Dr Mary Bushell MPS
Dr Mary Bushell MPS is a Senior Lecturer in Pharmacy at the University of Canberra.
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[post_content] => Holiday crowds bring unique clinical challenges, testing pharmacistsâ problem-solving skills from sun exposure injuries to urgent medicine gaps.
In many metropolitan areas, January is a lull period for pharmacists â as city dwellers head out of town to beat the heat and reset for the year ahead. But not so in many regional beachside areas, with pharmacies experiencing a steady uptick in visiting clientele, as Rebecca Davies, who works as a community pharmacist in Cotton Tree on Queensland's Sunshine Coast, would attest.
âWhere I'm working at the moment is right on the beach, so it's literally busy all the time,â said Ms Davies, who was formerly based in Mona Vale on Sydneyâs Northern Beaches. âI wouldn't say there's ever a quiet time, as in the winter, we still get people coming up from the southern states for holidays.â
With a caravan park stationed down the road, nearby units that are typically rented out during peak holiday periods and warm weather year-round, itâs a matter of balancing the holiday trade thatâs passing through with regular customers.
A clinical mix by the sea
Alongside routine dispensing and chronic disease management for locals, managing beach-related enquiries and conditions is a part of everyday practice.
Over-the-counter demand increases during holiday periods, with visitors seeking sunscreens, beach equipment and first-aid items, with many presentations requiring pharmacist oversight.
[caption id="attachment_31212" align="aligncenter" width="441"]
Rebecca Davies[/caption]
âYou get people that arenât used to the sun that come in with sunburn,â Ms Davies said.Â
Children feature prominently, particularly those visiting from interstate or overseas â presenting with significant sunburn, dehydration or injuries sustained during outdoor play.
âThe kids that come from places that arenât used to the beaches come in with the sunburn,â she said. âThen there are the holiday kids [whoâve fallen off] bikes or skateboards.â
In one recent case, a teenage girl presented with extensive sunburn that had initially been treated in the pharmacy. Several days later, she returned with worsening symptoms.
âShe came back about 5 days later and it looked like sheâd picked up a bacterial infection from broken skin.â
At that point, Ms Davies referred the patient to a doctor, recognising that pharmacy management was no longer sufficient. âIt had just gone too far for anything that we could do for her.â
Marine-related skin reactions are another frequent presentation, particularly sea lice, which can âget caught in between the swimmers and their skinâ.
Management usually involves antihistamines, topical corticosteroids and practical advice to reduce symptoms.
âYou tell them to keep the area cool,â Ms Davies said. âAnything that makes them hotter will make it worse.â
In most cases, these conditions can be managed entirely in-store, allowing patients to avoid medical appointments during short stays.
âBut there's a lot of regular customers and we still have all the Webster-paks among other things to manage,â she said.
Managing forgotten medicines
Beyond acute injuries and skin conditions, medicine continuity for holidaymakers is one of the most complex challenges Ms Davies faces.
Tourists frequently arrive without sufficient medicine supply, having forgotten it at home or miscalculating how long they would be away.
âitâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.'
rebecca davies
âIf the customer has a regular pharmacy at home, we can contact that pharmacy,â she said. âThey can fax scripts and post the originals.â
Electronic prescriptions have made this process significantly easier.
âWith eScripts, itâs really easy to sign them up to the Active Script List and have access to all their eScripts online,â Ms Davies said.
However, not all situations are quickly resolved.
âI had one customer the other day whoâd left her medicine at home and didnât have a script,â she said.Â
The medicine was venlafaxine, which should not be stopped abruptly.
In this particular situation, the best course of action was for the patient to arrange an urgent medical consultation with their regular GP, or via an online telehealth provider if necessary.
âI encourage people to stay with their regular doctor. But there are times when those services are very useful.â
Managing medicines for visiting patients often requires Ms Davies to look beyond her own dispensary.Â
âIf we donât have the medication and itâs for someone passing through, ordering it in isnât always a possibility, because the person might move on before it comes in,â she said.Â
âSo weâll ring the other pharmacies around to see if theyâve got it and direct the patient there. Itâs just about trying to source the medication for the patient before they move on.â
Expanded scope makes a difference on holiday
Expanded scope of practice services have proven particularly valuable in a tourist-heavy setting, especially pharmacist-led treatment for uncomplicated urinary tract infections (UTIs).
âPatients with symptoms of a UTI who have come here for the weekend can come into the pharmacy quite distressed,â Ms Davies said. âThe symptoms of the infection really disrupt how they get through the day and theyâre not familiar with the area or the doctors.â
Being able to assess and treat eligible patients in the pharmacy can significantly reduce discomfort and disruption.
âIt definitely puts them at ease when we go through that, that list of when we can and can't supply,â Ms Davies said. âWe can say, âYes, we can help youâ.â
For visitors, the impact is immediate.
âTheyâre not wasting 24 to 48 hours trying to figure out where to go,â she said. âIt makes a big difference to their holiday.â
According to Ms Davies, community awareness of pharmacist UTI services has increased, with many patients now presenting specifically requesting assessment rather than symptom-only treatments.
âMore people come in already knowing that the service exists rather than asking for Ural,â she said.
Staffing for constant demand
Maintaining service quality during sustained busy periods requires careful staff management.
âSometimes the owner puts more staff on over the holiday period. Because obviously thereâs going to be an influx of tourists, thereâs a couple of extra staff we can call on,â Ms Davies said.Â
âThe business also supports private clinics, so we have access to extra staff we can call on during the day if things start to back up.â
The pharmacy relies on a mix of permanent staff, casual pharmacists, students and graduates to manage peaks. Having experienced casual staff who can be called in at short notice is particularly valuable.
âWeâre lucky to have someone we can call on who used to be a permanent employee and now works casually,â she said.
Despite the intensity, Ms Davies finds the work highly rewarding.Â
âIt definitely tests your knowledge on how to navigate certain situations,â she said. âAnd itâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.â
For pharmacists considering a move to a coastal area, Rebecca sees beachside practice as challenging but professionally enriching.
âIt offers lots of different scenarios for helping patients compared to your regular customer coming in with the same things from month to month,â she said. âAnd thereâs lots of opportunities for problem-solving.â
Help patients avoid serious sunburn by completing the AP CPD: Sun safety, donât feel the burn.
Image licensed under Creative Commons.
[post_title] => Practising pharmacy where others vacation
[post_excerpt] => Holiday crowds bring unique clinical challenges for beachside pharmacy practice, from sun exposure injuries to urgent medicine gaps.
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[post_content] => A recent systematic review published in the BMJ has reignited debate about what happens when patients stop taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related GLP-1âbased incretin therapies.
The analysis found that weight often returns quickly once treatment is discontinued â in some cases faster than with other weight-loss interventions.
And itâs not just weight that rebounds. Cardiometabolic risk markers, including blood pressure, blood glucose and blood lipids, were also found to revert towards pre-treatment levels.
As prescribing of these medicines continues to rise, the findings raise a broader question: should patients be starting these medicines in the first place?
AP spoke with experts to unpack the evidence.
Weight regain predictable, but not the real problem
Professor Clare Collins, Professor of Nutrition and Dietetics at the University of Newcastle, said the pattern of rapid weight regain following cessation was entirely unsurprising.
âThis is exactly what you would expect,â she said.
[caption id="attachment_31196" align="aligncenter" width="400"]
Professor Clare Collins[/caption]
For Prof Collins, the findings reinforce a core principle of chronic disease management: when an effective treatment is withdrawn, the condition it was controlling usually returns.
âIf someone stops taking antihypertensives, what happens? Their blood pressure goes back up,â she said.Â
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.'
Prof clare collins
While weight regain attracts headlines, Prof Collins said the more clinically concerning signal is the deterioration in metabolic markers once treatment ceases.
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.â
Not a sign of treatment failure
Associate Professor Trevor Steward, Director of the Melbourne School of Psychological Sciencesâ Brain and Mental Health Hub, agrees that the rebound effect reflects how GLP-1 RA medicines work, rather than a failure of the drugs or patient behaviour.
Instead of creating permanent physiological change, GLP-1 RAs amplify hormonal signals that already exist in the body â particularly those involved in appetite regulation, digestion and satiety. The benefits seen during treatment depend on sustained exposure to these hormones.
[caption id="attachment_31197" align="aligncenter" width="400"]
Associate Professor Trevor Steward[/caption]
âThat's why we see this rapid rebound effect of people experiencing weight gain when they stop using them, because thereâs no longer increased circulating levels of hormones impacting their different body systems,â A/Prof Steward said.
However, the mechanisms behind the accelerated regain are not yet fully understood.
âSome indications are that while these newer medications help people lose weight faster, they may cause a stronger slingshot effect,â he said.
Prof Collins points to emerging evidence suggesting incretin therapies cross the bloodâbrain barrier, influencing reward pathways linked to appetite and environmental cues to eat.
âFor example, if you go to the supermarket for a loaf of bread and come back with donuts too â thatâs whatâs referred to as âfood noiseâ,â she said. âSome people say this [noise] really goes down when using these therapies.â
When treatment is withdrawn, the surrounding food environment can quickly reassert itself. This is where tapering, behavioural support and nutrition strategies become critical.
âIt may be that people are more receptive to maintenance support programs as theyâre tapering or finding out what their maintenance medication dose is,â she said. âIf theyâre aware of that point, theyâll recognise when the food noise starts again.â
Nutrition: the missing variable
Prof Collins recently led a systematic review which highlighted that changes in dietary intake and nutrition remain largely invisible in incretin trials.
âOf all the phase three trials, only two actually measured and reported what people ate,â she said.
Most trials provided standardised advice but did not collect data on dietary intake, leaving clinicians to infer how appetite suppression, nausea and early satiety shaped eating patterns over time.
âThey mostly worked with people to identify dietary changes that would remove about 2,000 kilojoules a day â enough to trigger weight loss,â she said.
But reduced intake doesnât automatically equate to improved diet quality or nutrient adequacy, with micronutrient deficiencies and loss of lean mass emerging if nutrition isnât actively monitored.
With frequent patient contact, Prof Collins believes pharmacists are uniquely placed to identify emerging problems, intervene early and support appropriate referral to dietitians for medical nutrition therapy.
â[And] if pharmacy staff are trained, they can say, âHang on a minute, you need to talk to the pharmacistâ.â
The University of Newcastle also has a suite of resources pharmacists could direct patients to, including a healthy eating quiz and obesity management podcast, available here.
When visible deterioration or rapid weight loss appears, referral becomes essential. âOnce you think, âthis person is fading before our eyesâ, thatâs when you alert the GP and refer to a dietitian,â Prof Collins said.
Supporting persistence with therapy also plays a role in outcomes.
âThe main benefit isnât weight â itâs metabolic health,â she said. âHelping people manage [adverse] effects supports continuation.â
As weight loss occurs, pharmacists should also be alert to the need to review other medicines.
âIf someone is dropping weight rapidly, blood sugars and blood pressure can fall,â she said. âThere are also rare but potentially severe complications â pancreatitis, gallstones, bowel obstruction and non-arteritic anterior ischaemic optic neuropathy,â she said. âStaying well hydrated is critical â urine should look straw-coloured.â
Playing the long game
A/Prof Steward said thereâs now sufficient evidence to normalise weight regain after cessation. And given the established risks associated with long-term obesity, he suggests continued therapy may represent a lower-risk option for some patients.
âAs we know, having a very high BMI for a long period of time confers its own levels of risks in terms of cardiovascular disease and other issues,â he said. âSo [many clinicians] think it's worth staying on these [medicines] long term as opposed to the potential risk of weight [regain].â
For people with repeated cycles of weight loss and regain, A/Prof Steward said GLP-1 RAs are increasingly being understood as potentially lifelong treatments â similar to medicines used for other chronic conditions.
âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.'
A/prof trevor steward
âI recently had a conversation with someone who has lost over 50 kilograms three times in her life,â he said. âAfter a sustained period of lifestyle change, the weight still comes back. She would rather stay on these medicines for life than put her body through that cycle again.â
As use expands, A/Prof Steward emphasised the importance of clarifying intent and expectations before treatment begins.
âIt's really important to have that conversation with a pharmacist or GP about whether they want to make that commitment to potentially taking these long term,â he said.
This also creates space to explore motivations for initiating therapy.
âA lot of people are taking these medications for non-health related reasons, e.g. if they have a wedding coming up,â A/Prof Steward said.
âSo it's really worth emphasising that these medications are serious drugs that impact the entire body, and it's not something that should be frivolously taken for the purpose of losing a few kg in a month â only to just have them come back.â
While Prof Collins doesnât think the BMJ findings should deter prescribing, she said cost must be contextualised early â particularly as maintenance strategies continue to evolve. This may include lower costs associated with food and other medicines.
âIf you're improving your weight-related health, how much would medical visits have cost if your health hadnât improved?â she said. âThese medications are a long-term cost, like a car or a mobile phone. We also don't yet know whether, for some people, they may be able to have periods where they don't take it and then reinitiate at lower doses again.â
With potential PBS listings and new formulations on the horizon, A/Prof Steward said clinical messaging will need to evolve alongside the evidence.
âOver half a million Australians are now taking these medicines,â he said. âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.â
For more information, read the AP CPD article Weight loss management.
[post_title] => Are GLP-1 RAs becoming lifelong medicines?
[post_excerpt] => A recent systematic review has reignited debate about what happens when patients stop taking GLP-1 RAs and related incretin therapies.
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[post_content] => In the Barossa Valley, Travis Schiller FPS shows aged care is about teamwork, trust and better outcomes for residents.
Whatâs it like working as a pharmacist in the Barossa?
While only an hour or so from the city, the Barossa has all the advantages of a regional location.
Itâs a privilege to serve in a community with such a rich history; the people and
the community embrace you and appreciate all you can do for them. When I first moved there, I was very quickly invited to present at service clubs and assist with local health programs.
Thereâs such a diversity of opportunity and organisations in the area willing
to explore new ways to improve care for the community. I was fortunate to have the support of local residential aged care facilities (RACFs) to explore new ways of supporting their staff and residents and improving medicines-related outcomes.
How did you get your start in aged care?
I developed a passion for it through my honours project on Residential Medication Management Reviews (RMMRs) post-hospital discharge.
I was fortunate to be involved in further projects, and with the support of a local facility, began spending regular time there in 2013.
I was not only interested in the on-site function but how a supply pharmacy and RACF could work together to achieve the best outcomes for residents â where pharmacy staff became part of the team rather than external contractors.
I was also fortunate to be involved in the initial Aged Care On-Site Pharmacist (ACOP) trials, and later assisted in a mentoring program where three privately funded pharmacists worked on site in aged care before the government-funded program rolled out.
Creating a mentoring environment allowed us to combine the benefits of experience in aged care with the enthusiasm, skill and knowledge of the next generation of pharmacists.
Working with independent RACFs meant we could act as the glue that helped them support one another locally, which we facilitated through regional Medication Advisory Committees.
What are the challenges of being embedded in aged care?
The âus and themâ mentality I had seen in many sites was the biggest challenge, with rigorous incident reporting leaving supply pharmacies as easy scapegoats.
Reinforcing to facility staff that I was there to assist them, that we were one team, and that our purpose was the residentsâ benefit led to a culture shift and better outcomes. Up until the government funded the ACOP measure, funding was always an issue; and the current levels of funded remuneration will continue to be a barrier to the best and brightest taking up and staying in these roles.
What advice do you have for ECPs?
Itâs often said that pharmacy is at a crossroads. While this sentiment is generally considered negative, I think itâs a great analogy for the exciting opportunities and options available to those starting out their careers.
There are many roads to travel professionally. When itâs time for a change, take a different route â explore, find what you love and do it. If it doesnât exist as a career path, create it.
Get involved in the industry through conferences, organisations and networks â and definitely find a mentor, or a few. There are so many great people willing to share their time and knowledge, so donât be afraid to tap into it.
Where do you see the pharmacy profession evolving?
With increasing role diversity, broader scope and rapid advances in technology, itâs an exciting time to be a pharmacist.
Iâd love to see us truly recognised and valued as integral members of the broader healthcare system for all that we do.
I can only see our roles expanding as the population ages, with more specialised positions becoming the norm. Ageing at home will be the next big challenge â and we need to work out how best to support our communities through it.
A day in the life of Travis Schiller FPS, pharmacist owner, Nuriootpa, Barossa Valley, South Australia.
| 7.30 am | Prepare for the day Quick check of emails, paperwork and messages for staffing issues for the day ahead. |
| 8.30 am | Medication advisory meeting Catch up with aged care staff, GPs and the aged care on-site pharmacist. Discuss a recent issue with completing drugs of dependence recording systems and improve procedures to prevent recurrences. Talk about residents removing patches. Also discuss alternate therapies, alternate patch placement and improved surveillance. |
| 10.00 am | In the mall Visit our âThe Barossa Pharmacist In the Mallâ pharmacy, touch base with rostering coordinator, check in with staff and see if the dispensary needs anything. Check prescriptions in the dispensary and counsel patients. Administer two COVID-19 vaccinations, and consult with other patients on hay fever and skincare treatment options. |
| 12.00 pm | In the main street Visit our nearby sister site, âThe Barossa Pharmacist In the Main Streetâ, check with staff and provide lunch cover in the dispensary. Packing client arrives with a change to medicines, so organise the profile change and adjust packs. Warfarin commenced for one of our regulars. Sat with them and discussed the new medicine and their concerns. Receive a prescription for a packing client that doesnât match profile; phone the GP to clarify. |
| 2.00 pm | Aged care supply and training Assist in the pharmacy with regular daily non-packed aged care orders for the afternoon, checking medication profiles and chart changes from the GP round. Also work through a Certificate III module with a pharmacy assistant after their S2/S3s schedules training. |
| 6.00 pm | Evening meeting Attend the local Health Care Advisory Committee meeting to discuss opportunities to fund facilities for our local hospitals. |
| 7.30 pm | Home time Hopefully make it home in time to say goodnight to my three girls, then relax and review the day with my wife. |
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[post_content] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope. But evolving roles must be grounded in clinical need, organisational priorities and demonstrable impact.
At the Alfred Hospital in Melbourne, pharmacists have long practised to an expanded scope. Pharmacy roles include running disease management and anticoagulation services, writing chart corrections in partnership with medical staff and participating in emergency responses such as stroke callouts.
Behind every expanded role is a clear need, said Professor Michael Dooley MPS, Director of Pharmacy at Alfred Health and Chair of PSAâs Hospital Pharmacy Practice Community of Specialty Interest.
âWhen you start to think about offering new services or evolving roles, you need to ask why,â he told attendees at a session on the topic at PSA25 in August. If there isnât a reason beyond âIâm interestedâ, then why are you doing it?â
To expand their services, hospital pharmacy departments must also align with organisational and broader governmental priorities, Prof Dooley said.Â
âIf I want more staff or more support, I need to talk in the language of the organisation and make sure we address issues that are organisational priorities.â
This approach has enabled pharmacists at the Alfred to move beyond dispensary-based roles and embed themselves at key points along the patient journey.
Around 50â60% of pharmacists at the Alfred are allocated to a clinical unit and work as part of the medical team, Prof Dooley explained. A further 20% work in operational roles, such as in sterile suites, dispensaries and outpatients, while around 5% focus on medicines use and safety, and others are in education and training.Â
âWe donât centre all our staff in dispensaries,â Prof Dooley said. âThe opportunities for people to practise across a whole range of things are really diverse. That happened because we first identified a clinical need and then investigated whether it was within our scope of practice.
âAnything youâre considering taking forward, you need to think about it in terms of impact.â
Training pathways for hospital pharmacists
For hospital pharmacists looking to expand their scope, there are now multiple pathways available.Â
âIt used to be said that you had to do your internship at a hospital pharmacy to get in the door,â said Lauren Foley, Lead Pharmacist for Learning and Development at Alfred Health. âBut whatâs happened over the last 5â10 years is we now have these diverse entry points. Itâs about finding the pathway that works for you.â
As well as an internship, pharmacists can undertake foundation residencies, which provide generalist training over a 2-year period.
âAt the 3- to 7-year mark, you can start thinking about specialisation or a registrar training program, which develops advanced practice in a particular area or scope,â Ms Foley said. âThere are also external training and credentialing programs.â
Ms Foley highlighted the stroke credentialing program at Alfred Health as an example of expanded practice driven by patient need.
âIt was identified that patients werenât receiving thrombolysis within the 60-minute timeframe that we know preserves brain function,â she said. âSo the question became: how can we improve that outcome?â
One solution was embedding a pharmacist into those stroke teams who see patients in the emergency department. The role of pharmacists was to obtain the best possible medication history, make recommendations around the management of acute blood pressure and facilitate the early administration of thrombolysis.
âthe initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes. Thatâs how we know the role is making a difference.â
lauren foley
To prepare pharmacists, credentialing requirements include a minimum level of experience, targeted education, assessment, and an objective structured clinical examination with a neurologist and senior pharmacist.
âWe needed to equip pharmacists with the knowledge, the expertise and the confidence to go there and be part of those stroke calls,â Ms Foley said. âIt's quite a confronting scenario so you need pharmacists who can make confident and appropriate recommendations in a life-or-death situation.â
Importantly, the impact of the program has been measurable.
âThere has been research showing the initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes,â Ms Foley said. âThatâs how we know the role is making a difference.â
Beyond the bedside
The scope of practice for hospital pharmacists goes further than direct patient care. Pharmacists lead medicines safety initiatives, antimicrobial stewardship programs, and research and education programs.
âThere's also an emerging role in hospital pharmacy departments for stewardship pharmacists, who have a particular role or area of interest, and they become the go-to person for specialised advice, whether it be for anticoagulants [or] antibiotics,â Ms Foley said.
In every role, pharmacists need to work closely with colleagues from other specialties, Prof Dooley said.
âYou need multidisciplinary support. You can't do any of these things by yourself. If you're interested in developing your services, you have to do that as part of the team.â
This is one of Ms Foleyâs favourite parts of the job. âThere are opportunities to have a chat with the physio or the speech pathologist, to ask the dietitian why theyâve recommended a particular type of enteral nutrition, and to be with the doctor on the ward round. Itâs so important to learn from people who are specialists in their area.â
Join PSAâs Communities of Specialty Interest to connect, collaborate and advance your specialty practice.
[post_title] => Hospital pharmacistsâ scope is expanding
[post_excerpt] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope.
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[post_content] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families alike.
Australiaâs population is living to a greater age, which in turn has led to increased need for end-of-life care. Itâs estimated that demand for palliative care in Australia will rise by 50% between now and 2035, and double by 2050.Â
Until now, most pharmacists have had to navigate complex medication regimes and challenging family conversations â with little to no formal training during university studies.
To help bridge this gap, PSA launched the ASPIRE Palliative Care Foundation Training Program last year. The course, delivered online across eight modules, aims to equip pharmacists with essential, proactive skills â not only for patients, but for the family and carers who also require significant support.
âThe ASPIRE training reminded me that palliative care is not just the last few days of life, itâs actually the weeks, months and sometimes even years after a person has a diagnosis that means that their life is going to be shortened,â said Amy Gibson MPS, a consultant clinical pharmacist and educator who works as an on-site pharmacist in an Aspect Health aged care facility outside Brisbane.
[caption id="attachment_31171" align="aligncenter" width="500"]
Amy Gibson MPS[/caption]
âPalliative care is about making plans to keep that patient as comfortable and in the best health possible for the time theyâve got left â often itâs heart failure and chronic lung disease patients.â
A holistic approach
Before completing the ASPIRE training program, Ms Gibson said she âdidnât have a lot of skills around palliative careâ.
âI knew about what we refer to as the âCore Fourâ medicines. I knew about anticipatory prescribing and making sure youâve got something on hand for pain management, agitation and so on,â she said.
âBut I hadnât really thought so much about those social aspects of having conversations with people to find out what actual issues they were having, and how as a pharmacist you could support them.â
While not designed to prepare pharmacists to specialise in palliative care, the ASPIRE training course explores a broad range of topics around end-of-life issues, from symptom management and interdisciplinary palliative care to the role of the pharmacist across everything from medicine management to bereavement and self-care.
The holistic approach of the training resonated with Ms Gibson. âThere was a lot of psychosocial education, including around what palliative care patients experience and also what thatâs like for their families,â she said. âIt reinforced cultural perspectives, particularly for [Aboriginal and Torres Strait Islander] peoples, acknowledging that different cultures deal with death and dying in diverse ways and thereâs not a one-size-fits-all approach.â
The ASPIRE training puts the carersâ perspectives in place, said Ruilin Ng MPS, a consultant pharmacist and credentialled diabetes educator based in suburban Adelaide. âA lot of the time, people are so focused on the person in care that the person around them is not given as much attention.â
The list of drugs a carer picks up can also be a vital clue for pharmacists to open a conversation. âA simple, âHow are youâ, or âHowâs it goingâ, goes a long way,â she said.Â
âOtherwise family members or carers sometimes fall through the cracks. They may not have the support of a counsellor because obviously the focus is not on them.â
The training also reminds pharmacists of their critical role in being proactive around the most fundamental parts of palliative care, Ms Gibson said.Â
âThere are cases when people have trouble even physically getting to the pharmacy, saying âWe need someone to be with Dad 24/7â for example,â she said. âThey donât have the headspace to say that [coming to the pharmacy] isnât working for them and might not even realise we can arrange delivery, so thereâs a lot of emphasis on the practical measures we can provide.â
Medicine management when itâs most critical
As most people aim to spend their final days at home or in an aged care facility rather than in a hospital, the training helps prepare pharmacists to support them, including the specifics of palliative care medicines management.
âWe can assist [prescribers] in knowing what medicines should be prescribed for comfort measures and what medicines should be ceased because they're no longer serving a purpose,â Ms Gibson said.Â
This also includes making sure the right medicines are available. âIf your loved one is in pain or quite agitated, you donât want to be told youâve got to wait 24 hours because itâs not in stock,â Ms Gibson said. âThe training encourages community pharmacies to have these key palliative [care] medicines on hand so patientsâ families donât have to run around the town trying to find supplies.â
In her aged care role, Ms Gibson works closely with registered nurses to maintain an imprest supply. âThis is emergency stock, including palliative care medicines, that they might need to use before the next delivery from the pharmacy comes,â she said.Â
âIf an after-hours GP comes at night and says, âWe need to start this patient on a morphine syringe driverâ, weâve got some ready to go â they donât have to wait until the order arrives at 3.00 pm the next afternoon. I help the nurses monitor that stock. And if weâre running low, I make sure the order goes through to our supply pharmacy in plenty of time.â
The skills Ms Gibson honed through the ASPIRE training program recently helped her treat a resident with advanced dementia who was admitted to hospital but discharged back to the aged care facility with little warning.Â
âShe was close to the end of [her] life and theyâd ceased everything but the palliative [care] medicines, anticipating she wouldnât [live] more than a couple of days,â she said.Â
âAs soon as I saw the message that she was expected back later that day, I checked that we had enough morphine and midazolam to make sure she could be administered those medicines as soon as she got back, because she was unlikely to be sent back to us with [a supply of] those medications.Â
âHer doses were escalating quickly and over the next couple of days I made sure we stayed on top of stock levels, putting orders into the pharmacy regularly to make sure we weren't going to run out overnight.â
The ASPIRE training reinforced the importance of this approach. âAt the very end of life, the situation can deteriorate quickly, with a change in condition often meaning a change in dose,â Ms Gibson said.Â
âWe donât want people to be uncomfortable and you donât want to wait a day for the order to arrive. Thereâs a real need to anticipate whatâs going to happen.â
Care after the end
When end of life arrives for the patient, itâs those left behind who need care.Â
âThe ASPIRE training puts the carerâs perspectives in place, [and] is a very good introduction to the bereavement aspectâ Ms Ng said. â[You learn] how to start the conversation, because itâs not an easy topic.â
Pharmacists have an important role in acknowledging carer grief and bereavement after the death of a loved one, and signposting to further support if required.
Keen to learn more about palliative care? Pharmacists, students and interns can enrol free of charge in the Training Plan: ASPIRE Palliative Care Foundation Training Program.
[post_title] => At the end of life, pharmacists are essential
[post_excerpt] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families.
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[post_content] => Holiday crowds bring unique clinical challenges, testing pharmacistsâ problem-solving skills from sun exposure injuries to urgent medicine gaps.
In many metropolitan areas, January is a lull period for pharmacists â as city dwellers head out of town to beat the heat and reset for the year ahead. But not so in many regional beachside areas, with pharmacies experiencing a steady uptick in visiting clientele, as Rebecca Davies, who works as a community pharmacist in Cotton Tree on Queensland's Sunshine Coast, would attest.
âWhere I'm working at the moment is right on the beach, so it's literally busy all the time,â said Ms Davies, who was formerly based in Mona Vale on Sydneyâs Northern Beaches. âI wouldn't say there's ever a quiet time, as in the winter, we still get people coming up from the southern states for holidays.â
With a caravan park stationed down the road, nearby units that are typically rented out during peak holiday periods and warm weather year-round, itâs a matter of balancing the holiday trade thatâs passing through with regular customers.
A clinical mix by the sea
Alongside routine dispensing and chronic disease management for locals, managing beach-related enquiries and conditions is a part of everyday practice.
Over-the-counter demand increases during holiday periods, with visitors seeking sunscreens, beach equipment and first-aid items, with many presentations requiring pharmacist oversight.
[caption id="attachment_31212" align="aligncenter" width="441"] Rebecca Davies[/caption]
âYou get people that arenât used to the sun that come in with sunburn,â Ms Davies said.Â
Children feature prominently, particularly those visiting from interstate or overseas â presenting with significant sunburn, dehydration or injuries sustained during outdoor play.
âThe kids that come from places that arenât used to the beaches come in with the sunburn,â she said. âThen there are the holiday kids [whoâve fallen off] bikes or skateboards.â
In one recent case, a teenage girl presented with extensive sunburn that had initially been treated in the pharmacy. Several days later, she returned with worsening symptoms.
âShe came back about 5 days later and it looked like sheâd picked up a bacterial infection from broken skin.â
At that point, Ms Davies referred the patient to a doctor, recognising that pharmacy management was no longer sufficient. âIt had just gone too far for anything that we could do for her.â
Marine-related skin reactions are another frequent presentation, particularly sea lice, which can âget caught in between the swimmers and their skinâ.
Management usually involves antihistamines, topical corticosteroids and practical advice to reduce symptoms.
âYou tell them to keep the area cool,â Ms Davies said. âAnything that makes them hotter will make it worse.â
In most cases, these conditions can be managed entirely in-store, allowing patients to avoid medical appointments during short stays.
âBut there's a lot of regular customers and we still have all the Webster-paks among other things to manage,â she said.
Managing forgotten medicines
Beyond acute injuries and skin conditions, medicine continuity for holidaymakers is one of the most complex challenges Ms Davies faces.
Tourists frequently arrive without sufficient medicine supply, having forgotten it at home or miscalculating how long they would be away.
âitâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.'
rebecca davies
âIf the customer has a regular pharmacy at home, we can contact that pharmacy,â she said. âThey can fax scripts and post the originals.â
Electronic prescriptions have made this process significantly easier.
âWith eScripts, itâs really easy to sign them up to the Active Script List and have access to all their eScripts online,â Ms Davies said.
However, not all situations are quickly resolved.
âI had one customer the other day whoâd left her medicine at home and didnât have a script,â she said.Â
The medicine was venlafaxine, which should not be stopped abruptly.
In this particular situation, the best course of action was for the patient to arrange an urgent medical consultation with their regular GP, or via an online telehealth provider if necessary.
âI encourage people to stay with their regular doctor. But there are times when those services are very useful.â
Managing medicines for visiting patients often requires Ms Davies to look beyond her own dispensary.Â
âIf we donât have the medication and itâs for someone passing through, ordering it in isnât always a possibility, because the person might move on before it comes in,â she said.Â
âSo weâll ring the other pharmacies around to see if theyâve got it and direct the patient there. Itâs just about trying to source the medication for the patient before they move on.â
Expanded scope makes a difference on holiday
Expanded scope of practice services have proven particularly valuable in a tourist-heavy setting, especially pharmacist-led treatment for uncomplicated urinary tract infections (UTIs).
âPatients with symptoms of a UTI who have come here for the weekend can come into the pharmacy quite distressed,â Ms Davies said. âThe symptoms of the infection really disrupt how they get through the day and theyâre not familiar with the area or the doctors.â
Being able to assess and treat eligible patients in the pharmacy can significantly reduce discomfort and disruption.
âIt definitely puts them at ease when we go through that, that list of when we can and can't supply,â Ms Davies said. âWe can say, âYes, we can help youâ.â
For visitors, the impact is immediate.
âTheyâre not wasting 24 to 48 hours trying to figure out where to go,â she said. âIt makes a big difference to their holiday.â
According to Ms Davies, community awareness of pharmacist UTI services has increased, with many patients now presenting specifically requesting assessment rather than symptom-only treatments.
âMore people come in already knowing that the service exists rather than asking for Ural,â she said.
Staffing for constant demand
Maintaining service quality during sustained busy periods requires careful staff management.
âSometimes the owner puts more staff on over the holiday period. Because obviously thereâs going to be an influx of tourists, thereâs a couple of extra staff we can call on,â Ms Davies said.Â
âThe business also supports private clinics, so we have access to extra staff we can call on during the day if things start to back up.â
The pharmacy relies on a mix of permanent staff, casual pharmacists, students and graduates to manage peaks. Having experienced casual staff who can be called in at short notice is particularly valuable.
âWeâre lucky to have someone we can call on who used to be a permanent employee and now works casually,â she said.
Despite the intensity, Ms Davies finds the work highly rewarding.Â
âIt definitely tests your knowledge on how to navigate certain situations,â she said. âAnd itâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.â
For pharmacists considering a move to a coastal area, Rebecca sees beachside practice as challenging but professionally enriching.
âIt offers lots of different scenarios for helping patients compared to your regular customer coming in with the same things from month to month,â she said. âAnd thereâs lots of opportunities for problem-solving.â
Help patients avoid serious sunburn by completing the AP CPD: Sun safety, donât feel the burn.
Image licensed under Creative Commons.
[post_title] => Practising pharmacy where others vacation
[post_excerpt] => Holiday crowds bring unique clinical challenges for beachside pharmacy practice, from sun exposure injuries to urgent medicine gaps.
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[post_content] => A recent systematic review published in the BMJ has reignited debate about what happens when patients stop taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related GLP-1âbased incretin therapies.
The analysis found that weight often returns quickly once treatment is discontinued â in some cases faster than with other weight-loss interventions.
And itâs not just weight that rebounds. Cardiometabolic risk markers, including blood pressure, blood glucose and blood lipids, were also found to revert towards pre-treatment levels.
As prescribing of these medicines continues to rise, the findings raise a broader question: should patients be starting these medicines in the first place?
AP spoke with experts to unpack the evidence.
Weight regain predictable, but not the real problem
Professor Clare Collins, Professor of Nutrition and Dietetics at the University of Newcastle, said the pattern of rapid weight regain following cessation was entirely unsurprising.
âThis is exactly what you would expect,â she said.
[caption id="attachment_31196" align="aligncenter" width="400"] Professor Clare Collins[/caption]
For Prof Collins, the findings reinforce a core principle of chronic disease management: when an effective treatment is withdrawn, the condition it was controlling usually returns.
âIf someone stops taking antihypertensives, what happens? Their blood pressure goes back up,â she said.Â
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.'
Prof clare collins
While weight regain attracts headlines, Prof Collins said the more clinically concerning signal is the deterioration in metabolic markers once treatment ceases.
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.â
Not a sign of treatment failure
Associate Professor Trevor Steward, Director of the Melbourne School of Psychological Sciencesâ Brain and Mental Health Hub, agrees that the rebound effect reflects how GLP-1 RA medicines work, rather than a failure of the drugs or patient behaviour.
Instead of creating permanent physiological change, GLP-1 RAs amplify hormonal signals that already exist in the body â particularly those involved in appetite regulation, digestion and satiety. The benefits seen during treatment depend on sustained exposure to these hormones.
[caption id="attachment_31197" align="aligncenter" width="400"] Associate Professor Trevor Steward[/caption]
âThat's why we see this rapid rebound effect of people experiencing weight gain when they stop using them, because thereâs no longer increased circulating levels of hormones impacting their different body systems,â A/Prof Steward said.
However, the mechanisms behind the accelerated regain are not yet fully understood.
âSome indications are that while these newer medications help people lose weight faster, they may cause a stronger slingshot effect,â he said.
Prof Collins points to emerging evidence suggesting incretin therapies cross the bloodâbrain barrier, influencing reward pathways linked to appetite and environmental cues to eat.
âFor example, if you go to the supermarket for a loaf of bread and come back with donuts too â thatâs whatâs referred to as âfood noiseâ,â she said. âSome people say this [noise] really goes down when using these therapies.â
When treatment is withdrawn, the surrounding food environment can quickly reassert itself. This is where tapering, behavioural support and nutrition strategies become critical.
âIt may be that people are more receptive to maintenance support programs as theyâre tapering or finding out what their maintenance medication dose is,â she said. âIf theyâre aware of that point, theyâll recognise when the food noise starts again.â
Nutrition: the missing variable
Prof Collins recently led a systematic review which highlighted that changes in dietary intake and nutrition remain largely invisible in incretin trials.
âOf all the phase three trials, only two actually measured and reported what people ate,â she said.
Most trials provided standardised advice but did not collect data on dietary intake, leaving clinicians to infer how appetite suppression, nausea and early satiety shaped eating patterns over time.
âThey mostly worked with people to identify dietary changes that would remove about 2,000 kilojoules a day â enough to trigger weight loss,â she said.
But reduced intake doesnât automatically equate to improved diet quality or nutrient adequacy, with micronutrient deficiencies and loss of lean mass emerging if nutrition isnât actively monitored.
With frequent patient contact, Prof Collins believes pharmacists are uniquely placed to identify emerging problems, intervene early and support appropriate referral to dietitians for medical nutrition therapy.
â[And] if pharmacy staff are trained, they can say, âHang on a minute, you need to talk to the pharmacistâ.â
The University of Newcastle also has a suite of resources pharmacists could direct patients to, including a healthy eating quiz and obesity management podcast, available here.
When visible deterioration or rapid weight loss appears, referral becomes essential. âOnce you think, âthis person is fading before our eyesâ, thatâs when you alert the GP and refer to a dietitian,â Prof Collins said.
Supporting persistence with therapy also plays a role in outcomes.
âThe main benefit isnât weight â itâs metabolic health,â she said. âHelping people manage [adverse] effects supports continuation.â
As weight loss occurs, pharmacists should also be alert to the need to review other medicines.
âIf someone is dropping weight rapidly, blood sugars and blood pressure can fall,â she said. âThere are also rare but potentially severe complications â pancreatitis, gallstones, bowel obstruction and non-arteritic anterior ischaemic optic neuropathy,â she said. âStaying well hydrated is critical â urine should look straw-coloured.â
Playing the long game
A/Prof Steward said thereâs now sufficient evidence to normalise weight regain after cessation. And given the established risks associated with long-term obesity, he suggests continued therapy may represent a lower-risk option for some patients.
âAs we know, having a very high BMI for a long period of time confers its own levels of risks in terms of cardiovascular disease and other issues,â he said. âSo [many clinicians] think it's worth staying on these [medicines] long term as opposed to the potential risk of weight [regain].â
For people with repeated cycles of weight loss and regain, A/Prof Steward said GLP-1 RAs are increasingly being understood as potentially lifelong treatments â similar to medicines used for other chronic conditions.
âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.'
A/prof trevor steward
âI recently had a conversation with someone who has lost over 50 kilograms three times in her life,â he said. âAfter a sustained period of lifestyle change, the weight still comes back. She would rather stay on these medicines for life than put her body through that cycle again.â
As use expands, A/Prof Steward emphasised the importance of clarifying intent and expectations before treatment begins.
âIt's really important to have that conversation with a pharmacist or GP about whether they want to make that commitment to potentially taking these long term,â he said.
This also creates space to explore motivations for initiating therapy.
âA lot of people are taking these medications for non-health related reasons, e.g. if they have a wedding coming up,â A/Prof Steward said.
âSo it's really worth emphasising that these medications are serious drugs that impact the entire body, and it's not something that should be frivolously taken for the purpose of losing a few kg in a month â only to just have them come back.â
While Prof Collins doesnât think the BMJ findings should deter prescribing, she said cost must be contextualised early â particularly as maintenance strategies continue to evolve. This may include lower costs associated with food and other medicines.
âIf you're improving your weight-related health, how much would medical visits have cost if your health hadnât improved?â she said. âThese medications are a long-term cost, like a car or a mobile phone. We also don't yet know whether, for some people, they may be able to have periods where they don't take it and then reinitiate at lower doses again.â
With potential PBS listings and new formulations on the horizon, A/Prof Steward said clinical messaging will need to evolve alongside the evidence.
âOver half a million Australians are now taking these medicines,â he said. âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.â
For more information, read the AP CPD article Weight loss management.
[post_title] => Are GLP-1 RAs becoming lifelong medicines?
[post_excerpt] => A recent systematic review has reignited debate about what happens when patients stop taking GLP-1 RAs and related incretin therapies.
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[post_content] => In the Barossa Valley, Travis Schiller FPS shows aged care is about teamwork, trust and better outcomes for residents.
Whatâs it like working as a pharmacist in the Barossa?
While only an hour or so from the city, the Barossa has all the advantages of a regional location.
Itâs a privilege to serve in a community with such a rich history; the people and
the community embrace you and appreciate all you can do for them. When I first moved there, I was very quickly invited to present at service clubs and assist with local health programs.
Thereâs such a diversity of opportunity and organisations in the area willing
to explore new ways to improve care for the community. I was fortunate to have the support of local residential aged care facilities (RACFs) to explore new ways of supporting their staff and residents and improving medicines-related outcomes.
How did you get your start in aged care?
I developed a passion for it through my honours project on Residential Medication Management Reviews (RMMRs) post-hospital discharge.
I was fortunate to be involved in further projects, and with the support of a local facility, began spending regular time there in 2013.
I was not only interested in the on-site function but how a supply pharmacy and RACF could work together to achieve the best outcomes for residents â where pharmacy staff became part of the team rather than external contractors.
I was also fortunate to be involved in the initial Aged Care On-Site Pharmacist (ACOP) trials, and later assisted in a mentoring program where three privately funded pharmacists worked on site in aged care before the government-funded program rolled out.
Creating a mentoring environment allowed us to combine the benefits of experience in aged care with the enthusiasm, skill and knowledge of the next generation of pharmacists.
Working with independent RACFs meant we could act as the glue that helped them support one another locally, which we facilitated through regional Medication Advisory Committees.
What are the challenges of being embedded in aged care?
The âus and themâ mentality I had seen in many sites was the biggest challenge, with rigorous incident reporting leaving supply pharmacies as easy scapegoats.
Reinforcing to facility staff that I was there to assist them, that we were one team, and that our purpose was the residentsâ benefit led to a culture shift and better outcomes. Up until the government funded the ACOP measure, funding was always an issue; and the current levels of funded remuneration will continue to be a barrier to the best and brightest taking up and staying in these roles.
What advice do you have for ECPs?
Itâs often said that pharmacy is at a crossroads. While this sentiment is generally considered negative, I think itâs a great analogy for the exciting opportunities and options available to those starting out their careers.
There are many roads to travel professionally. When itâs time for a change, take a different route â explore, find what you love and do it. If it doesnât exist as a career path, create it.
Get involved in the industry through conferences, organisations and networks â and definitely find a mentor, or a few. There are so many great people willing to share their time and knowledge, so donât be afraid to tap into it.
Where do you see the pharmacy profession evolving?
With increasing role diversity, broader scope and rapid advances in technology, itâs an exciting time to be a pharmacist.
Iâd love to see us truly recognised and valued as integral members of the broader healthcare system for all that we do.
I can only see our roles expanding as the population ages, with more specialised positions becoming the norm. Ageing at home will be the next big challenge â and we need to work out how best to support our communities through it.
A day in the life of Travis Schiller FPS, pharmacist owner, Nuriootpa, Barossa Valley, South Australia.
| 7.30 am | Prepare for the day Quick check of emails, paperwork and messages for staffing issues for the day ahead. |
| 8.30 am | Medication advisory meeting Catch up with aged care staff, GPs and the aged care on-site pharmacist. Discuss a recent issue with completing drugs of dependence recording systems and improve procedures to prevent recurrences. Talk about residents removing patches. Also discuss alternate therapies, alternate patch placement and improved surveillance. |
| 10.00 am | In the mall Visit our âThe Barossa Pharmacist In the Mallâ pharmacy, touch base with rostering coordinator, check in with staff and see if the dispensary needs anything. Check prescriptions in the dispensary and counsel patients. Administer two COVID-19 vaccinations, and consult with other patients on hay fever and skincare treatment options. |
| 12.00 pm | In the main street Visit our nearby sister site, âThe Barossa Pharmacist In the Main Streetâ, check with staff and provide lunch cover in the dispensary. Packing client arrives with a change to medicines, so organise the profile change and adjust packs. Warfarin commenced for one of our regulars. Sat with them and discussed the new medicine and their concerns. Receive a prescription for a packing client that doesnât match profile; phone the GP to clarify. |
| 2.00 pm | Aged care supply and training Assist in the pharmacy with regular daily non-packed aged care orders for the afternoon, checking medication profiles and chart changes from the GP round. Also work through a Certificate III module with a pharmacy assistant after their S2/S3s schedules training. |
| 6.00 pm | Evening meeting Attend the local Health Care Advisory Committee meeting to discuss opportunities to fund facilities for our local hospitals. |
| 7.30 pm | Home time Hopefully make it home in time to say goodnight to my three girls, then relax and review the day with my wife. |
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[post_content] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope. But evolving roles must be grounded in clinical need, organisational priorities and demonstrable impact.
At the Alfred Hospital in Melbourne, pharmacists have long practised to an expanded scope. Pharmacy roles include running disease management and anticoagulation services, writing chart corrections in partnership with medical staff and participating in emergency responses such as stroke callouts.
Behind every expanded role is a clear need, said Professor Michael Dooley MPS, Director of Pharmacy at Alfred Health and Chair of PSAâs Hospital Pharmacy Practice Community of Specialty Interest.
âWhen you start to think about offering new services or evolving roles, you need to ask why,â he told attendees at a session on the topic at PSA25 in August. If there isnât a reason beyond âIâm interestedâ, then why are you doing it?â
To expand their services, hospital pharmacy departments must also align with organisational and broader governmental priorities, Prof Dooley said.Â
âIf I want more staff or more support, I need to talk in the language of the organisation and make sure we address issues that are organisational priorities.â
This approach has enabled pharmacists at the Alfred to move beyond dispensary-based roles and embed themselves at key points along the patient journey.
Around 50â60% of pharmacists at the Alfred are allocated to a clinical unit and work as part of the medical team, Prof Dooley explained. A further 20% work in operational roles, such as in sterile suites, dispensaries and outpatients, while around 5% focus on medicines use and safety, and others are in education and training.Â
âWe donât centre all our staff in dispensaries,â Prof Dooley said. âThe opportunities for people to practise across a whole range of things are really diverse. That happened because we first identified a clinical need and then investigated whether it was within our scope of practice.
âAnything youâre considering taking forward, you need to think about it in terms of impact.â
Training pathways for hospital pharmacists
For hospital pharmacists looking to expand their scope, there are now multiple pathways available.Â
âIt used to be said that you had to do your internship at a hospital pharmacy to get in the door,â said Lauren Foley, Lead Pharmacist for Learning and Development at Alfred Health. âBut whatâs happened over the last 5â10 years is we now have these diverse entry points. Itâs about finding the pathway that works for you.â
As well as an internship, pharmacists can undertake foundation residencies, which provide generalist training over a 2-year period.
âAt the 3- to 7-year mark, you can start thinking about specialisation or a registrar training program, which develops advanced practice in a particular area or scope,â Ms Foley said. âThere are also external training and credentialing programs.â
Ms Foley highlighted the stroke credentialing program at Alfred Health as an example of expanded practice driven by patient need.
âIt was identified that patients werenât receiving thrombolysis within the 60-minute timeframe that we know preserves brain function,â she said. âSo the question became: how can we improve that outcome?â
One solution was embedding a pharmacist into those stroke teams who see patients in the emergency department. The role of pharmacists was to obtain the best possible medication history, make recommendations around the management of acute blood pressure and facilitate the early administration of thrombolysis.
âthe initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes. Thatâs how we know the role is making a difference.â
lauren foley
To prepare pharmacists, credentialing requirements include a minimum level of experience, targeted education, assessment, and an objective structured clinical examination with a neurologist and senior pharmacist.
âWe needed to equip pharmacists with the knowledge, the expertise and the confidence to go there and be part of those stroke calls,â Ms Foley said. âIt's quite a confronting scenario so you need pharmacists who can make confident and appropriate recommendations in a life-or-death situation.â
Importantly, the impact of the program has been measurable.
âThere has been research showing the initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes,â Ms Foley said. âThatâs how we know the role is making a difference.â
Beyond the bedside
The scope of practice for hospital pharmacists goes further than direct patient care. Pharmacists lead medicines safety initiatives, antimicrobial stewardship programs, and research and education programs.
âThere's also an emerging role in hospital pharmacy departments for stewardship pharmacists, who have a particular role or area of interest, and they become the go-to person for specialised advice, whether it be for anticoagulants [or] antibiotics,â Ms Foley said.
In every role, pharmacists need to work closely with colleagues from other specialties, Prof Dooley said.
âYou need multidisciplinary support. You can't do any of these things by yourself. If you're interested in developing your services, you have to do that as part of the team.â
This is one of Ms Foleyâs favourite parts of the job. âThere are opportunities to have a chat with the physio or the speech pathologist, to ask the dietitian why theyâve recommended a particular type of enteral nutrition, and to be with the doctor on the ward round. Itâs so important to learn from people who are specialists in their area.â
Join PSAâs Communities of Specialty Interest to connect, collaborate and advance your specialty practice.
[post_title] => Hospital pharmacistsâ scope is expanding
[post_excerpt] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope.
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[title] => Hospital pharmacistsâ scope is expanding
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[post_content] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families alike.
Australiaâs population is living to a greater age, which in turn has led to increased need for end-of-life care. Itâs estimated that demand for palliative care in Australia will rise by 50% between now and 2035, and double by 2050.Â
Until now, most pharmacists have had to navigate complex medication regimes and challenging family conversations â with little to no formal training during university studies.
To help bridge this gap, PSA launched the ASPIRE Palliative Care Foundation Training Program last year. The course, delivered online across eight modules, aims to equip pharmacists with essential, proactive skills â not only for patients, but for the family and carers who also require significant support.
âThe ASPIRE training reminded me that palliative care is not just the last few days of life, itâs actually the weeks, months and sometimes even years after a person has a diagnosis that means that their life is going to be shortened,â said Amy Gibson MPS, a consultant clinical pharmacist and educator who works as an on-site pharmacist in an Aspect Health aged care facility outside Brisbane.
[caption id="attachment_31171" align="aligncenter" width="500"] Amy Gibson MPS[/caption]
âPalliative care is about making plans to keep that patient as comfortable and in the best health possible for the time theyâve got left â often itâs heart failure and chronic lung disease patients.â
A holistic approach
Before completing the ASPIRE training program, Ms Gibson said she âdidnât have a lot of skills around palliative careâ.
âI knew about what we refer to as the âCore Fourâ medicines. I knew about anticipatory prescribing and making sure youâve got something on hand for pain management, agitation and so on,â she said.
âBut I hadnât really thought so much about those social aspects of having conversations with people to find out what actual issues they were having, and how as a pharmacist you could support them.â
While not designed to prepare pharmacists to specialise in palliative care, the ASPIRE training course explores a broad range of topics around end-of-life issues, from symptom management and interdisciplinary palliative care to the role of the pharmacist across everything from medicine management to bereavement and self-care.
The holistic approach of the training resonated with Ms Gibson. âThere was a lot of psychosocial education, including around what palliative care patients experience and also what thatâs like for their families,â she said. âIt reinforced cultural perspectives, particularly for [Aboriginal and Torres Strait Islander] peoples, acknowledging that different cultures deal with death and dying in diverse ways and thereâs not a one-size-fits-all approach.â
The ASPIRE training puts the carersâ perspectives in place, said Ruilin Ng MPS, a consultant pharmacist and credentialled diabetes educator based in suburban Adelaide. âA lot of the time, people are so focused on the person in care that the person around them is not given as much attention.â
The list of drugs a carer picks up can also be a vital clue for pharmacists to open a conversation. âA simple, âHow are youâ, or âHowâs it goingâ, goes a long way,â she said.Â
âOtherwise family members or carers sometimes fall through the cracks. They may not have the support of a counsellor because obviously the focus is not on them.â
The training also reminds pharmacists of their critical role in being proactive around the most fundamental parts of palliative care, Ms Gibson said.Â
âThere are cases when people have trouble even physically getting to the pharmacy, saying âWe need someone to be with Dad 24/7â for example,â she said. âThey donât have the headspace to say that [coming to the pharmacy] isnât working for them and might not even realise we can arrange delivery, so thereâs a lot of emphasis on the practical measures we can provide.â
Medicine management when itâs most critical
As most people aim to spend their final days at home or in an aged care facility rather than in a hospital, the training helps prepare pharmacists to support them, including the specifics of palliative care medicines management.
âWe can assist [prescribers] in knowing what medicines should be prescribed for comfort measures and what medicines should be ceased because they're no longer serving a purpose,â Ms Gibson said.Â
This also includes making sure the right medicines are available. âIf your loved one is in pain or quite agitated, you donât want to be told youâve got to wait 24 hours because itâs not in stock,â Ms Gibson said. âThe training encourages community pharmacies to have these key palliative [care] medicines on hand so patientsâ families donât have to run around the town trying to find supplies.â
In her aged care role, Ms Gibson works closely with registered nurses to maintain an imprest supply. âThis is emergency stock, including palliative care medicines, that they might need to use before the next delivery from the pharmacy comes,â she said.Â
âIf an after-hours GP comes at night and says, âWe need to start this patient on a morphine syringe driverâ, weâve got some ready to go â they donât have to wait until the order arrives at 3.00 pm the next afternoon. I help the nurses monitor that stock. And if weâre running low, I make sure the order goes through to our supply pharmacy in plenty of time.â
The skills Ms Gibson honed through the ASPIRE training program recently helped her treat a resident with advanced dementia who was admitted to hospital but discharged back to the aged care facility with little warning.Â
âShe was close to the end of [her] life and theyâd ceased everything but the palliative [care] medicines, anticipating she wouldnât [live] more than a couple of days,â she said.Â
âAs soon as I saw the message that she was expected back later that day, I checked that we had enough morphine and midazolam to make sure she could be administered those medicines as soon as she got back, because she was unlikely to be sent back to us with [a supply of] those medications.Â
âHer doses were escalating quickly and over the next couple of days I made sure we stayed on top of stock levels, putting orders into the pharmacy regularly to make sure we weren't going to run out overnight.â
The ASPIRE training reinforced the importance of this approach. âAt the very end of life, the situation can deteriorate quickly, with a change in condition often meaning a change in dose,â Ms Gibson said.Â
âWe donât want people to be uncomfortable and you donât want to wait a day for the order to arrive. Thereâs a real need to anticipate whatâs going to happen.â
Care after the end
When end of life arrives for the patient, itâs those left behind who need care.Â
âThe ASPIRE training puts the carerâs perspectives in place, [and] is a very good introduction to the bereavement aspectâ Ms Ng said. â[You learn] how to start the conversation, because itâs not an easy topic.â
Pharmacists have an important role in acknowledging carer grief and bereavement after the death of a loved one, and signposting to further support if required.
Keen to learn more about palliative care? Pharmacists, students and interns can enrol free of charge in the Training Plan: ASPIRE Palliative Care Foundation Training Program.
[post_title] => At the end of life, pharmacists are essential
[post_excerpt] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families.
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[post_content] => Holiday crowds bring unique clinical challenges, testing pharmacistsâ problem-solving skills from sun exposure injuries to urgent medicine gaps.
In many metropolitan areas, January is a lull period for pharmacists â as city dwellers head out of town to beat the heat and reset for the year ahead. But not so in many regional beachside areas, with pharmacies experiencing a steady uptick in visiting clientele, as Rebecca Davies, who works as a community pharmacist in Cotton Tree on Queensland's Sunshine Coast, would attest.
âWhere I'm working at the moment is right on the beach, so it's literally busy all the time,â said Ms Davies, who was formerly based in Mona Vale on Sydneyâs Northern Beaches. âI wouldn't say there's ever a quiet time, as in the winter, we still get people coming up from the southern states for holidays.â
With a caravan park stationed down the road, nearby units that are typically rented out during peak holiday periods and warm weather year-round, itâs a matter of balancing the holiday trade thatâs passing through with regular customers.
A clinical mix by the sea
Alongside routine dispensing and chronic disease management for locals, managing beach-related enquiries and conditions is a part of everyday practice.
Over-the-counter demand increases during holiday periods, with visitors seeking sunscreens, beach equipment and first-aid items, with many presentations requiring pharmacist oversight.
[caption id="attachment_31212" align="aligncenter" width="441"] Rebecca Davies[/caption]
âYou get people that arenât used to the sun that come in with sunburn,â Ms Davies said.Â
Children feature prominently, particularly those visiting from interstate or overseas â presenting with significant sunburn, dehydration or injuries sustained during outdoor play.
âThe kids that come from places that arenât used to the beaches come in with the sunburn,â she said. âThen there are the holiday kids [whoâve fallen off] bikes or skateboards.â
In one recent case, a teenage girl presented with extensive sunburn that had initially been treated in the pharmacy. Several days later, she returned with worsening symptoms.
âShe came back about 5 days later and it looked like sheâd picked up a bacterial infection from broken skin.â
At that point, Ms Davies referred the patient to a doctor, recognising that pharmacy management was no longer sufficient. âIt had just gone too far for anything that we could do for her.â
Marine-related skin reactions are another frequent presentation, particularly sea lice, which can âget caught in between the swimmers and their skinâ.
Management usually involves antihistamines, topical corticosteroids and practical advice to reduce symptoms.
âYou tell them to keep the area cool,â Ms Davies said. âAnything that makes them hotter will make it worse.â
In most cases, these conditions can be managed entirely in-store, allowing patients to avoid medical appointments during short stays.
âBut there's a lot of regular customers and we still have all the Webster-paks among other things to manage,â she said.
Managing forgotten medicines
Beyond acute injuries and skin conditions, medicine continuity for holidaymakers is one of the most complex challenges Ms Davies faces.
Tourists frequently arrive without sufficient medicine supply, having forgotten it at home or miscalculating how long they would be away.
âitâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.'
rebecca davies
âIf the customer has a regular pharmacy at home, we can contact that pharmacy,â she said. âThey can fax scripts and post the originals.â
Electronic prescriptions have made this process significantly easier.
âWith eScripts, itâs really easy to sign them up to the Active Script List and have access to all their eScripts online,â Ms Davies said.
However, not all situations are quickly resolved.
âI had one customer the other day whoâd left her medicine at home and didnât have a script,â she said.Â
The medicine was venlafaxine, which should not be stopped abruptly.
In this particular situation, the best course of action was for the patient to arrange an urgent medical consultation with their regular GP, or via an online telehealth provider if necessary.
âI encourage people to stay with their regular doctor. But there are times when those services are very useful.â
Managing medicines for visiting patients often requires Ms Davies to look beyond her own dispensary.Â
âIf we donât have the medication and itâs for someone passing through, ordering it in isnât always a possibility, because the person might move on before it comes in,â she said.Â
âSo weâll ring the other pharmacies around to see if theyâve got it and direct the patient there. Itâs just about trying to source the medication for the patient before they move on.â
Expanded scope makes a difference on holiday
Expanded scope of practice services have proven particularly valuable in a tourist-heavy setting, especially pharmacist-led treatment for uncomplicated urinary tract infections (UTIs).
âPatients with symptoms of a UTI who have come here for the weekend can come into the pharmacy quite distressed,â Ms Davies said. âThe symptoms of the infection really disrupt how they get through the day and theyâre not familiar with the area or the doctors.â
Being able to assess and treat eligible patients in the pharmacy can significantly reduce discomfort and disruption.
âIt definitely puts them at ease when we go through that, that list of when we can and can't supply,â Ms Davies said. âWe can say, âYes, we can help youâ.â
For visitors, the impact is immediate.
âTheyâre not wasting 24 to 48 hours trying to figure out where to go,â she said. âIt makes a big difference to their holiday.â
According to Ms Davies, community awareness of pharmacist UTI services has increased, with many patients now presenting specifically requesting assessment rather than symptom-only treatments.
âMore people come in already knowing that the service exists rather than asking for Ural,â she said.
Staffing for constant demand
Maintaining service quality during sustained busy periods requires careful staff management.
âSometimes the owner puts more staff on over the holiday period. Because obviously thereâs going to be an influx of tourists, thereâs a couple of extra staff we can call on,â Ms Davies said.Â
âThe business also supports private clinics, so we have access to extra staff we can call on during the day if things start to back up.â
The pharmacy relies on a mix of permanent staff, casual pharmacists, students and graduates to manage peaks. Having experienced casual staff who can be called in at short notice is particularly valuable.
âWeâre lucky to have someone we can call on who used to be a permanent employee and now works casually,â she said.
Despite the intensity, Ms Davies finds the work highly rewarding.Â
âIt definitely tests your knowledge on how to navigate certain situations,â she said. âAnd itâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.â
For pharmacists considering a move to a coastal area, Rebecca sees beachside practice as challenging but professionally enriching.
âIt offers lots of different scenarios for helping patients compared to your regular customer coming in with the same things from month to month,â she said. âAnd thereâs lots of opportunities for problem-solving.â
Help patients avoid serious sunburn by completing the AP CPD: Sun safety, donât feel the burn.
Image licensed under Creative Commons.
[post_title] => Practising pharmacy where others vacation
[post_excerpt] => Holiday crowds bring unique clinical challenges for beachside pharmacy practice, from sun exposure injuries to urgent medicine gaps.
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[post_content] => A recent systematic review published in the BMJ has reignited debate about what happens when patients stop taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related GLP-1âbased incretin therapies.
The analysis found that weight often returns quickly once treatment is discontinued â in some cases faster than with other weight-loss interventions.
And itâs not just weight that rebounds. Cardiometabolic risk markers, including blood pressure, blood glucose and blood lipids, were also found to revert towards pre-treatment levels.
As prescribing of these medicines continues to rise, the findings raise a broader question: should patients be starting these medicines in the first place?
AP spoke with experts to unpack the evidence.
Weight regain predictable, but not the real problem
Professor Clare Collins, Professor of Nutrition and Dietetics at the University of Newcastle, said the pattern of rapid weight regain following cessation was entirely unsurprising.
âThis is exactly what you would expect,â she said.
[caption id="attachment_31196" align="aligncenter" width="400"] Professor Clare Collins[/caption]
For Prof Collins, the findings reinforce a core principle of chronic disease management: when an effective treatment is withdrawn, the condition it was controlling usually returns.
âIf someone stops taking antihypertensives, what happens? Their blood pressure goes back up,â she said.Â
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.'
Prof clare collins
While weight regain attracts headlines, Prof Collins said the more clinically concerning signal is the deterioration in metabolic markers once treatment ceases.
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.â
Not a sign of treatment failure
Associate Professor Trevor Steward, Director of the Melbourne School of Psychological Sciencesâ Brain and Mental Health Hub, agrees that the rebound effect reflects how GLP-1 RA medicines work, rather than a failure of the drugs or patient behaviour.
Instead of creating permanent physiological change, GLP-1 RAs amplify hormonal signals that already exist in the body â particularly those involved in appetite regulation, digestion and satiety. The benefits seen during treatment depend on sustained exposure to these hormones.
[caption id="attachment_31197" align="aligncenter" width="400"] Associate Professor Trevor Steward[/caption]
âThat's why we see this rapid rebound effect of people experiencing weight gain when they stop using them, because thereâs no longer increased circulating levels of hormones impacting their different body systems,â A/Prof Steward said.
However, the mechanisms behind the accelerated regain are not yet fully understood.
âSome indications are that while these newer medications help people lose weight faster, they may cause a stronger slingshot effect,â he said.
Prof Collins points to emerging evidence suggesting incretin therapies cross the bloodâbrain barrier, influencing reward pathways linked to appetite and environmental cues to eat.
âFor example, if you go to the supermarket for a loaf of bread and come back with donuts too â thatâs whatâs referred to as âfood noiseâ,â she said. âSome people say this [noise] really goes down when using these therapies.â
When treatment is withdrawn, the surrounding food environment can quickly reassert itself. This is where tapering, behavioural support and nutrition strategies become critical.
âIt may be that people are more receptive to maintenance support programs as theyâre tapering or finding out what their maintenance medication dose is,â she said. âIf theyâre aware of that point, theyâll recognise when the food noise starts again.â
Nutrition: the missing variable
Prof Collins recently led a systematic review which highlighted that changes in dietary intake and nutrition remain largely invisible in incretin trials.
âOf all the phase three trials, only two actually measured and reported what people ate,â she said.
Most trials provided standardised advice but did not collect data on dietary intake, leaving clinicians to infer how appetite suppression, nausea and early satiety shaped eating patterns over time.
âThey mostly worked with people to identify dietary changes that would remove about 2,000 kilojoules a day â enough to trigger weight loss,â she said.
But reduced intake doesnât automatically equate to improved diet quality or nutrient adequacy, with micronutrient deficiencies and loss of lean mass emerging if nutrition isnât actively monitored.
With frequent patient contact, Prof Collins believes pharmacists are uniquely placed to identify emerging problems, intervene early and support appropriate referral to dietitians for medical nutrition therapy.
â[And] if pharmacy staff are trained, they can say, âHang on a minute, you need to talk to the pharmacistâ.â
The University of Newcastle also has a suite of resources pharmacists could direct patients to, including a healthy eating quiz and obesity management podcast, available here.
When visible deterioration or rapid weight loss appears, referral becomes essential. âOnce you think, âthis person is fading before our eyesâ, thatâs when you alert the GP and refer to a dietitian,â Prof Collins said.
Supporting persistence with therapy also plays a role in outcomes.
âThe main benefit isnât weight â itâs metabolic health,â she said. âHelping people manage [adverse] effects supports continuation.â
As weight loss occurs, pharmacists should also be alert to the need to review other medicines.
âIf someone is dropping weight rapidly, blood sugars and blood pressure can fall,â she said. âThere are also rare but potentially severe complications â pancreatitis, gallstones, bowel obstruction and non-arteritic anterior ischaemic optic neuropathy,â she said. âStaying well hydrated is critical â urine should look straw-coloured.â
Playing the long game
A/Prof Steward said thereâs now sufficient evidence to normalise weight regain after cessation. And given the established risks associated with long-term obesity, he suggests continued therapy may represent a lower-risk option for some patients.
âAs we know, having a very high BMI for a long period of time confers its own levels of risks in terms of cardiovascular disease and other issues,â he said. âSo [many clinicians] think it's worth staying on these [medicines] long term as opposed to the potential risk of weight [regain].â
For people with repeated cycles of weight loss and regain, A/Prof Steward said GLP-1 RAs are increasingly being understood as potentially lifelong treatments â similar to medicines used for other chronic conditions.
âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.'
A/prof trevor steward
âI recently had a conversation with someone who has lost over 50 kilograms three times in her life,â he said. âAfter a sustained period of lifestyle change, the weight still comes back. She would rather stay on these medicines for life than put her body through that cycle again.â
As use expands, A/Prof Steward emphasised the importance of clarifying intent and expectations before treatment begins.
âIt's really important to have that conversation with a pharmacist or GP about whether they want to make that commitment to potentially taking these long term,â he said.
This also creates space to explore motivations for initiating therapy.
âA lot of people are taking these medications for non-health related reasons, e.g. if they have a wedding coming up,â A/Prof Steward said.
âSo it's really worth emphasising that these medications are serious drugs that impact the entire body, and it's not something that should be frivolously taken for the purpose of losing a few kg in a month â only to just have them come back.â
While Prof Collins doesnât think the BMJ findings should deter prescribing, she said cost must be contextualised early â particularly as maintenance strategies continue to evolve. This may include lower costs associated with food and other medicines.
âIf you're improving your weight-related health, how much would medical visits have cost if your health hadnât improved?â she said. âThese medications are a long-term cost, like a car or a mobile phone. We also don't yet know whether, for some people, they may be able to have periods where they don't take it and then reinitiate at lower doses again.â
With potential PBS listings and new formulations on the horizon, A/Prof Steward said clinical messaging will need to evolve alongside the evidence.
âOver half a million Australians are now taking these medicines,â he said. âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.â
For more information, read the AP CPD article Weight loss management.
[post_title] => Are GLP-1 RAs becoming lifelong medicines?
[post_excerpt] => A recent systematic review has reignited debate about what happens when patients stop taking GLP-1 RAs and related incretin therapies.
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[post_content] => In the Barossa Valley, Travis Schiller FPS shows aged care is about teamwork, trust and better outcomes for residents.
Whatâs it like working as a pharmacist in the Barossa?
While only an hour or so from the city, the Barossa has all the advantages of a regional location.
Itâs a privilege to serve in a community with such a rich history; the people and
the community embrace you and appreciate all you can do for them. When I first moved there, I was very quickly invited to present at service clubs and assist with local health programs.
Thereâs such a diversity of opportunity and organisations in the area willing
to explore new ways to improve care for the community. I was fortunate to have the support of local residential aged care facilities (RACFs) to explore new ways of supporting their staff and residents and improving medicines-related outcomes.
How did you get your start in aged care?
I developed a passion for it through my honours project on Residential Medication Management Reviews (RMMRs) post-hospital discharge.
I was fortunate to be involved in further projects, and with the support of a local facility, began spending regular time there in 2013.
I was not only interested in the on-site function but how a supply pharmacy and RACF could work together to achieve the best outcomes for residents â where pharmacy staff became part of the team rather than external contractors.
I was also fortunate to be involved in the initial Aged Care On-Site Pharmacist (ACOP) trials, and later assisted in a mentoring program where three privately funded pharmacists worked on site in aged care before the government-funded program rolled out.
Creating a mentoring environment allowed us to combine the benefits of experience in aged care with the enthusiasm, skill and knowledge of the next generation of pharmacists.
Working with independent RACFs meant we could act as the glue that helped them support one another locally, which we facilitated through regional Medication Advisory Committees.
What are the challenges of being embedded in aged care?
The âus and themâ mentality I had seen in many sites was the biggest challenge, with rigorous incident reporting leaving supply pharmacies as easy scapegoats.
Reinforcing to facility staff that I was there to assist them, that we were one team, and that our purpose was the residentsâ benefit led to a culture shift and better outcomes. Up until the government funded the ACOP measure, funding was always an issue; and the current levels of funded remuneration will continue to be a barrier to the best and brightest taking up and staying in these roles.
What advice do you have for ECPs?
Itâs often said that pharmacy is at a crossroads. While this sentiment is generally considered negative, I think itâs a great analogy for the exciting opportunities and options available to those starting out their careers.
There are many roads to travel professionally. When itâs time for a change, take a different route â explore, find what you love and do it. If it doesnât exist as a career path, create it.
Get involved in the industry through conferences, organisations and networks â and definitely find a mentor, or a few. There are so many great people willing to share their time and knowledge, so donât be afraid to tap into it.
Where do you see the pharmacy profession evolving?
With increasing role diversity, broader scope and rapid advances in technology, itâs an exciting time to be a pharmacist.
Iâd love to see us truly recognised and valued as integral members of the broader healthcare system for all that we do.
I can only see our roles expanding as the population ages, with more specialised positions becoming the norm. Ageing at home will be the next big challenge â and we need to work out how best to support our communities through it.
A day in the life of Travis Schiller FPS, pharmacist owner, Nuriootpa, Barossa Valley, South Australia.
| 7.30 am | Prepare for the day Quick check of emails, paperwork and messages for staffing issues for the day ahead. |
| 8.30 am | Medication advisory meeting Catch up with aged care staff, GPs and the aged care on-site pharmacist. Discuss a recent issue with completing drugs of dependence recording systems and improve procedures to prevent recurrences. Talk about residents removing patches. Also discuss alternate therapies, alternate patch placement and improved surveillance. |
| 10.00 am | In the mall Visit our âThe Barossa Pharmacist In the Mallâ pharmacy, touch base with rostering coordinator, check in with staff and see if the dispensary needs anything. Check prescriptions in the dispensary and counsel patients. Administer two COVID-19 vaccinations, and consult with other patients on hay fever and skincare treatment options. |
| 12.00 pm | In the main street Visit our nearby sister site, âThe Barossa Pharmacist In the Main Streetâ, check with staff and provide lunch cover in the dispensary. Packing client arrives with a change to medicines, so organise the profile change and adjust packs. Warfarin commenced for one of our regulars. Sat with them and discussed the new medicine and their concerns. Receive a prescription for a packing client that doesnât match profile; phone the GP to clarify. |
| 2.00 pm | Aged care supply and training Assist in the pharmacy with regular daily non-packed aged care orders for the afternoon, checking medication profiles and chart changes from the GP round. Also work through a Certificate III module with a pharmacy assistant after their S2/S3s schedules training. |
| 6.00 pm | Evening meeting Attend the local Health Care Advisory Committee meeting to discuss opportunities to fund facilities for our local hospitals. |
| 7.30 pm | Home time Hopefully make it home in time to say goodnight to my three girls, then relax and review the day with my wife. |
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[post_content] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope. But evolving roles must be grounded in clinical need, organisational priorities and demonstrable impact.
At the Alfred Hospital in Melbourne, pharmacists have long practised to an expanded scope. Pharmacy roles include running disease management and anticoagulation services, writing chart corrections in partnership with medical staff and participating in emergency responses such as stroke callouts.
Behind every expanded role is a clear need, said Professor Michael Dooley MPS, Director of Pharmacy at Alfred Health and Chair of PSAâs Hospital Pharmacy Practice Community of Specialty Interest.
âWhen you start to think about offering new services or evolving roles, you need to ask why,â he told attendees at a session on the topic at PSA25 in August. If there isnât a reason beyond âIâm interestedâ, then why are you doing it?â
To expand their services, hospital pharmacy departments must also align with organisational and broader governmental priorities, Prof Dooley said.Â
âIf I want more staff or more support, I need to talk in the language of the organisation and make sure we address issues that are organisational priorities.â
This approach has enabled pharmacists at the Alfred to move beyond dispensary-based roles and embed themselves at key points along the patient journey.
Around 50â60% of pharmacists at the Alfred are allocated to a clinical unit and work as part of the medical team, Prof Dooley explained. A further 20% work in operational roles, such as in sterile suites, dispensaries and outpatients, while around 5% focus on medicines use and safety, and others are in education and training.Â
âWe donât centre all our staff in dispensaries,â Prof Dooley said. âThe opportunities for people to practise across a whole range of things are really diverse. That happened because we first identified a clinical need and then investigated whether it was within our scope of practice.
âAnything youâre considering taking forward, you need to think about it in terms of impact.â
Training pathways for hospital pharmacists
For hospital pharmacists looking to expand their scope, there are now multiple pathways available.Â
âIt used to be said that you had to do your internship at a hospital pharmacy to get in the door,â said Lauren Foley, Lead Pharmacist for Learning and Development at Alfred Health. âBut whatâs happened over the last 5â10 years is we now have these diverse entry points. Itâs about finding the pathway that works for you.â
As well as an internship, pharmacists can undertake foundation residencies, which provide generalist training over a 2-year period.
âAt the 3- to 7-year mark, you can start thinking about specialisation or a registrar training program, which develops advanced practice in a particular area or scope,â Ms Foley said. âThere are also external training and credentialing programs.â
Ms Foley highlighted the stroke credentialing program at Alfred Health as an example of expanded practice driven by patient need.
âIt was identified that patients werenât receiving thrombolysis within the 60-minute timeframe that we know preserves brain function,â she said. âSo the question became: how can we improve that outcome?â
One solution was embedding a pharmacist into those stroke teams who see patients in the emergency department. The role of pharmacists was to obtain the best possible medication history, make recommendations around the management of acute blood pressure and facilitate the early administration of thrombolysis.
âthe initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes. Thatâs how we know the role is making a difference.â
lauren foley
To prepare pharmacists, credentialing requirements include a minimum level of experience, targeted education, assessment, and an objective structured clinical examination with a neurologist and senior pharmacist.
âWe needed to equip pharmacists with the knowledge, the expertise and the confidence to go there and be part of those stroke calls,â Ms Foley said. âIt's quite a confronting scenario so you need pharmacists who can make confident and appropriate recommendations in a life-or-death situation.â
Importantly, the impact of the program has been measurable.
âThere has been research showing the initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes,â Ms Foley said. âThatâs how we know the role is making a difference.â
Beyond the bedside
The scope of practice for hospital pharmacists goes further than direct patient care. Pharmacists lead medicines safety initiatives, antimicrobial stewardship programs, and research and education programs.
âThere's also an emerging role in hospital pharmacy departments for stewardship pharmacists, who have a particular role or area of interest, and they become the go-to person for specialised advice, whether it be for anticoagulants [or] antibiotics,â Ms Foley said.
In every role, pharmacists need to work closely with colleagues from other specialties, Prof Dooley said.
âYou need multidisciplinary support. You can't do any of these things by yourself. If you're interested in developing your services, you have to do that as part of the team.â
This is one of Ms Foleyâs favourite parts of the job. âThere are opportunities to have a chat with the physio or the speech pathologist, to ask the dietitian why theyâve recommended a particular type of enteral nutrition, and to be with the doctor on the ward round. Itâs so important to learn from people who are specialists in their area.â
Join PSAâs Communities of Specialty Interest to connect, collaborate and advance your specialty practice.
[post_title] => Hospital pharmacistsâ scope is expanding
[post_excerpt] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope.
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[post_content] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families alike.
Australiaâs population is living to a greater age, which in turn has led to increased need for end-of-life care. Itâs estimated that demand for palliative care in Australia will rise by 50% between now and 2035, and double by 2050.Â
Until now, most pharmacists have had to navigate complex medication regimes and challenging family conversations â with little to no formal training during university studies.
To help bridge this gap, PSA launched the ASPIRE Palliative Care Foundation Training Program last year. The course, delivered online across eight modules, aims to equip pharmacists with essential, proactive skills â not only for patients, but for the family and carers who also require significant support.
âThe ASPIRE training reminded me that palliative care is not just the last few days of life, itâs actually the weeks, months and sometimes even years after a person has a diagnosis that means that their life is going to be shortened,â said Amy Gibson MPS, a consultant clinical pharmacist and educator who works as an on-site pharmacist in an Aspect Health aged care facility outside Brisbane.
[caption id="attachment_31171" align="aligncenter" width="500"] Amy Gibson MPS[/caption]
âPalliative care is about making plans to keep that patient as comfortable and in the best health possible for the time theyâve got left â often itâs heart failure and chronic lung disease patients.â
A holistic approach
Before completing the ASPIRE training program, Ms Gibson said she âdidnât have a lot of skills around palliative careâ.
âI knew about what we refer to as the âCore Fourâ medicines. I knew about anticipatory prescribing and making sure youâve got something on hand for pain management, agitation and so on,â she said.
âBut I hadnât really thought so much about those social aspects of having conversations with people to find out what actual issues they were having, and how as a pharmacist you could support them.â
While not designed to prepare pharmacists to specialise in palliative care, the ASPIRE training course explores a broad range of topics around end-of-life issues, from symptom management and interdisciplinary palliative care to the role of the pharmacist across everything from medicine management to bereavement and self-care.
The holistic approach of the training resonated with Ms Gibson. âThere was a lot of psychosocial education, including around what palliative care patients experience and also what thatâs like for their families,â she said. âIt reinforced cultural perspectives, particularly for [Aboriginal and Torres Strait Islander] peoples, acknowledging that different cultures deal with death and dying in diverse ways and thereâs not a one-size-fits-all approach.â
The ASPIRE training puts the carersâ perspectives in place, said Ruilin Ng MPS, a consultant pharmacist and credentialled diabetes educator based in suburban Adelaide. âA lot of the time, people are so focused on the person in care that the person around them is not given as much attention.â
The list of drugs a carer picks up can also be a vital clue for pharmacists to open a conversation. âA simple, âHow are youâ, or âHowâs it goingâ, goes a long way,â she said.Â
âOtherwise family members or carers sometimes fall through the cracks. They may not have the support of a counsellor because obviously the focus is not on them.â
The training also reminds pharmacists of their critical role in being proactive around the most fundamental parts of palliative care, Ms Gibson said.Â
âThere are cases when people have trouble even physically getting to the pharmacy, saying âWe need someone to be with Dad 24/7â for example,â she said. âThey donât have the headspace to say that [coming to the pharmacy] isnât working for them and might not even realise we can arrange delivery, so thereâs a lot of emphasis on the practical measures we can provide.â
Medicine management when itâs most critical
As most people aim to spend their final days at home or in an aged care facility rather than in a hospital, the training helps prepare pharmacists to support them, including the specifics of palliative care medicines management.
âWe can assist [prescribers] in knowing what medicines should be prescribed for comfort measures and what medicines should be ceased because they're no longer serving a purpose,â Ms Gibson said.Â
This also includes making sure the right medicines are available. âIf your loved one is in pain or quite agitated, you donât want to be told youâve got to wait 24 hours because itâs not in stock,â Ms Gibson said. âThe training encourages community pharmacies to have these key palliative [care] medicines on hand so patientsâ families donât have to run around the town trying to find supplies.â
In her aged care role, Ms Gibson works closely with registered nurses to maintain an imprest supply. âThis is emergency stock, including palliative care medicines, that they might need to use before the next delivery from the pharmacy comes,â she said.Â
âIf an after-hours GP comes at night and says, âWe need to start this patient on a morphine syringe driverâ, weâve got some ready to go â they donât have to wait until the order arrives at 3.00 pm the next afternoon. I help the nurses monitor that stock. And if weâre running low, I make sure the order goes through to our supply pharmacy in plenty of time.â
The skills Ms Gibson honed through the ASPIRE training program recently helped her treat a resident with advanced dementia who was admitted to hospital but discharged back to the aged care facility with little warning.Â
âShe was close to the end of [her] life and theyâd ceased everything but the palliative [care] medicines, anticipating she wouldnât [live] more than a couple of days,â she said.Â
âAs soon as I saw the message that she was expected back later that day, I checked that we had enough morphine and midazolam to make sure she could be administered those medicines as soon as she got back, because she was unlikely to be sent back to us with [a supply of] those medications.Â
âHer doses were escalating quickly and over the next couple of days I made sure we stayed on top of stock levels, putting orders into the pharmacy regularly to make sure we weren't going to run out overnight.â
The ASPIRE training reinforced the importance of this approach. âAt the very end of life, the situation can deteriorate quickly, with a change in condition often meaning a change in dose,â Ms Gibson said.Â
âWe donât want people to be uncomfortable and you donât want to wait a day for the order to arrive. Thereâs a real need to anticipate whatâs going to happen.â
Care after the end
When end of life arrives for the patient, itâs those left behind who need care.Â
âThe ASPIRE training puts the carerâs perspectives in place, [and] is a very good introduction to the bereavement aspectâ Ms Ng said. â[You learn] how to start the conversation, because itâs not an easy topic.â
Pharmacists have an important role in acknowledging carer grief and bereavement after the death of a loved one, and signposting to further support if required.
Keen to learn more about palliative care? Pharmacists, students and interns can enrol free of charge in the Training Plan: ASPIRE Palliative Care Foundation Training Program.
[post_title] => At the end of life, pharmacists are essential
[post_excerpt] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families.
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[post_content] => Holiday crowds bring unique clinical challenges, testing pharmacistsâ problem-solving skills from sun exposure injuries to urgent medicine gaps.
In many metropolitan areas, January is a lull period for pharmacists â as city dwellers head out of town to beat the heat and reset for the year ahead. But not so in many regional beachside areas, with pharmacies experiencing a steady uptick in visiting clientele, as Rebecca Davies, who works as a community pharmacist in Cotton Tree on Queensland's Sunshine Coast, would attest.
âWhere I'm working at the moment is right on the beach, so it's literally busy all the time,â said Ms Davies, who was formerly based in Mona Vale on Sydneyâs Northern Beaches. âI wouldn't say there's ever a quiet time, as in the winter, we still get people coming up from the southern states for holidays.â
With a caravan park stationed down the road, nearby units that are typically rented out during peak holiday periods and warm weather year-round, itâs a matter of balancing the holiday trade thatâs passing through with regular customers.
A clinical mix by the sea
Alongside routine dispensing and chronic disease management for locals, managing beach-related enquiries and conditions is a part of everyday practice.
Over-the-counter demand increases during holiday periods, with visitors seeking sunscreens, beach equipment and first-aid items, with many presentations requiring pharmacist oversight.
[caption id="attachment_31212" align="aligncenter" width="441"] Rebecca Davies[/caption]
âYou get people that arenât used to the sun that come in with sunburn,â Ms Davies said.Â
Children feature prominently, particularly those visiting from interstate or overseas â presenting with significant sunburn, dehydration or injuries sustained during outdoor play.
âThe kids that come from places that arenât used to the beaches come in with the sunburn,â she said. âThen there are the holiday kids [whoâve fallen off] bikes or skateboards.â
In one recent case, a teenage girl presented with extensive sunburn that had initially been treated in the pharmacy. Several days later, she returned with worsening symptoms.
âShe came back about 5 days later and it looked like sheâd picked up a bacterial infection from broken skin.â
At that point, Ms Davies referred the patient to a doctor, recognising that pharmacy management was no longer sufficient. âIt had just gone too far for anything that we could do for her.â
Marine-related skin reactions are another frequent presentation, particularly sea lice, which can âget caught in between the swimmers and their skinâ.
Management usually involves antihistamines, topical corticosteroids and practical advice to reduce symptoms.
âYou tell them to keep the area cool,â Ms Davies said. âAnything that makes them hotter will make it worse.â
In most cases, these conditions can be managed entirely in-store, allowing patients to avoid medical appointments during short stays.
âBut there's a lot of regular customers and we still have all the Webster-paks among other things to manage,â she said.
Managing forgotten medicines
Beyond acute injuries and skin conditions, medicine continuity for holidaymakers is one of the most complex challenges Ms Davies faces.
Tourists frequently arrive without sufficient medicine supply, having forgotten it at home or miscalculating how long they would be away.
âitâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.'
rebecca davies
âIf the customer has a regular pharmacy at home, we can contact that pharmacy,â she said. âThey can fax scripts and post the originals.â
Electronic prescriptions have made this process significantly easier.
âWith eScripts, itâs really easy to sign them up to the Active Script List and have access to all their eScripts online,â Ms Davies said.
However, not all situations are quickly resolved.
âI had one customer the other day whoâd left her medicine at home and didnât have a script,â she said.Â
The medicine was venlafaxine, which should not be stopped abruptly.
In this particular situation, the best course of action was for the patient to arrange an urgent medical consultation with their regular GP, or via an online telehealth provider if necessary.
âI encourage people to stay with their regular doctor. But there are times when those services are very useful.â
Managing medicines for visiting patients often requires Ms Davies to look beyond her own dispensary.Â
âIf we donât have the medication and itâs for someone passing through, ordering it in isnât always a possibility, because the person might move on before it comes in,â she said.Â
âSo weâll ring the other pharmacies around to see if theyâve got it and direct the patient there. Itâs just about trying to source the medication for the patient before they move on.â
Expanded scope makes a difference on holiday
Expanded scope of practice services have proven particularly valuable in a tourist-heavy setting, especially pharmacist-led treatment for uncomplicated urinary tract infections (UTIs).
âPatients with symptoms of a UTI who have come here for the weekend can come into the pharmacy quite distressed,â Ms Davies said. âThe symptoms of the infection really disrupt how they get through the day and theyâre not familiar with the area or the doctors.â
Being able to assess and treat eligible patients in the pharmacy can significantly reduce discomfort and disruption.
âIt definitely puts them at ease when we go through that, that list of when we can and can't supply,â Ms Davies said. âWe can say, âYes, we can help youâ.â
For visitors, the impact is immediate.
âTheyâre not wasting 24 to 48 hours trying to figure out where to go,â she said. âIt makes a big difference to their holiday.â
According to Ms Davies, community awareness of pharmacist UTI services has increased, with many patients now presenting specifically requesting assessment rather than symptom-only treatments.
âMore people come in already knowing that the service exists rather than asking for Ural,â she said.
Staffing for constant demand
Maintaining service quality during sustained busy periods requires careful staff management.
âSometimes the owner puts more staff on over the holiday period. Because obviously thereâs going to be an influx of tourists, thereâs a couple of extra staff we can call on,â Ms Davies said.Â
âThe business also supports private clinics, so we have access to extra staff we can call on during the day if things start to back up.â
The pharmacy relies on a mix of permanent staff, casual pharmacists, students and graduates to manage peaks. Having experienced casual staff who can be called in at short notice is particularly valuable.
âWeâre lucky to have someone we can call on who used to be a permanent employee and now works casually,â she said.
Despite the intensity, Ms Davies finds the work highly rewarding.Â
âIt definitely tests your knowledge on how to navigate certain situations,â she said. âAnd itâs quite satisfying to help someone who is on their holidays by keeping it running smoothly and taking the stress out of it.â
For pharmacists considering a move to a coastal area, Rebecca sees beachside practice as challenging but professionally enriching.
âIt offers lots of different scenarios for helping patients compared to your regular customer coming in with the same things from month to month,â she said. âAnd thereâs lots of opportunities for problem-solving.â
Help patients avoid serious sunburn by completing the AP CPD: Sun safety, donât feel the burn.
Image licensed under Creative Commons.
[post_title] => Practising pharmacy where others vacation
[post_excerpt] => Holiday crowds bring unique clinical challenges for beachside pharmacy practice, from sun exposure injuries to urgent medicine gaps.
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[post_content] => A recent systematic review published in the BMJ has reignited debate about what happens when patients stop taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related GLP-1âbased incretin therapies.
The analysis found that weight often returns quickly once treatment is discontinued â in some cases faster than with other weight-loss interventions.
And itâs not just weight that rebounds. Cardiometabolic risk markers, including blood pressure, blood glucose and blood lipids, were also found to revert towards pre-treatment levels.
As prescribing of these medicines continues to rise, the findings raise a broader question: should patients be starting these medicines in the first place?
AP spoke with experts to unpack the evidence.
Weight regain predictable, but not the real problem
Professor Clare Collins, Professor of Nutrition and Dietetics at the University of Newcastle, said the pattern of rapid weight regain following cessation was entirely unsurprising.
âThis is exactly what you would expect,â she said.
[caption id="attachment_31196" align="aligncenter" width="400"] Professor Clare Collins[/caption]
For Prof Collins, the findings reinforce a core principle of chronic disease management: when an effective treatment is withdrawn, the condition it was controlling usually returns.
âIf someone stops taking antihypertensives, what happens? Their blood pressure goes back up,â she said.Â
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.'
Prof clare collins
While weight regain attracts headlines, Prof Collins said the more clinically concerning signal is the deterioration in metabolic markers once treatment ceases.
âWhile predictable, the deterioration back to baseline is why we need to be thinking much more carefully about what is needed for long-term maintenance.â
Not a sign of treatment failure
Associate Professor Trevor Steward, Director of the Melbourne School of Psychological Sciencesâ Brain and Mental Health Hub, agrees that the rebound effect reflects how GLP-1 RA medicines work, rather than a failure of the drugs or patient behaviour.
Instead of creating permanent physiological change, GLP-1 RAs amplify hormonal signals that already exist in the body â particularly those involved in appetite regulation, digestion and satiety. The benefits seen during treatment depend on sustained exposure to these hormones.
[caption id="attachment_31197" align="aligncenter" width="400"] Associate Professor Trevor Steward[/caption]
âThat's why we see this rapid rebound effect of people experiencing weight gain when they stop using them, because thereâs no longer increased circulating levels of hormones impacting their different body systems,â A/Prof Steward said.
However, the mechanisms behind the accelerated regain are not yet fully understood.
âSome indications are that while these newer medications help people lose weight faster, they may cause a stronger slingshot effect,â he said.
Prof Collins points to emerging evidence suggesting incretin therapies cross the bloodâbrain barrier, influencing reward pathways linked to appetite and environmental cues to eat.
âFor example, if you go to the supermarket for a loaf of bread and come back with donuts too â thatâs whatâs referred to as âfood noiseâ,â she said. âSome people say this [noise] really goes down when using these therapies.â
When treatment is withdrawn, the surrounding food environment can quickly reassert itself. This is where tapering, behavioural support and nutrition strategies become critical.
âIt may be that people are more receptive to maintenance support programs as theyâre tapering or finding out what their maintenance medication dose is,â she said. âIf theyâre aware of that point, theyâll recognise when the food noise starts again.â
Nutrition: the missing variable
Prof Collins recently led a systematic review which highlighted that changes in dietary intake and nutrition remain largely invisible in incretin trials.
âOf all the phase three trials, only two actually measured and reported what people ate,â she said.
Most trials provided standardised advice but did not collect data on dietary intake, leaving clinicians to infer how appetite suppression, nausea and early satiety shaped eating patterns over time.
âThey mostly worked with people to identify dietary changes that would remove about 2,000 kilojoules a day â enough to trigger weight loss,â she said.
But reduced intake doesnât automatically equate to improved diet quality or nutrient adequacy, with micronutrient deficiencies and loss of lean mass emerging if nutrition isnât actively monitored.
With frequent patient contact, Prof Collins believes pharmacists are uniquely placed to identify emerging problems, intervene early and support appropriate referral to dietitians for medical nutrition therapy.
â[And] if pharmacy staff are trained, they can say, âHang on a minute, you need to talk to the pharmacistâ.â
The University of Newcastle also has a suite of resources pharmacists could direct patients to, including a healthy eating quiz and obesity management podcast, available here.
When visible deterioration or rapid weight loss appears, referral becomes essential. âOnce you think, âthis person is fading before our eyesâ, thatâs when you alert the GP and refer to a dietitian,â Prof Collins said.
Supporting persistence with therapy also plays a role in outcomes.
âThe main benefit isnât weight â itâs metabolic health,â she said. âHelping people manage [adverse] effects supports continuation.â
As weight loss occurs, pharmacists should also be alert to the need to review other medicines.
âIf someone is dropping weight rapidly, blood sugars and blood pressure can fall,â she said. âThere are also rare but potentially severe complications â pancreatitis, gallstones, bowel obstruction and non-arteritic anterior ischaemic optic neuropathy,â she said. âStaying well hydrated is critical â urine should look straw-coloured.â
Playing the long game
A/Prof Steward said thereâs now sufficient evidence to normalise weight regain after cessation. And given the established risks associated with long-term obesity, he suggests continued therapy may represent a lower-risk option for some patients.
âAs we know, having a very high BMI for a long period of time confers its own levels of risks in terms of cardiovascular disease and other issues,â he said. âSo [many clinicians] think it's worth staying on these [medicines] long term as opposed to the potential risk of weight [regain].â
For people with repeated cycles of weight loss and regain, A/Prof Steward said GLP-1 RAs are increasingly being understood as potentially lifelong treatments â similar to medicines used for other chronic conditions.
âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.'
A/prof trevor steward
âI recently had a conversation with someone who has lost over 50 kilograms three times in her life,â he said. âAfter a sustained period of lifestyle change, the weight still comes back. She would rather stay on these medicines for life than put her body through that cycle again.â
As use expands, A/Prof Steward emphasised the importance of clarifying intent and expectations before treatment begins.
âIt's really important to have that conversation with a pharmacist or GP about whether they want to make that commitment to potentially taking these long term,â he said.
This also creates space to explore motivations for initiating therapy.
âA lot of people are taking these medications for non-health related reasons, e.g. if they have a wedding coming up,â A/Prof Steward said.
âSo it's really worth emphasising that these medications are serious drugs that impact the entire body, and it's not something that should be frivolously taken for the purpose of losing a few kg in a month â only to just have them come back.â
While Prof Collins doesnât think the BMJ findings should deter prescribing, she said cost must be contextualised early â particularly as maintenance strategies continue to evolve. This may include lower costs associated with food and other medicines.
âIf you're improving your weight-related health, how much would medical visits have cost if your health hadnât improved?â she said. âThese medications are a long-term cost, like a car or a mobile phone. We also don't yet know whether, for some people, they may be able to have periods where they don't take it and then reinitiate at lower doses again.â
With potential PBS listings and new formulations on the horizon, A/Prof Steward said clinical messaging will need to evolve alongside the evidence.
âOver half a million Australians are now taking these medicines,â he said. âClinicians want clearer evidence around tapering and maintenance â and right now, theyâre operating in the dark.â
For more information, read the AP CPD article Weight loss management.
[post_title] => Are GLP-1 RAs becoming lifelong medicines?
[post_excerpt] => A recent systematic review has reignited debate about what happens when patients stop taking GLP-1 RAs and related incretin therapies.
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[post_content] => In the Barossa Valley, Travis Schiller FPS shows aged care is about teamwork, trust and better outcomes for residents.
Whatâs it like working as a pharmacist in the Barossa?
While only an hour or so from the city, the Barossa has all the advantages of a regional location.
Itâs a privilege to serve in a community with such a rich history; the people and
the community embrace you and appreciate all you can do for them. When I first moved there, I was very quickly invited to present at service clubs and assist with local health programs.
Thereâs such a diversity of opportunity and organisations in the area willing
to explore new ways to improve care for the community. I was fortunate to have the support of local residential aged care facilities (RACFs) to explore new ways of supporting their staff and residents and improving medicines-related outcomes.
How did you get your start in aged care?
I developed a passion for it through my honours project on Residential Medication Management Reviews (RMMRs) post-hospital discharge.
I was fortunate to be involved in further projects, and with the support of a local facility, began spending regular time there in 2013.
I was not only interested in the on-site function but how a supply pharmacy and RACF could work together to achieve the best outcomes for residents â where pharmacy staff became part of the team rather than external contractors.
I was also fortunate to be involved in the initial Aged Care On-Site Pharmacist (ACOP) trials, and later assisted in a mentoring program where three privately funded pharmacists worked on site in aged care before the government-funded program rolled out.
Creating a mentoring environment allowed us to combine the benefits of experience in aged care with the enthusiasm, skill and knowledge of the next generation of pharmacists.
Working with independent RACFs meant we could act as the glue that helped them support one another locally, which we facilitated through regional Medication Advisory Committees.
What are the challenges of being embedded in aged care?
The âus and themâ mentality I had seen in many sites was the biggest challenge, with rigorous incident reporting leaving supply pharmacies as easy scapegoats.
Reinforcing to facility staff that I was there to assist them, that we were one team, and that our purpose was the residentsâ benefit led to a culture shift and better outcomes. Up until the government funded the ACOP measure, funding was always an issue; and the current levels of funded remuneration will continue to be a barrier to the best and brightest taking up and staying in these roles.
What advice do you have for ECPs?
Itâs often said that pharmacy is at a crossroads. While this sentiment is generally considered negative, I think itâs a great analogy for the exciting opportunities and options available to those starting out their careers.
There are many roads to travel professionally. When itâs time for a change, take a different route â explore, find what you love and do it. If it doesnât exist as a career path, create it.
Get involved in the industry through conferences, organisations and networks â and definitely find a mentor, or a few. There are so many great people willing to share their time and knowledge, so donât be afraid to tap into it.
Where do you see the pharmacy profession evolving?
With increasing role diversity, broader scope and rapid advances in technology, itâs an exciting time to be a pharmacist.
Iâd love to see us truly recognised and valued as integral members of the broader healthcare system for all that we do.
I can only see our roles expanding as the population ages, with more specialised positions becoming the norm. Ageing at home will be the next big challenge â and we need to work out how best to support our communities through it.
A day in the life of Travis Schiller FPS, pharmacist owner, Nuriootpa, Barossa Valley, South Australia.
| 7.30 am | Prepare for the day Quick check of emails, paperwork and messages for staffing issues for the day ahead. |
| 8.30 am | Medication advisory meeting Catch up with aged care staff, GPs and the aged care on-site pharmacist. Discuss a recent issue with completing drugs of dependence recording systems and improve procedures to prevent recurrences. Talk about residents removing patches. Also discuss alternate therapies, alternate patch placement and improved surveillance. |
| 10.00 am | In the mall Visit our âThe Barossa Pharmacist In the Mallâ pharmacy, touch base with rostering coordinator, check in with staff and see if the dispensary needs anything. Check prescriptions in the dispensary and counsel patients. Administer two COVID-19 vaccinations, and consult with other patients on hay fever and skincare treatment options. |
| 12.00 pm | In the main street Visit our nearby sister site, âThe Barossa Pharmacist In the Main Streetâ, check with staff and provide lunch cover in the dispensary. Packing client arrives with a change to medicines, so organise the profile change and adjust packs. Warfarin commenced for one of our regulars. Sat with them and discussed the new medicine and their concerns. Receive a prescription for a packing client that doesnât match profile; phone the GP to clarify. |
| 2.00 pm | Aged care supply and training Assist in the pharmacy with regular daily non-packed aged care orders for the afternoon, checking medication profiles and chart changes from the GP round. Also work through a Certificate III module with a pharmacy assistant after their S2/S3s schedules training. |
| 6.00 pm | Evening meeting Attend the local Health Care Advisory Committee meeting to discuss opportunities to fund facilities for our local hospitals. |
| 7.30 pm | Home time Hopefully make it home in time to say goodnight to my three girls, then relax and review the day with my wife. |
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[post_content] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope. But evolving roles must be grounded in clinical need, organisational priorities and demonstrable impact.
At the Alfred Hospital in Melbourne, pharmacists have long practised to an expanded scope. Pharmacy roles include running disease management and anticoagulation services, writing chart corrections in partnership with medical staff and participating in emergency responses such as stroke callouts.
Behind every expanded role is a clear need, said Professor Michael Dooley MPS, Director of Pharmacy at Alfred Health and Chair of PSAâs Hospital Pharmacy Practice Community of Specialty Interest.
âWhen you start to think about offering new services or evolving roles, you need to ask why,â he told attendees at a session on the topic at PSA25 in August. If there isnât a reason beyond âIâm interestedâ, then why are you doing it?â
To expand their services, hospital pharmacy departments must also align with organisational and broader governmental priorities, Prof Dooley said.Â
âIf I want more staff or more support, I need to talk in the language of the organisation and make sure we address issues that are organisational priorities.â
This approach has enabled pharmacists at the Alfred to move beyond dispensary-based roles and embed themselves at key points along the patient journey.
Around 50â60% of pharmacists at the Alfred are allocated to a clinical unit and work as part of the medical team, Prof Dooley explained. A further 20% work in operational roles, such as in sterile suites, dispensaries and outpatients, while around 5% focus on medicines use and safety, and others are in education and training.Â
âWe donât centre all our staff in dispensaries,â Prof Dooley said. âThe opportunities for people to practise across a whole range of things are really diverse. That happened because we first identified a clinical need and then investigated whether it was within our scope of practice.
âAnything youâre considering taking forward, you need to think about it in terms of impact.â
Training pathways for hospital pharmacists
For hospital pharmacists looking to expand their scope, there are now multiple pathways available.Â
âIt used to be said that you had to do your internship at a hospital pharmacy to get in the door,â said Lauren Foley, Lead Pharmacist for Learning and Development at Alfred Health. âBut whatâs happened over the last 5â10 years is we now have these diverse entry points. Itâs about finding the pathway that works for you.â
As well as an internship, pharmacists can undertake foundation residencies, which provide generalist training over a 2-year period.
âAt the 3- to 7-year mark, you can start thinking about specialisation or a registrar training program, which develops advanced practice in a particular area or scope,â Ms Foley said. âThere are also external training and credentialing programs.â
Ms Foley highlighted the stroke credentialing program at Alfred Health as an example of expanded practice driven by patient need.
âIt was identified that patients werenât receiving thrombolysis within the 60-minute timeframe that we know preserves brain function,â she said. âSo the question became: how can we improve that outcome?â
One solution was embedding a pharmacist into those stroke teams who see patients in the emergency department. The role of pharmacists was to obtain the best possible medication history, make recommendations around the management of acute blood pressure and facilitate the early administration of thrombolysis.
âthe initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes. Thatâs how we know the role is making a difference.â
lauren foley
To prepare pharmacists, credentialing requirements include a minimum level of experience, targeted education, assessment, and an objective structured clinical examination with a neurologist and senior pharmacist.
âWe needed to equip pharmacists with the knowledge, the expertise and the confidence to go there and be part of those stroke calls,â Ms Foley said. âIt's quite a confronting scenario so you need pharmacists who can make confident and appropriate recommendations in a life-or-death situation.â
Importantly, the impact of the program has been measurable.
âThere has been research showing the initiative led to an improvement in the number of patients who received thrombolysis within 60 minutes,â Ms Foley said. âThatâs how we know the role is making a difference.â
Beyond the bedside
The scope of practice for hospital pharmacists goes further than direct patient care. Pharmacists lead medicines safety initiatives, antimicrobial stewardship programs, and research and education programs.
âThere's also an emerging role in hospital pharmacy departments for stewardship pharmacists, who have a particular role or area of interest, and they become the go-to person for specialised advice, whether it be for anticoagulants [or] antibiotics,â Ms Foley said.
In every role, pharmacists need to work closely with colleagues from other specialties, Prof Dooley said.
âYou need multidisciplinary support. You can't do any of these things by yourself. If you're interested in developing your services, you have to do that as part of the team.â
This is one of Ms Foleyâs favourite parts of the job. âThere are opportunities to have a chat with the physio or the speech pathologist, to ask the dietitian why theyâve recommended a particular type of enteral nutrition, and to be with the doctor on the ward round. Itâs so important to learn from people who are specialists in their area.â
Join PSAâs Communities of Specialty Interest to connect, collaborate and advance your specialty practice.
[post_title] => Hospital pharmacistsâ scope is expanding
[post_excerpt] => From roles in governance, research and education, hospital pharmacists are practicing to an increasingly advanced scope.
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[post_content] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families alike.
Australiaâs population is living to a greater age, which in turn has led to increased need for end-of-life care. Itâs estimated that demand for palliative care in Australia will rise by 50% between now and 2035, and double by 2050.Â
Until now, most pharmacists have had to navigate complex medication regimes and challenging family conversations â with little to no formal training during university studies.
To help bridge this gap, PSA launched the ASPIRE Palliative Care Foundation Training Program last year. The course, delivered online across eight modules, aims to equip pharmacists with essential, proactive skills â not only for patients, but for the family and carers who also require significant support.
âThe ASPIRE training reminded me that palliative care is not just the last few days of life, itâs actually the weeks, months and sometimes even years after a person has a diagnosis that means that their life is going to be shortened,â said Amy Gibson MPS, a consultant clinical pharmacist and educator who works as an on-site pharmacist in an Aspect Health aged care facility outside Brisbane.
[caption id="attachment_31171" align="aligncenter" width="500"] Amy Gibson MPS[/caption]
âPalliative care is about making plans to keep that patient as comfortable and in the best health possible for the time theyâve got left â often itâs heart failure and chronic lung disease patients.â
A holistic approach
Before completing the ASPIRE training program, Ms Gibson said she âdidnât have a lot of skills around palliative careâ.
âI knew about what we refer to as the âCore Fourâ medicines. I knew about anticipatory prescribing and making sure youâve got something on hand for pain management, agitation and so on,â she said.
âBut I hadnât really thought so much about those social aspects of having conversations with people to find out what actual issues they were having, and how as a pharmacist you could support them.â
While not designed to prepare pharmacists to specialise in palliative care, the ASPIRE training course explores a broad range of topics around end-of-life issues, from symptom management and interdisciplinary palliative care to the role of the pharmacist across everything from medicine management to bereavement and self-care.
The holistic approach of the training resonated with Ms Gibson. âThere was a lot of psychosocial education, including around what palliative care patients experience and also what thatâs like for their families,â she said. âIt reinforced cultural perspectives, particularly for [Aboriginal and Torres Strait Islander] peoples, acknowledging that different cultures deal with death and dying in diverse ways and thereâs not a one-size-fits-all approach.â
The ASPIRE training puts the carersâ perspectives in place, said Ruilin Ng MPS, a consultant pharmacist and credentialled diabetes educator based in suburban Adelaide. âA lot of the time, people are so focused on the person in care that the person around them is not given as much attention.â
The list of drugs a carer picks up can also be a vital clue for pharmacists to open a conversation. âA simple, âHow are youâ, or âHowâs it goingâ, goes a long way,â she said.Â
âOtherwise family members or carers sometimes fall through the cracks. They may not have the support of a counsellor because obviously the focus is not on them.â
The training also reminds pharmacists of their critical role in being proactive around the most fundamental parts of palliative care, Ms Gibson said.Â
âThere are cases when people have trouble even physically getting to the pharmacy, saying âWe need someone to be with Dad 24/7â for example,â she said. âThey donât have the headspace to say that [coming to the pharmacy] isnât working for them and might not even realise we can arrange delivery, so thereâs a lot of emphasis on the practical measures we can provide.â
Medicine management when itâs most critical
As most people aim to spend their final days at home or in an aged care facility rather than in a hospital, the training helps prepare pharmacists to support them, including the specifics of palliative care medicines management.
âWe can assist [prescribers] in knowing what medicines should be prescribed for comfort measures and what medicines should be ceased because they're no longer serving a purpose,â Ms Gibson said.Â
This also includes making sure the right medicines are available. âIf your loved one is in pain or quite agitated, you donât want to be told youâve got to wait 24 hours because itâs not in stock,â Ms Gibson said. âThe training encourages community pharmacies to have these key palliative [care] medicines on hand so patientsâ families donât have to run around the town trying to find supplies.â
In her aged care role, Ms Gibson works closely with registered nurses to maintain an imprest supply. âThis is emergency stock, including palliative care medicines, that they might need to use before the next delivery from the pharmacy comes,â she said.Â
âIf an after-hours GP comes at night and says, âWe need to start this patient on a morphine syringe driverâ, weâve got some ready to go â they donât have to wait until the order arrives at 3.00 pm the next afternoon. I help the nurses monitor that stock. And if weâre running low, I make sure the order goes through to our supply pharmacy in plenty of time.â
The skills Ms Gibson honed through the ASPIRE training program recently helped her treat a resident with advanced dementia who was admitted to hospital but discharged back to the aged care facility with little warning.Â
âShe was close to the end of [her] life and theyâd ceased everything but the palliative [care] medicines, anticipating she wouldnât [live] more than a couple of days,â she said.Â
âAs soon as I saw the message that she was expected back later that day, I checked that we had enough morphine and midazolam to make sure she could be administered those medicines as soon as she got back, because she was unlikely to be sent back to us with [a supply of] those medications.Â
âHer doses were escalating quickly and over the next couple of days I made sure we stayed on top of stock levels, putting orders into the pharmacy regularly to make sure we weren't going to run out overnight.â
The ASPIRE training reinforced the importance of this approach. âAt the very end of life, the situation can deteriorate quickly, with a change in condition often meaning a change in dose,â Ms Gibson said.Â
âWe donât want people to be uncomfortable and you donât want to wait a day for the order to arrive. Thereâs a real need to anticipate whatâs going to happen.â
Care after the end
When end of life arrives for the patient, itâs those left behind who need care.Â
âThe ASPIRE training puts the carerâs perspectives in place, [and] is a very good introduction to the bereavement aspectâ Ms Ng said. â[You learn] how to start the conversation, because itâs not an easy topic.â
Pharmacists have an important role in acknowledging carer grief and bereavement after the death of a loved one, and signposting to further support if required.
Keen to learn more about palliative care? Pharmacists, students and interns can enrol free of charge in the Training Plan: ASPIRE Palliative Care Foundation Training Program.
[post_title] => At the end of life, pharmacists are essential
[post_excerpt] => PSAâs ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care â to patients and families.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
