td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 26036 [post_author] => 3410 [post_date] => 2024-05-06 12:37:31 [post_date_gmt] => 2024-05-06 02:37:31 [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:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25998 [post_author] => 46 [post_date] => 2024-05-06 11:50:52 [post_date_gmt] => 2024-05-06 01:50:52 [post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most. Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation. To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd! [gallery type="flexslider" size="full" ids="26009,26007,26006,26010,26011,26012,26013,26016,26067,26018,26015,26019"]Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24. A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region. [caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption] With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients. Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations. ‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’ [gallery type="flexslider" size="full" ids="26025,26031,26022,26023,26024,26026,26027,26028,26029,26030,26032,26033,26034"] Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had. ‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said. ‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond. Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers. This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning. PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program. ‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim. ‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference. ‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’ PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible. ‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim. ‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25. ‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’ [post_title] => Transition announcements for ACOP and MMR at CPC24 [post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => highlights-from-cpc24 [to_ping] => [pinged] => [post_modified] => 2024-05-07 09:23:52 [post_modified_gmt] => 2024-05-06 23:23:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25998 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Transition announcements for ACOP and MMR at CPC24 [title] => Transition announcements for ACOP and MMR at CPC24 [href] => https://www.australianpharmacist.com.au/highlights-from-cpc24/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26061 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25965 [post_author] => 3410 [post_date] => 2024-05-01 13:01:56 [post_date_gmt] => 2024-05-01 03:01:56 [post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles. The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR). Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP). In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body. Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick. Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model. ‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’ The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick. ‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations. ‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick. ‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’ PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system. Pharmacists must transition to the new qualification within that 12-month period. PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS. ’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential. PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick. ‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said. To fill that gap pharmacists have the option to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25567 [post_author] => 3919 [post_date] => 2024-05-01 11:01:36 [post_date_gmt] => 2024-05-01 01:01:36 [post_content] => Optimising proton pump inhibitor therapy in pharmacy Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1 [caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption] While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2 Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1 However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25351 [post_author] => 3387 [post_date] => 2024-04-29 12:14:39 [post_date_gmt] => 2024-04-29 02:14:39 [post_content] => Pharmacists encounter pregnant and new mums more often than most health professionals, and can have a bird’s-eye view when things go awry. At 20 weeks pregnant, PSA’s Queensland Pharmacist of the Year Jacqueline Meyer MPS, was diagnosed with intrauterine growth restriction, which severely impacted her fetal growth. A few weeks later, she stopped working – effective immediately. ‘I was put on immediate bed rest, even though I felt fine,’ she says. With her amniotic fluid diminished, Ms Meyer’s daughter, Fallon, was born at 28 weeks. Weighing only 520 grams, Fallon was placed in an incubator in the neonatal intensive care unit where she remained for the next 2 months. Ms Meyer is one of thousands of women who experience pregnancy complications, including gestational diabetes mellitus (GDM), affecting 1 in 6 pregnant Australian women.1 Perinatal depression (PND) is another prevalent complication, affecting up to 1 in 5 expectant or new mothers.2 However, there are significant gaps in pregnancy and early childhood support in Australia. With GDM diagnoses doubled within a decade,3 many patients are forced to rely on group education classes, says Anna Barwick MPS, credentialed pharmacist, and founder of remote access telehealth advisory service PharmOnline. Meanwhile, suicide is the third-highest cause of death among new mothers in Australia.4 After her turbulent pregnancy, Ms Meyer thinks pharmacists can help to fill these gaps. ‘We can recognise red flags, direct patients where to seek help, and provide emotional support about the importance of looking after your own health and nutrition.’Medicine use in pregnancy
While ‘every woman’ wants to avoid exposing their unborn child to risks associated with taking medicines for chronic conditions such as epilepsy, inflammatory bowel disease and arthritis, those risks can sometimes be overestimated, says Noor Al-Adhami, Women’s and Newborn Pharmacy Team Leader at Brisbane’s Royal Brisbane and Women’s Hospital (RBWH). ‘A gap we often see in RBWH’s Maternity Outpatient Clinic is lack of discussions around safety of medicines prescribed for depression and anxiety in pregnancy and breastfeeding,’ she says. ‘This can lead to women stopping their medicines abruptly without discussing with their GP or midwife, resulting in a deterioration in mental health that can negatively impact maternal and fetal outcomes.’ Pharmacists are in a good position to provide support and information regarding the safety of medicines in pregnancy and to address any concerns in a non-judgemental manner. ‘Advice regarding safety of antidepressant medicines involves discussing the benefit of continuation/initiation on maternal health, including improved function and quality of life, as well as risk to the fetus, which evidence shows is minimal with appropriate antidepressants,’ says Ms Al-Adhami.Health monitoring
While pregnancy is a short-term phase of life, significant ongoing effects can be experienced, particularly in children from pregnancies that are not well managed, says Ms Barwick. ‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.’ Gestational diabetes When expectant mums are diagnosed with GDM, community pharmacists can walk them through the process of monitoring blood glucose levels (BGLs). Where insulin is prescribed, pharmacists can inquire whether the dose is controlling blood glucose levels, and check their injection technique, says Ms Meyer. The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says. Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick. With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too. ‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises. Nausea and vomiting in pregnancy The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick. ‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says. ‘A simple change in vitamin to focus on iodine and folate can make a big difference.’ Ms Barwick says community pharmacists may also recommend over-the-counter medicines such as doxylamine for symptoms of nausea and vomiting in pregnancy (NVP), and monitor its effectiveness.‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.' ANNA BARWICK MPSWhen women have symptoms of NVP, Ms Meyer points out that a family member might come into the pharmacy on their behalf if they are severely unwell. ‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency, such as vomiting to the point of severe dehydration, heart palpitations, blurred vision and cramping.’ When ondansetron is prescribed, pharmacists can recommend easy-to-consume forms, such as sublingual wafers, she adds. Preeclampsia Pregnant women who present with new hypertension after 20 weeks should be screened for preeclampsia.7 Community and credentialed pharmacists can assist patients with monitoring blood pressure, and look out for signs of preeclampsia, such as sudden oedema and weight gain, says Ms Barwick. ‘Patients can also be taught how to use a home blood pressure monitor appropriately and record the results. Women at high-risk of developing preeclampsia should consider treatment with low-dose aspirin,8 which can also be used to manage coagulation abnormalities in early pregnancy to prevent miscarriage. ‘A dose of around 75 mg has been shown to be effective for delivering a healthy baby, safely,’ notes Ms Barwick.9 Up to 150 mg can be used to prevent preeclampsia, she adds.10 Pharmacists should also keep a record of pregnant patients using aspirin to monitor for any potential adverse effects, such as bruising or bleeding. ‘While the risk of low-dose, aspirin-associated bleeding is low, reinforce the importance of looking out for any signs, either vaginal or rectal,’ Ms Barwick warns.Vaccinations
Australia has ‘dismal’ antenatal vaccination rates, with 15% vaccinated against influenza, 27% against pertussis, and only 12% against both among more than 591,000 pregnancies analysed in a population-based linked cohort study of data between 2012–2017.11 COVID-19 vaccine hesitancy has also been detected among pregnant Australian women.12 Overall, there is a lack of understanding of the benefits of antenatal vaccination, including providing immunity to both baby and mother against serious respiratory infections, says Ms Al-Adhami. Reduced access to vaccines is also an issue, particularly among vulnerable populations, such as those with mental health problems, and Aboriginal and Torres Strait Islander peoples. ‘Once we identified some women were having difficulties accessing antenatal vaccinations in the community, we recognised an opportunity to extend our scope of practice and improve our service delivery within the clinic,’ she says. This included credentialed training and the development of an opportunistic model of care, where ‘at-risk’ women were counselled and offered antenatal vaccinations during clinic visits. ‘Last year 546 vaccines were administered by our specialist antenatal pharmacists, adds Ms Al-Adhami.13 In Ms Meyer’s experience there has also been confusion among women about what vaccines are needed during pregnancy, and where to get them. ‘The states and territories all have different rules and regulations around who can provide National Immunisation Program (NIP) vaccines,’ she says. With most jurisdictions now increasing the number of vaccines pharmacists can administer, this should be used as an opportunity to initiate conversations with pregnant women about vaccination. ‘Ensure the mother is well educated on what vaccines she, and other family members, should receive according to current guidelines,’ says Ms Meyer.
All about birthing on country[caption id="attachment_25937" align="alignnone" width="500"] In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see www.bobbilockyer.com[/caption] Birthing on Country (BOC) is a holistic, integrated and culturally appropriate model of care, aimed at providing the best start in life for Aboriginal and Torres Strait Islander babies and their families.14 Broader than labour and delivery, BOC addresses socio-cultural and spiritual risk not dealt with through mainstream services. Guiding principles for a BOC program include respect for and incorporation of the knowledge and traditional practice of Aboriginal and Torres Strait Islander peoples, incorporate a holistic definition of health, respect for family involvement, women’s business, connection with Country and continuity of culturally safe care.15 Aboriginal and Torres Strait Islander mothers are 3–5 times more likely to die in childbirth than other mothers. Their babies are almost twice as likely to die in the first year of life – often due to premature birth.16 With research revealing access to community-governed, culturally safe birthing services is linked to a reduced risk of premature birth,17 pharmacists can advocate for and support BOC models of care. ‘BOC is so much broader than where a mother births – it is a social justice movement and system-wide reform. It’s an opportunity to Close the Gap in life outcomes for mums and bubs by recognising the impact of colonisation and the benefits of returning childbirth services to Aboriginal and Torres Strait Island community control,’ says Alice Nugent MPS, Aboriginal Community Controlled Health Organisation Pharmacist. Although not available everywhere, BOC can still involve birthing in a local hospital with the presence of an Aboriginal or Torres Strait Islander midwife or support worker throughout a woman’s pregnancy, birthing and post-natal journey. Once the baby is born, ongoing support is usually provided to the family, which may include cultural ceremonies for the mother and newborn. |
‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency.' Jacqueline Meyer MPSInfant formulas Formula manufacturers commonly use marketing that may feed into parental anxieties in claiming their products can prevent fussiness, help with colic, or improve night-time sleep.22 Pharmacists can emphasise the ‘antibodies, immunoglobulins and health benefits’ that breast milk can provide, along with advice on ensuring milk quality is at optimum levels, says Ms Meyer. ‘The number one thing is to eat before you feed,’ she says. ‘Mothers should also have a wholesome, balanced diet full of fresh nutrients and vegetables, so nutritional intake is at a premium.’ While breastfeeding should be encouraged, pharmacists can also guide mothers around selecting the right formulas when breastfeeding is not possible, says Ms Meyer. ‘We get a lot of questions around milk-free or dairy-free alternatives due to rising concerns of allergies and intolerances,’ she says. Factors to consider include the baby’s age, digestive issues, peptide profiles, short- or long-chain formula requirements, or whether specific formulas need to be prescribed. Pharmacists should also enquire how formulas are tolerated over a trial period – which ones and for how long, any reactions such as refusal, any reflux-type symptoms, changes in stool colour, irritability and any difficulty settling, suggests Ms Meyer. ‘Just trialling the formula for one day is often not enough. A longer period of time is required to identify a true intolerance.’ Medicines and breastfeeding Another reason why mothers opt to stop breastfeeding is medicine use.27 Pharmacists can reassure patients that very small amounts of medicines generally pass through breast milk, says Ms Meyer. ‘Medicine should never be a reason to stop breastfeeding, unless specifically advised to do so.’ Pharmacists can also advise patients when to take their medicines. ‘If the medicine is taken multiple times a day, recommend taking it directly after a breastfeed, so it reaches peak concentration in between feeding cycles,’ she says.
‘If your mum or dad had perinatal mental ill health, you’re more likely to have mental ill-health issues later on.' Lily Pham MPS
What's ailing pregnant and new mums?Pregnancy and the early stages of motherhood are fraught with discomfort. In addition to nausea and vomiting, some common ailments in pregnancy include constipation and indigestion, says Ms Al-Adhami. To overcome constipation, often due to hormone changes that slow down muscles in the bowel, patients should be advised to increase their fibre content by consuming fresh fruit and vegetables, wholemeal breads and breakfast cereals, nuts and legumes. Supplements such as psyllium husks can also be introduced. As iron tablets can also cause constipation, pharmacists can suggest another product for a trial period.23 Antacids for indigestion are safe to use in pregnancy. Calcium-based formulations are preferable to aluminium-containing antacids.24 When the baby arrives, back pain, incontinence and repetitive strain injuries are common. For mild to moderate pain, paracetamol is considered a safe analgesic during lactation, with the dose transferred through breast milk estimated to be 6% – much smaller than a child’s dose.25 Ibuprofen is also considered to be compatible with breastfeeding.25 Pelvic floor exercises can help to address post-birth incontinence, along with avoidance of persistent heavy lifting, repetitive coughing and straining.26 |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 26036 [post_author] => 3410 [post_date] => 2024-05-06 12:37:31 [post_date_gmt] => 2024-05-06 02:37:31 [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:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25998 [post_author] => 46 [post_date] => 2024-05-06 11:50:52 [post_date_gmt] => 2024-05-06 01:50:52 [post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most. Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation. To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd! [gallery type="flexslider" size="full" ids="26009,26007,26006,26010,26011,26012,26013,26016,26067,26018,26015,26019"]Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24. A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region. [caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption] With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients. Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations. ‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’ [gallery type="flexslider" size="full" ids="26025,26031,26022,26023,26024,26026,26027,26028,26029,26030,26032,26033,26034"] Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had. ‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said. ‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond. Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers. This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning. PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program. ‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim. ‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference. ‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’ PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible. ‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim. ‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25. ‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’ [post_title] => Transition announcements for ACOP and MMR at CPC24 [post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => highlights-from-cpc24 [to_ping] => [pinged] => [post_modified] => 2024-05-07 09:23:52 [post_modified_gmt] => 2024-05-06 23:23:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25998 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Transition announcements for ACOP and MMR at CPC24 [title] => Transition announcements for ACOP and MMR at CPC24 [href] => https://www.australianpharmacist.com.au/highlights-from-cpc24/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26061 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25965 [post_author] => 3410 [post_date] => 2024-05-01 13:01:56 [post_date_gmt] => 2024-05-01 03:01:56 [post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles. The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR). Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP). In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body. Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick. Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model. ‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’ The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick. ‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations. ‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick. ‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’ PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system. Pharmacists must transition to the new qualification within that 12-month period. PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS. ’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential. PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick. ‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said. To fill that gap pharmacists have the option to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25567 [post_author] => 3919 [post_date] => 2024-05-01 11:01:36 [post_date_gmt] => 2024-05-01 01:01:36 [post_content] => Optimising proton pump inhibitor therapy in pharmacy Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1 [caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption] While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2 Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1 However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25351 [post_author] => 3387 [post_date] => 2024-04-29 12:14:39 [post_date_gmt] => 2024-04-29 02:14:39 [post_content] => Pharmacists encounter pregnant and new mums more often than most health professionals, and can have a bird’s-eye view when things go awry. At 20 weeks pregnant, PSA’s Queensland Pharmacist of the Year Jacqueline Meyer MPS, was diagnosed with intrauterine growth restriction, which severely impacted her fetal growth. A few weeks later, she stopped working – effective immediately. ‘I was put on immediate bed rest, even though I felt fine,’ she says. With her amniotic fluid diminished, Ms Meyer’s daughter, Fallon, was born at 28 weeks. Weighing only 520 grams, Fallon was placed in an incubator in the neonatal intensive care unit where she remained for the next 2 months. Ms Meyer is one of thousands of women who experience pregnancy complications, including gestational diabetes mellitus (GDM), affecting 1 in 6 pregnant Australian women.1 Perinatal depression (PND) is another prevalent complication, affecting up to 1 in 5 expectant or new mothers.2 However, there are significant gaps in pregnancy and early childhood support in Australia. With GDM diagnoses doubled within a decade,3 many patients are forced to rely on group education classes, says Anna Barwick MPS, credentialed pharmacist, and founder of remote access telehealth advisory service PharmOnline. Meanwhile, suicide is the third-highest cause of death among new mothers in Australia.4 After her turbulent pregnancy, Ms Meyer thinks pharmacists can help to fill these gaps. ‘We can recognise red flags, direct patients where to seek help, and provide emotional support about the importance of looking after your own health and nutrition.’Medicine use in pregnancy
While ‘every woman’ wants to avoid exposing their unborn child to risks associated with taking medicines for chronic conditions such as epilepsy, inflammatory bowel disease and arthritis, those risks can sometimes be overestimated, says Noor Al-Adhami, Women’s and Newborn Pharmacy Team Leader at Brisbane’s Royal Brisbane and Women’s Hospital (RBWH). ‘A gap we often see in RBWH’s Maternity Outpatient Clinic is lack of discussions around safety of medicines prescribed for depression and anxiety in pregnancy and breastfeeding,’ she says. ‘This can lead to women stopping their medicines abruptly without discussing with their GP or midwife, resulting in a deterioration in mental health that can negatively impact maternal and fetal outcomes.’ Pharmacists are in a good position to provide support and information regarding the safety of medicines in pregnancy and to address any concerns in a non-judgemental manner. ‘Advice regarding safety of antidepressant medicines involves discussing the benefit of continuation/initiation on maternal health, including improved function and quality of life, as well as risk to the fetus, which evidence shows is minimal with appropriate antidepressants,’ says Ms Al-Adhami.Health monitoring
While pregnancy is a short-term phase of life, significant ongoing effects can be experienced, particularly in children from pregnancies that are not well managed, says Ms Barwick. ‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.’ Gestational diabetes When expectant mums are diagnosed with GDM, community pharmacists can walk them through the process of monitoring blood glucose levels (BGLs). Where insulin is prescribed, pharmacists can inquire whether the dose is controlling blood glucose levels, and check their injection technique, says Ms Meyer. The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says. Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick. With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too. ‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises. Nausea and vomiting in pregnancy The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick. ‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says. ‘A simple change in vitamin to focus on iodine and folate can make a big difference.’ Ms Barwick says community pharmacists may also recommend over-the-counter medicines such as doxylamine for symptoms of nausea and vomiting in pregnancy (NVP), and monitor its effectiveness.‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.' ANNA BARWICK MPSWhen women have symptoms of NVP, Ms Meyer points out that a family member might come into the pharmacy on their behalf if they are severely unwell. ‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency, such as vomiting to the point of severe dehydration, heart palpitations, blurred vision and cramping.’ When ondansetron is prescribed, pharmacists can recommend easy-to-consume forms, such as sublingual wafers, she adds. Preeclampsia Pregnant women who present with new hypertension after 20 weeks should be screened for preeclampsia.7 Community and credentialed pharmacists can assist patients with monitoring blood pressure, and look out for signs of preeclampsia, such as sudden oedema and weight gain, says Ms Barwick. ‘Patients can also be taught how to use a home blood pressure monitor appropriately and record the results. Women at high-risk of developing preeclampsia should consider treatment with low-dose aspirin,8 which can also be used to manage coagulation abnormalities in early pregnancy to prevent miscarriage. ‘A dose of around 75 mg has been shown to be effective for delivering a healthy baby, safely,’ notes Ms Barwick.9 Up to 150 mg can be used to prevent preeclampsia, she adds.10 Pharmacists should also keep a record of pregnant patients using aspirin to monitor for any potential adverse effects, such as bruising or bleeding. ‘While the risk of low-dose, aspirin-associated bleeding is low, reinforce the importance of looking out for any signs, either vaginal or rectal,’ Ms Barwick warns.Vaccinations
Australia has ‘dismal’ antenatal vaccination rates, with 15% vaccinated against influenza, 27% against pertussis, and only 12% against both among more than 591,000 pregnancies analysed in a population-based linked cohort study of data between 2012–2017.11 COVID-19 vaccine hesitancy has also been detected among pregnant Australian women.12 Overall, there is a lack of understanding of the benefits of antenatal vaccination, including providing immunity to both baby and mother against serious respiratory infections, says Ms Al-Adhami. Reduced access to vaccines is also an issue, particularly among vulnerable populations, such as those with mental health problems, and Aboriginal and Torres Strait Islander peoples. ‘Once we identified some women were having difficulties accessing antenatal vaccinations in the community, we recognised an opportunity to extend our scope of practice and improve our service delivery within the clinic,’ she says. This included credentialed training and the development of an opportunistic model of care, where ‘at-risk’ women were counselled and offered antenatal vaccinations during clinic visits. ‘Last year 546 vaccines were administered by our specialist antenatal pharmacists, adds Ms Al-Adhami.13 In Ms Meyer’s experience there has also been confusion among women about what vaccines are needed during pregnancy, and where to get them. ‘The states and territories all have different rules and regulations around who can provide National Immunisation Program (NIP) vaccines,’ she says. With most jurisdictions now increasing the number of vaccines pharmacists can administer, this should be used as an opportunity to initiate conversations with pregnant women about vaccination. ‘Ensure the mother is well educated on what vaccines she, and other family members, should receive according to current guidelines,’ says Ms Meyer.
All about birthing on country[caption id="attachment_25937" align="alignnone" width="500"] In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see www.bobbilockyer.com[/caption] Birthing on Country (BOC) is a holistic, integrated and culturally appropriate model of care, aimed at providing the best start in life for Aboriginal and Torres Strait Islander babies and their families.14 Broader than labour and delivery, BOC addresses socio-cultural and spiritual risk not dealt with through mainstream services. Guiding principles for a BOC program include respect for and incorporation of the knowledge and traditional practice of Aboriginal and Torres Strait Islander peoples, incorporate a holistic definition of health, respect for family involvement, women’s business, connection with Country and continuity of culturally safe care.15 Aboriginal and Torres Strait Islander mothers are 3–5 times more likely to die in childbirth than other mothers. Their babies are almost twice as likely to die in the first year of life – often due to premature birth.16 With research revealing access to community-governed, culturally safe birthing services is linked to a reduced risk of premature birth,17 pharmacists can advocate for and support BOC models of care. ‘BOC is so much broader than where a mother births – it is a social justice movement and system-wide reform. It’s an opportunity to Close the Gap in life outcomes for mums and bubs by recognising the impact of colonisation and the benefits of returning childbirth services to Aboriginal and Torres Strait Island community control,’ says Alice Nugent MPS, Aboriginal Community Controlled Health Organisation Pharmacist. Although not available everywhere, BOC can still involve birthing in a local hospital with the presence of an Aboriginal or Torres Strait Islander midwife or support worker throughout a woman’s pregnancy, birthing and post-natal journey. Once the baby is born, ongoing support is usually provided to the family, which may include cultural ceremonies for the mother and newborn. |
‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency.' Jacqueline Meyer MPSInfant formulas Formula manufacturers commonly use marketing that may feed into parental anxieties in claiming their products can prevent fussiness, help with colic, or improve night-time sleep.22 Pharmacists can emphasise the ‘antibodies, immunoglobulins and health benefits’ that breast milk can provide, along with advice on ensuring milk quality is at optimum levels, says Ms Meyer. ‘The number one thing is to eat before you feed,’ she says. ‘Mothers should also have a wholesome, balanced diet full of fresh nutrients and vegetables, so nutritional intake is at a premium.’ While breastfeeding should be encouraged, pharmacists can also guide mothers around selecting the right formulas when breastfeeding is not possible, says Ms Meyer. ‘We get a lot of questions around milk-free or dairy-free alternatives due to rising concerns of allergies and intolerances,’ she says. Factors to consider include the baby’s age, digestive issues, peptide profiles, short- or long-chain formula requirements, or whether specific formulas need to be prescribed. Pharmacists should also enquire how formulas are tolerated over a trial period – which ones and for how long, any reactions such as refusal, any reflux-type symptoms, changes in stool colour, irritability and any difficulty settling, suggests Ms Meyer. ‘Just trialling the formula for one day is often not enough. A longer period of time is required to identify a true intolerance.’ Medicines and breastfeeding Another reason why mothers opt to stop breastfeeding is medicine use.27 Pharmacists can reassure patients that very small amounts of medicines generally pass through breast milk, says Ms Meyer. ‘Medicine should never be a reason to stop breastfeeding, unless specifically advised to do so.’ Pharmacists can also advise patients when to take their medicines. ‘If the medicine is taken multiple times a day, recommend taking it directly after a breastfeed, so it reaches peak concentration in between feeding cycles,’ she says.
‘If your mum or dad had perinatal mental ill health, you’re more likely to have mental ill-health issues later on.' Lily Pham MPS
What's ailing pregnant and new mums?Pregnancy and the early stages of motherhood are fraught with discomfort. In addition to nausea and vomiting, some common ailments in pregnancy include constipation and indigestion, says Ms Al-Adhami. To overcome constipation, often due to hormone changes that slow down muscles in the bowel, patients should be advised to increase their fibre content by consuming fresh fruit and vegetables, wholemeal breads and breakfast cereals, nuts and legumes. Supplements such as psyllium husks can also be introduced. As iron tablets can also cause constipation, pharmacists can suggest another product for a trial period.23 Antacids for indigestion are safe to use in pregnancy. Calcium-based formulations are preferable to aluminium-containing antacids.24 When the baby arrives, back pain, incontinence and repetitive strain injuries are common. For mild to moderate pain, paracetamol is considered a safe analgesic during lactation, with the dose transferred through breast milk estimated to be 6% – much smaller than a child’s dose.25 Ibuprofen is also considered to be compatible with breastfeeding.25 Pelvic floor exercises can help to address post-birth incontinence, along with avoidance of persistent heavy lifting, repetitive coughing and straining.26 |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 26036 [post_author] => 3410 [post_date] => 2024-05-06 12:37:31 [post_date_gmt] => 2024-05-06 02:37:31 [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:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25998 [post_author] => 46 [post_date] => 2024-05-06 11:50:52 [post_date_gmt] => 2024-05-06 01:50:52 [post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most. Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation. To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd! [gallery type="flexslider" size="full" ids="26009,26007,26006,26010,26011,26012,26013,26016,26067,26018,26015,26019"]Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24. A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region. [caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption] With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients. Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations. ‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’ [gallery type="flexslider" size="full" ids="26025,26031,26022,26023,26024,26026,26027,26028,26029,26030,26032,26033,26034"] Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had. ‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said. ‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond. Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers. This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning. PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program. ‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim. ‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference. ‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’ PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible. ‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim. ‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25. ‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’ [post_title] => Transition announcements for ACOP and MMR at CPC24 [post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => highlights-from-cpc24 [to_ping] => [pinged] => [post_modified] => 2024-05-07 09:23:52 [post_modified_gmt] => 2024-05-06 23:23:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25998 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Transition announcements for ACOP and MMR at CPC24 [title] => Transition announcements for ACOP and MMR at CPC24 [href] => https://www.australianpharmacist.com.au/highlights-from-cpc24/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26061 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25965 [post_author] => 3410 [post_date] => 2024-05-01 13:01:56 [post_date_gmt] => 2024-05-01 03:01:56 [post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles. The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR). Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP). In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body. Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick. Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model. ‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’ The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick. ‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations. ‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick. ‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’ PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system. Pharmacists must transition to the new qualification within that 12-month period. PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS. ’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential. PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick. ‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said. To fill that gap pharmacists have the option to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25567 [post_author] => 3919 [post_date] => 2024-05-01 11:01:36 [post_date_gmt] => 2024-05-01 01:01:36 [post_content] => Optimising proton pump inhibitor therapy in pharmacy Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1 [caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption] While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2 Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1 However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25351 [post_author] => 3387 [post_date] => 2024-04-29 12:14:39 [post_date_gmt] => 2024-04-29 02:14:39 [post_content] => Pharmacists encounter pregnant and new mums more often than most health professionals, and can have a bird’s-eye view when things go awry. At 20 weeks pregnant, PSA’s Queensland Pharmacist of the Year Jacqueline Meyer MPS, was diagnosed with intrauterine growth restriction, which severely impacted her fetal growth. A few weeks later, she stopped working – effective immediately. ‘I was put on immediate bed rest, even though I felt fine,’ she says. With her amniotic fluid diminished, Ms Meyer’s daughter, Fallon, was born at 28 weeks. Weighing only 520 grams, Fallon was placed in an incubator in the neonatal intensive care unit where she remained for the next 2 months. Ms Meyer is one of thousands of women who experience pregnancy complications, including gestational diabetes mellitus (GDM), affecting 1 in 6 pregnant Australian women.1 Perinatal depression (PND) is another prevalent complication, affecting up to 1 in 5 expectant or new mothers.2 However, there are significant gaps in pregnancy and early childhood support in Australia. With GDM diagnoses doubled within a decade,3 many patients are forced to rely on group education classes, says Anna Barwick MPS, credentialed pharmacist, and founder of remote access telehealth advisory service PharmOnline. Meanwhile, suicide is the third-highest cause of death among new mothers in Australia.4 After her turbulent pregnancy, Ms Meyer thinks pharmacists can help to fill these gaps. ‘We can recognise red flags, direct patients where to seek help, and provide emotional support about the importance of looking after your own health and nutrition.’Medicine use in pregnancy
While ‘every woman’ wants to avoid exposing their unborn child to risks associated with taking medicines for chronic conditions such as epilepsy, inflammatory bowel disease and arthritis, those risks can sometimes be overestimated, says Noor Al-Adhami, Women’s and Newborn Pharmacy Team Leader at Brisbane’s Royal Brisbane and Women’s Hospital (RBWH). ‘A gap we often see in RBWH’s Maternity Outpatient Clinic is lack of discussions around safety of medicines prescribed for depression and anxiety in pregnancy and breastfeeding,’ she says. ‘This can lead to women stopping their medicines abruptly without discussing with their GP or midwife, resulting in a deterioration in mental health that can negatively impact maternal and fetal outcomes.’ Pharmacists are in a good position to provide support and information regarding the safety of medicines in pregnancy and to address any concerns in a non-judgemental manner. ‘Advice regarding safety of antidepressant medicines involves discussing the benefit of continuation/initiation on maternal health, including improved function and quality of life, as well as risk to the fetus, which evidence shows is minimal with appropriate antidepressants,’ says Ms Al-Adhami.Health monitoring
While pregnancy is a short-term phase of life, significant ongoing effects can be experienced, particularly in children from pregnancies that are not well managed, says Ms Barwick. ‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.’ Gestational diabetes When expectant mums are diagnosed with GDM, community pharmacists can walk them through the process of monitoring blood glucose levels (BGLs). Where insulin is prescribed, pharmacists can inquire whether the dose is controlling blood glucose levels, and check their injection technique, says Ms Meyer. The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says. Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick. With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too. ‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises. Nausea and vomiting in pregnancy The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick. ‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says. ‘A simple change in vitamin to focus on iodine and folate can make a big difference.’ Ms Barwick says community pharmacists may also recommend over-the-counter medicines such as doxylamine for symptoms of nausea and vomiting in pregnancy (NVP), and monitor its effectiveness.‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.' ANNA BARWICK MPSWhen women have symptoms of NVP, Ms Meyer points out that a family member might come into the pharmacy on their behalf if they are severely unwell. ‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency, such as vomiting to the point of severe dehydration, heart palpitations, blurred vision and cramping.’ When ondansetron is prescribed, pharmacists can recommend easy-to-consume forms, such as sublingual wafers, she adds. Preeclampsia Pregnant women who present with new hypertension after 20 weeks should be screened for preeclampsia.7 Community and credentialed pharmacists can assist patients with monitoring blood pressure, and look out for signs of preeclampsia, such as sudden oedema and weight gain, says Ms Barwick. ‘Patients can also be taught how to use a home blood pressure monitor appropriately and record the results. Women at high-risk of developing preeclampsia should consider treatment with low-dose aspirin,8 which can also be used to manage coagulation abnormalities in early pregnancy to prevent miscarriage. ‘A dose of around 75 mg has been shown to be effective for delivering a healthy baby, safely,’ notes Ms Barwick.9 Up to 150 mg can be used to prevent preeclampsia, she adds.10 Pharmacists should also keep a record of pregnant patients using aspirin to monitor for any potential adverse effects, such as bruising or bleeding. ‘While the risk of low-dose, aspirin-associated bleeding is low, reinforce the importance of looking out for any signs, either vaginal or rectal,’ Ms Barwick warns.Vaccinations
Australia has ‘dismal’ antenatal vaccination rates, with 15% vaccinated against influenza, 27% against pertussis, and only 12% against both among more than 591,000 pregnancies analysed in a population-based linked cohort study of data between 2012–2017.11 COVID-19 vaccine hesitancy has also been detected among pregnant Australian women.12 Overall, there is a lack of understanding of the benefits of antenatal vaccination, including providing immunity to both baby and mother against serious respiratory infections, says Ms Al-Adhami. Reduced access to vaccines is also an issue, particularly among vulnerable populations, such as those with mental health problems, and Aboriginal and Torres Strait Islander peoples. ‘Once we identified some women were having difficulties accessing antenatal vaccinations in the community, we recognised an opportunity to extend our scope of practice and improve our service delivery within the clinic,’ she says. This included credentialed training and the development of an opportunistic model of care, where ‘at-risk’ women were counselled and offered antenatal vaccinations during clinic visits. ‘Last year 546 vaccines were administered by our specialist antenatal pharmacists, adds Ms Al-Adhami.13 In Ms Meyer’s experience there has also been confusion among women about what vaccines are needed during pregnancy, and where to get them. ‘The states and territories all have different rules and regulations around who can provide National Immunisation Program (NIP) vaccines,’ she says. With most jurisdictions now increasing the number of vaccines pharmacists can administer, this should be used as an opportunity to initiate conversations with pregnant women about vaccination. ‘Ensure the mother is well educated on what vaccines she, and other family members, should receive according to current guidelines,’ says Ms Meyer.
All about birthing on country[caption id="attachment_25937" align="alignnone" width="500"] In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see www.bobbilockyer.com[/caption] Birthing on Country (BOC) is a holistic, integrated and culturally appropriate model of care, aimed at providing the best start in life for Aboriginal and Torres Strait Islander babies and their families.14 Broader than labour and delivery, BOC addresses socio-cultural and spiritual risk not dealt with through mainstream services. Guiding principles for a BOC program include respect for and incorporation of the knowledge and traditional practice of Aboriginal and Torres Strait Islander peoples, incorporate a holistic definition of health, respect for family involvement, women’s business, connection with Country and continuity of culturally safe care.15 Aboriginal and Torres Strait Islander mothers are 3–5 times more likely to die in childbirth than other mothers. Their babies are almost twice as likely to die in the first year of life – often due to premature birth.16 With research revealing access to community-governed, culturally safe birthing services is linked to a reduced risk of premature birth,17 pharmacists can advocate for and support BOC models of care. ‘BOC is so much broader than where a mother births – it is a social justice movement and system-wide reform. It’s an opportunity to Close the Gap in life outcomes for mums and bubs by recognising the impact of colonisation and the benefits of returning childbirth services to Aboriginal and Torres Strait Island community control,’ says Alice Nugent MPS, Aboriginal Community Controlled Health Organisation Pharmacist. Although not available everywhere, BOC can still involve birthing in a local hospital with the presence of an Aboriginal or Torres Strait Islander midwife or support worker throughout a woman’s pregnancy, birthing and post-natal journey. Once the baby is born, ongoing support is usually provided to the family, which may include cultural ceremonies for the mother and newborn. |
‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency.' Jacqueline Meyer MPSInfant formulas Formula manufacturers commonly use marketing that may feed into parental anxieties in claiming their products can prevent fussiness, help with colic, or improve night-time sleep.22 Pharmacists can emphasise the ‘antibodies, immunoglobulins and health benefits’ that breast milk can provide, along with advice on ensuring milk quality is at optimum levels, says Ms Meyer. ‘The number one thing is to eat before you feed,’ she says. ‘Mothers should also have a wholesome, balanced diet full of fresh nutrients and vegetables, so nutritional intake is at a premium.’ While breastfeeding should be encouraged, pharmacists can also guide mothers around selecting the right formulas when breastfeeding is not possible, says Ms Meyer. ‘We get a lot of questions around milk-free or dairy-free alternatives due to rising concerns of allergies and intolerances,’ she says. Factors to consider include the baby’s age, digestive issues, peptide profiles, short- or long-chain formula requirements, or whether specific formulas need to be prescribed. Pharmacists should also enquire how formulas are tolerated over a trial period – which ones and for how long, any reactions such as refusal, any reflux-type symptoms, changes in stool colour, irritability and any difficulty settling, suggests Ms Meyer. ‘Just trialling the formula for one day is often not enough. A longer period of time is required to identify a true intolerance.’ Medicines and breastfeeding Another reason why mothers opt to stop breastfeeding is medicine use.27 Pharmacists can reassure patients that very small amounts of medicines generally pass through breast milk, says Ms Meyer. ‘Medicine should never be a reason to stop breastfeeding, unless specifically advised to do so.’ Pharmacists can also advise patients when to take their medicines. ‘If the medicine is taken multiple times a day, recommend taking it directly after a breastfeed, so it reaches peak concentration in between feeding cycles,’ she says.
‘If your mum or dad had perinatal mental ill health, you’re more likely to have mental ill-health issues later on.' Lily Pham MPS
What's ailing pregnant and new mums?Pregnancy and the early stages of motherhood are fraught with discomfort. In addition to nausea and vomiting, some common ailments in pregnancy include constipation and indigestion, says Ms Al-Adhami. To overcome constipation, often due to hormone changes that slow down muscles in the bowel, patients should be advised to increase their fibre content by consuming fresh fruit and vegetables, wholemeal breads and breakfast cereals, nuts and legumes. Supplements such as psyllium husks can also be introduced. As iron tablets can also cause constipation, pharmacists can suggest another product for a trial period.23 Antacids for indigestion are safe to use in pregnancy. Calcium-based formulations are preferable to aluminium-containing antacids.24 When the baby arrives, back pain, incontinence and repetitive strain injuries are common. For mild to moderate pain, paracetamol is considered a safe analgesic during lactation, with the dose transferred through breast milk estimated to be 6% – much smaller than a child’s dose.25 Ibuprofen is also considered to be compatible with breastfeeding.25 Pelvic floor exercises can help to address post-birth incontinence, along with avoidance of persistent heavy lifting, repetitive coughing and straining.26 |
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 26036 [post_author] => 3410 [post_date] => 2024-05-06 12:37:31 [post_date_gmt] => 2024-05-06 02:37:31 [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:
Pharmacists should detect unnecessary and/or harmful uses of primary prevention, based on updated CVD risk, at any opportunity they have to review or consider a patient’s medicine profile.
This should be a key consideration for credentialed pharmacists conducting Home Medicines Reviews or Residential Medication Management Reviews.
Aside from antiplatelets, antihypertensives (which can lead to a significant drop in blood pressure among older patients) should also be investigated, along with beta blockers for primary hypertension, said Mr Winckel. ‘Beta blockers generally increase mortality for many frail elderly people by increasing risk of falls and subsequent fractures,’ he said. ‘When patients are not currently hypertensive, all hypertensives should be reviewed.’ But cessation of antiplatelets should only be considered when used in primary prevention, Mr Winckel warned. ‘If used for secondary prevention, lifelong antiplatelet therapy is required.’ [post_title] => New tool to counteract significant overestimate of CVD risk [post_excerpt] => Did you know a new Australian Cardiovascular risk calculator (AusCVDRisk) was released last year?If not, you’re not alone. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-tool-to-counteract-significant-overestimate-of-cvd-risk [to_ping] => [pinged] => [post_modified] => 2024-05-06 21:52:44 [post_modified_gmt] => 2024-05-06 11:52:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=26036 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New tool to counteract significant overestimate of CVD risk [title] => New tool to counteract significant overestimate of CVD risk [href] => https://www.australianpharmacist.com.au/new-tool-to-counteract-significant-overestimate-of-cvd-risk/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26038 )td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25998 [post_author] => 46 [post_date] => 2024-05-06 11:50:52 [post_date_gmt] => 2024-05-06 01:50:52 [post_content] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. The second annual Credentialed Pharmacist Conference CPC24 took place in Cairns over the weekend (3–5 May 2024), bringing together hundreds of pharmacists and leaders in the field who share a common purpose – to deliver accessible medication management reviews (MMRs) and medicines advice to those who need it most. Delegates heard from Australia’s leading experts about the current and future challenges facing the nation’s health system, and delved deeper into where and how pharmacists can contribute to a stronger, healthier nation. To recap the conference, Australian Pharmacist has shared some highlights and images from CPC24. See if you can spot your colleagues in the crowd! [gallery type="flexslider" size="full" ids="26009,26007,26006,26010,26011,26012,26013,26016,26067,26018,26015,26019"]Credentialed pharmacist of the year announced
Victorian GP Pharmacist, pharmacist immuniser, and champion of multidisciplinary care Brooke Shelly MPS was named PSA MIMS Credentialed Pharmacist of the Year at CPC24. A PSA Victorian Branch Committee member and advocate for the role of pharmacists in general practice, Ms Shelly has a focus addressing the rural health equity gap and the benefits of team-based care. For the past 4 years she has consulted at the Ontario Medical Clinic General Practice in Mildura, conducts Home Medicines Reviews (HMRs), works as a Senior Clinical Pharmacist at Beyond Pain and has developed and implemented new multidisciplinary models of care for aged care facilities in her region. [caption id="attachment_26014" align="alignnone" width="900"] 2024 Credentialed Pharmacist of the Year Brooke Shelly MPS[/caption] With a Graduate Diploma of Management and a Certificate IV in Training and Assessment, Ms Shelly also champions diversification of the traditional pharmacist role in her continued advocacy of GP Pharmacist collaborative prescribing to improve timely access to care for rural patients. Accepting her award, Ms Shelly told of her passion for her role and also led workshops on optimising outcomes from HMRs and the challenges of conducting medicine reviews in rural and remote locations. ‘Working in a multidisciplinary team profoundly impacts patient health outcomes but also enriches my own experience as a pharmacist,’ she told AP. ‘What’s not to love about that?’ [gallery type="flexslider" size="full" ids="26025,26031,26022,26023,26024,26026,26027,26028,26029,26030,26032,26033,26034"] Presenting the award to Ms Shelly, PSA National President Associate Professor Fei Sim FPS highlighted the widespread systemic impact her leadership and contribution has had. ‘Brooke is a trailblazer when it comes to highlighting the roles of credentialed pharmacists in medication management reviews wherever medicines are used,” A/Prof Sim said. ‘[She] is a leading national voice for this workforce, where she continues to make significant contributions to the development of credentialed pharmacy through her own practice and as a mentor and facilitator of discussions and support.’PSA announces package of support for credentialed pharmacists
PSA has announced a comprehensive membership package to support credentialed pharmacists through the transition to new credentials, and beyond. Opening CPC24 on Friday, A/Prof Sim announced the full membership package including dedicated resources and support for credentialed pharmacists, as well as dedicated education opportunities to continue developing practice throughout their careers. This membership offering comes in addition to the announcement of the MMR recognition of prior learning pathway (pending accreditation by the Australian Pharmacy Council), allowing qualified pharmacists to transition to the new credential by completing a short bridging assessment or providing evidence of prior learning. PSA Professional Plus members will have access to MMR RPL at no cost, and an exclusive discount on RPL for the aged care credential, which is a requirement to practise in the Aged Care On-site Pharmacist program. ‘PSA is and always will be the home of credentialed pharmacists,’ said A/Prof Sim. ‘When AACP closed, PSA chose to invest – rather than divest - in this part of the profession. We continued the tradition of a dedicated conference for accredited pharmacists, now called the Credentialed Pharmacist Conference. ‘We brought on trusted and talented leaders and built a team at the PSA to continue to deliver good work to support our credentialed pharmacist workforce.’ PSA also established in-house accreditation services, a public directory, and are currently undergoing accreditation of the credentialing process for MMRs and Aged Care, which is set to recognise the experience of practising consultant pharmacists free of charge for PSA Professional Plus members, making the transition more affordable and accessible. ‘Professional Plus members also benefit from free access to PSA’s Aged Care Foundations Course – built by some of Australia’s pioneering aged care pharmacists and covering the essential topics for effective practice in aged care,’ said A/Prof Sim. ‘In addition to education, PSA’s support for credentialed pharmacists is also growing, including access to PSA’s regular Clinical Update, which is a must-read that helps keep credentialed pharmacists on top of emerging clinical evidence from around the world, as well as discounts to all PSA conferences, including CPC25. ‘PSA’s full suite of support is a testament to our commitment to credentialed pharmacists, unmatched by any other organisation at present. I am proud that PSA continues to be the home for credentialed pharmacists.’ [post_title] => Transition announcements for ACOP and MMR at CPC24 [post_excerpt] => Department announces transition plan, PSA launches credential offer and Credentialed Pharmacist of the Year awarded. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => highlights-from-cpc24 [to_ping] => [pinged] => [post_modified] => 2024-05-07 09:23:52 [post_modified_gmt] => 2024-05-06 23:23:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=25998 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Transition announcements for ACOP and MMR at CPC24 [title] => Transition announcements for ACOP and MMR at CPC24 [href] => https://www.australianpharmacist.com.au/highlights-from-cpc24/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 26061 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25965 [post_author] => 3410 [post_date] => 2024-05-01 13:01:56 [post_date_gmt] => 2024-05-01 03:01:56 [post_content] => New credentialing requirements announced as pharmacists prepare to take on aged care roles. The federal Department of Health and Aged Care has announced that pharmacists will need an Aged Care credential to become an aged care on-site pharmacist. Those who want to provide medication reviews such as Residential Medication Management Reviews and/or Home Medicine Reviews reviews will also need to complete a Medication Management Review (MMR). Kerri Barwick, PSA General Manager of Education and Training at PSA, explains what that involves.What’s the difference between accredited and credentialed pharmacists?
The change from ‘accredited’ to ‘credentialed’ pharmacist was initiated after the Australian Pharmacy Council was asked by the Department of Health and Aged Care to design accreditation standards for education providers, such as PSA, following the closure of the Australian Association of Consultant Pharmacy (AACP). In order to access government funding, a credential will be required that meets those standards for MMR and Aged Care.Why have these changes been made?
The AACP’s accreditation process was self-regulated and wasn't governed by an accrediting body. Standards are now in place to ensure the quality of the education delivered – including accreditation standards for educators and performance outcomes for learners, said Ms Barwick. Because ‘credentialed’ is now looked at from the perspective of meeting performance outcomes at the end of the program, the AACP-based assessment style – which entailed multiple choice questionnaires on clinical information and communication – doesn’t fit within this model. ‘To meet all those performance outcomes and accreditation standards, you couldn't run the same program,’ she said. ‘It wouldn't meet the standards.’ The skills required to provide MMR and Aged Care services also require additional specialisation, said Ms Barwick. ‘For the government to be able to pay pharmacists for those services, they want to guarantee the quality,’ she said.What will the new credentials involve?
PSA’s MMR and Aged Care credential programs, currently undergoing accreditation with APC, will involve case-based discussion and learning, along with simulations. ‘This will give learners as many real-life examples as we can without requiring a large amount of time learning on the job,’ explained Ms Barwick. ‘The PSA will also deliver both the MMR and Aged Care credential, so you'll be able to enrol in either or the whole package.’ PSA’s MMR and Aged Care credentials should be available for pharmacists in June 2024, pending the outcome of the next accreditation meeting.When do the changes take effect?
Not for a while. This week (29 April), the government announced an extension to Medication Review Numbers (MRNs) to support credentialed pharmacists to continue providing MMR services until 30 June 2025 during the transition to the new credentialing system. Pharmacists must transition to the new qualification within that 12-month period. PSA has been involved in discussions with the Department ‘for some time’ to ensure transition arrangements are in place to minimise disruption to patient services, and allow the existing workforce to continue providing MMR services in the immediate term, said PSA National President Associate Professor Fei Sim FPS. ’PSA continues to approach this fast-moving practice area with the intent to support our workforce, and to ensure the credentialing and recredentialing process is achievable and affordable,’ she said.Do I have to start credentialing from scratch?
No! PSA will have a process for recognition of prior learning for the MMR and Aged Care credential. PSA has also mapped the assessment delivered by AACP against the performance outcomes and assessed the existing gaps, said Ms Barwick. ‘For example, for the MMR credential, there's a performance outcome around cultural safety and cultural competence which pharmacists accredited by the AACP or PSA in the last 12 months will not have fulfilled,’ she said. To fill that gap pharmacists have the option to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25567 [post_author] => 3919 [post_date] => 2024-05-01 11:01:36 [post_date_gmt] => 2024-05-01 01:01:36 [post_content] => Optimising proton pump inhibitor therapy in pharmacy Proton pump inhibitors (PPIs) are a widely used pharmacological treatment option for management of gastro-oesophageal reflux.1 [caption id="attachment_25337" align="alignright" width="233"] This activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the author and the views expressed are entirely their own.[/caption] While data on PPIs highlighted concerns about long-term use and the need for appropriate prescribing, an analysis of Pharmaceutical Benefits Scheme (PBS) data following the introduction of prescribing restrictions in 2019 suggests that a reliance on PPIs for management of reflux symptoms remains.2 Indeed, PPIs are an effective and well-tolerated pharmacotherapy for reflux and can be used confidently in the correct indications: first-line as a regular therapy for frequent/severe symptoms of gastro-oesophageal reflux disease (GORD), and second-line as an ‘on-demand’ therapy for mild/intermittent gastro-oesophageal reflux symptoms (see Therapeutic Guidelines for further information).1 However, for a variety of reasons, up to 40% of patients taking daily PPI for reflux symptoms are considered to have ‘PPI treatment failure’ or refractory GORD.3 Understanding the possible causes of persistent symptoms is important for pharmacists to efficiently troubleshoot next steps in management and/or recommend the appropriate course of action for the patient and their doctor to further investigate the issue. This article will provide an overview of 6 reasons why patients may find their PPIs failing — and courses of action to manage their concerns.
Learning objectivesAfter reading this article, pharmacists should be able to:
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td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 25351 [post_author] => 3387 [post_date] => 2024-04-29 12:14:39 [post_date_gmt] => 2024-04-29 02:14:39 [post_content] => Pharmacists encounter pregnant and new mums more often than most health professionals, and can have a bird’s-eye view when things go awry. At 20 weeks pregnant, PSA’s Queensland Pharmacist of the Year Jacqueline Meyer MPS, was diagnosed with intrauterine growth restriction, which severely impacted her fetal growth. A few weeks later, she stopped working – effective immediately. ‘I was put on immediate bed rest, even though I felt fine,’ she says. With her amniotic fluid diminished, Ms Meyer’s daughter, Fallon, was born at 28 weeks. Weighing only 520 grams, Fallon was placed in an incubator in the neonatal intensive care unit where she remained for the next 2 months. Ms Meyer is one of thousands of women who experience pregnancy complications, including gestational diabetes mellitus (GDM), affecting 1 in 6 pregnant Australian women.1 Perinatal depression (PND) is another prevalent complication, affecting up to 1 in 5 expectant or new mothers.2 However, there are significant gaps in pregnancy and early childhood support in Australia. With GDM diagnoses doubled within a decade,3 many patients are forced to rely on group education classes, says Anna Barwick MPS, credentialed pharmacist, and founder of remote access telehealth advisory service PharmOnline. Meanwhile, suicide is the third-highest cause of death among new mothers in Australia.4 After her turbulent pregnancy, Ms Meyer thinks pharmacists can help to fill these gaps. ‘We can recognise red flags, direct patients where to seek help, and provide emotional support about the importance of looking after your own health and nutrition.’Medicine use in pregnancy
While ‘every woman’ wants to avoid exposing their unborn child to risks associated with taking medicines for chronic conditions such as epilepsy, inflammatory bowel disease and arthritis, those risks can sometimes be overestimated, says Noor Al-Adhami, Women’s and Newborn Pharmacy Team Leader at Brisbane’s Royal Brisbane and Women’s Hospital (RBWH). ‘A gap we often see in RBWH’s Maternity Outpatient Clinic is lack of discussions around safety of medicines prescribed for depression and anxiety in pregnancy and breastfeeding,’ she says. ‘This can lead to women stopping their medicines abruptly without discussing with their GP or midwife, resulting in a deterioration in mental health that can negatively impact maternal and fetal outcomes.’ Pharmacists are in a good position to provide support and information regarding the safety of medicines in pregnancy and to address any concerns in a non-judgemental manner. ‘Advice regarding safety of antidepressant medicines involves discussing the benefit of continuation/initiation on maternal health, including improved function and quality of life, as well as risk to the fetus, which evidence shows is minimal with appropriate antidepressants,’ says Ms Al-Adhami.Health monitoring
While pregnancy is a short-term phase of life, significant ongoing effects can be experienced, particularly in children from pregnancies that are not well managed, says Ms Barwick. ‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.’ Gestational diabetes When expectant mums are diagnosed with GDM, community pharmacists can walk them through the process of monitoring blood glucose levels (BGLs). Where insulin is prescribed, pharmacists can inquire whether the dose is controlling blood glucose levels, and check their injection technique, says Ms Meyer. The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says. Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick. With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too. ‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises. Nausea and vomiting in pregnancy The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick. ‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says. ‘A simple change in vitamin to focus on iodine and folate can make a big difference.’ Ms Barwick says community pharmacists may also recommend over-the-counter medicines such as doxylamine for symptoms of nausea and vomiting in pregnancy (NVP), and monitor its effectiveness.‘There are many points, particularly during health crises, where pharmacists can intervene, monitor and provide recommendations.' ANNA BARWICK MPSWhen women have symptoms of NVP, Ms Meyer points out that a family member might come into the pharmacy on their behalf if they are severely unwell. ‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency, such as vomiting to the point of severe dehydration, heart palpitations, blurred vision and cramping.’ When ondansetron is prescribed, pharmacists can recommend easy-to-consume forms, such as sublingual wafers, she adds. Preeclampsia Pregnant women who present with new hypertension after 20 weeks should be screened for preeclampsia.7 Community and credentialed pharmacists can assist patients with monitoring blood pressure, and look out for signs of preeclampsia, such as sudden oedema and weight gain, says Ms Barwick. ‘Patients can also be taught how to use a home blood pressure monitor appropriately and record the results. Women at high-risk of developing preeclampsia should consider treatment with low-dose aspirin,8 which can also be used to manage coagulation abnormalities in early pregnancy to prevent miscarriage. ‘A dose of around 75 mg has been shown to be effective for delivering a healthy baby, safely,’ notes Ms Barwick.9 Up to 150 mg can be used to prevent preeclampsia, she adds.10 Pharmacists should also keep a record of pregnant patients using aspirin to monitor for any potential adverse effects, such as bruising or bleeding. ‘While the risk of low-dose, aspirin-associated bleeding is low, reinforce the importance of looking out for any signs, either vaginal or rectal,’ Ms Barwick warns.Vaccinations
Australia has ‘dismal’ antenatal vaccination rates, with 15% vaccinated against influenza, 27% against pertussis, and only 12% against both among more than 591,000 pregnancies analysed in a population-based linked cohort study of data between 2012–2017.11 COVID-19 vaccine hesitancy has also been detected among pregnant Australian women.12 Overall, there is a lack of understanding of the benefits of antenatal vaccination, including providing immunity to both baby and mother against serious respiratory infections, says Ms Al-Adhami. Reduced access to vaccines is also an issue, particularly among vulnerable populations, such as those with mental health problems, and Aboriginal and Torres Strait Islander peoples. ‘Once we identified some women were having difficulties accessing antenatal vaccinations in the community, we recognised an opportunity to extend our scope of practice and improve our service delivery within the clinic,’ she says. This included credentialed training and the development of an opportunistic model of care, where ‘at-risk’ women were counselled and offered antenatal vaccinations during clinic visits. ‘Last year 546 vaccines were administered by our specialist antenatal pharmacists, adds Ms Al-Adhami.13 In Ms Meyer’s experience there has also been confusion among women about what vaccines are needed during pregnancy, and where to get them. ‘The states and territories all have different rules and regulations around who can provide National Immunisation Program (NIP) vaccines,’ she says. With most jurisdictions now increasing the number of vaccines pharmacists can administer, this should be used as an opportunity to initiate conversations with pregnant women about vaccination. ‘Ensure the mother is well educated on what vaccines she, and other family members, should receive according to current guidelines,’ says Ms Meyer.
All about birthing on country[caption id="attachment_25937" align="alignnone" width="500"] In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see www.bobbilockyer.com[/caption] Birthing on Country (BOC) is a holistic, integrated and culturally appropriate model of care, aimed at providing the best start in life for Aboriginal and Torres Strait Islander babies and their families.14 Broader than labour and delivery, BOC addresses socio-cultural and spiritual risk not dealt with through mainstream services. Guiding principles for a BOC program include respect for and incorporation of the knowledge and traditional practice of Aboriginal and Torres Strait Islander peoples, incorporate a holistic definition of health, respect for family involvement, women’s business, connection with Country and continuity of culturally safe care.15 Aboriginal and Torres Strait Islander mothers are 3–5 times more likely to die in childbirth than other mothers. Their babies are almost twice as likely to die in the first year of life – often due to premature birth.16 With research revealing access to community-governed, culturally safe birthing services is linked to a reduced risk of premature birth,17 pharmacists can advocate for and support BOC models of care. ‘BOC is so much broader than where a mother births – it is a social justice movement and system-wide reform. It’s an opportunity to Close the Gap in life outcomes for mums and bubs by recognising the impact of colonisation and the benefits of returning childbirth services to Aboriginal and Torres Strait Island community control,’ says Alice Nugent MPS, Aboriginal Community Controlled Health Organisation Pharmacist. Although not available everywhere, BOC can still involve birthing in a local hospital with the presence of an Aboriginal or Torres Strait Islander midwife or support worker throughout a woman’s pregnancy, birthing and post-natal journey. Once the baby is born, ongoing support is usually provided to the family, which may include cultural ceremonies for the mother and newborn. |
‘Pharmacists can check how the woman is feeling and advise on the red flags that warrant a medical emergency.' Jacqueline Meyer MPSInfant formulas Formula manufacturers commonly use marketing that may feed into parental anxieties in claiming their products can prevent fussiness, help with colic, or improve night-time sleep.22 Pharmacists can emphasise the ‘antibodies, immunoglobulins and health benefits’ that breast milk can provide, along with advice on ensuring milk quality is at optimum levels, says Ms Meyer. ‘The number one thing is to eat before you feed,’ she says. ‘Mothers should also have a wholesome, balanced diet full of fresh nutrients and vegetables, so nutritional intake is at a premium.’ While breastfeeding should be encouraged, pharmacists can also guide mothers around selecting the right formulas when breastfeeding is not possible, says Ms Meyer. ‘We get a lot of questions around milk-free or dairy-free alternatives due to rising concerns of allergies and intolerances,’ she says. Factors to consider include the baby’s age, digestive issues, peptide profiles, short- or long-chain formula requirements, or whether specific formulas need to be prescribed. Pharmacists should also enquire how formulas are tolerated over a trial period – which ones and for how long, any reactions such as refusal, any reflux-type symptoms, changes in stool colour, irritability and any difficulty settling, suggests Ms Meyer. ‘Just trialling the formula for one day is often not enough. A longer period of time is required to identify a true intolerance.’ Medicines and breastfeeding Another reason why mothers opt to stop breastfeeding is medicine use.27 Pharmacists can reassure patients that very small amounts of medicines generally pass through breast milk, says Ms Meyer. ‘Medicine should never be a reason to stop breastfeeding, unless specifically advised to do so.’ Pharmacists can also advise patients when to take their medicines. ‘If the medicine is taken multiple times a day, recommend taking it directly after a breastfeed, so it reaches peak concentration in between feeding cycles,’ she says.
‘If your mum or dad had perinatal mental ill health, you’re more likely to have mental ill-health issues later on.' Lily Pham MPS
What's ailing pregnant and new mums?Pregnancy and the early stages of motherhood are fraught with discomfort. In addition to nausea and vomiting, some common ailments in pregnancy include constipation and indigestion, says Ms Al-Adhami. To overcome constipation, often due to hormone changes that slow down muscles in the bowel, patients should be advised to increase their fibre content by consuming fresh fruit and vegetables, wholemeal breads and breakfast cereals, nuts and legumes. Supplements such as psyllium husks can also be introduced. As iron tablets can also cause constipation, pharmacists can suggest another product for a trial period.23 Antacids for indigestion are safe to use in pregnancy. Calcium-based formulations are preferable to aluminium-containing antacids.24 When the baby arrives, back pain, incontinence and repetitive strain injuries are common. For mild to moderate pain, paracetamol is considered a safe analgesic during lactation, with the dose transferred through breast milk estimated to be 6% – much smaller than a child’s dose.25 Ibuprofen is also considered to be compatible with breastfeeding.25 Pelvic floor exercises can help to address post-birth incontinence, along with avoidance of persistent heavy lifting, repetitive coughing and straining.26 |
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