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[post_content] => Around 11% of errors reported to PDL are patient identification errors. While not the main source of dispensing error, it’s still significant – and has grown substantially in recent years.
Patient identification is seemingly straightforward. So why does it often go so wrong?
At the Medication Safety and Efficiency Conference held in Sydney from 2–3 April, experts including Jess Hadley, community pharmacist and Professional Officer at PDL, and Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA, highlighted how routine scenarios often mask high-risk situations and shared practical strategies to address them.
What does ‘patient identification’ mean?
The Australian Commission on Quality and Safety in Health Care defines patient identification as matching the right patient to the right treatment, procedure and therapy, Ms Hadley said.
[caption id="attachment_29084" align="aligncenter" width="600"]
Jess Hadley, community pharmacist and Professional Officer at PDL[/caption]
‘In incidents reported to PDL, it’s usually the direct supply where that might go wrong,’ she told the conference. ‘But we're seeing more and more that it can also be in the documentation.’
That means matching patients with the right record and documentation when care, medication, therapy and other services are provided; and when clinical handover, transfer or discharge documentation is generated.
Patients are predominantly identified in dispensing systems through their:
Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA[/caption]
Pharmacists today might serve 100–150 patients over an 8-hour shift. And scripts come via many channels, including by email or scanned tokens.
‘A patient may come to the counter and ask that we access their prescriptions through an active scripts list, or they might get us to scan an electronic token from their phone,’ he said.
‘People [also] send electronic tokens to us or prescriptions through third-party apps such as MedAdvisor, which will put this into a digital queue in the pharmacy.’
Pharmacies may also provide medicines to a health facility, such as a residential aged care facility, or send medication to a depot location for supply – including compounded medicines to the patient’s primary pharmacy.
And this is only the patient identification workflows for dispensing prescriptions. There are also other aspects of clinical care – such as administration of medicines, including vaccines and staged supply pharmacotherapy.
‘Sometimes, you actually need to [ask for three identifiers] multiple times,’ Mr Guthrey said. ‘And because we've gone from having a physical prescription, which contains those identifiers, to different things coming in different ways – we need to be more alert to identification challenges.’
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[post_content] => Expansive changes have been made to the Therapeutic Guidelines on antibiotics, encompassing over 1,400 drug recommendations.
The first stage targets infections managed in primary care, including patient information and a dosage calculator for aminoglycosides.
A key change impacting pharmacists, GPs and patients is that trimethoprim is no longer the first-line treatment of acute cystitis in non-pregnant adults due to resistance in Escherichia coli (E. coli).
The new treatment guidance for UTI in adults includes:
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[post_content] => From the United States to Europe, India and Southeast Asia – measles cases have been exploding worldwide.
In Texas, a measles outbreak with more than 500 cases is ravaging the state – leading to the death of an unvaccinated 6-year-old child. In our own backyard, an outbreak is fast developing in Western Australia – with 10 confirmed cases, and counting. Almost 40 measles cases have been confirmed across Australia this year.
The measles mumps rubella (MMR) vaccination rate in Texas among kindergarten-aged children is 94.3% – slightly below the World Health Organization’s 95% target.
Australia’s vaccination rate for all 5-year-olds is lower, sitting at 93.76%
[caption id="attachment_29037" align="alignright" width="267"]
Professor Margie Danchin[/caption]
So are we headed for Texas territory? Australian Pharmacist sat down with Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s (MCRI) Vaccine Uptake Group, to find out.
Is Australia at risk of losing control over measles spread?
To really stop measles transmission, a herd immunity threshold between 93–95% coverage is required. But many areas of the country are well below this figure.
This includes the Noosa Hinterland and the Northern Rivers region of New South Wales – where coverage (two doses of the MMR vaccine) only sits between 70–75%, said Prof Danchin.
‘Measles can spread pretty quickly in a low-coverage population,’ she said. ‘There will be local transmission from secondary cases because there just isn't that coverage there to stop it spreading.’
In a population with 70–75% overage, one case could infect approximately 5–8 people, and then each one of those people can infect another 5–8 people. ‘In low-coverage areas, cases need to be quickly isolated to stop transmission occurring, otherwise it can take off like a wildfire – which is exactly what's happened in the US.’
What’s driving the surge in measles cases?
A range of factors, Prof Danchin said. Take the current outbreak in Texas for example.
‘Geopolitics and the views of the current administration about vaccines being a personal choice is having some impact already,’ she said. ‘But it wouldn't be the whole story.’
Since the COVID-19 pandemic, vaccine coverage rates for children have decreased globally due to a complex mix of access and acceptance factors – leaving gaps in coverage that can fuel an outbreak.
In Australia, access barriers are the key driver for partially vaccinated children under 5 years, as identified by the MCRI, University of Sydney and National Centre for Immunisation Research and Surveillance’s (NCIRS) Vaccination Insights Project.
‘We measured nationally the main drivers of low vaccine coverage in Australia among partially and totally un-vaccinated children,’ Prof Danchin said.
‘And the strongest drivers for partially vaccinated kids were practical barriers – including not being able to get an appointment with the GP, or not being able to afford the costs associated with vaccination.’
Because many GPs don’t bulk bill anymore, parents are forced to pay gap payments, along with taking time off work, needing to find childcare for other children and possibly transport costs.
‘It's usually practice nurses who administer the vaccines in general practice, and they might not work full time, or only work once a week,’ she said.
In regions such as the Northern Rivers, hesitancy is likely the driving factor, Prof Danchin said.
‘There's a lot more mistrust in vaccines, providers and institutions post-COVID-19. Because the vaccines were under such intense scrutiny, vaccine safety concerns were really amplified in the media,’ she said.
‘At least 10% of the population still have a concern that the MMR vaccine can cause autism, despite 25 years of research that conclusively disproves the link.’
How can pharmacists promote the importance of vaccination?
By clearly communicating the benefits of vaccines while acknowledging the risks of vaccine-related adverse events.
‘We've got to be careful that we don't oversell vaccine safety,’ Prof Danchin said. ‘We need to be clear that tall vaccines have common and expected side effects, and that serious side effects are very rare.’
Given MMR is a live vaccine, patients can expect side effects around 1 week after receiving the vaccine. This can include a fever, coryza and a rash
But the key is communicating the risk-benefit to patients. ‘One in five people who get measles will have to go to hospital, one in 20 will get pneumonia and one in 1,000 will get inflammation of the brain or encephalitis – so the risks associated with contracting measles are high, especially among the most vulnerable such as babies under 1 year or children who have lowered immune systems,’ she said. ‘It is our responsibility to protect everyone in the community, especially those who cant be vaccinated with live vaccines.’
A communication strategy based on respect, listening and motivational interviewing can also help pharmacists understand where a person sits on the vaccine hesitancy spectrum.
‘For example, we need to assess if the parent is a true refuser or are they a bit of a fence sitter?’ Prof Danchin said. ‘Do they just want to partially vaccinate or do they want to vaccinate fully, but just have some questions?’
The next step is to listen to their concerns and validate them, then ask permission to share information and point them to trustworthy sources.
‘If they're not ready, invite them to come back,’ she said. ‘It’s not coercive and should bring people down from that heightened space of wanting to argue or defend themselves to genuinely being more receptive to the information.’
Pharmacists cal also refer to this resource, developed by a team of researchers and clinicians for parents and providers to help everyone have more non-judgmental conversations.
Who is eligible for a catch-up dose?
Anyone who is partially vaccinated. This also includes adults who were born between 1966 and 1992, with the two-dose schedule of the MMR vaccine only being introduced in Australia in 1992.
If patients are unsure about their or their children’s vaccination status, pharmacists can check the Australian Immunisation Register or advise patients to do so.
Different jurisdictions allow pharmacists to administer the MMR vaccine to children of various ages, so pharmacists should check the regulation in their state or territory before offering a catch-up vaccination.
Patients can receive a funded MMR vaccine under the NIP until 19 years of age, Prof Danchin said.
‘We recommend they get a second dose, because one dose of the MMR vaccine only provides about 91–93% protection,’ Prof Danchin said.
‘While people who've had one dose are more likely to get less severe measles, they can still get quite sick.’
How important is vaccination prior to travel?
Ahead of the Easter holiday break, NSW Minister for Health Ryan Park has called on people planning to travel overseas this April to ensure they and their family are fully protected against measles, with large outbreaks currently in many countries including Vietnam and other parts of Southeast Asia.
‘Measles is one of the most infectious diseases there is, and we are concerned about it spreading quickly in under-vaccinated communities,’ he said. ‘Anyone who is not immune is at risk of developing the disease if they are exposed.’
It’s particularly pertinent that both adults and children who are planning to travel are up to date with their two MMR vaccine doses.
‘Pharmacists should ask, “Are your kids up to date? Are you up to date?” And highlight the fact that you can get a catch-up dose, as one dose doesn't give you high enough protection,’ Prof Danchin said.
Pharmacists can advise parents that children under the eligible vaccination age can also receive protection prior to travelling.
‘Infants aged 6–11 months can be offered a free additional dose of the MMR vaccine in Victoria and NSW so they have at least some protection from measles if they're traveling through airports and on planes,’ she said. ‘But they still have to get their 12 and 18 month doses.’
Those who can’t get vaccinated, such as pregnant people or patients who are immunocompromised, can receive human immunoglobulin up to 6 days after an exposure.
‘And those who are not up to date with their MMR vaccine can get a dose within 4 days of an exposure,’ Prof Danchin added.
[post_title] => Is Australia heading for a massive measles outbreak?
[post_excerpt] => There have been two deaths in the southwest US due to measles. Western Australia is facing a fresh outbreak. Are we next?
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[title_attribute] => Is Australia heading for a massive measles outbreak?
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[post_content] => Pregabalin is being used far beyond its approved indications. With rising concerns over safety, the focus is shifting to careful, individualised deprescribing strategies.
Gabapentinoids, such as pregabalin and gabapentin, were registered by the Therapeutics Goods Administration (TGA) in the early 2000s for epileptic seizures and neuropathic pain.
But it was when pregabalin (Lyrica) was listed on the Pharmaceutical Benefits Scheme (PBS) in 2013 for refractory neuropathic pain unable to be controlled by other drugs, that prescribing of the drug really took off.
By the 2018–19 financial year, pregabalin became the sixth most prescribed subsidised drug in Australia, with over 3.5 million PBS subsidised prescriptions issued.
The highest rate of prescribing of pregabalin is for women over 80 years of age, with one in 10 taking the medicine. Yet this cohort of patients is also at high risk due to their susceptibility to adverse effects.
Originally developed as anti-epileptic drugs, it was discovered that gabapentinoids work for some types of neuropathic pain by dampening down nerve transmission, said credentialed pharmacist and pain educator Dr Peter Tenni MPS.
[caption id="attachment_29018" align="alignright" width="335"]
Dr Peter Tenni[/caption]
‘But over the years, they have been used for all sorts of nerve-related pain, some of which is not neuropathic,’ he said.
Because gabapentinoids are broad-acting drugs, they have other effects – such as reducing anxiety, leading to approval for use in the United Kingdom for this indication.
‘If you have a drug that reduces anxiety, you will feel better – so a lot of people have a subjective improvement,’ Dr Tenni said. ‘But when you ask them about their pain, it’s no better.’
The topic of reduction or cessation frequently elicits a strong reaction from patients.
‘Patients will say, “Oh no, don’t touch the Lyrica. It's working so well for me” – even when they haven’t seen an improvement in their pain,’ he said. ‘The big issue in the last 5–10 years has been dependence on these drugs.’
What nerve pain conditions does pregabalin actually help?
Only two types of neuropathic pain: diabetic neuropathy and post-herpetic neuralgia have strong evidence for effectiveness, said Dr Tenni.
‘There's also some evidence for fibromyalgia, which is not truly a neuropathic pain,’ he added.
The use of pregabalin for other indications such as non-specific back pain, sciatica or even back pain with neurological features is not evidence based.
‘There's no evidence that pregabalin is any better than placebo for these indications,’ Dr Tenni said.
In fact, around two out of every three prescriptions of pregabalin are for non-valid indications, most commonly for back pain and nerve sensitisation due to chronic pain, Dr Tenni said.
‘Although people feel better, and therefore may be able to tolerate their pain better, it's not actually treating the underlying problems.’
Gabapentinoids also come with a host of unpleasant adverse effects, including:
How should we deprescribe gabapentinoids, according to the Maudsley Deprescribing Guidelines[/caption]
‘So it’s more difficult in terms of withdrawal symptoms to drop from 25 mg to 0 mg than it is to drop from 600 mg to 300 mg.’
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[post_content] => The PSA hosted the General Practice Pharmacists Symposium in Melbourne on Friday 28 March, bringing leading voices and over 100 delegates together to explore the evolving role of pharmacists in general practice.
It is the first General Practice Pharmacists Symposium hosted by PSA, following 2 years delivered by the WentWest PHN in New South Wales.
As part of the symposium, PSA hosted a panel discussion featuring leaders from key pharmacy and medical groups including PSA’s Consultant Pharmacist Advisor Debbie Rigby FPS and representatives from the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) – facilitating constructive dialogue about the evolving role of pharmacists in general practice and the benefits of collaborative multidisciplinary models of care.
[gallery type="flexslider" size="full" ids="29011,29003,29002,29006,29012,29008,29007,29009,29005"]
PSA National President Associate Professor Fei Sim FPS reiterated PSA’s commitment to medicine safety and workforce support.
‘We know that each year 250,000 Australians are admitted to hospitals due to medication-related problems, which is only set to rise with the growing prevalence of chronic health conditions,’ she said.
‘We must support our health care system to meet this demand by investing in multidisciplinary care now, supporting general practitioners to grow their teams and foster greater pharmacist-GP collaboration to achieve true patient-centred care.
Pharmacists can make irreplaceable invaluable contribution in and within the general practice team.
‘Investing in isolated funding for QUM and medicine safety will directly benefit our health system and most importantly improve patient care,’ A/Prof Sim said.
‘The work that we’re doing today is building on more than 13 years of PSA advocacy for general practice pharmacists, from establishing pilot projects with primary health networks to embed pharmacists in general practices around the country to developing best practice frameworks to support the work pharmacists do as part of multidisciplinary teams.’
A/Prof Sim also pointed to PSA’s election platform advocacy, which calls for the doubling of the Workforce Incentive Program (WIP) to properly fund general practice pharmacists into the future.
‘This election, PSA is fighting for long-term, sustainable funding to encourage general practices to embed pharmacists into their teams, properly funding pharmacist roles through the Workforce Incentive Program,’ she said.
‘I once again wish to thank WentWest PHN for their leadership in establishing the Pharmacist in General Practice National Symposium in 2022, a legacy which PSA is proud to carry on.’
[post_title] => What transpired at the inaugural GP-Pharmacists Symposium?
[post_excerpt] => PSA's inaugural GP Pharmacists Symposium underscored the expanding scope of the profession – and the policy gaps that still need closing.
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[post_content] => Around 11% of errors reported to PDL are patient identification errors. While not the main source of dispensing error, it’s still significant – and has grown substantially in recent years.
Patient identification is seemingly straightforward. So why does it often go so wrong?
At the Medication Safety and Efficiency Conference held in Sydney from 2–3 April, experts including Jess Hadley, community pharmacist and Professional Officer at PDL, and Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA, highlighted how routine scenarios often mask high-risk situations and shared practical strategies to address them.
What does ‘patient identification’ mean?
The Australian Commission on Quality and Safety in Health Care defines patient identification as matching the right patient to the right treatment, procedure and therapy, Ms Hadley said.
[caption id="attachment_29084" align="aligncenter" width="600"] Jess Hadley, community pharmacist and Professional Officer at PDL[/caption]
‘In incidents reported to PDL, it’s usually the direct supply where that might go wrong,’ she told the conference. ‘But we're seeing more and more that it can also be in the documentation.’
That means matching patients with the right record and documentation when care, medication, therapy and other services are provided; and when clinical handover, transfer or discharge documentation is generated.
Patients are predominantly identified in dispensing systems through their:
Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA[/caption]
Pharmacists today might serve 100–150 patients over an 8-hour shift. And scripts come via many channels, including by email or scanned tokens.
‘A patient may come to the counter and ask that we access their prescriptions through an active scripts list, or they might get us to scan an electronic token from their phone,’ he said.
‘People [also] send electronic tokens to us or prescriptions through third-party apps such as MedAdvisor, which will put this into a digital queue in the pharmacy.’
Pharmacies may also provide medicines to a health facility, such as a residential aged care facility, or send medication to a depot location for supply – including compounded medicines to the patient’s primary pharmacy.
And this is only the patient identification workflows for dispensing prescriptions. There are also other aspects of clinical care – such as administration of medicines, including vaccines and staged supply pharmacotherapy.
‘Sometimes, you actually need to [ask for three identifiers] multiple times,’ Mr Guthrey said. ‘And because we've gone from having a physical prescription, which contains those identifiers, to different things coming in different ways – we need to be more alert to identification challenges.’
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[post_content] => Expansive changes have been made to the Therapeutic Guidelines on antibiotics, encompassing over 1,400 drug recommendations.
The first stage targets infections managed in primary care, including patient information and a dosage calculator for aminoglycosides.
A key change impacting pharmacists, GPs and patients is that trimethoprim is no longer the first-line treatment of acute cystitis in non-pregnant adults due to resistance in Escherichia coli (E. coli).
The new treatment guidance for UTI in adults includes:
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[post_content] => From the United States to Europe, India and Southeast Asia – measles cases have been exploding worldwide.
In Texas, a measles outbreak with more than 500 cases is ravaging the state – leading to the death of an unvaccinated 6-year-old child. In our own backyard, an outbreak is fast developing in Western Australia – with 10 confirmed cases, and counting. Almost 40 measles cases have been confirmed across Australia this year.
The measles mumps rubella (MMR) vaccination rate in Texas among kindergarten-aged children is 94.3% – slightly below the World Health Organization’s 95% target.
Australia’s vaccination rate for all 5-year-olds is lower, sitting at 93.76%
[caption id="attachment_29037" align="alignright" width="267"] Professor Margie Danchin[/caption]
So are we headed for Texas territory? Australian Pharmacist sat down with Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s (MCRI) Vaccine Uptake Group, to find out.
Is Australia at risk of losing control over measles spread?
To really stop measles transmission, a herd immunity threshold between 93–95% coverage is required. But many areas of the country are well below this figure.
This includes the Noosa Hinterland and the Northern Rivers region of New South Wales – where coverage (two doses of the MMR vaccine) only sits between 70–75%, said Prof Danchin.
‘Measles can spread pretty quickly in a low-coverage population,’ she said. ‘There will be local transmission from secondary cases because there just isn't that coverage there to stop it spreading.’
In a population with 70–75% overage, one case could infect approximately 5–8 people, and then each one of those people can infect another 5–8 people. ‘In low-coverage areas, cases need to be quickly isolated to stop transmission occurring, otherwise it can take off like a wildfire – which is exactly what's happened in the US.’
What’s driving the surge in measles cases?
A range of factors, Prof Danchin said. Take the current outbreak in Texas for example.
‘Geopolitics and the views of the current administration about vaccines being a personal choice is having some impact already,’ she said. ‘But it wouldn't be the whole story.’
Since the COVID-19 pandemic, vaccine coverage rates for children have decreased globally due to a complex mix of access and acceptance factors – leaving gaps in coverage that can fuel an outbreak.
In Australia, access barriers are the key driver for partially vaccinated children under 5 years, as identified by the MCRI, University of Sydney and National Centre for Immunisation Research and Surveillance’s (NCIRS) Vaccination Insights Project.
‘We measured nationally the main drivers of low vaccine coverage in Australia among partially and totally un-vaccinated children,’ Prof Danchin said.
‘And the strongest drivers for partially vaccinated kids were practical barriers – including not being able to get an appointment with the GP, or not being able to afford the costs associated with vaccination.’
Because many GPs don’t bulk bill anymore, parents are forced to pay gap payments, along with taking time off work, needing to find childcare for other children and possibly transport costs.
‘It's usually practice nurses who administer the vaccines in general practice, and they might not work full time, or only work once a week,’ she said.
In regions such as the Northern Rivers, hesitancy is likely the driving factor, Prof Danchin said.
‘There's a lot more mistrust in vaccines, providers and institutions post-COVID-19. Because the vaccines were under such intense scrutiny, vaccine safety concerns were really amplified in the media,’ she said.
‘At least 10% of the population still have a concern that the MMR vaccine can cause autism, despite 25 years of research that conclusively disproves the link.’
How can pharmacists promote the importance of vaccination?
By clearly communicating the benefits of vaccines while acknowledging the risks of vaccine-related adverse events.
‘We've got to be careful that we don't oversell vaccine safety,’ Prof Danchin said. ‘We need to be clear that tall vaccines have common and expected side effects, and that serious side effects are very rare.’
Given MMR is a live vaccine, patients can expect side effects around 1 week after receiving the vaccine. This can include a fever, coryza and a rash
But the key is communicating the risk-benefit to patients. ‘One in five people who get measles will have to go to hospital, one in 20 will get pneumonia and one in 1,000 will get inflammation of the brain or encephalitis – so the risks associated with contracting measles are high, especially among the most vulnerable such as babies under 1 year or children who have lowered immune systems,’ she said. ‘It is our responsibility to protect everyone in the community, especially those who cant be vaccinated with live vaccines.’
A communication strategy based on respect, listening and motivational interviewing can also help pharmacists understand where a person sits on the vaccine hesitancy spectrum.
‘For example, we need to assess if the parent is a true refuser or are they a bit of a fence sitter?’ Prof Danchin said. ‘Do they just want to partially vaccinate or do they want to vaccinate fully, but just have some questions?’
The next step is to listen to their concerns and validate them, then ask permission to share information and point them to trustworthy sources.
‘If they're not ready, invite them to come back,’ she said. ‘It’s not coercive and should bring people down from that heightened space of wanting to argue or defend themselves to genuinely being more receptive to the information.’
Pharmacists cal also refer to this resource, developed by a team of researchers and clinicians for parents and providers to help everyone have more non-judgmental conversations.
Who is eligible for a catch-up dose?
Anyone who is partially vaccinated. This also includes adults who were born between 1966 and 1992, with the two-dose schedule of the MMR vaccine only being introduced in Australia in 1992.
If patients are unsure about their or their children’s vaccination status, pharmacists can check the Australian Immunisation Register or advise patients to do so.
Different jurisdictions allow pharmacists to administer the MMR vaccine to children of various ages, so pharmacists should check the regulation in their state or territory before offering a catch-up vaccination.
Patients can receive a funded MMR vaccine under the NIP until 19 years of age, Prof Danchin said.
‘We recommend they get a second dose, because one dose of the MMR vaccine only provides about 91–93% protection,’ Prof Danchin said.
‘While people who've had one dose are more likely to get less severe measles, they can still get quite sick.’
How important is vaccination prior to travel?
Ahead of the Easter holiday break, NSW Minister for Health Ryan Park has called on people planning to travel overseas this April to ensure they and their family are fully protected against measles, with large outbreaks currently in many countries including Vietnam and other parts of Southeast Asia.
‘Measles is one of the most infectious diseases there is, and we are concerned about it spreading quickly in under-vaccinated communities,’ he said. ‘Anyone who is not immune is at risk of developing the disease if they are exposed.’
It’s particularly pertinent that both adults and children who are planning to travel are up to date with their two MMR vaccine doses.
‘Pharmacists should ask, “Are your kids up to date? Are you up to date?” And highlight the fact that you can get a catch-up dose, as one dose doesn't give you high enough protection,’ Prof Danchin said.
Pharmacists can advise parents that children under the eligible vaccination age can also receive protection prior to travelling.
‘Infants aged 6–11 months can be offered a free additional dose of the MMR vaccine in Victoria and NSW so they have at least some protection from measles if they're traveling through airports and on planes,’ she said. ‘But they still have to get their 12 and 18 month doses.’
Those who can’t get vaccinated, such as pregnant people or patients who are immunocompromised, can receive human immunoglobulin up to 6 days after an exposure.
‘And those who are not up to date with their MMR vaccine can get a dose within 4 days of an exposure,’ Prof Danchin added.
[post_title] => Is Australia heading for a massive measles outbreak?
[post_excerpt] => There have been two deaths in the southwest US due to measles. Western Australia is facing a fresh outbreak. Are we next?
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[title_attribute] => Is Australia heading for a massive measles outbreak?
[title] => Is Australia heading for a massive measles outbreak?
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[post_content] => Pregabalin is being used far beyond its approved indications. With rising concerns over safety, the focus is shifting to careful, individualised deprescribing strategies.
Gabapentinoids, such as pregabalin and gabapentin, were registered by the Therapeutics Goods Administration (TGA) in the early 2000s for epileptic seizures and neuropathic pain.
But it was when pregabalin (Lyrica) was listed on the Pharmaceutical Benefits Scheme (PBS) in 2013 for refractory neuropathic pain unable to be controlled by other drugs, that prescribing of the drug really took off.
By the 2018–19 financial year, pregabalin became the sixth most prescribed subsidised drug in Australia, with over 3.5 million PBS subsidised prescriptions issued.
The highest rate of prescribing of pregabalin is for women over 80 years of age, with one in 10 taking the medicine. Yet this cohort of patients is also at high risk due to their susceptibility to adverse effects.
Originally developed as anti-epileptic drugs, it was discovered that gabapentinoids work for some types of neuropathic pain by dampening down nerve transmission, said credentialed pharmacist and pain educator Dr Peter Tenni MPS.
[caption id="attachment_29018" align="alignright" width="335"] Dr Peter Tenni[/caption]
‘But over the years, they have been used for all sorts of nerve-related pain, some of which is not neuropathic,’ he said.
Because gabapentinoids are broad-acting drugs, they have other effects – such as reducing anxiety, leading to approval for use in the United Kingdom for this indication.
‘If you have a drug that reduces anxiety, you will feel better – so a lot of people have a subjective improvement,’ Dr Tenni said. ‘But when you ask them about their pain, it’s no better.’
The topic of reduction or cessation frequently elicits a strong reaction from patients.
‘Patients will say, “Oh no, don’t touch the Lyrica. It's working so well for me” – even when they haven’t seen an improvement in their pain,’ he said. ‘The big issue in the last 5–10 years has been dependence on these drugs.’
What nerve pain conditions does pregabalin actually help?
Only two types of neuropathic pain: diabetic neuropathy and post-herpetic neuralgia have strong evidence for effectiveness, said Dr Tenni.
‘There's also some evidence for fibromyalgia, which is not truly a neuropathic pain,’ he added.
The use of pregabalin for other indications such as non-specific back pain, sciatica or even back pain with neurological features is not evidence based.
‘There's no evidence that pregabalin is any better than placebo for these indications,’ Dr Tenni said.
In fact, around two out of every three prescriptions of pregabalin are for non-valid indications, most commonly for back pain and nerve sensitisation due to chronic pain, Dr Tenni said.
‘Although people feel better, and therefore may be able to tolerate their pain better, it's not actually treating the underlying problems.’
Gabapentinoids also come with a host of unpleasant adverse effects, including:
How should we deprescribe gabapentinoids, according to the Maudsley Deprescribing Guidelines[/caption]
‘So it’s more difficult in terms of withdrawal symptoms to drop from 25 mg to 0 mg than it is to drop from 600 mg to 300 mg.’
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[post_content] => The PSA hosted the General Practice Pharmacists Symposium in Melbourne on Friday 28 March, bringing leading voices and over 100 delegates together to explore the evolving role of pharmacists in general practice.
It is the first General Practice Pharmacists Symposium hosted by PSA, following 2 years delivered by the WentWest PHN in New South Wales.
As part of the symposium, PSA hosted a panel discussion featuring leaders from key pharmacy and medical groups including PSA’s Consultant Pharmacist Advisor Debbie Rigby FPS and representatives from the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) – facilitating constructive dialogue about the evolving role of pharmacists in general practice and the benefits of collaborative multidisciplinary models of care.
[gallery type="flexslider" size="full" ids="29011,29003,29002,29006,29012,29008,29007,29009,29005"]
PSA National President Associate Professor Fei Sim FPS reiterated PSA’s commitment to medicine safety and workforce support.
‘We know that each year 250,000 Australians are admitted to hospitals due to medication-related problems, which is only set to rise with the growing prevalence of chronic health conditions,’ she said.
‘We must support our health care system to meet this demand by investing in multidisciplinary care now, supporting general practitioners to grow their teams and foster greater pharmacist-GP collaboration to achieve true patient-centred care.
Pharmacists can make irreplaceable invaluable contribution in and within the general practice team.
‘Investing in isolated funding for QUM and medicine safety will directly benefit our health system and most importantly improve patient care,’ A/Prof Sim said.
‘The work that we’re doing today is building on more than 13 years of PSA advocacy for general practice pharmacists, from establishing pilot projects with primary health networks to embed pharmacists in general practices around the country to developing best practice frameworks to support the work pharmacists do as part of multidisciplinary teams.’
A/Prof Sim also pointed to PSA’s election platform advocacy, which calls for the doubling of the Workforce Incentive Program (WIP) to properly fund general practice pharmacists into the future.
‘This election, PSA is fighting for long-term, sustainable funding to encourage general practices to embed pharmacists into their teams, properly funding pharmacist roles through the Workforce Incentive Program,’ she said.
‘I once again wish to thank WentWest PHN for their leadership in establishing the Pharmacist in General Practice National Symposium in 2022, a legacy which PSA is proud to carry on.’
[post_title] => What transpired at the inaugural GP-Pharmacists Symposium?
[post_excerpt] => PSA's inaugural GP Pharmacists Symposium underscored the expanding scope of the profession – and the policy gaps that still need closing.
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[title_attribute] => What transpired at the inaugural GP-Pharmacists Symposium?
[title] => What transpired at the inaugural GP-Pharmacists Symposium?
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[post_content] => Around 11% of errors reported to PDL are patient identification errors. While not the main source of dispensing error, it’s still significant – and has grown substantially in recent years.
Patient identification is seemingly straightforward. So why does it often go so wrong?
At the Medication Safety and Efficiency Conference held in Sydney from 2–3 April, experts including Jess Hadley, community pharmacist and Professional Officer at PDL, and Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA, highlighted how routine scenarios often mask high-risk situations and shared practical strategies to address them.
What does ‘patient identification’ mean?
The Australian Commission on Quality and Safety in Health Care defines patient identification as matching the right patient to the right treatment, procedure and therapy, Ms Hadley said.
[caption id="attachment_29084" align="aligncenter" width="600"] Jess Hadley, community pharmacist and Professional Officer at PDL[/caption]
‘In incidents reported to PDL, it’s usually the direct supply where that might go wrong,’ she told the conference. ‘But we're seeing more and more that it can also be in the documentation.’
That means matching patients with the right record and documentation when care, medication, therapy and other services are provided; and when clinical handover, transfer or discharge documentation is generated.
Patients are predominantly identified in dispensing systems through their:
Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA[/caption]
Pharmacists today might serve 100–150 patients over an 8-hour shift. And scripts come via many channels, including by email or scanned tokens.
‘A patient may come to the counter and ask that we access their prescriptions through an active scripts list, or they might get us to scan an electronic token from their phone,’ he said.
‘People [also] send electronic tokens to us or prescriptions through third-party apps such as MedAdvisor, which will put this into a digital queue in the pharmacy.’
Pharmacies may also provide medicines to a health facility, such as a residential aged care facility, or send medication to a depot location for supply – including compounded medicines to the patient’s primary pharmacy.
And this is only the patient identification workflows for dispensing prescriptions. There are also other aspects of clinical care – such as administration of medicines, including vaccines and staged supply pharmacotherapy.
‘Sometimes, you actually need to [ask for three identifiers] multiple times,’ Mr Guthrey said. ‘And because we've gone from having a physical prescription, which contains those identifiers, to different things coming in different ways – we need to be more alert to identification challenges.’
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[post_content] => Expansive changes have been made to the Therapeutic Guidelines on antibiotics, encompassing over 1,400 drug recommendations.
The first stage targets infections managed in primary care, including patient information and a dosage calculator for aminoglycosides.
A key change impacting pharmacists, GPs and patients is that trimethoprim is no longer the first-line treatment of acute cystitis in non-pregnant adults due to resistance in Escherichia coli (E. coli).
The new treatment guidance for UTI in adults includes:
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[post_content] => From the United States to Europe, India and Southeast Asia – measles cases have been exploding worldwide.
In Texas, a measles outbreak with more than 500 cases is ravaging the state – leading to the death of an unvaccinated 6-year-old child. In our own backyard, an outbreak is fast developing in Western Australia – with 10 confirmed cases, and counting. Almost 40 measles cases have been confirmed across Australia this year.
The measles mumps rubella (MMR) vaccination rate in Texas among kindergarten-aged children is 94.3% – slightly below the World Health Organization’s 95% target.
Australia’s vaccination rate for all 5-year-olds is lower, sitting at 93.76%
[caption id="attachment_29037" align="alignright" width="267"] Professor Margie Danchin[/caption]
So are we headed for Texas territory? Australian Pharmacist sat down with Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s (MCRI) Vaccine Uptake Group, to find out.
Is Australia at risk of losing control over measles spread?
To really stop measles transmission, a herd immunity threshold between 93–95% coverage is required. But many areas of the country are well below this figure.
This includes the Noosa Hinterland and the Northern Rivers region of New South Wales – where coverage (two doses of the MMR vaccine) only sits between 70–75%, said Prof Danchin.
‘Measles can spread pretty quickly in a low-coverage population,’ she said. ‘There will be local transmission from secondary cases because there just isn't that coverage there to stop it spreading.’
In a population with 70–75% overage, one case could infect approximately 5–8 people, and then each one of those people can infect another 5–8 people. ‘In low-coverage areas, cases need to be quickly isolated to stop transmission occurring, otherwise it can take off like a wildfire – which is exactly what's happened in the US.’
What’s driving the surge in measles cases?
A range of factors, Prof Danchin said. Take the current outbreak in Texas for example.
‘Geopolitics and the views of the current administration about vaccines being a personal choice is having some impact already,’ she said. ‘But it wouldn't be the whole story.’
Since the COVID-19 pandemic, vaccine coverage rates for children have decreased globally due to a complex mix of access and acceptance factors – leaving gaps in coverage that can fuel an outbreak.
In Australia, access barriers are the key driver for partially vaccinated children under 5 years, as identified by the MCRI, University of Sydney and National Centre for Immunisation Research and Surveillance’s (NCIRS) Vaccination Insights Project.
‘We measured nationally the main drivers of low vaccine coverage in Australia among partially and totally un-vaccinated children,’ Prof Danchin said.
‘And the strongest drivers for partially vaccinated kids were practical barriers – including not being able to get an appointment with the GP, or not being able to afford the costs associated with vaccination.’
Because many GPs don’t bulk bill anymore, parents are forced to pay gap payments, along with taking time off work, needing to find childcare for other children and possibly transport costs.
‘It's usually practice nurses who administer the vaccines in general practice, and they might not work full time, or only work once a week,’ she said.
In regions such as the Northern Rivers, hesitancy is likely the driving factor, Prof Danchin said.
‘There's a lot more mistrust in vaccines, providers and institutions post-COVID-19. Because the vaccines were under such intense scrutiny, vaccine safety concerns were really amplified in the media,’ she said.
‘At least 10% of the population still have a concern that the MMR vaccine can cause autism, despite 25 years of research that conclusively disproves the link.’
How can pharmacists promote the importance of vaccination?
By clearly communicating the benefits of vaccines while acknowledging the risks of vaccine-related adverse events.
‘We've got to be careful that we don't oversell vaccine safety,’ Prof Danchin said. ‘We need to be clear that tall vaccines have common and expected side effects, and that serious side effects are very rare.’
Given MMR is a live vaccine, patients can expect side effects around 1 week after receiving the vaccine. This can include a fever, coryza and a rash
But the key is communicating the risk-benefit to patients. ‘One in five people who get measles will have to go to hospital, one in 20 will get pneumonia and one in 1,000 will get inflammation of the brain or encephalitis – so the risks associated with contracting measles are high, especially among the most vulnerable such as babies under 1 year or children who have lowered immune systems,’ she said. ‘It is our responsibility to protect everyone in the community, especially those who cant be vaccinated with live vaccines.’
A communication strategy based on respect, listening and motivational interviewing can also help pharmacists understand where a person sits on the vaccine hesitancy spectrum.
‘For example, we need to assess if the parent is a true refuser or are they a bit of a fence sitter?’ Prof Danchin said. ‘Do they just want to partially vaccinate or do they want to vaccinate fully, but just have some questions?’
The next step is to listen to their concerns and validate them, then ask permission to share information and point them to trustworthy sources.
‘If they're not ready, invite them to come back,’ she said. ‘It’s not coercive and should bring people down from that heightened space of wanting to argue or defend themselves to genuinely being more receptive to the information.’
Pharmacists cal also refer to this resource, developed by a team of researchers and clinicians for parents and providers to help everyone have more non-judgmental conversations.
Who is eligible for a catch-up dose?
Anyone who is partially vaccinated. This also includes adults who were born between 1966 and 1992, with the two-dose schedule of the MMR vaccine only being introduced in Australia in 1992.
If patients are unsure about their or their children’s vaccination status, pharmacists can check the Australian Immunisation Register or advise patients to do so.
Different jurisdictions allow pharmacists to administer the MMR vaccine to children of various ages, so pharmacists should check the regulation in their state or territory before offering a catch-up vaccination.
Patients can receive a funded MMR vaccine under the NIP until 19 years of age, Prof Danchin said.
‘We recommend they get a second dose, because one dose of the MMR vaccine only provides about 91–93% protection,’ Prof Danchin said.
‘While people who've had one dose are more likely to get less severe measles, they can still get quite sick.’
How important is vaccination prior to travel?
Ahead of the Easter holiday break, NSW Minister for Health Ryan Park has called on people planning to travel overseas this April to ensure they and their family are fully protected against measles, with large outbreaks currently in many countries including Vietnam and other parts of Southeast Asia.
‘Measles is one of the most infectious diseases there is, and we are concerned about it spreading quickly in under-vaccinated communities,’ he said. ‘Anyone who is not immune is at risk of developing the disease if they are exposed.’
It’s particularly pertinent that both adults and children who are planning to travel are up to date with their two MMR vaccine doses.
‘Pharmacists should ask, “Are your kids up to date? Are you up to date?” And highlight the fact that you can get a catch-up dose, as one dose doesn't give you high enough protection,’ Prof Danchin said.
Pharmacists can advise parents that children under the eligible vaccination age can also receive protection prior to travelling.
‘Infants aged 6–11 months can be offered a free additional dose of the MMR vaccine in Victoria and NSW so they have at least some protection from measles if they're traveling through airports and on planes,’ she said. ‘But they still have to get their 12 and 18 month doses.’
Those who can’t get vaccinated, such as pregnant people or patients who are immunocompromised, can receive human immunoglobulin up to 6 days after an exposure.
‘And those who are not up to date with their MMR vaccine can get a dose within 4 days of an exposure,’ Prof Danchin added.
[post_title] => Is Australia heading for a massive measles outbreak?
[post_excerpt] => There have been two deaths in the southwest US due to measles. Western Australia is facing a fresh outbreak. Are we next?
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[title_attribute] => Is Australia heading for a massive measles outbreak?
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[post_content] => Pregabalin is being used far beyond its approved indications. With rising concerns over safety, the focus is shifting to careful, individualised deprescribing strategies.
Gabapentinoids, such as pregabalin and gabapentin, were registered by the Therapeutics Goods Administration (TGA) in the early 2000s for epileptic seizures and neuropathic pain.
But it was when pregabalin (Lyrica) was listed on the Pharmaceutical Benefits Scheme (PBS) in 2013 for refractory neuropathic pain unable to be controlled by other drugs, that prescribing of the drug really took off.
By the 2018–19 financial year, pregabalin became the sixth most prescribed subsidised drug in Australia, with over 3.5 million PBS subsidised prescriptions issued.
The highest rate of prescribing of pregabalin is for women over 80 years of age, with one in 10 taking the medicine. Yet this cohort of patients is also at high risk due to their susceptibility to adverse effects.
Originally developed as anti-epileptic drugs, it was discovered that gabapentinoids work for some types of neuropathic pain by dampening down nerve transmission, said credentialed pharmacist and pain educator Dr Peter Tenni MPS.
[caption id="attachment_29018" align="alignright" width="335"] Dr Peter Tenni[/caption]
‘But over the years, they have been used for all sorts of nerve-related pain, some of which is not neuropathic,’ he said.
Because gabapentinoids are broad-acting drugs, they have other effects – such as reducing anxiety, leading to approval for use in the United Kingdom for this indication.
‘If you have a drug that reduces anxiety, you will feel better – so a lot of people have a subjective improvement,’ Dr Tenni said. ‘But when you ask them about their pain, it’s no better.’
The topic of reduction or cessation frequently elicits a strong reaction from patients.
‘Patients will say, “Oh no, don’t touch the Lyrica. It's working so well for me” – even when they haven’t seen an improvement in their pain,’ he said. ‘The big issue in the last 5–10 years has been dependence on these drugs.’
What nerve pain conditions does pregabalin actually help?
Only two types of neuropathic pain: diabetic neuropathy and post-herpetic neuralgia have strong evidence for effectiveness, said Dr Tenni.
‘There's also some evidence for fibromyalgia, which is not truly a neuropathic pain,’ he added.
The use of pregabalin for other indications such as non-specific back pain, sciatica or even back pain with neurological features is not evidence based.
‘There's no evidence that pregabalin is any better than placebo for these indications,’ Dr Tenni said.
In fact, around two out of every three prescriptions of pregabalin are for non-valid indications, most commonly for back pain and nerve sensitisation due to chronic pain, Dr Tenni said.
‘Although people feel better, and therefore may be able to tolerate their pain better, it's not actually treating the underlying problems.’
Gabapentinoids also come with a host of unpleasant adverse effects, including:
How should we deprescribe gabapentinoids, according to the Maudsley Deprescribing Guidelines[/caption]
‘So it’s more difficult in terms of withdrawal symptoms to drop from 25 mg to 0 mg than it is to drop from 600 mg to 300 mg.’
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[post_content] => The PSA hosted the General Practice Pharmacists Symposium in Melbourne on Friday 28 March, bringing leading voices and over 100 delegates together to explore the evolving role of pharmacists in general practice.
It is the first General Practice Pharmacists Symposium hosted by PSA, following 2 years delivered by the WentWest PHN in New South Wales.
As part of the symposium, PSA hosted a panel discussion featuring leaders from key pharmacy and medical groups including PSA’s Consultant Pharmacist Advisor Debbie Rigby FPS and representatives from the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) – facilitating constructive dialogue about the evolving role of pharmacists in general practice and the benefits of collaborative multidisciplinary models of care.
[gallery type="flexslider" size="full" ids="29011,29003,29002,29006,29012,29008,29007,29009,29005"]
PSA National President Associate Professor Fei Sim FPS reiterated PSA’s commitment to medicine safety and workforce support.
‘We know that each year 250,000 Australians are admitted to hospitals due to medication-related problems, which is only set to rise with the growing prevalence of chronic health conditions,’ she said.
‘We must support our health care system to meet this demand by investing in multidisciplinary care now, supporting general practitioners to grow their teams and foster greater pharmacist-GP collaboration to achieve true patient-centred care.
Pharmacists can make irreplaceable invaluable contribution in and within the general practice team.
‘Investing in isolated funding for QUM and medicine safety will directly benefit our health system and most importantly improve patient care,’ A/Prof Sim said.
‘The work that we’re doing today is building on more than 13 years of PSA advocacy for general practice pharmacists, from establishing pilot projects with primary health networks to embed pharmacists in general practices around the country to developing best practice frameworks to support the work pharmacists do as part of multidisciplinary teams.’
A/Prof Sim also pointed to PSA’s election platform advocacy, which calls for the doubling of the Workforce Incentive Program (WIP) to properly fund general practice pharmacists into the future.
‘This election, PSA is fighting for long-term, sustainable funding to encourage general practices to embed pharmacists into their teams, properly funding pharmacist roles through the Workforce Incentive Program,’ she said.
‘I once again wish to thank WentWest PHN for their leadership in establishing the Pharmacist in General Practice National Symposium in 2022, a legacy which PSA is proud to carry on.’
[post_title] => What transpired at the inaugural GP-Pharmacists Symposium?
[post_excerpt] => PSA's inaugural GP Pharmacists Symposium underscored the expanding scope of the profession – and the policy gaps that still need closing.
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[post_content] => Around 11% of errors reported to PDL are patient identification errors. While not the main source of dispensing error, it’s still significant – and has grown substantially in recent years.
Patient identification is seemingly straightforward. So why does it often go so wrong?
At the Medication Safety and Efficiency Conference held in Sydney from 2–3 April, experts including Jess Hadley, community pharmacist and Professional Officer at PDL, and Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA, highlighted how routine scenarios often mask high-risk situations and shared practical strategies to address them.
What does ‘patient identification’ mean?
The Australian Commission on Quality and Safety in Health Care defines patient identification as matching the right patient to the right treatment, procedure and therapy, Ms Hadley said.
[caption id="attachment_29084" align="aligncenter" width="600"] Jess Hadley, community pharmacist and Professional Officer at PDL[/caption]
‘In incidents reported to PDL, it’s usually the direct supply where that might go wrong,’ she told the conference. ‘But we're seeing more and more that it can also be in the documentation.’
That means matching patients with the right record and documentation when care, medication, therapy and other services are provided; and when clinical handover, transfer or discharge documentation is generated.
Patients are predominantly identified in dispensing systems through their:
Peter Guthrey, Senior Pharmacist – Strategic Policy at PSA[/caption]
Pharmacists today might serve 100–150 patients over an 8-hour shift. And scripts come via many channels, including by email or scanned tokens.
‘A patient may come to the counter and ask that we access their prescriptions through an active scripts list, or they might get us to scan an electronic token from their phone,’ he said.
‘People [also] send electronic tokens to us or prescriptions through third-party apps such as MedAdvisor, which will put this into a digital queue in the pharmacy.’
Pharmacies may also provide medicines to a health facility, such as a residential aged care facility, or send medication to a depot location for supply – including compounded medicines to the patient’s primary pharmacy.
And this is only the patient identification workflows for dispensing prescriptions. There are also other aspects of clinical care – such as administration of medicines, including vaccines and staged supply pharmacotherapy.
‘Sometimes, you actually need to [ask for three identifiers] multiple times,’ Mr Guthrey said. ‘And because we've gone from having a physical prescription, which contains those identifiers, to different things coming in different ways – we need to be more alert to identification challenges.’
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[post_content] => Expansive changes have been made to the Therapeutic Guidelines on antibiotics, encompassing over 1,400 drug recommendations.
The first stage targets infections managed in primary care, including patient information and a dosage calculator for aminoglycosides.
A key change impacting pharmacists, GPs and patients is that trimethoprim is no longer the first-line treatment of acute cystitis in non-pregnant adults due to resistance in Escherichia coli (E. coli).
The new treatment guidance for UTI in adults includes:
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[post_date] => 2025-04-02 12:03:57
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[post_content] => From the United States to Europe, India and Southeast Asia – measles cases have been exploding worldwide.
In Texas, a measles outbreak with more than 500 cases is ravaging the state – leading to the death of an unvaccinated 6-year-old child. In our own backyard, an outbreak is fast developing in Western Australia – with 10 confirmed cases, and counting. Almost 40 measles cases have been confirmed across Australia this year.
The measles mumps rubella (MMR) vaccination rate in Texas among kindergarten-aged children is 94.3% – slightly below the World Health Organization’s 95% target.
Australia’s vaccination rate for all 5-year-olds is lower, sitting at 93.76%
[caption id="attachment_29037" align="alignright" width="267"] Professor Margie Danchin[/caption]
So are we headed for Texas territory? Australian Pharmacist sat down with Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s (MCRI) Vaccine Uptake Group, to find out.
Is Australia at risk of losing control over measles spread?
To really stop measles transmission, a herd immunity threshold between 93–95% coverage is required. But many areas of the country are well below this figure.
This includes the Noosa Hinterland and the Northern Rivers region of New South Wales – where coverage (two doses of the MMR vaccine) only sits between 70–75%, said Prof Danchin.
‘Measles can spread pretty quickly in a low-coverage population,’ she said. ‘There will be local transmission from secondary cases because there just isn't that coverage there to stop it spreading.’
In a population with 70–75% overage, one case could infect approximately 5–8 people, and then each one of those people can infect another 5–8 people. ‘In low-coverage areas, cases need to be quickly isolated to stop transmission occurring, otherwise it can take off like a wildfire – which is exactly what's happened in the US.’
What’s driving the surge in measles cases?
A range of factors, Prof Danchin said. Take the current outbreak in Texas for example.
‘Geopolitics and the views of the current administration about vaccines being a personal choice is having some impact already,’ she said. ‘But it wouldn't be the whole story.’
Since the COVID-19 pandemic, vaccine coverage rates for children have decreased globally due to a complex mix of access and acceptance factors – leaving gaps in coverage that can fuel an outbreak.
In Australia, access barriers are the key driver for partially vaccinated children under 5 years, as identified by the MCRI, University of Sydney and National Centre for Immunisation Research and Surveillance’s (NCIRS) Vaccination Insights Project.
‘We measured nationally the main drivers of low vaccine coverage in Australia among partially and totally un-vaccinated children,’ Prof Danchin said.
‘And the strongest drivers for partially vaccinated kids were practical barriers – including not being able to get an appointment with the GP, or not being able to afford the costs associated with vaccination.’
Because many GPs don’t bulk bill anymore, parents are forced to pay gap payments, along with taking time off work, needing to find childcare for other children and possibly transport costs.
‘It's usually practice nurses who administer the vaccines in general practice, and they might not work full time, or only work once a week,’ she said.
In regions such as the Northern Rivers, hesitancy is likely the driving factor, Prof Danchin said.
‘There's a lot more mistrust in vaccines, providers and institutions post-COVID-19. Because the vaccines were under such intense scrutiny, vaccine safety concerns were really amplified in the media,’ she said.
‘At least 10% of the population still have a concern that the MMR vaccine can cause autism, despite 25 years of research that conclusively disproves the link.’
How can pharmacists promote the importance of vaccination?
By clearly communicating the benefits of vaccines while acknowledging the risks of vaccine-related adverse events.
‘We've got to be careful that we don't oversell vaccine safety,’ Prof Danchin said. ‘We need to be clear that tall vaccines have common and expected side effects, and that serious side effects are very rare.’
Given MMR is a live vaccine, patients can expect side effects around 1 week after receiving the vaccine. This can include a fever, coryza and a rash
But the key is communicating the risk-benefit to patients. ‘One in five people who get measles will have to go to hospital, one in 20 will get pneumonia and one in 1,000 will get inflammation of the brain or encephalitis – so the risks associated with contracting measles are high, especially among the most vulnerable such as babies under 1 year or children who have lowered immune systems,’ she said. ‘It is our responsibility to protect everyone in the community, especially those who cant be vaccinated with live vaccines.’
A communication strategy based on respect, listening and motivational interviewing can also help pharmacists understand where a person sits on the vaccine hesitancy spectrum.
‘For example, we need to assess if the parent is a true refuser or are they a bit of a fence sitter?’ Prof Danchin said. ‘Do they just want to partially vaccinate or do they want to vaccinate fully, but just have some questions?’
The next step is to listen to their concerns and validate them, then ask permission to share information and point them to trustworthy sources.
‘If they're not ready, invite them to come back,’ she said. ‘It’s not coercive and should bring people down from that heightened space of wanting to argue or defend themselves to genuinely being more receptive to the information.’
Pharmacists cal also refer to this resource, developed by a team of researchers and clinicians for parents and providers to help everyone have more non-judgmental conversations.
Who is eligible for a catch-up dose?
Anyone who is partially vaccinated. This also includes adults who were born between 1966 and 1992, with the two-dose schedule of the MMR vaccine only being introduced in Australia in 1992.
If patients are unsure about their or their children’s vaccination status, pharmacists can check the Australian Immunisation Register or advise patients to do so.
Different jurisdictions allow pharmacists to administer the MMR vaccine to children of various ages, so pharmacists should check the regulation in their state or territory before offering a catch-up vaccination.
Patients can receive a funded MMR vaccine under the NIP until 19 years of age, Prof Danchin said.
‘We recommend they get a second dose, because one dose of the MMR vaccine only provides about 91–93% protection,’ Prof Danchin said.
‘While people who've had one dose are more likely to get less severe measles, they can still get quite sick.’
How important is vaccination prior to travel?
Ahead of the Easter holiday break, NSW Minister for Health Ryan Park has called on people planning to travel overseas this April to ensure they and their family are fully protected against measles, with large outbreaks currently in many countries including Vietnam and other parts of Southeast Asia.
‘Measles is one of the most infectious diseases there is, and we are concerned about it spreading quickly in under-vaccinated communities,’ he said. ‘Anyone who is not immune is at risk of developing the disease if they are exposed.’
It’s particularly pertinent that both adults and children who are planning to travel are up to date with their two MMR vaccine doses.
‘Pharmacists should ask, “Are your kids up to date? Are you up to date?” And highlight the fact that you can get a catch-up dose, as one dose doesn't give you high enough protection,’ Prof Danchin said.
Pharmacists can advise parents that children under the eligible vaccination age can also receive protection prior to travelling.
‘Infants aged 6–11 months can be offered a free additional dose of the MMR vaccine in Victoria and NSW so they have at least some protection from measles if they're traveling through airports and on planes,’ she said. ‘But they still have to get their 12 and 18 month doses.’
Those who can’t get vaccinated, such as pregnant people or patients who are immunocompromised, can receive human immunoglobulin up to 6 days after an exposure.
‘And those who are not up to date with their MMR vaccine can get a dose within 4 days of an exposure,’ Prof Danchin added.
[post_title] => Is Australia heading for a massive measles outbreak?
[post_excerpt] => There have been two deaths in the southwest US due to measles. Western Australia is facing a fresh outbreak. Are we next?
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[title_attribute] => Is Australia heading for a massive measles outbreak?
[title] => Is Australia heading for a massive measles outbreak?
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[post_date] => 2025-03-31 14:40:50
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[post_content] => Pregabalin is being used far beyond its approved indications. With rising concerns over safety, the focus is shifting to careful, individualised deprescribing strategies.
Gabapentinoids, such as pregabalin and gabapentin, were registered by the Therapeutics Goods Administration (TGA) in the early 2000s for epileptic seizures and neuropathic pain.
But it was when pregabalin (Lyrica) was listed on the Pharmaceutical Benefits Scheme (PBS) in 2013 for refractory neuropathic pain unable to be controlled by other drugs, that prescribing of the drug really took off.
By the 2018–19 financial year, pregabalin became the sixth most prescribed subsidised drug in Australia, with over 3.5 million PBS subsidised prescriptions issued.
The highest rate of prescribing of pregabalin is for women over 80 years of age, with one in 10 taking the medicine. Yet this cohort of patients is also at high risk due to their susceptibility to adverse effects.
Originally developed as anti-epileptic drugs, it was discovered that gabapentinoids work for some types of neuropathic pain by dampening down nerve transmission, said credentialed pharmacist and pain educator Dr Peter Tenni MPS.
[caption id="attachment_29018" align="alignright" width="335"] Dr Peter Tenni[/caption]
‘But over the years, they have been used for all sorts of nerve-related pain, some of which is not neuropathic,’ he said.
Because gabapentinoids are broad-acting drugs, they have other effects – such as reducing anxiety, leading to approval for use in the United Kingdom for this indication.
‘If you have a drug that reduces anxiety, you will feel better – so a lot of people have a subjective improvement,’ Dr Tenni said. ‘But when you ask them about their pain, it’s no better.’
The topic of reduction or cessation frequently elicits a strong reaction from patients.
‘Patients will say, “Oh no, don’t touch the Lyrica. It's working so well for me” – even when they haven’t seen an improvement in their pain,’ he said. ‘The big issue in the last 5–10 years has been dependence on these drugs.’
What nerve pain conditions does pregabalin actually help?
Only two types of neuropathic pain: diabetic neuropathy and post-herpetic neuralgia have strong evidence for effectiveness, said Dr Tenni.
‘There's also some evidence for fibromyalgia, which is not truly a neuropathic pain,’ he added.
The use of pregabalin for other indications such as non-specific back pain, sciatica or even back pain with neurological features is not evidence based.
‘There's no evidence that pregabalin is any better than placebo for these indications,’ Dr Tenni said.
In fact, around two out of every three prescriptions of pregabalin are for non-valid indications, most commonly for back pain and nerve sensitisation due to chronic pain, Dr Tenni said.
‘Although people feel better, and therefore may be able to tolerate their pain better, it's not actually treating the underlying problems.’
Gabapentinoids also come with a host of unpleasant adverse effects, including:
How should we deprescribe gabapentinoids, according to the Maudsley Deprescribing Guidelines[/caption]
‘So it’s more difficult in terms of withdrawal symptoms to drop from 25 mg to 0 mg than it is to drop from 600 mg to 300 mg.’
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[post_content] => The PSA hosted the General Practice Pharmacists Symposium in Melbourne on Friday 28 March, bringing leading voices and over 100 delegates together to explore the evolving role of pharmacists in general practice.
It is the first General Practice Pharmacists Symposium hosted by PSA, following 2 years delivered by the WentWest PHN in New South Wales.
As part of the symposium, PSA hosted a panel discussion featuring leaders from key pharmacy and medical groups including PSA’s Consultant Pharmacist Advisor Debbie Rigby FPS and representatives from the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) – facilitating constructive dialogue about the evolving role of pharmacists in general practice and the benefits of collaborative multidisciplinary models of care.
[gallery type="flexslider" size="full" ids="29011,29003,29002,29006,29012,29008,29007,29009,29005"]
PSA National President Associate Professor Fei Sim FPS reiterated PSA’s commitment to medicine safety and workforce support.
‘We know that each year 250,000 Australians are admitted to hospitals due to medication-related problems, which is only set to rise with the growing prevalence of chronic health conditions,’ she said.
‘We must support our health care system to meet this demand by investing in multidisciplinary care now, supporting general practitioners to grow their teams and foster greater pharmacist-GP collaboration to achieve true patient-centred care.
Pharmacists can make irreplaceable invaluable contribution in and within the general practice team.
‘Investing in isolated funding for QUM and medicine safety will directly benefit our health system and most importantly improve patient care,’ A/Prof Sim said.
‘The work that we’re doing today is building on more than 13 years of PSA advocacy for general practice pharmacists, from establishing pilot projects with primary health networks to embed pharmacists in general practices around the country to developing best practice frameworks to support the work pharmacists do as part of multidisciplinary teams.’
A/Prof Sim also pointed to PSA’s election platform advocacy, which calls for the doubling of the Workforce Incentive Program (WIP) to properly fund general practice pharmacists into the future.
‘This election, PSA is fighting for long-term, sustainable funding to encourage general practices to embed pharmacists into their teams, properly funding pharmacist roles through the Workforce Incentive Program,’ she said.
‘I once again wish to thank WentWest PHN for their leadership in establishing the Pharmacist in General Practice National Symposium in 2022, a legacy which PSA is proud to carry on.’
[post_title] => What transpired at the inaugural GP-Pharmacists Symposium?
[post_excerpt] => PSA's inaugural GP Pharmacists Symposium underscored the expanding scope of the profession – and the policy gaps that still need closing.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
