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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"]
PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"]
Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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[post_content] => Australia’s understanding and adoption of Quality Use of Medicines (QUM) principles across general practice and primary care has led to overall improvements in medicine use, such as curtailing high-dose use of proton pump inhibitors.
But the challenge has since changed, with Australians living longer – resulting in an older, sicker population who uses more medicines, said Professor Libby Roughead – Director of the QUM and Pharmacy Research Centre at the University of South Australia.
‘Now the game is to say, how do we go forward when we’ve got a frail older population, and lots of specialty medicine? she asked.
This is the question a panel of experts sought to answer at the National Medicines Symposium 2024 yesterday (19 November).
Be wary of using ‘wonder drugs’ in older patients
When clinical trials are conducted on new medicines, they’re not tested in the over 65 age group, said Steve Waller, Senior Advisor, Medication without Harm, Australian Commission on Safety and Quality in Health Care.
[caption id="attachment_28267" align="alignnone" width="800"]
National Medicines Symposium 2024 speakers (L to R): Steve Waller, Professor Jennifer Martin, Professor Libby Roughead, Tegan Taylor[/caption]
‘That creates complications, because we often don’t know what the impact in that older age group is … and pharmaceutical companies don’t have that information when they’re making an application for a new drug to be listed with the TGA [Therapeutic Goods Administration] and PBS [Pharmaceutical Benefits Scheme],’ he said.
Healthcare professionals must have awareness of the limitations of the data, thinks Professor Jennifer Martin, clinical pharmacologist and president of the Royal Australian College of Physicians.
‘Often, I say to people “why are you using a statin in [an older] population? We know the life expectancy when you go to a nursing home is less than 2 years, and you have to be on this drug at this dose for 5 years just to see a small reduction in a composite end point”,’ she said.
Healthcare professionals should rely on Australia’s ‘good sources of objective information’ such as Therapeutic Guidelines and the Australian Medicines Handbook, said Prof Roughead.
But more work needs to be done on increasing uptake of non-pharmacological interventions that are suitable for many conditions, including art therapy, music therapy, exercise and diet.
‘We know compassion practices are really helpful in some of the hard-to-treat conditions [such as] pain and depression, so we need to get better at involving the whole therapeutic armamentarium,’ she said. ‘The first definition of QUM is judicious selection of management options.’
Involve older patients in deprescribing decisions
Doctors, pharmacists, family members and carers typically talk among themselves about an older patient's medicine regimen. But it’s the patient they need to focus on, thinks Prof Martin.
‘When you talk to an older person, they will typically say “I don’t know why they started those pills” or “I don’t think I was supposed to be on them long-term, but no one stopped them, so I just kept taking them”,’ she said.
‘So, come back to the patient and ask, “Why are you taking these medications? What are your goals of care? Do you want pain relief? What are you looking for?”’
As patients reach their final chapter, many are just after quality of life – which doesn’t necessarily entail losing cognitive function through heavy use of opioids.
‘Opioids may play some role in pain, but they certainly take away a lot of the quality of life for older people,’ said Prof Martin. ‘It’s not until you spend time talking to the person that you find out they actually want to be very sharp; they think they can cope with their pain by other measures, and we can probably reduce some of their opioids.’
Warranted distrust in medicines and healthcare needs to be built back up
While we live in an age where misinformation is rife, some of it stems from the health system and pharma model, said Prof Martin.
‘For example, we know with gabapentin, which some people use for pain, most of the information that got onto the market was fraudulent,’ she said. ‘[There] was then a big investigation, with lawsuits still ongoing.’
The same goes for opioids, ineffective for many of the conditions they are prescribed for – particularly chronic pain.
‘The public are looking at their health providers saying, “We now know this is misinformation, but you prescribed this”, so we’ve lost a bit of engagement with our community,’ said Prof Martin.
With many patients with chronic pain on high doses of opioids that are not treating their conditions and impairing their quality of life, Prof Martin thinks the healthcare sector has ‘something to answer for’.
‘That misinformation is coming from industry and from the fact that we’re too busy to actually go back to their source material,’ she said.
The good news is that opioid deaths have decreased over the last 5 years in Australia, thanks to tighter prescribing regulations and better resources such as the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, said Mr Waller.
Work on state formularies has also reduced the number of opioids that people can prescribe, said Prof Martin.
‘It has helped to get that conversation going of “Why do you need to have access to 10 different opioids in an in-patient setting?” and “Why do you need all these different concentrations?”’ she said.
However, more changes in practice are required to ensure that trend continues in the right direction, said Mr Waller.
‘We need to stop using opioids for chronic pain,’ he said. ‘There’s limited to no evidence to suggest that they work, and we need to be very judicious about our use of modified-release opioid analgesics.’
Yet as that work is done, it’s crucial to remember that these patients are suffering and compassion should be brought to the encounter – rather than simply saying ‘you can’t have that’, said Prof Roughead.
‘It’s not just ceasing a medicine. It’s ceasing a medicine and starting other things that you might need to help you be well, whether it be an exercise program or psychological services,’ she said.
Pharmacists can bridge communication and healthcare gaps in RACFs
With the Aged Care On-site Pharmacist (ACOP) program kicking off on 1 July 2024, pharmacists can improve the approach to healthcare by simply getting to know people – a skill well-honed by pharmacists in other settings, said Prof Roughead.
This includes understanding patient preferences and non-pharmacological activities that might support them.
‘If we can build a system where we can create relationships, particularly in a virtual world … we’re all going to be safer and we’re all going to feel better,’ she said.
‘That’s got to be the strength of an embedded pharmacist in aged care, that day-to-day knowledge of what the patient’s likes and dislikes are and how they’ve been managed over a continuum, as opposed to a visit that might happen once a year,’ added Mr Waller.
As the custodian of the pharmacy profession’s Professional Practice Standards and an education and training provider, PSA has continued to invest and embark into practice support training and education for pharmacists to become ACOP credentialed, said PSA National President Associated Professor Fei Sim.
The training covers all elements of this role – from professionalism, to understanding the governance of an RACF, collaborative practice, providing person-centred medication management and working within a multidisciplinary team to improve the safe and quality use of medicines.
‘Pharmacists undertaking the training program would then acquire the necessary credentials, qualifications and skill set to be able to undertake the role as an aged care on-site pharmacist,’ she said.
‘We’re also providing ongoing resources and clinical updates for credentialed pharmacists so they can be kept up to date with their knowledge and skills to undertake the role.’
With any new areas of practice, there is a great need for mentoring and networking for like-minded pharmacists who work in the same area to forge bonds, said A/Prof Sim. ‘That’s why PSA created the Consultant Pharmacists CSI group [and] an annual Consultant Pharmacist Conference, focusing on supporting and meeting the learning needs of credentialed pharmacists.’
[post_title] => Giving a voice back to elderly patients
[post_excerpt] => Yesterday’s National Medicine Symposium delivered a stark critique of how our health system is failing older patients – and how to fix it.
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[post_content] => Mpox cases are surging in Australia. An expert reveals how pharmacists can address the rising spread.
When mpox was first reported in Australia in May 2022, case numbers remained relatively low for the better part of 2 years.
However, in 2024 there has been a significant spike in case numbers in several Australian states and territories, with New South Wales, Victoria and Western Australia all seeing rising locally acquired notifications.
In September, it was reported that mpox cases grew a staggering 570% since July 2024 –with over 724 cases recorded this year. Yet vaccination rates remain low.
Meanwhile, cases of clade Ib – which has a much higher fatality rate than clade IIb strain spreading in Australia – have been detected in numerous countries around the world, most recently the United States. The worldwide spread of the new clade led the World Health Organisation to declare the mpox outbreak a public health emergency of international concern.
At this stage, pharmacists can only administer the mpox vaccine in Victoria and the Northern Territory.
However, pharmacists in all jurisdictions have an essential role in raising awareness of vaccine eligibility and dosing schedule, when to get vaccinated and where to get tested – all of which can help to bring down rising case numbers.
Watch the video below to hear sexual health expert Dr Tom Morley explain how pharmacists can go about this in a culturally safe way.
https://www.youtube.com/watch?v=ZPzbadkq8sM
[post_title] => Curbing the spread as mpox cases skyrocket
[post_excerpt] => Mpox cases are surging both in Australia and around the world. An expert reveals how pharmacists can address the rising spread.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
[post_title] => Neuropathic pain medicines can increase the risk of falls
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[post_content] => Australia’s understanding and adoption of Quality Use of Medicines (QUM) principles across general practice and primary care has led to overall improvements in medicine use, such as curtailing high-dose use of proton pump inhibitors.
But the challenge has since changed, with Australians living longer – resulting in an older, sicker population who uses more medicines, said Professor Libby Roughead – Director of the QUM and Pharmacy Research Centre at the University of South Australia.
‘Now the game is to say, how do we go forward when we’ve got a frail older population, and lots of specialty medicine? she asked.
This is the question a panel of experts sought to answer at the National Medicines Symposium 2024 yesterday (19 November).
Be wary of using ‘wonder drugs’ in older patients
When clinical trials are conducted on new medicines, they’re not tested in the over 65 age group, said Steve Waller, Senior Advisor, Medication without Harm, Australian Commission on Safety and Quality in Health Care.
[caption id="attachment_28267" align="alignnone" width="800"] National Medicines Symposium 2024 speakers (L to R): Steve Waller, Professor Jennifer Martin, Professor Libby Roughead, Tegan Taylor[/caption]
‘That creates complications, because we often don’t know what the impact in that older age group is … and pharmaceutical companies don’t have that information when they’re making an application for a new drug to be listed with the TGA [Therapeutic Goods Administration] and PBS [Pharmaceutical Benefits Scheme],’ he said.
Healthcare professionals must have awareness of the limitations of the data, thinks Professor Jennifer Martin, clinical pharmacologist and president of the Royal Australian College of Physicians.
‘Often, I say to people “why are you using a statin in [an older] population? We know the life expectancy when you go to a nursing home is less than 2 years, and you have to be on this drug at this dose for 5 years just to see a small reduction in a composite end point”,’ she said.
Healthcare professionals should rely on Australia’s ‘good sources of objective information’ such as Therapeutic Guidelines and the Australian Medicines Handbook, said Prof Roughead.
But more work needs to be done on increasing uptake of non-pharmacological interventions that are suitable for many conditions, including art therapy, music therapy, exercise and diet.
‘We know compassion practices are really helpful in some of the hard-to-treat conditions [such as] pain and depression, so we need to get better at involving the whole therapeutic armamentarium,’ she said. ‘The first definition of QUM is judicious selection of management options.’
Involve older patients in deprescribing decisions
Doctors, pharmacists, family members and carers typically talk among themselves about an older patient's medicine regimen. But it’s the patient they need to focus on, thinks Prof Martin.
‘When you talk to an older person, they will typically say “I don’t know why they started those pills” or “I don’t think I was supposed to be on them long-term, but no one stopped them, so I just kept taking them”,’ she said.
‘So, come back to the patient and ask, “Why are you taking these medications? What are your goals of care? Do you want pain relief? What are you looking for?”’
As patients reach their final chapter, many are just after quality of life – which doesn’t necessarily entail losing cognitive function through heavy use of opioids.
‘Opioids may play some role in pain, but they certainly take away a lot of the quality of life for older people,’ said Prof Martin. ‘It’s not until you spend time talking to the person that you find out they actually want to be very sharp; they think they can cope with their pain by other measures, and we can probably reduce some of their opioids.’
Warranted distrust in medicines and healthcare needs to be built back up
While we live in an age where misinformation is rife, some of it stems from the health system and pharma model, said Prof Martin.
‘For example, we know with gabapentin, which some people use for pain, most of the information that got onto the market was fraudulent,’ she said. ‘[There] was then a big investigation, with lawsuits still ongoing.’
The same goes for opioids, ineffective for many of the conditions they are prescribed for – particularly chronic pain.
‘The public are looking at their health providers saying, “We now know this is misinformation, but you prescribed this”, so we’ve lost a bit of engagement with our community,’ said Prof Martin.
With many patients with chronic pain on high doses of opioids that are not treating their conditions and impairing their quality of life, Prof Martin thinks the healthcare sector has ‘something to answer for’.
‘That misinformation is coming from industry and from the fact that we’re too busy to actually go back to their source material,’ she said.
The good news is that opioid deaths have decreased over the last 5 years in Australia, thanks to tighter prescribing regulations and better resources such as the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, said Mr Waller.
Work on state formularies has also reduced the number of opioids that people can prescribe, said Prof Martin.
‘It has helped to get that conversation going of “Why do you need to have access to 10 different opioids in an in-patient setting?” and “Why do you need all these different concentrations?”’ she said.
However, more changes in practice are required to ensure that trend continues in the right direction, said Mr Waller.
‘We need to stop using opioids for chronic pain,’ he said. ‘There’s limited to no evidence to suggest that they work, and we need to be very judicious about our use of modified-release opioid analgesics.’
Yet as that work is done, it’s crucial to remember that these patients are suffering and compassion should be brought to the encounter – rather than simply saying ‘you can’t have that’, said Prof Roughead.
‘It’s not just ceasing a medicine. It’s ceasing a medicine and starting other things that you might need to help you be well, whether it be an exercise program or psychological services,’ she said.
Pharmacists can bridge communication and healthcare gaps in RACFs
With the Aged Care On-site Pharmacist (ACOP) program kicking off on 1 July 2024, pharmacists can improve the approach to healthcare by simply getting to know people – a skill well-honed by pharmacists in other settings, said Prof Roughead.
This includes understanding patient preferences and non-pharmacological activities that might support them.
‘If we can build a system where we can create relationships, particularly in a virtual world … we’re all going to be safer and we’re all going to feel better,’ she said.
‘That’s got to be the strength of an embedded pharmacist in aged care, that day-to-day knowledge of what the patient’s likes and dislikes are and how they’ve been managed over a continuum, as opposed to a visit that might happen once a year,’ added Mr Waller.
As the custodian of the pharmacy profession’s Professional Practice Standards and an education and training provider, PSA has continued to invest and embark into practice support training and education for pharmacists to become ACOP credentialed, said PSA National President Associated Professor Fei Sim.
The training covers all elements of this role – from professionalism, to understanding the governance of an RACF, collaborative practice, providing person-centred medication management and working within a multidisciplinary team to improve the safe and quality use of medicines.
‘Pharmacists undertaking the training program would then acquire the necessary credentials, qualifications and skill set to be able to undertake the role as an aged care on-site pharmacist,’ she said.
‘We’re also providing ongoing resources and clinical updates for credentialed pharmacists so they can be kept up to date with their knowledge and skills to undertake the role.’
With any new areas of practice, there is a great need for mentoring and networking for like-minded pharmacists who work in the same area to forge bonds, said A/Prof Sim. ‘That’s why PSA created the Consultant Pharmacists CSI group [and] an annual Consultant Pharmacist Conference, focusing on supporting and meeting the learning needs of credentialed pharmacists.’
[post_title] => Giving a voice back to elderly patients
[post_excerpt] => Yesterday’s National Medicine Symposium delivered a stark critique of how our health system is failing older patients – and how to fix it.
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[post_content] => Mpox cases are surging in Australia. An expert reveals how pharmacists can address the rising spread.
When mpox was first reported in Australia in May 2022, case numbers remained relatively low for the better part of 2 years.
However, in 2024 there has been a significant spike in case numbers in several Australian states and territories, with New South Wales, Victoria and Western Australia all seeing rising locally acquired notifications.
In September, it was reported that mpox cases grew a staggering 570% since July 2024 –with over 724 cases recorded this year. Yet vaccination rates remain low.
Meanwhile, cases of clade Ib – which has a much higher fatality rate than clade IIb strain spreading in Australia – have been detected in numerous countries around the world, most recently the United States. The worldwide spread of the new clade led the World Health Organisation to declare the mpox outbreak a public health emergency of international concern.
At this stage, pharmacists can only administer the mpox vaccine in Victoria and the Northern Territory.
However, pharmacists in all jurisdictions have an essential role in raising awareness of vaccine eligibility and dosing schedule, when to get vaccinated and where to get tested – all of which can help to bring down rising case numbers.
Watch the video below to hear sexual health expert Dr Tom Morley explain how pharmacists can go about this in a culturally safe way.
https://www.youtube.com/watch?v=ZPzbadkq8sM
[post_title] => Curbing the spread as mpox cases skyrocket
[post_excerpt] => Mpox cases are surging both in Australia and around the world. An expert reveals how pharmacists can address the rising spread.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
[post_title] => Neuropathic pain medicines can increase the risk of falls
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[post_content] => Australia’s understanding and adoption of Quality Use of Medicines (QUM) principles across general practice and primary care has led to overall improvements in medicine use, such as curtailing high-dose use of proton pump inhibitors.
But the challenge has since changed, with Australians living longer – resulting in an older, sicker population who uses more medicines, said Professor Libby Roughead – Director of the QUM and Pharmacy Research Centre at the University of South Australia.
‘Now the game is to say, how do we go forward when we’ve got a frail older population, and lots of specialty medicine? she asked.
This is the question a panel of experts sought to answer at the National Medicines Symposium 2024 yesterday (19 November).
Be wary of using ‘wonder drugs’ in older patients
When clinical trials are conducted on new medicines, they’re not tested in the over 65 age group, said Steve Waller, Senior Advisor, Medication without Harm, Australian Commission on Safety and Quality in Health Care.
[caption id="attachment_28267" align="alignnone" width="800"] National Medicines Symposium 2024 speakers (L to R): Steve Waller, Professor Jennifer Martin, Professor Libby Roughead, Tegan Taylor[/caption]
‘That creates complications, because we often don’t know what the impact in that older age group is … and pharmaceutical companies don’t have that information when they’re making an application for a new drug to be listed with the TGA [Therapeutic Goods Administration] and PBS [Pharmaceutical Benefits Scheme],’ he said.
Healthcare professionals must have awareness of the limitations of the data, thinks Professor Jennifer Martin, clinical pharmacologist and president of the Royal Australian College of Physicians.
‘Often, I say to people “why are you using a statin in [an older] population? We know the life expectancy when you go to a nursing home is less than 2 years, and you have to be on this drug at this dose for 5 years just to see a small reduction in a composite end point”,’ she said.
Healthcare professionals should rely on Australia’s ‘good sources of objective information’ such as Therapeutic Guidelines and the Australian Medicines Handbook, said Prof Roughead.
But more work needs to be done on increasing uptake of non-pharmacological interventions that are suitable for many conditions, including art therapy, music therapy, exercise and diet.
‘We know compassion practices are really helpful in some of the hard-to-treat conditions [such as] pain and depression, so we need to get better at involving the whole therapeutic armamentarium,’ she said. ‘The first definition of QUM is judicious selection of management options.’
Involve older patients in deprescribing decisions
Doctors, pharmacists, family members and carers typically talk among themselves about an older patient's medicine regimen. But it’s the patient they need to focus on, thinks Prof Martin.
‘When you talk to an older person, they will typically say “I don’t know why they started those pills” or “I don’t think I was supposed to be on them long-term, but no one stopped them, so I just kept taking them”,’ she said.
‘So, come back to the patient and ask, “Why are you taking these medications? What are your goals of care? Do you want pain relief? What are you looking for?”’
As patients reach their final chapter, many are just after quality of life – which doesn’t necessarily entail losing cognitive function through heavy use of opioids.
‘Opioids may play some role in pain, but they certainly take away a lot of the quality of life for older people,’ said Prof Martin. ‘It’s not until you spend time talking to the person that you find out they actually want to be very sharp; they think they can cope with their pain by other measures, and we can probably reduce some of their opioids.’
Warranted distrust in medicines and healthcare needs to be built back up
While we live in an age where misinformation is rife, some of it stems from the health system and pharma model, said Prof Martin.
‘For example, we know with gabapentin, which some people use for pain, most of the information that got onto the market was fraudulent,’ she said. ‘[There] was then a big investigation, with lawsuits still ongoing.’
The same goes for opioids, ineffective for many of the conditions they are prescribed for – particularly chronic pain.
‘The public are looking at their health providers saying, “We now know this is misinformation, but you prescribed this”, so we’ve lost a bit of engagement with our community,’ said Prof Martin.
With many patients with chronic pain on high doses of opioids that are not treating their conditions and impairing their quality of life, Prof Martin thinks the healthcare sector has ‘something to answer for’.
‘That misinformation is coming from industry and from the fact that we’re too busy to actually go back to their source material,’ she said.
The good news is that opioid deaths have decreased over the last 5 years in Australia, thanks to tighter prescribing regulations and better resources such as the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, said Mr Waller.
Work on state formularies has also reduced the number of opioids that people can prescribe, said Prof Martin.
‘It has helped to get that conversation going of “Why do you need to have access to 10 different opioids in an in-patient setting?” and “Why do you need all these different concentrations?”’ she said.
However, more changes in practice are required to ensure that trend continues in the right direction, said Mr Waller.
‘We need to stop using opioids for chronic pain,’ he said. ‘There’s limited to no evidence to suggest that they work, and we need to be very judicious about our use of modified-release opioid analgesics.’
Yet as that work is done, it’s crucial to remember that these patients are suffering and compassion should be brought to the encounter – rather than simply saying ‘you can’t have that’, said Prof Roughead.
‘It’s not just ceasing a medicine. It’s ceasing a medicine and starting other things that you might need to help you be well, whether it be an exercise program or psychological services,’ she said.
Pharmacists can bridge communication and healthcare gaps in RACFs
With the Aged Care On-site Pharmacist (ACOP) program kicking off on 1 July 2024, pharmacists can improve the approach to healthcare by simply getting to know people – a skill well-honed by pharmacists in other settings, said Prof Roughead.
This includes understanding patient preferences and non-pharmacological activities that might support them.
‘If we can build a system where we can create relationships, particularly in a virtual world … we’re all going to be safer and we’re all going to feel better,’ she said.
‘That’s got to be the strength of an embedded pharmacist in aged care, that day-to-day knowledge of what the patient’s likes and dislikes are and how they’ve been managed over a continuum, as opposed to a visit that might happen once a year,’ added Mr Waller.
As the custodian of the pharmacy profession’s Professional Practice Standards and an education and training provider, PSA has continued to invest and embark into practice support training and education for pharmacists to become ACOP credentialed, said PSA National President Associated Professor Fei Sim.
The training covers all elements of this role – from professionalism, to understanding the governance of an RACF, collaborative practice, providing person-centred medication management and working within a multidisciplinary team to improve the safe and quality use of medicines.
‘Pharmacists undertaking the training program would then acquire the necessary credentials, qualifications and skill set to be able to undertake the role as an aged care on-site pharmacist,’ she said.
‘We’re also providing ongoing resources and clinical updates for credentialed pharmacists so they can be kept up to date with their knowledge and skills to undertake the role.’
With any new areas of practice, there is a great need for mentoring and networking for like-minded pharmacists who work in the same area to forge bonds, said A/Prof Sim. ‘That’s why PSA created the Consultant Pharmacists CSI group [and] an annual Consultant Pharmacist Conference, focusing on supporting and meeting the learning needs of credentialed pharmacists.’
[post_title] => Giving a voice back to elderly patients
[post_excerpt] => Yesterday’s National Medicine Symposium delivered a stark critique of how our health system is failing older patients – and how to fix it.
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[post_content] => Mpox cases are surging in Australia. An expert reveals how pharmacists can address the rising spread.
When mpox was first reported in Australia in May 2022, case numbers remained relatively low for the better part of 2 years.
However, in 2024 there has been a significant spike in case numbers in several Australian states and territories, with New South Wales, Victoria and Western Australia all seeing rising locally acquired notifications.
In September, it was reported that mpox cases grew a staggering 570% since July 2024 –with over 724 cases recorded this year. Yet vaccination rates remain low.
Meanwhile, cases of clade Ib – which has a much higher fatality rate than clade IIb strain spreading in Australia – have been detected in numerous countries around the world, most recently the United States. The worldwide spread of the new clade led the World Health Organisation to declare the mpox outbreak a public health emergency of international concern.
At this stage, pharmacists can only administer the mpox vaccine in Victoria and the Northern Territory.
However, pharmacists in all jurisdictions have an essential role in raising awareness of vaccine eligibility and dosing schedule, when to get vaccinated and where to get tested – all of which can help to bring down rising case numbers.
Watch the video below to hear sexual health expert Dr Tom Morley explain how pharmacists can go about this in a culturally safe way.
https://www.youtube.com/watch?v=ZPzbadkq8sM
[post_title] => Curbing the spread as mpox cases skyrocket
[post_excerpt] => Mpox cases are surging both in Australia and around the world. An expert reveals how pharmacists can address the rising spread.
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[post_content] => Under a new government plan, pharmacists will be key to dramatically reducing HIV transmission.
Ahead of World AIDS Day (Sunday 1 December), the federal government released the Ninth National HIV Strategy (2024–2030) with the ambitious aim of eliminating HIV transmission by 2030.
Australia has achieved significant progress in reducing HIV transmission over the last decade, marked by a 33% decline in HIV notifications between 2014 and 2023.
Key to this success is increased rates of viral suppression among people living with HIV and the widespread uptake of pre-exposure prophylaxis (PrEP) among HIV-negative people, particularly among gay, bisexual, and other men who have sex with men.
Australia has also surpassed the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 target of 86%, with 87% of all people living with HIV achieving viral suppression – reducing the risk of onward transmission to zero when there’s an undetectable viral load.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.'
a/prof FEI SIM FPS
‘In the 40 years since HIV/AIDS reached Australia, we have made remarkable progress,’ said Minister for Health and Aged Care Mark Butler. ‘This Strategy marks one of the final steps to achieving the virtual elimination of HIV transmission in Australia.’
We’ve come a long way
The first AIDS diagnosis in Australia occurred in 1982. But over the past four decades, Australia has experienced significant changes in HIV transmission rates.
Following the introduction of HIV testing in 1985, newly diagnosed HIV infections peaked at 2,773 cases in 1987. This dropped by 1,062 the following year and continued to decline to 833 in 1995.
By 1999, the number of new diagnoses had decreased significantly, largely due to the adoption of prevention practices such as safe sex and needle and syringe exchange programs. This downward trend continued into the 21st century, with 552 new HIV diagnoses reported in 2021, attributable to increased testing and widespread use of antiretroviral therapy.
Public perception has also shifted since the 1987 ‘Grim Reaper’ campaign, which aimed to raise awareness but instead instilled widespread fear, stigmatising affected communities.
Advancements in treatment transforming HIV into a manageable condition has led to a shift in public perception. But stigma remains an issue. In 2017, the Australian Survey of Social Attitudes revealed that 52% of the general public indicated they would still behave negatively towards people living with HIV.
Inequitable outcomes
Despite Australia’s successes, improvements in transmission rates have not been experienced across the board – with some populations and regions lagging in testing and PrEP uptake.
HIV diagnosis rates are disproportionately higher among individuals from culturally and linguistically diverse (CALD) backgrounds, with a 21.5% increase in HIV notifications over the past decade, with these patients often diagnosed late. Late diagnosis rates are particularly common among those born in Sub-Saharan Africa , Southeast Asia and Central/South America.
Among Aboriginal and Torres Strait Islander peoples, the HIV notification rate in 2022 was 3.2 per 100,000, compared to 2.2 per 100,000 in the non-Indigenous population.
What are the key aspects of the strategy?
The three key elements of the strategy include reducing new and late diagnoses, promoting understanding and support of U=U (Undetectable = Untransmittable), and implementing and sustaining models of service for intervention – particularly among priority populations.
How does the new national strategy compare to the previous one?
The Eighth National HIV Strategy (2018–2022) and Ninth National HIV Strategy share a commitment to reducing HIV transmission in Australia. But the goals and pathway to achieving this vary.
The Eighth Strategy aimed to meet UNAIDS 90-90-90 targets, focusing on increasing diagnosis, treatment, and viral suppression rates through prioritised expanded access to PrEP, post-exposure prophylaxis (PEP), and harm reduction programs. Addressing stigma and barriers to care for key populations, such as gay and bisexual men, sex workers, and Aboriginal and Torres Strait Islander peoples was also a key focus.
Key achievements under this strategy include allowing people living with HIV who are ineligible for Medicare to access free treatment through government-funded hospital pharmacies in 2023 and providing options for rapid HIV testing and self-test kits in pharmacies under updated Therapeutic Goods Administration regulations.
But the ninth iteration has pushed the envelope further towards virtually eradicating HIV transmission.
This strategy reflects advancements in treatment and prevention technologies, such as long-acting injectable antiretrovirals and expanded use of U=U.
With a higher proportion of men from CALD backgrounds and Aboriginal and Torres Strait Islander peoples acquiring HIV, the ninth strategy emphasises tailored approaches to improve access to care and ensure equitable treatment.
Multicultural organisations and Aboriginal Community Controlled Health Organisations are key to improving awareness of HIV in these communities. This includes design and delivery of culturally appropriate health promotion programs, delivery of peer-based services or directing patients to existing resources.
What’s the role of pharmacists?
Pharmacies are identified as a priority setting within the strategy as an important healthcare service used by priority populations to access HIV care, said a spokesperson for the Department of Health and Aged Care.
‘Pharmacists can play a key role in the virtual elimination of HIV transmission through the four key priorities of the strategy: prevention, testing, treatment and care, and stigma,’ said the spokesperson.
‘In partnership with the HIV sector, the Australian Government is investigating options to increase access to PrEP, including through pharmacists, as recommended by the HIV Taskforce and reflected in the new 9th National HIV Strategy.’
This includes options for promoting, prescribing or supplying PrEP through pharmacies, which is particularly vital among populations with limited access to healthcare services such as in rural or remote areas and CALD communities.
Simplifying PrEP regimen management, such as extending prescription cycles and monitoring requirements beyond 3 months and providing multiple pathology forms for repeat testing could encourage uptake.
However, at this time, there are no plans to change current access arrangements to post-exposure prophylaxis (PEP) for HIV, said the spokesperson.
[caption id="attachment_28347" align="alignnone" width="600"] PSA National President Associate Professor Fei Sim FPS[/caption]
While PSA shares the ambitious but achievable goal of the government’s updated national HIV strategy to virtually eliminate HIV transmission in Australia by 2030, PSA National President Associate Professor Fei Sim FPS said we can go further in utilising the skills and expertise of pharmacists to reduce barriers to care for people living with or at risk of HIV.
‘[This includes] making medications like PrEP and PEP more accessible to the communities who need them, increasing access to HIV testing and reducing stigma,’ she said.
‘PSA is ready to work with government to investigate how pharmacists can be supported to increase HIV PrEP uptake to eligible people through pharmacist prescribing of PrEP, including long-acting injectables and oral formulations.’
As new formulations come to the Australian market, such as long-acting injectable antiretroviral therapy, pharmacists can play an even greater role in supporting patients at risk of HIV, including both medicine administration and point of care testing.
‘To deliver on the goals of our HIV strategy, all health professionals, including pharmacists, need to do more to combat stigma,’ said A/Prof Sim. ‘This includes increasing awareness and understanding of U=U in the general population and supporting health workers to provide accessible, non-judgmental, and evidence-based care.’
[post_title] => Pharmacists could prescribe PrEP to combat HIV transmission
[post_excerpt] => Under a new national government strategy, pharmacists will be key to dramatically reducing HIV transmission.
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[post_content] => The Therapeutic Goods Administration (TGA) has issued a Serious Scarcity Substitution Instruments (SSSI) to help pharmacists and patients manage the shortage of hormone replacement therapy (HRT) patches.
A global shortage of menopausal hormone therapies (MHT) has persisted throughout 2024, leaving many women 'unable to function’.
Around 13% (260,000) of Australian menopausal women take MHT. But with another 80,000 women estimated to have gone through menopause this year, demand is only set to increase.
But it's not only older women who benefit from using these patches. Younger women undergoing early menopause due to chemotherapy or conditions affecting the ovaries or pituitary gland need oestrogen. So do transgender women and non-binary individuals as part of feminising hormone therapy for gender affirmation.
With shortages of many of these medicines set to persist into 2025, the SSSI allows pharmacists to dispense an alternative brand or strengths to these patients, if appropriate, without a new prescription from the prescriber.
What HRT substitutions are available for patients?
A representative for Sandoz told Australian Pharmacist that the manufacturer is ‘committed to addressing the global supply challenges for MHT and HRT transdermal patches’.
‘In collaboration with the local authorities and global manufacturing partners, we have taken proactive steps to alleviate supply constraints,’ said the spokesperson.
‘Although Estradot (estradiol) registered products will have constrained supply throughout the first half of 2025, as noted on the TGA medicines shortages website, we are pleased to confirm alternative products have received Section 19A conditional approval for release in Australia.’
Medsurge Healthcare, which sources and supplies essential medicines in times of critical need and uncertainty, has also been able to arrange for the supply of alternative products on a temporary basis until the shortages of Australian registered medicines are resolved, a spokesperson for Medsurge told AP.
‘Medsurge was granted temporary S19A approval under section 19A of the Therapeutic Goods Act 1989 and has worked diligently to fill a critical need for patients,’ said the Medsurge spokesperson.
Under Section 19A, the following brands and strengths of HRT patches can be substituted for out-of-stock Estraderm MX and Estradot patches:
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[post_content] => These oft-used medicines have become the analgesia of choice for many prescribers. But care should be taken before prescribing gabapentinoids to certain patients.
Gabapentinoid medicines are widely prescribed in Australia. Considered a safer alternative to opioids for neuropathic pain, there was an 8-fold increase in prescriptions for gabapentinoids from 2012 to 2018 – with 1 in 7 Australians aged 80 and older prescribed a gabapentinoid.
[caption id="attachment_28316" align="aligncenter" width="1280"] Source – Pregabalin prescribing patterns in Australian general practice, 2012–2018: a cross-sectional study[/caption]
But a new study from Monash University researchers, including pharmacists Miriam Leung and Professor Simon Bell FPS, found that harm can be caused within 2 months of initiation.
Over a 5-year period, the researchers analysed data for 28,293 patients in Victoria who experienced hip fractures.
‘Our research found that patients who were recently dispensed either pregabalin or gabapentin had 30% higher odds of experiencing a hip fracture,’ Prof Bell told Australian Pharmacist.
Who is most at risk?
The link between gabapentinoid use and hip fractures existed across different age groups.
However, the risk of hip fracture associated with gabapentinoid medicines was highest in patients who were frail or had renal impairment, said Prof Bell.
‘Frail older people are prone to falls and fractures,’ he said. ‘One in 25 adults aged 80 years and older experience a hip fracture each year.’
The impact of these incidents can be fatal.
‘Around one in four people who experience a hip fracture die within 12 months,’ said Prof Bell.
How should pharmacists assess and manage falls risk?
For certain neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and mixed or post-traumatic neuropathy, gabapentinoids such as pregabalin or gabapentin can provide effective relief.
However, while approved by the Australian Therapeutic Goods Administration for refractory focal (partial) epilepsy and neuropathic pain, gabapentin and pregabalin are often prescribed off label – with limited evidence to support efficacy for off-label indications.
In patients who are likely to see some benefit of therapy, pharmacists should advise patients how to minimise risk before dispensing these medicines.
‘The risk of falls is highest at the start of treatment,’ said Prof Bell.
‘Therefore, it’s important that pharmacists and other clinicians advise on strategies to minimise falls risk at this time. This could include avoidance of other falls-risk increasing substances such as alcohol.’
Evaluating what other medicines at-risk patients are prescribed is also an important strategy for preventing harm.
‘It’s known that gabapentinoids can cause side-effects such as drowsiness, sedation and dizziness,’ said Prof Bell.
‘These side-effects may increase the risk of falls, particularly if gabapentinoids are co-administrated with other psychotropic or cardiovascular falls risk medications.’
What impact can dose have on falls risk?
Given risk is highest at the outset of treatment, the starting dose of gabapentinoids can also have an impact on the likelihood of falls.
‘It’s advisable that patients start with a low dose and titrate slowly,’ said Prof Bell. ‘This particularly applies to people who are frail or have renal impairment.’
When is a discussion with the prescriber warranted?
The ongoing need for gabapentinoid treatment for neuropathic pain should be reviewed regularly, said Prof Bell.
‘If patients do not experience benefit after an adequate trial of treatment, then gradual discontinuation may be warranted,’ he said.
However, it’s important to advise people who take a gabapentinoid medicine that they shouldn’t stop taking their medication without first speaking with their prescriber or pharmacist first.
‘Stopping gabapentinoid medications abruptly can cause withdrawal symptoms,’ Prof Bell added.
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[post_content] => Australia’s understanding and adoption of Quality Use of Medicines (QUM) principles across general practice and primary care has led to overall improvements in medicine use, such as curtailing high-dose use of proton pump inhibitors.
But the challenge has since changed, with Australians living longer – resulting in an older, sicker population who uses more medicines, said Professor Libby Roughead – Director of the QUM and Pharmacy Research Centre at the University of South Australia.
‘Now the game is to say, how do we go forward when we’ve got a frail older population, and lots of specialty medicine? she asked.
This is the question a panel of experts sought to answer at the National Medicines Symposium 2024 yesterday (19 November).
Be wary of using ‘wonder drugs’ in older patients
When clinical trials are conducted on new medicines, they’re not tested in the over 65 age group, said Steve Waller, Senior Advisor, Medication without Harm, Australian Commission on Safety and Quality in Health Care.
[caption id="attachment_28267" align="alignnone" width="800"] National Medicines Symposium 2024 speakers (L to R): Steve Waller, Professor Jennifer Martin, Professor Libby Roughead, Tegan Taylor[/caption]
‘That creates complications, because we often don’t know what the impact in that older age group is … and pharmaceutical companies don’t have that information when they’re making an application for a new drug to be listed with the TGA [Therapeutic Goods Administration] and PBS [Pharmaceutical Benefits Scheme],’ he said.
Healthcare professionals must have awareness of the limitations of the data, thinks Professor Jennifer Martin, clinical pharmacologist and president of the Royal Australian College of Physicians.
‘Often, I say to people “why are you using a statin in [an older] population? We know the life expectancy when you go to a nursing home is less than 2 years, and you have to be on this drug at this dose for 5 years just to see a small reduction in a composite end point”,’ she said.
Healthcare professionals should rely on Australia’s ‘good sources of objective information’ such as Therapeutic Guidelines and the Australian Medicines Handbook, said Prof Roughead.
But more work needs to be done on increasing uptake of non-pharmacological interventions that are suitable for many conditions, including art therapy, music therapy, exercise and diet.
‘We know compassion practices are really helpful in some of the hard-to-treat conditions [such as] pain and depression, so we need to get better at involving the whole therapeutic armamentarium,’ she said. ‘The first definition of QUM is judicious selection of management options.’
Involve older patients in deprescribing decisions
Doctors, pharmacists, family members and carers typically talk among themselves about an older patient's medicine regimen. But it’s the patient they need to focus on, thinks Prof Martin.
‘When you talk to an older person, they will typically say “I don’t know why they started those pills” or “I don’t think I was supposed to be on them long-term, but no one stopped them, so I just kept taking them”,’ she said.
‘So, come back to the patient and ask, “Why are you taking these medications? What are your goals of care? Do you want pain relief? What are you looking for?”’
As patients reach their final chapter, many are just after quality of life – which doesn’t necessarily entail losing cognitive function through heavy use of opioids.
‘Opioids may play some role in pain, but they certainly take away a lot of the quality of life for older people,’ said Prof Martin. ‘It’s not until you spend time talking to the person that you find out they actually want to be very sharp; they think they can cope with their pain by other measures, and we can probably reduce some of their opioids.’
Warranted distrust in medicines and healthcare needs to be built back up
While we live in an age where misinformation is rife, some of it stems from the health system and pharma model, said Prof Martin.
‘For example, we know with gabapentin, which some people use for pain, most of the information that got onto the market was fraudulent,’ she said. ‘[There] was then a big investigation, with lawsuits still ongoing.’
The same goes for opioids, ineffective for many of the conditions they are prescribed for – particularly chronic pain.
‘The public are looking at their health providers saying, “We now know this is misinformation, but you prescribed this”, so we’ve lost a bit of engagement with our community,’ said Prof Martin.
With many patients with chronic pain on high doses of opioids that are not treating their conditions and impairing their quality of life, Prof Martin thinks the healthcare sector has ‘something to answer for’.
‘That misinformation is coming from industry and from the fact that we’re too busy to actually go back to their source material,’ she said.
The good news is that opioid deaths have decreased over the last 5 years in Australia, thanks to tighter prescribing regulations and better resources such as the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, said Mr Waller.
Work on state formularies has also reduced the number of opioids that people can prescribe, said Prof Martin.
‘It has helped to get that conversation going of “Why do you need to have access to 10 different opioids in an in-patient setting?” and “Why do you need all these different concentrations?”’ she said.
However, more changes in practice are required to ensure that trend continues in the right direction, said Mr Waller.
‘We need to stop using opioids for chronic pain,’ he said. ‘There’s limited to no evidence to suggest that they work, and we need to be very judicious about our use of modified-release opioid analgesics.’
Yet as that work is done, it’s crucial to remember that these patients are suffering and compassion should be brought to the encounter – rather than simply saying ‘you can’t have that’, said Prof Roughead.
‘It’s not just ceasing a medicine. It’s ceasing a medicine and starting other things that you might need to help you be well, whether it be an exercise program or psychological services,’ she said.
Pharmacists can bridge communication and healthcare gaps in RACFs
With the Aged Care On-site Pharmacist (ACOP) program kicking off on 1 July 2024, pharmacists can improve the approach to healthcare by simply getting to know people – a skill well-honed by pharmacists in other settings, said Prof Roughead.
This includes understanding patient preferences and non-pharmacological activities that might support them.
‘If we can build a system where we can create relationships, particularly in a virtual world … we’re all going to be safer and we’re all going to feel better,’ she said.
‘That’s got to be the strength of an embedded pharmacist in aged care, that day-to-day knowledge of what the patient’s likes and dislikes are and how they’ve been managed over a continuum, as opposed to a visit that might happen once a year,’ added Mr Waller.
As the custodian of the pharmacy profession’s Professional Practice Standards and an education and training provider, PSA has continued to invest and embark into practice support training and education for pharmacists to become ACOP credentialed, said PSA National President Associated Professor Fei Sim.
The training covers all elements of this role – from professionalism, to understanding the governance of an RACF, collaborative practice, providing person-centred medication management and working within a multidisciplinary team to improve the safe and quality use of medicines.
‘Pharmacists undertaking the training program would then acquire the necessary credentials, qualifications and skill set to be able to undertake the role as an aged care on-site pharmacist,’ she said.
‘We’re also providing ongoing resources and clinical updates for credentialed pharmacists so they can be kept up to date with their knowledge and skills to undertake the role.’
With any new areas of practice, there is a great need for mentoring and networking for like-minded pharmacists who work in the same area to forge bonds, said A/Prof Sim. ‘That’s why PSA created the Consultant Pharmacists CSI group [and] an annual Consultant Pharmacist Conference, focusing on supporting and meeting the learning needs of credentialed pharmacists.’
[post_title] => Giving a voice back to elderly patients
[post_excerpt] => Yesterday’s National Medicine Symposium delivered a stark critique of how our health system is failing older patients – and how to fix it.
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[post_content] => Mpox cases are surging in Australia. An expert reveals how pharmacists can address the rising spread.
When mpox was first reported in Australia in May 2022, case numbers remained relatively low for the better part of 2 years.
However, in 2024 there has been a significant spike in case numbers in several Australian states and territories, with New South Wales, Victoria and Western Australia all seeing rising locally acquired notifications.
In September, it was reported that mpox cases grew a staggering 570% since July 2024 –with over 724 cases recorded this year. Yet vaccination rates remain low.
Meanwhile, cases of clade Ib – which has a much higher fatality rate than clade IIb strain spreading in Australia – have been detected in numerous countries around the world, most recently the United States. The worldwide spread of the new clade led the World Health Organisation to declare the mpox outbreak a public health emergency of international concern.
At this stage, pharmacists can only administer the mpox vaccine in Victoria and the Northern Territory.
However, pharmacists in all jurisdictions have an essential role in raising awareness of vaccine eligibility and dosing schedule, when to get vaccinated and where to get tested – all of which can help to bring down rising case numbers.
Watch the video below to hear sexual health expert Dr Tom Morley explain how pharmacists can go about this in a culturally safe way.
https://www.youtube.com/watch?v=ZPzbadkq8sM
[post_title] => Curbing the spread as mpox cases skyrocket
[post_excerpt] => Mpox cases are surging both in Australia and around the world. An expert reveals how pharmacists can address the rising spread.
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[title_attribute] => Curbing the spread as mpox cases skyrocket
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CPD credits
Accreditation Code : CAP2410DMBW
Group 1 : 0.75 CPD credits
Group 2 : 1.5 CPD credits
This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 2 CPD (or 1.5 CPD credits) upon successful completion of relevant assessment activities.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
