Paul Sinclair OAM MPS
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"]
Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
[post_title] => Early intervention through HMRs could save thousands per patient
[post_excerpt] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
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[title] => Early intervention through HMRs could save thousands per patient
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"]
Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
[post_excerpt] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => This in-demand credentialed pharmacist can’t adequately service her community due to restrictions on the Home Medicines Review (HMR) service.
As a credentialed pharmacist in regional Victoria, Kelly Abbott MPS provides medicines reviews to patients with complex health needs. But strict monthly caps and stagnant fees mean she can’t see everyone who is referred to her – even when the need is clear.
And sometimes, the call comes too late.
‘I’ve knocked on a door to have the [patient’s] husband tell me, “oh, she died”,’ Ms Abbott said. ‘That’s happened multiple times.’
[caption id="attachment_31424" align="alignright" width="282"]
Kelly Abbott MPS[/caption]
There’s no way to prove whether an earlier HMR would have changed those outcomes. But for a pharmacist trained to identify medicine-related risk, these moments stay with you.
‘It’s heartbreaking, it’s wrong and it shouldn’t be that way,’ she said.
Knocking on doors
Ms Abbott practises in Gippsland, Victoria – recently labelled ‘Australia’s unhealthiest region’ in the media.
The statistics are confronting: high smoking rates, significant socioeconomic disadvantage, and high burden of chronic obstructive pulmonary disease and cardiovascular disease. ‘If you look at a map of heart attacks in Victoria,’ Ms Abbott said, ‘Gippsland is just red.’
In a region like this, preventive medicines care matters. Yet access is rationed.
Ms Abbott consistently hits the 30-HMR monthly cap.
‘I have not had a month under 30 [HMRs] since September 2023,’ she said.
Demand far exceeds what she’s allowed to provide. Referrals have to wait, clinics juggle priorities, and some GPs even stop sending patients her way because they know she’s hit her limit.
Like many credentialed pharmacists, Ms Abbott’s wait list is about 2 months long.
‘Currently, if I received your referral today [28 January], I might see you in March at the earliest.’
A workforce running on goodwill
Gippsland is not remote in the traditional sense. It sits within reach of Melbourne. Yet Ms Abbott describes a thinning workforce of credentialed pharmacists.
‘There are only four of us in the Latrobe Valley, an hour in either direction,’ she said. ‘Only one of us has come on board in the last few years.’
Others have retired and some have simply stopped.
Ms Abbott is unsurprised by this. ‘Why would you bother becoming accredited financially right now?’ she asked. ‘You’re going to earn more and [have] a stable pay cheque in hospital or community pharmacy. Why would you pay to go through a course when you’ve got an absolutely capped income in that work stream?’
‘I have not had a month under 30 [HMRs] since September 2023.'
kelly abbott mps
The 30-service cap, introduced in 2014, limits how many HMRs a provider can claim per month. HMR fees have not been indexed since July 2019, eroding their real value over time.
For credentialed pharmacists like Ms Abbott, that combination sends a clear message that their work is undervalued.
‘What other specialist is limited like this?’
The cost of saying no
Ms Abbott described refusing some distant referrals because travel makes them financially unviable.
‘I am refusing to go to certain places because it’s just too far,’ she said.
Pharmacists can’t charge for travel as part of an HMR so the system means ‘those people are missing out’.
‘This means entire towns are not serviced by HMR providers in Gippsland, Ms Abbott said. ‘In an area with an ageing population, some of these towns would benefit enormously from medication reviews by a local pharmacist face-to-face.’
It’s not how she wants to practise.
‘I hate thinking that way. I hate being that way.
But the financial reality is that she can’t afford to make a loss on referrals.
Her frustration is about sustainability, not about status.
When remuneration doesn’t reflect the complexity and levels of responsibility, fewer pharmacists choose to become credentialed. And in high-need areas, that has real consequences.
Let pharmacists do what they are trained to do
Despite the challenges, Ms Abbott still believes in the value of HMRs.
‘We have great evidence that they reduce hospitalisations and they reduce healthcare costs,’ she said.
‘And patients and GPs absolutely love them. The demand alone tells you that.’
But she can’t meet that demand under current restrictive settings.
‘I love what I do,’ she said. ‘And there’s so many pharmacists like me who want to do more here. Just let me loose.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
[post_excerpt] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => This in-demand credentialed pharmacist can’t adequately service her community due to restrictions on the Home Medicines Review (HMR) service.
As a credentialed pharmacist in regional Victoria, Kelly Abbott MPS provides medicines reviews to patients with complex health needs. But strict monthly caps and stagnant fees mean she can’t see everyone who is referred to her – even when the need is clear.
And sometimes, the call comes too late.
‘I’ve knocked on a door to have the [patient’s] husband tell me, “oh, she died”,’ Ms Abbott said. ‘That’s happened multiple times.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
There’s no way to prove whether an earlier HMR would have changed those outcomes. But for a pharmacist trained to identify medicine-related risk, these moments stay with you.
‘It’s heartbreaking, it’s wrong and it shouldn’t be that way,’ she said.
Knocking on doors
Ms Abbott practises in Gippsland, Victoria – recently labelled ‘Australia’s unhealthiest region’ in the media.
The statistics are confronting: high smoking rates, significant socioeconomic disadvantage, and high burden of chronic obstructive pulmonary disease and cardiovascular disease. ‘If you look at a map of heart attacks in Victoria,’ Ms Abbott said, ‘Gippsland is just red.’
In a region like this, preventive medicines care matters. Yet access is rationed.
Ms Abbott consistently hits the 30-HMR monthly cap.
‘I have not had a month under 30 [HMRs] since September 2023,’ she said.
Demand far exceeds what she’s allowed to provide. Referrals have to wait, clinics juggle priorities, and some GPs even stop sending patients her way because they know she’s hit her limit.
Like many credentialed pharmacists, Ms Abbott’s wait list is about 2 months long.
‘Currently, if I received your referral today [28 January], I might see you in March at the earliest.’
A workforce running on goodwill
Gippsland is not remote in the traditional sense. It sits within reach of Melbourne. Yet Ms Abbott describes a thinning workforce of credentialed pharmacists.
‘There are only four of us in the Latrobe Valley, an hour in either direction,’ she said. ‘Only one of us has come on board in the last few years.’
Others have retired and some have simply stopped.
Ms Abbott is unsurprised by this. ‘Why would you bother becoming accredited financially right now?’ she asked. ‘You’re going to earn more and [have] a stable pay cheque in hospital or community pharmacy. Why would you pay to go through a course when you’ve got an absolutely capped income in that work stream?’
‘I have not had a month under 30 [HMRs] since September 2023.'
kelly abbott mps
The 30-service cap, introduced in 2014, limits how many HMRs a provider can claim per month. HMR fees have not been indexed since July 2019, eroding their real value over time.
For credentialed pharmacists like Ms Abbott, that combination sends a clear message that their work is undervalued.
‘What other specialist is limited like this?’
The cost of saying no
Ms Abbott described refusing some distant referrals because travel makes them financially unviable.
‘I am refusing to go to certain places because it’s just too far,’ she said.
Pharmacists can’t charge for travel as part of an HMR so the system means ‘those people are missing out’.
‘This means entire towns are not serviced by HMR providers in Gippsland, Ms Abbott said. ‘In an area with an ageing population, some of these towns would benefit enormously from medication reviews by a local pharmacist face-to-face.’
It’s not how she wants to practise.
‘I hate thinking that way. I hate being that way.
But the financial reality is that she can’t afford to make a loss on referrals.
Her frustration is about sustainability, not about status.
When remuneration doesn’t reflect the complexity and levels of responsibility, fewer pharmacists choose to become credentialed. And in high-need areas, that has real consequences.
Let pharmacists do what they are trained to do
Despite the challenges, Ms Abbott still believes in the value of HMRs.
‘We have great evidence that they reduce hospitalisations and they reduce healthcare costs,’ she said.
‘And patients and GPs absolutely love them. The demand alone tells you that.’
But she can’t meet that demand under current restrictive settings.
‘I love what I do,’ she said. ‘And there’s so many pharmacists like me who want to do more here. Just let me loose.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_excerpt] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => This in-demand credentialed pharmacist can’t adequately service her community due to restrictions on the Home Medicines Review (HMR) service.
As a credentialed pharmacist in regional Victoria, Kelly Abbott MPS provides medicines reviews to patients with complex health needs. But strict monthly caps and stagnant fees mean she can’t see everyone who is referred to her – even when the need is clear.
And sometimes, the call comes too late.
‘I’ve knocked on a door to have the [patient’s] husband tell me, “oh, she died”,’ Ms Abbott said. ‘That’s happened multiple times.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
There’s no way to prove whether an earlier HMR would have changed those outcomes. But for a pharmacist trained to identify medicine-related risk, these moments stay with you.
‘It’s heartbreaking, it’s wrong and it shouldn’t be that way,’ she said.
Knocking on doors
Ms Abbott practises in Gippsland, Victoria – recently labelled ‘Australia’s unhealthiest region’ in the media.
The statistics are confronting: high smoking rates, significant socioeconomic disadvantage, and high burden of chronic obstructive pulmonary disease and cardiovascular disease. ‘If you look at a map of heart attacks in Victoria,’ Ms Abbott said, ‘Gippsland is just red.’
In a region like this, preventive medicines care matters. Yet access is rationed.
Ms Abbott consistently hits the 30-HMR monthly cap.
‘I have not had a month under 30 [HMRs] since September 2023,’ she said.
Demand far exceeds what she’s allowed to provide. Referrals have to wait, clinics juggle priorities, and some GPs even stop sending patients her way because they know she’s hit her limit.
Like many credentialed pharmacists, Ms Abbott’s wait list is about 2 months long.
‘Currently, if I received your referral today [28 January], I might see you in March at the earliest.’
A workforce running on goodwill
Gippsland is not remote in the traditional sense. It sits within reach of Melbourne. Yet Ms Abbott describes a thinning workforce of credentialed pharmacists.
‘There are only four of us in the Latrobe Valley, an hour in either direction,’ she said. ‘Only one of us has come on board in the last few years.’
Others have retired and some have simply stopped.
Ms Abbott is unsurprised by this. ‘Why would you bother becoming accredited financially right now?’ she asked. ‘You’re going to earn more and [have] a stable pay cheque in hospital or community pharmacy. Why would you pay to go through a course when you’ve got an absolutely capped income in that work stream?’
‘I have not had a month under 30 [HMRs] since September 2023.'
kelly abbott mps
The 30-service cap, introduced in 2014, limits how many HMRs a provider can claim per month. HMR fees have not been indexed since July 2019, eroding their real value over time.
For credentialed pharmacists like Ms Abbott, that combination sends a clear message that their work is undervalued.
‘What other specialist is limited like this?’
The cost of saying no
Ms Abbott described refusing some distant referrals because travel makes them financially unviable.
‘I am refusing to go to certain places because it’s just too far,’ she said.
Pharmacists can’t charge for travel as part of an HMR so the system means ‘those people are missing out’.
‘This means entire towns are not serviced by HMR providers in Gippsland, Ms Abbott said. ‘In an area with an ageing population, some of these towns would benefit enormously from medication reviews by a local pharmacist face-to-face.’
It’s not how she wants to practise.
‘I hate thinking that way. I hate being that way.
But the financial reality is that she can’t afford to make a loss on referrals.
Her frustration is about sustainability, not about status.
When remuneration doesn’t reflect the complexity and levels of responsibility, fewer pharmacists choose to become credentialed. And in high-need areas, that has real consequences.
Let pharmacists do what they are trained to do
Despite the challenges, Ms Abbott still believes in the value of HMRs.
‘We have great evidence that they reduce hospitalisations and they reduce healthcare costs,’ she said.
‘And patients and GPs absolutely love them. The demand alone tells you that.’
But she can’t meet that demand under current restrictive settings.
‘I love what I do,’ she said. ‘And there’s so many pharmacists like me who want to do more here. Just let me loose.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_excerpt] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
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[post_content] => This in-demand credentialed pharmacist can’t adequately service her community due to restrictions on the Home Medicines Review (HMR) service.
As a credentialed pharmacist in regional Victoria, Kelly Abbott MPS provides medicines reviews to patients with complex health needs. But strict monthly caps and stagnant fees mean she can’t see everyone who is referred to her – even when the need is clear.
And sometimes, the call comes too late.
‘I’ve knocked on a door to have the [patient’s] husband tell me, “oh, she died”,’ Ms Abbott said. ‘That’s happened multiple times.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
There’s no way to prove whether an earlier HMR would have changed those outcomes. But for a pharmacist trained to identify medicine-related risk, these moments stay with you.
‘It’s heartbreaking, it’s wrong and it shouldn’t be that way,’ she said.
Knocking on doors
Ms Abbott practises in Gippsland, Victoria – recently labelled ‘Australia’s unhealthiest region’ in the media.
The statistics are confronting: high smoking rates, significant socioeconomic disadvantage, and high burden of chronic obstructive pulmonary disease and cardiovascular disease. ‘If you look at a map of heart attacks in Victoria,’ Ms Abbott said, ‘Gippsland is just red.’
In a region like this, preventive medicines care matters. Yet access is rationed.
Ms Abbott consistently hits the 30-HMR monthly cap.
‘I have not had a month under 30 [HMRs] since September 2023,’ she said.
Demand far exceeds what she’s allowed to provide. Referrals have to wait, clinics juggle priorities, and some GPs even stop sending patients her way because they know she’s hit her limit.
Like many credentialed pharmacists, Ms Abbott’s wait list is about 2 months long.
‘Currently, if I received your referral today [28 January], I might see you in March at the earliest.’
A workforce running on goodwill
Gippsland is not remote in the traditional sense. It sits within reach of Melbourne. Yet Ms Abbott describes a thinning workforce of credentialed pharmacists.
‘There are only four of us in the Latrobe Valley, an hour in either direction,’ she said. ‘Only one of us has come on board in the last few years.’
Others have retired and some have simply stopped.
Ms Abbott is unsurprised by this. ‘Why would you bother becoming accredited financially right now?’ she asked. ‘You’re going to earn more and [have] a stable pay cheque in hospital or community pharmacy. Why would you pay to go through a course when you’ve got an absolutely capped income in that work stream?’
‘I have not had a month under 30 [HMRs] since September 2023.'
kelly abbott mps
The 30-service cap, introduced in 2014, limits how many HMRs a provider can claim per month. HMR fees have not been indexed since July 2019, eroding their real value over time.
For credentialed pharmacists like Ms Abbott, that combination sends a clear message that their work is undervalued.
‘What other specialist is limited like this?’
The cost of saying no
Ms Abbott described refusing some distant referrals because travel makes them financially unviable.
‘I am refusing to go to certain places because it’s just too far,’ she said.
Pharmacists can’t charge for travel as part of an HMR so the system means ‘those people are missing out’.
‘This means entire towns are not serviced by HMR providers in Gippsland, Ms Abbott said. ‘In an area with an ageing population, some of these towns would benefit enormously from medication reviews by a local pharmacist face-to-face.’
It’s not how she wants to practise.
‘I hate thinking that way. I hate being that way.
But the financial reality is that she can’t afford to make a loss on referrals.
Her frustration is about sustainability, not about status.
When remuneration doesn’t reflect the complexity and levels of responsibility, fewer pharmacists choose to become credentialed. And in high-need areas, that has real consequences.
Let pharmacists do what they are trained to do
Despite the challenges, Ms Abbott still believes in the value of HMRs.
‘We have great evidence that they reduce hospitalisations and they reduce healthcare costs,’ she said.
‘And patients and GPs absolutely love them. The demand alone tells you that.’
But she can’t meet that demand under current restrictive settings.
‘I love what I do,’ she said. ‘And there’s so many pharmacists like me who want to do more here. Just let me loose.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
