s NPS Media Releases for Junel 2010 | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2010         Volume. 2 No. 6   
Information to Pharmacists

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Newslflash updates for July 2010

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Regular updates from the global world of pharmacy.
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Feature Contribution

The New Competitors- Wholesalers, Manufacturers, Pharmacists and Nurses

Peter Jackson

As manufacturers get pressure from funders of their products such as the Pharmaceutical Benefits Scheme (PBS) in Australia, they will look at reducing costs in the supply chain.
Quite commonly this will take the form of direct distribution to pharmacies (and other business formats) rather than through wholesalers.
Wholesalers in turn face a series of challenges that includes developing a range of efficiencies, the battle for pharmacy numbers, manufacturer strategy, generic strategy and vertical integration. However, this may not be enough and wholesalers may need to develop a strategy involving industry dynamics.
While there will be modest industry growth over the next decade, new products will not be the major generator and research indicates that growth of branded products will be driven by primary care.

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English Pharmacists See Opportunity - Australian Pharmacists Hesitate

Staff Writer

The health systems of England and Australia have many similarities.
However, one NHS rule that we have escaped here in Australia is the 48-hour waiting time guarantee for a GP appointment.
Introduced by the former Labor government, it is now being scrapped as an initiative of the new government to eliminate bureaucracy and targets that had no clinical justification.
Patients in England will no longer be guaranteed a GP appointment within 48 hours under a scaling back of all NHS targets.
Instead, doctors will be allowed to prioritise patients, affecting up to 189 million consultations a year.

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Remote Dispensing Expands Globally

Peter Sayers

Systems for dispensing prescriptions remotely have been available in Australia for some time, but have yet to gain traction.
These systems are characterised by having a TV link to a “live” pharmacist who is located remotely from the machine.
One of the first remote dispensing machines built using Australian technology and manufacture was ExpressRx.

Comments: 3

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How to measure competence?

Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

The concept of ensuring that our workforce is competent is an excellent idea. At a time of rapidly changing clinical information, our undergraduate degree of 30 years ago (now doesn’t that make you feel old!!) is simply inadequate. For those of us that went to University we learned Knowledge, Understanding, Thinking and problem solving. The rest of us were taught on the job. Our work experience, built on this foundation, helped make us competent. The problem is – measuring that competence over time.

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Community pharmacy’s crystal ball is fogging up

Neil Retallick

At the Generics Conference held in Sydney a couple of years ago, when PBS Reforms I was the Government’s latest and greatest initiative to contain the cost of the PBS, a number of speakers addressed the impending impact of WADP or Weighted Average Disclosed Pricing.
Two of these speakers had developed mathematical models to chart the revenue and gross profit dollars that would be generated in the dispensaries of community pharmacies over the following years through to 2012 and 2013. In both instances, the speakers presented data that showed the dispensary revenue and gross profit lines decreasing quite dramatically as the effects of WADP took hold of PBS medicine prices.
These soothsayers saw gloom and doom in their crystal balls, or their spreadsheets if that’s what they preferred to use.

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Quackery, Skeptics and Acupuncture….

Chris Wright

The reaction to the little piece about Naturopathy and my doctor (published in a June i2P update) has caused some not entirely surprising flame bursting by those who believe a remedy must be science based.
Hmmm, a good point.

Comments: 2

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Show me the Money!

Peter Sayers

Well, we are past July 1 and there has been no official statement on how, when and where the 15 cent payment for electronic prescriptions materialises.
Government does not appear to have specified how it wants a pharmacy claim presented, and system vendors may not have included a module to create an acceptable audit trail as yet.

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In the midst of change – everything remains the same

Neil Johnston

Pharmacist survival strategies have essentially remained the same for well over a century.
In simple terms when pressure is applied to dispensary margins more OTC opportunities are developed.
A conscious decision is made to expand the range of inventory items in niche markets and then key items are discounted to expand market share within that new market.

Comments: 2

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Sublime treachery, delivered par excellence

Chris Wright

It’s probably all been said but that astonishing ascent of the Member for Lalor Julia Gillard has nailed yet another nail in the coffin of our long cherished democracy.
Again, the power-crazed toe-cutters of the Labor Party were unable to muster the restraint required to allow an elected comrade see out the full game.
The bitter hatred (which is often factional but not necessarily in this case) that lurks behind closed doors was just too much. In the end those who read from the Graham Richardson manual on dealing with personnel superfluous to current requirements acted with rare brutality and “Kevin 07” became “Kevin gone to political Heaven” in a blink.

Comments: 7

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Cutting Carbon with Hydrogen Batteries

Staff Writer

TELSTRA'S mobile base stations and some exchanges could soon be backed up by energy efficient hydrogen fuel cells that promise to deliver a 20 per cent carbon emissions reduction compared with the diesel generators currently in use.

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The RACGP announces its new President

Staff Writer

The Royal Australian College of General Practitioners (RACGP) is pleased to announce the appointment of Professor Claire Jackson as President-elect.
Professor Jackson is a GP and GP Supervisor in Inala, Brisbane and is Professor in General Practice and Primary Health Care and Head of Discipline at the University of Queensland. She has been chair of the RACGP Council and the RACGP Queensland Faculty. She has had significant involvement in health reform in many areas, serving on the National Primary Care Strategy Expert Advisory Group and providing a commissioned paper for the National Health and Hospital Reform Commission.

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Outliving most of the world, but not healthy in every way, says nation’s health report card

Staff Writer

The national health report card released by the AIHW gives a pointer as to where primary health care funds are going to be directed to, and a guide as to what "specialties" will need to be invested in by pharmacists.
And following similar lines, the education that will need to be provided to back those specialties.
A systematic approach to developing and marketing pharmacy clinical services is long overdue, and leadership is stagnant.
What can be done?
In practical terms - probably nothing until after the next federal elections, but that gives a small window of opportunity for our lead pharmacy organisations to work out a plan of action and support each other in the process.
Political game playing, whether at the local, state or federal levels, is crippling initiative in all sectors of the economy - but in particular, health.
And pharmacy needs to attract some urgent funding to initiate some primary health care projects that can soak up some of the surplus graduates before it is too late, and we lose these valuable human resources.
It would also be interesting to know what impact existing pharmacy activities contribute to the report card statistics.

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Reviewing the Pharmacist Code of Ethics

Staff Writer

Renewing the code of ethics for pharmacists in the wake of the recent changes to healthcare legislation will be among the topics considered at a wide-ranging ethics conference at the University of Sydney (17-18 June 2010)
World-renowned ethics expert and Laureate Professor Peter Singer will deliver a keynote address on World Poverty: What are our obligations?
The Australian Association for Professional and Applied Ethics conference is being hosted by the Faculty of Pharmacy, under the theme Ethics in the Professional Life: Past, Present and Future.

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Study finds antidepressants not working in older men

Staff Writer

A recently published study in the journal PLoS-One has found that more than half of older men who use antidepressant medication or psychotherapy are not responding to treatment.
Lead author, Professor Osvaldo Almeida, Research Director of the Western Australian Centre for Health and Ageing at The University of Western Australia, said the finding was surprising and alarming.

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Tests help predict falls by Parkinson’s sufferers

Staff Writer

A group of tests may help predict which people with Parkinson's disease are more likely to fall, according to a study by Queensland University of Technology (QUT).
The study results were published recently in the American Academy of Neurology's online medical journal Neurology®.

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Cling Wrap Catches Carbon Dioxide

Staff Writer

High tech cling wraps that ‘sieve out’ carbon dioxide from waste gases can help save the world, says Melbourne University chemical engineer, Colin Scholes who developed the technology.

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Tea tree oil offers hope to skin cancer patients

Staff Writer

Tea tree oil may be used in future as a fast, cheap, safe and effective treatment for non-melanoma skin cancers and precancerous lesions, according to researchers at The University of Western Australia.
A three-year study by the University of Western Australia Tea Tree Oil Research Group has found solid tumours grown under the skin in mice and treated with a tea tree oil formulation causes inhibition of tumour growth and tumour regression within a day of treatment. Within three days, the tumours cannot be detected.

Comments: 1

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NPS Replaces TAIS Service

Staff Writer

NPS will discontinue funding the Therapeutic Advice and Information Service (TAIS) for health professionals as of 1 July 2010.

A guide to medicines information resources has been compiled on the NPS website which can be accessed via the health professional web page. Please note that some of the listed resources are freely available and others for a subscription fee.
Follow this link http://nps.org.au/medicines_information_guide.

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Consultant Pharmacists Freed Up

Staff Writer

The following press release issued by the AACP confirms changes to the HMR model that will at last see an opportunity to professionally collaborate with GP’s and to build a relationship with hospitals.That it has taken so long to deliver the obvious is sad.
But not to dwell on any negatives, it now frees up consultant pharmacists to develop independent business models to deliver services in a more economical, timely and streamlined fashion.
It may also open a secondary market for e-document exchanges capable of quickly sharing information for intended recipients.

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Vitamin C plays vital role in battle against cancer

Staff Writer

New research from the University of Otago, Christchurch, shows that vitamin C can help curb the growth of cancer cells.
The study, led by Associate Professor Margreet Vissers of the University’s Free Radical Research Group, is the first real evidence of a connection between vitamin C and tumour growth.
Associate Professor Vissers says “Our results offer a promising and simple intervention to help in our fight against cancer, at the level of both prevention and cure”.
The article is in the latest edition of the prestigious Cancer Research journal.

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Gut flora study gives insight into obesity

Staff Writer

A UQ academic's research into whether nature or nurture influences the development of gut flora has been published in Nature and may hold the key to understanding obesity.
Dr Florent Angly said the fundamental research was significant since some forms of obesity could be caused by the action of microbiota.

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At last - a peak national pharmacy group in formation

Staff Writer

A forum initiative developed by the Pharmaceutical Society of Australia (PSA) has seen discussion on the early stages of the first truly representative peak national pharmacy body.
It is presumed, when eventually formalised, that this body will be capable of generating national policies that will bind its membership and provide a cohesive single face for the "whole of pharmacy".
It is also presumed that this group will have provision to absorb emerging and new pharmacy organisations.
PSA is to be congratulated on taking the lead role in the establishment of the initial forum that is certain to win support by all pharmacists in whatever sector they work in.
In the current climate of severe political and commercial pressures on pharmacy, one wonders why it has not happened a lot earlier than this, because the disparate ambitions of various pharmacy organisations up to now has definitely worked against the best interests of the pharmacy profession as a whole.
i2P has often commented on this issue and the need for a peak body that is truly representative of pharmacy.

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Youth lead the adoption of e-health

Staff Writer

The ‘net’ generation, spanning 13 to 33 year olds, has embraced technology as the norm and is expected to adopt e-health as just par for the course in their highly connected lives according to several leading youth health experts.
Jonathan Nicholas, Chief Executive Officer of the Inspire Foundation, the organisation behind the web-based mental health support service for young people, ReachOut.com said, “As an organisation that uses the internet to connect with young people, we see a number of benefits for young people flowing from the proposed e-health record.

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US ‘Renaissance’ in pharmacy’s role as a vital health resource

Staff Writer

Pharmacists in Australia may be forgiven for feeling invisible as they search for roles and activities that gainfully utilise their experience and skills.
New projects and programs often mention "allied health" and nurses, but not pharmacists.
There are probably two major reasons for this problem:
* The Pharmacy Guild of Australia (PGA) has allocated resources exclusively to PBS-centric activities.
This has led to a reduction in jobs for new pharmacists and a surplus human resource. This is in stark contrast to all other health professions that seek to increase their practitioner numbers.
* GP lobby groups have promoted the use of practice nurses in key areas normally in the pharmacy domain. This has had the effect of increasing the number of "short" consultations, with the GP providing evaluation and the practice nurse to complete the work.
GP lobby groups have also been active in suppressing pharmacy initiatives particularly in the concept area of medication continuance.

In the US the opposite is occurring, mainly because of the fractured health service that exists in that country. However, while it can be said that Australia's health system may be better, it seems to be dysfunctional for the moment.
This may represent an opportunity for pharmacy if it can be properly articulated to politicians.
It appears that governments only turn to pharmacy when they need bailing out.
The end result always sees pharmacy disadvantaged as policies and promises are inevitably changed.
The following story recently appeared in Drug Store News

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Complementary and alternate medicines

Neil Johnston

There are many views held in pharmacy as to the efficacy and value of complementary and alternate medicines.
At i2P we endeavour to cater for all perspectives by publishing the views of skeptics such as Loretta Marron, who takes a “no holds barred” approach, and insist that the only perspective for medical professionals to prescribe/sell drugs be evidence-based.
On the other side, we recently published an article by Chris Wright (a regular i2P author), who is not a pharmacist but has a good working knowledge of pharmacy.
He opted to take acupuncture treatment from his GP instead of consuming anti-inflammatory drugs.
His GP gave him the choice.
Chris’s article drew strong comments from the “evidence-based perspective”.
(Follow this link to view comments at the end of the article)
Chris chose acupuncture because he felt it would work for him.

i2P asked Mark Coleman to make a comment which appears below the news item that originally appeared in Pharmacy News on June 24 2010.
Acupuncture is mentioned in the last line of that news item.

Comments: 1

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NPS Media Releases for Junel 2010

NPS Spokesperson

articles by this author...

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.

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10 June 2010

Be Medicine Wise – talk to your doctor or pharmacist about NSAIDs

The research, published in the Journal of the American Heart Association, is broadly consistent with existing information about these products and their cardiovascular effects.

“This is an interesting and complex study that deserves careful interpretation,” NPS CEO, Dr Lynn Weekes said.

“Importantly, it highlights that all medicines – including those with a long history of routine use – have the potential to cause harms as well as to provide benefits.”

The potential harms of NSAIDs include stomach ulcers and an increased risk of high blood pressure and heart disease. At the same time, NSAIDs provide significant pain relief and anti-inflammatory effects for many people.

“It’s vital people realise that just because they can purchase something in a supermarket or petrol station doesn’t mean the product is without serious potential side effects,” Dr Weekes said.

“Similarly, people should understand this study focuses on increased risk, which is not to say that by taking these products you will experience an adverse event.”

“All medicines come with potential side effects and react differently in individuals, depending on what other medicines they may be taking. For this reason it’s important to tell your doctor and pharmacist if you are taking these medicines, even if you have been taking them for some time and feel fine.”

If you are taking an NSAID regularly for pain, talk to your doctor about the lowest effective dose and discuss any concerns you may have about side effects.

3 June 2010
June edition of Australian Prescriber out now 

The latest edition of Australian Prescriber is out now and looks at topical issues including: 

Variability in response to clopidogrel

Andrew McLachlan, Professor of Pharmacy (Aged Care) at the University of Sydney, and Terence Campbell, Head of the University Department of Medicine at St Vincent's Hospital, Sydney, look at possible factors contributing to variability in patients' responses to clopidogrel. The authors give suggestions for overcoming so-called 'clopidogrel resistance'.

Multiresistant infections

Infections caused by multiresistant bacteria are being seen with increasing frequency in the community. Professor John Turnidge, Clinical Director of SA Pathology in Adelaide, discusses how treatment options for these infections are limited, but in most cases a suitable drug can be found. 

Managing cardiovascular disease in Aboriginal and Torres Strait Islander people

Cardiovascular diseases are responsible for much of the reduced life expectancy of Aboriginal and Torres Strait Islander people. Professor Jenny Reath of the University of Western Sydney’s School of Medicine and Associate Professor Ngiare Brown of the Poche Centre for Indigenous Health at the University of Sydney look at how calculators may underestimate the absolute risk of a cardiovascular event. Risk factors need to be modified, and the authors argue that screening and drug therapy may need to be started sooner than in other people. Comorbidities are common, and psychosocial and other factors need to be considered.


The safety of plasma-derived products in Australia

Dr Andrew Guirguis and Dr Erica Wood of the Australian Red Cross Blood Service and the Alfred Hospital in Melbourne discuss the preparation and use ofplasma-derived products in Australia, and the importance of correct storage and handling. 

TGA’s Medication Safety Update

  • AUST R and AUST L numbers – why are they important?
  • Sibutramine
  • Drug-induced pancreatitis and exenatide (Byetta)

To view the full articles go to www.australianprescriber.com

1 June 2010 
New NPS program to address opioid use in chronic pain

Chronic pain affects one-in-five Australians and costs the economy $34 billion per year. Opioids are an option for some patients with chronic pain but there has been a significant increase in the supply of prescription opioids over the last two decades.

The latest NPS therapeutic program, Opioid use in chronic pain: use a planned approach, explores ways of optimising the benefits of opioids in chronic pain while minimising the harms associated with inappropriate use. These include careful patient selection, clear communication about the goals of opioid therapy, careful advice about proper use and close monitoring.

“Opioids are an option for some patients with chronic pain, with their goals being to reduce pain and to improve function and quality of life. However they should only be prescribed as part of a comprehensive pain management plan developed in consultation with the patient,” NPS CEO, Dr Lynn Weekes said.

“Documenting the plan and outlining the terms for opioid use can prevent unsanctioned use and provide pre-agreed approaches if the patient experiences repeated episodes of breakthrough pain. Finally, it can help patients to be realistic about the goals of their treatment,” Dr Weekes said.

Long-acting opioids are recommended for chronic pain and short-acting opioids can be used to establish pain relief requirements. However the choice of opioid, initial dose and titration schedule should be developed in line with the patient’s health, age, response and past experience with opioids.

“In cases of non-specific low back pain, a thorough patient history and physical examination are critical in checking for red flag indicators of potentially serious underlying conditions. In the absence of red flags, imaging tests are not routinely recommended and are unlikely to improve patient outcomes or alter clinical decision-making,” Dr Weekes said.

As part of this program, health professionals are encouraged to:  

  • Perform a thorough history and physical examination to determine if investigations are necessary
  • Prescribe an opioid as part of an agreed pain management plan
  • Initiate an opioid only as a short term therapeutic trial
  • Continue an opioid in those who demonstrate benefit from a trial and regularly reassess the need for ongoing therapy
  • Discuss options for managing breakthrough pain 

The following resources have been developed for health professionals:

  • NPS News (69): A planned approach to prescribing opioids
  • Prescribing Practice Review (51): Opioids in chronic pain: use a planned approach
  • Drug Use Evaluation (DUE) tool: Opioid therapy for chronic non-cancer pain
  • Pain management plan and diary for patients
  • Counselling tool for patients: Using opioid medicines for your chronic pain
  • One-on-one educational visiting and small group discussions by NPS facilitators
  • Interactive workshop for residential aged care nursesGP and GP Registrar Clinical Audit: Review of opioid prescribing in chronic pain
  • Pharmacy Practice Review: Optimal use of opioid-containing analgesics in chronic pain
  • Case study: Opioid therapy in chronic pain: use a planned approach

 

For further information visit www.nps.org.au/health_professionals.

 

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