Ruth Cooper
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[post_content] => Cheaper medicines, expanded vaccination services and clarity on pharmacist programs and agreements were central to the 2024–25 federal budget handed down last night in Canberra.
After several years of interest rate hikes and soaring inflation, the focus of the Albanese government’s 2024–25 budget – was on the cost-of-living, with the announcement of a $7.8 billion relief package.
Central to this initiative, among others, is ensuring essential medicines are affordable, and healthcare services are accessible.
Australian Pharmacist breaks down the key budget measures that impact pharmacists and patients.
1. Cheaper medicines for all
A focal point of the government’s cost-of-living relief package is funding for a $469.1 million Cheaper Medicines initiative.
This includes a freeze on Pharmaceutical Benefits Scheme (PBS) indexation for at least 1 year so medicine prices stay stable as the cost of living continues to increase.
First Nations Australians will also benefit from an expansion to the Closing the Gap PBS copayment, which will now include all PBS medicines dispensed by community pharmacies, hospital, or approved prescribers. This will ensure essential medicines are either free or cheaper for Aboriginal and Torres Strait Islander peoples, with PSA long advocating for better access to medicines for First Nations Australians.
Other medicine funding measure include investments of:
The Aged Care On-site Pharmacists (ACOP) program will benefit from $333.7 million in funding, allowing credentialed pharmacists to work on-site in residential aged care facility (RACF) from 1 July 2024.
Pharmacists who wish to participate in the ACOP workforce will need an Aged Care residential and a Medication Management Reviews (MMR), should they wish to provide Residential Medication Management Reviews.
There will also be a a transition measure that allows pharmacists with only the MMR credential to work in a RACF.
More details on the MMR recognition of prior learning pathway, ACOP program participation and funding pathways is available on PSA’s Pharmacist Credentialing Page and the below explainer from Kerri Barwick, PSA General Manager of Education and Training.
https://www.youtube.com/watch?v=qD5DYjTZbNkFollowing the government’s announcement of a $3 billion investment in the 8th Community Pharmacy Agreement in March 2024, there were some revelations on what that funding would go towards in last night’s budget, including a freeze on indexation of the PBS co-payment for:
This will see a phasing out of the optional $1.00 discount over time.
‘As negotiations on the 8th Community Pharmacy Agreement and other agreements continue, PSA is highlighting the importance of funding for the delivery and quality improvement of pharmacist programs to further support patient safety,’ said A/Prof Sim.
With primary care services stretched and hospitals under pressure, the government announced a host of measures to improve healthcare access, including:
While PSA’s welcomed the cost of living measures and expanded pharmacy programs to ensure more accessible healthcare, there were some missed opportunities to better service those in need, as outlined in PSA’s 2024–25 budget submission. This includes funding for:
The PSA will continue to advocate for funded programs to optimise the role of pharmacists across specialisations and practice areas.
‘We continue to highlight that pharmacists are key to improving Australians’ access to care and quality use of medicines and medicine safety,’ said A/Prof Sim.
‘This is only the start of the journey, and I look forward to working collaboratively with the government, the Department and other stakeholders on this important work.
‘On behalf of PSA and Australia’s 37,000 pharmacists, I commend Minister for Health and Aged Care Mark Butler, Treasurer Jim Chalmers MP on a budget addressing cost of living pressures of Australians.’
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[post_content] => Rapid Antigen Tests (RATs) have become the first step for diagnosing COVID-19, with PCR tests primarily now used in high-risk individuals who test negative on a RAT.
There are currently 87 COVID-19 RATs approved by the Therapeutic Goods Administration (TGA) for use in Australia. But not all tests are created equal, revealed new research.
Following a preliminary study on 10 Australian RATs in 2023, researchers at James Cook University (JCU) partnered with National Research Council Canada to compare the analytical sensitivity of 26 RATs currently available in Canada and/or Australia.
‘We were not satisfied with how the analytical sensitivity is disclaimed by the manufacturers,’ said co-author Associate Professor Patrick Schaeffer from JCU. ‘So the goal was to detect the tests worth taking.’
The products’ buffers were spiked with a nucleocapsid protein engineered by the researchers at various concentrations.
But only six, three of which are available in Australia, were able to detect the lowest concentration of SARS-CoV-2.
So which RATs work best?
Out of the 16 products used in the study that have been approved for use by the TGA, the best-performing RATs were Fanttest, Innoscreen, and Juschek.
‘Some RATs were 100-fold less sensitive than the best ones,’ said A/Prof Schaeffer. ‘That means you would need a 100-fold higher viral load to produce a positive result with those RATs.’
The TGA only approves RATs that have a ‘clinical sensitivity’ of at least 80% when used within 7 days of symptom onset. But the research findings indicate that the clinical data submitted by some manufacturers was ‘probably misleading’, he said.
For example, if a clinical study is conducted in a hospital among patients severely unwell with COVID-19, the clinical sensitivity could reach up to 99%.
‘That doesn't mean if you do the test in the [community] where people have different states of infection that you will get that 99% sensitivity,’ said A/Prof Schaeffer.
Knowing which products are the best in terms of analytical sensitivity removes the ‘bias of studies’.
‘It really looks at the analytical power of performance of RAT tests,’ he added.
How does this impact pharmacists?
While A/Prof Schaeffer said it’s obviously up to pharmacists what products they opt to stock, there’s ‘no point’ selling RATs that are less sensitive than the best products available.
‘They all claim they are the best ones,’ he said. ‘[But] down the track, you may have an infection line that possibly resulted in people ending up on a ventilator, or in death.’
Now that data on the performance of RATs is accessible to pharmacists, they can opt to use it to inform their supply purchases and counselling advice to patients – particularly ahead of winter.
‘It's particularly important to consider if your decision-making around taking a RAT is to visit your grandmother in an aged care facility, or someone in a cancer ward who is immunocompromised,’ said A/Prof Schaeffer.
What’s the future of rapid testing?
RATs are an important tool for disease control and fast-tracking infection notifications, thinks A/Prof Schaeffer.
‘We can use them, then retest the next day or 3 days later to make sure we are negative,’ he said.
But most importantly, it’s crucial to keep the RATs that perform well.
All Australian RATs tested all detected the nucleocapsid protein ‘to a certain level’. But one RAT – currently available in Canada and revoked in Australia by the TGA in 2022 – failed to detect the COVID-19 protein entirely at any level of concentration used in the dilution series.
‘We were absolutely shocked,’ said A/Prof Schaeffer.
Without ongoing quality control, the same thing could happen here.
‘The reality is, we could have situations like in Canada, where you could buy a RAT that doesn't detect the protein at all,’ he said.
‘We need continual independent testing of RATS to keep the brandmakers on their toes, so they know people can actually test the accuracy of their RAT tests.’
This approach should also promote easier revocation of the RATs that underperform.
‘As better medical devices come in, low-performing RATs need to be pushed out,’ said A/Prof Schaeffer.
To that end, the team is aiming to secure funding to establish a watchdog program for RATs coming onto the market for respiratory viruses, particularly with combined test kits becoming more freely available.
This includes broadening the study to analyse RATs capable of detecting different strains of Influenza A and B viruses.
‘There were two RATs in this latest study which are designed to detect Influenza A and B as well as COVID-19, but neither of them detected influenza proteins particularly well,’ he said.
‘We’d like to look at how well influenza RATs can detect subtypes like H3N2, H5N1 “bird flu” and H1N1, otherwise known as swine flu.
‘We're [also] developing the RSV protein now so we can carry on evaluating RATs and making sure brand makers know that we’re here to conduct post-market evaluation on sensitivity.’
[post_title] => How to identify the most accurate RATs
[post_excerpt] => Find out which COVID-19 rapid antigen tests are the best-performing, and what product has failed to detect the virus.
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[post_content] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
From GP clinics to Aboriginal Community Controlled Health Organisations (ACCHOs) and residential aged care facilities, credentialed pharmacists play a vital role in multidisciplinary healthcare teams.
Not only do they have the accreditation to conduct medication reviews, they are on-the-ground medicines experts who can provide education to patients and staff, conduct clinical audits and provide follow-up reviews, among other tasks.
No matter the setting, one thing is key to pharmacists’ success: building trust with other members of the healthcare team. In a study of GP pharmacists in the ACT, researchers suggested this trust could be developed by ensuring the credentialed pharmacist has a clear job description, improving awareness of what they can do, and taking the time to break down communication barriers.
When trust is present, pharmacists can have a big impact. ‘Pharmacist-GP-nurse collaboration to identify medication-related problems was reported as an important mechanism to improve integrated care and team effectiveness and reduce workload,’ the authors wrote.1
‘Participants described how making decisions for patients as a team could improve the quality of care in the general practice setting.’
PSA MIMS Credentialed Pharmacist of the Year for 2024 Brooke Shelly MPS has what she describes as a ‘portfolio career’.
She conducts Home Medicines Reviews (HMRs), works as a GP pharmacist at Ontario Medical Clinic in Mildura, Victoria, and is a clinical pharmacist at Beyond Pain, a Victorian-based consulting service providing tailored programs for chronic pain as well as chronic illness and mental health disorders. She says team-based care is fundamental to all her roles.
‘I couldn’t imagine doing pharmacy in any other way,’ Ms Shelly says. ‘The key to effective multidisciplinary team-based care lies in clearly defining each team member’s roles and responsibilities.
‘It’s not about confining yourself to “typical” roles, but leveraging each team member’s individual scope of practice to the fullest.’
For example, while Ms Shelly is a pharmacist, she also has experience in business operations, change management and leadership.
‘This means I can play a significant role in influencing the strategic direction of the clinic. I lead clinical meetings, develop new cycles of care to address gaps in our practice, and contribute to staff development and recruitment,’ she says.
‘Moreover, like the nurses in our practice, I’m also capable of administering vaccinations and providing wound care, and akin to GPs, I can manage chronic disease.
‘This adaptability is especially vital in the regions where we’re significantly affected by uneven healthcare workforce distribution.’
While credentialed pharmacists know the part they play in the wider healthcare system, Ms Shelly says it’s a message that should be spread wider.
‘As well as being the medicines experts, pharmacists are collaborators, solution seekers and champions of person-centred care.
‘Despite consistently being overlooked in multidisciplinary team descriptors, pharmacists are an indispensable component of the healthcare system,’ she says. ‘We need to be louder and prouder about the essential role that we play within a patient’s healthcare team and the Australian healthcare system at large.’
AP spoke with Ms Shelly and Yvette McGrath in Queensland (see over) about their approach to team-based care.
Case 1
Brooke Shelly MPS (she/her) Credentialed and GP pharmacist, Ontario Medical Clinic, Mildura, Victoria
We had an older patient who had been hospitalised due to heart failure exacerbation. Upon discharge, I did a medicine reconciliation and optimisation and drafted his GP management plan. I also provided vaccination services during subsequent visits.
It was clear the patient and his wife needed domiciliary services to maintain their safety and independence at home. But, despite referrals from the GP to multiple health professionals and agencies, they refused any help, and their health deteriorated.
I suggested to the GP that an HMR might be beneficial. She agreed, so I called the patient and said, ‘Hi Mr X, it’s Brooke from the clinic. Would it be ok if I came past your house on the way home to go through your medicines for Dr Y?’
Much to our surprise, he said yes. That was a result of having built rapport and trust with him.
The HMR revealed it was the patient’s wife who was concerned about getting help. She feared any visit might result in their institutionalisation, leading to their loss of independence. I mentioned a trusted colleague who could link them in with some domestic services. I also attended the home to complete a follow-up HMR when the aged care assessment was happening to further support them.
As a result, they now have access to services they were unaware of, including transport, food delivery and assistance with cleaning and gardening.
Now that their fear is gone, they have people around them to keep them as healthy and safe as possible. This experience underscores the importance of personalised care and addressing the holistic needs of patients and their families.
It’s important to remember that the person you’re caring for is the most important member of the team. Patients need to be actively involved in decision making, and we always need to ensure that what we as clinicians do is in line with the person’s goals of care – nothing we do is worthwhile if it’s at odds with that.
Case 2
Yvette McGrath MPS (she/her) Credentialed pharmacist, Cairns Queensland
I work in an ACCHO that’s about an hour and a half away from where I live in Cairns. It’s then another 40 minutes to an outreach clinic. We have a doctor, registered nurse, health workers, an amazing receptionist who keeps everyone organised – and a driver.
When we visit the clinic, we take a big bus, and patients can come and visit the doctor or the health worker. At the same time, some of us do HMRs.
One of our patients was a 69-year-old First Nations woman who had been in hospital for an extended period. The doctor wanted to see how she was, and the nurse, health worker and I went with him. It’s important to note that the nurse and health worker are both First Nations peoples, while the doctor and I aren’t.
It really helps to have those cultural connections in this setting.
While we were visiting the patient, I went through her medicine cupboard and pulled out those she didn’t need any more, such as spironolactone and perindopril, which had been ceased in hospital. The patient had also mentioned to the nurse that she hadn’t been taking all her medicines.
I did some education around why each medicine was important, and we tweaked the timing of some so that she would be more likely to take them.
We all went in as a team and did our own little bit.
I travel to the community about once a fortnight, and the impact I can have depends in part on the rest of the team.
For example, we have a lot of locum doctors at the moment. It was much easier to identify a patient who would benefit from an HMR and get a referral when we had a permanent doctor, as they know the system and the patients.
They would be really alert to who would benefit from a review so that I always had work to do when I came up.
Now, I rely on the health worker to identify people for HMRs and use their standing in the clinic to ask the locum to do referrals.
After being credentialed for over 20 years, there are still patients, doctors, nurses, carers and nurse navigators who tell me they never knew the service was available. When they find out about it, they always say how amazing it is.
Reference
- Sudeshika T, Deeks LS, Naunton M, et al. Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists. J Pharm Policy Pract 2023;16:49.
[post_title] => A team with credentials
[post_excerpt] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"]
Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-13 16:18:58 [post_modified_gmt] => 2024-05-13 06:18:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26133 )td_module_mega_menu Object
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[post_content] => Cheaper medicines, expanded vaccination services and clarity on pharmacist programs and agreements were central to the 2024–25 federal budget handed down last night in Canberra.
After several years of interest rate hikes and soaring inflation, the focus of the Albanese government’s 2024–25 budget – was on the cost-of-living, with the announcement of a $7.8 billion relief package.
Central to this initiative, among others, is ensuring essential medicines are affordable, and healthcare services are accessible.
Australian Pharmacist breaks down the key budget measures that impact pharmacists and patients.
1. Cheaper medicines for all
A focal point of the government’s cost-of-living relief package is funding for a $469.1 million Cheaper Medicines initiative.
This includes a freeze on Pharmaceutical Benefits Scheme (PBS) indexation for at least 1 year so medicine prices stay stable as the cost of living continues to increase.
First Nations Australians will also benefit from an expansion to the Closing the Gap PBS copayment, which will now include all PBS medicines dispensed by community pharmacies, hospital, or approved prescribers. This will ensure essential medicines are either free or cheaper for Aboriginal and Torres Strait Islander peoples, with PSA long advocating for better access to medicines for First Nations Australians.
Other medicine funding measure include investments of:
The Aged Care On-site Pharmacists (ACOP) program will benefit from $333.7 million in funding, allowing credentialed pharmacists to work on-site in residential aged care facility (RACF) from 1 July 2024.
Pharmacists who wish to participate in the ACOP workforce will need an Aged Care residential and a Medication Management Reviews (MMR), should they wish to provide Residential Medication Management Reviews.
There will also be a a transition measure that allows pharmacists with only the MMR credential to work in a RACF.
More details on the MMR recognition of prior learning pathway, ACOP program participation and funding pathways is available on PSA’s Pharmacist Credentialing Page and the below explainer from Kerri Barwick, PSA General Manager of Education and Training.
https://www.youtube.com/watch?v=qD5DYjTZbNkFollowing the government’s announcement of a $3 billion investment in the 8th Community Pharmacy Agreement in March 2024, there were some revelations on what that funding would go towards in last night’s budget, including a freeze on indexation of the PBS co-payment for:
This will see a phasing out of the optional $1.00 discount over time.
‘As negotiations on the 8th Community Pharmacy Agreement and other agreements continue, PSA is highlighting the importance of funding for the delivery and quality improvement of pharmacist programs to further support patient safety,’ said A/Prof Sim.
With primary care services stretched and hospitals under pressure, the government announced a host of measures to improve healthcare access, including:
While PSA’s welcomed the cost of living measures and expanded pharmacy programs to ensure more accessible healthcare, there were some missed opportunities to better service those in need, as outlined in PSA’s 2024–25 budget submission. This includes funding for:
The PSA will continue to advocate for funded programs to optimise the role of pharmacists across specialisations and practice areas.
‘We continue to highlight that pharmacists are key to improving Australians’ access to care and quality use of medicines and medicine safety,’ said A/Prof Sim.
‘This is only the start of the journey, and I look forward to working collaboratively with the government, the Department and other stakeholders on this important work.
‘On behalf of PSA and Australia’s 37,000 pharmacists, I commend Minister for Health and Aged Care Mark Butler, Treasurer Jim Chalmers MP on a budget addressing cost of living pressures of Australians.’
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[post_content] => Rapid Antigen Tests (RATs) have become the first step for diagnosing COVID-19, with PCR tests primarily now used in high-risk individuals who test negative on a RAT.
There are currently 87 COVID-19 RATs approved by the Therapeutic Goods Administration (TGA) for use in Australia. But not all tests are created equal, revealed new research.
Following a preliminary study on 10 Australian RATs in 2023, researchers at James Cook University (JCU) partnered with National Research Council Canada to compare the analytical sensitivity of 26 RATs currently available in Canada and/or Australia.
‘We were not satisfied with how the analytical sensitivity is disclaimed by the manufacturers,’ said co-author Associate Professor Patrick Schaeffer from JCU. ‘So the goal was to detect the tests worth taking.’
The products’ buffers were spiked with a nucleocapsid protein engineered by the researchers at various concentrations.
But only six, three of which are available in Australia, were able to detect the lowest concentration of SARS-CoV-2.
So which RATs work best?
Out of the 16 products used in the study that have been approved for use by the TGA, the best-performing RATs were Fanttest, Innoscreen, and Juschek.
‘Some RATs were 100-fold less sensitive than the best ones,’ said A/Prof Schaeffer. ‘That means you would need a 100-fold higher viral load to produce a positive result with those RATs.’
The TGA only approves RATs that have a ‘clinical sensitivity’ of at least 80% when used within 7 days of symptom onset. But the research findings indicate that the clinical data submitted by some manufacturers was ‘probably misleading’, he said.
For example, if a clinical study is conducted in a hospital among patients severely unwell with COVID-19, the clinical sensitivity could reach up to 99%.
‘That doesn't mean if you do the test in the [community] where people have different states of infection that you will get that 99% sensitivity,’ said A/Prof Schaeffer.
Knowing which products are the best in terms of analytical sensitivity removes the ‘bias of studies’.
‘It really looks at the analytical power of performance of RAT tests,’ he added.
How does this impact pharmacists?
While A/Prof Schaeffer said it’s obviously up to pharmacists what products they opt to stock, there’s ‘no point’ selling RATs that are less sensitive than the best products available.
‘They all claim they are the best ones,’ he said. ‘[But] down the track, you may have an infection line that possibly resulted in people ending up on a ventilator, or in death.’
Now that data on the performance of RATs is accessible to pharmacists, they can opt to use it to inform their supply purchases and counselling advice to patients – particularly ahead of winter.
‘It's particularly important to consider if your decision-making around taking a RAT is to visit your grandmother in an aged care facility, or someone in a cancer ward who is immunocompromised,’ said A/Prof Schaeffer.
What’s the future of rapid testing?
RATs are an important tool for disease control and fast-tracking infection notifications, thinks A/Prof Schaeffer.
‘We can use them, then retest the next day or 3 days later to make sure we are negative,’ he said.
But most importantly, it’s crucial to keep the RATs that perform well.
All Australian RATs tested all detected the nucleocapsid protein ‘to a certain level’. But one RAT – currently available in Canada and revoked in Australia by the TGA in 2022 – failed to detect the COVID-19 protein entirely at any level of concentration used in the dilution series.
‘We were absolutely shocked,’ said A/Prof Schaeffer.
Without ongoing quality control, the same thing could happen here.
‘The reality is, we could have situations like in Canada, where you could buy a RAT that doesn't detect the protein at all,’ he said.
‘We need continual independent testing of RATS to keep the brandmakers on their toes, so they know people can actually test the accuracy of their RAT tests.’
This approach should also promote easier revocation of the RATs that underperform.
‘As better medical devices come in, low-performing RATs need to be pushed out,’ said A/Prof Schaeffer.
To that end, the team is aiming to secure funding to establish a watchdog program for RATs coming onto the market for respiratory viruses, particularly with combined test kits becoming more freely available.
This includes broadening the study to analyse RATs capable of detecting different strains of Influenza A and B viruses.
‘There were two RATs in this latest study which are designed to detect Influenza A and B as well as COVID-19, but neither of them detected influenza proteins particularly well,’ he said.
‘We’d like to look at how well influenza RATs can detect subtypes like H3N2, H5N1 “bird flu” and H1N1, otherwise known as swine flu.
‘We're [also] developing the RSV protein now so we can carry on evaluating RATs and making sure brand makers know that we’re here to conduct post-market evaluation on sensitivity.’
[post_title] => How to identify the most accurate RATs
[post_excerpt] => Find out which COVID-19 rapid antigen tests are the best-performing, and what product has failed to detect the virus.
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[post_content] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
From GP clinics to Aboriginal Community Controlled Health Organisations (ACCHOs) and residential aged care facilities, credentialed pharmacists play a vital role in multidisciplinary healthcare teams.
Not only do they have the accreditation to conduct medication reviews, they are on-the-ground medicines experts who can provide education to patients and staff, conduct clinical audits and provide follow-up reviews, among other tasks.
No matter the setting, one thing is key to pharmacists’ success: building trust with other members of the healthcare team. In a study of GP pharmacists in the ACT, researchers suggested this trust could be developed by ensuring the credentialed pharmacist has a clear job description, improving awareness of what they can do, and taking the time to break down communication barriers.
When trust is present, pharmacists can have a big impact. ‘Pharmacist-GP-nurse collaboration to identify medication-related problems was reported as an important mechanism to improve integrated care and team effectiveness and reduce workload,’ the authors wrote.1
‘Participants described how making decisions for patients as a team could improve the quality of care in the general practice setting.’
PSA MIMS Credentialed Pharmacist of the Year for 2024 Brooke Shelly MPS has what she describes as a ‘portfolio career’.
She conducts Home Medicines Reviews (HMRs), works as a GP pharmacist at Ontario Medical Clinic in Mildura, Victoria, and is a clinical pharmacist at Beyond Pain, a Victorian-based consulting service providing tailored programs for chronic pain as well as chronic illness and mental health disorders. She says team-based care is fundamental to all her roles.
‘I couldn’t imagine doing pharmacy in any other way,’ Ms Shelly says. ‘The key to effective multidisciplinary team-based care lies in clearly defining each team member’s roles and responsibilities.
‘It’s not about confining yourself to “typical” roles, but leveraging each team member’s individual scope of practice to the fullest.’
For example, while Ms Shelly is a pharmacist, she also has experience in business operations, change management and leadership.
‘This means I can play a significant role in influencing the strategic direction of the clinic. I lead clinical meetings, develop new cycles of care to address gaps in our practice, and contribute to staff development and recruitment,’ she says.
‘Moreover, like the nurses in our practice, I’m also capable of administering vaccinations and providing wound care, and akin to GPs, I can manage chronic disease.
‘This adaptability is especially vital in the regions where we’re significantly affected by uneven healthcare workforce distribution.’
While credentialed pharmacists know the part they play in the wider healthcare system, Ms Shelly says it’s a message that should be spread wider.
‘As well as being the medicines experts, pharmacists are collaborators, solution seekers and champions of person-centred care.
‘Despite consistently being overlooked in multidisciplinary team descriptors, pharmacists are an indispensable component of the healthcare system,’ she says. ‘We need to be louder and prouder about the essential role that we play within a patient’s healthcare team and the Australian healthcare system at large.’
AP spoke with Ms Shelly and Yvette McGrath in Queensland (see over) about their approach to team-based care.
Case 1
Brooke Shelly MPS (she/her) Credentialed and GP pharmacist, Ontario Medical Clinic, Mildura, Victoria
We had an older patient who had been hospitalised due to heart failure exacerbation. Upon discharge, I did a medicine reconciliation and optimisation and drafted his GP management plan. I also provided vaccination services during subsequent visits.
It was clear the patient and his wife needed domiciliary services to maintain their safety and independence at home. But, despite referrals from the GP to multiple health professionals and agencies, they refused any help, and their health deteriorated.
I suggested to the GP that an HMR might be beneficial. She agreed, so I called the patient and said, ‘Hi Mr X, it’s Brooke from the clinic. Would it be ok if I came past your house on the way home to go through your medicines for Dr Y?’
Much to our surprise, he said yes. That was a result of having built rapport and trust with him.
The HMR revealed it was the patient’s wife who was concerned about getting help. She feared any visit might result in their institutionalisation, leading to their loss of independence. I mentioned a trusted colleague who could link them in with some domestic services. I also attended the home to complete a follow-up HMR when the aged care assessment was happening to further support them.
As a result, they now have access to services they were unaware of, including transport, food delivery and assistance with cleaning and gardening.
Now that their fear is gone, they have people around them to keep them as healthy and safe as possible. This experience underscores the importance of personalised care and addressing the holistic needs of patients and their families.
It’s important to remember that the person you’re caring for is the most important member of the team. Patients need to be actively involved in decision making, and we always need to ensure that what we as clinicians do is in line with the person’s goals of care – nothing we do is worthwhile if it’s at odds with that.
Case 2
Yvette McGrath MPS (she/her) Credentialed pharmacist, Cairns Queensland
I work in an ACCHO that’s about an hour and a half away from where I live in Cairns. It’s then another 40 minutes to an outreach clinic. We have a doctor, registered nurse, health workers, an amazing receptionist who keeps everyone organised – and a driver.
When we visit the clinic, we take a big bus, and patients can come and visit the doctor or the health worker. At the same time, some of us do HMRs.
One of our patients was a 69-year-old First Nations woman who had been in hospital for an extended period. The doctor wanted to see how she was, and the nurse, health worker and I went with him. It’s important to note that the nurse and health worker are both First Nations peoples, while the doctor and I aren’t.
It really helps to have those cultural connections in this setting.
While we were visiting the patient, I went through her medicine cupboard and pulled out those she didn’t need any more, such as spironolactone and perindopril, which had been ceased in hospital. The patient had also mentioned to the nurse that she hadn’t been taking all her medicines.
I did some education around why each medicine was important, and we tweaked the timing of some so that she would be more likely to take them.
We all went in as a team and did our own little bit.
I travel to the community about once a fortnight, and the impact I can have depends in part on the rest of the team.
For example, we have a lot of locum doctors at the moment. It was much easier to identify a patient who would benefit from an HMR and get a referral when we had a permanent doctor, as they know the system and the patients.
They would be really alert to who would benefit from a review so that I always had work to do when I came up.
Now, I rely on the health worker to identify people for HMRs and use their standing in the clinic to ask the locum to do referrals.
After being credentialed for over 20 years, there are still patients, doctors, nurses, carers and nurse navigators who tell me they never knew the service was available. When they find out about it, they always say how amazing it is.
Reference
- Sudeshika T, Deeks LS, Naunton M, et al. Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists. J Pharm Policy Pract 2023;16:49.
[post_title] => A team with credentials
[post_excerpt] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-13 16:18:58 [post_modified_gmt] => 2024-05-13 06:18:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26133 )td_module_mega_menu Object
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[post_content] => Cheaper medicines, expanded vaccination services and clarity on pharmacist programs and agreements were central to the 2024–25 federal budget handed down last night in Canberra.
After several years of interest rate hikes and soaring inflation, the focus of the Albanese government’s 2024–25 budget – was on the cost-of-living, with the announcement of a $7.8 billion relief package.
Central to this initiative, among others, is ensuring essential medicines are affordable, and healthcare services are accessible.
Australian Pharmacist breaks down the key budget measures that impact pharmacists and patients.
1. Cheaper medicines for all
A focal point of the government’s cost-of-living relief package is funding for a $469.1 million Cheaper Medicines initiative.
This includes a freeze on Pharmaceutical Benefits Scheme (PBS) indexation for at least 1 year so medicine prices stay stable as the cost of living continues to increase.
First Nations Australians will also benefit from an expansion to the Closing the Gap PBS copayment, which will now include all PBS medicines dispensed by community pharmacies, hospital, or approved prescribers. This will ensure essential medicines are either free or cheaper for Aboriginal and Torres Strait Islander peoples, with PSA long advocating for better access to medicines for First Nations Australians.
Other medicine funding measure include investments of:
The Aged Care On-site Pharmacists (ACOP) program will benefit from $333.7 million in funding, allowing credentialed pharmacists to work on-site in residential aged care facility (RACF) from 1 July 2024.
Pharmacists who wish to participate in the ACOP workforce will need an Aged Care residential and a Medication Management Reviews (MMR), should they wish to provide Residential Medication Management Reviews.
There will also be a a transition measure that allows pharmacists with only the MMR credential to work in a RACF.
More details on the MMR recognition of prior learning pathway, ACOP program participation and funding pathways is available on PSA’s Pharmacist Credentialing Page and the below explainer from Kerri Barwick, PSA General Manager of Education and Training.
https://www.youtube.com/watch?v=qD5DYjTZbNkFollowing the government’s announcement of a $3 billion investment in the 8th Community Pharmacy Agreement in March 2024, there were some revelations on what that funding would go towards in last night’s budget, including a freeze on indexation of the PBS co-payment for:
This will see a phasing out of the optional $1.00 discount over time.
‘As negotiations on the 8th Community Pharmacy Agreement and other agreements continue, PSA is highlighting the importance of funding for the delivery and quality improvement of pharmacist programs to further support patient safety,’ said A/Prof Sim.
With primary care services stretched and hospitals under pressure, the government announced a host of measures to improve healthcare access, including:
While PSA’s welcomed the cost of living measures and expanded pharmacy programs to ensure more accessible healthcare, there were some missed opportunities to better service those in need, as outlined in PSA’s 2024–25 budget submission. This includes funding for:
The PSA will continue to advocate for funded programs to optimise the role of pharmacists across specialisations and practice areas.
‘We continue to highlight that pharmacists are key to improving Australians’ access to care and quality use of medicines and medicine safety,’ said A/Prof Sim.
‘This is only the start of the journey, and I look forward to working collaboratively with the government, the Department and other stakeholders on this important work.
‘On behalf of PSA and Australia’s 37,000 pharmacists, I commend Minister for Health and Aged Care Mark Butler, Treasurer Jim Chalmers MP on a budget addressing cost of living pressures of Australians.’
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[post_content] => Rapid Antigen Tests (RATs) have become the first step for diagnosing COVID-19, with PCR tests primarily now used in high-risk individuals who test negative on a RAT.
There are currently 87 COVID-19 RATs approved by the Therapeutic Goods Administration (TGA) for use in Australia. But not all tests are created equal, revealed new research.
Following a preliminary study on 10 Australian RATs in 2023, researchers at James Cook University (JCU) partnered with National Research Council Canada to compare the analytical sensitivity of 26 RATs currently available in Canada and/or Australia.
‘We were not satisfied with how the analytical sensitivity is disclaimed by the manufacturers,’ said co-author Associate Professor Patrick Schaeffer from JCU. ‘So the goal was to detect the tests worth taking.’
The products’ buffers were spiked with a nucleocapsid protein engineered by the researchers at various concentrations.
But only six, three of which are available in Australia, were able to detect the lowest concentration of SARS-CoV-2.
So which RATs work best?
Out of the 16 products used in the study that have been approved for use by the TGA, the best-performing RATs were Fanttest, Innoscreen, and Juschek.
‘Some RATs were 100-fold less sensitive than the best ones,’ said A/Prof Schaeffer. ‘That means you would need a 100-fold higher viral load to produce a positive result with those RATs.’
The TGA only approves RATs that have a ‘clinical sensitivity’ of at least 80% when used within 7 days of symptom onset. But the research findings indicate that the clinical data submitted by some manufacturers was ‘probably misleading’, he said.
For example, if a clinical study is conducted in a hospital among patients severely unwell with COVID-19, the clinical sensitivity could reach up to 99%.
‘That doesn't mean if you do the test in the [community] where people have different states of infection that you will get that 99% sensitivity,’ said A/Prof Schaeffer.
Knowing which products are the best in terms of analytical sensitivity removes the ‘bias of studies’.
‘It really looks at the analytical power of performance of RAT tests,’ he added.
How does this impact pharmacists?
While A/Prof Schaeffer said it’s obviously up to pharmacists what products they opt to stock, there’s ‘no point’ selling RATs that are less sensitive than the best products available.
‘They all claim they are the best ones,’ he said. ‘[But] down the track, you may have an infection line that possibly resulted in people ending up on a ventilator, or in death.’
Now that data on the performance of RATs is accessible to pharmacists, they can opt to use it to inform their supply purchases and counselling advice to patients – particularly ahead of winter.
‘It's particularly important to consider if your decision-making around taking a RAT is to visit your grandmother in an aged care facility, or someone in a cancer ward who is immunocompromised,’ said A/Prof Schaeffer.
What’s the future of rapid testing?
RATs are an important tool for disease control and fast-tracking infection notifications, thinks A/Prof Schaeffer.
‘We can use them, then retest the next day or 3 days later to make sure we are negative,’ he said.
But most importantly, it’s crucial to keep the RATs that perform well.
All Australian RATs tested all detected the nucleocapsid protein ‘to a certain level’. But one RAT – currently available in Canada and revoked in Australia by the TGA in 2022 – failed to detect the COVID-19 protein entirely at any level of concentration used in the dilution series.
‘We were absolutely shocked,’ said A/Prof Schaeffer.
Without ongoing quality control, the same thing could happen here.
‘The reality is, we could have situations like in Canada, where you could buy a RAT that doesn't detect the protein at all,’ he said.
‘We need continual independent testing of RATS to keep the brandmakers on their toes, so they know people can actually test the accuracy of their RAT tests.’
This approach should also promote easier revocation of the RATs that underperform.
‘As better medical devices come in, low-performing RATs need to be pushed out,’ said A/Prof Schaeffer.
To that end, the team is aiming to secure funding to establish a watchdog program for RATs coming onto the market for respiratory viruses, particularly with combined test kits becoming more freely available.
This includes broadening the study to analyse RATs capable of detecting different strains of Influenza A and B viruses.
‘There were two RATs in this latest study which are designed to detect Influenza A and B as well as COVID-19, but neither of them detected influenza proteins particularly well,’ he said.
‘We’d like to look at how well influenza RATs can detect subtypes like H3N2, H5N1 “bird flu” and H1N1, otherwise known as swine flu.
‘We're [also] developing the RSV protein now so we can carry on evaluating RATs and making sure brand makers know that we’re here to conduct post-market evaluation on sensitivity.’
[post_title] => How to identify the most accurate RATs
[post_excerpt] => Find out which COVID-19 rapid antigen tests are the best-performing, and what product has failed to detect the virus.
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[post_content] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
From GP clinics to Aboriginal Community Controlled Health Organisations (ACCHOs) and residential aged care facilities, credentialed pharmacists play a vital role in multidisciplinary healthcare teams.
Not only do they have the accreditation to conduct medication reviews, they are on-the-ground medicines experts who can provide education to patients and staff, conduct clinical audits and provide follow-up reviews, among other tasks.
No matter the setting, one thing is key to pharmacists’ success: building trust with other members of the healthcare team. In a study of GP pharmacists in the ACT, researchers suggested this trust could be developed by ensuring the credentialed pharmacist has a clear job description, improving awareness of what they can do, and taking the time to break down communication barriers.
When trust is present, pharmacists can have a big impact. ‘Pharmacist-GP-nurse collaboration to identify medication-related problems was reported as an important mechanism to improve integrated care and team effectiveness and reduce workload,’ the authors wrote.1
‘Participants described how making decisions for patients as a team could improve the quality of care in the general practice setting.’
PSA MIMS Credentialed Pharmacist of the Year for 2024 Brooke Shelly MPS has what she describes as a ‘portfolio career’.
She conducts Home Medicines Reviews (HMRs), works as a GP pharmacist at Ontario Medical Clinic in Mildura, Victoria, and is a clinical pharmacist at Beyond Pain, a Victorian-based consulting service providing tailored programs for chronic pain as well as chronic illness and mental health disorders. She says team-based care is fundamental to all her roles.
‘I couldn’t imagine doing pharmacy in any other way,’ Ms Shelly says. ‘The key to effective multidisciplinary team-based care lies in clearly defining each team member’s roles and responsibilities.
‘It’s not about confining yourself to “typical” roles, but leveraging each team member’s individual scope of practice to the fullest.’
For example, while Ms Shelly is a pharmacist, she also has experience in business operations, change management and leadership.
‘This means I can play a significant role in influencing the strategic direction of the clinic. I lead clinical meetings, develop new cycles of care to address gaps in our practice, and contribute to staff development and recruitment,’ she says.
‘Moreover, like the nurses in our practice, I’m also capable of administering vaccinations and providing wound care, and akin to GPs, I can manage chronic disease.
‘This adaptability is especially vital in the regions where we’re significantly affected by uneven healthcare workforce distribution.’
While credentialed pharmacists know the part they play in the wider healthcare system, Ms Shelly says it’s a message that should be spread wider.
‘As well as being the medicines experts, pharmacists are collaborators, solution seekers and champions of person-centred care.
‘Despite consistently being overlooked in multidisciplinary team descriptors, pharmacists are an indispensable component of the healthcare system,’ she says. ‘We need to be louder and prouder about the essential role that we play within a patient’s healthcare team and the Australian healthcare system at large.’
AP spoke with Ms Shelly and Yvette McGrath in Queensland (see over) about their approach to team-based care.
Case 1
Brooke Shelly MPS (she/her) Credentialed and GP pharmacist, Ontario Medical Clinic, Mildura, Victoria
We had an older patient who had been hospitalised due to heart failure exacerbation. Upon discharge, I did a medicine reconciliation and optimisation and drafted his GP management plan. I also provided vaccination services during subsequent visits.
It was clear the patient and his wife needed domiciliary services to maintain their safety and independence at home. But, despite referrals from the GP to multiple health professionals and agencies, they refused any help, and their health deteriorated.
I suggested to the GP that an HMR might be beneficial. She agreed, so I called the patient and said, ‘Hi Mr X, it’s Brooke from the clinic. Would it be ok if I came past your house on the way home to go through your medicines for Dr Y?’
Much to our surprise, he said yes. That was a result of having built rapport and trust with him.
The HMR revealed it was the patient’s wife who was concerned about getting help. She feared any visit might result in their institutionalisation, leading to their loss of independence. I mentioned a trusted colleague who could link them in with some domestic services. I also attended the home to complete a follow-up HMR when the aged care assessment was happening to further support them.
As a result, they now have access to services they were unaware of, including transport, food delivery and assistance with cleaning and gardening.
Now that their fear is gone, they have people around them to keep them as healthy and safe as possible. This experience underscores the importance of personalised care and addressing the holistic needs of patients and their families.
It’s important to remember that the person you’re caring for is the most important member of the team. Patients need to be actively involved in decision making, and we always need to ensure that what we as clinicians do is in line with the person’s goals of care – nothing we do is worthwhile if it’s at odds with that.
Case 2
Yvette McGrath MPS (she/her) Credentialed pharmacist, Cairns Queensland
I work in an ACCHO that’s about an hour and a half away from where I live in Cairns. It’s then another 40 minutes to an outreach clinic. We have a doctor, registered nurse, health workers, an amazing receptionist who keeps everyone organised – and a driver.
When we visit the clinic, we take a big bus, and patients can come and visit the doctor or the health worker. At the same time, some of us do HMRs.
One of our patients was a 69-year-old First Nations woman who had been in hospital for an extended period. The doctor wanted to see how she was, and the nurse, health worker and I went with him. It’s important to note that the nurse and health worker are both First Nations peoples, while the doctor and I aren’t.
It really helps to have those cultural connections in this setting.
While we were visiting the patient, I went through her medicine cupboard and pulled out those she didn’t need any more, such as spironolactone and perindopril, which had been ceased in hospital. The patient had also mentioned to the nurse that she hadn’t been taking all her medicines.
I did some education around why each medicine was important, and we tweaked the timing of some so that she would be more likely to take them.
We all went in as a team and did our own little bit.
I travel to the community about once a fortnight, and the impact I can have depends in part on the rest of the team.
For example, we have a lot of locum doctors at the moment. It was much easier to identify a patient who would benefit from an HMR and get a referral when we had a permanent doctor, as they know the system and the patients.
They would be really alert to who would benefit from a review so that I always had work to do when I came up.
Now, I rely on the health worker to identify people for HMRs and use their standing in the clinic to ask the locum to do referrals.
After being credentialed for over 20 years, there are still patients, doctors, nurses, carers and nurse navigators who tell me they never knew the service was available. When they find out about it, they always say how amazing it is.
Reference
- Sudeshika T, Deeks LS, Naunton M, et al. Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists. J Pharm Policy Pract 2023;16:49.
[post_title] => A team with credentials
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-13 16:18:58 [post_modified_gmt] => 2024-05-13 06:18:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26133 )td_module_mega_menu Object
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[post_content] => Cheaper medicines, expanded vaccination services and clarity on pharmacist programs and agreements were central to the 2024–25 federal budget handed down last night in Canberra.
After several years of interest rate hikes and soaring inflation, the focus of the Albanese government’s 2024–25 budget – was on the cost-of-living, with the announcement of a $7.8 billion relief package.
Central to this initiative, among others, is ensuring essential medicines are affordable, and healthcare services are accessible.
Australian Pharmacist breaks down the key budget measures that impact pharmacists and patients.
1. Cheaper medicines for all
A focal point of the government’s cost-of-living relief package is funding for a $469.1 million Cheaper Medicines initiative.
This includes a freeze on Pharmaceutical Benefits Scheme (PBS) indexation for at least 1 year so medicine prices stay stable as the cost of living continues to increase.
First Nations Australians will also benefit from an expansion to the Closing the Gap PBS copayment, which will now include all PBS medicines dispensed by community pharmacies, hospital, or approved prescribers. This will ensure essential medicines are either free or cheaper for Aboriginal and Torres Strait Islander peoples, with PSA long advocating for better access to medicines for First Nations Australians.
Other medicine funding measure include investments of:
The Aged Care On-site Pharmacists (ACOP) program will benefit from $333.7 million in funding, allowing credentialed pharmacists to work on-site in residential aged care facility (RACF) from 1 July 2024.
Pharmacists who wish to participate in the ACOP workforce will need an Aged Care residential and a Medication Management Reviews (MMR), should they wish to provide Residential Medication Management Reviews.
There will also be a a transition measure that allows pharmacists with only the MMR credential to work in a RACF.
More details on the MMR recognition of prior learning pathway, ACOP program participation and funding pathways is available on PSA’s Pharmacist Credentialing Page and the below explainer from Kerri Barwick, PSA General Manager of Education and Training.
https://www.youtube.com/watch?v=qD5DYjTZbNkFollowing the government’s announcement of a $3 billion investment in the 8th Community Pharmacy Agreement in March 2024, there were some revelations on what that funding would go towards in last night’s budget, including a freeze on indexation of the PBS co-payment for:
This will see a phasing out of the optional $1.00 discount over time.
‘As negotiations on the 8th Community Pharmacy Agreement and other agreements continue, PSA is highlighting the importance of funding for the delivery and quality improvement of pharmacist programs to further support patient safety,’ said A/Prof Sim.
With primary care services stretched and hospitals under pressure, the government announced a host of measures to improve healthcare access, including:
While PSA’s welcomed the cost of living measures and expanded pharmacy programs to ensure more accessible healthcare, there were some missed opportunities to better service those in need, as outlined in PSA’s 2024–25 budget submission. This includes funding for:
The PSA will continue to advocate for funded programs to optimise the role of pharmacists across specialisations and practice areas.
‘We continue to highlight that pharmacists are key to improving Australians’ access to care and quality use of medicines and medicine safety,’ said A/Prof Sim.
‘This is only the start of the journey, and I look forward to working collaboratively with the government, the Department and other stakeholders on this important work.
‘On behalf of PSA and Australia’s 37,000 pharmacists, I commend Minister for Health and Aged Care Mark Butler, Treasurer Jim Chalmers MP on a budget addressing cost of living pressures of Australians.’
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[post_content] => Rapid Antigen Tests (RATs) have become the first step for diagnosing COVID-19, with PCR tests primarily now used in high-risk individuals who test negative on a RAT.
There are currently 87 COVID-19 RATs approved by the Therapeutic Goods Administration (TGA) for use in Australia. But not all tests are created equal, revealed new research.
Following a preliminary study on 10 Australian RATs in 2023, researchers at James Cook University (JCU) partnered with National Research Council Canada to compare the analytical sensitivity of 26 RATs currently available in Canada and/or Australia.
‘We were not satisfied with how the analytical sensitivity is disclaimed by the manufacturers,’ said co-author Associate Professor Patrick Schaeffer from JCU. ‘So the goal was to detect the tests worth taking.’
The products’ buffers were spiked with a nucleocapsid protein engineered by the researchers at various concentrations.
But only six, three of which are available in Australia, were able to detect the lowest concentration of SARS-CoV-2.
So which RATs work best?
Out of the 16 products used in the study that have been approved for use by the TGA, the best-performing RATs were Fanttest, Innoscreen, and Juschek.
‘Some RATs were 100-fold less sensitive than the best ones,’ said A/Prof Schaeffer. ‘That means you would need a 100-fold higher viral load to produce a positive result with those RATs.’
The TGA only approves RATs that have a ‘clinical sensitivity’ of at least 80% when used within 7 days of symptom onset. But the research findings indicate that the clinical data submitted by some manufacturers was ‘probably misleading’, he said.
For example, if a clinical study is conducted in a hospital among patients severely unwell with COVID-19, the clinical sensitivity could reach up to 99%.
‘That doesn't mean if you do the test in the [community] where people have different states of infection that you will get that 99% sensitivity,’ said A/Prof Schaeffer.
Knowing which products are the best in terms of analytical sensitivity removes the ‘bias of studies’.
‘It really looks at the analytical power of performance of RAT tests,’ he added.
How does this impact pharmacists?
While A/Prof Schaeffer said it’s obviously up to pharmacists what products they opt to stock, there’s ‘no point’ selling RATs that are less sensitive than the best products available.
‘They all claim they are the best ones,’ he said. ‘[But] down the track, you may have an infection line that possibly resulted in people ending up on a ventilator, or in death.’
Now that data on the performance of RATs is accessible to pharmacists, they can opt to use it to inform their supply purchases and counselling advice to patients – particularly ahead of winter.
‘It's particularly important to consider if your decision-making around taking a RAT is to visit your grandmother in an aged care facility, or someone in a cancer ward who is immunocompromised,’ said A/Prof Schaeffer.
What’s the future of rapid testing?
RATs are an important tool for disease control and fast-tracking infection notifications, thinks A/Prof Schaeffer.
‘We can use them, then retest the next day or 3 days later to make sure we are negative,’ he said.
But most importantly, it’s crucial to keep the RATs that perform well.
All Australian RATs tested all detected the nucleocapsid protein ‘to a certain level’. But one RAT – currently available in Canada and revoked in Australia by the TGA in 2022 – failed to detect the COVID-19 protein entirely at any level of concentration used in the dilution series.
‘We were absolutely shocked,’ said A/Prof Schaeffer.
Without ongoing quality control, the same thing could happen here.
‘The reality is, we could have situations like in Canada, where you could buy a RAT that doesn't detect the protein at all,’ he said.
‘We need continual independent testing of RATS to keep the brandmakers on their toes, so they know people can actually test the accuracy of their RAT tests.’
This approach should also promote easier revocation of the RATs that underperform.
‘As better medical devices come in, low-performing RATs need to be pushed out,’ said A/Prof Schaeffer.
To that end, the team is aiming to secure funding to establish a watchdog program for RATs coming onto the market for respiratory viruses, particularly with combined test kits becoming more freely available.
This includes broadening the study to analyse RATs capable of detecting different strains of Influenza A and B viruses.
‘There were two RATs in this latest study which are designed to detect Influenza A and B as well as COVID-19, but neither of them detected influenza proteins particularly well,’ he said.
‘We’d like to look at how well influenza RATs can detect subtypes like H3N2, H5N1 “bird flu” and H1N1, otherwise known as swine flu.
‘We're [also] developing the RSV protein now so we can carry on evaluating RATs and making sure brand makers know that we’re here to conduct post-market evaluation on sensitivity.’
[post_title] => How to identify the most accurate RATs
[post_excerpt] => Find out which COVID-19 rapid antigen tests are the best-performing, and what product has failed to detect the virus.
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[post_content] => Credentialed pharmacists can help to change the lives of patients by taking an active role in team-based care.
From GP clinics to Aboriginal Community Controlled Health Organisations (ACCHOs) and residential aged care facilities, credentialed pharmacists play a vital role in multidisciplinary healthcare teams.
Not only do they have the accreditation to conduct medication reviews, they are on-the-ground medicines experts who can provide education to patients and staff, conduct clinical audits and provide follow-up reviews, among other tasks.
No matter the setting, one thing is key to pharmacists’ success: building trust with other members of the healthcare team. In a study of GP pharmacists in the ACT, researchers suggested this trust could be developed by ensuring the credentialed pharmacist has a clear job description, improving awareness of what they can do, and taking the time to break down communication barriers.
When trust is present, pharmacists can have a big impact. ‘Pharmacist-GP-nurse collaboration to identify medication-related problems was reported as an important mechanism to improve integrated care and team effectiveness and reduce workload,’ the authors wrote.1
‘Participants described how making decisions for patients as a team could improve the quality of care in the general practice setting.’
PSA MIMS Credentialed Pharmacist of the Year for 2024 Brooke Shelly MPS has what she describes as a ‘portfolio career’.
She conducts Home Medicines Reviews (HMRs), works as a GP pharmacist at Ontario Medical Clinic in Mildura, Victoria, and is a clinical pharmacist at Beyond Pain, a Victorian-based consulting service providing tailored programs for chronic pain as well as chronic illness and mental health disorders. She says team-based care is fundamental to all her roles.
‘I couldn’t imagine doing pharmacy in any other way,’ Ms Shelly says. ‘The key to effective multidisciplinary team-based care lies in clearly defining each team member’s roles and responsibilities.
‘It’s not about confining yourself to “typical” roles, but leveraging each team member’s individual scope of practice to the fullest.’
For example, while Ms Shelly is a pharmacist, she also has experience in business operations, change management and leadership.
‘This means I can play a significant role in influencing the strategic direction of the clinic. I lead clinical meetings, develop new cycles of care to address gaps in our practice, and contribute to staff development and recruitment,’ she says.
‘Moreover, like the nurses in our practice, I’m also capable of administering vaccinations and providing wound care, and akin to GPs, I can manage chronic disease.
‘This adaptability is especially vital in the regions where we’re significantly affected by uneven healthcare workforce distribution.’
While credentialed pharmacists know the part they play in the wider healthcare system, Ms Shelly says it’s a message that should be spread wider.
‘As well as being the medicines experts, pharmacists are collaborators, solution seekers and champions of person-centred care.
‘Despite consistently being overlooked in multidisciplinary team descriptors, pharmacists are an indispensable component of the healthcare system,’ she says. ‘We need to be louder and prouder about the essential role that we play within a patient’s healthcare team and the Australian healthcare system at large.’
AP spoke with Ms Shelly and Yvette McGrath in Queensland (see over) about their approach to team-based care.
Case 1
Brooke Shelly MPS (she/her) Credentialed and GP pharmacist, Ontario Medical Clinic, Mildura, Victoria
We had an older patient who had been hospitalised due to heart failure exacerbation. Upon discharge, I did a medicine reconciliation and optimisation and drafted his GP management plan. I also provided vaccination services during subsequent visits.
It was clear the patient and his wife needed domiciliary services to maintain their safety and independence at home. But, despite referrals from the GP to multiple health professionals and agencies, they refused any help, and their health deteriorated.
I suggested to the GP that an HMR might be beneficial. She agreed, so I called the patient and said, ‘Hi Mr X, it’s Brooke from the clinic. Would it be ok if I came past your house on the way home to go through your medicines for Dr Y?’
Much to our surprise, he said yes. That was a result of having built rapport and trust with him.
The HMR revealed it was the patient’s wife who was concerned about getting help. She feared any visit might result in their institutionalisation, leading to their loss of independence. I mentioned a trusted colleague who could link them in with some domestic services. I also attended the home to complete a follow-up HMR when the aged care assessment was happening to further support them.
As a result, they now have access to services they were unaware of, including transport, food delivery and assistance with cleaning and gardening.
Now that their fear is gone, they have people around them to keep them as healthy and safe as possible. This experience underscores the importance of personalised care and addressing the holistic needs of patients and their families.
It’s important to remember that the person you’re caring for is the most important member of the team. Patients need to be actively involved in decision making, and we always need to ensure that what we as clinicians do is in line with the person’s goals of care – nothing we do is worthwhile if it’s at odds with that.
Case 2
Yvette McGrath MPS (she/her) Credentialed pharmacist, Cairns Queensland
I work in an ACCHO that’s about an hour and a half away from where I live in Cairns. It’s then another 40 minutes to an outreach clinic. We have a doctor, registered nurse, health workers, an amazing receptionist who keeps everyone organised – and a driver.
When we visit the clinic, we take a big bus, and patients can come and visit the doctor or the health worker. At the same time, some of us do HMRs.
One of our patients was a 69-year-old First Nations woman who had been in hospital for an extended period. The doctor wanted to see how she was, and the nurse, health worker and I went with him. It’s important to note that the nurse and health worker are both First Nations peoples, while the doctor and I aren’t.
It really helps to have those cultural connections in this setting.
While we were visiting the patient, I went through her medicine cupboard and pulled out those she didn’t need any more, such as spironolactone and perindopril, which had been ceased in hospital. The patient had also mentioned to the nurse that she hadn’t been taking all her medicines.
I did some education around why each medicine was important, and we tweaked the timing of some so that she would be more likely to take them.
We all went in as a team and did our own little bit.
I travel to the community about once a fortnight, and the impact I can have depends in part on the rest of the team.
For example, we have a lot of locum doctors at the moment. It was much easier to identify a patient who would benefit from an HMR and get a referral when we had a permanent doctor, as they know the system and the patients.
They would be really alert to who would benefit from a review so that I always had work to do when I came up.
Now, I rely on the health worker to identify people for HMRs and use their standing in the clinic to ask the locum to do referrals.
After being credentialed for over 20 years, there are still patients, doctors, nurses, carers and nurse navigators who tell me they never knew the service was available. When they find out about it, they always say how amazing it is.
Reference
- Sudeshika T, Deeks LS, Naunton M, et al. Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists. J Pharm Policy Pract 2023;16:49.
[post_title] => A team with credentials
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[post_content] => Pregnant women are having difficulty accessing essential medicines due to a reliance on off-patent drugs and a lack of trial data into the safety of newer medicines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has raised concerns about the lack of available therapies for pregnant women due to the reluctance to include them in clinical trials.
With many of the medicines available to pregnant women typically older drugs that are no longer under patent, pharmaceutical companies have little financial incentive to distribute them in the Australian market – leading to supply shortages.
The combination of these factors has left many pregnant women unable to access new or existing therapies for conditions such as hypertension or syphilis – which is increasing in prevalence, particularly among First Nations Australians.
What are the health implications?
Medicine unavailability for pregnant women is ‘really scary’, particularly when it comes to conditions such as hypertension, with patients having difficulty maintaining control, said credentialed pharmacist and women’s health expert Anna Barwick MPS.
‘The prescribing team identifies a need for treatment and writes a script, but when women go to the pharmacy the find the medicine is out of stock. They might go to a number of other pharmacies and can't find it,’ she said.
‘When they go back for follow-up with their care team, they then need to be hospitalised to get their blood pressure down quickly.’
This takes a toll on both the healthcare system, and women and families.
‘Women often need to be hospitalised for a period of time to get control, and then we still need to source ongoing treatment to keep them well managed,’ said Ms Barwick.
The resulting health impacts can be ‘catastrophic’. ‘[Uncontrolled blood pressure] has a massive impact on the pregnancy, often affecting birth weight, and can cause a number of issues with baby and mum's health going forward.’
Untreated syphilis in pregnancy can lead to congenital syphilis, which can cause premature birth and stillbirth. If diagnosed and treated early, prognosis is good, however supply of its treatment benzathine benzylpenicillin is a concern.
What do pharmacists need to know about off-label medicine use?
Because of the difficulty accessing medicines in pregnancy, off-label medicine use is often the norm, said Ms Barwick.
‘But there's no published data that these medicines are safe to use, even though they are used regularly to help support women through their pregnancy,’ she said.
A prime example of this is the Schedule 3 medicine doxylamine to treat nausea and vomiting.
‘Some of the packaging [for doxylamine] has previously said it's not safe in pregnancy and breastfeeding, when we know it is a category A medication,’ said Ms Barwick.
When unsure whether an off-label medicine is safe to use in pregnancy, she recommends consulting and/or directing patients towards state/territory-based services such as state-based MotherSafe, which operates in NSW.
‘Women and children's hospitals often collect data to identify whether medicines are not safe, or if there is any reason when it comes to the mechanism of action that would cause a concern during the pregnancy,’ she said.
‘That data is then used by MotherSafe to reassure women and health professionals about about what treatments are ok or should be avoided.’
A spokesperson for MotherSafe told Australian Pharmacist that as they don’t know patients’ medical histories, it’s important to refer the patient back for a chat with their prescriber to discuss whether a medicine is appropriate for them.
Checking the Therapeutic Guidelines or other reliable resources is also key. Children’s hospitals are also a reliable source of information, often having treatment guides or consumer-directed information on their website which provides recommendations for safe use of medicines in pregnancy and confidence in off-label use.
Pharmacists can also complete the PSA CPD Not as easy as ABCD or X to understand the issues with the Therapeutic Goods Administration’s (TGA) categorisation system for prescribing medicines in pregnancy, and how to consider whether a medicine is safe to use.
‘Sometimes you might need to consult specialist guidelines, or go back to the prescriber and ask what the reason for treatment is, so you understand and can reinforce that with a patient to encourage adherence,’ said Ms Barwick.
‘It’s also important to find resources that demonstrate evidence that a medicine is reliable and appropriate, including RANZCOG guidelines, which are likely the most up to date. The SOMANZ Guidelines are also highly useful.’
How can pharmacists keep tabs on stock shortages?
Medicines such as benzathine benzylpenicillin to treat syphilis or clonidine for hypertension are currently in short supply. Pharmacists should utilise the Department of Health and Aged Care’s Medicines shortage reports database to keep up to speed with other medicines that are out of stock, advised Ms Barwick.
‘You can search for particular products and when the next expected supply is,’ she added.
Pharmacists can also pass information about shock shortages to GPs, who can start the patient on another available medicine instead, advised Ms Barwick.
Antenatal pharmacists may be able to source essential medications through the Federal Government’s Special Access Scheme, however this may be more difficult in regional, rural or remote areas.
What else can pharmacists do to help?
During medication reviews, pharmacists can potentially suggest an alternative therapy if they know a medicine will be out of stock. For example, labetalol, nifedipine or methyldopa can be recommended in place of clonidine to treat hypertension, said Ms Barwick.
But it’s important to keep patients abreast of different adverse effect profiles and advise
them what to look out for.
‘A required change in therapy due to out of stock medicine may mean adjustment for the body and resultant adverse effects,’ she said.
‘Often it’s a bit of an adjustment for the body around adverse effects,’ she said.
Supporting pregnant women through point-of-care testing, particularly for blood pressure, is another important role for pharmacists, said Ms Barwick.
‘Pharmacists can [explain] what targets pregnant women should be aiming for to manage their blood pressure,’ she said.
‘We can show them how to use blood pressure machines for testing at home. They can use the notes function on their phone for recording their measurements to pass on to their pregnancy care team in their next appointment.’
Monitoring for preeclampsia is also key for patients at risk (see the AP article Shouldering the load for a detailed explainer on pharmacists' role in pregnancy monitoring).
Lastly, Ms Barwick thinks pharmacists should support RANZCOG’s call for changing the recommendations for medicines in pregnancy.
‘We know [off-label medicines] clearly work and are safe through exposure during pregnancy over a long period of time,’ she said. ‘Hopefully that will mean medicines are less likely to go out of stock because they are a recognised and approved treatment regimen for pregnant women.’
[post_title] => Medicine shortages placing pregnant women at risk
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[post_content] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?
If not, you’re not alone, said Karl Winckel, pharmacist at Princess Alexandra Hospital and the University of Queensland’s School of Pharmacy.
[caption id="attachment_26040" align="alignright" width="222"] Karl Winckel[/caption]
‘It’s gone under the radar,’ he said. ‘Education about the new tool is mostly targeted at GPs rather than nurses or pharmacists.’
As it turns out, CVD risk has been ‘massively overestimated’ through use of previous CVD risk tables.
With landmark studies such as ASPREE, ARRIVE, ASCEND all showing much lower benefit than expected for aspirin in primary prevention, it’s time to shift approach to preventative care.
To kick off Heart Week (6–12 May 2024), Australian Pharmacist explains how to best wield the new tool to your patients’ advantage.
What was wrong with the previous CVD calculator
Previous CVD risk assessments were based on the ongoing Framingham Heart Study, conducted in the small Massachusetts town of Framingham, dating back to the late 1940s.
But cardiovascular risk has changed significantly since then, with people more aware of the risks, said Mr Winckel.
‘People are also exercising more and using preventative therapies,’ he said.
The new AusCVDRisk tool uses QRISK3 risk prediction model and PREDICT model incorporating data from the United Kingdom and New Zealand, with baseline risk adjusted to suit the Australian context.
‘They looked at all the Australian Bureau of Statistics (ABS) and relevant surveys in New Zealand to dictate the number of strokes and heart attacks in different age and comorbidity brackets,’ he said.
There was also lack of nuance when using the Framingham risk tables. For example, when users classified their smoking habits, they would simply click ‘smoker’ or ‘non-smoker’.
‘That means if you quit smoking a week ago, that classifies you as a nonsmoker, but you might have been smoking for 30 years,’ Mr Winckel said.
While CVD risk reduces upon cessation, it never returns to baseline. With AusCVDRisk, users can include more details about their smoking history, including if they’re a never-smoker or ex-smoker.
To demonstrate the variation in risk estimation between the Framingham and AusCVDRisk tools, the author calculated a family member's CVD risk using both. The former placed their risk at 5–10% over 5 years. Using AusCVDRisk, it was 2%.
What are the benefits of the new calculator?
When it comes to calculating CVD risk, the devil is in the details.
More information is included in AusCVDRisk about users' diabetes history to quantify a more accurate risk score, including:
The author's CVD risk, calculated using AusCVDRisk, in printable image form[/caption]
Patients can also determine their risk once they hit certain health goals, including:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-13 16:18:58 [post_modified_gmt] => 2024-05-13 06:18:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26133 ) Get your weekly dose of the news and research you need to help advance your practice.
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