td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3663 [post_author] => 82 [post_date] => 2019-01-16 08:48:36 [post_date_gmt] => 2019-01-15 22:48:36 [post_content] => On 19 June, the Voluntary Assisted Dying (VAD) Act 2017 comes into effect in Victoria. In preparation, there are several things that pharmacists need to be aware of. Victoria’s Acting Minister for Health Martin Foley recently announced that all dispensing of VAD medicines would take place in a single point of access, The Alfred Hospital. In accordance with the Act (as explained in more detail below), pharmacists should not:
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One in six Australians receive a mental health-related prescription each year.1 Almost half the population is set to experience a mental health condition in their lifetime.2 Pharmacists play a vital role in alleviating their burden.How to help a consumer wrestling with dark thoughts? Perhaps you already have and didn’t realise.The answer can be as simple as spending time with patients, listening actively and being non-judgemental, suggests Victorian pharmacist Beatrix Zielonka-Perry MPS. ‘I did a Home Medicines Review for a lady some years ago now who came back to me later that day with a bag full of very potent antipsychotics,’ Ms Zielonka-Perry remembers. ‘She said: “I was contemplating suicide with all these drugs and I can’t do that now because you spent time with me – your name is on this medication and I can’t do that to you”.’ The 2016 winner of the PSA Victorian Pharmacist Medal says the incident was ‘an incredible gift’. ‘It showed me that even just a short time can make a difference in someone’s life,’ says Ms Zielonka-Perry, who owns and operates McCrae Pharmacy on the Mornington Peninsula. Pharmacists have an opportunity to help people with mental illness every single day – data shows 35.7 million mental health-related prescriptions were provided to 4 million Australians in 2016–17.1 Yet more than half (54%) of all people with a mental illness do not access treatment.3
Well-placedAs we know, pharmacists are the most accessible of health professionals – certainly more so than GPs, psychologists and psychiatrists. And there is a strong link between the chronic illnesses that pharmacists routinely treat, and depression and anxiety. ‘We know that people with mental health problems have poor physical health, particularly in the severe and persistent mental illness space,’ says Dr Claire O’Reilly MPS, Senior Lecturer at the University of Sydney Pharmacy School. People with persistent pain are four times more likely to experience anxiety or depression than those without pain.4
Mental health services in community pharmacyWhile many pharmacists are already providing mental health care in an instinctive way, some are taking a more formal approach.
PharmafriendCanberra pharmacist Kayla Lee MPS introduced her Pharmafriend program to Capital Chemist Wanniassa in 2016. ‘The basics of the program is engaging the customer to have a one-on-one conversation with their pharmacist each time that they present with their prescription for a mental health medication,’ Ms Lee explains. The program aims to boost medication compliance and improve access to therapies. ‘We’re arming them with all of the information that they need so that they can be most successful in their journey,’ Ms Lee says. (See ‘A friend in need’, below.)
Mental health disease state management servicesIn Perth’s CBD, Craven’s Pharmacy’s mental health services started out when it was approached by a case manager from the nearby mental health service, explains co-owner Pooja Maru MPS. ‘They said, “I’ve got this patient, I’m worried about compliance – are you able to do up a dose administration aid?”’ she says. ‘This was about 15 years ago.’ The service has expanded to keeping comprehensive patient records and sharing them with the mental health service. ‘The clinic gets new registrars every six months, but the pharmacy remains the same. So we’ve become a good source of knowledge and patient history,’ says Ms Maru. Craven’s Pharmacy also now employs a nurse practitioner to run a metabolic clinic offering screening and prescribing for patients with side effects from long-term antipsychotic usage. ‘Most of our patients didn’t have a regular GP and hadn’t ever been screened for blood pressure, diabetes or cholesterol,’ Ms Maru says.
On-site counsellingAlso in Western Australia in the Perth suburb of Nollamara, Pharmacy 777 owner Swarup Afsar introduced on-site counselling in response to the increasing number of anti-depressant scripts he saw coming over the counter. The pharmacy now has a counsellor and clinical hypnotherapist on-site three days a week offering psycho-dynamic therapy, cognitive behavioural therapy, hypnotherapy and group therapy sessions. Community members can sign up for six-week programs on depression management, anxiety support, stress management, adjusting to retirement, grief and loss, separation and divorce, adolescent stress and anxiety, and self-confidence and managing bullying.
Steps you can take todayHelping to improve mental illness within community pharmacy doesn’t have to involve a formal program – there are plenty of simple steps pharmacists can take.
Mental health first aidPharmafriend creator Kayla Lee says mental health first aid is the number one thing all pharmacists can do in this space. ‘A lot of people say “but mental health first aid is for the general population, not healthcare professionals”,’ she says. ‘Well, yes, we have a higher health literacy than the general population. But the first aid provides the basics needed to deal with a crisis situation if it presents in our pharmacy.’
PSA’s Mental Health First Aid programPSA believes that completing Mental Health First Aid (MHFA) training is essential for all pharmacists and frontline pharmacy staff. As such, PSA state and territory branches regularly offer MHFA courses allowing pharmacists to earn 20–24 CPD points over a period of one to two days. The MHFA courses cover the symptoms, causes and evidence-based treatments for depression, anxiety disorders, psychotic disorders and substance use problems. They explore the early warning signs of mental illness, the importance of intervening before a crisis develops, and how pharmacists can address crisis situations arising from mental health problems.
A friend in needWhen Kayla Lee was a child she lost her father to suicide. Years later, she saw a chance to make a difference to many of the other Australian families affected by mental illness. ‘I was very fortunate to start working in a community pharmacy when I was in college, which inspired me to become a pharmacist,’ she recalls. ‘I noticed that community pharmacy was a great setting to help people who may not be getting the mental health support they need – because their GP doesn’t have time, they’re not accessible or affordable.’ Now a pharmacist at Capital Chemist Wanniassa, Ms Lee has created Pharmafriend to fi ll that gap. The Pharmafriend program aims to engage patients in a one-on-one conversation each time they present with a mental health-related prescription. It starts with regular medication counselling for first-time dispensing, but pharmacists invite patients to a private area and outline the support offered through Pharmafriend. ‘If you counsel someone at the out-counter, a lot of the time they listen and say, “Great, yep, the doctor told me most of that, see you later”,’ Ms Lee observes. ‘But once you get them into a private consultation room, often they’ll really open up.’ After that initial conversation, the program engages with willing patients each time they get a script filled. ‘We check in – ask how they’re going with their medication, what other therapies they’re engaging with, how they feel their progress is going,’ Ms Lee says. The program also provides a series of information pamphlets that Ms Lee has collated on topics such as complementary medicines, sleep, diet and exercise. ‘We’re increasing the number of tools in their tool belt to help them on their mental health journey,’ Ms Lee says. And the good word is spreading: ‘We have people say, “My friend said they talked to you about their mental health. Can we have a conversation?”’
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3610 [post_author] => 82 [post_date] => 2019-01-09 14:30:09 [post_date_gmt] => 2019-01-09 04:30:09 [post_content] => Whooping cough and measles vaccinations can now be performed by pharmacists in New South Wales (NSW), after approval by the state government. The initiative, which came into effect on 1 January, allows NSW pharmacists to provide diphtheria-tetanus-pertussis (dTpa) and measles mumps-rubella (MMR) vaccines to anyone aged 16 years and over. NSW joins other states and territories such as Queensland, the Northern Territory, South Australia and Victoria – where pharmacists were already able to administer the vaccinations. The move was welcomed by the Pharmaceutical Society of Australia (PSA), after many years of advocating in collaboration with the Pharmacy Guild of Australia for pharmacists to be able to deliver more vaccinations. PSA National President Dr Chris Freeman said that the initiative will allow NSW to improve its already high vaccination rates. PSA NSW President Professor Peter Carroll concurred, adding that the availability of the vaccines in pharmacies will make immunisation more accessible and will allow patients to have more options around when and where they get vaccinated. Professor Carroll said this was crucial to protect the people of NSW from these preventable diseases. ‘Particularly in regional and remote NSW, people may have trouble accessing a GP. In addition, some people do not visit a GP regularly, or do not have a GP. Allowing authorised pharmacists to vaccinate will increase vaccination rates and herd immunity within the community.’ Last year, the Council of Australian Governments (COAG) Health Council announced a plan to work towards a nationally consistent approach to pharmacist administered vaccinations. Dr Freeman said that the establishment of a nationally consistent approach to vaccinations would ensure access for Australians across the country. ‘PSA is looking forward to working with the Australian Health Protection Principal Committee to make full use of pharmacists’ expertise across the country so they can provide a wider range of vaccinations,’ he said. As previously reported in Australian Pharmacist, PSA NSW State Manager Simone Diamandis said that the legislation will likely lead to other vaccinations being more widely available in pharmacies in the future – such as travel vaccinations or pneumococcal vaccinations in adults under 65 years old. Ms Diamandis also emphasised the expanding role of pharmacists in vaccination. ‘Pharmacists will also most likely play a greater role in increasing public awareness around vaccination – encouraging the uptake of immunisation in the community,’ she said. ‘Most importantly, in times of emergency, for example a pandemic or outbreak, pharmacists will be a highly accessible workforce with appropriate levels of training that can be mobilised quickly to vaccinate.’ [post_title] => More vaccinations now available in NSW pharmacies [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => vaccinations-available-nsw-pharmacies [to_ping] => [pinged] => [post_modified] => 2019-01-10 15:43:33 [post_modified_gmt] => 2019-01-10 05:43:33 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3610 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => More vaccinations now available in NSW pharmacies [title] => More vaccinations now available in NSW pharmacies [href] => https://www.australianpharmacist.com.au/vaccinations-available-nsw-pharmacies/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3623 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3203 [post_author] => 12 [post_date] => 2019-01-03 03:03:53 [post_date_gmt] => 2019-01-02 17:03:53 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Australia prides itself on its multicultural chemistry, but it presents everyday challenges. Community pharmacy services can play their part by catering specifically for people from diverse backgrounds. Every third or fourth patient you treat is likely to have been born overseas.1,2 In fact, almost half (49%) of all Australians were either born overseas or have at least one parent who was.1 It’s a statistic that’s very close to home for Veronica Nou, pharmacist and proprietor of Morris Care & Advice Pharmacy in St Mary’s in Sydney’s west. Her family fled Cambodia in 1981 when she was an infant. Ms Nou (pictured) speaks the Khmer (Cambodian) language and is often called upon to help ensure Cambodian immigrants with poor English skills are taking their medicines properly. She recalls one home visit to a newly diagnosed insulin-dependent person with diabetes. When Ms Nou asked the elderly lady how she took her medicine, she received an unexpected response. ‘She got an orange, then she got her insulin, then she injected the insulin into the orange and ate the orange,’ says Ms Nou, ‘because that’s how the educator had done it in front of her a few weeks earlier. She didn’t understand the orange was meant to represent her.’ In many developing countries around the world, traditional herbal remedies are still regularly used by local populations. And thus, eating an insulin-injected orange doesn’t seem so ridiculous. ‘For so many people, Australian and western medicine is like a whole new world,’ explains Ms Nou. ‘The culture shock and the adjustment are huge. It’s not that people are stupid, it’s just that there’s a lot of adjustment to make.’
A different mindsetWhile over 250,000 Australians from culturally and linguistically diverse (CALD) backgrounds are estimated to experience some form of mental disorder in a 12-month period, a significant proportion of them do not seek help for their mental health problems, according to the Department of Health.3 Ms Nou explains that in many south-east Asian cultures, for example, mental health issues remain heavily stigmatised. ‘That means by the time someone comes to you saying they’ve had trouble sleeping due to a lot of stress at work, it’s probably taken them a lot more to get to that point than the next person,’ Ms Nou says. ‘Therefore, you have to put extra effort in to understand that, and make sure that their privacy is completely respected.’
Australian diversity 7 ways
Key PSA resourcesThe PSA offers the following CPD education courses and resources to help pharmacists improve how they deal with patients from CALD backgrounds. Customer service management (Group 2 course): Build the skills, abilities and experience to manage quality customer service. Learn how to understand customers and their pharmaceutical needs through sensational customer service as well as how to set service standards and train staff to meet and exceed those standards (1 CPD credit). Emotional intelligence and workplace relationships (Group 2 course): Learn how to use emotional intelligence to increase self-awareness, self-management, social awareness and relationship management in the workplace. Also learn how to establish and manage processes and procedures to support workplace relationships taking into account the organisation’s values, goals and cultural diversity (1 CPD credit). Develop and use emotional intelligence (Group 2 course): Develop and use emotional intelligence to increase self-awareness, self-management, social awareness and relationship management in the context of the workplace (12 CPD credits). Providing Pharmacy Services to Aboriginal and Torres Strait Islander People (Resource): A Guide designed to assist pharmacists to deliver a consistently high quality of service to Aboriginal and Torres Strait Islander people, to communicate effectively and to be culturally responsive health professionals (2014). Go to PSA CPD and Education portal at: my.psa.org.au/s Go to PSA Resources portal at: psa.org.au
Found in translation
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3383 [post_author] => 82 [post_date] => 2018-12-19 08:56:48 [post_date_gmt] => 2018-12-18 22:56:48 [post_content] => The Pharmaceutical Society of Australia (PSA) has released a list of recommendations for healthcare professionals to ensure the safe use of medicines. The launch of Choosing Wisely Australia will provide healthcare professionals with much needed advice about medicines use. PSA collaborated with NPS MedicineWise to develop the list of six recommendations to promote the safe use of medicines, addressing issues such as prescribing cascades, polypharmacy and homeopathy. The list will help pharmacists conduct thorough reviews of patient medication and provide subsequent recommendations to consumers around medicines use. PSA National President Dr Chris Freeman said, ‘While the use of medicines offers significant benefits for many people, they may also cause unnecessary harm. It is important that we balance the positive and negative effects of each medicine, tailored to each individual with their care goals front of mind.’ Medication misadventure continues to be a significant problem throughout Australia. Every year, around 230,000 Australians are admitted to hospital due to complications with medicines use,1 which costs the health system $1.2 billion annually. However, 23% of adverse drug events in primary care are preventable. Dr Freeman added: ‘As experts in medicines, pharmacists have the ability to provide a specialised review of a person’s medication regimen, resulting in recommendations or actions to help people get the most out of their medicines. Any person taking multiple medicines, high-risk medicines, or who is at high risk of medicine misadventure, including transitioning between care settings, should have their medicines reviewed.’ ‘Sometimes people are unsure of what medicines they’re taking and why. We encourage you to discuss the implications of each new medicine with your healthcare provider and ensure you are fully informed about issues such as necessity, risks and side effects,’ said NPS MedicineWise Client Relations Manager, Dr Robyn Lindner. ‘These new recommendations will help guide health professionals and their patients in a discussion about appropriate use of medicines based on the latest evidence.’
Key areas of pharmacist expertiseDr Freeman emphasised that there is not reliable evidence for the efficacy of homeopathic products, and urged healthcare professionals to take the time to discuss this with patients who are taking, or considering taking, these products. Pharmacists should make the lack of efficacy of these products clear to patients and the risks in rejecting or delaying other treatments that are known to be safe and effective. Prescribing data has indicated that around 25% of repeat antibiotic prescriptions were dispensed more than four weeks after the initial dispensing. This indicates that there is potentially inappropriate antibiotic use in the community. ‘Pharmacists can help to reduce the burden of antibiotic resistance by first clarifying the clinical appropriateness of repeat antibiotic prescriptions before dispensing,’ Dr Freeman said. Health consumers often turn to complementary and alternative medicines for a variety of reasons, he said, and often seek expert advice from pharmacists relating to these products. ‘Pharmacists and medical practitioners should present clear information to consumers about the safety of and evidence for complementary and alternative medicines and only recommend these products when the known benefit outweighs the potential harm,’ Dr Freeman said.
The Choosing Wisely listThe six PSA recommendations are as follows:
- Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
- Do not promote or provide homeopathic products, as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
- Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
- Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications – including over-the-counter medications and dietary supplements – to determine whether any of the medications or supplements should or can be reduced or discontinued.
- Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
- Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.
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- Roughead, L, Semple, S, Rosenfeld, E. Literature Review: Medication Safety in Australia. ACSQHC 2013. At: https://safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-Safety-in-Australia-2013.pdf
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3669 [post_author] => 82 [post_date] => 2019-01-17 10:42:18 [post_date_gmt] => 2019-01-17 00:42:18 [post_content] => Australia is in the midst of a record-breaking heatwave – with Western Australia, South Australia, Tasmania, Victoria, the ACT and NSW all reaching maximum temperatures of 8-12°C above average. Parts of South Australia, Victoria and NSW are expected to reach maximum daytime temperatures in the mid-40s. In a joint statement, the Bureau of Meteorology, New South Wales Health and the New South Wales Rural Fire Service have warned that the heatwave conditions are expected to bring elevated fire risks to NSW a the ACT, as well as pose a danger to people’s health. People have been advised to avoid strenuous activity, drink plenty of water and ensure the safety of those who are most vulnerable – including older people and children.
Recognising heat-related illnessAs previously reported by Australian Pharmacist in an article written by University of Tasmania Professor of Pharmacy Gregory Peterson, heat-related illness is often preceded by heat exhaustion, which is caused by water or salt depletion due to high heat exposure or strenuous physical activity. Signs include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3630 [post_author] => 76 [post_date] => 2019-01-11 10:24:23 [post_date_gmt] => 2019-01-11 00:24:23 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] Many women in their mid-to-late forties are quick to accept headaches, irritability and memory loss as an unavoidable part of stressful lives. But new research suggests that they might be suffering from perimenopausal depression – an under-researched condition where pharmacists can play a valuable role. For the past decade a team from Monash Alfred Psychiatry Research Centre – led by the centre’s Director, Professor Jayashri Kulkarni – have compiled data from women going through the menopause transition to better understand the impact this period has on women’s psychological health. Perimenopause is defined by WHO as ‘the time immediately preceding the menopause, beginning with endocrine, biologic and clinical changes, and ending a year after the final menstrual period.'1 Professor Kulkarni noted the high rates of suicide in women aged between 45-492 , and suggests that they should 'alert us to think about contributing factors, including biological changes in the gonadal hormones associated with the transition to menopause as well as social and psychological stresses in the midlife period.'
The symptomsThere are a range of psychological and somatic symptoms in perimenopausal depression that are also seen in ‘typical depression,’ which often leads to incorrect diagnoses and treatment. But Professor Kulkarni said many of that the psychological symptoms of the condition are different to what you would normally see in major depression in men or younger women. Perimenopausal depression can often fluctuate in severity where irritability, paranoia and memory loss are often prominent compared to major depression. ‘We see many women who say “I don’t know what’s going on, I suddenly can’t remember things such as phone numbers, shopping lists and so on”,’ she said. In addition to psychological symptoms, many women also experience somatic symptoms. ‘There’s often joint or muscle aches and pains, and frequent headaches. There are different aches and pains that occur that don’t really fit within the pattern of any particular pathology. Nonetheless, it adversely impacts a person’s capacity to function.’ Unlike other forms of depression, which are usually the result of an interaction between a genetic predisposition and environmental triggers, Professor Kulkarni and her team have found that perimenopausal depression is primarily the result of hormonal changes. This means that hormonal treatment can be highly effective, but a lack of information about the condition can make an accurate diagnosis and treatment difficult. ‘One of the problems we have is that many women get started on SSRI’s or an SNRI, which might make a little bit of a difference but won’t make a complete difference to the symptoms. The patient’s depression might then be considered treatment resistant depression and there’s a terrible cycle through the different antidepressants or combinations of medications, each with their own side effects. Patients will get this sort of half response, but not a great response,’ Professor Kulkarni explained. She said healthcare professionals such as pharmacists can help women around the age of 45 years and older to recognise that the sudden development of any of these symptoms can be a result of hormonal changes. These changes will occur well before physical changes and should be thought of as the trigger for the symptoms, which will then inform treatment choice .
How pharmacists can helpProfessor Kulkarni suggests that pharmacists might have a key role to play in treating perimenopausal depression, especially given the reluctance of many women to seek help from their doctors. ‘Pharmacists could alert patients to the symptoms of perimenopausal depression and advise them to seek help when appropriate,’ she said. ‘Given their accessibility to patients, pharmacists can refer patients to other healthcare professionals who can prescribe hormone replacement therapy.’ In her recent study, Professor Kulkarni suggested a range of treatments. ‘Effective treatments include tibolone, a synthetic steroid with a mixed hormonal profile, and bioidentical hormones, which are compounds synthesised to resemble ovarian hormones. Bioidentical hormones are not recommended by the International Menopause Society due to the limited available safety and dosing data,’ the study read.3 Professor Kulkarnii said that perimenopausal depression is a relatively new concept and that ultimately, education and awareness are essential for healthcare professionals. ‘When you talk about menopause, everyone thinks hot flushes. That’s what most of the community’s education centres on. But all women go through menopause and a significant number struggle with the mental health aspect of it.’ References 1-3: Kulkarni J. Perimenopausal depression – an under-recognised entity. Aust Prescr 2018;41(6):183–5. At: https://www.nps.org.au/australian-prescriber/articles/perimenopausal-depression-an-under-recognised-entity[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Perimenopausal depression could increase risk of suicide [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => perimenopausal-depression-could-increase-the-risk-of-suicide [to_ping] => [pinged] => [post_modified] => 2019-01-11 15:15:16 [post_modified_gmt] => 2019-01-11 05:15:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3630 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Perimenopausal depression could increase risk of suicide [title] => Perimenopausal depression could increase risk of suicide [href] => https://www.australianpharmacist.com.au/perimenopausal-depression-could-increase-the-risk-of-suicide/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3640 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3582 [post_author] => 76 [post_date] => 2019-01-07 12:02:58 [post_date_gmt] => 2019-01-07 02:02:58 [post_content] => Hypertension is the leading cause of cardiovascular disease, affecting 1.13 billion people worldwide, including six million adult Australians. Research has indicated that a new pharmacological approach to treatment could be imminent,1 following the results of a recent study in mice.2 Despite the prevalence and mortality rate attributed to hypertension, effective treatment remains challenging, according to Professor Grant Drummond, Co-director of La Trobe University’s Research Centre for Cardiovascular Biology and Disease. ‘Up to 20% of patients with high blood pressure fail to have their condition controlled by current therapies – which include diuretics, blood vessel dilating agents and drugs that reduce heart rate,’ he said. Professor Drummond and his research team – comprised of collaborators from La Trobe University, Baker University, Hudson Institute and University of Bonn in Germany – are leading a major research project into treating renal inflammation. Renal inflammation, leading to fibrosis and impaired function, is a major contributor to the development of hypertension. NLRP3 is an inflammatory enzyme found in the kidneys.3 ‘Once activated, this enzyme produces chemical signals that attract immune cells, setting up an inflammatory response that disrupts the blood pressure-regulating functions of the kidneys and blood vessels,’ Dr Samuel Vinh, one of the lead authors on the study, said. ‘This process is normally used to protect us from bacteria and viruses, but occasionally immune cells get confused and mount a response to relatively harmless substances. ‘In the case of hypertension, the “harmless” substances that appear to be at the centre of the problem are glass-like shards of crystalline salt, cholesterol and uric acid that build up in the blood vessels and kidneys.’ Dr Drummond and his team observed that MCC950, a drug recently found to be an inhibitor of NLRP3, limits renal inflammation, fibrosis and dysfunction in mice with established hypertension.3 While the research is still in its early stages, Professor Drummond and his team are optimistic about its impact. ‘Inflammation-suppressing drugs are already used for the treatment of autoimmune diseases such as rheumatoid arthritis and gout... We have [now] shown that similar drugs can be used just as effectively to reduce blood pressure in mice with hypertension,’ Professor Drummond said. ‘These findings could pave the way for new treatment approaches, where drugs currently reserved for patients with autoimmune diseases are repurposed for the treatment of high blood pressure.’ ‘Ultimately this could help save millions of lives and significantly reduce the global burden of disease resulting from high blood pressure,’ he said. References
[post_title] => Treating hypertension – a new approach [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => treating-hypertension-new-approach [to_ping] => [pinged] => [post_modified] => 2019-01-07 15:43:49 [post_modified_gmt] => 2019-01-07 05:43:49 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3582 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Treating hypertension – a new approach [title] => Treating hypertension – a new approach [href] => https://www.australianpharmacist.com.au/treating-hypertension-new-approach/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3598 )
- World Health Organisation. Global Health Observatory (GHO) data. At: https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/
- Australian Heart Foundation. Heart Disease in Australia. At: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia
- Krishnan SM, Ling YH, Huuskes BM, Ferens DM, Saini N, Chan CT, Diep H, Kett MM, Samuel CS, Kemp-Harper BK, Robertson AAB, Cooper MA, Peter K, Latz E, Mansell AS, Sobey CG, Drummond GR, Vinh A. Pharmacological inhibition of the NLRP3 inflammasome reduces blood pressure, renal damage, and dysfunction in salt-sensitive hypertension. Oxford Academic: Cardiovascular Research 2018. At: https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvy252/5144200
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3426 [post_author] => 12 [post_date] => 2018-12-21 09:30:05 [post_date_gmt] => 2018-12-20 23:30:05 [post_content] => More than 1000 people have completed an online assessment in Australian pharmacies to determine their potential risk of developing glaucoma, and there's a call for more pharmacies to get on board. The Glaucoma Risk Calculator allows users to assess their risk of developing glaucoma based on age, gender, ethnicity, family history of glaucoma and other health issues such as diabetes and myopia. Glaucoma is the name given to a group of eye diseases where vision is lost due to optic nerve damage. Approximately 300,000 Australians have glaucoma. 'Sadly, 50% of Australians with glaucoma remain undiagnosed because they have not had a simple eye exam,' said Annie Gibbins, CEO of Glaucoma Australia. ‘Considering every person visits a pharmacy 18 times per year in metropolitan, rural and remote locations,1 it’s vital that Glaucoma Australia works with community pharmacies to target those individuals at risk of developing this blinding eye disease.' Of the 1071 people who have already completed the assessment, more than one in 10 (11.8%) were identified as having the greatest risk of developing glaucoma, and were prompted to visit an eye health professional if they hadn’t already seen one recently. A further 7.7% of people were identified as having the second greatest risk of developing glaucoma.
How it worksThe glaucoma risk assessment consists of five questions and takes less than one minute to complete. Based on the answers provided, users are given a colour coded risk score: least risk (blue), average risk (green), second greatest risk (orange) and greatest risk (red). Depending on a patient's score Glaucoma Australia recommends they see an eye health professional every two years, every year, every six months, or as soon as possible. 'We're asking pharmacists to help us identify those people at risk by setting up an iPad or tablet in store, so customers can complete the Glaucoma Risk Calculator while they wait for their prescriptions to be filled,' added Mrs Gibbins.
The benefitsSimon Carroll, who sits on the Pharmacy Committee at Glaucoma Australia and is a Director of S&JC Consulting, said pharmacies offering this risk assessment can have a profound influence on the eye health and long-term wellbeing of their patients. 'This service can provide professional satisfaction as well as a grateful and loyal patient,' he said. Mr Carroll advised that glaucoma is frequently symptom free and importantly vision loss is currently irreversible. However, the earlier the diagnosis and commencement of treatment the greater the patient benefit, because disease progression can be slowed. 'Therefore the patient benefits by being able to slow the disease and thereby slow their loss of vision,' Mr Carroll said.
Get startedPharmacists wanting to implement this risk assessment service need to familiarise themselves and their team with the Glaucoma Risk Calculator tool. Mr Carroll said pharmacists also need to identify which target audiences they should offer the service to. Pharmacies need a private, sit-down space with an internet-connected computer in which to offer the service. Pharmacists need to decide how they are going to obtain patient consent and record the service. It’s important that pharmacists train staff on the reasons for offering the service, who to offer the service, and how and when to offer it. Mr Carroll recommended pharmacists set service goals or objectives with their team which they later evaluate with respect to the results and outcomes achieved. 'For example, a goal could be: “We will offer the risk assessment to all patients with diabetes who are over 50 years of age and are not on glaucoma medication, for the next four weeks”,' he said. The Glaucoma Risk Calculator is available online and is mobile and tablet friendly. PSA has an online CPD module available for members on Glaucoma and the pharmacist. References
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- ABS Demographic Statistics, PBS Date of Supply
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Why patients might ask about beetroot juice as a treatment for heart failure.Beetroot is a staple in pretty much every true Aussie hamburger. However, apart from being deliciously tasty, there is another reason why it might soon become more popular. Beetroot, more specifically beetroot juice, contains dietary nitrate, and has been suggested for helping patients with heart conditions associated with overstimulation of the sympathetic nervous system. For instance, in heart failure, there is upregulation of the sympathetic nervous system, e.g. increased heart rate and contractility, as an attempt by the body to compensate for the failing heart. It was the understanding of the mechanisms around sympathetic overstimulation, and the role of the renin-angiotensin system in heart failure, that led to the use of medicines such as beta-blockers and ACE-inhibitors for the condition. Unfortunately, these compensatory mechanisms will eventually further exacerbate heart failure symptoms and disease progression e.g. cardiac remodelling.
The role of nitrateRegardless of the type of heart failure, i.e. with reduced ejection fraction (HFrEF) or with preserved ejection fraction (HFprEF), patients will experience shortness of breath and reduced peak oxygen uptake (VO2peak) during exercise, which affect their capacity for physical activity. VO2peak is plateauing oxygen consumption occurring during maximum physical activity and provides an indication of one’s capacity to sustain maximum physical performance. Improvements in exercise capacity (e.g. endurance training and VO2peak) have been observed to improve quality of life and reduce morbidity in people living with HFrEF. One of the reasons thought to contribute to exercise intolerance in people living with heart failure, particularly HFrEF, is a reduction in nitric oxide (NO) signaling because of reduced NO production and increased NO destruction from oxidative stress related to endothelial dysfunction. NO plays an important role as a vasodilator and modulates exercise performance, e.g. skeletal muscle contractions. Nitrates are typically used in conditions such as the prevention and treatment of angina, chronic heart failure (isosorbide dinitrate with hydralazine), and acute heart failure associated with heart attacks and unstable angina (glyceryl trinitrate infusion). These nitrates (e.g. glyceryl trinitrate, isosorbide dinitrate and isosorbide mononitrate) work by providing an exogenous source of NO which mediates vasodilator effects, predominantly venodilation, to reduce venous return and preload to the heart, thereby reducing the heart’s oxygen requirements.
Studying the effectsThere has been interest in using nitrate supplementation, e.g. beetroot juice, for heart health, and in conditions such as heart failure. This is because dietary nitrates (NO3 -) are reduced into nitrite (NO2 -) with the help of microbes in the saliva, and then reduced to NO in the tissues, particularly if there is pre-existing low levels of NO or oxygen dissolved in the blood (pO2). Most recently, a proof-of-concept study investigated the effects of acute beetroot juice intake on exercise responses in eight people with HFrEF (ejection fraction ≤45%) on stable medical therapy, and not taking nitrates or other medicines that would affect the reduction of NO3 - to NO2 - to NO. It was a randomised, double-blinded, crossover trial design comparing 140 mL of concentrated beetroot juice supplement containing 11.2 mmol of NO3 -, against a placebo where the juice manufacturer extracted all of the NO3 -. The primary outcomes investigated were changes in breathing responses and VO2peak, while secondary outcomes looked at exercise performance and efficiency (a measure of energy input vs external work achieved). Breathing response and effciency was unchanged, but there was a significant improvement in VO2peak (8 ± 2% from 21.4 ± 2.1 to 23 ± 2.3 mLmin-1kg-1 ; p <0.05). Improvements were also noted in some of the tertiary outcomes such as levels of NO in the breath, which is a biomarker for NO production by the whole-body (increasing 60 ± 18%; p <0.05), and improvement in time to fatigue (7 ± 3% from 582 ± 84 to 612 ± 81 seconds; p <0.05). One of the most obvious limitations of these findings is the small sample size, single strength of beetroot juice investigated, and the acute nature of the study.
ConclusionWhile the results indicate statistical significance, it is important more work is conducted to investigate the clinical significance of these findings including adverse effects, applicability in patients with varying severities of HFrEF and potential place with existing management protocols, and even other heart conditions. Nevertheless, beetroot juice might be an easy and tasty way to help improve the quality of life and survival of patients living with HFrEF.
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- Coggan AR, Broadstreet SR, Mahmood K, Mikhalkova D, Madigan M, Bole I, Park S, Leibowitz JL, Kadkhodayan A, Thomas DP, Thies D, Peterson LR. Dietary Nitrate Increases VO2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients With Heart Failure With Reduced Ejection Fraction. J Card Fail. 2018;24(2):65-73. At: https://www.ncbi.nlm.nih.gov/pubmed/28916479
- Notay K, Incognito AV, Millar PJ. Acute beetroot juice supplementation on sympathetic nerve activity: a randomized, double-blind, placebo-controlled proof-of-concept study. Am J Physiol Heart Circ Physiol. 2017;313(1):H59-H65. At: https://www.ncbi.nlm.nih.gov/pubmed/28476923
- Lara J, Ashor AW, Oggioni C, Ahluwalia A, Mathers JC, Siervo M. Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis. Eur J Nutr. 2016;55(2):451-459. At: https://www.ncbi.nlm.nih.gov/pubmed/25764393
- Eggebeen J, Kim-Shapiro DB, Haykowsky M, Morgan TM, Basu S, Brubaker P, Rejeski J, Kitzman DW. One Week of Daily Dosing With Beetroot Juice Improves Submaximal Endurance and Blood Pressure in Older Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail. 2016;4(6):428-37. At: https://www.ncbi.nlm.nih.gov/pubmed/26874390
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2806 [post_author] => 27 [post_date] => 2018-10-01 13:30:59 [post_date_gmt] => 2018-10-01 03:30:59 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Lithium is an invaluable and lifesaving treatment for a range of psychiatric disorders, but its origins lie in patent medicine and the pioneering work of an Australian doctor. People have been flocking to hot springs of lithium-heavy water for their perceived health benefits for millennia, but it was not until the second half of the 19th century that modern medicine put the element to use. In 1859, an English physician described the use of lithium carbonate to treat gout by solubilising uric acid in the blood, as well as treating ‘brain gout’, or mental upset. Over the next few decades, some US and Danish doctors reported that lithium carbonate could calm patients with ‘general nervousness’, mania or depression.1 However, its use in medicine remained rare, with most use instead in food products. Until 1950, popular soft drink 7-Up2 contained lithium citrate and even beer3 was brewed with lithium-heavy water and promoted for its mood-enhancing abilities. However, both the real and perceived health benefits of lithium were overshadowed when lithium was prescribed to patients with heart disease as a replacement for salt.4 The resulting overdoses and deaths led to the US banning lithium as an additive in 1950. Elemental reactions The exact action of lithium to manage mood remains unclear, though it is clear the molecule acts on the brain on multiple levels. It offers neuroprotective and neuroproliferative effects on brain structure, as well as plasticity.5 It also modulates neurotransmission, inhibiting excitatory neurotransmitters such as dopamine and glutamate,6 and promoting GABA-mediated neurotransmission.6 In 1949 in a Melbourne mental hospital for World War II veterans, Dr John Cade theorised the mania he witnessed in his patients might be linked to the high levels of uric acid he detected in their urine, in line with the 19th century theories about gout. He experimented with injecting the urine collected from patients demonstrating mania into guinea pigs, which subsequently showed signs of agitation.1 Guinea pigs that were subsequently administered lithium following the urine injections rapidly calmed. Dr Cade then experimented on himself and when he showed no ill effects after a dose of lithium, he started a trial on 10 patients.7 His trial showed significant positive results, but a mixture of poor timing (given lithium’s then-recent banning from food) and the then-obscurity of the Medical Journal of Australia where his article was published meant little acknowledgment.¹ Instead, Danish research published in 1954 detailing the results of a randomised trial kick-started lithium’s renaissance.1 By 1970, lithium had been widely approved for treating bipolar disorder and other mental health issues.1 Thinking big In recent years, some studies have found a correlation between high levels of naturally occurring lithium in tap water and lower rates of suicide and mental health problems.2 However, these studies have had many limitations and there is no reliable evidence that says lithium addition to water or food would provide any health benefits.5 References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => The story of lithium and mental health [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-story-of-lithium-and-mental-health [to_ping] => [pinged] => [post_modified] => 2018-10-03 14:18:15 [post_modified_gmt] => 2018-10-03 04:18:15 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2806 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The story of lithium and mental health [title] => The story of lithium and mental health [href] => https://www.australianpharmacist.com.au/the-story-of-lithium-and-mental-health/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 2811 )
- Shorter E. The History of Lithium Therapy. Bipolar Disorders. 2009;11.
- Fels A. Should We All Take A Bit of Lithium? The New York Times. 2014 September 13. At: https://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html?_r=0.
- Shepherd R. Lithia Beer returns to West Bend, expands across Wisconsin. Isthmus. At: https://isthmus.com/food-drink/beer/lithia-beer-returns-to-west-bend-expands-across-wisconsin/.
- Hardman JG. Limbird PB. Gilman AG. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th Ed. New York. McGraw-Hill. 2001:507.
- Sachdev P. Let’s not put lithium in the drinking water just yet. Medical Republic. 2017 November 21. At: http://medicalrepublic.com.au/lets-not-put-lithium-drinking-water-just-yet/11998.
- Brunton L. Chabner B. Knollman B. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th Ed. New York. McGraw-Hill. 2010:445.
- Mitchell PB. Hadzi-Pavlovic D. Lithium treatment for bipolar disorder. [Reproduced from The Medical Journal of Australia]. Bulletin of the World Health Organization, 2000;78(4):515.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2425 [post_author] => 12 [post_date] => 2018-08-22 08:45:22 [post_date_gmt] => 2018-08-21 22:45:22 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]With community pharmacies feeling the squeeze, there has never been a more important time to provide continuity of care by building patient loyalty. Self-serve checkouts, online stores and banking through phone apps: these days there’s often little need to talk to a person when making day-to-day purchases or transactions. Pharmacy, however, remains one of the last bastions of good ol’ fashioned human connection. ‘Patients are looking for connection,’ said Capital Chemist’s Elise Apolloni MPS. ‘So often when people engage with services or businesses there’s nothing magical about the interaction.’ Fortunately, pharmacists can use these increasingly rare personal interactions to provide patient-centred service and foster continuity of care, bringing positive patient outcomes. What customers want The strength of a patient’s loyalty is primarily driven by the behaviour of the pharmacist treating them – not the price of the medication or the location of the pharmacy. And there’s no shortage of studies that reach this conclusion. A 2013 Griffith University study found that patient-centred care, such as providing individualised medication counselling, continuity of care, development of relationships and respectful advice, emerged as the most important attribute when it came to retention of regular community pharmacy users. Additionally, a US study published in the Journal of the American Pharmacists Association found that a pharmacist’s patient-centred communication style had a major influence on whether a patient would return to the pharmacy. Associate Professor in Marketing at the QUT Business School Dr Gary Mortimer said while many customers seek pharmacies with lower prices, consumers are turning to pharmacy for healthcare solutions and triage prior to consulting their GP. ‘We see this mostly in consumers seeking access to flu jabs and health check-ups, possibly as a result of patients looking to avoid the high costs of seeing a GP for minor healthcare matters,’ said Dr Mortimer, who is currently working on the research topic ‘Clinical trials or pharmacist advice: The influence on health consumers’ perceptions of trust and decision making’. PSA NSW Branch Vice President Krysti-Lee Rigby MPS said that consumers also wanted value. But that does not necessarily mean being the cheapest. ‘Value can come from having engaged and competent staff, service that meets or exceeds expectations, the pharmacist being accessible, being able to trust their pharmacist, and of course convenience,’ Ms Rigby said. Holistic care benefits for patients The relationship between pharmacist and patient should not be the transactional kind of relationship you have at your local convenience store, Dr Mortimer said. ‘Better patient healthcare outcomes result from ongoing, regular contact based on continuity of service and advice,’ he said. Ms Apolloni said this was particularly apparent in the chronic disease space, where often a one visit solution wasn’t possible. ‘If a patient is not dazzled by your pharmacy and team, they may not return and you’ve missed an opportunity to build a therapeutic relationship with that person and contribute positively to their healthcare,’ Ms Apolloni said. ‘We’ve laughed with patients – and cried with them. I can’t see how that kind of connection and holistic care can be anything but great for the patient, the job satisfaction of the pharmacist, and the wider healthcare system.’ Ms Rigby added: ‘By building trust with patients, we can increase compliance of medications, create better health outcomes by educating patients on how to better manage their medications, and empower patients to take a proactive approach to their health.’ Ensuring continuity of care Dr Mortimer suggests pharmacies take a five-stage approach to maximising holistic care opportunities, starting with establishing integrity. ‘Pharmacy must consistently deliver open and honest information across all touch points with consumers. Integrity cultivates trust between the patient and the pharmacy retailer,’ he said. Pharmacists and assistants then need to provide expert advice around purchasing decisions. ‘Consumers have access to significant amounts of information today,’ Dr Mortimer said. ‘If a pharmacy assistant delivers inaccurate advice, or ill-informed advice that is not consistent, the patient-pharmacist trust relationship is damaged.’ The third ingredient for maximising holistic care opportunities is ensuring the security of personal data, said Dr Mortimer. And fourth, pharmacies need to demonstrate competence. ‘Trust and continuity of care decrease when the consumer perceives that the pharmacy is incompetent in its dealings with them,’ he said. ‘For example, if the pharmacy is unable to perform transactions efficiently, loses prescriptions, has poor service, fails to offer a lower-priced generic alternatives, or fails to keep promises.’ Finally, and most importantly, said Dr Mortimer, the pharmacy must exhibit benevolence. ‘When a pharmacy demonstrates or promotes actions that indicate the support of the welfare of others over financial outcomes, consumers develop stronger levels of trust,’ Dr Mortimer said. ‘Benevolence is di cult to cultivate, as benevolent acts must be purely altruistic.’ Ms Apolloni added that being genuinely present and interested in a patient was another important precondition for holistic care. ‘We have many competing priorities, but it takes very little extra time to really listen and repeat back key pieces of information,’ she said. Digital solutions One way pharmacists can deliver more holistic care and maximise time with patients is by harnessing the power of technology. Robert Read is CEO of MedAdvisor, a mobile and web app that manages all aspects of prescription medication use. One of the advantages of this type of digital solution, said Mr Read, was that it prompted patients when it was time to re-order their medication. ‘And 50% of orders from the app go into the pharmacy outside of business hours,’ he said. ‘A pharmacy can then process those scripts before the doors even open so that when the patient comes in they can spend quality time counselling them.’ ‘It’s really busy at the dispensary and pharmacists are doing all this processing work and not spending time talking to the patient about all the various things they might be eligible for,’ Mr Read said. ‘What MedAdvisor does is identify all the eligible consumers, and then helps you invite them to services they’re eligible for.’ Mr Read said their research showed more than 90% of patients stayed loyal to the pharmacy that signed them up to the app. ‘Not only does it play a big role in driving loyalty, but it improves a patient’s adherence to their medication,‘ he said. Another way pharmacists are spending more time in front of patients is by purchasing an automated dispensing cabinet. Pharmacy owner and technology consultant Robert Sztar MPS said the cabinets could free up your staff to deliver high-quality services, while the dispenser tackles the more routine tasks. Avoiding poor patient service Making patients aware of additional services they’re eligible for is an important part of providing holistic care, but Dr Mortimer said pharmacists need to be aware that not all up-sells are appreciated – especially product-based ones. ‘It frustrates consumers. They’ll pop in to collect a prescription and be up-sold OTC products, cosmetics or skincare products,’ he said. ‘While revenue and the bottom line is important, pushing sales is a short-term solution. If a consumer genuinely feels a pharmacy is taking the time to get to know them, really understanding their needs to develop healthcare solutions, they will keep coming back.’ Take a stand While consumers do not necessarily become loyal to a particular brand or pharmacy, they do become loyal to what the business stands for, Ms Rigby suggested. ‘For community pharmacies to continue to be viable, they need to have clear missions and values, and ensure their staff align with them,’ she said. ‘Pharmacies need to show consumers what they stand for, besides making money.’
|Ways to foster patient loyalty
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2442 [post_author] => 66 [post_date] => 2018-08-07 11:45:10 [post_date_gmt] => 2018-08-07 01:45:10 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A group of Melbourne pharmacists have developed a data aggregation and visualisation platform used for strengthening health supply chains, disaster response and improving health services throughout the South Pacific. In June, the project won the People’s Prize at the the Australian Public Service Innovation Awards in Canberra. The tool builds a map of every health facility within the countries that are participating in the project. Currently, six countries have partnered (Solomon Islands, Vanuatu, Kiribati, Cook Islands, Tokelau and Tonga) and that number is expected to grow further in 2018, with potential applications for Australia. ‘Kiribati has seen a 21% increase in the availability of medicines at the primary healthcare level since September 2017, which is a terrific result in a difficult geographic area,’ project member Kahlinda Mahoney said. The project is named after Tupaia, a legendary Pacific Island navigator who joined Captain Cook’s crew as he sailed through Tahiti in 1769. Using an app called Tupaia MediTrak to collect information from public health facilities, the tool syncs this information with data pulled from the pharmacy software used in each country – mSupply, used in about 30 countries around the world. Tupaia also pulls data from the software used for disease tracking in many countries in the region (using open-source health information software DHIS2) and it presents this information in preconfigured dashboards and map overlays on a public website. Password-enabled access allows higher-level users to see more data but the public can see the location of facilities, the services they provide and their opening hours. So far, the project has mapped all 600 facilities across the six partner countries. ‘Tupaia can be used for a huge range of programs. For example, it provides a map of the fridges in all the health clinics in Solomon Islands, showing whether they are working or not. This can be used by the national cold chain manager there to help plan their annual maintenance schedule,’ mapping team lead Susie Lake said. ‘The EPI program manager in Vanuatu might use it to map the availability of vaccines and pregnant mums might look up the location of the nearest facility that can handle emergency obstetric situations.’ The project is strongly focused on improving access to essential medicines. In Kiribati, Tupaia worked in partnership with mSupply to roll-out a mobile version of the widely used pharmacy software. Ms Mahoney said the current version of mSupply Mobile was launched in 2016 and Australia’s Department of Foreign Affairs and Trade (DFAT) paid for it to be released ‘open-source’ in 2017. ‘This meant countries were able to roll it out more quickly and more widely than was possible before, as there are no longer licensing fees attached to it,’ she said. ‘We started this project to strengthen health supply chains in the Pacific, to make sure that medicines were getting to the right people at the right time – but it has grown to include disaster response, disease tracking, infrastructure, HR – it’s exciting but we’re always keen to do more,’ Ms Lake said. ‘There may be application here in Australia, particularly with recent commentary and events around medicines and vaccine stock-outs but we’ll just have to wait and see.’ Now 12 months old, the Tupaia project has been funded by the innovationXchange, part of the aid program at Australia’s DFAT. The focus on essential medicines in the region comes at a time when antimicrobial resistance, counterfeit medicines and medicines shortages are being recognised as serious regional health threats. [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Navigating South Pacific health care on a sea of data [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => navigating-south-pacific-health-infrastructure-on-a-sea-of-data [to_ping] => [pinged] => [post_modified] => 2018-08-07 12:01:36 [post_modified_gmt] => 2018-08-07 02:01:36 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2442 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Navigating South Pacific health care on a sea of data [title] => Navigating South Pacific health care on a sea of data [href] => https://www.australianpharmacist.com.au/navigating-south-pacific-health-infrastructure-on-a-sea-of-data/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_primary_cat] => 26 [smart_list_template] => td_smart_list_5 ) [is_review:protected] => [post_thumb_id:protected] => 2443 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2191 [post_author] => 2 [post_date] => 2018-07-28 14:00:30 [post_date_gmt] => 2018-07-28 04:00:30 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Pharmacist-led health interventions in Aboriginal communities came under the spotlight at PSA18 in Sydney yesterday, as delegates got early insight into some of the Pharmacy Trial Program (PTP) studies currently underway. The 6CPA allocated $50 million to fund the program, aimed at gathering evidence to expand the role of pharmacy in delivering a wider range of primary healthcare services, with a particular focus on Aboriginal and Torres Strait Islander populations. One trial currently in start-up is the Indigenous Medication Review Service Feasibility Study (IMeRSe), led by Griffith University’s Professor Amanda Wheeler. ‘The overall goal is to improve medication management and health and wellbeing for Aboriginal and Torres Strait Islander people through strengths-based collaborative and culturally appropriate pharmacy service,’ she said. ‘We know that medication reviews are funded but the research told us that for Indigenous people they have problems accessing medication reviews for many reasons. One of those is that talking to a pharmacist at a pharmacy or in their own home may not be a culturally safe space.’ ‘That review service doesn’t involve anyone from the Aboriginal Health Service (AHS) – their trusted person who they work with and knows them so well. Only a GP may refer someone for a Home Medicines Review and that process may take several weeks. ‘They also tend to be a one-off and there is no ability for the pharmacist to check in in a funded way and see how things are going or tackle complex problems over a few months. There is also a lack of integration between pharmacists and Aboriginal Health Services.’ IMeRSe will involve up to 23 pharmacies across Queensland, the Northern Territory and New South Wales, and up to 540 AHS patients. ‘It’s a pharmacy service to promote health and wellbeing by optimising an individual’s medication management through a culturally responsive medication review service,’ Prof Wheeler said. ‘It will be delivered by community pharmacists but they are going to be integrated with Aboriginal Health Services as part of holistic care. We want to enhance existing services.’ With seven patients already recruited, the project is already gathering positive feedback, including from involved GPs.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Greater pharmacist role in Aboriginal health trialled [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => trials-lead-the-way-for-greater-pharmacist-role-in-aboriginal-health [to_ping] => [pinged] => [post_modified] => 2018-07-28 14:01:52 [post_modified_gmt] => 2018-07-28 04:01:52 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2191 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Greater pharmacist role in Aboriginal health trialled [title] => Greater pharmacist role in Aboriginal health trialled [href] => https://www.australianpharmacist.com.au/trials-lead-the-way-for-greater-pharmacist-role-in-aboriginal-health/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_primary_cat] => 21 ) [is_review:protected] => [post_thumb_id:protected] => 2256 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2187 [post_author] => 2 [post_date] => 2018-07-27 13:58:55 [post_date_gmt] => 2018-07-27 03:58:55 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]The rise in patient access to information about managing their own health should not threaten to supplant pharmacists but instead make them more essential than ever, according to International Pharmaceutical Federation (FIP) CEO Dr Catherine Duggan. Helping open PSA18 in Sydney yesterday, Dr Duggan said pharmacists should take a leading role in helping healthcare transition to being digitally led. 'Where we find ourselves now is not in the Industrial Age but in the Information Age and that puts us into a position where patients seem to be empowered and have access to more and more relevant information at their fingertips through, for example, Dr Google,’ she said. 'Patients and consumers have greater education, knowledge and power – or more access to education, knowledge and power – and can put us into tricky situations. Do we need pharmacists any more? Do we need pharmacists as we used to be? Those are the questions that many fear in our profession. 'The answer is never more. Ever more medicines are being taken by ever more frail and elderly patients in a society where we are growing more resistant to the antimicrobials we know and trust. Never more have we needed pharmacists and pharmaceutical scientists to be the solution-makers of our future.' Dr Duggan said pharmacists needed to be empowered, enabled and emboldened to be the custodians of their patients’ medicines. 'We need to empower our patients and the public to be able to look after themselves while well and to look after themselves while frail, and we need to be the stewards and the custodians of the medicines they are prescribed,’ she said. Dr Duggan also highlighted the vast gulf in access to pharmacy services between low- and high-income countries, with FIP research finding just one pharmacist per 20,000 people in many low-income countries, a figure more than 13 times lower than that of high-income countries. 'It is the level of inequity that should cause us concern,’ she said. 'What should concern is that not every patient has access to the pharmacist care they need.'[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Pharmacists must be 'empowered and emboldened' in the new digital age [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => dr-catherine-duggan-talks-innovation-in-pharmacy [to_ping] => [pinged] => [post_modified] => 2018-07-28 13:53:26 [post_modified_gmt] => 2018-07-28 03:53:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2187 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists must be ’empowered and emboldened’ in the new digital age [title] => Pharmacists must be ’empowered and emboldened’ in the new digital age [href] => https://www.australianpharmacist.com.au/dr-catherine-duggan-talks-innovation-in-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_primary_cat] => 26 ) [is_review:protected] => [post_thumb_id:protected] => 2251 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3614 [post_author] => 74 [post_date] => 2019-01-10 14:00:59 [post_date_gmt] => 2019-01-10 04:00:59 [post_content] => The new President of the Pharmaceutical Society of Australia (PSA) is Dr Chris Freeman – currently Clinical Senior Lecturer and the Director of the Centre for Optimising Pharmacy Practice-based Excellence in Research (COPPER) at the University of Queensland and Consultant Practice Pharmacist at Camp Hill Healthcare in Brisbane. Chris’ professional contribution began in 2009 when he joined the PSA’s Early Career Pharmacist working group of the Queensland Branch – he was elected Chair soon after. By 2016 he had been elected National Vice President of PSA with significant contributions to the policy, advocacy and innovation at the organisation. His full biography is available here. Australian Pharmacist sat down for a chat soon after his appointment. AP: Congratulations on your new role, Chris. What can you say about those shoes you’re stepping into? CF: It's been an absolute honour to serve as Shane Jackson's Vice President. I've not come across anyone who has invested his level of energy, enthusiasm and commitment – not only to the PSA but to the profession more widely. He has been a passionate advocate for moving the profession forward on a very positive pathway, and he's certainly set the platform for me. I hope I’m able to continue his great work. AP: The trajectory of your career path seems to have been aimed towards this kind of leadership role. CF: An opportunity came up to join the PSA Queensland Branch’s ECP working group and I thought I had something to offer. I felt compelled to try and do something about the issues that pharmacists were facing, rather than sitting on the sidelines. Over time, I found that I also wanted to contribute to the governance of the PSA given my interest in policy and innovation. I love my profession and want to see pharmacists respected and rewarded for the integral role we have in the health system. This continues to drive me today and stepping into the Presidency of the PSA provides me with an opportunity to do just that. AP: Do you still plan to maintain your role as a consultant pharmacist in a general practice setting? CF: Yes, the body of work that I've been focused on recently has been trying to further develop collaborative practice models and the evidence to support those practice models. I've tried to do that by example, not just within my own research work, but also in my own clinical practice. I plan to maintain my clinical activity moving forward – I think it provides a great touchpoint with consumers and a grounding so that I can have an understanding of the things that are going on within the profession. And it's an absolute pleasure to work alongside GPs and other allied health professionals who genuinely believe in interdisciplinary care, where they see a genuine role for pharmacists and community pharmacy in the care of patients. AP: That is a big part of the PSA’s vision for the profession, and will be headlined in the Pharmacists In 2023 launch in March. How would you summarise that vision for the future of pharmacy in Australia? CF: I want to see pharmacists practising to their full scope, filling genuine patient need, and this drives everything that we've done from the PSA point of view. The underlying philosophy is that whenever or wherever a medicine is being used or considered, a pharmacist should be involved to ensure the quality use of that medicine is being considered. This ensures that pharmacists are regarded by consumers, the public, by government and other health professionals as integral members of the healthcare team. Sometimes pharmacists are seen as nice to have but not a necessity. Pharmacists In 2023 will provide the platform from which we can say we are a necessity in the healthcare team. Patient outcomes are improved if pharmacists are provided with opportunities to meaningfully engage with their care and we can do this by delivering that care to our full scope of practice. Pharmacists In 2023 provides the action items – not only for the PSA, but for the profession more widely, to achieve that goal. AP: What are the impediments to achieving these goals? CF: We have to facilitate pharmacists to practise to the best of their ability, and that's done through professional support and tools led by professional organisations such as the PSA. It's through setting standards and enabling quality of practice. It’s also ensuring that we've got the right funding framework to allow pharmacists to meaningfully engage in a model of practice where patients are going to get the most out of the pharmacist’s care. And that might include things like external funding from Primary Health Networks, the Medicare Benefits Schedule (MBS) or it might be related to how the Community Pharmacy Agreement is structured. AP: A bit about yourself. How do you achieve work/life balance? CF: I've got a really young family – a six and a four-year-old. So a lot of my spare time is focused on the children and their activities. I love spending time at home here in Brisbane with them and my wife, and I try to make the most out of that. I've tried to manoeuvre things around my clinical practice as well as my practice at the university to really allow me to still dedicate genuine family time. AP: And if you have any time to yourself? CF: Exercise is my release. When I do get a bit of spare time I'm either out at the gym or on the bike. It gives me some thinking time, too, and is really important for maintaining the energy levels. I'm really focused on trying to maintain that energy in my role as President of the PSA. [post_title] => Meet PSA's new President [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => meet-psas-new-president [to_ping] => [pinged] => [post_modified] => 2019-01-14 13:45:26 [post_modified_gmt] => 2019-01-14 03:45:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3614 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Meet PSA’s new President [title] => Meet PSA’s new President [href] => https://www.australianpharmacist.com.au/meet-psas-new-president/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3622 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3439 [post_author] => 82 [post_date] => 2019-01-04 09:00:50 [post_date_gmt] => 2019-01-03 23:00:50 [post_content] => What happens when emotional pain becomes physical? Dr Anchita Karmakar and clinical pharmacist and PainWISE Director Joyce McSwan explore this concept. When Dr Karmakar lost her daughter, abducted by the child’s father and taken to a foreign country, it began a decade-long quest for justice. ‘As a parent you never imagine that someday, you will not be able to see, hug and love your beautiful children,’ she said. ‘You assume that you will watch your children grow up, go through their milestones and ensure that they have the best shot in life with the support and love you provide for them.’ Dr Karmakar and Ms McSwan have a close working relationship, with Dr Karmakar often referring patients to PainWISE. But unbeknownst to Ms McSwan, Dr Karmakar was suffering from pain of her own. At one point in her journey, Dr Karmakar began to experience tangible, debilitating physical pain in her hand. After having a series of tests including X-Rays for conditions such as carpal tunnel syndrome, no underlying physical causes for the pain were unearthed. ‘We were rather perplexed by her pain condition, because it wasn’t caused by anything physical as such. It turned out that it was actually emotional pain that turned into physical pain,' Ms McSwan said.
How the pain manifestsAccording to Ms McSwan, the progression of this type of pain is insidious. ‘People will complain of a pain of some kind – it could be whole body or limited to a certain limb,’ she said. ‘It has to do with how our brain expresses pain and the regions in the brain where this occurs and more importantly how our brain is massively connected with the rest of the body as a single entity. What has to be acknowledged here is that there are direct neural connections between all our body systems and each feedback and modulate the other. Whether we allow ourselves to be aware of it or not, the psychobiological connection is there and ongoing. And the expression of pain is real. ‘Pain is truly very complex. The neural, blood, and immune pathways between brain and body are tagged with body location information in the somatosensory part of our brain. The involvement of our communication pathways of the spinal cord, brain stem and thalamus, continues to add layers of complexities until the pain experience becomes conscious and grabs our attention. Our nervous system is a true marvel,’ Ms McSwan said. ‘Pain is protective for our survival so this alert can maladapt to stay on high alert. The nervous system, brain and body is just doing the job it is designed to do. And what we have to do is acknowledge that it is there, feel the pain (even if it is unpleasant) and seek treatment supportively to be able to help our system to modulate back again. There are many techniques these days to help with that.’ Ms McSwan said that the typical investigative routes of pain, such as MRIs and X-rays, will not reveal the underlying cause. She said it’s imperative that investigation extends beyond these limited methods. ‘We have to talk to the patients and look at the pain in a broader context, such as finding out when it began and some history of what kind of things were happening around the time the pain response started. ‘In Dr Karmakar’s case, we couldn’t see anything in the conventional tests, but the pain was incredibly real. On the hand she had the pain in, she used to wear a ring associated with her daughter. So, the emotional pain was expressed in that hand, almost to the finger that she wore it on,’ Ms McSwan said. Once they worked out that it was emotional pain, the underlying trauma needed to be dealt with through therapy. Dr Karmakar’s recovery is ongoing, but she has healed through writing the book – and proven that despite the distress and despair she experienced, she could use the pain for greater good. She hopes it will help others who are faced with emotional pain that presents physically to be validated, acknowledged and assisted without judgement, Ms McSwan said.
Working togetherMs McSwan said that it’s important for doctors and physicians to collaborate through patients, and that in her experience, doctors appreciate the support in their understanding of pharmacology and pain management. It is simply impossible to manage such complex care needs on their own. ‘If they know your intention of care, they value that support. It’s vital to communicate – but it takes an investment of time and effort to cultivate these relationships,’ she said. It all comes down to picking up the phone and figuring out the best way to communicate in order to express a concern, Ms McSwan said. When faced with a patient that has complex care needs, she recommended asking them who their doctor is so everyone involved in their care can be on the same page and can express any concerns. The initial effort expended saves time in the long run. It’s equally important to bear in mind that pain is subjective, and that’s it’s vital to listen to patients, she said. ‘There are some good assessments that we as pharmacists can do – for example, asking patients about daily function, their barriers and their limitations. Before long, you will get a good idea of how pain is affecting their lives. If they say they have been screened and nothing indicates a reason for the physical pain, that's when it’s time to help them unpack some of their thoughts and emotions about the pain experience.’ Assessing the ‘yellow flags’ will highlight some important aspects of the patient’s beliefs about their pain. Catastrophisation or rumination, for example, will slow down healing process, Ms McSwan said. She also said that it’s important not to judge, but to be empathetic, and recommended finding a psychologist that they can collaborate with and link the patient to. Patients who are taking analgesics for their physical pain will achieve so much more when it is combined with emotional support. Through the rapport pharmacists have with their patients, they can really help to facilitate the patient’s confidence to engage with this support. ‘Being able to use the right language to help the patient understand their pain is vital. Rather than saying, “I think you need to see a psychologist for your pain”, which can send the wrong message that you think their pain is in their head, perhaps let them know that the way they think about their pain can affect how they experience their pain. A psychologist can teach them some helpful tools on how to influence this.’ For further information on pain management, pharmacists can refer to PSA’s Chronic Pain MedsCheck CPD modules (Identifying patients and Using a chronic pain MedsCheck). Joyce McSwan and Anchita Karmakar have authored the book, ‘With or Without your Smile’. [post_title] => The connection between emotional and physical pain [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => connection-emotional-physical-pain [to_ping] => [pinged] => [post_modified] => 2019-01-08 11:09:19 [post_modified_gmt] => 2019-01-08 01:09:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3439 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The connection between emotional and physical pain [title] => The connection between emotional and physical pain [href] => https://www.australianpharmacist.com.au/connection-emotional-physical-pain/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3443 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3148 [post_author] => 74 [post_date] => 2018-11-30 09:30:04 [post_date_gmt] => 2018-11-29 23:30:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Ravi Sharma’s credentials in pharmacy are formidable. Recently appointed the Royal Pharmaceutical Society’s (RPS’s) director for England, he was also National Clinical Lead for Clinical Pharmacy and Genomics for the National Health Service (NHS) while holding several honouree and advisory positions. His key role has been focussed on the development of integrated/collaborative and innovative roles for pharmacists. He has published several articles in reputable journals and is involved in several research projects around the impact of clinical pharmacy within primary care. He was recently invited to Australia on a speaking tour by PSA to share his insights, research and inspiration. Before his departure, Australian Pharmacist sat down with him to discover his impressions of Australian pharmacy – and what we need to do to catch up. You were here in 2015 on a speaking tour. What changes are you noticing in the pharmacy landscape in Australia between then and now? I’m really seeing some traction around integration and collaborative working. I’ve had some very interesting days catching up with internal and external healthcare stakeholders. I think there is now more open dialogue between the PSA and various healthcare organisations on the role and the clinical contributions that pharmacists can make being part of collaborative and integrated multidisciplinary teams – utilising the pharmacist’s expertise in medicines to help improve patient care and safety, and ensuring people get the best out of their medicines. Integrated care and collaborative care are what I’m truly passionate about, and I feel that here in Australia it’s starting to be acknowledged that there is evidence out there. We’re not here in a silo, we’re here to work collaboratively as a team using pharmacists’ expertise. These teams will drive improvements in the healthcare system and most importantly patient quality of life. You appear to be leading the way in the UK in the advancement of pharmacists’ roles and the integration of pharmacists into various models of primary care. How far behind is Australia? I think it is fair to say there’s growing recognition and body of evidence around non-prescribing and prescribing pharmacists’ contribution to healthcare. The UK has been on a real journey to enable some of those models of care and practices to develop. In the UK we are currently focussing on medicines value and safety. In the last five years there has been a real change in the landscape to enable greater multidisciplinary working to ensure members of the public get the best use out of their medicines. Subsequently, this has opened the door for pharmacists to go into many new and exciting roles. We are not only seeing pharmacists work in community, hospital, industry or academia. We’re seeing non-dispensing pharmacist roles in general practice, aged care settings, urgent care, mental health services, prison services, and other community services such as homeless care or social care. Many of which are pharmacist prescribers. We are evaluating the impacts that many of these roles have on patient care and how they benefit the wider healthcare system. I believe PSA are and continue to be strong advocates for positive change in the pharmacy profession in Australia. I see many new roles opening for pharmacists here, particularly in general practice and aged care settings. I am positive that in the future there will be many opportunities for pharmacists to be able to collaboratively prescribe within integrated teams alongside our medical colleagues. Have you been able to discern the biggest obstacles to these advances in Australia? It is important for healthcare professionals and the public to understand the knowledge and skills that pharmacists have. We undergo a significant amount of training in medicines and the application of medicines in real-life clinical practice. Furthermore, there is a growing evidence base showcasing the impacts that pharmacists can make on improving the delivery of care, improving patient care and safety, improving access to the medicines at the right time for the right individuals while improving greater collaborative multidisciplinary working between healthcare professionals. We do need to work on changing the culture, perceptions and behaviours of other healthcare professionals and help them understand the value that pharmacists bring to the management of people’s care. Upon reflection, there’s something about the contracting and payment mechanism in Australia that is very different to the UK mechanisms. The UK mechanisms of funding and contracting enables greater collaborative and integrated working with multiple healthcare professionals. If that was to happen in Australia, I think it would enable further forward-thinking conversations around pharmacist role extension and collaborative prescribing. What about yourself? Was there any single episode or patient interaction where you realised you could really advance pharmacy? When working in general practice you have access to patient medical records, their histories and pathologies such as blood tests. I soon could see how I could make a huge difference to care by ensuring people were being prescribed the best medicines for their conditions. One episode that comes to mind; I had a 65-year-old patient who was on three antihypertensive medicines. They had been on these medicines for a number of years. The patient came in for a clinical medication review with me in the GP practice. During the review, I measured his blood pressure and it was extremely low, something like 80/42 mmHg, suggesting that he was being overprescribed his current medication. I was able to go through his medications and overall care in detail. He had clear signs and symptoms of hypotension and was at potential risk of falls. I suggested to the patient it would be appropriate to take them off one or two of his medications. I initially started off by taking off one of the antihypertensive medications and the plan was to follow him up within the next coming days. The patient was happy with the approach. Obviously working as part of the general practice team I can speak to the doctor about these decisions, but generally, the doctors appreciate that pharmacists know lots about medications and trust us to help improve patient care on a day-to-day basis. After deprescribing one of the medicines, I followed up with the patient a week later and the blood pressure had improved to around 100/60 mmHg. I then decide to titrate the second antihypertensive medication down (i.e. a lower dose) and followed up the patient a week later. The patient returned with a blood pressure reading of around 120/75. The patient’s signs and symptoms of hypotension had resolved completely. Not only did the patient enjoy the conversation and approach to their care, the doctors were impressed by the pharmacist’s ability to manage, monitor and review the patients long-term condition. I reflected on this one example and thought to myself, ‘This is me being an autonomous clinician with the support of a collaborative environment. The patient’s symptoms have been alleviated. I had monitored the patient, I’d reviewed their medications; I was able to educate the patient on their medicines and on how to take them. It was a detailed consultation that my GP colleagues respected – they really saw my ability to contribute.’’ There’s also work that I and my team of pharmacists have done in GP practices around complex polypharmacy – people on loads of medicines with lots of comorbidities, going through those medicines in detail and seeing if all of them are needed. And we’ve done some great work around patient safety deprescribing, as well as reducing medicine-related errors in general practice. As an undergraduate, I really wanted to do this type of work. I’d learned about medicines, I’d learned about how they work. I’d applied my clinical knowledge, and this was unleashing that potential. It enabled me to work with colleagues around a person-centred approach to healthcare. What advice would you give an early career pharmacist about their future? I would tell them their profession is getting very exciting. Some advice I would give:
Overall, be the change you want to see in the profession. I have met with some early career pharmacists during my trip and have been amazed by their enthusiasm, their vision for change and their will to make a difference to patient care. That’s the leadership we should be embracing and elevating. I am confident that the future of pharmacy in Australia is in safe hands. What do you see are the most exciting new realms of pharmacy? I would like pharmacists involved with collaborative prescribing – the ability to work as part of a team to improve patient care. The PSA has said that they want this happening by 2020. This holds great opportunity – to develop your clinical skills, to enable greater collaborative working with doctors, to work at the top of your scope, but also enhance your skills to extend your scope of practice. That is really exciting. Other areas in the future? Artificial intelligence, digital medicine and genomics, particularly pharmacogenomics – being able to personalise medicines based on a person’s genomic makeup. This holds real opportunities for the pharmacy profession to ensure people get the best use of their medicines. We are the experts in medicine after all.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Royal Pharmaceutical Society director on the future of pharmacy [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => royal-pharmaceutical-societys-director-on-the-future-of-pharmacy [to_ping] => [pinged] => [post_modified] => 2018-11-30 09:34:37 [post_modified_gmt] => 2018-11-29 23:34:37 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3148 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Royal Pharmaceutical Society director on the future of pharmacy [title] => Royal Pharmaceutical Society director on the future of pharmacy [href] => https://www.australianpharmacist.com.au/royal-pharmaceutical-societys-director-on-the-future-of-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3149 )
- Make sure you always put patient care first.
- Collaborate and work alongside other healthcare professionals. Be open and inclusive to those discussions.
- Develop your network in and outside of pharmacy. Many opportunities can come from broadening your network and connecting with new like-minded people.
- Seek new opportunities that goes beyond the traditional role of pharmacists e.g. artificial intelligence, genomics, health informatics and digital healthcare.
- Never burn bridges or ruin relationships. You never know when you will need work with people in the future.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3124 [post_author] => 82 [post_date] => 2018-11-27 15:05:09 [post_date_gmt] => 2018-11-27 05:05:09 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Consultant pharmacist Robyn Saunders has spent much of her career committed to improving the standard of aged care but that doesn't mean the young have escaped her attention. Ms Saunders, who was awarded the Victorian Pharmacist Medal at the recent 2018 Victorian Pharmacists’ Dinner, has also personally mentored hundreds of ECPs as she strove to drive her industry’s professionalism and clinical expertise higher. The first 15 years of her career were spent as a hospital pharmacist, establishing the drug information centre at Heidelberg Repatriation Hospital. Her work at Heidelberg mainly centred on the care of returned veterans, an ageing population, which ignited her interest in the aged care demographic. ‘Because of the number of disease states they have, and therefore the number of medications they need, this increased the complexity of their care,’ she said. ‘The work gave us a lot of insights into the problems associated with polypharmacy in that age group.’ Ms Saunders later moved to the private hospital sector, implementing ward pharmacy services at Epworth Hospital. She eventually partnered with fellow pharmacist Jenny Gowan to establish MediCom Medication Services, which provides clinical services to residential care facilities and partners in medication education. Ms Saunders said Medicom strives to provide training for young pharmacists moving into residential care and medication education in order to encourage them in their careers and improve standards of care. ‘Our funding certainly depends on us being experts in medication management, and being clinicians rather than being associated with the suppliers of medications,’ she said. ‘It’s therefore paramount that we do have a high quality of knowledge about pharmacology and the ageing population. ‘We aim to impart this knowledge into the pharmacists that really don’t have a lot of experience in this area, mainly because they come from the private sector and have little experience in collaboration with other areas within the healthcare system.’ Ms Saunders also worked with software developers to create a cloud-based tool platform named QUMulus, which provides medication guides, clinical auditing tools and drug information for consultant pharmacists. Meanwhile, her work as a practitioner researcher has seen her involvement in pharmacy practice research projects in Quality Use of Medicines and medication management. When presenting the medal to Ms Saunders, PSA Victorian President Benjamin Marchant said, ‘Robyn is a strong advocate for evidence-based practice and has personally mentored hundreds of pharmacists. ‘She has provided countless education sessions through PSA and other professional organisations and government agencies, supporting them via best practice for the sole purpose of better health outcomes through quality use of medicine. She is no doubt a role model for us all.’ Ms Saunders said she was humbled and delighted to have received the award. ‘I’m absolutely thrilled, especially when I look at the names that have been presented with this great honour in the past,’ she said. ‘Hopefully it actually encourages other pharmacists to put their head down and do a good job. The quiet ones do eventually get recognised.’ Also recognised at the dinner were pharmacists Angela Lawrence, Dimitra Tsucalas and Christine Bellamy for their significant contributions in rural hospital pharmacy, community pharmacy and primary healthcare network respectively. PSA past Victorian President David Newgreen received his Lifetime Service Award, marking his recent retirement from the Victorian Pharmacy Authority. PSA National President Dr Shane Jackson also joined Mr Marchant in recognising PSA Life Members Ann Howe, Tom Shen, Warren Ritchie, Russell McPhee, Joe Sztar and David Meller, as well as Student of the Year Rhiannon Froude from Monash University and RMIT Gold Medalist Sarah Hassan. Image caption: Janelle Devereus (NWMPHN), John Guy (PDL), Robyn Saunders, The Hon Mary Wooldridge (Shadow Health Minister) and Ben Marchant (PSA Victorian President).[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Victorian pharmacist wins award for work with young and old [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => victorian-pharmacist-wins-award-young-old [to_ping] => [pinged] => [post_modified] => 2018-11-30 15:37:04 [post_modified_gmt] => 2018-11-30 05:37:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3124 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Victorian pharmacist wins award for work with young and old [title] => Victorian pharmacist wins award for work with young and old [href] => https://www.australianpharmacist.com.au/victorian-pharmacist-wins-award-young-old/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3131 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 2996 [post_author] => 11 [post_date] => 2018-11-08 09:04:04 [post_date_gmt] => 2018-11-07 23:04:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Male pharmacy graduates earn an average $10,000 more than their female counterparts after three years on the job, a new report has shown. Although female graduates start their careers earning ever-so-slightly more than men ($200 a year more), after three years male pharmacists earn an average 12% more, according to the recently released 2018 Graduate Outcomes Survey. General Manager at Raven's Recruitment Heidi Dariz says the $10,000 disparity is disappointing. 'On the one hand I find it a little surprising since pharmacy is an industry that employs more women than men,' she says. 'However, it's also unsurprising in that there are definitely more male pharmacists working in higher-paying managerial roles a lot sooner than females.' The Quality Indicators for Learning and Teaching report suggests that the gender pay gap cannot be attributed to the employment status – three years after graduating 93.4% of female graduates were in full-time employment versus 92.1% of men. Instead, Ms Dariz suggests that male pharmacists' higher confidence levels may lead to better pay outcomes. 'We find that we have male pharmacists feeling confident in applying for management roles as soon as they finish their internship, when generally women would want a few years experience working as a team pharmacist before taking this step,' Ms Dariz says. 'Also, men are typically more confident and happy to ask their current employers for a pay rise than women, leading to a discrepancy in wages.' Ms Dariz says that shared parental leave and affordable child care could go a long way towards closing the pay gap. 'I don't think enough is being done in this area at present in pharmacy unfortunately,' she says. The findings are in line with previous Australian and international trends. In 2016, analysis of ATO and ABS data showed that male pharmacists earned an average $85,362 a year while women earned more than $20,000 less at $63,503 a year. When adjusted for hours worked, there was still a 14% gender pay gap. Research shows that in the UK the gap is 12.6%, while in the US women pharmacists make 82 cents to the dollar men earn doing the same job. Ms Dariz says there are reasons for optimism in Australia however. 'I know that many pharmacy employers and groups are offering mentoring programs for women in pharmacy – promoting female entrepreneurship and ownership – which will go a long way in closing this gap,' she says. 'Also, we are currently experiencing pharmacist shortages in community pharmacy, which has led to an overall increase in pharmacist wages in the past 12 months. 'I believe the gap will lessen as more women enter the pharmacy industry and will take on these managerial roles earlier, due to current skill shortages.' [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => $10,000 gender pay gap between early career pharmacists [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => 10000-gender-pay-gap-between-early-career-pharmacists [to_ping] => [pinged] => [post_modified] => 2018-11-08 09:05:06 [post_modified_gmt] => 2018-11-07 23:05:06 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=2996 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => $10,000 gender pay gap between early career pharmacists [title] => $10,000 gender pay gap between early career pharmacists [href] => https://www.australianpharmacist.com.au/10000-gender-pay-gap-between-early-career-pharmacists/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 2997 )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.