Welcome to the July edition of i2P, and of course, the first week of the new financial year.
Note that we are developing a new range of categories for you to follow e.g. health politics, hospital news, an expanded IT offer and we will be developing the category of anti-ageing medicine
Also, out of interest, could I refer you to the e-publications category located immediately below our columnists. If you click on the link contained there, you will find a range of e-publications that are recommended reading.
The first publication noted is the Pharmacist Activist written by Dr Daniel A. Hussar of the faculty of the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He is a pharmacy advocate.
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The ubiquitous Mrs Wright, in her quest to unearth a new erotic shopping experience, ushered this writer to a new Coles store located at the all very nice and leafy suburb of Ivanhoe in Melbourne recently.
This is contemporary retailing at its best, no doubt influenced by the gurus at Westfarmers and the rapidly changing retail climate in Australia, which of course involves the future of Pharmacy in some way….but more about Pharmacy later.
I read some market research recently that ought to concern community pharmacists across the country, as well as the Pharmacy Guild of Australia.
Groups of average Australians were brought together for a series of focus groups to discuss the community pharmacy landscape as they see it.
Some of the feedback was disconcerting.
Some twenty years ago uneasy tremors were running through hospital pharmacy here in Perth. Hospital management had suggested to one of my fellow Chief Pharmacists that the hospital needed a total parenteral and intravenous additive service (IVAS) .
When it was pointed out that this would be very labour intensive and the pharmacy did not have sufficient staff to provide it, the comment was that “nurses would be happy to run such a service”.
In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.
Disgraceful – discuss
The newspapers have been chock-a-block the past few days with dire tales but true about the black hole we are about to enter with the insane policy to re-regulate the ‘workplace’ to suit the union paymaster cliques.
While I never voted for Keating I did admire him a little bit this morning when I read a quote of his from the bad old days.
He said to some union goose: “you are carrying the jobs of (100,000) dead men around your shoulders”.
Giving a dead hand to this union unfettered power play will ensure that the nation will soon look like NSW; where the government is actually the plaything of a few loosely combined public ‘service’ union mugs.
Depending on how large your pharmacy is, in terms of overall staffing, you will soon be touched by the coming dead hand of the new/old order.
The recent furore in the UK over pharmacist Elizabeth Lee receiving a conviction for a criminal offence and subsequently a suspended jail sentence, has really lit a fire under the imbalances that exist when a pharmacy dispensing error is made.
The dispensing pharmacist or the supervising pharmacist under current UK legislation, has been made to bear the brunt of legal responsibility, with pharmacy owners escaping with little pain.
According to an article in PJ Online "In many cases, all that the employer needs to establish is that he had standard operating procedures in place and that the employee or locum had simply not complied with them. In these cases, the employer can walk away leaving the employee or locum to face the, often damaging, consequences".
There is now a rush in the UK to have current legislation amended to reflect a more proportionate responsibility for all parties involved.
The appointment for the first time of a Minister for Indigenous, Rural and Regional Health and Regional Service Delivery is an important strategic recognition of the special needs and circumstances facing people in Australia's rural and remote communities.
People in the bush will expect this position to be part of a permanent increase in the Government's commitment to rural communities.
In welcoming Minister Warren Snowdon to the new position, Dr Jenny May, Chairperson of the National Rural Health Alliance (NRHA), said the appointment will be important both for substantive policy reasons and to boost the place of rural issues on the political agenda.
The following news item was recently published in Science Alert. It would seem that the pristine environment of New Zealand is under attack. The reasons are similar to those findings in Australia surrounding the protection of the Great Barrier Reef.
A new "fertility first" hypothesis published this week by a group of international experts in the American Journal of Human Biology, proposes that the global epidemic of Type 2 diabetes has its origins in the struggle, over millennia, to sustain human fertility in environments defined by famine.
A surprising and important implication for us in the modern world is that this hypothesis gives cause for optimism that the modern epidemics of diabetes and cardiovascular disease will diminish.
Source: Sydney University
A team of Monash University researchers has discovered the importance of a protein, which could improve the way the drug interferon is used to strengthen the human immune system.
Published online in the prestigious journal Immunity, the findings show that the protein promyelocytic leukemia zinc finger (PLZF) is a key player in the body's immune response to disease, increasing our understanding of the function of the immune system.(Source: Science Alert )
China is notable for its authoritarian approach to the Internet and other forms of media communications.
Restrictions on Internet activity may have some long-term implications for Australia, particularly as these restrictions are intruding into the health arena.
Little thought seems to have occurred in maintaining and supporting mature aged pharmacists in the workplace.
Given that this group of pharmacists is the one with the "corporate memory" of the profession, with many having started life as compounding pharmacists and counter-prescribers, there is a wealth of untapped intellectual resource that could be internally utilised in mentoring or even training pharmacists in how to sell a professional service.
This group of pharmacists is concerned with the development of retail clinics proposing to do almost exactly what they were successfully doing 30-40 years ago.
What went wrong?
Well, there is plenty of evidence to illustrate that the process of commoditising medicines is the primary reason for this loss, because if you strip everything out of a process to sell at the cheapest possible price, you get a barren professional offering
Source: Science Alert
It is clear that the Terry White pharmacy group is on the move with the recent purchase of Pharmacy Direct and a restructure of its own management. Terry has had a distinguished pharmacy career and his stewardship will see possibly the strongest pharmacy group in Australia emerge He is opening up the opportunity for equity for senior members of his management team.
The following excerpt extracted from pharmacy media reports explains the process.
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.
9 June 2009
Review finds errors occurring at all stages of medication process
A literature review of medication safety in the community, conducted by the National Prescribing Service Ltd (NPS), has found adverse drug events* and medication errors are a significant problem in Australia.
The study, which cites more than 300 articles from Australia and overseas, is the first comprehensive review of medication safety issues and possible solutions in the community setting.
It explores the prevalence, contributing factors, and outcomes of adverse drug events and medication errors in the community. It also considers the impact of methods to improve medication safety including medication reviews, medication reconciliation, patient education and e-health interventions.
“This review confirms that medication errors continue to occur at all stages of the medication process - prescribing, supply, administration, monitoring and documentation. Up to 73% of these events are preventable, meaning patient safety is being jeopardised and avoidable burdens are being placed on our health system,” NPS CEO, Dr Lynn Weekes said.
Some key findings from the report include:
* Those at high risk of adverse events associated with medicines are older people, those with serious health conditions, those taking multiple medications, those using high risk medicines and those being transferred between community and hospital care.
* Around 6% of hospital admissions in Australia are associated with adverse drug events, with almost one third of admissions for the elderly associated with adverse events.
* Consistently high error rates occurred during transfer of care between hospital and community settings; and
* 10% of general practice patients in Australia report experiencing an adverse drug event; while 25% of high risk patients reported adverse events associated with medicines.
The most commonly reported contributing factor of medication errors and adverse events was poor communication, which is highlighted when patients are transferred between hospital and community settings.
The review also found that while many interventions do not have a significant impact on patient outcomes, those that take a comprehensive approach to managing specific disease states such as heart failure and include medication reviews, home visits and/ or telephone follow ups, do show positive patient outcomes.
“For medication management to be effective it must involve the patient and/ or their carer, and all members of their health care team. Interventions should be monitored, assessed and if necessary, revised. To address medication issues that arise during the transfer of care a systems-based approach must be developed and implemented nationally,” Dr Weekes said.
* Adverse drug events are any incidents involving a medicine that cause harm to the patient. They include harm that results from known adverse drug reactions, medication errors or system failures associated with the manufacture, distribution or use of medicines.
29 June 2009
Managing patient expectations of antibiotics
Health professionals are being given clear guidelines for prescribing particular antibiotics in different diagnostic scenarios in the latest National Prescribing Service (NPS) education program, Management of specific respiratory tract infections.
The therapeutic program aims to address inappropriate antibiotic use, particularly for treating acute bronchitis, sore throat and other respiratory tract infections, but also gives prescribers the facts to be confident prescribing symptomatic treatments.
“Prescribing for antibiotics in acute bronchitis continues, even though the illness is usually viral and antibiotics are only appropriate when a cough is the result of pneumonia or an exacerbation of chronic obstructive pulmonary disease (COPD),” NPS Deputy CEO, Karen Kaye said.
“GPs have told us they often feel pressured by patients to prescribe something but they aren’t confident to only recommend rest, saline solution, steam inhalation*, and analgesics if the patient has pain and fever,” Ms Kaye said.
Acute sore throat is usually viral and clinical features that distinguish a sore throat requiring antibiotics include fever over 38°C, exudate on the tonsils, tender cervical lymphadenopathy and the absence of cough. These features indicate infection by group A Streptococcus and require antibiotics.
Management of specific respiratory tract infections reinforces the following:
· Antibiotics are only appropriate in acute cough if a chest X-ray suggests pneumonia or in exacerbations of chronic obstructive pulmonary disease (COPD) with sputum purulence, plus increased sputum volume and/or dyspnoea
· Antibiotics are only appropriate in sore throat if all four diagnostic criteria (fever, exudate, lymphadenopathy and absence of cough) for streptococcal infection are present
· Use penicillin V for 10 days in uncomplicated sore throat that appears to be streptococcal
· Reserve macrolides when treating respiratory tract infections for those with pertussis or those hypersensitive to penicillin
· Cough and cold medicines have limited efficacy
· Provide advice to patients on appropriate symptomatic relief
“Home remedies such as honey and lemon, rather than a cough medicine which has limited efficacy, are the simplest and cheapest treatment options for uncomplicated acute coughs,” Ms Kaye said.
As part of the therapeutic program, NPS provides health professionals with:
· Case study (58): Antibiotics and respiratory tract illness – thinking of patient-centred care
· GP Clinical Audit: Management of specific respiratory tract infections (enrol by 7 August 2009)
· Prescribing Practice Review (46): Management of specific respiratory tract infections
· NPS News (63): Managing expectations for antibiotics in respiratory tract infections
The GP clinical audit is recognised by the RACGP Quality Assurance & Continuing Professional Development Program, total points 40 (category 1) and in the ACRRM Professional Development Program, 30 points (extended skills). It also qualifies as an activity for QPI of the PIP (Quality Prescribing Initiative of the Practice Incentives Program), year ending April 2010.
To enrol in the clinical audit visit www.nps.org.au/health_professionals.
*steam inhalation should not be used by children
Media enquiries to Katie Butt, Media Adviser, 0419 618 365 or email@example.com
The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.
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