Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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NPS Media Releases for May 2012

NPS Spokesperson

articles by this author...

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 Stephanie Childs on (02) 8217 8667 or 0419 618 365 or

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31 MAY 2012


A recording of the inaugural NPS webinar for GPs on medical imaging in respiratory tract infections (RTIs) is now available for all health professionals to view for free on the NPS website.

The webinar, hosted as part of the NPS campaign on antibiotic resistance, allowed GPs to engage with imaging experts and gain insights into when imaging is appropriate for RTIs.

NPS CEO, Dr Lynn Weekes, says that inappropriate use of imaging tests to diagnose defined RTIs is on the rise.

“There is a limited role for medical imaging in the diagnosis of acute RTIs outside of pneumonia, however the number of tests continues to rise. Evidence shows that chest x-rays are the most commonly ordered imaging test and they are mostly ordered for respiratory problems – the top two being acute bronchitis and bronchiolitis, and cough.

“The result of this is a large number of needless scans, exposing patients to unnecessary ionising radiation and potentially risking their future health,” says Dr Weekes.

“Insufficient national GP guidelines about imaging may be contributing to the rise in inappropriate testing. Taking part in activities like the NPS webinar will help GPs make better decisions when it comes to ordering imaging tests for RTIs.”

Dr Weekes says there are a number of factors GPs need to consider when it comes to imaging in RTIs.

“When considering a test’s usefulness in the diagnosis and management of an RTI, GPs should think about whether the potential benefits of the test are likely to outweigh the risks and whether the results will contribute in a meaningful way to the management decision. If an imaging test is indicated then the benefits and risks should be explained to the patient and any concerns should be addressed.”

Another significant contributor to inappropriate testing, and one that is often less discussed, is patient pressure.

“In the interest of preserving the doctor-patient relationship and the desire to allay patient fears of a more serious diagnosis, some GPs feel pressure to order imaging tests despite there being no evidence base to do so,” says Dr Weekes.

“The NPS webinar provided GPs the opportunity to raise these difficult patient situations with imaging experts, clarify when medical imaging should be ordered for an RTI and discuss which tests are most appropriate.”

Expert panelists in the webinar included radiologist Dr Greg Briggs, respiratory physician Associate Professor Graeme Maguire, and GP Dr James Best. Dr Philippa Binns, NPS Clinical Adviser, convened the webinar.

The webinar can be viewed for free on the NPS website at

By viewing the recording and completing the evaluation form at the end:

* GPs can earn 2 (category 2) RACGP QI&CPD Points and/or 2 ACRRM PRPD Points + 2 PRPD Radiology MOPS Points for the 2011–2013 triennium

* Pharmacists can earn 2 Group 2 CPD credits as accredited by PSA. (PSA is authorised by the Australian Pharmacy Council to accredit providers of CPD activities for pharmacists that may be used as supporting evidence of continuing competence.)

28 MAY 2012


Professor Emily Banks, Chairperson of the Advisory Committee on the Safety of Medicines (ACSOM) has called for better labelling for medicines which have been made available for use in the community but still require additional monitoring.

Speaking at the NPS National Medicines Symposium in Sydney last week, Professor Banks called for an additional symbol to be placed on a new medicine's packaging, advertising and other materials indicating that authorities are interested in gathering additional information on the medicine and inviting consumers to be a key part of this process.

Professor Banks said that under the Australian system, medicines undergo rigorous testing prior to being registered for use in the community.

“However, when medicines are first used, it is vital that we gather information about the experiences among people using it, particularly whether there are any unexpected adverse effects, outside the clinical trial setting,” she said.

Professor Banks says that this additional monitoring would complement the existing risk management framework of the Therapeutic Goods Administration, by allowing consumers to identify medicines are operating under a risk management plan.

"A better risk communication system would help keep consumers better informed about the medicines they are using and encourage their participation in ensuring we can collect further information once the medicine is in use.

In announcing ‘TGA Reforms: A Blueprint for the Future of the TGA’ in December 2011, the Government agreed that the TGA should conduct, and report on, a feasibility study into the development of an early post marketing risk communication scheme for therapeutic goods, with consideration of international models.”

Similar programs are currently underway or planned in Europe.

Professor Banks says it’s important consumers remain at the centre of care when it comes to ensuring medicines are used safely and effectively in the community.

“This means providing consumers with the information they need to make the best decisions about their medicines. Providing people with a more complete picture about the ways of evaluating the risks of their medicines would help facilitate a better understanding of the processes that work to ensure we have safe medicines in Australia,” she said.

For a full copy of Professor Banks’ abstract, visit

25 MAY 2012


Health professionals need to be vigilant to the symptom cascades that might arise in palliative care settings due to adverse effects of medicines, delegates at the NPS National Medicines Symposium have heard.

Presenter Debra Rowett, who has a special interest in pharmacovigilance, said the medicine regime often becomes much more complex as patients near the end of their lives, when symptom control medicines are added to medicines for long term co-morbid disease.

“For patients in palliative care, medicines play an important role in relieving suffering and distress at a time when symptom relief is paramount,” she said.

“However, symptom cascades can result from the adverse effects of medicines themselves.”

Coinciding with National Palliative Care Week 2012, NPS CEO Dr Lynn Weekes agrees that medicines play a vital role in improving the quality of life for patients in palliative care.

“Patients at the end stages of life often require multiple medicines to manage the pain or other symptoms associated with their illness. By applying best practice quality use of medicines, health professionals can improve the day-to-day quality of life for these patients giving them the best possible outcomes during this difficult time.

“Health professionals can help facilitate patient understanding and ease their decision making when it comes to using medicines in a palliative care situation by outlining all the options available to them and the pros and cons of each treatment, including any possible side effects,” says Dr Weekes.

It’s also important for patients at the end stages of life to clearly communicate their wishes for care, including where they would like to be cared for, how and by whom.

“Clear communication with your health professional regarding your treatment preferences can help ensure you receive the best possible care. Recording these preferences in an advanced care plan and sharing this plan with your family and close friends can help eliminate any confusion and enable them to make decisions on your behalf in line with your chosen treatment plan,” says Dr Weekes.

Further information on National Palliative Care Week is available at

A copy of the joint consultation report between NPS and Palliative Care Australia is available at


25 MAY 2012


A new competency framework outlining the skills, knowledge and behaviours required for safe and effective prescribing is being launched today at the 2012 National Medicines Symposium in Sydney.

The project involved 12 months of broad consultation with health professionals and representative groups from around Australia to develop the framework.

NPS CEO Dr Lynn Weekes, who is launching the framework, says that good prescribing involves a complex range of skills, and that all prescribers - regardless of professional background - should demonstrate adequate competency before they are able to prescribe.

"The competency framework will be able to be applied broadly to all health professionals, including new and existing prescribers," says Dr Weekes.

The competency framework incorporates seven competency areas, each describing an activity essential for prescribing. The competency areas include how a competent prescriber understands the patient’s social and clinical needs, assesses their treatment options, supports shared decision making and implements and communications a treatment plan.

A competent prescriber also communicates the treatment plan clearly to other health professionals and monitors and reviews the person's response to treatment.

In addition the competency framework identifies that a competent prescriber practises professionally and communicates and collaborates effectively with the person and other health professionals.


“We will be encouraging Australian registration, accreditation, professional and other organisations to adopt this framework as the benchmark for the training, credentialing, and ongoing professional development of prescribers," says Dr Weekes.

For more information about the prescribing competencies framework project, visit


25 MAY 2012


Australia’s most innovative activities designed to improve medicines use and health outcomes have been formally recognised in an awards ceremony at the National Medicines Symposium (NMS) dinner.

The National MedicineWise Awards, organised by NPS, were announced at NMS 2012 and recognise the high quality of work being done by companies and individuals to assist and educate both consumers and health professionals.

The winners were announced by Parliamentary Secretary for Health and Ageing, Catherine King and NPS CEO, Dr Lynn Weekes as part of the evening’s formalities, following a full day of stimulating and challenging presentations and debate about building a medicinewise community.

Dr Weekes said the award winners represent the breadth of quality use of medicines activities happening in the community.

"Consumers need to be at the centre of all we do in building a medicinewise community, and each of the National MedicineWise Award winners demonstrates one way in which health outcomes can be positively impacted through quality use of medicines activity,” said Dr Weekes.

The judging panel consisted of representatives from across the health sector and considered entries based on impact, innovation and reach. Abstracts and posters were assessed on objectives, methodology, results and contribution to quality use medicines.

The winners

* Building a medicinewise community: consumer programs - joint winners

The Northern Rivers Career Link Pharmacy Program

CareerLink works with members of the indigenous community, selecting and training young Aboriginal people to train to be pharmacy assistants, and providing pharmacists with indigenous cultural awareness training.

RedUSE (Reducing Use of Sedatives) Program

The program involved extensively researching the way psychotropic medicines were prescribed in the aged care setting, and then using this information to shape an intervention study – RedUSE - to reduce the use of sedatives in Aged Care homes.

* Education for health professionals to build QUM skills - under $100,000

BE ALERT AND WORK TOGETHER for medicine safety: DAA Incident Awareness Toolkit

The project identified that medicines packed into dosage administration devices, particularly in the aged care setting are often packed incorrectly or packs contain medicines which aren’t suitable for packing. From this, a toolkit was produced to improve the accuracy and appropriateness of packed medicines and improve overall medicine administration.

* Education for health professionals to build QUM skills - under $100,000

Medicines Book for Aboriginal Health Workers

This project developed a manual to provide education about medicines for Aboriginal Health Workers with low literacy levels, empowering them to provide appropriate and effective information about medicines to consumers.

* Excellence in labelling and packaging

APHS Packaging: Medication Compliance Sachet

The APHS satchet allows community pharmacists to deliver a DAA which assists patients to manage multiple medicines more safely and effectively than traditional manually packed alternatives.

* Best e-health resources

Pharmacovigilance in pregnancy using population-based linked datasets

This project monitored medicines dispensed to pregnant patients in Western Australia and linked them to their impact on pregnancy outcomes – a resource which can be used to better determine the safe use of medicines in pregnancy.

* Best media report of a medicines story

“Accidental Counsellors” by Peter Waterman, Australian Pharmacist

The article provides unique insight into the various roles pharmacists perform in the area of mental health, moving it from an ‘accidental counselling role’ to a more structured and cohesive model, highlighting the need for further education, skills and knowledge so pharmacists can help the growing number of people suffering mental health issues.

* Best abstract

Can I live longer? Will I get side effects? Understanding consumer decisions about medication use.

Tracey-Lea Laba, Jo-anne Brien and Stephen Jan, University of Sydney and The George Institute for Global Health

* Best student abstract

Understanding compliance to antibiotic prescribing guidelines.

Chee Kong Teo, Faculty of Medicine, UNSW

* Best poster

The medicine information needs of parents of children with attention-deficit hyperactivity disorder.

Rana Ahmed, Jacqueline Borst, Yong Wei Cheng and Parisa Aslani, University of Sydney and University of Nottingham

* People’s choice poster

Quantifying the value of Pharmacists as NPS Facilitators in a Medicare Local.

Amy McIntyre and Aneesa Davis, Townsville-Mackay Medicare Local

The National Medicines Symposium continues today, Friday 25 May. For more information about the National MedicineWise Awards and to view today’s symposium program visit


21 MAY 2012


Depression is only second to hypertension as the most common chronic problem seen by Australian GPs. With two thirds of these consultations for depression resulting in a prescription for antidepressants the use of these medicines continues to rise in Australia.

The latest therapeutic program from NPS, Depression: Challenges in primary care, encourages GPs to carefully assess the severity of depressive symptoms in patients diagnosed with major depressive disorder and then consider whether an antidepressant is necessary.

NPS clinical adviser Dr Danielle Stowasser says that current guidelines endorse antidepressants for moderate-to-severe major depressive disorder but recommend non-drug therapies as first line for mild depression and in combination with antidepressants for more severe depression.

“When determining if a patient could benefit from taking an antidepressant, a global assessment of the severity of their symptoms should be made, with particular consideration of the degree to which their day to day functioning is impaired and whether they have had suicidal thoughts or intent,” says Dr Stowasser.

If an antidepressant is indicated, the patient’s previous experience with antidepressants should be taken into account, along with potential drug interactions and the likelihood of adverse events, such as weight gain, sexual dysfunction and gastrointestinal upset.

“It is particularly important to assess the balance of benefits and harms in older patients, since they experience adverse effects and drug interactions more frequently than younger patients,” says Dr Stowasser.

“Also, take the time to explain to patients in detail what they should expect from antidepressant treatment. A medicinewise patient is more likely to adhere to treatment and get the best outcomes.”

It is commonly known that between one-third and one-half of patients prescribed an antidepressant discontinue within three months of starting treatment. Common reasons for this include side effects of antidepressant medicines, lack of understanding about depression as a condition, and what to expect from treatment.

Things to discuss with your patients about antidepressant therapy include:

* potential side effects

* how long before the full benefit of treatment is likely to be experienced

* likely duration of treatment

* dangers of non-adherence and of stopping treatment abruptly

* concerns about addiction

* interactions with over-the-counter medicines such as St John’s Wort and many cough and cold medicines.

Non-drug treatments can be of benefit for people with a depressive disorder regardless of the severity. Physical exercise, cognitive behavioural therapy and interpersonal therapy have been proven to help reduce relapse post-treatment.

“When deciding on the most suitable non-drug treatment, the patient’s preference should be taken into account to ensure the best chance of success in terms of adherence,” says Dr Stowasser.

For more information on depression, and to access the relevant resources for health professionals, visit

17 MAY 2012


NPS has published new information to help guide GPs in monitoring patients with metal-on-metal (MoM) total hip replacement prostheses.

The safety of these types of hip prostheses is currently under review due to a higher than expected rate of repeat surgery to replace some of these devices, accompanied by an emerging concern about the potential for metal ion toxicity due to erosion of chromium and cobalt from their metal surfaces.

NPS head of programs Karen Kaye says that GPs have an important role in reassuring patients who have had hip replacement surgery that for most their prostheses will perform well for many years, but for some with metal-on-metal prostheses, monitoring metal ion levels may be necessary.

“People who have had metal-on-metal hip prostheses may be presenting to their GP either with concerns about their implant and/or with adverse effects,” says Ms Kaye.

Although hip replacement surgery has a very high success rate, over time, the wear of metal-on-metal surfaces in some of these implants produces metal debris in the form of nano- and microparticles, resulting in metal ion release into the bloodstream, which together may affect both the local tissue and other body systems.

Extended exposure to metal debris and released metal ions in people with MoM implants may produce a range of adverse effects, often within 5 years of surgery.

“While many people with metal-on-metal implants will have high levels of chromium and cobalt ion levels in their blood, some will have fully functioning joint implants with no symptoms of toxicity and these will not need to be referred to an orthopaedic surgeon for further investigation,” says Ms Kaye.

“But GPs need to be vigilant for those who do need to be referred, by identifying those at risk and being aware of the key symptoms of toxicity, which include neurosensory symptoms such as hearing and vision loss.”

The NPS information outlines how GPs should:

* Assess patients with MoM implants for symptoms of toxicity.

* Consider serum cobalt ion screening in symptomatic patients or patients with a history of hip revision for MoM implants.

* Consider orthopaedic referral for people with high serum cobalt concentration, especially if they increase over time, and those who have symptoms.

* Be aware that patients with MoM implants who also have renal failure are at particular risk.

The information for health professionals on monitoring patients with metal-on-metal hip prostheses is published on the NPS website at

16 MAY 2012


This week all community pharmacies around Australia will receive a pack of NPS resources. The resources are designed to support conversations with consumers about choosing a medicine brand, reduce confusion about multiple medicine brands and improve medicine safety.

The pack is supported by the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia.

Ms Karen Kaye, Head of Programs at NPS, says that with the number of medicines coming off patent over the next few months, it is likely pharmacists will be offering more customers a choice of medicine brand.

“The choice between medicine brands can cause confusion for some people, however regardless of the medicine brand they choose, it’s important for people to feel confident knowing that if the active ingredient is the same and the medicine is known to be bioequivalent, it will work in the same way,” says Ms Kaye.

“The new NPS pack for community pharmacies is designed to support conversations with consumers so they can make more informed and confident choices about their medicine brand.”

The pack includes:

* Medicine brand choices brochures to improve consumer understanding about medicine brands and help consumers find the active ingredient on their medicine label

* NPS Medicines Lists to help consumers keep track of all the medicines they are using and record any changes (especially between brands)

* Repeat prescription folders with a medicine safety message

* Pharmacy Assistant Quick Guides to help pharmacy staff have conversations with consumers about medicine brand choices

* Pharmacists and staff guide to making medicine brand choices less confusing for consumers

* A bookmark reminder with information on how to order resources.

“We encourage pharmacists to use the new resources and discuss the messages with their staff in the context of their own pharmacy’s brand substitution policy,” says Ms Kaye.

The Quick Guides in the new pack have been designed specifically for pharmacy assistants who begin most of the conversations with consumers about medicine brand choices.

“Pharmacy assistants play a key role in making medicine brand choices less confusing and can help connect people with advice when they need it so they feel confident in their choice,” says Ms Kaye.

“The Quick Guides can be attached on computer screens and on the prescription counter so pharmacy assistants can easily refer to them when discussing medicine brand choices with consumers.”

The Medicine brand choices brochure will also be available for consumers in over 2,500 GP practice waiting rooms nationally between May-July, in English and some other languages.

The pack is being distributed to pharmacies around the country this week. To order additional materials, as well as a number of additional free resources (including brochures and NPS Medicines Lists in 10 different languages), visit

15 MAY 2012


Pharmacists attending the National Medicines Symposium (NMS 2012) will be able to apply for professional development points through the PSA.

Activities at the Symposium have been accredited for a total of 10 hours of Group 1 CPD (or 10 CPD credits) and 3 hours of Group 2 CPD (or 6 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan. A list of sessions and corresponding credits and accreditation numbers will be available at the registration desk.

Of particular interest to pharmacists, the concurrent stream “for safer use of medicines” includes clinical presentations on issues including the risk of diabetes complications with corticosteroid use and the effect on older women following the withdrawal of rofecoxib.

Professor Nick Barber from the UCL School of Pharmacy in London will deliver the opening presentation on initiatives in the UK to improve the medication system in the community. Prof Barber has focused his career on pharmacist interventions and will discuss electronic prescribing, evaluation of electronic patient records in hospitals and a re-engineering of the medication process in primary care. Delegates will also hear about a phone support service running in the UK by community pharmacists for patients starting a new medicine for a chronic condition that Prof Barber has been involved in setting up.

For the first time ever, an open audience discussion in the style of SBS's Insight program with facilitator Jenny Brockie will enable delegates to participate in a hardline look at Australia's National Medicines Policy and whether it needs a rethink 12 years on.

There will be several presentations on e-health records and other ways technology is being used to improve compliance and medicine management in multi-comorbid patients.

To register visit


2 MAY 2012


NPS has updated its online Medicine Name Finder with a new feature to help consumers make choices between medicine brands.

Designed to help people find important information about their prescription medicines, the tool has a quick and easy-to-use interface where users can type in the name of their medicine to find out more about the active ingredient and brands available, plus a link to the Consumer Medicine Information (CMI) leaflet.

This new feature enables users to type in either the active ingredient or brand name of their medicine and, after selecting their prescribed dose, view a list of bioequivalent PBS-listed brands which they may be offered at the pharmacy.

CEO of NPS Dr Lynn Weekes says the new feature will help consumers identify the different brands available for their medicine, helping them to make a safe and confident choice.

“When the active ingredient of a medicine comes off patent, the number of available brands can quickly increase. This can be confusing, so it’s important people know that if the medicine they are offered has the same active ingredient and the same size dose as their original medicine, it will work the same in their body.

Using the Medicine Name Finder, people can quickly see a list of the different equivalent brands available so they can be sure they are taking the right medicine and avoid confusion.”

Dr Weekes says that with the patent for Lipitor - a commonly-prescribed cholesterol medicine – expiring, a number of different brands will now be available in addition to Lipitor. It’s likely many people will be offered a different brand of medicine than the one they were originally prescribed, and may have been taking for some time.

“For people who take medicines regularly, it can be confusing if they are suddenly offered a different brand by their pharmacist. The brand name, the design of the packaging and even the colour or size of the tablets, may all look different.

“They may also find that the new brand costs less. But none of these factors are cause for alarm. You will only be offered a different brand of medicine if the active ingredient and the strength are the same or ‘bioequivalent’. Bioequivalence is the term used to describe the fact that it has been approved as having same effect in your body.”

The best way to make a decision is to weigh up all the possible benefits of a brand with the potential drawbacks, Dr Weekes says.

“Price is one factor, but there are many other things to think about. For example, for people who are on multiple medicines, a brand which looks too much like your other medicines or has a similar name may cause more confusion and can lead to mistakes.

“The best thing to do if you are unsure is to talk to your doctor, pharmacist or other health professional who can help you make the best decision.”

The data about medicines supporting the online tool is provided by the Pharmaceutical Benefits Division of the Department of Health and Ageing and will be updated monthly. The tool does not cover over-the-counter, natural, herbal or complementary medicines, or medicines that are not listed on the Pharmaceutical Benefits Scheme.

The NPS Medicine Name Finder is available at

NPS has a variety of resources to help consumers navigate their medicine brand choices at


1 MAY 2012


Delegates attending next month’s National Medicines Symposium (NMS 2012) will be spoilt for choice with a full and diverse program, available from

Over the two-day conference more than 60 presenters will cover topics ranging from improving medication safety to new technologies, and the role of specific medicines in treatment regimens.

The plenary sessions address the five themes of NMS and will be presented by international and nationally-acclaimed experts, including Professor Nick Barber who has been involved in innovative medication safety and e-health programs in the UK and Professor Emily Banks, Chairperson, Advisory Committee on the Safety of Medicines (ACSOM).

A highlight of NMS will be a panel and audience discussion hosted by SBS Insight presenter, Jenny Brockie, on whether the National Medicines Policy is due for a rethink, with a range of views and issues expected to be hotly contested.

Concurrent workshops will give delegates the chance to discuss and debate issues like transitions of care, translating policy into different cultural settings and what e-health will deliver, while the proffered papers sessions provide an opportunity to hear more about the research and work underway by other individuals and groups to address quality use of medicines issues within different health care settings and the broader community. Topics to be covered include:

* The rofecoxib withdrawal and health outcomes for older Australian women

* Does electronic prescribing reduce medication errors at discharge?

* Medication safety issues in Australians aged 50 years and older

* Medication concordance between patients and their GP in a high risk population

* Dabigatran - learnings from the listing of a new class of pharmaceutical

A record 267 posters will be on display in the foyer and breakout areas, demonstrating the breadth of research and innovation occurring in the quality use of medicines space at local, state and national levels.

This year the program will be available as a web app (available on all smart phones and tablets) featuring detailed presenter bios and contact information, which can be downloaded via the link at

For more information or to register go to


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