Dr Sarah McMillan, Dr Amanda Wheeler & Dr Claire O'Reilly
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
[post_title] => Why are so many adults diagnosed with ADHD these days?
[post_excerpt] => An expert weighs in on the legitimacy of ADHD diagnoses and where pharmacists fit into the equation.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"]
Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
[post_excerpt] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"]
PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"]
PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"]
PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"]
PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"]
Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
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[post_excerpt] => An expert weighs in on the legitimacy of ADHD diagnoses and where pharmacists fit into the equation.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
[post_title] => Why are so many adults diagnosed with ADHD these days?
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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