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[post_content] => Emergency department (ED) presentations for non-urgent care can be lessened through improved healthcare services in the community, a new report has found.
The Australian Institute of Health and Welfare report sought to understand who uses emergency services and for what reason to ensure that the right services are delivered when needed. In-hours and after-hours use of emergency services were analysed by the individual's residence and the urgency of the care required.
Data sources included the National Non-admitted Patient Emergency Department Care Database between 2015–2018, the ABS Australian Bureau of Statistics (ABS) and Estimated Resident Population (ERP) from 2001, 2015, 2016 and 2017.1
Measures of non-urgent care were based on the 2018 National Health Agreement (NHA) indicator and were defined as presentations that:
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[post_content] => The new Australian Charter of Healthcare Rights has a strong focus on the partnership between healthcare professionals and patients to improve health outcomes. With an existing focus on patient-centred care, pharmacy is already on the right track to fulfil these rights.
Developed by the Australian Commission on Safety and Quality in Health Care, this is the second edition of the charter, first released in 2008. To compile the list of rights, data from more than 1,600 survey respondents along with eight workshops with consumers, health service staff and policy-makers, was analysed. The outcome of the research identified a need for patient-centred care and empowering consumers to actively participate in their own healthcare.
The Charter outlines the rights entitled to all Australians when receiving healthcare across any setting. These include:
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[post_content] => While urban and rural community pharmacy practice are frequently compared, is there a reliable evidence base around these differences?
There is a difference in health status between rural and urban populations. Those that live in rural areas typically experience more chronic health issues and have less access to services. Rural populations are more likely to have diabetes, arthritis, cardiovascular disease, asthma and mental health problems than those in urban areas. Data from the Australian Institute of Health and Welfare, indicates that in 2014, ‘rural death rates due to chronic disease were higher and rural people lived, on average, four years less’.
Pharmacists in rural areas are clearly serving a different population than their urban counterparts – but more data around what these pharmacy services look like is necessary to make an informed comparison.1
This is the observation that came about in a recent narrative systematic review that analysed the differences in the nature of the services provided in rural and urban settings, conducted by PSA CEO Dr Shane Jackson, University of Tasmania Professor Gregory Peterson and PHD student Helen Howarth.1
‘I was looking for articles where rural and non-rural practice had really been compared, and it was very hard to actually find the articles,’ Ms Howarth said.
‘Everyone is always saying that there are differences, but to actually find the differences is really difficult.’
After a search of 3,830 titles, only 17 reviews were fitting in their analysis of pharmacy practice differences, which the review focused on rather than dispensing and consumer counselling. Current or proposed services were investigated, including the provision of pharmaceutical care, public health activities and prescribing.1
However, the 17 studies were all diverse in nature and it was difficult to identify more than one within the same context.
The findings in some studies were also not-consistent across others. For example, rural patients were found to seek advice more willingly than their urban counterparts, although this wasn’t always the case. There was also limited evidence to indicate that more services were available in rural settings. An Australian study, however identified that rural pharmacists were more willing to see more patients for opioid substitution therapy.1
‘While we did find that rural pharmacists were more willing to talk to people, that was often counteracted by the fact that they probably have more time to,’ Ms Howarth said. ‘So each time we found a difference, it was often negated in the discussion of the article, which is really unfortunate as it is important to nominate those differences.’
Some evidence suggested that rural pharmacists were more open to the development of new roles, the delivery of more comprehensive services, and that they were more regularly in touch with prescribers – however the data pool was too limited to definitively make this claim.1
Of the 17 studies analysed, only four related to the differences in professional services between the two locales. Comparative data was often a by-product of an investigation into different kinds of community pharmacy practice.1
Where to next?
The study concluded that more research needs to be done in order to identify any meaningful differences between rural and urban community pharmacy practice.1
‘There needs to be more research and more analysis of existing research,’ Ms Howarth said. ‘The existing research was analysed statistically, but it wasn’t analysed in any depth. So that’s where it was difficult to actually find the trends.’
The focus of the research also needs to be more clearly defined, she said. ‘I was looking for differences in professional services, because it’s something tangible that you can actually search for. In Australia it’s difficult because of our PhARIA system. Meaning there are many healthcare services that are classed as rural in other systems, which are not considered rural in pharmacy – that makes it difficult to gather that good cohort of pharmacies to analyse.’
Ms Howarth suggested a more uniform definition of what the term ‘professional services’ consists of, which tended to vary across the studies analysed. A review of the PhARIA system would be similarly beneficial, for example the use of a modified Modified Monash Model (a Government developed geographical classification system, using up-to-date population data) to define rurality, she said.
More involvement of pharmacy in rural health policy on a national level is also necessary. ‘Pharmacy services are often mentioned loosely, such as promoting blood pressure screening. But these are tiny snippets of what a pharmacist can do in practice. That’s where policy is needed,’ Ms Howarth said.
‘But I’m not doubting that differences occur, it’s just trying to find the proof was very difficult. I was looking for the proof so that it would benefit for rural pharmacists. I think they provide a fantastic service, but I was looking for evidence to support them, and this is what I found very hard to find.’
References
- Howarth HD, Peterson GM, Jackson SL. Does rural and urban community pharmacy practice differ? A narrative systematic review. 2019. At: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijpp.12567
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Better remuneration and career support are key to the future of pharmacists’ roles.
The pharmacy profession provides a much broader range of health services than in the past, including supporting population health initiatives, and growing roles in health prevention, medicine safety and clinical governance. This role evolution will continue into the future and must be underpinned by system changes which unlock the potential of pharmacists to practice to their full scope.
The PSA’s two key reports, Medicine Safety: Take Care and Pharmacists in 2023, advocate for empowering pharmacists to do more than the current healthcare system allows by harnessing their skills and expertise as medicine experts.
At PSA’s flagship conference, PSA19, we launched Pharmacists in 2023: Roles and Remuneration which describes existing pharmacists’ roles, and their evolution over the next few years. This includes within new and emerging settings and, importantly, the remuneration that should underpin these roles.
Currently, remuneration for Australian pharmacists does not reflect their skills, training, expertise or level of responsibility in the healthcare system. As the complexity of pharmacy practice increases, pharmacists need to be properly remunerated and supported in career pathways.
These pathways must be embedded in routine, everyday practice to support skills development now and into the future. Development pathways like the Advanced Practice Framework must not create artificial barriers to achievement but should support practitioners to be rewarded with increasing remuneration and recognition.
It is PSA’s view that the most appropriate mechanism to support increased remuneration for pharmacists is to link remuneration with activity as well as the skills, expertise and training of the pharmacist. The Advanced Practice Framework is the most logical application of this. While this may take some time to implement, it is clear we need to forge a path that delivers better pay for pharmacists – we believe this is the way.
Formal recognition of advancing practice, from graduation through to transition, consolidation and advanced practice, is a key objective for PSA. But we don’t want to see the mechanism or process of recognising advanced practice as a barrier to development. By 2023, the pharmacy profession should have a recognition program across the board that allows all pharmacists to be included in practitioner development programs no matter the stage of their career. Remuneration attached to development will drive pharmacists to have the greatest impact they can.
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[post_content] => Another Australian state has expanded the scope of pharmacist-administered vaccinations this month, meaning pharmacists can help to protect the community against more infectious diseases like meningococcal.
Since 1 August, pharmacists in Western Australia (WA) can now administer additional vaccines to those aged 16 years and over against dTpa (diphtheria, tetanus, and pertussis), MMR, (measles, mumps and rubella) and meningococcal (ACWY).
‘I am delighted at our WA Minister for Health the Hon. Roger Cook’s announcement that will see trained pharmacists administering MMR, dTpa and meningococcal ACWY vaccinations,’ said Dr Fei Sim, Senior Pharmacy Lecturer at Curtin University, PSA WA Branch President, and recent recipient of the PSA ECP of the year award.
‘This great news came after the announcement in June this year which lowered the pharmacist-administered influenza vaccination age restriction from 18 years down to 10 and above. These are excellent initiatives of the WA Government to protect more of those who live in or are travelling to WA against vaccine-preventable diseases,’ she said.
Meningococcal is a rising threat in Australia,1,2 and globally there have been outbreaks of measles.3 Dr Sim said the role of pharmacists as vaccinators helping ensure herd immunity is now more important than ever.
‘We’re talking about opportunistic vaccination with these diseases. We are encouraging people who are normally healthy to get the vaccine,’ Dr Sim said.
‘Healthy people don’t think about vaccines or going to their GP, but community pharmacists can reach these people, considering the convenience, the accessibility, and the credibility of pharmacists. We’re leveraging the convenience, and in most cases, it will be a more cost-effective way to get someone vaccinated.’
Preventing meningococcal disease
While Neisseria meningitidis is a common respiratory tract commensal, it has the potential to cause invasive meningococcal disease, typically presenting as septicaemia and meningitis.
Incidence is relatively low in Australia, but cases have been increasing recently, with five serogroups – A, C, W, Y and B – accounting for the majority of cases. According to the Federal Health Department, Australia sees 1.1–1.5 cases of invasive meningococcal disease per 100,000 people.2
Cases of the disease have been steadily increasing since 2013. In 2017, cases in Australia hit 1.5 per 100,000, the highest incidence since 2007.4
While pharmacist-administered vaccination for meningococcal disease is only available to people 16 and over, the meningococcal ACWY vaccine is available under the National Immunisation Program for infants (12 months) and adolescents (14–16 years).
The vaccine is suitable for anyone who wants to be protected against the meningococcal disease, but especially those at higher risk of contracting the disease or of suffering severe complications.
‘People who are immunocompromised, babies, young children, adolescents, and those living in close quarters, for instance, or people who have regular contact with such groups,’ said Dr Sim.
While side effects such as injection site reactions, fever, lethargy, and headache can occur with the vaccine, Dr Sim said it’s important for pharmacists to remind people that the benefits of vaccines outweigh any minimal chance of patients experiencing a serious adverse effect.
‘Of course, pharmacists should always advise patients to come back to the pharmacy or see their GP if they notice any adverse effects or experience any symptoms post-vaccination which worry them,’ Dr Sim said.
Improving public health
As pharmacists are Australia’s most accessed health professionals,4 Dr Sim said they play an important role not only in vaccine administration, but also increasing the community’s health literacy.
‘Pharmacists have regular contact with the community and play an important role in this public health issue, increasing the community’s awareness about the importance of vaccinations and, in this case, providing advice regarding the meningococcal vaccine and encouraging vaccination uptake,’ Dr Sim said.
Pharmacy administered vaccines have been steadily growing in Australia, with different states and territories allowing progressively more vaccines to be administered by appropriately trained community pharmacists.
Tasmania has extended its meningococcal ACWY vaccine program through 2019, with community pharmacists also able to administer vaccines. By September 2018, 47% of the state’s eligible cohort had been vaccinated under the program.6
‘We should really leverage the convenience that community pharmacists can offer to deal with such public health issues, and I think the other states should follow WA’s lead. We are one nation. Why should people in other parts of Australia not have the same level of access?’ Dr Sim said.
‘I’m a big advocate for a national approach to achieve consistency, but it is great to see WA leading the way with this important initiative.’
Complete PSA's Immunisation Update 2019 for a comprehensive overview of the influenza, diphtheria-tetanus-pertussis and measles-mumps-rubella vaccines:
https://my.psa.org.au/s/detail
- Government of Western Australia Department of Health. Statewide notifiable diseases weekly report. At: https://ww2.health.wa.gov.au/Articles/F_I/Infectious-disease-data/Statewide-notifiable-diseases-weekly-report
- Sharma K, Chiu C, Wood N. Meningococcal vaccines in Australia: a 2019 update. Aust Prescr. 1 August 2019. At: https://www.nps.org.au/australian-prescriber/articles/meningococcal-vaccines-in-australia-a-2019-update
- The Department of Health. Measles Outbreaks 2019. April 2019. At: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-measles-outbreaks-2019.htm
- The Department of Health. Meningococcal Disease. April 2019. At: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-meningococcal-W.htm
- The Pharmacy Guild of Australia. Submission to the Legal and Social Issues Legislation Committee, Inquiry into Community Pharmacy in Victoria. 2014. At: https://www.parliament.vic.gov.au/images/stories/documents/council/SCLSI/Community_Pharmacy/Submissions/Sub_13_Pharmacy_Guild_of_Australia_30062014.pdf
- Tasmanian Government Department of Health and Human Services. Department of Health Meningococcal ACWY Immunisation Program. September 2018. At: https://www.dhhs.tas.gov.au/menw/home/2018_tasmania_meningococcal_acwy_immunisation_program_-_progress_report_one
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With the fast-approaching 30 September marking the end of the current CPD year, pharmacists should take stock of the progress of their CPD plans.
Pharmacists should determine the CPD activities needed to complete the plan in order to satisfy the Pharmacy Board of Australia (PBA) Registration Standard: Continuing Professional Development (2015). All pharmacists holding general registration, and claiming they satisfied the standard when they renew their PBA registration, must have completed 40 CPD credits between 1 October 2018 and 30 September 2019. There are no ‘pro-rata’ concessions if you only practised for part of the registration period. Interns must meet the annual requirements in the 12 months before registration.
The 40 CPD credits must be made up of at least 20 credits from group 2 and/or group 3 (i.e. no more than 20 credits from group 1). CPD activities must be relevant to your scope of practice, primarily relate to the practice of pharmacy, be composed of significant intellectual or practical content, and consist of a range of different CPD types.
The practice of pharmacy is defined as any role, remunerated or not, in which you use your skills and knowledge as a pharmacist in your profession. Practice is not restricted to the provision of direct clinical care. According to the CPD standard, your scope of practice is ‘the professional role and services that an individual health practitioner is educated and competent to perform.’ If your practice does not involve direct clinical care, you may still undertake CPD in clinical areas if this is useful to your role.
The PBA accepts that accredited CPD activities satisfy their requirement for academic rigour or practical utility, and are relevant to the practice of pharmacy. PSA prides itself on providing members with accredited CPD activities of high educational standard. PSA offers a range of CPD activities for members to help satisfy their PBA requirements. It is the responsibility of the individual pharmacist to assess non-accredited activities for quality, suitability and relevance and to determine whether individual learning needs are likely to be addressed by undertaking these activities.
The PBA also requires that pharmacists reflect on all of the CPD activities they undertake. CPD reflection can be a simple process. It might involve reflecting on how the activity relates to your practice – how you carry out that function within your practice currently, and how that may change as a result of the activity. It might be that the CPD did not address all of the learning goals you planned to attain from that activity, and you identify that you need more learning in order to achieve those goals. The form the reflection takes is not prescribed; it is your personal consideration about the activity and how it relates to you and your practice as a pharmacist.
Don’t forget: all of what is discussed here needs to be recorded. You may be audited by the PBA at some stage in the future, or need to demonstrate your recency of practice. The PBA requires that all pharmacists (including interns) retain their CPD plans and records for the previous three full CPD periods. The PSA provides members with online solutions for the recording and storing of CPD records and plans.
Resources
PSA CPD education catalogue: https://my.psa.org.au/s/education-catalogue
Plan your CPD: https://www.psa.org.au/cpd/plan-your-cpd/
Latest PSA CPD articles: https://www.psa.org.au/cpd/submit-answers/
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[post_content] => The CEO of Diabetes Australia, Professor Greg Johnson, recently called attention to the high numbers of Australians living with undiagnosed type 2 diabetes.
In a statement, Professor Johnson highlighted the need for greater awareness of the disease, referencing a study conducted by Austin Health. The study, which examined over 5,000 patients aged 54 years or older admitted to hospital between July 2013 and January 2014, found that one in six patients admitted to hospital did not previously know they were suffering from diabetes.1
Professor Johnson said that it’s imperative to improve early identification of diabetes and reduce hospitalisation rates for diabetes-related admissions.
‘Every year diabetes is associated with more than one million hospitalisations, but it doesn’t have to be like this. Earlier detection of type 2 diabetes, and optimal early treatment can reduce the risk of people developing diabetes-related complications, which account for many of these hospitalisations, by up to 37%,’ he said.
Diagnosis
Diabetes educator and pharmacist Tara Whelan said that pharmacists could be an important part of this process, noting that their role as frontline healthcare professionals allows them to observe symptoms of the condition, which can be challenging to detect.
‘Because type 2 diabetes is often slow in onset, the red flags may not always be waving directly in our faces. Everyone will present a little differently,’ she told Australian Pharmacist.
Even so, she said that there are some ‘red flags’ to look out for, including persistent tiredness, where people may complain of falling asleep on the couch in the afternoon, or needing regular naps which they have not needed to take previously.
She also urged pharmacists to be aware of patients who mention experiencing frequent urination or disturbed sleep. She noted that many patients might not tell their pharmacist about this, and advised initiating a conversation about night-time toilet habits with patients who are experiencing poor sleep.
Ms Whelan also pointed out that symptoms such as dry mouth or fungal infections are often attributed to other conditions, or are thought to be a side effect of medications. She encouraged pharmacists to go through medical and medicine history, and consider undiagnosed diabetes with dehydration and thirst presenting as dry mouth.
Similarly, she noted that patients who present with thrush and other fungal infections are often asked if they have diabetes, but are often not flagged as having undiagnosed diabetes.
Pharmacist and diabetes educator, Nicole Frayne, added that these symptoms might manifest in unexpected ways. Speaking to Australian Pharmacist she said that patients might purchase multivitamins to provide more energy, repeat prescriptions for UTIs, antibiotics for slow-healing wounds, which could all indicate that a patient has undiagnosed type 2 diabetes.
She also encouraged pharmacists to be aware of other risk factors, such as a family history of type 2 diabetes.
Ms Whelan urged pharmacists who have identified ‘red flags’ to use the Australian type 2 diabetes risk assessment tool (AUSDRISK). If patients score a 12 or above she advised offering a point-of-service blood glucose or HbA1c test before referring them to a GP, noting that if the blood glucose or HbA1c test falls outside the normal range pharmacists should provide an urgent referral.
‘The key here is to follow up. Take down their number and call in a week to see how they got on with their GP. If there is no diagnosis made after your assessment and referral, invite them back to discuss how they can improve their modifiable risk factors based on their answers to the original AUSDRISK ie. nutrition, physical movement, smoking status and waist circumference. Show them that there are ways that they can reduce their own risk through improvements in these areas,’ she said.
Increasing awareness
As reported in the ABC, Austin Health research also indicated that 62% of people aged 40 and above are not concerned about developing type 2 diabetes.
Ms Whelan said that awareness campaigns can be useful, but she encouraged pharmacists to leverage their position as frontline healthcare providers to make a meaningful impact on their patients understanding of the disease.
‘It's important as healthcare professionals that we speak to an individual about their own set of circumstances rather than using statistics which may not resonate with them,’ she said.
For more information about diabetes information in community pharmacy, complete PSA's Diabetes in Practice short course, developed in collaboration with Diabetes Qualified: https://my.psa.org.au/s/training-plan/a117F000001A460/diabetes-in-practice-introduction
References
- Nanayakkara N, Nguyen H, Churilov L et al. BMJ Open Diabetes Res Care. 2015 Sep 7;3(1). At: https://www.ncbi.nlm.nih.gov/pubmed/26380095#
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[post_content] => Most people with clinically severe obesity live and die without the underlying disease having ever been treated, leading global expert in obesity, Professor John Dixon told PSA19 at the weekend.
Pharmacists, like other health practitioners, accept that patients with diabetes and cardiovascular disease and its complications are treated. And the treatment goes beyond ‘lifestyle modification’ to which obese people are directed. This includes medicines to lower blood glucose, to lower lipids and to reduce blood pressure.
Professor Dixon, a researcher at the Baker Heart and Diabetes Institute and Adjunct Professor at the Primary Care Research Unit at Monash University and at the Iverson Health Innovation Institute at Swinburne University, said that 1.4 million Australians have type 2 diabetes and the same number has clinically severe obesity.
The obese group ‘are largely provided nothing’ because it is regarded as ‘their fault’ when lifestyle interventions fail. But that, he said, is what ‘is exactly wrong’ with the health system.
‘We must go beyond lifestyle in treating this disease,’ he said, noting that while women dominate globally in severe forms of obesity, it was fairly equal in terms of gender in Australia. We need a chronic disease care management plan in place, Professor Dixon said.
According to Professor Dixon, establishing the risk factors in the first 1,000 days after birth that ‘determine your weight trajectory for life, given where you’ve been planted (in our obesogenic environment) in Australia’ should be ‘a real focus’ for researchers.
The gut microbiome ‘could [also]…well be influential, but we don’t know if it will lead to effective therapy at this time’, he told a session on the latest interventions in weight management.
No diet was superior he said, and it was a good idea to outsource behavioural plans to dieticians and ‘enhanced programs’ such as Weight Watchers.
‘Obesity is a progressive, chronic relapsing disease that is not curable,’ he said.
Community pharmacists have a role in advising on meal replacements, very-low-calorie diets (VLCDs) and pharmacotherapy. He stressed that losing just 5–10% of bodyweight had the most benefit.
‘All the areas of the brain that control weight are not cortically-controlled.’
He said that while people don’t hesitate to use treatments for high blood pressure, it is different for obesity which is the ‘canary in the mineshaft’ – a warning to the disease, death and disability it generates.
Lean people have satiety after a meal, and that feeling of comfort is prolonged to the next meal, Professor Dixon told the conference. In contrast, an obese person may never be satisfied. ‘They are focused on food, they are looking for food, they’re always hungry,’ Professor Dixon said.
‘So when we’re talking about how we manage this, we’ve got to completely turn away from the reliance on lifestyle interventions and have an understanding of our patients that they’ve used these [diets and exercises] for years. A healthy diet and plenty of exercise are very beneficial in many ways, but for preventing and managing obesity they are disappointing for the majority,’ Professor Dixon said.
Counselling in-pharmacy, or by a dietician or GP is probably best for very-low-calorie diets (VLCDs) and low-calorie diets (LCDs), he advised. While LCDs, VLCDs, drugs and bariatric surgery are all ‘routine’, only 5% per cent of Australians living with severe obesity would receive any of these effective therapies in a year.
Most people can use VLCDs which are ‘available in your pharmacy, less than 800 calories a day. They are superb … patients will use them again and again … they’re extraordinarily safe’ and are designed to promote ketosis – using fat stores for energy in preference to carbohydrate, while meeting all daily nutritional requirements.
However, studies have shown that combination treatments with medicines, behavioural modifications and meal replacements are more successful than single interventions for chronic disease management, he said. In people weighing around 100 kilograms, a 15% reduction in body weight would result in a greater likelihood of diabetes control and remission.
Available drugs include orlistat (Xenical), phentermine (Duromine), liraglutide (Saxenda), topiramate and, most recently, the TGA-approved Contrave, a naltrexone and bupropion combination. Both topiramate and liraglutide are used ‘off-label’ for weight management. Contrave should be titrated up, taken whole with water and food, and evaluated after 16 weeks for at least a 5% baseline body weight loss, which is to be re-evaluated annually.
It is not indicated for either smoking cessation (buproprion alone) or for alcohol or opioid dependence issues (naltrexone).
He urged pharmacists not to be ‘judgemental when people have a weight problem’. A 5–10% sustained weight loss generates ‘major health benefits’.
Some people, particularly those who are insulin-resistant or diabetic, often respond better to a low-carbohydrate diet, while others may fare better on a low-fat diet, Professor Dixon said.
‘Your support during the early phase of meal replacements and pharmacotherapy is vital,’ Professor Dixon reminded pharmacists, in a community-based transdisciplinary approach to care for chronic disease management.
[post_title] => Don’t judge the obese
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Could selective serotonin reuptake inhibitors (SSRIs) help reduce the burden of Alzheimer’s disease and prevent decline from mild cognitive impairment?
An estimated 10% of people over 65 years of age, and 30% of people over 85 years of age, have dementia. Dementia is the second leading cause of death in Australia, and is the single greatest cause of disability in Australians older than 65 years of age. These numbers are expected to only increase with the ageing population. While there are many different forms of dementia, Alzheimer’s disease is the most common – accounting for 70% of people with dementia.
Alzheimer’s disease is a neurodegenerative condition and does not have a cure. It is characterised by ‘β-amyloid plaques’ found outside of brain cells, thought to impair brain synapses, and ‘tangles’ inside brain cells, thought to impair metabolic processes – causing cholinergic neuron destruction and low levels of acetylcholine.
Anticholinesterases such as donepezil, galantamine or rivastigmine reduce the apparent cholinergic deficiency by reducing the breakdown of acetylcholine. As Alzheimer’s disease is also thought to be associated with glutamate excess, an N-methyl-D-aspartate (NMDA) antagonist – memantine – which may reduce glutamate-induced neuronal degeneration may be used.
However, existing pharmacological management is limited in its effectiveness in reducing symptoms and improving quality of life, and does not slow the progression of the condition. The recent spate of failed clinical trials with new medicines intended to target these plaques and tangles has led to questions around the fundamental understanding of the pathophysiology behind Alzheimer’s disease. Therefore, the race is still on to find an effective pharmacological option.
The impact of SSRIs
Animal studies have found SSRIs improve cognition by reducing the levels of β-amyloid plaques found with Alzheimer’s disease. A recent in vitro study looking at binding interactions identified fluoxetine and paroxetine to be the most effective of the SSRIs at inhibiting Aβ β 42 aggregation – the major component of the s-amyloid plaques. However, detail around how this interaction occurs is not well understood.
In humans, several randomised and placebo-controlled trials (the majority ranging from 8–24 weeks in duration) have returned mixed results with regards to the effect of SSRIs on cognition in Alzheimer’s disease. SSRIs may also confer the additional benefit of preventing cognitive decline as depression in late life is also associated with an increased risk of Alzheimer’s disease.
In lieu of large-scale long-term prospective studies, researchers evaluated data sets from the longitudinal Alzheimer’s Disease Neuroimaging Initiative, to investigate the impact of SSRIs on prevalence, and risk of deteriorating from mild cognitive impairment to Alzheimer’s disease, and cerebral spinal fluid biomarkers.
A look at the data
A total of 755 data sets of participants without current depression were analysed. Patients were categorised according to whether they had a history of depression based on their medical history, and grouped at baseline as ‘cognitively normal control subjects’, ‘patients with mild cognitive impairment’ and ‘patients with Alzheimer’s dementia’.
The mean follow-up period was 691 days and the mean duration of antidepressant treatment was 2,256 days (SD=2,474, range=4–16,051), with 22.8% being treated for up to 1 year before baseline, 52.1% between 1 and 4 years, and 25.1% for more than 4 years.
While a history of depression was found to be associated with a higher risk of a baseline diagnosis of mild cognitive impairment, and an even higher risk of a baseline diagnosis of Alzheimer’s disease, it was not associated with an increased rate of conversion from mild cognitive decline to Alzheimer’s dementia.
When analysis (Kaplan-Meier survival analysis) was limited to the fi rst three years of the observation period, patients with mild cognitive impairment and a history of depression with long-term SSRI treatment had significantly lower probability of conversion to Alzheimer’s dementia compared with all other comparison groups. Benefits conferred by use of the SSRIs appeared to be lost after three years, and the probability of subsequent Alzheimer’s dementia became similar to that of all other groups. No differences were noted with the biomarkers.
Conclusion
Much more research is required to better understand how SSRIs affect Alzheimer’s disease, and how it might prevent decline from mild cognitive impairment. Prospective interventional studies are needed to better understand whether this is a class effect, as well as indicative doses and implications for clinical practice.
Certainly, studies delving further into the different patient subtypes such as early and late-life depression, type of antidepressant used and so on are required. More work is definitely warranted in this area if such a readily affordable and well tolerated medicine can help reduce the burden of Alzheimer’s disease for such a significant amount of time.
References
- Tin G, Mohamed T, Shakeri A, Pham AT, Rao PPN. Interactions of Selective Serotonin Reuptake Inhibitors with β-Amyloid. ACS Chem Neurosci. 2019;10(1):226–34. At: https://www.ncbi.nlm.nih.gov/pubmed/30157623
- Bartels C, Wagner M, Wolfsgruber S, Ehrenreich H, Schneider A, Alzheimer’s Disease Neuroimaging Initiative. Impact of SSRI Therapy on Risk of Conversion From Mild Cognitive Impairment to Alzheimer’s Dementia in Individuals With Previous Depression. Am J Psychiatry. 2018;175(3):232–41. At: https://www.ncbi.nlm.nih.gov/pubmed/29179578
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[post_content] => [vc_row][vc_column width="2/3"][vc_column_text]While most women experience primary dysmenorrheoa (period pain), a recent longitudinal study has revealed the extent of its impact on the academic, social and professional lives of young women.
The Australian retrospective study analysed data on dysmenorrheoa in women with mean ages between 13–23 years from 37 studies. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline, Embase and PsychINFO was carried out, and in total, 20,813 women were included in the meta-analysis.1
Primary dysmenorrhoea is the presence of pain during menstruation without an underlying pathology. Secondary dysmenorrhoea is menstrual pain associated with an identifiable cause. Armour et al found that dysmenorrhoea affects 70.8% of young women, regardless of their geographical location, and can impact their education. A significant amount (20%) of young women reported absences from school as a result of menstrual symptoms and 40% reported that classroom performance was negatively affected.1
The authors noted that dysmenorrhea can impact young women in their late teens – a crucial point in their academic lives – potentially impacting on opportunities in tertiary education as well as future career prospects.1
In over one third of women (37%), dysmenorrhoea resulted in a reduction in social and sporting activities. In an article for The Conversation, the authors of the study emphasised the importance of these activities for overall good health in adolescence.1
Misinformation
Despite the impact and prevalence of dysmenorrhea, researchers found that many women reported a reluctance to seek help from healthcare professionals, believing that their symptoms were ‘normal, and therefore not worth reporting’.1
Sexual Health Physician and Director of the Master of Women’s Health Medicine Degree at the University of New South Wales, Dr Therese Foran, noted that this perception is often compounded by generational misinformation surrounding both the severity of symptoms and treatment.
‘Young women’s perceptions may be reinforced by surrounding mothers and older women who may have had significant period pain themselves when they were adolescents, but found that it settled as they got older – the underlying message being that it will get better if you just wait it out. Some of these women and their mothers may even be reluctant to consider measures such as the oral contraceptive pill or nonsteroidal anti-inflammatory drugs (NSAIDs) because of concerns about side-effects and complications,’ she told Australian Pharmacist.
Furthermore, researchers said their findings did not indicate a reduction in symptoms of dysmenorrhea over time and noted that ‘a significant proportion of women with severe dysmenorrhoea may go on to develop more persistent pelvic pain.1
Dr Foran said that these persistent mistaken perceptions can prevent women from seeking necessary treatment.
In order to improve health outcomes, she reinforced the researcher’s conclusion that the commonality of primary dysmenorrhea should not stop women seeking treatment.
‘While primary dysmenorrhoea is normal, pain so severe that you have to miss school or work is not, and the effects both on the young woman and her future should not be minimised or accepted,’ she said.
Community pharmacist Taren Gill told Australian Pharmacist that community events, such as Women’s Health Week – where members of the community are invited to access their community pharmacists and discuss a range of issues relating to women’s health, including menstruation and dysmenorrhoea – can increase community knowledge about symptoms and treatment.
Treatment
Ms Gill said that the accessibility of pharmacists, as well as their access to effective over the counter medicines, makes them are ideally placed to support women experiencing dysmenorrhoea.
Dr Foran emphasised that by validating their symptoms, pharmacists are in a strong position to support women; previous research indicates that many women report their pain being dismissed by family, partners and healthcare providers.
While researchers noted in the Conversation article that there is no ‘one-size-fits-all approach’ to treating the symptoms of primary dysmenorrhea, there are a number of ways that symptoms can be alleviated.
Dr Foran echoed this, pointing to NSAIDs as an ‘obvious starting point,’ providing there are no contraindications. She noted that it can be useful to advise patients to take NSAIDs regularly for the first few days of the period, not just if pain becomes intolerable.
‘The object here is reduction of inflammation not just analgesia,’ she said.
She also noted that pharmacists can be a valuable voice in validating the need for patients to see a GP if NSAIDs are ineffective, or pain extends beyond the standard symptoms of primary dysmenorrhoea. This can be necessary if, for example, pain continues throughout menstruation, bleeding between periods, associated fever or pain with intercourse or defecation.
Ms Gill agreed, noting a depressed mood or migraines around the time of menstruation can also suggest that the patient should be referred to their GP for additional support.
To this end, Dr Foran noted that it is often valuable for pharmacists to keep a list of local ‘youth friendly’ GPs, who are willing to bulk bill people who come to their practice.
Furthermore, noting the prevalence of generational misinformation about primary dysmenorrhoea, she said that it is worth reminding young patients that they can get their own Medicare card at 15 years of age so that they can ‘start taking control of their own health issues’.
Hear more from Dr Therese Foran at PSA19, held in Sydney from 26–28 July. Register here to attend.
References:
- Armour M, Parry K, Manohar N et al. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. Journal of Women’s Health 2019. Epub 2019 June 6. At: https://www.liebertpub.com/doi/abs/10.1089/jwh.2018.7615?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=jwh
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Faye McMillan is a pioneer, paving the way for other Aboriginal and Torres Strait Islander people who want to work in the pharmacy profession. When she’s not busy winning awards, she works as a community pharmacist, university lecturer and is a founding member of Indigenous Allied Health Australia.
Why did you decide to become a pharmacist?
Over 20 years ago, I was working as a pharmacy assistant in my hometown of Trangie (NSW) when I thought to myself, ‘I actually want to be the pharmacist.’ The pharmacist I was working with at the time was extremely supportive and encouraged me to apply to study. I ended up being part of the inaugural cohort of students when Charles Sturt University introduced their pharmacy program in Wagga Wagga, NSW in 1997.
What’s the main focus of your practice?
I’m a community pharmacist, and I also teach in the area of Indigenous health, mental health and pharmacy at CSU. But the main focus of my work is patient-centred care, and ensuring that I’m working with people, so that they feel engaged. That’s what really drew me to pharmacy in the first place – an opportunity to have a relationship and help people as they navigate their health journey.
You’re passionate about recruiting Indigenous Australians into healthcare. What work do you do in this area?
As a founding member of Indigenous Allied Health Australia (IAHA), we strive to recognise Aboriginal and Torres Strait Islander people in the allied health workforce. I sat on the board from its inception in 2009 until 2017 and I was also the chair from 2010–2016. We started with just seven members, now we have 1,500.
IAHA is seen as one of the key bodies representing Aboriginal and Torres Strait Islander people to government and was involved in the development and implementation of the National Aboriginal and Torres Strait Islander Health Plan. We also work with universities to ensure that when Aboriginal and Torres Strait Islander students undertake allied health courses, they are being provided with support, mentors and networking opportunities.
But at IAHA, it’s not just about how we recruit people, it’s how we retain them. We work to ensure they feel engaged, not just in their profession but as a part of their community in the form of a trained healthcare professional.
You were Australia’s first registered Indigenous pharmacist and won the 2019 NSW Aboriginal Woman of the Year Award. How do you feel about being a role model?
It didn’t sit comfortably at first, but I think I’ve settled into it and recognised that people do need role models. When I was starting out I looked around for role models, and I appreciated the journeys of the people who I looked up to. If I’m that to someone else, then that’s a wonderful thing. Sometimes you’re able to use the platform of being an award recipient to give a nuanced opinion or view, and we need people to take up those positions.
You’re also a member of PSA’s National Aboriginal Community Controlled Health Organisation Leadership Group. Why is pharmacist intervention in Indigenous health so important?
Pharmacists play an integral role in the lives of so many people, whether clinically, in the community, or in hospitals – there are so many touch points where pharmacists can be included to provide insight into the health of Aboriginal and Torres Strait Islander people. The knowledge and skills that pharmacists have through their education, their life experiences and by being a consistent presence in the community means that they are able to provide a point of reference for other health professionals.
The Leadership Group is making significant contributions by ensuring people have access to a highly skilled and trained workforce, as well as providing education around the medicines that are needed in these communities, while ensuring they are accessible and affordable.
What’s the next big project that you’re working on?
I’m putting the final touches on a mental health app that I’ve been developing over the past 18 months. I wanted to create something that would provide meaningful support to people – not in place of trained mental health professionals, of course. The app is an extension of an existing self-awareness app that keeps you connected with people you’ve identified in your contact list as your ‘caring community’. It assesses where people are sitting on the scale of mental wellness, followed by contact from someone who will reach out and have a conversation with you. It’s all about having real conversations – listening out for warning signs such as changes in the timbre of the voice, and pauses, things that are easily masked in social media use.
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[post_title] => Pushing boundaries: the pioneer pharmacist
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A range of apps enable pharmacists and patients to see and/or manage their medical information.
As the benefits of My Health Record (MHR) become more widely known, its uptake and usage can be expected to grow. As pharmacists, we are well positioned to take a leadership role and guide patients on this topic, given our status as the most digitally enabled of all health professionals.
It is important for patients who wish to play an active role in their healthcare, or carers of vulnerable patient groups (e.g. children, disabled, elderly, mentally impaired), to understand what information is available to them and how they can access and control access to clinical documents (shared health summary, discharge summary, pathology, diagnostic imaging), prescriptions (prescriptions issued and dispense uploads), consumer documents (patient health summaries, patient notes) and Medicare documents (e.g. immunisation register, organ donor status, Medicare benefits).
How do patients access their MHR?
There are two ways for patients to access their My Health Record.
1. WEB PORTAL (myrecord.ehealth.gov.au)
This site:
| Using a great smartphone app with your patients? Share your insights with your colleagues. Email australianpharmacist@psa.org.au and tell us about your experience and the results you’ve seen. |
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[post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A new MedicineWise program aims to increase the number of patients seeking help for anxiety and other mood disorders by educating healthcare professionals.
Anxiety disorders, including panic disorder, agoraphobia, social anxiety disorder and generalised anxiety disorder, are the most common mental health conditions in Australia. According to a 2008 national survey conducted by the Australian Bureau of statistics the conditions affect 14% of people aged 16–85 years. But despite their ubiquity, a study has indicated that it takes Australians between the ages of 18 and 77 an average of 8.2 years to seek treatment for anxiety and mood disorders.
Pharmacist, mental health researcher and lecturer at the University of Sydney Dr Claire O’Reilly, told Australian Pharmacist that there are many reasons why patients might delay seeking treatment for anxiety disorders, including a lack of awareness surrounding the condition.
‘The symptoms are a bit varied between the different types of anxiety disorders, so when we talk about anxiety there’s all sorts of different anxiety disorders and there can be a lot of crossover between them,’ she said.
‘But also, we all feel stressed from time-to-time, so the feeling of anxiety is a normal mechanism for us. It’s about being able to recognise when it’s more than that. When it’s more severe and longer lasting, it interferes with your work and your relationships. And I think people aren’t always able to pick that up themselves.’
She said that community pharmacists could play an important role in recognising symptoms of anxiety in their patients, and encourage them to seek specialised treatment.
The new program from NPS MedicineWise is based on new clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists, and aims to equip healthcare professionals to perform a similar function by increasing their access to educational tools, including free one-on-one educational visits for GPs, access to a webinar, clinical audit, patient decision aid and other information for health.
NPS MedicineWise told Australian Pharmacist that pharmacists working in general practice are invited to attend small group meetings to discuss therapeutic areas, including resources to support patient decision-making around medicines and health technologies. For practices enrolled in MedicineInsight, these facilitated quality improvement meetings that involve all practice staff, including pharmacists, and utilise individualised practice data to support interventions and to improve patient outcomes in general practice.
Dr O’Reilly, who has consulted with NPS MedicineWise about the involvement of pharmacists in the program, welcomes educational opportunities for pharmacists in the area of anxiety.
‘I think pharmacists can upskill by learning about psychological therapies so that we’re informed when approaching people about treatment options. Pharmacists don’t necessarily have to be experts in this area, but it’s about having an awareness of the options and knowing where to refer people for help,’ she said.
Dr O’Reilly said that education in this area is particularly important given the sensitive nature of mental health. While some patients might already suspect that they are experiencing anxiety, others could be more resistant. In these cases, she advised pharmacists to be aware of patients’ need for privacy, and offer to have a conversation with patients in a private area. She also stressed the importance of having information on hand, such as self-care cards, BeyondBlue information or NPS MedicineWise resources. There are also some PSA State offices that offer Mental Health First Aid courses.
References
- Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Media%20Release12007?opendocument&tabname=Summary&prodno=4326.0&issue=2007&num=&view=
- Thompson, A., Issakidis, C., & Hunt, C. Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behaviour Change 2008; 25(2):71–84. At: https://www.cambridge.org/core/journals/behaviour-change/article/delay-to-seek-treatment-for-anxiety-and-mood-disorders-in-an-australian-clinical-sample/9DF8128BE0F802DB0F6D76724FDEA776
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[title_attribute] => Anxiety is often untreated – how pharmacists can help
[title] => Anxiety is often untreated – how pharmacists can help
[href] => https://www.australianpharmacist.com.au/patients-often-dont-seek-treatment-for-anxiety-how-pharmacists-can-help/
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[post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Psilocybin, a psychoactive compound found in ‘magic mushrooms’, is being trialled in the treatment of terminally ill patients to reduce symptoms of depression and anxiety at Melbourne’s St Vincent’s Hospital.
The treatment has proven to be successful in several international clinical trials, including US-based John Hopkins University in 2016 and Imperial College in London in 2017.
The St Vincent’s trial, headed by clinical psychologist Dr Margaret Ross, aims to provide relief for terminally ill patients – many of whom suffer from underdiagnosed mental health problems.
Major depression in terminally ill patients has been found to be common, ranging from 25% to 77%.1
While depression can diminish quality of life for patients, it has also been associated with a further decline in survival rate and treatment adherence in terminally ill cancer patients. A 2013 study found that about a third of patients with non-small cell lung cancer were suffering from depression. Those patients showed a median overall survival rate of 6.8 months, compared to that in non-depressed patients whose median survival rate was 14 months.2
Researchers from the John Hopkins University trial reported that the compound psilocybin is particularly effective at altering damaging thought processes.3
Serotonergic hallucinogens, including psilocybin (psilocin) and lysergic acid diethylamide (LSD) and mescaline, are a structurally diverse group of compounds that are 5-HT2A receptor agonists. They produce a unique profile of changes in thoughts, perceptions, and emotions.3,4,5
The John Hopkins trial administered psilocybin to cancer patients with a life-threatening diagnosis. Varying doses of psilocybin were given over a period of nine months, with five weeks between sessions. The study found that patients who received high doses of psilocybin (22 or 30 mg) reported decreases in symptoms of depression and anxiety as well as increased quality of life and optimism. Patient reports were echoed by psychiatrists who observed similar results.3
Furthermore, these changes were sustained with 80% of participants continuing to show ‘significant’ decreases in symptoms of depression and anxiety at a six-month follow-up.
Similarly, the Imperial College study found patients with severe depression experienced decreased symptoms after they were given two doses of psilocybin, 10 mg and 25 mg respectively, one week apart.3
fMRI scans revealed observable changes in their cognitive functioning.
‘Whole-brain analyses revealed post-treatment decreases in cerebral blood flow (CBF) in the temporal cortex, including the amygdala. Decreased amygdala CBF correlated with reduced depressive symptoms,’ researchers said in the subsequent paper.6
The St Vincent’s trial will commence in April, when a group of 30 patients will be given 25 mg of synthetic psilocybin alongside psychotherapy sessions.
‘We don't want it to be underwhelming, we don't want it to be overwhelming,’ Dr Ross said. ‘We know that higher doses are associated with anxiety but if it's too low a dose you're not really going to experience that psychological shift in the thinking that we're really looking for.’
While more trials need to be conducted, the positive results suggest that with more research, psilocybin could be offered routinely for relief of anxiety and depression in terminally ill patients.
References:
- Fine RL. Depression, anxiety, and delirium in the terminally ill patient. Proc (Bayl Univ Med Cent). 2001;14(2):130-3. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/
- Arrieta Ó, Angulo LP, Núñez-Valencia C et al. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Ann Surg Oncol 2013; 20: 1941-1948. https://doi.org/10.1245/s10434-012-2793-5
- Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D. Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197. https://journals.sagepub.com/doi/full/10.1177/0269881116675513#_i37
- Halberstadt AL. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behav Brain Res 2015; 277: 99–120. At: https://www.sciencedirect.com/science/article/pii/S0166432814004562?via%3Dihub
- Nichols DE. Psychedelics. Pharmacol Rev 2016; 68(2): 264-355 http://pharmrev.aspetjournals.org/content/68/2/264
- Carhart-Harris RL, RosemanL et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific Reports 2017. Epub 2017 October 13: https://www.nature.com/articles/s41598-017-13282-7#article-info
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[post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Lithium is an invaluable and lifesaving treatment for a range of psychiatric disorders, but its origins lie in patent medicine and the pioneering work of an Australian doctor.
People have been flocking to hot springs of lithium-heavy water for their perceived health benefits for millennia, but it was not until the second half of the 19th century that modern medicine put the element to use.
In 1859, an English physician described the use of lithium carbonate to treat gout by solubilising uric acid in the blood, as well as treating ‘brain gout’, or mental upset.
Over the next few decades, some US and Danish doctors reported that lithium carbonate could calm patients with ‘general nervousness’, mania or depression.1 However, its use in medicine remained rare, with most use instead in food products.
Until 1950, popular soft drink 7-Up2 contained lithium citrate and even beer3 was brewed with lithium-heavy water and promoted for its mood-enhancing abilities.
However, both the real and perceived health benefits of lithium were overshadowed when lithium was prescribed to patients with heart disease as a replacement for salt.4 The resulting overdoses and deaths led to the US banning lithium as an additive in 1950.
Elemental reactions
The exact action of lithium to manage mood remains unclear, though it is clear the molecule acts on the brain on multiple levels. It offers neuroprotective and neuroproliferative effects on brain structure, as well as plasticity.5 It also modulates neurotransmission, inhibiting excitatory neurotransmitters such as dopamine and glutamate,6 and promoting GABA-mediated neurotransmission.6
In 1949 in a Melbourne mental hospital for World War II veterans, Dr John Cade theorised the mania he witnessed in his patients might be linked to the high levels of uric acid he detected in their urine, in line with the 19th century theories about gout.
He experimented with injecting the urine collected from patients demonstrating mania into guinea pigs, which subsequently showed signs of agitation.1 Guinea pigs that were subsequently administered lithium following the urine injections rapidly calmed.
Dr Cade then experimented on himself and when he showed no ill effects after a dose of lithium, he started a trial on 10 patients.7 His trial showed significant positive results, but a mixture of poor timing (given lithium’s then-recent banning from food) and the then-obscurity of the Medical Journal of Australia where his article was published meant little acknowledgment.¹
Instead, Danish research published in 1954 detailing the results of a randomised trial kick-started lithium’s renaissance.1 By 1970, lithium had been widely approved for treating bipolar disorder and other mental health issues.1
Thinking big
In recent years, some studies have found a correlation between high levels of naturally occurring lithium in tap water and lower rates of suicide and mental health problems.2
However, these studies have had many limitations and there is no reliable evidence that says lithium addition to water or food would provide any health benefits.5
References
- Shorter E. The History of Lithium Therapy. Bipolar Disorders. 2009;11.
- Fels A. Should We All Take A Bit of Lithium? The New York Times. 2014 September 13. At: https://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html?_r=0.
- Shepherd R. Lithia Beer returns to West Bend, expands across Wisconsin. Isthmus. At: https://isthmus.com/food-drink/beer/lithia-beer-returns-to-west-bend-expands-across-wisconsin/.
- Hardman JG. Limbird PB. Gilman AG. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th Ed. New York. McGraw-Hill. 2001:507.
- Sachdev P. Let’s not put lithium in the drinking water just yet. Medical Republic. 2017 November 21. At: http://medicalrepublic.com.au/lets-not-put-lithium-drinking-water-just-yet/11998.
- Brunton L. Chabner B. Knollman B. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th Ed. New York. McGraw-Hill. 2010:445.
- Mitchell PB. Hadzi-Pavlovic D. Lithium treatment for bipolar disorder. [Reproduced from The Medical Journal of Australia]. Bulletin of the World Health Organization, 2000;78(4):515.
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Luke Vrankovich MPS, a former locum and one half of the Roaming Pharmacist duo, gained an online following living life on the road. So how is pharmacy ownership working out?
Can you describe the ethos of The Roaming Pharmacist?
It was started by Liam Murphy a few years ago. It was a way, using social media, to show how you can be a locum and travel at the same time. It was also a way to educate the public on some key ideas that are important to Liam, such as harm minimisation through pill testing at festivals. I came on board and began locuming around the country, incorporating my passion into my work, which is mental health. Ethos? I’d say sharing our adventures and educating along the way.
What are some of the most interesting places that your work as a locum has taken you?
I’ve been all over. I took a road trip down the coast of New South Wales (NSW) and Victoria – I ended up rock climbing in Arapiles. One of my favourite places was Broome in Western Australia (WA) – really interesting work and a good group of people. Another favourite was Merimbula in NSW – a great sense of community. The pharmacy staff made me feel very welcome.
How did you adapt to the different legislation when moving between states?
It required a bit of brain power to look out for the differences, mainly with the scripts on file and Schedule 8 medicines. The easiest way to adapt was to do some research beforehand so I would have a rough idea of how things worked, but I also leaned on the other pharmacists around me. I didn’t necessarily need to know everything in intricate detail before I got there, it was more about knowing what questions I needed to ask when certain situations arose.
You now own a pharmacy in Townsville. Why did you make the switch?
Just over a year ago I was on a six-month trip around Australia, but I only made it to Carnarvon in WA when I got a call from my former boss in Coffs Harbour about an opportunity to run a pharmacy in Townsville. I thought it might be a while before another opportunity presented itself, so I took the plunge. It’s a very different lifestyle to working as a locum and comes with its own set of challenges, but I’ve always wanted to own my own pharmacy so I could prepare myself and my family for the future.
You’re a former mental health first aid facilitator. Do you use these skills a lot in your pharmacy practice?
I use them every day. What’s great about mental health first aid is that it teaches you how to pick up on signs and approach conversations with more confidence. In a busy pharmacy, it’s easy to get caught in the cycle of receiving a repeat prescription for escitalopram, for example, and just dispense it. But the training empowers you to want to have that conversation with every person that comes through who takes an antidepressant – whether it’s new or continued. It’s important to ask how it’s been working for them, and if they’ve been on it for a while, if they are happy with the results. Sometimes this leads to deeper conversations around efficacy and adherence, which almost always turns to treatment recommendations or referrals.
Do you think other pharmacists would benefit from training in mental health first aid?
A lot of pharmacists lack confidence to approach the conversations around mental health, particularly if a person has suicidal thoughts and they are voicing that within the pharmacy. It’s definitely not an easy situation to be in and it takes its toll. Nothing will ever fully prepare you, but the confidence you develop through training, along with the knowledge about the right referral points, particularly in acute situations, certainly helps.
You’re a former ECP of the Year, in 2017. Where do you see pharmacy practice going in the future?
I see pharmacists specialising in one way or another. PSA is doing great work with pharmacists in general practice and pharmacist vaccination services have also been expanding. A lot of pharmacies try and be everything to everyone, but it’s not sustainable for community pharmacies to be across all areas of health care. I think the profession will branch out further into specialties and that the pathways will become more official.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row]
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[post_content] => The social highlight of the annual PSA conference is the Gala Dinner, and this year certainly did not disappoint.
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[post_title] => Pharmacists shine at the PSA19 Gala Dinner
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[post_content] => University of Western Australia student Alice Hashiguchi was awarded the 2019 PSA Mylan Pharmacy Student of the Year (PSOTY) Award last night.
Ms Hashiguchi was selected from a group of six finalists for demonstrating exceptional skills in a practical setting.
PSA National President Dr Chris Freeman congratulated Ms Hashiguchi on her exceptional achievement.
‘The PSOTY Award gives outstanding pharmacy students the chance to showcase their counselling skills to their peers and the wider profession,’ Dr Freeman said.
Dr Freeman also acknowledged the high calibre of this years finalists: ‘We saw many rising stars of pharmacy apply their clinical knowledge and communication skills in this year’s competition.’
This year's six finalists included:
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[post_content] => In case you missed it, here's some of the action from the first day of PSA19 – from the Welcome Reception, Early Career Pharmacists Party and Fellows Dinner.
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[post_content] => Ayomide Ogundipe’s initiative, commitment to patient-centred care, and leadership while interning at Pharmacy777 in Perth has earned her PSA’s Intern of the Year award.
Ms Ogundipe initiated a dementia-friendly working group and – together with input from staff, affected patients and their families – secured accreditation from Dementia Friendly Australia for an action plan.
'What spurred that on was that late last year one of our patients with quite severe dementia had gone missing. He passed away before he was found,' Ms Ogundipe said.
'It really pushed me to come up with solutions that we could offer people to engage with them, support them with medication management, and improve their quality of living,' she said.
The action plan included medication management solutions, a commitment to seeing 70–80% of support staff trained in dementia-friendly principles and the introduction of personal tracking devices.
'We have invested in wearable, easy-to-use personal tracking devices that people can hire or purchase,' she said.
'They have quite a long battery life and SIM card capability which allows families and carers to contact the patient directly, without them having to press any buttons or engage with the device in any way.'
Initiative in service delivery
Another opportunity Ms Ogundipe saw was for the pharmacy to run a health promotion campaign focusing on community health needs.
So she planned, promoted and secured sponsorship for the five-day 'Your Health Expo' exploring nearly a dozen different topics.
‘Earlier in the week we ran a sleep apnoea clinic that helped people learn how to maintain their machines, and provided information about warranties, servicing parts, and the purchase or update of machines,' she said.
Pharmacists and pharmacy support staff were also able to engage with patients using the Obstructive Sleep Apnoea Engagement Protocol that Ms Ogundipe developed.
'It's an easy to use guide that not only improves staff awareness of at-risk patients, but also allows them to have tools readily available to aid comprehensive history taking and referral to general practitioners, with interactions being recorded in dispensing history,' she explained.
On other days the expo offered health checks, free blood glucose testing, a chance to see the compounding lab in action, sessions on complementary medicines and wound care, and brought in a paediatric nurse and lactation consultant.
'The expo also made a lot of people realise that we were offering these services all the time, not just on one day a month or week,' Ms Ogundipe said.
'We got lots of feedback from patients saying that they really trusted our opinion, asking us when the next health expo would be,' she said.
Leadership and professional engagement
While completing her intern year, Ms Ogundipe was the National Australian Pharmacy Students’ Association (NAPSA) Executive Director of Public Relations, a member of the International Pharmaceutical Students’ Federation (IPSF) Asia Pacific Regional Office, and a member of PSA Western Australia's Early Career Pharmacist (ECP) working group.
Ms Ogundipe also helped develop Curtin University's practical guide to successful fieldwork for millennial students.
'What inspires me the most about the future of pharmacy is the new ideas that are coming from ECPs – wherever it is they practice they are saying “how can I bring a solution, fill this gap or do that better”,' she said.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
