Welcome to the August 2011 edition of i2P- Information to Pharmacists.
Direct distribution by pharmaceutical manufacturers is back in the news once more.
This disruptive attack on an efficient community pharmacy business model must be checked before it gets too far out of hand.
Neil Retallick discusses some of the issues as does Mark Coleman in the Pharmedia section of i2P.
Read and see what you can do to help.
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Regular weekly updates that supplement the regular monthly homepage edition of i2P.
Access and click on the title links that are illustrated.
A range of global and local news snippets and links that may be of interest to readers.
Pipeline Extra simply broadens the range of topics that can be concentrated in one delivery of i2P to your desktop.
Pfizer is working hard to improve its direct supply model, but no matter how efficient it becomes, it will still wreak havoc in community pharmacies.
It is almost a case of the more effective Pfizer’s logistics become, the more damage their direct supply model will inflict on community pharmacies.
The issue here has never been whether or not Pfizer can supply the right drugs at the right time to the right place.
If they lack the will to make this happen, there is a multitude of logistics experts that can help them achieve efficient supply.
Recent relaxation of order cut-off times is an indicator that Pfizer wants their model to be accepted by pharmacists and is willing to make concessions to meet their needs.
New parents are congregating at alternative practitioner clinics for after-hours 'information' seminars, eager to learn anything they can do to improve their families health and wellbeing. Seniors and major illness patients are attending meetings to learn how to better manage their illnesses. But what advice are they being given and why is their local pharmacist not there to support them?
People want to feel they are in control of their health. When they are told about a lecture on lifestyle and health education, they will turn up in droves to listen to what their friendly neighbourhood natural therapist has to say.
First came the randomised controlled trial1,which linked calcium supplementation with vascular events, then there was a meta-analysis linking calcium with cardiovascular events2 and then a further confirmatory meta-analysis of calcium plus Vitamin D and using individual patient data.3
The conclusions were reasonably secure that calcium supplements are likely to increase the risk of a cardiovascular event. It is now advised that people obtain their calcium intake by dietary means – which is feasible even for those who do not consume a lot of dairy products. General practitioners have now stopped prescribing calcium, leaving me confused as to what arguments are being used by the community pharmacists who continue to sell the calcium supplements.
Through the 5th Community Pharmacy Agreement hospital initiated HMRs will now be available for high-risk patients recently discharged from hospital. This is an important step in addressing the fact that patients recently discharged from hospital are at risk of medication misadventure. The question I would like to raise is who is best placed to undertake these HMRs. The traditional model of HMR referral has been through a General Practitioner (GP) to the consumer’s community pharmacy. Under this model the HMR may be undertaken by an accredited pharmacist directly involved with or employed by the community pharmacy or be outsourced to an independent accredited pharmacist. Under the 5th Community Pharmacy Agreement this model has now been modified to enable direct referral from a GP to an accredited pharmacist and also direct referral from a hospital based medical practitioner for a newly discharged patient. The traditional model will continue in tandem with this new model.Comments: 2
We've reached a point in our country's history where authority and power seem to be manifested by the need to shout down the other person. Discussion and compromise are words freely bandied about, but they've largely lost their meaning.
What is really lost is perspective.
Just as there are two (or more) sides to every story, there are plenty of different ideas on how to get things done. No one person has a corner on that market.
I’ve been thinking about baseball, movies, ambiguous bar codes, and the FDA.
On June 26, 1974, New York Yankee All-Star Derek Jeter was born, two-time Academy Award winner Elizabeth Taylor divorced (for the fifth time), and Sharon Buchanan, a young grocery clerk in Troy, Ohio, was the first ever to ring up a retail purchase by scanning a bar code. On the same day in 2011, I drove from Arlington, Virginia, to Silver Spring, Maryland, to meet with people at the FDA to talk about the future of bar-code labeling on drug packaging.
There are more shocks and economic pain on the near-term horizon for taxpayers, small business owners and corporations.
This is a key finding of an extensive and intensive strategic analysis undertaken by Barry Urquhart, Managing Director of Marketing Focus, who will deliver a keynote address on the analysis at the forthcoming annual national conference for the Australian Mining and Exploration Companies Association.
Among the significant points which have been identified are: -
AUSTRALIA'S OWN SILICON VALLEY
"Wealth....Innovation. Creativity. Originality. Dynamism. Growth. Capital. Technology."
Silicon Valley is both a name and locality known throughout the world and is synonymous with each of the above listed attributes. It means and is perceived to be many things to many people.
Since the 1960's Silicon Valley has been the birthplace of many scenario changes, iconic products, services, concepts and business entities. In itself it is a magnet which attracts some of the world's brightest, most enterprising, free thinking and driven entrepreneurs.
The Federal and State governments, in Washington DC and California, have welcomed, encouraged and supported investment in countless large and small, established and start-up businesses to enable them to blossom and to create wealth, employment, education and opportunities.
Financial injections and tax relief/incentives have been provided in abundance.
Everyone, it seems, is a winner.
Over the years I've asked a lot of people what makes a great salesperson, and the answers are fairly predictable: passion; persistence; personality/likeability; planning; trustworthiness; strong work ethic; drive/initiative; quick learner; goal-oriented; good communications skills; sense of humor; humility; good timing; strong at building relationships; and follow-up (or as I say, the sale begins when the customer says yes).
My own answer is always the same: hungry fighter. In many ways, that is the embodiment of all of the above traits.
Politicians in the UK are starting to wake up to the fact that their Department of Health is unable to deliver its electronic care records system, after investing 2.7 billion pounds sterling in the project without being able to demonstrate a single benefit of the system.
The project has suffered from the same problems that have beset a similar Australian project being developed by the National e-Health Transition Authority (NEHTA).
It is now recognised that the pitfalls and waste might have been avoided in the UK had they consulted a range of health professionals before starting the project.
It seems the National Health and Medical Research Council (NHMRC) is likely to follow the lead of the UK and denounce homeopathy as an ineffective and unethical therapy that shouldn’t attract scarce government research funds.
This is within the remit of the NHMRC’s role to provide health advice to clinicians and the Australian public. But the NHMRC also funds the majority of health and medical research in Australia.
And this dual role means the NHMRC – or those looking to it for guidance – may look unfavourably at funding any research involving homoeopathy.
Homeophathy has its shortcomings but researchers still have a lot to learn from studying this practice.
United States Secretary of State, Hillary Clinton has acknowledged Monash University researchers for a life-saving new drug concept at the Saving Lives at Birth global challenge forum held yesterday in Washington DC.
Following the forum, at which Monash University researcher Dr Michelle McIntosh spoke, the research team received funding to engineer a drug that could save the lives of mothers of newborn children in developing countries.
The University of Queensland is preparing for an increased uptake in post-graduate legal courses as lawyers, consultants and accountants prepare to implement the Government's carbon tax scheme, due to take effect in July 2012.
Head of the TC Beirne School of Law Professor Ross Grantham said he expected a significant demand for specialist skills in areas such as consumer law, contracts, taxation, climate change and policy, and mining and offshore resources law.
A medicine designed to improve levels of 'good' cholesterol may also help control blood sugar in people with diabetes who are taking cholesterol-lowering drugs, according to a recently published study in Circulation: Journal of the American Heart Association.
The study, led by the University of Sydney's Professor Philip Barter, made the finding while analysing data from a clinical trial on the drug torcetrapib. Torcetrapib is a cholesterol ester transfer protein (CETP) inhibitor, a type of drug that increases levels of high-density lipoproteins (HDLs, or 'good' cholesterol).
A $100,000 Microsoft fellowship awarded to a lecturer leading the University of Sydney in the emerging field of bioelectronics will accelerate the development of electrical devices used to diagnose and monitor stroke and cardiovascular disease.
Macquarie University's innovative Indigenous Science Education Program has been recognised with an Australian Learning and Teaching Council (ALTC) Award for Programs that Enhance Learning.
The Indigenous Science Education Program (ISEP) works with Casino, Lismore and Maclean High Schools in northern NSW and Chifley College in Western Sydney and has its origins in requests for help from Aboriginal Elders in addressing the poor completion rate of secondary education by their Indigenous youth.
Residents of the West Pilbara will soon have better access to GPs and allied health professionals following the signing of a $7 million agreement with the Pilbara Health Network for a GP Super Clinic to operate in Karratha.
Acting Minister for Health and Ageing, Mark Butler, today welcomed the signing of the $7 million agreement as a welcome boost to health care in West Pilbara.
“This GP Super Clinic will deliver better access to health services for locals in a single, convenient location,” Mr Butler said.
Sleep apnoea patients who are successfully treated have lower blood fat levels and a reduced risk of heart attack than people who are left untreated, University of Sydney researchers have found.
Sleep apnoea, a condition in which people stop breathing momentarily while sleeping, affects up to 20 percent of the population. The researchers found treatment with a continuous positive airway pressure (CPAP) device reduced post-meal blood fat (triglyceride) levels.
Moves to prevent the lifestyle risks of chronic disease in Australia have been boosted with the creation of an expert Advisory Council for the Australian National Preventive Health Agency.
Acting Minister for Health and Ageing Mark Butler today welcomed the appointment of 10 expert members to a new advisory council for the Agency in another significant step forward for national health reform.
Nearly 3000 blind and partially-sighted New Zealanders could be suffering from undiagnosed sleep timing disorders according to a recent study from The University of Auckland.
The study, which was undertaken in conjunction with the Royal New Zealand Foundation of the Blind (RNZFB), was recently published in the journal PLosOne. It looked at self-reported sleep habits, sleep disruptions and medication use in people completely blind in one or both eyes; partially-sighted and fully-sighted.
While some people may feel anxious about their body's condition as they age, US academician Professor Michael Rose has no qualms about it; claiming once individuals reach their 90s their bodies stop ageing.
According to Professor Rose, who is an expert in evolutionary biology, “if you are lucky enough to live that long, you stop ageing”.
To reach this point, he suggests adopting a 'stone age' diet when you hit 30 years of age.
Commercial viability of high-value macroalgal (seaweed) bioproducts for human health is a step closer with a research collaboration between Flinders University biotechnologists and Australian Kelp Products.
Under the agreement, Flinders researchers will trial new processes developed at the University to create products for the food, nutraceutical and cosmeceutical industries.
These include marine sugars refined from seaweed that can have applications in anti-viral pharmaceuticals, functional cosmetics, and environmentally friendly agricultural pesticides and fertiliser.
On behalf of the pharmacy profession of Australia, the Pharmacists’ Support Service (PSS) is pleased to announce that financial support for pharmacists affected by the floods, via the funds raised by the joint Pharmacists’ Support Service Inc and Pharmaceutical Society of Australia flood appeal, has now been distributed. A total of 18 pharmacists were provided with financial assistance which was generously donated by their pharmacy colleagues from around Australia.
Editor’s Note: It was expected that other manufacturers would consider a direct distribution model after Pfizer had initiated a system that when developed, would appear to have most of the “bugs” knocked out of it.
The “who” and the “when” would then be the only unanswered questions.
i2P has covered a lot of the earlier discussion regarding this industry-changing decision, and in light of recent commentary, i2P has asked Mark Coleman to give us an update.
His comments appear below the media item in brown text published recently in Pharmacy News.
Regular information provided by NPS – Better choices, better health - NPS enables people to be medicinewise.
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 Lisa Chikarovski, NPS Media Adviser on or firstname.lastname@example.org
NPS is a valued independent resource for accurate, evidence-based prescribing information and education.
20 JULY 2011
NEW INFORMATION ON VARENICLINE (CHAMPIX) INCONCLUSIVE: NPS
Uncertainty remains despite new research published this month linking a smoking-cessation medicine to an increased risk of heart attacks, according to NPS.
The research, published in the Canadian Medical Association Journal, suggests that the smoking cessation medicine varenicline (Champix) is linked to a small increase in the risk of serious cardiovascular events, such as heart attacks.
NPS Clinical Adviser Dr Danielle Stowasser says that although the new research found a greater rate of serious cardiovascular events with varenicline than with a placebo, there is still some uncertainty about what this means for people taking the medicine.
“Weaknesses of the study make it hard to determine whether varenicline caused the cardiovascular events and also the true size of any increased risk,” said Dr Stowasser.
“It’s important to note that the reported increased risk of experiencing a cardiovascular event for people taking varenicline needs to be weighed up against the cardiovascular benefits of quitting smoking.”
Smoking is a major risk factor for cardiovascular disease, and quitting smoking is one of the most important things people can do to reduce that risk.
“Effective methods of quitting smoking are available and include other medicines and non-drug options such as counselling support. People who are concerned about varenicline may wish to talk to their doctor about alternatives to continue their quitting efforts,” said Dr Stowasser.
NPS monitors issues with medicines through the calls made to its phone line services, and the NPS Medicines Line received 54 calls about varenicline over the past 12 months on a range of issues, very few of which concerned cardiovascular side effects. The Adverse Medicine Events (AME) Line had not received any reports from consumers of cardiovascular side effects with varenicline up to June 2011.
“Varenicline is a relatively new medicine and its full range of adverse effects is becoming clearer with time,” said Dr Stowasser.
“When starting a new medicine, people should report any new symptoms to their health professional. People taking varenicline should see a doctor immediately if they experience new or worsening symptoms of cardiovascular disease, such as chest pain, shortness of breath or trouble breathing, or pain in the legs when walking.”
NPS is currently assessing the cardiovascular event data for varenicline in light of the new information, and subscribers to our regular health professionals newsletter about new medicines, NPS RADAR, will be notified of any updates. Consumers can subscribe to Medicine Update to receive updates.
Resources for health professionals:
· Health professionals can subscribe to RADAR to be notified of any updates on varenicline: http://www.nps.org.au/health_professionals/publications/nps_radar
· Health professionals can report side effects via the TGA: http://www.tga.gov.au/hp/problem-report-howto.htm
· Health professionals can access a guide to medicines information resources on the NPS website at: http://www.nps.org.au/health_professionals/guide_to_medicines_information_resources
Resources for your patients:
· To report and discuss side effects that might be related to their medicine, your patients can call the Adverse Medicine Events (AME) Line on 1300 134 237. The side effects — but not personal details — are reported to the TGA.
· For more information about varenicline, your patients can call the Medicines Line on 1300 MEDICINE (1300 633 424).
· For help with quitting smoking, your patients can call the Quitline on 137 848.
19 JULY 2011
MANAGING THOSE AT RISK OF OSTEOPOROTIC FRACTURES: NEW NPS CLINICAL AUDIT
GPs and GP registrars can now participate in the latest NPS clinical audit on reducing the risk of osteoporotic fractures and falls.
Building on the recent NPS therapeutic program, Reducing osteoporotic fracture risk and building healthy bones, this clinical audit provides information and guidance on how to manage those most at risk of osteoporotic fractures.
To take part in the audit, GPs are only required to review ten patients aged 50 years or over with associated risk factors.
“By participating in this clinical audit GPs will start thinking more broadly about osteoporotic fractures and falls, and consider whether aspects such as medicines, lifestyle factors or other medical conditions may be contributing to increased fracture risk,” said NPS clinical adviser, Dr Danielle Stowasser.
Studies show that in Australia, between 70% and 80% of people with osteoporotic fractures remain undiagnosed and untreated.
“This NPS audit provides a structure by which GPs can review management of their patients with, or at risk of, osteoporotic fractures and falls and monitor their progress as part of a continuous cycle of quality improvement,” said Dr Stowasser.
Participation in this clinical audit assists GPs to be confident in:
· Assessing multiple risk factors to determine overall fracture and falls risk
· Managing modifiable risk factors, including adequate physical activity, calcium, vitamin D and falls reduction strategies.
· Treating those at high risk by considering primary and secondary prevention of osteoporotic fracture.
· Assessing and promoting adherence to drug and non-drug interventions.
To assess overall fracture risk, GPs can take advantage of two freely available and validated internet-based fracture risk calculators: the WHO fracture risk assessment tool, FRAX®, accessible at sheffield.ac.uk/FRAX/tool.jsp?country=31 and the Garvan Institute Fracture Risk Calculator, accessible at garvan.org.au/bone-fracture-risk/
NPS clinical audits are free quality improvement activities that can be done independently using the evidence-based clinical guidance provided. Following submission, GPs receive individualised feedback and comparison with peers along with expert commentary.
“NPS clinical audits continue to positively influence GP prescribing habits to be more in line with best practice guidelines, ultimately providing better health outcomes for many Australians,” Dr Stowasser said.
This clinical audit has been approved by the RACGP Quality Improvement & Continuing Professional Development Program for 40 Category 1 points and by the ACRRM Professional Development Program for 30 PRPD Points. It is also a recognised activity for the Quality Prescribing Initiative of the Practice Incentives Program in the current year (May 2011 to April 2012).
Enrolments are open now until 12 August 2011. Completed audit forms must be submitted before 9 September 2011. To enrol visit www.nps.org.au/osteporosis_enrol
To view the range of new and existing clinical audits from NPS visit www.nps.org.au/clinical_audit
or for more information contact Joanne Zeilinga on (02) 8217 8700 or email email@example.com
4 JULY 2011
MAKE YOUR SMART PHONE A WISE PHONE – GET THE NPS MEDICINES LIST IPHONE APP
If your patient loves their iPhone and regularly takes medicines then they’ll also love the brand new NPS Medicines List iPhone app, now available for free from iTunes. For those caring for a relative, or those who just can’t remember those long names and impossible strengths, the app will be a game changer.
The app is currently ranking as the number one medical app on iTunes Australia. It will allow your patients to be medicinewise by tracking the brand, active ingredient, strength and dosage of their medicines, including prescription, over-the-counter and complementary medicines.
The launch of the app represents the first NPS initiative in the area of smartphone application development and has already been downloaded by more than 2000 people since it went up on the iTunes site in mid June.
NPS clinical adviser Dr Danielle Stowasser says people who take one or more medicines often struggle to keep track of what they are taking and the important details that they need to tell their health care providers. Not having this information at hand can sometimes lead to missing a dose, accidentally taking a double dose, interactions with other medicines or forgetting to finish a course of medicines.
“Very few people can remember the name of their active ingredient, regular brand, or the number of milligrams they need to take – all essential information for healthcare providers when managing a patient’s care in the long term,” said Dr Stowasser.
“We know that the more people know about their medicines, the more confident they are to talk about their options with their prescriber or pharmacist, and that helps people get the most benefit from their medicines.”
The new Medicines List iPhone app provides a way for people to keep this essential information on hand. There are also other features of the app that enable people to:
- Keep photos of medicines, packaging and dispensing labels
- Track any changes to a medicine regimen using the change log
- Export and print or email a copy of their medicine list and change log to discuss with their doctor or pharmacist
- Save personal details and health professionals’ contact details
- Note questions to discuss at the next medical appointment.
“Health professionals can help their patients be medicinewise by encouraging them to download the Medicines List app and recording their medicine details or those of the person they are caring for,” said Dr Stowasser.
“We hope the app will help people avoid medicine mix-ups and reduce brand confusion, and also trigger better-informed conversations with doctors and pharmacists.”
The Medicines List app was developed with assistance from Creative Licence Digital, a Sydney-based mobile applications development house. NPS is currently welcoming feedback on the app from health professionals via the NPS website, to guide future developments.
A second version is scheduled to be released in the coming months and will be available automatically to those who have already downloaded the app. The second version will include the ability to set reminders so the patient can be alerted when a medicine dose is due.
You can preview the NPS app and download it for free from iTunes (you will need to have the iTunes software installed on your computer first), or from the App Store on your iPhone, iPod Touch or iPad. For a link to the app in the iTunes store, tips and videos about how to get the best from the app visit the NPS website: www.nps.org.auReturn to home