COPD is significantly underdiagnosed
Associate Professor Debbie Rigby FPS[/caption]
Nicolette Ellis MPS[/caption]
A national education program for pharmacists funded by the Australian Government under the Quality Use of Diagnostics, Therapeutics and Pathology program.[/caption]
Both these disorders can occur separately, but if they co-occur, this is termed COMISA. Approximately 30–50% of people with OSA have comorbid insomnia, and 30–40% of people with chronic insomnia have comorbid OSA.9,12 A recent population-based study reported that 11% of Australian adults report symptoms of COMISA.13
The ‘gold standard’ measure of OSA presence and severity is an overnight sleep study (Table 1).25 The most common single metric to determine OSA presence and severity is the apnoea-hypopnoea index (AHI), representing the average number of airway narrowing and closure events occurring per hour of sleep.24 Identifying the most appropriate management approaches for OSA also requires consideration of lifestyle factors, symptoms and consequences, occupation, chronic conditions, and other sleep conditions. Self-report questionnaires may be used to screen for a high-risk of OSA and identify patients suitable for referral and consideration of overnight sleep study assessment (Table 1).24
Although evidence-based guidelines unanimously recommend avoiding long-term use of hypnotics, they are indicated for a minority of patients that present with severe acute insomnia that is causing significant psychological distress or functional impairment.29 Most people who experience short-term insomnia symptoms (1–2 weeks) can be reassured that sleep will return to ‘normal’ after the underlying precipitant has subsided, without targeted treatment (i.e. hypnotic medicines).29,33 For those who experience persistent insomnia, cognitive behavioural therapy for insomnia (CBTi) is the first-line treatment. Pharmacotherapy may be considered in patients with severe insomnia that is causing significant impairment or distress (e.g. times of acute work/exam stress, bereavement).34
Tailored recommendations for non-CPAP therapies may also be provided to patients with different levels of OSA severity and presenting features.17 For example, weight management advice where indicated, positional devices (in the presence of supine-predominant OSA), mandibular advancement splints (in patients with mild-to-moderate OSA), and upper airway surgery are effective treatments that may be tailored to each individual patient.24
Dr Alexander Sweetman (he/him) PhD
Senior Program Manager, and chair of the psychologist education subcommittee at the Australasian Sleep Association.
Associate Professor Sutapa Mukherjee (she/her) MBBS, FRACP, PhD
Respiratory and sleep physician, Associate Professor of Respiratory and Sleep Medicine at Flinders University and past President of the Australasian Sleep Association.
Professor Garun Hamilton (he/him) MBBS, FRACP, PhD
Respiratory and sleep physician, clinical professor at Monash Health and Monash University and President of the Australasian Sleep Association.
Professor John Turnidge AO[/caption]
Sleep is a hot topic for Anousheh Page MPS, Director of Pharmacy at Brisbane’s only 24-hour pharmacy.
Why did you choose pharmacy?
Becoming a pharmacist was actually one of three options on my university application. At the time, all I really knew was that I enjoyed science-based subjects at school and also helping people (natural Virgo at heart, of course!). When it came to the pros and cons list, pharmacy felt like the best option. And I don’t have any regrets.
I absolutely love being a pharmacist. I completed a Bachelor of Pharmacy at the University of Sydney and can honestly say my university experience was the best of all time, which reinforced my choice to become a pharmacist.
What led you to your current role?
I knew whilst completing my pharmacy degree that I always wanted to work within a hospital environment. My pharmacy career in hospital began after completing my internship at the Children’s Hospital, Westmead, in Sydney. In 2007, I was moving back from a hospital role on the South Coast of New South Wales when I saw a Pharmacist In Charge role advertised for Kareena Private Hospital (God’s country, aka the Sutherland Shire in southern Sydney). I was fortunate enough to be offered the role. Working within any Ramsay Health Care facility never feels like work. The hospital staff become your adopted family and you work within a well-supported multidisciplinary team. I gained experience within multiple Ramsay Hospitals and eventually landed Director of Pharmacy at Greenslopes Private Hospital.
How do you and your staff cope with the late-night and overnight hours?
In general, staff cope very well and have an amazing ability to adapt to the various hours. There is a good balance of work which flows through the hospital inpatient stream but is also complemented by the variety of community patients that come through. I personally would sleep a few hours before a shift if I knew I had to cover an overnight. Like most, I would stay awake and try and get back to a normal sleep routine for the next shift.
What are common requests from patients who visit in the wee small hours?
Patients do often come in for sleep issues at night, however what stands out the most are patients who request salbutamol inhalers. Every night can be different depending on the day of the week, but the most consistent request is salbutamol. We have had patients coming from areas like the Gold Coast or even Mount Barney (130 kilometres south-east of Brisbane, population less than 50). This really highlights the opportunity pharmacists have to be able to deliver full-scope activities such as improved asthma management – including developing an asthma action plan – particularly outside standard business hours. The second-most common would be the management of acute illnesses to treat gastroenteritis or flu-like symptoms. We have many local public facilities surrounding Greenslopes, including our own emergency department, so we service lots of patients requiring after-hours medicines.
What are your strategies to deal with barriers to overnight care?
In most scenarios we would just use our experience and clinical judgment when helping patients. Working an overnight shift is similar to working a weekend shift in some respects, so we are very accustomed to managing or referring when necessary. We are also fortunate to work in an area with late-opening medical centres and local emergency centres. This allows us to refer patients who require further review. QScript (Queensland’s real-time prescription monitoring system) has also been a game changer in helping provide better support and clinical judgement for dispensing high-risk medicines; this had often been a challenge when working outside normal hours in pharmacy.
If you could change anything about your 24-hour pharmacy, what would it be?
Coffee is the gift that keeps on giving. A barista-made coffee on hand at any hour wouldn’t be too much to ask, would it?
What’s your advice for ECPs?
It’s important to work in an environment you love. Surrounded by the right team and environment can absolutely make the difference on how you approach work. If you dread work or feel anxious before the work week, you’re not in the right job.
A day in the life of Anousheh Page MPS, Director of Pharmacy, Greenslopes Private Hospital, QLD
| 4.30 am |
Up and at it Never in my life did I think I would be one of those early morning risers to hit the gym, but the pandemic forced a change and that schedule gets me mentally prepared for the day. |
| 7.30 am |
Handover time A double-shot of cappuccino in hand, my day begins with a handover between the 24-hour retail pharmacy and hospital dispensary team. Urgent action might be needed on alteplase orders to replace stock used overnight for a stroke patient in ED, or ensuring discharge medicines that were completed are given to that ward’s pharmacist for patient counselling. |
| 8.30 am |
Hospital bed managers’ meeting Meeting daily with the ward and other multidisciplinary hospital team managers helps me reallocate pharmacy staff to areas that need support i.e. for timely discharges or immediate communication if a regular pharmacy staff member is on leave. On Thank You Thursdays, meetings end by nominating a team member deserving of recognition, who later receives a card and lunch voucher from the hospital executive team. |
| 9.30 am |
Current shortages Next meeting addresses state shortages – this time its fluids. This entails direct contact with other Ramsay Queensland hospitals via the state procurement manager who organises a consistent supply of fluids, such as saline. |
| 10 am – 4 pm |
Daily challenges Every work day is different. Overseeing a 24-hour pharmacy that never closes requires being prepared for anything, and problem-solving is a strong skill set in my role. If I have multiple staff on leave with the spread of colds and flu, I actively help cover an area, (which has helped me be a better manager with greater knowledge of what shifts entail or how wards operate). Urgent deliveries of home IV antibiotics for patients and expensive IV anti-fungals at short notice are part of it. |
| 4.00 pm |
Home time I start my second job, which could ideally be a paid Uber driver, but is actually driving my children to their various daily extracurricular activities. At least I’m off my feet! |
