td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4635 [post_author] => 82 [post_date] => 2019-03-22 13:50:04 [post_date_gmt] => 2019-03-22 03:50:04 [post_content] => As the date for implementation of the Voluntary Assisted Dying (VAD) Act moves closer, the development of clinical practices around the law is underway. But what are the challenges involved? The Medical Journal of Australia (MJA) recently published a paper about the barriers to clinical implementation of the Act, due to come into effect on 19 June. The paper stated that conversations around VAD have revolved around scope and reaction, with little focus on implementation. But how the Act is transformed into practice could have implications for healthcare professionals, including pharmacists, and patients alike. As previously reported by Australian Pharmacist, the VAD scheme is only accessible to adults with decision-making capacity who:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4452 [post_author] => 74 [post_date] => 2019-03-21 13:34:20 [post_date_gmt] => 2019-03-21 03:34:20 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] PSA’s Pharmacists in 2023 vision advocates the implementation of a ‘research culture’ in Australia. Here’s how members can pursue valuable research in their own practices. It’s there in Action 10 of the PSA’s just-released Pharmacists in 2023 roadmap of the profession’s future – one of the proposed pillars of change: ‘Develop and maintain a research culture across the pharmacist profession to ensure a robust evidence base for existing and future pharmacist programs. ‘Pharmacists’ contribution to the care of individuals in their healthcare journey across all settings must be measured,’ it reads. ‘In partnership with emerging and established researchers, academics, practising pharmacists, funders and consumers, a pharmacy practice research agenda needs to be developed to address evidence gaps and needs.’ How to get there? ‘Provide the mechanism and incentives for pharmacists to participate in practice research that enhances the quality and recognition of professional practice.’ On a macro level, it’s ostensibly a call for government support, and suitable funding. ‘PSA is leading the way in developing new models and approaches within pharmacy practice,’ says Professor Greg Peterson of the University of Tasmania. ‘But we have to show the benefit of new services to governments, in order to fund those services and for them to be accepted by other health professional and by consumers.’ There is an argument that quality research into the delivery of primary care in Australia has been slow to get off the ground, and that pharmacy has some catching up to do. ‘One of the things general practice has been doing is creating practice-based research networks,’ Professor Greg Peterson explains. ‘There’s a number of these across Australia, where GP practices form small networks, perhaps a dozen of them in a locality – the Hunter Region in NSW, for instance. They work together to collect data, look at a particular issue, whether it’s the management of some condition or a practice issue, and basically pool their data, analyse it, all with the aim of improving practice. They do this as a collaboration, which means the workload becomes less, but the number of cases, or patients, is greater. And that’s been a very successful model, not only in Australia, but overseas. There is good evidence for the effectiveness of this research model. ‘This is very much PSA’s vision for pharmacy: community pharmacies within a region or location working on projects together. One model for the future is to eventually link in with these GP practice-based networks. But in the near future the idea is to start with community pharmacy-based research practice networks, which PSA would be foster, with the involvement of the local universities and their schools of pharmacy.’ That’s the big picture. But on a micro level, Pharmacists in 2023 is also a rallying cry. The PSA wants its members engaged, enthused and involved. So, where does an aspiring pharmacist researcher sign up? And what can they hope to be doing?
What’s in it for me?‘This is where people might get confused,’ says Professor Peterson. ‘When they think of research they might think of lab-based work. But PSA is talking about practice-based research for quality improvement. There is a great demand for quality research at the pointy end of improving practice. For instance, pharmacists in general practice is a major issue at the moment. There have been a number of small studies around Australia, but it would be fair to say we probably haven’t had a full, scientific, high-quality study – a randomised controlled study, which we obviously need to do soon.’ Professor Peterson knows about research. He has had more than 470 papers published in refereed international and national journals – his research has received over $38 million of external funds. He has held a personal Chair at the University of Tasmania since 2000 – he was PSA’s Pharmacist of the Year in 2007. All the while he has continued to practice as a pharmacist. ‘Research is about the future,’ he says. ‘Being involved in research will help forge these new roles for pharmacy, particularly for the new graduates and ECPs.’ So we know it’s important for the profession as a whole. The next question some might ask: what’s in it for me? Are we talking extra workload here for no reward? Is this pure altruism? ‘There is a degree of altruism involved, no doubt,’ agrees Professor Peterson. ‘But there is definitely enjoyment there. There can be great satisfaction from studying a particular area and then finding an improvement that you have contributed to. ‘Research can add variety and flavour to a role within pharmacy, particularly if they’re able to do this within their workplace; and if the research is relevant to their practice, there is definitely extra job satisfaction.’ But research can also boost a career and a pharmacist’s profile, particularly in a hospital setting and academia, where published papers are known to influence career progression. While for younger pharmacists, doors open to greater career flexibility if they have some kind of research background. ‘This is what we often tell our students who are looking at doing Honours: having some research experience means they’re more able to then go into other career paths other than community pharmacy. Doors can open,’ says Professor Peterson.
Improving practiceDoes a research background make for better pharmacists? Does it enhance a pharmacist’s clinical skills? ‘Certainly. It’s about teaching analytical thinking,’ says Professor Peterson. ‘Here’s a comparison: I did an MBA a number of years ago. In that case, an MBA gives you generic skills that you can apply towards management issues. In the research area, it develops skills to solve analytical problems. And it also develops your writing skills – your ability to argue a case. Those sort of skills then become very relevant and useful, no matter what pharmacy role you go into. ‘To illustrate, a pharmacy I have a partnership in has recently been able to offer pharmacy services within aged care. I think part of the success there has been our ability to write an evidence-based, robust case for what we would offer. And that sort of skill I am sure comes out of our research background.’ So if research makes for better pharmacists, which personality types among pharmacists make the best researchers? ‘Inquisitive,’ says Professor Peterson. ‘Curious. Most pharmacists probably have those qualities. You hear it said a lot that people choose pharmacy because they are interested in both the health aspects and the science aspects combined in the one degree. I suspect quite a lot of pharmacists have that sort of inquisitive nature, and that very solid scientific base is one of the great strengths of the profession. Pharmacy, compared to some of the other health professions, is still very science-based and underpinned by research. I suspect the bulk of pharmacy people are probably by nature attuned to research if they chose to give it a go.’
Where to startSo picture an early career pharmacist who has completed their degree, maybe completed their Honours, found themselves a position in a community pharmacy – and is just finding out that they are not as challenged as they thought they would be . . . Is this an ideal candidate to get involved? Would research add some extra interest in their professional life? Absolutely, says Professor Peterson. ‘They could get involved in a number of ways. One of the first things I would advise is for them to contact their nearest university with a pharmacy school – and given the number of schools we’ve got now, that generally won’t be too hard. Make an advance with an email or a phone call. Ask to get in touch with someone who’s interested in pharmacy practice research who can advise and mentor them, to help guide their research questions and their planning. ‘It should be straightforward. It’s about seeking assistance from someone who can help guide or mentor the process. It could be that they have contacts – other practitioners who’ve done some research. But either way it’s important they link up with a network. It’s hard to do research on your own, because depending on the type of work there are always issues to deal with. At some point you’re going to come to a crossroad where you’re going to need guidance and collaboration.’
Bring your ideas with youUniversity pharmacy schools are often looking for projects on topics that students could work on, says Professor Peterson. ‘A model that works very well is a student doing the data collection, with the community pharmacist overseeing the project. The university can collaborate, and generally be able to provide guidance from an academic and quite possibly collaboration with a student who’s looking for a project.’ Professor Peterson says this scenario will become more common now as university pharmacy schools are moving towards incorporating Honours degrees within their programs – meaning these universities are on the lookout for these types of smaller, contained, practice-based projects. Which makes it a win-win for everybody. ‘Of course the PSA has those links as well with the universities and know the relevant people to contact,’ says Professor Peterson.
Network, networkCollaboration is the key – and networking is the key to collaboration. PSA conferences, workshops, working groups and other training services are all opportunities to engage with other motivated, energetic pharmacists looking to broaden their skills.
Further resourcesPharmacists in 2023: For patients, for our profession, for Australia’s health system, is available for download at www.psa.org.au/2023plan
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4588 [post_author] => 46 [post_date] => 2019-03-18 08:31:05 [post_date_gmt] => 2019-03-17 22:31:05 [post_content] => The Pharmaceutical Society of Australia’s (PSA) Pharmacists in 2023 report found that the inclusion of pharmacists in healthcare teams will ensure that medicines are used safely and appropriately. But a certain level of investment is required first. Action item three in the report provides a blueprint for including pharmacists at all levels of patient care.
03 Embed pharmacists within healthcare teamsIn a collaborative care team, patients and their healthcare providers work together to achieve optimal health outcomes. The team may be located in the same practice setting and interact closely, or they may work in separate locations but provide care to the same patient. Care providers may also be integrated through the use of digital technologies. These teams have evolved within hospitals over recent decades, with pharmacists recognised as vital to achieve quality prescribing and appropriate medicine administration. Attention must be given to appropriate pharmacy workforce resourcing to allow this pharmacist contribution to be more consistently available.
What has to happenEmbed pharmacists wherever medicines are used, particularly in primary care – general practice, aged care and Aboriginal Community Controlled Health Organisations. Roles for pharmacists include clinical governance activities, patient-level activities and supporting QUM education and training of staff. Increase funding to incentivise and support these primary care roles. Federal Government investment is needed to ensure that pharmacists are included in these settings. A flexible funding pool should be established to support pharmacist activity at the system level of the service provider, as well as establishing fee-for-service models of care that allow the pharmacist to support patient-level activities, such as through the Medicare Benefits Scheme. Increase investment in hospital pharmacist resources to achieve medicine safety targets, and to ensure patients receive comparable access to pharmacist care, regardless of location, timing or nature of their stay. Investment is needed to ensure that all patients received the same level of care.
DOWNLOAD THE REPORTPharmacists in 2023: For patients, for our profession, for Australia’s health system, is available for download at www.psa.org.au/advocacy/working-for-our-profession/pharmacists-in-2023
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4500 [post_author] => 82 [post_date] => 2019-03-12 09:48:00 [post_date_gmt] => 2019-03-11 23:48:00 [post_content] => The Pharmaceutical Society of Australia’s (PSA) two recently released reports, Pharmacists in 2023 and Medicine Safety: Take Care, both identify the need for medicine safety to be a National Health Priority Area (NHPA). But what action needs to be taken to ensure this happens? NHPAs are diseases and conditions that are focused on due to their contribution to the burden of illness, injury and death throughout the nation. Current NHPAs include arthritis and musculoskeletal conditions, asthma, cancer control, cardiovascular health, diabetes mellitus, injury prevention and control, mental health and obesity. In 2007, NHPAs were either associated with or were the underlying cause of 90% of mortalities in Australia. Medicine safety may not yet have the same level of investment or awareness as other critical areas of healthcare, but it should be decreed to be a NHPA, according to PSA President Dr Chris Freeman. Such a move could be justified on the cost to the community alone, said Dr Freeman. ‘Take road safety, for example,’ Dr Freeman said. ‘Injuries are rightly declared a NHPA, yet you’re nearly four times more likely to be admitted to hospital due to a problem with your medicine compared to being in a motor vehicle accident. But we don’t have the same level of investment for medicine safety.’ Awareness and investment in medicine safety will be the key outcomes of the issue becoming a NHPA, along with further research and evaluation, as identified in the Pharmacists in 2023 report. ‘We have significant funds being attributed to medical and health research – we have the National Health and Medical Research (NHMRC) scheme and the Medical Research Future Fund (MRFF), the latter of which has targeted specifically narrow fields of work,’ Dr Freeman said. ‘It’s our view that medicine safety should be a funded research program out of the MRFF so that we can gain better insights into the causes of medicine-related problems and also what innovations we can implement to reduce the burden of medicine-related harm.’
The first stepsAchieving medicine safety means empowering pharmacists to be more accountable for the quality use of medicines, a core component of any pharmacist’s role – whether in community pharmacy, hospital pharmacy or within a government organisation such as the Therapeutic Goods Administration (TGA). But, Dr Freeman said, pharmacists have not been granted the responsibility to lead medicine safety, which is a necessary step forward. Transitions of care is also a key risk area for medicine misadventure. PSA suggests more effort should be invested to allow pharmacists to engage with patients when they are going in and out of hospital, so that medicine errors are less likely to occur with an improved clinical handover process. Workplace reform would help ensure medicine safety is at the forefront of pharmacists’ roles, Dr Freeman said. This includes the implementation of a national reporting system for clinical intervention. The establishment of a coordinated pharmacovigilance program, which would entail the development of national measures around medicine safety, would help to determine if medicine misadventure was improving or getting worse. ‘We believe pharmacovigilance programs should be run in and from community pharmacy. Pharmacists could report medicine events, which can be done now through reporting to the Adverse Drug Reactions Advisory Committee (ADRAC), but a pharmacovigilance program would allow for a more simplified process. Having that data available will give us some understanding of whether the problem is getting better or worse,’ Dr Freeman said.
Decision-makingIn order to make medicine safety a NHPA, action needs to be taken by key stakeholders. These include policy makers from government organisations to set the directive from a top-down approach, but also professional organisations, such as PSA, that are driving forward on behalf of the profession. Individual practitioners and pharmacists, those on the ground, are also vital. This workforce is required to take up the challenge of medicine safety and start running with these programs. ‘I always say that medicine safety is everyone’s responsibility. That includes consumers themselves, and we need to empower consumers to be able to connect with pharmacists who are experts in medicine safety, to have appropriate and in-depth conversations around their medicines. They are then more likely to get the most out of their medicines and to do so in a safe manner,’ Dr Freeman said.
The outcome for pharmacistsIf medicine safety was a National Health Priority, pharmacy practice and interactions would change and improve. ‘We would see a refocusing of our efforts into activities which are centred on medicine safety. Many pharmacists in current practice already have some role in medicine safety, but we really want to bring this to the forefront,’ Dr Freeman said. ‘Pharmacists would be able to make decisions with patients around making their medicines safer. If a pharmacist thinks that a patient is at risk of medicine-related harm, they would be empowered to prevent that from happening,’ he said. ‘The ideal system would be that when a person walks into a community pharmacy, the pharmacist can engage with them about medicine safety and be paid based on the time and complexity of the consultation, rather than just on the provision of the product,’ Dr Freeman said.
Other national health prioritiesA number of things occur when conditions achieve NHPA status, Dr Freeman said. Firstly, there is greater awareness of the disease or problem, which empowers people to consider their own personal circumstances and seek the assistance of a trained healthcare professional to help them. More people will seek help when the awareness is there, he said. For many conditions that are listed as NHPAs, there have been favourable incidence and death rate trends. In cardiovascular health, for example, there has been a decrease in smoking rates, blood pressure levels, contributions of saturated fat to total energy intake, coronary heart disease death rates and stroke death rates. There are also increased identification rates, Dr Freeman said. ‘We know that there are people who might be having these problems, who are not identified, but by bringing these people to the surface, we can actually intervene and help them with that condition.’ When other conditions have been made NHPAs, there are improvements in how those conditions are managed, because there is a focus on them and increased investment for healthcare professionals to intervene, he said. ‘If we are serious about medicine safety, then we need the level of investment commensurate with it being a National Health Priority,’ Dr Freeman said. [post_title] => Making medicine safety a National Health Priority Area [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => medicines-safety-national-health-priority [to_ping] => [pinged] => [post_modified] => 2019-03-13 12:20:15 [post_modified_gmt] => 2019-03-13 02:20:15 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4500 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Making medicine safety a National Health Priority Area [title] => Making medicine safety a National Health Priority Area [href] => https://www.australianpharmacist.com.au/medicines-safety-national-health-priority/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4505 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4507 [post_author] => 74 [post_date] => 2019-03-12 09:47:32 [post_date_gmt] => 2019-03-11 23:47:32 [post_content] => Pharmacists are the healthcare professionals best placed to address the crisis in medicine safety in Australia, and could contribute to cost savings of $1.4 billion per annum, said the Interim CEO of the Pharmaceutical Society of Australia (PSA), Dr Shane Jackson. Dr Jackson was speaking on stage during a panel discussion at the Australian Pharmacy Professional Conference (APP 2019) on the Gold Coast on the subject of ‘Redefining value in the management of chronic disease.’ ‘As we know from the Medicine Safety: Take Care report released by PSA earlier this year, over 600,000 Australians report to hospitals each year because of medicine-related problems, which could be avoided. We’ve got an opportunity to put up our hand and say we can have a greater level of involvement – pharmacists are the best placed to address some of those medicine safety issues and contribute to cost savings to taxpayers of $1.4 billion dollars. ‘It comes back to our Pharmacists in 2023 document, which is about empowering our profession and taking a greater level of responsibility for the safe use of medicines,’ Dr Jackson said. ‘Pharmacists need a structure where we can sit down, if necessary, and solve a patient’s presenting problems – sometimes acutely, but often in a preventive way for that patient. I know we do that every day, but there are challenges in the remuneration structure to incentivise that. ‘We’ve got half the people taking the medicines that they should when they should, and reaching their treatment goals. But if the person is not taking the medicine or is getting side effects from those medicines, then we’re not getting value for money. ‘Medicine adherence and optimisation means making sure that those medicines are reaching the treatment goals that are defined. Otherwise, as a community we are actually not getting the health benefits and the value that we should.’
An extraordinary step forwardDr Jackson reminded delegates of the recent policy advances in the area of chronic disease management as a result of PSA advocacy. ‘One of the opportunities we’ve got for better integration comes with the recent recommendation of the Review Taskforce of the Medicare Benefits Schedule (MBS) – for the first time ever pharmacists have been recommended to be included on the MBS. Dr Jackson said that this major step forward step forward is something PSA has been very much on the front foot with. ‘The recommendations allow us to be involved with case conferencing with the practice nurse and the GP for patients with chronic disease. Importantly, GPs can refer patients to the pharmacist for consultations directed at the health needs of that person. We see this as the first step in the greater recognition of pharmacist’s role in the healthcare system and better integration of those services.’ ‘This is the reason that we train as pharmacists – to deliver that health outcome, to improve the lives of patients,’ said Dr Jackson. ‘It’s about looking into your own heart and saying, “This is why I’m a pharmacist, to use our expertise to deliver the outcome that we know we can deliver”.’ [post_title] => Pharmacists’ true value not yet realised: PSA [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-true-value-realised-psa [to_ping] => [pinged] => [post_modified] => 2019-03-13 12:18:57 [post_modified_gmt] => 2019-03-13 02:18:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4507 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacists’ true value not yet realised: PSA [title] => Pharmacists’ true value not yet realised: PSA [href] => https://www.australianpharmacist.com.au/pharmacists-true-value-realised-psa/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4509 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4625 [post_author] => 76 [post_date] => 2019-03-20 11:49:47 [post_date_gmt] => 2019-03-20 01:49:47 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A recent survey by NPS MedicineWise has found that more than 7 million Australians take some form of complementary medicines every day. Fifty-nine per cent of these people were also found to be taking prescription medicines. In response, NPS MedicineWise is calling for increased consumer education about the possible interactions between complementary and prescription medicines. Pharmacists have a role in reminding consumers that complementary medicines should be taken with care, just like all medicines. In July 2018, NPS MedicineWise surveyed 1,015 adults across Australia about their use of complementary medicines. It revealed that only 20% of Australians never take complementary medicines. In addition, the survey found that about 8 million Australians usually took more than two forms of complementary medicines per week.1 NPS MedicineWise Medical Adviser and general practitioner, Dr Jill Thistlethwaite said, ‘Complementary medicines may not work well with prescription medicines.’ She mentioned that St John’s Wort may interact with some prescribed epilepsy, anticoagulant, and antidepressant medicines increasing the risk of side effects.1 Complementary medicines are listed with the Therapeutic Goods Administration (marked AUST L), but they are not registered (AUST R), indicating that although they are tested for safety and quality, their efficacy is not assessed. NPS MedicineWise Medical Advisor Dr Jeannie Yoo stressed the need for open communication between pharmacists and their consumers. She told Australian Pharmacist, ‘Complementary medicines are certainly a part of daily life or a weekly routine for many people, so all of us as healthcare professionals, whether we’re GPs or pharmacists, need to create an environment where our patients can feel comfortable to talk about the full range of medicines that they’re taking, and not to feel like their health professional will judge them. From there, we are able to guide that person to access reliable sources of information to make sure that they’re not going to come to any harm from taking that medicine.’ Dr Yoo also urged pharmacists to assist consumers who are interested in taking complementary medicines and help them reflect on what kind of benefits they are seeking. ‘It’s really weighing up the evidence of the benefit against what the potential downsides might be, and helping the consumer make the right and safe choice,’ she said. NPS MedicineWise states that the efficacy of some complementary medicines have been tested in good quality scientific trials, but noted that most have not. Complementary medicines undergo less testing than prescription and other medicines available in pharmacies, before they are sold in Australia. Therefore, less is known about their effectiveness, and potential for side effects and interactions.2 One of the six recommendations released for pharmacists by Choosing Wisely, in partnership with PSA, encourages pharmacists to provide consumers with clear information about the safety of and evidence for complementary medicines. Pharmacists are advised to only recommend complementary medicines if there is credible evidence of efficacy and the benefit of use outweighs the risk.3 References:
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- NPS MedicineWise. Complementary medicines – reveal all to your pharmacist to stay safe. 2018. At: www.nps.org.au/media/complementary-medicines-reveal-all-to-your-pharmacist-to-stay-safe
- NPS MedicineWise. Consumer information: Complementary medicines explained. 2016. At: https://nps.org.au/medical-info/consumer-info/complementary-medicines-explained?c=what-are-complementary-medicines-248433bc
- Choosing Wisely Australia. Pharmaceutical Society of Australia: tests, treatments and procedures consumers and clinicians should question. 2018. At: www.choosingwisely.org.au/recommendations/pharmaceutical-society-of-australia
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Can oxybutynin be useful for some patients who are unsuited for hormonal pharmacotherapy?Some people might describe hot flashes as an unannounced and brief feeling of intense heat, with the sensation that their body is on fire and they are about to combust. Hot flashes can last from 30 seconds to a few minutes, and can occur once a day, to much more frequently e.g. every hour. They tend to start as a sudden feeling of heat on the upper chest and face that quickly spreads, and is associated with profuse sweating, flushing and palpitations. This is then sometimes followed by chills and shivering as the body tries to regulate and restore the core temperature. Hot flashes are most commonly experienced by women in menopause (up to 80%), but other medical conditions can be responsible for causing hot flashes e.g. in breast cancer survivors after treatment. Hot flashes are thought to be related to oestrogen withdrawal, leading to a thermoregulatory dysregulation at the hypothalamus – but this only occurs after the person has been exposed to adult levels of oestrogen. Interestingly, low oestrogen alone does not appear sufficient for causing hot _ ashes as these are not experienced by prepubertal girls with low oestrogen levels. As such, hot _ ashes are often managed by administration of oestrogen. However, not everyone can use hormone replacement therapy e.g. women with, or a history of breast cancer. Unfortunately, these women also tend to be more affected by hot _ ashes because they become oestrogen deficient quite abruptly due to chemotherapy causing ovarian failure, or bilateral oophorectomies. Additionally, antioestrogen therapies (e.g. tamoxifen, when used either as treatment, adjuvant or for chemoprophylaxis) can cause hot flashes in many women. Options for non-hormonal pharmacotherapy include low-dose antidepressants (venlafaxine or paroxetine), gabapentin or clonidine. It is not clear why venlafaxine (a serotonin and noradrenaline reuptake inhibitor) and paroxetine (a selective serotonin reuptake inhibitor) help with hot _ ashes. This is also the case with gabapentin, which works by reducing calcium influx and neurotransmitter release by binding to the alpha-2 delta protein subunit of high threshold voltage-dependent calcium channels. There is only limited evidence from short-term studies (<12 weeks) supporting the use of these medicines for reducing the frequency and severity of hot flashes, and more work is needed to better understand their clinical utility. Of the non-hormonal pharmacotherapies, clonidine (a centrally acting agonist at alpha2 adrenoreceptors, and imidazoline receptors) is the only one with a marketed indication for menopausal flushing. However, side effects, limited evidence for efficacy, and the emergence of other non-hormonal pharmacotherapies also limits the usefulness of clonidine. Therefore, the search is still on for non-hormonal pharmacotherapies to help with hot flashes. In trials with oxybutynin for controlling muscle spasms, decreased sweating was noted as a side effect – presumably due to its anticholinergic effects. As such, more work was conducted to explore the usefulness of oxybutynin for hot flashes. Initial studies looked at oxybutynin at doses similar to that used for urinary incontinence, but found many patients discontinued use due to side effects.
TABLE 1. Oxybutynin (oral) dosing information (AMH)
|Urinary urge incontinence||Oral, usual range 2.5–5 mg 2 or 3 times daily; maximum 20 mg daily. For elderly patients, start with 2.5 mg at night; if necessary, increase dose slowly.|
|Hot flashes*||2.5 mg twice daily, with the option of a subsequent increase to 5 mg twice daily.|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4565 [post_author] => 82 [post_date] => 2019-03-15 10:48:31 [post_date_gmt] => 2019-03-15 00:48:31 [post_content] => The National Asthma Council Australia announced a significant update to the Australian Asthma Handbook earlier this month. Known as Handbook version 2.0, it will continue to form the national guidelines for diagnosis and management of asthma in primary care. Key changes in Handbook version 2.0 include a focus on paediatric asthma advice. Guidelines Committee Chair and General Practitioner Professor Amanda Barnard said this is reflective of the different diagnosis and management approaches that are necessary throughout childhood. Professor Barnard said that the development of the severe asthma and management challenges sections of the Handbook provide guidance on the latest advanced treatment options, as well as practical strategies for managing uncontrolled asthma at an individual patient level. Handbook version 2.0 also contains the latest best-practice evidence on primary prevention of asthma, and updated guidance on managing acute asthma in clinical settings. ‘The Handbook is an evidence-based practical resource for GPs, pharmacists and nurses. It supports a team approach to improve asthma outcomes in partnership with patients and their families,’ Professor Barnard said.
Management of asthma in childrenRecommendations on childhood asthma have been separated into two age groups: 1–5 years and six years and over. No specific recommendations are included for children under 12 months due to the low probability of asthma. There has been a reorganisation and update of advice for a stepped approach to adjusting medication in children, including a new table of recommendations for the 1–5 year age group. Terminology to describe symptom patterns in children aged 1–5 has been simplified, and the term ‘multiple-trigger wheeze’ has been removed. Separate classification systems for wheezing disorders (where asthma diagnosis is uncertain) and asthma have been replaced by a single classification system for each age group. These include indications for preventer treatment. New information includes risk factors for life-threatening flare-ups in children and advice on asthma management at the beginning of the school year. There has also been an update of evidence for management guided by various monitoring approaches. Information on medicines used to treat asthma in children has been updated. Cromones are no longer included in main recommendations for preventer therapy. Information has been updated on montelukast, tiotropium, inhaled corticosteroids, inhaled corticosteroid/long-acting beta-2 agonist combinations and short courses of oral corticosteroids for flare-ups.
Primary prevention of asthmaEvidence around risk and protective factors for developing asthma has been updated. This includes risk associated with various exposures e.g. paracetamol exposure in prenatal/early life. There is also updated evidence for the effects of various interventions to prevent asthma, such as the effect of nutrition, restrictive diets in pregnancy, dietary supplementation during pregnancy and in newborns, allergen avoidance, hypoallergenic infant formula and specific allergen immunotherapy.
Severe asthma in adults and adolescentsUpdates include identification of severe asthma, investigations and non-pharmacological strategies (e.g. Cycle of Breathing technique, air temperature control). Information also includes updated evidence for various pharmacological treatments, including monoclonal antibody therapy, and their revised TGA indications and PBS listings. Guidance is provided on prevention of thunderstorm asthma, targeting at-risk people.
Managing acute asthmaUpdated evidence and advice for management of severe or life-threatening asthma includes the use of ipratropium in initial bronchodilator therapy. Criteria for hospital admissions now include risk factors for poor outcomes. Advice on effective transition from hospital to primary care has been revised to include a discharge checklist and interim asthma action plans for children and adults. Other updates include:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4536 [post_author] => 76 [post_date] => 2019-03-14 09:35:32 [post_date_gmt] => 2019-03-13 23:35:32 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Naloxone has long been used by emergency responders in cases of known or suspected opioid overdose. It has been accessible over-the-counter (OTC) in an injectable form since 2016, however, high costs, confidence in administration of injections, lack of awareness amongst at-risk groups, and stock unavailability from pharmacies have been significant barriers to uptake. Now, a new naloxone product in an intranasal form, Nyxoid, is available as an OTC medicine. Federal Minister for Health Greg Hunt announced last year that intranasal naloxone would be made available OTC in pharmacies across Australia.1 Naloxone reverses opioid effects and is used as an emergency rescue treatment for overdoses that manifest as respiratory and/or central nervous system depression.1 The intranasal spray (Nyxoid) contains 1.8 mg naloxone (as 2.2 mg naloxone hydrochloride dihydrate), and presents as a ready-to-use product according to a statement from the manufacturer Mundipharma. Thus, bystanders and first responders can administer the medicine immediately to prevent morbidities and mortalities associated with opioid overdoses.1 ‘In an overdosed patient, respiration is reduced. So the nasal spray squirts out a pre-metered dose, which attaches to the nasal mucosa. No ‘breathing in’ is required, and it’s easy to administer for people unfamiliar with needles or subcutaneous devices,’ Dr Marianne Jauncey, Medical Director at the Sydney Medically Supervised Injecting Centre for UnitingCare NSW/ACT, told Australian Pharmacist. ‘People who are already drug users are generally fine with administering traditional opioid overdose kits. It’s the family members, staff members at facilities, non-medical emergency responders who find syringes threatening and will welcome the nasal spray,’ she said. Administration of intranasal naloxone is not a substitute for emergency medical treatment. A pharmacist supplying the medicine should advise that an emergency medical service should be contacted in conjunction to administering naloxone.1 The OTC availability of the medicine promises to be similarly beneficial. A 2018 report from Penington Institute identified lack of awareness, cost and accessibility of naloxone are still barriers to at-risk people despite rescheduling of the naloxone injections in 2016. It noted that while the medicine is accessible on prescription via the Pharmaceutical Benefits Scheme (PBS) and available OTC at pharmacies, it is often not prescribed to at-risk people. In addition, the significant cost of the OTC medicine and onerous process of accessing it via prescription remain as barriers for those most likely to benefit.2 Lack of awareness and education of the need for naloxone in opioid overdose by at-risk people and those close to them were also identified as significant barriers. Pharmacists have an important role in the promotion of preventable health and harm minimisation, and can facilitate discussions and promote awareness about these programs to at-risk people and other health providers. In addition, they have a role in the education of at-risk people and those close to them on how and when to safely administer naloxone. While the new product increases the availability and usability of the medicine, as identified by the Penington Institute report, cost remains as a barrier to accessing the life-saving medicine. The Penington Institute identified that take-home naloxone is available in other countries at a reduced cost, and is often free.2 It has been reported that in Australia a twin-pack of naloxone (Nyxoid) may retail for approximately $70–85 depending on mark-up. On the other hand injectable naloxone costs between $50–80 OTC, a cost that is reduced to $40.30 with a prescription subsidised by the PBS, and still further for those that hold a health concession card. A proposal has been made by the Penington Institute for ‘kits’ to be made freely available to people at risk of experiencing, or witnessing an overdose, to increase access to this life-saving medicine.2 For further information, education, and practice support tools for pharmacists on the use of naloxone see What Drug-Naloxone. References 1. Mundipharma. Munidpharma welcomes registration of Nyxoid nasal spray for opioid overdose antidote. 2018 At: www.mundipharma.com.au/mundipharma-welcomes-registration-of-nasal-spray-for-opioid-overdose-antidote/ 2. Penington Institute. Saving Lives: Australian naloxone access model. Melbourne: Penington Institute; 2018. At: www.penington.org.au/wp-content/uploads/2018/10/Saving-Lives-Australian-naloxone-access-model.pdf[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Intranasal naloxone spray could reduce opioid-related deaths [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => intranasal-naloxone-spray-could-reduce-opioid-related-deaths [to_ping] => [pinged] => [post_modified] => 2019-03-18 16:11:13 [post_modified_gmt] => 2019-03-18 06:11:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4536 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Intranasal naloxone spray could reduce opioid-related deaths [title] => Intranasal naloxone spray could reduce opioid-related deaths [href] => https://www.australianpharmacist.com.au/intranasal-naloxone-spray-could-reduce-opioid-related-deaths/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4537 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4438 [post_author] => 76 [post_date] => 2019-03-07 11:32:16 [post_date_gmt] => 2019-03-07 01:32:16 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] A new retrospective cohort study has found that self-poisoning, by ingesting psychotropic medicines, in Australian children and adolescents is increasing. The prescribed medicines often used in these self-harm episodes are not recommended for use in children. The study analysed calls taken by NSW and Victorian Poisons Information centres over a period of 11 years (2006-2016). There was a 98% overall increase in the number of intentional poisonings in people aged between five and 19, with females outnumbering males at a ratio of 3:1. The data also revealed that self-poisoning is the most common form of hospitalised self-harm within the study’s target age group.1 They found that from July 2012 to June 2016 the increased rate of psychotropic dispensing in individuals aged 5-14 and 15-19 had ‘substantially’ increased, with a 40% and 35% rise respectively, in prescriptions of selective serotonin reuptake inhibitors (SSRIs). The study indicated that there was a strong correlation between the psychotropics most commonly prescribed and the medicines used in self-harm.1 The substances most often used in self-poisonings include fluoxetine, quetiapine, sertraline and escitalopram as well as paracetamol, ibuprofen, ethanol and paracetamol/opioid combinations.1 The authors conclude that there is a lack of evidence for the efficacy of most psychotropics in this age group and, where possible, medicines that are toxic in overdose (e.g. quetiapine, amisulpride, venlafaxine, citalopram and escitalopram) should be avoided. The results, however, do indicate that prescribers have made some attempt to adhere to guidelines. The most prescribed psychotropic was fluoxetine, which is the first-line treatment for depression in children and adolescents.’1 Researchers suggested a range of reasons for the outcomes of the study, including the influence of marketing on prescribers, and the pervasive impact of social media on youth mental health. However, it was noted that people often self-poison with medicines that are prescribed to them, and that there is ‘little evidence for the efficacy of most psychotropics in this age group.’1 Prescribers were advised to ‘keep medicine supplies to a minimum’ when prescribing psychotropics to patients who might be at risk of self-harm, and monitor signs of anxiety and depression.1 Lead author, Dr Rose Cairns of the University of Sydney’s School of Pharmacy, told Australian Pharmacist that this can be done at an individual level by dispensing smaller, safer quantities of psychotropic drugs to high risk individuals. She noted that this is ‘especially important’ for psychotropics such as tricyclic antidepressants, venlafaxine, citalopram/escitalopram, amisulpride and quetiapine, which are toxic in overdose. She urged community pharmacists to be ‘vigilant [by]... prevent[ing] stockpiling of excess psychotropic medicines.’ The study found that that self-poisonings with over-the-counter (OTC) medicines also occurred in the target age-group– paracetamol and ibuprofen were the top two substances used.1 Dr Cairns said pharmacists have an important role in preventing this. ‘Pharmacists should ensure sale of OTC medicines includes the provision of appropriate assessment and advice. If a healthy looking young person is coming in wanting to buy large quantities of paracetamol, pharmacists should be asking why. Sale of smaller pack sizes reduces the amount a person can take in overdose. In addition, putting large packs of paracetamol in “dump bins” is of concern and the Pharmacy Board of Australia has labelled this inappropriate,’ she said. The study emphasised the importance of understanding the trend, given the evidence that self-poisoning is often an indicator of future suicide attempts. Ultimately, they called for a ‘different approach’ to mental illness, to more effectively meet the needs of a new generation.1 The changing role of pharmacists in mental health could be on the horizon, however. At the Australian Pharmacy Professional Conference (APP 2019) Federal Minister for Health Greg Hunt announced the establishment of a $5 million trial program to allow pharmacists to support of patients living with mental health challenges. References:
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Psychotropic self-poisoning on the rise in youth [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psychotropic-self-poisoning-on-the-rise-in-children-and-adolescents [to_ping] => [pinged] => [post_modified] => 2019-03-13 12:13:23 [post_modified_gmt] => 2019-03-13 02:13:23 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4438 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Psychotropic self-poisoning on the rise in youth [title] => Psychotropic self-poisoning on the rise in youth [href] => https://www.australianpharmacist.com.au/psychotropic-self-poisoning-on-the-rise-in-children-and-adolescents/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4439 )
- Cairns R, Karanges EA, Wong A et al. Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: a population-based retrospective cohort study in Australia. BMJ Open 2019;9(2). At: https://bmjopen.bmj.com/content/9/2/e026001?rss=1
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4455 [post_author] => 20 [post_date] => 2019-03-07 21:35:04 [post_date_gmt] => 2019-03-07 11:35:04 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text] A range of apps enable pharmacists and patients to see and/or manage their medical information. As the benefits of My Health Record (MHR) become more widely known, its uptake and usage can be expected to grow. As pharmacists, we are well positioned to take a leadership role and guide patients on this topic, given our status as the most digitally enabled of all health professionals. It is important for patients who wish to play an active role in their healthcare, or carers of vulnerable patient groups (e.g. children, disabled, elderly, mentally impaired), to understand what information is available to them and how they can access and control access to clinical documents (shared health summary, discharge summary, pathology, diagnostic imaging), prescriptions (prescriptions issued and dispense uploads), consumer documents (patient health summaries, patient notes) and Medicare documents (e.g. immunisation register, organ donor status, Medicare benefits).
How do patients access their MHR?There are two ways for patients to access their My Health Record. 1. WEB PORTAL (myrecord.ehealth.gov.au) This site:
|Using a great smartphone app with your patients? Share your insights with your colleagues. Email firstname.lastname@example.org and tell us about your experience and the results you’ve seen.|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4386 [post_author] => 76 [post_date] => 2019-03-04 09:51:42 [post_date_gmt] => 2019-03-03 23:51:42 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A new MedicineWise program aims to increase the number of patients seeking help for anxiety and other mood disorders by educating healthcare professionals. Anxiety disorders, including panic disorder, agoraphobia, social anxiety disorder and generalised anxiety disorder, are the most common mental health conditions in Australia. According to a 2008 national survey conducted by the Australian Bureau of statistics the conditions affect 14% of people aged 16–85 years. But despite their ubiquity, a study has indicated that it takes Australians between the ages of 18 and 77 an average of 8.2 years to seek treatment for anxiety and mood disorders. Pharmacist, mental health researcher and lecturer at the University of Sydney Dr Claire O’Reilly, told Australian Pharmacist that there are many reasons why patients might delay seeking treatment for anxiety disorders, including a lack of awareness surrounding the condition. ‘The symptoms are a bit varied between the different types of anxiety disorders, so when we talk about anxiety there’s all sorts of different anxiety disorders and there can be a lot of crossover between them,’ she said. ‘But also, we all feel stressed from time-to-time, so the feeling of anxiety is a normal mechanism for us. It’s about being able to recognise when it’s more than that. When it’s more severe and longer lasting, it interferes with your work and your relationships. And I think people aren’t always able to pick that up themselves.’ She said that community pharmacists could play an important role in recognising symptoms of anxiety in their patients, and encourage them to seek specialised treatment. The new program from NPS MedicineWise is based on new clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists, and aims to equip healthcare professionals to perform a similar function by increasing their access to educational tools, including free one-on-one educational visits for GPs, access to a webinar, clinical audit, patient decision aid and other information for health. NPS MedicineWise told Australian Pharmacist that pharmacists working in general practice are invited to attend small group meetings to discuss therapeutic areas, including resources to support patient decision-making around medicines and health technologies. For practices enrolled in MedicineInsight, these facilitated quality improvement meetings that involve all practice staff, including pharmacists, and utilise individualised practice data to support interventions and to improve patient outcomes in general practice. Dr O’Reilly, who has consulted with NPS MedicineWise about the involvement of pharmacists in the program, welcomes educational opportunities for pharmacists in the area of anxiety. ‘I think pharmacists can upskill by learning about psychological therapies so that we’re informed when approaching people about treatment options. Pharmacists don’t necessarily have to be experts in this area, but it’s about having an awareness of the options and knowing where to refer people for help,’ she said. Dr O’Reilly said that education in this area is particularly important given the sensitive nature of mental health. While some patients might already suspect that they are experiencing anxiety, others could be more resistant. In these cases, she advised pharmacists to be aware of patients’ need for privacy, and offer to have a conversation with patients in a private area. She also stressed the importance of having information on hand, such as self-care cards, BeyondBlue information or NPS MedicineWise resources. There are also some PSA State offices that offer Mental Health First Aid courses. References
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Anxiety is often untreated – how pharmacists can help [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => patients-often-dont-seek-treatment-for-anxiety-how-pharmacists-can-help [to_ping] => [pinged] => [post_modified] => 2019-03-07 09:46:53 [post_modified_gmt] => 2019-03-06 23:46:53 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4386 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Anxiety is often untreated – how pharmacists can help [title] => Anxiety is often untreated – how pharmacists can help [href] => https://www.australianpharmacist.com.au/patients-often-dont-seek-treatment-for-anxiety-how-pharmacists-can-help/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4387 )
- Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Media%20Release12007?opendocument&tabname=Summary&prodno=4326.0&issue=2007&num=&view=
- Thompson, A., Issakidis, C., & Hunt, C. Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behaviour Change 2008; 25(2):71–84. At: https://www.cambridge.org/core/journals/behaviour-change/article/delay-to-seek-treatment-for-anxiety-and-mood-disorders-in-an-australian-clinical-sample/9DF8128BE0F802DB0F6D76724FDEA776
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 3685 [post_author] => 76 [post_date] => 2019-01-21 14:45:31 [post_date_gmt] => 2019-01-21 04:45:31 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Psilocybin, a psychoactive compound found in ‘magic mushrooms’, is being trialled in the treatment of terminally ill patients to reduce symptoms of depression and anxiety at Melbourne’s St Vincent’s Hospital. The treatment has proven to be successful in several international clinical trials, including US-based John Hopkins University in 2016 and Imperial College in London in 2017. The St Vincent’s trial, headed by clinical psychologist Dr Margaret Ross, aims to provide relief for terminally ill patients – many of whom suffer from underdiagnosed mental health problems. Major depression in terminally ill patients has been found to be common, ranging from 25% to 77%.1 While depression can diminish quality of life for patients, it has also been associated with a further decline in survival rate and treatment adherence in terminally ill cancer patients. A 2013 study found that about a third of patients with non-small cell lung cancer were suffering from depression. Those patients showed a median overall survival rate of 6.8 months, compared to that in non-depressed patients whose median survival rate was 14 months.2 Researchers from the John Hopkins University trial reported that the compound psilocybin is particularly effective at altering damaging thought processes.3 Serotonergic hallucinogens, including psilocybin (psilocin) and lysergic acid diethylamide (LSD) and mescaline, are a structurally diverse group of compounds that are 5-HT2A receptor agonists. They produce a unique profile of changes in thoughts, perceptions, and emotions.3,4,5 The John Hopkins trial administered psilocybin to cancer patients with a life-threatening diagnosis. Varying doses of psilocybin were given over a period of nine months, with five weeks between sessions. The study found that patients who received high doses of psilocybin (22 or 30 mg) reported decreases in symptoms of depression and anxiety as well as increased quality of life and optimism. Patient reports were echoed by psychiatrists who observed similar results.3 Furthermore, these changes were sustained with 80% of participants continuing to show ‘significant’ decreases in symptoms of depression and anxiety at a six-month follow-up. Similarly, the Imperial College study found patients with severe depression experienced decreased symptoms after they were given two doses of psilocybin, 10 mg and 25 mg respectively, one week apart.3 fMRI scans revealed observable changes in their cognitive functioning. ‘Whole-brain analyses revealed post-treatment decreases in cerebral blood flow (CBF) in the temporal cortex, including the amygdala. Decreased amygdala CBF correlated with reduced depressive symptoms,’ researchers said in the subsequent paper.6 The St Vincent’s trial will commence in April, when a group of 30 patients will be given 25 mg of synthetic psilocybin alongside psychotherapy sessions. ‘We don't want it to be underwhelming, we don't want it to be overwhelming,’ Dr Ross said. ‘We know that higher doses are associated with anxiety but if it's too low a dose you're not really going to experience that psychological shift in the thinking that we're really looking for.’ While more trials need to be conducted, the positive results suggest that with more research, psilocybin could be offered routinely for relief of anxiety and depression in terminally ill patients. References:
[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => How psilocybin can help terminally ill patients [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => psilocybin-help-terminally-ill-patients [to_ping] => [pinged] => [post_modified] => 2019-01-22 16:33:13 [post_modified_gmt] => 2019-01-22 06:33:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=3685 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How psilocybin can help terminally ill patients [title] => How psilocybin can help terminally ill patients [href] => https://www.australianpharmacist.com.au/psilocybin-help-terminally-ill-patients/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 3690 )
- Fine RL. Depression, anxiety, and delirium in the terminally ill patient. Proc (Bayl Univ Med Cent). 2001;14(2):130-3. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/
- Arrieta Ó, Angulo LP, Núñez-Valencia C et al. Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Ann Surg Oncol 2013; 20: 1941-1948. https://doi.org/10.1245/s10434-012-2793-5
- Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D. Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197. https://journals.sagepub.com/doi/full/10.1177/0269881116675513#_i37
- Halberstadt AL. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behav Brain Res 2015; 277: 99–120. At: https://www.sciencedirect.com/science/article/pii/S0166432814004562?via%3Dihub
- Nichols DE. Psychedelics. Pharmacol Rev 2016; 68(2): 264-355 http://pharmrev.aspetjournals.org/content/68/2/264
- Carhart-Harris RL, RosemanL et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific Reports 2017. Epub 2017 October 13: https://www.nature.com/articles/s41598-017-13282-7#article-info
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] => 4119 [post_author] => 11 [post_date] => 2019-02-05 02:01:00 [post_date_gmt] => 2019-02-04 16:01:00 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]The same day Jessica Chapman-Goetz MPS became a registered pharmacist in late 2015 she received a diagnosis for breast cancer. But she wasn’t about to step away from the job she loved, and has come to understand the integral role that pharmacists can play in providing supportive care for oncology patients.
How did you manage your treatment while working as an early career pharmacist?It certainly wasn’t easy, but I made a decision that I wanted to try and limit the impact that breast cancer was going to have on my life. So I would organise treatment on a Friday afternoon, try to be back at work (at TerryWhite Chemmart Grange, in South Australia) by Tuesday, and then I was able to work full-time for about two and a half weeks before the next round of treatment. It was important for my mental health to work during treatment and be surrounded by my co-workers and beautiful community.
In what ways did your personal experience inform how you approach oncology care with patients?As a patient I was observing what information was given at different stages and who provided it. I noticed that quite a lot was lacking. I also noticed that a lot of women were using online breast cancer forums to ask about the management of common chemotherapy adverse effects, and often the answers were not evidence-based. That prompted me to investigate how pharmacists feel about providing supportive care in the community for oncology patients. I found that a lot of community pharmacists feel a bit apprehensive about it because they’re not sure exactly what treatment the person is on, or what it’s for. They more commonly refer to a GP because they feel more comfortable doing so than, say, managing basic mucositis themselves.
You said you noticed that quite a lot was lacking in terms of information. How can pharmacists help fill the gap?Pharmacists can help make sure patients are getting information as they go through their journey, rather than all at once at the time of diagnosis, which is what commonly happens. Along the way, pharmacists can provide support and prompts by saying, ‘Okay, how is your mental health going? Have you thought about calling Cancer Council for services there? How are you going with side effects?’ Also, check what medicine information the oncology team has given the patient and, if there are gaps, offer to provide education from resources like EviQ (www.eviq.org.au). I didn’t receive anything from my oncology unit in terms of printed medication lists, and I know many other patients haven’t either.
What role could pharmacists be playing in assisting with treatment?The biggest gap would be managing what would be termed ‘minor’ adverse effects from chemotherapy, whether it’s oral or intravenous. Often the oncology patient will feel like it’s too minor to bother the oncologist, or they’ll call the oncology nurse which takes them away from caring for inpatients. But often these minor adverse effects are something a pharmacist could really assist with. If patients aren’t managing side effects such as small mouth ulcers, they can progress to the point where they can’t eat. And if you’re having multiple side effects at one time it really doesn’t take much for you to feel like everything’s too much. So pharmacists can make a big difference.
You’re now working as a hospital pharmacist at Flinders Medical Centre in Adelaide, but you’re continuing to explore ways of improving care for oncology patients. How?I’ve done the Cancer Pharmacists Group Foundation Course with the Clinical Oncology Society of Australia (COSA). I could do stage two, which would make it easier for me to work in hospital oncology, but at the moment I don’t know that I want to do it full-time – it’s still a little bit close to home. Instead I’m really enjoying empowering other pharmacists to provide supportive oncology care. I started off with a presentation here in Adelaide just with some peers. I’ve also spoken in Whyalla, Alice Springs and Darwin, and I’m going to be presenting at the TerryWhite Chemmart masterclass in April. I’ve also established connections with the Cancer Council to increase pharmacist involvement in allied healthcare for oncology patients. Photography: Simon Casson [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Inside oncology pharmacy [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => ready-inside-story-oncology-pharmacy [to_ping] => [pinged] => [post_modified] => 2019-02-05 15:01:26 [post_modified_gmt] => 2019-02-05 05:01:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4119 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Inside oncology pharmacy [title] => Inside oncology pharmacy [href] => https://www.australianpharmacist.com.au/ready-inside-story-oncology-pharmacy/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4190 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4122 [post_author] => 11 [post_date] => 2019-02-01 02:05:24 [post_date_gmt] => 2019-01-31 16:05:24 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]It took a trip to Canada, but Danielle Bancroft MPS went from community pharmacist to Product Manager and User Experience (UX) Designer at Fred IT Group. We spoke to the self-described ‘tech ninja’ about her unconventional career pathway.
You hold a Bachelor of Pharmaceutical Science and a Masters of Pharmacy. How did you end up in the tech world?After university I was working as a locum pharmacist and my brother and I were discussing moving to Canada. So I did the qualification exam to work there as a pharmacist, but then I was short on money. I thought I’d get some extra cash working part time and saw an advertisement for a software company support team role for people with healthcare industry experience. During the interview they put a piece of XML (a computer and website coding language) in front of me. I had never studied technology but I noticed the pattern looked like a prescription. That got me the role! On my first day I discovered we were working on a new e-prescriptions program.
At what point did you decide to pursue UX more seriously?I worked at that software company for three years and then I got a role at FRED, where I worked in the eRx script exchange team as a product specialist. But I wanted to understand more about the software we were building, not just the business side, so I decided to do a diploma of software development. Through that I got to understand more about UX design – where you actually look at how a user interacts with your products – and human-centred design. I really grew a passion for it.
You’ve been at FRED seven years now. What has satisfied you the most?Being involved in delivering real-time prescription monitoring in Victoria through SafeScript. It’s really satisfying not only to see my workflows in design and production, but also to hear feedback from practitioners and the community that this product actually does save lives.
What’s the most challenging thing you face day-to-day?The software industry is undergoing continual change and improvement. So the biggest challenge is making sure you’re not only planning for what’s next, but you’re making sure you don’t lose sight of continually evolving and improving current products and customer experience.
What do you wish you’d known earlier in your career?That you don’t need to have technology knowledge, or be some super computer nerd, to be successful in this industry. As pharmacists, you already have the core soft skills – you analyse on a daily basis, problem solve, you’re constantly looking at outcomes and how to better improve them.
A DAY IN THE LIFE of Danielle Bancroft MPS, Product Manager and User Experience Designer Fred IT Group, Victoria
8.30 am: The working day beginsArrive at work at the office in Abbotsford, consume first coffee of the day, go through emails.
9.00 am: Where it’s atAttend daily product stand-ups with development team. Stand-ups are progress meetings – they’re a good opportunity to hear what everyone is working on and if there are any blockers or issues.
10.30 am: Teamwork, teamworkThen it’s teleconferences or status meetings with external customers, project teams or internal project teams. We discuss where the current work is at, any new requirements, upcoming workshops, and demonstrate work and functionality of projects we’ve built so far. Consume second coffee!
12.00 pm: Head downTime to concentrate on design. I work through user experience research and customer journeys, translate user workflows and mock up potential screen designs. More emails. Third coffee.
2.00 pm: Go with the flowI either attend various internal and external meetings, head out on site to review prototypes, gather new ideas and feedback, or attend workshops with customers and stakeholders. When not in meetings, I prioritise product backlogs, ensure the team is on track to deliver work, and keep product roadmaps up to date.
5.00 pm: Getting it doneIf there’s urgent work I like to stay back. Otherwise I often head out to a design meetup or an industry-related workgroup.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 4116 [post_author] => 130 [post_date] => 2019-02-01 01:55:16 [post_date_gmt] => 2019-01-31 15:55:16 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]A key tenet of PSA’s strategic intent is ensuring pharmacists are rewarded and recognised to reflect our high levels of training, our expertise and our contribution to the health system. I know many pharmacists are greatly dissatisfied with how their efforts in improving patient care are currently recognised. Role fulfilment and acknowledgment of our integral place within the healthcare team are important, but many believe pharmacist remuneration is key to increasing professional satisfaction. The funding frameworks used to remunerate pharmacist practice are largely governed by the Community Pharmacy Agreement (CPA). If individual pharmacist remuneration is to increase, we must seek an improvement in the application of the funding within the CPA to ensure a services or consultation model of pharmacy practice is worthy of genuine commitment by the community pharmacy sector. But the CPA should not be seen as the only funding source; we must also look to diversify. The Medicare Benefits Schedule (MBS) presents an obvious funding pool which currently not only finances the services delivered by medical practitioners but an array of nursing and allied health practitioners. Many PSA members have been perplexed and disappointed that pharmacists have not been included through this mechanism. Given the funding freezes and relative low base of reimbursement, the MBS is no silver bullet. But it is a logical adjunct to the CPA. The current review of the MBS provides a unique opportunity to drive this agenda. If we, as a profession, are to make claims of remuneration for services under the MBS, then we need to be specific about what this model might look like, what services should be funded, and how the health system will benefit from this investment. PSA has written to the MBS Review Taskforce, again calling for inclusion of pharmacists as eligible allied health professionals to access MBS items as part of Team Care Arrangements within Chronic Disease Management (CDM) items. We remain highly concerned that pharmacists continue to be the only AHPRA-registered allied health professionals who are not eligible to provide allied health services through the CDM services. This exclusion causes major problems with integration and collaboration in primary care. Given the central role of medicines in the treatment of these patients, this exclusion doesn’t make sense, with the potential for sub-optimal health outcomes. Inclusion of pharmacists (irrespective of setting) as eligible allied health professionals would have minimal, if any, impact on the budget for those MBS items, as GPs can only refer up to a maximum of five items within a 12-month period. But the inclusion of pharmacists as eligible allied health professionals would enable greater flexibility for the GP to engage with pharmacists to support patients with their chronic disease management. Let me be clear: PSA is strongly advocating for inclusion of pharmacists on the MBS. It has been one of our major priorities in 2018, and continues to be so. PSA is highly concerned that pharmacists continue to be the only AHPRA-registered allied health professionals who are not eligible. DR CHRIS FREEMAN FPS BPharm, GDipClinPharm, PhD, AACPA, AdvPracPharm, BCACP, MAICD [/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => From the President: Include pharmacists on the Medicare Benefits Schedule [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacists-medicare-benefits-schedule [to_ping] => [pinged] => [post_modified] => 2019-02-14 09:17:29 [post_modified_gmt] => 2019-02-13 23:17:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=4116 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => From the President: Include pharmacists on the Medicare Benefits Schedule [title] => From the President: Include pharmacists on the Medicare Benefits Schedule [href] => https://www.australianpharmacist.com.au/pharmacists-medicare-benefits-schedule/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 4117 )
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 )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.