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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"]
Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => At the 2024 Queensland Excellence Awards in Brisbane on Saturday night, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
PSA Queensland President Shane MacDonald MPS acknowledged the achievements of the award winners as well as the continued dedication of pharmacists practising throughout the state.
‘It’s an inspiration to see the amazing work pharmacists are doing in communities across Queensland, and a great privilege to recognise them for their dedication in advancing the profession,’ he said.
‘On behalf of the PSA I congratulate the outstanding pharmacists presented with awards and thank them for their commitment to bettering the health of Queenslanders.’
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PSA Queensland Pharmacist of the Year Associate Professor Esther Lau MPS, University of Queensland
One of the first trained pharmacy vaccinators in Australia, A/Prof Lau was the cornerstone for the development of Australia’s first non-medical prescribing course at Queensland Institute of Technology, a foundation for the expansion of the current North Queensland practice prescribing pilots. For the past decade she has written AP’s Old Drug New Indication column, mentored many students and reviewed the APF and PSA’s 2023 Professional Practice Standards.
PSA Queensland Early Career Pharmacist of the Year James Buckley MPS, LiveLife Pharmacy Port Douglas
Filling a critical gap in his Far North Queensland community, Mr Buckley upskilled in otoscopy to accurately identify conditions like otitis media and otitis externa, as well as collaborative pathways to ensure patients were referred seamlessly for timely treatment. One of the first pharmacists to pass the North Queensland Pharmacist Full Scope of Practice Pilot, he sits on the ECP Community of Specialty Interest (CSI) leadership group and promotes pharmacy practice to students and interns.
PSA Queensland Intern Pharmacist of the Year Antonia Hurd, Kepnock Pharmacy Bundaberg
Interning at four separate pharmacies in Bundaberg, Peregian Springs, remote Agnes Water and regional town Cooroy, Ms Hurd has demonstrated exceptional leadership and initiative across pharmacy services including managing a dose administration aid service, an R U OK Day presentation, training in compounding and providing vaccination and first aid advice. Her research on managing the quality of life for people living with severe and persistent mental illness is anticipated to be published as part of the PhaMIbridge trial.
Lifetime Achievement Award Beverley Glass FPS, James Cook University
After a lifetime of service and devotion to the pharmacy profession as a clinician, teacher, researcher, academic and advocate, South African-born Professor Glass has made an outstanding contribution to the development of pharmacy education, practice and research, specifically within rural and remote Queensland and Australia. She has invested immense amounts of time into the future academic workforce, some of whom are among her 50 honours and 33 PhD and Masters students.
Professor James Dare Graduate of the Year Shylee-Jade Hadar-Pagliari, James Cook University
As a final year pharmacy student, Ms Hadar-Pagliari has packed in many experiences since starting as a pharmacy assistant in 2020. Not only does she represent NAPSA students at pharmacy conferences, she has learned under supervision at the Alive Pharmacy Warehouse in Cairns how to dispense medicines, assist patients with non-prescription requests and run the complex compounding laboratory. She is known for her caring nature with patients.
[post_title] => PSA awards leading Queensland pharmacists
[post_excerpt] => At the 2024 Queensland Excellence Awards, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
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[post_content] => At one point in time, Menopausal hormone therapy (MHT) was used fairly extensively.
But this has changed since 2002, when the Women's Health Initiative (WHI) published a study linking combined MHT (oestrogen and progestin) with an increased risk of blood clots, stroke, breast cancer and heart attacks.
Almost overnight, women stopped using hormone therapy, said CEO of Jean Hailes for Women's Health, Dr Sarah White.
[caption id="attachment_27901" align="alignright" width="300"]
Dr Sarah White[/caption]
But there are several factors that led to the study results being skewed.
‘It was [based on] an older group of women who started taking hormone therapy late, and it was a different form of hormone therapy, so those results did not stand up and the increased risk in breast cancer was terribly small,’ she said.
The sensationalist reporting did a huge amount of damage, Dr White said.
‘We still have women today who believe that MHT causes breast cancer, and GPs who are nervous about prescribing it.’
While around one in four women who go through menopause will be asymptomatic or have mild symptoms, a quarter will be at the opposite end of the spectrum and experience severe symptoms, said Dr White.
‘We're talking about an inability to sleep, terrible brain fog, anxiety, a loss of confidence, and hot flushes that can be catastrophic,’ she said.
The remaining half of women are on a spectrum of experiencing mildly annoying to must-be-managed symptoms.
‘We have women who are trying to soldier on through some really unpleasant physical and mental effects,’ she said. ‘And it's a bit heartbreaking to think that there's a medication that can help manage a lot of the symptoms and women are worried about taking it when they have no need to be.’
Is MHT underprescribed?
There's ‘no doubt’ that MHT is underused in Australia, said Dr White – with barriers to access a compounding factor.
‘It's not just going to get that doctor's appointment, it's the cost of the MHT,’ she said.
Some forms of MHT are subsidised under the Pharmaceutical Benefits Scheme (PBS), such as estradiol patches, but there has been a global shortage of this therapy in 2024.
But newer medicines such as Prometrium – a progesterone-based treatment matching the hormone the body makes when ovulating – are not, setting women back around $60 per month.
Are all women suitable candidates for MHT?
No, cautioned Dr White.
For example, a person who has had a hormone responsive cancer should have a careful discussion with their GP about whether the risks of MHT outweigh the benefits.
‘If you've had a hormone responsive cancer, then taking a hormone increases the risk of recurrence,’ she said.
Oral combined MHT will increase the ‘baseline’ risk of thrombosis around two-fold – however the baseline risk remains low in most women. Thrombosis risk increases with increasing age, smoking, increased body weight, in those with genetic predisposition to clotting and in certain illnesses. Risk factors should be considered prior to commencing MHT.
MHT treatment should be individualised based on the patient’s needs, clinical features and risk assessment, and reviewed regularly. Women with a personal or family history of venous thrombosis should undergo screening for risk factors to guide the choice of MHT delivery method. In cases where a woman is deemed to be at high risk for developing deep vein thrombosis (DVT), transdermal MHT should be used.
‘That’s why the message is very clear to speak about your individual circumstances with your doctor,’ added Dr White, who said a consultation to discuss the appropriateness of therapy could include:
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => At the 2024 Queensland Excellence Awards in Brisbane on Saturday night, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
PSA Queensland President Shane MacDonald MPS acknowledged the achievements of the award winners as well as the continued dedication of pharmacists practising throughout the state.
‘It’s an inspiration to see the amazing work pharmacists are doing in communities across Queensland, and a great privilege to recognise them for their dedication in advancing the profession,’ he said.
‘On behalf of the PSA I congratulate the outstanding pharmacists presented with awards and thank them for their commitment to bettering the health of Queenslanders.’
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PSA Queensland Pharmacist of the Year Associate Professor Esther Lau MPS, University of Queensland
One of the first trained pharmacy vaccinators in Australia, A/Prof Lau was the cornerstone for the development of Australia’s first non-medical prescribing course at Queensland Institute of Technology, a foundation for the expansion of the current North Queensland practice prescribing pilots. For the past decade she has written AP’s Old Drug New Indication column, mentored many students and reviewed the APF and PSA’s 2023 Professional Practice Standards.
PSA Queensland Early Career Pharmacist of the Year James Buckley MPS, LiveLife Pharmacy Port Douglas
Filling a critical gap in his Far North Queensland community, Mr Buckley upskilled in otoscopy to accurately identify conditions like otitis media and otitis externa, as well as collaborative pathways to ensure patients were referred seamlessly for timely treatment. One of the first pharmacists to pass the North Queensland Pharmacist Full Scope of Practice Pilot, he sits on the ECP Community of Specialty Interest (CSI) leadership group and promotes pharmacy practice to students and interns.
PSA Queensland Intern Pharmacist of the Year Antonia Hurd, Kepnock Pharmacy Bundaberg
Interning at four separate pharmacies in Bundaberg, Peregian Springs, remote Agnes Water and regional town Cooroy, Ms Hurd has demonstrated exceptional leadership and initiative across pharmacy services including managing a dose administration aid service, an R U OK Day presentation, training in compounding and providing vaccination and first aid advice. Her research on managing the quality of life for people living with severe and persistent mental illness is anticipated to be published as part of the PhaMIbridge trial.
Lifetime Achievement Award Beverley Glass FPS, James Cook University
After a lifetime of service and devotion to the pharmacy profession as a clinician, teacher, researcher, academic and advocate, South African-born Professor Glass has made an outstanding contribution to the development of pharmacy education, practice and research, specifically within rural and remote Queensland and Australia. She has invested immense amounts of time into the future academic workforce, some of whom are among her 50 honours and 33 PhD and Masters students.
Professor James Dare Graduate of the Year Shylee-Jade Hadar-Pagliari, James Cook University
As a final year pharmacy student, Ms Hadar-Pagliari has packed in many experiences since starting as a pharmacy assistant in 2020. Not only does she represent NAPSA students at pharmacy conferences, she has learned under supervision at the Alive Pharmacy Warehouse in Cairns how to dispense medicines, assist patients with non-prescription requests and run the complex compounding laboratory. She is known for her caring nature with patients.
[post_title] => PSA awards leading Queensland pharmacists
[post_excerpt] => At the 2024 Queensland Excellence Awards, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
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[post_content] => At one point in time, Menopausal hormone therapy (MHT) was used fairly extensively.
But this has changed since 2002, when the Women's Health Initiative (WHI) published a study linking combined MHT (oestrogen and progestin) with an increased risk of blood clots, stroke, breast cancer and heart attacks.
Almost overnight, women stopped using hormone therapy, said CEO of Jean Hailes for Women's Health, Dr Sarah White.
[caption id="attachment_27901" align="alignright" width="300"] Dr Sarah White[/caption]
But there are several factors that led to the study results being skewed.
‘It was [based on] an older group of women who started taking hormone therapy late, and it was a different form of hormone therapy, so those results did not stand up and the increased risk in breast cancer was terribly small,’ she said.
The sensationalist reporting did a huge amount of damage, Dr White said.
‘We still have women today who believe that MHT causes breast cancer, and GPs who are nervous about prescribing it.’
While around one in four women who go through menopause will be asymptomatic or have mild symptoms, a quarter will be at the opposite end of the spectrum and experience severe symptoms, said Dr White.
‘We're talking about an inability to sleep, terrible brain fog, anxiety, a loss of confidence, and hot flushes that can be catastrophic,’ she said.
The remaining half of women are on a spectrum of experiencing mildly annoying to must-be-managed symptoms.
‘We have women who are trying to soldier on through some really unpleasant physical and mental effects,’ she said. ‘And it's a bit heartbreaking to think that there's a medication that can help manage a lot of the symptoms and women are worried about taking it when they have no need to be.’
Is MHT underprescribed?
There's ‘no doubt’ that MHT is underused in Australia, said Dr White – with barriers to access a compounding factor.
‘It's not just going to get that doctor's appointment, it's the cost of the MHT,’ she said.
Some forms of MHT are subsidised under the Pharmaceutical Benefits Scheme (PBS), such as estradiol patches, but there has been a global shortage of this therapy in 2024.
But newer medicines such as Prometrium – a progesterone-based treatment matching the hormone the body makes when ovulating – are not, setting women back around $60 per month.
Are all women suitable candidates for MHT?
No, cautioned Dr White.
For example, a person who has had a hormone responsive cancer should have a careful discussion with their GP about whether the risks of MHT outweigh the benefits.
‘If you've had a hormone responsive cancer, then taking a hormone increases the risk of recurrence,’ she said.
Oral combined MHT will increase the ‘baseline’ risk of thrombosis around two-fold – however the baseline risk remains low in most women. Thrombosis risk increases with increasing age, smoking, increased body weight, in those with genetic predisposition to clotting and in certain illnesses. Risk factors should be considered prior to commencing MHT.
MHT treatment should be individualised based on the patient’s needs, clinical features and risk assessment, and reviewed regularly. Women with a personal or family history of venous thrombosis should undergo screening for risk factors to guide the choice of MHT delivery method. In cases where a woman is deemed to be at high risk for developing deep vein thrombosis (DVT), transdermal MHT should be used.
‘That’s why the message is very clear to speak about your individual circumstances with your doctor,’ added Dr White, who said a consultation to discuss the appropriateness of therapy could include:
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => At the 2024 Queensland Excellence Awards in Brisbane on Saturday night, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
PSA Queensland President Shane MacDonald MPS acknowledged the achievements of the award winners as well as the continued dedication of pharmacists practising throughout the state.
‘It’s an inspiration to see the amazing work pharmacists are doing in communities across Queensland, and a great privilege to recognise them for their dedication in advancing the profession,’ he said.
‘On behalf of the PSA I congratulate the outstanding pharmacists presented with awards and thank them for their commitment to bettering the health of Queenslanders.’
[gallery type="flexslider" size="full" ids="27956,27957,27955,27958,27959"]
PSA Queensland Pharmacist of the Year Associate Professor Esther Lau MPS, University of Queensland
One of the first trained pharmacy vaccinators in Australia, A/Prof Lau was the cornerstone for the development of Australia’s first non-medical prescribing course at Queensland Institute of Technology, a foundation for the expansion of the current North Queensland practice prescribing pilots. For the past decade she has written AP’s Old Drug New Indication column, mentored many students and reviewed the APF and PSA’s 2023 Professional Practice Standards.
PSA Queensland Early Career Pharmacist of the Year James Buckley MPS, LiveLife Pharmacy Port Douglas
Filling a critical gap in his Far North Queensland community, Mr Buckley upskilled in otoscopy to accurately identify conditions like otitis media and otitis externa, as well as collaborative pathways to ensure patients were referred seamlessly for timely treatment. One of the first pharmacists to pass the North Queensland Pharmacist Full Scope of Practice Pilot, he sits on the ECP Community of Specialty Interest (CSI) leadership group and promotes pharmacy practice to students and interns.
PSA Queensland Intern Pharmacist of the Year Antonia Hurd, Kepnock Pharmacy Bundaberg
Interning at four separate pharmacies in Bundaberg, Peregian Springs, remote Agnes Water and regional town Cooroy, Ms Hurd has demonstrated exceptional leadership and initiative across pharmacy services including managing a dose administration aid service, an R U OK Day presentation, training in compounding and providing vaccination and first aid advice. Her research on managing the quality of life for people living with severe and persistent mental illness is anticipated to be published as part of the PhaMIbridge trial.
Lifetime Achievement Award Beverley Glass FPS, James Cook University
After a lifetime of service and devotion to the pharmacy profession as a clinician, teacher, researcher, academic and advocate, South African-born Professor Glass has made an outstanding contribution to the development of pharmacy education, practice and research, specifically within rural and remote Queensland and Australia. She has invested immense amounts of time into the future academic workforce, some of whom are among her 50 honours and 33 PhD and Masters students.
Professor James Dare Graduate of the Year Shylee-Jade Hadar-Pagliari, James Cook University
As a final year pharmacy student, Ms Hadar-Pagliari has packed in many experiences since starting as a pharmacy assistant in 2020. Not only does she represent NAPSA students at pharmacy conferences, she has learned under supervision at the Alive Pharmacy Warehouse in Cairns how to dispense medicines, assist patients with non-prescription requests and run the complex compounding laboratory. She is known for her caring nature with patients.
[post_title] => PSA awards leading Queensland pharmacists
[post_excerpt] => At the 2024 Queensland Excellence Awards, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
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[post_content] => At one point in time, Menopausal hormone therapy (MHT) was used fairly extensively.
But this has changed since 2002, when the Women's Health Initiative (WHI) published a study linking combined MHT (oestrogen and progestin) with an increased risk of blood clots, stroke, breast cancer and heart attacks.
Almost overnight, women stopped using hormone therapy, said CEO of Jean Hailes for Women's Health, Dr Sarah White.
[caption id="attachment_27901" align="alignright" width="300"] Dr Sarah White[/caption]
But there are several factors that led to the study results being skewed.
‘It was [based on] an older group of women who started taking hormone therapy late, and it was a different form of hormone therapy, so those results did not stand up and the increased risk in breast cancer was terribly small,’ she said.
The sensationalist reporting did a huge amount of damage, Dr White said.
‘We still have women today who believe that MHT causes breast cancer, and GPs who are nervous about prescribing it.’
While around one in four women who go through menopause will be asymptomatic or have mild symptoms, a quarter will be at the opposite end of the spectrum and experience severe symptoms, said Dr White.
‘We're talking about an inability to sleep, terrible brain fog, anxiety, a loss of confidence, and hot flushes that can be catastrophic,’ she said.
The remaining half of women are on a spectrum of experiencing mildly annoying to must-be-managed symptoms.
‘We have women who are trying to soldier on through some really unpleasant physical and mental effects,’ she said. ‘And it's a bit heartbreaking to think that there's a medication that can help manage a lot of the symptoms and women are worried about taking it when they have no need to be.’
Is MHT underprescribed?
There's ‘no doubt’ that MHT is underused in Australia, said Dr White – with barriers to access a compounding factor.
‘It's not just going to get that doctor's appointment, it's the cost of the MHT,’ she said.
Some forms of MHT are subsidised under the Pharmaceutical Benefits Scheme (PBS), such as estradiol patches, but there has been a global shortage of this therapy in 2024.
But newer medicines such as Prometrium – a progesterone-based treatment matching the hormone the body makes when ovulating – are not, setting women back around $60 per month.
Are all women suitable candidates for MHT?
No, cautioned Dr White.
For example, a person who has had a hormone responsive cancer should have a careful discussion with their GP about whether the risks of MHT outweigh the benefits.
‘If you've had a hormone responsive cancer, then taking a hormone increases the risk of recurrence,’ she said.
Oral combined MHT will increase the ‘baseline’ risk of thrombosis around two-fold – however the baseline risk remains low in most women. Thrombosis risk increases with increasing age, smoking, increased body weight, in those with genetic predisposition to clotting and in certain illnesses. Risk factors should be considered prior to commencing MHT.
MHT treatment should be individualised based on the patient’s needs, clinical features and risk assessment, and reviewed regularly. Women with a personal or family history of venous thrombosis should undergo screening for risk factors to guide the choice of MHT delivery method. In cases where a woman is deemed to be at high risk for developing deep vein thrombosis (DVT), transdermal MHT should be used.
‘That’s why the message is very clear to speak about your individual circumstances with your doctor,’ added Dr White, who said a consultation to discuss the appropriateness of therapy could include:
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[post_content] => At the end of this month, new pack sizes will start to arrive in pharmacies – ahead of the impending scheduling change of paracetamol.
From 1 February 2025, pack sizes of paracetamol will change, with larger quantities (50 plus in most jurisdictions) shifting to Schedule 3 following the final decision on paracetamol access controls made by the Therapeutic Goods Administration (TGA) on 3 May 2023.
Why are the changes occurring?
In short, the TGA changes aim to reduce the volume of paracetamol which is kept in people’s homes.
Paracetamol is frequently involved in self-poisoning cases worldwide. Due to concerns around rising cases of paracetamol poisoning in Australia, the TGA commissioned an independent review into the risks of intentional self-poisoning with paracetamol.
The harm caused by paracetamol is commonly perceived as low, given its safety at therapeutic doses, widespread use and broad availability, said Peter Guthrey MPS, PSA Senior Pharmacist – strategic policy.
‘However, paracetamol is still overrepresented in poisoning events – both intentional and unintentional,’ he said.
Around 225 Australians are hospitalised with liver injury and 50 Australians die from paracetamol overdose every year – with intentional overdose highest in female adolescents and young adults.
Given paracetamol is a commonly used medicine in Australia, with people likely having multiple packs at home, along with several different medicines containing paracetamol – reducing access through smaller pack sizes was a key focus of action, said Kay Sorimachi MPS, PSA Manager Policy and Regulatory Affairs.
‘The access route is multifactorial, but the TGA’s report focused on the fact that it's not that people go out and say, “I'm going to buy 100 tablets and take all of them,” but really it's what they had access to at the time,’ she said.
What’s occurring internationally?
The availability and regulation of paracetamol varies significantly across countries, but those with stricter regulations generally report lower incidences of severe poisoning.
In many European countries, including France, Germany, and Italy, paracetamol is not available in supermarkets and is only available in pharmacies, with much tighter pack size limits than Australia. For example, France limits pharmacy sales to 8 g per pack, while Germany only allows up to 10 g.
Modified-release (MR) paracetamol is generally unavailable in most European nations, contrasting with its availability in countries such as Australia and New Zealand.
In countries such as the USA and Canada, there are fewer restrictions on paracetamol sales, with larger pack sizes available outside pharmacies. However, similar to Australia, the USA has reported rising cases of paracetamol-related poisonings – particularly among adolescents.
Will the changes work?
If the findings following the UK’s legislation on paracetamol pack sizes is anything to go by, size matters. Since the legislation was implemented, there was an average reduction of 17 deaths (43%) in England and Wales from paracetamol poisoning per quarter.
Change 1: Pack sizes will shrink
The TGA’s final decision involves reducing pack sizes; key changes include:
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[post_content] => More than 23.9 million Australians have My Health Record (MHR), but it is vastly underused in primary care.
A new report by the Royal Australian College of General Practitioners revealed that 31% out of 3,000 surveyed GPs rarely or never use MHR. Meanwhile, MHR insights highlighted that pharmacists access and review clinical information uploaded by other healthcare providers less often than other healthcare professionals.
PSA Digital Health Lead (and Victorian state manager) Jarrod McMaugh MPS explains five ways pharmacists can use MHR to improve healthcare outcomes.
1. Verifying requests for continued dispensing or emergency supply
While MHR records can be incomplete, this ‘catch-all’ for health data is a useful first port of call when other methods are unavailable, said Mr McMaugh.
For example, if a traveller presents to a community pharmacy claiming they left their medicines at home and their regular pharmacist can’t be contacted, MHR can be used as a validation tool to determine if supplying a Pharmaceutical Benefits Scheme (PBS) medicine via continued dispensing is appropriate.
A scan of ‘Medicines Information View’ provides a 2-year overview of a patient’s prescription and dispense records and other PBS claims – allowing pharmacists to establish if they are stabilised on a medicine.
‘Where that person’s history is in their MHR, you can see if it’s enough to satisfy those obligations that it’s an ongoing medicine unlikely to change, in which case, a month’s supply or similar, depending on the particular medicine, is appropriate to provide,’ he said.
MHR can also prove handy to deem if emergency supply of a Schedule 4 medicine – either 3 day’s supply or the smallest pack size – is warranted. For example, if a patient with asthma has exhausted their inhaler supply before obtaining another prescription.
Checking ‘Event summaries’ in MHR can confirm the patient’s diagnosis of asthma.
‘And checking their prescription history in MHR can confirm all the aspects of the medicine, [such as] what strength it is, when they last had it, what their adherence rate is like and where they are getting their scripts filled on a regular basis,’ he said.
‘Once pharmacists have enough information to establish that a medicine is part of a patient’s current therapy, it empowers them to make the decision to provide an emergency supply.’
2. Determining a post-discharge medicine plan when a patient presents a hospital prescription
If a patient presents to a community pharmacy with a hospital prescription, MHR can provide some helpful information around the context of the prescription via the discharge summary – including diagnoses, a clinical overview and current medicines on discharge.
‘It contextualises the prescription that’s in front of you as well as providing an understanding of whether the patient will be reviewed soon, are there other plans in place, or are we likely to see the person go back to hospital in a few weeks, because they don't have a [medicine] plan in place, and they get confused,’ said Mr McMaugh.
Where post-discharge plans are uploaded to MHR, pharmacists can create and upload a Pharmacist Shared Medicines List, based on a reconciled hospital discharge medicines list.
‘If you are the pharmacist that person normally visits, and you are presented with a hospital script that has all their chronic medicines on it, it’s a normal step to check, “when did they last take this, or has there been a change”,’ he said.
But if you have no information beyond the prescription, and the patient does not have any discharge notes, you can perform that same check by accessing their MHR.
‘This helps in a number of ways such as identifying recent changes. If your pharmacy does not have the person's dispensing history, you can also check to see what they have had dispensed elsewhere recently, so that you only send them home with the medicines they need at the moment,’ said Mr McMaugh.
3. Looking for missing vaccines in AIR history
My Health Record provides access to a patient’s full immunisation history, including records for the Australian Immunisation Register (AIR). This means a pharmacist doesn’t need to log into PRODA to access that information.
‘For example, if you're providing home medicines review (HMR), a review of MHR could help you determine if a patient is in the criteria for having a shingles vaccines but hasn’t had one yet,’ said Mr McMaugh.
The system also indicates upcoming NIP immunisations a patient is eligible for 3 months in advance, which are marked as overdue after 1 month after the due date.
This can also help pharmacists provide comprehensive care for patients with chronic disease, such as chronic obstructive pulmonary disease (COPD), who may not be up to date with the recommended vaccines.
‘If I’m dispensing medicines for their respiratory health, I might want to look at their MHR and provide advice about what vaccinations can keep their lung health optimal, such as influenza and pneumococcal,’ he said.
With many children and adolescents missing out on vaccines during COVID-19, MHR can also help pharmacists easily determine where the gaps lie.
‘It can help pharmacists in providing catch-up vaccinations for teenagers who might not have received them in high school,’ added Mr McMaugh.
And it’s not just children – MHR is the fastest way to access AIR records at the dispensing counter to engage older adults in conversations about recommended vaccination such as pneumococcal, RSV, influenza and COVID-19.
4. Checking if a medicine is 'new' when you haven't dispensed it before
When dispensing a seemingly new medicine to a patient, as far as your records are concerned, a look at ‘Prescription and Dispense View’ in MHR allows pharmacists to view all the details of their prescribed and dispensed medicines in one place.
‘If, for instance, they have had it [before] and it was recorded in MHR, it would include information on when they had it, what the dose was etc.,’ said Mr McMaugh.
It can also prompt further investigation, for example if a medicine was ceased some time ago but is now being prescribed again.
‘It may not have the answer to all the questions you have about a person's care when they’re standing in front of you but it can certainly provide you with enough information to make follow-up inquiries,’ he said.
‘[For example], “Let's discuss why it's been too long. Is it something that's been stopped and started again?” or “Is it being reinitiated in error?”’ he said.
Checking MHR can also help to shape counselling advice. ‘If it’s a brand new medicine, that will be a different conversation to when it has been prescribed five times, or it has been stopped and started again,’ Mr McMaugh added.
5. Finding a recent pathology test in a discharge summary
From next month, pathology providers are legally obligated to upload patient results to MHR – providing community pharmacists with newfound access to patient health information.
‘Pathology information is very useful for pharmacists who are doing medicine reviews of any kind, whether an HMR or a MedsCheck,’ said Mr McMaugh.
A recent pathology test can help to determine if a medicine is having a negative impact, or for some medicines if it’s having an effective impact.
For example, if a patient has a condition that impacts their potassium rate, such as chronic kidney disease, and they are prescribed a medicine to decrease their potassium levels, access to pathology results can help pharmacists determine if their potassium is in range.
‘This can give pharmacists a prompt to check if the patient is on a higher dose of the medicine, or ask if they stopped taking their medicine,’ he said.
One thing to be wary of is that MHR will contain patients’ entire pathology history.
‘So if you looked at a result that was 6 months old, it’s probably not relevant,’ Mr McMaugh added.
[post_title] => Are you using My Health Record to optimise patient care?
[post_excerpt] => PSA Digital health lead Jarrod McMaugh MPS shares the top ways My Health Record makes every day easier for pharmacists.
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[post_content] => Despite vaccination rates dropping, pharmacists continue to be vaccinators of choice for COVID-19 and influenza vaccinations. But more needs to be done to reach vulnerable groups.
These key insights, and more, were revealed at the 2024 Queensland Immunisation Symposium, held on Friday (18 October).
Pharmacists continue to lead COVID-19 and influenza vaccination
The COVID-19 vaccine rollout was the largest immunisation program Australia has seen as a country, with pharmacists delivering over 12.5 million COVID-19 vaccines alone in a 3-year period, said Genevieve Donnelly Assistant Secretary, Access, Engagement and Compliance Branch at the Department of Health and Aged Care.
‘Pharmacists have consistently delivered close to 50% of the COVID-19 vaccinations in primary care,’ she said.
‘It speaks quite considerably to the trust that people have in you as a profession as to how to access care and where they see that they can easily access it’
Furthermore, while influenza vaccination rates are declining nationally, Ms Donnelly said pharmacists were the only channel that not only held the number of vaccines administered this year for influenza, but increased it.
‘In an environment where people aren't taking the opportunity to go elsewhere, they will come to the pharmacy,’ she said. ‘That's where the trust is, and that's where the access is.’
Childhood vaccination continues to drop below the critical 95% mark
The fluctuating community sentiment about healthcare, spurred on by COVID-19, is driving vaccination rates down, said Ms Donnelly.
‘I don't think I've ever seen anyone so engaged in a medicine as what we saw during COVID-19 … on such a scale,’ she said. ‘[But] unfortunately, we’ve seen a sustained decline in childhood immunisations in this country.’
[caption id="attachment_27970" align="alignnone" width="2096"] Source: Queensland Health Immunisation Program[/caption]
The decline in childhood vaccination for children under 5 continued in 2024, moving Australia further from the 95% coverage target it held prior to the pandemic.
The vaccination rate of First Nations people is below the national average – particularly in the 1–2 years age cohort, said Sarah Risdale from the Queensland Health Immunisation Program.
‘The biggest risk for us is that some of these diseases rely on herd immunity, so the more we drop off, the more risk that previously eradicated diseases will return,’ warned Ms Risdale.
Because many vaccine-preventable diseases, such as polio and measles, were under control for many years – a key challenge is that many people don’t know the health impacts they can wreak.
‘It's really hard to sell something to someone when they don't really understand or have never seen what the impact could be,’ she said. ‘Particularly off the back of COVID-19, everyone is hesitant to believe what the government is telling them, and they seek their own healthcare advice and information.’
But because pharmacists have always been trusted healthcare professionals who the community comes to for advice, patients will be willing to trust that advice on vaccination, Ms Risdale advised.
‘It's a big responsibility for pharmacists when they're engaging with people [about] healthcare,’ she said.
Long way to go on meningococcal B protection
Pharmacists should also prioritise meningococcal B vaccination – with outbreaks of the deadly disease occurring in far North Queensland among other regions recently, said Ms Risdale.
‘This year in Queensland, we have a state-funded meningococcal B program for infants under 2 and adolescents 15–19,’ she said. ‘Unfortunately, we haven't seen the uptake we thought we would see this year, and that's across all provider types.’
Australian Immunisation Register data revealed uptake of the meningococcal B vaccine reduces with age, with the rates in various age cohorts including:
‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus].' Sarah risdale MPS‘With National Immunisation Program Vaccinations in Pharmacy (NIPVIP) funding, it's a big opportunity for pharmacists to start engaging more with the older community. ‘But [it’s important] to balance that relationship with the pharmacist and the GP and make sure people are getting what they need from the right provider.’ But while older Australians are at risk of serious and life-threatening complications from influenza, Ms Risdale said they are far more likely to actively seek out shingles vaccines than influenza and COVID-19 immunisation. There was a 2.6% reduction in the influenza vaccination rate in Australians aged 65 and over this year, dropping from 64.1% to 61.5% coverage. ‘They are more than likely not going to die from shingles, but they could die from flu, COVID-19 or RSV [Respiratory syncytial virus],’ she said. Despite numerous government and health body messages about the importance of vaccination against these potentially deadly diseases, it’s challenging to change perceptions. ‘That did help for a time, then people started to say, 'I'm getting COVID-19 and [influenza] anyway, so why would I go get that [vaccine]?’ While having conversations with people about their questions, concerns and fears about vaccines takes time, it adds long-term value, said Ms Risdale. ‘People come back to you as a trusted professional who spent half an hour talking to them about how important getting the MMR [measles, mumps, and rubella] vaccine was for their child, or how important having the pneumococcal vaccine was for their husband,’ she said. ‘They start to understand that you have time for them, you really value them as a person, and can give them reliable and helpful information, and they will come back to you again.’
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[post_content] => At the 2024 Queensland Excellence Awards in Brisbane on Saturday night, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
PSA Queensland President Shane MacDonald MPS acknowledged the achievements of the award winners as well as the continued dedication of pharmacists practising throughout the state.
‘It’s an inspiration to see the amazing work pharmacists are doing in communities across Queensland, and a great privilege to recognise them for their dedication in advancing the profession,’ he said.
‘On behalf of the PSA I congratulate the outstanding pharmacists presented with awards and thank them for their commitment to bettering the health of Queenslanders.’
[gallery type="flexslider" size="full" ids="27956,27957,27955,27958,27959"]
PSA Queensland Pharmacist of the Year Associate Professor Esther Lau MPS, University of Queensland
One of the first trained pharmacy vaccinators in Australia, A/Prof Lau was the cornerstone for the development of Australia’s first non-medical prescribing course at Queensland Institute of Technology, a foundation for the expansion of the current North Queensland practice prescribing pilots. For the past decade she has written AP’s Old Drug New Indication column, mentored many students and reviewed the APF and PSA’s 2023 Professional Practice Standards.
PSA Queensland Early Career Pharmacist of the Year James Buckley MPS, LiveLife Pharmacy Port Douglas
Filling a critical gap in his Far North Queensland community, Mr Buckley upskilled in otoscopy to accurately identify conditions like otitis media and otitis externa, as well as collaborative pathways to ensure patients were referred seamlessly for timely treatment. One of the first pharmacists to pass the North Queensland Pharmacist Full Scope of Practice Pilot, he sits on the ECP Community of Specialty Interest (CSI) leadership group and promotes pharmacy practice to students and interns.
PSA Queensland Intern Pharmacist of the Year Antonia Hurd, Kepnock Pharmacy Bundaberg
Interning at four separate pharmacies in Bundaberg, Peregian Springs, remote Agnes Water and regional town Cooroy, Ms Hurd has demonstrated exceptional leadership and initiative across pharmacy services including managing a dose administration aid service, an R U OK Day presentation, training in compounding and providing vaccination and first aid advice. Her research on managing the quality of life for people living with severe and persistent mental illness is anticipated to be published as part of the PhaMIbridge trial.
Lifetime Achievement Award Beverley Glass FPS, James Cook University
After a lifetime of service and devotion to the pharmacy profession as a clinician, teacher, researcher, academic and advocate, South African-born Professor Glass has made an outstanding contribution to the development of pharmacy education, practice and research, specifically within rural and remote Queensland and Australia. She has invested immense amounts of time into the future academic workforce, some of whom are among her 50 honours and 33 PhD and Masters students.
Professor James Dare Graduate of the Year Shylee-Jade Hadar-Pagliari, James Cook University
As a final year pharmacy student, Ms Hadar-Pagliari has packed in many experiences since starting as a pharmacy assistant in 2020. Not only does she represent NAPSA students at pharmacy conferences, she has learned under supervision at the Alive Pharmacy Warehouse in Cairns how to dispense medicines, assist patients with non-prescription requests and run the complex compounding laboratory. She is known for her caring nature with patients.
[post_title] => PSA awards leading Queensland pharmacists
[post_excerpt] => At the 2024 Queensland Excellence Awards, these five pharmacists were honoured for their commitment to excellence in pharmacy practice.
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[post_content] => At one point in time, Menopausal hormone therapy (MHT) was used fairly extensively.
But this has changed since 2002, when the Women's Health Initiative (WHI) published a study linking combined MHT (oestrogen and progestin) with an increased risk of blood clots, stroke, breast cancer and heart attacks.
Almost overnight, women stopped using hormone therapy, said CEO of Jean Hailes for Women's Health, Dr Sarah White.
[caption id="attachment_27901" align="alignright" width="300"] Dr Sarah White[/caption]
But there are several factors that led to the study results being skewed.
‘It was [based on] an older group of women who started taking hormone therapy late, and it was a different form of hormone therapy, so those results did not stand up and the increased risk in breast cancer was terribly small,’ she said.
The sensationalist reporting did a huge amount of damage, Dr White said.
‘We still have women today who believe that MHT causes breast cancer, and GPs who are nervous about prescribing it.’
While around one in four women who go through menopause will be asymptomatic or have mild symptoms, a quarter will be at the opposite end of the spectrum and experience severe symptoms, said Dr White.
‘We're talking about an inability to sleep, terrible brain fog, anxiety, a loss of confidence, and hot flushes that can be catastrophic,’ she said.
The remaining half of women are on a spectrum of experiencing mildly annoying to must-be-managed symptoms.
‘We have women who are trying to soldier on through some really unpleasant physical and mental effects,’ she said. ‘And it's a bit heartbreaking to think that there's a medication that can help manage a lot of the symptoms and women are worried about taking it when they have no need to be.’
Is MHT underprescribed?
There's ‘no doubt’ that MHT is underused in Australia, said Dr White – with barriers to access a compounding factor.
‘It's not just going to get that doctor's appointment, it's the cost of the MHT,’ she said.
Some forms of MHT are subsidised under the Pharmaceutical Benefits Scheme (PBS), such as estradiol patches, but there has been a global shortage of this therapy in 2024.
But newer medicines such as Prometrium – a progesterone-based treatment matching the hormone the body makes when ovulating – are not, setting women back around $60 per month.
Are all women suitable candidates for MHT?
No, cautioned Dr White.
For example, a person who has had a hormone responsive cancer should have a careful discussion with their GP about whether the risks of MHT outweigh the benefits.
‘If you've had a hormone responsive cancer, then taking a hormone increases the risk of recurrence,’ she said.
Oral combined MHT will increase the ‘baseline’ risk of thrombosis around two-fold – however the baseline risk remains low in most women. Thrombosis risk increases with increasing age, smoking, increased body weight, in those with genetic predisposition to clotting and in certain illnesses. Risk factors should be considered prior to commencing MHT.
MHT treatment should be individualised based on the patient’s needs, clinical features and risk assessment, and reviewed regularly. Women with a personal or family history of venous thrombosis should undergo screening for risk factors to guide the choice of MHT delivery method. In cases where a woman is deemed to be at high risk for developing deep vein thrombosis (DVT), transdermal MHT should be used.
‘That’s why the message is very clear to speak about your individual circumstances with your doctor,’ added Dr White, who said a consultation to discuss the appropriateness of therapy could include:
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
