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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
[post_title] => Medicine shortages placing pregnant women at risk
[post_excerpt] => Pregnant women are having difficulty accessing medicines due to a reliance on off-patent drugs and lack of trial data into medicine safety.
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"]
Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )
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[post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most.
Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation.
To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd!
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Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24.
A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region.
[caption id="attachment_26014" align="alignnone" width="900"]
2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption]
With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients.
Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations.
‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’
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Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had.
‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said.
‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’
PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond.
Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers.
This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning.
PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program.
‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim.
‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference.
‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’
PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible.
‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim.
‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25.
‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’
[post_title] => Transition announcements for ACOP and MMR at CPC24
[post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
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[post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles.
The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR).
Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.
What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP).
In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.
Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body.
Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick.
Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model.
‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’
The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick.
‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.
What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations.
‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick.
‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’
PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.
When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system.
Pharmacists must transition to the new qualification within that 12-month period.
PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS.
’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.
Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential.
PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick.
‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said.
To fill that gap pharmacists have the option to:
Rub shoulders with Kerri Barwick MPS (centre) and other members of team PSA at CPC24[/caption]
Attendees will benefit from sessions addressing the credential standards from David Laffan, Assistant Secretary, Pharmacy Branch, Department of Health and Aged Care, as well as hear from the PSA team including A/Prof Sim, CEO Steve Morris and Credentialing Manager Sarah Gillespie FPS.
Pharmacists will be able to network with fellow credentialed pharmacists who have experience in aged care.
‘Credentialed pharmacists are often working in isolation, so being able to meet up with others [in the same boat] is a unique opportunity,’ said Ms Barwick.
PSA is also available to meet pharmacists’ education needs as the new credentialing system takes effect, said Ms Barwick.
‘Because the on-site aged care component is quite new for some credentialed pharmacists, PSA will provide the Residential Aged Care Pharmacist: Foundation Training Program free as a Professional Plus Member benefit,’ said Ms Barwick.
While the course is not equivalent to the credential required to fill an on-site aged care pharmacist role, it provides insight into what the role might look like, along with an introduction to the aged care system.
‘This training and [accompanying] videos can give pharmacists an idea of if they want to pursue an aged care credential,’ she said. ‘In the next 12 months, PSA will also develop targeted CPD for credentialed pharmacists.’
All other inquiries about the MMR and Aged Care credentials can be directed to PSA’s training and learning support team here.
[post_title] => Clarity on aged care on-site pharmacist skills revealed
[post_excerpt] => The Department of Health and Aged Care announce new credentialing requirements announced as pharmacists prepare to take on aged care roles.
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[post_content] => Optimising proton pump inhibitor therapy in pharmacy
Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1
[caption id="attachment_25337" align="alignright" width="233"]
This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]
While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2
Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1
However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
[post_title] => Medicine shortages placing pregnant women at risk
[post_excerpt] => Pregnant women are having difficulty accessing medicines due to a reliance on off-patent drugs and lack of trial data into medicine safety.
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object
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[post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most.
Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation.
To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd!
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Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24.
A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region.
[caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption]
With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients.
Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations.
‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’
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Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had.
‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said.
‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’
PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond.
Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers.
This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning.
PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program.
‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim.
‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference.
‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’
PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible.
‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim.
‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25.
‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’
[post_title] => Transition announcements for ACOP and MMR at CPC24
[post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
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[post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles.
The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR).
Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.
What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP).
In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.
Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body.
Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick.
Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model.
‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’
The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick.
‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.
What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations.
‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick.
‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’
PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.
When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system.
Pharmacists must transition to the new qualification within that 12-month period.
PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS.
’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.
Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential.
PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick.
‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said.
To fill that gap pharmacists have the option to:
Rub shoulders with Kerri Barwick MPS (centre) and other members of team PSA at CPC24[/caption]
Attendees will benefit from sessions addressing the credential standards from David Laffan, Assistant Secretary, Pharmacy Branch, Department of Health and Aged Care, as well as hear from the PSA team including A/Prof Sim, CEO Steve Morris and Credentialing Manager Sarah Gillespie FPS.
Pharmacists will be able to network with fellow credentialed pharmacists who have experience in aged care.
‘Credentialed pharmacists are often working in isolation, so being able to meet up with others [in the same boat] is a unique opportunity,’ said Ms Barwick.
PSA is also available to meet pharmacists’ education needs as the new credentialing system takes effect, said Ms Barwick.
‘Because the on-site aged care component is quite new for some credentialed pharmacists, PSA will provide the Residential Aged Care Pharmacist: Foundation Training Program free as a Professional Plus Member benefit,’ said Ms Barwick.
While the course is not equivalent to the credential required to fill an on-site aged care pharmacist role, it provides insight into what the role might look like, along with an introduction to the aged care system.
‘This training and [accompanying] videos can give pharmacists an idea of if they want to pursue an aged care credential,’ she said. ‘In the next 12 months, PSA will also develop targeted CPD for credentialed pharmacists.’
All other inquiries about the MMR and Aged Care credentials can be directed to PSA’s training and learning support team here.
[post_title] => Clarity on aged care on-site pharmacist skills revealed
[post_excerpt] => The Department of Health and Aged Care announce new credentialing requirements announced as pharmacists prepare to take on aged care roles.
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[post_content] => Optimising proton pump inhibitor therapy in pharmacy
Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]
While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2
Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1
However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
[post_title] => Medicine shortages placing pregnant women at risk
[post_excerpt] => Pregnant women are having difficulty accessing medicines due to a reliance on off-patent drugs and lack of trial data into medicine safety.
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object
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[post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most.
Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation.
To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd!
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Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24.
A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region.
[caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption]
With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients.
Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations.
‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’
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Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had.
‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said.
‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’
PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond.
Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers.
This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning.
PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program.
‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim.
‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference.
‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’
PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible.
‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim.
‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25.
‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’
[post_title] => Transition announcements for ACOP and MMR at CPC24
[post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
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[post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles.
The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR).
Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.
What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP).
In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.
Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body.
Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick.
Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model.
‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’
The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick.
‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.
What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations.
‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick.
‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’
PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.
When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system.
Pharmacists must transition to the new qualification within that 12-month period.
PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS.
’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.
Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential.
PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick.
‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said.
To fill that gap pharmacists have the option to:
Rub shoulders with Kerri Barwick MPS (centre) and other members of team PSA at CPC24[/caption]
Attendees will benefit from sessions addressing the credential standards from David Laffan, Assistant Secretary, Pharmacy Branch, Department of Health and Aged Care, as well as hear from the PSA team including A/Prof Sim, CEO Steve Morris and Credentialing Manager Sarah Gillespie FPS.
Pharmacists will be able to network with fellow credentialed pharmacists who have experience in aged care.
‘Credentialed pharmacists are often working in isolation, so being able to meet up with others [in the same boat] is a unique opportunity,’ said Ms Barwick.
PSA is also available to meet pharmacists’ education needs as the new credentialing system takes effect, said Ms Barwick.
‘Because the on-site aged care component is quite new for some credentialed pharmacists, PSA will provide the Residential Aged Care Pharmacist: Foundation Training Program free as a Professional Plus Member benefit,’ said Ms Barwick.
While the course is not equivalent to the credential required to fill an on-site aged care pharmacist role, it provides insight into what the role might look like, along with an introduction to the aged care system.
‘This training and [accompanying] videos can give pharmacists an idea of if they want to pursue an aged care credential,’ she said. ‘In the next 12 months, PSA will also develop targeted CPD for credentialed pharmacists.’
All other inquiries about the MMR and Aged Care credentials can be directed to PSA’s training and learning support team here.
[post_title] => Clarity on aged care on-site pharmacist skills revealed
[post_excerpt] => The Department of Health and Aged Care announce new credentialing requirements announced as pharmacists prepare to take on aged care roles.
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[post_content] => Optimising proton pump inhibitor therapy in pharmacy
Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]
While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2
Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1
However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object
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[post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most.
Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation.
To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd!
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Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24.
A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region.
[caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption]
With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients.
Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations.
‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’
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Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had.
‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said.
‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’
PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond.
Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers.
This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning.
PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program.
‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim.
‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference.
‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’
PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible.
‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim.
‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25.
‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’
[post_title] => Transition announcements for ACOP and MMR at CPC24
[post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded.
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[title_attribute] => Transition announcements for ACOP and MMR at CPC24
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[post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles.
The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR).
Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.
What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP).
In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.
Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body.
Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick.
Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model.
‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’
The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick.
‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.
What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations.
‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick.
‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’
PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.
When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system.
Pharmacists must transition to the new qualification within that 12-month period.
PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS.
’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.
Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential.
PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick.
‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said.
To fill that gap pharmacists have the option to:
Rub shoulders with Kerri Barwick MPS (centre) and other members of team PSA at CPC24[/caption]
Attendees will benefit from sessions addressing the credential standards from David Laffan, Assistant Secretary, Pharmacy Branch, Department of Health and Aged Care, as well as hear from the PSA team including A/Prof Sim, CEO Steve Morris and Credentialing Manager Sarah Gillespie FPS.
Pharmacists will be able to network with fellow credentialed pharmacists who have experience in aged care.
‘Credentialed pharmacists are often working in isolation, so being able to meet up with others [in the same boat] is a unique opportunity,’ said Ms Barwick.
PSA is also available to meet pharmacists’ education needs as the new credentialing system takes effect, said Ms Barwick.
‘Because the on-site aged care component is quite new for some credentialed pharmacists, PSA will provide the Residential Aged Care Pharmacist: Foundation Training Program free as a Professional Plus Member benefit,’ said Ms Barwick.
While the course is not equivalent to the credential required to fill an on-site aged care pharmacist role, it provides insight into what the role might look like, along with an introduction to the aged care system.
‘This training and [accompanying] videos can give pharmacists an idea of if they want to pursue an aged care credential,’ she said. ‘In the next 12 months, PSA will also develop targeted CPD for credentialed pharmacists.’
All other inquiries about the MMR and Aged Care credentials can be directed to PSA’s training and learning support team here.
[post_title] => Clarity on aged care on-site pharmacist skills revealed
[post_excerpt] => The Department of Health and Aged Care announce new credentialing requirements announced as pharmacists prepare to take on aged care roles.
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[post_content] => Optimising proton pump inhibitor therapy in pharmacy
Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1
[caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption]
While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2
Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1
However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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