td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11639 [post_author] => 1532 [post_date] => 2020-10-23 04:36:29 [post_date_gmt] => 2020-10-22 17:36:29 [post_content] => The interim findings of the aged care royal commission, the horrific bushfire season and the COVID-19 pandemic have all highlighted – in one year – the critical role pharmacists can play in the lives of older Australians. A ’shocking tale of neglect’. And, ‘unsafe, unkind and uncaring’. These are some of the damning descriptors of the country’s aged-care system found in last year’s interim report of the Royal Commission into Aged Care, Quality and Safety.1 Sadly, such findings are not news to pharmacists, who have long been advocating for better care for older Australians, whether living independently or in residential aged care facilities (RACFs). COVID-19 has simply shone a spotlight on issues that have long existed, particularly those relating to medicine supply and management and palliative care. The PSA has continued to call for better outcomes, beginning in February with the launch of its Medicine Safety: Aged Care report,2 a sobering read that found more than 95% of people living in RACFs had at least one problem with their medicines at the time of a medicines review. Most had three. Up to 20% of unplanned hospital admissions for aged-care residents were a result of inappropriate medicine use, and 60% of people in RACFs were administered at least one potentially hazardous combination of medicines. In August, PSA submitted its final report to the royal commission outlining eight recommendations set against the impact of COVID-19 on aged-care services.3 Those recommendations included:
Jo McMahon Pharmacist, Moruya, NSWJo McMahon is a proud rural pharmacist from Moruya on the New South Wales South Coast with a strong interest in palliative care and geriatrics. ‘I find palliative care very rewarding,’ says Ms McMahon. ‘You can make a huge difference to an individual and to their family by doing good palliative care.’ Since 2018 she has provided weekly sessions of 3–4 hours to three RACFs in Moruya, Batemans Bay and Narooma, all on the coast. ‘My role involves implementation of Quality Use of Medicines principles across the facilities,’ says Ms McMahon. ‘This ranges from antimicrobial and opioid stewardship to reducing polypharmacy and inappropriate use of medicines such as antipsychotics, sedatives and anticholinergics. ‘The pharmacist in an aged care facility is in an ideal situation to liaise with the GP and nursing staff as well as the palliative care team and community pharmacy to ensure implementation of tools such as the Clinical Excellence Commission Last Days of Life flowcharts. ‘The use of Caring@home resources simplifies care for the registered nurse who may have the charge of many residents,’ Ms McMahon says. She believes community pharmacists should be called on regularly to be part of palliative care teams. ‘They can play a pivotal role, in deprescribing recommendations, advising patients, families and nurses on symptom management, drug compatibilities for syringe drivers, dose modification, home delivery, safe drug storage in the home, staged supply to the home to keep costs down and how to dispose of medicines after the person has passed away.’ As part of a team, Ms McMahon believes it helps to deal with the pressures that come with palliative care. ‘Sharing the care and responsibilities in supporting rural palliative patients – who may also be known personally to us – can reduce the risk of professional and carer burnout. ‘Decisions are not made in isolation. ‘We all have each other on speed dial and will talk through options, decisions, calculations,’ she says. ‘The very nature of the palliative approach: meticulous assessment, always sharing decisions with the patient and the family, and making small changes which are always monitored before the next step means any disappointments are shared and addressed,’ Ms McMahon says. The approach involves good communication and preparation with the patient. ‘Hoping for the best but planning for the rest.’
Zhiyong Zachary Sum MPS Consultant pharmacist, Melbourne, VICProblem at initial review Connie* is a new patient at the general practice. She recently relocated and her previous medical records have not yet been received. Connie comes to the general practice for a regular check-up with her new GP. Her in-clinic blood pressure reading was 182/100 mmHg. She doesn’t know what tablets she is taking. From there, Connie has been referred for an HMR for interim medication reconciliation while awaiting transfer of her old medical records. Advice An HMR identified that she is on antihypertensives (lercanidipine 10 mg, olmesartan 20 mg and hydrochlorothiazide 12.5 mg). However, due to financial constraints and not ‘feeling’ the effects of hypertension, she has been intentionally non-compliant with her medicines for the past 15 months. The review recommended she restart her antihypertensive regime immediately, with regular blood pressure reviews by the GP. Recommendation The importance of hypertension control and compliance with antihypertensive therapy for improved clinical outcomes was discussed with Connie. A follow-up HMR visit was scheduled to ensure compliance and to identify strategies to help achieve comprehensive therapeutic outcomes including lifestyle changes in exercise, diet and risky health behaviours. Follow-up 1 The first follow-up service was conducted 4 weeks after Connie’s HMR. Her blood pressure had reduced significantly. However, the blood pressure monitor picked up an irregular heart rhythm, which prompted an immediate referral to the GP, followed by an immediate transfer to the local hospital emergency department. She was diagnosed with silent myocardial ischaemia. Follow-up 2 A month after the first follow-up service, Connie has optimal blood pressure control and is compliant with her medicines. She adopted healthier lifestyle habits in nutrition and exercise and now regularly visits her GP for a comprehensive health check, including a heart health assessment and team care arrangement involving a consultant pharmacist. Comment If not for the follow-up service, Connie would not have been screened and referred to the right specialist care in a timely manner, leading to possible morbidity and/or mortality from undiagnosed cardiovascular disease. The follow-up service gives consultant pharmacists responsibilities towards patients under their care and provides immense job satisfaction when a recommendation to a GP has been followed up leading to positive patient outcomes. *not her real name
Dr Natalie Soulsby MPS Advanced practice pharmacist Head of Clinical Development, WardMM, based in Adelaide, SAProblem at initial review Mary* requested I conduct an HMR for her during a heart failure education session I run as part of a heart failure rehabilitation program. She had been started on multiple medicines after she had a NSTEMI and an LV thrombus, leaving her with a reduced EF of 37% and was unsure about the indication of her medicines. On further discussion she complained of lethargy and diarrhoea. For diabetes, she was taking metformin as well as insulin. Her most recent pathology was only for urea and electrolytes. Advice The HMR was an opportunity to educate her and provide CMIs for each of her medicines. With no recent full blood counts, her lethargy may have been due to vitamin B12 deficiency. The metformin may have caused diarrhoea as the dose had been increased recently. She had been taking clopidogrel for her stent since May 2019. She was also prescribed warfarin for her LV thrombus but did not have a MedicAlert bracelet. Recommendation At the review we discussed, at length, her medications and the need for a MedicAlert bracelet, which she agreed to organise. She has a dose administration aid but would forget to take her bed-time medicine as she had medicines in the pack for dinner. I contacted her pharmacy and asked staff to change her bedtime medicine to dinner time. I contacted the GP about possible anaemia and told Mary the metformin may be causing her diarrhoea. Follow-up 1 The first follow-up service was 6 months later as the initial review was conducted prior to the new rules. This visit was initiated by the patient as there had been some changes to her medicines. The changes to allow for follow-up enabled me to book in a visit without the need to contact her GP. The GP had conducted blood tests and discovered she had iron deficiency anaemia and she had been started on iron supplements. Her diarrhoea had settled and she was now tolerating the higher dose of metformin. The doses of some of her medicines had been increased. She was confused about her heart failure management plan which I went through again, explained its importance and that she would be on it for life. She was still taking the clopidogrel, so I recommended to the GP that this needed to be reviewed and suggested a PPI in light of her anaemia, especially if the clopidogrel was to be continued. Follow-up 2 Mary now has a MedicAlert bracelet and her clopidogrel has been ceased. Comment Without the follow-up visits and ability to reinforce the importance of continuing to take her medicines Mary may well have ceased some, if not all of them, which would have resulted in a hospital admission. She may also have continued on clopidogrel indefinitely, with the increased risk of gastrointestinal bleeding and the diagnosis of iron deficiency anaemia.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11620 [post_author] => 235 [post_date] => 2020-10-21 14:24:05 [post_date_gmt] => 2020-10-21 03:24:05 [post_content] => Artificial barriers that prevent pharmacists in Queensland from caring for their patients should be removed, PSA has argued in the lead-up to the 2020 state election this month. The election was the perfect time for legislators to commit to new reforms that would help pharmacists improve the health of Queenslanders, PSA Queensland Branch President Shane MacDonald said. This includes allowing pharmacists to administer more routine medicines, such as injectable buprenorphine, enoxaparin (Clexane), denosumab (Prolia), risperidone, insulin or vitamin B12, to improve the management of complex health conditions. ‘Pharmacists are skilled in administering subcutaneous and intramuscular injections,’ he said. ’However, Queensland law currently limits the medicines which can be administered to some vaccines and adrenaline.’ ‘Amending regulations will remove the barrier artificially preventing pharmacists from providing safe, convenient and timely healthcare to Queenslanders and be at no cost to the Queensland government.’ [caption id="attachment_10644" align="alignright" width="224"] PSA Queensland Branch President Shane MacDonald MPS[/caption] With PSA’s Medicine Safety: take care report revealing that more than 90% of patients have at least one medicine-related problem on leaving hospital, PSA has also asked the elected party to establish and fund transition-of-care pharmacists in all Queensland tertiary hospitals to avoid preventable readmissions. Transition-of-care pharmacists would work with a patient’s care team to provide services that could reduce medicine harm. ‘[This could be] through reviewing medicines for patients who have experienced a heart attack, phoning patients to help safely wean doses of steroid medicines or coordinating medicines for patients with complex medicine profiles,’ Mr MacDonald said.
Pharmacists shouldn’t be forgottenThe state also needs a Chief Pharmacist to provide strategic leadership in improving medicine safety for Queensland and to drive coordination and rapid implementation of public health measures during emergencies. This was made clear during the COVID-19 pandemic, with pharmacists overwhelmed not only by demand for medicines but by patients seeking guidance. ‘The absence of a Chief Pharmacist in Queensland during COVID-19 saw delays in implementing vital initiatives to support continuing medicine supply, such as digital image prescriptions and electronic prescriptions,’ Mr MacDonald said. ‘A Chief Pharmacist is needed to provide advice and leadership for timely government responses to emergencies as they occur and to deliver on Queensland’s commitment to Australia’s 10th National Health Priority Area: The Safe and Quality Use of Medicines.’ The PSA has provided pre-election submissions to the Queensland Labor and Liberal National Parties. [post_title] => Injectable buprenorphine, B12 should be administered by pharmacists [post_excerpt] => Artificial barriers that prevent pharmacists in Queensland from caring for their patients should be removed, PSA has argued in the lead-up to the 2020 state election this month. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => injectable-insulin-b12-should-be-administered-by-pharmacists [to_ping] => [pinged] => [post_modified] => 2020-10-22 12:24:05 [post_modified_gmt] => 2020-10-22 01:24:05 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11620 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Injectable buprenorphine, B12 should be administered by pharmacists [title] => Injectable buprenorphine, B12 should be administered by pharmacists [href] => https://www.australianpharmacist.com.au/injectable-insulin-b12-should-be-administered-by-pharmacists/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11621 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11573 [post_author] => 235 [post_date] => 2020-10-14 13:04:31 [post_date_gmt] => 2020-10-14 02:04:31 [post_content] => Both major political parties in the Australian Capital Territory (ACT) have committed to improving access to vaccinations in the lead-up to the 2020 territory election, where polling closes this Saturday.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11565 [post_author] => 23 [post_date] => 2020-10-14 12:57:22 [post_date_gmt] => 2020-10-14 01:57:22 [post_content] => In a difficult year that began with the bushfire crisis followed by the coronavirus pandemic, it is vitally important to recognise the relationship between a person affected by mental illness, their pharmacist and a healthcare team. This was highlighted on World Mental Health Day (10 October) recently, which encouraged the community to ‘look after your mental health, Australia!’. One in five Australians is affected by mental illness each year, and many more have been impacted by COVID-19. According to World Health Organization (WHO) research, almost 80% of people living with mental illness say that COVID-19 and the national response have made their mental health worse. The Federal Government acknowledged this with a $5.7 billion investment in mental health in the Budget, released last week. Acting PSA President Michelle Lynch said this would pave the way for pharmacists to play a greater role in the delivery of mental health care in Australia. ‘A majority of Australians visit their pharmacist around 14 times a year, and as trusted and accessible health professionals pharmacists often come in contact with patients suffering mental ill-health,’ she said. ‘Enabling pharmacists to recognise potential signs and symptoms of mental ill-health, as well as support patients and refer on to GPs or emergency care, has the potential to not only improve outcomes, but potentially save lives.’
A mental health pharmacist's approachIn central Victoria, mental health pharmacist Jess Hibbert MPS looks after 80 patients across four inpatient wards at Bendigo Health. [caption id="attachment_11567" align="alignleft" width="228"] Mental health pharmacist Jess Hibbert MPS[/caption] She said pharmacists were in the perfect position to identify patients experiencing mental illness and suicidal ideation. COVID-19 has impacted her practice, with increased hospital admissions due to the closure of community-based programs and less social connection. As a hospital pharmacist with a focus on mental health, one of the big challenges she deals with is a lack of compliance. ‘It’s hard because we’re working in the space of dual diagnosis, as a lot of people do have a mental health issue and substance misuse issue and they are interlinked,’ she said. ‘The patients know the importance of their [medicines] but some people with bipolar, for example, they like being in their manic state and don’t understand why we don’t want them to be in it.’ Ms Hibbert also works closely with local community pharmacists who know their patients well, which is important in rural communities with locum GPs and limited health services. ‘Knowing your patients and recognising their risk factors (e.g. family background) is key,’ she said. ‘Remind them about their protective factors, including children, a sense of belonging and support by health professionals.’ She asks ‘how have you been since I saw you last?’ and ‘can you tell me more about how you are feeling?’. She also isn’t afraid to ask pointed questions such as ‘have you thought about taking your own life?’. Ms Hibbert said pharmacists could be champions for suicide prevention programs such as the rural organisation Ripple Effect.
Community pharmacist perspectiveRoslyn Stewart MPS, pharmacist and instructor for Mental Health First Aid (MHFA) Australia, lives in the central Victorian town of Broadford, which remains under Step 3 COVID-19 restrictions. [caption id="attachment_11568" align="alignright" width="257"] Roslyn Stewart MPS was awarded the Victorian Pharmacist Medal in 2019[/caption] She told AP that the pandemic had created many challenges for her community, such as social isolation, financial pressure, homelessness, family violence and exacerbation of mental illness. This has placed enormous pressures on pharmacies and their patients, she said. Ms Stewart runs courses as a volunteer with the Mitchell Suicide Prevention Network and advised pharmacists to watch for changes in regular customers. ‘For many people with mental illness, their struggles might only be revealed in conversation with someone who is empathetic and understanding,’ she said. ‘Pharmacists are in a prime position to have that conversation. Gaining trust is what pharmacists do.’ And in a caring way, ‘don’t be afraid to ask a person directly if they are feeling suicidal,’ she said. ‘There's no evidence that this increases the risk of self-harm, but it shows you are someone who wants to help.’ Ms Stewart said that if a person is suspected of having suicidal thoughts, they should not be left alone until connected with help. Whether in the pharmacy or during a Home Medicines Review, access to the means of self-harm, particularly medicine, should be ascertained and removed by negotiation, if possible. Staged supply may be appropriate. Both Ms Hibbert and Ms Stewart emphasised the importance of discussing medicine safety. This includes management of adverse effects, duration of therapy, adherence issues and, for some, excretion in breast milk. Tailoring information and problem solving with the patient is key, as health literacy may be limited.
Training for pharmacistsIn its draft report on mental health in Australia released in October last year, the Productivity Commission recommended reforms including early intervention strategies, greater investment in services and care coordination. In its response, PSA argued that the report failed to recognise the problems with medicine management in mental health. It also advocated for greater support for pharmacists in early detection and delivery of mental healthcare, and outlined key recommendations for their engagement. Ms Lynch said there was an opportunity to use the skills of pharmacists to improve the use of medicines for mental ill-health by integrating pharmacists into multidisciplinary mental healthcare teams, as well as supporting early detection and intervention for a patient in mental health crisis. The PSA provides government-funded mental health first aid training for pharmacists and pharmacy support staff, which began during the bushfire crisis. Having run many MHFA courses, Ms Stewart encouraged pharmacists to undertake the course offered by PSA, as it teaches the skills to recognise the signs and symptoms of mental illness and covers several crises such as suicidal thoughts, panic attacks and aggressive behaviour. Ms Hibbert also endorsed the PSA training and said it gave her the confidence to approach someone and start a difficult conversation directly. She has also found Beyond Blue’s training sessions for pharmacists useful. [post_title] => How these pharmacists support their patients' mental health [post_excerpt] => On this year’s World Mental Health Day (10 October), the community was encouraged to ‘look after your mental health, Australia!’ [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => marking-world-mental-health-day [to_ping] => [pinged] => https://www.australianpharmacist.com.au/federal-budget-delivers-2-8b-improvement-for-new-medicines-access/ [post_modified] => 2020-10-14 17:32:28 [post_modified_gmt] => 2020-10-14 06:32:28 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11565 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How these pharmacists support their patients’ mental health [title] => How these pharmacists support their patients’ mental health [href] => https://www.australianpharmacist.com.au/marking-world-mental-health-day/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11578 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11556 [post_author] => 1703 [post_date] => 2020-10-14 12:08:38 [post_date_gmt] => 2020-10-14 01:08:38 [post_content] => A novel therapy under investigation could see pharmacists playing a greater role in helping patients to manage some common eye conditions. Researchers at the University of New South Wales (UNSW) Sydney are collaborating with Uka Tarsadia University’s Maliba Pharmacy College in India to investigate contact lenses as drug delivery systems to control, manage and treat various ocular diseases.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11624 [post_author] => 23 [post_date] => 2020-10-21 14:35:42 [post_date_gmt] => 2020-10-21 03:35:42 [post_content] => Pharmacists should use their skills to provide evidence-based advice to consumers purchasing supplements and complementary medicines, according to new research from the University of Queensland. Senior Lecturer at the University of Queensland’s School of Pharmacy Dr Adam La Caze MPS said one in two Australians take complementary medicines – described as products containing herbs, vitamins or nutritional supplements – and many of these are purchased from pharmacies. This is despite a lack of evidence on the efficacy of most of these products.1 ‘In Australia, these products are considered sufficiently safe for self-care and are sold in pharmacies and a range of alternative outlets,’ Dr La Caze said. ‘Our research recognised the conflict between a pharmacist’s responsibility to respect consumer health choice and their duty to provide evidence-based advice.’ To assist in this, Dr La Caze and his colleagues developed a framework to support and guide pharmacists when selling complementary medicines. Their recommendations include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11507 [post_author] => 23 [post_date] => 2020-10-07 19:04:02 [post_date_gmt] => 2020-10-07 08:04:02 [post_content] => Amendments to the Schedule 3 (S3) listing for salbutamol released last week will ease dispensing restrictions, hopefully reducing patient frustration and stopping abuse of some pharmacists. The Therapeutic Goods Administration (TGA) made the amendments to the S3 entry for salbutamol that took effect in March, which aimed to limit excessive demand and stockpiling in the early days of the COVID-19 pandemic in Australia. Seeking to ease and clarify these dispensing restrictions, the amendments include1:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11294 [post_author] => 23 [post_date] => 2020-09-16 13:16:44 [post_date_gmt] => 2020-09-16 03:16:44 [post_content] => The Therapeutic Goods Administration (TGA) has delivered an interim decision to down-schedule low dose cannabidiol from Prescription Only Medicine (S4) to Pharmacist Only Medicine (S3), with additional Appendix M controls, to allow greater access for patients.1 Stakeholders and companies in the cannabis industry have welcomed the move, but some say evidence to support the efficacy of low dose cannabidiol is lacking. Down-scheduling would apply to oral, oral mucosal and sublingual formulations of cannabidiol (CBD) products with requirements including a maximum recommended daily dose of 60 mg or less in packs containing 30 days’ supply or less, where CBD comprises at least 98% of the total cannabinoid content in the product. An additional condition specified in Appendix M, to allow it to be provided by a pharmacist, is that supply is limited to medicines on the Australian Register of Therapeutic Goods.1 PSA provided a submission in response to the proposed amendments, where it acknowledged that greater access to CBD was consistent with the current policy approach and reforms around medicinal cannabis availability and use in Australia.2 However, PSA did not support a separate proposal to exempt from scheduling cannabidiol as 98% or greater of total cannabinoid content, and 0.2% or less of tetrahydrocannabinol content, citing ‘significant concerns around safety implications for patients and carers, as well as the broader public’. 2 PSA National President Associate Professor Chris Freeman noted that the down-scheduling was not requested by the pharmacy profession. ‘Whilst low dose cannabidiol may be relatively safe, it is important that it has a therapeutic purpose and evidence behind the claims,’ Prof Freeman said. The submission also contended that evidence was limited in different indications and patient groups.2 The PSA believes additional Appendix M controls are needed, and did not support the inclusion of CBD in Appendix H (able to be advertised to the public).2 The published outcomes, however, are interim decisions and subject to further public consultation.
Stakeholder responseCBD is one of more than 100 compounds known as cannabinoids found in the cannabis (marijuana) plant, Cannabis sativa. It is the second most prevalent of the active ingredients in cannabis, but is not psychoactive, unlike tetrahydrocannabinol (THC). Brisbane community pharmacist and Executive Chairman and CEO of MedReleaf Australia Russell Harding has seen the benefits of CBD and combination CBD products for patients with many conditions since medicinal cannabis was legalised in 2016. Side effects have been generally mild, he told Australian Pharmacist. As with others working in the cannabis industry, he is eager to see greater accessibility of medicinal cannabis for the vulnerable and disadvantaged. However, he has reservations about the TGA decision. Although clinical trials are underway, Mr Harding believes there is little evidence to support a daily dose of 60 mg and thinks a more appropriate dose would be much higher – at least 200 mg daily. And even low-dose CBD would be cost-prohibitive without a government subsidy, ‘either as a mandated good manufacturing practice-compliant registration process or a new Aust-C category for medicinal cannabis’, he said. Mr Harding foresees the challenges in bringing a low-dose CBD product to market and to achieve ARTG listings with a whole plant medicine. He believes it will be a long time coming.
Challenges for pharmacistsDebbie Rigby FPS, well-known consultant clinical pharmacist, referred to the ‘hype, hope and hoops’ of CBD. ‘Down-scheduling will reduce the hoops, but would probably escalate the hype and hope,’ she told AP. Although down-scheduling would increase access for patients who are likely to benefit from its use, it would bring some challenges for community pharmacists. ‘I think the community’s expectations on the benefits of CBD are often unrealistic and influenced by media and anecdotal hype and false hope,’ Ms Rigby said. ‘A sound understanding of the evidence of benefit and absence of benefit would be essential for community pharmacists.’ ‘As an accredited pharmacist conducting Home Medicines Reviews, I have been asked about the use of CBD and usually spend some time discussing the evidence (or lack of) with patients, as well as considering the potential for drug interactions with the other medicines. We must remain evidence-based in our approach, whilst respecting the consumer’s rights and preferences.’ References
[post_title] => Should cannabidiol be down-scheduled to S3? [post_excerpt] => The Therapeutic Goods Administration (TGA) has delivered an interim decision to down-schedule low dose cannabidiol. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => should-cannabidiol-be-down-scheduled-to-s3 [to_ping] => [pinged] => [post_modified] => 2020-09-16 18:00:50 [post_modified_gmt] => 2020-09-16 08:00:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11294 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Should cannabidiol be down-scheduled to S3? [title] => Should cannabidiol be down-scheduled to S3? [href] => https://www.australianpharmacist.com.au/should-cannabidiol-be-down-scheduled-to-s3/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11300 )
- Australian Government Department of Health: Therapeutic Goods Administration. Notice of interim decisions to amend (or not amend) the current Poisons Standard. 2020. At: www.tga.gov.au/sites/default/files/notice-interim-decisions-proposed-amendments-poisons-standard-acms-and-joint-acms-accs-meetings-june-2020.pdf
- Pharmaceutical Society of Australia. Consultation: Proposed amendments to the Poisons Standard – Joint ACMS-ACCS meeting. 2020. At: www.tga.gov.au/sites/default/files/public-submissions-scheduling-matters-referred-acms-31-and-joint-acms-accs-25-meetings-held-june-2020-psa-01.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11249 [post_author] => 23 [post_date] => 2020-09-09 11:49:18 [post_date_gmt] => 2020-09-09 01:49:18 [post_content] => For the fifth year in a row, more than 2,000 Australians lost their lives to overdose in 2018, according to Australia’s Annual Overdose Report 2020 from Penington Institute. Opioids were the drug group most identified in unintentional overdose deaths, followed by benzodiazepines and stimulants, and alcohol was a contributing factor. The impact of the COVID-19 pandemic is yet to be determined, but is expected to be considerable.1 The 2018 overdose findings included1:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11182 [post_author] => 1703 [post_date] => 2020-09-02 11:43:49 [post_date_gmt] => 2020-09-02 01:43:49 [post_content] => The National Asthma Council Australia has released an updated version of its Australian Asthma Handbook, which includes a new treatment option for adults and adolescents (aged 12 years and over) with mild asthma.
For more information on the Australian Asthma Handbook Update, don’t miss PSA’s webinar on 30 September. For more information and to register, click here.[post_title] => New recommendations for patients with mild asthma [post_excerpt] => The latest version of the Australian Asthma Handbook includes a new treatment option for adults and adolescents with mild asthma. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-treatment-recommendations-patients-asthma [to_ping] => [pinged] => [post_modified] => 2020-09-02 17:27:16 [post_modified_gmt] => 2020-09-02 07:27:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11182 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New recommendations for patients with mild asthma [title] => New recommendations for patients with mild asthma [href] => https://www.australianpharmacist.com.au/new-treatment-recommendations-patients-asthma/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11188 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11642 [post_author] => 3286 [post_date] => 2020-10-23 07:08:59 [post_date_gmt] => 2020-10-22 20:08:59 [post_content] =>
IntroductionConventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and, more recently, biological and targeted-synthetic DMARDs (bDMARDs and tsDMARDs) have enhanced management outcomes for patients with diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Optimising pharmacotherapy for these patients requires an understanding of the risks and benefits of available treatments. It also requires an appreciation of how the medicine ‘fits in’ with the patient’s life. Pharmacists are in a unique frontline position to understand how a patient’s medicine and disease affect their quality of life and activities of daily living, and provide advice and resources to help optimise care. Discussed in this article is the role of methotrexate (MTX) and b/tsDMARDS in the management of RA, PsA and AS. It is one of a number of resources and activities that will be available in support of the Value in Prescribing – bDMARDs Program.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|RHEUMATOID ARTHRITIS||PSORIATIC ARTHRITIS||ANKYLOSING SPONDYLITIS|
|TNF-inhibitors Adalimumab Certolizumab pegol Etanercept Golimumaba Infliximaba CD20 inhibitor Rituximab CTLA4-Ig Abatacepta IL-6 inhibitor Tocilizumab JAK inhibitor Baricitinibb Tofacitinibb Upadacitinibb||TNF-inhibitors Adalimumab Certolizumab pegol Etanercept Golimumab Infliximab IL-17 inhibitor Ixekizumab Secukinumab IL-12/23 inhibitor Ustekinumab JAK inhibitor Tofacitinibb||TNF-inhibitors Adalimumab Certolizumab pegol Etanercept Golimumab Infliximab IL-17 inhibitor Secukinumab|
|bDMARDs information hub||NPS MedicineWise and Targeted Therapies Alliance||www.nps.org.au/bdmards|
|Position statement on lowdose METHOTREXATE (oral and subcutaneous dosage forms)||Council of Australian Therapeutic Advisory Groups (CATAG)||www.catag.org.au|
|Position Statements and other Clinical Recommendations||Australian Rheumatology Association||https://rheumatology.org.au/gps/clinical-guidelines.asp|
|Clinical practice guidelines||European League Against Rheumatism||www.eular.org/recommendations_home.cfm|
|Clinical practice guidelines||American College of Rheumatology||www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines|
|Rheumatoid arthritis: low-dose methotrexate action plan||NPS MedicineWise||www.nps.org.au/professionals/rheumatoid-arthritis#resources|
|Biosimilar Awareness Initiative for health professionals and consumers||Biosimilar Awareness Initiative Australian Government, Department of Health||www1.health.gov.au/internet/main/publishing.nsf/Content/biosimilar-awareness-initiative|
|Biosimilar Hub. Information on biosimilars for health professionals and consumers||Generic and Biosimilar Medicines Association (GBMA) Education||https://biosimilarhub.com.au/ https://arthritisaustralia.com.au/|
|Resources for pharmacists and consumers||Arthritis Australia||https://arthritisaustralia.com.au/healthcareprofessionals/pharmacists/|
|Rheumatoid arthritis support program||Arthritis Australia||https://myra.org.au/|
|painHEALTH Clinically supported information and support to help patients manage musculoskeletal pain||painHEALTH, Department of Health, Western Australia, Curtin University, the University of Western Australia and the Musculoskeletal Health Network||https://painhealth.csse.uwa.edu.au/|
|Patient and condition information||Australian Rheumatology Association||https://rheumatology.org.au/patients/|
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Case scenarioAnnie, a regular consumer at your pharmacy, brings in a script for her daughter Elsie, 3. The script is for amoxicillin syrup 250 mg/5 mL, with 5 mL to be given 3 times a day for 5 days. You notice that the doctor has handwritten a note on the bottom of the prescription – wait 48 hours. The prescription is dated today. You ask Annie what her doctor said about the antibiotics and why they have been prescribed for Elsie. She explains that Elsie has had an earache since last night, has been unwell with a bit of a cough and has been irritable. The doctor explained that Elsie may have otitis media and gave her a prescription for the antibiotic with direction to monitor Elsie and fill the prescription only if Elsie’s symptoms do not improve or worsen in 48 hours. Annie explains that neither of them got much sleep last night and that she would rather fill the prescription today. You tell Annie you understand how difficult it must be to see Elsie in pain. When you ask Annie about what she has been giving Elsie to relieve the pain, Annie tells you she doesn’t like giving Elsie pain relievers.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Case scenario continuedYou explain to Annie that there are some risks to antibiotic treatment, particularly if they’re not needed and that antibiotics won’t necessarily reduce the pain. You explain that Annie should follow her doctor’s advice as most cases of otitis media resolve spontaneously. If Elsie’s symptoms do not improve or worsen in the next 48 hours, Annie should come back to the pharmacy to fill the prescription. You also explain that when used correctly, regular paracetamol is safe and effective at helping with ear pain. Annie accepts your explanation and is happy to wait to have the prescription filled. She asks about using paracetamol for Elsie and seems less anxious now.
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IntroductionAngina refers to episodes of ischaemic chest pain or discomfort that lasts for 10 minutes or less and is alleviated with rest.1
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|MODIFIABLE CARDIOVASCULAR DISEASE RISK FACTORS||NON-MODIFIABLE CARDIOVASCULAR DISEASE RISK FACTORS|
|COMMON SYMPTOMS OF ACS||LESS COMMON SYMPTOMS OF ACS|
BOX 1 – KEY STEPS FOR SELF-MANAGEMENT OF AN ANGINA EPISODE
|TREATMENT OF ANGINA EPISODES|
|Glyceryl trinitrate sublingual spray||400–800 microgram (1–2 sprays) sublingually, as needed to treat acute angina|
|OR 400 microgram (1 spray) 5–10 minutes prior to activity likely to precipitate angina|
|Glyceryl trinitrate sublingual tablet||300–600 microgram (0.5–1 tablet) sublingually, as needed to treat acute angina|
|OR 5–10 minutes prior to activity likely to precipitate angina|
|Isosorbide dinitrate sublingual tablet||5–10 mg (1–2 tablets) sublingually, as needed to treat acute angina|
|OR 10 minutes prior to activity likely to precipitate angina|
|PREVENTION OF ANGINA EPISODES|
|DRUG||ROLE IN THERAPY|
|Beta blockers||First-line therapy for prevention of stable angina unless contraindicated or not tolerated|
|Bisoprolol, carvedilol, nebivolol or long-acting metoprolol are useful in comorbid heart failure|
|Diltiazem||First-line therapy for the prevention of stable angina. Alternative agent to beta blockers|
|Avoid in heart failure|
|Avoid in combination with beta blockers due to risk of heart block|
|Verapamil||First-line therapy for the prevention of stable angina. Alternative agent to beta blockers|
|Avoid in heart failure|
|Avoid in combination with beta blockers due to risk of heart block|
|Dihydropyridine calcium channel blockers||First-line therapy for prevention of stable angina. Alternative agent to beta blockers, but may worsen angina and cause reflex tachycardia when first started|
|Can be added to beta blocker therapy if beta blocker therapy alone is inadequate|
|Isosorbide mononitrate (slow release oral tablet)||Second-line therapy for prevention of stable angina where beta blockers and or calcium channel blockers are contraindicated, not tolerated or provide inadequate symptom control|
|Dose once daily to avoid tachyphylaxis|
|Glyceryl trinitrate (transdermal patch)||Second-line therapy for prevention of stable angina where beta blockers and or calcium channel blockers are contraindicated, not tolerated or provide inadequate symptom control|
|Requires a patch-free interval to avoid tachyphylaxis|
|Nicorandil||Third-line therapy for the prevention of stable angina. Can be added to beta blockers, calcium channel blockers or long acting nitrates (or combinations of these agents), where symptom control is inadequate|
|Ivabradine||Third-line therapy for the prevention of stable angina. Can be added to beta blockers, dihydropyridine calcium channel blockers or long acting nitrates (or combinations of these agents) with caution, where symptom control is inadequate|
|Indicated for refractory angina in patients with heart rate over 70 beats per minute|
|Perhexiline||Specialist use for the prevention of angina refractory to other medical or surgical treatment|
|Requires therapeutic drug monitoring|
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IntroductionBlood cancers, or haematological malignancies, are a complex group of diseases linked by their origin in the bone marrow where blood cells are produced.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|LEVEL OF MOLECULAR RESPONSE (MR)||EQUIVALENT BCR-ABL1 %||SIGNIFICANCE AND ALTERNATIVE TERMS|
|100%||Median at diagnosis|
|MR1||≤10%||Also known as early molecular response (EMR) Ideally should be reached by 3 months|
|MR2||≤1%||Equivalent to complete cytogenetic remission (CyR) Ideally should be reached by 6 months|
|MR3||≤0.1%||Also known as major molecular response (MMR) Ideally should be reached by 12 months A level of remission associated with optimal overall survival|
|MR4||≤0.01%||Below this level is termed deep molecular response (DMR) The minimum level of response required for consideration of treatment free remission (TFR)|
|MR4.5||≤0.0032%||May be associated with higher chance of successful TFR|
|MR5||≤0.001%||Current limit of detection|
|PATIENTS WITH RECENTLY DIAGNOSED CML||PATIENTS WITH ESTABLISHED THERAPY FOR CML|
|DOSING||KEY ADVERSE EVENTS||CYP3A4 SUBSTRATE||PPI/H2 INTERACTION||QT INTERVAL PROLONGATION|
|Imatinib||Daily with food||
|Nilotinib||Twice daily on empty stomach||
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IntroductionBenign prostatic hypertrophy/hyperplasia (BPH) is the histological cause of benign prostatic enlargement; it is a common cause of lower urinary tract symptoms (LUTS) in men, usually over the age of 40.1,2 An increase in prostatic smooth muscle tone (dynamic component) and an increase in benign prostatic tissue narrowing of the urethral canal (static component) are the two main components.3 BPH affects nearly all men at some stage, however, some men remain asymptomatic.2 BPH is usually not life-threatening but can have a significant effect on quality of life (QoL).4 Global estimates of BPH vary.5,6,7 In Australia between 2009 and 2011, more than 200,000 cases of BPH were managed by general practitioners (GPs) in the community.1
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|SUMMARY OF TREATMENT OPTIONS FOR BPH|
|1. Non-pharmacological management options
|3. Surgical management|
|4. Novel/emerging therapies|
|DRUG||MECHANISM OF ACTION||PRECAUTIONS/ADVERSE EFFECTS||MONITORING||COMPARATIVE AND OTHER INFORMATION|
|Silodosin||Alpha1A receptor antagonist Significantly less systemic side effects such as hypotension.||Highest propensity to cause ejaculatory dysfunction. Start with a reduced dose if CrCl <60 mL/min. Not recommended for CrCl <30mL/ min. No data for use in severe hepatic impairment Can cause first dose hypotension Drug specific adverse effects include thirst, loose stools||Monitor for hypotension particularly when used with other antihypertensives||More selective than but similar efficacy to tamsulosin Significant improvements in symptom scores at 12 weeks Currently not covered under Pharmaceutical Benefit Scheme (PBS) May be a drug of choice in men where ejaculatory side effects are not a concern|
|Tamsulosin||Alpha1A receptor antagonist Significantly less systemic side effects such as hypotension||Can cause retrograde ejaculation First dose hypotension particularly in renal impairment. Caution in hepatic impairment||Monitor for hypotension particularly when used with other antihypertensives and in older patients||Reimbursement is only covered under Repatriation PBS|
|Alfuzosin||Alpha1 receptor antagonist||Use with caution in renal impairment Contraindicated in hepatic impairment||Monitor for hypotension particularly when used with other antihypertensives Alfuzosin contraindicated with strong Cytochrome P450 subtype 3A4 inhibitors||Reimbursement is only covered under Repatriation PBS|
|Prazosin||Alpha1 receptor antagonist Highest systemic effect particularly on blood pressure Higher propensity to cause dizziness and discontinuation of therapy. No longer recommended as first line||Use with caution in renal impairment||Close monitoring required for hypotensive adverse effects – particularly after the first dose Use with caution in older adults||Available under general schedule of PBS|
|DRUG||% REDUCTION IN DHT CONCENTRATION||DOSING, ONSET OF ACTION||SOME ADVERSE EFFECTS AND COMPARATIVE INFORMATION||AVAILABILITY|
|Dutasteride – inhibits both the type 1 and type 2 isoenzymes of 5-alpha-reductase.||90–95%||Longer half-life (3–5 weeks) than finasteride. Clinical improvement can take up to 3 to 6 months. Patients and their female partners should be counselled on handling precautions; risk of feminisation of male foetus.||Reduced libido, erectile dysfunction, ejaculation disorder (including decreased ejaculate volume, breast tenderness and enlargement. Finasteride and dutasteride appear to be similarly effective in reducing prostate size, improving symptoms and urinary flow rate. Both have similar side effect profile.||Available as mono drug or in combination with tamsulosin. Available under both general and repatriation schedule of PBS.|
|Finasteride only inhibits the type 2 isoenzyme.||75%||Half-life – 6 hours Clinical improvement can take up to 3 to 6 months.||Long-term use of 5ARIs reduces the risk of acute urinary retention and the need for surgery.||Finasteride is only available as mono-drug. Available under both general and repatriation schedule of PBS.|
|PLANT EXTRACT||PROPOSED MECHANISM OF ACTION||QUALITY OF EVIDENCE|
|Saw palmetto – fruit (Serenoa repens)||Antiandrogenic, Anti-inflammatory||Saw Palmetto (Serenoa repens) remains the most widely used herbal medication for the treatment of BPH Despite its popularity, clinical evidence is conflicting. A Cochrane review published in 2012 concluded that Serenoa repens was no more effective than placebo for treatment of urinary symptoms consistent with BPH|
|African plum bark (Pygeum africanum)||Antiandrogenic, potential growth factor manipulation, anti-inflammation actions Decrease in nocturia, residual urine volume||Likely effective, however lacks strong clinical evidence; requires further robust clinical trials|
|Pumpkin– seed (Cucurbita pepo)||Phytosterols are thought to be amongst the active compounds||Possibly effective, however requires further robust clinical trials|
|Cernilton pollen (Secale cereale, Rye)||Inhibition of alpha adrenergic receptors||Results from a systematic review observed a modest improvement in symptoms and did not significantly improve peak and mean urine flow rates|
|South African star grass root (Hypoxis rooperi)||Antiandrogenic, alteration in detrusor function||Nil robust evidence|
|Stinging nettle root||Steroid hormone manipulation reducing prostate growth||Nil robust evidence|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11615 [post_author] => 1703 [post_date] => 2020-10-21 14:08:58 [post_date_gmt] => 2020-10-21 03:08:58 [post_content] => Community pharmacist Dianne Brown MPS has helped many patients achieve better health outcomes during her four-decade career. The secret? Building strong relationships and a desire to help. Ms Brown, who recently received the Lifetime Achievement Award at the Tasmanian Pharmacist Awards, said forming connections had been the highlight of her 42 years in pharmacy. ‘Building that relationship of trust and knowing patients well enough to know when things are wrong have been the main things I have enjoyed,’ said Ms Brown, owner of TerryWhite Chemmart Ravenswood in Launceston. ‘We had a gentleman in a few weeks back who hadn’t been feeling very well and we sat him down and took his blood pressure. It was 200/120. ‘He’s now on medication and very grateful. ‘We were also recently able to help two long-term customers to get a dose administration aid … It’s about knowing your customers, knowing how to approach them and sometimes trying different things.’
Changing timesMs Brown, now 65, said it was a very different work environment when she began her pharmacy career. ‘We were writing in prescription books,’ she told Australian Pharmacist. ‘Having everything on the computer has been a huge step forward. ‘It has also brought with it a whole slew of information – continuing education and health apps, for example.’ Technology has impacted pharmacy in other ways, she said. ‘I remember using huge glucometers to test customers’ glucose levels,’ Ms Brown said. ‘Now we use tiny ones and we can offer people cholesterol testing, vaccinations, health checks and pharmacist-prescribed medicines too.’ While the positives of progress are many, Ms Brown said everyone has become busier. ‘Way back when you rang a surgery to talk to a doctor, you could get an answer within 30 seconds,’ she said. ‘Now it’s almost impossible to speak to a GP.’
A challenging yearAs with many pharmacists, COVID-19 has made this year the most challenging of Ms Brown’s pharmacy career. ‘Many people were not sure what they were supposed to be doing – seeing the doctor, calling the doctor, turning up at surgery – and that was complicated by prescriptions being faxed and the quick introduction of e-scripts,’ she said. ‘The real battle was just keeping up with paperwork and marrying everything up.’ Her hope for the future is for a more integrated health system. ‘It is so fragmented and people get confused about who they are supposed to see,’ she said. ‘There doesn’t seem to be a clear path, especially for people with a definite illness. ‘Pharmacy could play a big part in that. ‘There needs to be someone on the ground who can have a conversation with patients in a non-threatening environment.’ Ms Brown currently works 50 hours a week and, while she has no plans to retire, would like to spend more time outside the pharmacy. ‘I’d like to walk more with friends, cook, read and travel – I’m seeing quite a bit of Tasmania.’ Ms Brown was presented with her Lifetime Achievement Award by the Tasmanian Minister for Health Sarah Courtney. Ilwoo Park claimed the Early Career Pharmacist of the Year Award, presented by PSA Tasmania Branch President Dr Ella van Tienen. [post_title] => Lessons from four decades in pharmacy [post_excerpt] => Community pharmacist Dianne Brown MPS has helped many patients achieve better health outcomes during her four-decade career. The secret? Building strong relationships and a desire to help. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => dianne-brown-four-decades-in-pharmacy [to_ping] => [pinged] => [post_modified] => 2020-10-22 12:24:33 [post_modified_gmt] => 2020-10-22 01:24:33 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11615 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Lessons from four decades in pharmacy [title] => Lessons from four decades in pharmacy [href] => https://www.australianpharmacist.com.au/dianne-brown-four-decades-in-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11616 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11608 [post_author] => 1925 [post_date] => 2020-10-21 08:58:42 [post_date_gmt] => 2020-10-20 21:58:42 [post_content] => Rather than be overwhelmed by COVID-19, Wint Ye Ywe Phu used social media to help pharmacy interns feel connected. Finding herself as an intern in the middle of the worst pandemic in 100 years was the challenge confronting Wint Ye Ywe Phu in 2020. The former avid traveller who photographed her travels around Western Australia, and vlogged about adventures in Singapore, Taiwan and her native Myanmar, is now interning at Market City Pharmacy in the Perth suburb of Canning Vale. She graduated from the University of Western Australia with a Master of Pharmacy last year. ‘For me, 2020 has definitely been a challenging year. I was adapting to my first year of full-time work, studies, assignments, then faced isolation from friends and family,’ she says. ‘On top of that I was dealing, for the first time, with the great variety of personalities who presented at my local community pharmacy during the COVID-19 period, which was life changing for everyone. ‘I imagine my fellow interns were, like me, almost overwhelmed by the changes taking place in pharmacy as a result.’
Using Facebook to connectRather than be overwhelmed, Ms Phu stepped forward to help others, selecting social media as the way forward. ‘My pharmacist and I came up with an idea to use social media to not only help me but also my fellow interns get through this pandemic together. We wanted them to feel connected,’ she explains. ‘We created a group called “Mindful Pharmacist Campfire” on Facebook. We committed to upload a new informative video each day. I worked my way through the top 100 drugs in 100 days. ‘I was fortunate to have my mentor’s support. We wanted to bring together pharmacy students, pharmacy interns, and even pharmacists themselves, during this stressful period, so we would all not feel as if we were alone.’ Her pharmacy intern colleagues gave Ms Phu great feedback, and soon it became a daily activity that was ‘enjoyable and also informative’. https://www.youtube.com/watch?v=SV51Ng25I_g&feature=emb_title
Benefits of social mediaMs Phu’s ‘Campfire’ project brought her recognition from other interns and the wider pharmacy community. ‘Being recognised for something I enjoyed doing was definitely very pleasurable for me,’ she says. ‘The benefits of using social media to communicate were something that shone through during the crisis. ‘Having seen how effective it can be, I would hope – for my future in pharmacy – to be able to innovate and adapt social media using whatever resources I have available to close up some gaps in the healthcare community. After all, times are always changing.’
Passion for learningDuring her time at Canning Vale, Ms Phu has developed a passion for community pharmacy. ‘I have always been told by my seniors not to feel as if I needed to have mastered everything by the time I graduated,’ she says, ‘and that there would always be learning opportunities. It is true! ‘I have learnt so much during my internship. I am definitely overwhelmed to be awarded the title of “Intern of the Year” and I honestly still don’t know where [pharmacy] will take me. But I am willing to try out the different roles and responsibilities pharmacy has to offer.’ Ms Phu loves listening to the stories of the people she meets through her work in the pharmacy. ‘I strongly believe in the ability of everyone to access the same level of healthcare, and that the removal of barriers will be the game changer in the healthcare system. ‘I work in a district where there are diverse cultures, so there are language, cultural, physical and other barriers. If we are able to overcome them, we as pharmacists can continue to contribute much more to society. ‘I do look forward to more changes in pharmacy because, after all, this is only the start of my career.
What change in pharmacy in the past 2 years were you most excited about?The recent shift from paper-based prescriptions to electronic scripts. It not only saves the time normally used to dispense scripts and reduces potential errors, it could potentially change the look and feel of pharmacies and improve health outcomes for all patients.
What action in PSA’s Pharmacists in 2023 report is the most important to be realised?Action 8 stood out to me. To generate more funding into this field is to recognise the value and quality of pharmacist care. Pharmacists have always been on the front line of our healthcare and available for clients to access. Funding to place them in a position where they can be directly involved in the healthcare system, and at the same time offer more funded services, will be beneficial for all stakeholders. Explore new paths at www.psa.org.au/career-and-support/career-pathways/ [post_title] => Wint Ye Ywe Phu is PSA's Intern of the Year [post_excerpt] => Rather than be overwhelmed by COVID-19, Wint Ye Ywe Phu used social media to help pharmacy interns feel connected. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => 2020-intern-of-the-year [to_ping] => [pinged] => [post_modified] => 2020-10-21 13:51:37 [post_modified_gmt] => 2020-10-21 02:51:37 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11608 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Wint Ye Ywe Phu is PSA’s Intern of the Year [title] => Wint Ye Ywe Phu is PSA’s Intern of the Year [href] => https://www.australianpharmacist.com.au/2020-intern-of-the-year/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11610 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11549 [post_author] => 2390 [post_date] => 2020-10-13 06:52:42 [post_date_gmt] => 2020-10-12 19:52:42 [post_content] => The first woman to win a PSA Lifetime Achievement Award, Debbie Rigby FPS has been many things – mentor, educator, advocate and much more – during her 4-decade career of ‘two halves’. There was never any question in Debbie Rigby’s mind about career choice. Though encouraged at school to ‘do medicine’, for her it was always pharmacy. As a school student on the bus in Brisbane, she remembers stopping at an old-school compounding pharmacy, marvelling at its array of vintage apothecary bottles, ‘fascinated by the idea of all these different chemicals’. And with her father and two brothers in chemistry-related professions, she just had to accept ‘chemistry was in my blood’, she says. After finishing her degree at the University of Queensland, she spent her year of ‘pre-reg’ – now internship – at a Brisbane community pharmacy, supplying prescriptions to residential aged care facilities (RACFs). While doing the ‘grunt work’ of delivering medicines to aged care she found herself looking at what additional insight a pharmacist could add over and above dispensing. One ‘light bulb moment’ came shortly after ACE inhibitors became the preferred treatment for hypertension, superseding diuretics and potassium. As ACE inhibitors also increased potassium levels, Ms Rigby suggested to the attendant general practitioner (GP) that perhaps patients shouldn’t remain on regular potassium chloride supplements 3 times a day. She helped him over his initial shock at advice from a pharmacist by offering him some papers on the subject. During this pre-reg year she met people who were instrumental in ‘setting the tone’ for her pharmacy career. https://www.youtube.com/watch?v=gH-yG1ghGPo
Consultancy workMuch later, after she’d moved into hospital and geriatric pharmacy, profession stalwart Peter Brand suggested she write a newsletter aimed at registered nurses in RACFs. ‘That really started me on the second half of my career, doing consultancy work, doing medication reviews and other services to aged care facilities.’ The modest description ‘pharmacy consultant’ fails to paint a full picture of the vast scope of Ms Rigby’s accomplishments and her influence on the profession and policy.
Accolades over decadesUndoubtedly one of Australian pharmacy’s highest profile figures, she has seemingly permanent resident status on every professional ‘who’s who’ top list. The winner of PSA’s Pharmacist of the Year (2001) and PSA Queensland Bowl of Hygeia 2002, a full list of her achievements, appointments and qualifications fills pages. Ms Rigby has recently completed a marathon 12 years on the NPS MedicineWise board – four consecutive stints of 3 years apiece.
Mentoring and reviewsThough she has these achievements to her credit, Ms Rigby is renowned for being a humble, approachable figure, willing to make the time to answer questions and help in mentoring. A tireless advocate for the Quality Use of Medicines (QUM) and pharmacists in general practice, Ms Rigby is still more than enthusiastic about the opportunities for increased co-operation between pharmacists and GPs. And what excites her right now is how far HMRs and RMMRs have evolved over the last 20 years. ‘In the last 2–3 years we’ve been seeing roles as GP pharmacists working in a GP practice in a non-dispensing role – which is what I’ve been doing – as well as pharmacists also working in aged care,’ she says. ‘I think those sorts of roles for pharmacists, as part of a team looking at better medicine management, will potentially have a huge impact but also recognise the impact a pharmacist can have in that collaborative environment,’ she says.
Where to from here?‘There are many more cages to rattle and mountains to climb,’ she says. Ms Rigby intends to continue as a strong advocate for integrated pharmacist roles and, through her company Pharmeducation, wants to support the ethos of life-long learning. Fully cognisant of the importance of her being the first female recipient of PSA’s Lifetime Achievement Award, she says ‘it makes the award even more special to me’.
What change in pharmacy in the past 2 years were you most excited about?The role of pharmacists in immunisation is exciting, especially now we’re faced with the COVID-19 pandemic and the prospect of a vaccine in the not-too-distant future. The capacity for community pharmacy to roll that out to the population is exciting for the pharmacy profession generally, community pharmacy in particular, and also for the Australian population.
What action in PSA’s Pharmacists in 2023 report is the most important to be realised?The first one – medicines safety and use of medicine. The words that stand out are taking 'responsibility' and 'quality of medicine'. The PSA has made great advances in the past few years motivating and challenging the profession, but we need to feel empowered and that goes right back to undergraduate training.
|Explore new paths at www.psa.org.au/careerpathways|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 11501 [post_author] => 1925 [post_date] => 2020-10-07 18:50:08 [post_date_gmt] => 2020-10-07 07:50:08 [post_content] => A strong advocate of pharmacy in the Northern Territory, Samuel Keitaanpaa MPS has an enviable track record of supporting ECPs as an outstanding leader. With wrecks in the harbour and rivers and lakes to explore around Darwin, Sam Keitaanpaa might just as easily have become a scuba diving instructor. But the Kendo enthusiast, whose team represented the Northern Territory (NT) in the Japanese martial art and placed third in the national championships last year, likes to learn and help people, ‘and pharmacy is perfect for that’, the new father explains. Mr Keitaanpaa is an enthusiastic role model in the world of pharmacy, thanks to his work on the SA/NT branch committee and advocating for pharmacists in Darwin. ‘My passion has always been in how people use medicine, how they access health systems and how well (or frequently, not well) those systems meet their needs.’ The desire for better models of medicine use and reduced instances of inappropriate use of medicine have been at the centre of his career. https://www.youtube.com/watch?v=gz1EbpPt21c
Recognition of valuePharmacy is at a pivotal moment, according to Mr Keitaanpaa. ‘We are getting more recognition for the value we bring to the health of Australians and our own need to move away from supply-centric models. ‘There is now a massive opportunity to take the lead in a range of non-traditional settings,’ he says ’where our skills in medicine, law, health systems and logistics can make a significant difference in how our services care for our clients. 'In the NT, I have tried to encourage every opportunity for better recognition of pharmacy and medicine safety, and to build links with other health sectors.’
Meet them where they areGrowing up in the NT, Mr Keitaanpaa saw first hand how models of care stayed stagnant for many years and sometimes led to poor patient outcomes. ‘We too often tried to force people to manage their health in the way we told them to,’ he says, ‘rather than giving them the knowledge and confidence to manage it themselves, and presenting a model that matched their own views of what being healthy meant. ‘The only way to bring people to where we want them to be is to meet them where they are and work with them, not force them into a system they don’t feel involved in.’ Mr Keitaanpaa has built his career looking for problems that need fixing and increasing his skills to do that. ‘Probably the most influential parts have been working with my community in Darwin’s rural area, the trust I have built and the personal relationships I’ve developed with many people in that community,’ he says. ‘To know that my base practice and effort is making people’s lives easier, giving them skills to manage their own and their families’ health better, and almost making them mini-advocates for others to engage with the health system, is extremely rewarding and reaffirms my desire to see pharmacists maximise our impact on communities.’
Future prioritiesMr Keitaanpaa has two areas of focus. ‘I would like to see a real telehealth service between pharmacies and health services that focuses on emulating the range of activities a pharmacist can do, not just a phone or video consultation. ‘I am excited about the results of the IPAC trial and hopeful the next stage will be to augment individual services in remote areas, to allow pharmacists to be part of the entire operation of that service, not just auditing drug rooms and the occasional medicine review. ‘With our current IT capacity, there is so much we can do to work with staff on the ground and support their communities.’ Mr Keitaanpaa would also love to lead a partnership project in the NT that could be replicated elsewhere. When not fishing, camping or walking in national parks with his partner (and baby), another of his goals is to improve opioid pharmacotherapy, which has ‘undeniable’ benefits. ‘Pharmacists are a vital part of team-care arrangements with alcohol and other drug services and need to be given more scope to encourage better uptake and use of supportive programs.’
What change in pharmacy in the past 2 years were you most excited about?The ever-increasing integration of information technology into how medicines are prescribed and then reviewed by pharmacists. The My Health Record, real-time prescription monitoring, e-prescribing, and pharmacist-curated medicines lists all increase the visibility of the pharmacist and offer ways to work with clients, manage their medicines and encourage them to be active participants in their health discussions.
What action in PSA’s Pharmacists in 2023 report is the most important to be realised?I think it’s impossible to separate the actions, but if we focus on Action 9, we will actually capture the others. If we can build a model of pharmacy in the bush that increases collaboration and offers opportunities to grow skills, and be recognised and remunerated for it, we can transpose this to other settings. [post_title] => Samuel Keitaanpaa MPS is PSA's Early Career Pharmacist of the Year [post_excerpt] => A strong advocate of pharmacy in the Northern Territory, Samuel Keitaanpaa MPS has an enviable track record of supporting ECPs as an outstanding leader. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => samuel-keitaanpaa-mps-psa-early-career-pharmacist-of-the-year [to_ping] => [pinged] => [post_modified] => 2020-10-07 18:50:46 [post_modified_gmt] => 2020-10-07 07:50:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11501 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Samuel Keitaanpaa MPS is PSA’s Early Career Pharmacist of the Year [title] => Samuel Keitaanpaa MPS is PSA’s Early Career Pharmacist of the Year [href] => https://www.australianpharmacist.com.au/samuel-keitaanpaa-mps-psa-early-career-pharmacist-of-the-year/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11502 )
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An unswerving idealism and a drive to safeguard the mental health and physical wellbeing of her colleagues has earned Melbourne’s Kay Dunkley MPS the title of Symbion PSA Pharmacist of the Year.
A challenging initiation into pharmacy via the Neonatal Intensive Care Unit at Victoria’s Monash Medical Centre set Kay Dunkley on a career path that has spanned more than three decades.
‘It sounds gruesome, I know, but being involved in the regular neonatal mortality meetings for the medical and nursing staff, such a lot can be learnt through investigation of what contributed to a death,’ she says.
Positioned at the coalface of grief as a young adult, Ms Dunkley acquired an instinctive empathy for people dealing with trauma, loss and depression, including those within her own profession.
This led to her role as executive officer of the Pharmacists’ Support Service (PSS), which under her leadership over the past 15 years has grown from a fledgling single-state volunteer group to an essential nationwide counselling organisation.
Inspiring role models
Along the way Ms Dunkley expanded her mission to support healthcare workers in high-pressure and stressful workplaces, taking on the dual role as coordinator at the Australian Medical Association Victoria’s Doctor Wellbeing Program.
‘I fell into a career in pharmacy as a student who studied sciences and liked working with people, but I never had the desire to study medicine,’ she says.
‘The pharmacy profession has so many inspiring role models, and over my career I have been exposed to many of these wonderful people.’
They have all had a passion for pharmacy, she says, and are acutely aware of the broad scope of opportunities the profession provides to make a difference in the community.https://www.youtube.com/watch?v=eg6-A4sBjb8
A wife and mother of two young adult children, Ms Dunkley spoke to Australian Pharmacist on the phone from her East Brighton home while in lockdown in Melbourne.
Apart from working long hours in isolation, she keeps busy building a new fox-proof chook pen in the family’s yard and watching the documentary series Emergency, set in the Royal Melbourne Hospital.
‘I keep watching, hoping that at least one episode will include a pharmacist,’ she laughs.
In times where it seems the entire country has at some point been in a state of emergency, the services provided by the PSS have never been more needed.
The real heroes
As bushfires swept through large swathes of the country early this year, PSS volunteers heard reports of pharmacists and pharmacy staff working without power or phone connections and refusing to take payment to ensure their communities had access to essential medicines.
‘There were pharmacists who slept in their cars as they could not travel out of bushfire affected areas, and others who organised delivery of medicines to areas via jet ski when there was no road access,’ she says.
‘There were those who attended evacuation centres to organise medication for people who had lost everything, and some of those pharmacy workers had lost their own homes and property in the fires.’
Then the pandemic hit. Pharmacy staff once more found themselves on the front line.
‘In my opinion these are the heroes of pharmacy who are all deserving of this award,’ Ms Dunkley says.
‘I hope that in some way I am accepting this award on their behalf.’
A prolific contributor in her field, she has spread research and experience across multiple platforms including journals, research publications, conference stands, webinars, lectures and on social media.
The dedication comes in part out of a frustration, Ms Dunkley says, because unlike doctors, pharmacists are rarely recognised as an at-risk group for poor mental health, despite the profession’s suicide rate being significantly higher than the national average.
She believes in the power of kindness and compassion in healthcare, not only for patients and customers but also for professional colleagues from other disciplines and one another.
What change in pharmacy in the past 2 years were you most excited about?In the community pharmacy setting I am excited about electronic prescribing that will reduce a lot of paperwork and streamline the dispensing of medicines, as well as remove a lot of red tape and allow pharmacists to focus on clinical matters rather than clerical issues. I am also pleased to see 24-hour pharmacy services becoming a reality both in hospitals and in community pharmacy as pharmacists provide essential services.
What action in PSA’s Pharmacists in 2023 report is the most important to be realised?All 11 actions for change are important but you can’t achieve most of them without a pharmacy workforce that is well equipped to address Australia’s existing and emerging health challenges. [post_title] => Kay Dunkley MPS is PSA's 2020 Pharmacist of the Year [post_excerpt] => A challenging initiation into pharmacy via the Neonatal Intensive Care Unit at Victoria’s Monash Medical Centre set Kay Dunkley on a career path that has spanned more than three decades. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => kay-dunkley-2020-pharmacist-of-the-year [to_ping] => [pinged] => [post_modified] => 2020-09-30 17:12:06 [post_modified_gmt] => 2020-09-30 07:12:06 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=11391 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Kay Dunkley MPS is PSA’s 2020 Pharmacist of the Year [title] => Kay Dunkley MPS is PSA’s 2020 Pharmacist of the Year [href] => https://www.australianpharmacist.com.au/kay-dunkley-2020-pharmacist-of-the-year/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 11409 )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.