td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7860 [post_author] => 213 [post_date] => 2019-09-03 11:03:58 [post_date_gmt] => 2019-09-03 01:03:58 [post_content] => As the rate of accidental prescribed drug-induced overdoses continues to climb, pharmacists have an increased responsibility to focus on early intervention. The Penington Institute’s Australia’s Annual Overdose Report 2019 released last week, has revealed the number of Australians dying from unintentional drug-induced overdoses has been increasing by 3.4% a year since 2001. In 2017 the 1,612 unintentional drug-induced deaths accounted for almost three-quarters (74.6%) of all drug-induced deaths. In comparison, 1,246 people died on our roads that year, and the gap between these figures continues to widen, according to the report. Prescription opioids have been involved in the majority of accidental drug-induced deaths – 53% of all deaths in 2017. Unintentional deaths involving opioids have more than tripled in the last 10 years, from 338 deaths in 2006 to 904 in 2017.1 According to the Pharmacists in 2023 report, the use of opioids is an immediate priority of care.2 After opioids, benzodiazepines, for which the most commonly prescribed are diazepam and temazepam, lead to the most accidental overdoses resulting in death1. Long-term use of these drugs can lead to the development of tolerance, and physical and psychological dependence.1 The Penington report recommendations to decrease overdoses and prevent fatalities include real-time prescription monitoring,1 an initiative to which the Federal Government in 2017 committed $16 million in funding. Dr Renly Lim, a Research Fellow in the University of South Australia’s School of Pharmacy and Medical Sciences, conducts research focusing on identifying associations between medicine use and health outcomes. She told Australian Pharmacist that real-time prescription monitoring allows pharmacists to proactively intervene if patients are prescribed potentially dangerous medicine combinations, high risk medicines or contraindicated medicines. The Penington report said real-time prescription monitoring can be useful, provided it is implemented in a way that increases access to health services.1 ‘If we just just rely on supply-side interventions, patients may attempt to treat their pain or withdrawal symptoms with illicit opioids like heroin,’ the report said.1
Risk assessmentThe Deputy Director of the Monash Addiction Research Centre at Monash University, Associate Professor Suzanne Nielsen, said pharmacists are key to contributing to early intervention. Assoc. Prof. Nielsen is also a National Health and Medical Research Council Career Development Fellow, and her research targets understanding how to improve identification of prescribed opioid use disorder. Assoc. Prof. Nielsen’s team has developed a collection of screening tools that act as early-intervention tactics to monitor outcomes with prescribed opioids. In trying to improve identification of overuse of prescribed opioids community pharmacy and primary care settings, Assoc. Prof. Nielsen said it is important the language used is doesn’t create a barrier to effective conversations. ‘We have to be both conscious and careful with our language because there is so much stigma around developing problems with substance use,’ she said. Assoc. Prof. Nielsen said that many screening tools for opioid dependence use addiction-focused language, such as one tool which asked whether patients ever feel ‘dope sick’, which is inappropriate for a patient who has been prescribed medicine for chronic pain. ‘We set about to try and develop tools that would have language and content that's salient for asking people about their use, side effects and worries with pain medicine,’ she said. One example Assoc. Prof. Nielsen used is a simple change from using ‘addiction’ to ‘over-reliance’, such as when medicine is used long term – the physical dependence is something patients can expect, but relying on pain medicines for sleep, or to manage stress can be a sign that problems are emerging. According to Assoc. Prof. Nielsen, it is crucial to balance the focus on whether there are problems emerging with assessing whether patients are getting benefits from their pain medicines, and what, if any, other side effects are present. Not focusing the conversation on dependence alone, but framing it around the benefits and any possible downsides that the patient is experiencing from the medicine can help patients feel more comfortable talking about their experience. ‘When you start to put all those things together it can be easy to talk to a patient about whether or not their medicine is still the best medicine for them,’ she said. Assoc. Prof. Nielsen said these conversations, which at first can be quite confronting, do rely on having a good rapport and trust between the pharmacist and the patient. If pharmacists are able to spot warning signs that a patient is overusing their pain medicines, such as patients coming in to get their medicine early, having those conversations early can help prevent more serious problems developing. Dr Lim suggested that where possible, pharmacists can suggest the use of non-opioid alternatives. This is separate to counselling points during dispensing, such as talking about the risk and danger of overdose, the importance of avoiding alcohol and having a communication channel with their GP about their usage. ‘Pharmacists should also emphasise the importance of keeping an up-to-date medicines list so that [they] can review the medicines for any inappropriate, unnecessary or potentially dangerous drug-drug interactions,’ Dr Lim said. According to Assoc. Prof. Nielsen, pharmacists should be able to have those conversations, and let people know about opioid substitution therapy. However, expect that it might take a little bit of time for patients that think about these options and be willing to seek further help. Assoc. Prof. Nielsen said this may involve pharmacists taking more time to review a patient's medicines, history and current functioning, and if this can be done in a private consultation room it could increase the likelihood of the patient feeling comfortable and sharing more of their challenges.
Treatment strategiesAssoc. Prof. Nielsen said pharmacists have a key role in identifying patients at higher risk of opioid-related harm, including those prescribed higher doses or those who are prescribed high risk combinations of medicines.1 ‘Ideally, pharmacists might be able to identify and have conversations in the pharmacy around these key factors. Providing education about overdose prevention is critical. Providing information about naloxone, which can be sold without a prescription, can be a patient-centred way to discuss the risks around opioids, but also offer a strategy that patients and their families can be aware of if they are concerned,’ she said. A second strategy Assoc. Prof. Nielsen said that reduces mortality dramatically where people have developed an opioid use disorder is offering evidence-based opioid agonist treatment, such as methadone and buprenorphine-naloxone.3 ‘When people with opioid use disorder are engaged in these treatments their risk of mortality is roughly halved compared to people with opioid disorder who are not in these treatments. ‘But we know for a range of reasons, including costs and stigma, that many people who develop opioid dependence with prescribed opioids can be very reluctant towards treatments,’ she said. ‘However, often once people experience treatment they have an overwhelmingly positive experience,’ she said The Penington report said community-wide and targeted education to potential overdose witnesses, expanded access to drug treatment including opioid-agonist therapy, improved access to naloxone, pain management and allied health are key factors in treatment.1 ‘Localised interventions for regional and rural communities that are community-led and based on partnership should also be expanded,’ the report said.
Drugs and demographicsThe demographic group most susceptible to accidental drug-induced deaths involving pharmaceutical opioids is users aged 40-49. Between 2013 and 2017, 817 deaths occurred in this demographic.1 A risk factor for accidental overdose is prescriptions or benzodiazepines or other depressants at the same time as opioids.1 According to Dr Lim, antihistamines can be added to this list. ‘Patients may not know that using these medicines together can be deadly. If a patient is started on any new medicines that can increase the risk of benzodiazepine overdose, pharmacists should call up and check that the doctor is aware of the danger, they will closely monitor the patient and [provide] a tapering and discontinuation plan where possible,’ said Dr Lim. The PSA’s Medicine Safety: Take Care report referred to a study that used the 2015 Beers criteria to assess the prevalence of potentially inappropriate medicines administered to residents of a residential care facility (RCF). Among the cohort of 533 residents, most of whom had dementia or another cognitive impairment, 81% were exposed to at least one potentially inappropriate medicine, increasing their risk of hospitalisation. The most commonly-administered medicines were long-term (>8 weeks) proton pump inhibitors, administered to 42% of residents, benzodiazepines, administered to 38%, and anti-psychotics, administered to 31%. Another study included in the Medicine Safety report found that between 1993 and 2005, 17% of unplanned hospital admissions among high-care residents of RCFs were attributed to the administration of these potentially inappropriate medicines.4 According to Assoc. Prof. Nielsen, more men than women die from accidental opioid-induced overdoses, however, the statistics for non-fatal opioid-induced overdoses are higher for women. The rate of unintentional overdose deaths in regional Australia also continues to climb. In 2017, the per capita rate for these deaths in regional Australia was 7.3 per 100,000 compared to 6.3 in metropolitan areas.1 Indigenous people also continue to be overrepresented in deaths related to overdoses, due to poorer access to treatment and intervention. In 2017, the rate per 100,000 Aboriginal people was 19.2, compared to 6.2 for non-Aboriginal Australians across NSW, QLD, SA, WA and NT. ‘We do see poorer treatment access in rural and regional areas, which increases the risk of harm including overdose and mortality, and due to longer travel times for ambulances, really highlights how important it is to increase naloxone awareness and availability,’ said Assoc. Prof. Nielsen. To view PSA’s S3 guidance document on Naloxone, please click here: https://my.psa.org.au/s/article/Naloxone-S3-guidance-document References
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- Pennington Institute. Australia’s Annual Overdose Report 2019. Pennington Institute; 2019 [cited 2019 August 30]. At: http://www.penington.org.au/australias-annual-overdose-report-2019/.
- Pharmaceutical Society of Australia. Pharmacists in 2023: For patients, for our profession, for Australia’s health system. Pharmaceutical Society of Australia Ltd; 2019 [cited 2019 August 30]. At: https://www.psa.org.au/wp-content/uploads/2019/02/Pharmacists-In-2023-digital.pdf
- Nielsen S, Larance, B, Degenhardt, L, et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database of Systematic Reviews. 2016:(5). At: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011117.pub2/full
- Pharmaceutical Society of Australia. Medicine Safety: Take Care. Pharmaceutical Society of Australia Ltd; [cited 2019 August 30]. At: https://www.psa.org.au/wp-content/uploads/2019/01/PSA-Medicine-Safety-Report.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7820 [post_author] => 10 [post_date] => 2019-09-02 12:17:15 [post_date_gmt] => 2019-09-02 02:17:15 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Some might assume employing someone with a declared disability would only bring complications. But some community pharmacies around Australia are leading the way in disability employment, and they say the benefits make it all worthwhile. It makes simple, ethical sense for businesses like pharmacies to accurately represent the social and cultural mix of the communities they serve. But increasing evidence shows that having a diverse workforce is also great for business.1,2 Companies with diverse management teams have 19% higher revenues, while improved company culture, leadership and greater innovation are all benefits of a diverse workforce.3,4 According to JobAccess, the Australian Government’s disability employment service, there’s considerable evidence of the benefits of hiring people with disability. ‘Employees with disability are four times more likely to stay with their current employer than other employees, and 90% as or more productive,’ says JobAccess General Manager, Daniel Valiente-Riedl. ‘And they’re innovative; 75% report having an idea that would drive value for their company, versus 66% of employees without disabilities.’ But while many are starting to appreciate the business value of diversity, it seems people with a declared disability still face discrimination. According to a Hays survey on diversity in Australian workplaces, people with a declared disability were the least likely to believe their employers understand the business benefits of diversity, the least likely to trust their managers to deliver change on diversity, and were the most likely to believe bias exists.4 Of those with a declared disability surveyed, 83% said they had experienced discrimination based on their disability when they had applied for employment.4
Sam’s experienceIn the final year of a Bachelor of Pharmacy at the University of Tasmania, Sam Flood started applying for intern positions for the following year and expected he would secure one without any issues. Despite above average grades and countless applications, Mr Flood says potential employers couldn’t see past his wheelchair and he found a lot of apprehension about putting him on as an intern. ‘Three quarters of the way through the year, well before graduation, everyone I studied with had an internship secured. It got to actual graduation day and I still hadn’t got a job,’ he says. Mr Flood had worked part-time during high school, had done placements in community and hospital pharmacies during his degree. He says he didn’t want to give anyone an excuse not to put him on, so he volunteered and worked part-time at university after graduation. By August 2017, still getting turned down for internships, Mr Flood made a video about his experiences through the University Specialist Employment Partnership (USEP) which was widely received by the Australian pharmacy community. ‘I saw the video and thought it’s not acceptable that he’s still looking for work. Sam’s completely capable and needs the opportunity to get his internship done,’ says Jarrod McMaugh MPS, the managing partner of Capital Chemist Coburg North in Melbourne. ‘I had some familiarity with Sam when he first graduated and just assumed that he had found a role in Tasmania.’ The pair spoke the following day and after an interview and some discussion, Mr Flood moved to Victoria and started on as an intern pharmacist. The pharmacy had recently been renovated and already had some ramp access, but a few minor physical changes were needed. ‘Sam coordinated all of that work and the work was funded. It was really straightforward and easy,’ Mr McMaugh says. For him, the benefits of someone like Mr Flood working at the pharmacy are clear. ‘All his life he’s had to find innovative ways to achieve the things the rest of us take for granted, which means he thinks laterally and is a problem solver. He has identified a solution before most people have clarified what the problem is, which is very useful in the clinical setting.’ For Samantha Kourtis MPS, Managing Partner of Capital Chemist Charnwood in Canberra, diversity and disability employment is a personal priority. When her father suffered a stroke 14 years ago that left him with hemiplegia, he was no longer able to work as a nurse and had no other employment opportunities. ‘I felt his frustration at not being able to feel that he was contributing to society and not be able to feel personal value,’ she says. ‘When I became the pharmacy owner, I was contacted by a disability employment agency to see if I wanted to employ an incredibly intelligent young man, physically impaired with cerebral palsy, and that was the first time I was like, “Well, why not?”’ Ms Kourtis has continued to prioritise diversity and currently employs Jack, a young man living with autism, to restock the pharmacy’s robotic dispensary. ‘Jack’s been with us for almost four years, and he works four mornings a week,’ she says. Recently, Ms Kourtis has also brought on Mitch, another employee with a disability. But hiring people with a declared disability has been an organic process for Kourtis, as she says her experiences with disability employment service (DES) providers have been disappointing. She says some providers have prioritised payments for placing an employee instead of ensuring people and business are a good fit. ‘This is a controversial comment, but I believe some DES providers are only in the industry because of the payments they get when they place somebody,’ Ms Kourtis says. She encourages pharmacists to do their research. ‘Find a DES that’s actually committed to the outcomes of the employee and the employer. Maybe talk to some past clients and see what runs they’ve got on the board there,’ she says.
Getting it rightWhen it comes to employing people with a declared disability, Mr Flood says openness and communication are vital. ‘As someone with a disability, I’ve been probed with all kinds of questions my whole life. If someone with a disability is motivated enough to apply for work, they’re probably happy enough to answer those questions to make sure it works,’ he says. It’s a sentiment Ms Kourtis echoes. ‘I would be very vulnerable and open and honest, and say “This is a space that I haven’t professionally worked in before, so I might not know the right questions to ask or I might not use the right words. Could you please guide me?’” she says. Ultimately, Mr McMaugh calls for self-reflection if people are still hesitant. ‘If they think there’s a downside to employing a person with a disability, they need to re-examine what makes them think that and be honest with themselves about what makes them think that person doesn’t deserve the opportunity to work in pharmacy?’ he says. ‘Most pharmacists, if they ask themselves that question, would probably change their mind if they were honest with themselves.’ As PSA19, keynote speaker and disability and Paralympian Kurt Fearnley said increasing the number of people with disabilities in pharmacy would also help improve the sector’s ability to understand and respond to the needs of patients with disabilities.
Make the moveJobAccess is the Australian Government’s online portal to promote and facilitate disability employment. ‘It is a free service that exists to drive disability employment in the easiest way possible for people with disability, employers and service providers,’ says JobAccess General Manager, Daniel Valiente-Riedl. ‘Disability is more commonplace than one might think. Whether employers are aware of it or not, it’s quite likely they know a person with disability, or employ a person with disability in their workplace.’ When it comes to employers looking at disability employment, JobAccess provides a number of services. ‘People with disability don’t often need any specific workplace changes to be effective in their jobs. It’s important not to assume that people with disability need adjustments,’ says Mr Valiente- Riedl. But for those that do, JobAccess can help with coordinating adjustments and modifications, including referrals for free workplace assessments, advice on required modifications and support, which may also be eligible for reimbursement through the Employment Assistance Fund (EAF). ‘Many adjustments are at no cost at all as it is also about putting in reasonable adjustments such as flexible work hours and work from home, which can also assist other staff with their work-life balance,’ says Valiente-Riedl. For larger organisations, there is the JobAccess Employer Engagement Team, or National Disability Recruitment Coordinator (NDRC). This team works in 12-month partnerships to provide practical tailored support to help organisations increase their disability confidence and competence. The aim is to help organisations increase their knowledge and remove barriers in employment practices, so they become more inclusive. JobAccess also offers a free, confidential call service providing advice on disability employment. ‘The team includes a range of field experts, such as allied health professionals and specialists in workplace adjustments and occupational therapy,’ Mr Valiente-Riedl says. ‘Becoming a disability-con_ dent employer involves time and e_ ort, but it’s not hard. And, every single step can lead to a big change. My advice would be to take a step forward and break the ice. Image: Sam Flood and father Chris at his graduation
Further resourcesFor more information on disability employment tailored to people with a disability, employers, or disability service providers, visit www.jobaccess.gov.au or call 1800 464 800.
- McKinsey & Company. Why diversity matters. 2015. At: mckinsey.com/business-functions/organization/our-insights/why-diversity-matters
- Ellison SF, Mullin WP. Diversity, social goods provision and performance in the _ rm. JBEM 2014;23(2):465–481. At: https://economics.mit.edu/files/8851
- Boston Consulting Group. How diverse leadership teams boost innovation. 2018. At: bcg.com/en-us/publications/2018/how-diverse-leadership-teams-boost-innovation.aspx
- Asia Diversity & Inclusion report. 2018. At: www.hays.com.sg/DIreport/HAYS_1990337
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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7699 [post_author] => 205 [post_date] => 2019-09-02 10:15:54 [post_date_gmt] => 2019-09-02 00:15:54 [post_content] => Eating disorders (EDs) are an area of focus in the Federal Government’s Long Term National Health Plan. But how common are they and what support can pharmacists offer patients? Early detection, diagnosis and treatment of EDs have been addressed in the Government’s new health plan through measures such as community mental health care and admitted patient care.1 The Australian Institute of Welfare (AIHW) characterises EDs as ‘problems associated with disordered eating or body weight control, and a severe concern with body weight or shape’.2 The most well-known EDs are bulimia and anorexia nervosa, and they fall into two other categories: binge eating, which can also trigger depression and anxiety, and other specified feeding or eating disorders (OSFED). Despite anorexia being well-known, it isn’t commonly understood, said Christine Naismith, a community pharmacist who founded the advocacy organisation Eating Disorders Families Australia (EDFA). Most people with mental illnesses do not seek treatment.3 One study found the average number of mental health visits was well below the number of sessions of evidence-based psychotherapy or cognitive behavioural therapy advised for patients.4 People living with EDs typically don’t receive the support they need.3 In a British Journal of Psychology study, out of 61 women with an ED, 85.2% reported wanting treatment, 57% reported making contact with health services at some point, but only 8% had ever received treatment specifically for their ED.5 Ms Naismith established EDFA after battling to save her daughter from anorexia in 2013. She said EDs can go undetected for years as they are ‘manipulating illnesses’. ‘The sufferer is good at deception and lies to cover up and protect their ED,’ she said.
How many people are affected?Part of the Government's Intergenerational Health and Mental Health Study will include a survey of more than 60,000 participants to investigate their mental health and general well-being. EDs were excluded in previous surveys in 1997 and 20073, making estimates of Australians affected difficult. This is due to EDs having various diagnostic thresholds to determine their prevalence, and the small number of large-scale ‘population research projects’, according to the AIHW.2 Many people living with mental illnesses such as EDs may not realise they have a diagnosable illness in the first place. But in a recent article in The Conversation, University of Melbourne Senior Research Fellow Laura Hart reveals that people with an ED are likely to respond ‘yes’ to ‘direct questions about their experiences with body dissatisfaction or thinking difficulties’.3 The Government’s new health plan will also include research from the Million Minds Mission that will enable one million people living with ED to participate in trials aimed at improving the understanding and treatment of these disorders. Ms Naismith estimates that over one million people, (around 4%) of the Australian population have EDs, but they predominantly affect young people between the ages of 16–25. According to AIHW, 16% of this demographic is affected.2 This percentage is higher for sexual minorities. Research from Current Psychiatry Reports found that gay, bisexual, and unsure men reported 3–4.5 times the likelihood of purging compared to heterosexual men, and lesbian and bisexual females overall have 3.23–3.95 times the odds of purging compared to heterosexual females.6
Pharmacist supportMs Naismith said it is imperative that pharmacists are readily accessible and able to impart knowledge to concerned parents or partners to support those living with EDs. ‘Understand those with the illness will not accept advice or help as they often cannot recognise or admit there is a problem,’ she said. Ms Naismith said early detection and urgent action are the keys to reaching a full recovery and reducing relapses. The average recovery span of anorexia is five years, and it is still the mental illness with the highest mortality rate with up to 20% of people dying from suicide or organ failure. She suggested family-based therapy as the best evidenced-based treatment for anorexia and bulimia, however, with only a 29% success rate of recovery, there is a need for better options and more research. Ms Naismith suggests pharmacists should direct carers to crisis-prevention resources such as Feed Your Instinct, an interactive tool to better understand EDs, and The Butterfly Foundation, a helpline. Ms Naismith said there is generally a poor understanding of the complexities and dangers of EDs, and urges pharmacists to be aware that a person living with an ED does not need to be ‘overtly skinny to by very mentally and physically unwell’. Other mental health services pharmacists need to be aware of are walk-in centres for adults, local residential ED centres, an expanded headspace network and a real-time suicide monitoring system. References
[post_title] => How pharmacists can support people with eating disorders [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-support-patients-eating-disorders [to_ping] => [pinged] => [post_modified] => 2019-09-06 11:11:59 [post_modified_gmt] => 2019-09-06 01:11:59 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7699 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How pharmacists can support people with eating disorders [title] => How pharmacists can support people with eating disorders [href] => https://www.australianpharmacist.com.au/pharmacists-support-patients-eating-disorders/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7701 )
- Department of Health. Australia’s long term national health plan. Canberra (Australia): Department of Health; 2019 [cited 2019 August 26]. At: https://www.health.gov.au/sites/default/files/australia-s-long-term-national-health-plan_0.pdf
- Australian Institute of Health and Welfare. Australia’s health 2018. Canberra (Australia): AIHW; 2018 [cited 2019 August 26]. No. 16. At: https://www.aihw.gov.au/getmedia/ab86db9d-410a-4c93-89c4-99c8bdbdf125/aihw-aus-221-chapter-3-13.pdf.aspx
- Hart L. How many people have eating disorders? We don’t really know, and that’s a worry. 2019. At: https://theconversation.com/how-many-people-have-eating-disorders-we-dont-really-know-and-thats-a-worry-121938
- Striegel-Moore R, DeBar L, Wilson G, et al. Health services use in eating disorders. Psych Med 2008; 38(10):1465-1474. At: https://www.cambridge.org/core/journals/psychological-medicine/article/health-services-use-in-eating-disorders/B9499FE558481D4E76A276845E866337
- Hart L, Granillo T, Jorm A, et al. Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases. Clin Psych Review 2011; 31(5):727-735. At: https://www.sciencedirect.com/science/article/pii/S0272735811000523
- Calzo J, Blashill A, Brown T, et al. Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Current Psych Reports 2017; 19(49). At: https://link.springer.com/article/10.1007/s11920-017-0801-y
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7705 [post_author] => 10 [post_date] => 2019-08-30 11:15:52 [post_date_gmt] => 2019-08-30 01:15:52 [post_content] => The healthcare sector was recently called out for the devastating levels of waste generated from single-use plastics and medicines. Both hospital and community pharmacists can help to tackle this problem. Waste generated from the health care sector accounts for 7% of Australia’s total annual CO2 emissions, almost double the level of the UK’s percentage of total emissions (4%). While public and private hospitals account for 44% of those emissions, medicines– both PBS and others – account for 19% of Australia’s health sector CO2 emissions.1 ‘Are pharmacists, as QUM [Quality Use of Medicines] specialists aware of the significant impact of pharmaceuticals on the environment?’ asks Grace Wong, Senior Pharmacist at Western Health and Founder of Pharmacists for the Environment, an online community which looks to identify ways in which pharmacists can reduce waste in their practice. The advocacy group aims to promote awareness in the pharmacy profession about environmental issues and stimulate initiatives for change. Ms Wong and many others see pharmacists playing a crucial role in helping reduce waste from the sector and ensuring public health. The 2015 Rockefeller Foundation-Lancet Commission on Planetary Health emphasised the link between human health and the environment, the natural system that humans depend on.2 ‘I believe an understanding and acknowledgment of this link is critical for any pharmacist to really, truly engage with their patients in conversations and also be open and able to instigate and support actions in reducing the pharmacy’s environmental footprint,’ Ms Wong said. For those pharmacists working in hospitals, they can support and participate in developing hospital wide initiatives, such as a Local Sustainability Action Plan (LSAP). Thinking outside the box is vital. ‘Western Health pharmacy were recently involved with contributing unneeded syringes to the production of 3D printed cutlery for people with dexterity issues as part of Melbourne Design Week,’ Ms Wong said. But while hospitals are the main source of waste from the sector, community pharmacies can play an important role, but need coordination. ‘You need a champion in your store for reducing waste, always coming up with another idea for waste reduction and mindfulness,’ said Lauren Haworth, a community pharmacist based in Victoria. Central to waste reduction in community pharmacies is handling medicines waste through the Return Unwanted Medicines (RUM) program: a free, convenient, and environmentally safe way for the public to dispose of unwanted and expired medication via their local community pharmacy. ‘Advertise the RUM program – reducing medicines ending up in our waterways limits the environmental harm they can cause and is really important,’ Ms Haworth said. She encourages community pharmacists to develop a thorough system for handling recyclable and non-recyclable waste, with separate bins for paper, label shredding, soft plastics, cardboard paper, and normal kerbside recycling. Options for recycling and reuse also go beyond the kerbside; Ms Haworth’s pharmacy collects their bubble wrap, which goes to local op-shop for reuse. ‘And our local footy club collect our cardboard and paper recycling, sort it, and then on-sell it to help fund the club.’ ‘We also buy our vaccines in bulk packs of ten instead of individual vaccines. We have a recycling box in our consultation room for these boxes, along with recycling boxes in our bathroom and staff room. We haven't started composting here yet, but it's in the pipeline,’ she said. When it comes to plastic bags, Ms Haworth advises to cut them. ‘Use paper bags; there is no reason for plastic. Even better, encourage patients to bring in their own bags. Start a loyalty program giving patients an extra point or two if they bring in their own bag, much like Woolies do,’ she said. Ultimately, waste reduction and protecting the environment is central to a pharmacist’s role. ‘Judicious use of resources is a part of providing quality healthcare,’ Ms Wong said. ‘It doesn’t oppose delivery of quality healthcare. If we care for our patients, then we need to also care about the environment, the resources which we use, and the impact of waste on the environment, which supports their and our own ability to live well.’ Image: Lauren Haworth (left) and Intern Pharmacist Corie Raymond recycling in action. References
[post_title] => How can pharmacists fight waste? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => how-can-pharmacists-fight-waste [to_ping] => [pinged] => [post_modified] => 2019-08-30 11:43:02 [post_modified_gmt] => 2019-08-30 01:43:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7705 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How can pharmacists fight waste? [title] => How can pharmacists fight waste? [href] => https://www.australianpharmacist.com.au/how-can-pharmacists-fight-waste/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7726 )
- Malik A et al. The carbon footprint of Australian health care. Springer 2018. At: https://www.sciencedirect.com/science/article/pii/S2542519617301808
- Whitmee S. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet 2015;VOLUME 386, ISSUE 10007. At: https://www.thelancet.com/journals/lancet/issue/vol386no10007/PIIS0140-6736(15)X0015-8
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7691 [post_author] => 82 [post_date] => 2019-08-29 10:05:26 [post_date_gmt] => 2019-08-29 00:05:26 [post_content] => After the recent hold-up of a Supercare Pharmacy, Australian Pharmacist investigates the prevalence of violence towards pharmacists and the measures that can put in place to ensure staff safety. On Thursday 15 August, Ascot Vale pharmacy in Melbourne was assailed by armed robbers who took prescription medicine and cash, threatening two staff members and binding the wrists of a security guard. But this is hardly an isolated incident. Research conducted in 2011 into the prevalence of violence in community pharmacy found that of the 248 pharmacists surveyed, almost all (91%) had either witnessed or had been on the receiving end of a form of violence within 12 months. A significant proportion of the surveyed pharmacists indicated that they ‘sometimes’ or ‘never’ reported such incidents, and over 50% said that they were not offered support after violent incidents.1 The Pharmacists' Support Service’s (PSS) 2018 report, Managing Stress in Pharmacy, said that, ‘Pharmacy owners should take an approach that aims to minimise the impact of injury as well as providing support as a result of the “indirect” intangible feelings of vulnerability and fear that staff may experience.’2 But what does this look like in practice?
The supercare approachJane Mitchell, owner of Ascot Vale pharmacy spoke to Australian Pharmacist about the recent incident and the security measures they have in place pre, during and post event. ‘We employ security guards and have great cameras and CCTV footage. We also have an emergency lockdown button for the pharmacy and panic alarms installed, with mobile panic alarms for the staff and guards,’ she said. Pre-incident, Ms Mitchell said that the pharmacy doors were open 24 hours a day, however this has since changed. ‘Since the incident, our pharmacy doors will be closed between 10pm–6am with a security guard operating the front doors to let customers enter and exit the pharmacy. The security guard will have visibility of all people before they enter the pharmacy,’ she said. ‘We talk about risk management in our staff meetings, and we’ve reviewed all our security procedures again since the incident. Although we do have comprehensive security procedures, we’ve tightened them so that our doors are closed – something we didn’t want to do and which we might change – but at the moment this is what we have decided as a group,’ Ms Mitchell said. ‘Some of the other Supercare Pharmacies do close their doors and allow people to come and go via a security guard, intercom or other arrangements.’ Ascot Vale pharmacy staff are trained to use the lock-down button in the event of an emergency or if they see something happening outside that they don’t want to come inside the pharmacy. ‘If staff feel vulnerable or uncomfortable in a situation, they are encouraged to press the panic alarm or call the police.’ But practice doesn't necessarily make perfect. ‘The other night, despite our training and protocols, a staff member went to push the panic alarm and one of the assailants saw her try and do that.’ Post-incident, there are various administration and support procedures in place. ‘We have documented procedures that advise staff about the steps to follow to alert the department [of health], depending on the security level of the incident. We also have online forms to complete for the department to give them all the information that they require about the incident.’ On counselling after the fact, Mitchell said that it’s up to the individual about the level of support they need – counselling is always offered. ‘Our staff will receive their counselling tonight [seven days post-incident], which is definitely a part of our procedure. When incidents have happened in the past, we have used staff counselling.’ Ms Mitchell added that staff are encouraged to access services such as the PSS if they feel like they need additional support on top of the counselling offered. PSS can be contacted on 1300 244 910. For information about how to manage a violent incident, steps to take post-event and managing trauma, visit: https://www.supportforpharmacists.org.au/index.php/resources-2/information-and-resources/trauma
Legal mattersMost states and territories have online resources that provide information about preventative safeguarding measures, what to do during an event and reporting protocols post-event. NSW Police recommend measures such as:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7861 [post_author] => 23 [post_date] => 2019-09-03 10:54:53 [post_date_gmt] => 2019-09-03 00:54:53 [post_content] => This week marks the beginning of spring and National Asthma Week, a time when the National Asthma Council (NAC) urges Australians with asthma to prepare for the pollen season.1 In November 2016, Melbourne and Geelong experienced the world’s largest epidemic thunderstorm asthma event. It resulted in thousands of presentations to hospital emergency departments and primary care, hundreds of hospital admissions, and 10 deaths due to asthma. Asthma was triggered in individuals with allergies when they inhaled air containing a high concentration of pollen allergens during the thunderstorm. This event was not unprecedented – Australians in south-eastern states have experienced thunderstorm asthma events before.2 A likely cause of Australian thunderstorm asthma events is perennial ryegrass (Lolium perenne), a common pasture crop. Fungal spores (e.g. Alternaria) may also be a contributing factor, but their role in thunderstorm asthma in Australia is unclear.2 People at risk of acute asthma flare-ups triggered by a thunderstorm include: those with seasonal allergic rhinitis (hay fever), with or without asthma; those with asthma (or a history of asthma); and those with undiagnosed asthma. NAC CEO Siobhan Brophy says that pharmacists are ideally placed to work with patients to make sure they are well-prepared for spring and thunderstorm asthma season. ‘When dispensing medicines for hay fever, asthma or both conditions, pharmacists can take the opportunity to counsel patients about managing their airways during pollen season,’ Ms Brophy says. ‘Pharmacists can help ensure patients are using medicines such as preventers or other treatments like nasal irrigation effectively and correctly, or refer the patient to their GP for further advice.’ Individuals with asthma and allergic rhinitis are vulnerable to a loss of asthma control at this time of the year, particularly when their allergy is to grass pollens. It is important for pharmacists to encourage these individuals to maintain good asthma control by taking their regular preventer medicine and proactively manage their symptoms. Ms Brophy suggests asking patients ‘could your nose be making your asthma worse?’ and letting them know that uncontrolled hay fever can make asthma more difficult to control. Check how often a patient is using their reliever, more than twice a week is a sign of poor control. Checking inhaler and nasal spray technique is also important. Asking the patient to demonstrate how they use it is more beneficial than asking if they know how to use it. Thunderstorm season can be serious for patients with poorly controlled asthma, so it's important that they're made aware of the risks and how they can stay safe. Refer to the NAC thunderstorm asthma flowchart for risk factors and appropriate questions to ask. According to the NAC’s treatment guidelines in the Australian Asthma Handbook3, prevention of thunderstorm asthma in individuals is based on:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7830 [post_author] => 23 [post_date] => 2019-09-03 10:30:41 [post_date_gmt] => 2019-09-03 00:30:41 [post_content] => Pharmacists can minimise opioid harm by helping patients step down. While opioids play an important role in the management of acute pain, their widespread use to treat chronic pain and misuse in dependent individuals has resulted in multiple cases of harm. This has been highlighted as a public health issue in Australia’s Annual Overdose Report 2019.1 The report revealed that opioids (pharmaceutical opioids and heroin) caused over 900 deaths in 2017, accounting for over half of all unintentional deaths. Although heroin deaths were found to be increasing, pharmaceutical opioids comprised the largest proportion of deaths involving opioids. The findings suggest we need improved management of persistent pain and less reliance on opioids long-term. Part of the harm minimisation strategy is to step down opioid doses with a view to stopping where possible. Pharmacists can support patients in the stepping down process in a safe, effective way. Opioids present a challenge as they are addictive and can lead to significant harm. From 1992–2012 there was a 15-fold increase in opioids dispensed, and the Pennington report demonstrates that this is increasing.1 Over the course of a year, 20% of Australians over 45 years of age will be prescribed at least one opioid, for either acute or chronic pain. Patients on longer-term therapy are more likely to be prescribed a higher dose opioid.2 Opioids have a limited role in the management of chronic non-cancer pain (CNCP). Current evidence does not support long-term opioid therapy. Because of the lack of evidence of efficacy and risk of harm with long-term use, deprescribings should be considered for patients using them long-term, particularly when adverse effects have been reported.2 Adverse effects include opioid-induced hyperalgesia and tolerance which cause a perceived increase in pain and need for dose escalation. Recent studies indicate that opioids may contribute directly to chronic pain. This toxicity may commence after a brief exposure and leave a vulnerability to increased pain responses that may be of indefinite duration. Other long-term opioid toxicities include depression, sleep interference, hypogonadism, prolonged disability and delayed return to work.3
Deprescribing opioidsWhen deprescribing, the dose should be gradually reduced, and the patient monitored for withdrawal symptoms, level of pain and effect on quality of life.2 Patients undergoing opioid tapering should be continually reviewed and assessed; pharmacists are well placed to do this. Dr Marc Russo of Sydney Pain Specialists has reported minimal opioid withdrawal symptoms by stepping down sequentially each week over four to eight weeks. Typically, there’s a 10–20% reduction from the baseline dose each week or fortnight in order to achieve this outcome.4 Dr Russo stated: ‘If patients can feel that they are being empathically supported and that the deprescribing trial is exactly that, i.e. just a trial and that they are not going to be left with coping with increased pain, then they can be very open to the concept of reducing their conventional pure mu opioid medication.’ But for some patients, the deprescribing process may prove challenging and require months of gradual withdrawal to safely stop opioids. Gradual weaning may be derailed by an abstinence syndrome involving insomnia, emotional blunting, deficits in executive control and the exacerbation or reemergence of comorbid psychiatric disorders.1 If an attempt at deprescribing has been unsuccessful, it may be wise to plan a slower taper or consider opioid substitution therapy. Refer to the Australian Pharmaceutical Formulary (APF) for advice on opioid tapering and opioid substitution therapy, including equi-analgesic doses for opioid conversion.5 Ideally, multidisciplinary services including a pharmacist, should support patients living with CNCP and identify when to refer those at high risk of harm from opioids. Pharmacists could refer to PSA’s Medicine Safety: Take Care report for further information on the role of the pharmacist in reducing medication events in Australia. Advise patients to speak to their pharmacist or general practitioner when having difficulty managing their pain or reducing their opioid doses. Pharmacists could refer patients to state and territory alcohol and other drugs telephone counselling and referral services, many of which operate 24 hours a day, seven days a week. To learn more about deprescribing, refer to the CPD articles:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7714 [post_author] => 23 [post_date] => 2019-08-28 13:30:44 [post_date_gmt] => 2019-08-28 03:30:44 [post_content] => The Therapeutic Goods Administration (TGA) has made a final decision on the rescheduling of modified release (MR) paracetamol due to safety concerns. The safety of MR paracetamol preparations has been under the spotlight since reports of its potential toxicity emerged. In line with international concerns, the TGA initiated a scheduling review of the medicine. An interim decision by the TGA to up-schedule MR paracetamol from Schedule 2 (Pharmacy Medicine) to S3 (Pharmacist Only) was made in June this year.1 The interim decision has been upheld in a final decision, and comes into effect on 1 June 2020. The TGA review followed the decision by the European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee to suspend all MR paracetamol products in the European Union in September 2017. That decision was based on increased risks to people who overdosed on the MR formulation compared to immediate release (IR) paracetamol. The TGA decided to take a more measured approach and initiate a scheduling review.2 The decision was not referred to an expert advisory committee, but rather made by a TGA delegate. Delegate-approved changes are added to Appendix H of the Poisons Standard, per requirement of the Therapeutic Goods Act.2 PSA has supported the reclassification of MR paracetamol, concerned about large pack size availability within an S2 classification. This will allow for greater supervision and education to ensure that intentional and unintentional overdoses are avoided. While paracetamol is a commonly used over-the-counter analgesic, misuse and accidental overdose are of increasing concern. Toxicity can occur even at doses lower than the recommended daily maximum dose. Gaps in patient knowledge, particularly around the perceived safety of paracetamol, are contributing factors to misuse and accidental overdose. Used appropriately, under supervision and advice from pharmacists, MR paracetamol is considered safe. MR paracetamol is sometimes labelled as ‘sustained release’, ‘slow release’ or ‘extended release’ and is formulated with 665 mg paracetamol per tablet compared to IR paracetamol at 500 mg per tablet. The MR formulation releases the drug slowly into the body, allowing a more convenient 8-hourly dosing regimen compared to the IR products (usually taken 4–6-hourly).2 Pharmacists need to ensure consumers are aware of maximum paracetamol doses, especially if MR, IR and combination products are used together.
What does this mean for patients?Patients will be required to consult a pharmacist before purchasing these products to receive appropriate advice on their use and to discuss the best treatment options available for ongoing pain. No prescription is necessary. These changes do not apply to the IR paracetamol products available on the market, including from supermarket and convenience store outlets.
What does this mean for pharmacies?Once the change is implemented, MR paracetamol products will need to be placed behind the counter, where pharmacists will be able to better ensure appropriate use. MR products may continue to be advertised and included in catalogues. Pharmacy staff should start thinking about workflow changes now, particularly around the amount of stock they are holding, and future buy-in quantities. PSA has emphasised the importance of medicine safety in both its Medicine Safety: Take Care and Pharmacists in 2023 reports. Measures such as harm minimisation of widely used paracetamol products, including this rescheduling change, are a positive move for patient safety and should be embraced by pharmacists. Learn more about the supply of S2 and S3 medicines in PSA's online course: Support the supply of Pharmacy Medicines and Pharmacist Only Medicines (S2/S3). Click here to register: https://my.psa.org.au/s/training-plan/a117F0000019vdGQAQ/support-the-supply-of-pharmacy-medicines-and-pharmacist-only-medicines-s2s3 References
[post_title] => Final scheduling changes for modified release paracetamol [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => final-scheduling-changes-paracetamol-modified-release [to_ping] => [pinged] => [post_modified] => 2019-08-28 14:14:36 [post_modified_gmt] => 2019-08-28 04:14:36 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7714 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Final scheduling changes for modified release paracetamol [title] => Final scheduling changes for modified release paracetamol [href] => https://www.australianpharmacist.com.au/final-scheduling-changes-paracetamol-modified-release/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7717 )
- Therapeutic Goods Administration. Interim decision in relation to paracetamol (modified release). June 2019. At: https://www.tga.gov.au/book-page/15-interim-decision-relation-paracetamol-modified-release
- Therapeutic Goods Administration. Changes to the way modified release paracetamol products are supplied. August 2019. At: https://www.tga.gov.au/changes-way-modified-release-paracetamol-products-are-supplied-questions-and-answers
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7571 [post_author] => 10 [post_date] => 2019-08-23 10:15:09 [post_date_gmt] => 2019-08-23 00:15:09 [post_content] => Symbicort prn is now indicated to treat mild asthma flare-ups after an extended indication was approved by the TGA. Symbicort Turbuhaler and Rapihaler are now listed on the Australian Register of Therapeutic Goods (ARTG) as an anti-inflammatory reliever to treat mild asthma flare-up. The extended indication means the inhaled corticosteroid/long-acting beta agonist (ICS/LABA) can now be prescribed as needed for anti-inflammatory reliever (AIR) therapy to treat mild asthma in people aged 12 years and older. ‘It’s a big shift,’ said Advanced Practice Pharmacist and asthma educator, Debbie Rigby. ‘Right now, any doctor can prescribe Symbicort as an anti-inflammatory reliever.’ Previously, Symbicort’s ARTG certification was limited to reliever plus maintenance therapy, or maintenance therapy alone, but the extended indication brings the drug’s potential use in Australia into line with the Global Initiative for Asthma (GINA) guidelines on asthma management.1 ‘The evidence supports the use of AIR therapy,’ Ms Rigby said. ‘Recent trials, SYGMA and Novel START, show benefits, reducing the number of exacerbations compared to prn short-acting beta2 agonist (SABA) use, and reducing the total steroid exposure to the patient.’ Concern about the long-term effects of steroids was one reason people are not adherent to using their regular preventer therapy, according to Ms Rigby. For quick relief of acute symptoms, Ms Rigby said the evidence showed Symbicort worked just as quickly as SABAs (i.e. Symbicort has a short onset of action), but that international and Australian guidelines still recommend a SABA (e.g. salbutamol) for asthma first aid. While the extended indication for Symbicort isn’t reflected in current Australian guidelines (e.g. the Australian Asthma Handbook), Ms Rigby said the Handbook is under revision. Symbicort’s extended indication was another opportunity for pharmacists to have a conversation with consumers about their asthma control, according to Ms Rigby. ‘We know that many people who come into the pharmacy for their SABAs are not well controlled. There’s many reasons why they don’t use their preventers as prescribed, but pharmacists play a critical role, because we provide SABAs and we know there are many times when there is overuse.’ A recent study by the Woolcock Institute of over 400 Australians found that around 70% of respondents were classed as SABA over-users.2 ‘People with mild asthma, who rely on over-the-counter SABAs, represent about 20% of the 441 people who died from asthma last year,’ Ms Rigby said. Language in the Australian Asthma Handbook has changed from ‘asthma attacks’ to ‘asthma flare-ups’, a change Ms Rigby said pharmacists need to adopt for the benefit of their consumers. ‘Pharmacists need to help [consumers] understand they have a chronic disease with intermittent flare-ups. Pharmacists shouldn’t use “attack” as it just reinforces the misconception that they are only just sick at the time of the “attack,”’ she said. When it comes to Symbicort, Ms Rigby said she expects it will gain PBS approval later this month, and that it could be downgraded from a Schedule 4 (S4) drug in the near future. ‘It had a positive PBAC (Pharmaceutical Benefit Advisory Committee) recommendation, so it’s highly likely it will be included on the PBS. Perhaps some time in the future it will be downgraded to S3 so pharmacists can provide it over the counter,’ she said. To learn more about optimum treatment options for asthma, access the following PSA resources:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7517 [post_author] => 136 [post_date] => 2019-08-19 11:15:11 [post_date_gmt] => 2019-08-19 01:15:11 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] As the saying goes, ‘You’ve got to know when to hold ’em, and know when to fold ’em.’ Complementary medicines may also be called ‘traditional’ or ‘alternative’ medicines and include items such as vitamins, minerals, herbal products, aromatherapy and homoeopathic products. Many of the products available in pharmacies, supermarkets or health food outlets have limited evidence of efficacy. There is some evidence of efficacy for some complementary medicines, however this may be formulation and dose dependent, and health practitioners are encouraged to seek this information before recommending such products. For these reasons, the PSA provided advice to pharmacists about complementary medicines in its Choosing Wisely recommendations that were released last year.1 The recommendation made was:
‘Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.’Just because something is natural doesn’t mean it’s safe, and just because something has been used for centuries doesn’t mean it works. These are just two ideas that consumers often hold dear to their hearts which can cause dilemmas for pharmacists. Unfortunately, it is not always clearcut. Whilst one branch of these medicines, homeopathy, has been discredited as ‘sham’ medicines by several bodies including Australia’s National Health and Medical Research Council,2 other complementary medicines do have therapeutic uses, and proven clinical benefits. These discrepancies can make this area hard for pharmacists to know what works, what might work, and what doesn’t work at all. The pharmacy board states: When complementary and alternative medicine is provided at a pharmacy, pharmacists should provide products of proven safety and quality. Relevant accompanying advice should be offered to assist patients in making a well-informed choice regarding treatment with a complementary or alternative medicine, which should include available information on the potential benefits and harms, and whether there is sufficient evidence to support its proposed use. Where appropriate, pharmacists should incorporate details of the supply of complementary and alternative medicines in the dispensing record and, where possible, in the patient’s health record.3 A recent systematic review pertaining to the role of the pharmacist outlined the following seven major roles of pharmacists: 1) to acknowledge the use; 2) to be knowledgeable about the products; 3) to ensure safe use of complementary products; 4) to document the use of these products; 5) to report adverse reactions to products; 6) to educate others about complementary products and; 7) to collaborate with other healthcare professionals.4
How can pharmacists find out what does work and what doesn’t?NPS MedicineWise has a set of listed websites that may be useful for consumers and health professionals to use to search for more information about complementary medicines.5 These include:
See PSA’s six recommendations to the Choosing Wisely initiative at:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7431 [post_author] => 10 [post_date] => 2019-08-28 01:12:30 [post_date_gmt] => 2019-08-27 15:12:30 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Conducting research can be a daunting prospect. But by choosing a mentor and working intelligently, pharmacists can research and have their work published. A study published earlier this year in the Journal of Pharmacy Practice and Research found that pharmacists have a keen interest in conducting research.1 Yet these same pharmacists had comparatively low levels of research confidence and experience. The lack of confidence is understandable, as research and publication can be a formidable, lengthy undertaking. Thankfully, no one expects early career pharmacists (ECPs) to launch straight into a randomised control trial by themselves. But while practising pharmacists may not always seem themselves as researchers, leading academics say the opposite is true. ‘Pharmacists working in clinical practice are in an ideal position to identify opportunities to change health care for the better,’ says Professor Simon Bell MPS, Director at Monash University’s Centre for Medicine Use and Safety. ‘Doing research is a way to explore those opportunities for change, to generate evidence that’s necessary to bring about change in clinical practice or health policy.’ So picture an ECP at work, wanting to get involved in research, with the distant goal of publishing work – where do they start? ‘Simple audit processes of the way you do things in your clinical practice is important research, and that can lead on to publications,’ says John Coutsouvelis, Senior Oncology and Haematology Pharmacist at Alfred Health, and a Senior Lecturer at Monash University. ‘It could be clinical, it could be a process. Start with audits and drug usage evaluations in hospitals. If you’re in community pharmacy, start with an audit of customer satisfaction with services. It’s all simple research, but starts you thinking about how to set up a study and what you’re measuring.’ Meredith Wiseman, a Senior Lecturer at Monash University, also encourages practising pharmacists to start with their own scope of practice. ‘Question what you see around you, and if you have a question, raise it with the people you work with – that’s often the start of more discussion around potential research projects,’ she says. Discussing practice with colleagues and seniors is not only useful in mapping out a research question, but often yields potential opportunities for participating or collaborating with other projects and researchers. ‘Researchers are passionate about what they do and are happy to discuss research opportunities with any pharmacist,’ says Professor Bell. ‘Make an appointment with academic staff at your university, or if you’re working in a hospital, approach the director of pharmacy for advice. Universities and hospitals often have ongoing research projects that pharmacists can get involved in. This is a great way to gain experience.’ Mr Coutsouvelis also recommends that those who are looking to conduct research attend conferences in their field. ‘They’re a great way to start understanding what you need to put in an abstract and the things that reviewers look for.’ When it comes to developing a research question, Ms Wiseman encourages pharmacists to read academic literature. ‘It provides a good background. Read, read, read, talk with collaborators, get involved, and put yourself out there,’ she says. ‘Hospitals and other institutions often run journal clubs that can be a great resource for keeping abreast of current research.’ Reading naturally leads into the next step of research – a literature review. ‘It’s important to understand what’s already been published,’ says Professor Bell. ‘Often people come up with good ideas, but when they look further into the research literature they find several other studies have covered the area. It’s important to think about what your research will add.’
Determining methodsAfter identifying a research topic, pharmacists need to determine the research methodology for their study. For those new to research, this can be the most daunting stage of a study. ‘People often want to do complex research, but it’s more important to pick a methodology that is suitable to your question and that may mean a simpler methodology,’ says Mr Coutsouvelis. Professor Bell says one common reason studies are rejected for publication is due to concerns over methodological quality. ‘I would encourage people to have a discussion with their research mentor about the most appropriate methods before they start doing their research,’ he says. ‘That way, the time and resources they invest will produce the best returns on investment and a high-quality piece of evidence at the end.’ Looking at past research can also help. ‘Go back to the literature and see how people have studied a similar topic in a different area, or a similar thing with a different drug, and try and map your methodology out that way,’ says Mr Coutsouvelis.
Finding that journalWhen it comes to publishing research, finding the right journal can be a challenge. ‘There are many different scientific journals out there, with different readerships,’ says Professor Bell. ‘It’s important to keep your readership in mind when writing your article and selecting a target journal. Work is often rejected because it’s outside the scope of the journal, so you need to target your work to the right readership.’ A good place to start, says Ms Wiseman, are the professional journals. ‘Australian Pharmacist, the Journal of Pharmacy Practice and Research – they’re obviously going to be good links.’ She also advises close collaboration with experienced researchers. ‘Work with them to identify the best journal, and then read those journals yourself to ensure they fit your theme.’ When it comes to identifying and submitting to journals, Professor Bell says an experienced research mentor can save time, avoid needless rejections, and help optimise the impact of your work. ‘Regardless of where you choose to publish your research, it’s important to have a good research mentor who can guide you through that process. Publishing doesn’t have to be a daunting experience. ‘It’s fantastic when a student or pharmacist comes to us with an idea for research – it’s the kind of innovation and enthusiasm we need. But it’s important to take the time to work with a research mentor to help ensure that your proposed work is novel and the methods are rigorous before getting started.’
Dealing with rejectionWhen it comes to the final step of publishing their work, should new researchers expect to be knocked back by journals? ‘Even experienced researchers have their papers rejected,’ says Professor Bell. ‘The good journals only accept a small percentage of the articles they receive. If you do receive a rejection, that doesn’t mean that the work wouldn’t be suitable to be published in another journal. It can be easy to feel disappointed when a manuscript is rejected, but people shouldn’t lose heart if that happens.’ Having a research mentor is important as they can help identify more suitable journals to submit work to, and it requires patience. ‘ECPs sometimes expect something straight away, which is not a criticism. But to really get a good paper published can sometimes take a year,’ says Mr Coutsouvelis. Reaching publication is a consultative process between researchers, publishers and reviewers. ‘Any article will go through several rounds of peer review and editing before it’s submitted for publication, so don’t get disheartened,’ he says. References
- Waddell J. Research confidence, interest and experience of an Australian hospital pharmacy population. Journal of Pharmacy Practice and Research. May 2019. doi.org/10.1002/jppr.1480. At: https://onlinelibrary.wiley.com/doi/abs/10.1002/jppr.1480
|Submit your research to AP at firstname.lastname@example.org|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7509 [post_author] => 196 [post_date] => 2019-08-12 13:17:30 [post_date_gmt] => 2019-08-12 03:17:30 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] It’s no longer plain sailing in Australian community pharmacy. Bruce Annabel helps navigate in this, the fourth instalment of our Future Health series. Most have heard the saying, ‘You cannot direct the wind, but you can adjust the sails.’ The nautical analogy is helpful. Pharmacy has sailed along propelled by the winds of regulation; the exclusive distribution of PBS pharmaceuticals and scheduled medicines have generated patient visits and profit. In return, consumers have received a reliable, accessible medicine distribution network. But in an era of tectonic change, is that sufficient to maintain pharmacy’s financial returns and relevance in the health spectrum? The winds of change are blowing hard on the traditional business model, requiring owners, peak bodies, industry and the profession to assess where community pharmacy now stands. Initiatives are needed to harness these forces, beginning with the forthcoming Seventh Community Pharmacy Agreement (7CPA).
Winds of change
1. Market and technologyThe key to community pharmacy success has been location, maximising script throughput, and operating efficiently as a business. However, fundamental change in the competitive and technological landscape has resulted in flat script volumes and falling patient visits pressuring profitability and viability. One of the biggest concerns is falling patient visits, down 3.8% during the last five years including 1.9% last year,1 reflecting the reduced market relevance of the traditional business model. Therefore, historical success factors have become ‘hygiene’, and it’s getting worse because few are responding appropriately to the changes.
2. Blown off courseUnfortunately, price discounting is the result, financed by cutting wages and pressuring suppliers for deals that no longer exist. Something has to change – net profit is down 22% compared with five years ago, while return on investment has fallen to 14% compared with 25% just 10 years ago.1 Pharmacists clinging to the script-processing role means ‘pharmacist professional service’ is inconsistently delivered to patients, who are left to interact with pleasant assistants. That is referred to as ‘service’, which is now a ‘hygiene’ factor too. But even though it has been blown off course, the old model is chugging along, made possible by dispensing profitability sufficient to hold the bottom line together … for the time being.
3. CommoditisationBecause of price discounting and wage cuts, pharmacists are working even harder processing scripts with less time for advice and professional services. The result is that patients and the community have been trained to value pharmacies based on price instead of health benefits i.e. an industry focused on ‘selling to customers’ instead of ‘helping patients’. The majority of new medicines being listed on the PBS are highly specialised, usually high cost, and mostly delivered to patients in hospital or specialist practices. Pharmacy has been left primarily dispensing cheap off -patent pharmaceuticals with an average cost of $25.1 Many of these medicines have become commoditised by competing for market share through price discounting in a flat market.
4. Federal governmentPBS script volume fell by 2 million between 2013/14 and 2017/18 and net outlays have been flat in nominal terms for 10 years. That policy will continue, evidenced by the April 2019 budget forecasting expenditure of $9.7 billion in 2022/23 compared with the 2018/19 estimate of $9.6 billion. So the government expects costly new medicines to be paid for by the industry, manufacturers, distributors and perhaps even pharmacy. Perhaps that was the motivation behind the proposed extended 60-day script supply for 143 drugs. The proposal could resurface!
5. Cyclonic windsWinds of change may turn cyclonic as the Fourth Industrial Revolution gathers pace. It has been written: ‘During the next three years, the Fourth Industrial Revolution will really take hold as technologies in the physical, digital and biological spheres begin to come together under the impetus of ‘the internet of things’, artificial intelligence, robotics and additive manufacturing.’2 Immunotherapy, gene and cell therapy, along with technological convergence, will fundamentally reshape the industry.
Adjusting the sailsThere is much support for pharmacist-only ownership, although it should be capitalised on by utilising their skills and trust with patients. Innovation in the quality of the patient offer is the key to a non-price competitive value equation aimed at holding existing patients, attracting new ones and giving them great reasons to return. Some pharmacies have done this by offering patients innovative services. This includes minor ailments, mental health, medication management and condition management in addition to script supply and advice. These innovative pharmacies outperform the industry standard in most measures, including earning professional services income over $100,000 pa, some $300,000 pa, compared with the average of a touch above $30,000.1 Virtually every pharmacy is capable of operating that model but they lack the incentive and/or implementation assistance. The innovators model should be adopted as the industry framework. The key elements are:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 5170 [post_author] => 82 [post_date] => 2019-05-16 09:13:50 [post_date_gmt] => 2019-05-15 23:13:50 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Faye McMillan is a pioneer, paving the way for other Aboriginal and Torres Strait Islander people who want to work in the pharmacy profession. When she’s not busy winning awards, she works as a community pharmacist, university lecturer and is a founding member of Indigenous Allied Health Australia.
Why did you decide to become a pharmacist?Over 20 years ago, I was working as a pharmacy assistant in my hometown of Trangie (NSW) when I thought to myself, ‘I actually want to be the pharmacist.’ The pharmacist I was working with at the time was extremely supportive and encouraged me to apply to study. I ended up being part of the inaugural cohort of students when Charles Sturt University introduced their pharmacy program in Wagga Wagga, NSW in 1997.
What’s the main focus of your practice?I’m a community pharmacist, and I also teach in the area of Indigenous health, mental health and pharmacy at CSU. But the main focus of my work is patient-centred care, and ensuring that I’m working with people, so that they feel engaged. That’s what really drew me to pharmacy in the first place – an opportunity to have a relationship and help people as they navigate their health journey.
You’re passionate about recruiting Indigenous Australians into healthcare. What work do you do in this area?As a founding member of Indigenous Allied Health Australia (IAHA), we strive to recognise Aboriginal and Torres Strait Islander people in the allied health workforce. I sat on the board from its inception in 2009 until 2017 and I was also the chair from 2010–2016. We started with just seven members, now we have 1,500. IAHA is seen as one of the key bodies representing Aboriginal and Torres Strait Islander people to government and was involved in the development and implementation of the National Aboriginal and Torres Strait Islander Health Plan. We also work with universities to ensure that when Aboriginal and Torres Strait Islander students undertake allied health courses, they are being provided with support, mentors and networking opportunities. But at IAHA, it’s not just about how we recruit people, it’s how we retain them. We work to ensure they feel engaged, not just in their profession but as a part of their community in the form of a trained healthcare professional.
You were Australia’s first registered Indigenous pharmacist and won the 2019 NSW Aboriginal Woman of the Year Award. How do you feel about being a role model?It didn’t sit comfortably at first, but I think I’ve settled into it and recognised that people do need role models. When I was starting out I looked around for role models, and I appreciated the journeys of the people who I looked up to. If I’m that to someone else, then that’s a wonderful thing. Sometimes you’re able to use the platform of being an award recipient to give a nuanced opinion or view, and we need people to take up those positions.
You’re also a member of PSA’s National Aboriginal Community Controlled Health Organisation Leadership Group. Why is pharmacist intervention in Indigenous health so important?Pharmacists play an integral role in the lives of so many people, whether clinically, in the community, or in hospitals – there are so many touch points where pharmacists can be included to provide insight into the health of Aboriginal and Torres Strait Islander people. The knowledge and skills that pharmacists have through their education, their life experiences and by being a consistent presence in the community means that they are able to provide a point of reference for other health professionals. The Leadership Group is making significant contributions by ensuring people have access to a highly skilled and trained workforce, as well as providing education around the medicines that are needed in these communities, while ensuring they are accessible and affordable.
What’s the next big project that you’re working on?I’m putting the final touches on a mental health app that I’ve been developing over the past 18 months. I wanted to create something that would provide meaningful support to people – not in place of trained mental health professionals, of course. The app is an extension of an existing self-awareness app that keeps you connected with people you’ve identified in your contact list as your ‘caring community’. It assesses where people are sitting on the scale of mental wellness, followed by contact from someone who will reach out and have a conversation with you. It’s all about having real conversations – listening out for warning signs such as changes in the timbre of the voice, and pauses, things that are easily masked in social media use. Get more news at www.australianpharmacist.com.au [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Pushing boundaries: the pioneer pharmacist [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pushing-boundaries-the-pioneer-pharmacist [to_ping] => [pinged] => [post_modified] => 2019-05-16 11:27:59 [post_modified_gmt] => 2019-05-16 01:27:59 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=5170 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pushing boundaries: the pioneer pharmacist [title] => Pushing boundaries: the pioneer pharmacist [href] => https://www.australianpharmacist.com.au/pushing-boundaries-the-pioneer-pharmacist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 5171 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4455 [post_author] => 20 [post_date] => 2019-03-07 21:35:04 [post_date_gmt] => 2019-03-07 11:35:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] A range of apps enable pharmacists and patients to see and/or manage their medical information. As the benefits of My Health Record (MHR) become more widely known, its uptake and usage can be expected to grow. As pharmacists, we are well positioned to take a leadership role and guide patients on this topic, given our status as the most digitally enabled of all health professionals. It is important for patients who wish to play an active role in their healthcare, or carers of vulnerable patient groups (e.g. children, disabled, elderly, mentally impaired), to understand what information is available to them and how they can access and control access to clinical documents (shared health summary, discharge summary, pathology, diagnostic imaging), prescriptions (prescriptions issued and dispense uploads), consumer documents (patient health summaries, patient notes) and Medicare documents (e.g. immunisation register, organ donor status, Medicare benefits).
How do patients access their MHR?There are two ways for patients to access their My Health Record. 1. WEB PORTAL (myrecord.ehealth.gov.au) This site:
|Using a great smartphone app with your patients? Share your insights with your colleagues. Email email@example.com and tell us about your experience and the results you’ve seen.|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4386 [post_author] => 76 [post_date] => 2019-03-04 09:51:42 [post_date_gmt] => 2019-03-03 23:51:42 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A new MedicineWise program aims to increase the number of patients seeking help for anxiety and other mood disorders by educating healthcare professionals. Anxiety disorders, including panic disorder, agoraphobia, social anxiety disorder and generalised anxiety disorder, are the most common mental health conditions in Australia. According to a 2008 national survey conducted by the Australian Bureau of statistics the conditions affect 14% of people aged 16–85 years. But despite their ubiquity, a study has indicated that it takes Australians between the ages of 18 and 77 an average of 8.2 years to seek treatment for anxiety and mood disorders. Pharmacist, mental health researcher and lecturer at the University of Sydney Dr Claire O’Reilly, told Australian Pharmacist that there are many reasons why patients might delay seeking treatment for anxiety disorders, including a lack of awareness surrounding the condition. ‘The symptoms are a bit varied between the different types of anxiety disorders, so when we talk about anxiety there’s all sorts of different anxiety disorders and there can be a lot of crossover between them,’ she said. ‘But also, we all feel stressed from time-to-time, so the feeling of anxiety is a normal mechanism for us. It’s about being able to recognise when it’s more than that. When it’s more severe and longer lasting, it interferes with your work and your relationships. And I think people aren’t always able to pick that up themselves.’ She said that community pharmacists could play an important role in recognising symptoms of anxiety in their patients, and encourage them to seek specialised treatment. The new program from NPS MedicineWise is based on new clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists, and aims to equip healthcare professionals to perform a similar function by increasing their access to educational tools, including free one-on-one educational visits for GPs, access to a webinar, clinical audit, patient decision aid and other information for health. NPS MedicineWise told Australian Pharmacist that pharmacists working in general practice are invited to attend small group meetings to discuss therapeutic areas, including resources to support patient decision-making around medicines and health technologies. For practices enrolled in MedicineInsight, these facilitated quality improvement meetings that involve all practice staff, including pharmacists, and utilise individualised practice data to support interventions and to improve patient outcomes in general practice. Dr O’Reilly, who has consulted with NPS MedicineWise about the involvement of pharmacists in the program, welcomes educational opportunities for pharmacists in the area of anxiety. ‘I think pharmacists can upskill by learning about psychological therapies so that we’re informed when approaching people about treatment options. Pharmacists don’t necessarily have to be experts in this area, but it’s about having an awareness of the options and knowing where to refer people for help,’ she said. Dr O’Reilly said that education in this area is particularly important given the sensitive nature of mental health. While some patients might already suspect that they are experiencing anxiety, others could be more resistant. In these cases, she advised pharmacists to be aware of patients’ need for privacy, and offer to have a conversation with patients in a private area. She also stressed the importance of having information on hand, such as self-care cards, BeyondBlue information or NPS MedicineWise resources. There are also some PSA State offices that offer Mental Health First Aid courses. References
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- Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Media%20Release12007?opendocument&tabname=Summary&prodno=4326.0&issue=2007&num=&view=
- Thompson, A., Issakidis, C., & Hunt, C. Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behaviour Change 2008; 25(2):71–84. At: https://www.cambridge.org/core/journals/behaviour-change/article/delay-to-seek-treatment-for-anxiety-and-mood-disorders-in-an-australian-clinical-sample/9DF8128BE0F802DB0F6D76724FDEA776
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7520 [post_author] => 82 [post_date] => 2019-08-15 13:49:41 [post_date_gmt] => 2019-08-15 03:49:41 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Deirdre Criddle FPS is a complex care coordinator pharmacist at Sir Charles Gairdner Hospital in WA, and also a senior pharmacist steering professional services and development. It keeps her busy – and inspired.
Can you tell us what your complex care role entails?It’s quite new. In 2012, an inter-disciplinary team of advanced practitioners – nurses, social workers, occupational therapists, physiotherapists – were charged with improving health system navigation for complex patients. They asked Bruce Williamson, an experienced clinical pharmacist, if he could upskill them. Bruce tried to draft a program, but basically said, ‘You don’t need upskilling – you need a pharmacist embedded in your team.’ So he started this journey and I have been fortunate enough to follow in his footsteps since 2014. It’s now three days a week in an inter-disciplinary team. I do a lot of intensive work in medication management for patients who are medically complex. It’s a fantastic position, I love it, and it’s growing. I think there’s a huge opportunity for progression in that area – hospitals are facing such difficulty with patients becoming more complex, and pharmacists are an integral part of the solution.
What got you started in hospital settings?I’ve had a varied journey. I started as a hospital pharmacist, then was with NPS MedicineWise for 14 years as an educational visiting pharmacist, which was invaluable. I branched into being an independent accredited pharmacist doing medicines reviews, and I hoped to make a career of that. But the cap came along in 2014, and that killed it. That’s when I came back into hospital pharmacy at Sir Charles Gairdner. And I heard Bruce talking at a clinical pharmacy meeting about his role, and I just thought, ‘Oh, I so want that job.’ Everything that I had done to that point was consolidated in that role. That’s what brought me back. But I’m a bit of a jack-of-all-trades. I see the value in every aspect of our profession. It’s not like this role is better than that role. I would never dream of doing anything else.
You’re also a Director of the Society of Australian Hospital Pharmacists (SHPA). What are today’s biggest challenges in hospital settings?It’s a very challenging environment. The need to prioritise is paramount, and that’s a difficult thing. In my role as a care coordinator pharmacist you are dealing with stressed patients, and also stressed staff. They’re working with insufficient resources, staffing levels are not what they should be, patient complexity is increasing ... basically, they’re working in a very stretched system. If you’re spending all your time with your nose to the grindstone, there’s no opportunity to do the reflection to ask, ‘How can I do my job better?’ That can only come if you’re given room to breathe. Trying to get those in power to understand the value pharmacists bring to complex systems, especially to reduce medicine-related harm across the patient journey, that’s where we need to go.
How would you like to see pharmacists’ roles in complex care develop?For my first two years in this role, people would say, ‘What’s a pharmacist doing in a complex care coordination team?’ My dream now is that everyone will say, ‘Where’s the pharmacist?’ There are people like me all across Australia, and that is so exciting. Sometimes you think you’re alone, but I can guarantee you you’re not. If we have mechanisms to network, and to improve the collaboration and sharing across our profession, especially in these emerging areas of practice, it can only be a good thing.
A DAY IN THE LIFE of Deirdre Criddle, hospital pharmacist8.00am: The day begins Connect with the cardiology pharmacist, who updates the team on new guidelines. Take a phone call from a clinical pharmacist concerned about a patient. 9.00am: Stopovers Visit a ward with a family, telephone interpreter in tow. Consent gained for a visit with an on-site interpreter in two days. 10.00am: Drive by Home visit with a patient who is confused by medicine changes. I make a phone call to his GP and General Medicine Consultant to discuss. Arrange a visit with patient at GP clinic the following day to trial a dose administration aid. 12.30pm: Meetings Meet with Head of Pharmacy Gillian Babe and Clinical Pharmacist David Lui to discuss the results of the Medicines Management Mapping Project about facilitating early post discharge using community and hospital pharmacists. 2.00pm: More meetings Catch up with the clinical nurse leads for the Cognitive Impairment Committee to discuss content development for an education package dedicated to antipsychotics prescribed in the hospital setting. 3.00pm: And another ... Multidisciplinary team meeting with CoNeCT social worker, pain consultant and addiction specialist to discuss concerns for a patient. 4.00pm: Check in What’s new in the email inbox? Check new referrals, and plan visits for the coming week. Phone patients scheduled for an outreach visit. 9.00pm: Moonlighting Teleconference with the International Pharmaceutical Federation (FIP) Working Group, based in the Netherlands. Final review of The pharmacist’s role in beating noncommunicable diseases. High fives all round as we agree to final edits and submit to the FIP Council for approval.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7523 [post_author] => 82 [post_date] => 2019-08-05 13:56:33 [post_date_gmt] => 2019-08-05 03:56:33 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Luke Vrankovich MPS, a former locum and one half of the Roaming Pharmacist duo, gained an online following living life on the road. So how is pharmacy ownership working out?
Can you describe the ethos of The Roaming Pharmacist?It was started by Liam Murphy a few years ago. It was a way, using social media, to show how you can be a locum and travel at the same time. It was also a way to educate the public on some key ideas that are important to Liam, such as harm minimisation through pill testing at festivals. I came on board and began locuming around the country, incorporating my passion into my work, which is mental health. Ethos? I’d say sharing our adventures and educating along the way.
What are some of the most interesting places that your work as a locum has taken you?I’ve been all over. I took a road trip down the coast of New South Wales (NSW) and Victoria – I ended up rock climbing in Arapiles. One of my favourite places was Broome in Western Australia (WA) – really interesting work and a good group of people. Another favourite was Merimbula in NSW – a great sense of community. The pharmacy staff made me feel very welcome.
How did you adapt to the different legislation when moving between states?It required a bit of brain power to look out for the differences, mainly with the scripts on file and Schedule 8 medicines. The easiest way to adapt was to do some research beforehand so I would have a rough idea of how things worked, but I also leaned on the other pharmacists around me. I didn’t necessarily need to know everything in intricate detail before I got there, it was more about knowing what questions I needed to ask when certain situations arose.
You now own a pharmacy in Townsville. Why did you make the switch?Just over a year ago I was on a six-month trip around Australia, but I only made it to Carnarvon in WA when I got a call from my former boss in Coffs Harbour about an opportunity to run a pharmacy in Townsville. I thought it might be a while before another opportunity presented itself, so I took the plunge. It’s a very different lifestyle to working as a locum and comes with its own set of challenges, but I’ve always wanted to own my own pharmacy so I could prepare myself and my family for the future.
You’re a former mental health first aid facilitator. Do you use these skills a lot in your pharmacy practice?I use them every day. What’s great about mental health first aid is that it teaches you how to pick up on signs and approach conversations with more confidence. In a busy pharmacy, it’s easy to get caught in the cycle of receiving a repeat prescription for escitalopram, for example, and just dispense it. But the training empowers you to want to have that conversation with every person that comes through who takes an antidepressant – whether it’s new or continued. It’s important to ask how it’s been working for them, and if they’ve been on it for a while, if they are happy with the results. Sometimes this leads to deeper conversations around efficacy and adherence, which almost always turns to treatment recommendations or referrals.
Do you think other pharmacists would benefit from training in mental health first aid?A lot of pharmacists lack confidence to approach the conversations around mental health, particularly if a person has suicidal thoughts and they are voicing that within the pharmacy. It’s definitely not an easy situation to be in and it takes its toll. Nothing will ever fully prepare you, but the confidence you develop through training, along with the knowledge about the right referral points, particularly in acute situations, certainly helps.
You’re a former ECP of the Year, in 2017. Where do you see pharmacy practice going in the future?I see pharmacists specialising in one way or another. PSA is doing great work with pharmacists in general practice and pharmacist vaccination services have also been expanding. A lot of pharmacies try and be everything to everyone, but it’s not sustainable for community pharmacies to be across all areas of health care. I think the profession will branch out further into specialties and that the pathways will become more official.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => From locum to pharmacy owner [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => locum-pharmacy-owner-roaming-pharmacist [to_ping] => [pinged] => [post_modified] => 2019-08-15 17:37:19 [post_modified_gmt] => 2019-08-15 07:37:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7523 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => From locum to pharmacy owner [title] => From locum to pharmacy owner [href] => https://www.australianpharmacist.com.au/locum-pharmacy-owner-roaming-pharmacist/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7525 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7211 [post_author] => 82 [post_date] => 2019-07-29 11:14:27 [post_date_gmt] => 2019-07-29 01:14:27 [post_content] => The social highlight of the annual PSA conference is the Gala Dinner, and this year certainly did not disappoint. [gallery type="flexslider" size="large" ids="7224,7225,7226,7227,7229,7228,7230,7232,7231"] [post_title] => Pharmacists shine at the PSA19 Gala Dinner [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-shine-psa19-gala-dinner [to_ping] => [pinged] => [post_modified] => 2019-07-30 10:31:21 [post_modified_gmt] => 2019-07-30 00:31:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7211 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists shine at the PSA19 Gala Dinner [title] => Pharmacists shine at the PSA19 Gala Dinner [href] => https://www.australianpharmacist.com.au/pharmacists-shine-psa19-gala-dinner/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7226 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7197 [post_author] => 82 [post_date] => 2019-07-28 10:00:16 [post_date_gmt] => 2019-07-28 00:00:16 [post_content] => University of Western Australia student Alice Hashiguchi was awarded the 2019 PSA Mylan Pharmacy Student of the Year (PSOTY) Award last night. Ms Hashiguchi was selected from a group of six finalists for demonstrating exceptional skills in a practical setting. PSA National President Dr Chris Freeman congratulated Ms Hashiguchi on her exceptional achievement. ‘The PSOTY Award gives outstanding pharmacy students the chance to showcase their counselling skills to their peers and the wider profession,’ Dr Freeman said. Dr Freeman also acknowledged the high calibre of this years finalists: ‘We saw many rising stars of pharmacy apply their clinical knowledge and communication skills in this year’s competition.’ This year's six finalists included:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 7149 [post_author] => 82 [post_date] => 2019-07-27 10:45:53 [post_date_gmt] => 2019-07-27 00:45:53 [post_content] => In case you missed it, here's some of the action from the first day of PSA19 – from the Welcome Reception, Early Career Pharmacists Party and Fellows Dinner. [gallery type="flexslider" size="large" ids="7154,7155,7158,7151,7153,7152,7156,7157"] [post_title] => Highlights from PSA19, day one [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => highlights-from-psa19-day-one [to_ping] => [pinged] => [post_modified] => 2019-07-30 10:32:34 [post_modified_gmt] => 2019-07-30 00:32:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=7149 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Highlights from PSA19, day one [title] => Highlights from PSA19, day one [href] => https://www.australianpharmacist.com.au/highlights-from-psa19-day-one/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 7152 )
Accreditation Code :
Group 1 : CPD credits
Group 2 : CPD credits
This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 1 CPD (or 1.50 CPD credits) upon successful completion of relevant assessment activities.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.