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Regular updates from the global world of pharmacy.
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Consumer welfare program or small business support program?
This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.
"Exergames", like Nintendo Wii, are usually designed for fun, recreation and exercise.
However, they are gradually being transformed into tools to treat depression, assist in stroke rehabilitation and improve mental health-related quality of life.
Currently researchers are exploring the potential of "exergames" to reduce the risk of falls in older adults.
When people walk through their own environment they may be subjected to an occasional "trip" or "slip" that could result in a fall if people are unable to make an adjustment to quickly and accurately to recover their balance.
Stepping is something that few of us think about, yet our ability to step declines with age, increasing our risk of having a fall.
Now the same exergames are set to become medical tools linked to a range of health programs, hopefully connected to the National Broadband Network.
It struck me that this may represent an opportunity for pharmacists to be involved in the supply of this type of equipment and assist in the training and supervision of patients involved in this evolving list of programs.
It also provides a link with aged care and community nursing and may provide a useful service in a pharmacy-style walk-in clinic, providing pharmacists with a "hands on" entry point to patient care.
This lack of "hands on" activity often sees pharmacists ignored in the primary health care practice activities.
The American poet Robert Frost did not have the Pharmacy Guild in mind when he wrote this incisive poem, but I think the decision-makers at the Guild need to read it.
It may help them understand the far-reaching consequences of the choices they are making today.
Frost describes walking through a wood and coming to a fork in the road. He contemplates the two. One seems to be a little more worn, probably the more popular choice. The other is a little more grassy, chosen less often. Neither path showed signs of recent travellers. Frost chooses the less worn road knowing he will never be able to reverse this seemingly trivial decision. He knows that the rest of his life is irreversibly impacted by this simple choice. His history can never be re-written.
Pharmacy, in general. is a destination point for illness.
It has yet to spark consumer interest in the broad concept of wellness, and this is where consumer concerns are being increasingly directed.
An interest in "wellness" used to be something exotic. And to the extent consumers gave any thought to the concept, it was often defined simply as the absence of illness. But "wellness" is now very much a mainstream preoccupation, and one that's viewed more broadly as a marker for quality of life. A report released this month by The Hartman Group, a US-based consultancy/research firm that has made a specialty of analyzing attitudes and behaviors in this area, took a detailed look at what wellness now means to various consumer cohorts and how this affects their engagement with products and services, especially foods.
One only has to look at the Woolworths logo to realise how seriously wellness is being taken in Australia and why that organisation wants to create a health and wellness environment plus leverage the pharmacy destination point of illness.
This would create a model with a strong holistic image, attractive to a majority of consumers.
The National Institute of Complementary Medicine (NICM) is an organisation established to provide leadership and support for strategically directed research into complementary medicine, and the translation of that evidence into clinical practice and relevant policy, to benefit the health of all Australians.
It is an organisation that generates much needed credibility for the complementary medicine area and will do much to temper improper use of these medicines and moderate unwarranted criticism.
Polarisation of these two extremes has occurred, generating confusion among health providers.
For the last decade, Australians have been talking about their average age increasing, to the extent that at least 25% of the population will be over the age of 64 within twenty years.
With that increase in age comes an increase in lifestyle illness and the need to invest in aged care facilities and to provide funding for medicines on the PBS that will increasingly be utilised.
It seems demand will outstrip available resources.
But another social/ethical issue accompanies the ageing process and lifestyle illness, and that is quality of life.
What purpose is there to living a long life if it has no quality or becomes too unbearable and draining for the individual and their surrounding family?
So when somebody decides they wish to die ahead of schedule because of unbearable pain and suffering they suddenly find that right has been taken away from them by politicians.
Euthanasia is a subject that has been kept under the radar for a long time but containment now appears impractical as evidence of suffering will simply increase with the volume of aged persons.
Walk-in clinics in pharmacy is an idea that is now gaining traction around the world.
Long established in the US, they are now appearing in the UK - with one great difference - the UK model is staffed mostly by pharmacists with only a small number of nurse-led clinics.
All are funded by government.
If this type of clinic was to gain sufficient traction in Australia, plus receive government funding, an easing of the oversupply of pharmacists in some parts of Australia would possibly result, as well as ease pressure on GP's.
Boots, a chain pharmacy group in the UK is providing walk-in services during extended hours to ease pressure on GPs and hospitals.
Pharmacists at a Boots store in Edinburgh have started to provide walk-in services during extended opening hours this month as part of the Pharmore pilot project funded by the Scottish Government.
It's really just a more professional and properly resourced version of the old style counter prescribing, but this time in privacy, plus being paid for the service.
Dr Deanna D'Alessandro has been recognised for her promising research into climate change.
A University of Sydney researcher has won recognition for her groundbreaking work into capturing carbon emissions, which has the potential to significantly impact climate change.
Dr Deanna D'Alessandro, a postdoctoral fellow based in the School of Chemistry, is one of three female researchers to be awarded a L'Oréal Australia For Women in Science Fellowship.
Deakin University medical researchers are working on a treatment for cancer cachexia, the debilitating weight loss and muscle wasting condition that affects patients with cancer.
Cancer cachexia has a major impact on quality of life for cancer patients. It can also inhibit the effectiveness of cancer treatments such as chemotherapy and radiotherapy.
There is currently no effective treatment.
University of Queensland and Deakin University researchers have released a report with dozens of recommendations that strongly support more spending on prevention, but also warn that not all prevention measures are wise investments.
The Assessing Cost Effectiveness of Prevention (ACE-Prevention) project is the result of five years of research, funded by the National Health and Medical Research Council.
It is believed to be the most comprehensive evaluation of health prevention measures ever conducted world-wide, involving input from 130 top health experts.
Jonathan Penm, a PhD candidate at the Faculty of Pharmacy has just been awarded the Young Pharmacists Group (YPG) Grant for Professional Innovation 2010.
The announcement was made by the International Pharmaceutical Federation (FIP) Board of Directors during the 70th FIP World Congress of Pharmacy /Pharmaceutical Sciences in Lisbon, Portugal, which ran from 28th August to the 2nd September 2010.
Australian scientists, in association with US pharmaceutical company DiaKine Therapeutics, have shown that a drug candidate, Lisofylline, could be useful in treating Type 2 diabetes.
Drs Georgia Frangioudakis and Carsten Schmitz-Peiffer from Sydney’s Garvan Institute of Medical Research, tested the anti-inflammatory drug which is undergoing clinical trials for other diseases, on mice being fed high-fat diets.
Their findings are published in the journal Endocrinology, now online.
Mobile technology is advancing at a rapid pace and mobile phones in particular are now beginning to overtake fixed landline phones.
Some technology companies are now providing physical platforms to handle both mobile phone calls and fixed landline calls in a more integrated fashion, distributing all calls throughout the home or office using "hands free" extension phones.
The new platforms include other applications such as electronic diaries, Internet connection, Facebook and other social media extensions, weather displays, latest news displays, personal or other photo albums - the list is becoming very extensive.
Health technology developers now need to factor this expanding "tool" into their various architectures to ensure that they too are able to "keep in touch".
The mobile phone is now cemented into all age demographics, including "seniors", where it is regarded as an essential tool for keeping in touch with family and friends, and more importantly, for connection to their health professionals for emergencies.
I also notice that health professionals, particularly GP's and dentists, are using the telephone to remind patients of their appointments, usually a day or so in advance.
Health telephone systems need to become more intuitive to handle emergencies to bypass the normal blockages to a health practitioner in the event of an emergency.
A recent survey published in Retail Clinician indicates to what extent consumers would currently engage in an integrated and interactive system.
MIMS Australia and IMgateway recently signed a Memorandum of Understanding (MoU) with the intention of delivering a unique Australian developed, evidence based drug-herb interactions database directly to a healthcare professional's desk top.
This database has been developed by researchers from the Faculty of Pharmacy at The University of Sydney.
The objective of WHO and health partners in Pakistan is to reduce avoidable death and illness
In a massive health relief effort underway in the flood-affected parts of Pakistan, nearly six million people have been treated for health conditions since the floods began in late July; but there are urgent needs to prevent further health crises or food insecurity caused by large-scale damage to crops and agricultural land.
"Increasing cases of communicable diseases, like diarrhoea and malaria, fears about children being malnourished, the massive disruption to healthcare, crop systems and rising food insecurity are the main health threats facing Pakistan's flood-affected people," says Dr Guido Sabatinelli, WHO's Representative to Pakistan.
Children affected by serious diseases and medical conditions either personally or in their families often don't really understand those illnesses or the treatments required to fight them. New Zealand-based Kidzcomics aims to change all that with a series of comic books designed to explain medical information for children.
The Medikidz series features five superheroes by the same name, each of them a specialist in a different part of the body. With stories designed to be fun and appealing, the comics aim to entertain as well as educate children about serious medical issues. Conditions covered in the Medikidz line so far include leukemia, epilepsy, diabetes, HIV and ADHD, among many others; rather than “sugar-coating” the topics, Kidzcomics' books aim to empower and educate children for better self-management and less fear. All content is written by professional medical writers and doctors and then peer-reviewed.
And while the comics attract children they also serve to educate parents who sneak the occasional look.
There are currently more than 50 million children afflicted by illness in English-speaking countries.
A team led by a North Carolina State University researcher has shown that water-gel-based solar devices – “artificial leaves” – can act like solar cells to produce electricity.
The findings prove the concept for making solar cells that more closely mimic nature.
They also have the potential to be less expensive and more environmentally friendly than the current standard-bearer: silicon-based solar cells.
A message delivered to delegates attending the International Pharmacy Federation (FIP) Congress in Lisbon Portugal was for pharmacists to explore new horizons.
One can sense and appreciate this message because pharmacy does seem to be stuck in a time warp without a unified sense of purpose for the future.
Our two major peak bodies, the PSA and the PGA have not closely worked together, with open warfare being declared on occasions.
There does not yet seem to be a coherent positive theme running from either organisation that the "troops" can align with, although there are signs of positivity developing in PSA and a slightly lesser aggressive stance being taken by PGA.
But what's on your horizon and what is your future vision?
To help kick off a discussion, i2P asked Mark Coleman to comment on the media item reported in Pharmacy News on the 31 August 2010
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.
For more information please contact Katie Butt, NPS Media Adviser, 02 8217 8667 or firstname.lastname@example.org
The National Prescribing Service (NPS) is a valued independent resource for accurate, evidence-based prescribing information and education.
24 August 2010
Independent reviews of new type 2 diabetes medicines help people be medicinewise
People with type 2 diabetes can find independent reviews of two new blood glucose lowering medicines in the latest edition of Medicine Update, a newsletter published by NPS – better choices, better health. NPS (formerly known as the National Prescribing Service) is an independent organisation that enables people to be medicinewise.
The reviews of Januvia (sitagliptin) and Galvus (vildagliptin) outline who the medicines are suitable for, how they work and ways in which they differ from existing medicines for type 2 diabetes. Both articles also discuss possible side effects of these and other medicines for diabetes.
Karen Kaye, acting CEO of NPS, says anyone with type 2 diabetes who is considering one of these new medicines should read the Medicine Update before having a discussion with their doctor.
“Medicine Update provides people with an independent clinical review of new medicines in a language they can understand. It outlines clearly what people need to consider before starting these medicines and how the medicines differ from existing medicine choices,” Ms Kaye said.
“The medicines you take for your diabetes may change over time. For example, you might only need a single tablet to control your blood glucose initially, but diabetes tends to get worse as you get older. At some point your doctor may recommend that you take more than one type of tablet, or that you take insulin, or a combination of tablets and insulin. Each medicine will work in a different way to control your blood glucose level.”
Both Januvia (sitagliptin) and Galvus (vildagliptin) are relatively new medicines available in tablet form. They can be used by people with type 2 diabetes whose blood glucose cannot be controlled effectively with certain other medicines. Neither medicine is designed to be taken on its own – you will need to continue taking your other diabetes medicine too.
Although both medicines have been through the required clinical trials and have been shown to lower blood glucose, they are quite new so it is not yet known if they can reduce the long term complications of diabetes.
“Before starting any new medicine talk to your doctor and pharmacist about how they work, potential side effects and whether it is definitely the best medicine for you. Educate yourself about your medicine options so you can have a well-informed discussion with your health professionals and be an active partner in your own health care,” Ms Kaye said.
To view the full reviews go to www.nps.org.au/medicineupdate
4 August 2010
Gliptins and Adrenaline autoinjector reviewed in latest edition of NPS RADAR
NPS RADAR is a timely publication containing independent, evidence-based assessments of new drugs, new PBS listings and the latest research for doctors, pharmacists and other health professionals.
The following medicines are reviewed in the latest edition:
Sitagliptin (Januvia) and vildagliptin (Galvus) are two drugs from a relatively new class of dipeptidyl peptidase-4 (DPP-4) inhibitors - or ‘gliptins’. Vildagliptin (Galvus) is available on the PBS from 1 August.
Before prescribing these medicines doctors should consider the following:
Adrenaline autoinjector (Anapen)
Anapen is a new autoinjector for the emergency treatment of anaphylaxis. Prior to its listing there was only one form of adrenaline autoinjector – the Epipen brand.
Before prescribing Anapen, doctors should note that Anapen has a substantially different administration technique to that of EpiPen, but has a clinically equivalent effect. Due to the potential for confusion when administering adrenaline in an emergency, patients and carers including schools need to be aware of the differences between the two devices.
Brief reviews of the following medicines are also in this edition of NPS RADAR:
v Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies
v Colchicine for acute gout: updated information about dosing and drug interactions
v PBS listing of extended-release pramipexole (Sifrol ER) for Parkinson’s disease
v Anakinra (Kineret) to be deleted from the PBS
v Exenatide (Byetta): first in another new class of diabetes drugs
To read the full reviews go to www.nps.org.au/radar
2 August 2010
Question mark over combination pain relief products
Codeine is a weak opioid used in many combination pain relief products, but its role in managing acute pain is questioned in this month’s edition of Australian Prescriber.
In the article Dr Bridin Murnion, from the Drug Health Service at Royal Prince Alfred Hospital Sydney, discusses the evidence around combinations of different painkillers in the same tablet (eg. ibuprofen or paracetamol with codeine). She argues that in many cases pain relief is not increased by using two different painkillers.
“Codeine is often an ingredient in combination painkillers, however there is not much evidence for its effectiveness and the role of codeine in managing acute pain is unclear,” says Dr Murnion.
NPS’s review of evidence shows that studies in acute pain suggest only modest additional pain relief is achieved when codeine is added to paracetamol, and the risk of side effects increases after repeated doses.
As an opioid, codeine can be addictive. When people take it in higher doses than recommended, they are also taking high doses of the other pain relief ingredients, paracetamol or ibuprofen, and it’s these ingredients which, when misused, can cause serious adverse events such as stomach and liver damage.
A National Health and Medical Research Council review found insufficient evidence to recommend the use of paracetamol/codeine combinations in acute low back pain, acute neck pain, acute shoulder pain or acute knee pain.
“For dental pain, the most effective approach is to undertake appropriate dental treatment. After dental extraction, anti-inflammatory medications are better than combinations of paracetamol and codeine,” Dr Murnion advises.
While there is a significant body of evidence identifying the efficacy of NSAIDs (e.g. ibuprofen, aspirin, diclofenac) in acute pain, there are limited data on combining them with opioids.
“Many anti-inflammatory drugs are more effective than combinations of codeine with paracetamol or aspirin,” she writes.
Dr Murnion says the recent rescheduling of these products is unlikely to impact significantly on people’s pain relief options but may reduce the harms from overuse.
These findings are in line with NPS reviews of evidence that show when treating acute pain, only modest additional pain relief is achieved when codeine is added to other analgesics.
“As a weak opioid, codeine can be addictive but because it can’t be purchased without either paracetamol, aspirin or ibuprofen, people end up consuming more than they need of these products too,” NPS acting CEO, Karen Kaye said.
“Taking more than the recommended maximum amount of these products can result in serious side effects. Overuse or misuse of products containing aspirin or ibuprofen can result in gastric ulcer perforation, or in products containing paracetmol, liver toxicity or death.”
“The recent rescheduling of these products ensures people using these products will get the professional advice from a pharmacist and addictions will be identified.”
To view the full article go to www.australianprescriber.comReturn to home