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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
[post_title] => Ahpra’s new login system leaves some pharmacists locked out
[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[title] => Ahpra’s new login system leaves some pharmacists locked out
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[post_content] => Case scenario
Mrs Tan, an 82-year-old woman, visits your pharmacy to refill her medicines for hypertension and arthritis. When asked about how she is doing with all her medicines, she mentions to you that she recently had increasing episodes of urinary leakage, which she had not previously disclosed to her doctor due to embarrassment.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
The bladder serves two primary roles: it stores urine and facilitates its release. When either function is impaired, it can lead to urinary incontinence, which refers to the unintentional leakage of urine.1,2
Incontinence often leads to reduced quality of life and is under-recognised due to stigma. Urinary incontinence affects all ages and is particularly common in older people. Approximately 5% of people aged 65–84 years experience severe incontinence, increasing to up to 28% in those aged 85 years and over.1
Urinary incontinence can be classified into several types. The main types of urinary incontinence include stress incontinence, urge incontinence, overflow incontinence, functional incontinence and mixed incontinence (see Table 1).2,3 Stress incontinence is the most common type of urinary incontinence and affects predominantly women.

Pharmacists play a crucial role in identifying medicines that may cause or exacerbate urinary incontinence. Medicine-induced incontinence is particularly prevalent in older people and requires a careful review of pharmacotherapy. Medicine or medicine classes associated with urinary incontinence include6:
Biological sex may influence the risk factors for urinary incontinence, with some differences observed between females and males.6,7 In females, key risk factors include advanced age, obstetric history (parity and mode of delivery), higher body mass index, menopause, and comorbidities such as urinary tract infection, diabetes, dementia, cardiorespiratory disorders, chronic cough and obstructive sleep apnoea.6 In males, urinary incontinence is more commonly associated with advanced age, benign prostatic hyperplasia, diabetes, detrusor overactivity, limitation in physical function or disability, an increased body mass index, dementia and Parkinson’s disease.7
The overarching goal in managing urinary incontinence is to alleviate symptoms, prevent complications of incontinence and ultimately improve quality of life.8 Management strategies are tailored to the type and severity of incontinence, the underlying cause and patient-specific factors, such as comorbidities and preferences.
Lifestyle modifications and control techniques play a significant role in the management of urinary incontinence. Lifestyle modifications include minimising intake of bladder irritants (such as caffeine and alcohol), reducing fluid intake, avoiding constipation, smoking cessation, weight loss and regular exercise.5 Control techniques include bladder training, pelvic floor muscle exercises and scheduled toileting.5 Continence nurse specialists and physiotherapists have the expertise to support this training. Continence aids such as protective pads are the least invasive but generally not preferred. They may be suitable for very frail older patients or those who prefer to avoid, or are unsuitable for, medication or surgery.9
Pharmacological options are typically considered when non-pharmacological strategies are either insufficient or inappropriate. These include8:
Medication management in older people should follow the principle of ‘start low, go slow’, considering comorbidities, polypharmacy and anticholinergic burden. Regular medication review is essential, and deprescribing decisions should be considered when appropriate. For instance, deprescribing of anticholinergics can be considered in older people12:
Patient resourcesNational Continence Helpline (1800 33 00 66): Provides free, confidential patient advice from continence nurse advisors from 8.00 am to 8.00 pm (AEST) Monday to Friday.
Continence Health Australia (www.continence.org.au): Offers comprehensive information in English and other languages on bladder, bowel and pelvic floor health, incontinence management strategies, support for carers and available financial assistance.
Pharmacists can support people experiencing incontinence who may hesitate to raise the issue due to embarrassment, cultural factors, or believing that it is a normal part of ageing. Pharmacists can play an important role in offering confidential advice and referring individuals to appropriate services (e.g. nurse continence specialists). Conducting medication reviews is a key responsibility, helping to identify medicines that may contribute to or worsen incontinence. Pharmacists can also raise awareness of helpful resources, such as the National Continence Helpline and Continence Health Australia. These actions can improve continence symptoms, enhance quality of life, reduce complications, and empower consumers to manage their health more effectively.
Incontinence is common but often manageable with early recognition and intervention. Identifying contributing factors, including medicine-related causes, can significantly improve quality of life. Pharmacists play a key role through medication review, education and timely referral to support services. By proactively addressing incontinence, pharmacists can help reduce stigma, prevent complications and support better health outcomes for consumers.
Case scenario continuedYou gently initiate a conversation about incontinence, reassuring Mrs Tan that it is a common and manageable condition. After reviewing her medicines, you identify that Mrs Tan is taking a diuretic which can increase urine production and may lead to or worsen urinary incontinence. You suggest Mrs Tan discuss her condition with her GP and review the possibility of stopping or reducing the dose of the diuretic. Additionally, you provide Mrs Tan with information about urinary incontinence and refer her to the National Continence Helpline for further support. Within a few weeks, Mrs Tan reports a noticeable reduction in urinary frequency and fewer leakage episodes. She feels more confident and can participate more actively in social activities, improving her overall quality of life. |
Dr Amy Page (she/her) PhD, MClinPharm, GradDipBiostat, GCertHProfEd, GAICD, GStat, FSHPA, FPS is a consultant pharmacist, biostatistician, and a senior lecturer at the University of Western Australia. She is recognised as a national expert in the quality use of medicines.
Amanda Quek (she/her) BPharm(Hons), GradCertAppPharmPrac is a pharmacist and PhD candidate at the University of Western Australia. Her research focuses on optimising medication use and the development of clinical practice guidelines.
Dr Amy Page is supported by the Western Australian Future Health Research and Innovation Fund/Western Australian Department of Health, Grant ID WANMA/EL2022/1. She is an employee of the University of Western Australia, practitioner member of the Pharmacy Board of Australia, and the Victorian state president of the Pharmaceutical Society of Australia (PSA).
Amanda Quek is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia.
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[post_content] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
Q fever cases are on the rise in Victoria. In 2024, there were 77 Q fever notifications – a significant uptick on cases compared to the previous 5 years.
The zoonotic disease – primarily carried by cattle, sheep, and goats – can cause significant long-term health impacts, including heart disease, bone and joint infections and vascular infections. Around 10–15% of people who have this develop chronic fatigue.
The Victorian Department of Health has urged people working with animals, animal products or animal waste to get vaccinated against the bacterium. But given it’s a multi-step process requiring a specific skill set, vaccination isn’t always readily accessible.
AP spoke with community pharmacist Alexander Look MPS, based in the rural town of Ouyen in north-west Victoria, who recognised a gap in care in his community and took action to address it.
Building a local solution
Ouyen is a key livestock-selling and transport centre, hosting fortnightly sheep sales with significant numbers of sheep and lambs traded each year. With no permanent local GP, Mr Look’s pharmacy became a vaccination hub, drawing frequent enquiries about Q fever vaccination.
‘We were getting a lot of farmers [coming through] who were worrying about this particular vaccination,’ he said.
There are few providers, even in larger regional centres, that offer Q fever vaccination. There’s only one clinic in Mildura, the largest nearby town, providing the service
‘Farmers would have to drive several hours [for the service], and return on at least three occasions,’ Mr Look said.
Besides, the clinic is no longer taking on new patients. ‘So you can't get in, even if you wanted to,’ he added.
Identifying a need for a local Q fever vaccination clinic, Mr Look first conducted research into the viability of the service to determine whether it would work from a business perspective. He then partnered with a GP from a clinic located 1 hour away from Ouyen to arrange for the service to be offered in town – making vaccination more accessible to those in need.
A lengthy assessment process
Before patients can be vaccinated against Q fever, they must undergo a three-stage assessment process, with the first being an interview to test suitability, Mr Look said.
‘This includes identifying whether they've had the vaccination or Q fever before,’ he said. ‘Because this is a once-in-a-lifetime vaccination, they are not suitable to be vaccinated if they have. And if someone has previously had Q fever, they are at risk of having a severe adverse reaction.’
The second step is to get a blood test, with the partnering GP issuing a pathology request to the patient. After that, a skin test is required.
‘I inject a small amount of bacteria underneath the skin, then I get the patient to return 7 days later – so we can review to make sure there's not any skin reaction,’ Mr Look said. ‘Because if there is, they are not eligible for the vaccine.’
These intricacies prevent many clinics from offering the service, Mr Look said.
‘With the skin testing, you have to reconstitute the vial of bacteria,’ he said. ‘So it’s most efficient to [assess] 20 people or so to maximise the testing vial. And there isn’t usually that volume of people.’
Charging a little extra allows for ad hoc testing rather than batching, ensuring all patients are covered on demand. ‘Patients find it worthwhile, because it reduces the serious adverse effects of Q fever,’ Mr Look said.
Ensuring compliance
Q fever vaccination is within Victorian pharmacists’ scope of practice to administer, when prescribed by a GP. However, the clinical assessment was another story.
‘Both myself and the other pharmacist doing it had to undertake additional training from the Australian College of Rural and Remote Medicine, which has a pathway to train people on Q fever vaccination,’ Mr Look said.
The training involved an online, validated course that introduced a new skillset.
‘Pharmacists are comfortable with intramuscular vaccination, and to some degree subcutaneous vaccination,’ he said. ‘However, this testing involves intradermal administration of the bacteria, followed by a review with proper clinical replication.’
And just to ensure all was above board, the team consulted a lawyer.
‘We wanted to make sure that [the service] was compliant with a number of conditions,’ Mr Look added.
Extending the reach of rural health services
So far, the service has had a significant impact for clientele – both in time and cost saved, Mr Look said.
‘Taking time off from farming work is quite difficult,’ he said. ‘With each course of vaccination, we're saving patients at least 6 hours of commuting time, and more in terms of waiting for the clinician when they get to the clinic to the larger cities.’
The key demographic the team is hoping to reach is younger farmers, including students just starting out in the industry.
‘They would most benefit from this type of protection because they are early on in their career,’ Mr Look said.
Around a dozen people have come through the clinic, with significant interest from other groups.
‘We are about to have further discussions with the Livestock Exchange involving [vaccination for] people who don't live within our town, including livestock agents, because it's so difficult to get – even in the cities,’ he said. ‘If they're coming here once a month, this is a brand new service we can offer them.’
The team has also spoken with the local GP about offering the service more broadly across rural areas, including to abattoir workers.
At this stage, only Q fever vaccination is provided through the off-site clinic.
However, the team is checking the Australian Immunisation Register to determine whether patients are up to date with their tetanus vaccination.
‘Farmers are exposed to a lot of soils which might be contaminated,’ he said. ‘So when we're looking at combining this service with other existing services, it certainly would be something like tetanus vaccination.’
Continued collaboration with the GP is an essential part of the service, which has helped to strengthen the team’s skills.
‘He's deputised us to do a lot of the functions, including the skin test and assessment,’ Mr Look said. ‘And he's confident with our skills, which is really reassuring for us to know we're on the right track.’
[post_title] => Closing the gap on Q fever vaccination access
[post_excerpt] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
[post_title] => Ahpra’s new login system leaves some pharmacists locked out
[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[post_content] => Case scenario
Mrs Tan, an 82-year-old woman, visits your pharmacy to refill her medicines for hypertension and arthritis. When asked about how she is doing with all her medicines, she mentions to you that she recently had increasing episodes of urinary leakage, which she had not previously disclosed to her doctor due to embarrassment.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
The bladder serves two primary roles: it stores urine and facilitates its release. When either function is impaired, it can lead to urinary incontinence, which refers to the unintentional leakage of urine.1,2
Incontinence often leads to reduced quality of life and is under-recognised due to stigma. Urinary incontinence affects all ages and is particularly common in older people. Approximately 5% of people aged 65–84 years experience severe incontinence, increasing to up to 28% in those aged 85 years and over.1
Urinary incontinence can be classified into several types. The main types of urinary incontinence include stress incontinence, urge incontinence, overflow incontinence, functional incontinence and mixed incontinence (see Table 1).2,3 Stress incontinence is the most common type of urinary incontinence and affects predominantly women.

Pharmacists play a crucial role in identifying medicines that may cause or exacerbate urinary incontinence. Medicine-induced incontinence is particularly prevalent in older people and requires a careful review of pharmacotherapy. Medicine or medicine classes associated with urinary incontinence include6:
Biological sex may influence the risk factors for urinary incontinence, with some differences observed between females and males.6,7 In females, key risk factors include advanced age, obstetric history (parity and mode of delivery), higher body mass index, menopause, and comorbidities such as urinary tract infection, diabetes, dementia, cardiorespiratory disorders, chronic cough and obstructive sleep apnoea.6 In males, urinary incontinence is more commonly associated with advanced age, benign prostatic hyperplasia, diabetes, detrusor overactivity, limitation in physical function or disability, an increased body mass index, dementia and Parkinson’s disease.7
The overarching goal in managing urinary incontinence is to alleviate symptoms, prevent complications of incontinence and ultimately improve quality of life.8 Management strategies are tailored to the type and severity of incontinence, the underlying cause and patient-specific factors, such as comorbidities and preferences.
Lifestyle modifications and control techniques play a significant role in the management of urinary incontinence. Lifestyle modifications include minimising intake of bladder irritants (such as caffeine and alcohol), reducing fluid intake, avoiding constipation, smoking cessation, weight loss and regular exercise.5 Control techniques include bladder training, pelvic floor muscle exercises and scheduled toileting.5 Continence nurse specialists and physiotherapists have the expertise to support this training. Continence aids such as protective pads are the least invasive but generally not preferred. They may be suitable for very frail older patients or those who prefer to avoid, or are unsuitable for, medication or surgery.9
Pharmacological options are typically considered when non-pharmacological strategies are either insufficient or inappropriate. These include8:
Medication management in older people should follow the principle of ‘start low, go slow’, considering comorbidities, polypharmacy and anticholinergic burden. Regular medication review is essential, and deprescribing decisions should be considered when appropriate. For instance, deprescribing of anticholinergics can be considered in older people12:
Patient resourcesNational Continence Helpline (1800 33 00 66): Provides free, confidential patient advice from continence nurse advisors from 8.00 am to 8.00 pm (AEST) Monday to Friday.
Continence Health Australia (www.continence.org.au): Offers comprehensive information in English and other languages on bladder, bowel and pelvic floor health, incontinence management strategies, support for carers and available financial assistance.
Pharmacists can support people experiencing incontinence who may hesitate to raise the issue due to embarrassment, cultural factors, or believing that it is a normal part of ageing. Pharmacists can play an important role in offering confidential advice and referring individuals to appropriate services (e.g. nurse continence specialists). Conducting medication reviews is a key responsibility, helping to identify medicines that may contribute to or worsen incontinence. Pharmacists can also raise awareness of helpful resources, such as the National Continence Helpline and Continence Health Australia. These actions can improve continence symptoms, enhance quality of life, reduce complications, and empower consumers to manage their health more effectively.
Incontinence is common but often manageable with early recognition and intervention. Identifying contributing factors, including medicine-related causes, can significantly improve quality of life. Pharmacists play a key role through medication review, education and timely referral to support services. By proactively addressing incontinence, pharmacists can help reduce stigma, prevent complications and support better health outcomes for consumers.
Case scenario continuedYou gently initiate a conversation about incontinence, reassuring Mrs Tan that it is a common and manageable condition. After reviewing her medicines, you identify that Mrs Tan is taking a diuretic which can increase urine production and may lead to or worsen urinary incontinence. You suggest Mrs Tan discuss her condition with her GP and review the possibility of stopping or reducing the dose of the diuretic. Additionally, you provide Mrs Tan with information about urinary incontinence and refer her to the National Continence Helpline for further support. Within a few weeks, Mrs Tan reports a noticeable reduction in urinary frequency and fewer leakage episodes. She feels more confident and can participate more actively in social activities, improving her overall quality of life. |
Dr Amy Page (she/her) PhD, MClinPharm, GradDipBiostat, GCertHProfEd, GAICD, GStat, FSHPA, FPS is a consultant pharmacist, biostatistician, and a senior lecturer at the University of Western Australia. She is recognised as a national expert in the quality use of medicines.
Amanda Quek (she/her) BPharm(Hons), GradCertAppPharmPrac is a pharmacist and PhD candidate at the University of Western Australia. Her research focuses on optimising medication use and the development of clinical practice guidelines.
Dr Amy Page is supported by the Western Australian Future Health Research and Innovation Fund/Western Australian Department of Health, Grant ID WANMA/EL2022/1. She is an employee of the University of Western Australia, practitioner member of the Pharmacy Board of Australia, and the Victorian state president of the Pharmaceutical Society of Australia (PSA).
Amanda Quek is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia.
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[post_content] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
Q fever cases are on the rise in Victoria. In 2024, there were 77 Q fever notifications – a significant uptick on cases compared to the previous 5 years.
The zoonotic disease – primarily carried by cattle, sheep, and goats – can cause significant long-term health impacts, including heart disease, bone and joint infections and vascular infections. Around 10–15% of people who have this develop chronic fatigue.
The Victorian Department of Health has urged people working with animals, animal products or animal waste to get vaccinated against the bacterium. But given it’s a multi-step process requiring a specific skill set, vaccination isn’t always readily accessible.
AP spoke with community pharmacist Alexander Look MPS, based in the rural town of Ouyen in north-west Victoria, who recognised a gap in care in his community and took action to address it.
Building a local solution
Ouyen is a key livestock-selling and transport centre, hosting fortnightly sheep sales with significant numbers of sheep and lambs traded each year. With no permanent local GP, Mr Look’s pharmacy became a vaccination hub, drawing frequent enquiries about Q fever vaccination.
‘We were getting a lot of farmers [coming through] who were worrying about this particular vaccination,’ he said.
There are few providers, even in larger regional centres, that offer Q fever vaccination. There’s only one clinic in Mildura, the largest nearby town, providing the service
‘Farmers would have to drive several hours [for the service], and return on at least three occasions,’ Mr Look said.
Besides, the clinic is no longer taking on new patients. ‘So you can't get in, even if you wanted to,’ he added.
Identifying a need for a local Q fever vaccination clinic, Mr Look first conducted research into the viability of the service to determine whether it would work from a business perspective. He then partnered with a GP from a clinic located 1 hour away from Ouyen to arrange for the service to be offered in town – making vaccination more accessible to those in need.
A lengthy assessment process
Before patients can be vaccinated against Q fever, they must undergo a three-stage assessment process, with the first being an interview to test suitability, Mr Look said.
‘This includes identifying whether they've had the vaccination or Q fever before,’ he said. ‘Because this is a once-in-a-lifetime vaccination, they are not suitable to be vaccinated if they have. And if someone has previously had Q fever, they are at risk of having a severe adverse reaction.’
The second step is to get a blood test, with the partnering GP issuing a pathology request to the patient. After that, a skin test is required.
‘I inject a small amount of bacteria underneath the skin, then I get the patient to return 7 days later – so we can review to make sure there's not any skin reaction,’ Mr Look said. ‘Because if there is, they are not eligible for the vaccine.’
These intricacies prevent many clinics from offering the service, Mr Look said.
‘With the skin testing, you have to reconstitute the vial of bacteria,’ he said. ‘So it’s most efficient to [assess] 20 people or so to maximise the testing vial. And there isn’t usually that volume of people.’
Charging a little extra allows for ad hoc testing rather than batching, ensuring all patients are covered on demand. ‘Patients find it worthwhile, because it reduces the serious adverse effects of Q fever,’ Mr Look said.
Ensuring compliance
Q fever vaccination is within Victorian pharmacists’ scope of practice to administer, when prescribed by a GP. However, the clinical assessment was another story.
‘Both myself and the other pharmacist doing it had to undertake additional training from the Australian College of Rural and Remote Medicine, which has a pathway to train people on Q fever vaccination,’ Mr Look said.
The training involved an online, validated course that introduced a new skillset.
‘Pharmacists are comfortable with intramuscular vaccination, and to some degree subcutaneous vaccination,’ he said. ‘However, this testing involves intradermal administration of the bacteria, followed by a review with proper clinical replication.’
And just to ensure all was above board, the team consulted a lawyer.
‘We wanted to make sure that [the service] was compliant with a number of conditions,’ Mr Look added.
Extending the reach of rural health services
So far, the service has had a significant impact for clientele – both in time and cost saved, Mr Look said.
‘Taking time off from farming work is quite difficult,’ he said. ‘With each course of vaccination, we're saving patients at least 6 hours of commuting time, and more in terms of waiting for the clinician when they get to the clinic to the larger cities.’
The key demographic the team is hoping to reach is younger farmers, including students just starting out in the industry.
‘They would most benefit from this type of protection because they are early on in their career,’ Mr Look said.
Around a dozen people have come through the clinic, with significant interest from other groups.
‘We are about to have further discussions with the Livestock Exchange involving [vaccination for] people who don't live within our town, including livestock agents, because it's so difficult to get – even in the cities,’ he said. ‘If they're coming here once a month, this is a brand new service we can offer them.’
The team has also spoken with the local GP about offering the service more broadly across rural areas, including to abattoir workers.
At this stage, only Q fever vaccination is provided through the off-site clinic.
However, the team is checking the Australian Immunisation Register to determine whether patients are up to date with their tetanus vaccination.
‘Farmers are exposed to a lot of soils which might be contaminated,’ he said. ‘So when we're looking at combining this service with other existing services, it certainly would be something like tetanus vaccination.’
Continued collaboration with the GP is an essential part of the service, which has helped to strengthen the team’s skills.
‘He's deputised us to do a lot of the functions, including the skin test and assessment,’ Mr Look said. ‘And he's confident with our skills, which is really reassuring for us to know we're on the right track.’
[post_title] => Closing the gap on Q fever vaccination access
[post_excerpt] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
[post_title] => Ahpra’s new login system leaves some pharmacists locked out
[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[post_content] => Case scenario
Mrs Tan, an 82-year-old woman, visits your pharmacy to refill her medicines for hypertension and arthritis. When asked about how she is doing with all her medicines, she mentions to you that she recently had increasing episodes of urinary leakage, which she had not previously disclosed to her doctor due to embarrassment.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
The bladder serves two primary roles: it stores urine and facilitates its release. When either function is impaired, it can lead to urinary incontinence, which refers to the unintentional leakage of urine.1,2
Incontinence often leads to reduced quality of life and is under-recognised due to stigma. Urinary incontinence affects all ages and is particularly common in older people. Approximately 5% of people aged 65–84 years experience severe incontinence, increasing to up to 28% in those aged 85 years and over.1
Urinary incontinence can be classified into several types. The main types of urinary incontinence include stress incontinence, urge incontinence, overflow incontinence, functional incontinence and mixed incontinence (see Table 1).2,3 Stress incontinence is the most common type of urinary incontinence and affects predominantly women.

Pharmacists play a crucial role in identifying medicines that may cause or exacerbate urinary incontinence. Medicine-induced incontinence is particularly prevalent in older people and requires a careful review of pharmacotherapy. Medicine or medicine classes associated with urinary incontinence include6:
Biological sex may influence the risk factors for urinary incontinence, with some differences observed between females and males.6,7 In females, key risk factors include advanced age, obstetric history (parity and mode of delivery), higher body mass index, menopause, and comorbidities such as urinary tract infection, diabetes, dementia, cardiorespiratory disorders, chronic cough and obstructive sleep apnoea.6 In males, urinary incontinence is more commonly associated with advanced age, benign prostatic hyperplasia, diabetes, detrusor overactivity, limitation in physical function or disability, an increased body mass index, dementia and Parkinson’s disease.7
The overarching goal in managing urinary incontinence is to alleviate symptoms, prevent complications of incontinence and ultimately improve quality of life.8 Management strategies are tailored to the type and severity of incontinence, the underlying cause and patient-specific factors, such as comorbidities and preferences.
Lifestyle modifications and control techniques play a significant role in the management of urinary incontinence. Lifestyle modifications include minimising intake of bladder irritants (such as caffeine and alcohol), reducing fluid intake, avoiding constipation, smoking cessation, weight loss and regular exercise.5 Control techniques include bladder training, pelvic floor muscle exercises and scheduled toileting.5 Continence nurse specialists and physiotherapists have the expertise to support this training. Continence aids such as protective pads are the least invasive but generally not preferred. They may be suitable for very frail older patients or those who prefer to avoid, or are unsuitable for, medication or surgery.9
Pharmacological options are typically considered when non-pharmacological strategies are either insufficient or inappropriate. These include8:
Medication management in older people should follow the principle of ‘start low, go slow’, considering comorbidities, polypharmacy and anticholinergic burden. Regular medication review is essential, and deprescribing decisions should be considered when appropriate. For instance, deprescribing of anticholinergics can be considered in older people12:
Patient resourcesNational Continence Helpline (1800 33 00 66): Provides free, confidential patient advice from continence nurse advisors from 8.00 am to 8.00 pm (AEST) Monday to Friday.
Continence Health Australia (www.continence.org.au): Offers comprehensive information in English and other languages on bladder, bowel and pelvic floor health, incontinence management strategies, support for carers and available financial assistance.
Pharmacists can support people experiencing incontinence who may hesitate to raise the issue due to embarrassment, cultural factors, or believing that it is a normal part of ageing. Pharmacists can play an important role in offering confidential advice and referring individuals to appropriate services (e.g. nurse continence specialists). Conducting medication reviews is a key responsibility, helping to identify medicines that may contribute to or worsen incontinence. Pharmacists can also raise awareness of helpful resources, such as the National Continence Helpline and Continence Health Australia. These actions can improve continence symptoms, enhance quality of life, reduce complications, and empower consumers to manage their health more effectively.
Incontinence is common but often manageable with early recognition and intervention. Identifying contributing factors, including medicine-related causes, can significantly improve quality of life. Pharmacists play a key role through medication review, education and timely referral to support services. By proactively addressing incontinence, pharmacists can help reduce stigma, prevent complications and support better health outcomes for consumers.
Case scenario continuedYou gently initiate a conversation about incontinence, reassuring Mrs Tan that it is a common and manageable condition. After reviewing her medicines, you identify that Mrs Tan is taking a diuretic which can increase urine production and may lead to or worsen urinary incontinence. You suggest Mrs Tan discuss her condition with her GP and review the possibility of stopping or reducing the dose of the diuretic. Additionally, you provide Mrs Tan with information about urinary incontinence and refer her to the National Continence Helpline for further support. Within a few weeks, Mrs Tan reports a noticeable reduction in urinary frequency and fewer leakage episodes. She feels more confident and can participate more actively in social activities, improving her overall quality of life. |
Dr Amy Page (she/her) PhD, MClinPharm, GradDipBiostat, GCertHProfEd, GAICD, GStat, FSHPA, FPS is a consultant pharmacist, biostatistician, and a senior lecturer at the University of Western Australia. She is recognised as a national expert in the quality use of medicines.
Amanda Quek (she/her) BPharm(Hons), GradCertAppPharmPrac is a pharmacist and PhD candidate at the University of Western Australia. Her research focuses on optimising medication use and the development of clinical practice guidelines.
Dr Amy Page is supported by the Western Australian Future Health Research and Innovation Fund/Western Australian Department of Health, Grant ID WANMA/EL2022/1. She is an employee of the University of Western Australia, practitioner member of the Pharmacy Board of Australia, and the Victorian state president of the Pharmaceutical Society of Australia (PSA).
Amanda Quek is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia.
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[post_content] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
Q fever cases are on the rise in Victoria. In 2024, there were 77 Q fever notifications – a significant uptick on cases compared to the previous 5 years.
The zoonotic disease – primarily carried by cattle, sheep, and goats – can cause significant long-term health impacts, including heart disease, bone and joint infections and vascular infections. Around 10–15% of people who have this develop chronic fatigue.
The Victorian Department of Health has urged people working with animals, animal products or animal waste to get vaccinated against the bacterium. But given it’s a multi-step process requiring a specific skill set, vaccination isn’t always readily accessible.
AP spoke with community pharmacist Alexander Look MPS, based in the rural town of Ouyen in north-west Victoria, who recognised a gap in care in his community and took action to address it.
Building a local solution
Ouyen is a key livestock-selling and transport centre, hosting fortnightly sheep sales with significant numbers of sheep and lambs traded each year. With no permanent local GP, Mr Look’s pharmacy became a vaccination hub, drawing frequent enquiries about Q fever vaccination.
‘We were getting a lot of farmers [coming through] who were worrying about this particular vaccination,’ he said.
There are few providers, even in larger regional centres, that offer Q fever vaccination. There’s only one clinic in Mildura, the largest nearby town, providing the service
‘Farmers would have to drive several hours [for the service], and return on at least three occasions,’ Mr Look said.
Besides, the clinic is no longer taking on new patients. ‘So you can't get in, even if you wanted to,’ he added.
Identifying a need for a local Q fever vaccination clinic, Mr Look first conducted research into the viability of the service to determine whether it would work from a business perspective. He then partnered with a GP from a clinic located 1 hour away from Ouyen to arrange for the service to be offered in town – making vaccination more accessible to those in need.
A lengthy assessment process
Before patients can be vaccinated against Q fever, they must undergo a three-stage assessment process, with the first being an interview to test suitability, Mr Look said.
‘This includes identifying whether they've had the vaccination or Q fever before,’ he said. ‘Because this is a once-in-a-lifetime vaccination, they are not suitable to be vaccinated if they have. And if someone has previously had Q fever, they are at risk of having a severe adverse reaction.’
The second step is to get a blood test, with the partnering GP issuing a pathology request to the patient. After that, a skin test is required.
‘I inject a small amount of bacteria underneath the skin, then I get the patient to return 7 days later – so we can review to make sure there's not any skin reaction,’ Mr Look said. ‘Because if there is, they are not eligible for the vaccine.’
These intricacies prevent many clinics from offering the service, Mr Look said.
‘With the skin testing, you have to reconstitute the vial of bacteria,’ he said. ‘So it’s most efficient to [assess] 20 people or so to maximise the testing vial. And there isn’t usually that volume of people.’
Charging a little extra allows for ad hoc testing rather than batching, ensuring all patients are covered on demand. ‘Patients find it worthwhile, because it reduces the serious adverse effects of Q fever,’ Mr Look said.
Ensuring compliance
Q fever vaccination is within Victorian pharmacists’ scope of practice to administer, when prescribed by a GP. However, the clinical assessment was another story.
‘Both myself and the other pharmacist doing it had to undertake additional training from the Australian College of Rural and Remote Medicine, which has a pathway to train people on Q fever vaccination,’ Mr Look said.
The training involved an online, validated course that introduced a new skillset.
‘Pharmacists are comfortable with intramuscular vaccination, and to some degree subcutaneous vaccination,’ he said. ‘However, this testing involves intradermal administration of the bacteria, followed by a review with proper clinical replication.’
And just to ensure all was above board, the team consulted a lawyer.
‘We wanted to make sure that [the service] was compliant with a number of conditions,’ Mr Look added.
Extending the reach of rural health services
So far, the service has had a significant impact for clientele – both in time and cost saved, Mr Look said.
‘Taking time off from farming work is quite difficult,’ he said. ‘With each course of vaccination, we're saving patients at least 6 hours of commuting time, and more in terms of waiting for the clinician when they get to the clinic to the larger cities.’
The key demographic the team is hoping to reach is younger farmers, including students just starting out in the industry.
‘They would most benefit from this type of protection because they are early on in their career,’ Mr Look said.
Around a dozen people have come through the clinic, with significant interest from other groups.
‘We are about to have further discussions with the Livestock Exchange involving [vaccination for] people who don't live within our town, including livestock agents, because it's so difficult to get – even in the cities,’ he said. ‘If they're coming here once a month, this is a brand new service we can offer them.’
The team has also spoken with the local GP about offering the service more broadly across rural areas, including to abattoir workers.
At this stage, only Q fever vaccination is provided through the off-site clinic.
However, the team is checking the Australian Immunisation Register to determine whether patients are up to date with their tetanus vaccination.
‘Farmers are exposed to a lot of soils which might be contaminated,’ he said. ‘So when we're looking at combining this service with other existing services, it certainly would be something like tetanus vaccination.’
Continued collaboration with the GP is an essential part of the service, which has helped to strengthen the team’s skills.
‘He's deputised us to do a lot of the functions, including the skin test and assessment,’ Mr Look said. ‘And he's confident with our skills, which is really reassuring for us to know we're on the right track.’
[post_title] => Closing the gap on Q fever vaccination access
[post_excerpt] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
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[post_excerpt] => Although somewhat kept on the down low, nicotine inhalators have been discontinued. Are Pharmacist Only vapes the next best option?
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[post_content] => The PSA released its 2025 Strategic Projects Impact Report last week (6 November), showcasing its leadership in advancing pharmacist practice and promoting medicines safety nationally.
The report highlights how PSA drives the safe use of medicines forward through projects in palliative care, mental health, and vaping reform that demonstrate collaborative, evidence-based initiatives.
In 2025, PSA’s projects team delivered more than 40 initiatives in collaboration with over 30 partners, cementing its role as the national peak body driving the Quality Use of Medicines (QUM) agenda.
The PSA’s commitment to supporting pharmacists through change is demonstrated in the report with key education projects including:
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[post_content] => This year, the Australian Health Practitioner Regulation Agency (Ahpra) debuted a new platform that many pharmacists have found less than user friendly.
With the re-registration date fast approaching (30 November), AP looks at the troubles pharmacists have faced and why you should initiate your renewal sooner rather than later.
Multifactor authentication fails
To improve user security, the new Ahpra portal requires two-step verification, with the Google Authenticator app recommended by the regulator.
Seems simple enough, but the process has been far from straightforward for many.
‘I had trouble logging in to the new Ahpra portal as the initial authenticator sign up didn’t work,’ said Gold Coast–based pharmacist Samantha Arche.
‘I looked on the Ahpra website for how to troubleshoot but there wasn’t anything listed. I then tried resetting my password which also didn’t work.’
Unable to reach Ahpra by phone, Ms Arche lodged an online complaint which took some time to resolve.
‘After 2 business days they got back to me with instructions, and said they would send me a new link which never came through,’ she said.
‘I couldn’t reply to the email and I had to lodge a new complaint which took another 2 business days to be answered. [But] my login has been rectified now and I was able to renew my registration.’
Authentication only works with one app
Some pharmacists who set up authentication early – and/or used a different app – have found themselves locked out of the new Ahpra portal.
‘When they updated the portal, I set up new login details and a two-factor authentication app and left it there. This was a few months ago,’ said Melbourne-based pharmacist Heem Yesjusthim.
After logging in again to renew his registration, Mr Yesjusthim was unable to recall what authenticator app he used at the time. But the Google app is now the only one accepted, he said.
‘I looked through my phone and couldn’t find it. Then I looked at the other authentication apps I have (Apple and Microsoft). And none of them showed the Ahpra portal.’
After downloading the Google Authenticator app and attempting to sign up again, Mr Yesjusthim was unable to log in.
‘Once you set up the authentication app the first time, you’re not able to make any changes or log in using other methods,’ he said.
‘If you attempt to log in with another app and you’re at the authentication stage, you’ll notice you can’t go further than that step without a code.
‘Multi-factor authentication is pretty important to prevent hacks and scams but when you implement it, you need to have a system in place to be able to recover your account without the need to call that agency every single time you have an issue logging in.
‘Other ways could be a recovery key that you save somewhere safe, sending a code via message, an automated call back, or you can set up a recovery email or security questions.’
Other pharmacists have also lamented that they’ve submitted multiple contact forms and requested password reset links that never came. While most issues appear to resolve, it takes time.
‘[When I got through on the phone] the lady on the phone was kind and responsive and helped with setting up and logging in quickly from there,’ Yesjusthim said.
AP reached out to Ahpra for comment, and was advised that pharmacists experiencing technical difficulties should visit the advice and information page on Ahpra’s website. Pharmacists can also call the regulator on 1300 419 495 Monday to Friday, 9.00 am – 5.00 pm AEDT.
[post_title] => Ahpra’s new login system leaves some pharmacists locked out
[post_excerpt] => The Australian Health Practitioner Regulation Agency has debuted a new platform that many pharmacists have found less than user friendly.
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[post_content] => Case scenario
Mrs Tan, an 82-year-old woman, visits your pharmacy to refill her medicines for hypertension and arthritis. When asked about how she is doing with all her medicines, she mentions to you that she recently had increasing episodes of urinary leakage, which she had not previously disclosed to her doctor due to embarrassment.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
The bladder serves two primary roles: it stores urine and facilitates its release. When either function is impaired, it can lead to urinary incontinence, which refers to the unintentional leakage of urine.1,2
Incontinence often leads to reduced quality of life and is under-recognised due to stigma. Urinary incontinence affects all ages and is particularly common in older people. Approximately 5% of people aged 65–84 years experience severe incontinence, increasing to up to 28% in those aged 85 years and over.1
Urinary incontinence can be classified into several types. The main types of urinary incontinence include stress incontinence, urge incontinence, overflow incontinence, functional incontinence and mixed incontinence (see Table 1).2,3 Stress incontinence is the most common type of urinary incontinence and affects predominantly women.

Pharmacists play a crucial role in identifying medicines that may cause or exacerbate urinary incontinence. Medicine-induced incontinence is particularly prevalent in older people and requires a careful review of pharmacotherapy. Medicine or medicine classes associated with urinary incontinence include6:
Biological sex may influence the risk factors for urinary incontinence, with some differences observed between females and males.6,7 In females, key risk factors include advanced age, obstetric history (parity and mode of delivery), higher body mass index, menopause, and comorbidities such as urinary tract infection, diabetes, dementia, cardiorespiratory disorders, chronic cough and obstructive sleep apnoea.6 In males, urinary incontinence is more commonly associated with advanced age, benign prostatic hyperplasia, diabetes, detrusor overactivity, limitation in physical function or disability, an increased body mass index, dementia and Parkinson’s disease.7
The overarching goal in managing urinary incontinence is to alleviate symptoms, prevent complications of incontinence and ultimately improve quality of life.8 Management strategies are tailored to the type and severity of incontinence, the underlying cause and patient-specific factors, such as comorbidities and preferences.
Lifestyle modifications and control techniques play a significant role in the management of urinary incontinence. Lifestyle modifications include minimising intake of bladder irritants (such as caffeine and alcohol), reducing fluid intake, avoiding constipation, smoking cessation, weight loss and regular exercise.5 Control techniques include bladder training, pelvic floor muscle exercises and scheduled toileting.5 Continence nurse specialists and physiotherapists have the expertise to support this training. Continence aids such as protective pads are the least invasive but generally not preferred. They may be suitable for very frail older patients or those who prefer to avoid, or are unsuitable for, medication or surgery.9
Pharmacological options are typically considered when non-pharmacological strategies are either insufficient or inappropriate. These include8:
Medication management in older people should follow the principle of ‘start low, go slow’, considering comorbidities, polypharmacy and anticholinergic burden. Regular medication review is essential, and deprescribing decisions should be considered when appropriate. For instance, deprescribing of anticholinergics can be considered in older people12:
Patient resourcesNational Continence Helpline (1800 33 00 66): Provides free, confidential patient advice from continence nurse advisors from 8.00 am to 8.00 pm (AEST) Monday to Friday.
Continence Health Australia (www.continence.org.au): Offers comprehensive information in English and other languages on bladder, bowel and pelvic floor health, incontinence management strategies, support for carers and available financial assistance.
Pharmacists can support people experiencing incontinence who may hesitate to raise the issue due to embarrassment, cultural factors, or believing that it is a normal part of ageing. Pharmacists can play an important role in offering confidential advice and referring individuals to appropriate services (e.g. nurse continence specialists). Conducting medication reviews is a key responsibility, helping to identify medicines that may contribute to or worsen incontinence. Pharmacists can also raise awareness of helpful resources, such as the National Continence Helpline and Continence Health Australia. These actions can improve continence symptoms, enhance quality of life, reduce complications, and empower consumers to manage their health more effectively.
Incontinence is common but often manageable with early recognition and intervention. Identifying contributing factors, including medicine-related causes, can significantly improve quality of life. Pharmacists play a key role through medication review, education and timely referral to support services. By proactively addressing incontinence, pharmacists can help reduce stigma, prevent complications and support better health outcomes for consumers.
Case scenario continuedYou gently initiate a conversation about incontinence, reassuring Mrs Tan that it is a common and manageable condition. After reviewing her medicines, you identify that Mrs Tan is taking a diuretic which can increase urine production and may lead to or worsen urinary incontinence. You suggest Mrs Tan discuss her condition with her GP and review the possibility of stopping or reducing the dose of the diuretic. Additionally, you provide Mrs Tan with information about urinary incontinence and refer her to the National Continence Helpline for further support. Within a few weeks, Mrs Tan reports a noticeable reduction in urinary frequency and fewer leakage episodes. She feels more confident and can participate more actively in social activities, improving her overall quality of life. |
Dr Amy Page (she/her) PhD, MClinPharm, GradDipBiostat, GCertHProfEd, GAICD, GStat, FSHPA, FPS is a consultant pharmacist, biostatistician, and a senior lecturer at the University of Western Australia. She is recognised as a national expert in the quality use of medicines.
Amanda Quek (she/her) BPharm(Hons), GradCertAppPharmPrac is a pharmacist and PhD candidate at the University of Western Australia. Her research focuses on optimising medication use and the development of clinical practice guidelines.
Dr Amy Page is supported by the Western Australian Future Health Research and Innovation Fund/Western Australian Department of Health, Grant ID WANMA/EL2022/1. She is an employee of the University of Western Australia, practitioner member of the Pharmacy Board of Australia, and the Victorian state president of the Pharmaceutical Society of Australia (PSA).
Amanda Quek is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia.
[post_title] => Urinary incontinence: let's talk about leaks [post_excerpt] => Incontinence often leads to reduced quality of life and is under-recognised due to stigma. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => urinary-incontinence-lets-talk-about-leaks [to_ping] => [pinged] => [post_modified] => 2025-11-12 15:30:10 [post_modified_gmt] => 2025-11-12 04:30:10 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30699 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Urinary incontinence: let’s talk about leaks [title] => Urinary incontinence: let’s talk about leaks [href] => https://www.australianpharmacist.com.au/urinary-incontinence-lets-talk-about-leaks/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 30838 [authorType] => )td_module_mega_menu Object
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[post_content] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
Q fever cases are on the rise in Victoria. In 2024, there were 77 Q fever notifications – a significant uptick on cases compared to the previous 5 years.
The zoonotic disease – primarily carried by cattle, sheep, and goats – can cause significant long-term health impacts, including heart disease, bone and joint infections and vascular infections. Around 10–15% of people who have this develop chronic fatigue.
The Victorian Department of Health has urged people working with animals, animal products or animal waste to get vaccinated against the bacterium. But given it’s a multi-step process requiring a specific skill set, vaccination isn’t always readily accessible.
AP spoke with community pharmacist Alexander Look MPS, based in the rural town of Ouyen in north-west Victoria, who recognised a gap in care in his community and took action to address it.
Building a local solution
Ouyen is a key livestock-selling and transport centre, hosting fortnightly sheep sales with significant numbers of sheep and lambs traded each year. With no permanent local GP, Mr Look’s pharmacy became a vaccination hub, drawing frequent enquiries about Q fever vaccination.
‘We were getting a lot of farmers [coming through] who were worrying about this particular vaccination,’ he said.
There are few providers, even in larger regional centres, that offer Q fever vaccination. There’s only one clinic in Mildura, the largest nearby town, providing the service
‘Farmers would have to drive several hours [for the service], and return on at least three occasions,’ Mr Look said.
Besides, the clinic is no longer taking on new patients. ‘So you can't get in, even if you wanted to,’ he added.
Identifying a need for a local Q fever vaccination clinic, Mr Look first conducted research into the viability of the service to determine whether it would work from a business perspective. He then partnered with a GP from a clinic located 1 hour away from Ouyen to arrange for the service to be offered in town – making vaccination more accessible to those in need.
A lengthy assessment process
Before patients can be vaccinated against Q fever, they must undergo a three-stage assessment process, with the first being an interview to test suitability, Mr Look said.
‘This includes identifying whether they've had the vaccination or Q fever before,’ he said. ‘Because this is a once-in-a-lifetime vaccination, they are not suitable to be vaccinated if they have. And if someone has previously had Q fever, they are at risk of having a severe adverse reaction.’
The second step is to get a blood test, with the partnering GP issuing a pathology request to the patient. After that, a skin test is required.
‘I inject a small amount of bacteria underneath the skin, then I get the patient to return 7 days later – so we can review to make sure there's not any skin reaction,’ Mr Look said. ‘Because if there is, they are not eligible for the vaccine.’
These intricacies prevent many clinics from offering the service, Mr Look said.
‘With the skin testing, you have to reconstitute the vial of bacteria,’ he said. ‘So it’s most efficient to [assess] 20 people or so to maximise the testing vial. And there isn’t usually that volume of people.’
Charging a little extra allows for ad hoc testing rather than batching, ensuring all patients are covered on demand. ‘Patients find it worthwhile, because it reduces the serious adverse effects of Q fever,’ Mr Look said.
Ensuring compliance
Q fever vaccination is within Victorian pharmacists’ scope of practice to administer, when prescribed by a GP. However, the clinical assessment was another story.
‘Both myself and the other pharmacist doing it had to undertake additional training from the Australian College of Rural and Remote Medicine, which has a pathway to train people on Q fever vaccination,’ Mr Look said.
The training involved an online, validated course that introduced a new skillset.
‘Pharmacists are comfortable with intramuscular vaccination, and to some degree subcutaneous vaccination,’ he said. ‘However, this testing involves intradermal administration of the bacteria, followed by a review with proper clinical replication.’
And just to ensure all was above board, the team consulted a lawyer.
‘We wanted to make sure that [the service] was compliant with a number of conditions,’ Mr Look added.
Extending the reach of rural health services
So far, the service has had a significant impact for clientele – both in time and cost saved, Mr Look said.
‘Taking time off from farming work is quite difficult,’ he said. ‘With each course of vaccination, we're saving patients at least 6 hours of commuting time, and more in terms of waiting for the clinician when they get to the clinic to the larger cities.’
The key demographic the team is hoping to reach is younger farmers, including students just starting out in the industry.
‘They would most benefit from this type of protection because they are early on in their career,’ Mr Look said.
Around a dozen people have come through the clinic, with significant interest from other groups.
‘We are about to have further discussions with the Livestock Exchange involving [vaccination for] people who don't live within our town, including livestock agents, because it's so difficult to get – even in the cities,’ he said. ‘If they're coming here once a month, this is a brand new service we can offer them.’
The team has also spoken with the local GP about offering the service more broadly across rural areas, including to abattoir workers.
At this stage, only Q fever vaccination is provided through the off-site clinic.
However, the team is checking the Australian Immunisation Register to determine whether patients are up to date with their tetanus vaccination.
‘Farmers are exposed to a lot of soils which might be contaminated,’ he said. ‘So when we're looking at combining this service with other existing services, it certainly would be something like tetanus vaccination.’
Continued collaboration with the GP is an essential part of the service, which has helped to strengthen the team’s skills.
‘He's deputised us to do a lot of the functions, including the skin test and assessment,’ Mr Look said. ‘And he's confident with our skills, which is really reassuring for us to know we're on the right track.’
[post_title] => Closing the gap on Q fever vaccination access
[post_excerpt] => A new pharmacist-led Q fever vaccination service is providing essential protection for farmers in Victoria.
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[title_attribute] => Closing the gap on Q fever vaccination access
[title] => Closing the gap on Q fever vaccination access
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
[post_title] => Nicotine inhalators discontinued: are vapes an alternative?
[post_excerpt] => Although somewhat kept on the down low, nicotine inhalators have been discontinued. Are Pharmacist Only vapes the next best option?
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