claire Antrobus MPS, Manager, Practice Support at PSA explains the importance of simple and explicit dosing instructions tailored to medicine type, dosing requirements and patient comprehension.What do guidelines say about how to make instructions ‘explicit and clear’?
Most importantly, dosing instructions on dispensed medicine labels should be explicit and clear, according to the Australian Commission on Safety and Quality in Health Care’s National Standard for Labelling Dispensed Medicines 2021. Using common, everyday words improves readability and comprehension by consumers, says the standard. Example: [table id=31 /] The ‘Good dispensing practice’ chapter of the Australian Pharmaceutical Formulary and Handbook (APF) is consistent with the National Standard for Labelling Dispensed Medicines and contains concise practical advice on how pharmacists can meet the standard.Should dosage intervals always be specific?
The standard says that dispensing label instructions should include a specific dosing interval (e.g. every 4 hours) if this level of specificity is critical to the dosing of the medicine. Common medicines for which specific dosing intervals are important include novel anticoagulants (e.g. apixaban), heparins, antimicrobial medicines and nitrates. For example, the recommended dosage of Paxlovid is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) taken together orally every 12 hours for 5 days. A narrow time interval range (e.g. every 3–4 hours) or using time periods (e.g. morning, midday, evening, bedtime) can allow some flexibility for patients to incorporate dosing of their medicine into their daily routine, if this is appropriate for the medicine in question. Pharmacists should use professional judgement to determine when flexible dosing instructions are appropriate.Does the type of medicine influence how dosing instructions should be written?
For medicines that are dosed infrequently (e.g. once or twice a day) it is usually preferable to write the dose instructions according to the time of day rather than according to time periods – unless the level of specificity of time interval is critical to the dosing of the medicine. For medicines that are dosed more frequently (e.g. more than three times a day) it might depend on the medicine and how important it is for the dosing times to be specific. For example, for medicines used for pain relief, it is more appropriate to write the dosing interval within a narrow range (e.g. every 4–6 hours).When should specific times be included on the dispensing label?
For medicines such as levodopa and other medicines to treat Parkinson's disease, a specific dosing schedule is therapeutically necessary to prevent the wearing-off phenomenon. The prescriber may have prescribed a dosing schedule for levodopa (e.g. 7.00 am, 11.00 am, 2.00 pm, 5.00 pm) that has been agreed with the patient according to their medicine needs, food intake and daily routine. In this situation, the label instructions should include these specific times and align with the prescription instructions.Written words are never an effective substitute for verbal communication when dispensing medicines
One of the most important factors to consider when writing dose instructions on the label is the individual patient and their health literacy. You should tailor both verbal and written health information (including information about how to take a medicine) to the patient’s needs. Use terms and concepts that patients can understand and relate to. Check the patient can understand the dosing instructions on the dispensing label when discussing the medicine and amend if necessary. [post_title] => Does how you print dosing intervals on medicine labels matter? [post_excerpt] => Expert advice for applying the right dosage instructions on dispensed medicine labels on a case-by-case basis. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => does-how-you-print-dosing-intervals-on-medicine-labels-matter [to_ping] => [pinged] => [post_modified] => 2024-03-13 15:42:02 [post_modified_gmt] => 2024-03-13 04:42:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25417 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Does how you print dosing intervals on medicine labels matter? [title] => Does how you print dosing intervals on medicine labels matter? [href] => https://www.australianpharmacist.com.au/does-how-you-print-dosing-intervals-on-medicine-labels-matter/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25433 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 23793 [post_author] => 3387 [post_date] => 2024-03-19 10:21:08 [post_date_gmt] => 2024-03-18 23:21:08 [post_content] => Since 1 November 2023, almost 5 million Australians at risk of severe complications from shingles have had access to the SHINGRIX vaccine under the National Immunisation Program (NIP). Herpes zoster (HZ), a reactivation of the varicella-zoster virus in patients who have had chicken pox previously, has a significant disease burden. Of all vaccine preventable diseases, HZ and its complications accounted for 7% of the overall burden in 2015. One of the most common complications from the virus is post-herpetic neuralgia (PHN), particularly among older and immunocompromised patients. Up to 5–30% of patients with HZ go on to develop PHN, with risks of this complication increasing with age. PHN, a type of nerve pain described as having a burning sensation that can persist long after acute HZ symptoms resolve, can be debilitating. One in three Australians will get shingles in their lifetime. Vaccination can reduce this likelihood.What’s changed and why?
SHINGRIX replaced Zostavax on the NIP following advice from the Pharmaceutical Benefits Advisory Committee and the Australian Technical Advisory Group on Immunisation. SHINGRIX is administered as two doses, 2–6 months apart, at a current private market cost of approximately $560. The age limit for NIP shingles vaccination eligibility is now 65 years and older, down from 70 years. Patients eligible to receive SHINGRIX under the NIP include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25470 [post_author] => 3410 [post_date] => 2024-03-18 12:06:45 [post_date_gmt] => 2024-03-18 01:06:45 [post_content] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. A sizable proportion of the clientele at Emerton Amcal Pharmacy in Western Sydney are Aboriginal and Torres Strait Islander peoples, with First Nations clients making up around 15.3% of the patient base. In the quest to provide culturally safe health care services, all pharmacists at Emerton, owned by Curtis Ruhnau MPS, Margaret Ruhnau MPS and Matthew Quick MPS, have completed PSA’s Deadly pharmacists foundation training course. Yet, despite their training, the pharmacists at Emerton (and sometimes, the proprietors) felt reluctant to wear First Nations designs, shirts, or pins for fear of appearing tokenistic. Ahead of National Close the Gap Day (21 March 2024), an Early Career Pharmacist explains how she overcame these feelings of imposter syndrome through a mix of client reception and acquiring cultural knowledge to work towards improving health outcomes for Aboriginal and Torres Strait Islander peoples.Turning points
Before completing the Deadly pharmacists training course, Zara Gul MPS was just trying to fulfil her role as a health professional when providing services to Aboriginal and Torres Strait Islander clients. ‘I was aiming to treat everyone the same, adapting my approach based on health literacy,’ she said. Post-training, she has a much broader understanding of how Aboriginal and Torres Strait Islander clients view health, the importance of a good yarn, and how to tailor information accordingly. But it took some time to arrive at this point, and feel comfortable rocking the deadly pharmacists shirt. ‘I finished the course earlier on, so it was just me wearing it at first, along with Curtis, Margaret and Matthew,’ said Ms Gul. ‘I would have my cardigan over the top just in case I offended someone or overstepped any cultural boundaries.’ It was the positive feedback from Aboriginal and Torres Strait Islander clients, coupled with some gentle leadership encouragement, that helped Ms Gul and her colleagues feel comfortable wearing First Nation designs. The starting point was when a young Aboriginal client complimented Margaret on her shirt, and she pointed out that Zara was wearing one too. ‘Margaret said, “she's also done her training”, and the client gave me two big thumbs up,’ she said. ‘We’ve since had a lot of positive feedback from clients. Everyone [says], “We like your shirt. Where did you get your shirt from? Can we get a shirt?”’ This has fueled a rapport with clients, with Ms Gul noticing people from the Aboriginal Torres Strait Islander backgrounds feel comfortable speaking more openly with her about their health. ‘We try not to stay behind the counter so we can chat face-to-face with clients,’ she said. ‘We also let clients know we've earned this shirt, and that we had to do a course that helped to improve our knowledge for providing healthcare to First Nations people.’Collaborative healthcare
A key takeout for Ms Gul from undergoing the Deadly Pharmacists training was the understanding that First Nations clients take a community approach to healthcare. ‘It's not just individual patients, they work with other members in the community and receive a lot of help from their family,’ she said. ‘It's about understanding that we need to take an integrated approach to healthcare, including with doctors and medical centres that clients frequent to ensure timely access to medicines.’ The team also strives to facilitate access to funded services. ‘For example, with conditions such as sleep apnea, we can work with the Integrated Team Care Program to help Aboriginal and Torres Strait Islander clients obtain funding for their devices,’ said Ms Gul. Working closely with Aboriginal health and support workers, particularly when organising dose administration aids (DAA), is also an important component of providing community-based care. ‘We liaise with them, make sure clients’ scripts are organised, and that medications are ready for pickup when they come in, so there are no gaps in care.’ Through relationship building, health outcomes for one Aboriginal and Torres Strait Islander client with significant mental health issues drastically improved. ‘Some of her medications are quite regulated, so by communicating well with her as well as her doctor, we're getting the scripts for the regulated medicines prepared in a timely manner,’ she said. When the client comes to pick up her medication every week, her DAA is complete, removing any additional stressors. ‘Her mental health is no longer deteriorating because she’s more adherent to her medication, and she's coming in to pick up her DAA on the right days as well,’ said Ms Gul. Programs such as the Deadly Pharmacists foundation training course are not only for those interested in working in Aboriginal Community-Controlled Health Services, but for any pharmacist who wants to improve service delivery. ‘Now that we've received such positive feedback, it has built my confidence – both in terms of wearing the shirt and providing information to First Nations clients about their healthcare,’ she said. The pharmacy’s floor staff have also undergone cultural competency training, earning the right to wear their own shirts with Aboriginal and Torres strait Islander designs. ‘That way, on Mondays and Fridays, we all wear the shirts. So we stand united as a team,’ added Ms Gul.Get involved
Any pharmacist can undertake PSA’s Deadly pharmacists foundation training course as part of their continuing professional development to improve cultural awareness and safety while earning up to 14 Group 2 CPD credits. Pharmacists who have completed the course still have the opportunity to purchase a Deadly Pharmacist polo shirt or scarf through reaching out to projects@psa.org.au. For pharmacists who identify as Aboriginal and Torres Strait Islander individuals, Expressions of Interest (EOI) for the annual PSA Faye McMillan Conference Grant to attend PSA24, sponsored by Care Pharmaceuticals and Hydralyte, opens this Thursday (21 March). The EOI is open until 16 May, with the successful applicant announced on 27 May. [post_title] => Wearing Aboriginal and Torres Strait Islander designs with intention [post_excerpt] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => wearing-aboriginal-and-torres-strait-islander-designs-with-intention [to_ping] => [pinged] => [post_modified] => 2024-03-18 15:02:03 [post_modified_gmt] => 2024-03-18 04:02:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25470 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Wearing Aboriginal and Torres Strait Islander designs with intention [title] => Wearing Aboriginal and Torres Strait Islander designs with intention [href] => https://www.australianpharmacist.com.au/wearing-aboriginal-and-torres-strait-islander-designs-with-intention/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25478 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25458 [post_author] => 175 [post_date] => 2024-03-17 20:53:09 [post_date_gmt] => 2024-03-17 09:53:09 [post_content] => The ACT Pharmacist of the Year Kirstin Turner MPS has forged a non-traditional, speciality role that is ideal for her life.Why did you choose pharmacy?
Since I was a teenager I have wanted to become a pharmacist. I believed that it would combine my love for medicine with opportunities to contribute to the health of people in the community as well as allow me to have endless career opportunities. And it has done exactly that. I completed a Bachelor of Pharmacy and was awarded the Academic Medal for bachelor coursework at James Cook University in Townsville in 2008 where I interned at a local community pharmacy through the PSA intern program until registering as a pharmacist in 2009.Did you follow the traditional community/hospital pharmacy route?
I worked in community pharmacy for a decade until 2019. In that time, I worked as an intern pharmacist, front-of-shop pharmacist and as pharmacist in charge within QLD, WA, and the ACT. I have always enjoyed being a pharmacist, however felt something was always missing; that I didn’t quite belong within the community setting. I found it difficult to incorporate my credentialed pharmacist, credentialed diabetes educator and GP pharmacist work within my community pharmacy roles over the years. In 2019 I was given the opportunity to extend my position as a GP Pharmacist and made the leap to leave community pharmacy so I could build up my own career path to ensure I had job mobility, stability, and flexibility all the while maintaining professional satisfaction. And again, no regrets.Which of your specialties came first?
I became a Credentialed Pharmacist through the PSA course in 2010. Interested in diabetes and chronic disease management through the Home Medicines Reviews I was undertaking at the time, I then became a Credentialed Diabetes Educator, starting my study after the birth of my first child. I completed my credentialing while in hospital after the birth of my second child in 2016. In 2018, I was offered an opportunity to participate in phase 2 of the Pharmacists in GP Practice Program and continued in that role for more than 5 years – and continue now, just in my own way.With your varied specialisations, how have you managed a work/life balance with two young children?
I am fortunate that as a pharmacist, I have been able to incorporate all my specialties into my daily practice where I can work as part of a healthcare team and improve the health outcomes of people within the community without restriction. Working for myself has allowed me to have the flexibility for the work/life balance my young family requires. Health care never stops and working independently has allowed me the flexibility to work late nights, weekends, make after-hours phone calls to GPs or patients, and even sneak off during a scouts camp to find mobile reception to finish a report. I can also do research or attend an online meeting, all the while making sure I can still attend my children’s activities and appointments. As they grow, I envisage that my role will also grow and I will never be short on work opportunities, hopefully.How did you get into mentoring younger pharmacists?
I kind of fell into mentoring. As a very approachable and accommodating person, I’ve been mentoring pharmacists ever since I was registered, and it is something that I absolutely love! I mentor pharmacists at any stage of their career and under any circumstance – newly registered pharmacists, university students, prospective Credentialed Diabetes Educators or GP pharmacists and others who are just curious about what I do. I have lost count as I do it formally through ADEA for CDE accreditation and informally by allowing myself to be contactable by any pharmacist via any means – for an on-off discussion or as a long-term professional contact. I just wish that I had the same mentor access when I was starting out.Any advice for ECPs?
Find a mentor in the career pathway that interests you. Be open to accept mistakes and grow, welcome feedback, set goals, ask for help, grow your professional network, and identify your strengths and interests to develop your own career path.
8.30 am | Get sorted Drop kids at before-school care. Pack bags and Home Medicines Review (HMR) schedules, usually 2 per day. Organise referrals for three diabetes education patients, seen at my home clinic room or alongside HMRs. |
9.00 am | Administration Triple check calendar, send out recalls and confirmations for appointments tomorrow, and contact recipients of referrals. |
10.00 am | HMR/diabetes education home visit Drive to see woman, 80, recently moved from a regional area to the ACT. New GP requires a medicine reconciliation and patient history for multiple diagnoses, including diabetes, asthma, gout, retinopathy, hypertension, microalbuminuria, back pain and osteoarthritis. Records from previous GP not sent. Medicine reconciliation identifies three missing medicines (aspirin, furosemide, and an iron supplement). Significant drug-related problems identified include: (1) metformin (1,000 mg tds) and pioglitazone (45 mg once daily) over recommended dose for current renal function and well-controlled diabetes (2) triple whammy (perindopril, furosemide and celecoxib) (3) non-adherence to inhalers (4) no indication for furosemide, aspirin or paracetamol and codeine phosphate hemihydrate (Panadeine Forte) (5) adverse effects of fluid retention, oedema, constipation and GI bleeding noted. Urgent contact was made with the GP who implemented recommended changes immediately. HMR report issued and patient was booked for follow-up reviews. While patient was willing to make changes, she was surprised so many problems had been identified with the apparent ‘set and forget’ medicine regimen. |
2–5.00 pm | Referrals, appointments, emails Referrals received for HMRs and diabetes education contacted for appointments. Write reports, check emails for mentoring or potential work or educational opportunities |
5.00 pm | Home time Collect kids for extracurricular engagements. After dinner – write reports, mentor, etc. |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25217 [post_author] => 3919 [post_date] => 2024-03-14 10:23:24 [post_date_gmt] => 2024-03-13 23:23:24 [post_content] =>Pain is a highly complex and subjective phenomenon, characterised by high levels of inter-individual variability.1,2 This can make it difficult to quantify and compare pain between individuals and different population groups.1,2
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]Access to timely and appropriate pain management is also influenced by numerous factors, including some related to the patient, such as level of health literacy, socio-economic disadvantage, geographic location, and others related to society, including, discrimination, stigma, and gender norms.3
Considering this, there has been growing literature citing the presence of what has been termed a 'gender pain gap' both locally and globally.4–11 This article shares insights from an Australian survey of healthcare professionals evaluating attitudes towards unconscious gender biases, with the aim of helping pharmacists conceptualise the gender pain gap as it applies to their own practice as well as the broader healthcare landscape. It includes practical strategies to help pharmacists identify and address unconscious gender biases relating to the management of pain in their practice. While this article focuses on the gender pain gap as it pertains to cisgender women and men, it’s crucial to acknowledge that gender bias may similarly impact non-cisgender individuals experiencing pain.12,13 Many of the strategies aimed at mitigating unconscious bias discussed may also be relevant for addressing disparities faced by non-cisgender individuals.12,13
Learning objectivesAfter reading this article, pharmacists should be able to:
Competency (2016) Standards addressed: 1.1, 1.4, 1.5, 1.6, 2.1, 2.4, 3.1, 3.5, 3.6 Accreditation expiry: CAP2404SYPCP Accreditation number: 31/03/2027 |
The term ‘gender pain gap’ is usually used to refer to the disparities in the pain experience between men and women. In literature, the term encompasses ideas such as4–8:
NOTE: In discussing the 'gender pain gap', it’s important to note that while ‘sex’ refers to biological differences between males and females, ‘gender’ encompasses the sociocultural, psychological, and behavioural aspects associated with being male, female, or another gender identity.14 Therefore, while in places this paper discusses data comparing males and females, we recognise that gender is a multifaceted construct that goes beyond biological differences and influences individuals’ experiences of pain and pain management. |
The gender pain gap has been demonstrated in Australian healthcare settings in relation to the diagnosis and treatment of pain.9–11 A retrospective audit in the Australian acute care setting (n = 192) demonstrated that women presenting with acute abdominal pain received different analgesics, fewer doses of analgesics, and experienced longer wait times for analgesics to be administered compared to men.9 With regard to gender specific conditions, a study of Australian women with endometriosis (n = 532) indicated many felt let down by medical staff, with their pain often viewed as psychological or the reported severity being distrusted.10 Additionally, diagnosis of endometriosis in Australia has been shown to be delayed by an average of 6.4 years due to various reasons, including misunderstanding and lack of knowledge of endometriosis by healthcare professionals, misdiagnoses and normalisation of period pain.11
Several factors contribute to the gender pain gap. Historically, women have been under-represented in medical research.15,16 Initial pain studies included average male subjects with results being generalised to females, contributing to a poorer understanding of how certain pain conditions manifest or need to be managed in this demographic.6,15,16 Differences in physiological pain pathways between men and women have now been reported, but a comprehensive understanding of these distinctions remains elusive.17,18 While representation of female subjects has been increasing in research, many areas of medicine still lack gender-specific recommendations.19
Moreover, another key cited contributor to the gender pain gap is unconscious gender bias.7–9
Awareness of this phenomenon was evaluated in a quantitative online survey of Australian pharmacists and general practitioners (n = 305) conducted in December 2023.20 The vast majority of respondents believed in the existence of unconscious biases among healthcare professionals, indicating that this is generally a well-known and accepted concept (see Figure 1). These unconscious biases were primarily reported to manifest in relation to gender, culture and race. When questioned about the existence of gender biases in the context of patient care, this was again widely acknowledged and almost half of the healthcare professionals considered it to be a widespread problem.20
In the pain treatment setting, a common perception was that gender bias among healthcare professionals manifested in the form of female pain being overlooked, underdiagnosed, misdiagnosed, and taking too long to be diagnosed (see Figure 2).20
Unconscious bias (also known as implicit bias) often differs starkly from an individual’s conscious beliefs.21 It develops in early life from repeated reinforcement of social stereotypes until they become automatic.21 In this context, stereotypes refer to well-learned sets of associations between certain traits and a social group.21 For example, from a very young age, children are socialised to react to pain in certain ways; in particular, most societies discourage men from expressing their emotions while women are taught to verbalise discomfort.6,7,22 While gender stereotypes are nuanced, a common overarching theme is the perception of men as stoic and/or rational, and that of women as emotional, dramatic and/or prone to exaggeration.5,7
Although these social stereotypes are not consciously endorsed in healthcare settings, healthcare professionals are not immune to them.21 Furthermore, the uncertainty and time pressures in most healthcare settings may favour reliance on stereotypes for decision making.21,24
Pain management is an area that may be particularly vulnerable to unconscious biases, given that pain is a subjective experience, likely influenced by biological, psychological, and social factors.25 When managing pain, healthcare professionals are required to make inferences about pain authenticity and intensity.5,8 These judgements cannot be objectively verified and can be influenced by perceiver biases based on gender, race, and other contextual factors.5,8
For instance, a healthcare providers’ perception of a patients’ trustworthiness may impact their pain assessment and treatment decisions.26 In a United Kingdom study where pain clinicians and medical students made judgements based on a video and a brief history of a patient with shoulder pain, women, especially those rated as being of low trustworthiness (ratings were provided by trainee clinical psychologists), were estimated to have less pain, and judged to be more likely to exaggerate. For treatment recommendations, men were more likely to be recommended analgesics while women were more likely to be recommended psychological treatment.26
In the Chronic Pain Australia 2023 National Pain Survey, findings indicated that women felt they are less likely to be believed when presenting with chronic pain.27 Some respondents described feelings of judgement, shame and ridicule when accessing healthcare. Many (76.3%) shared experiences of feeling ignored or dismissed.27
In the present survey, healthcare professionals recognised that unconscious gender bias could potentially influence the mental health of female patients and impact their experience of pain conditions, as well as impact their interactions with healthcare providers in a negative manner (see Figure 3).20
Figure 3 – Australian healthcare professional perceptions of the impacts of gender pain bias
The International Pharmaceutical Federation (FIP) 2023 report on the role of pharmacists in closing the gender pain gap noted that the topic was not well covered during pharmacy education.23 This was reflected in the present survey where most healthcare professionals, including pharmacists, noted that they had not received any training on understanding and addressing female pain experiences (see Figure 4).20
Figure 4 – Training on understanding and addressing female pain experiences in Australia
Unconscious gender bias needs to be addressed at all levels of healthcare. In the context of pain management, pharmacists play a key role – from providing medicines advice and dispensing to referring patients to other healthcare professionals as needed. As such, pharmacists need to be aware of gender stereotypes in pain management to be able to identify and address any inequities in care.23
It is important to keep in mind that different genders have different pain management needs that change at each stage of life.3 Closing the gender pain gap doesn’t mean providing the same pain care for all genders, but rather working towards equitable care for all.
Unconscious gender biases are complex, thus there is no single debiasing strategy that will work for everyone.21,28 However, since gender biases are automatic, habitual activation of stereotypes, the first step to addressing them is for healthcare professionals to be aware of their susceptibility to them.16,28
While it is difficult to quantify bias, these strategies may be useful for identifying unconscious gender biases:
Some strategies that may help to address unconscious gender biases include:
These strategies can help to improve the quality of communication with patients and may prevent filling in partial information with stereotype-based assumptions.21,23 Self-reflection when interacting with patients may also help to avoid stereotype-based assumptions – ask yourself questions such as28:
A simple acronym such as ACE (see Figure 5) may be helpful for habitualising this process during interactions with patients seeking analgesia.
Figure 5 – ACE acronym
Finally, keep in mind that men and women tend to express pain differently due to early socialisation of pain responses,6,7,22 and this should be considered during consultations to help avoid stereotypical categorisations.
For instance6,7:
The gender pain gap refers to the disparities in the pain experience between genders. While a range of factors contribute to the gender pain gap, unconscious gender bias has been cited as one of the key factors.
Unconscious biases develop early in life from repeated reinforcement of social stereotypes until they become automatic. Given that pain is a subjective experience, pain management may be particularly vulnerable to unconscious biases.
The issue of unconscious gender biases needs to be tackled at all levels of healthcare. Taking small steps in the pharmacy to address it can help lay the foundations for closing the gender pain gap and ensure equitable provision of healthcare services for all patients.
[cpd_submit_answer_button]Dr Jacinta Johnson PhD, FANZCAP (Edu. Research), FPS, FSHP is a credentialed Advanced Practice Pharmacist. She is a Senior Lecturer in Pharmacy at the University of South Australia and Senior Pharmacist for Research within SA Pharmacy.
Jacinta Johnson has received consultancy fees for development and delivery of educational materials or Advisory Group participation from Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd.
[post_title] => Are unconscious gender biases widening the Australian gender pain gap? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2 [to_ping] => [pinged] => [post_modified] => 2024-03-15 14:00:32 [post_modified_gmt] => 2024-03-15 03:00:32 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25217 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Are unconscious gender biases widening the Australian gender pain gap? [title] => Are unconscious gender biases widening the Australian gender pain gap? [href] => https://www.australianpharmacist.com.au/are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 25220 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25417 [post_author] => 7918 [post_date] => 2024-03-13 12:48:04 [post_date_gmt] => 2024-03-13 01:48:04 [post_content] => Expert advice for applying the right dosage instructions on medicine labels on a case-by-case basis. How do you word instructions on dispensing labels? Could some simple changes make your instructions clearer for patients? Claire Antrobus MPS, Manager, Practice Support at PSA explains the importance of simple and explicit dosing instructions tailored to medicine type, dosing requirements and patient comprehension.What do guidelines say about how to make instructions ‘explicit and clear’?
Most importantly, dosing instructions on dispensed medicine labels should be explicit and clear, according to the Australian Commission on Safety and Quality in Health Care’s National Standard for Labelling Dispensed Medicines 2021. Using common, everyday words improves readability and comprehension by consumers, says the standard. Example: [table id=31 /] The ‘Good dispensing practice’ chapter of the Australian Pharmaceutical Formulary and Handbook (APF) is consistent with the National Standard for Labelling Dispensed Medicines and contains concise practical advice on how pharmacists can meet the standard.Should dosage intervals always be specific?
The standard says that dispensing label instructions should include a specific dosing interval (e.g. every 4 hours) if this level of specificity is critical to the dosing of the medicine. Common medicines for which specific dosing intervals are important include novel anticoagulants (e.g. apixaban), heparins, antimicrobial medicines and nitrates. For example, the recommended dosage of Paxlovid is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) taken together orally every 12 hours for 5 days. A narrow time interval range (e.g. every 3–4 hours) or using time periods (e.g. morning, midday, evening, bedtime) can allow some flexibility for patients to incorporate dosing of their medicine into their daily routine, if this is appropriate for the medicine in question. Pharmacists should use professional judgement to determine when flexible dosing instructions are appropriate.Does the type of medicine influence how dosing instructions should be written?
For medicines that are dosed infrequently (e.g. once or twice a day) it is usually preferable to write the dose instructions according to the time of day rather than according to time periods – unless the level of specificity of time interval is critical to the dosing of the medicine. For medicines that are dosed more frequently (e.g. more than three times a day) it might depend on the medicine and how important it is for the dosing times to be specific. For example, for medicines used for pain relief, it is more appropriate to write the dosing interval within a narrow range (e.g. every 4–6 hours).When should specific times be included on the dispensing label?
For medicines such as levodopa and other medicines to treat Parkinson's disease, a specific dosing schedule is therapeutically necessary to prevent the wearing-off phenomenon. The prescriber may have prescribed a dosing schedule for levodopa (e.g. 7.00 am, 11.00 am, 2.00 pm, 5.00 pm) that has been agreed with the patient according to their medicine needs, food intake and daily routine. In this situation, the label instructions should include these specific times and align with the prescription instructions.Written words are never an effective substitute for verbal communication when dispensing medicines
One of the most important factors to consider when writing dose instructions on the label is the individual patient and their health literacy. You should tailor both verbal and written health information (including information about how to take a medicine) to the patient’s needs. Use terms and concepts that patients can understand and relate to. Check the patient can understand the dosing instructions on the dispensing label when discussing the medicine and amend if necessary. [post_title] => Does how you print dosing intervals on medicine labels matter? [post_excerpt] => Expert advice for applying the right dosage instructions on dispensed medicine labels on a case-by-case basis. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => does-how-you-print-dosing-intervals-on-medicine-labels-matter [to_ping] => [pinged] => [post_modified] => 2024-03-13 15:42:02 [post_modified_gmt] => 2024-03-13 04:42:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25417 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Does how you print dosing intervals on medicine labels matter? [title] => Does how you print dosing intervals on medicine labels matter? [href] => https://www.australianpharmacist.com.au/does-how-you-print-dosing-intervals-on-medicine-labels-matter/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25433 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 23793 [post_author] => 3387 [post_date] => 2024-03-19 10:21:08 [post_date_gmt] => 2024-03-18 23:21:08 [post_content] => Since 1 November 2023, almost 5 million Australians at risk of severe complications from shingles have had access to the SHINGRIX vaccine under the National Immunisation Program (NIP). Herpes zoster (HZ), a reactivation of the varicella-zoster virus in patients who have had chicken pox previously, has a significant disease burden. Of all vaccine preventable diseases, HZ and its complications accounted for 7% of the overall burden in 2015. One of the most common complications from the virus is post-herpetic neuralgia (PHN), particularly among older and immunocompromised patients. Up to 5–30% of patients with HZ go on to develop PHN, with risks of this complication increasing with age. PHN, a type of nerve pain described as having a burning sensation that can persist long after acute HZ symptoms resolve, can be debilitating. One in three Australians will get shingles in their lifetime. Vaccination can reduce this likelihood.What’s changed and why?
SHINGRIX replaced Zostavax on the NIP following advice from the Pharmaceutical Benefits Advisory Committee and the Australian Technical Advisory Group on Immunisation. SHINGRIX is administered as two doses, 2–6 months apart, at a current private market cost of approximately $560. The age limit for NIP shingles vaccination eligibility is now 65 years and older, down from 70 years. Patients eligible to receive SHINGRIX under the NIP include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25470 [post_author] => 3410 [post_date] => 2024-03-18 12:06:45 [post_date_gmt] => 2024-03-18 01:06:45 [post_content] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. A sizable proportion of the clientele at Emerton Amcal Pharmacy in Western Sydney are Aboriginal and Torres Strait Islander peoples, with First Nations clients making up around 15.3% of the patient base. In the quest to provide culturally safe health care services, all pharmacists at Emerton, owned by Curtis Ruhnau MPS, Margaret Ruhnau MPS and Matthew Quick MPS, have completed PSA’s Deadly pharmacists foundation training course. Yet, despite their training, the pharmacists at Emerton (and sometimes, the proprietors) felt reluctant to wear First Nations designs, shirts, or pins for fear of appearing tokenistic. Ahead of National Close the Gap Day (21 March 2024), an Early Career Pharmacist explains how she overcame these feelings of imposter syndrome through a mix of client reception and acquiring cultural knowledge to work towards improving health outcomes for Aboriginal and Torres Strait Islander peoples.Turning points
Before completing the Deadly pharmacists training course, Zara Gul MPS was just trying to fulfil her role as a health professional when providing services to Aboriginal and Torres Strait Islander clients. ‘I was aiming to treat everyone the same, adapting my approach based on health literacy,’ she said. Post-training, she has a much broader understanding of how Aboriginal and Torres Strait Islander clients view health, the importance of a good yarn, and how to tailor information accordingly. But it took some time to arrive at this point, and feel comfortable rocking the deadly pharmacists shirt. ‘I finished the course earlier on, so it was just me wearing it at first, along with Curtis, Margaret and Matthew,’ said Ms Gul. ‘I would have my cardigan over the top just in case I offended someone or overstepped any cultural boundaries.’ It was the positive feedback from Aboriginal and Torres Strait Islander clients, coupled with some gentle leadership encouragement, that helped Ms Gul and her colleagues feel comfortable wearing First Nation designs. The starting point was when a young Aboriginal client complimented Margaret on her shirt, and she pointed out that Zara was wearing one too. ‘Margaret said, “she's also done her training”, and the client gave me two big thumbs up,’ she said. ‘We’ve since had a lot of positive feedback from clients. Everyone [says], “We like your shirt. Where did you get your shirt from? Can we get a shirt?”’ This has fueled a rapport with clients, with Ms Gul noticing people from the Aboriginal Torres Strait Islander backgrounds feel comfortable speaking more openly with her about their health. ‘We try not to stay behind the counter so we can chat face-to-face with clients,’ she said. ‘We also let clients know we've earned this shirt, and that we had to do a course that helped to improve our knowledge for providing healthcare to First Nations people.’Collaborative healthcare
A key takeout for Ms Gul from undergoing the Deadly Pharmacists training was the understanding that First Nations clients take a community approach to healthcare. ‘It's not just individual patients, they work with other members in the community and receive a lot of help from their family,’ she said. ‘It's about understanding that we need to take an integrated approach to healthcare, including with doctors and medical centres that clients frequent to ensure timely access to medicines.’ The team also strives to facilitate access to funded services. ‘For example, with conditions such as sleep apnea, we can work with the Integrated Team Care Program to help Aboriginal and Torres Strait Islander clients obtain funding for their devices,’ said Ms Gul. Working closely with Aboriginal health and support workers, particularly when organising dose administration aids (DAA), is also an important component of providing community-based care. ‘We liaise with them, make sure clients’ scripts are organised, and that medications are ready for pickup when they come in, so there are no gaps in care.’ Through relationship building, health outcomes for one Aboriginal and Torres Strait Islander client with significant mental health issues drastically improved. ‘Some of her medications are quite regulated, so by communicating well with her as well as her doctor, we're getting the scripts for the regulated medicines prepared in a timely manner,’ she said. When the client comes to pick up her medication every week, her DAA is complete, removing any additional stressors. ‘Her mental health is no longer deteriorating because she’s more adherent to her medication, and she's coming in to pick up her DAA on the right days as well,’ said Ms Gul. Programs such as the Deadly Pharmacists foundation training course are not only for those interested in working in Aboriginal Community-Controlled Health Services, but for any pharmacist who wants to improve service delivery. ‘Now that we've received such positive feedback, it has built my confidence – both in terms of wearing the shirt and providing information to First Nations clients about their healthcare,’ she said. The pharmacy’s floor staff have also undergone cultural competency training, earning the right to wear their own shirts with Aboriginal and Torres strait Islander designs. ‘That way, on Mondays and Fridays, we all wear the shirts. So we stand united as a team,’ added Ms Gul.Get involved
Any pharmacist can undertake PSA’s Deadly pharmacists foundation training course as part of their continuing professional development to improve cultural awareness and safety while earning up to 14 Group 2 CPD credits. Pharmacists who have completed the course still have the opportunity to purchase a Deadly Pharmacist polo shirt or scarf through reaching out to projects@psa.org.au. For pharmacists who identify as Aboriginal and Torres Strait Islander individuals, Expressions of Interest (EOI) for the annual PSA Faye McMillan Conference Grant to attend PSA24, sponsored by Care Pharmaceuticals and Hydralyte, opens this Thursday (21 March). The EOI is open until 16 May, with the successful applicant announced on 27 May. [post_title] => Wearing Aboriginal and Torres Strait Islander designs with intention [post_excerpt] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => wearing-aboriginal-and-torres-strait-islander-designs-with-intention [to_ping] => [pinged] => [post_modified] => 2024-03-18 15:02:03 [post_modified_gmt] => 2024-03-18 04:02:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25470 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Wearing Aboriginal and Torres Strait Islander designs with intention [title] => Wearing Aboriginal and Torres Strait Islander designs with intention [href] => https://www.australianpharmacist.com.au/wearing-aboriginal-and-torres-strait-islander-designs-with-intention/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25478 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25458 [post_author] => 175 [post_date] => 2024-03-17 20:53:09 [post_date_gmt] => 2024-03-17 09:53:09 [post_content] => The ACT Pharmacist of the Year Kirstin Turner MPS has forged a non-traditional, speciality role that is ideal for her life.Why did you choose pharmacy?
Since I was a teenager I have wanted to become a pharmacist. I believed that it would combine my love for medicine with opportunities to contribute to the health of people in the community as well as allow me to have endless career opportunities. And it has done exactly that. I completed a Bachelor of Pharmacy and was awarded the Academic Medal for bachelor coursework at James Cook University in Townsville in 2008 where I interned at a local community pharmacy through the PSA intern program until registering as a pharmacist in 2009.Did you follow the traditional community/hospital pharmacy route?
I worked in community pharmacy for a decade until 2019. In that time, I worked as an intern pharmacist, front-of-shop pharmacist and as pharmacist in charge within QLD, WA, and the ACT. I have always enjoyed being a pharmacist, however felt something was always missing; that I didn’t quite belong within the community setting. I found it difficult to incorporate my credentialed pharmacist, credentialed diabetes educator and GP pharmacist work within my community pharmacy roles over the years. In 2019 I was given the opportunity to extend my position as a GP Pharmacist and made the leap to leave community pharmacy so I could build up my own career path to ensure I had job mobility, stability, and flexibility all the while maintaining professional satisfaction. And again, no regrets.Which of your specialties came first?
I became a Credentialed Pharmacist through the PSA course in 2010. Interested in diabetes and chronic disease management through the Home Medicines Reviews I was undertaking at the time, I then became a Credentialed Diabetes Educator, starting my study after the birth of my first child. I completed my credentialing while in hospital after the birth of my second child in 2016. In 2018, I was offered an opportunity to participate in phase 2 of the Pharmacists in GP Practice Program and continued in that role for more than 5 years – and continue now, just in my own way.With your varied specialisations, how have you managed a work/life balance with two young children?
I am fortunate that as a pharmacist, I have been able to incorporate all my specialties into my daily practice where I can work as part of a healthcare team and improve the health outcomes of people within the community without restriction. Working for myself has allowed me to have the flexibility for the work/life balance my young family requires. Health care never stops and working independently has allowed me the flexibility to work late nights, weekends, make after-hours phone calls to GPs or patients, and even sneak off during a scouts camp to find mobile reception to finish a report. I can also do research or attend an online meeting, all the while making sure I can still attend my children’s activities and appointments. As they grow, I envisage that my role will also grow and I will never be short on work opportunities, hopefully.How did you get into mentoring younger pharmacists?
I kind of fell into mentoring. As a very approachable and accommodating person, I’ve been mentoring pharmacists ever since I was registered, and it is something that I absolutely love! I mentor pharmacists at any stage of their career and under any circumstance – newly registered pharmacists, university students, prospective Credentialed Diabetes Educators or GP pharmacists and others who are just curious about what I do. I have lost count as I do it formally through ADEA for CDE accreditation and informally by allowing myself to be contactable by any pharmacist via any means – for an on-off discussion or as a long-term professional contact. I just wish that I had the same mentor access when I was starting out.Any advice for ECPs?
Find a mentor in the career pathway that interests you. Be open to accept mistakes and grow, welcome feedback, set goals, ask for help, grow your professional network, and identify your strengths and interests to develop your own career path.
8.30 am | Get sorted Drop kids at before-school care. Pack bags and Home Medicines Review (HMR) schedules, usually 2 per day. Organise referrals for three diabetes education patients, seen at my home clinic room or alongside HMRs. |
9.00 am | Administration Triple check calendar, send out recalls and confirmations for appointments tomorrow, and contact recipients of referrals. |
10.00 am | HMR/diabetes education home visit Drive to see woman, 80, recently moved from a regional area to the ACT. New GP requires a medicine reconciliation and patient history for multiple diagnoses, including diabetes, asthma, gout, retinopathy, hypertension, microalbuminuria, back pain and osteoarthritis. Records from previous GP not sent. Medicine reconciliation identifies three missing medicines (aspirin, furosemide, and an iron supplement). Significant drug-related problems identified include: (1) metformin (1,000 mg tds) and pioglitazone (45 mg once daily) over recommended dose for current renal function and well-controlled diabetes (2) triple whammy (perindopril, furosemide and celecoxib) (3) non-adherence to inhalers (4) no indication for furosemide, aspirin or paracetamol and codeine phosphate hemihydrate (Panadeine Forte) (5) adverse effects of fluid retention, oedema, constipation and GI bleeding noted. Urgent contact was made with the GP who implemented recommended changes immediately. HMR report issued and patient was booked for follow-up reviews. While patient was willing to make changes, she was surprised so many problems had been identified with the apparent ‘set and forget’ medicine regimen. |
2–5.00 pm | Referrals, appointments, emails Referrals received for HMRs and diabetes education contacted for appointments. Write reports, check emails for mentoring or potential work or educational opportunities |
5.00 pm | Home time Collect kids for extracurricular engagements. After dinner – write reports, mentor, etc. |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25217 [post_author] => 3919 [post_date] => 2024-03-14 10:23:24 [post_date_gmt] => 2024-03-13 23:23:24 [post_content] =>Pain is a highly complex and subjective phenomenon, characterised by high levels of inter-individual variability.1,2 This can make it difficult to quantify and compare pain between individuals and different population groups.1,2
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]Access to timely and appropriate pain management is also influenced by numerous factors, including some related to the patient, such as level of health literacy, socio-economic disadvantage, geographic location, and others related to society, including, discrimination, stigma, and gender norms.3
Considering this, there has been growing literature citing the presence of what has been termed a 'gender pain gap' both locally and globally.4–11 This article shares insights from an Australian survey of healthcare professionals evaluating attitudes towards unconscious gender biases, with the aim of helping pharmacists conceptualise the gender pain gap as it applies to their own practice as well as the broader healthcare landscape. It includes practical strategies to help pharmacists identify and address unconscious gender biases relating to the management of pain in their practice. While this article focuses on the gender pain gap as it pertains to cisgender women and men, it’s crucial to acknowledge that gender bias may similarly impact non-cisgender individuals experiencing pain.12,13 Many of the strategies aimed at mitigating unconscious bias discussed may also be relevant for addressing disparities faced by non-cisgender individuals.12,13
Learning objectivesAfter reading this article, pharmacists should be able to:
Competency (2016) Standards addressed: 1.1, 1.4, 1.5, 1.6, 2.1, 2.4, 3.1, 3.5, 3.6 Accreditation expiry: CAP2404SYPCP Accreditation number: 31/03/2027 |
The term ‘gender pain gap’ is usually used to refer to the disparities in the pain experience between men and women. In literature, the term encompasses ideas such as4–8:
NOTE: In discussing the 'gender pain gap', it’s important to note that while ‘sex’ refers to biological differences between males and females, ‘gender’ encompasses the sociocultural, psychological, and behavioural aspects associated with being male, female, or another gender identity.14 Therefore, while in places this paper discusses data comparing males and females, we recognise that gender is a multifaceted construct that goes beyond biological differences and influences individuals’ experiences of pain and pain management. |
The gender pain gap has been demonstrated in Australian healthcare settings in relation to the diagnosis and treatment of pain.9–11 A retrospective audit in the Australian acute care setting (n = 192) demonstrated that women presenting with acute abdominal pain received different analgesics, fewer doses of analgesics, and experienced longer wait times for analgesics to be administered compared to men.9 With regard to gender specific conditions, a study of Australian women with endometriosis (n = 532) indicated many felt let down by medical staff, with their pain often viewed as psychological or the reported severity being distrusted.10 Additionally, diagnosis of endometriosis in Australia has been shown to be delayed by an average of 6.4 years due to various reasons, including misunderstanding and lack of knowledge of endometriosis by healthcare professionals, misdiagnoses and normalisation of period pain.11
Several factors contribute to the gender pain gap. Historically, women have been under-represented in medical research.15,16 Initial pain studies included average male subjects with results being generalised to females, contributing to a poorer understanding of how certain pain conditions manifest or need to be managed in this demographic.6,15,16 Differences in physiological pain pathways between men and women have now been reported, but a comprehensive understanding of these distinctions remains elusive.17,18 While representation of female subjects has been increasing in research, many areas of medicine still lack gender-specific recommendations.19
Moreover, another key cited contributor to the gender pain gap is unconscious gender bias.7–9
Awareness of this phenomenon was evaluated in a quantitative online survey of Australian pharmacists and general practitioners (n = 305) conducted in December 2023.20 The vast majority of respondents believed in the existence of unconscious biases among healthcare professionals, indicating that this is generally a well-known and accepted concept (see Figure 1). These unconscious biases were primarily reported to manifest in relation to gender, culture and race. When questioned about the existence of gender biases in the context of patient care, this was again widely acknowledged and almost half of the healthcare professionals considered it to be a widespread problem.20
In the pain treatment setting, a common perception was that gender bias among healthcare professionals manifested in the form of female pain being overlooked, underdiagnosed, misdiagnosed, and taking too long to be diagnosed (see Figure 2).20
Unconscious bias (also known as implicit bias) often differs starkly from an individual’s conscious beliefs.21 It develops in early life from repeated reinforcement of social stereotypes until they become automatic.21 In this context, stereotypes refer to well-learned sets of associations between certain traits and a social group.21 For example, from a very young age, children are socialised to react to pain in certain ways; in particular, most societies discourage men from expressing their emotions while women are taught to verbalise discomfort.6,7,22 While gender stereotypes are nuanced, a common overarching theme is the perception of men as stoic and/or rational, and that of women as emotional, dramatic and/or prone to exaggeration.5,7
Although these social stereotypes are not consciously endorsed in healthcare settings, healthcare professionals are not immune to them.21 Furthermore, the uncertainty and time pressures in most healthcare settings may favour reliance on stereotypes for decision making.21,24
Pain management is an area that may be particularly vulnerable to unconscious biases, given that pain is a subjective experience, likely influenced by biological, psychological, and social factors.25 When managing pain, healthcare professionals are required to make inferences about pain authenticity and intensity.5,8 These judgements cannot be objectively verified and can be influenced by perceiver biases based on gender, race, and other contextual factors.5,8
For instance, a healthcare providers’ perception of a patients’ trustworthiness may impact their pain assessment and treatment decisions.26 In a United Kingdom study where pain clinicians and medical students made judgements based on a video and a brief history of a patient with shoulder pain, women, especially those rated as being of low trustworthiness (ratings were provided by trainee clinical psychologists), were estimated to have less pain, and judged to be more likely to exaggerate. For treatment recommendations, men were more likely to be recommended analgesics while women were more likely to be recommended psychological treatment.26
In the Chronic Pain Australia 2023 National Pain Survey, findings indicated that women felt they are less likely to be believed when presenting with chronic pain.27 Some respondents described feelings of judgement, shame and ridicule when accessing healthcare. Many (76.3%) shared experiences of feeling ignored or dismissed.27
In the present survey, healthcare professionals recognised that unconscious gender bias could potentially influence the mental health of female patients and impact their experience of pain conditions, as well as impact their interactions with healthcare providers in a negative manner (see Figure 3).20
Figure 3 – Australian healthcare professional perceptions of the impacts of gender pain bias
The International Pharmaceutical Federation (FIP) 2023 report on the role of pharmacists in closing the gender pain gap noted that the topic was not well covered during pharmacy education.23 This was reflected in the present survey where most healthcare professionals, including pharmacists, noted that they had not received any training on understanding and addressing female pain experiences (see Figure 4).20
Figure 4 – Training on understanding and addressing female pain experiences in Australia
Unconscious gender bias needs to be addressed at all levels of healthcare. In the context of pain management, pharmacists play a key role – from providing medicines advice and dispensing to referring patients to other healthcare professionals as needed. As such, pharmacists need to be aware of gender stereotypes in pain management to be able to identify and address any inequities in care.23
It is important to keep in mind that different genders have different pain management needs that change at each stage of life.3 Closing the gender pain gap doesn’t mean providing the same pain care for all genders, but rather working towards equitable care for all.
Unconscious gender biases are complex, thus there is no single debiasing strategy that will work for everyone.21,28 However, since gender biases are automatic, habitual activation of stereotypes, the first step to addressing them is for healthcare professionals to be aware of their susceptibility to them.16,28
While it is difficult to quantify bias, these strategies may be useful for identifying unconscious gender biases:
Some strategies that may help to address unconscious gender biases include:
These strategies can help to improve the quality of communication with patients and may prevent filling in partial information with stereotype-based assumptions.21,23 Self-reflection when interacting with patients may also help to avoid stereotype-based assumptions – ask yourself questions such as28:
A simple acronym such as ACE (see Figure 5) may be helpful for habitualising this process during interactions with patients seeking analgesia.
Figure 5 – ACE acronym
Finally, keep in mind that men and women tend to express pain differently due to early socialisation of pain responses,6,7,22 and this should be considered during consultations to help avoid stereotypical categorisations.
For instance6,7:
The gender pain gap refers to the disparities in the pain experience between genders. While a range of factors contribute to the gender pain gap, unconscious gender bias has been cited as one of the key factors.
Unconscious biases develop early in life from repeated reinforcement of social stereotypes until they become automatic. Given that pain is a subjective experience, pain management may be particularly vulnerable to unconscious biases.
The issue of unconscious gender biases needs to be tackled at all levels of healthcare. Taking small steps in the pharmacy to address it can help lay the foundations for closing the gender pain gap and ensure equitable provision of healthcare services for all patients.
[cpd_submit_answer_button]Dr Jacinta Johnson PhD, FANZCAP (Edu. Research), FPS, FSHP is a credentialed Advanced Practice Pharmacist. She is a Senior Lecturer in Pharmacy at the University of South Australia and Senior Pharmacist for Research within SA Pharmacy.
Jacinta Johnson has received consultancy fees for development and delivery of educational materials or Advisory Group participation from Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd.
[post_title] => Are unconscious gender biases widening the Australian gender pain gap? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2 [to_ping] => [pinged] => [post_modified] => 2024-03-15 14:00:32 [post_modified_gmt] => 2024-03-15 03:00:32 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25217 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Are unconscious gender biases widening the Australian gender pain gap? [title] => Are unconscious gender biases widening the Australian gender pain gap? [href] => https://www.australianpharmacist.com.au/are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 25220 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25417 [post_author] => 7918 [post_date] => 2024-03-13 12:48:04 [post_date_gmt] => 2024-03-13 01:48:04 [post_content] => Expert advice for applying the right dosage instructions on medicine labels on a case-by-case basis. How do you word instructions on dispensing labels? Could some simple changes make your instructions clearer for patients? Claire Antrobus MPS, Manager, Practice Support at PSA explains the importance of simple and explicit dosing instructions tailored to medicine type, dosing requirements and patient comprehension.What do guidelines say about how to make instructions ‘explicit and clear’?
Most importantly, dosing instructions on dispensed medicine labels should be explicit and clear, according to the Australian Commission on Safety and Quality in Health Care’s National Standard for Labelling Dispensed Medicines 2021. Using common, everyday words improves readability and comprehension by consumers, says the standard. Example: [table id=31 /] The ‘Good dispensing practice’ chapter of the Australian Pharmaceutical Formulary and Handbook (APF) is consistent with the National Standard for Labelling Dispensed Medicines and contains concise practical advice on how pharmacists can meet the standard.Should dosage intervals always be specific?
The standard says that dispensing label instructions should include a specific dosing interval (e.g. every 4 hours) if this level of specificity is critical to the dosing of the medicine. Common medicines for which specific dosing intervals are important include novel anticoagulants (e.g. apixaban), heparins, antimicrobial medicines and nitrates. For example, the recommended dosage of Paxlovid is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) taken together orally every 12 hours for 5 days. A narrow time interval range (e.g. every 3–4 hours) or using time periods (e.g. morning, midday, evening, bedtime) can allow some flexibility for patients to incorporate dosing of their medicine into their daily routine, if this is appropriate for the medicine in question. Pharmacists should use professional judgement to determine when flexible dosing instructions are appropriate.Does the type of medicine influence how dosing instructions should be written?
For medicines that are dosed infrequently (e.g. once or twice a day) it is usually preferable to write the dose instructions according to the time of day rather than according to time periods – unless the level of specificity of time interval is critical to the dosing of the medicine. For medicines that are dosed more frequently (e.g. more than three times a day) it might depend on the medicine and how important it is for the dosing times to be specific. For example, for medicines used for pain relief, it is more appropriate to write the dosing interval within a narrow range (e.g. every 4–6 hours).When should specific times be included on the dispensing label?
For medicines such as levodopa and other medicines to treat Parkinson's disease, a specific dosing schedule is therapeutically necessary to prevent the wearing-off phenomenon. The prescriber may have prescribed a dosing schedule for levodopa (e.g. 7.00 am, 11.00 am, 2.00 pm, 5.00 pm) that has been agreed with the patient according to their medicine needs, food intake and daily routine. In this situation, the label instructions should include these specific times and align with the prescription instructions.Written words are never an effective substitute for verbal communication when dispensing medicines
One of the most important factors to consider when writing dose instructions on the label is the individual patient and their health literacy. You should tailor both verbal and written health information (including information about how to take a medicine) to the patient’s needs. Use terms and concepts that patients can understand and relate to. Check the patient can understand the dosing instructions on the dispensing label when discussing the medicine and amend if necessary. [post_title] => Does how you print dosing intervals on medicine labels matter? [post_excerpt] => Expert advice for applying the right dosage instructions on dispensed medicine labels on a case-by-case basis. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => does-how-you-print-dosing-intervals-on-medicine-labels-matter [to_ping] => [pinged] => [post_modified] => 2024-03-13 15:42:02 [post_modified_gmt] => 2024-03-13 04:42:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25417 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Does how you print dosing intervals on medicine labels matter? [title] => Does how you print dosing intervals on medicine labels matter? [href] => https://www.australianpharmacist.com.au/does-how-you-print-dosing-intervals-on-medicine-labels-matter/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25433 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 23793 [post_author] => 3387 [post_date] => 2024-03-19 10:21:08 [post_date_gmt] => 2024-03-18 23:21:08 [post_content] => Since 1 November 2023, almost 5 million Australians at risk of severe complications from shingles have had access to the SHINGRIX vaccine under the National Immunisation Program (NIP). Herpes zoster (HZ), a reactivation of the varicella-zoster virus in patients who have had chicken pox previously, has a significant disease burden. Of all vaccine preventable diseases, HZ and its complications accounted for 7% of the overall burden in 2015. One of the most common complications from the virus is post-herpetic neuralgia (PHN), particularly among older and immunocompromised patients. Up to 5–30% of patients with HZ go on to develop PHN, with risks of this complication increasing with age. PHN, a type of nerve pain described as having a burning sensation that can persist long after acute HZ symptoms resolve, can be debilitating. One in three Australians will get shingles in their lifetime. Vaccination can reduce this likelihood.What’s changed and why?
SHINGRIX replaced Zostavax on the NIP following advice from the Pharmaceutical Benefits Advisory Committee and the Australian Technical Advisory Group on Immunisation. SHINGRIX is administered as two doses, 2–6 months apart, at a current private market cost of approximately $560. The age limit for NIP shingles vaccination eligibility is now 65 years and older, down from 70 years. Patients eligible to receive SHINGRIX under the NIP include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25470 [post_author] => 3410 [post_date] => 2024-03-18 12:06:45 [post_date_gmt] => 2024-03-18 01:06:45 [post_content] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. A sizable proportion of the clientele at Emerton Amcal Pharmacy in Western Sydney are Aboriginal and Torres Strait Islander peoples, with First Nations clients making up around 15.3% of the patient base. In the quest to provide culturally safe health care services, all pharmacists at Emerton, owned by Curtis Ruhnau MPS, Margaret Ruhnau MPS and Matthew Quick MPS, have completed PSA’s Deadly pharmacists foundation training course. Yet, despite their training, the pharmacists at Emerton (and sometimes, the proprietors) felt reluctant to wear First Nations designs, shirts, or pins for fear of appearing tokenistic. Ahead of National Close the Gap Day (21 March 2024), an Early Career Pharmacist explains how she overcame these feelings of imposter syndrome through a mix of client reception and acquiring cultural knowledge to work towards improving health outcomes for Aboriginal and Torres Strait Islander peoples.Turning points
Before completing the Deadly pharmacists training course, Zara Gul MPS was just trying to fulfil her role as a health professional when providing services to Aboriginal and Torres Strait Islander clients. ‘I was aiming to treat everyone the same, adapting my approach based on health literacy,’ she said. Post-training, she has a much broader understanding of how Aboriginal and Torres Strait Islander clients view health, the importance of a good yarn, and how to tailor information accordingly. But it took some time to arrive at this point, and feel comfortable rocking the deadly pharmacists shirt. ‘I finished the course earlier on, so it was just me wearing it at first, along with Curtis, Margaret and Matthew,’ said Ms Gul. ‘I would have my cardigan over the top just in case I offended someone or overstepped any cultural boundaries.’ It was the positive feedback from Aboriginal and Torres Strait Islander clients, coupled with some gentle leadership encouragement, that helped Ms Gul and her colleagues feel comfortable wearing First Nation designs. The starting point was when a young Aboriginal client complimented Margaret on her shirt, and she pointed out that Zara was wearing one too. ‘Margaret said, “she's also done her training”, and the client gave me two big thumbs up,’ she said. ‘We’ve since had a lot of positive feedback from clients. Everyone [says], “We like your shirt. Where did you get your shirt from? Can we get a shirt?”’ This has fueled a rapport with clients, with Ms Gul noticing people from the Aboriginal Torres Strait Islander backgrounds feel comfortable speaking more openly with her about their health. ‘We try not to stay behind the counter so we can chat face-to-face with clients,’ she said. ‘We also let clients know we've earned this shirt, and that we had to do a course that helped to improve our knowledge for providing healthcare to First Nations people.’Collaborative healthcare
A key takeout for Ms Gul from undergoing the Deadly Pharmacists training was the understanding that First Nations clients take a community approach to healthcare. ‘It's not just individual patients, they work with other members in the community and receive a lot of help from their family,’ she said. ‘It's about understanding that we need to take an integrated approach to healthcare, including with doctors and medical centres that clients frequent to ensure timely access to medicines.’ The team also strives to facilitate access to funded services. ‘For example, with conditions such as sleep apnea, we can work with the Integrated Team Care Program to help Aboriginal and Torres Strait Islander clients obtain funding for their devices,’ said Ms Gul. Working closely with Aboriginal health and support workers, particularly when organising dose administration aids (DAA), is also an important component of providing community-based care. ‘We liaise with them, make sure clients’ scripts are organised, and that medications are ready for pickup when they come in, so there are no gaps in care.’ Through relationship building, health outcomes for one Aboriginal and Torres Strait Islander client with significant mental health issues drastically improved. ‘Some of her medications are quite regulated, so by communicating well with her as well as her doctor, we're getting the scripts for the regulated medicines prepared in a timely manner,’ she said. When the client comes to pick up her medication every week, her DAA is complete, removing any additional stressors. ‘Her mental health is no longer deteriorating because she’s more adherent to her medication, and she's coming in to pick up her DAA on the right days as well,’ said Ms Gul. Programs such as the Deadly Pharmacists foundation training course are not only for those interested in working in Aboriginal Community-Controlled Health Services, but for any pharmacist who wants to improve service delivery. ‘Now that we've received such positive feedback, it has built my confidence – both in terms of wearing the shirt and providing information to First Nations clients about their healthcare,’ she said. The pharmacy’s floor staff have also undergone cultural competency training, earning the right to wear their own shirts with Aboriginal and Torres strait Islander designs. ‘That way, on Mondays and Fridays, we all wear the shirts. So we stand united as a team,’ added Ms Gul.Get involved
Any pharmacist can undertake PSA’s Deadly pharmacists foundation training course as part of their continuing professional development to improve cultural awareness and safety while earning up to 14 Group 2 CPD credits. Pharmacists who have completed the course still have the opportunity to purchase a Deadly Pharmacist polo shirt or scarf through reaching out to projects@psa.org.au. For pharmacists who identify as Aboriginal and Torres Strait Islander individuals, Expressions of Interest (EOI) for the annual PSA Faye McMillan Conference Grant to attend PSA24, sponsored by Care Pharmaceuticals and Hydralyte, opens this Thursday (21 March). The EOI is open until 16 May, with the successful applicant announced on 27 May. [post_title] => Wearing Aboriginal and Torres Strait Islander designs with intention [post_excerpt] => Far from being a sign of disrespect, displaying Aboriginal and Torres Strait Islander symbols is a sign of allyship. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => wearing-aboriginal-and-torres-strait-islander-designs-with-intention [to_ping] => [pinged] => [post_modified] => 2024-03-18 15:02:03 [post_modified_gmt] => 2024-03-18 04:02:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25470 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Wearing Aboriginal and Torres Strait Islander designs with intention [title] => Wearing Aboriginal and Torres Strait Islander designs with intention [href] => https://www.australianpharmacist.com.au/wearing-aboriginal-and-torres-strait-islander-designs-with-intention/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25478 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25458 [post_author] => 175 [post_date] => 2024-03-17 20:53:09 [post_date_gmt] => 2024-03-17 09:53:09 [post_content] => The ACT Pharmacist of the Year Kirstin Turner MPS has forged a non-traditional, speciality role that is ideal for her life.Why did you choose pharmacy?
Since I was a teenager I have wanted to become a pharmacist. I believed that it would combine my love for medicine with opportunities to contribute to the health of people in the community as well as allow me to have endless career opportunities. And it has done exactly that. I completed a Bachelor of Pharmacy and was awarded the Academic Medal for bachelor coursework at James Cook University in Townsville in 2008 where I interned at a local community pharmacy through the PSA intern program until registering as a pharmacist in 2009.Did you follow the traditional community/hospital pharmacy route?
I worked in community pharmacy for a decade until 2019. In that time, I worked as an intern pharmacist, front-of-shop pharmacist and as pharmacist in charge within QLD, WA, and the ACT. I have always enjoyed being a pharmacist, however felt something was always missing; that I didn’t quite belong within the community setting. I found it difficult to incorporate my credentialed pharmacist, credentialed diabetes educator and GP pharmacist work within my community pharmacy roles over the years. In 2019 I was given the opportunity to extend my position as a GP Pharmacist and made the leap to leave community pharmacy so I could build up my own career path to ensure I had job mobility, stability, and flexibility all the while maintaining professional satisfaction. And again, no regrets.Which of your specialties came first?
I became a Credentialed Pharmacist through the PSA course in 2010. Interested in diabetes and chronic disease management through the Home Medicines Reviews I was undertaking at the time, I then became a Credentialed Diabetes Educator, starting my study after the birth of my first child. I completed my credentialing while in hospital after the birth of my second child in 2016. In 2018, I was offered an opportunity to participate in phase 2 of the Pharmacists in GP Practice Program and continued in that role for more than 5 years – and continue now, just in my own way.With your varied specialisations, how have you managed a work/life balance with two young children?
I am fortunate that as a pharmacist, I have been able to incorporate all my specialties into my daily practice where I can work as part of a healthcare team and improve the health outcomes of people within the community without restriction. Working for myself has allowed me to have the flexibility for the work/life balance my young family requires. Health care never stops and working independently has allowed me the flexibility to work late nights, weekends, make after-hours phone calls to GPs or patients, and even sneak off during a scouts camp to find mobile reception to finish a report. I can also do research or attend an online meeting, all the while making sure I can still attend my children’s activities and appointments. As they grow, I envisage that my role will also grow and I will never be short on work opportunities, hopefully.How did you get into mentoring younger pharmacists?
I kind of fell into mentoring. As a very approachable and accommodating person, I’ve been mentoring pharmacists ever since I was registered, and it is something that I absolutely love! I mentor pharmacists at any stage of their career and under any circumstance – newly registered pharmacists, university students, prospective Credentialed Diabetes Educators or GP pharmacists and others who are just curious about what I do. I have lost count as I do it formally through ADEA for CDE accreditation and informally by allowing myself to be contactable by any pharmacist via any means – for an on-off discussion or as a long-term professional contact. I just wish that I had the same mentor access when I was starting out.Any advice for ECPs?
Find a mentor in the career pathway that interests you. Be open to accept mistakes and grow, welcome feedback, set goals, ask for help, grow your professional network, and identify your strengths and interests to develop your own career path.
8.30 am | Get sorted Drop kids at before-school care. Pack bags and Home Medicines Review (HMR) schedules, usually 2 per day. Organise referrals for three diabetes education patients, seen at my home clinic room or alongside HMRs. |
9.00 am | Administration Triple check calendar, send out recalls and confirmations for appointments tomorrow, and contact recipients of referrals. |
10.00 am | HMR/diabetes education home visit Drive to see woman, 80, recently moved from a regional area to the ACT. New GP requires a medicine reconciliation and patient history for multiple diagnoses, including diabetes, asthma, gout, retinopathy, hypertension, microalbuminuria, back pain and osteoarthritis. Records from previous GP not sent. Medicine reconciliation identifies three missing medicines (aspirin, furosemide, and an iron supplement). Significant drug-related problems identified include: (1) metformin (1,000 mg tds) and pioglitazone (45 mg once daily) over recommended dose for current renal function and well-controlled diabetes (2) triple whammy (perindopril, furosemide and celecoxib) (3) non-adherence to inhalers (4) no indication for furosemide, aspirin or paracetamol and codeine phosphate hemihydrate (Panadeine Forte) (5) adverse effects of fluid retention, oedema, constipation and GI bleeding noted. Urgent contact was made with the GP who implemented recommended changes immediately. HMR report issued and patient was booked for follow-up reviews. While patient was willing to make changes, she was surprised so many problems had been identified with the apparent ‘set and forget’ medicine regimen. |
2–5.00 pm | Referrals, appointments, emails Referrals received for HMRs and diabetes education contacted for appointments. Write reports, check emails for mentoring or potential work or educational opportunities |
5.00 pm | Home time Collect kids for extracurricular engagements. After dinner – write reports, mentor, etc. |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25217 [post_author] => 3919 [post_date] => 2024-03-14 10:23:24 [post_date_gmt] => 2024-03-13 23:23:24 [post_content] =>Pain is a highly complex and subjective phenomenon, characterised by high levels of inter-individual variability.1,2 This can make it difficult to quantify and compare pain between individuals and different population groups.1,2
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]Access to timely and appropriate pain management is also influenced by numerous factors, including some related to the patient, such as level of health literacy, socio-economic disadvantage, geographic location, and others related to society, including, discrimination, stigma, and gender norms.3
Considering this, there has been growing literature citing the presence of what has been termed a 'gender pain gap' both locally and globally.4–11 This article shares insights from an Australian survey of healthcare professionals evaluating attitudes towards unconscious gender biases, with the aim of helping pharmacists conceptualise the gender pain gap as it applies to their own practice as well as the broader healthcare landscape. It includes practical strategies to help pharmacists identify and address unconscious gender biases relating to the management of pain in their practice. While this article focuses on the gender pain gap as it pertains to cisgender women and men, it’s crucial to acknowledge that gender bias may similarly impact non-cisgender individuals experiencing pain.12,13 Many of the strategies aimed at mitigating unconscious bias discussed may also be relevant for addressing disparities faced by non-cisgender individuals.12,13
Learning objectivesAfter reading this article, pharmacists should be able to:
Competency (2016) Standards addressed: 1.1, 1.4, 1.5, 1.6, 2.1, 2.4, 3.1, 3.5, 3.6 Accreditation expiry: CAP2404SYPCP Accreditation number: 31/03/2027 |
The term ‘gender pain gap’ is usually used to refer to the disparities in the pain experience between men and women. In literature, the term encompasses ideas such as4–8:
NOTE: In discussing the 'gender pain gap', it’s important to note that while ‘sex’ refers to biological differences between males and females, ‘gender’ encompasses the sociocultural, psychological, and behavioural aspects associated with being male, female, or another gender identity.14 Therefore, while in places this paper discusses data comparing males and females, we recognise that gender is a multifaceted construct that goes beyond biological differences and influences individuals’ experiences of pain and pain management. |
The gender pain gap has been demonstrated in Australian healthcare settings in relation to the diagnosis and treatment of pain.9–11 A retrospective audit in the Australian acute care setting (n = 192) demonstrated that women presenting with acute abdominal pain received different analgesics, fewer doses of analgesics, and experienced longer wait times for analgesics to be administered compared to men.9 With regard to gender specific conditions, a study of Australian women with endometriosis (n = 532) indicated many felt let down by medical staff, with their pain often viewed as psychological or the reported severity being distrusted.10 Additionally, diagnosis of endometriosis in Australia has been shown to be delayed by an average of 6.4 years due to various reasons, including misunderstanding and lack of knowledge of endometriosis by healthcare professionals, misdiagnoses and normalisation of period pain.11
Several factors contribute to the gender pain gap. Historically, women have been under-represented in medical research.15,16 Initial pain studies included average male subjects with results being generalised to females, contributing to a poorer understanding of how certain pain conditions manifest or need to be managed in this demographic.6,15,16 Differences in physiological pain pathways between men and women have now been reported, but a comprehensive understanding of these distinctions remains elusive.17,18 While representation of female subjects has been increasing in research, many areas of medicine still lack gender-specific recommendations.19
Moreover, another key cited contributor to the gender pain gap is unconscious gender bias.7–9
Awareness of this phenomenon was evaluated in a quantitative online survey of Australian pharmacists and general practitioners (n = 305) conducted in December 2023.20 The vast majority of respondents believed in the existence of unconscious biases among healthcare professionals, indicating that this is generally a well-known and accepted concept (see Figure 1). These unconscious biases were primarily reported to manifest in relation to gender, culture and race. When questioned about the existence of gender biases in the context of patient care, this was again widely acknowledged and almost half of the healthcare professionals considered it to be a widespread problem.20
In the pain treatment setting, a common perception was that gender bias among healthcare professionals manifested in the form of female pain being overlooked, underdiagnosed, misdiagnosed, and taking too long to be diagnosed (see Figure 2).20
Unconscious bias (also known as implicit bias) often differs starkly from an individual’s conscious beliefs.21 It develops in early life from repeated reinforcement of social stereotypes until they become automatic.21 In this context, stereotypes refer to well-learned sets of associations between certain traits and a social group.21 For example, from a very young age, children are socialised to react to pain in certain ways; in particular, most societies discourage men from expressing their emotions while women are taught to verbalise discomfort.6,7,22 While gender stereotypes are nuanced, a common overarching theme is the perception of men as stoic and/or rational, and that of women as emotional, dramatic and/or prone to exaggeration.5,7
Although these social stereotypes are not consciously endorsed in healthcare settings, healthcare professionals are not immune to them.21 Furthermore, the uncertainty and time pressures in most healthcare settings may favour reliance on stereotypes for decision making.21,24
Pain management is an area that may be particularly vulnerable to unconscious biases, given that pain is a subjective experience, likely influenced by biological, psychological, and social factors.25 When managing pain, healthcare professionals are required to make inferences about pain authenticity and intensity.5,8 These judgements cannot be objectively verified and can be influenced by perceiver biases based on gender, race, and other contextual factors.5,8
For instance, a healthcare providers’ perception of a patients’ trustworthiness may impact their pain assessment and treatment decisions.26 In a United Kingdom study where pain clinicians and medical students made judgements based on a video and a brief history of a patient with shoulder pain, women, especially those rated as being of low trustworthiness (ratings were provided by trainee clinical psychologists), were estimated to have less pain, and judged to be more likely to exaggerate. For treatment recommendations, men were more likely to be recommended analgesics while women were more likely to be recommended psychological treatment.26
In the Chronic Pain Australia 2023 National Pain Survey, findings indicated that women felt they are less likely to be believed when presenting with chronic pain.27 Some respondents described feelings of judgement, shame and ridicule when accessing healthcare. Many (76.3%) shared experiences of feeling ignored or dismissed.27
In the present survey, healthcare professionals recognised that unconscious gender bias could potentially influence the mental health of female patients and impact their experience of pain conditions, as well as impact their interactions with healthcare providers in a negative manner (see Figure 3).20
Figure 3 – Australian healthcare professional perceptions of the impacts of gender pain bias
The International Pharmaceutical Federation (FIP) 2023 report on the role of pharmacists in closing the gender pain gap noted that the topic was not well covered during pharmacy education.23 This was reflected in the present survey where most healthcare professionals, including pharmacists, noted that they had not received any training on understanding and addressing female pain experiences (see Figure 4).20
Figure 4 – Training on understanding and addressing female pain experiences in Australia
Unconscious gender bias needs to be addressed at all levels of healthcare. In the context of pain management, pharmacists play a key role – from providing medicines advice and dispensing to referring patients to other healthcare professionals as needed. As such, pharmacists need to be aware of gender stereotypes in pain management to be able to identify and address any inequities in care.23
It is important to keep in mind that different genders have different pain management needs that change at each stage of life.3 Closing the gender pain gap doesn’t mean providing the same pain care for all genders, but rather working towards equitable care for all.
Unconscious gender biases are complex, thus there is no single debiasing strategy that will work for everyone.21,28 However, since gender biases are automatic, habitual activation of stereotypes, the first step to addressing them is for healthcare professionals to be aware of their susceptibility to them.16,28
While it is difficult to quantify bias, these strategies may be useful for identifying unconscious gender biases:
Some strategies that may help to address unconscious gender biases include:
These strategies can help to improve the quality of communication with patients and may prevent filling in partial information with stereotype-based assumptions.21,23 Self-reflection when interacting with patients may also help to avoid stereotype-based assumptions – ask yourself questions such as28:
A simple acronym such as ACE (see Figure 5) may be helpful for habitualising this process during interactions with patients seeking analgesia.
Figure 5 – ACE acronym
Finally, keep in mind that men and women tend to express pain differently due to early socialisation of pain responses,6,7,22 and this should be considered during consultations to help avoid stereotypical categorisations.
For instance6,7:
The gender pain gap refers to the disparities in the pain experience between genders. While a range of factors contribute to the gender pain gap, unconscious gender bias has been cited as one of the key factors.
Unconscious biases develop early in life from repeated reinforcement of social stereotypes until they become automatic. Given that pain is a subjective experience, pain management may be particularly vulnerable to unconscious biases.
The issue of unconscious gender biases needs to be tackled at all levels of healthcare. Taking small steps in the pharmacy to address it can help lay the foundations for closing the gender pain gap and ensure equitable provision of healthcare services for all patients.
[cpd_submit_answer_button]Dr Jacinta Johnson PhD, FANZCAP (Edu. Research), FPS, FSHP is a credentialed Advanced Practice Pharmacist. She is a Senior Lecturer in Pharmacy at the University of South Australia and Senior Pharmacist for Research within SA Pharmacy.
Jacinta Johnson has received consultancy fees for development and delivery of educational materials or Advisory Group participation from Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd.
[post_title] => Are unconscious gender biases widening the Australian gender pain gap? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2 [to_ping] => [pinged] => [post_modified] => 2024-03-15 14:00:32 [post_modified_gmt] => 2024-03-15 03:00:32 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25217 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Are unconscious gender biases widening the Australian gender pain gap? [title] => Are unconscious gender biases widening the Australian gender pain gap? [href] => https://www.australianpharmacist.com.au/are-unconscious-gender-biases-widening-the-australian-gender-pain-gap-2/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 25220 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25417 [post_author] => 7918 [post_date] => 2024-03-13 12:48:04 [post_date_gmt] => 2024-03-13 01:48:04 [post_content] => Expert advice for applying the right dosage instructions on medicine labels on a case-by-case basis. How do you word instructions on dispensing labels? Could some simple changes make your instructions clearer for patients? Claire Antrobus MPS, Manager, Practice Support at PSA explains the importance of simple and explicit dosing instructions tailored to medicine type, dosing requirements and patient comprehension.What do guidelines say about how to make instructions ‘explicit and clear’?
Most importantly, dosing instructions on dispensed medicine labels should be explicit and clear, according to the Australian Commission on Safety and Quality in Health Care’s National Standard for Labelling Dispensed Medicines 2021. Using common, everyday words improves readability and comprehension by consumers, says the standard. Example: [table id=31 /] The ‘Good dispensing practice’ chapter of the Australian Pharmaceutical Formulary and Handbook (APF) is consistent with the National Standard for Labelling Dispensed Medicines and contains concise practical advice on how pharmacists can meet the standard.Should dosage intervals always be specific?
The standard says that dispensing label instructions should include a specific dosing interval (e.g. every 4 hours) if this level of specificity is critical to the dosing of the medicine. Common medicines for which specific dosing intervals are important include novel anticoagulants (e.g. apixaban), heparins, antimicrobial medicines and nitrates. For example, the recommended dosage of Paxlovid is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) taken together orally every 12 hours for 5 days. A narrow time interval range (e.g. every 3–4 hours) or using time periods (e.g. morning, midday, evening, bedtime) can allow some flexibility for patients to incorporate dosing of their medicine into their daily routine, if this is appropriate for the medicine in question. Pharmacists should use professional judgement to determine when flexible dosing instructions are appropriate.Does the type of medicine influence how dosing instructions should be written?
For medicines that are dosed infrequently (e.g. once or twice a day) it is usually preferable to write the dose instructions according to the time of day rather than according to time periods – unless the level of specificity of time interval is critical to the dosing of the medicine. For medicines that are dosed more frequently (e.g. more than three times a day) it might depend on the medicine and how important it is for the dosing times to be specific. For example, for medicines used for pain relief, it is more appropriate to write the dosing interval within a narrow range (e.g. every 4–6 hours).When should specific times be included on the dispensing label?
For medicines such as levodopa and other medicines to treat Parkinson's disease, a specific dosing schedule is therapeutically necessary to prevent the wearing-off phenomenon. The prescriber may have prescribed a dosing schedule for levodopa (e.g. 7.00 am, 11.00 am, 2.00 pm, 5.00 pm) that has been agreed with the patient according to their medicine needs, food intake and daily routine. In this situation, the label instructions should include these specific times and align with the prescription instructions.Written words are never an effective substitute for verbal communication when dispensing medicines
One of the most important factors to consider when writing dose instructions on the label is the individual patient and their health literacy. You should tailor both verbal and written health information (including information about how to take a medicine) to the patient’s needs. Use terms and concepts that patients can understand and relate to. Check the patient can understand the dosing instructions on the dispensing label when discussing the medicine and amend if necessary. [post_title] => Does how you print dosing intervals on medicine labels matter? [post_excerpt] => Expert advice for applying the right dosage instructions on dispensed medicine labels on a case-by-case basis. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => does-how-you-print-dosing-intervals-on-medicine-labels-matter [to_ping] => [pinged] => [post_modified] => 2024-03-13 15:42:02 [post_modified_gmt] => 2024-03-13 04:42:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25417 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Does how you print dosing intervals on medicine labels matter? [title] => Does how you print dosing intervals on medicine labels matter? [href] => https://www.australianpharmacist.com.au/does-how-you-print-dosing-intervals-on-medicine-labels-matter/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 25433 )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.