td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10656 [post_author] => 235 [post_date] => 2020-07-01 14:58:45 [post_date_gmt] => 2020-07-01 04:58:45 [post_content] => Nearly all Australian pharmacies are now registered for the My Health Record, following an increase in the use of technology brought about by the COVID-19 pandemic.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10649 [post_author] => 1703 [post_date] => 2020-07-01 14:34:59 [post_date_gmt] => 2020-07-01 04:34:59 [post_content] => While the rest of Australia maintains low rates of COVID-19 infection, 36 suburbs in Victoria will enter lockdown from midnight tonight as case numbers continue to rise.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10640 [post_author] => 23 [post_date] => 2020-07-01 14:09:42 [post_date_gmt] => 2020-07-01 04:09:42 [post_content] => Queensland women now have access to immediate advice and treatment, including the supply of antibiotics when appropriate, for uncomplicated urinary tract infections (UTIs) through their participating community pharmacy.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10569 [post_author] => 227 [post_date] => 2020-06-24 14:19:29 [post_date_gmt] => 2020-06-24 04:19:29 [post_content] =>
In line with Therapeutic Goods Administration (TGA) regulatory changes to enhance medicine safety, PSA has developed a cautionary advisory label (CAL) that warns consumers about the risk of opioid overdose and dependence.
The CAL (Label 24, at right) can be applied to opioid medicines at the time of dispensing as an aid to counselling patients about the safe and effective use of opioids. An Opioid medicines patient information handout has been developed as a counselling aid.
The CAL is recommended for opioid medicines, including buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, tapentadol, and tramadol.
Pharmacists are advised to provide the Opioid medicines patient information handout to any patient receiving opioid medicine that carries Label 24.
Two rolls of Label 24, a copy of the patient handout and a letter to pharmacists were posted this month to all community and hospital pharmacies.PSA General Manager Knowledge Development Stefanie Johnston MPS said the CAL could help pharmacists speak to their patients about medicine safety. ‘Label 24 provides a new opportunity to have open conversations with your patients about the safe use of opioids,’ she said. ‘I encourage all pharmacists to incorporate it into their practice.’
CPD material about Label 24, the patient handout, TGA opioid regulatory reforms and safe and effective use of opioids has been developed by both PSA and the Society of Hospital Pharmacists of Australia and is expected to be available from next month.
Emeritus Professor Lloyd Sansom AO FPS, chair of the Australian Pharmaceutical Formulary and Handbook (APF) editorial board, chaired the stakeholder roundtable meeting that led to the development of the CAL and patient handout.[caption id="attachment_9769" align="alignright" width="356"] Lloyd Sansom FPS[/caption]
As chair of the editorial board as well as the APF’s New Drugs Advisory Group (NDAG), Professor Sansom has approved publication of both documents in the APF.
The CAL and patient handout were reviewed by the 10 pharmacist members of the APF NDAG as well as the Professor of Medicines Use Optimisation at the University of Sydney School of Pharmacy Parisa Aslani FPS.
Professor Aslani has expertise in patient counselling and education, including consumer medicines information (CMI).
The new TGA regulations require opioid sponsors to update prescribing indications for opioids to ensure patients are prescribed opioids only where the benefits outweigh the risks.
They also require sponsors to add additional warning statements to Product Information and CMI for all opioids. This is so prescribers and consumers are reminded of the appropriate circumstances for opioid prescribing and potential adverse effects.
Sponsors must also now register smaller pack sizes for immediate-release opioids that provide a more appropriate option for short-term pain relief.
Exisiting larger pack sizes will remain available for patients who need them.
For more information, visit www.tga.gov.au/alert/prescription-opioids.[post_title] => New Label 24 to help pharmacists reduce opioid risks [post_excerpt] => In line with TGA regulatory changes to enhance medicine safety, PSA has developed a cautionary advisory label that warns consumers about the risk of opioid overdose and dependence. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-opioid-cautionary-advisory-label-available [to_ping] => [pinged] => https://www.australianpharmacist.com.au/pbs-changes-prescription-opioids/ [post_modified] => 2020-06-25 15:08:50 [post_modified_gmt] => 2020-06-25 05:08:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10569 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New Label 24 to help pharmacists reduce opioid risks [title] => New Label 24 to help pharmacists reduce opioid risks [href] => https://www.australianpharmacist.com.au/new-opioid-cautionary-advisory-label-available/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10580 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10574 [post_author] => 1703 [post_date] => 2020-06-24 14:01:44 [post_date_gmt] => 2020-06-24 04:01:44 [post_content] => A cheap and widely used corticosteroid may be employed in Australia in the treatment of seriously ill COVID-19 patients. Following preliminary results of a UK trial conducted by researchers at the University of Oxford and released by the World Health Organisation last week, Federal Health Minister Greg Hunt said there were ‘no barriers’ to the use of dexamethasone for COVID-19 treatment. ‘It’s not going to prevent you getting it, it’s not going to cure it, but the early, but [sic] high-quality evidence out of the UK is that [for] people who are very, very sick, it gives them a much better chance of survival,’ he told a Sydney radio station. Commenced in March, the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is one of the world’s largest randomised, controlled trials for coronavirus treatments. Dexamethasone was found to reduce deaths in patients with COVID-19 by a third in ventilated patients and a fifth in other patients receiving oxygen. No benefit was reported among patients who did not require respiratory support. There are currently just three people in Australian intensive care units due to COVID-19, all of them in Victoria, which is currently experiencing an increase in the number of new cases.
A need for cautionPeer review of clinical data is still required prior to any recommendations being made by the National COVD-19 Clinical Evidence Taskforce about the use of dexamethasone. However, in a statement, the taskforce acknowledged that the preliminary results were promising and said it was hopeful the benefits would be confirmed in a peer-reviewed publication in the very near future. ‘At this time, the living evidence approach employed by the taskforce will enable us to respond rapidly to provide evidence-based recommendations about the use of dexamethasone in COVID-19,’ the statement said. Program Director of Undergraduate Pharmacy at the University of Sydney Associate Professor Nial Wheate told Australian Pharmacist that the medical community was aware of criticism that could surround publishing drug study results too early. Substantial concerns were raised by the global research community regarding the integrity of data published in The Lancet last month about the potential benefits of hydroxychloroquine in relation to COVID-19. A/Prof Wheate added that while exercising initial caution, it was also necessary to consider the side effects of dexamethasone and to ensure members of the public were aware it helped mitigate one of the symptoms of COVID-19 infection – lung inflammation – rather than treat the virus itself. ‘One of the potential risks is that it could make patients more susceptible to other diseases in a hospital setting because it is a steroidal medication that suppresses immunity,’ he said.
Managing demandThe initial outbreak of COVID-19 in Australia resulted in a high demand for drugs that had been publicised in the media or discovered on the internet. The Therapeutic Goods Administration (TGA) is eager to avoid a similar situation involving dexamethasone. It said there is currently no national shortage of dexamethasone injection or tablets and that demand for the medicines is being monitored. The TGA also cautioned that the RECOVERY trial reportedly showed benefit only for ventilated or oxygenated COVID-19 patients in hospital, not for mild cases or prophylactic use. Researchers involved in the RECOVERY trial are also looking at drugs including lopinavir–ritonavir, azithromycin and tocilizumab as possible treatments for patients admitted to hospital with COVID-19. [post_title] => Dexamethasone and COVID-19 [post_excerpt] => A cheap and widely used corticosteroid may be employed by Australian doctors in the treatment of seriously ill COVID-19 patients. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => dexamethasone-covid-19 [to_ping] => [pinged] => https://www.australianpharmacist.com.au/who-temporary-pause-hydroxychloroquine-trial-coronavirus/ [post_modified] => 2020-06-29 20:47:56 [post_modified_gmt] => 2020-06-29 10:47:56 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10574 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Dexamethasone and COVID-19 [title] => Dexamethasone and COVID-19 [href] => https://www.australianpharmacist.com.au/dexamethasone-covid-19/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10576 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10538 [post_author] => 1092 [post_date] => 2020-06-22 08:30:16 [post_date_gmt] => 2020-06-21 22:30:16 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]When Paul Karason died of a heart attack in 2013, age 62, few noticed. But he had achieved global infamy in 2008 when he appeared on the US morning TV show Today.
The uglyWhy? Mr Karason was blue, literally blue. Persuaded of the healing powers of colloidal silver – minute silver particles suspended in a liquid – Mr Karason concocted and consumed his own brew of water and silver nanoparticles. After several years, he developed an irreversible condition called argyria, a blue-grey discolouration of the skin.1,2 Because of his daily dosing, the silver particles accumulated, ionised in his stomach and were transported to the skin. There they reacted with sunlight, causing the blue discolouration.2 Mr Karason was not alone in his misbelief. Celebrities such as Gwyneth Paltrow espoused alleged health benefits from ingesting colloidal silver. The supposed benefits range from boosting the immune system to treating cancer, HIV/AIDS, shingles, herpes, eye ailments and prostatitis.1,3 However, no rigorous studies supporting these claims exist.3
The badWorse, as Mayo Clinic physician and researcher Dr Brent Bauer notes: ‘Excessive doses of colloidal silver can cause possibly irreversible serious health problems, including kidney damage and neurological problems such as seizures’. Heavy ingestion can also cause bone marrow suppression, hepatotoxicity and acute tubular necrosis. Colloidal silver products also interact with some medicines.2,3 Little wonder, then, that in 1999 the US Food and Drug Administration ruled that products containing colloidal silver ingredients or silver salts were neither safe nor effective.4 Similarly, in 2002 the Therapeutic Goods Administration (TGA) concluded: ‘There are no colloidal silver products approved for supply as medicines in Australia.’5 Both the TGA and the US Health Department’s National Center for Complementary and Integrative Health note that while unsupported by evidence, products marketed as ‘dietary supplements’ are available online.4-6
The goodSilver was once widely used. In AD 78, Pliny the Elder reported that slag from smelting silver ‘has healing properties as an ingredient in plasters’. According to Herodotus, Cyrus the Great – king of Persia from 550 BC to 529 BC – stayed healthy by drinking only boiled water stored in silver flagons. During the Middle Ages, monks popularised the use of silver nitrate, a salt formed by reacting silver with nitric acid, to treat ulcers and burns.1,7 As early advocates observed, silver does have antiseptic properties. Until the advent of antibiotics, it was used topically with variable success.8 The exact mechanism by which silver attacks bacterial cells is unclear. Scientists suggest the key is the biocidal effect of heavy metals such as silver. They kill microbes by binding to proteins, thus inhibiting enzymatic activity.9 Today, the biocidal effect is being harnessed anew. Although thorough testing and standardisation of products has not yet been undertaken, silver-containing coatings on medical devices and fabrics can have clinical uses.9 Among these uses are: wound care, bone prostheses, reconstructive orthopaedic surgery, cardiac devices, catheters, surgical appliances and, of relevance to COVID-19, ventilators.10 References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => The good, the bad and the ugly: Colloidal silver and its chequered history [post_excerpt] => Celebrities such as Gwyneth Paltrow espoused alleged health benefits from ingesting colloidal silver. However, no rigorous studies supporting these claims exist. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => colloidal-silver-chequered-history [to_ping] => [pinged] => [post_modified] => 2020-06-29 21:51:35 [post_modified_gmt] => 2020-06-29 11:51:35 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10538 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The good, the bad and the ugly: Colloidal silver and its chequered history [title] => The good, the bad and the ugly: Colloidal silver and its chequered history [href] => https://www.australianpharmacist.com.au/colloidal-silver-chequered-history/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10539 )
- Pickett, M. Colloidal silver turns you blue—but can it save your life? Wired 2017 Feb 10. At: www.wired.com/story/does-colloidal-silver-work/
- Bracy NA, Zipursky JK, Juurlink DN. Argyria caused by chronic ingestion of silver. CMAJ 2018;190(5):E139. At: www.cmaj.ca/content/190/5/E139.long
- Bauer BA. My dad takes colloidal silver for his health, but is it safe? Mayo Clinic. 2017. At: www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/colloidal-silver/faq-20058061
- US Food and Drug Administration. Over-the-counter drug products containing colloidal silver ingredients or silver salts. Fed Regist 1999;64(158):44653–8. At: www.ncbi.nlm.nih.gov/pubmed/10558603
- Therapeutic Goods Administration. Change to excluded goods order: Colloidal silver products. 19 December 2002. At: www.tga.gov.au/sites/default/files/foi-156-1213-25.pdf
- National Institutes of Health. National Center for Complementary and Integrative Health. Colloidal silver. At: www.nccih.nih.gov/health/colloidal-silver
- Alexander JW. History of the medical use of silver. Surg Infect 2009;10(3):289–92. At: www.liebertpub.com/doi/10.1089/sur.2008.9941
- Chopra I. The increasing use of silver-based products as antimicrobial agents: a useful development or a cause for concern? J Antimicrob Chemother 2007;59(4):587–90. At: pubmed.ncbi.nlm.nih.gov/17307768/
- Lumen Learning. Using Chemicals to Control Microorganisms. At: courses.lumenlearning.com/microbiology/chapter/using-chemicals-to-control-microorganisms/
- Lansdown A. Silver in health care: antimicrobial effect and safety in use. In: Biofunctional textiles and the skin. Hipler UC, Elsner P (eds). Curr Probl Dermatol Basel, Karger 2006;33:17–34. At: www.karger.com/Article/Abstract/93928
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10519 [post_author] => 36 [post_date] => 2020-06-22 06:57:48 [post_date_gmt] => 2020-06-21 20:57:48 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]There are 344 registered interventional clinical trials under way for the treatment and prevention of COVID-19. The WHO is looking at four of them. At the time of press on 22 May, there are more than 5.2 million confirmed cases of novel coronavirus disease 2019 (COVID-19) around the world.1 COVID-19 is caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2).2 Approximately 80% of infections with clinical presentations will cause mild respiratory illness and people will recover without hospital care.3 Another 15% will present with moderate to severe pneumonia requiring hospital care, and 5% will need intensive care due to critical illness.3 At this stage, it is not known how many people are asymptomatic and infected. Additionally, it is unclear if succumbing to COVID-19 is a result of the virus itself or the innate immune response.4 Given the global emergency and the speed at which the virus has spread, drug repurposing has obvious advantages, particularly given the amount of time usually required to take a molecule from drug discovery to regulatory approval. Some of these agents have received more media interest than others, e.g. hydroxychloroquine (Plaquenil), following social media tweets by people such as US President Donald Trump. This led to excessive attempts to acquire the medicine, resulting in the introduction of restrictions to ensure supply only to those with a therapeutic need (e.g. rheumatoid arthritis, lupus). While numerous therapies are being tested all around the world, there are no pharmacological agents approved for either the treatment or prevention of COVID-19. In Australia, the consensus guidelines state: ‘For patients with COVID-19, only administer antiviral medications or other disease-modifying treatments in the context of clinical trials with appropriate ethical approval.’2 A recent review looked at the registered interventional clinical trials for the treatment and prevention of COVID-19.5 As of 20 March 2020, 344 studies were registered, of which 100 involved the use of traditional Chinese medicine, e.g. herbal medicines and acupuncture. The remainder include5:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10477 [post_author] => 23 [post_date] => 2020-06-17 11:13:30 [post_date_gmt] => 2020-06-17 01:13:30 [post_content] => The offspring of mothers exposed to extreme stress, undernutrition or infectious diseases during pregnancy are at heightened risk of psychosis, studies suggest.1
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10393 [post_author] => 23 [post_date] => 2020-06-03 15:47:17 [post_date_gmt] => 2020-06-03 05:47:17 [post_content] => Changes to regulations on opioid supply in Australia came into effect this week, with new Pharmaceutical Benefits Scheme listings resulting in smaller quantities and restrictions around opioid prescribing for pain treatment.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10344 [post_author] => 23 [post_date] => 2020-05-27 12:18:46 [post_date_gmt] => 2020-05-27 02:18:46 [post_content] => For people with food allergies, medicines meant to benefit health can in fact present a risk due to food products used as inactive (excipient) ingredients.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10595 [post_author] => 140 [post_date] => 2020-06-29 21:33:38 [post_date_gmt] => 2020-06-29 11:33:38 [post_content] =>
Case scenarioLachlan, a 28-year old man with type 1 diabetes, presents to the pharmacy to speak with a pharmacist. He has a headache, sore throat, dry cough, fever (39.5 °C) and muscle pain. The symptoms started 20 hours ago. Lachlan was anticipating getting the flu vaccine. However, he said he had not got around to it yet. As a young father, Lachlan is particularly concerned about spreading the viral infection to his family. He asks if it is too late to have the influenza vaccine.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Influenza or ‘the flu’ is generally a self-limiting acute viral illness. However, it can also be severe and fatal. In 2019, there were 308,847 laboratory confirmed cases of influenza in Australia.1 Many more cases went unconfirmed. A total of 3,915 individuals were hospitalised and 812 died from influenza.1 The World Health Organization (WHO) estimates globally, that annual epidemics of influenza cause approximately 1 billion infections, 3–5 million severe infections and between 290,000 and 650,000 deaths.2 Prevention and control of suspected and diagnosed influenza are key to reducing its disease burden.
Influenza is an acute, highly contagious, viral infection of the upper (and sometimes lower) respiratory tract that affects individuals of all ages and backgrounds. It is primarily spread by large respiratory droplets (>5 microns) and aerosols, produced when an infected individual coughs, sneezes or talks, that are subsequently inhaled by others. It can also be spread by self-contamination through hand-to-nose, hand-to-eye, hand-to-mouth transmission after touching virus-laden fomites (door handles, toys) or the skin or hands of another person.
It has an average incubation period of between 0.5 and 2 days. Signs and symptoms present abruptly and may include fever (≥37.8 °C)/chills, sore throat, non-productive cough, malaise, headache, myalgia, arthralgia and loss of appetite.3 Some individuals will experience nasal rhinitis and sneezing. Most individuals have symptom resolution within 3–7 days of onset, although a dry cough and/or general malaise may continue for up to 2 weeks.
There are many overlapping symptoms between the common cold, influenza and COVID-19. Table 1 (previous page) outlines the similarities and differences between the three.
Complications of influenza include primary viral and secondary bacterial pneumonia, bacterial coinfection, myocarditis, myelitis, pericarditis, croup, bronchitis, myositis, sinus infection, otitis media, encephalopathy, encephalitis, Reye’s syndrome and death.4 Influenza can also exacerbate existing chronic disease (e.g. asthma, COPD, diabetes, congestive heart failure). Complications of influenza are more frequently seen in individuals who are immunosuppressed, have a chronic disease, residents of aged care facilities, Indigenous, elderly, very young, pregnant, or morbidly obese.5 See Table 2.
Influenza viruses are single stranded RNA-containing viruses that belong to the family Orthomyxoviridae. There are three types of influenza virus that infect humans – types A, B, C. Influenza A and B are by far the most common and responsible for seasonal epidemics. From January through to October 2019, the World Health Organization Collaborating Centre for Reference and Research on Influenza (WHOCC) isolated and characterised 3,949 influenza viruses globally.1 Of this, 88% were influenza A: 60% influenza A, (H3N2) and 28% influenza A (H1N1)pdm09 and 12% were influenza B (11% influenza B Victoria lineage, 1% influenza B Yamagata lineage). During the same time period in Australia, 76.9% of laboratory confirmed influenza cases were influenza A and 22.8% were influenza B.1 While influenza B is responsible for a considerable number of hospital admissions and can be life-threatening, it is not known to cause pandemics. In terms of genetic and antigenic properties, influenza B viruses generally change more slowly (see antigenic drift and shift below).
When viewing influenza A and B viruses via an electron microscope, they are nearly indistinguishable. In both A and B the virus particle (virion) has a spherical or filamentous shape and the virus genome is made up of eight negative single-stranded RNA segments. Once enclosed in a host cell-derived lipid membrane, influenza A and B are studded with haemagglutinin (HA) and neuraminidase (NA) surface proteins.6
Haemagglutinin enables the virus to bind to the sialic acid (SA) receptor on host cells. Once bound, the virus can penetrate inside the host cell by membrane fusion and subsequently become infected. To be virulent, the virus must leave the infected host cell and go on to infect another cell. To do this, the neuraminidase enzyme acts to cleave (or cut) sialic acid from the haemagglutinin molecule attached to the surface of the influenza virus, thereby assisting release of the virus from the host cell. The neuraminidase enzyme is the target for neuraminidase inhibitors (antiviral drugs), including oseltamivir and zanamivir.7
Influenza A, but not influenza B, has matrix (M2) ion channels that traverse the membrane. Inside the lipid membrane, encoded by the virion, are three viral RNA polymerase subunits (PA and PB1, PB2) and the nucleoprotein (NP).
Influenza A viruses can infect a range of mammalian (including human) and avian species. Influenza B virus is categorised based on lineage and spreads almost exclusively in humans (and seals).8
Influenza viruses have a standard nomenclature, i.e. there is an internationally accepted convention for naming influenza viruses.9
Naming involves the:
People at high risk for developing serious influenza-related complications
Other people at high risk from influenza:
Additional details are provided in online edition of The Australian Immunisation Handbook. immunisationhandbook.health.gov.au (refer to Additional resources for primary medical care/vaccination providers).30
Influenza viruses change in two notable ways, antigenic drift and antigenic shift. Antigenic drift is a gradual process which occurs in all influenza viruses and is due to frequent point mutations when the RNA virus replicates. Eventually the mutations accumulate in multiple antigenic sites (e.g. HA or NA) and the virus is no longer recognisable to antibodies that were generated to the parental virus. Without the protection from the antibodies the host once again becomes susceptible to infection by the ‘drifted’ influenza strain. Influenza B viruses change via the more gradual process of antigenic drift; they are not known to cause pandemics.6
In contrast, antigenic shift occurs in influenza A viruses only when there is a major change in the H or N surface protein. It may be a result of genetic reassortment (when influenza viruses swap gene segments). This genetic reassortment can occur when one host (e.g. a pig) is infected with two different influenza viruses. The mixing of the viruses may encode completely novel antigenic proteins (HA and/or NA), to which the human population has no immunity. A pandemic occurs when there is a novel influenza virus (no existing immunity), which can be transmitted in immunologically naive humans. There have been seven antigenic shifts (reassortments) in influenza A virus since 1899 causing five pandemics.9 Pandemics can cause widespread morbidity and mortality across international borders. Influenza pandemics have resulted in millions of influenza-related deaths. The influenza pandemic of 1918, also known as the ‘Spanish flu’, was responsible for approximately 50 million deaths globally.9 The biology and history of influenza A viruses informs us that future pandemics are unavoidable.
Vaccination remains the best protection against influenza. Nationally, pharmacists play a critical role in increasing vaccination uptake and administering vaccinations, particularly in healthy young and middle-aged adults.10 Influenza viruses are rapidly and continuously evolving. This is the rationale behind changing the influenza vaccine composition each year. Vaccination is indicated annually for all individuals aged >6 months.
To provide the greatest protection, seasonal vaccinations should contain viruses that ‘match’ or are antigenically like those currently circulating. Vaccine efficacy is yet to be determined for last year’s influenza season. It will be calculated through observational studies (cohort and case control studies). However, preliminary 2019 data comparing 1,502 circulating influenza viruses to the corresponding vaccine component revealed ‘good’ vaccine effectiveness. Noting that influenza vaccine effectiveness is usually between 30–60%.11
Influenza is easily spread, mainly through respiratory droplets and aerosols, produced when infected individuals sneeze, cough or talk. The virus can also be spread by fomites (any surface that the virus has landed on) that is then touched and passed from the hands to the nose, mouth or eyes. One small study (N =26) showed that on average individuals touch their face 23 times per hour.12 One way of reducing risk of influenza infection and transmission is by thorough hand hygiene.13 Studies show that routine hand hygiene with either soap and running water or alcohol-based hand rubs (ABHR) are effective at removing influenza virus from hands.14,15 Pharmacists should counsel individuals on the importance of regular hand washing with soap and water for at least 20 seconds. When soap and water are not readily available, and hands are not visibly soiled, individuals should be advised to use a hand sanitiser (containing between 60% and 80% v/v ethanol or equivalent) to prevent influenza transmission. Alcohol-based hand rubs should cover the hands thoroughly and cleaning should take 20–30 seconds. More information can be found online at Hand Hygiene Australia at www.hha.org.au
Pharmacists should advise unwell individuals to cover coughs and sneezes, and cough into their elbow. They should also be informed to dispose of used tissues appropriately.
Social distancing measures reduce influenza transmission.16 At a public health level, social distancing strategies that may be employed in an influenza pandemic include school and work closure, working from home, voluntary isolation of cases, quarantine of contacts and cancellation of mass gatherings.
A single use face mask (or surgical mask, face shield) is a loose fitting, disposable face mask that provides a protective barrier around the wearer’s nose and mouth. They are primarily designed to trap respiratory droplets from the wearer and in theory should reduce transmission of infectious microorganisms to others. Several case-control studies identified that wearing masks reduce the incidence of respiratory viruses (OR 0.32, 0.25 to 0.40; NNT = 6, 4.54 to 8.03).17 While a systematic review states that there is little robust evidence to support the effectiveness of face masks to prevent transmission of influenza virus in the natural setting.18
Disposable respirators (e.g. P2, N95) are designed to protect the wearer from infectious aerosols. Respirators can filter out approximately 94% of particles <5 microns in size. Case-control studies have identified they reduce the risk of incidence of respiratory viruses (OR 0.09, 0.03 to 0.30; NNT = 3, 2.37 to 4.06).17
Pharmacists should advise patients to change the mask when it becomes moist, to wash their hands if they touch or dispose of a used mask and to maintain proper hand hygiene.
To date, in Australia, there are three classes of antivirals available for the treatment and prevention of influenza; the M2 ion channel inhibitors, the neuraminidase inhibitors (NAI) and a new antiviral, polymerase inhibitor, which was trialled in several Australian hospitals in 2019.
M2 ion channel inhibitors (e.g. amantadine) prevent the release of viral RNA into the host cell, by targeting viral uncoating. While M2 inhibitors have recognised antiviral activity against influenza A, greater than 95% of the isolated H1N1 and H3N2 influenza viruses are now resistant. Appropriately, this class of medicines is not currently indicated for the treatment or prevention of influenza due to high resistance which has rendered them ineffective.19
Neuraminidase inhibitors (NAI), oseltamivir (Tamiflu) and zanamivir (Relenza), are used clinically worldwide including in Australia. Both work by inhibiting the influenza virus surface protein enzyme neuraminidase (NA). Neuraminidase is a virulent factor and facilitates the release of the influenza virus from the host cell, enabling the influenza virus to go on and infect other healthy host cells. Inhibiting NA reduces the release of the recently formed virus particles from infected cells. Observational studies that included people at high risk of influenza or mortality from influenza, showed that treatment with a NAI is associated with a reduction in influenza complications, hospital admissions and deaths. However, studies of healthy, low-risk adults did not identify a risk reduction in hospitalisation or death (HR 1.03 95% CI 0.64 to 1.65).20 Studies report treatment with a NAI reduces the duration of influenza symptoms by approximately 1 day; oseltamivir 16.8 hours (95% CI 8.4 to 25.1 hrs); zanamivir 0.6 days (95% CI 0.39 to 0.81 days).20 The earlier treatment starts after symptom onset, the shorter and less severe the influenza. Common adverse effects of NAIs include nausea, vomiting and headaches.21
Oseltamivir is administered orally, and is commercially available in both capsules (30 mg, 45 mg, 75mg) and an oral liquid (6 mg/ml). For the treatment of influenza in adults and children 13 years and older, oseltamivir should be given at a dose of 75 mg twice daily for 5 days.21 Treatment is most effective when commenced within 48 hours of symptom onset. Dose reduction is required in individuals with renal impairment. Dosing in children under 13 years is according to total body weight.
For prevention of influenza (e.g. when a household contact has influenza and the individual wants to reduce their risk of getting ill), oseltamivir should be dosed within 2 days of exposure. Adults and those 13 years and over should take 75 mg once daily for 10 days. Children between 1 to 13 years are dosed according to total body weight. In the event of a community outbreak oseltamivir may be taken once daily for 6 weeks.20,22
Case scenario continued
Lachlan has suspected influenza. COVID-19 has been excluded. Individuals with diabetes (type 1, type 2, or gestational), are at high risk of influenza complications, which can result in hospitalisation and even death.
You refer Lachlan to his general practitioner as he will likely benefit from an antiviral. You counsel Lachlan to get rest (stay at home away from work and public places), drink lots of water, to take paracetamol to reduce his fever and relieve his headache and muscle pain.
To reduce spread, you point out the importance of hand hygiene, respiratory/cough etiquette and encourage the use of a face mask. Commencement of antiviral therapy is most effective when commenced early.
As there are many strains of influenza and individuals can catch the flu more than once in a season, you advise Lachlan to get the flu vaccine when he has recovered.
Zanamavir is administered via oral inhalation only. It is available commercially as a dry powder inhaler (DPI), which contains 5 mg of zanamivir inhalation powder in each pre-dispensed blister. For the treatment of influenza, within 48 hours of symptom onset, adults and children 5 years and over should inhale 2 blisters (10 mg), twice daily (approximately 12 hours apart) each day for 5 days.21 When prevention is required treatment should commence within 36 hours of exposure, and two blisters should be inhaled once daily for 10 days. Prevention can be extended up to 28 days when required (e.g. during a community outbreak).
Poor inhaler technique, results in inadequate drug delivery and therapeutic failure. Pharmacists should provide appropriate counselling (including device demonstration) on how to administer and use the DPI for all individuals prescribed zanamivir. Individuals who take a bronchodilator at the same time as zanamivir, should use the bronchodilator first, followed by the antiviral. During pregnancy zanamivir is the preferred NAI due to its low systemic bioavailability.21
Recent surveillance data has identified that oseltamivir-resistant viruses are circulating.23 Of concern, is that drug-resistant virus strains can spread to contacts. Resistance to neuraminidase inhibitors, is of concern at the public health level, as they are stockpiled and used in the prevention and treatment of pandemics.24
Baloxavir marboxil (trade name Xofluza) is a new influenza antiviral with a novel mechanism of action, that is effective at reducing the severity of both influenza A and B.25
Each influenza virus contains three polymerase subunits (PA, P1 and P2). The subunits are responsible for the replication and transcription of viral mRNA genome.26 Baloxavir targets, binds and inhibits the endonuclease function of the viral PA polymerase subunit. Binding prevents the transcription of viral mRNA and subsequent replication of the virus in the host cell. Baloxavir marboxil offers a novel mechanism of action when compared to older antivirals. None of the currently available antivirals for the treatment of influenza are listed on the Pharmaceutical Benefits Scheme.27
As the most accessible health professional, many individuals seek care and advice from pharmacists when symptomatic with influenza. Pharmacists are well placed to both recommend symptomatic treatment and refer individuals when required. Symptomatic treatment includes recommendations such as rest, drinking plenty of water and using analgesics such as paracetamol for pain. Pharmacists should encourage individuals at high risk of developing influenza-related complications (see Table 2) to see their general practitioner for an assessment and possible early antiviral treatment.
DR MARY BUSHELL BPharm (Hons), PhD, GCTLHE, AFACP, AACPA, MPS is the Clinical Assistant Professor in Pharmacy at the University of Canberra.[post_title] => Managing suspected influenza [post_excerpt] => Influenza or ‘the flu’ is generally a self-limiting acute viral illness. However, it can also be severe and fatal. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-suspected-influenza-cpd [to_ping] => [pinged] => [post_modified] => 2020-06-29 21:33:38 [post_modified_gmt] => 2020-06-29 11:33:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10595 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Managing suspected influenza [title] => Managing suspected influenza [href] => https://www.australianpharmacist.com.au/managing-suspected-influenza-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 10596 )
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Case scenarioSteve is a 69-year-old man with T2DM who was diagnosed two years ago by his GP. He is classified as obese with a body mass index of 31; he has a past history of cardiovascular disease, peripheral neuropathy, anxiety and a 40 pack/year smoking history which he quit after being diagnosed with T2DM. His current medicines include: clopidogrel, atorvastatin, ramipril, duloxetine, metformin and insulin glargine 100 units/mL. He has no other comorbidities nor allergies. As his regular pharmacist, you know that Steve was reluctant to start on insulin glargine 100 units/mL 4 months ago even though his ‘sugars were a mess’; he has been having difficulty managing the dose to control his blood sugar levels. Since he commenced the insulin, you’ve noticed he’s become more anxious, often calling you – uncertain about his dose and what to do if he gives himself the wrong dose. You know that Lantus Solostar will no longer be available from 1 July 2020 and Steve will need to transition to an alternative option. Whilst Steve has his other medicines dispensed as generics, you’re uncertain how he’ll react to a change in brand of his insulin glargine 100 units/mL. You’re concerned he’ll potentially be given the wrong information by someone else, risking harming the relationship you have with Steve as well as further compromising his diabetes control.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Case scenario continuedYou contact Steve’s prescriber, Phil, to discuss your concerns and suggest he review Steve before the upcoming discontinuation of Lantus Solostar. You ask Phil if you can provide any assistance to help with the transition or if he has any questions about the options that are available. Phil agrees with the significance of reviewing Steve prior to July to assess his T2DM management and provide information. Phil is happy for you to discuss brand options with Steve. When Steve is next in the pharmacy, you discuss his options, informing him there is a biosimilar and second brand available. You offer Steve information about the options, including CMIs and patient information leaflets. Steve thanks you for the information and informs you he doesn’t need his insulin glargine 100 units/mL today and will make a decision later when he fills the script.
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IntroductionCommonwealth Pharmaceutical Benefits Scheme legislation enabling electronic prescribing was introduced in October 2019. It has paved the way for electronic prescriptions to become a valid and legal method for a person to receive medicines from their pharmacist while paper prescriptions will still be available. Implementation cannot occur overnight. Progress has been made in instructing the clinical software vendors of both dispensing and prescribing software of the features required to ensure conformance. Conformance requirements are set out in the Australian Digital Health Agency’s (the Agency) technical framework that includes the conformance profile.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
BOX 1 – CRITERIA FOR GENERATING AN ELECTRONIC PRESCRIPTION
BOX 2 – CRITERIA FOR COMMUNICATING AN ELECTRONIC PRESCRIPTION
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Case scenario 1 – aged care facility
Sasha is a resident of a residential aged care facility. Currently, visits are restricted to help reduce the transmission of a gastrointestinal virus among the residents that’s causing acute diarrhoea, vomiting, and dehydration. In order to reduce transmission among her patients, Dr Armin has elected to utilise telehealth initiatives and electronic prescribing to maintain quarantine.Sasha is due for her regular chart review today. Dr Armin calls Sasha and Erwin (a registered nurse) via telehealth video consultation from her surgery. She asks Sasha how regular treatments are working, or if she has any other concerns. It is noted that Sasha has been experiencing instances of postural hypotension, which have affected her ability to walk short distance without symptoms. It is agreed that her orthostatic blood pressure will be reviewed regularly. In the meantime, her dose of angiotensin converting enzyme (ACE) inhibitor is reduced with a plan to review within 1–2 weeks.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Dr Armin also reviews the chart remotely. She updates her electronic records and the records within the facility’s Medication Management Software (MMS). Marco, a pharmacist at the facility’s contracted pharmacy, receives an update of Sasha’s chart changes in their MMS. These changes are then imported into their dose administration aid software. Dr Armin annotates Sasha’s My Health Record to reflect the medication change and consultation notes, including that the review was performed by telehealth.
Marco utilises secure messaging software to request a prescription for the new strength of ACE inhibitor, as Sasha does not have a prescription on record. Dr Armin writes an electronic prescription for the new strength. As the facility has a supply contract with Marco’s pharmacy and Sasha agreed that the facility could use this pharmacy for her medicines when she moved in, Dr Armin is able to transmit the electronic prescription directly to the contracted supply pharmacy.
Marco dispenses the new strength of ACE inhibitor from the electronic prescription without having to wait for a paper prescription to be collected or posted. Sasha’s dose administration aid is created, and an additional pack is delivered to the facility. Erwin accepts the pack and checks it against the updated chart in the medication management system.
A series of unprecedented events have occurred in 2020, one after the other, including bushfires and floods in Australia and a global pandemic. They have impacted the ability of pharmacists, and the greater health sector, to perform their duties. As a consequence, healthcare has had to be delivered in a manner that has meant health practitioners have been separated from their resources and even their patients.
There are a number of existing and new digital options to assist practitioners provide health care to their patients in these challenging times. Recently, emergency changes to funding for telehealth for healthcare providers have been introduced. This emergent change has seen a transformation in the way the health sector delivers services. Although there are many new telehealth initiatives, they will exist alongside non-digital services rather than replacing them.
The Federal Government announced in March that implementation of electronic prescribing would be fast-tracked to support telehealth consultations. Changes to Commonwealth legislation commenced on 31 October 2019, recognising an electronic prescription as an alternative legal form by which medicines can be supplied, and clinical software providers are making progress updating their prescribing and dispensing systems to provide electronic prescribing capability.
Existing digital resources, such as My Health Record (MHR), can also work complementary to future digital health resources to enhance patient outcomes.
Emergency situations vary in each scenario and can impact on the ability of health professionals to deliver care. During the bushfires, we saw displacement of people from their homes. This caused reduced access to medicines and health records. Pharmacies and surgeries were also cut off from electricity, preventing the clarification of medication histories as would normally occur when a person needs medical assistance while away from home.
With the COVID-19 pandemic, we are seeing a situation where people need to minimise contact with each other. Health professionals are in a vulnerable position as they are more exposed to infection and/or illness and may also act as a vector for others.
Traditional methods of consulting with a patient, assessing patient history, and providing medicines is hampered by the lack of access to information, and delays in communication methods. Digital health initiatives can play a key role in filling the gaps in communication and health information access. Scenarios featuring different digital health initiatives that can assist in emergency situations are outlined throughout this article.
Telemedicine is the use of secure digital communication methods to undertake a clinical consultation. The most common method is via video-conferencing.1 For example, a video consultation may occur with a specialist medical practitioner in real time, providing convenient and efficient access to health care.1
In response to the COVID-19 pandemic, the Federal Government has expanded access to Medicare-funded telehealth, including for mental health. The expansion of this funding supports general practitioners consulting with people who are in isolation without increasing the risk of viral transmission to themselves and their patients.2
A telephone or email consultation may also be considered telemedicine. In some models of telehealth that are currently utilised in Australia, a person may fill in a questionnaire online that is later reviewed by a prescriber to determine if a prescription for a requested medicine is appropriate, although this is not considered best practice. The Royal Australian College of General Practitioners (RACGP) provides guidelines to members on the best practice delivery of telehealth services as well as the Australian College of Rural and Remote Medicine (ACRRM).1,3
Telemedicine techniques may also be used by pharmacists in their practice. For example, when a third party presents a request for a prescription or Schedule 3 medicine. Currently there are interim arrangements in place for a clear copy of the entire prescription to be sent to the patient’s pharmacy of choice via fax, email or text message (in certain states and territories). A pharmacist should also document the telehealth interaction.
Funding for telemedicine is restricted to certain situations. It is also not generally available for pharmacists. Pharmacists can make a professional judgement to provide an in-depth consultation, such as a medication reconciliation or counselling service, via telemedicine. However, such a service is ineligible to receive Federal Government funding, although it may be charged privately.
At the time of writing, pharmacists have not been provided with extra funding to provide medicine counselling via telemedicine. However, it is important to note that professional practice standards and the dispensing fee for PBS medicines should ensure that a pharmacist provides the same level of advice to the person living in isolation as to a person who physically presents in the pharmacy.4,5
Access to My Health Record has provided pharmacists with greater access to a person’s health information than was previously possible.
While it is additional to taking a medicines history, it does provide a guide on questions that may need to be asked or what previous medicines or medical issues may impact on current treatment.
In an emergency situation, My Health Record increases the access to more current information and can reduce communication time in situations where it may be difficult to contact a doctor. During the recent bushfires, pharmacies were able to utilise the person’s medicines information in My Health Record to support their decision to provide an emergency supply of medicines.7
Secure messaging provides point-to-point sharing of encrypted clinical information. It allows a message to be delivered securely and mitigates risks that traditional everyday communication methods present, such as interception or transmission to an incorrect destination address.
There are a number of secure messaging providers that offer solutions tailored to the software and digital health tools that healthcare services have available.
Secure messaging is available to primary, secondary and tertiary providers through these individual software solutions, but has yet to be implemented as a national infrastructure available to all practitioners.
Developments will see a system in place where pharmacists and general practitioners can communicate with each other directly. This will occur in a secure encrypted manner with regards to specific issues as needed and include the clarification of instructions. During public emergencies, secure messaging may provide a means of communication when existing infrastructure (e.g. telecommunications) fails due to high call volume, or if is deemed inappropriate.8
Case scenario 2 – Away from home
Mikasa is travelling with her family on a holiday and realises she has used the last of her inhaler for chronic obstructive pulmonary disease (COPD). She had thought she would have enough for the entire trip.
Mikasa visits a local pharmacy near where she is holidaying. She explains the situation to Levi, the pharmacist on duty.
Levi discusses her current medicines history, and asks if she has a My Health Record (MHR) or has ever been prescribed medicines electronically. Mikasa indicated that she has a MHR and has used electronic prescriptions. However, the inhaler was the last repeat, and she had planned to see her doctor, Dr Ymir, when she had returned from her trip.
Levi accesses Mikasa’s MHR which shows that her history is consistent with the present situation. He decides to contact Dr Ymir’s surgery. Dr Ymir consults her records, and agrees to write a new electronic prescription, and sends the token for the electronic prescription to Mikasa’s phone. Dr Ymir asks Levi to pass on a request for a follow-up appointment when Mikasa returns from holiday.
Mikasa receives the token for a new electronic prescription for her medicines via SMS. The pharmacy assistant scans the token into their pharmacy’s digital queuing software, along with a note about a request for over-the-counter (OTC) salbutamol.
Levi accesses the queuing software and sees that there is a token in the queue for Mikasa, from which he unlocks the electronic prescription. The prescription information is imported into his dispensing software and is dispensed. As Mikasa also has a MHR, this information is automatically uploaded to her MHR (unless she requests not to upload this information).
Levi and Mikasa discuss the medicine, including the OTC salbutamol. He passes on the request from Dr Ymir for a follow-up appointment when Mikasa returns home from holiday.
Electronic prescribing provides a new option for the generation of a prescription and its dispensing. It is part of the development of prescribing practice that has already progressed from hand-written paper prescriptions to computer-generated prescriptions and is expected to be available from May 2020. It utilises the same infrastructure for the delivery of existing electronic transfer of prescription information i.e. secure, cloud-based prescription delivery services (PDS). Prescription delivery services include the existing prescription exchange services: eRxScript Exchange and MediSecure.
The primary difference between an electronic prescription and a paper prescription is that paper is not required. The legal prescription is in an electronic format that resides in the PDS until it is downloaded for dispensing in a pharmacy. A person prescribed a medicine via an electronic prescription will receive an ‘evidence of prescription’ which contains a summary of the prescription information and a ‘token’. Downloading an electronic prescription will be facilitated by the token represented by a QR code. The evidence of prescription along with the token may be received by the patient as an SMS or email or even printed on paper, but is not itself a legal document. It is the key to unlock the electronic prescription from the prescription delivery service.9
The potential benefit of electronic prescribing during health emergencies is significant, without revolutionising the processes of dispensing. During such times, electronic prescribing provides new methods for ensuring continuity of care with respect to medicine access. The primary health benefit in these situations is the ability for a prescriber to transmit a prescription in real time. This allows a prescription to be dispensed at full PBS quantity and rebate without the need for an emergency supply.
Another function of the electronic prescribing infrastructure that will be beneficial during an emergency is the Active Script List, which is expected to be available by the end of 2020. If a person chooses to use the Active Script List functionality rather than using tokens, they will be able to have all their active electronic prescriptions collated into a list that shows them what electronic prescriptions they have available to be dispensed.
A pharmacy will be able to access this list once the person has provided consent. This function will allow a person to have access to all their electronic prescriptions from any pharmacy, even if they are away from their usual pharmacy. Using this function will make losing an electronic prescription very unlikely.
Electronic prescriptions provide convenience and flexibility for the patient. A patient can receive prescriptions from a healthcare provider while they are in medical isolation (such as during a pandemic), access their prescriptions even when separated from their home and belongings, and transmit a prescription to a pharmacy from any location.
There are many potential benefits in using electronic prescribing to improve communications during emergency situations. However, there is a risk that low implementation within the pharmacy sector or inadequate integration within existing pharmacy workflows could lead to low uptake of electronic prescriptions, slower processing of prescriptions, errors, and frustrations.
A key requirement of electronic prescribing is the ability for a pharmacist to access a computer terminal to check a prescription for accuracy and appropriateness. As the electronic prescription does not exist in a physical form, the pharmacist must be able to access a terminal to visualise the prescription. Any pharmacist or dispensary workflow model that currently does not include a step where the pharmacist accesses a terminal will need to be changed to accommodate electronic prescriptions.
Also, when a pharmacy receives an electronic prescription from a person via presentation of a token on their phone, the token will need to be scanned to unlock the electronic prescription. It is not feasible to retain a person’s mobile phone in a basket in the queue of prescriptions waiting to be dispensed.
Software vendors are developing electronic queueing software that allows tokens to be received by a pharmacy when forwarded by a person remotely (e.g. sent in advance of collection to limit wait times, or sent when in medical isolation) prior to dispensing by a technician or pharmacist.
This process will be streamlined with access to a terminal at the point where physical prescriptions are received. In both situations, pharmacies may need to consider infrastructure changes and modify existing workflow patterns.
Public health emergencies place a large burden on the health sector. While it is unusual to have a series of major emergencies so close together in one year, 2020 has demonstrated already that the infrastructure for health delivery needs to evolve and incorporate newer technologies that facilitate access to health care.
Digital health initiatives are taking advantage of these new technologies with the intent of streamlining the delivery of health, including pharmacy practice. At the same time, digital health advances provide pharmacists with more tools and greater flexibility to respond to public health emergencies.
Carlene McMaugh BSc, MPharm, MPS is a pharmacist who works in community pharmacy and the pharmaceutical industry. She is also the global lead for the International Pharmaceutical Federation for gender equity, podcast host for the AJP and a Deakin University human research ethics committee member.[post_title] => Digital health during public emergencies [post_excerpt] => There are a number of existing and new digital options to assist practitioners provide health care to their patients in these challenging times. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => digital-health-during-public-emergencies [to_ping] => [pinged] => [post_modified] => 2020-06-09 22:00:12 [post_modified_gmt] => 2020-06-09 12:00:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10416 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Digital health during public emergencies [title] => Digital health during public emergencies [href] => https://www.australianpharmacist.com.au/digital-health-during-public-emergencies/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 10420 )
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Case scenarioMary, 34 years old, is seeking your assistance with ‘something embarrassing’. After waking up, she noticed some pain and itchiness around her anus, and upon inspection, a sore, discoloured bulge that ‘definitely wasn’t there last week’.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
BOX 1 – HAEMORRHOIDS IN PREGNANCY
|It is estimated that 25–35% of women experience haemorrhoids during pregnancy, most commonly during the second and third trimesters, with some reports of up to 85% in some populations during the third trimester. For most women, haemorrhoids resolve without intervention following childbirth.|
|BLEEDING OR PRESENCE OF BRIGHT RED BLOOD||ANAL PRURITIS|
|MEDICATION COMBINATION||MECHANISM OF ACTION||DOSE||COMMON ADVERSE EFFECTS||INTERACTIONS||PREGNANCY AND BREASTFEEDING||NOTES|
|Hydrocortisone/ cinchocaine hydrochloride ointment (external and internal) and suppositories Proctosedyl||Corticosteroid to reduce inflammation and itch Local anaesthetic||Apply/insert up to three times daily||Stinging of the skin, sensitisation of skin, exacerbation of local infection, skin atrophy.||Used externally, systemic absorption risk is low. Rectal absorption may occur when used internally. Check for potential interactions if being used for internal haemorrhoids.||Safe Category A||Apply/insert after a bowel motion. Wash and dry anal area before application. Nozzle available for internal use of ointment. Limit use to <7 days.|
|Zinc oxide 300 mg, Peru balsam 50 mg, benzyl benzoate 33 mg suppositories and ointment Anusol||Astringent and ingredients purported to have benefits that may lack evidence||Suppositories: one suppository morning and night, and after each bowel movement Ointment: apply twice daily, ensuring area is completely covered.||Safe Category B2||Suppositories for internal use only Ointment useful for both external and internal haemorrhoids (applicator included) Limit use to <7 days.|
|Zinc oxide/cinchocaine hydrochloride ointment Rectinol||Astringent and analgesic||Apply three times a day, after a bowel movement.||Sensitisation of skin||Safe||Indicated for both external and internal haemorrhoids (applicator included) Limit use to <7 days.|
|Lidocaine/ allantoin/ hamamelis liquid extract/ zinc oxide ointment Hemocane||Astringent and analgesic||Apply around the anus morning and night, after each bowel movement.||Sensitisation of skin||Safe||Indicated for both external and internal haemorrhoids (applicator included) Limit use to <7 days.|
|Lidocaine/hydrocortisone cream SOOV IT||Corticosteroid to reduce inflammation and itch Local anaesthetic||Apply three times a day, and after a bowel movement.||Stinging of the skin, sensitisation of skin, exacerbation of local infection, skin atrophy.||Safe||Indicated for both external and internal haemorrhoids (applicator included). Limit use to <7 days.|
|Glyceryl trinitrate ointment Rectogesic Not indicated for use in haemorrhoids||Release of nitric oxide relaxes internal anal sphincter, reducing anal pressure and increasing blood flow||Insert 1–1.5cm strip of ointment into anal canal up to three times a day for at least two weeks. Anal fissures may require up to four weeks of treatment.||Headache, dizziness||Do not use if currently using sildenafil, vardenafil, tadalafil or other PDE5 inhibitors.||Category B2 Should be safe to use in breastfeeding – apply a small amount after breastfeeding.||Indicated for anal fissures and relief of pain and discomfort following haemorrhoid surgery. Not for haemorrhoids Ensure patients have a 12-hour period per day where they are not using this treatment as tolerance can develop.|
BOX 2 – GLYCERYL TRINITRATE – MECHANISM OF ACTION
|Glyceryl trinitrate works by releasing nitric oxide, the predominant non-adrenergic, non-cholinergic neurotransmitter in the internal anal sphincter. This results in relaxation of the internal anal sphincter and vasodilatation to improve blood flow to the fissure and promote healing.24|
Case scenario continuedAfter taking Mary’s history, it appears she is suffering from a thrombosed, external haemorrhoid due to the presence of acute pain and Mary‘s description of a discoloured lump that appeared in a very short period of time. She had been prescribed paracetamol with low-dose codeine by her doctor 2 weeks ago for tooth pain, which has likely resulted in constipation, leading to straining. You recommend a topical ointment to be applied externally up to 3 times a day, as well as a stool softener to assist with constipation. You also advise Mary to increase her fibre and fluid intake to reduce the risk of constipation in the future.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10514 [post_author] => 1925 [post_date] => 2020-06-22 05:49:58 [post_date_gmt] => 2020-06-21 19:49:58 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Jocelyn Watson, a PSA life member, was awarded an Order of Australia medal in January for services to Launceston and contributions to her church, horticultural society and her industry.
Where and when did you start your career in pharmacy?In 1956, I started as an apprentice in the Ballarat pharmacy. I would work during the day and study a correspondence course in the evenings. I was interested in the medicine side of the profession and wanted a career where I could help people. Although attracted to nursing, I felt pharmacy was a better fit. In those days, as now, pharmacy was a good career choice for a woman because of the flexible hours.
What attracted you to community pharmacy?When I graduated, I worked at the Royal Melbourne Hospital, which was good training for a young person. It exposed me to the full range of services a pharmacist provides. Then I went to a large pharmacy in Mildura. I preferred it because there was more contact with the community and I could see how we were helping people. When I got married, my husband and I moved to Launceston, which is where he was from. Again, pharmacy proved to be a good career choice. When we started a family, I was able to pick and choose my hours. I worked one day a week in different pharmacies whenever someone needed a locum.
What advice would you give early career pharmacists?I would advise them to take every opportunity and keep learning. It is a rewarding business. I would advise them to leave some of their learning until after they have done some practical work. That way they can apply the things they read in books to the things they see in the workplace. A hospital pharmacy is a great place to learn. Another thing I would recommend is to become a specialist in a particular area you are interested in. I was interested in wound management and dermatology and got to learn a lot about these fields. And finally, keep your eyes open. Pharmacists can learn a lot from their clients. No two are the same. I think closely monitoring patients, especially people being discharged from hospitals, is a vital role for pharmacists. You need to see how people are doing with their medicines. They usually get only a week’s supply on discharge and often there are questions or mistakes when they go to their doctors for new prescriptions. Hospital admission for medicine misuse is a significant issue.
What changes were the best in the profession between when you started and your retirement?Computerisation was unquestionably the best thing that happened to pharmacy. It made such a huge change to the way we did business day to day. The other big changes that affected me were the changes in the legal requirements. When I started, we used our judgement a lot more, especially around the dispensing of things like codeine and pseudoephedrine. There are definitely more opportunities for pharmacists these days, including new contributions in healthcare and hospitals.
What is your next project?I plan to enjoy my retirement. We want to do a bit more travel after going to the west coast of Tasmania a few months ago. We are restricted because of COVID-19, but we have plans ready to visit our grandchildren in Brisbane, Adelaide, Melbourne and in the United States. I like gardening and to keep fit at the PCYC. I’m a School for Seniors member, I do singing for pleasure and Scottish country dancing, but they have been cancelled because of the virus. I’m on the pastoral committee of the Pilgrim Uniting Church in Launceston. The other thing I like to do, which is what I always did as a pharmacist, is to stay in touch and care for people wherever I can.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Still blooming… [post_excerpt] => Jocelyn Watson, a PSA life member, was awarded an Order of Australia medal in January for services to Launceston and contributions to her church, horticultural society and her industry. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => still-blooming-psa-life-member [to_ping] => [pinged] => [post_modified] => 2020-06-29 21:41:15 [post_modified_gmt] => 2020-06-29 11:41:15 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10514 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Still blooming… [title] => Still blooming… [href] => https://www.australianpharmacist.com.au/still-blooming-psa-life-member/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10515 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10451 [post_author] => 1532 [post_date] => 2020-06-15 21:27:50 [post_date_gmt] => 2020-06-15 11:27:50 [post_content] => Hannah Knowles MPS loves being involved in every stage of a patients’ journey, an interest well suited to her new role at a leading Brisbane hospital pharmacy.
Why did you choose pharmacy?Coming from a rural background, I saw the impact of a pharmacist on a community. Pharmacy combines my interest in science and people and the opportunity to work in a wide range of practice areas. Throughout my degree, I worked in different community pharmacies and then transitioned into hospital pharmacy in my intern year. I am currently completing my residency training at Royal Brisbane and Women’s Hospital.
Was community pharmacy a stepping stone for your current interests?Yes, working in community pharmacy has been invaluable for my development as a pharmacist. I have worked with and been mentored by some exceptional pharmacists who fostered my passion for the profession, my appreciation for the importance of developing effective relationships, and the key skill of explaining medicines in a way patients can understand.
How has COVID-19 impacted your role?This is a response that could change quite quickly! Currently, I am upskilling for partnered charting and as being the second check for medicine administration in addition to my regular work. In partnered charting, credentialled pharmacists work closely with the medical team to undertake a medication review and chart medicines for nursing staff to administer. There are COVID-19 specific research projects and trials within the department ongoing, and social distancing has meant that all meetings have moved onto a virtual platform.
What are the benefits to early career pharmacists in attending FIP and PSA conferences?Conferences are a fun and effective way to connect with other people in the profession, to discuss current issues in pharmacy and to share ideas. Through attending International Pharmaceutical Federation (FIP) conferences, I have gained a global network of pharmacy colleagues, broadened my understanding of international pharmacy practice and the importance of policy to implement programs and how it relates to my daily practice.
What are your thoughts on pharmacists’ remuneration?The role of a pharmacist is evolving quickly to meet the needs of patients and the healthcare system. The increasing complexity and accountability of pharmacy roles should be supported with training pathways and advanced practice credentials. This change in role needs to be reflected in remuneration. This is discussed in detail in the PSA Roles and Remuneration report published last year.
What’s next?I’m excited to see new roles for pharmacists emerging. For now, I will be completing my foundation residency training, attending professional conferences and working on my research skills.
A DAY IN THE LIFE of Hannah Knowles MPS, Resident Pharmacist at the Royal Brisbane and Women’s Hospital8.00 am: Organisation and planning Administration and prioritisation of workload. Set goals and expectations for intern. Attend ward MDT meeting for overview of patients, planned procedures and expected discharges. 8.30 am: Discharges Clinical review of medication, reconciliation, patient counselling, HF titration schedules, liaising with pharmacies to ensure medicine supply. One patient admitted with angioedema from ramipril was started on irbesartan and prescribed a C1 esterase inhibitor in case of reoccurrence. I organised supply of stock and liaised with her closest hospital to keep medicine for any required administration. The patient was also counselled about identifying future episodes of angioedema, what actions to take and the importance of having medicine on hand when travelling. 12.00 pm: Reviews Admission histories, clinical and medicines supply – all part of being involved in every stage of the patient journey. Work closely with the ward team, identifying missing therapy, drug interactions, giving dosing and administration advice, TDM, reviewing appropriateness of therapy, identifying and reporting adverse drug reactions. 3.00 pm: Continuing education and research An array of education opportunities available within the department and hospital. Recent topics: COVID-19, renal medicine, research skills, case based discussions and journal club. 4.00 pm: Outpatient reviews With blood tests, I identified iron deficiency in a female, aged in her 60s, with fatigue and shortness of breath and a background of heart failure (HFrEF). The patient received my recommended iron infusion. This avoided an extra visit to the heart failure clinic for medicine uptitration where the patient was then referred. IV iron replacement is shown to improve symptom burden and quality of life in patients with HFrEF.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10429 [post_author] => 235 [post_date] => 2020-06-10 12:51:25 [post_date_gmt] => 2020-06-10 02:51:25 [post_content] => You couldn’t pay 99-year-old William ‘Bill’ Lumley MPS to be a pharmacist in the ‘new normal’ world today. Set to celebrate his 100th birthday on 16 June, Mr Lumley responded with a resounding ‘no way’ when asked if he wished he could, like others called out of retirement, work during the pandemic. ‘My pharmacy training was far different from what is practiced today,’ said the Life Member, who clocks up 70 years with PSA next month. Mr Lumley joins Queenslander JSD ‘Stan’ Mellick (Member Insight AP April 2020) in the PSA centenarian stakes this year. As with Mr Mellick, much has changed since 29-year-old Bill graduated from the Victorian College of Pharmacy in 1949 and began working as a locum in Korumburra, 120 km south-east of Melbourne. Two years later he became a pharmacy owner, running his own practice in Chelsea, a Melbourne suburb, for 13 years. Following this, he served as an inspection pharmacist at the then Commonwealth Department of Health, and remained in the Melbourne office until his retirement in 1983. Like many young men of his time, Mr Lumley had lived an entire life before he began his pharmacy career. At just 17, he joined the Militia, now known as the Army Reserves. At this time he also was studying applied science at Melbourne Technical College, now RMIT. In September 1939, two days after Britain declared war on Germany following Hitler’s invasion of Poland, the Australian Government announced it would begin calling up members of the Militia to aid the war effort. Mr Lumley ultimately received his call in 1941, when he joined the Second Australian Imperial Force (AIF) and became a second lieutenant in the 2/2nd Field Regiment. The regiment was due to leave for Libya shortly afterwards, but plans changed with the bombing of Pearl Harbour in November. As a result, Mr Lumley’s regiment remained in Australia, where he spent time helping protect Western Australia. After his discharge from the AIF in 1944, Mr Lumley joined the Royal Australian Air Force (RAAF). In December of that year he was granted leave to marry Barbara Eltis, with whom he raised three children – Michael, Catherine and Ian.
Community mindedAs well as his military service, Mr Lumley devoted much of his life to the community and helping people. After leaving the RAAF he worked in his brother’s pharmacy and went on to study pharmacy at the Pharmacy College in Melbourne. Mr Lumley was the first President of the Victorian Pharmacy Students' Association and, when the Victorian association joined with its New South Wales counterpart to form the National Pharmacy Students' Association, Mr Lumley became the first president of that organisation, too. He was also active in local politics, serving as a councillor for the City of Chelsea and as the city’s Mayor in 1955–56. In the 1960s, he was the First Aid Officer and Treasurer of the Chelsea Life Saving Club and trained in first aid with the St John Ambulance Brigade. As his son Mike remembers fondly, at this time Mr Lumley had a rare 16 mm film projector, which he would use to screen first aid training films and entertain members of the Life Saving Club, family and friends. He was also President of the Peninsula Ambulance Service for 5 years until it was absorbed into the Melbourne Metropolitan Ambulance Service in 1987. ‘My father was then Vice President of the Metropolitan Ambulance Service for 2 years before he retired in 1989,’ Mike Lumley told Australian Pharmacist. ‘This was all voluntary service … He has spent much of his life serving and supporting the health of the Victorian community.’ Bill was recognised for this work in 1991, when appointed a Member of the Order of Australia (AM). Mr Lumley, who said he has been waiting for the milestone birthday to happen for a long time, attributes his longevity to ‘pure living’. ‘I have had a fairly good life,’ he said. ‘I’ve lived reasonably well. I was married to Barbara for 62 years. I will be relieved when the birthday is over and I can look forward to the next 100 years.’ With no group birthday parties possible, colleagues are invited to send letters or cards to Mr Lumley at: Village Glen Aged Care Residences, 34a Balaka St, Capel Sound. VIC. 3940. Or call him on 0403 813 575. [post_title] => Another 100 years ... says birthday boy [post_excerpt] => You couldn’t pay 99-year-old William ‘Bill’ Lumley MPS to be a pharmacist in the ‘new normal’ world today. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => another-100-years-says-birthday-boy [to_ping] => [pinged] => [post_modified] => 2020-06-10 12:58:02 [post_modified_gmt] => 2020-06-10 02:58:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10429 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Another 100 years … says birthday boy [title] => Another 100 years … says birthday boy [href] => https://www.australianpharmacist.com.au/another-100-years-says-birthday-boy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10430 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 10306 [post_author] => 1925 [post_date] => 2020-05-25 09:20:16 [post_date_gmt] => 2020-05-24 23:20:16 [post_content] => Australian Pharmacist of the Year 2017 Irvine Newton OAM FPS was inaugural chairman of PSA’s Harm Minimisation Committee in Victoria, presenting patient perspectives and treating substance abuse as a health, not criminal, issue.
What started you on the road to community pharmacy?Becoming a pharmacist was one of my two preferred career options in high school (the other was to be a carpenter)! I was always attracted to what I saw as a professional role that would allow me to help people with their healthcare. I have been very fortunate to enter a profession that I came to love and would certainly take the same path if I had my time over. Later, I became a PSA Victoria board member and PSA Victorian President because I believe we have a great story to tell. One, in particular, became especially important to me – drug dependence and a pharmacy’s role in providing treatment and support for people with drug dependencies. I ran a methadone program at my pharmacies and saw firsthand how important pharmacy could be in helping these people. I became a passionate advocate for better pharmacist training in harm minimisation and drug treatment.
What insights can you bring to pharmacists after your many years in the profession?Pharmacists have a valuable role in healthcare, but our skills and knowledge are under-utilised. Some governments are starting to acknowledge and provide for expanding pharmacy services, such as providing emergency contraception, medicine management, influenza and other vaccines and some prescription medicines. But we can do so much more. Patients need us.
How has the role of the pharmacist changed until your recent retirement?Pharmacy has changed enormously since I started in the early 1970s. We have developed great professional services, discovered and developed our critical role in drug-dependence treatment and support and we now provide prescribing support in hospitals and other facilities.
What have the changing qualifications and language meant to the profession?I have never answered to being a “chemist”. My response is that I am a “pharmacist” and very proud to be one. After all, we complete a pharmacy degree, not a science degree. From a degree status point of view, we have never rated higher and I believe our graduates are the best educated they have ever been.
What do you think are your greatest achievements in harm minimisation?There was a time when my attendance at drug treatment meetings and conferences was questioned. I can gladly say that has changed. There is a genuine respect for pharmacists now, particularly in their role in the methadone/buprenorphine program. Our clients value what we do and many trust and respect pharmacists above all others. The Australian pharmacy/general practice model is world’s best practice.
What are your plans in retirement?I still have a small role in harm minimisation education, and I maintain my interest in pharmacy. Otherwise, I am enjoying my love of carpentry, building maintenance and gardening. I am not getting to the golf course at all under virus restrictions but I still plan to travel when it is all over. And, of course, I can’t wait to get back to the footy to watch my beloved Essendon Bombers. [post_title] => Minimising harm, building trust [post_excerpt] => Australian Pharmacist of the Year 2017 Irvine Newton OAM FPS was inaugural chairman of PSA’s Harm Minimisation Committee in Victoria. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => minimising-harm-building-trust [to_ping] => [pinged] => [post_modified] => 2020-05-25 15:58:36 [post_modified_gmt] => 2020-05-25 05:58:36 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=10306 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Minimising harm, building trust [title] => Minimising harm, building trust [href] => https://www.australianpharmacist.com.au/minimising-harm-building-trust/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 10307 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9727 [post_author] => 12 [post_date] => 2020-03-17 14:24:54 [post_date_gmt] => 2020-03-17 04:24:54 [post_content] => Distinguished Professor Gregory Peterson FPS has co-owned two pharmacies, been a hospital pharmacist and advised Sigma Pharmaceuticals. Now it’s teaching, research and other varied roles.
How did you come to lead state and national projects aimed at improving the use of medicines and patient outcomes in community, hospital and aged care sectors?This was a natural progression in my career. I started out as an undergraduate pharmacy student at a school that pioneered clinical pharmacy education, which allowed me to spend time in general medical practices, aged care settings, and community and hospital pharmacies. I then attended nursing home ward rounds and wrote therapeutic bulletins for GPs while an intern pharmacist. After that I worked as a community and hospital pharmacist in low socioeconomic areas of Hobart and Melbourne where medicine-related issues were very prevalent. I’ve also been fortunate to keep practising in community pharmacy throughout my academic career, which is critically important for learning about real-world experiences of consumers and seeing what needs tackling through research to improve outcomes from medicine use.
What sort of person excels in the role you’ve carved out?Someone with an equally short attention span, who rapidly gets bored doing one activity and craves variety, and likes to be in the underdog’s corner.
What’s the biggest challenge you face?The biggest challenge is balancing – somewhat successfully – a multitude of roles and activities ranging from laboratory-based and clinical research through to practice as a community pharmacist, consulting, writing, and being a board director of community organisations that are pivotal to health care delivery in Tasmania.
What’s most satisfying about your work?Apart from the variety, being lucky enough to be in a position to directly help others, whether that be students, fellow academics and pharmacists, patients or the public through ongoing roles in teaching, research, pharmacy practice, consultancy and board director positions.
Any fulfilling experiences you’ve recently experienced?The most fulfilling and motivating aspect I regularly see in our pharmacy, located in a suburb of predominantly older residents, is the many elderly people – some who have reached 100 years of age – who are such positive role models in society. They’re modest and unassuming, they remain active and engaged, and they appreciate assistance when managing their medicines.
What do you wish you’d known before embarking on your career?I was probably naïve in assuming everyone in the profession was focused on improving public health outcomes, when instead there is self-interest and greed at both an individual and organisational level. That has, unfortunately, stymied the advancement of pharmacy practice in this country compared with some others. For example, the routine presence of pharmacists working in general practice and aged care settings as part of a team, with associated prescribing privileges in a collaborative model, should have occurred many years ago.
Any other interesting insights?Ending on a positive note, I think that the self-interest that has held back the profession for so long is now being diluted through pressure from many quarters, including an army of low-paid yet highly skilled pharmacy graduates, continued trimming of Pharmaceutical Benefits Scheme dispensing costs, the Commonwealth, consumers, the impact of the Royal commission into Aged Care Quality and Safety, and Quality Use of Medicines (QUM) and medicines safety becoming the 10th National Health Priority Area. It’s a great time to enter the profession for those committed to helping society.
A TYPICAL DAY for Distinguished Professor Gregory PetersonMORNING Teaching, student meetings, manuscript work
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.