Chloe Hava and Joseph Harding
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[post_content] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on Saturday (26 October 2024).
Bill was an active community pharmacist and long-standing pharmacy owner in the ACT, who’s profound contribution to the profession and the Australian public spanned many roles and many decades.
Bill was a career-long member of the PSA, regularly attending events and lectures and volunteering his time and expertise for the benefit of the profession. Bill served on Special Interest Groups and was appointed as the pharmacy representative on a diverse range of boards and bodies including the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project.
In 2013, Bill celebrated 50 years of continuous PSA membership and was made a Life Member in recognition of his service to the profession and to PSA.
Bill was the first Chairman of the ACT Division of the Pharmaceutical Society of New South Wales in 1971. He made a significant contribution to the profession as a member of the ACT Pharmacy Board from 1998-2015. He was an active contributor to the International Pharmaceutical Federation (FIP) and an inaugural member of the Pharmacy Guild of Australia’s ACT Branch Committee, who later recognised him as a life member. Bill was also one of the leaders behind Auspharmlist, one of the first online forums for pharmacists to collaborate and mentor each in the virtual world.
Outside of pharmacy, Bill had a love of the Australian bush, was a soccer tragic and undertook extensive chaplaincy work in prisons.
Upon awarding Mr Arnold the honour of life membership, then ACT Branch President Greg Kyle, recognised Bill as a stalwart of PSA for many years, describing his as ‘a very active member [whose] ongoing commitment to the profession and the community is an example that many other pharmacists look up to.’
‘He never shirks from volunteering to offer his expertise and his work has seen him appointed as the pharmacy representative on a diverse range of boards and bodies which have included the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project,’ Associate Professor Kyle said.
On receiving this honour, Bill reflected:
‘I seem to remember going from the Pharmacy Board Office in Sydney after collecting that bit of paper straight round to the PSA NSW Office to join. I have always enjoyed the community pharmacy environment and being able to help people, and this continues to be a great satisfaction for me. We have an expression in Hebrew; "Tikun Olam" which is translated in different ways. Essentially the concept is that each one of us should try to make the only world we have a better place.’
‘My father's version was that if you are part of anything you should be an active participant, and leave it better than when you started. I hope I have made a contribution to the profession.’
His funeral will be held tomorrow (31 October 2024) in Canberra.
Vale Bill Arnold MPS.
[post_title] => Vale William (Bill) Arnold (1940–2024)
[post_excerpt] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on 26 October 2024.
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[post_content] => Australia coped better than many countries during COVID-19, avoiding severe health system collapse, mass casualties, and deeper economic downturns.
But the government’s COVID-19 Response Inquiry Report found significant collateral damage that could have been avoided – and that pharmacists were not activated in the vaccine roll-out soon enough.
Pharmacists should have been involved in the vaccine rollout much sooner
A delayed vaccine rollout was costly for Australia – leaving people vulnerable to severe illness and death, with a $31 billion economic loss also incurred – as we transitioned to ‘living with COVID-19’.
The Inquiry found that the COVID-19 vaccine rollout was way too slow to activate pharmacists and other vaccinators.
While the vaccine rollout commenced in Australia in February 2021, community pharmacists were not included until August that year. This contrasts with international responses, including the United States – where pharmacists began vaccinating patients in December 2020.
But pharmacists are clearly a vaccinator of choice, delivering around 40% of weekly vaccinations since the start of the rollout.
Vaccination scope harmonisation needs to happen, NOW
The scope of practice changes that occurred during the pandemic revealed inconsistencies in vaccination legislation across Australia. While pharmacists can administer COVID-19 vaccines throughout Australia, legislation around other vaccines, such as herpes zoster (Shingrix), differs per state and territory.
The inquiry panel agreed that a nationally consistent approach is required, and Scope of Practice Review recommendations harmonising existing legislation around what services pharmacists provide should be prioritised.
Prescribing restrictions on ivermectin: wrong approach
Unapproved COVID-19 treatments such as ivermectin and hydroxychloroquine were in high demand during the height of the pandemic, with pharmacists concerned this would lead to supply shortages for those prescribed the medicines for approved indications.
But the government's approach of implementing prescribing restrictions fueled mistrust, particularly given ivermectin is a safe drug when used correctly.
Instead of restricting off-label use of the drug for COVID-19, which had no proven clinical benefit, alternative measures to better manage demand should have been used to safeguard supply for the small number of Australians prescribed the medicine for legitimate users.
Equity fail: Antivirals mainly went to the wealthy
Access to COVID-19 antivirals is not equitable, even for those more at risk of severe complications. First Nations people, who have nearly 70% higher risk of dying from COVID-19 are 25% less likely to receive antivirals. Australians based in rural areas are also 37% less likely to obtain these treatments compared to those in cities.
There’s even a pronounced disparity in cities, with individuals over 70 in Sydney’s affluent Eastern suburbs almost twice as likely to access antivirals compared to those in the Western suburbs.
Better measures to provide access to people in priority populations are required.
Vaccination rates need an urgent boost
The lack of real time evidence based policy and the lack of transparency has driven a large decline in trust, said Minister for Health and Aged Care Mark Butler in a press conference held on Tuesday (30 October).
‘The erosion of trust is not only constraining our ability to respond to a pandemic when it next occurs, but we know it's already bled into the performance of our vaccination programs, including our childhood vaccination program.’
But according to social scientist and public health expert Professor Julie Leask: ‘It’s a slight decline in public trust. It’s not collapsing. It hasn’t taken a nosedive. There is an issue, but the sky is not falling. To claim it is worse risks people responding to that perception negatively.’
But to rebuild what is lost, a key action is the development of a national strategy to instil community confidence in vaccines and improve vaccination rates by target dates is an urgent priority, particularly among priority cohorts.
There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels.
Australians won’t accept the same restrictions next time
When the next pandemic inevitably hits, the inquiry found that Australians are unlikely to accept the same measures. So a different pandemic response will be required, based on the Australia we are today – not the pre-pandemic version.
‘Right now, we are arguably worse placed as a country to deal with a pandemic than we were in early 2020 for a range of reasons,’ said Minister Butler.
This includes a fractured and fragmented healthcare system and an exhausted healthcare workforce.
[So we need] to build … a high-level playbook for the next pandemic because we know there will be a next pandemic.’
One example of this is vaccine mandates. The report found the application of vaccine mandates to the general population during COVID-19 reduced public trust. Any future implementation of vaccine mandates must be carefully considered, weighing their potential to undermine public trust and increase hesitancy against the need to protect public health. And thresholds to remove those mandates must be defined when they are instituted.
The new CDC could re-engage Australians with vaccination, but pharmacists need to be engaged
Yesterday the Australian Government immediately implemented the recommendation to establish an Australian Centre for Disease Control (CDC) committing $217.5 million to shift from an interim to ongoing arrangements. The intent is for a more coordinated, transparent approach to decision making for both pandemics and chronic health conditions.
The independent CDC is expected to launch on 1 January 2026, pending passage of legislation through federal parliament.
Welcoming the Federal Government’s commitment to establish a CDC as part of our national response to preventable disease, PSA National President Associate Professor Fei Sim FPS said, pharmacists can and should be better utilised as trusted healthcare professionals.
‘We have long known that the skills and expertise of Australia’s pharmacists are not fully utilised in reducing the burden of preventable diseases,’ she said.
‘While pharmacists are delivering more vaccinations than ever before, there is still a long way to go to make vaccination standards consistent across the country, recognising that a pharmacist immuniser in one state is just as qualified as a pharmacist immuniser in another state, and should be able to provide the same vaccinations to the same subsect of patients.’
PSA continues to fight for all pharmacists across the country to be able to deliver all vaccines to patients of all ages, under a nationally consistent vaccination schedule.
[post_title] => What went right (and wrong) with Australia's COVID-19 response?
[post_excerpt] => COVID-19 enquiry criticises delays involving pharmacists in rollout, calling for urgent harmonisation of vaccine scope.
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[title_attribute] => What went right (and wrong) with Australia’s COVID-19 response?
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"]
Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on Saturday (26 October 2024).
Bill was an active community pharmacist and long-standing pharmacy owner in the ACT, who’s profound contribution to the profession and the Australian public spanned many roles and many decades.
Bill was a career-long member of the PSA, regularly attending events and lectures and volunteering his time and expertise for the benefit of the profession. Bill served on Special Interest Groups and was appointed as the pharmacy representative on a diverse range of boards and bodies including the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project.
In 2013, Bill celebrated 50 years of continuous PSA membership and was made a Life Member in recognition of his service to the profession and to PSA.
Bill was the first Chairman of the ACT Division of the Pharmaceutical Society of New South Wales in 1971. He made a significant contribution to the profession as a member of the ACT Pharmacy Board from 1998-2015. He was an active contributor to the International Pharmaceutical Federation (FIP) and an inaugural member of the Pharmacy Guild of Australia’s ACT Branch Committee, who later recognised him as a life member. Bill was also one of the leaders behind Auspharmlist, one of the first online forums for pharmacists to collaborate and mentor each in the virtual world.
Outside of pharmacy, Bill had a love of the Australian bush, was a soccer tragic and undertook extensive chaplaincy work in prisons.
Upon awarding Mr Arnold the honour of life membership, then ACT Branch President Greg Kyle, recognised Bill as a stalwart of PSA for many years, describing his as ‘a very active member [whose] ongoing commitment to the profession and the community is an example that many other pharmacists look up to.’
‘He never shirks from volunteering to offer his expertise and his work has seen him appointed as the pharmacy representative on a diverse range of boards and bodies which have included the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project,’ Associate Professor Kyle said.
On receiving this honour, Bill reflected:
‘I seem to remember going from the Pharmacy Board Office in Sydney after collecting that bit of paper straight round to the PSA NSW Office to join. I have always enjoyed the community pharmacy environment and being able to help people, and this continues to be a great satisfaction for me. We have an expression in Hebrew; "Tikun Olam" which is translated in different ways. Essentially the concept is that each one of us should try to make the only world we have a better place.’
‘My father's version was that if you are part of anything you should be an active participant, and leave it better than when you started. I hope I have made a contribution to the profession.’
His funeral will be held tomorrow (31 October 2024) in Canberra.
Vale Bill Arnold MPS.
[post_title] => Vale William (Bill) Arnold (1940–2024)
[post_excerpt] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on 26 October 2024.
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[post_content] => Australia coped better than many countries during COVID-19, avoiding severe health system collapse, mass casualties, and deeper economic downturns.
But the government’s COVID-19 Response Inquiry Report found significant collateral damage that could have been avoided – and that pharmacists were not activated in the vaccine roll-out soon enough.
Pharmacists should have been involved in the vaccine rollout much sooner
A delayed vaccine rollout was costly for Australia – leaving people vulnerable to severe illness and death, with a $31 billion economic loss also incurred – as we transitioned to ‘living with COVID-19’.
The Inquiry found that the COVID-19 vaccine rollout was way too slow to activate pharmacists and other vaccinators.
While the vaccine rollout commenced in Australia in February 2021, community pharmacists were not included until August that year. This contrasts with international responses, including the United States – where pharmacists began vaccinating patients in December 2020.
But pharmacists are clearly a vaccinator of choice, delivering around 40% of weekly vaccinations since the start of the rollout.
Vaccination scope harmonisation needs to happen, NOW
The scope of practice changes that occurred during the pandemic revealed inconsistencies in vaccination legislation across Australia. While pharmacists can administer COVID-19 vaccines throughout Australia, legislation around other vaccines, such as herpes zoster (Shingrix), differs per state and territory.
The inquiry panel agreed that a nationally consistent approach is required, and Scope of Practice Review recommendations harmonising existing legislation around what services pharmacists provide should be prioritised.
Prescribing restrictions on ivermectin: wrong approach
Unapproved COVID-19 treatments such as ivermectin and hydroxychloroquine were in high demand during the height of the pandemic, with pharmacists concerned this would lead to supply shortages for those prescribed the medicines for approved indications.
But the government's approach of implementing prescribing restrictions fueled mistrust, particularly given ivermectin is a safe drug when used correctly.
Instead of restricting off-label use of the drug for COVID-19, which had no proven clinical benefit, alternative measures to better manage demand should have been used to safeguard supply for the small number of Australians prescribed the medicine for legitimate users.
Equity fail: Antivirals mainly went to the wealthy
Access to COVID-19 antivirals is not equitable, even for those more at risk of severe complications. First Nations people, who have nearly 70% higher risk of dying from COVID-19 are 25% less likely to receive antivirals. Australians based in rural areas are also 37% less likely to obtain these treatments compared to those in cities.
There’s even a pronounced disparity in cities, with individuals over 70 in Sydney’s affluent Eastern suburbs almost twice as likely to access antivirals compared to those in the Western suburbs.
Better measures to provide access to people in priority populations are required.
Vaccination rates need an urgent boost
The lack of real time evidence based policy and the lack of transparency has driven a large decline in trust, said Minister for Health and Aged Care Mark Butler in a press conference held on Tuesday (30 October).
‘The erosion of trust is not only constraining our ability to respond to a pandemic when it next occurs, but we know it's already bled into the performance of our vaccination programs, including our childhood vaccination program.’
But according to social scientist and public health expert Professor Julie Leask: ‘It’s a slight decline in public trust. It’s not collapsing. It hasn’t taken a nosedive. There is an issue, but the sky is not falling. To claim it is worse risks people responding to that perception negatively.’
But to rebuild what is lost, a key action is the development of a national strategy to instil community confidence in vaccines and improve vaccination rates by target dates is an urgent priority, particularly among priority cohorts.
There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels.
Australians won’t accept the same restrictions next time
When the next pandemic inevitably hits, the inquiry found that Australians are unlikely to accept the same measures. So a different pandemic response will be required, based on the Australia we are today – not the pre-pandemic version.
‘Right now, we are arguably worse placed as a country to deal with a pandemic than we were in early 2020 for a range of reasons,’ said Minister Butler.
This includes a fractured and fragmented healthcare system and an exhausted healthcare workforce.
[So we need] to build … a high-level playbook for the next pandemic because we know there will be a next pandemic.’
One example of this is vaccine mandates. The report found the application of vaccine mandates to the general population during COVID-19 reduced public trust. Any future implementation of vaccine mandates must be carefully considered, weighing their potential to undermine public trust and increase hesitancy against the need to protect public health. And thresholds to remove those mandates must be defined when they are instituted.
The new CDC could re-engage Australians with vaccination, but pharmacists need to be engaged
Yesterday the Australian Government immediately implemented the recommendation to establish an Australian Centre for Disease Control (CDC) committing $217.5 million to shift from an interim to ongoing arrangements. The intent is for a more coordinated, transparent approach to decision making for both pandemics and chronic health conditions.
The independent CDC is expected to launch on 1 January 2026, pending passage of legislation through federal parliament.
Welcoming the Federal Government’s commitment to establish a CDC as part of our national response to preventable disease, PSA National President Associate Professor Fei Sim FPS said, pharmacists can and should be better utilised as trusted healthcare professionals.
‘We have long known that the skills and expertise of Australia’s pharmacists are not fully utilised in reducing the burden of preventable diseases,’ she said.
‘While pharmacists are delivering more vaccinations than ever before, there is still a long way to go to make vaccination standards consistent across the country, recognising that a pharmacist immuniser in one state is just as qualified as a pharmacist immuniser in another state, and should be able to provide the same vaccinations to the same subsect of patients.’
PSA continues to fight for all pharmacists across the country to be able to deliver all vaccines to patients of all ages, under a nationally consistent vaccination schedule.
[post_title] => What went right (and wrong) with Australia's COVID-19 response?
[post_excerpt] => COVID-19 enquiry criticises delays involving pharmacists in rollout, calling for urgent harmonisation of vaccine scope.
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on Saturday (26 October 2024).
Bill was an active community pharmacist and long-standing pharmacy owner in the ACT, who’s profound contribution to the profession and the Australian public spanned many roles and many decades.
Bill was a career-long member of the PSA, regularly attending events and lectures and volunteering his time and expertise for the benefit of the profession. Bill served on Special Interest Groups and was appointed as the pharmacy representative on a diverse range of boards and bodies including the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project.
In 2013, Bill celebrated 50 years of continuous PSA membership and was made a Life Member in recognition of his service to the profession and to PSA.
Bill was the first Chairman of the ACT Division of the Pharmaceutical Society of New South Wales in 1971. He made a significant contribution to the profession as a member of the ACT Pharmacy Board from 1998-2015. He was an active contributor to the International Pharmaceutical Federation (FIP) and an inaugural member of the Pharmacy Guild of Australia’s ACT Branch Committee, who later recognised him as a life member. Bill was also one of the leaders behind Auspharmlist, one of the first online forums for pharmacists to collaborate and mentor each in the virtual world.
Outside of pharmacy, Bill had a love of the Australian bush, was a soccer tragic and undertook extensive chaplaincy work in prisons.
Upon awarding Mr Arnold the honour of life membership, then ACT Branch President Greg Kyle, recognised Bill as a stalwart of PSA for many years, describing his as ‘a very active member [whose] ongoing commitment to the profession and the community is an example that many other pharmacists look up to.’
‘He never shirks from volunteering to offer his expertise and his work has seen him appointed as the pharmacy representative on a diverse range of boards and bodies which have included the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project,’ Associate Professor Kyle said.
On receiving this honour, Bill reflected:
‘I seem to remember going from the Pharmacy Board Office in Sydney after collecting that bit of paper straight round to the PSA NSW Office to join. I have always enjoyed the community pharmacy environment and being able to help people, and this continues to be a great satisfaction for me. We have an expression in Hebrew; "Tikun Olam" which is translated in different ways. Essentially the concept is that each one of us should try to make the only world we have a better place.’
‘My father's version was that if you are part of anything you should be an active participant, and leave it better than when you started. I hope I have made a contribution to the profession.’
His funeral will be held tomorrow (31 October 2024) in Canberra.
Vale Bill Arnold MPS.
[post_title] => Vale William (Bill) Arnold (1940–2024)
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[post_content] => Australia coped better than many countries during COVID-19, avoiding severe health system collapse, mass casualties, and deeper economic downturns.
But the government’s COVID-19 Response Inquiry Report found significant collateral damage that could have been avoided – and that pharmacists were not activated in the vaccine roll-out soon enough.
Pharmacists should have been involved in the vaccine rollout much sooner
A delayed vaccine rollout was costly for Australia – leaving people vulnerable to severe illness and death, with a $31 billion economic loss also incurred – as we transitioned to ‘living with COVID-19’.
The Inquiry found that the COVID-19 vaccine rollout was way too slow to activate pharmacists and other vaccinators.
While the vaccine rollout commenced in Australia in February 2021, community pharmacists were not included until August that year. This contrasts with international responses, including the United States – where pharmacists began vaccinating patients in December 2020.
But pharmacists are clearly a vaccinator of choice, delivering around 40% of weekly vaccinations since the start of the rollout.
Vaccination scope harmonisation needs to happen, NOW
The scope of practice changes that occurred during the pandemic revealed inconsistencies in vaccination legislation across Australia. While pharmacists can administer COVID-19 vaccines throughout Australia, legislation around other vaccines, such as herpes zoster (Shingrix), differs per state and territory.
The inquiry panel agreed that a nationally consistent approach is required, and Scope of Practice Review recommendations harmonising existing legislation around what services pharmacists provide should be prioritised.
Prescribing restrictions on ivermectin: wrong approach
Unapproved COVID-19 treatments such as ivermectin and hydroxychloroquine were in high demand during the height of the pandemic, with pharmacists concerned this would lead to supply shortages for those prescribed the medicines for approved indications.
But the government's approach of implementing prescribing restrictions fueled mistrust, particularly given ivermectin is a safe drug when used correctly.
Instead of restricting off-label use of the drug for COVID-19, which had no proven clinical benefit, alternative measures to better manage demand should have been used to safeguard supply for the small number of Australians prescribed the medicine for legitimate users.
Equity fail: Antivirals mainly went to the wealthy
Access to COVID-19 antivirals is not equitable, even for those more at risk of severe complications. First Nations people, who have nearly 70% higher risk of dying from COVID-19 are 25% less likely to receive antivirals. Australians based in rural areas are also 37% less likely to obtain these treatments compared to those in cities.
There’s even a pronounced disparity in cities, with individuals over 70 in Sydney’s affluent Eastern suburbs almost twice as likely to access antivirals compared to those in the Western suburbs.
Better measures to provide access to people in priority populations are required.
Vaccination rates need an urgent boost
The lack of real time evidence based policy and the lack of transparency has driven a large decline in trust, said Minister for Health and Aged Care Mark Butler in a press conference held on Tuesday (30 October).
‘The erosion of trust is not only constraining our ability to respond to a pandemic when it next occurs, but we know it's already bled into the performance of our vaccination programs, including our childhood vaccination program.’
But according to social scientist and public health expert Professor Julie Leask: ‘It’s a slight decline in public trust. It’s not collapsing. It hasn’t taken a nosedive. There is an issue, but the sky is not falling. To claim it is worse risks people responding to that perception negatively.’
But to rebuild what is lost, a key action is the development of a national strategy to instil community confidence in vaccines and improve vaccination rates by target dates is an urgent priority, particularly among priority cohorts.
There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels.
Australians won’t accept the same restrictions next time
When the next pandemic inevitably hits, the inquiry found that Australians are unlikely to accept the same measures. So a different pandemic response will be required, based on the Australia we are today – not the pre-pandemic version.
‘Right now, we are arguably worse placed as a country to deal with a pandemic than we were in early 2020 for a range of reasons,’ said Minister Butler.
This includes a fractured and fragmented healthcare system and an exhausted healthcare workforce.
[So we need] to build … a high-level playbook for the next pandemic because we know there will be a next pandemic.’
One example of this is vaccine mandates. The report found the application of vaccine mandates to the general population during COVID-19 reduced public trust. Any future implementation of vaccine mandates must be carefully considered, weighing their potential to undermine public trust and increase hesitancy against the need to protect public health. And thresholds to remove those mandates must be defined when they are instituted.
The new CDC could re-engage Australians with vaccination, but pharmacists need to be engaged
Yesterday the Australian Government immediately implemented the recommendation to establish an Australian Centre for Disease Control (CDC) committing $217.5 million to shift from an interim to ongoing arrangements. The intent is for a more coordinated, transparent approach to decision making for both pandemics and chronic health conditions.
The independent CDC is expected to launch on 1 January 2026, pending passage of legislation through federal parliament.
Welcoming the Federal Government’s commitment to establish a CDC as part of our national response to preventable disease, PSA National President Associate Professor Fei Sim FPS said, pharmacists can and should be better utilised as trusted healthcare professionals.
‘We have long known that the skills and expertise of Australia’s pharmacists are not fully utilised in reducing the burden of preventable diseases,’ she said.
‘While pharmacists are delivering more vaccinations than ever before, there is still a long way to go to make vaccination standards consistent across the country, recognising that a pharmacist immuniser in one state is just as qualified as a pharmacist immuniser in another state, and should be able to provide the same vaccinations to the same subsect of patients.’
PSA continues to fight for all pharmacists across the country to be able to deliver all vaccines to patients of all ages, under a nationally consistent vaccination schedule.
[post_title] => What went right (and wrong) with Australia's COVID-19 response?
[post_excerpt] => COVID-19 enquiry criticises delays involving pharmacists in rollout, calling for urgent harmonisation of vaccine scope.
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[title_attribute] => What went right (and wrong) with Australia’s COVID-19 response?
[title] => What went right (and wrong) with Australia’s COVID-19 response?
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on Saturday (26 October 2024).
Bill was an active community pharmacist and long-standing pharmacy owner in the ACT, who’s profound contribution to the profession and the Australian public spanned many roles and many decades.
Bill was a career-long member of the PSA, regularly attending events and lectures and volunteering his time and expertise for the benefit of the profession. Bill served on Special Interest Groups and was appointed as the pharmacy representative on a diverse range of boards and bodies including the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project.
In 2013, Bill celebrated 50 years of continuous PSA membership and was made a Life Member in recognition of his service to the profession and to PSA.
Bill was the first Chairman of the ACT Division of the Pharmaceutical Society of New South Wales in 1971. He made a significant contribution to the profession as a member of the ACT Pharmacy Board from 1998-2015. He was an active contributor to the International Pharmaceutical Federation (FIP) and an inaugural member of the Pharmacy Guild of Australia’s ACT Branch Committee, who later recognised him as a life member. Bill was also one of the leaders behind Auspharmlist, one of the first online forums for pharmacists to collaborate and mentor each in the virtual world.
Outside of pharmacy, Bill had a love of the Australian bush, was a soccer tragic and undertook extensive chaplaincy work in prisons.
Upon awarding Mr Arnold the honour of life membership, then ACT Branch President Greg Kyle, recognised Bill as a stalwart of PSA for many years, describing his as ‘a very active member [whose] ongoing commitment to the profession and the community is an example that many other pharmacists look up to.’
‘He never shirks from volunteering to offer his expertise and his work has seen him appointed as the pharmacy representative on a diverse range of boards and bodies which have included the ACT Alcohol, Tobacco and Other Drugs Taskforce Working Group, the ACT Opiate Treatment Advisory Committee and the ACT Vulnerable Families Project,’ Associate Professor Kyle said.
On receiving this honour, Bill reflected:
‘I seem to remember going from the Pharmacy Board Office in Sydney after collecting that bit of paper straight round to the PSA NSW Office to join. I have always enjoyed the community pharmacy environment and being able to help people, and this continues to be a great satisfaction for me. We have an expression in Hebrew; "Tikun Olam" which is translated in different ways. Essentially the concept is that each one of us should try to make the only world we have a better place.’
‘My father's version was that if you are part of anything you should be an active participant, and leave it better than when you started. I hope I have made a contribution to the profession.’
His funeral will be held tomorrow (31 October 2024) in Canberra.
Vale Bill Arnold MPS.
[post_title] => Vale William (Bill) Arnold (1940–2024)
[post_excerpt] => The PSA is saddened to learn of the passing of life member William (Bill) Arnold MPS, who died peacefully in his sleep on 26 October 2024.
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[post_content] => Australia coped better than many countries during COVID-19, avoiding severe health system collapse, mass casualties, and deeper economic downturns.
But the government’s COVID-19 Response Inquiry Report found significant collateral damage that could have been avoided – and that pharmacists were not activated in the vaccine roll-out soon enough.
Pharmacists should have been involved in the vaccine rollout much sooner
A delayed vaccine rollout was costly for Australia – leaving people vulnerable to severe illness and death, with a $31 billion economic loss also incurred – as we transitioned to ‘living with COVID-19’.
The Inquiry found that the COVID-19 vaccine rollout was way too slow to activate pharmacists and other vaccinators.
While the vaccine rollout commenced in Australia in February 2021, community pharmacists were not included until August that year. This contrasts with international responses, including the United States – where pharmacists began vaccinating patients in December 2020.
But pharmacists are clearly a vaccinator of choice, delivering around 40% of weekly vaccinations since the start of the rollout.
Vaccination scope harmonisation needs to happen, NOW
The scope of practice changes that occurred during the pandemic revealed inconsistencies in vaccination legislation across Australia. While pharmacists can administer COVID-19 vaccines throughout Australia, legislation around other vaccines, such as herpes zoster (Shingrix), differs per state and territory.
The inquiry panel agreed that a nationally consistent approach is required, and Scope of Practice Review recommendations harmonising existing legislation around what services pharmacists provide should be prioritised.
Prescribing restrictions on ivermectin: wrong approach
Unapproved COVID-19 treatments such as ivermectin and hydroxychloroquine were in high demand during the height of the pandemic, with pharmacists concerned this would lead to supply shortages for those prescribed the medicines for approved indications.
But the government's approach of implementing prescribing restrictions fueled mistrust, particularly given ivermectin is a safe drug when used correctly.
Instead of restricting off-label use of the drug for COVID-19, which had no proven clinical benefit, alternative measures to better manage demand should have been used to safeguard supply for the small number of Australians prescribed the medicine for legitimate users.
Equity fail: Antivirals mainly went to the wealthy
Access to COVID-19 antivirals is not equitable, even for those more at risk of severe complications. First Nations people, who have nearly 70% higher risk of dying from COVID-19 are 25% less likely to receive antivirals. Australians based in rural areas are also 37% less likely to obtain these treatments compared to those in cities.
There’s even a pronounced disparity in cities, with individuals over 70 in Sydney’s affluent Eastern suburbs almost twice as likely to access antivirals compared to those in the Western suburbs.
Better measures to provide access to people in priority populations are required.
Vaccination rates need an urgent boost
The lack of real time evidence based policy and the lack of transparency has driven a large decline in trust, said Minister for Health and Aged Care Mark Butler in a press conference held on Tuesday (30 October).
‘The erosion of trust is not only constraining our ability to respond to a pandemic when it next occurs, but we know it's already bled into the performance of our vaccination programs, including our childhood vaccination program.’
But according to social scientist and public health expert Professor Julie Leask: ‘It’s a slight decline in public trust. It’s not collapsing. It hasn’t taken a nosedive. There is an issue, but the sky is not falling. To claim it is worse risks people responding to that perception negatively.’
But to rebuild what is lost, a key action is the development of a national strategy to instil community confidence in vaccines and improve vaccination rates by target dates is an urgent priority, particularly among priority cohorts.
There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels.
Australians won’t accept the same restrictions next time
When the next pandemic inevitably hits, the inquiry found that Australians are unlikely to accept the same measures. So a different pandemic response will be required, based on the Australia we are today – not the pre-pandemic version.
‘Right now, we are arguably worse placed as a country to deal with a pandemic than we were in early 2020 for a range of reasons,’ said Minister Butler.
This includes a fractured and fragmented healthcare system and an exhausted healthcare workforce.
[So we need] to build … a high-level playbook for the next pandemic because we know there will be a next pandemic.’
One example of this is vaccine mandates. The report found the application of vaccine mandates to the general population during COVID-19 reduced public trust. Any future implementation of vaccine mandates must be carefully considered, weighing their potential to undermine public trust and increase hesitancy against the need to protect public health. And thresholds to remove those mandates must be defined when they are instituted.
The new CDC could re-engage Australians with vaccination, but pharmacists need to be engaged
Yesterday the Australian Government immediately implemented the recommendation to establish an Australian Centre for Disease Control (CDC) committing $217.5 million to shift from an interim to ongoing arrangements. The intent is for a more coordinated, transparent approach to decision making for both pandemics and chronic health conditions.
The independent CDC is expected to launch on 1 January 2026, pending passage of legislation through federal parliament.
Welcoming the Federal Government’s commitment to establish a CDC as part of our national response to preventable disease, PSA National President Associate Professor Fei Sim FPS said, pharmacists can and should be better utilised as trusted healthcare professionals.
‘We have long known that the skills and expertise of Australia’s pharmacists are not fully utilised in reducing the burden of preventable diseases,’ she said.
‘While pharmacists are delivering more vaccinations than ever before, there is still a long way to go to make vaccination standards consistent across the country, recognising that a pharmacist immuniser in one state is just as qualified as a pharmacist immuniser in another state, and should be able to provide the same vaccinations to the same subsect of patients.’
PSA continues to fight for all pharmacists across the country to be able to deliver all vaccines to patients of all ages, under a nationally consistent vaccination schedule.
[post_title] => What went right (and wrong) with Australia's COVID-19 response?
[post_excerpt] => COVID-19 enquiry criticises delays involving pharmacists in rollout, calling for urgent harmonisation of vaccine scope.
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[title_attribute] => What went right (and wrong) with Australia’s COVID-19 response?
[title] => What went right (and wrong) with Australia’s COVID-19 response?
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[title_attribute] => Are you using My Health Record to optimise patient care?
[title] => Are you using My Health Record to optimise patient care?
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
