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Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.
In the April edition of i2P, a story involving the ministerial removal of pharmacy location rules was published.
It involved a disparate group of Colac residents coming together to fight the location rules and to establish a third independent pharmacy.
The story was important for a number of important reasons:
(i) The Colac residents did not want a "chain-type" pharmacy.
(ii) They wanted true competition between local pharmacies to avoid a perceived monopoly.
(iii) They wanted good old-fashioned pharmacy personalised service in an appropriate time frame.
As pharmacists we often bemoan the spectre of "Colesworth" providing pharmacy services and the potential for them to strip personalised service out of the independent pharmacy environment.
Yet the existing Colac pharmacies (having the same owner) did exactly that.
The question I pose is if this is the direction of pharmacy (as formulated by the PGA supply side pharmacy and warehouse-type pharmacies) the Colac community have clearly demonstrated that those models are not the preferred version.
i2P asked Jeanette Sell to tell her story in her own words.
Health Reform? Is that what we have been given by COAG: I don’t think so at all. It is wrong from the get go. In that 60% will come from here; 30% will be taken away from there; 40% will be paid by them and we will layer some more highly experienced and very necessary bureaucrats on the top to make sure no one ever knows what is actually going on.
Same old, same old, just tarted up differently so the punters think something is happening.
Health Reform it aren’t. Pretending to reform hospital funding it is.
Not a word about technology, e-health, savings, over-staffing of suits in place of white coats and blue blouses, blame shifting, waste, incompetence and all the other ills that riddle the hospital operational (non-clinical related) networks.
And there are enough ills for a zillion hypochondriacs to wallow in. Just this past week I had occasion to sample it first hand with a relative that needed emergency attention. The ambulance picked her up at 6:55 pm, after just a ten minute wait. We arrived at the hospital about the same time as the ambulance at 7:15 pm.
So far so good.
On July 1 2006, the Federal Government reduced the pharmacy wholesaling margin from 10% to 7%. This action was an outcome of the Government’s negotiations with the Pharmacy Guild as these two parties hammered out the 5 year deal that was the Fourth Community Pharmacy Agreement (4CPA).
To put this change into today’s context, Sigma’s wholesaling business turned over around $2.4 billion in the last twelve months.
If 70% of this turnover is generated by dispensary medicines, and if 65% of these are PBS items, then the 4CPA pulled about $33 million in revenues off Sigma’s top line in today’s dollars.
Living in outback Queensland, especially during the long periods of drought, the elderly grazier has struggled from day-to-day to keep his cattle property going.
He had only been 12 years old when his father died, but with the Second World War still raging, and with no men available, the local police officer had issued him with a drivers licence and told him to go home to help his mother run the property.
That had been the end of his schooling and to this day, he can still barely read and write.
Tasmanian pharmacists now have access to the Pharmacists’ Support Service (PSS), developed by the Victorian PSA.
It can be contacted by phone on the toll free number: 1300 244 910.
Consumers and the Australian Government are paying up to 10 times more for generic cholesterol-lowering drugs compared to the United Kingdom, according to research carried out by health economists at the University of Sydney.
A recent study published by the Medical Journal of Australia (MJA) found Australia could have saved approximately $900 million on statin treatments (drugs used to lower cholesterol) over the past four years and could save up to an additional $3.2 billion over the next 10 years.
Pharmacy designers in Australia have yet to come up with a zero emission pharmacy building, but they will have a model t draw from in the form of an AusZEH private home, designed and built by CSIRO.
Designed to fit the Australian climate – and the lifestyle of a typical middle-income family – Australia's first Zero Emission House (AusZEH) has been officially opened in Melbourne.
Working with industry partners Delfin-Lend Lease and the Henley Property Group, and supported by the AusZEH consortium, CSIRO designed and built the demonstration house 30 kilometres north of Melbourne’s CBD, in the community of Laurimar in Doreen, Victoria.
The eight-star energy-efficiency rated AusZEH showcases off-the-shelf building and renewable energy-generation technologies, and new future-ready energy management systems.
Nearly 13 per cent of Australia’s greenhouse gas emissions are due to home energy use.
With the changes occurring restricting the sale of analgesic products within pharmacies, there has not been a great deal of discussion as to how best to handle these changes.
It has been said that the new processes impact severely on the pharmacist’s workflow.
The analgesic market is a very large one within pharmacy and the ability to lose a major income stream is very real.
The following is a press release from the PSA and we have asked Mark Coleman to comment on the various issues:
Regular information provided by NPS – Better choices, better health - NPS enables people to be medicinewise.
The National Prescribing Service (NPS) is a valued independent resource for accurate, evidence-based prescribing information and education. Given the marketing pressures applied by global drug companies, NPS plays a vital and unique role across the healthcare sector.
The National Prescribing Service (NPS) is a valued independent resource for accurate, evidence-based prescribing information and education.
Given the marketing pressures applied by global drug companies, NPS plays a vital and unique role across the healthcare sector.
27 April 2010
Health professionals reminded of importance of reporting adverse events
Doctors, pharmacists and nurses are reminded of the importance of accurately reporting adverse medicine events and ways to do so following an increase of consumer reports to the Adverse Medicine Events line about the seasonal flu vaccine.
The Adverse Medicines Events (AME) phone line, funded by the National Prescribing Service, has had a spike in calls since Friday from parents whose children have experienced illnesses after having the seasonal flu vaccine.
“Reporting adverse events is a vital part of post-marketing surveillance of any new medicine in determining its safety and efficacy in the community,” NPS CEO Dr Lynn Weekes said.
“Health professionals have a duty of care to report suspected reactions to new medicines and vaccines as this is the only way in which information can be accurately collected and used in the interest of public health,” Dr Weekes said.
Health professionals can report adverse drug reactions to the TGA via the adverse drug reaction reporting system website or the TGA blue card. Adverse events relating to vaccines can also be reported via State health departments. The AME phone line is available for consumers to report adverse events.
It is particularly important health professionals record as much information as possible for the adverse event report, including batch numbers, which helps authorities determine whether cases are isolated or there is a wide-spread issue.
“It is normal for there to be a sudden spike in consumer reports about a product when it has received negative media attention. While the number of calls about the seasonal flu vaccine has decreased in the last 24 hours, health professionals should remain alert to patient concerns about possible reactions to the vaccine and continue to report suspected cases,” Dr Weekes said.
27 April 2010
Study identifies key prescribing software features that impact patient safety
A study by the National Prescribing Service (NPS) into how electronic software can impact prescribing practice has identified a list of key features that contribute to safe medicines use and patient safety.
Published in the online journal, BMC Medical Informatics & Decision Making, the study discusses the importance of appropriate features in electronic prescribing software and offers a list of key features to guide vendors.
“Most GPs in Australia use electronic prescribing software however there are no standards or guidelines for features of these systems. This makes it difficult for vendors to know what should be included and can have a big impact on the safe and effective use of medicines,” NPS CEO Dr Lynn Weekes said.
This study builds on past research conducted by NPS into decision support alerts and contributes a valuable body of knowledge to the e-health sector.
“If implemented across all software programs, the key features identified in the study are likely to increase patient safety and improve prescribing practice. In the absence of national standards we believe this list could be used as a basis for software standards and guidance for software vendors,” Dr Weekes said.
The study was done with input from NEHTA, the Australian Commission on Safety and Quality in Health Care (ACSQHC), the Medical Software Industry Association (MSIA), RACGP, software vendors and a number of prescribers, health informaticians and consumers.
To determine the most important features, a review panel rated 114 different software features by expected impact across four domains - patient safety, quality of care, usefulness to the clinician and usefulness to the patient. While all 114 features were rated as having a positive impact on at least one domain, 27 features were found to have a high impact on three or all domains.
“The key features identified range from warnings when a medicine is prescribed and the patient has a contraindication to that medicine, to clearer designs, and automatic medicines lists that can be printed for each patient with clear instructions and dose information,” Dr Weekes said.
“Most of these functions seem simple but when you consider the potential impact they can have they become very important.”
The second stage of this study, which includes an analysis of the features of individual software systems used in Australia, will be published later this year.
26 April 2010
Codeine changes will help identify patients in pain
Changes to the scheduling of codeine-based analgesics will help doctors, pharmacists and nurses identify patients who need more support to manage their pain, according to the National Prescribing Service (NPS).
From Saturday 1 May combination analgesics containing codeine (e.g. Nurofen Plus, Panadeine) will be rescheduled to S3 (Pharmacist Only) and come in five-day quantities.
NPS CEO Dr Lynn Weekes says consumers with chronic pain are being urged to speak to their doctor or pharmacist about how the changes will affect them and whether they should begin or revise a pain management plan.
“A number of people who suffer chronic pain caused by arthritis and serious injuries turn to combination analgesics to manage break-through pain, but for various reasons don’t tell their doctor or pharmacist,” Dr Weekes said.
“These scheduling changes mean people who use these products frequently will need to speak to their doctor about alternative options or see their pharmacist more regularly.”
“Both doctors and pharmacists will have opportunities to discuss long-term pain management options with patients and assist with management plans including the use of non-drug therapies.”
The current scheduling of codeine-based analgesics has enabled people to intentionally and unintentionally misuse these products, resulting in serious health implications.
High doses of pain relief containing codeine can result in dependence on codeine, as well as overuse of the analgesic components, resulting in liver toxicity and death (paracetamol combinations) or gastric ulcer perforation (ibuprofen and aspirin combinations).
Research conducted by Arthritis NSW in 2007 found 79% of respondents who said they were taking over-the-counter anti-inflammatory medicines (2650 people) had been doing so for more than two years.
“Up to 10% of Australians don’t actually experience an analgesic effect from codeine as they lack the enzyme that converts it in the body, yet there are people who have been using these products without realising they contain codeine or the possible implications,” Dr Weekes said.
“Pharmacists and doctors need to use this opportunity to talk to patients about managing pain, and help them understand the active ingredient and the product/s most suitable for their personal circumstance.”
For more information about codeine go to www.nps.org.au/news_and_media/position_statements/codeine
20 April 2010
Invitation to attend the National Medicines Symposium 2010
Where: Melbourne Conference and Exhibition Centre, Melbourne, Australia
When: Thursday and Friday, 27-28 May 2010
The biennial National Medicines Symposium, hosted by the National Prescribing Service, is on again and we would love to see you there.
The National Medicines Symposium is unique forum that brings together everyone involved with medicines use including doctors, pharmacists, nurses, specialists, policy makers, academics and international experts.
It transcends industry silos and provides those working at the coalface the opportunity to share expertise, experience and opinion, and benefit from discussion with industry peers.
The theme of NMS 2010 is Medicines in people’s lives, which enables us to address medicines use issues in the wider context of changes within the health sector, including reforms and new prescribers.
NMS 2010 will include a number of panel sessions with key opinion leaders addressing political issues, as well as in-depth clinical presentations from leading clinicians and academics.
Speakers will be available for interviews after their presentations in the designated media room.
For a list of the speakers please see the program available at www.nms2010.org.au
Journalists interested in attending the Symposium can contact Katie Butt, NPS Media Adviser, to arrange free registration.
Phone: 02 8217 8667
8 April 2010
New program to identify at-risk smokers and help them quit
Approximately two-thirds of Australia’s 4 million smokers are currently considering quitting smoking, but some people need a little extra support to maintain a cessation program and quit for good.
The latest education program from the National Prescribing Service (NPS) assists doctors and pharmacists to identify patients who may be ready to quit smoking – especially those with chronic obstructive pulmonary disease (COPD) – and develop effective, tailored smoking cessation programs for them.
“Smoking is the largest single preventable cause of death and disease in Australia,” NPS senior clinical adviser, Judith Mackson said.
“While many people have tried to give up at some point, attempts to quit are more likely to succeed if coupled with the right information, products and support.”
“Even if patients haven’t indicated they want to quit smoking, health professionals have a responsibility to discuss smoking cessation as you are in a position to prompt people to begin a serious cessation program.”
According to research from the NSW Cancer Institute, the number of smokers seeking advice about quitting from GPs and pharmacists has doubled since 2007.
“Health concerns are often the reason why people decide to quit smoking. This is particularly compelling for people with COPD, yet approximately one in six COPD patients continues to smoke,” Ms Mackson said.
The NPS therapeutic program Smoking cessation and managing stable chronic obstructive pulmonary disease encourages health professionals to:
Discuss smoking cessation with all patients who smoke, particularly those with COPD
Determine intention to quit and level of nicotine dependence to tailor smoking cessation strategies
Discuss the patient’s preference for nicotine replacement therapy (NRT), varenicline or bupropion if a pharmacotherapy is most suitable
Use spirometry to confirm COPD diagnosis and assess severity
Start therapy with an inhaled short-acting bronchodilator and regularly review inhaler technique
Refer early for pulmonary rehabilitation to improve symptoms and quality of life.
As part of the therapeutic program the following resources and activities have been developed for doctors, pharmacists and nurses:
For further information visit www.nps.org.au/health_professionals
6 April 2010
April edition of NPS RADAR out now
Written by the National Prescribing Service, RADAR provides independent, evidence-based assessments of new drugs, new PBS listings and the latest research for doctors, pharmacists and other health professionals.
The April issue of RADAR provides in depth reviews on the following PBS-listed medicines:
Dabigatran (Pradaxa) for preventing venous thromboembolism after hip or knee replacement surgery
Nebivolol (Nebilet) for chronic heart failure
Methylnaltrexone injection (Relistor) for opioid-induced constipation in palliative care
Additional reviews are also provided on:
Rizatriptan (Maxalt) 10 mg wafers for migraine and revised listings for other 5HT1 agonists ('triptans')
Albendazole (Zentel) listing extended to treat hookworm and strongyloidiasis
· Post-marketing reports of acute pancreatitis with sitagliptin products (Janumet, Januvia)
Authority listing for terbinafine extended to children and adolescents
Extended PBS listings for zoledronic acid 5mg (Aclasta)
For a full copy of RADAR go to www.nps.org.au/radar.
6 April 2010
H1N1, renal bone disease and oral anticoagulants
The April edition of Australian Prescriber is out now and looks at topical issues including:
H1N1 immunisation – too much too soon?
Professor Peter Collignon, Director of the Infectious Diseases Unit and Microbiology Department at the Canberra Hospital, discusses mass immunisation programs.
Management of renal bone disease
Dr Darren Roberts and Dr Richard Singer of the Renal unit at the Canberra Hospital outline the systemic complications of renal bone disease, which can be minimised through careful prescribing of drugs and dialysis to achieve specific biochemical targets. The authors recommend early referral to a nephrologist for monitoring, treatment and early diet advice.
New oral anticoagulant drugs
In 2008, two new oral anticoagulant drugs were registered in Australia for the prevention of venous thrombosis after elective knee or hip replacement. Dr Timothy Brighton,haematologist at Prince of Wales Hospital, Sydney, compares the mechanisms of rivaroxaban and dabigatran etexilate and discusses their potential advantages over heparin and warfarin. Alex Gallus, Professor of Haematology at Flinders University, Adelaide, analyses the clinical applications of the two drugs.
Medicines Safety Update (which has replaced the Australian Adverse Drug Reactions Bulletin)
Provides information about the safety of fish oil and omega-3 fatty acids.
For full copies of these and other articles, visit www.australianprescriber.com.
NPS News #67
The April edition of NPS News covers COPD and smoking cessation. To view the full publication visit www.nps.org.au/nps_news
Media enquiries to Katie Butt, NPS Media Adviser, 02 8217 8667 or firstname.lastname@example.org
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